Esteem® Active Middle Ear Implant versus Conventional Hearing Aids: Long-Term Performance.

Introduction: The totally implantable active middle ear implant Esteem® may be considered an effective alternative to conventional hearing aids (cHAs) to manage moderate-to-severe forms of sensorineural hearing loss. This study aimed to provide long-term comparative data of Esteem performances with those achieved by cHA.

Methods: From a total of 46 subjects who received unilateral application of Esteem®, and were followed up over the years, ten underwent an audiological assessment that compared the outcomes with those achieved in the contralateral ear by a cHA, considering the initially symmetric auditory thresholds in both ears.

Competence by Design: The Role of High-Stakes Examinations in a Competence Based Medical Education System.

Competency based medical education is developed utilizing a program of assessment that ideally supports learners to reflect on their knowledge and skills, allows them to exercise a growth mindset that prepares them for coaching and eventual lifelong learning, and can support important progression and certification decisions. Examinations can serve as an important anchor to that program of assessment, particularly when considering their strength as an independent, third-party assessment with evidence that they can predict future physician performance and patient outcomes. This paper describes the aims of the ("the Royal College") certification examinations, their future role, and how they relate to the Competence by Design model, particularly as the culture of workplace assessment and the evidence for validity evolves.

Invasive fungal rhinosinusitis associated with COVID-19: Course changes and prognosis predictors.

Background: This study aimed to analyze the behavior of acute invasive fungal rhinosinusitis (AIFRS) associated with COVID-19 infection as there has been an increase in the rate of AIFRS cases in the last two years, and many reports connected this rising with the COVID-19 infection. We studied most factors that may impact the prognosis as a trial to find the most affecting factors to improve the outcomes.

Methods: It was a retrospective observational study that included cases from four tertiary referral institutions between November 2020 to February 2022.

Is there a role for a learner education handover as part of the Medical Council of Canada assessment and licensing process?

The transition from undergraduate medical education (UGME) to postgraduate medical education (PGME) is a time of vulnerability for medical schools, postgraduate residency programs, and most importantly, traineesThere is a disconnect between the UGME and PGME experience. Student information shared by UGME is primarily summative of knowledge and skills; PGME programs are unaware of specific learner accommodation requirements, tailored supervisory needs, or potential professionalism concerns identified during UGMEThis lack of integration between UGME and PGME increases potential risk to learners, postgrad programs and patientsBetter linkages and communication along the education continuum could optimize learning and reduce inefficiency and riskThe Medical Council of Canada (MCC) has asked if there is a role for a learner handover (LH) within their licensing processes; however the intended purpose of an LH must first be determinedA Canadian-based LH referred to as a Learner Education Handover (LEH) model including disclosure of student learning/disability accommodation needs, general health concerns, EDI/religious requirements, professionalism concerns, and recommendations for special focus in residency of specific areas of medical knowledge/skill is described.Findings from beta and pilot testing support the value and feasibility of the LEH model.

Early non-EPI DW-MRI after cholesteatoma surgery.

Objective: Middle ear cholesteatoma may lead to the erosion of the bony structures of the temporal bone, possibly causing intra- and extracranial complications. Surgical treatment is mandatory, and due to possible residual/recurrent disease, the use of reliable diagnostic methods is essential. Our study aimed to evaluate the reliability of non-EPI DW-MRI for the follow-up of cholesteatoma after surgery.

Re-examining the value proposition for Competency-Based Medical Education.

The adoption of competency-based medical education (CBME) by Canadian postgraduate training programs has created a storm of excitement and controversy. Implementing the system-wide Competency by Design (CBD) project initiated by the Royal College of Physicians & Surgeons of Canada (RCPSC), is an ambitious transformative change challenge. Not surprisingly, tensions have arisen across the country around the theoretical underpinnings of CBME and the practicalities of implementation, resulting in calls for evidence justifying its value.

Psychiatric Emergencies During the Covid-19 Pandemic: A 6-Month Observational Study.

Background: The new SARS-CoV-2 has caused an ongoing pandemic. Health prevention measures to contain the outbreak are profoundly affecting the physical and mental health as well as personal freedom of the population.

Aim: To evaluate psychiatric emergencies in a 6-month period during the COVID-19 pandemic in 2020 compared to those of the corresponding period of the previous year.

Effective accreditation in postgraduate medical education: from process to outcomes and back.

Background: The accreditation of medical educational programs is thought to be important in supporting program improvement, ensuring the quality of the education, and promoting diversity, equity, and population health. It has long been recognized that accreditation systems will need to shift their focus from processes to outcomes, particularly those related to the end goals of medical education: the creation of broadly competent, confident professionals and the improvement of health for individuals and populations. An international group of experts in accreditation convened in 2013 to discuss this shift.

The current utility and future use of the medical student performance record: A survey of perceptions across Canada.

Introduction: The MSPR is a Canada wide tool that provides aggregate information on MD students' performance during training and used widely as part of PG admissions. This survey study elicits the perceptions of PG admissions stakeholders on the current use and future utility of the MSPR in Canada.

Methods: PG admissions stakeholders across the faculties of medicine were convenience sampled for a 15-question online survey in the fall of 2018.

Design Thinking-Informed Simulation: An Innovative Framework to Test, Evaluate, and Modify New Clinical Infrastructure.

Introduction: Designing new healthcare facilities is complex and transitions to new clinical environments carry high risks, as unanticipated problems may arise resulting in inefficient care and patient harm. Design thinking, a human-centered design method, represents a unique framework to support the planning, testing, and evaluation of new clinical spaces throughout all phases of construction. Healthcare simulation has been used to test new clinical spaces, yet most report using simulation only in the late design stages.

The competency-based medical education evolution of Canadian emergency medicine specialist training.

Canadian specialist emergency medicine (EM) residency training is undergoing the most significant transformation in its history. This article describes the rationale, process, and redesign of EM competency-based medical education. The rationale for this evolution in residency education includes 1) improved public trust by increasing transparency of the quality and rigour of residency education, 2) improved fiscal accountability to government and institutions regarding specialist EM training, 3) improved assessment systems to replace poor functioning end-of-rotation assessment reports and overemphasis on high-stakes, end-of-training examinations, and 4) and tailored learning for residents to address individualized needs.

It's a Marathon, Not a Sprint: Rapid Evaluation of Competency-Based Medical Education Program Implementation.

Purpose: Despite the broad endorsement of competency-based medical education (CBME), myriad difficulties have arisen in program implementation. The authors sought to evaluate the fidelity of implementation and identify early outcomes of CBME implementation using Rapid Evaluation to facilitate transformative change.

Method: Case-study methodology was used to explore the lived experience of implementing CBME in the emergency medicine postgraduate program at Queen's University, Canada, using iterative cycles of Rapid Evaluation in 2017-2018.

Know thy platypus: The insidiousness of cognitive bias.

Cognitive biases are omnipresent in medical practice. The danger of such biases rests largely on the fact that they are difficult to recognize and, by their nature, are positively reinforcing. This paper describes a real experience in which I discovered a classic example of cognitive bias to which I had fallen victim and the lengths I went to in order to preserve the bias.

Transition to practice: Evaluating the need for formal training in supervision and assessment among senior emergency medicine residents and new to practice emergency physicians.

Objectives: Emergency medicine residents may be transitioning to practice with minimal training on how to supervise and assess trainees. Our study sought to examine: 1) physician comfort with supervision and assessment, 2) what the current training gaps are within these competencies, and 3) what barriers or enablers might exist in implementing curricular improvements.

Methods: Qualitative data were collected in two phases through individual interviews from September 2016 to November 2017, at the University of Toronto and McMaster University after receiving ethics approval from both sites.

Emergency medicine resident wellness: Lessons learned from a national survey.

Objectives: Emergency medicine (EM) residents face many challenges during residency. Given the negative effects of residency training and the paucity of information on EM resident wellness experiences, we conducted a national survey to characterize the current landscape of Canadian EM resident wellness.

Methods: A cross-sectional study of Canadian EM residents was done using an online survey created by a Canadian Association of Emergency Physicians Resident Section working group on wellness.

Admission factors associated with international medical graduate certification success: a collaborative retrospective review of postgraduate medical education programs in Ontario.

Background: The failure rate on certification examinations of The College of Family Physicians of Canada (CFPC) and the Royal College of Physicians and Surgeons of Canada (RCPSC) is significantly higher for international medical graduates than for Canadian medical school graduates. The purpose of the current study was to generate evidence that supports or refutes the validity of hypotheses proposed to explain the lower success rates.

Methods: We conducted retrospective analyses of admissions and certification data to determine the factors associated with success of international medical graduate residents on the certification examinations.