PRISM :: Browsing by Author "Kassam, Aliya"

Browsing by Author "Kassam, Aliya"

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Open Access
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.
Open Access
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
Open Access
Behaviors in Advance Care Planning and ACtions Survey (BACPACS): development and validation part 1
(2017-11-22) Kassam, Aliya; Douglas, Maureen L; Simon, Jessica; Cunningham, Shannon; Fassbender, Konrad; Shaw, Marta; Davison, Sara N
Abstract Background Although advance care planning (ACP) is fairly well understood, significant barriers to patient participation remain. As a result, tools to assess patient behaviour are required. The objective of this study was to improve the measurement of patient engagement in ACP by detecting existing survey design issues and establishing content and response process validity for a new survey entitled Behaviours in Advance Care Planning and ACtions Survey (BACPACS). Methods We based our new tool on that of an existing ACP engagement survey. Initial item reduction was carried out using behavior change theories by content and design experts to help reduce response burden and clarify questions. Thirty-two patients with chronic diseases (cancer, heart failure or renal failure) were recruited for the think aloud cognitive interviewing with the new, shortened survey evaluating patient engagement with ACP. Of these, n = 27 had data eligible for analysis (n = 8 in round 1 and n = 19 in rounds 2 and 3). Interviews were audio-recorded and analyzed using the constant comparison method. Three reviewers independently listened to the interviews, summarized findings and discussed discrepancies until consensus was achieved. Results Item reduction from key content expert review and conversation analysis helped decrease number of items from 116 in the original ACP Engagement Survey to 24–38 in the new BACPACS depending on branching of responses. For the think aloud study, three rounds of interviews were needed until saturation for patient clarity was achieved. The understanding of ACP as a construct, survey response options, instructions and terminology pertaining to patient engagement in ACP warranted further clarification. Conclusions Conversation analysis, content expert review and think aloud cognitive interviewing were useful in refining the new survey instrument entitled BACPACS. We found evidence for both content and response process validity for this new tool.
Open Access
Benzodiazepine and similar sedative-hypnotic use in Canada
(2005) Kassam, Aliya; Patten, Scott B.
Open Access
Competence committees decision-making; an interplay of data, group orientation, and intangible impressions
(2023-10-10) Curtis, Colleen; Kassam, Aliya; Lord, Jason; Cooke, Lara J.
Abstract Background The implementation of competency-based medical education and utilization of competence committees (CC) represents a paradigm shift in residency education. This qualitative study aimed to explore the methods used by two operational CC and their members to make decisions about progression and competence of their residents. Methods An instrumental case study methodology was used to study the CC of two postgraduate training programs. Transcripts from observed CC meetings, member interviews, and guiding documents were analyzed using a constructivist grounded theory approach to reveal themes explaining the decision-making process. Results Our study found that the CC followed a process that began within a social decision schema model and evolved to a discussion that invoked social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. We identified that the CC decision-making was at risk of bias, primarily influenced by the group composition, the group orientation and individual members’ mindset, as well as their personal experiences with the trainees. Conclusions Increased awareness of the sources of bias in CC functioning and familiarity with the CC role in competency-based medical education would enable committees to provide valuable feedback to all trainees regardless of their trajectory.
Open Access
Comprehensive Video-Module Instruction an Alternative for Teaching IUD Insertion to Family Medicine Residents
(2013-05-13) Garcia-Rodriguez, Juan Antonio; Donnon, Tyrone; Kassam, Aliya
There are different challenges currently faced by the Department of Family Medicine to impart procedural skills instruction to residents. An IUD video-module was created to provide an alternative approach for such training, offering the possibility of its use in any clinical setting or teaching situation. A randomized, two group experimental research design was used to focused on the comparison of residents’ procedural skills performance between the instruction methods (video-module vs. traditional approach) to teaching IUD insertion. The results showed that both methods were effective in providing procedural skill instruction. The performance scores were significantly higher in the video-module group, but there were no significant differences in residents’ satisfaction scores. There was no correlation between the different scores and sex or age, or between performance and level of satisfaction. In conclusion, the use of video-module instruction is effective to provide IUD training and significantly higher than the gold standard in the performance component.
Open Access
A controlled trial of mental illness related stigma training for medical students
(BioMed Central, 2011-07-29) Kassam, Aliya; Glozier, Nick; Leese, Morven; Loughran, Joanne; Thornicroft, Graham
Open Access
Crowdsourcing trainees in a living systematic review provided valuable experiential learning opportunities: A mixed-methods study
(2022-03-29) Lee, Chloe; Thomas, Megan; Ejaredar, null; Kassam, Aliya; Whittle, Samuel L; Buchbinder, Rachelle; Tugwell, Peter; Wells, George; Pardo, Jordi Pardo; Hazlewood, Glen S
Objective: To understand trainee experiences of participating in a living systematic review (LSR) for rheumatoid arthritis, and the potential benefits in terms of experiential evidence-based medicine (EBM) education. Study Design and Setting: We conducted a mixed-methods study with trainees that participated in the LSR who were recruited broadly from training programs in two countries. Trainees received task-specific training and completed one or more tasks in the review: assessing article eligibility, data extraction, quality assessment. Trainees completed a survey followed by a 1-on-1 interview. Data were triangulated to produce broad themes. Results: Twenty-one trainees, most of whom had little prior experience with systematic reviews, reported a positive overall experience. Key benefits included learning opportunities, task segmentation (ability to focus on a single task, as opposed to an entire review), working in a supportive environment, international collaboration, and incentives such as authorship or acknowledgement. Trainees reported improvement in their competency as a Scholar, Collaborator, Leader, and Medical Expert. Challenges included communication and technical difficulties, and appropriate matching of tasks to trainee skillsets. Conclusion: Participating in a LSR provided benefits to a wide range of trainees and may provide an opportunity for experiential EBM training, while helping LSR sustainability.
Open Access
Developing an Antimicrobial Stewardship Education Curriculum Framework
(2021-03-03) Constantinescu, Cora Mihaela; Kassam, Aliya; Conly, John M.; Vayalumkal, Joseph Varkey; Gilfoyle, Elaine
Background: Antimicrobial Stewardship (AS) education initiatives often neglect to account for the psychosocial factors driving antimicrobial prescribing (AP). Understanding these key factors is important in the design and implementation of tailored educational initiatives. Methods: This study which applied a mixed-methods embedded design, involved quantitative analysis of AS concerns observed by pharmacists through a clinical team rounds audit, as well as qualitative semi-structured interviews based on the Theoretical Domain Framework (TDF). Interviews (n=23) with staff and resident physicians, nurse practitioners and pharmacists were conducted for the Clinical Teaching Unit (CTU) and Pediatric Intensive Care Unit (PICU). We analyzed the data using deductive and inductive methods by mapping nodes from the TDF to a model for social determinants of antimicrobial prescribing (SDAP) in pediatrics. Facilitators and barriers to AP behaviour were identified and represented with respect to Kern’s Model of curriculum development targeted at future PICU and CTU AS education initiatives. Results: The quantitative phase served as an educational needs assessment, identifying chief AS practice (e.g., de-escalation) and antibiotics concerns. The qualitative phase explored AP behaviours and identified psychosocial facilitators and barriers for AS practice. Some facilitators included: 1. Collaboration and trust, 2. Shared decision-making with pharmacy and the Infectious Disease (ID) service, 3. Local accessible guidelines and 4. Overarching goals such as: doing right by the patient and feeling empowered as a prescriber. Some barriers included: 1. The norm of non-interference, 2. Professional comparisons including issues with hierarchy and egos, 3. Limited resources, 4. Feeling inadequately trained in AS, 5. Emotional prescribing in the face of clinical deterioration and diagnostic uncertainty and 6. Pejorative monitoring system. A conceptual framework was then developed using these facilitators and barriers for future educational initiatives for inpatient teams. Conclusions: This study contributes to the gap of knowledge around how best to optimize AS education for multidisciplinary teams. This is the first study in pediatrics taking into consideration the psychosocial drivers of AP behaviour in the context of team decisions around patient-centred clinical rounds. Mapping these facilitators and barriers to an established educational framework, allows for tailored curriculum development of future AS interventions.
Open Access
The development and psychometric properties of a new scale to measure mental illness related stigma by health care providers: The opening minds scale for Health Care Providers (OMS-HC)
(BioMed Central, 2012-06-13) Kassam, Aliya; Papish, Andriyka; Modgill, Geeta; Patten, Scott
Open Access
Ethical Issues in Residency Education Related to the First Wave of the COVID-19 Pandemic: A Narrative Inquiry Study
(2022-09) Kassam, Aliya; Mitchell, Ian; Page, Stacey; Lauzon, Julie
Background: Around the world, the unprecedented COVID-19 pandemic has increased the demand for, and on, healthcare workers as it also continues to strain healthcare systems. Ethical issues that arise during pandemic health emergencies understandably impact such individuals as healthcare providers who have responsibilities to the public. Residency programs were faced with new challenges to provide care and educate junior doctors (resident physicians) while ensuring learner and patient safety and resource allocation amidst the suspension of standard in-person learning opportunities. We sought to understand both the positive and negative experiences of first-year residents during the first wave of COVID-19, as well as to describe potential ethical issues from their stories. Method: We used narrative inquiry (NI) methodology to explore resident physicians’ experiences. A semi-structured interview guide was utilized and included questions pertaining to ethical principles as well as both positive and negative aspects of the pandemic. Sampling was purposive. Interviews were audio-recorded and transcribed. Three members of the research team coded transcripts in duplicate to determine themes surrounding experiences as well as observations of ethical principles and arguments. To describe resident experiences of both the positive and negative aspects of the pandemic, a composite story with threads was constructed. Discrepancies were resolved through discussion to attain consensus. Results: Eleven residents participated from Internal Medicine (n=2), Family Medicine (n=2), Ophthalmology (n=1), General Surgery (n=1), Pediatrics (n=1), Diagnostic Radiology (n=1), Public Health (n=1), Psychiatry (n=1), Emergency Medicine (n=1). Resident stories had three common themes in which ethical issues were described: 1) Intersecting healthcare and medical education systems, 2) Public health and the public good, 3) Health systems planning/healthcare delivery. Junior’s journal entry became the composite story of the eleven participants. Three key narrative threads of the story were: 1) Engage us, 2) Because we see the need for the duty to treat, 3) And we are all in this together. Discussion: While residents identified lack of autonomy as they straddled roles as both novice employees and learners across intersecting systems, this was not unique to the pandemic. The pandemic, however may have exacerbated the lack of autonomy experienced by resident physicians. The notion of public health and the public good at times eclipsed individual wellbeing for residents and patients alike, leading to consequences in health systems’ planning/healthcare delivery. Despite these challenges, there were positive aspects to the pandemic such as teamwork and collaboration as well as the feeling of altruism to help achieve what was best for the public good. Conclusion: Efforts to understand how resident physicians can be engaged in their own education as well as how they can navigate public health crises with respect to ethical principles could benefit both residency education and healthcare delivery.
Open Access
Evaluating the Impact of Mindfulness Meditation on Family Medicine Residents' Well-being
(2016) Horton, Joan; Kassam, Aliya; Donnon, Tyrone L.; Palacios Mackay, Maria; Myhre, Douglas; McCaffrey, Graham
Professional competence in medicine requires a commitment to physician health and well-being, for sustainable practice and optimal patient care. Yet few doctors are taught wellness-enhancing techniques during their training. Mindfulness-based stress reduction has been extensively studied and can be beneficial in reducing stress and burnout while enhancing empathy in medical personnel. This study evaluated the impact of an adapted 8-week program of mindfulness meditation on the well-being of a convenience sample of family medicine residents. Significant improvements were seen in the active group in measurements of personal burnout (d = 1.02, p < 0.05) and mindfulness (d = 1.04, p < 0.05) at 8 weeks, with significant improvement in perceived stress (d = 1.002, p < 0.05) and mindfulness (d = 1.48, p < 0.01) persisting at 16 weeks. Post-mindfulness training evaluations rated the initial group training, meditation recordings and feasibility positively but identified fatigue, conflicting schedules and lack of group time as barriers to the practice of mindfulness-based stress reduction. Protected program time for stress management training may benefit residents' development of Professional competence and patient care outcomes.
Open Access
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.
Open Access
Goals of care conversation teaching in residency – a cross-sectional survey of postgraduate program directors
(2017-01-06) Roze des Ordons, Amanda; Kassam, Aliya; Simon, Jessica
Abstract Background Residents are commonly involved in establishing goals of care for hospitalized patients. While education can improve the quality of these conversations, whether and how postgraduate training programs integrate such teaching into their curricula is not well established. The objective of this study was to characterize perceptions of current teaching and assessment of goals of care conversations, and program director interest in associated curricular integration. Methods An electronic survey was sent to all postgraduate program directors at the University of Calgary. Quantitative data was analyzed using descriptive statistics and qualitative comments were analyzed using thematic analysis. Results The survey response rate was 34% (22/64). Formal goals of care conversation teaching is incorporated into 63% of responding programs, and most commonly involves lectures. Informal teaching occurs in 86% of programs, involving discussion, direct observation and role modeling in the clinical setting. Seventy-three percent of programs assess goals of care conversation skills, mostly in the clinical setting through feedback. Program directors believe that over two-thirds of clinical faculty are prepared to teach goals of care conversations, and are interested in resources to teach and assess goals of care conversations. Themes that emerged include 1) general perceptions, 2) need for teaching, 3) ideas for teaching, and 4) assessment of goals of care conversations. Conclusions The majority of residency training programs at the University of Calgary incorporate some goals of care conversation teaching and assessment into their curricula. Program directors are interested in resources to improve teaching and assessment of goals of care conversations.
Open Access
How do competence committees make decisions about resident progression? A qualitative study
(2021-10-15) Curtis, Colleen Mary; Cooke, Lara; Kassam, Aliya; Lord, Jason
Competence committees (CC) determine trainees’ progression through postgraduate competency-based medical education (CBME) programs. Models of how CC function identify that most programs take a problem-identification approach while others provide developmental feedback to every trainee. While CC are tasked with high stakes decisions, the process by which they discuss and make decisions about resident progression remains uncertain, with few publications addressing this question. The purpose of this qualitative study was to describe the factors affecting CC decision-making. This instrumental case study examined two CC at a Canadian institution, three years post-CBME launch. Over a six-month period, one researcher observed four CC meetings and conducted interviews with 10 CC members which were audio recorded and transcribed verbatim. Royal College documents, CC terms of reference, investigator reflections, and memos created throughout the study were also examined. Following a constructivist grounded theory approach with constant comparison, two investigators coded transcripts independently and jointly to refine a codebook and identify themes in the data. Our theory-informed analysis led to a theoretical framework of CC decision-making: a process beginning within a social decision schema model and evolving to a discussion invoking social influence theory, shared mental models, and social judgment scheme to clarify the points of contention. The committee mindset determined the likelihood of entering a discussion about trainees; triggers for discussion related to CC members’ uncertainty of the process or concerns with the adequacy of the data. Ensuing conversations considered the context of the individual resident and CC members’ experiences. We found that ongoing challenges with CC functioning persist three years post-CBME implementation. Despite Royal College recommendations and local terms of reference, CC provide limited developmental feedback to trainees who are doing well, and acknowledge that biases could affect the intended process. While this study only examined two CC, it identified important themes to address when considering a robust CC process.
Open Access
Hypnotic use in a population-based sample of over thirty-five thousand interviewed Canadians
(BioMed Central Ltd., 2006-11-24) Patten, Scott B.; Kassam, Aliya
Open Access
Key stakeholder opinions for a national learner education handover
(2019-05-16) Kassam, Aliya; Ruetalo, Mariela; Topps, Maureen; Mountjoy, Margo; Walton, Mark; Edwards, Susan; Nickell, Leslie
Abstract Background Sharing information about learners during training is seen as an important component supporting learner progression and relevant to patient safety. Shared information may cover topics from accommodation requirements to unprofessional behavior. The purpose of this study was to determine the views of key stakeholders on a proposed national information sharing process during the transition from undergraduate to postgraduate medical education in Canada, termed the Learner Education Handover (LEH). Method Key stakeholder groups including medical students, resident physicians, residency program directors, medical regulatory authority representatives, undergraduate medical education deans, student affairs leaders, postgraduate medical education deans participated in focus groups conducted via teleconference. Data were transcribed and coded independently by two coders, then analyzed for themes informed by principles of constructivist grounded theory. Results Sixty participants (33 males and 27 females) from 16 focus groups representing key stakeholder groups participated. Most recognized value in a national LEH that would facilitate a smooth learner transition from medical school to residency. Potential risks and benefits of the LEH were identified. Themes significant to the content, process and format of the LEH also emerged. Guiding principles of the LEH process were determined to include that it be learner-centered while supporting patient safety, resident wellness and professional behavior. The learner and representatives from their undergraduate medical education environment would each contribute to the LEH. Conclusions The LEH must advocate for the learner with respect for learner privacy, while promoting professionalism, patient safety and learner wellness.
Open Access
Paving a Path for Pediatric Hospital Medicine in Canada: Defining National Competencies Using Delphi Methodology
(2024-07-01) Vetere, Peter Joseph; Cooke, Suzette; Beran, Tanya; Millar, Kelly; Kassam, Aliya; Lorenzetti, Diane
Background: The field of Pediatric Hospital Medicine (PHM) has grown considerably in North America over the last three decades in response to the increasing complexity and acuity of the pediatric in-patient population. Although PHM fellowship programs have been developed in Canada, no national competencies framework currently exists to guide curricular content. This study aimed to identify competencies required for the practice of PHM in Canada. Methods: Using Delphi methodology, a national panel of experts in PHM iteratively rated potential competencies, on a 5-point scale, to determine their priority for inclusion. Responses were analyzed after each round. Competencies that were assigned a rating of three or less by 80% or more of panelists were removed from subsequent rounds. The remaining competencies were re-sent to panelists for further ratings until consensus was reached, defined as Cronbach’s α ≥0.95 and after a minimum of two survey rounds. At the conclusion of the Delphi process, competencies where 80% or more of the panelists assigned a rating or four or higher were included. Results: Two rounds of the Delphi process were required to reach consensus. Thirty-five participants completed both survey rounds. The participants represented 13 Canadian pediatric tertiary care centers and five community hospitals. Of 176 initial competencies, 109 PHM competencies achieved consensus. Conclusion: This is the first study to define national competencies for PHM in Canada. The competencies identified provide a framework for PHM fellowship program directors to shape local curricula. The results may also be used to inform the development of comprehensive national PHM fellowship curricula.
Open Access
Quality Improvement Training in Medical Education
(2020-05-06) Brown, Allison J.; Kassam, Aliya; Hecker, Kent; Sharma, Nishan; McCaughey, Deirdre
Problem: Training healthcare professionals in Quality Improvement (QI) has been highlighted as a potential strategy to reduce the prevalence of error and harm in healthcare. As a result, various health professions education programs have integrated QI into the competency frameworks that inform the core curriculum, including those used in the training of medical doctors. However, QI has been integrated, emphasized, and taught to medical trainees (i.e., medical students and residents) in a variety of ways across countries, programs, and stages of training. As contemporary medical education increasingly adapts outcomes-oriented, competency-based models of training, medical trainees may be required to demonstrate competency in QI during their training. Method of Study: This research considered how best to train future physicians in QI during their core medical training. First, methods for examining complex social phenomena were analyzed through a thought experiment exploring the methodological intersections of realist inquiry (RI) with structural equation modelling (SEM). Next, a realist synthesis examined the literature for teaching QI at the undergraduate and postgraduate levels of medical training. This generated an explanatory program theory that highlighted common associations between contexts, mechanisms, and outcomes of QI training in undergraduate and postgraduate medical training. Finally, a collective case study of four postgraduate programs at the University of Calgary examined how residents learned about QI during their training using four data sources. The combinations of RI and SEM were re-visited and operationalized as the program theory informed the specification of structural models using the quantitative data in the case study. This resulted in a novel, realist-informed SEM that statistically modelled elements associated with resident self-assessments of QI knowledge, skills, and attitudes. Conclusions: Explicit training in QI might ensure that all physicians enter practice equipped with the fundamental knowledge and skills to not only recognize areas for improvement, but implement sustainable solutions that improve the quality and safety of care. The conscientious design of QI curricula in the core medical curriculum that considers integrating features commonly associated with successful QI curricula may be beneficial to optimize training in this domain, and ultimately, catalyze the development of QI competencies amongst future physicians.
Open Access
Reducing the stigma of mental illness in undergraduate medical education: a randomized controlled trial
(BioMed Central, 2013-10-24) Papish, Andriyka; Kassam, Aliya; Modgill, Geeta; Vaz, Gina; Zanussi, Lauren; Patten, Scott