Although nationally recognized learning objectives for undergraduate surgical education exist, the extent to which Canadian medical schools follow these guidelines has never been established.
We distributed a survey to all program directors and clinical-teaching-unit coordinators for undergraduate surgery at Canada's 16 medical schools, and subsequently assessed the perceived emphasis placed on learning objectives and student performance, and the impact of instructional tools and teaching locations.
Program directors in 15 medical schools responded to the survey. We identified a wide variation in the emphasis placed on basic learning objectives as well as specialty specific learning objectives. The length of rotations, methods of instruction and tools used to grade student performance also varied widely.
Our findings suggest significant variation in the design and implementation of undergraduate surgical education in Canada. This study may serve as a basis for reassessing learning objectives in Canadian undergraduate surgical education.
Cites: Can J Surg. 1999 Dec;42(6):451-610593247
Cites: Can J Surg. 2000 Aug;43(4):295-30010948691
Cites: Am J Surg. 1998 Jun;175(6):515-79645785
Cites: Am J Surg. 1997 Mar;173(3):231-39124633
Cites: Am J Surg. 1996 Oct;172(4):366-728873532
Cites: Am J Surg. 1988 Jul;156(1):38-433394891
Cites: Am Surg. 2003 Apr;69(4):280-6; discussion 28612716084
Since continuous ambulatory peritoneal dialysis (PD) was introduced in 1978 by Popovich and Moncrief, the use of peritoneal dialysis as effective renal replacement therapy has expanded on an international level. Improvements in technology and technique have lessened the incidence of infectious complications, although strategies continue to evolve to improve technical success. As technical challenges have been met, increasing attention has been turned to PD dose. Retrospective studies have strongly suggested that patient outcome is related to the amount of toxin removal. Recently, prospective data confirm that morbidity and mortality are strongly associated with dialysis adequacy. The important contribution of residual renal function to total toxin clearance is now recognized and implies a need to adjust dialysis dose to maintain adequate clearance as residual renal function declines. Reasonable, yet arbitrary, targets for dialysis clearances can now be asserted as Kt/V of 2.0 per week and weekly creatinine clearance of 60 L/wk. These current guidelines indicate a need to individualize dialysis dose to achieve target clearances and improved outcome. Current data also indicate that malnutrition is highly prevalent in the PD population and is associated with poor clinical outcomes, including decreased survival. Deterioration in nutritional status begins before the initiation of dialysis, and it seems that worse nutritional status at the start of dialysis is a strong predicator of poor outcome. These findings suggest that earlier initiation of dialysis, before a significant decline in nutritional status occurs, is warranted to maintain good nutrition and optimize outcome.
Patients who suffer from ocular genetic diseases have special needs in terms of diagnosis and management of rare entities, low-vision needs, genetic counselling, and psychosocial adjustments that are usually not addressed by an ophthalmologist alone. The Ocular Genetics Program (OGP) at the Hospital for Sick Children, Toronto, was established in 1994 to provide comprehensive, multidisciplinary care of patients with inherited eye disorders. We now assess the benefits of such a program and of integrating research into the care of patients.
We report our experience in developing a multidisciplinary ocular genetics program and the results of a pilot patient satisfaction survey that involved 61 patients.
The OGP multidisciplinary aspects are described. Of the 61 patients surveyed, 98% stated that they were satisfied with the OGP; 93%-96% of patients were content with "one day of appointments", "understanding of eye problem", and "coordination of ancillary tests such as visual fields test, electrophysiology, and others"; and for 70%-86% of respondents "waiting time to get an appointment", "information received on current research", and "primary health care provider adequately informed" were satisfactory.
The OGP is a unique service in Canada, which strives to provide the comprehensive care needed by ocular genetic patients. High patient satisfaction is an indicator of the success of this approach. Long waiting times for appointments and application of laboratory research in clinical care remain challenging.
To provide updated, evidence-based recommendations for the diagnosis and assessment of adults with hypertension.
The diagnosis of hypertension is dependent on appropriate blood pressure measurement, the timely assessment of serially elevated readings, degree of blood pressure elevation, method of measurement (office, ambulatory, home) and associated comorbidities. The presence of cardiovascular risk factors and target organ damage should be ascertained to assess global cardiovascular risk and determine the urgency, intensity and type of treatment required.
MEDLINE searches were conducted from November 2006 to October 2007 with the aid of a medical librarian. Reference lists were scanned, experts were contacted, and the personal files of authors and subgroup members were used to identify additional studies. Content and methodological experts assessed studies using prespecified, standardized evidence-based algorithms. Recommendations were based on evidence from peer-reviewed, full-text articles only.
Recommendations for blood pressure measurement, criteria for hypertension diagnosis and follow-up, assessment of global cardiovascular risk, diagnostic testing, diagnosis of renovascular and endocrine causes of hypertension, home and ambulatory monitoring, and the use of echocardiography in hypertensive individuals are outlined. Key messages in 2008 include continued emphasis on the expedited, accurate diagnosis of hypertension, the importance of global risk assessment and the need for ongoing monitoring of hypertensive patients to identify incident type 2 diabetes.
All recommendations were graded according to strength of the evidence and voted on by the 57 members of the Canadian Hypertension Education Program Evidence-Based Recommendations Task Force. All recommendations reported here received at least 70% consensus. These guidelines will continue to be updated annually.
Cites: Am Heart J. 2000 Feb;139(2 Pt 1):272-8110650300
Cites: Arch Intern Med. 2007 Nov 26;167(21):2296-30318039987
Cites: Clin Radiol. 2000 May;55(5):346-5310816399
Cites: Can J Cardiol. 2000 Sep;16(9):1094-10211021953
This paper describes the development and characteristics of a comprehensive, integrated and sustained program for the education, recruitment and retention of physicians for rural practice in Alberta--the Rural Physician Action Plan. The participation of key stakeholders (including government, the provincial medical association, the licensing authority, faculties of medicine, practising rural physicians and regional health authorities) and a sustained program budget have been key organizational issues for success. Critical to the effectiveness of this program has been the focus on professional and lifestyle issues targeting 3 distinct groups: physicians in training, physicians in practice, and rural communities and health authorities. Substantial program funding since 1991-92 of up to $3 million per year has increased rural-based activities significantly. For example, 87% of medical students and 91% of residents in family medicine in Alberta now experience 4 weeks or more of rural practice. The authors believe that the historic issues and recent trends militating against recruitment and retention of rural physicians will continue unchecked without comprehensive and sustained approaches such as Alberta's Rural Physician Action Plan.
Cites: CMAJ. 1992 Sep 1;147(5):617-231521207
Cites: J Contin Educ Health Prof. 1990;10(3):237-4310124693
Comment In: CMAJ. 1998 May 19;158(10):1269; author reply 1269-709614816
Comment In: CMAJ. 1998 May 19;158(10):1269; author reply 1269-709614817