Exceptional 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).

Cervical ripening and induction of labour are common topics of discussion in both family medicine and obstetric offices. Patients requiring counselling on induction are faced with new concepts and terms that can be overwhelming. In addition, delivering a significant amount of information in a short period of time proves to be challenging for healthcare practitioners. An understanding of the indications for induction of labour are important for patient education and understanding. Cervical ripening methods include both mechanical (foley catheter) and hormonal (PGE1/PGE2 analogs), whereas labour contractions can be induced with a variety of strategies including prostaglandins, amniotomy and oxytocin. Clinical education tools exist in both paper and online formats to help supplement the counselling provided by care practitioners. The goal of this project is to create a brief, easily digestible 2-page patient education tool to help supplement the discussions that occur in office settings. The target audience is pregnant patients and their chosen supports. Canva design tool was used to make a visually appealing and straight forward document for education. Patient understanding and comfort is top priority in obstetrical care, and having quick access to evidence based information will decrease anxiety around the induction process.

Background: Ultrasonography is becoming a necessary skill in a variety of medical settings and medical students would benefit from its addition to the undergraduate medical education curriculum. The aim of this study was to develop a point-of-care ultrasound (POCUS) curricular session for longitudinal integrated clerkship (LIC) students in Nova Scotia, Canada. 

Methods: A needs assessment and literature review were completed to identify objectives for the curricular session. Four students from Dalhousie University completing their LIC in Cape Breton, Nova Scotia were included in the study. A pre- and post-session questionnaire was distributed to learners to gauge the utility of the curricular session. 

Results: The needs assessment and literature review identified a need for hand-on exposure to cardiac and lung POCUS in addition to conducting E-FAST exams. There was a 33 % increase in correct responses in the post-session questionnaire compared to the pre-session questionnaire and all students reported that their skills in ultrasound had slightly or greatly improved after the session. 

Interpretation: This was an effective curricular session for LIC learners. Incorporating an ultrasound curriculum for LIC learners would benefit their future practice and this model could be used in other centres where with LIC learners. While this study has a small sample size, there may be benefit to expanding this curricular session to LIC sites across Nova Scotia and other maritime provinces.

In a changing climate with rising temperatures, the frequency of extreme weather events, notably heat waves, is predicted to continue to increase. This upward trajectory of heat waves inevitably forecasts an increase in heat-related illnesses including heat stroke and heat exhaustion.

To shed light on these trends, this project consists of the development of a simulation-based medical educational tool on heat-related illness. Grounded in the literature, this tool will educate learners on the approach to heat stroke in the emergency department (ED) and encourage further debriefing on the complications and risk factors associated with heat illness. The implementation of this simulation into medical education will encourage primary care providers (PCPs) to educate and prepare at-risk patients, in hopes of reducing the incidence of heat-related illness and subsequent ED presentations for these conditions. Ultimately, this project aims to serve as a beacon of awareness, highlighting the pressing need for proactive measures in mitigating the impact of heat-related illnesses amidst a changing climate.

Background: Down syndrome is the most common cause of intellectual disability in developed countries and is associated with several distinct physical features as well as health concerns such as congenital heart disease, gastrointestinal issues, sleep issues, thyroid problems, and vision and hearing problems. Primary care providers are expected to provide comprehensive care to their Down Syndrome patients despite limited training specific to caring for this population. There are guidelines available regarding regular screening for people with Down syndrome; however, not all are up to date nor easily found and integrated into a providers’ electronic medical record. The objective of this project is to review the recommendations for screening in adults with Down syndrome and design a tool for family physicians to use during the Canadian Consensus Guideline recommended periodic health checks for their patients with Down syndrome to ensure their unique health needs are being met.

Methods: Eighteen articles were reviewed, and screening recommendations were synthesized into an evidence based tool for primary care providers to use during periodic health checks. The tool is a 5-page form that can be integrated into a physicians’ electronic medical record and provided to the patient for tracking completed screening.

Results: Experts recommend annual screening for vision and hearing disorders, atlantoaxial instability, cardiac abnormalities, obesity, gastrointestinal disorders, dementia, and testicular and breast cancer. They also recommend regular assessment of dental hygiene, skin condition, thyroid function, autism, mental health concerns, sleep quality, and symptoms of menopause. Lastly, regular screening for diabetes, cardiovascular risk factors and cervical cancer are recommended as well as consideration of screening for osteoporosis.

Conclusion: This tool (Appendix I) was designed to help physicians facilitate regular health checks to increase health outcomes as recommended by the Canadian Consensus Guidelines. The tool provides an easy check list for physicians to complete with their patients with Down syndrome with the goal of improving the long-term health outcomes of people with Down syndrome.

Background: Simulation is an effective tool for teaching technical procedural skills to medical residents, yet barriers such as limited space, faculty availability, and conflicting schedules can hinder its use in family medicine residency. To address these barriers, we developed a central line insertion task trainer kit designed to provide resources and guidance for residents to independently simulate ultrasound-guided internal jugular central venous catheterization. The objective of this tool is to allow family medicine residents to engage in self-regulated procedural simulations, enhancing their skills and confidence in performing central line insertions.

Methods: The development of this medical education tool was informed by Experiential Learning Theory, along with the principles of self-regulated learning and spaced repetition learning. 

Results: The central line insertion task trainer kit is available in the Colchester East Hants Health Center simulation lab. A dedicated website outlines how to access the simulation space and required equipment locations. The website also provides essential resources such as a procedural video, ultrasound guides, written procedural manual, images, a self-testing checklist, and references. These resources integrate self-regulated learning and spaced repetition learning to optimize learner experience.

Interpretation: We developed a medical education tool to facilitate independent resident simulation of ultrasound-guided central line insertion. Future research opportunities include comparing self-regulated versus facilitator-led procedural simulation, exploring optimal intervals 

Background: The incorporation of high fidelity simulation training in medical education has been growing in popularity in Canadian medical undergraduate programs. It has been shown to be well received by medical students and improves outcomes on exams as well as communication, collaboration, professionalism, and leadership skills, all of which are part of the CanMEDS framework. In Cape Breton, there are currently 4-5 Longitudinal Integrated Clerkship (LIC) students from Dalhousie Medical school that rotate through Cape Breton Regional Hospital during their third year. They currently only have one half day of simulation training dedicated to their level of training throughout the year. As a result, there is a need to expand the LIC simulation case library and increase the number of simulation sessions. The objective of this project was to expand on the current simulation curriculum for medical students in Cape Breton which includes the preparation of pre-simulation reading material and development of additional simulation cases.

Methods: The development of cases was informed by feedback from medical students and evidence from literature review. Each case developed had objectives that correspond to ones outlined by Dalhousie University Faculty of Medicine for clerkship students. Feedback from LIC students was collected from a survey which was released to graduating and incoming LIC students in September 2024. The survey gathers data on prior simulation experiences and cases that the participants have been exposed to, their satisfaction with pre-reading material, and qualitative feedback on their simulation experience and what they hope to see in the curriculum in the future. Qualitative responses were reviewed and categorized into themes. A literature

search was conducted prior to the design of new simulation cases in order to incorporate recent evidence.

Results: Six new simulation case scenarios were created for the case library including: acute pulmonary edema (congestive heart failure), urosepsis/shock, gastrointestinal bleeding from peptic ulcer disease, respiratory failure from pneumonia (with escalation to intubation), small bowel obstruction, and pediatric meningitis.

Conclusion: With the addition of the six new simulation cases, there are now a total of nine scenarios in the LIC case library. The next phase of this project involves the implementation of these new cases for the current cohort of LIC students and to gather their feedback to identify potential areas for improvement