Together again: a community redefining residency education

Abstract

and effective way of teaching junior residents about common on-call pathologies. Preliminary results revealed positive subjective feedback and greater than 100 listeners. This innovative approach to radiology education requires ongoing assessment. Abstract : Hematology residents spend a large proportion of their training diagnosing and treating life-threatening blood cancers. Psycho-oncology research has identified that oncologists feel ill-equipped to deal with frequent patient deaths and suggest the development of residency curriculum in this space is an important goal (Granek et al., 2012 \& 2017). The promotion of safety and wellness throughout the learning environment is encouraged in residency education (RCPSC, 2019, p 19). Specifically, as a professional, a hematologist should: “recognize the impact of caring for a dying patient” (RCPSC 2015, p.13). In response, a hematology specific wellness module has been developed. Method: The learning theories applied to this module include humanistic (learner centered) and cognitive learning theory (use of reflective thinking and focus of learning is on the mental processes rather than behaviours) (Khalil \& Eklhider 2016). In terms of content the residents are assigned three articles to read two weeks in advance. They receive a link to a blog post and podcast that will explain the thought, question, epiphany (TQE) method of discussion-based learning (see Cult of pedagogy, 2018 for more). They submit their TQE’s on the readings along with a reflective post on an experience around a patient death prior to the session. The half day module is discussion based around the articles, their TQE’s and reflections as comfortable. Conclusion: This half day was piloted locally, with excellent informal feedback. There was interest in patient death in the outpatient setting where they recognized clear communication at end of life can be challenging but beneficial in closure for both the physician and family. Going forward, gathering national data to detail the of hematology trainees will allow issue to training programs to augment their EPA assessment strategies via simulation for smaller training programs. Introduction: Workplace-based assessments (WBA) are used to document formative feedback and inform summative assessment for residents. Though one WBA per half day of learning is suggested, there is a dearth of literature to inform the optimum number to support learning. This study explores perceptions of Family Medicine (FM) residents and preceptors on the optimal quantity and quality of WBA for learning. Methods: Qualitative study consisting of interviews with preceptors and focus groups with residents at an FM residency program in Ontario. Data analyzed using thematic analysis through open coding in NVivo. Results: Ten preceptors and 7 residents participated. Five themes emerged: Purpose of WBA, current and optimal frequency, factors affecting frequency, content, and perceptions of WBA. Preceptors and residents felt the purpose of WBA was to provide feedback, document, or fulfill departmental requirements. Half of preceptors reported meeting the suggested frequency, however most residents reported receiving fewer than this, particularly in second year. Some preceptors felt one WBA per half day is optimal for resident learning, though others, and most residents, felt this is too frequent. Logistics, resident performance and preceptor habits/beliefs influenced frequency of WBA. Residents and preceptors agreed the most valuable WBA content is specific or new information. Residents found WBA with vague or positive feedback least valuable. Residents and preceptors agreed that feeling pressure to meet the quota contributed to dissatisfaction. Conclusions: Results of this study will inform best practice for resident assessment and help to determine the optimal frequency of workplace-based assessment in FM residency programs. following outcome variables: low-stakes and high-stakes assessments; learning plans; remediation; Domains Framework (TDF; Cane et al., 2012) provide salient frameworks for understanding the behavioural components of coaching and identifying effective interventions. The objectives of this study were to (a) examine clinical teachers’ perspectives of effective coaching behaviours, (b) identify barriers and facilitators to coaching, and (c) identify appropriate coaching interventions. Methods: Using a social constructionist approach, 13 clinical teachers participated in individual semi-structured interviews. A two-phase analysis was adopted. First, reflexive thematic analysis was used to analyse the data inductively and iteratively. Second, themes were then deductively mapped onto the BCW and TDF to further explore the behavioural determinants of coaching and to identify salient interventions. Results: Participants’ perceptions of coaching behaviours were captured in six themes pertaining to clinical teachers’ capability (a self-directed journey and a balancing act), opportunity (the show must go on and setting the stage), and motivation (call me coach and an audience for coaching). Results indicated that although clinical teachers felt they had the necessary knowledge and skills to engage in coaching behaviours, social and environmental constraints limited the practical implementation of these behaviours. Participants expressed concerns regarding the incompatibility of coaching behaviours with an assessment-focused learning environment. Conclusion: The findings of this work offer support for the application of behaviour change theories in medical education research and capture nuances specific to the clinical learning environment. Practical recommendations include shifting interventions beyond individual-level knowledge and skills to creating social and environmental contexts that support coaching. We conducted a cross-sectional study of specialties how consistently clinician teachers We to measure agreement with classifications found in formal EPA (% matching responses) and among (inter-rater reliability via intraclass correlation; Results: Thirty-eight clinician teachers participated with no attrition. to all Obstetrics and Gynaecology residents. The first assessed fatigue, sleeping hours, and barriers to sleep. The second recorded pages received and classified them based on urgency. Data was analyzed using mixed methods; quantitative data compared junior residents (PGY1/2) to senior residents (PGY3/4/5) and low-risk shifts to high-risk shifts. Qualitative analysis was performed with two study members identifying themes and conflicts resolved by a third. Results : The response was 67% (n=21). Junior residents had less sleep on average than senior residents with 60% of juniors sleeping 6 hours per night and 81.8% of seniors sleeping 7 hours per night. The most reported reason for inhibited sleep was academic responsibilities, which were cited more often by seniors in comparison to juniors (p=0.0116). Post-call habits were not different between senior and junior residents. In general, senior residents tend to get more sleep on-call than junior residents though this was non-significant. The number of non-urgent pages was cited by 45.6% of residents as a key barrier to sleep on call and by 76.2% as the priority area for intervention. Of 358 pages over 18 shifts (retention 81%), 38.4% of high-risk and 43.75% of low-risk pages were classified as non-urgent. Conclusion : While the ability to sleep before and during on-call shifts differs by PGY year, both groups identify non-urgent pages as a significant source of fatigue and key area for intervention. The current coronavirus pandemic increases the risk of work-related stress and presents challenges for all NHS workers never experienced before, being described as the ‘perfect storm’ for potential stress-related illness for healthcare staff (Khajuri 2020). A cross-sectional study undertaken in China identified mental health distress among front-line healthcare workers, particularly nurses, and emphasised the need for psychological intervention (Lai et al, 2020). Results: As a result of Covid 19, the demand for PACE increased and from a reflection of the research and the actual PACE assessments, it became evident that more was required by staff than an education in acute and chronic stress reactions. Conclusion: PACE has evolved further to meet the needs of staff during Covid-19 and to support employers by minimising sick leave by providing employees with protective factors and coping strategies. PACE offers a structured way to support colleagues in the busyness of day-to-day workload, provides an education in coping strategies and protective factors that can be utilised in the midst of stressful exposure and is also an opportunity to raise awareness about the importance of individual mental health investment. A mental health coding process, anchored by direct content analysis methodology, and informed by three theoretical frameworks: instructional design, sociologic translation and simulation design. Results: Three themes were identified: (1) creating safety for SPs paid to be vulnerable, (2) fidelity as an issue broader than who plays the role, and (3) mobilizing despite inequities. SP work involving traditionally marginalized groups risks re-traumatization, highlighting the importance of empowerment of SPs. Fidelity issues not only reflect who plays the role, but also by not obscuring critical perspectives by facilitating inclusion of traditionally underrepresented or marginalized groups in creating educational objectives, co-creating content, determining who and how to recruit SPs, and training and debriefing SPs. Finally, building relationships with communities, and empowering members who are also health providers and/or educators facilitates community mobilization for SP based education. co-delivery Methods: In this mixed methods study, 54 emergency medicine residents from two institutions were randomly assigned