We assessed the effectiveness and safety of a 5-day intravenous prostaglandin (iloprost) protocol at reducing digital amputation for patients with severe frostbite injuries at urban emergency departments. This retrospective study examines consecutive patients who presented to Calgary emergency departments from April 2017 to April 2020 with Grade 2–4 frostbite injuries. Patients from February 2019 onward were managed using a 5-day iloprost infusion protocol, whereas patients prior to this time were managed with standard care (local best practice without iloprost as a therapeutic option). The primary effectiveness outcome was rate of affected digits amputated, stratified by frostbite severity. The secondary safety outcome was the incidence of serious adverse events associated with iloprost (allergic reactions or symptomatic hypotension requiring treatment or discontinuation of the infusion). 90 patients were included, 26 were treated with iloprost, compared to 64 patients who received usual care. Both the treatment and usual care groups experienced substantial rates of homelessness and substance use. No digital amputations were required for patients with Grade 2 injuries in either group, but significantly lower digital amputation rates were observed for patients with more severe frostbite injuries treated with iloprost versus usual care: Grade 3 (18% vs 44%, p < 0.001), Grade 4 (46% vs 95%, p < 0.001). No serious adverse events were associated with iloprost. In this unselected socially complex urban population, administration of iloprost for patients with frostbite was shown to be safe and was associated with lower digital amputation rates, particularly for those with more severe injuries.

BACKGROUND:With the 2015 publication of the Truth and Reconciliation Commission of Canada's calls to action, health professional schools are left grappling with how to increase the recruitment and success of Indigenous learners. Efforts to diversify trainee pools have long looked to quota-based approaches to recruit students from underserved communities, though such approaches pose dilemmas around meaningfully dismantling structural barriers to health professional education. Lessons shared here from developing one multi-layered admissions strategy highlight the importance of equity-rather than equality-in any recruitment for learners from medically underserved communities.SUMMARY:The promotion of fairness in the recruitment of future practitioners is not just a question of equalizing access to, in this case, medical school; it involves recognizing the wider social and structural mechanisms that enable privileged access to the medical profession by members of dominant society. This recognition compels a shift in focus beyond merely giving the disadvantaged increased access to an unfair system, towards building tools to address deeper questions about what is meant by the kind of excellence expected of applicants, how it is to be measured, and to what extent these recruits may contribute to improved care for the communities from which they come.CONCLUSION:Equity-based approaches to student recruitment move health professional schools beyond the dilemma of recruiting students from marginalized backgrounds who happen to be most similar to the dominant student population. Achieving this requires a complex view of the target population, recognizing that disadvantage is experienced in many diverse ways, that barriers are encountered along a spectrum of access, and that equity may only emerge when a critically, socially conscious approach is embedded throughout institutional practices.

Background Research on the predictive validity of the Medical College Admissions Test (MCAT) on licensing examination performance is varied in its conclusions, with only a few studies examining this relationship in a Canadian context. We assessed the predictive validity of the MCAT on successful performance on the Medical Council of Canada Qualifying Examination (MCCQE) Part 1 by students attending the Cumming School of Medicine. Methods Prospective data were collected on MCAT score and sub-section scores, MCCQE decision, multiple mini interview (MMI) performance, gender, and age. The cohort was divided into a derivation cohort (2013 and 2014) and validation cohort (2015 and 2016). Students were dichotomized into pass or fail on MCCQE. Multiple logistic regression in which our dependent variable was MCCQE Part I examination success at the first attempt was used, and potential explanatory variables were age, gender, MCAT total score, and sub-scores for the biological sciences (MCAT-BS), physical sciences, and verbal reasoning, GPA, and MMI ratings. Results For the derivation cohort MCAT-BS was associated with success on the MCCQE Part I. The odds ratio for this association of 1.37 (95% confidence interval [1.01, 1.85], p = 0.04). When we applied the MCAT-BS to our validation cohort the odds ratio of MCCQE Part I examination success was 1.42 [1.10, 1.83], p = 0.007) and the area under the ROC curve was 0.66 [0.54, 0.79]). Conclusion The MCAT-BS predicted successful performance on the MCCQE Part 1 Examination in the Canadian setting.

In 2015, the Medical College Admission Test (MCAT) was redesigned to better assess the concepts and reasoning skills students need to be ready for the medical school curriculum. During the new exam’s design and rollout, careful attention was paid to the opportunities examinees had to learn the new content and their access to free and low-cost preparation resources. The design committee aimed to mitigate possible unintended effects of the redesign, specifically increasing historical mean group differences in MCAT scores for examinees from lower socioeconomic status (SES) backgrounds and races/ethnicities underrepresented in medicine compared with those from higher SES backgrounds and races/ethnicities not underrepresented in medicine. In this article, the authors describe the characteristics and scores of examinees who took the new MCAT exam in 2017 and compare those trends with historical ones from 2013, presenting evidence that the diversity and performance of examinees has remained stable even with the exam’s redesign. They also describe the use of free and low-cost MCAT preparation resources and MCAT preparation courses for examinees from higher and lower SES backgrounds and who are enrolled in undergraduate institutions with more and fewer resources, showing that examinees from lower SES backgrounds and who attend institutions with fewer resources use many free and low-cost test preparation resources at lower rates than their peers. The authors conclude with a description of the next phase of this research: to gather qualitative and quantitative data about the preparation strategies, barriers, and needs of all examinees, but especially those from lower SES and underrepresented racial/ethnic backgrounds.

Background: Despite a growing focus on the social accountability of medical schools, there has been no substantive review of admissions related to the social mission of medical schools. This paper reports on a critical scoping review of the connections between social mission and medical school admissions.Methods: Searches of seven bibliographic databases identified 1258 unique articles. After filtering for relevance, 71 articles were considered for final review. The results of the data extraction were synthesized using a combination of qualitative and quantitative techniques.Results: Five reviewers conducted 149 data extractions from 71 papers. Social missions tended to focus either on access and equity issues for applicants from underrepresented populations or on the career choices of medical graduates and how they meet particular social needs. The connection between social missions and admissions was often implied but rarely considered or evaluated directly. There was a notable absence of empirical evidence, with calls for reform or program descriptions far outweighing the number of papers based on empirical findings.Conclusions: Despite the move to social missions in medical education, there remains little direct connection between missions and admissions and little evidence reflecting the efficacy or impacts of making this connection.

Purpose The multiple mini-interview (MMI) improves reliability and validity of medical school interviews, and many schools have introduced this in an attempt to select individuals more skilled in communication, critical thinking, and ethical decision making. But every change in the admissions process may produce unintended consequences, such as changing intake demographics. In this article, two studies exploring gender differences in MMI ratings are reported. Method Cumulative meta-analysis was used to compare MMI ratings for female and male applicants to the University of Calgary Cumming School of Medicine between 2010 and 2014. Multiple linear regression was then performed to explore gender differences in MMI ratings after adjusting for other variables, followed by a sensitivity analysis of the impact of varying the weight given to MMI ratings on the odds of females being ranked in the top 150 applicants for 2014. Results Females were rated higher than male applicants (standardized mean difference 0.21, 95% CI [0.11, 0.30], P < .001). After adjusting for other explanatory variables, there was a positive association between female applicant and MMI rating (regression coefficient 0.23 [0.14, 0.33], P < .001). Increasing weight assigned to MMI ratings was associated with increased odds of females being ranked in the top 150 applicants. Conclusions In this single-center study, females were rated higher than males on the MMI, and the odds of a female applicant being offered a position increased as more weight was given to MMI ratings. Further studies are needed to confirm and explain gender differences in MMI ratings.

BACKGROUND:We sought to evaluate the independent effects of preparing to teach and teaching on peer teacher learning outcomes.AIM:To evaluate the independent contributions of both preparing to teach and teaching to the learning of peer teachers in medical education.METHOD:In total, 17 third-year medical students prepared to teach second-year students Advanced Cardiac Life Support algorithms and electrocardiogram (ECG) interpretation. Immediately prior to teaching they were randomly allocated to not teach, to teach algorithms, or to teach ECG. Peer teachers were tested on both topics prior to preparation, immediately after teaching and 60 days later.RESULTS:Compared to baseline, peer teachers' mean examination scores (±SD) demonstrated the greatest gains for content areas they prepared for and then taught (43.0% (13.9) vs. 66.3% (8.8), p < 0.001, d = 2.1), with gains persisting to 60 days (45.1% (13.9) vs. 61.8% (13.9), p < 0.01, d = 1.3). For content they prepared to teach but did not teach, less dramatic gains were evident (43.6% (8.3) vs. 54.7% (9.4), p < 0.001, d = 1.3), but did persist for 60 days (42.6% (8.1) vs. 53.2% (14.5), p < 0.05, d = 1.3). Increase in test scores attributable to the act of teaching were greater than those for preparation (23.3% (10.9) vs. 8% (9.6), p < 0.001, d = 1.6), but the difference was not significant 60 days later (16.7% (14.4) vs. 10.2% (16.9), p = 0.4).CONCLUSION:Our results suggest preparing to teach and actively teaching may have independent positive effects on peer teacher learning outcomes.

OBJECTIVEResidents must become proficient in a variety of procedures. The practice of learning procedural skills on patients has come under ethical scrutiny, giving rise to the concept of simulation-based medical education. Resident training in a simulated environment allows skill acquisition without compromising patient safety. We assessed the impact of a simulation-based procedural skills training course on residents' competence in the performance of critical resuscitation procedures.METHODSWe solicited self-assessments of the knowledge and clinical skills required to perform resuscitation procedures from a cross-sectional multidisciplinary sample of 28 resident study participants. Participants were then exposed to an intensive 8-hour simulation-based training program, and asked to repeat the self-assessment questionnaires on completion of the course, and again 3 months later. We assessed the validity of the self-assessment questionnaire by evaluating participants' skills acquisition through an Objective Structured Clinical Examination station.RESULTSWe found statistically significant improvements in participants' ratings of both knowledge and clinical skills during the 3 self-assessment periods ( p < 0.001). The participants' year of postgraduate training influenced their self assessment of knowledge ( F = 4.91, p< 0.01) and clinical 2,25 skills ( F = 10.89, p< 0.001). At the 3-month follow-up, junior 2,25 level residents showed consistent improvement from their baseline scores, but had regressed from their posttraining measures. Senior-level residents continued to show further increases in their assessments of both clinical skills and knowledge beyond the simulation-based training course.CONCLUSIONSignificant improvement in self-assessed theoretical knowledge and procedural skill competence for residents can be achieved through participation in a simulation-based resuscitation course. Gains in perceived competence appear to be stable over time, with senior learners gaining further confidence at the 3-month follow-up. Our findings support the benefits of simulation-based training for residents.

CONTEXT:Prior research has demonstrated that residents have poor clinical skills in cardiology and respirology. It is not clear how these skills can be improved because the number of patients with suitable clinical findings whose cooperation might help residents to better develop these clinical skills is limited. Objectives Our objective was to evaluate the effect of training on a cardiorespiratory simulator (CRS) on skills acquisition, retention and transfer.METHODS:We randomly allocated 146 students to CRS training in either chest pain or dyspnoea and compared each student's performance on the clinical presentation in which he or she had received CRS training with performance on the control presentation.RESULTS:Immediately after training, students were more accurate in identifying abnormal clinical findings on the CRS (70.0% versus 52.2%; d = 7.6, P < 0.0001) and showed improved diagnostic performance (72.1% versus 55.6%; d = 4.3, P = 0.0007) on the training clinical presentation. At the end of the course they were still better at identifying abnormal findings (57.1% versus 51.7%; d = 2.5, P = 0.004) and diagnosing correctly (50.0% versus 38.1%; d = 3.0, P = 0.002) on problems included in the training clinical presentation. However, they showed no difference between training and control presentations in diagnostic performance when required to transfer their skills between problems (45.9% versus 43.8%; P = 0.5) or in performance on multiple-choice questions (64.1% versus 63.6%; P = 0.8).CONCLUSIONS:Students can acquire and retain clinical skills with CRS training, but demonstrate limited ability to transfer these to other problems. Further studies are needed to explore ways of improving learning and transfer with CRS training.

We sought to assess the impact of procedural skills simulation training on residents’ competence in performing critical resuscitation skills. Our study was a prospective, cross-sectional study of residents from three residency training programs (Family Medicine, Emergency Medicine and Internal Medicine) at the University of Calgary. Participants completed a survey measuring competence in the performance of the procedural skills required to manage hemodynamic instability. The study intervention was an 8 hour simulation based training program focused on resuscitation procedure psychomotor skill acquisition. Competence was criterion validated at the Right Internal Jugular Central Venous Catheter Insertion station by an expert observer using a standardized checklist (Observed Structured Clinical Examination (OSCE) format). At the completion of the simulation course participants repeated the self-assessment survey. Descriptive Statistics, Cronbach’s alpha, Pearson’s correlation coefficient and Paired Sample t-test statistical tools were applied to the analyze the data. Thirty-five of 37 residents (9 FRCPC Emergency Medicine, 4 CCFP-Emergency Medicine, 17 CCFP, and 5 Internal Medicine) completed both survey instruments and the eight hour course. Seventy-two percent of participants were PGY-1 or 2. Mean age was 30.7 years of age. Cronbach’s alpha for the survey instrument was 0.944. Pearson’s Correlation Coefficient was 0.69 (p < 0.001) for relationship between Expert Assessment and Self-Assessment. The mean improvement in competence score pre- to post-intervention was 6.77 (p < 0.01, 95% CI 5.23-8.32). Residents from a variety of training programs (Internal Medicine, Emergency Medicine and Family Medicine) demonstrated a statistically significant improvement in competence with critical resuscitation procedural skills following an intensive simulation based training program. Self-assessment of competence was validated using correlation data based on expert assessments. Dawson S. Procedural simulation: a primer. J Vasc Interv Radiol. 2006; 17(2.1):205-13. Vozenilek J, Huff JS, Reznek M, Gordon JA. See one, do one, teach one: advanced technology in medical education. Acad Emerg Med. 2004; 11(11):1149-54. Ziv A, Wolpe PR, Small SD, Glick S. Simulation-based medical education: an ethical imperative. Acad Med. 2003; 78(8):783-8.

à remercier les pairs qui ont donné généreusement leur temps, leur savoir et leur efforts à la révision d'articles pour le journal.La révision par les pairs est une composante essentielle à la crédibilité et au succès d'une revue médicale.