Resident Projects

Clinical Education Tool
This involves developing a tool or resource useful for the education of physicians, other health care workers, patients or the public. The educational tool needs to be accompanied by a description of how the topic was selected, a literature review and the reason for the need of the tool.

Literature Appraisal
This involves a detailed review of the literature on a specific topic pertinent to Family Medicine.

Medical Education Tool
This involves developing a tool or resource useful for undergraduate or postgraduate medical education, with accompanied reason for tool and literature review to support the tool.

Medical/Health Humanities
This stream requires residents to ask an important question relevant to Family Medicine. The resident will conduct a review of the evidence on the topic and the final project may include an arts-based piece, or use of art in the scholarly project, both clinical and humanities. This may take the form of writing, visual art, performance (e.g. dance, theatre), production or a musical composition. While the health humanities may be considered a category of its own, it could also be a component of any of the above categories.

Paper/Essay
This involves an extensive treatise on a topic of importance to Family Medicine. Topics can also relate to a broad range of pertinent issues such as the history of medicine, medical philosophy, medical education, politics, etc.

Practice Quality Improvement Project
This involves identifying a practice-based question (aim statement), constructing a method for measuring change, developing that change by finding evidence-based guidelines/recommendations to guide the approach to clinical care with respect to the question, reporting the results and recommendations to target population, along with reassessments after change has been initiated (PDSA cycle; Plan, Do, Study, Act).

Research
This involves the posing of a question, reviewing the literature, selecting the methods needed to answer the research question, collecting original data, conducting the data analysis, and reporting the findings. Most research projects require approval by the local Research Ethics Board (REB).

Background
The aims of this study were to investigate the impact of orientation on residents, and utilize Gifford et al’s orientation template to create a rotation orientation handbook (Appendix B) for the Dalhousie Family Medicine Residency Sydney site.

Methods
This was a mixed methods research project. Current medical residents from the Sydney and Inverness Dalhousie Family Medicine sites were invited to participate in a survey to provide feedback on the orientation process and on specific rotations. All rotation lead preceptors were invited to meet individually with the principal investigator to provide feedback on the handbook. The handbook was created based on the Gifford et al. template, feedback provided by staff and residents, and prior rotation information.

Results
The degree of orientation information affected residents’ well-being (92%), academic performance (75%) and ability to provide patient care (57%). 64.2% of residents were generally dissatisfied (57.1% dissatisfied and 7.1% very dissatisfied) with prior orientation information. 92.9% found the Gifford et al template to be generally helpful (78.6% helpful and 14.3% very helpful).

Interpretation
Clinical learning environment orientation impacts residents’ academic performance, patient care and well-being. Gifford et al’s template was seen as a helpful tool in creating an orientation handbook for the Cape Breton Dalhousie Family Medicine programs.

Personal Reflection
Throughout my medical and residency training, I have found that the rotations that provided a thorough orientation and addressed my learning goals set me up for success. I would find myself experiencing whiplash when rotating through various specialties as some provided no orientation while others set aside time to address pertinent information and expectations. I hope that this project highlights the need for innovative orientation practices in clinical learning environments to benefit learners, teachers, and patients. This is especially important at the Cape Breton Regional Hospital, where a new medical school and hospital are being built.

There is concern for the longevity of this project, especially as rotations continually change, however my hope is that each lead resident divides the sections amongst the residents and updates them on a yearly basis. I hope that this project is a jumping point for future work in Dalhousie medical education.

Background
Despite its numerous documented benefits, advance care planning has only been completed by a minority of Canadians. Although provincial and national resources on the topic exist, the problem remains that the public has limited knowledge of the purpose or process of engaging in advance care planning.

Methods
A review of local resources revealed that there was no short, easily mailed resource to introduce the concept of advance care planning. A pamphlet was designed as a concise manner to outline the key components of advance care planning in a visually appealing and easily comprehensible manner. The pamphlet was reviewed by the provincial leadership team. This educational tool could then be distributed across the province in virtual and physical format to patients, regardless of
whether they have a primary care provider.

Results
The pamphlet was designed in both English and in French. It was approved by Health PEI. Distribution networks have been established to target residents of Prince Edward Island ages 50 and above.

Interpretation
The pamphlet serves to introduce and remind patients of the importance of advance care planning for preserving their autonomy when they are unable to speak for themselves. It does not rely on an already overburdened medical system to implement. Future projects should consider other interventions and their impact for improving public uptake of advance care planning.

Background
There are effective and ineffective approaches to learning. In medical education, appropriate coverage of evidence-based learning strategies is lacking. Undergraduate medical learners could benefit from having foundational knowledge on learning strategies.

Methods
Review of the literature was used to help develop appropriate objectives and resources for the science of learning targeting early undergraduate medical students. Local curriculum was reviewed for current content and optimal placement of this material.

Results
Dalhousie’s undergraduate medical Professional Competencies curriculum was identified as an appropriate target for implementing a medical education tool on effective learning strategies. Both a didactic lecture (video recording) and a case-based tutorial module (text document) were developed in keeping with the current curriculum format.

Background:
This study aims to assess the impact of monthly Resident Ice Cream Rounds on the wellbeing and program satisfaction of residents in the Dalhousie Family Medicine residency programs in Cape Breton, NS.

Methods:
The study adopted a pre- and post-intervention design, enrolling all 21 Family Medicine residents on Cape Breton Island. Assessments were conducted utilizing the Physician Wellbeing Index and program-specific questions to assess satisfaction. The intervention involved five monthly Resident Ice Cream Round sessions, voluntary gatherings for peer support, debriefing, and fostering connections. Data analysis employed unpaired t-tests, with statistical significance at a p-value of 0.05.

Results:
Over the study period, the average wellbeing score increased from 3.9 / 7 (s.d. 1.94, 95% CI 2.99 - 4.81), to 4.1 / 7 (s.d. 1.44, 95% CI 3.30 - 4.83, p-value 0.782). First-year residents scored significantly higher than second-year residents pre-intervention, 4.9 vs. 2.9 / 7 (p-value 0.017) while post-intervention the scores were no longer significantly different, 3.9 vs. 4.3 / 7 (p-value 0.601). The average program satisfaction score for all residents was 3.2 / 4 (s.d. 1.14, 95% CI 2.62 - 3.68) which increased to 3.4 / 4 (s.d. 0.96, 95% CI 2.92 - 3.95, p-value 0.426) post-intervention. First-year residents consistently reported higher satisfaction than second-year residents (pre-intervention p-value 0.076, post-intervention p-value 0.112).

Interpretation:
While the results suggest a positive impact of Resident Ice Cream Rounds on overall wellbeing and program satisfaction, the study’s short duration and small sample size limit generalizability. The differing trends between first- and second-year residents warrant further exploration. Despite study limitations, the low overall wellbeing scores highlight the need for ongoing wellness monitoring and support.

As Canada becomes more linguistically diverse, the skills required to work with limited English proficiency (LEP) patients and interpreters become increasingly valuable to family medicine. This project proposes a medical education tool for third-year medical students to start developing these skills early. It incorporates evidence from current literature about existing medical education tools, the impact of simulation experiences on learner empathy, and best practice guidelines for working with interpreters. “Working with Interpreters: A Medical Education Tool for Cross-Cultural Communication” is an Objective Structure Clinical Education (OSCE)-style simulation with a preceding introductory module and post-simulation debrief.

The introductory module follows the flipped classroom model to review recommendations for working with interpreters and to prime students to reflect on the impact that language barriers can have on LEP patients. The simulation session places medical students in the LEP patient role by using the Pocket Talker device to simulate a communication barrier, and asks students to rotate through the roles of patient, interpreter, and interviewer. Suggested methods for evaluation of this tool include the Jefferson Scale of Physician Empathy (JSE) and a skills checklist to evaluate students’ competency working with interpreters.