Browsing by Author "Ma, Irene"

Now showing 1 - 7 of 7
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    An experimental study on the impact of clinical interruptions on simulated trainee performances of central venous catheterization
    (BioMed Central, 2017-02) Jones, Jessica; Wilkins, Matthew; Caird, Jeff; Kaba, Alyshah; Cheng, Adam; Ma, Irene
    Background: Interruptions are common in the healthcare setting. This experimental study compares the effects of interruptions on simulated performances of central venous catheterization during a highly versus minimally complex portion of the task. Methods: Twenty-six residents were assigned to interruptions during tasks that are (1) highly complex: establishing ultrasound-guided venous access (experimental group, n = 15) or (2) minimally complex: skin cleansing (control group, n = 11). Primary outcomes were (a) performance scores at three time points measured with a validated checklist, (b) time spent on the respective tasks, and (c) number of attempts to establish venous access. Results: Repeated measure analyses of variances of performance scores over time indicated no main effect of time or group. The interaction between time and group was significant: F (2, 44) = 4.28, p = 0.02, and partial eta2 = 0.16, indicating a large effect size. The experimental group scores decreased steadily over time, while the control group scores increased with time. The experimental group required longer to access the vein (148 s; interquartile range (IQR) 60 to 361 vs. 44 s; IQR 27 to 133 s; p = 0.034). Median number of attempts to establish venous access was higher in the experimental group (2, IQR 1–7 vs. 1, IQR 1–2; p = 0.03). Conclusions: Interruptions during a highly complex task resulted in a consistent decrement in performance scores, longer time required to perform the task, and a higher number of venous access attempts than interruptions during a minimally complex tasks. We recommend avoiding interrupting trainees performing bedside procedures.
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    The Impact of Content Specific Resident Teaching on the Knowledge and Clinical Skills of Medical Students
    (2021-08) Zondervan, Nathan; McLaughlin, Kevin; Ma, Irene; Harvey, Adrian; Oddone Paolucci, Elizabeth
    Residents are positioned to create safe learning environments where medical students are comfortable asking questions and presenting ideas. However, residents frequently teach without training or confidence in their teaching ability. Resident-as-teacher training improves observed teaching skill, but little is known about their impact on medical student learning. A realist review was conducted to describe the impact of resident-as-teacher training on the knowledge, skills, and perceptions of medical students. Studies reporting medical student outcomes following exposure to trained resident-teachers were identified in five databases and independently reviewed by two investigators. Analysis of contextual factors suggested that longer, dispersed, and mandatory interventions that targeted a larger number of residents with low prior ratings of teaching effectiveness were more likely to show a positive effect on student ratings of resident teaching. The provision of highly rated training sessions that improve residents’ confidence and self-ratings of teaching ability was the proposed mechanism. There were no studies that elicited changes in medical student knowledge or skills, suggesting that improved teaching ability may not translate into improved student performance unless the content of the teaching is congruent with the examination. A sequential explanatory mixed methods study was then completed to explore the impact of introducing a resident-led and content specific curriculum on medical student performance on certifying examinations. Quantitative analysis demonstrated an increased percentage of medical students passing the surgery OSCE station. However, there was no difference in performance on the surgery MCQ or student ratings of resident teaching. Student ratings of the surgery rotation significantly declined. Qualitative analysis of medical student and resident focus groups revealed poor utilization of the curriculum resources designed for knowledge transfer, while the clinical skills elements were readily integrated into clinical activities. Overall, resident-as-teacher training can improve medical student perceptions of resident-led teaching, but independently have little effect on measures of knowledge and skill. Providing residents with learning objectives and teaching resources that are appropriate for the clinical environment can improve medical student performance on standardized examinations. Creating the time required to address the learning needs of medical students remains an ongoing barrier to teaching amid busy clinical rotations.
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    Re-Purposing the Ordering of Routine Laboratory Tests in Hospitalized Medical Patients (RePORT): protocol for a multicenter stepped-wedge cluster randomised trial to evaluate the impact of a multicomponent intervention bundle to reduce laboratory test over-utilization
    (2024-07-02) Ambasta, Anshula; Holroyd-Leduc, Jayna M.; Pokharel, Surakshya; Mathura, Pamela; Shih, Andrew W.; Stelfox, Henry T.; Ma, Irene; Harrison, Mark; Manns, Braden; Faris, Peter; Williamson, Tyler; Shukalek, Caley; Santana, Maria; Omodon, Onyebuchi; McCaughey, Deirdre; Kassam, Narmin; Naugler, Chris
    Abstract Background Laboratory test overuse in hospitals is a form of healthcare waste that also harms patients. Developing and evaluating interventions to reduce this form of healthcare waste is critical. We detail the protocol for our study which aims to implement and evaluate the impact of an evidence-based, multicomponent intervention bundle on repetitive use of routine laboratory testing in hospitalized medical patients across adult hospitals in the province of British Columbia, Canada. Methods We have designed a stepped-wedge cluster randomized trial to assess the impact of a multicomponent intervention bundle across 16 hospitals in the province of British Columbia in Canada. We will use the Knowledge to Action cycle to guide implementation and the RE-AIM framework to guide evaluation of the intervention bundle. The primary outcome will be the number of routine laboratory tests ordered per patient-day in the intervention versus control periods. Secondary outcome measures will assess implementation fidelity, number of all common laboratory tests used, impact on healthcare costs, and safety outcomes. The study will include patients admitted to adult medical wards (internal medicine or family medicine) and healthcare providers working in these wards within the participating hospitals. After a baseline period of 24 weeks, we will conduct a 16-week pilot at one hospital site. A new cluster (containing approximately 2–3 hospitals) will receive the intervention every 12 weeks. We will evaluate the sustainability of implementation at 24 weeks post implementation of the final cluster. Using intention to treat, we will use generalized linear mixed models for analysis to evaluate the impact of the intervention on outcomes. Discussion The study builds upon a multicomponent intervention bundle that has previously demonstrated effectiveness. The elements of the intervention bundle are easily adaptable to other settings, facilitating future adoption in wider contexts. The study outputs are expected to have a positive impact as they will reduce usage of repetitive laboratory tests and provide empirically supported measures and tools for accomplishing this work. Trial Registration This study was prospectively registered on April 8, 2024, via ClinicalTrials.gov Protocols Registration and Results System (NCT06359587). https://classic.clinicaltrials.gov/ct2/show/NCT06359587?term=NCT06359587&recrs=ab&draw=2&rank=1
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    Sociodemographic and geospatial associations with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections in a large Canadian city: an 11 year retrospective study
    (2019-07-09) Gill, Victoria C; Ma, Irene; Guo, Maggie; Gregson, Dan B; Naugler, Christopher; Church, Deirdre L
    Abstract Background The first Canadian outbreak of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) was identified in 2004 in Calgary, Alberta. Using a novel model of MRSA population-based surveillance, sociodemographic risk associations, yearly geospatial dissemination and prevalence of CA-MRSA infections over an 11 year period was identified in an urban healthcare jurisdiction of Calgary. Methods Positive MRSA case records, patient demographics and laboratory data were obtained from a centralized Laboratory Information System of Calgary Laboratory Services in Calgary, Alberta, Canada between 2004 and 2014. Public census data was obtained from Statistics Canada, which was used to match with laboratory data and mapped using Geographic Information Systems. Results During the study period, 52.5% of positive MRSA infections in Calgary were CA-MRSA cases. The majority were CMRSA10 (USA300) clones (94.1%; n = 4255), while the remaining case (n = 266) were CMRSA7 (USA400) clones. Period prevalence of CMRSA10 increased from 3.6 cases/100000 population in 2004, to 41.3 cases/100000 population in 2014. Geospatial analysis demonstrated wide dissemination of CMRSA10 annually in the city. Those who are English speaking (RR = 0.05, p <  0.0001), identify as visible minority Chinese (RR = 0.09, p = 0.0023) or visible minority South Asian (RR = 0.25, p = 0.015), and have a high median household income (RR = 0.27, p <  0.0001) have a significantly decreased relative risk of CMRSA10 infections. Conclusions CMRSA10 prevalence increased between 2004 and 2007, followed by a stabilization of cases by 2014. Certain sociodemographic factors were protective from CMRSA10 infections. The model of MRSA population-surveillance and geomap outbreak events can be used to track the epidemiology of MRSA in any jurisdiction.
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    Sociodemographic associations with abnormal estimated glomerular filtration rate (eGFR) in a large Canadian city: a cross-sectional observation study
    (2018-08-09) Ma, Irene; Guo, Maggie; Muruve, Daniel; Benediktsson, Hallgrimur; Naugler, Christopher
    Abstract Background Chronic kidney disease (CKD) is often asymptomatic in its early stages but is indicated and is diagnosed with an estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73m2. Certain sociodemographic groups are known to be at risk for CKD, but it is unclear if there are strong associations between these at risk groups with abnormal eGFR test results in Canada. Using only secondary laboratory and Census data, geospatial variation and sociodemographic associations with abnormal eGFR result rate were investigated in Calgary, Alberta. Methods Secondary laboratory data from all adult community patients who received an eGFR test result were collected from Calgary Laboratory Service’s Laboratory Information System, which is the sole supplier of laboratory services for the large metropolitan city. Group-level sociodemographic variables were inferred by combining laboratory data with the 2011 Canadian Census data. Poisson regression and relative risk (RR) were used to calculate associations between sociodemographic variables with abnormal eGFR. Geographical distribution of abnormal eGFR result rates were analyzed by geospatial analysis using ArcGIS. Results Of the 346,663 adult community patients who received an eGFR test result, 28,091 were abnormal (8.1%; eGFR < 60 ml/min/1.73m2). Geospatial analysis revealed distinct geographical variation in abnormal eGFR result rates in Calgary. Women (RR = 1.11, P < 0.0001), and the elderly (age ≥ 70 years; P < 0.0001) were significantly associated with an increased risk for CKD, while visible minority Chinese (RR = 0.73, P = 0.0011), South Asians (RR = 0.67, P < 0.0001) and those with a high median household income (RR = 0.88, P < 0.0001) had a significantly reduced risk for CKD. Conclusions Presented here are significant sociodemographic risk associations, and geospatial clustering of abnormal eGFR result rates in a large metropolitan Canadian city. Using solely publically available secondary laboratory and Census data, the results from this study aligns with known sociodemographic risk factors for CKD, as certain sociodemographic variables were at a higher risk for having an abnormal eGFR test result, while others were protective in this analysis.
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    Start spreading the news: a deliberate approach to POCUS program development and implementation
    (2023-03-09) Gaudreau-Simard, Mathilde; Kilabuk, Elaine; Halman, Samantha; Wooller, Krista; Woo, Michael Y.; Arntfield, Robert; Ma, Irene; Forster, Alan J.
    Abstract While there is an expanding body of literature on Point-of-Care Ultrasound (POCUS) pedagogy, administrative elements that are necessary for the widespread adoption of POCUS in the clinical environment have received little attention. In this short communication, we seek to address this gap by sharing our institutional experience with POCUS program development and implementation. The five pillars of our program, selected to tackle local barriers to POCUS uptake, are education, workflow, patient safety, research, and sustainability. Our program logic model outlines the inputs, activities, and outputs of our program. Finally, key indicators for the monitoring of program implementation efforts are presented. Though designed for our local context, this approach may readily be adapted toward other clinical environments. We encourage others leading the integration of POCUS at their centers to adopt this approach not only to achieve sustainable change but also to ensure that quality safeguards are in place.
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    The evolution of a pattern language of feedback in medical education
    (2024-07-03) Patocka, Catherine; Ellaway, Rachel; Cooke, Lara; Ma, Irene
    Feedback is embedded within the fabric of medical education. Although the literature refers to feedback as if it were well-defined, in practice what feedback means can vary greatly. Consequently, it remains a source of consternation for learners and teachers as a process fraught with paradoxes. When done well, feedback can improve performance, however it can also have highly variable outcomes. Through an in-depth examination of feedback, my research has acknowledged the challenges presented by it and other equally polysemic concepts. My research has considered the philosophical, theoretical, and methodological assumptions underpinning our existing approaches to feedback and in response I present a path to a more inclusive approach through the application of pattern theory. To approach the task of applying pattern theory, I adapted scoping review methodology to develop a pattern system of feedback in medical education which includes 36 pattern representations. Through a comparative case study, I applied the pattern system to models of feedback, and I provided validity evidence for the pattern system. By outlining the connections between pattern representations within it, I also began to elaborate the pattern system into a pattern language. Finally, I used a case study research methodology to develop a thick description of the challenges of bringing this novel theory-informed conceptual framing of feedback into a more practical space. In all this work, I have advocated for generative (rather than successionist) models of explanations of feedback and lay the foundations for exploring the intersection of realist inquiry and pattern epistemology. Feedback is used as an illustrative case throughout this thesis. The pattern system of feedback I developed, my documentation of the disjointed discourses of feedback in medical education, and my description of this evolving pattern language of feedback can all serve to advance thinking and theory building in this conceptual space. Furthermore, my use of various methodologies to tackle this polysemic concept is, I will argue, a viable approach for studying other fuzzy concepts in our field. As such, not only can my work provide insights into feedback, but it also provides opportunities to explore other equally vexing problems.