bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
66. Innovation in the academic half-day CanMEDS medical expert competency for residency educations
Authors: Rajani H. R. , Good C. 
Published: May 2017

Over the past decade we have attempted various iterations of the academic half-day, but recurring trainee complaints of only didactic sessions, a parallel resident-directed “Nelsons” rounds, and low attendance necessitated a reconsideration of the approach.
After discussion with the postgraduate trainees we divided the academic year into two blocks. An initial 8 week “summer program” with 24 student contact hours, focuses on the introduction to and review of common, critical care and emergency pediatric issues. The following 40 weeks has 120 student contact hours. Two thirds of the time is directed at the CanMEDS Medical Expert Core Competency. The postgraduate trainees have developed a three year core knowledge curriculum. The 200 “core” topics are mapped onto four international curricula; the RCPSC’s Objectives of Training and Specialty Training Requirements in Pediatrics using the Systems-Based Educational Objectives in the Core Program in Pediatrics, the American Board of Pediatrics – General Pediatrics Outline, and the Royal College of Pediatrics & Child Health (RCPCH) Framework of Competencies for Basic Specialist Training, and Core Higher Specialist Training in Paediatrics.
The two hour Medical Expert session is divided equally into a postgraduate trainee didactic presentation, and a collaborator case-based learning session. Six weeks prior to the scheduled session the trainee and the assigned faculty collaborator receive the core Medical Expert topic mapped to the four international curricula. The pediatric trainee develops a didactic presentation along with a two page summary. The collaborator, a resource for the trainee’s didactic presentation, develops three clinical cases that emphasize core knowledge, and attends as a Medical Expert resource person.
We are currently surveying the postgraduate trainees and faculty about this international-based core medical expert program of study.
67. Loving your child to death: Considerations of the care of chronically-ill children and euthanasia in Emil Sher's Mourning Dove and implications for medical educations
Authors: Mukhida K. 
Published: May 2017

How do parents cope when their child is ill or dying, when he or she experiences constant pain or suffering? What do parents think of the contributions that medical professionals make to the care of their chronically or terminally ill child? Is it possible for a parent to love a child so much that the child is wished dead? The purpose of this paper is to explore those questions and aspects of the care of chronically or terminally ill children using Mourning Dove’s portrayal of one family’s attempt to care for their ill daughter. A play written by Canadian playwright Emil Sher, Mourning Dove is based on the case of Saskatchewan wheat farmer Robert Latimer who killed his 12 year old daughter Tracy who suffered with cerebral palsy and lived in tremendous pain. Rather than focusing on the medical or legal aspects of the care of a chronically ill child, the play offers a glimpse into how a family copes with the care of such a child and the effects the child’s illness has on a family. Reading and examination of non-medical literature, such as Mourning Dove, therefore serve as a useful means for medical professionals to better understand how illness affects and is responded to by patients and their families. This understanding is a prerequisite for them to be able to provide complete care of children with chronic or terminal illnesses and their families.
Nuutila L, Salanterä S. Children with long-term illness: parents’ experiences of care. J Pediatr Nurs 2006; 21(2):153-160.
Sharman M, Meert KL, Sarnaik AP. What influences parents’ decisions to limit or withdraw life support? Pediatr Crit Care Med 2005; 6(5):513-518.
Steele R. Strategies used by families to navigate uncharted territory when a child is dying. J Palliat Care 2005; 21(2):103-110.
68. The resident experience in a large urban teaching setting: Results of the 2005-2006 resident exit survey, University of Torontos
Authors: Tenn-Lyn N. , Verma S. , Zulla R. 
Published: May 2017

We developed and implemented an annual online survey to administer to residents exiting residency training in order to (1) assess the quality of the residency experience and (2) identify areas of strength and areas requiring improvement. Long-term goals include program planning, policy-making and maintenance of quality control. Survey content was developed from an environmental scan, pre-existing survey instruments, examination of training criteria established by the CFPC and the CanMEDS criteria established by the RCPSC. The survey included evaluation benchmarks and satisfaction ratings of program director and faculty, preparation for certification and practice, quality of life, quality of education, and work environment.
The response rate was 28%. Seventy-five percent of respondents were exiting from Royal College training programs. Results of descriptive statistics determined that the overall educational experience was rated highly, with 98.9% of respondents satisfied or very satisfied with their overall patient care experience. Ninety-six percent of respondents were satisfied or very satisfied with the overall quality of teaching. Preparation for practice was identified as needing improvement, with 26% and 34% of respondents giving an unsatisfactory rating to career guidance and assistance with finding employment, respectively. Although 80% of respondents reported receiving ongoing feedback and 84% discussed their evaluations with their supervisors, only 38% of evaluations were completed by the end of the rotation.
The results indicate that residents are generally satisfied with their experiences during residency training, especially with their overall educational experience. Areas of improvement include preparation for practice and timeliness of evaluations. Further iterations of this survey are needed to refine the instrument, identify data trends and maintain quality control in residency training programs.
Frank JR (ed.). The CanMEDS competency framework: better standards, better physicians, better care. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005.
Merritt, Hawkins and Associates. Summary Report: 2003 Survey of final-year medical residents. http://www.merritthawkins.com/pdf/MHA2003residentsurv.pdf. Accessed May 1, 2006.
Regnier K, Kopelow M, Lane D, Alden A. Accreditation for learning and change: Quality and improvement as the outcome. The Journal of Continuing Education in the Health Professions 2005; 25:174-182.
72. Evaluatation of an innovative mentorship program - Multilevel mentorship model - Does it meet the needs of residents?
Authors: Elliott C. T.J. , Buxton J. , Froese S. 
Published: May 2017

The UBC community medicine mentorship program was established in 2003 and is continually evaluated. In response to resident feedback, we developed an innovative mentorship model that involves mentorship of junior residents by both mentors from the professional community and senior residents. This new multilevel mentorship model (MMM) was implemented in 2005. It was evaluated for its ability to (1) foster professional and personal relationships among mentors and mentees, (2) help residents develop career goals and (3) support residents who were having challenges in the program.
The program was evaluated using an on-line survey, with both Likert scale and short-answer responses. The survey was completed by 10/13 (77%) residents, 7/13 (54%) community medicine professionals (CMPs). For the first level, CMP-resident mentorship, 9/10 residents and 5/7 CMPs agreed that a positive relationship was maintained, and that they benefited from the relationship; 8/10 residents agreed that career counseling occurred. Two of the three residents who had conflict in the program felt that they were supported by their CMP mentor. Mentorship was a positive experience even for two residents who left the program. For the second level, senior-junior resident mentorship, all relationships started within the first month of the program and all residents agreed that a positive relationship was maintained throughout the year. Career counseling occurred in 2/3 junior-senior resident pairs. All three residents agreed that their resident mentor supported them during a conflict. Several resident- and CMP-mentors described heightened awareness of issues that residents face in training.
The multilevel mentorship model has considerable potential for fostering mentoring relationships, career planning, and helping residents overcome the challenges of residency.
Barondess JA. Mentoring in biomedicine. J Lab Clin Med 1197; 129:487-91.
Jackson VA, Palepu A, Szalacha L, Caswell C, Carr PL, Inui T. “Having the right chemistry”: a qualitative study of mentoring in academic medicine. Acad Med 2003; 78:328-334.
Williams LL, Levine JB, Malhotra S, Holtzheimer P. The good-enough mentoring relationship. Academic Psychiatry 2004; 28:111-115.
73. "I just don't want to kill anybody": The first six months of postgraduate trainings
Authors: Martin D. , Takahashi S. Glover 
Published: May 2017

This paper describes a qualitative study that used focus groups and individual interviews to explore newly graduated medical students’ experience of the first six months of a postgraduate training programme. This study explored the residents’ concerns, changes that occurred and the influences the residents attributed to those changes during the first six months, this paper focuses on the residents’ experience of responsibility during this initial training period. Residents felt there was a huge leap in responsibility when they made the transition from being a medical student to being a doctor, specifically in the areas of knowledge, practice management, and relationships. This paper describes how the residents felt there was a disconnect between their experience of responsibility as a medical student and their experience of responsibility as a doctor. Residents were concerned they lacked the necessary medical experience and expertise for someone wearing the title “doctor”. It was not until residents felt relatively confident that they were not going to harm patients with their knowledge that they were able to begin the process of understanding what it meant to be the family physician, which allowed them to begin identifying with the role of family medicine resident. This process took weeks for some residents and several months for others. This study lays the groundwork for better understanding the transition experience from undergraduate to postgraduate training from the resident’s perspective. This paper focuses specifically on the concerns residents had adjusting to their new responsibilities and the implications this might have for medical educators and curriculum developers.
Hirsh DA., Ogur B, Thibault GE, Cox M. “Continuity” as an Organizing Principle for Clinical Education Reform. The New England Journal of Medicine 2007 (Feb):858-866.
Kendall ML, Hesketh EA, Macpherson SG. The learning environment for junior doctor training – what hinders, what helps. Medical Teacher 2005; 25:619 – 24.
Luthy C, Perrier A, Perrin E, Cedrascht C, Allaz AF. Exploring the major difficulties perceived by residents in training: a pilot study. Swiss Medical Weekly 2004; 134:612-17.
Atomoxetine, but not paroxetine, blocks norepinephrine reuptake in depressed patientss
Authors: Aldosary F. , Tremblay P. , Hébert C. , Blier P. 
Published: May 2017

Purpose: Paroxetine is a potent serotonin (5-HT) reuptake inhibitor. However, a purported norepinephrine (NE) reuptake blockade action remains to be established. Atomoxetine is a potent NE reuptake inhibitor with the indication of attention deficit hyperactivity disorder (ADHD). The present study was aimed at confirming a NE reuptake inhibitory action with ascending doses of atomoxetine and possibly with paroxetine in depressed patients.
Methods: Patients were randomized to escalating doses of either paroxetine (20 to 50 mg/day), or atomoxetine (25-80 mg/day) in a four to six week period. Inhibition of NE reuptake was assessed using the attenuation of systolic blood pressure (SBP) elevations produced by intravenous injections of tyramine. Tyramine penetrates into peripheral NE terminals via the NE reuptake transporter and releases NE. Then, NE acts on the vascular adrenoceptors, which causes an elevation of SBP. Drugs that block NE reuptake attenuate the pressor effects of tyramine. Two-way ANOVA for repeated measures for doses of tyramine and treatments were used to assess the effects of the different drug regimens on the pressor response to loads of 3–6 mg of tyramine. Sixteen patients with unipolar major depressive disorder were assessed weekly after increasing the dose of paroxetine (9 patients) and atomoxetine (7 patients).
Results: Atomoxetine exerted a robust inhibition of the tyramine response, starting at the dose of 25mg/day in a dose-dependent pattern. Neither the low nor the high doses of paroxetine altered the tyramine pressor response.
Conclusions: These results provide evidence that atomoxetine started significantly inhibiting NE reuptake at subtherapeutic dose for ADHD, whereas paroxetine leaves the activity of the NE transporter unaltered, even at the highest recommended dose for depression.
The role of AMP-activate protein kinase (AMPK) in the regulation of cardiac hypertrophy
Authors: Chan Anita Y M , Soltys Carrie-Lynn M , Dyck Jason RB 
Published: May 2017

Backgrond: The polyphenol resveratrol has been attributed to some of the cardioprotective effects of red wine consumption, including the ability to inhibit hypertrophy via its antioxidant properties. A recent discovery in hepatocytes showed that resveratrol can activate AMP-activated protein kinase (AMPK), a key regulator of cellular energy homeostasis. However, it is currently unknown whether resveratrol can also activate cardiac AMPK and the functional consequence of this. As we have shown that activation of AMPK inhibits protein synthesis associated with cardiac hypertrophy, we hypothesized that an additional mechanism by which resveratrol inhibits hypertrophy is via AMPK activation.
Methods: To investigate this, neonatal rat cardiac myocytes were treated with vehicle (Veh) or 50 µM resveratrol (Resv) for 24 hours and 10 µM phenylephrine (PE) to induce hypertrophy. Contributors of the hypertrophic response, such as protein synthesis and specific intracellular signalling pathways, were measured using [3H]-phenylalanine incorporation and immunoblot analysis, respectively.
Results: Activation of AMPK was achieved with resveratrol even in the presence of phenylephrine, as shown by increased AMPK phosphorylation (Veh+PE = 0.69±0.06 vs Resv+PE = 1.57±0.29 arbitrary units, p < 0.01). Resveratrol also significantly decreased protein synthesis induced by phenylephrine (Veh+PE = 45702.5±5252.9 vs Resv+PE = 32929.0±4512.9 disintegrations per minute, p < 0.05). This was associated with reduced activities of regulators of protein synthesis, namely p70S6 kinase and eukaryotic elongation factor-2 (eEF2). Specifically, resveratrol countered the effects of phenylephrine by blunting the increase in p70S6 kinase phosphorylation while partially restoring eEF2 phosphorylation. Furthermore, resveratrol dramatically decreased nuclear factor of activated T-cells (NFAT) promoter activity, as shown by reduced luciferase activity driven by a NFAT-responsive promoter (Veh+PE = 171100±7881 vs Resv+PE = 27530±5975 luciferase activity, p < 0.001).
Conclusions: As the calcineurin-NFAT pathway is thought to be involved in pathological hypertrophy, this provides further evidence that AMPK activation has therapeutic potential, and shows another mechanism by which resveratrol can prevent hypertrophic growth.