Generative artificial intelligence (AI) has entered the spaces of reflection and narrative learning in medical education, spaces once defined by authenticity, introspection, and human voice. This Eye Opener examines tensions identified through a recent survey of undergraduate medical students and their ePortfolio physician coaches at the University of Ottawa regarding the use of AI in reflective writing. While the student response rate was notably lower (9.6%) than that of coaches (52.9%), this asymmetry prompted consideration of how the evaluative context of reflective writing may influence disclosure of AI use in voluntary surveys. Students who did respond described AI as a scaffold for idea generation and writing support, whereas coaches expressed unease, perceiving even limited AI use as a potential threat to authenticity. The resulting tension between pragmatism and preservation mirrors broader questions in medical education regarding reflective authorship and independent critical thinking. This moment invites reconsideration of reflection not solely as a written product but as a developmental process. Educators may need to move beyond detection toward dialogue that supports psychological safety, transparency, and shared understanding of authorship in the age of digitally assisted writing. Reflection has long been understood as a means of engaging with professional identity formation. The challenge now is determining how this process can remain meaningful as generative tools become increasingly embedded in learners’ academic work.

Role modelling is important in developing professionalism with a need for reliable, evidence-based tools to assess professionalism in the learning environment (LE). The Learning Environment for Professionalism (LEP) survey is brief, anonymous and balanced assessing medical trainees' and attendings’ positive and negative professionalism behaviours that can be tracked longitudinally and identify problem areas in the LE. Seven training programs agreed to facilitate administration of the LEP survey at four hospitals in Ottawa, Canada. The survey was carried out iteratively between 2013 and 2020. A total of 3783 LE ratings of training programs and hospitals were assessed longitudinally using univariate linear regression. A Bonferroni corrected p-value of ≤.0045 was used to account for multiple comparisons. Positive professional behaviours were observed across time with some of the negative behaviors having improved. A negative signal was found, with attendings appearing to be treating patients unfairly because of their financial status, ethnic background, sexual or religious preferences. Applying LEP survey longitudinally across diverse training programs and institutions is feasible and may assist programs to identify areas requiring attention and acknowledging areas of exemplary professionalism. Continuous monitoring of LE to meet requirements of accrediting bodies can also be considered an important quality improvement metric.

With a growing population of older adults living with dementia in the community, nurse practitioners (NPs) are increasingly expected to address issues of medical fitness to drive (MFTD) and driving cessation within their clinical practice. With their expertise in clinical assessment and communication skills, NPs are well suited to this area of practice. Studies that examined MFTD and/or driving cessation suggest that NPs want and need further knowledge and training with this population. As part of our aim to develop an online educational program on driving and dementia for health care providers, including NPs, this mixed-methods study explored NPs' preferences regarding the format and content for the proposed online program. Results from an online survey completed by 90 NPs and interviews with six NPs highlighted key areas of focus for virtual modules, where communication strategies, tools to assess MFTD, and the reporting process for medically unfit drivers were emphasized. Reflecting on their team approach to care, participants in this study preferred a hybrid approach of asynchronous and synchronous learning delivery for this educational program. The next step will be to evaluate this program and its impact on both NP knowledge and skills in terms of its real-world application.

Abstract Background Professionalism is a key competency in multiple medical education frameworks. The teaching and evaluation of professionalism is an accreditation standard for undergraduate and postgraduate medical training in Canada. As a result, there is a need for valid tools to assess professionalism in the learning environment (LE). One method that has demonstrated promise is the Learning Environment for Professionalism (LEP) survey. It is a brief and balanced tool consisting of 11 questions that assesses medical trainees' and attending physicians' positive and negative professionalism behaviours. Previous studies have shown it is an easily administered, reliable tool that produces valid results for assessing professionalism in both undergraduate and postgraduate LEs. This study aimed to expand the application of the LEP survey to more varied programs, across several institutions and to examine LEs longitudinally over a longer period of time.Methods All postgraduate medical programs at the University of Ottawa were approached to participate in this study. Seven training programs (anesthesiology, cardiac surgery, plastic surgery, urology, family medicine, internal medicine, and pediatrics) agreed to facilitate the administration of the LEP survey at four hospitals in Ottawa (The Ottawa Hospital Civic and General campuses, the Ottawa Heart Institute, and Children’s Hospital of Eastern Ontario). The LEP survey was carried out iteratively between 2013 and 2020. The LE ratings in each training program and hospital were assessed longitudinally using univariate linear regression. A Bonferroni corrected p-value of ≤ .0045 was used to account for multiple comparisons.Results 3783 survey responses over seven years were included in the analysis. Overall, positive professional behaviours were observed across time and programs. However, one negative item relating to attending physicians treating patients unfairly because of their financial status, ethnic background, sexual or religious preferences worsened.Conclusions This study demonstrated that applying the LEP survey longitudinally across diverse training programs is feasible. Furthermore, it can help program leaders identify areas that require attention and acknowledge areas of exemplary professionalism. Implementation of the LEP survey is an effective strategy to demonstrate continuous monitoring of the LE to accrediting bodies and can be considered an important quality improvement metric.

Patients with mild cognitive impairment (MCI) are at risk of progressing to Alzheimer’s dementia, yet only a fraction of them do. We explore here whether a very high-risk MCI subgroup can be identified using additional cognitive assessments and structural neuroimaging. A multimodal signature of Alzheimer’s dementia was first extracted using machine learning tools in the ADNI1 sample, and was comprised of cognitive deficits across multiple domains as well as atrophy in temporal, parietal and occipital regions. We then validated the predictive value of this signature on two MCI cohorts. In ADNI1 (N=235), the presence of the signature predicted progression to dementia over three years with 80.4% positive predictive value, adjusted for a “typical” MCI baseline rate of 33% (95.6% specificity, 55.1% sensitivity). These results were replicated in ADNI2 (N=235), with 87.8% adjusted positive predictive value (96.7% specificity, 47.3% sensitivity). Our results demonstrate that, even for widely used markers, marked improvement in positive predictive value over the literature can be achieved by focusing on a subgroup of individuals with similar brain characteristics. The signature can be readily applied for the enrichment of clinical trials. Crowd Sourced Quality Control of Brain Registration on the Zooniverse Platform Yassine Benhajali1,2, Helen Spiers 3, AmanPreet Badhwar3,4, Sebastian Urchs5, Laura Trouille6, Pierre Bellec2,4. 1Anthropology, University of Montreal, Canada, 2CRIUGM, University of Montreal, Canada, 3Department of Physics, University of Oxford, UK, 4DIRO, University of Montreal, Canada, 5MNI, McGill University, Canada, 6Adler Planetarium, Chicago, USA. Introduction: Despite widespread usage, there is no validated quality control (QC) procedure for MRI brain registration. In this work, we assess the reliability of a QC protocol in raters with prior experience (PE), and compare these raters with a consensus vote derived from hundreds of raters with no prior experience in registration QC (NE), recruited through the zooniverse crowdsourcing Internet platform [1]. Methods: A QC procedure was developed through user feedback over the past 5 years, and includes a series of key anatomical landmarks and associated confidence intervals [2] for 3 ratings: OK, Maybe or Fail. Based on ratings generated by YB and PB, we selected 100 T1 images from the ADHD (n=86) and COBRE (n=14) databases with 25 OK, 51 Maybe and 24 Fail. Images were then rated by 240 NE and 4 PE raters on Zooniverse. Each PE raters rated all 100 images.

Driving cessation in dementia is one of the toughest issues in dementia care, presenting a significant challenge for people with dementia (PWD), family caregivers and primary care physicians (PCPs). To support individuals through the process of decision-making and transitioning to non-driving we developed the Driving Cessation in Dementia Intervention Framework and Toolkit (DCD-IT). As part of our on-going research involving key stakeholders in the further development of the DCD-IT, our objective was to examine the context-specific factors that are relevant to its effective implementation in settings that support older adults with dementia. Individual in-depth interviews were conducted with 15 representatives from Alzheimer Society organizations in five Canadian provinces (British Columbia, Manitoba, Ontario and Nova Scotia). Participants were asked to describe the key challenges facing current and former drivers with dementia and their family caregivers in their local areas and how existing supportive programs address these challenges. Data were examined using interpretative thematic analysis. As reported in previous research, the importance of early conversations about driving cessation, and the lack of them, was an over-arching concern identified by participants. Although driving cessation was described as a “hot topic” that frequently came up in their work with their clients, participants reported that it was not addressed early enough and sometimes not at all between PWD and their family caregivers or with their primary care physicians (PCPs), until driving cessation was required or imminent. Within Alzheimer Society organization settings, participants also experienced challenges and resistance in engaging clients to address this issue. Perceived barriers to having conversations about driving cessation included avoidance and fears related to potential family discord and on-going system level factors (lack of alternative transportation, unclear reporting and assessment processes, lack of PCP education and training), as well as the individualized nature of the dementia journey with its competing priorities. Strategies to promote early conversations included easy access to tools and resources that support discussions about driving cessation, and broader community-wide initiatives. Addressing driving cessation in dementia through early conversations remains a critical element that requires attention at the individual, family, PCP and system levels.

Objectives A structured, reflection-based electronic portfolio program (ePortfolio), with novel faculty development initiative, involving ‘shadow coaches’, was shared with the newly formed Ottawa-Shanghai Joint School of Medicine (OSJSM). OSJSM is a partnership between Shanghai Jiao Tong University and the University of Ottawa. As the world’s first Sino-Canadian Joint Medical School, OSJSM introduced North American undergraduate medical curriculum to China. ‘Shadow coaching’ involved trans-Pacific pairing of coaches, supplemented by local faculty development. Framework (a) Pre-implementation: The well-established online ePortfolio platform at the University of Ottawa was mirrored at OSJSM. University of Ottawa ePortfolio coaches were recruited to serve as shadow coaches to their OSJSM counterparts. Shadow coaches provided mentoring and resources while maintaining awareness of cross-cultural issues. Faculty development consisted of face-to-face faculty development in Shanghai, several online synchronous sessions, and familiarization of University of Ottawa coaches with the Chinese medical education system. (b) Description/Components: This intervention, introduced in 2016–2017, involved five University of Ottawa shadow coaches paired with five OSJSM ePortfolio coaches. Student reflection encourages open frank discussion which is a new paradigm for Chinese students and faculty. Shadow coaches were encouraged to challenge new OSJSM coaches to widely explore physician roles and competencies. Results Initial results indicate that the experience served to effectively develop OSJSM coaches’ skills as evidenced by shadow coaches’ review of anonymized OSJSM student reflective writing. Conclusions Our project describes a novel tool using shadow coaching for faculty development for a cross-cultural partnership. Similar approaches can be utilized for culturally-sensitive long-distance faculty development.

Background Physicians often find significant challenges in assessing automobile driving in persons with mild cognitive impairment and mild dementia and deciding when to report to transportation administrators. Care must be taken to balance the safety of patients and other road users with potential negative effects of issuing such reports. Objective The aim of this study was to assess whether a computer-based Driving in Dementia Decision Tool (DD-DT) increased appropriate reporting of patients with mild dementia or mild cognitive impairment to transportation administrators. Methods The study used a parallel-group cluster nonblinded randomized controlled trial design to test a multifaceted knowledge translation intervention. The intervention included a computer-based decision support system activated by the physician-user, which provides a recommendation about whether to report patients with mild dementia or mild cognitive impairment to transportation administrators, based on an algorithm derived from earlier work. The intervention also included a mailed educational package and Web-based specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were stratified by sex and randomized to either use the DD-DT or a control version of the tool that required identical data input as the intervention group, but instead generated a generic reminder about the reporting legislation in Ontario, Canada. The trial ran from September 9, 2014 to January 29, 2016, and the primary outcome was the number of reports made to the transportation administrators concordant with the algorithm. Results A total of 69 participating physicians were randomized, and 36 of these used the DD-DT; 20 of the 35 randomized to the intervention group used DD-DT with 114 patients, and 16 of the 34 randomized to the control group used it with 103 patients. The proportion of all assessed patients reported to the transportation administrators concordant with recommendation did not differ between the intervention and the control groups (50% vs 49%; Z=−0.19, P=.85). Two variables predicted algorithm-based reporting—caregiver concern (odds ratio [OR]=5.8, 95% CI 2.5-13.6, P<.001) and abnormal clock drawing (OR 6.1, 95% CI 3.1-11.8, P<.001). Conclusions On the basis of this quantitative analysis, in-office abnormal clock drawing and expressions of concern about driving from caregivers substantially influenced physicians to report patients with mild dementia or mild cognitive impairment to transportation administrators, but the DD-DT tool itself did not increase such reports among these expert physicians. Trial Registration ClinicalTrials.gov NCT02036099; https://clinicaltrials.gov/ct2/show/NCT02036099 (Archived by WebCite at http://www.webcitation.org/6zGMF1ky8)

Introduction. For optimal direction in career paths and postgraduate training, students can benefit from information to guide them through options. Using geriatric medicine as a template, the goal was to develop a multimedia podcast resource that can give a clearer picture of what a specialty entails. Methods. The project included a survey of existing resources and needs assessment of medical students at the University of Ottawa, Canada. This survey assessed students' knowledge of geriatrics and interest in the field and explored what they foresee as being important to be informed on when considering application to programs. Based on this, interview questions and content were developed for a podcast which was then evaluated. Results. Interviews were conducted with physicians and residents nationwide. Relevant resources and links were added to the podcast. Evaluation demonstrated improved student understanding and interest in geriatric medicine as a career. Point-by-point format for a template on how to develop similar podcasts was developed to assist other specialties looking to develop similar information. Conclusions. As no such framework currently exists, results of this project can serve as a template for other postgraduate programs in developing a multimedia resource for informing prospective trainees.

Background: Driving in persons with dementia poses risks that must be counterbalanced with the importance of the care for autonomy and mobility. Physicians often find substantial challenges in the assessment and reporting of driving safety for persons with dementia. This paper describes a driving in dementia decision tool (DD-DT) developed to aid physicians in deciding when to report older drivers with either mild dementia or mild cognitive impairment to local transportation administrators.Methods: A multi-faceted, computerized decision support tool was developed, using a systematic literature and guideline review, expert opinion from an earlier Delphi study, as well as qualitative interviews and focus groups with physicians, caregivers of former drivers with dementia, and transportation administrators. The tool integrates inputs from the physician-user about the patient's clinical and driving history as well as cognitive findings, and it produces a recommendation for reporting to transportation administrators. This recommendation is translated into a customized reporting form for the transportation authority, if applicable, and additional resources are provided for the patient and caregiver.Conclusions: An innovative approach was needed to develop the DD-DT. The literature and guideline review confirmed the algorithm derived from the earlier Delphi study, and barriers identified in the qualitative research were incorporated into the design of the tool.

Background For persons with dementia (PWD), driving becomes very dangerous. Physicians in Canada are legally responsible to report unfit drivers and then must disclose that decision to their patients. That difficult discussion is fraught with challenges: physicians want to maintain a healthy relationship; patients often lack insight into their cognitive loss and have very strong emotional reactions to the loss of their driving privileges. All of which may stifle the exchange of accurate information. The goal of this project was to develop a multimedia module that would provide strategies and support for health professionals having these difficult conversations. Methods Literature search was conducted of Embase and OVID MedLine on available driving and dementia tools, and on websites of online tools for communication strategies on driving cessation. A workshop module was developed with background material, communication strategies, links to resources and two videos demonstrating the "bad" then the "good" ways of managing this emotionally charged discussion. Results When the module was tested with internal medicine trainees, results demonstrated that confidence increased significantly (p < .001), and comfort and willingness in discussing the subject improved. Conclusion This project demonstrated the positive impact of the module on improving health professionals' attitude and readiness to communicate driving cessation to PWD.

Medical EducationVolume 50, Issue 11 p. 1153-1154 Really Good Stuff: Lessons learned though innovation in medical education Boosters for clerkship professionalism curriculum: online self-learning modules Derek Petit, Corresponding Author Derek Petit dpeti057@uottawa.ca Correspondence: Derek Petit, Faculty of Medicine Professionalism, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5. Tel: 613 562 5800; E-mail: dpeti057@uottawa.caSearch for more papers by this authorHeather Lochnan, Heather LochnanSearch for more papers by this authorAnna Byszewski, Anna ByszewskiSearch for more papers by this author Derek Petit, Corresponding Author Derek Petit dpeti057@uottawa.ca Correspondence: Derek Petit, Faculty of Medicine Professionalism, University of Ottawa, 451 Smyth Road, Ottawa, Ontario, Canada K1H 8M5. Tel: 613 562 5800; E-mail: dpeti057@uottawa.caSearch for more papers by this authorHeather Lochnan, Heather LochnanSearch for more papers by this authorAnna Byszewski, Anna ByszewskiSearch for more papers by this author First published: 19 October 2016 https://doi.org/10.1111/medu.13184Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume50, Issue11November 2016Pages 1153-1154 RelatedInformation

The objective of this study was to use a knowledge translation intervention to aid physicians in deciding when to report older drivers with mild dementia or mild cognitive impairment (MCI) to transportation authorities. A parallel-group randomized controlled trial was conducted to assess a Driving in Dementia Decision Tool (DD-DT). The DD-DT was based on an algorithm derived from an earlier study, a new computerized clinical decision system, an educational package, and specialized reporting forms. Specialists and family physicians with expertise in dementia or care of the elderly were randomized to either use the DD-DT or a control version of the tool. In the experimental DD-DT, participants received an algorithm-based recommendation on whether or not to report their patient; in the control version, they received a generic reminder about reporting legislation. Participants were stratified by gender and randomized. Quantitative analysis examined reporting decisions and recommendation of a specialized road test. Qualitative interviews examined users’ experience of the tool. Sixty-eight participating physicians were randomized; 20/35 randomized to the intervention group used the DD-DT with 100 patients, and 16/33 randomized to the control group used it with 86 patients. The proportion of patients reported to the authorities per protocol did not differ statistically in the intervention and in the control groups (49% vs. 43%; Z=-1.02, p=0.31). In a multivariate analysis, caregiver concern (OR 6.2, 95% CI 2.7-14.3, p<0.0001) and abnormal clock drawing (OR 10.6, 95% CI 5.0-22.5, p<0.0001) predicted algorithm-based reporting. Physicians’ perceived stress from medical uncertainty was an additional predictor of all reports (OR 1.04, 95% CI 1.00-1.08, p=0.03), and females were more likely than males to recommend a formal road test (OR 3.4, 95% CI 1.1-10.1, p=0.03). Interviews revealed frustration with the tool’s recommendation that there was no expert consensus on reporting in some cases, and a perception that the tool would be most valuable for family physicians. The intervention did not increase physician reporting of patients with MCI/mild dementia to transportation authorities, beyond the effects of caregiver concern and clock drawing abnormalities. Future directions will focus on assessing the tool in primary care settings.

Background: Given their essential role in developing professional identity, academic institutions now require formal assessment of the learning environment (LE). We describe the experience of introducing a novel and practical tool in postgraduate programmes. The Learning Environment for Professionalism (LEP) survey, validated in the undergraduate setting, is relatively short, with 11 questions balanced for positive and negative professionalism behaviours. LEP is anonymous and focused on rotation setting, not an individual, and can be used on an iterative basis. We describe how we implemented the LEP, preliminary results, challenges encountered and suggestions for future application.Methods: The study was designed to test the feasibility of introducing the LEP in the postgraduate setting, and to establish the validity and the reliability of the survey. Residents in four programmes completed 187 ratings using LEP at the end of one of 11 rotations.Results: The resident response rate was 87percent. Programme and rotation ratings were similar but not identical. All items rated positively (favourably), but displays of altruism tended to have lower ratings (meaning less desirable behaviour was witnessed), as were ratings for derogatory comments (again meaning that less desirable behaviour was witnessed).Discussion: We have shown that the LEP is a feasible and valid tool that can be implemented on an iterative basis to examine the LE. Two LEP questions in particular, regarding derogatory remarks and demonstrating altruism, recorded the lowest scores, and these areas deserve attention at our institution. Implementation in diverse programmes is planned at our teaching hospitals to further assess reliability. This work may influence other postgraduate programmes to introduce this assessment tool.

There is a paucity of evidence-based literature on the essential communication and collaboration skills to guide health care teams in conducting and assessing their performance in the Family Conference (FC). The authors developed and collected validity evidence for a rating scale of team FC performance, the Family Conference Rating Scale (FCRS). In phase 1, essential FC communication and collaboration skills were identified through a review of existing communication tools and literature on team functioning; a draft 34-item scale was developed. In phase 2, the scale was narrowed to a 6-category, 9-point scale with descriptors of expected behaviours through an iterative process: testing of the scale on 10 FC transcripts by two experts, soliciting feedback from a focus group of seven health care providers, and testing by non-experts on 49 live FCs. In phase 3, scores on the revised scale were validated by 10 health care providers from different disciplines by rating three videos of FCs of variable quality. Raters were able to detect inter-video variation in FC quality. The reliability of the FCRS was 0.95 and the inter-rater reliability, 0.68. The FCRS may enhance the ability of health professions educators to teach and assess interprofessional patient-centred communication and collaboration competencies.

Background Accrediting bodies now recognize the importance of developing the professionalism competency, by setting standards that require medical schools to identify where professionalism is addressed and how it is evaluated within the formal curriculum. The objective of this study was to compare how professionalism competency is formally addressed in the curricula of Canadian medical schools, and to better understand the Canadian approach to reporting and remediation of lapses. Methods A literature review was performed and with the input of the AFMC(Association of Faculties of Medicine of Canada) Professionalism group, questionnaires were generated. An electronic survey was circulated to key leaders across the country at all the medical schools. In-depth telephone interviews were used to further explore themes, and a subsequent focus group was held to discuss challenges, particularly related to reporting and remediation. Results The preponderance of formal professionalism teaching remains in the form of lectures and small group sessions in the preclinical years. Formal teaching declines significantly in the clerkship/clinical years. Evaluation is usually performed by a clinical supervisor, but OSCE, portfolio, and concern notes are increasingly used. Role modeling is heavily relied upon in clinical years, suggesting faculty training can help ensure clinical teachers recognize their influence on trainees. Formal remediation strategies are in place at most schools, and often involve essay writing, reflection exercises, or completion of learning modules about professionalism. Lack of clarity on what defines a lapse and fear of reprisal (for both trainees and faculty) limits reporting. Conclusions This study provides an overview of how professional identity formation is supported in the Canadian context, guided by the standards set out by CanMEDS. Despite a rich literature that describes the definition, program design and evaluation methods for professionalism, in some areas of the curriculum there is still an opportunity to ensure programs embrace the suggested framework. Examples of teaching and evaluation methods, deficiencies in the clinical years of study (clerkship) and challenges in addressing lapses and organizational structure are identified. The results help identify the gaps that need to be addressed and some solutions that can be modeled at other academic institutions.

Background: Acquiring the values of medical professionalism has become a critical issue in medical education. The purpose of this study was to identify lapses in professionalism witnessed by medical students during their four year MD curriculum, and to categorize, from the students' perspective, who was responsible and the settings in which these occurred.Methods: An electronic survey, developed by faculty and medical students, was sent to all students with two email reminders. It included quantitative responses and some open-ended opportunities for comments. All analyses were performed with SAS version 9.1.Results: The response rate was 45.6% (255 of 559 students) for all four years of the medical school curriculum. Thirty six percent of students had witnessed or been part of an exemplary demonstration of professionalism; 64% responded that they had witnessed a lapse of professionalism. At the pre-clerkship level, the most frequent lapses involved students: arrogance (42.2%), impairment (24.2%), followed by cultural or religious insensitivity (20.5%). At the clerkship level of training, where students are exposed to real clinical situations, the lapses involved primarily faculty (including preceptor and clinician) or other staff; these included arrogance (55.3%), breach of confidentiality (28.3%), and cultural or religious insensitivity (26.6%); impairment involved mostly students (25.5%). These findings are analyzed from the perspective of role modeling by faculty and in the context of the learning environment.Conclusions: Medical students witnessed a lapse of professionalism involving both fellow students as well as faculty and administrative staff, in several domains. Results from this study emphasize the importance of role modeling and the need for faculty development, to improve the learning environment. This study adds to the limited emerging literature on the forces that influence medical student professional identity formation.

Background The aim of this project was to develop a toolkit to assist persons with dementia (PWD) and their caregivers, in planning for retirement from driving. The information gathered was used to develop a tool that can assist reflection about, and make sound decisions in this challenging area of the dementia journey. The purpose is to keep safe drivers on the road and to prepare those who are moving towards being at risk of being involved in crashes, to eventually stop driving when they are unsafe. The toolkit was prepared to address the concerns of both the PWD as well as the caregivers. Strategies and solutions are presented for both the PWD and the caregivers. A grief insert was also developed that can assist caregivers in supporting the PWD in the grief process that can accompany losing one’s driving privileges.

The University of Ottawa (uOttawa) Faculty of Medicine in 2008 launched a revised undergraduate medical education (UGME) curriculum that was based on the seven CanMEDS roles (medical expert, communicator, collaborator, health advocate, manager, scholar, and professional) and added an eighth role of person to incorporate the dimension of mindfulness and personal well-being. In this article, the authors describe the development of an electronic Portfolio (ePortfolio) program that enables uOttawa medical students to document their activities and to demonstrate their development of competence in each of the eight roles. The ePortfolio program supports reflective practice, an important component of professional competence, and provides a means for addressing the "hidden curriculum." It is bilingual, mandatory, and spans the four years of UGME. It includes both an online component for students to document their personal development and for student-coach dialogue, as well as twice-yearly, small-group meetings in which students engage in reflective discussions and learn to give and receive feedback. The authors reflect on the challenges they faced in the development and implementation of the ePortfolio program and share the lessons they have learned along the way to a successful and sustainable program. These lessons include switching from a complex information technology system to a user-friendly, Web-based blog platform; rethinking orientation sessions to ensure that faculty and students understand the value of the ePortfolio program; soliciting student input to improve the program and increase student buy-in; and providing faculty development opportunities and recognition.