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Background: Virtual patient simulations are interactive, computer-based cases. We designed scenarios based on the McGill Simulation Complexity Score (MSCS), a previously described objective complexity score. We aimed to establish validity of the MSCS and introduce a novel learning tool in trauma education at our institution. Methods: After design of an easy and difficult patient scenario, we randomized medical students and residents to each perform 1 of the 2 scenarios. We conducted a 2-way analysis of variance of training level (medical student, resident) and scenario complexity (easy, difficult) to assess their effects on virtual time, the number of steps taken in the scenario, beneficial and harmful actions, and the ratio of beneficial over harmful actions. Results: Virtual patient scenarios were successfully designed using the MSCS. Twenty-four medical students and 12 residents participated in the easy scenario (MSCS = 3), and 27 medical students and 12 residents did the difficult scenario (MSCS = 18). Though beneficial actions were similar between students and residents, sudents performed more harmful actions, particularly when the scenario was difficult. One virtual patient died in the easy scenario and 3 died in the diffcult one (all medical students). Performance varied with level of complexity and there was significant interaction between level of training and number of steps, as well as with number of harmful actions. Decreasing performance with increasing level of complexity, as defined by the MSCS, suggests this score can accurately quantify difficulty. Conclusion: We established validity of the MSCS and showed its successful application on virtual patient scenario design. Contexte : Les simulations medicales virtuelles sont des cas interactifs informatises. Nous avons concu des scenarios en utilisant le score de complexite des simulations McGill (SCSM), un score de complexite objectif decrit precedemment. Nous avons voulu confirmer la validite du SCSM et presenter un nouvel outil d'apprentissage en traumatologie pour notre etablissement. Methodes : Apres avoir concu le scenario d'un cas facile et d'un cas difficile, nous avons assigne aleatoirement des etudiants en medecine et des residents a 1 des 2 scenarios pour qu'ils y travaillent. Nous avons procede a une analyse de la variance a 2 facteurs, formation (etudiant en medecine, resident) et complexite des cas (facile, difficile,) pour mesurer leurs effets sur le temps virtuel, le nombre d'etapes franchies dans le scenario, les interventions benefques et nuisibles et le rapport entre les deux. Resultats : Les scenarios de cas virtuels ont ete concus avec succes a l'aide du SCSM. Vingt-quatre etudiants en medecine et 12 residents ont travaille au scenario facile (SCSM = 3), et 27 etudiants en medecine et 12 residents ont travaille au scenario difficile (SCSM = 18). Meme si les interventions benefques etaient similaires entre les etudiants et les residents, les etudiants ont applique plus d'interventions nuisibles que les residents, particulierement lorsque le scenario etait difficile. Un patient virtuel du scenario facile et 3 du scenario difficile sont decedes (etudiants dans tous les cas). Le rendement a varie selon le degre de complexite et on a note un lien significatif entre le niveau de formation et le nombre d'etapes et de mesures nuisibles. Le fait que le rendement ait ete inversement proportionnel a la complexite definie par le SCSM, suggere que ce dernier mesure avec exactitude le degre de complexite. Conclusion : Nous avons confirme la validite du score SCSM et montre son utilite dans la conception de scenarios de cas virtuels.

Virtual patient simulations are interactive, computer-based cases. We designed scenarios based on the McGill Simulation Complexity Score (MSCS), a previously described objective complexity score. We aimed to establish validity of the MSCS and introduce a novel learning tool in trauma education at our institution. After design of an easy and difficult patient scenario, we randomized medical students and residents to each perform 1 of the 2 scenarios. We conducted a 2-way analysis of variance of training level (medical student, resident) and scenario complexity (easy, difficult) to assess their effects on virtual time, the number of steps taken in the scenario, beneficial and harmful actions, and the ratio of beneficial over harmful actions. Virtual patient scenarios were successfully designed using the MSCS. Twenty-four medical students and 12 residents participated in the easy scenario (MSCS = 3), and 27 medical students and 12 residents did the difficult scenario (MSCS = 18). Though beneficial actions were similar between students and residents, sudents performed more harmful actions, particularly when the scenario was difficult. One virtual patient died in the easy scenario and 3 died in the difficult one (all medical students). Performance varied with level of complexity and there was significant interaction between level of training and number of steps, as well as with number of harmful actions. Decreasing performance with increasing level of complexity, as defined by the MSCS, suggests this score can accurately quantify difficulty. We established validity of the MSCS and showed its successful application on virtual patient scenario design. Les simulations médicales virtuelles sont des cas interactifs informatisés. Nous avons conçu des scénarios en utilisant le score de complexité des simulations McGill (SCSM), un score de complexité objectif décrit précédemment. Nous avons voulu confirmer la validité du SCSM et présenter un nouvel outil d’apprentissage en traumatologie pour notre établissement. Après avoir conçu le scénario d’un cas facile et d’un cas difficile, nous avons assigné aléatoirement des étudiants en médecine et des résidents à 1 des 2 scénarios pour qu’ils y travaillent. Nous avons procédé à une analyse de la variance à 2 facteurs, formation (étudiant en médecine, résident) et complexité des cas (facile, difficile,) pour mesurer leurs effets sur le temps virtuel, le nombre d’étapes franchies dans le scénario, les interventions bénéfiques et nuisibles et le rapport entre les deux. Les scénarios de cas virtuels ont été conçus avec succès à l’aide du SCSM. Vingt-quatre étudiants en médecine et 12 résidents ont travaillé au scénario facile (SCSM = 3), et 27 étudiants en médecine et 12 résidents ont travaillé au scénario difficile (SCSM = 18). Même si les interventions bénéfiques étaient similaires entre les étudiants et les résidents, les étudiants ont appliqué plus d’interventions nuisibles que les résidents, particulièrement lorsque le scénario était difficile. Un patient virtuel du scénario facile et 3 du scénario difficile sont décédés (étudiants dans tous les cas). Le rendement a varié selon le degré de complexité et on a noté un lien significatif entre le niveau de formation et le nombre d’étapes et de mesures nuisibles. Le fait que le rendement ait été inversement proportionnel à la complexité définie par le SCSM, suggère que ce dernier mesure avec exactitude le degré de complexité. Nous avons confirmé la validité du score SCSM et montré son utilité dans la conception de scénarios de cas virtuels.

Purpose While enhanced breast screening of germline pathogenic variant (GPV) carriers results in earlier stage at diagnosis, the impact of tumour biology and GPV on chemotherapy receipt in early-stage disease remains understudied. Methods We retrospectively reviewed treatment administered following a first diagnosis of BRCA1/2 - and PALB2 -associated breast cancer between 2002 and 2022. Chemotherapy receipt was compared according to tumor size, biologic subtype, and GPV. Subgroup analyses were performed in women with T1N0 disease and in those with pre-diagnostic awareness of their GPV. Results Overall, 309 affected BRCA1/2 and PALB2 carriers with a median age of 43 years at breast cancer diagnosis (range, 19–80 years) were included; 160 (51.8%) BRCA1 , 130 (42.1%) BRCA2 , and 19 (6.1%) PALB2 carriers. Chemotherapy was administered in 70.9% of index breast cancer cases and was significantly associated with younger age, tumor size, histologic grade, nodal status, and biologic subtype (all p  < 0.05). Chemotherapy receipt was 80.6% in BRCA1 -associated breast cancers compared to 56.9% in BRCA2 and 84.2% in PALB2 associated breast cancers ( p  < 0.001). In subgroup analysis of early stage, T1N0 disease, chemotherapy was administered in 78.9% BRCA1 and 59.5% BRCA2/PALB2 patients ( p  = 0.04). Pre-diagnostic awareness of a GPV in BRCA1/2 or PALB2 was associated with smaller invasive tumors (%T1, 50% vs. 32.9%; p  = 0.002) and node-negative invasive disease (87.1% vs. 72.2%), as well as a reduced likelihood of chemotherapy (59.7% vs. 74.3%, p  = 0.02). Conclusion Chemotherapy receipt is high in BRCA1/2 and PALB2 -associated breast cancers including in early stage, node-negative disease. Pre-diagnostic awareness is associated with a lower likelihood of requiring chemotherapy for a breast cancer diagnosis.

We report a novel fertility preservation strategy that may be useful for young breast cancer patients who present with time constraints or concerns about the effect of ovarian stimulation. The protocol involves retrieval of immature oocyte from unstimulated ovaries followed by in vitro maturation (IVM), and vitrification of oocytes or embryos. Thirty-eight patients (age 24–45 years) underwent vitrification of oocytes (n = 18) or embryos (n = 20). The mean ages were 33.1 ± 5.0 years and 34.7 ± 4.8 years, respectively. The mean days required to complete the egg collection was 13 days. The median numbers of vitrified oocytes and embryos per retrieval were 7 (range 1–22) and 4 (range 1–13), respectively. The strategy of immature oocyte retrieval without ovarian stimulation followed by IVM and oocyte or embryo vitrification, which does not increase the serum estradiol level and delay cancer treatment, represents an attractive option of fertility preservation for many breast cancer patients.

Background: Competency-based medical education is a framework of organized representations of sets of interrelated knowledge and procedural skills. Each competency is aligned with entrustable professional activities (EPAs). These are specified by regulatory bodies. Undergraduate medical education knowledge and their associated EPAs are designed to prepare learners for the first year of their residencies. Methods: This oral presentation will provide an overview of a project that used a virtual patient case (VP) to highlight and address specific postgraduate medical education EPAs. Supported by the Canadian Association of General Surgeons, a VP was developed by a clinical content expert and then integrated into a virtual patient case application by developers with strong pedagogical and clinical backgrounds. The clinical narrative was initially constructed using a template that was then followed by online discussions, reviews and modifications. The completed case will be peer-reviewed prior to publication. Results: The resulting case provides an online standardized exercise for learners that can be made available irrespective of geographical limitations. This process permits wide distribution of clinical content expertise. The addition of individualized metrics and data allows for objective assessment of competencies and EPAs and permits formative identification of strengths and weaknesses that can then be addressed. The authors will present examples of several Canadian EPAs as well as associated CanMEDS roles that can be related to specific elements of the case. Conclusion: VPs aligned with EPAs provide an innovative teaching strategy for on-site and remote learning. They permit self, formative and summative assessment and provide educators with innovative evaluation methodologies.

Interprofessional collaboration is central to quality patient care; however, little is known about developing interprofessional care plans, particularly in oncology. This article describes the development of an interprofessional care plan for an older adult woman with breast cancer. Two collaborative expert workshops were used; 15 clinical experts reviewed an online patient case and were asked to prepare a uniprofessional care plan. In workshop 1, participants worked from a draft interprofessional care plan, synthesized from the uniprofessional care plans by research associates, to arrive at consensus on an ideal interprofessional care plan. Using qualitative inductive content analysis of workshop transcripts, specific changes and overall key principles were identified and used to revise the draft plan. Based on these findings, a generalized interprofessional care plan/oncology model was developed. Revisions and proposed model were validated through consensus by participants during workshop 2. Participants highlighted the iterative, cyclical, and multilayered nature of patient care experiences; the importance of central patient profiles, which are contributed to and validated by all healthcare professionals; and the importance of assessing patient understanding. Participation of a patient representative provided an invaluable contribution. The process and model provide a unique framework for interprofessional care plan development in other settings and patient populations.

Stereotactic breast biopsy techniques minimize the surgical trauma associated with conventional wire‐guided open breast biopsy for non‐palpable breast lesions (NPBLs). Advanced breast biopsy instrumentation (ABBI) allows for a 2‐cm core of breast tissue to be excised under stereotactic guidance in an outpatient setting. We report our initial experience with ABBI. Hospital charts from 89 ABBI procedures between 10/1996 and 07/2002 were retrospectively reviewed for patient characteristics, ABBI parameters, radiographic appearance, pathology, complications, and clinical follow‐up. Data are presented as percentage/median (range). Median age was 59 years (range: 39–80 years), mammographic lesions were classified as calcifications 49% (44/89), soft tissue 39% (35/89), or mixed 11% (10/89). Median radiographic size was 7 mm (1–60 mm). Final pathology revealed ductal carcinoma in situ (DCIS) in 7% (6/89) and invasive cancer in 22% (20/89). Microscopically clear margins were obtained in 55% (11/20) of patients with invasive cancer. Of these, 82% (9/11) chose not to undergo further local surgical therapy. Eight patients remain disease free at 56 months (range: 41–95 months) follow‐up. The ninth patient was deceased at 6 months from an unrelated cause. The overall complication rate was 3% (3/89). A definitive diagnosis was obtained in 100% of malignant and 87% of benign cases. Median waiting time was 19 days (range: 0–90 days). Our experience demonstrates that ABBI is an effective diagnostic tool for NPBLs. It is associated with minimal complications, and provides negative margins in over half of malignant cases. In selected patients with invasive cancer and negative margins, ABBI may obviate the need for further local surgical treatment. ABBI merits additional investigation as a therapeutic modality for early breast cancer.

To analyze experience at the McGill University Health Centre with cardiopulmonary bypass (CPB) in trauma, complemented by a review of the literature to define its role globally and outline indications for its expanded use in trauma management. All available published English-language articles from peer reviewed journals, located using the MEDLINE database. Chapters from relevant, current textbooks were also utilized. Nine relevant case reports, original articles or reviews pertaining to the use of CPB in trauma. Original data as well as authors' opinions pertinent to the application of CPB to trauma were extracted, incorporated and appropriately referenced in our review. Overall mortality in the selected series of CPB used in the trauma setting was 44.4%. Four of 5 survivors had CPB instituted early (first procedure in operative management) whereas 3 of 4 deaths involved late institution of CPB. Although CPB has traditionally been used in the setting of cardiac trauma alone, a better understanding of its potential benefit in noncardiac injuries will likely make for improved outcomes in the increasingly diverse number of severely injured patients seen in trauma centres today. Further studies by other trauma centres will allow for standardized indications for the use of CPB in trauma.