The evolution of academic advisor and resident dyadic coaching relationships: a two-year longitudinal qualitative study.

Implementing competency based medical education (CBME) has generated enormous amounts of assessment data. To help residents synthesize and use these data, some programs have appointed academic advisors (AA) to 'coach over time'. This study explored how resident and faculty AA dyads perceived their relationship developing and evolving, and the extent to which it aligned with 'coaching over time'.

(Mis)Alignment in resident and advisor co-regulated learning in competency-based training.

Background/objective: In implementing competence-based medical education (CBME), some Canadian residency programmes recruit clinicians to function as Academic Advisors (AAs). AAs are expected to help monitor residents' progress, coach them longitudinally, and serve as sources of co-regulated learning (Co-RL) to support their developing self-regulated learning (SRL) abilities. Implementing the AA role is optional, meaning each residency programme must decide whether and how to implement it, which could generate uncertainty and heterogeneity in how effectively AAs will "monitor and advise" residents.

Dual purposes by design: exploring alignment between residents' and academic advisors' documents in a longitudinal program.

Longitudinal academic advising (AA) and coaching programs are increasingly implemented in competency based medical education (CBME) to help residents reflect and act on the voluminous assessment data they receive. Documents created by residents for purposes of reflection are often used for a second, summative purpose-to help competence committees make decisions-which may be problematic. Using inductive, thematic analysis we analyzed written comments generated by 21 resident-AA dyads in one large internal medicine program who met over a 2 year period to determine what residents write when asked to reflect, how this aligns with what the AAs report, and what changes occur over time (total 109 resident self-reflections and 105 AA reports).

Potentially avoidable admissions to general internal medicine at an academic teaching hospital: an observational study.

Background: Identifying potentially avoidable admissions to Canadian hospitals is an important health system goal. With general internal medicine (GIM) accounting for 40% of hospital admissions, we sought to develop a method to identify potentially avoidable admissions and characterize patient, provider and health system factors.

Methods: We conducted an observational study of GIM admissions at our institution from August 2019 to February 2020.

Effect of Ward-Based High-Flow Nasal Cannula (HFNC) Oxygen Therapy on Critical Care Utilization During the COVID-19 Pandemic: A Retrospective Cohort Analysis.

Background: Hospitals expanded critical care capacity during the COVID-19 pandemic by treating COVID-19 patients with high-flow nasal cannula oxygen therapy (HFNC) in non-traditional settings, including general internal medicine (GIM) wards. The impact of this practice on intensive care unit (ICU) capacity is unknown.

Objective: To describe how our hospital operationalized the use of HFNC on GIM wards, assess its impact on ICU capacity, and examine the characteristics and outcomes of treated patients.

Necessary but Insufficient and Possibly Counterproductive: The Complex Problem of Teaching Evaluations.

The evaluation of clinical teachers' performance has long been a subject of research and debate, yet teaching evaluations (TEs) by students remain problematic. Despite their intuitive appeal, there is little evidence that TEs are associated with students' learning in the classroom or clinical setting. TEs are also subject to many forms of bias and are confounded by construct-irrelevant factors, such as the teacher's physical attractiveness or personality.

Using Virtual Care to Facilitate Direct Hospital Admissions in Outpatients with Worsening COVID-19 Infection.

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Understanding the Influence of the Junior Attending Role on Transition to Practice: A Qualitative Study.

Background: The Junior Attending (JA) role is an educational model, commonly implemented in the final years of training, wherein a very senior resident assumes the responsibilities of an attending physician under supervision. However, there is heterogeneity in the model's structure, and data are lacking on how it facilitates transition to independent practice.

Objective: The authors sought to determine the value of the JA role and factors that enabled a successful experience.

Beyond the ratings: gender effects in written comments from clinical teaching assessments.

Assessment of clinical teachers by learners is problematic. Construct-irrelevant factors influence ratings, and women teachers often receive lower ratings than men. However, most studies focus only on numeric scores.

Gender Effects in Assessment of Clinical Teaching: Does Concordance Matter?

Background: Gender bias is thought to exist in the assessment of clinical teachers, yet its extent in different specialties is not well-documented nor has it been studied at the individual-dyadic level.

Objective: The authors sought to determine whether gender bias exists in residents' assessments of faculty teaching in 3 clinical departments, and if present, whether this is influenced by gender concordance or discordance between the faculty and resident.

Methods: Residents' ratings of faculty in internal medicine (800 faculty, 5753 ratings), surgery (377, 2249), and family medicine (672, 3438) at the University of Toronto from 2016-2017 were analyzed using the overall global rating on a 5-point scale.

Feedback from health professionals in postgraduate medical education: Influence of interprofessional relationship, identity and power.

Introduction: Capitalising on direct workplace observations of residents by interprofessional team members might be an effective strategy to promote formative feedback in postgraduate medical education. To better understand how interprofessional feedback is conceived, delivered, received and used, we explored both feedback provider and receiver perceptions of workplace feedback.

Methods: We conducted 17 individual interviews with residents and eight focus groups with health professionals (HPs) (two nurses, two rehabilitation therapists, two pharmacists and two social workers), for a total of 61 participants.

Assumptions About Competency-Based Medical Education and the State of the Underlying Evidence: A Critical Narrative Review.

Purpose: As educators have implemented competency-based medical education (CBME) as a framework for training and assessment, they have made decisions based on available evidence and on the medical education community's assumptions about CBME. This critical narrative review aimed to collect, synthesize, and judge the existing evidence underpinning assumptions the community has made about CBME.

Method: The authors searched Ovid MEDLINE to identify empirical studies published January 2000 to February 2019 reporting on competence, competency, and CBME.

Tensions in Assessment: The Realities of Entrustment in Internal Medicine.

Purpose: A key unit of assessment in competency-based medical education (CBME) is the entrustable professional activity. The variations in how entrustment is perceived and enacted across specialties are not well understood. This study aimed to develop a thorough understanding of the process, concept, and language of entrustment as it pertains to internal medicine (IM).

Choosing Words Wisely: Residents' Use of Rhetorical Appeals in Conversations About Unnecessary Tests.

Purpose: To characterize how residents employ rhetorical appeals (i.e., the strategic use of communication to achieve specifiable goals) when discussing unnecessary diagnostic tests with patients.

Contextualizing Work-Based Assessments of Faculty and Residents: Is There a Relationship Between the Clinical Practice Environment and Assessments of Learners and Teachers?

Purpose: Competence is bound to context, yet seldom is environment explicitly considered in work-based assessments. This study explored faculty and residents' perspectives of the environment during internal medicine clinical teaching unit (CTU) rotations, the extent that each group accounts for environmental factors in assessments, and relationships between environmental factors and assessments.

Method: From July 2014 to June 2015, 212 residents and 54 faculty across 5 teaching hospitals at University of Toronto rated their CTU environment using a novel Practice Environment Rating Scale (PERS) matched by block and hospital.

I-CATCH: A Novel Bundle to Improve Postcall Morning Handoffs.

Background: Conducting postcall morning handoffs using a resident handoff bundle such as I-PASS can prove challenging. This may delay recognizing and acting on clinically important patient issues that arose overnight.

Objective: We developed and implemented the I-CATCH morning handoff bundle and evaluated its impact on the proportion of overnight patient issues handed off from the on-call resident to the daytime team.

Moving beyond orientations: a multiple case study of the residency experiences of Canadian-born and immigrant international medical graduates.

Many international medical graduates (IMGs) enter North American residency programs every year. The Canadian IMG physician pool increasingly includes Canadian-born IMGs (C-IMGs) along with Immigrant-IMGs (I-IMGs). Similar trends exist in the United States.

Characterizing Resident Preferences for Faculty Involvement and Support in Disclosing Medical Errors to Patients.

Background: Residents may be commonly involved with medical errors and need faculty support when disclosing these to patients.

Objective: We characterized residents' preferences for faculty involvement and support during the error disclosure process.

Methods: We surveyed residents from internal medicine, pediatrics, emergency medicine, general and orthopedic surgery, and obstetrics and gynecology residency programs at the University of Toronto in 2014-2015 about their preferences for faculty involvement across a variety of different error scenarios (ie, error type, severity, and proximity) and for elements of support they perceive to be most helpful during the disclosure process.

Professional Responsibilities and Personal Impacts: Residents' Experiences as Participants in Education Research.

Purpose: Although the field of medical education research is growing and residents are increasingly recruited to participate as subjects in research studies, little is known about their experiences. The goal of this study was to explore the experiences and perceptions of residents who are study participants in medical education research.

Method: A phenomenographic approach was chosen to examine the range of residents' experiences as research participants.