The report by the Association of Faculties of Medicine of Canada (AFMC) entitled "The Future of Medical Education in Canada: A Collective Vision for MD Education" includes recommendations to enhance admissions processes and increase national collaboration. To achieve these goals, the AFMC conducted a nationwide environmental scan appraising medical schools' readiness for national collaboration and progress toward establishing "made-in-Canada" admissions processes. A critical narrative review of the academic and gray literature was conducted as part of this environmental scan. Four core admissions practice and policy domains were identified: (1) social accountability strategies, (2) standardized admissions testing, (3) interviewing procedures, and (4) application procedures.In this article, the authors summarize and discuss the findings of this narrative review with regard to the four domains. They provide documentation of historical and present-day admissions factors relevant to Canadian medical schools' readiness for nationwide collaboration and a descriptive analysis of the facilitators and barriers to establishing "made-in-Canada" admissions processes.All four domains had facilitators and barriers. One barrier, however, cut across multiple domains-medical schools' pursuit of prestige and its potential to conflict with the goals of the other domains. The authors recommend holding a national forum to debate these issues and to advance the AFMC's goals, a process that will not be straightforward. Yet, national collaboration holds promise for applicants, medical schools, and Canada's diverse population of patients, so efforts toward this end must continue.
Twenty-five male delinquents (aged nine to 16) who had legal charges for setting fires filed against them were compared to a group of age and sex matched delinquents who had legal charges filed against them that were not related to firesetting. Groups were compared on demographic variables and on their delinquency and fire related histories. The only significant difference to emerge was a higher proportion of past firesetting in the group with fire-related charges. The present results indicate that a subgroup of antisocial recidivist firesetters exists among young offenders and underscore the importance of obtaining a thorough fire related history from youth who are before the court on fire related charges.
To ensure uniform design and evaluation of a clerkship curriculum for child and adolescent psychiatry teaching common disorders and problems in an efficient manner across 5 teaching sites and to include structures for continuous improvement.The curriculum committee selected for course inclusion disorders and problems of child psychiatry that were commonly encountered by primary care physicians. Instruction methods that encouraged active student learning were selected. Course coordination across sites was encouraged by several methods: involving faculty, adopting a centralized examination format, and aligning teaching methods with examination format. Quantitative and qualitative methods were used to measure students' perceptions of the course's value. These evaluative results were reviewed, and course modifications were implemented and reevaluated.The average adjusted student return rate for course evaluation questionnaires for the 3-year study period was 63%. Clerks' ratings of course learning value demonstrated that the course improved significantly and continually across all sites, according to a Scheffé post-hoc analysis. Analysis of student statements from focus-group transcripts contributed to course modifications, such as the Brief Focused Interview (BFI).Our curriculum in child psychiatry, which focused on common problems and used active learning methods, was viewed as a valuable learning experience by clinical clerks. Curriculum coordination across multiple teaching sites was accomplished by including faculty in the process and by using specific teaching and examination strategies. Structures for continuous course improvement were effective.
Abstract Background Fluorescence-guided precision cancer surgery may improve survival and minimize patient morbidity. Efficient development of promising interventions is however hindered by a lack of common methodology. This methodology review aimed to synthesize descriptions of technique, governance processes, surgical learning and outcome reporting in studies of fluorescence-guided cancer surgery to provide guidance for the harmonized design of future studies. Methods A systematic search of MEDLINE, EMBASE and CENTRAL databases from 2016–2020 identified studies of all designs describing the use of fluorescence in cancer surgery. Dual screening and data extraction was conducted by two independent teams. Results Of 13,108 screened articles, 426 full text articles were included. The number of publications per year increased from 66 in 2016 to 115 in 2020. Indocyanine green was the most commonly used fluorescence agent (391, 91.8%). The most common reported purpose of fluorescence guided surgery was for lymph node mapping (195, 5%) and non-specific tumour visualization (94, 2%). Reporting about surgical learning and governance processes incomplete. A total of 2,577 verbatim outcomes were identified, with the commonly reported outcome lymph node detection (796, 30%). Measures of recurrence (32, 1.2%), change in operative plan (23, 0.9%), health economics (2, 0.1%), learning curve (2, 0.1%) and quality of life (2, 0.1%) were rarely reported. Conclusion There was evidence of methodological heterogeneity that may hinder efficient evaluation of fluorescence surgery. Harmonization of the design of future studies may streamline innovation.
Balancing reliability and resource limitations as well as recruitment activities during admission interviews is a challenge for many medical schools. The Modified Personal Interview (MPI) has been shown to have good psychometric properties while being resource efficient for specialized admission interviews. We describe implementation of an MPI adaptation integrating psychometric rigour alongside resourcing and recruitment goals for larger-scale medical school admission interviewing at the University of Toronto.The MPI was implemented during the 2013-2014 admission cycle. The MPI uses multiple independent sampling by having applicants interviewed in a circuit of four brief semi-structured interviews. Recruitment is reflected in a longer MPI interviewing time to foster a 'human touch'. Psychometric evaluation includes generalizability studies to examine inter-interview reliability and other major sources of error variance. We evaluated MPI impact upon applicant recruitment yield and resourcing.MPI reliability is 0.56. MPI implementation maintained recruitment compared with previous year. MPI implementation required 160 interviewers for 600 applicants whereas for pre-MPI implementation 290 interviewers were required to interview 587 applicants. MPI score correlated with first year OSCE performance at 0.30 (p < 0.05).MPI reliability is measured at 0.56 alongside enhanced resource utilization and maintenance of recruitment yield. This 'intermediate approach' may enable broader institutional uptake of integrated multiple independent sampling-based admission interviewing within institution-specific resourcing and recruitment goals.
Efforts to increase access for and participation of groups that are underrepresented in postsecondary education (PSE) have included encouraging members of underrepresented groups to apply to PSE programmes, revising admission requirements to reduce barriers to attendance, providing assistance in completing applications for admission, and providing financial assistance. Such initiatives address different assumed causes of underrepresentation, but these assumptions are often not explicit. Drawing from programme evaluation, we describe and illustrate the use of change models to make explicit each access initiative’s assumptions about barriers to participation, thus providing the basis for evaluation of the initiatives. The evaluation of an access initiative involving a change in admission requirements for an initial teacher education programme is discussed as an illustration of this approach.
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