Publications by authors named "Steve Mann"
Background: During the COVID-19 pandemic, opportunities for hands-on surgical and procedural skills training and practice were significantly reduced, as many curricular activities were deferred or converted to a virtual format. This study focused on whether these changes contributed to increased anxiety and decreased confidence for medical students performing these skills.
Methods: The Surgical Skills Technology Elective Program (SSTEP) is an annual five-day intensive procedural skills program after second-year medical school.
Background: Prescription opioid use places a considerable economic burden on health care systems. Older patients undergoing surgical procedures for painful conditions commonly receive opioids pre- and postoperatively, and are susceptible to adverse reactions. This study explores predictors of prolonged postoperative opioid use among older patients after lumbar spine surgery and the consequences in terms of health care utilization and costs.
View Article and Find Full Text PDFBackground: Our institution simultaneously transitioned all postgraduate specialty training programs to competency-based medical education (CBME) curricula. We explored experiences of CBME-trained residents graduating from five-year programs to inform the continued evolution of CBME in Canada.
Methods: We utilized qualitative description to explore residents' experiences and inform continued CBME improvement.
Objective: To assess the quality of narrative feedback given to surgical residents during the first 5 years of competency-based medical education implementation.
Background: Competency-based medical education requires ongoing formative assessments and feedback on learners' performance.
Methods: We conducted a retrospective cross-sectional study using assessments of entrustable professional activities (EPAs) in the Surgical Foundations curriculum at Queen's University from 2017 to 2022.
As competency-based medical education (CBME) is implemented across Canada, little is known about residents' perceptions of this model. This study examined how Canadian residents understand CBME and their lived experiences with implementation. We administered a survey in 2018 with Likert-type and open-ended questions to 375 residents across Canada, of whom 270 were from traditional programs ("pre-CBME") and 105 were in a CBME program.
View Article and Find Full Text PDFObjective: The aim of the study is to document the current state of musculoskeletal (MSK) medicine education across nationally accredited undergraduate medical programs.
Design: A cross-sectional survey design was used to gather curricular data on the following three musculoskeletal themes: (1) anatomy education, (2) preclinical education, and (3) clerkship education.
Results: The survey had a 100% response rate with all 14 English-language medical schools in Canada responding.
Background: Although uncommon, pneumothorax is a potentially serious complication following open reduction and internal fixation (ORIF) of clavicle fractures. In many centres it is routine practice to obtain postoperative chest radiographs following ORIF of clavicle fractures to assess for iatrogenic pneumothorax. Given the need to contain health care costs, the low sensitivity for detecting small pneumothorax and a desire to decrease patient radiation exposure, the practice of ordering chest radiographs following ORIF of clavicle fractures may be unnecessary.
View Article and Find Full Text PDFObjectives: The transition to competency-based medical education (CBME) has increased the volume of residents' assessment data; however, the quality of the narrative feedback is yet to be used as feedback-on-feedback for faculty. Our objectives were (1) to explore and compare the quality and content of narrative feedback provided to residents in medicine and surgery during ambulatory patient care and (2) to use the Deliberately Developmental Organization framework to identify strengths, weaknesses, and opportunities to improve quality of feedback within CBME.
Methods: We conducted a mixed convergent methods study with residents from the Departments of Surgery (DoS; = 7) and Medicine (DoM; = 9) at Queen's University.
Purpose: To update normative data on fluoroscopy dose indices in the United States for the first time since the Radiation Doses in Interventional Radiology study in the late 1990s.
Materials And Methods: The Dose Index Registry-Fluoroscopy pilot study collected data from March 2018 through December 2019, with 50 fluoroscopes from 10 sites submitting data. Primary radiation dose indices including fluoroscopy time (FT), cumulative air kerma (K), and kerma area product (P) were collected for interventional radiology fluoroscopically guided interventional (FGI) procedures.
Purpose: To compare radiation dose index distributions for fluoroscopically guided interventions in interventional radiology from the American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR-Fluoro) pilot to those from the Radiation Doses in Interventional Radiology (RAD-IR) study.
Materials And Methods: Individual and grouped ACR Common identification numbers (procedure types) from the DIR-Fluoro pilot were matched to procedure types in the RAD-IR study. Fifteen comparisons were made.
Background: The COVID-19 pandemic resulted in a rapid shift from in-person to virtual care delivery for many medical specialties across Canada. The purpose of this study was to explore the lived experiences of resident physicians and faculty related to teaching, learning and assessment during ambulatory virtual care encounters within the competency-based medical education model.
Methods: In this qualitative phenomenological study, we recruited resident physicians (postgraduate year [PGY] 1-5 trainees) and faculty from the Departments of Surgery and Medicine at Queen's University, Ontario, via purposive sampling.
Purpose: Postoperative opioid use may be associated with increased healthcare utilization and costs. We sought to examine the relationship between duration of postoperative opioid prescriptions and healthcare costs and resource utilization in senior patients following hip and knee replacement.
Methods: We conducted a historical cohort study evaluating postoperative opioid use and healthcare costs in patients over the age of 65 yr undergoing primary total hip or knee arthroplasty over a ten-year period from 1 April 2006 to 31 March 2016.
Article Synopsis
- * Over a two-week period, gloves from the surgical team were analyzed, revealing a 5.9% perforation rate, with attending staff experiencing the highest frequency of unnoticed outer glove perforations.
- * The findings suggest a need for improved awareness and practices, recommending that all team members change both pairs of gloves upon noticing any outer glove perforation to enhance safety.
Purpose: Canadian seniors who undergo hip and knee arthroplasty often experience significant postoperative pain, which could result in persistent opioid use. We aimed to document the impact of preoperative opioid use and other characteristics on postoperative opioid prescriptions in elderly patients following hip and knee replacement before widespread dissemination of opioid reduction strategies.
Methods: We conducted a historical cohort study to evaluate postoperative opioid use in patients over 65 yr undergoing primary total hip and knee replacement over a ten-year period from 1 April 2006 to 31 March 2016, using linked de-identified Ontario administrative data.
Background: Exercise referral schemes in England offer referred participants an opportunity to take part in an exercise prescription in a nonclinical environment. The aim of these schemes is to effect clinical health benefits, yet there is limited evidence of schemes' effectiveness, which could be due to the heterogeneity in design, implementation, and evaluation. Additionally, there has been no concerted effort to map program characteristics.
View Article and Find Full Text PDFA 61-year-old man underwent elective primary total hip arthroplasty at an academic center and presented to the emergency department 2 weeks later with a periprosthetic infection. Intraoperative cultures were positive for He was successfully treated with one-stage revision and 6 weeks of intravenous cefazolin. It was later determined that the patient has a pet dog who frequently licks his legs.
View Article and Find Full Text PDFBackground: Structured physical activity (PA) interventions (ie, intentionally planned) can be implemented in a variety of facilities, and therefore can reach a large proportion of the population. The aim of the authors was to summarize the effectiveness of structured interventions upon PA outcomes, in addition to proportions of individuals adopting and maintaining PA, and adherence and retention rates.
Methods: Systematic review with narrative synthesis and exploratory meta-analyses.
Article Synopsis
- - Residents recognize potential benefits of competency-based medical education (CBME), including better assessment methods, quicker identification of struggling peers, and more flexibility for personal learning goals.
- - Challenges highlighted by residents include logistical hurdles in implementing CBME, ensuring attending physicians can give appropriate feedback, and the risk of assessment fatigue.
- - Effective communication and opportunities for resident feedback are essential for addressing practical challenges and ensuring a smooth transition to CBME, emphasizing the need for faculty development in these areas.
Purpose: To characterize the accuracy and consistency of fluoroscope dose index reporting and report rates of occupational radiation safety hardware availability and use, trainee participation in procedures, and optional hardware availability at pilot sites for the American College of Radiology (ACR) Fluoroscopy Dose Index Registry (DIR).
Materials And Methods: Nine institutions participated in the registry pilot, providing fluoroscopic technical and clinical practice data from 38 angiographic C-arm-type fluoroscopes. These data included measurements of the procedure table and mattress transmission factors and accuracy measurements of the reference-point air kerma (K) and air kerma-area product (P).
Objectives: To examine if exercise referral schemes (ERSs) are associated with meaningful changes in physical activity in a large cohort of individuals throughout England, Scotland, and Wales from The National Referral Database.
Methods: Data were obtained from 5246 participants from 12 different ERSs, lasting 6-12 weeks. The preexercise referral scheme and changes from the preexercise to the postexercise referral scheme in self-reported International Physical Activity Questionnaire scores were examined.
Article Synopsis
- Physical activity (PA) is essential for health and well-being, especially for university students, who face new lifestyle choices and stressors during this transitional phase.
- A study involving over 11,600 students across UK colleges and universities found that only 51% met the recommended PA levels, highlighting a concerning trend.
- Active students reported better mental well-being, reduced social isolation, and more positive perceptions of their academic success and job readiness, suggesting the importance of promoting PA in this demographic.
Article Synopsis
- The study aimed to assess how inaccuracies in fluoroscopy systems and table attenuation affect reported radiation dose values during lumbar epidural injections.
- Researchers gathered detailed patient exposure data and evaluated fluoroscope dosimetry accuracy in relation to factors like x-ray technique and table positioning.
- Results showed that system-reported dose values typically overestimated patient exposure by about 34%, emphasizing the need for corrections in dosimetry for reliable radiation assessments.