Providing international medical educators with opportunities for faculty development has become a favorable moment for capacity building and the creation of partnerships with universities around the world. It has also become a social responsibility when such a development implies growth and improvement for the institutions involved. In 2018 and 2019, the University of Alberta Faculty of Medicine & Dentistry designed and delivered an international faculty development program (IFDP) in Edmonton, Canada, in collaboration with the faculty management from Jilin University and Wenzhou Medical University, and Shandong University. The inspiration for program driven by capacity development for three universities in China, all of whom were developing strategies to respond to new government policies for medical education. The focus of the course was based on the needs that the three institutions expressed: teaching innovation, research, and quality curriculum development. By design, the two-week, in-person program included lectures, personal tutorials, class and laboratories observations, as well as guided teaching visits to hospitals and university museums. Recommendations are offered to assist other international faculty development programs focused on capacity building for medical education.

Intrinsically Important: rebranding faculty development as a unifying key concept for CanMEDS 2025 Importance intrinsèque : Changer l’image de marque du perfectionnement du corps professoral en tant que concept clé unificateur pour CanMEDS 2025 Mia Lang,1 Lara Hazelton,2 Teresa M Chan,3 Ruth Chen,3 Karen Leslie4 1University of Alberta, Alberta, Canada; 2Faculty of Medicine, Dalhousie University, Nova Scotia, Canada; 3McMaster University, Ontario, Canada; 4Department of Pediatrics, University of Toronto, Ontario, Canada Correspondence to: Teresa M Chan; email: teresa.chan@medportal.ca Published ahead of issue: Sept 19, 2022; CMEJ 2022 Available at https://doi.org/10.36834/cmej.75261 © 2022 Lang, Hazelton, Chan, Chen, Leslies; licensee Synergies Partners. This is an Open Journal Systems article distributed under the terms of the Creative Commons Attribution License. (https://creativecommons.org/licenses/by-nc-nd/4.0) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is cited.

Purpose Many academic leaders have little formal leadership training, which can result in challenges to effective leadership, succession planning and burnout. This paper aims to explore the leadership skills needed to be an effective senior academic leader in a Canadian medical faculty. Design/methodology/approach An anonymous voluntary survey of needed leadership skills and supports was sent to 60 senior academic leaders at the University of Alberta. This was followed by interviewing a purposive sample, using open-ended questions based on a multimodal needs assessment of senior academic leaders. The authors used an iterative process to analyze the data; anonymized transcripts were coded and categorized separately by two researchers, and themes were created. Findings The “ability to influence” was the highest rated needed leadership skill in the survey. The interviewed leaders (n = 12) were unanimous that they felt unprepared at the start of the leadership role. The survey and interviews identified five major themes for leadership skills: Mentoring, Finances, Human Resources, Building Relationships and Protected Time. Networking and leadership courses were identified as major sources of support. Research limitations/implications Although a single site study, the results were similar to another large Canadian medical faculty (University of Toronto, Lieff et al., 2013). While the survey had a 42% response rate (25/60), the survey responses were echoed in the interviews. Although the purposive sample was small, the interviewed leaders were a representative sample of the larger leadership group. Originality/value Academic leaders may benefit from a mentorship team/community of leaders and specific university governance knowledge which may help their ability to influence and advance their strategic initiatives.

This article was migrated. The article was not marked as recommended. Objectives: For residency programs with a mandatory research component, it is challenging to match residents with optimal preceptors and projects early in residency to expedite project completion. An evaluation of a "Speed Dating" format adopted in 2011 to match pediatric residents with research preceptors was performed. Methods: Residents and preceptors who participated in Speed Dating 2011 through 2016 were surveyed for their views on the process. Additionally, research output by residents with access to Speed Dating was measured, Results: Forty of 52 preceptors (77%) and 48 of 54 residents (89%) responded of which 32 preceptors and 46 residents had attended Speed Dating. Of 32 preceptors, 18 (56%) had found "a match" and 16 (50%) considered Speed Dating to be a very good strategy for matching residents with preceptors. Twenty-six of 46 residents (57%) had selected their project, preceptor or both from Speed Dating and 34 of 48 who responded to the survey (71%) preferred Speed Dating vs simply receiving a list of potential preceptors and projects. Twenty-eight residents who trained in the Speed Dating era and have completed their general pediatric training reported 30 presentations at conferences and 25 publications stemming from work completed during residency with only 3 (11%) having no presentations or publications. Conclusions: Residents tended to have a more positive attitude towards Speed Dating than did preceptors but most participants were neutral or enthusiastic about this method of matching residents with preceptors The majority of residents chose a project or preceptor or both at Speed Dating. The rate of research project completion and dissemination was high.

réservés L es infections urinaires sont une cause courante de maladie aiguë chez les nourrissons et les jeunes enfants.On estime que 8 % des filles et 2 % des garçons en ont contracté une avant l'âge de sept ans et que le taux de récurrence se situe entre 10 % et 30 %.(1) La Société canadienne de pédiatrie a récemment mis à jour les lignes directrices et les recommandations relatives au diagnostic des infections urinaires, qu'il faut consulter pour savoir comment prélever et analyser l'urine, comment interpréter les résultats et quelles stratégies thérapeutiques privilégier.(2)Le présent document de principes porte sur les données publiées au sujet de l'efficacité de la prophylaxie après une infection urinaire chez les nourrissons et les jeunes enfants. LA PRoPHyLAxIE EST-ELLE PARFoIS INDIQuÉE?Dans le cas des infections urinaires, la prophylaxie antibiotique repose sur la prémisse qu'elle peut prévenir la maladie et les séquelles à long terme (p.ex.l'hypertension et l'insuffisance rénale).(3)Selon le raisonnement traditionnel, les nourrissons et les jeunes enfants qui ont reçu un diagnostic de reflux vésicourétéral (RVU), quel que soit son grade, sont plus vulnérables aux infections urinaires récurrentes et ont donc besoin d'une prophylaxie antibiotique.(4)Cependant, bien des études anciennes sur la prophylaxie antibiotique, réalisées à petite échelle, étaient de mauvaise qualité.(5)Par ailleurs, puisqu'elles ne reposaient pas sur une définition rigoureuse de l'infection urinaire, ces études avaient tendance à surestimer l'efficacité de la prophylaxie.(6)Même lorsque la prophylaxie est efficace, on doute de plus en plus que les infections urinaires récurrentes entraînent des séquelles à long terme chez les enfants ayant des reins normaux, malgré la présence de cicatrices rénales.(7)En 2011, le sous-comité des infections urinaires de l'American Academy of Pediatrics a mis à jour ses directives cliniques.Une méta-analyse de six études réalisées auprès d'enfants de moins de 24 mois ne démontrait pas d'avantages importants à la prophylaxie antibiotique, tout autant chez les nourrissons sans RVU que chez ceux ayant un RVU de grade I à IV.Peu d'enfants faisaient partie de certains sous-groupes de ces études.(6) Cependant, d'après une méta-analyse Cochrane de 12 études auprès d'enfants de divers groupes d'âge, si on combinait les études les plus vastes et les mieux conçues (Montini et coll.,[8]publiée en 2008, et essai PRIVENT [acronyme anglais désignant la prévention des infections urinaires récurrentes chez les enfants ayant un RVU et des reins normaux],[9] publié en 2009), on constatait une diminution modeste, mais significative, des infections urinaires récurrentes au sein du groupe sous prophylaxie, en présence d'un RVU ou non.(10)Document de principes de la SCP

Prophylactic antibiotics for urinary tract infections are no longer routinely recommended. A large number of children must be given prophylaxis to prevent one infection and antibiotic resistance is a major concern when treating community-acquired urinary tract infections. The results of three recent significant studies are examined, with focus on the efficacy of prophylaxis, and recommendations are made.

Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should be ruled out in preverbal children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency, hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate. UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy.

Background: Partnership with parents is a vital part of pediatric medical education, yet few studies have examined parent attitudes towards learners in pediatric settings. Methods: Questionnaires were used to determine parent and student assessment of professional and clinical skills (primary outcome) and parent attitudes towards 3rd year medical students (secondary outcome) at the University of Alberta. Chi Square, Kendall’s Tau and Kappa coefficients were calculated to compare parent and student responses in 8 areas: communication, respect, knowledge, listening, history taking, physical examination, supervision, and overall satisfaction. Results: Overall satisfaction with medical student involvement by parents was high: 56.7% of all parents ranked the encounter as ‘excellent’. Areas of lesser satisfaction included physician supervision of students. Compared to the parent assessment, students tended to underrate many of their skills, including communication, history taking and physical exam. There was no relationship between parent demographics and their attitude to rating any of the students’ skills. Conclusions: Parents were satisfied with medical student involvement in the care of their children. Areas identified for improvement included increased supervision of students in both history taking and physical examination. This is one of the largest studies examining parent attitudes towards pediatric students. The results may enhance undergraduate curriculum development and teaching in pediatric ambulatory clinics and strengthen the ongoing partnership between the community and teaching clinics.

OBJECTIVE To identify early clinical factors that are correlated with death or severe disability in paediatric patients who have sustained an injury by hanging or strangulation. METHODS A retrospective review of all patient records from January 1, 1997, to September 30, 2007, was conducted. Patient records were identified by International Classification of Diseases and Related Health Problems, Tenth Revision, Canada diagnostic codes for asphyxia, strangulation, hypoxic-ischemic encephalopathy, hanging, hypoxemia, hypoxia or anoxia. RESULTS A total of 109 records were identified. Of these, 41 met the inclusion criteria for the study. Of 19 (46%) children who were pulse-less and received cardiopulmonary resuscitation, 16 died and the survivors were severely disabled. Of the 22 (54%) children who were found with a pulse, 18 made a full recovery. CONCLUSIONS Children who are pulseless at discovery for hanging injuries are at high risk of death or severe disability. Early clinical and neurophysiological indicators should be applied systematically to best guide clinicians and parents in their decision making.

40 INTRODUCTION AND OBJECTIVES As outlined in “Part A: Canadian trends in child care, behaviour and developmental outcomes (1),” daycare use is common and is increasing in Canada. It is important for families, health care workers and policy makers to understand these Canadian trends and the health implications of children in child care. This section was developed to describe the trends in injuries and infections among Canadian children in child care centres and to provide recommendations for prevention and health promotion.

A Cochrane review of literature from 1966 to 2004 on screening for correctable visual acuity defects in school-aged children and adolescents found “no robust trials available that allow the benefits of school vision screening to be measured. The disadvantage of attending school with a visual acuity deficit also needs to be quantified. The impact of a screening program will depend on the geographical, and the socio-economic setting in which it is conducted” [2]. However, major refractive errors can occur in 5% to 7% of preschoolers [3][4]; individual randomized, longitudinal studies report that early screening has been associated with a decrease in the prevalence of amblyopia and improved acuity by 60% [5]. Screening before three years of age is associated with a 70% lower prevalence of amblyopia after treatment [4][6]. The single and most effective test for amblyopia is the determination of visual acuity by noninvasive testing. A Cochrane review on screening specifically for amblyopia (1966 to 2005) concluded that “the lack of data from randomized controlled trials makes it difficult to analyze the impact of screening programs on the prevalence of amblyopia. The absence of such evidence cannot be taken to mean that vision screening is not beneficial; simply that this intervention has not yet been tested in robust studies” [7]. Adverse effects on educational and social development, as well as limitations to career choice are obvious consequences of poor visual acuity. Uncorrected amblyopia is a significant risk factor for total blindness, in the case of injury or disease, in the better functioning eye. The American Academy of Ophthalmology and the American Academy of Pediatrics [6] recommend visual assessment from birth and at all routine health supervisory visits. The child’s anatomy and function should be checked at regular infant and well-child visits, and visual acuity should be assessed at the preschool stage as well as when there is a complaint. Infants with a known risk (retinopathy of prematurity, Down’s syndrome, etc) or significant family history (congenital glaucoma, strabismus) should be referred for further evaluation [6].

When should my child start to wear shoes?Some people think that shoes are needed to support a child's developing leg and foot muscles and bone structure to help prevent future problems with walking.Your child's feet will develop well on their own and don't require any special footwear.If your child isn't walking yet, she doesn't need to wear shoes.If she has just started walking, shoes will help to prevent accidental injuries.Shoes with higher ankle support don't necessarily offer better support than those with low-cut ankles.However, a shoe with a higher ankle might help at this stage simply because they are harder for your toddler to take off.Your child's feet will change quickly as he grows.Before 18 months of age, his feet will probably grow by more than one-half a shoe size every 2 months.Toddler's feet grow an average of one-half a size every three months.Once your child is 3 years of age, his feet will grow by one size every year. How do I choose the right kind of shoes for my child?Shoes have become softer, wider, lighter and more comfortable.Your child's shoes should:

Over the past 100 years, recommended toilet training (TT) methods have oscillated between the two most common TT methods used in North America – rigid adult-directed programs and child-oriented ones (1). In 1962, Brazelton (2) developed the ‘child readiness’ approach, which focused on gradual training and is child-oriented. Current TT guidelines developed by the Canadian Paediatric Society and the American Academy of Pediatrics include a child-oriented approach, not starting before 18 to 24 months of age, and beginning when the child displays interest (3,4). The Foxx and Azrin (FA) (5) method emerged in 1971 as a parent-oriented method that emphasized structured behavioural end point training aimed at eliciting a specific chain of independent events by quickly teaching the component skills of TT. These two methods differ with respect to goal development, end points and emphasis on the child’s self-esteem. Other methods include variations of operant conditioning and assisted infant TT (6,7). The goal of operant conditioning is to establish habits and proper behaviours through positive reinforcement with rewards (8). Assisted infant TT emphasizes simultaneous training of bowel and bladder control by the parent learning the infant’s elimination signals (6). This can begin at two to three weeks of age (9). This method has been criticized as the ‘parent training’ method because the parents must be trained to recognize their infant’s elimination cues. A systematic review was performed to determine which method of TT was best for healthy children. MEDLINE, EMBASE, ERIC, PsycINFO and Cinahl databases were searched using combinations and variations of the following terms – toilet or potty; and behaviour, learn, train or condition. While there are six noncomparative studies examining TT in a single cohort of children, only four comparative studies were included. Matson and Ollendick (10) randomly assigned 10 children (20 to 26 months of age) into one of the following groups – the FA method with an experienced trainer or the FA method conducted by mothers using a book to guide the TT process (10). The goal was to toilet train the children within five daily 4 h sessions. Four of five children in the former group were successfully trained within five sessions, while only one of five in the latter group was completely successful (one obtained partial success and the remaining three failed). All mothers reported that their child exhibited emotional side effects of the training, such as avoidance behaviour or temper tantrums. Candelora (11) randomly assigned 71 healthy children between 18 and 35 months of age to FA’s method of TT in less than one day or the child-oriented method outlined in Spock’s Baby and Child Care book (12). When comparing pretraining and post-training results, and pretraining and follow-up results, the FA method was found to be superior to Spock’s method. Using the FA method, the number of accidents per child per day was reduced by 3.17 from pretraining to follow-up, whereas the child-oriented Spock method resulted in a reduction of 1.89 accidents per child per day. The number of successes per child per day was increased by 3.37 from pretreatment to follow-up when using the FA method and 1.91 for children randomized to the Spock method. Taubman et al (13) randomly assigned 406 children, 17 to 19 months of age, to one of two TT groups – one group was given instructions to praise defecation in the diaper before TT and avoid negative terms to describe defecation, and the other group received no such direction. All parents trained their children using the child-oriented approach and determined when TT would commence. There was no difference in the number of children who developed stool toileting refusal, but duration of the refusal was significantly longer in the control group (7.3 versus 5.1 months). No significant differences were found between the groups in the incidence of stool withholding or hiding during defecation. TT was achieved at a significantly earlier age among those in the intervention group (40 versus 43 months). Bakker et al (14) conducted a retrospective study that collected data on 4332 primary school age children and compared children who did (n=928) and did not (n=3404) develop abnormal bladder control symptoms, such as daytime and/or night-time wetting, and urinary tract infections. Significantly more children in the control group had parental prompting during TT than those in the symptom group (68% versus 62%). Parents of the symptom group used significantly more rewards and punished behaviour than parents in the control group (53% versus 46%). Parents in the control group were significantly more likely to encourage the child to try again later (83% versus 67%). Parents in the symptom group were significantly more likely to make the child wait until voiding, encourage the child to push or strain, make special noises and open a tap.

Over 76,000 children and youth are in foster care in Canada, and their numbers are increasing annually [1]. Children and youth in foster care have higher than average medical, emotional, developmental and educational needs [2]. These special needs are often chronic, under-recognized and neglected. There are many barriers to health care including lack of or inadequate medical records, lack of consistent care or follow-up due to temporary placements, and difficulty accessing services. There are no practice guidelines specifically designed to meet the health care needs of children and youth in foster care. Despite that, most paediatricians will encounter foster children within their practices.

Puisque plus d'enfants se déplacent en avion, les professionnels de la santé devraient se familiariser avec les problèmes de santé associés aux vols aériens. Une analyse bibliographique approfondie effectuée dans plusieurs bases de données (entre 1966 et 2006) n'a permis de colliger que très peu d'articles probants sur les voyages en avion et les enfants. Bon nombre des recommandations existantes se fondent sur des données descriptives et sur l'avis d'experts. Le présent document de principes aidera les médecins à informer les familles des enjeux de santé reliés aux voyages en avion et aux enfants, y compris l'otite moyenne, les troubles cardiopulmonaires, les allergies, le diabète, les infections et la prévention des blessures.