No description available.

Orthopaedic residency training is in the midst of a paradigm shift. Recent mandates from the Residency Review Committee (RRC) for Orthopaedic Surgery and the American Board of Orthopaedic Surgery (ABOS) are requiring that programs must provide structured motor skills training to first year residents. Although other surgical fields such as laparoscopic surgery have been using simulation tools to train incoming residents for over a decade, the orthopaedic field has lagged behind in developing these training tools. Given the need for orthopaedic training devices and the lack of currently available solutions to residency programs, this work has focused on developing a surgical simulator for the task of hip guide wire navigation. Hip wire navigation was targeted for this work because it is a core competency skill for surgical residents and few options currently exist for training residents on this task. Much of this work focuses on the development of the wire navigation simulator. The simulator has six main components; a single camera interfaced with a Raspberry Pi (a credit-card sized computer), a series of three mirrors, a surrogate femur, a guide wire driver, a laser etched guide wire, and a laptop. These components interact to create virtual radiograph images that the resident can use to place the guide wire inside the bone. The goal in developing this simulator is to provide a platform which enables residents to acquire the skill of hip wire navigation in a safe environment and eventually transfer that skill into the operating room. Assessment of the simulator has shown that the guide wire can be located in bone within 1.5mm of its true position and less than a degree of its true trajectory. This level of accuracy is sufficient for providing residents with a training tool to practice their technique on. In training with resident surgeons, initial trends show that practicing with the simulator can result in an improvement in one’s technique. Residents who have trained with the simulator show a decrease in both the amount of radiographic images required to complete the procedure and the amount of time required to perform the procedure in a pseudo operating room environment. While more work is needed to be done to show the significance of this trend, this work has achieved its goal of providing residents with a safe platform for practicing the task of hip guide wire navigation.

No description available.

Purpose: The purpose was to assess and understand operating room (OR) utilization and efficiency in a pediatric dental residency program. Methods: A retrospective study was performed using chart extraction from 778 patients completed by both pediatric dentistry faculty (n=7) and residents (n=17) in an ambulatory care setting over a 32 month period (between July 2010 and March 2013). Patterns in OR usage time were determined by documenting various timing metrics (start and stop times for anesthesia, start and stop times for the dental procedure, times for throat pack in and out), noting patient information (age and ASA patient classification status), and creating variables by grouping data by clinical provider type and dental procedure. OR usage time was analyzed using multiple regression to estimate the per-tooth or per-mouth time for each type of procedure. Results: The median procedure time was 75 minutes (range= 1 to 517 minutes). Multiple regression indicated that for the average patient, a faculty member took 63.8 minutes (95% CI = 60.8 to 66.7 minutes) and a resident took 81.9 minutes (95% CI = 78.7 to 85.0 minutes, P<.0001).These results demonstrate that the appropriate scheduling of operating room should be based on the proficiency level of provider as well as the complexity of the dental procedure. Conclusion: This study concludes that pediatric dental operating room planning and scheduling in teaching hospitals should take into account real constraints such as residents’ level of training and skill.

Patient centred collaborative practice between nurses and physicians is currently being promoted worldwide. There is increasing evidence that post licensure interprofessional educational interventions improve patient outcomes but similar evidence for pre-licensure interprofessional learning is lacking. The impact of contemporary nursing and medical education on graduates’ ability to collaborate in the workplace is also unclear. To address this gap, an interview based qualitative study underpinned by hermeneutic phenomenology and informed by the theoretical lens of social identity was designed. Eleven junior registered nurses and eleven junior residents from a single healthcare jurisdiction each, in Canada and the United Kingdom (UK) were interviewed to explore how the processes that lead to socialization, professional identification and identity formation in professional schools are perceived to influence collaborative teamwork upon graduation. Data were as analyzed through iterative naive and thematic interpretations aligned with the hermeneutic process, to arrive at a comprehensive understanding. The impact of contemporary undergraduate nursing and medical education on the ability to practice collaboratively was found to be obfuscated by internal contradictions and overshadowed by the contingencies and demands of the workplace, during residency and early nursing practice in both locations. In medical schools, the intense socialization described in literature was replaced by individual reflection and a struggle to maintain work-life balance. Values internalized were of a sense of responsibility and hard work. Students espoused an attitude of collaboration but lacked training in enabling competencies and practical application. Exposure to interprofessional learning and its impact was variable and inconsistent and formal assertions of collaboration were not consistently modeled by faculty. In nursing schools, the value of caring, self-awareness and assertiveness was promoted. Training for collaboration with physicians was largely transactional and teaching about the status of the nurse vis-à-vis the physician was mired in contradictions. Residents and the nurses could not rely on their experience of professional school as they transited to the workplace. Initiation was frequently precipitous and contingencies of the workplace determined how they acted. For residents the community of clinical practice was fluid and repeatedly new. Both residents and nurses were overwhelmed by unpreparedness, workload, and responsibility and acted to get by and get the job done. Residents learned to preface doing the best for the patient and not compromising patient care, while nurses became proficient at routine tasks and found fulfilment as the patient’s advocate. There was a propensity for conflict when uniprofessional roles and values collided. In busy wards each group had interdependent but competing priorities which lead to adversarial expressions of uniprofessional identity and consequent derogatory out-group stereotyping. In contrast situations demanding urgent focused attention, such as a cardiac arrest, lead to the spontaneous formation of a collaborative team which briefly expressed an interprofessional identity. Complex cross-generational and gender based interactions were sometimes adversarial and provoked resentment. Consequently junior nurses retreated to derive fulfilment as the patient`s advocate while residents looked forward to collaborating with other health professionals on their own terms, in the future. Neither contemporary professional education nor the hospital environment sustained consistent collaborative practice. / Graduate

No description available.

INTRODUCTION: Academic half-days (AHDs) are regular teaching events that occur outside of patient care. AHDs often take the form of extended didactic lectures, despite the literature around effective teaching techniques. This may decrease residents’ ability to pay attention to the content being presented and instead promote mind wandering (defined in this thesis as self-reported task-unrelated thought). This thesis examines mind wandering during academic half-days (AHDs) in postgraduate medical training through two studies, with the overarching goal of understanding how results might inform the design of classroom-based teaching sessions in postgraduate medical education. METHODS: In the first study, a qualitative approach was used to examine residents’ perceptions about the nature of their learning experience during AHDs. Two focus groups were held with residents in hematology (n = 5) and obstetrics and gynecology (n = 15) and analyzed using a thematic analysis approach. In the second study, thought probes were administered approximately every 15 minutes during three AHD sessions in each program (hematology: n = 6 residents; obstetrics and gynecology: n = 30 residents) to quantitatively examine how three commonly-used instructional methods (didactic lecture, group discussion, and case-based learning) influenced mind wandering during AHDs. RESULTS: Findings of the qualitative study revealed differences with respect to residents’ overall perceptions of AHDs, perceptions of attention during AHDs, and motivations for learning. However, residents in both programs agreed that presenters could maximize resident engagement and learning by spending more time on case-based learning and group discussions as opposed to didactic lectures. Quantitative findings supported resident perceptions, demonstrating significantly less mind wandering during case-based learning (7%) than didactic lectures (33%). CONCLUSIONS: The findings of this work suggest that instructional method influences the amount of self-reported mind wandering during AHDs, and specifically, that case-based learning may be more effective than didactic lectures in maintaining engagement during AHDs. / Thesis / Master of Science (MSc) / Academic half-days (AHDs) are regular teaching events that occur outside of patient care. AHDs often take the form of extended didactic lectures, despite the literature around effective teaching techniques. This may decrease residents’ ability to pay attention to the content being presented and instead promote mind wandering (defined in this thesis as self-reported task-unrelated thought). This thesis examines mind wandering during AHDs, with the goal of understanding how results might inform the design of classroom-based teaching sessions in postgraduate medical education through two studies: a qualitative study examining residents’ perceptions about their learning experience during AHDs, and a quantitative study examining how three commonly-used instructional methods (didactic lecture, group discussion, and case-based learning) influenced mind wandering during AHDs. Taken together, these two studies make a contribution to the exploration of how classroom-based teaching sessions such as AHDs can be optimized to enhance student learning in postgraduate medical education.