Michener Institute

BACKGROUND: As the adoption of artificial intelligence (AI) in health care increases, it will become increasingly crucial to involve health care professionals (HCPs) in developing, validating, and implementing AI-enabled technologies. However, because of a lack of AI literacy, most HCPs are not adequately prepared for this revolution. This is a significant barrier to adopting and implementing AI that will affect patients. In addition, the limited existing AI education programs face barriers to development and implementation at various levels of medical education. OBJECTIVE: With a view to informing future AI education programs for HCPs, this scoping review aims to provide an overview of the types of current or past AI education programs that pertains to the programs' curricular content, modes of delivery, critical implementation factors for education delivery, and outcomes used to assess the programs' effectiveness. METHODS: After the creation of a search strategy and keyword searches, a 2-stage screening process was conducted by 2 independent reviewers to determine study eligibility. When consensus was not reached, the conflict was resolved by consulting a third reviewer. This process consisted of a title and abstract scan and a full-text review. The articles were included if they discussed an actual training program or educational intervention, or a potential training program or educational intervention and the desired content to be covered, focused on AI, and were designed or intended for HCPs (at any stage of their career). RESULTS: Of the 10,094 unique citations scanned, 41 (0.41%) studies relevant to our eligibility criteria were identified. Among the 41 included studies, 10 (24%) described 13 unique programs and 31 (76%) discussed recommended curricular content. The curricular content of the unique programs ranged from AI use, AI interpretation, and cultivating skills to explain results derived from AI algorithms. The curricular topics were categorized into three main domains: cognitive, psychomotor, and affective. CONCLUSIONS: This review provides an overview of the current landscape of AI in medical education and highlights the skills and competencies required by HCPs to effectively use AI in enhancing the quality of care and optimizing patient outcomes. Future education efforts should focus on the development of regulatory strategies, a multidisciplinary approach to curriculum redesign, a competency-based curriculum, and patient-clinician interaction.

The study described in this article explored breast cancer survivors' perceptions and experiences as they decided whether to use a variety of complementary/alternative therapies. Six focus groups were conducted composed of women who had been diagnosed with breast cancer. Each 2-hour session was audiotaped and transcribed verbatim. In this article, the process by which the participants made the decision to use or not to use complementary/alternative therapies, including their discovery and investigation of complementary/alternative medicine (CAM) and their experiences using or not using CAM, are described. Barriers to using CAM included cost, access, and time. Family and friends generally supported the decision to use CAM; however, the participants described health care practitioners' reactions as mixed.

Interprofessional communication and collaboration are promoted by policymakers as fundamental building blocks for improving patient safety and meeting the demands of increasingly complex care. This paper reports qualitative findings of an interprofessional intervention designed to improve communication and collaboration between different professions in general internal medicine (GIM) hospital wards in Canada. The intervention promoted self-introduction by role and profession to a collaborating colleague in relation to the shared patient, a question or communication regarding the patient, to be followed by an explicit request for feedback from the partner professional. Implementation and uptake of the intervention were evaluated using qualitative methods, including 90 hours of ethnographic observations and interviews collected in both intervention and comparison wards. Documentary data were also collected and analysed. Fieldnotes and interviews were transcribed and analysed thematically. Our findings suggested that the intervention did not produce the anticipated changes in communication and collaboration between health professionals, and allowed us to identify barriers to the implementation of effective collaboration interventions. Despite initially offering verbal support, senior physicians, nurses, and allied health professionals minimally explained the intervention to their junior colleagues and rarely role-modelled or reiterated support for it. Professional resistances as well as the fast paced, interruptive environment reduced opportunities or incentive to enhance restrictive interprofessional relationships. In a healthcare setting where face-to-face spontaneous interprofessional communication is not hostile but is rare and impersonal, the perceived benefits of improvement are insufficient to implement simple and potentially beneficial communication changes, in the face of habit, and absence of continued senior clinician and management support.

Simulated learning and interprofessional education (IPE) are increasingly becoming more prevalent in health care curriculum. As the focus shifts to patient-centred care, health professionals will need to learn with, from and about one another in real-life settings in order to facilitate teamwork and collaboration. The provision of simulated learning in an interprofessional environment helps replicate these settings thereby providing the traditional medical education model with opportunities for growth and innovation. Learning in context is an essential psychological and cognitive aspect of education.This paper offers a conceptual analysis of the salient issues related to IPE and medical simulation. In addition, the paper argues for the integration of simulation into IPE in order to develop innovative approaches for the delivery of education and improved clinical practice that may benefit students and all members of the health care team.

General internal medicine (GIM) is a communicatively complex specialty because of its diverse patient population and the number and diversity of health care providers working on a medicine ward. Effective interprofessional communication in such information-intensive environments is critical to achieving optimal patient care. Few empirical studies have explored the ways in which health professionals exchange patient information and the implications of their chosen communication forms. In this article, we report on an ethnographic study of health professionals' communication in two GIM wards through the lens of communication genre theory. We categorize and explore communication in GIM into two genre sets-synchronous and asynchronous-and analyze the relationship between them. Our findings reveal an essential relationship between synchronous and asynchronous modes of communication that has implications for the effectiveness of interprofessional collaboration in this and similar health care settings, and is intended to inform efforts to overcome existing interprofessional communication barriers.

BACKGROUND: Improving walking capacity is a key objective of post-stroke rehabilitation. Evidence describing the quality and protocols of standardized tools for assessing walking capacity can facilitate their implementation. OBJECTIVE: To synthesize existing literature describing test protocols and measurement properties of distance-limited walk tests in people post-stroke. METHODS: Electronic database searches were completed in 2017. Records were screened and appraised for quality. RESULTS: Data were extracted from 43 eligible articles. Among the 12 walk tests identified, the 10-metre walk test (10mWT) at a comfortable pace was most commonly evaluated. Sixty-three unique protocols at comfortable and fast paces were identified. Walking pace and walkway surface, but not walkway length, influenced walking speed. Intraclass correlation coefficients for test-retest reliability ranged from 0.80-0.99 across walk tests. Measurement error values ranged from 0.04-0.40 and 0.06 to 0.20 for the 10mWT at comfortable and fast and paces, respectively. Across walk tests, performance was most frequently correlated with measures of strength, balance, and physical activity (r = 0.26-0.8, p < 0.05). CONCLUSIONS: The 10mWT has the most evidence of reliability and validity. Findings indicate that studies that include people with severe walking deficits, in acute and subacute phases of recovery, with improved quality of reporting, are needed.

A recent national assessment of emergency planning in Canada suggests that health care professionals are not properly prepared for disasters. In response to this gap, an interprofessional course in disaster management was developed, implemented and evaluated in Toronto, Canada from 2007 to 2008. Undergraduate students from five educational institutions in nursing, medicine, paramedicine, police, media and health administration programs took an eight-week online course. The course was highly interactive and included video, a discussion forum, an online board game and opportunity to participate in a high fidelity disaster simulation with professional staff. Curriculum developers set interprofessional competency as a major course outcome and this concept guided every aspect of content and activity development. A study was conducted to examine change in students' perceptions of disaster management competency and interprofessional attitudes after the course was completed. Results indicate that the course helped students master basic disaster management content and raised their awareness of, and appreciation for, other members of the interdisciplinary team. The undergraduate curriculum must support the development of collaborative competencies and ensure learners are prepared to work in collaborative practice.

INTRODUCTION: Like medicine and health care, feedback is a practice imbued with emotions: saturated with feelings relevant to one's identity and status within a given context. Often this emotional dimension of feedback is cast as an impediment to be ignored or managed. Such a perspective can be detrimental to feedback practices as emotions are fundamentally entwined with learning. In this critical review, we ask: What are the discourses of emotion in the feedback literature and what 'work' do they do? METHODS: We conducted a critical literature review of emotion and feedback in the three top journals of the field: Academic Medicine, Medical Education and Advances in Health Sciences Education. Analysis was informed by a Foucauldian critical discourse approach and involved identifying discourses of emotion and interpreting how they shape feedback practices. FINDINGS: Of 32 papers, four overlapping discourses of emotion were identified. Emotion as physiological casts emotion as internal, biological, ever-present, immutable and often problematic. Emotion as skill positions emotion as internal, mainly cognitive and amenable to regulation. A discourse of emotion as reflexive practice infers a social and interpersonal understanding of emotions, whereas emotion as socio-cultural discourse extends the reflexive practice discourse seeing emotion as circulating within learning environments as a political force. DISCUSSION: Drawing on scholarship within the sociology of emotions, we suggest the merits of studying emotion as inevitable (not pathological), as potentially paralysing and motivating and as situated within (and often reinforcing) a hierarchical social health care landscape. For future feedback research, we suggest shifting towards recognising the discourse-theory-practice connection with emotion in health professional education drawing from reflexive and socio-cultural discourses of emotion.

PURPOSE: To examine how a structured inter-professional education (IPE) clinical placement influences health care professional (HCP) students' perceptions of inter-professional collaboration (IPC) relative to that of students in a traditional clinical placement. METHODS: This study used a mixed-methods design. The Interdisciplinary Education Perception Scale (IEPS) was administered to HCP students (n=36) in two Toronto hospitals before and after a structured 5-week IPE clinical placement to examine changes in their perceptions of IPC. Students in a traditional clinical placement (n=28) were used as a control group. Focus groups were then conducted with seven students who took part in the structured IPE clinical placement. A coding framework was devised a priori, and the qualitative results were used to explain the quantitative findings. RESULTS: There were no statistically significant differences between groups after the structured IPE clinical placement, but the intervention group showed a greater positive trend in total IEPS scores from baseline to follow-up. Qualitative data suggest that students valued the knowledge and skills gained through the structured IPE clinical placement. CONCLUSIONS: Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students. Findings suggest that structured IPE clinical placements may provide students with valuable collaborative learning opportunities, enhanced respect for other professionals, and insight into the value of IPC in healthcare delivery. More research is needed to explore other factors that influence specific perceptions among physical therapy students.

The objective of our study was to propose an innovative applied health undergraduate curriculum model that uses simulation and interprofessional education to facilitate students' integration of both technical and "humanistic" core skills. The model incorporates assessment of student readiness for clinical education and readiness for professional practice in a collaborative, team-based, patient-centred environment. Improving the education of health care professionals is a critical contributor to ultimately improving patient care and outcomes. A review of the current models in health sciences education reveals a scarcity of clinical placements, concerns over students' preparedness for clinical education, and profession-specific delivery of health care education which fundamentally lacks collaboration and communication amongst professions. These educational shortcomings ultimately impact the delivery and efficacy of health care. Construct validation of clinical readiness will continue through primary research at The Michener Institute for Applied Health Sciences. As the new educational model is implemented, its impact will be assessed and documented using specific outcomes measurements. Appropriate modifications to the model will be made to ensure improvement and further applicability to an undergraduate medical curriculum.

BACKGROUND: The objective of this study was to develop a consensus-based algorithm for the management of the unanticipated difficult airway in obstetrics, and to use this algorithm for the assessment of anesthesia residents' performance during high-fidelity simulation. METHODS: An algorithm for unanticipated difficult airway in obstetrics, outlining the management of six generic clinical situations of "can and cannot ventilate" possibilities in three clinical contexts: elective cesarean section, emergency cesarean section for fetal distress, and emergency cesarean section for maternal distress, was used to create a critical skills checklist. The authors used four of these scenarios for high-fidelity simulation for residents. Their critical and crisis resource management skills were assessed independently by three raters using their checklist and the Ottawa Global rating scale. RESULTS: Sixteen residents participated. The checklist scores ranged from 64-80% and improved from scenario 1 to 4. Overall Global rating scale scores were marginal and not significantly different between scenarios. The intraclass correlation coefficient of 0.69 (95% CI: 0.58, 0.78) represents a good interrater reliability for the checklist. Multiple critical errors were identified, the most common being not calling for help or a difficult airway cart. CONCLUSIONS: Aside from identifying common critical errors, the authors noted that the residents' performance was poorest in two of our scenarios: "fetal distress and cannot intubate, cannot ventilate" and "maternal distress and cannot intubate, but can ventilate." More teaching emphasis may be warranted to avoid commonly identified critical errors and to improve overall management. Our study also suggests a potential for experiential learning with successive simulations.

BACKGROUND: Significant investments and advances in health care technologies and practices have created a need for digital and data-literate health care providers. Artificial intelligence (AI) algorithms transform the analysis, diagnosis, and treatment of medical conditions. Complex and massive data sets are informing significant health care decisions and clinical practices. The ability to read, manage, and interpret large data sets to provide data-driven care and to protect patient privacy are increasingly critical skills for today's health care providers. OBJECTIVE: The aim of this study is to accelerate the appropriate adoption of data-driven and AI-enhanced care by focusing on the mindsets, skillsets, and toolsets of point-of-care health providers and their leaders in the health system. METHODS: To accelerate the adoption of AI and the need for organizational change at a national level, our multistepped approach includes creating awareness and capacity building, learning through innovation and adoption, developing appropriate and strategic partnerships, and building effective knowledge exchange initiatives. Education interventions designed to adapt knowledge to the local context and address any challenges to knowledge use include engagement activities to increase awareness, educational curricula for health care providers and leaders, and the development of a coaching and practice-based innovation hub. Framed by the Knowledge-to-Action framework, we are currently in the knowledge creation stage to inform the curricula for each deliverable. An environmental scan and scoping review were conducted to understand the current state of AI education programs as reported in the academic literature. RESULTS: The environmental scan identified 24 AI-accredited programs specific to health providers, of which 11 were from the United States, 6 from Canada, 4 from the United Kingdom, and 3 from Asian countries. The most common curriculum topics across the environmental scan and scoping review included AI fundamentals, applications of AI, applied machine learning in health care, ethics, data science, and challenges to and opportunities for using AI. CONCLUSIONS: Technologies are advancing more rapidly than organizations, and professionals can adopt and adapt to them. To help shape AI practices, health care providers must have the skills and abilities to initiate change and shape the future of their discipline and practices for advancing high-quality care within the digital ecosystem. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): PRR1-10.2196/30940.

This article has been written for the 40th year of the publication of Medical Teacher. While we celebrate the contribution of simulated participants (SPs) to health professions education through values and value-based learning, we also offer critical reflection on elements of our practice, commencing with language. We argue for the use of the term simulated rather than standardized and acknowledge the dominant role of the SP as patient and the origins of the methodology. These shifts in terms and their implications in practice reflect changes in the conceptualization of SP-based methodology. Recently published standards for those who work with SPs (SP practitioners) are noted as an important milestone in our community’s development. We consider contemporary practices addressing the complex notions of values and value in SP-based learning. We simultaneously refer to the work of SPs and SP practitioners. Phases of educational design including identifying learning objectives, scenario design, implementation, feedback and debriefing are used to illustrate methodological shifts. Within each of these phases, there are relational issues that have to date often gone unchecked and are under reported in literature. Finally, using the metaphor of a murmuration, we celebrate contemporary practices of the global SP practitioner community.

BACKGROUND: In response to current trends in healthcare education, teachers at the Michener Institute for Applied Health Sciences implemented a New Curriculum Model (NCM) in 2006, building a curriculum to better transition students from didactic to clinical education. Through the implementation of interprofessional education and simulated clinical scenarios, educators created a setting to develop, contextualize and apply students' skills before entry to the clinical environment. AIMS: In this pilot study, researchers assessed the impact of the NCM intervention on student preparedness for clinical practicum. METHODS: A mixed-methods evaluation was conducted, collecting survey assessments and qualitative focus group feedback from clinical educators and students. RESULTS: Clinical educators identified Michener NCM students to be significantly better prepared for clinical practicum when compared to previous cohorts (p < 0.05%). Students also noted significant improvements as implementation issues were resolved from years one to two of the NCM. CONCLUSIONS: The infusion of simulation and interprofessional education into Michener's applied health curricula resulted in a significant improvement in clinical preparedness. The Michener NCM bridged the gap previously separating didactic education and clinical practice, transitioning applied health students from trained technicians to more complete health care professionals.

Advanced remote sensing techniques are used to: (1)Detect development and spread of corn leaf blight during the growing season; (2) assess the extent and severity of blight infection; (3) assess the impact of blight on corn production; and (4) estimate the applicability of these techniques to similar situations occurring in the future.

Current healthcare education in Canada is marked by the integration of interprofessional education (IPE) into the curriculum. Students from different health professions that were educated in “silos...

PURPOSE: The purpose of this study was to compare treatment complications for early-stage prostate cancer managed by either brachytherapy or three-dimensional conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: [corrected] Records were reviewed for 86 men treated with transperineal interstitial permanent prostate brachytherapy and for 76 men treated with dose-escalated (75.6-Gy) six-field 3DCRT between 1998 and 2000. Median ages were 65 and 66 years, respectively; median Gleason scores were 6 and 7; baseline prostate-specific antigen levels were 6.1 and 9.0 ng/mL; and the follow-up period was 42 months. In the urinary domain, patients who underwent brachytherapy recorded an International Prostate Symptom Score prospectively at baseline, as well as 3 months and every 6 months following, whereas patients who underwent 3D-CRT were assigned a Radiation Therapy Oncology Group (RTOG) late toxicity score at similar time intervals. In the bowel domain, RTOG late toxicity score was used for both groups, and physician-dictated notes were used to assess sexual function. All patients who underwent brachytherapy were prescribed tamsulosin (Flomax) to manage urinary symptoms for a minimum of 3 months after treatment. RESULTS: With respect to urinary symptoms, a direct comparison cannot be made between the International Prostate Symptom Score and the RTOG late toxicity score. Nonetheless, it was evident that patients who underwent brachytherapy had more severe urinary sequelae in the months after implantation. Tamsulosin was still being used by 78% of patients at 6 months, decreasing to 55% at 1 year and 27% at 2 years. Intermittent self-catheterization was required at 6 months after treatment by 5% of patients who underwent brachytherapy, and a transurethral resection of the prostate was performed in one of these patients at 12 months. In patients who underwent 3D-CRT, 14% used tamsulosin at some point in the follow-up period and none required catheterization or transurethral resection of the prostate. In the bowel domain, 20% of patients who underwent brachytherapy experienced grade 1 gastrointestinal toxicity, most within the first 12 months of follow-up, compared with 30% grade 1 or 2 gastrointestinal scores in the 3D-CRT group (peaking in the second year after treatment). In the sexual domain, 9% of patients who underwent brachytherapy who were previously potent reported a loss of potency by 18 months, compared with 53% of patients who underwent 3D-CRT. Without the help of sildenafil (Viagra), these figures rose to 24% and 58%. CONCLUSIONS: 3D-CRT is associated with fewer urinary symptoms, whereas brachytherapy has a more favorable toxicity profile for bowel and sexual function. In the absence of a randomized clinical trial, such a comparison can be helpful both in counseling patients as to what to expect from either treatment and in facilitating their treatment decision process.

BACKGROUND: As new technologies emerge, there is a significant shift in the way care is delivered on a global scale. Artificial intelligence (AI) technologies have been rapidly and inexorably used to optimize patient outcomes, reduce health system costs, improve workflow efficiency, and enhance population health. Despite the widespread adoption of AI technologies, the literature on patient engagement and their perspectives on how AI will affect clinical care is scarce. Minimal patient engagement can limit the optimization of these novel technologies and contribute to suboptimal use in care settings. OBJECTIVE: We aimed to explore patients' views on what skills they believe health care professionals should have in preparation for this AI-enabled future and how we can better engage patients when adopting and deploying AI technologies in health care settings. METHODS: Semistructured interviews were conducted from August 2020 to December 2021 with 12 individuals who were a patient in any Canadian health care setting. Interviews were conducted until thematic saturation occurred. A thematic analysis approach outlined by Braun and Clarke was used to inductively analyze the data and identify overarching themes. RESULTS: Among the 12 patients interviewed, 8 (67%) were from urban settings and 4 (33%) were from rural settings. A majority of the participants were very comfortable with technology (n=6, 50%) and somewhat familiar with AI (n=7, 58%). In total, 3 themes emerged: cultivating patients' trust, fostering patient engagement, and establishing data governance and validation of AI technologies. CONCLUSIONS: With the rapid surge of AI solutions, there is a critical need to understand patient values in advancing the quality of care and contributing to an equitable health system. Our study demonstrated that health care professionals play a synergetic role in the future of AI and digital technologies. Patient engagement is vital in addressing underlying health inequities and fostering an optimal care experience. Future research is warranted to understand and capture the diverse perspectives of patients with various racial, ethnic, and socioeconomic backgrounds.

Hematologic malignancies comprise a considerable part of cancers with high mortality at any age. Since the introduction of hematopoietic stem cell transplantation (HSCT), the overall survival of patients dramatically increased. The main goal of HSCT is the induction of a graft-versus-leukemia effect to eradicate the residual cancer cells and also reconstitute a healthy immune system for patients. However, relapse is a nettlesome challenge of HSCT. Like many other tumors, hematologic cancer cells induce immune exhaustion leading to immune escape and relapses after HSCT. Besides malignant cells, inhibitory cells such as tumor-associated macrophages and myeloid-derived suppressor cells express various inhibitory receptors capable of inducing exhaustion in immune cells, especially T and natural killer cells. The significance of immune checkpoint blocking in tumor regression in clinical trials led to the 2018 Nobel Prize in Physiology/Medicine. Here, we reviewed the clinical roles of immune checkpoints in hematologic malignancies and post-HSCT relapses.

INTRODUCTION: Academic difficulty can often be a significant problem for students in health professional programmes. Students in difficulty are often identified late in their training and run the risk of dismissal if remediation is not successful. Since the inception of the Medical Radiation Sciences Program (MRSP) at the University of Toronto, Faculty of Medicine, and the Michener Institute (MI) in 1999, a number of students have required remediation due to problems in the didactic or clinical component of their training. Not all remediation was successful, and a number of students have been dismissed. There is relatively sparse evidence in the educational literature regarding the nature of academic difficulties that health professional students encounter, and what constitutes appropriate remedial education. The purpose of this research was to evaluate the incidence and prevalence of remediation in the MRSP and the nature of the academic problems. In addition, this study looked at the type of remedial instruction that the Radiation Sciences Board of Examiners (BOE) recommended for these students as well as the effectiveness of these recommendations. MATERIALS AND METHODS: This study consisted of a review of the academic records of students who failed one or more courses and underwent pre-clinical or clinical remediation, and who were presented at the Medical Radiation Sciences Board of Examiners at the University of Toronto between September 1999 and December 2004. Data extraction forms were developed to obtain demographic information, the nature of the academic problems, the remedial recommendation, and their outcomes. RESULTS: This study identified 69 students who were presented to the BOE 95 times. Forty-four students (44/69, 64%) were from the Radiation Therapy stream, 16 students (16/69, 23%) were from the Nuclear Medicine stream and 9 students (9/69, 13%) were from the Radiographic Technology stream. Most of the remediation occurred due to pre-clinical 50 (50/69, 72%), clinical 15 (15/69, 22%) and both preclinical and clinical problems 4 students (4/69, 6%). Out of 54 students who required pre-clinical remediation, 40 (74%) were promoted. Out of 19 students who required clinical remediation, 10 (10/19, 53%) passed their remediation. Six students (6/69, 9%) were dismissed from the programme due to unsuccessful remediation; 2 due to pre-clinical and 4 due to clinical problems. Based on these results, the remediation process at the MRSP was successful; however, 6 students (6/69, 9%) were dismissed from the programme during the last 4 years despite lengthy unsuccessful remediation. CONCLUSION: Our study provided an important perspective about the remediation process at the MRSP at the Michener Institute for Applied Health Sciences. Despite its retrospective methodology, it attempted to identify the magnitude of learning problems that lead to remediation, and identified the efficacy of the remedial programmes.