Literacy in school-aged children: A paediatric approach to advocacy and assessment.

Literacy is a key social determinant of health that affects the daily socioemotional lives of children and their economic prospects later in life. Being able to read, write, and understand written text is essential to participating in society, achieving goals, developing knowledge, and fulfilling potential. Yet a significant proportion of adults in Canada do not have the literacy skills they need to meet and manage increasingly complex workforce demands.

Navigating Challenging Conversations: The Interplay Between Inquiry and Knowledge Drives Preparation for Future Learning.

Introduction: While some physicians hone their skills through informal learning in clinical practice, others do not. There is a lack of understanding of some physicians seek improvement and they use the workplace context to build their capabilities. Because physicians rarely pursue formal professional development activities to improve communication skills, examining physician-patient communication offers a powerful opportunity to illuminate important aspects of preparation for future learning in the workplace.

Productive struggle and failing safely: implications for developing adaptive expertise in communication.

Navigating difficult conversations is a complex task that requires flexible and adaptive approaches. Residents developing this skill may initially struggle or fail, and require support. However, this experience may prepare residents for future learning which is essential to adaptive expertise.

Examining the Impact of Dialogic Learning on Critically Reflective Practice.

Purpose: While research is beginning to reveal the potential of dialogue in sparking critical reflection (critically reflective ways of seeing), additional research is needed to guide the teaching of critical reflection toward enabling critically reflective practice (critically reflective ways of seeing and doing). An experimental study was conducted to investigate the impact of dialogic learning on critically reflective practice, compared to discussion-based learning. The dialogic intervention integrated the theory of Mikhail Bakhtin with the theory of critical reflection and critical disability studies.

Critically reflective practice and its sources: A qualitative exploration.

Context: Critical reflection may improve health professionals' performance of the social roles of care (eg collaboration) in indeterminate zones of practice that are ambiguous, unique, unstable or value-conflicted. Research must explore critical reflection in practice and how it is developed. In this study, we explored what critical reflection consisted of in a context known for indeterminacy, and to what sources participants attributed their critically reflective insights and approaches.

Can adaptive expertise, reflective practice, and activity theory help achieve systems-based practice and collective competence?

Physicians must function as integral members of the complex social systems in which they work to support the health of their patients; competency-based education frameworks describe this function of physicians in terms of systems- based practice, advocacy, and collaboration. Yet education for these social competencies continues to present challenges, perhaps because medical education has tended to focus less on social systems and more on traditional healthcare systems. In this paper, we use a clinical example from the discipline of Developmental Pediatrics, that of early identification of autism spectrum disorder (ASD), as an illustration of a socially complex zone of practice necessitating systems-based practice.

Chromosome 12p Deletion Spanning the GRIN2B Gene Presenting With a Neurodevelopmental Phenotype: A Case Report and Review of Literature.

The (glutamate receptor, ionotropic, N-methyl-d-aspartate 2B) gene, located in the short arm of chromosome 12, encoding the NR2B subunit of the N-methyl-D-aspartate receptor, has recently been recognized to play an important role in corticogenesis and brain plasticity. Deletions in the short arm of chromosome 12 are rare. Hemizygous loss of function of the gene results in developmental delay, whereas gain of function leads to epilepsy, and infantile spasms in particular.

Promoting the Development of Adaptive Expertise: Exploring a Simulation Model for Sharing a Diagnosis of Autism With Parents.

Purpose: To explore how a simulation model promoted the development of integrated competencies associated with adaptive expertise in senior health professions trainees as they learned to share a diagnosis of autism with parents.

Method: A qualitative instrumental case study method was used at the University of Toronto in 2014 to explore what eight developmental pediatrics residents and two clinical psychology interns learned from participating in a simulation model designed to enable trainees to practice sharing a diagnosis of autism with parents. This model incorporated variability (three cases), active experimentation in a safe environment, and feedback from multiple perspectives (peers, faculty, standardized patients, and a parent).

Integrating competencies: exploring complex problem solving through case formulation in developmental pediatrics.

Purpose: To understand how experienced clinicians formulate cases and to use this understanding to explore the broader processes involved in how clinicians solve complex problems in their daily work. Case formulation is a process that allows clinicians to provide a tentative explanation for why a patient with a certain condition presents in a particular way at a particular time.

Method: In this constructivist grounded theory study, the authors conducted semistructured interviews with 12 physicians (9 experienced clinicians, 3 new graduates and residents) from the University of Toronto Division of Developmental Pediatrics between July and December 2012.

Residents as health advocates: The development, implementation and evaluation of a child advocacy initiative at the University of Toronto (Toronto, Ontario).

Background And Objective: Advocacy is an integral part of a paediatrician's role. The Royal College of Physicians and Surgeons of Canada has identified advocacy as one of the essential Canadian Medical Education Directives for Specialists competencies, and participation in child advocacy work as an important component of paediatric residency training. The objective of the present paper was to describe the development, implementation and evaluation of the first four years of the child advocacy initiative at the University of Toronto (Toronto, Ontario).

Clinical features, investigations and management of adolescents with polycystic ovary syndrome.

Background: Polycystic ovary syndrome (PCOS) is defined as chronic anovulation with evidence of hyperandrogenism, after the exclusion of secondary causes. It is commonly linked to obesity and the presence of the metabolic syndrome.

Objectives: To review the clinical features and medical assessment of adolescents referred for PCOS to gynecology or endocrinology services at The Hospital for Sick Children (Toronto, Ontario).

Childhood acute myelomonocytic leukemia (AML-M4) presenting as catastrophic antiphospholipid antibody syndrome.

: The authors describe a 15-year-old girl presenting with a cerebral ischemic stroke as the first manifestation of catastrophic antiphospholipid antibody syndrome secondary to acute myeloid leukemia (AML). Despite treatment with anticoagulants, therapeutic plasma exchange, and chemotherapy, the patient developed multiorgan thromboses and failure, eventually culminating in death. This unusual presentation of AML has not been previously described in children.

Medical decision-making and information needs in end-stage renal disease patients.

Health information and decision-making are increasingly important to patients with diverse illnesses. The aim of this study was to examine health information needs and decision-making in individuals with end-stage renal disease (ESRD) and to examine the influence of age and gender. A self-report survey was administered to 197 consecutive ESRD patients receiving renal replacement therapy.