Browsing by Author "Oddone Paolucci, Elizabeth"

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    A Meta-Analysis of Hydroxyurea Use for β-thalassemia: Implications for Clinical Practice and Medical Education
    (2015-11-18) Algiraigri, Ali; Kassam, Aliya; Oddone Paolucci, Elizabeth; Wright, Nicola
    Chronic blood transfusion remains the most feasible therapeutic option for the majority of patients with severe β-thalassemia. However, it is associated with serious risks and complications. An alternative option is desirable and may prevent some of the problems associated with current therapy. Hydroxyurea (HU), an oral chemotherapeutic drug, is expected to increase hemoglobin, thereby minimizing the burden of blood transfusion and its complications. The objective of this study was to conduct a systematic review and meta-analysis to evaluate the clinical efficacy and safety of HU in patients with severe β-thalassemia. HU appears to be effective, well tolerated and associated with mild and transient adverse events; however, large randomized clinical trials (RCTs) should be done to confirm such findings. Nonetheless, based on the results of the present meta-analysis, it is recommended that current practice guidelines for severe β-thalassemia be appended to include a trial of HU.
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    A Targeted Needs Assessment for a Transitional “Boot Camp” Curriculum for Pediatric Surgery Residents
    (2015-04-30) Blackmore, Christopher; Oddone Paolucci, Elizabeth
    Transition periods in medical education are associated with increased risk for learners and patients. In pediatric surgery, the transition to specialty is especially difficult as learners adjust to new patient populations. In this study we performed a targeted needs assessment to determine the ideal content and format of a pediatric surgery boot camp to aid in the transition to residency. The survey was distributed to pediatric surgery residents and staff across North America. No significant differences were identified between staff and residents in survey responses. The top 5 topics identified for inclusion in a boot camp were: 1) Fluid and electrolyte management, 2) Appendicitis, 3) Pediatric Hernias, 4) Nutrition and 5) Pain Management. The preferred duration for a boot camp was 3-4 days using a variety of educational methods including e-learning, simulation and small group teaching. Based on results of the needs assessment survey, a novel pediatric surgery boot camp curriculum can be developed.
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    An Exploration of Deference Behaviours Exhibited within the Paediatric Resuscitation Environment
    (2017) Delaloye, Nicole; Gilfoyle, Elaine; Oddone Paolucci, Elizabeth; Ellaway, Rachel; Kassam, Aliya
    Healthcare professionals’ deference to physician expertise has been observed across a variety of clinical settings. Although such behaviour often results in appropriate and efficient patient care, deference can become detrimental when an inappropriate order or action goes unchallenged. This study aimed to identify the underlying factors influencing deference behaviours exhibited within the paediatric resuscitation environment. Through a three-phase study design and thematic analysis approach informed by principles of grounded theory, six overarching factors were found to influence deference behaviours: factors located outside the resuscitation environment, factors located inside the resuscitation environment, individual characteristics, mental state and experience, cognition, and motivation. Together these six factors were found to influence deference and its associated actions and responses (obedience, conformity, compromise, and rejection). The identification of these factors and this novel understanding of deference could potentially guide healthcare professionals, educators, and researchers in the development of strategies to mitigate instances of compromised patient care.x
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    Assessment of Conformity: Instrument Development
    (2018-06-04) Al Harbi, Nouf Sulaiman; Beran, Tanya Nathalie; Oddone Paolucci, Elizabeth; Drefs, Michelle A.; Altabbaa, Ghazwan; Davidson, Sandra; Goldsworthy, Sandra
    Current educational systems, including medical programs, incorporate learning in groups. However, subtle social factors functioning within these groups can influence learning and professional development. Thus, these social factors should be considered by both educators and learners. One social factor that has gained the attention of medical educators is conformity. Conformity is submission to the pressure of the group or its members and is represented by changing one’s behaviour, attitudes or beliefs to align with those of the group. It is associated with peer pressure and hierarchy whereby the need to be accepted within a professional milieu is paramount. Hence, conformity could prevent learners from actively engaging (e.g., asking questions) in education. Moreover, conformity has been associated with learners reporting feeling overwhelmed, and it has contributed to information mismanagement, inaccurate decision-making, and learners inefficiently using health care resources or compromising their role as patient advocates. The eventual outcome is deterioration in the provision of health care. The aim of this study was to create an instrument that enables both learners and educators to track verbal and nonverbal behaviours that are indicative of conformity. An observational cross-sectional design was used in three phases in this study. In Phase I, an initial conformity instrument was created based on behaviours identified in the communication, social psychology, and medical education literature and through discussion with conformity experts. The researcher then used this instrument in Phase II to code archival videos of the conformity behaviours of medical and nursing students from a prior study on conformity. Finally, in Phase III the instrument was used in real-time simulation sessions to record the behaviours of medical residents and students who were given the challenge of managing a patient case. This case was designed to expose the medical residents and students to pressure that would potentially influence their clinical decision making. Also, this study examined whether conformity as a construct is uni- or multidimensional. The study results showed that the instrument’s scores did not differentiate conforming from nonconforming behaviours. Also, the principal component analysis generated uninterpretable results, suggesting that the behaviours measured are not multidimensional. Participants also shared their perspectives about conformity, and revealed that they viewed conformity as a natural dynamic in their daily practice and could potentially yield to the pressure of the group or their senior colleagues when faced with a conflict. The implications for teaching and practice are discussed. It is also recommended that further research examine conformity in clinical settings to determine if the results obtained in clinical simulations are consistent with practice.
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    Experiences of Conformity in Postgraduate Medical Education
    (2015-12-22) Grendar, Jan; Beran, Tanya; Oddone Paolucci, Elizabeth; Hecker, Kent; Kassam, Aliya; Ellard, John
    A questionnaire was used to study the perception of conformity in Postgraduate Medical Education. The goals were to describe: (1) the extent of perception of pressure to conform in PGME, (2) factors that influence pressure to conform, and (3) trainees’ perception of how conformity influences their educational experience. 166 residents participated (21.3% of all residents). Individual characteristics (age, sex, PGY level, educational background) and residency program characteristics (surgical/nonsurgical, size) were not associated with a significant difference in perception of pressure to conform. Participants’ higher hierarchy rank, scenarios during off-service rotations and informal educational encounters were associated with significantly higher perception of pressure to conform. An equal number of residents perceived conformity as having a positive and negative influence on acquisition of knowledge and skills. In conclusion, although individual or program characteristics were not associated with differences in perception of pressure to conform in PGME, educational scenario characteristics were.
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    Faculty Mentorship: A Comparative Case Study of Factors Associated with Academic Career Mentoring Programs
    (2016) Lorenzetti, Diane Louise; Beran, Tanya NA; Oddone Paolucci, Elizabeth; Casebeer, Ann Louise; Hayden, Katharine Alix; Lashewicz, Bonnie Mylinda
    Informal mentoring has long been a means of facilitating the transfer of knowledge, skills, and experience from senior to junior faculty. Although many continue to benefit from these relationships, others report that they lack mentorship. Formal mentoring programs are structured interventions designed to provide equitable access to mentorship. While previous research suggests that such programs can further professional development and career outcomes in academia, few studies have examined those factors which may impact on the success of these initiatives. The purpose of this dissertation study was to enhance conceptual understanding of faculty-to-faculty mentorship by exploring how academics perceive their roles, benefit from, and are challenged by their participation in formal programs. I employed a comparative qualitative dual case study approach to conduct an in-depth examination of the faculty mentoring experience. Faculty mentorship was explored against the backdrop of two emerging programs at the University of Calgary (Alberta, Canada): one a functional dyadic structure, the other a peer group model. This research was informed by data from 23 semi-structured interviews, program documentation, and observational field notes. Faculty share many similar beliefs, and concerns, with respect to mentorship, and their participation in, and satisfaction with, formal mentoring programs. Chief among these are an intrinsic belief in comfort, safety, and trust as innate attributes of mentorship, and an awareness that formal programs may do little to support the development of that depth of intimacy and trust that faculty associate with these relationships. While faculty appear to view mentorship as an inherent good, tensions can arise when they feel unprepared, and unsupported, in their efforts to engage in these relationships. In this study, I found that a lack of training, clear expectations, and dedicated time were key barriers to mentorship participation. My analysis further revealed that organizational cultures and priorities can influence attitudes towards, and participation in, these relationships. Efforts to address these educational, program-level, and organizational impediments may enable faculty to derive greater benefit from these experiences. Finally, my analysis of study findings informed the development of a best-practice framework for conceptualizing the design, implementation, and evaluation of faculty mentorship programs.
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    Faculty Portfolio Development: Perception vs. Practices in a Major University, Riyadh, Saudi Arabia
    (2017) Alyousif, Sarah; Beran, Tanya; Baig, Lubna; Oddone Paolucci, Elizabeth; Hecker, Kent; Magzoub, Mohi Eldin
    Higher educational institutions have been using faculty portfolios to help ensure that the mission of academia is being met. This study aimed to develop a faculty portfolio using a sequential mixed methods design. The portfolio development process took place in King Saud bin Abdulaziz University of Health Sciences (KSAU-HS) colleges based in Riyadh, Jeddah and Alhassa, Saudi Arabia. In-depth interviews and focus groups, two ubiquitous approaches for qualitative research, were used to collect data from purposefully selected interviewees (n = 18) and focus group participants (n = 24). The quantitative arm of this study included questionnaire administration to 66 participants. They completed a 59-item questionnaire developed to obtain evidence of the validity and reliability of items used to form a portfolio. The audio taped and videotaped data were transcribed and analysed using thematic content analysis. The quantitative data were analysed using between group differences. This hybrid approach identified five main portfolio domains and their 59 subdomains. The individual domains, which were prioritized using judgemental weightings assigned by 18 participants, included education, service, research, professional development and academic management and leadership. Subdomains were identified within focus groups, with a total of 59 items representing measurable faculty daily activities that constitute the five main domains. The portfolio scores were found to have good reliability and validity based on the quantitative analyses and their triangulation with the qualitative results, thereby providing evidence of the trustworthiness and credibility of the data. This study informs the scientific community by presenting a faculty portfolio developed through a multi-step validation process. It is expected that this faculty portfolio will be implemented successfully in KSAU-HS colleges because its development is based on the opinions of all stakeholders affiliated with this higher educational institution.
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    Group peer-mentorship in academic libraries: an approach to enhancing research engagement
    (American Library Association, 2022-01) Lorenzetti, Diane; Powelson, Susan; Lashewicz, Bonnie; Casebeer, Ann; Hayden, K. Alix; Oddone Paolucci, Elizabeth; Beran, Tanya
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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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    Patient-reported outcome measures in pediatric asthma care: using theoretical domains framework to explore healthcare providers’ perceptions
    (2022-08-19) Bele, Sumedh; Rabi, Sarah; Zhang, Muning; Oddone Paolucci, Elizabeth; Johnson, David W.; Quan, Hude; Santana, Maria J.
    Abstract Background Patient-reported outcome measures (PROMs) play an important role in promoting and supporting patient and family-centered care. Implementing interventions like PROMs in routine clinical care require key stakeholders to change their behavior. The aim of this study was to utilize the Theoretical Domains Framework (TDF) to identify barriers and enablers to the implementation of PROMs in pediatric outpatient asthma clinics from healthcare providers’ perspective. Methods This TDF-guided qualitative descriptive study is part of a larger multi-phase project to develop the KidsPRO program, an electronic platform to administer, collect, and use PROMs in pediatrics. Semi-structured qualitative interviews were conducted with 17 participants, which included pediatricians, nurses, allied health professionals and administrative staff from outpatient asthma clinics. All the interviews were transcribed, deductively coded, inductively grouped in themes, and categorized into barriers and enablers. Results We identified 33 themes within 14 TDF domains, which were further categorized and tabulated into 16 barriers and 17 enablers to implementing PROMs in asthma clinics. Barriers to behavioral change were attributed to personal, clinical, non-clinical, and other system-level factors; they ranged from limited awareness of PROMs to language barriers and patient’s complex family background. Enablers ranged from a personal commitment to providing patient and family-centered care to administering PROMs electronically. Conclusion This implementation of science-based systematic inquiry captured the complexity of PROMs implementation in pediatric outpatient clinical care for asthma. Considering the consistency in barriers and enablers to implementing PROMs across patient populations and care settings, many findings of this study will be directly applicable to other pediatric healthcare settings.
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    Preventable adverse events in surgical patients: A meta-analysis and knowledge, attitude, and practice (KAP) assessment
    (2018-04-09) Austin, Janice Lynn; Oddone Paolucci, Elizabeth; Donnon, Tyrone L.; Buie, Donald
    All surgical procedures come with a risk of adverse events (AEs). To improve patient safety and prevent similar errors in the future, errors must be acknowledged and addressed. In this study a meta-analysis of patient safety literature in surgery was conducted and a Knowledge, Attitudes, and Practice (KAP) assessment survey of Calgary academic surgeons was performed.Results of the meta-analysis demonstrated a preventable adverse event (PAE) rate of 10.5 PAEs per 100 patients across all surgical specialties and a preventable death rate of 0.5 per 100 surgical patients. The KAP survey assessment demonstrated that 20% of surgeons could correctly identify the definition of both AE and error. Participants reported the factors contributing to an error to be multifactorial. The most frequently used methods to teach patient safety were Morbidity and Mortality rounds and individual feedback. Less than 25% of surgeons track their own AE rate. These results have implications for surgical postgraduate education, as well as for surgical practice in Canada. Recommendations are made for the development of a formal patient safety curriculum for all surgical trainees, with the aim of decreasing the number of errors. In addition, it is essential that more high-quality studies that include reproducible methods and consistent definitions of AEs and errors be conducted.
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    Psychosocial and career outcomes of peer mentorship in medical resident education: a systematic review protocol
    (2017-08-31) Pethrick, Helen; Nowell, Lorelli; Oddone Paolucci, Elizabeth; Lorenzetti, Liza; Jacobsen, Michele; Clancy, Tracey; Lorenzetti, Diane L
    Abstract Background Many medical residents lack ready access to social and emotional supports that enable them to successfully cope with the challenges associated with medical residency. This absence of support has been shown to lead to high levels of burnout, decreased mental wellbeing, and difficulty mastering professional competencies in this population. While there is emerging evidence that peer mentoring can be an important source of psychosocial and career-related support for many individuals, the extent of the evidence regarding the benefits of peer mentorship in medical residency education has not yet been established. We describe a protocol for a systematic review to assess the effects of peer mentoring on medical residents’ mental wellbeing, social connectedness, and professional competencies. Methods Studies included in this review will be those that report on peer-mentoring relationships among medical residents. Quantitative, qualitative, and mixed-methods studies will be eligible for inclusion. No date or language limits will be applied. We will search EMBASE, MEDLINE, PsychINFO, Web of Science, Scopus, ERIC, Education Research Complete, and Academic Research Complete databases to identify relevant studies. Two authors will independently assess all abstracts and full-text studies for inclusion and study quality and extract study data in duplicate. Discussion This is the first systematic review to explicitly explore the role of peer mentoring in the context of medical residency education. We anticipate that the findings from this review will raise awareness of the benefits and challenges associated with peer-mentoring relationships, further the development and implementation of formal peer-mentoring programs for medical residents, and, through identifying gaps in the existing literature, inform future research efforts. Systematic review registration This protocol has not been registered in PROSPERO or any other publicly accessible registry.
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    Reliability & Validity of the Objective Structured Clinical Examination (OSCE): A Meta-Analysis
    (2016) Al Ghaithi, Ibrahim; Donnon, Tyrone; Oddone Paolucci, Elizabeth; Kassam, Aliya; Felisa Palacios, Maria
    Background: The objective structured clinical examination (OSCE) provides one of the most commonly used methods for assessing clinical skill competencies in the health professions. Objectives: To investigate the existing published research on the reliability, validity and feasibility of the OSCE in the assessment of physicians and residents in medical education programs. Methods: In addition to a MEDLINE, the literature search for peer-reviewed, journal publications that used an OSCE assessment method to evaluate clinical skill competence also included PsychINFO, ERIC and EMBASE databases. Results: In total, 49 studies met the inclusion and exclusion criteria in the final analysis. The OSCE assessment method has a moderate internal reliability [mean alpha coefficient (α) = 0.70], low to moderate criterion validity [mean Pearson correlation (r)= 0.46] and low to moderate construct validity (mean r = 0.42). High heterogeneity was observed and large part was attributed to multiple sources of measurement errors. The mean cost per candidate is $353 ± $ 362 (95% Confidence Intervals: $25-$1083). Conclusions: The OSCE method for the assessment of clinical skill competence was found to be reliable and valid, however, the administration costs are much higher than written or direct observation of clinical skill performance in practice.
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    Student Evaluations and the Effect of Timely Feedback on Course Quality and Faculty Development in Saudi Arabia: A Mixed Methods Approach
    (2018-06-07) Alhassan, Abdulaziz Ibrahim; Beran, Tanya N.; Oddone Paolucci, Elizabeth; Baig, Lubna; Magzoub, Mohi Eldin
    Feedback from students is one of the most frequently used tools for evaluating/improving university instructors’ performance, assessing teaching quality, and improving learning outcomes. However, few studies have fully examined the effect of instructors receiving timely feedback from students, or student and instructor perceptions about feedback to instructors. This study’s first goal was to determine whether timely student feedback to Problem-Based Learning (PBL) instructors affects teaching styles and teaching quality in a Saudi Arabian university. The second goal was to explore whether student feedback in general and timely student feedback in particular to PBL instructors would contribute to faculty professional development. An embedded mixed methods design was used, whereby a qualitative method was embedded within a quantitative experimental major design. Quantitative data were first collected via a survey administered twice during a study block to 329 first-year, male and female medical students in novice and advanced streams. Students and instructors were divided into an experimental (E) and a control (C) group where students evaluated 22 PBL instructors on instructor performance and PBL session organization. However, only E group instructors received timely student feedback. Qualitative data were then collected from 61 of these students and 13 instructors through one-on-one semi-structured interviews. The quantitative results showed significant differences in student scores between the E and C groups. Then, student results were analyzed separately for differences based on gender and novice and advanced streams. The results showed differences in student scores between the E and C groups for the male and novice stream students, and no significant difference in student scores for the female and advanced stream students. Qualitative data for the instructors and students revealed three major overarching themes concerning the importance, process, and use of student feedback. The mixed methods’ results showed the effectiveness of timely student feedback on instructors’ performance and PBL session organization items. Additionally, the effectiveness of timely student feedback was shown for both men and women and for novice students, but not for advanced students.
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    The Role of Peer Mentors in Promoting Knowledge and Skills Development in Graduate Education
    (2020-11-08) Lorenzetti, Diane L.; Nowell, Lorelli; Jacobsen, Michele; Lorenzetti, Liza; Clancy, Tracey; Freeman, Georgina; Oddone Paolucci, Elizabeth
    The objective of this study was to explore the role of peer mentorship in facilitating graduate student resiliency, knowledge acquisition, and development of academic competencies. We conducted a qualitative case study, using in-person interview data from sixty-two students recruited from four professional faculties (Education, Medicine, Nursing, and Social Work) at a large Canadian University. We identified four broad themes derived from a thematic and constant comparative analysis of interview data: (1) knowledge sharing, (2) skills development, (3) academic milestones, and (4) program supports. Graduate students reported that peer mentorship promoted the development of learning environments that emphasized community, collaboration, and shared purpose. Students believed that peer mentors facilitated their access to essential procedural and disciplinary knowledge and helped them to develop academic and research skills and achieve key academic milestones. While the majority of the students interviewed had not participated in any formal peer-mentoring program, they recommended that any future program incorporate mentorship training and include access to collaborative spaces and targeted opportunities for students to develop these relationships.
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    What are the factors influencing Canadian-trained residents’ choice of pursuing the subspecialty of Maternal-Fetal Medicine?
    (2017-12-19) Roggensack, Anne; Lockyer, Jocelyn; Oddone Paolucci, Elizabeth; Veale, Pamela; Chandra, Sujata
    An increasing need for Maternal-Fetal Medicine (MFM) physicians in Canada has been reported, along with decreasing resident interest in the subspecialty. This study was designed to explore the factors influencing Canadian-trained residents’ career choice of Maternal-Fetal Medicine (MFM), focusing on their perceptions of MFM residency and career, the positive and negative influencing factors, and how MFM could be perceived as a more attractive career choice by residents. Twenty-one residents from Canadian Obstetrics and Gynecology (O&G) and MFM residency programs participated in semi-structured telephone interviews. A qualitative approach was selected, and interview data were analyzed using a thematic analysis approach, drawing on constructivist grounded theory techniques. Seven themes influencing resident perception of MFM were identified, including the field of MFM, O&G residency experiences, the MFM residency program, perceived variety of MFM practice, lifestyle of MFM, academic career, and finances. Current trainees identified the field itself, a dislike of gynecology, academic practice, and mentorship from MFM faculty as positive factors influencing their choice of MFM. Residents viewed the emotional toll of MFM practice, increasing demand and burnout, patient complexity, the exclusion of gynecology, and their O&G residency MFM experience as negative factors pushing them away from MFM. The resident perception of positive and negative influencing factors varied by their general favourability towards MFM. Factors intrinsic and extrinsic to MFM were identified, as well as potential changes to attract residents to the subspecialty, including opportunities for change within O&G residency, MFM residency, and gynecology practice as part of a MFM career. This study revealed several novel and contemporaneous factors influencing MFM subspecialisation decision-making, including the field of MFM itself, exposure to MFM residents and residency program requirements, and the impact of staff physician burnout on residency education and career choice. The results have implications for O&G and MFM postgraduate education, as well as for the subspecialty of MFM in Canada. Further research is needed to (1) define Canadian MFM practice, (2) determine accurate workforce needs, (3) assess the effect of physician burnout on trainees, and (4) resolve the question of gynecology practice in MFM.