bluuebunny/crossref_metadata_2025_split huggingface dataset:
43. "Consider whether I show a man's wisdom": The enigmatic Dr. James Barry
Authors: Afolabi T. 
Published: May 2017

No matter how thorough and diligent the approach to compiling a historical record, occasionally crucial and interesting figures are overlooked. Such is the case with Dr. James Barry.
A nineteenth Century British doctor, Barry was named inspector general of military hospitals and traveled extensively throughout the British Empire. Barry’s story merits telling for both professional and personal reasons. Firstly, in the 1820s, Barry performed what is understood to be the first Cesarean section in which both mother and child survived. However, this notable accomplishment remains absent from many accounts of the history of the cesarean section.
Far more astonishing, however, is that Barry expertly performed his role as a military doctor while somehow concealing his sex, for upon his death he was discovered to not be male.
This paper will examine how a member of the British army was able to conceal such a crucial fact during a career that spanned nearly 50 years. By revisiting army letters, nineteenth Century reports and recent developments, it will be argued that our oversight of Barry’s story is due largely to two main reasons. Firstly, Barry possessed intelligence and skill that gained him the respect of colleagues and superiors alike, and allowed him to quickly rise up military ranks. This respect and high rank no doubt shielded him scrutiny and questioning. Secondly, Barry’s secret was further concealed by a diplomatic and tactful doctor who, after performing a post-mortem, attempted to save face for a doctor he no doubt respected immensely. The circumstances surrounding this attempted concealment as well as the ensuing controversy are examined in this discussion of an elusive and enigmatic doctor.
Rae I. The strange story of Dr. James Barry. London: Longmans, 1958.
Kirby P. Dr. James Barry, Controversial South African Medical Figure: A recent evaluation of his life and sex. S.A. Med. J 1970; 506-516.
Kubba A, Young M. The Life, Work and Gender of Dr. James Barry MD (1795-1865). Proc. R Col. Phys. Eding. 2001; 31:352-356.
46. Did the CME/CPD train leave with half the passengers? A needs assessment of Qu&#233;bec specialist associations' CPD units
Authors: Hudon G. , Laprise R. , Guindon L. 
Published: May 2017

This presentation reports on the results of a needs assessment conducted amongst the 34 Quebec specialist associations, which are accredited as CME/CPD providers by Quebec’s College of Physicians, in accordance with the Canadian Association of Continuing Medical Education’s criteria.
In 2006, a mix of methods (survey, semi-structured interviews and program documentation review) were used to assess CPD units’ learning needs in the areas of CME and CPD, the extent to which they carried out a list of specific tasks associated to providers’ responsibilities, barriers encountered in meeting standards, and the kind of help needed to improve performance.
Although CME/CPD fields have evolved considerably in the past 20 years, results indicate that few of the advances have made their way down to the associations. The majority still provides education in the form of traditional CME, where speakers talk about new developments in medicine. Whereas the systematic approach of CME is well integrated in most units, few go beyond perceptions in their needs assessments, use problem-based learning methods, enablers, reinforcement and outcome evaluations, or help specialists self-evaluate and reflect on their practice. These methods and approaches are believed to increase CME effectiveness.
Most Canadian specialists get a large proportion of their CE from non academic medical organizations such as professional associations and learned societies. However, information available in the literature does not allow generalization of our observations to other organizations of this nature. Since non academic organizations are important CME/CPD providers, we propose that more attention be given on the way trainers are trained and innovations are shared in our CE system. What minimal knowledge and skills should be required of a CME/CPD professional today? Together with its affiliated associations and academic partners, the Federation of Medical Specialists of Quebec (FMSQ) has decided to tackle this important issue in the coming years.
Olson CA, Tooman TR, Leist JC. Contents of a core library in continuing medical education: a delphi study. JCEHP 2005; 25:278-88.
Davis DA, Thomson MA, Oxman AD, Haynes RB. Changing physician performance: a systematic review of the effect of continuing medical education strategies. JAMA 1995; 274:700-5.
Grol R, Grimshaw J. From best evidence to best practice: effective implementation of change in patients' care. Lancet 2003; 362:1225-30.
50. Health advocacy in surgical training: A Canadian survey on attitudes and experience in urology residency
Authors: Siemens D. R. , Leveridge M. , Beiko D. , Wilson J. W.L. 
Published: May 2017

We sought to assess surgical residents’ perceptions and attitudes toward health advocacy in residency training and practice by administering an anonymous, cross-sectional, self-report questionnaire to all final year urology residents in Canadian training programs.
The survey was closed-ended and employed a 5-point Likert scale designed to assess familiarity with the concept of health advocacy and its application and importance to training and practice. Descriptive and correlative statistics were used to analyze the responses.
There was a 93% response rate from the chief residents. Most residents were well aware of the role of health advocate in urology, and a majority (68%) believe it to be important in residency training and in the urologist’s role in practice. However, a minority (7-25%) agreed that formal training or mentorship in health advocacy was available at their institution, and only 21-39% felt that they had employed its principles in the clinic or community. Only 4-7% or residents surveyed were aware of or had participated in local urologic health advocacy groups.
Despite knowledge and acceptance of the importance of the health advocate role, there is a perceived lack of formal training and a dearth of participation during urologic residency training.
Verma S, Flynn L, Seguin R. Faculty’s and Residents’ Perceptions of Teaching and Evaluating the Role of Health Advocate. Acad Med. 2005; 80:103–108.
Oandasen I. Health advocacy: bringing clarity to educators through the voices of physician health advocates. Acad Med. 2005 (Oct); 80(10 Suppl):S38-41.
Frank JR. (Ed). The CanMEDS 2005 physician competency framework. Better standards. Better physicians. Better care. Ottawa: The Royal College of Physicians and Surgeons of Canada, 2005.
54. Assessing cardiac physical examination competence using simulation technology and real patientss
Authors: Cole G. , Hatala R. , Issenberg S. B. , Kassen B. , Bacchus C. M. , Scalese R. J. 
Published: May 2017

Assessment of residents’ physical examination skills often involves the use of standardized patients lacking physical abnormalities. Simulation technology offers the potential benefit of mimicking physical abnormalities. The current study was undertaken to examine the relationship between physicians’ competence in cardiac physical examination as assessed using simulation technology compared to real patients.
An OSCE was created using 3 modalities of cardiac patients: real patients (RP) with cardiac abnormalities, standardized patients (SP) combined with a computer-based audio-video simulation of auscultatory abnormalities and a cardiopulmonary patient simulator (CPS). The same four cardiac diagnoses were tested with each modality.
Participants were 28 internists, within 3 years of passing the Royal College of Physicians and Surgeons of Canada’s (RCPSC) Comprehensive Examination in Internal Medicine. At each station, two RCPSC examiners independently rated a participant’s physical examination technique and provided a global rating of clinical competence. The accuracy of a participant’s cardiac diagnosis for each patient was scored separately by two investigators.
The inter-rater reliability between examiners, for the global rating outcome, was 0.76 for RP stations, 0.78 for SP stations and 0.75 for CPS stations. The correlations between participants’ global ratings on each modality were: RP vs. SP, r=0.19; RP vs. CPS, r=0.22; SP vs. CPS, r=0.57 (p < 0.01).
A number of methodological limitations were highlighted during the study, including difficulties in truly matching patients within and between modalities, differential weighting of components into the examiners’ global ratings based on modality and limitations of case specificity. No modality provided a clear “gold standard” to assess residents’ cardiac physical examination competence. In the context of assessment, until these limitations are addressed, simulation modalities may not be directly interchangeable with real patients.
Boulet JR, Swanson DB. Psychometric challenges of using simulations for high-stakes assessment. In: Dunn WF (ed). Simulators in critical care education and beyond. Des Plaines, IL: Society of Critical Care Medicine 2004; 119-30.
Hatala R, Kassen BO, Nishikawa J, Cole G, Issenberg SB. Incorporating simulation technology in a Canadian national specialty examination: a descriptive report. Academic Medicine. 2005; 80(6):554-6.
Issenberg SB, McGaghie WC, Petrusa ER, Gordon DL, Scalese RJ. Features and uses of high-fidelity medical simulations that lead to effective learning: a BEME systematic review. Med Teach. 2005; 27(1):10-28.
59. General medicine residents' perception of the mini-CEXs
Authors: Malhotra S. , Hatala R. , Courneya C.-A. 
Published: May 2017

The mini-CEX is a 30 minute observed clinical encounter. It can be done in the outpatient, inpatient or emergency room setting. It strives to look at several parameters including a clinical history, physical, professionalism and overall clinical competence. Trainees are rated using a 9-point scoring system: 1-3 unsatisfactory, 4-6 satisfactory and 7-9 superior.
Eight months after the introduction of the mini-CEX to the core University of British Columbia Internal Medicine Residents, a one hour semi-structured focus group for residents in each of the three years took place. The focus groups were conducted by an independent moderator, audio-recorded and transcribed.
Using a phenomenological approach the comments made by the focus groups participants were read independently by three authors, organized into major themes. In doing so, several intriguing common patterns were revealed on how General Medicine Residents perceive their experience in completing a mini-CEX.
The themes include Education, Assessment and Preparation for the Royal College of Physicians and Surgeons Internal Medicine exam. Resident learners perceived that the mini-CEX process provided insight into their clinical strengths and weaknesses. Focus group participants favored that the mini-CEX experience will benefit them in preparation, and successful completion of their licensing exam.
Daelmans HE, Overmeer RM, van der Hem-Stockroos HH, Scherpbier AJ, Stehouwer CD, van der Vleuten CP. In-training assessment: qualitative study of effects on supervision and feedback in an undergraduate clinical rotation. Medical Education 2006; 40(1):51-8.
De Lima AA, Henquin R, Thierer J, Paulin J, Lamari S, Belcastro F, Van der Vleuten CPM. A qualitative study of the impact on learning of the mini clinical evaluation exercise in postgraduate training. Medical Teacher January 2005; 27(1):46-52.
DiCicco-Bloom B, Crabtree BF. The Qualitative Research Interview. Medical Education 2006; 40:314-32.
60. Using a pocket card to improve end-of-life care on clinical teaching units: A controlled trials
Authors: Downar J. , Mikhael J. 
Published: May 2017

Although palliative and end-of-life is a critical part of in-hospital medical care, residents often have very little formal education in this field. To determine the efficacy of a symptom management pocket card in improving the comfort level and knowledge of residents in delivering end-of-life care on medical clinical teaching units, we performed a controlled trial involving residents on three clinical teaching units.
Residents at each site were given a 5-minute questionnaire at the start and at the end of their medicine ward rotation. Measures of self-reported comfort levels were assessed, as were 5 multiple-choice questions reflecting key knowledge areas in end-of-life care. Residents at all three sites were given didactic teaching sessions covering key concepts in palliative and end-of-life care over the course of their medicine ward rotation. Residents at the intervention site were also given a pocket card with information regarding symptom management in end-of-life care.
Over 10 months, 137 residents participated on the three clinical teaching units. Comfort levels improved in both control (p < 0.01) and intervention groups (p < 0.01), but the intervention group was significantly more comfortable than the control group at the end of their rotations (z=2.77, p < 0.01). Knowledge was not significantly improved in the control group (p=0.07), but was significantly improved in the intervention group (p < 0.01). The knowledge difference between the two groups approached but did not reach statistical significance at the end of their rotation.
In conclusion, our pocket card is a feasible, economical educational intervention that improves resident comfort level and knowledge in delivering end-of-life care on clinical teaching units.
Oneschuk D, Moloughney B, Jones-McLean E, Challis A. The Status of Undergraduate Palliative Medicine Education in Canada: a 2001 Survey. Journal Palliative Care 2004; 20:32.
Tiernan E, Kearney M, Lynch AM, Holland N, Pyne P. Effectiveness of a teaching programme in pain and symptom management for junior house officers. Support Care Cancer 2001; 9:606-610.
Okon TR, Evans JM, Gomez CF, Blackhall LJ. Palliative Educational Outcome with Implementation of PEACE Tool Integrated Clinical Pathway. Journal of Palliative Medicine 2004; 7:279-295.
61. Primary ophthalmic care patterns and training of University of Ottawa residentss
Authors: Sogbesan E. A. , Fournier A. , Damji K. 
Published: May 2017

This study assessed whether residents are equipped to perform recommended standards of ophthalmic primary care and determined if the findings reflect the adequacy of their undergraduate and postgraduate teaching in ophthalmology. Information was collected using web based online questionnaire that was completed by residents in the residency program at the University of Ottawa. Data was extracted and analyzed using Epi Info software.
One hundred and sixteen residents (17% capture rate) in all years of training completed the online questionnaire. Majority of the residents were not familiar with the different vision screening guidelines, less so with the Canadian (63 – 97%) than the American guidelines (91 – 94%). This was reflected in their referral patterns and mixed results of ophthalmic knowledge assessments. Only 21% of respondents were highly confident or confident in dealing with patients with eye problems. However, most were confident in history taking, visual acuity assessment and examination, but less so with ophthalmoscopy and intraocular pressure measurements.
The duration of undergraduate ophthalmic clerkship was at least one week in most of the institutions. However, about one third of the residents surveyed did not have any ophthalmology clerkship in medical school. Only 33% felt that their clerkship was adequate and about the same proportion felt that they received adequate ophthalmic exposure of relevance to their current practice. About 90% of the residents have not attended an update course in ophthalmology. Over 75% of the residents thought that a continuing education program in Ophthalmology would be useful and would be interested in attending such a program in the future.
Opportunities exist to address these inadequacies to better prepare residents for clinical practice. These include improvements in undergraduate ophthalmic education, inclusion of ophthalmology electives in residency training programs and the development of a continuing education program in ophthalmology for primary eye care physicians.
US Preventive Services Task Force: Screening for visual impairment in Children younger than five years: recommendation statement. American Family Physician 2005; 71(2): 333-340.
Feightner JW. Routine preschool screening for visual and hearing problems. In: Canadian Task Force on the Periodic Health Examination. Canadian guide to clinical preventive health care. Ottawa: Health Canada, 1994:298-304.
Bellan L. Ophthalmology undergraduate education in Canada. Can J Ophthalmol. 1998; 33(1):3 – 7.
63. Developing a program for resident wellness at the postgraduate medical education office, University of Torontos
Authors: Edwards S. , Verma S. , Zulla R. 
Published: May 2017

Prevalence of stress-related mental health problems in residents is equal to, or greater than, the general population. Medical training has been identified as the most significant negative influence on resident mental health. At the same time, residents possess inadequate stress management and general wellness skills and poor help-seeking behaviours. Unique barriers prevent residents from self-identifying and seeking assistance. Stress management programs in medical education have been shown to decrease subjective distress and increase wellness and coping skills.
The University of Toronto operates the largest postgraduate medical training program in the country. The Director of Resident Wellness position was created in the Postgraduate Medical Education Office to develop a systemic approach to resident wellness that facilitates early detection and intervention of significant stress related problems and promote professionalism.
Phase One of this new initiative has been to highlight its presence to residents and program directors by speaking to resident wellness issues at educational events. Resources on stress management, professional services, mental health, and financial management have been identified and posted on the postgraduate medical education website and circulated to program directors. Partnerships have been established with physician health professionals, the University of Toronto, and the Professional Association of Residents and Internes of Ontario. Research opportunities for determining prevalence and effective management strategies for stress related problems are being identified and ultimately programs/resources will be implemented to ensure that resident have readily accessible resources.
The establishment of a Resident Wellness Strategy from its embryonic stags and the challenges faced are presented as a template for implementing similar programs at other medical schools.
Earle L, Kelly L. Coping Strategies, Depression and Anxiety among Ontario Family Medicine Residents. Canadian Family Physician 2005; 51:242-3.
Cohen J, Patten S. Well-being in residency training: a survey examining resident physician satisfaction both within and outside of residency training and mental health in Alberta. BMC Medical Education; 5(21).
Levey RE. Sources of stress for residents and recommendations for programs to assist them. Academic Med 2001; 70(2):142-150.
65. Concurrent pursuit of degrees and courses during community medicine residency: Challenges, policies and proceduress
Authors: Russell M. L. , Vollman A. Robinson , Strudsholm T. 
Published: May 2017

We describe the policies and practices of Canadian Community Medicine (CM) residency programs regarding the Royal College requirement for one year of academic course work.
We surveyed 10 Program Directors (PD) of the 11 Canadian CM residency programs (excluding our university) by either telephone interview or written completion of a structured interview guide. Questions addressed: what is currently allowed and/or encouraged; the policies in place; and the benefits and challenges to concurrent pursuit of degrees by CM residents. Of particular interest were policies regarding residents studying off-site and what actions PDs take if courses or degrees desired by a resident were not available at the home university.
Seven of 10 PDs replied. Most programs did not have written policies to deal with requests to study off-site; decisions were made on a case-by-case basis. When approved, residents received salary support and bore all costs of off-site education. Several CM programs require degree acquisition during the academic year; others encourage degree acquisition. While CM program websites indicate degree completion is possible within one calendar year, often practicum placements run concurrently with resident clinical rotations or projects are competed during residency rotations. Most programs prefer residents to stay on campus for their contribution to rounds and on-call, socialization of the cohort, and continuity.
It would be helpful to programs generally if PDs had policies to guide decisions; it would be particularly useful for the specialty if this were (to the degree possible) a common policy across universities. PDs and universities wish to make academic learning more readily accessible. We suggest a focus on the development of quality distance learning and innovative strategies to share course development and improve residents’ access to learning without the need to go off-site.
Zweifler J, Evans R. Development of a residency/MPH Program. Fam Med 2001; 33(6):453-8.
Tilak GS, Baker SR. Self-subsidization of educational expenses by senior radiology residents. Acad Radiol 2007; 14:105-9.
Walter DA, Rosenquist PB, Bawtinhimer G. Distance learning technologies in the training of psychiatry residents; a critical assessment. Acad Psychiatry 2004; 28(10):60-5.
69. International medical graduates (IMGs) needs assessment study: A comparison between current IMG trainees and program directorss
Authors: Verma S. , Zulla R. , Baerlocher M. O. 
Published: May 2017

A needs assessment study was conducted to explore the types of issues or challenges IMG trainees encounter and the experiences of Program Directors with teaching this unique group. Both groups were asked to rate the importance of a series of issues in a horizontal curriculum using a 5-point Likert Scale. These issues fell under one of the following categories: Clinical Skills and Knowledge, Other Skills, Communication and Working Relationships, Macro Issues and Other Work-Related Issues. The scale was then collapsed to a 3-point Likert scale. Results were used to develop a horizontal curriculum for incoming IMGs to help ease their transition into residency training within the Canadian context.
The majority of program directors (93%) and IMG trainees (63%) surveyed agreed that a horizontal curriculum for IMGs should be developed. Program Directors indicated that basic clinical skills and communication with team members were important to include (79% and 90%, respectively). IMGs felt that Marco Issues were importance in a horizontal curriculum, namely an orientation about the Canadian healthcare system and site hospitals (71% and 59%, respectively), followed by communication with patients (67%). Significant differences were found with regards to the inclusion of communication with other residents and the inclusion of orientation sessions on the Canadian Health Care System and site hospitals.
These findings demonstrate there is a need for a core IMG curriculum. There is a slight disparity regarding what specific topics to include but a consensus between both groups exists on the primary domains of communication, inclusion of specialty specific skills and knowledge as well as professional interaction.
Kraemer M. Educational Challenges of International Medical Graduates in Psychiatric Residents. Journal of the American Academy of Psychoanalysis and Dynamic Psychiatry 2006; 34(1):163-171.
Whelan GP. Coming to American: The integration of the International Medical Graduates into the American Medical Culture. Academic Medicine 2005; 81(2):176-178.
Majumdar, B, Keystone JS, Cuttress LA. Cultural Sensitivity Training among Foreign Medical Graduates. Medical Education 1999; 33:177-184.