bluuebunny/crossref_metadata_2025_split huggingface dataset:
10. Designing an online curriculum supporting risk management and patient safety
Authors: Gondocz T. , Wallace G. 
Published: May 2017

The Canadian Medical Protective Association (CMPA) is a not for profit mutual defence organization with a mandate to provide medico-legal assistance to physician members and to educate health professionals on managing risk and enhancing patient safety. To expand the outreach to its 72,000 member physicians, the CMPA built an online learning curriculum of risk management and patient safety materials in 2006. These activities are mapped to the real needs of members ensuring the activities are relevant.
Eight major categories were developed containing both online courses and articles. Each course and article is mapped to the RCPSC's CanMEDS roles and the CFPC's Four Principles.
This poster shares the CMPA’s experience in designing an online patient safety curriculum within the context of medico-legal risk management and provides an inventory of materials linked to the CanMEDS roles.
Our formula for creation of an online curriculum included basing the educational content on real needs of member physicians; using case studies to teach concepts; and, monitoring and evaluating process and outcomes.
The objectives are to explain the benefits of curricular approach for course planning across the continuum in medical education; outline the utility of the CanMEDS roles in organizing the risk management and patient safety medical education curriculum; describe the progress of CMPA's online learning system; and, outline the potential for moving the curriculum of online learning materials and resources into medical schools.
14. Influences on choice of a generalist career in general surgery, general internal medicine and general pediatrics
Authors: Chung C. , Nickell L. 
Published: May 2017

We performed a literature review to summarize the primary influences that encourage or discourage the pursuit of careers in General Surgery (GS), General Internal Medicine (GIM), and General Pediatrics (GP). Relevant studies were identified through a PUBMED and MEDLINE search from 1982 to 2006. All included studies were peer-reviewed and pertained to factors influencing career choice in GS, GIM, GP, and their respective subspecialties. The identified literature was analyzed based on demography, the curriculum, and the nature of the discipline, etc. Consistent factors influencing career choice were established a priori as those supported by ≥2 independent studies or reviews without contradictory findings reported to date. The top two factors favoring the choice of residency in GS are positive clerkship experiences and exposure to positive role models, whereas the top factors discouraging interest in GS are lifestyle issues and the length of residency. As for GIM, influences that favor the specialty include the female gender and preference for GIM upon entry into medical school. Factors that discourage the choice of GIM are high income expectations, the widening salary gap between generalist and specialist, negative clerkship experience and the type of patients in internal medicine. In pediatrics, the top two influences that favor GP are female gender and a predisposition for GP upon entry into medical school. A consistent factor that negatively influences career choice in GP is a favorable attitude towards research. To summarize, the main influences on the choice of a generalist career include gender, role modeling, clerkship experience, lifestyle issues, and financial compensation. Medical schools can encourage the pursuit of generalist careers by enhancing student exposure to positive role models and by providing a positive clerkship experience in GS, GIM, and GP.
Kirkham JC, Widmann WD, Leddy D, Goldstein MJ, Samstein B, El-Tamer M, Harari A, Arnell TD, John R, Hardy MA. Medical student entry into general surgery increases with early exposure to surgery and to surgeons. Current Surgery 2006 (Nov-Dec); 63(6):397-400.
Arora V, Wetterneck TB, Schnipper JL, Auerbach AD, Kaboli P, Wachter RM, Levinson W, Humphrey HJ, Meltzer D. Effect of the inpatient general medicine rotation on student pursuit of a generalist career. Journal of General Internal Medicine 2006 (May); 21(5):471-475.
Cochran A, Melby S, Neumayer LA. An internet-based survey of factors influencing medical student selection of a general surgery career. American Journal of Surgery 2005; 189:742-746.
17. Boundaries or overlap: An examination of the community-oriented clinical practice of community medicine specialists and family/general practitioners
Authors: Russell M. L. , McIntyre L. 
Published: May 2017

We compared the work settings and “community-oriented clinical practice” of Community Medicine (CM) specialists and family physicians/general practitioners (FP).
We conducted secondary data analysis of the 2004 National Physician Survey (NPS) to examine main work setting and clinical activity reported by 154 CM (40% of eligible CM in Canada) and 11,041 FP (36% of eligible FP in Canada). Text data from the specialist questionnaire related to “most common conditions that you treat” were extracted from the Master database for CM specialists, and subjected to thematic analysis and coded.
CM specialists were more likely than FP to engage in “community medicine/public health” (59.7% vs 15.3%); while the opposite was found for primary care (13% vs. 78.2%). CM specialists were less likely to indicate a main work setting of private office/clinic/community health centre/community hospital than were FP (13.6% vs. 75.6%). Forty-five percent of CM provided a response to “most common conditions treated” with the remainder either leaving the item blank or indicating that they did not treat individual patients. The most frequently named conditions in rank order were: psychiatric disorders; public health program/activity; respiratory problems; hypertension; and metabolic disorders (diabetes).
There is some overlap in the professional activities and work settings of CM specialists and FP. The “most commonly treated conditions” suggest that some CM specialists may be practicing primary care as part of the Royal College career path of “community-oriented clinical practice.” However the “most commonly treated conditions” do not specifically indicate an orientation of that practice towards “an emphasis on health promotion and disease prevention” as also specified by the Royal College for that CM career path. This raises questions about the appropriateness of the current training requirements and career paths as delineated for CM specialists by the Royal College of Physicians & Surgeons of Canada.
Bhopal R. Public health medicine and primary health care: convergent, divergent, or parallel paths? J Epidemiol Community Health 1995; 49:113-6.
Pettersen BJ, Johnsen R. More physicians in public health: less public health work? Scan J Public Health 2005; 33:91-8.
Stanwell-Smith R. Public health medicine in transition. J Royal Society of Medicine 2001; 94(7):319-21.
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.