bluuebunny/crossref_metadata_2025 huggingface dataset:
19. Prevalence of diagnostic discordance: A retrospective analysis of autopsy findings and clinical diagnoses
Authors: Suryavanshi S. , Gomez J. D. , Mulla A. , Kalra J.
Published: May 2017

The prevalence of medical error in health care systems has compromised the quality of health care delivery. The research on medical errors in hospitalized population has consistently revealed high rates of misdiagnosis. Autopsy examination has been an established tool for quality assurance programs. The objective of this study was to determine the discrepancy rates between clinical and autopsy findings in patients admitted to various hospitals (Royal University hospital, RUH; St. Paul’s hospital, SPH; Saskatoon city hospital, SCH) of Saskatoon Health Region. A retrospective record review of the medical and autopsy charts was carried out for all the deceased adult in-patients admitted during the years 2002, 2003, and 2004. All autopsies were carried out either in the morgue of RUH or at SPH hospital. A total of 3416 in-patient deaths were registered during the study period. Autopsies were performed on 206 of the deceased resulting in an autopsy rate of 6%. In accordance with selection criteria, 158 cases were included for this study. The mean age of subjects was 66.6 ± 15.2 years with a range of 16 – 94 years. The total concordance rate in this study between clinical and autopsy diagnoses was 75.3%. The discordance rate was 20.9% and in 3.8% of the study population a conclusive clinical or autopsy diagnoses was not finalized. The concordance and discordance rate between clinical diagnoses and autopsy findings when compared between the patients of two hospitals (RUH and SPH) were not significantly different. These results suggest that despite the technical advances in medical and diagnostic modalities, there still persists a significant discordance in clinical and autopsy diagnoses. Our study confirms the wide prevalence of diagnostic discrepancies in the health care system and emphasizes the value of autopsy as an effective quality improvement and educational tool with a strong impact on quality management.

Roosen J, Frans E, Wilmer A, Knockaert DC, Bobbaers H. Comparison of premortem clinical diagnoses in critically ill patients and subsequent autopsy findings. Mayo Clin Proc 2000; 75:562-67.

Sonderegger-Iseli K, Burger S, Muntwyler J, Salomon F. Diagnostic errors in three medical eras: a necropsy study. Lancet 2000; 10355:2027-31.

Kalra J. Medical Error: An Introduction to Concepts. Clinical Biochemistry 2004;37:1043-51.
20. Does Saskatchewan health policy encourage specialization?
Authors: Gheis M. A.M.
Published: May 2017

This study targets the period between 2001 and 2006. Physician’s pay statistics relating to all fee for service practitioners in Saskatchewan were collected. Data related to a number of independent variables commonly used in the design of pay policies were also obtained. These variables include physicians’ places of training, availability of local graduates from each specialty program in Saskatchewan, physicians percentage turnover, changes of physician to population ratio in most specialties, average number of physician patient contacts in most specialties and income distribution skewness per specialty. Statistical analysis was carried out using STATA package version 9. Correlations between a number of variables was established. These correlations include Percentage turnover and change in pay per year between 2001 and 2006, Percentage of provincial graduates to total work force per specialty on one hand and change in pay between 2001 and 2006 on the other hand. Change in pay on one hand and change in volume of clinical activities carried out on the other.

This paper revealed three relevant findings. Firstly Saskatchewan Health seems to have responded to the shortage of local graduates in certain specialties by allocating these specialties higher pay rise over the last five years. However this increase was associated with increased recruitment of foreign graduates. Secondly there was a consistent, mostly above inflation rate increase in pay for all specialists except clinical pathologists and diagnostic radiologists (two specialties with a relatively high local graduate retention rates). Thirdly, the overall increase in pay negatively correlated with the turnover rates in the case of family physicians, and did not adequately correlate with the changes in work load of the specialists. The writer argues that Saskatchewan Health has to adjust pay modification practices to respond more effectively to graduates recruitment and retention variables.

Blaufuss J, Maynard J, Schollars G. Methods of evaluating turnover costs. Nursing Management 1992 (May); 23(5):52-4,56,58-9.

Hyde JC, Fottler MD. Determinants of physician vacancy rates in rural hospitals. Journal of Rural Health 1994; 10(1):38-48, 1994.

Saskatchewan Health: Annual Financial Report 2006 and Annual Statistical Report 2006.
21. Optimal care in rheumatoid arthritis: Preliminary findings from a focus group study
Authors: Bernatsky S. , Feldman D. , Roper M. , Rosenberg E.
Published: May 2017

The objective of our work was to identify facilitators of optimal care, as well as potential barriers, for patients with rheumatoid arthritis (RA). The design was a focus group study. Individuals with established RA were identified through invitation letters sent using a random sample of the Quebec Arthritis Society mailing list. Patients were eligible for participation if they had a diagnosis of RA confirmed by a rheumatologist and if they had sought care within the McGill Réseau Universitaire Intégré de Santé network. We planned a series of focus group meetings (90 minutes each) to obtain sufficient data in terms of spectrum of ideas. In each moderator-led group, participants were asked to discuss five questions related to quality care. A co-moderator was available to document non-verbal communication, with audio-taping of all sessions and professional transcription for data analysis. Qualitative content analysis, based on grounded theory, was the chosen means of identifying recurring themes and categories.

Two focus group sessions have been completed with two more scheduled. Preliminary findings indicate the importance of good communication between family physicians, specialists, and allied health care workers. Final coding of transcripts and computer-assisted content analysis is being completed. However it appears that focus group may be useful in studying optimal care for chronic diseases such as RA. Our preliminary findings emphasize the necessity of good communication among health care providers. Ultimately we hope to generate knowledge that can be transformed into better health for Canadians with arthritis and other chronic diseases.
22. The warden and the doctor: Kingston penetentiary in the 1840s
Authors: Jacques R.
Published: May 2017

Canada’s first prison, Kingston penitentiary, opened its doors to six male inmates in 1835. This institution rested on a religious model, which postulated a dichotomy between good and evil people. Hence, suffering was justifiably inflicted to restore the convict to a state of grace.

This research will explore the life of prisoners and the awkward responsibilities of the physician, using as its principle sources the annual reports of the prison and the remarkable infirmary registry kept by Dr. James Sampson. While Warden Henry Smith prescribed the punishment, Dr. Sampson was obliged to verify that the inmate was fit to be punished. The physical and mental consequences of punishments were recorded in the prison’s hospital registry.

The prison population tripled to approximately 500 from 1842-1845. Ten percent of the prison population was female, with the rest being adult male offenders, the criminally insane and boys, some as young as 8 years old. A single standard of punishment was impossible since it was permissible to hit children but not women. This paper will show the nature and frequency of punishments meted out by the Warden. It will demonstrate that there was a concomitant increase in the number of overall injuries. Morbidity was directly linked to punishment, but mortality was not.

Warden Smith was dismissed from office in 1848 on charges of starving the convicts and cruel, excessive punishment. Prior to his dismissal Dr. Sampson took a leave of absence as a statement of his inability to properly treat his patients and upon the warden’s removal returned to his duties as the prison physician. Evidence from this study demonstrates that the prison physician was in a position of divided allegiance between his duty to the prisoner-patients and his duty to the moral code of his society as interpreted by the warden.

St. Onge D. Curator, Correctional Services Canada Museum. Kingston, Ontario, 2007.

Hennessy PH. Canada’s Big House: The dark history of the Kingston Penitentiary. Toronto: Dundern Press, 1999.

Hospital Records, 1842-1848. The Archives of Queen’s University at Kingston, Ontario.
24. The controversial conquering of pain
Authors: Van Heerden D.
Published: May 2017

Before the extensive use of anaesthesia, great surgeons were measured by how little pain could be caused to patients in the shortest possible time. Simple operations, such as the extraction of rotting teeth, were terrible nightmares to patients. Some people compared surgery to the Spanish inquisition and there are many accounts in the literature of yells, screams, panicking, and resistance in the operating room. Because of this, before anaesthesia, surgery was mainly restricted to amputations and external growth removals and little advancements could be made over hundreds of years.

Five men make the claim to have conquered the horror of surgery in the operating room by discovering ether as an anaesthetic agent: William T.G. Morton, Charles T. Jackson, Crawford W. Long, Horace Wells, and William Clarke. However, only William T.G. Morton is credited with discovering ether as an anaesthetic agent. Mr. Morton publicly used ether during the excision of a tumour from a patient’s neck on October 16, 1846 at the Massachusetts General Hospital in Boston.

But William T.G. Morton was not the saint that he portrayed himself to be. There is no doubt that he made the first public discovery of anaesthesia but there is doubt as to whether it was because of his great knowledge and research in the field, or because he took advantage of an opportunity to display this borrowed method to the public.

Keys TE. The History of Surgical Anaesthesia. New York: Dover Publications, 1963.

Smith HM, Bacon DR. The History of Anesthesia. Clinical Anaesthesia. (PG Barash, B. Cullen, RK Stoeling, eds.) Philadelphia: Lippincott, Williams and Wilkins, 2006.

Wolffe RJ. Tarnished Idol. California: Norman Publishing Company, 2001.
25. A Christmas conundrum: What ailed Tiny Tim?
Authors: Bogle L.
Published: May 2017

Tiny Tim Cratchit is the captivating soul of one of the English language’s most beloved stories, Charles Dickens’ A Christmas Carol. His mysterious crippling disorder is quite the medical enigma, being intermittent, unilateral and fatal if left untreated. His tiny stature can also be counted amongst his symptoms. However, the most startling aspect of his condition is its ability to be cured in 1840s London with Ebenezer Scrooge’s limitless funds.

While Tim is saved after Scrooge’s reformation, Dickens never mentions what disease afflicted the little youngster. Upon examining Dickens personal health and previous literary talent of describing diseases unknown to medical science at the time, the ailment is validated as an accurate depiction of a real malady.

Two major theories exist as to the nature of the disease. Tuberculosis and renal tubular acidosis are offered as explanations to the interesting symptoms Tim experienced. The debate hinges on the interpretation of the original manuscript that, ‘Tiny Tim did not die.’ While survival is possible from the more common tuberculosis in 1843, a full cure was available from renal tubular acidosis via the alkali tonics available at that time. The debate may rage on indefinitely.

Callahan C. Tiny Tim remembered. Am J Dis Child 1991; 145:1355-6.

Jones P. Dickens’ literary children. Aust Pediatr J 1972; 8:233-45.

Lewis D. What was wrong with Tiny Tim? Am J Dis Child 1992; 146:1403-1407.
28. Lithotomy through the ages: Big stones, small stones and all the ways to cut them out
Authors: Elliott J. E.
Published: May 2017

The first known specimen of urological interest was a vesicle calculi dated to 5000 BC, found by Elliot Smith in 1901, in an ancient tomb in Egypt. Since these ancient times, urolithiasis has been a condition which fascinated and frustrated the medical world, both in understanding of its etiology and in how to treat patients afflicted with such stones.

Medical management of urinary calculi has a complex and suspect past; when such therapies failed, as their mystical and unscientific approaches often did, patients sometimes resorted to more drastic and dramatic means such as lithotomy.

Lithotomy was known since early times in India and Persia; when it was introduced to Europe is unclear. Writings by Susruta in India describe early forms of the procedure, and techniques were improved by Celsus of Rome (1st Century AD), remaining in use, largely unchanged until the eighteenth Century.

Marianus Sanctus (1490-1550) described a technique, the “grand appareil” which superseded the Celsus method, and other approaches by Franco (1500-1570), Jacques de Beaulieu (1651-1714), Johann Rau (1658-1709) and William Cheselden (1688-1752) gained and lost dominance over the centuries.

Perhaps most interesting about lithotomy was the development of the tools used in its practice. From the beginning, the various knives, forceps, dilators and sounds became ever more complicated, intricate and gruesome looking, resembling more the armamentarium of a torture master than the curative tools of a physician.

As endoscopic techniques began and evolved, the necessity to make large incisions for stone removal decreased. Nonetheless, the approaches and instrumentation used to treat bladder stones helped shape the practice of urology and contributed to the continuing goal of minimizing invasion of the patient while still providing effective treatment of stone disease and other genitourinary problems.

Murphy LJT. The History of Urology. Springfield, Ill.: Charles C. Thomas, 1972.

Chevalier RL. Kidney and urologic disorders in the age of enlightenment. Am J Nephrol 1994; 14(4-6):461-6.

Herman, JR. Urology; a view through the retrospectroscope. Hagerstown, Md.: Harper & Row, 1973.
31. The birth of a new specialty: The history of emergency medicine in Canada
Authors: Elyas R.
Published: May 2017

Modern day emergency rooms across Canada have almost completely transformed over the past 30 years; perhaps more so than any other specialty. Before the 1970’s, it was primarily general practitioners working on a part-time basis who ran our emergency departments. Some hospitals used interns and residents as first-line emergency care providers, often under the direction of a surgeon or internist. Emergency Medicine has evolved into a highly sophisticated and respected medical specialty that extends beyond clinical medicine, into both research and academia. The appeal of Emergency Medicine is so great that it is now one of the most sought after specialties in the annual CaRMS match. The success story of Emergency Medicine is characterized by the tireless efforts and determination of its founders across the country. They fought for adequate and supervised care of the acutely ill or traumatized patient, believing in a special body of knowledge that should be available to physicians who spend most, if not all, their time in Emergency Departments. In 1977, these founders formally united and The Canadian Association of Emergency Physicians was born. A few years later, in 1980, Emergency Medicine was finally designated as a free-standing specialty by the Royal College of Physicians and Surgeons of Canada. Meanwhile, the College of Family Physicians of Canada also sought to establish a parallel route for Emergency Training of Family Physicians, feeling that Emergency Medicine lay within the realm of Family Medicine. The result was that both colleges established Emergency Medicine training programs that exist until this day.

Using journals, archives, a survey, and interviews, the paper will trace the history of the professionalization of Emergency Medicine in Canada.

Johnson R. The Canadian Association of Emergency Physicians. The Journal of Emergency Medicine 1993; 11:362-364.

Reudy J, Seaton T, Walker D, Rowat B, Cassie J. Report of the Task Force on Emergency Medicine: RCPSC Accreditation Section, 1988.

Walker DMC. History and Development of the Royal College Specialty of Emergency Medicine. Annals Royal College of Physicians and Surgeons of Canada 1987; 20:349-352.
36. Practicing medicine and music II: Ophthalmology and music
Authors: Hwi L. P. , Ting J. W.
Published: May 2017

Cecil Cameron Ewing (1925-2006) was a lecturer and head of ophthalmology at the University of Saskatchewan. Throughout his Canadian career, he was an active researcher who published several articles on retinoschisis and was the editor of the Canadian Journal of Ophthalmology. For his contributions to Canadian ophthalmology, the Canadian Ophthalmological Society awarded Ewing a silver medal. Throughout his celebrated medical career, Ewing maintained his passion for music. His love for music led him to be an active member in choir, orchestra, opera and chamber music in which he sang and played the piano, violin and viola. He was also the director of the American Liszt Society and a member for over 40 years.

The connection between music and ophthalmology exists as early as the 18th Century. John Taylor (1703-1772) was an English surgeon who specialized in eye diseases. On the one hand, Taylor was a scientist who contributed to ophthalmology by publishing books on ocular physiology and diseases, and by advancing theories of strabismus. On the other hand, Taylor was a charlatan who traveled throughout Europe and blinded many patients with his surgeries. Taylor’s connection to music was through his surgeries on two of the most famous Baroque composers: Johann Sebastian Bach (1685-1750) and George Frederick Handel (1685-1759). Bach had a painful eye disorder and after two surgeries by Taylor, Bach was blind. Handel had poor or absent vision prior to Taylor’s surgery, and his vision did not improve after surgery. The connection between ophthalmology and music spans over three centuries from the surgeries of Taylor to the musical passion of Ewing.

Ewing E. Cecil Cameron Ewing. BMJ 2006; 332(7552):1278.

Jackson DM. Bach, Handel, and the Chevalier Taylor. Med Hist 1968; 12(4):385-93.

Zegers RH. The Eyes of Johann Sebastian Bach. Arch Ophthalmol 2005; 123(10):1427-30.
37. Unlikely bedmates: A critical look at the history of public health and prostitution
Authors: Berkhout S.
Published: May 2017

The trope of the prostitute as a vector of sexually transmitted disease is longstanding, though not as old as the profession itself. The regulation and control of sex work also boasts of an incredibly long history; the practices that have developed into the field of public health in particular have been an important source of the ideology suffusing sex work, as well as the social identities associated with sex workers.

A general form of a ‘medical police’ (to borrow from Foucault) emerged rather abruptly in the 18th Century, gaining greater support with the advent of positivism in the early 19th Century. The developing methods of epidemiology were intertwined with the uncovering of correlations between poverty, class, and disease, providing both a methodological and ethical foundation for public health interventions and social control, including the legal regulation and sequestering of women thought to be prostituting, forced medical examinations, as well as moral rehabilitation campaigns directed toward sex workers. The breadth of interventions justified by the interests of public health demonstrates that the relationship between public health and prostitution is far deeper than the use of population statistics and outbreak investigations to curb the spread of disease.

In this paper, I consider some of the various ways in which prostitution has been constructed through norms regarding class, gender, and sexuality, and how aspects of the historical relationship between public health practices and prostitution have influenced, and been influenced by, these understandings. Appreciating the historical context of sex work and public health is of significance, given that current ideas about appropriate interventions and regulations continue to be informed by this type of politics of health.

Bell S. Reading, Writing, and Rewriting the Prostitute Body. Indiana University Press, 1994.

Brock D. Making Work, Making Trouble: Prostitution as a Social Problem. Toronto: University of Toronto Press, 1998.

Lupton D. The Imperative of Health: Public Health and the Regulated Body. Sage Publications, 1995.
38. Max Brodel (1870-1941): His artistic influence on surgical learning at John Hopkins Medical School
Authors: Pace-Asciak P. , Gelfand T.
Published: May 2017

Medical students depend on illustration to learn anatomical facts and details that may be too subtle for the written or spoken word. For surgical disciplines, learners rely on tools such as language, 2-dimensional illustrations, and 3-dimensional models to pass on important concepts. Although a photograph can convey factual information, illustration can highlight and educate the pertinent details for understanding surgical procedures, neurovascular structures, and the pathological disease processes.

In order to understand the current role of medical illustration in education, one needs to look to the past to see how art has helped solve communication dilemmas when learning medicine. This paper focuses on Max Brodel (1870-1941), a German-trained artist who eventually immigrated to the United States to pursue his career as a medical illustrator. Shortly after his arrival in Baltimore, Brodel made significant contributions to medical illustration in Gynecology at John Hopkins University, and eventually in other fields of medicine such as Urology and Otolaryngology. Brodel is recognized as one of America’s most distinguished medical illustrators for creating innovative artistic techniques and founding the profession of medical illustration.

Today, animated computer based art is synergistically used with medical illustration to educate students about anatomy. Some of the changes that have occurred with the advancement of computer technology will be highlighted and compared to a century ago, when illustrations were used for teaching anatomy due to the scarcity of cadavers.

Schultheiss D, Udo J. Max Brodel (1870-1941) and Howard A.Kelly (1858-1943) – Urogynecology and the birth of modern medical illustration. European Journal of Obstetrics & gynecology and Reproductive Biology 1999; 86:113-115.

Crosby C. Max Brodel: the man who put art into medicine. New York: Springer-Verlag, 1991.

Papel ID. Max Brodel’s contributions to otolaryngology – Head and Neck surgery. The American Journal of Otology 1986; 7(6):460-469.
39. Thomas Hodgkin. 1798-1866. Health advocate for Manitoba
Authors: Warren P.
Published: May 2017

CanMEDS 2005 includes health advocate. Pertinently Michel Foucault wrote “The first task of the doctor is therefore political…Man will be totally and definitively cured only if first liberated.” No one exemplified this more than Thomas Hodgkin widely known for his eponymous disease. What is less known is his unceasing work, as a Quaker, for aboriginal people around the world. He was secretary of the Aboriginal Protection Society. He had been interested in Canada since meeting John Norton, as a teenager. His involvement in the plight of Canada’s Indians may have cost him a staff position at Guy’s Hospital; the Treasurer, Benjamin Harrison, is quoted as saying “he would have no officer of the hospital who drove about with a North American Indian in his carriage.” Hodgkin played an active role in the history of Manitoba. His friend Dr Richard King undertook expeditions in Western Canada to find Sir John Franklin corresponded with Hodgkin on his anthropological observations on the Aboriginals and the treatment of them by the Hudson’s Bay Company (HBC). Hodgkin campaigned actively about the management of the Manitoba aboriginals by the HBC. The presentation will illustrate this with excerpts from his letters to Sir George Simpson, Governor HBC, from Captain Kennedy who also sought Franklin and the archives of the Faculty of Medicine, University of Manitoba. He presented evidence to the House of Commons as HBC was ceded to Canada. As editor of the Colonial Intelligencer he wrote much on Manitoba and received a letter from Louis Riel. Hodgkin was passionately committed to ensure that people were free both politically and economically.

Foucault M. The Birth of the Clinic. Archaeology of Medical Perception. trans. A.M. Sheridan Smith. New York: Vintage Books, 1994.

Wilks S, Bettany GT. A Biographical History of Guy’s Hospital. London: Ward, Lock and Co., 1892.

Kass AM, Kass EH. Perfecting the World. The Life and Times of Dr. Thomas Hodgkin 1798-1866. Boston: Harcourt Brace Johanovich Publishers, 1988.
41. The cost of mistakes: Penalties for surgical malpractice through the ages
Authors: Vartian B. A.
Published: May 2017

In recent years the United States has undergone what some have termed a malpractice “crisis”. It has affected Canada and other parts of the world to a lesser extent and has been the subject of much debate. Throughout history the idea of what constitutes negligent surgical care and its consequences has not been an immutable concept but rather has fluctuated between seemingly polar extremes.

In ancient Mesopotamia, the Hammurabi code describes bountiful rewards for successful surgery contrasted with mutilation or death for failed attempts. In ancient Egypt we see the extremes of strict dogma, where acceptable practice was laid out by ancient priestly documents and those who strayed from their precise format could be met with deportation or beheading, a practice that discouraged developing treatment for those with a poor chance of survival. In stark contrast to these cultures the physician/surgeons of ancient Greece had almost complete impunity. After the monastic orders in Europe were banned from surgical practice in 1130 the uneducated barber surgeons dominated the field. The minority of educated surgeons pointed out many examples of negligence and improper care by this group. Capital punishment and mutilation of negligent surgeons became common once again in the crusader states, as public humiliation was added to the punishment. During the renaissance in Italy, the actions of a regulatory council levied stiff fines for surgeons who infringed on the practice of physicians while seemingly paying very little attention to examples of gross negligence and patient abuse. Finally in the modern era, surgery developed much more effective treatments for many conditions. Paradoxically as soon as a technique became better for a condition, accusations of negligence for treatment of that condition became common.
42. The psychoneuroimmunophysiological responses to incongruous actions or statements/prevarications made for the purpose of eliciting rhythmic, spasmodic expiratory reflexes
Authors: Ahmed S.
Published: May 2017

Although humans know instinctually that humour has healing powers, an understanding of the precise effects of humour and laughter had been largely unknown until the twentieth Century, due to the lack of technology. Not all of the barriers to research have been removed – it is still not possible to know “how much” good humour a person has or is experiencing – but there have been significant discoveries that help to prove that while laughter may not be the best medicine, it certainly helps the medicine go down.

The understanding of humour has come in four distinct areas, and in periods that reflect the available technologies. With the discovery of laughing diseases, interest in humour drove Harry Paskind in 1932 to create a new machine to study muscle tone during good humour. From the 1950s to 1970s, the neurology of laughter was researched, accompanying further research into the pathology of laughter after an epidemic of laughter in Uganda from 1962-64. After this came the study of the immunology and the discovery that laughter fights cancer, with the champion of laughter research, William Fry, dedicating a decade from 1969-79 to this work. Finally came research on the indisputable effect of laughter – its healthy effects on human psychology. Thanks, in part, to this research, and also supporting it, the past forty years have seen men like Norman Cousins and Hunter “Patch” Adams bring humour into mainstream healthcare. This research provides doctors an opportunity both now and in the future, as we learn even more about humour, to bring a softer face to medicine and truly give patients something to smile about.

Cousins N. Anatomy of an Illness. New York: WW Norton & Company, Inc., 1979.

Paskind H. Effect of Laughter on Muscle Tone. Archives of Neurology and Psychiatry 1932; 28-3:623-628.

Robinson VM. Humor and the Health Professions. New York: McGraw-Hill, 1991.
47. Evaluation of new implementation strategies, program effectiveness and dissemination of new pedagogical knowledge: Centre for faculty development's stepping stones teaching certificate program
Authors: Richardson D. , Silver I. , Dionne A.
Published: May 2017

This evaluation of the integrated Stepping Stones (SS) Teaching Certificate program, including its instructional development (workshops) and theory review (journal club) components, will inform further program development. Results of this project will also add to the limited amount of scholarly work in the area of faculty development program evaluation.

Faculty development literature in the area of organized program assessment reveals use of either quantitative OR qualitative methods. In this project, a novel method combining both techniques was used to explore program impact. Participants completed 2 questionnaires to identify skill-set knowledge gaps in teaching effectiveness. Pre- and post-program quantitative gaps were generated. Focus groups were used for qualitative exploration. Areas explored pre-program included: a) motives for enrollment, b) program expectations and c) prior teaching preparation. Post-program discussion explored: the impact of the program on a) participant’s perceived gaps, b) teaching behaviour change, and c) its influence on their career in education.

We believed the program’s interprofessional environment would foster development of a learning community having impact on faculty knowledge, skills and attitudes related to teaching, and potentially elicit behavioural change in teaching practices. Results from a 2004-2005 cohort of participants have identified a variety of benefits for faculty and their teaching practice. Results from a second separate cohort, 2005-2006 participants, validated the initial findings. Remarkable harmonization in the results of the qualitative analysis between the two cohort samples was evident. Statistically significant differences (p < 0.05) were found in each of the domains examined qualitatively.

Both qualitative and quantitatively, program effectiveness was demonstrated immediately following completion of the program. Follow up to assess the sustainability of the effects is ongoing. The analysis of the quantitative discrepancy (gaps) data has lead to a possible technique to assist in identifying unperceived educational needs.

McLeod PJ, Steinert Y, Nasmith L, Conochie L. Faculty Development in Canadian medical schools: a 10-year update. CMAJ 1997; 156(10):1419-23.

Hewson MG, Copeland HL, Fishleder AJ. What’s the use of faculty development? Program evaluation using retrospective self-assessments and independent performance ratings. Teach Learn Med 2001; 13(3):153-60.

Moore EM. A Framework for Outcomes Evaluation in the Continuing Development of Physicians, in: The Continuing Professional Development of Physicians. Eds. Davis D, Barnes BE, Fox R. AMA Press, 2003.
48. MD/MBA: A useful combination in Canadian specialty medicine?
Authors: Shantz J.
Published: May 2017

The practice of medicine has changed greatly in the face of rapidly changing technology, limited or controlled funding and heightened patient expectations. In the early 1990s curricula for the management education of residents appeared. The Social Needs Working Group identified competencies grouped under the manager role as a major weakness of residency training in Canada. Recent graduates in the United States and Canada found they were unprepared for the increased responsibility of office management, contract negotiation and healthcare administration.

The popularity of masters degrees in business administration (MBA) has grown exponentially. At the same time the number of medical professionals completing MBAs in Canada is still small by comparison, as opposed to the United States where MD-MBAs are more prevalent. The utility of MBAs is still in question in Canada. The effects on practice patterns of Canadian residents completing an MBA is also unknown.

The following workshop aims to allow participants to experience the format of case-based learning applied in many MBA programs. The cases will also highlight the unique approach a business mind can bring to current issues within medicine. The usefulness of an MBA will also be explored through small group exercises and testimonials. The process of applying to and funding this degree will be elaborated.

Frank RA. Practice management education--are residency programs properly preparing physicians for the 21st Century? College review - Denver, Colo. 1993 (Fall); 10(2):22-47.

Gill JB, Schutt RC, Jr. Practice management education in orthopaedic surgical residencies. The Journal of bone and joint surgery 2007; Jan; 89(1):216-9.

Parekh SG, Singh B. An MBA: the utility and effect on physicians' careers. The Journal of bone and joint surgery 2007 (Feb); 89(2):442-7.
75. Learning on the run - Practical strategies for physician learning
Authors: Bankey R. , Campbell C.
Published: May 2017

As a part of the Center for Learning in Practice’s (CLIP) mandate, a white paper series on topics of relevance to the educational needs of fellows was developed. The first in this series of white papers, was one entitled: Lifelong Learning White Paper - Supporting Physician Lifelong Learning: Strategies, Tools and Recommendations. This white paper focused on a variety of themes including the concept of ‘learning on the run’, which means that learning takes place wherever you are and occurs on a daily basis over the course of one’s work routine. In other words, learning and the learning context is driven by one’s practice context as well as by one’s own career goals and needs. The center for learning in practice is currently producing a series of thematic monographs/booklets for physicians based on the white papers, the first of which is entitled: Learning on the run- practical strategies for physician learning. The purpose of these monographs are to assist physicians with their learning and practice needs and contain a section on how tools and programs within the Maintenance of Certification (MOC) program can enhance and contribute to physician learning strategies. This poster details the content of a draft monograph on ‘learning on the run’ for physicians to use and comment on. These comments will be used to refine and enhance the monograph in order for CLIP to disseminate it more widely across North America. The monograph can also be accessed under CLIP’s section of The Royal College of Physicians and Surgeons of Canada website - http://rcpsc.medical.org/clip/index.php
49. Effect of a resident-as-teacher training programme on surgical resident clinical teaching skills
Authors: Ying Y. , Fitzgerald P. , Reid S.
Published: May 2017

This study was designed to assess the benefits of a resident-as-teacher training programme on surgical residents within a surgical clinical teaching unit.

A randomized controlled trial was conducted at McMaster University between July 2005 and June 2006. Twenty-eight (28) General Surgery Residents and one 134 Medical Students participated in the study. Residents were randomly assigned to participate in a two-day training course on clinical teaching skills at the 3 or 12-month interval. Medical Students completed teaching evaluations on residents whom they had significant exposure. Resident scores on teaching evaluations as well as medical student performance on rotation examinations were assessed.

The intervention (n=14) and control (n=14) groups were at similar levels of training. Only 5 intervention and 9 control residents had both pre and post intervention evaluations. Evaluations were measured on a 1 to 5 Likert scale. Data was analyzed by intention-to-treat. The mean evaluation score in both control and intervention groups were higher than pre-intervention (8% and 14%, p=0.03). However, the magnitude of change between the 2 groups was not statistically significant. Medical student performance by those exposed to more intervention residents was not significantly different from those exposed to more control residents.

There is a significant improvement in resident teaching over an academic year, as determined by medical student evaluations of the resident-teachers. Although there was a trend of improved teaching with the teaching- skills intervention, the difference was not statistically significant, and did not affect medical student performance on the end-of rotation examinations.

Blue AV, et al. Surgical Teaching Quality Makes a Difference. American Journal of Surgery 1999; 177:86-9.

Dunnington GL, DaRosa D. A prospective Randomized Trial of Residents-as-teachers Training Program. Academic Medicine 1998; 73: 696-700.

Griffith CH, et al. Relationship of How Well Attending Physicians Teach to Their Students’ Performances and Residency Choices. Academic Medicine 1997; 72:S118-120.
51. Structured assessment format for evaluating operative reports (SAFE-OR) in general surgery
Authors: Vergis A. , Gillman L. , Taylor M. , Minor S. , Park J.
Published: May 2017

This study determined the construct validity, inter-rater reliability and internal consistency of a “Structured Assessment Format for Evaluating Operative Reports” (SAFE-OR) in general surgery. The assessment instrument was developed using consensus criteria set forth by the Canadian Association of General Surgeons. It includes a structured assessment and a global quality rating scale. Residents divided into novice and experienced groups viewed and dictated a video-taped laparoscopic sigmoid colectomy. Transcriptions were then graded by blinded, independent faculty evaluators using SAFE-OR.

Twenty-one residents participated in the study. Mean structured assessment scores (out of 44) were significantly lower for novice versus experienced residents (23.3 ± 5.2 vs 34.1 ± 6.0, t=0.001). Mean global quality scores (out of 45) were similarly lower for novice residents (25.6 ± 4.7 vs 35.9 ± 7.6, t=0.006). Inter-class correlation coefficients were 0.98 (95% CI 0.96-0.99) for structured assessment and 0.93 (95% CI 0.83-0.97) for global quality scales. Cronbach’s alpha coefficients for internal consistency were 0.85 for structured assessment and 0.96 for global quality assessment scales.

SAFE-OR demonstrates significant construct validity, excellent inter-rater reliability and high internal consistency. This tool will allow educators to objectively evaluate the quality of trainee operative reports and ultimately provide a mechanism for implementing, monitoring, and refining curriculum for operative dictation communication skills.

Moore R. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190(5):639-40.

Novitsky Y, Sing R, et al. Prospective, blinded evaluation of accuracy of operative reports dictated by surgical residents. The American Surgeon 2005; 71(8):627-31.

Wanzel K, Ward R, et al. Teaching the surgical craft: From selection to certification. Current Problems in Surgery 2002; 39(6):573-659.
53. Resident training and the dictated operative report - A national perspectives
Authors: Gillman L. M. , Vergis A. , Park J. , Taylor M.
Published: May 2017

Operative dictation training is a poorly studied area of surgical resident education and there is currently no literature on the national experience with operative dictation training in Canada. We therefore undertook a web-based survey of residents and program directors in general surgery training programs in Canada to determine if there is an ongoing desire for formal operative dictation training.

Every resident and program director in English speaking General Surgery programs in Canada was contacted by email and asked to participate in the study. A secure, web based survey program was developed to conduct the survey and collect the data. The survey contained questions regarding comfort level with dictation, feedback on dictations and methods of dictation training employed by the individual residents and the resident training programs.

Two hundred and seventy-four residents and 11 program directors responded to the survey (70.4% and 78.5% response rate, respectively). Among residents, 201 residents (73.3%) reported that their dictations were in need of improvement while 191 residents (69.7%) requested further training in dictation. Two-hundred and six residents (75.2%) reported that their training program did not employ any formal methods to help improve their dictations. Furthermore, 153 residents (55.8%) had never received feedback on their dictations.

Ten program directors (90.9%) felt that residency programs should include formal training in operative dictation. Unfortunately, half of these program directors could not identify any formal methods currently being employed in their training programs, this despite the fact that 45.5% of program directors could identify specific instances where direct patient care was negatively affected by a poor operative report.

Both program directors and residents identified operative dictation templates and formal feedback on dictations as the two interventions they would like to see instituted to improve operative dictations in their residency training programs.

Residents and program director recognize a need for the development of formal operative dictation training in Canada.

Eichholz AC, Van Voorhis BJ, Sorosky JI, Smith BJ, Sood AK. Operative note dictation: should it be taught routinely in residency programs? Obstetrics and Gynecology 2004; 103:342-6.

Menzin AW, Spitzer M. Teaching operative dictation. A survey of obstetrics/gynecology residency program directors. Journal of Reproductive Medicine 2003; 48:850-2.

Moore RA. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190:639-40.
55. Simulation based training of technical surgical skills: A review of a five-year collaborative research program supported by the RCPSC Medical Education Funds
Authors: Dubrowski A. , LeBlanc V. , Gofton W. , Xeroulis G. , Carnahan H.
Published: May 2017

During the past five years, with support from the RCPSC, a collaborative group of researchers conducted projects investigating issues related to simulation based training of technical surgical skills. The aim of this presentation is to review the body of work generated, its significance, and outline future research plans.

In all studies, participants were medical students and residents from 3 medical schools in Ontario. First, we successfully demonstrated that trainees benefit from simulation-based practice by improving their ability to multitask. This ability not only increases technical proficiency, but also results in an enhanced ability to learn other aspects of surgery. Second, we showed that the adaptation of learning theories helps in optimizing training curricula by matching the fidelity of a simulator to the trainees’ level of expertise. Third, we provided validation of both expert and computer based methods for assessment. We showed that computer based assessments are sufficient for the evaluation of trainees learning fundamental skills, while expert based measures are more effective in the evaluation of performance on complex technical skills. Finally we demonstrated that examination-induced stress has a facilitating effect on trainees’ skills performance.

This body of research lends support for the inclusion of a simulation based approach to training technical skills. It also highlights the importance of the choice of assessment methods. Collectively this work highlights the need for further research in the optimization of training methods by the incorporation of learning theory into the existing training curricula. Related to this, further research in our laboratory will investigate the effects of practice schedule and expert feedback, as well as the role of self-regulated practice in the acquisition of technical surgical skills.

Xeroulis GJ, Park J, Moulton CA, Reznick RK, Leblanc V, Dubrowski A. Teaching suturing and knot-tying skills to medical students: a randomized controlled study comparing computer-based video instruction and (concurrent and summary) expert feedback. Surgery 2007; 141(4):442-9.

Brydges R, Sidhu R, Park J, Dubrowski A. Construct validity of computer-assisted assessment: quantification of movement processes during a vascular anastomosis on a live porcine model. Am J Surg. 2007; 193(4):523-9.

Brydges R, Carnahan H, Backstein D, Dubrowski A. Application of motor learning principles to complex surgical tasks: searching for the optimal practice schedule. J Mot Behav. 2007; 39(1):40-8.
58. Stories - Structured operative reporting in enteric surgerys
Authors: Gillman L. M. , Vergis A. , Park J. , Minor S. , Taylor M.
Published: May 2017

The purpose of this study was to determine whether the introduction of a Standardized Operative Dictation Template improved the quality of resident dictation.

General surgery residents (N = 20) from the University of Manitoba participated in the study. All residents were shown a standardized surgical procedure video and then asked to dictate an operative report. Residents were randomized with the intervention group receiving the Operative Dictation Template. Three months later, all residents were retested. Resident comfort level with dictation and satisfaction with the template was evaluated with a questionnaire. Dictations were evaluated by two blinded independent reviewers using the previously validated SAFE-OR assessment tool. This tool consists of a Structured Assessment Form (SAF) scored out of 45 and a Global Quality Ratings Scale (GQRS) out of 36. Pre and post scores were analyzed using a two-tailed Wilcoxon signed rank test.

Subjective comfort level with dictation, as measured by responses on a five point Likert scale, improved significantly in the intervention group (p=0.02). In addition, 90% of residents in the intervention group subjectively reported their dictations improved because of the template. There was no overall difference in the quality of dictation in the intervention group pre and post intervention as measured by the SAF (28.6 vs. 30.0; p=0.36) and GQRS (21.7 vs. 21.8, p=0.96). However, junior resident subgroup analysis revealed statistically significant improvement in the intervention on both the SAF (23.2 vs. 28.3; p=0.02) and GQRS (17.1 vs. 20.4; p=0.02). Senior resident subgroup analysis showed no difference in the intervention group on either the SAF (36.8 vs. 32.4; p=0.07) and GQRS (28.5 vs. 23.9; p=0.07).

The Operative Dictation Template can result in a significant improvement in resident comfort level with dictation and has the potential to improve the quality of junior resident dictations.

Eichholz AC, Van Voorhis BJ, Sorosky JI, Smith BJ, Sood AK. Operative note dictation: should it be taught routinely in residency programs? Obstetrics and Gynecology 2004; 103:342-6.

Menzin AW, Spitzer M. Teaching operative dictation. A survey of obstetrics/gynecology residency program directors. Journal of Reproductive Medicine 2003; 48:850-2.

Moore RA. The dictated operative note: important but is it being taught? Journal of the American College of Surgeons 2000; 190:639-40.