Welcome to the Canadian Medical Education Journal (CMEJ) that publishes scientific and scholarly work in medical education. The CMEJ is indexed in Medline, distributed on our website and through Erudit, and tracked by Google Scholar. For current metrics, especially annual citations and i10 and h-index, see About the Journal, Journal Metrics. Online ISSN: 1923-1202
Submission of an original manuscript to the Canadian Medical Education Journal will be taken to mean that it represents original work not previously published, that it is not being considered elsewhere for publication. If accepted for publication, it will be published online and it will not be published elsewhere in the same form, for commercial purposes, in any language, without the consent of the publisher. Authors who publish in the Canadian Medical Education Journal agree to release their articles under the Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 Canada Licence. This licence allows anyone to copy and distribute the article for non-commercial purposes provided that appropriate attribution is given. For details of the rights an author grants users of their work, please see the licence summary and the full licence.
Rethinking Social accountability in Health
Copyright (c) 2025 Ahmed Maherzi, Saja Farhat https://creativecommons.org/licenses/by-nc-nd/4.0
Transforming medical education leadership through a Pedagogy of Peace
Background: Leadership in Canadian medical education continues to be shaped by hierarchical, Western-derived paradigms that inadequately address systemic inequities, reconciliation, and the Calls to Action of the Truth and Reconciliation Commission. There is a pressing need for leadership models that reflect Indigenous worldviews and respond to the challenges of medical education in the twenty-first century. Purpose: This paper introduces the Pedagogy of Peace—a theoretical framework grounded in Haudenosaunee and Anishinaabe teachings—as a novel conceptual model for medical education leadership. While originally developed as a curricular framework, its teachings hold important implications for re-imagining how leadership is understood, practiced, and cultivated in academic medicine. Framework: The Pedagogy of Peace is structured around four interrelated dimensions: knowing (self-in-relation), understanding (nurturing a good mind), doing (strengths-based action), and honouring (peace-focused solutions). Together, these principles articulate a holistic and relational approach to leadership that emphasizes positionality, reciprocity, integrity, and balance across physical, mental, emotional, and spiritual domains. Implications: By positioning the Pedagogy of Peace alongside existing leadership competencies (e.g., CanMEDS, AFMC frameworks), this paper advances a vision of leadership that is relational, peace-focused, and strengths-based. This theoretical contribution suggests pathways for medical schools to engage meaningfully with reconciliation, diversify leadership practices, and embed Indigenous epistemologies into institutional governance. Conclusion: The Pedagogy of Peace offers a theoretically grounded, Indigenous-informed model for leadership in medical education. By shifting how leadership is conceptualized, it opens new possibilities for cultivating leaders who can guide Canadian medical education toward equity, sustainability, and reconciliation.
Reviews, Theoretical Papers, and Meta-Analyses
Copyright (c) 2025 Jamaica Cass, Lindsay Brant https://creativecommons.org/licenses/by-nc-nd/4.0
A learner-led conference to enhance interdisciplinary social accountability education in healthcare: participant perspectives on engagement and educational experience
Implication Statement We developed the Interdisciplinary Social Accountability Conference in Healthcare to address educational gaps and empower learners to advocate for healthcare needs. This conference aimed to strengthen social accountability competencies in students through three areas: (1) a learner-led planning model that promotes initiative-taking and leadership, (2) interactive sessions on locally relevant topics, and (3) a student research showcase to foster interdisciplinary dialogue. Survey findings demonstrated high engagement and positive experiences with cross-disciplinary networking. We encourage institutions to adopt similar learner-led initiatives, facilitating students to take an active role in shaping social accountability education and supporting attendees in gaining practical skills through workshops on locally-relevant issues. These initiatives will equip learners with the collaborative mindset and skills required to improve health outcomes in their communities.
Copyright (c) 2025 Meera Chopra, Rebecca Wong, Reeya Kothari, Yevin Cha, Mohammad Jay https://creativecommons.org/licenses/by-nc-nd/4.0
Affirming the physician assistant role: moving beyond hierarchical assumptions in medical education
Copyright (c) 2026 Steven Piotrowski https://creativecommons.org/licenses/by-nc-nd/4.0
The rural emergency department: an overlooked learning opportunity for pre-clerkship medical students
Copyright (c) 2025 Benjamin Hewins, Joe Gillis https://creativecommons.org/licenses/by-nc-nd/4.0
Implementing a Choosing Wisely Certificate in resource stewardship
Implication Statement The Choosing Wisely Resource Stewardship Certificate demonstrates that students can meaningfully develop practical resource stewardship and evidence-informed decision-making skills through a virtual, interprofessional and case-based curriculum. We found that combining student-led discussions with guidance from diverse healthcare professionals helped learners connect resource stewardship theory to real-world clinical decisions and strengthen patient-centred care practices. The program’s virtual format allows institutions to implement flexible, effective content on resource stewardship to learners, addressing a key curriculum gap. Expanding the Choosing Wisely Resource Stewardship Certificate to include recorded sessions or asynchronous modules will further expand its impact.
Copyright (c) 2026 Chloe Blackman, Marissa MacInnis, Jakalee Myette, Joshua Collins, Dara Liu https://creativecommons.org/licenses/by-nc-nd/4.0
Evaluating surgical airway education intervention for medical students
Implication Statement A targeted surgical airway session with interactive lecture and teaching is useful in undergraduate medical education settings with limited prior critical care and otolaryngology teaching. This session allows students to learn basic surgical airway anatomy, devices, and clinical scenarios. It requires minimal personnel, utilizes online lecture resources, and uses cost-effective reusable products obtained largely from expired hospital inventory. The session aims to enhance clinical competency for learners in clerkship when caring for surgical airway patients. The participants in the session should be able to understand the anatomy of surgical airways, understand the steps of performing an emergency surgical airway, and assess and manage surgical airways.
Copyright (c) 2026 Janjulee Ellis, Timothy Phillips https://creativecommons.org/licenses/by-nc-nd/4.0
Quantifying the “glass ceiling”: the versatility of the Gini Coefficient in medical education
Copyright (c) 2025 Carlos Acosta-Batista https://creativecommons.org/licenses/by-nc-nd/4.0
Weaving our narrative: perspectives from hijab-wearing learners in the operating room
Background: Hijab-wearing healthcare practitioners and learners endorse that hijab is important to their identity. However, in the operating room (OR), they have reported experiencing negative emotions and lacking personal protective equipment (PPE) for their hijab. Guidelines for PPE for hijabs are institution-specific, and uptake can be inconsistent. As Canadian medical schools diversify, hijab-wearing learners’ (HWLs) unique barriers to OR participation and surgical career planning become increasingly pressing for establishing equity and inclusion in surgical specialties. Our study aims to characterize OR experiences of medical students and residents who trained in Canadian ORs, impacts on career planning, and potential solutions for perceived barriers to participation in the OR and surgical career planning. Methods: We conducted semi-structured interviews with ten hijab-wearing medical students and residents who trained in Kingston Health Sciences Centre (KHSC) ORs. We analyzed the data using an essentialist, experiential, inductive approach where we generated codes and subsequently themes based on the participants’ descriptions of OR experiences. We used Reflexive Thematic Analysis (TA) to consider the surface qualities and the hidden or inferred meanings of participants’ words based on our team members’ subjectivity as minoritized medical learners. Results: We identified four themes: (1) The lack of OR attire standardization indicated a lack of institutional commitment to inclusivity; (2) There was conflict between identities as medical students and hijab-wearing women, with pressure to fit in by uncomfortably modifying the hijab; (3) Negative experiences related to wearing the hijab in the OR deterred learners from pursuing surgical careers; and (4) Solutions included provision of disposable and reusable hijabs and improved cultural education for OR staff. An infographic on PPE for hijabs should include definitions of hijab and be widely distributed. Conclusions: Hijab-wearing learners face barriers to participating in the OR. Addressing these challenges requires accessible PPE for hijabs and widespread educational resources to support these learners.
Copyright (c) 2026 Jasmine Ng, Henna Salim, Jaskarn Dhaliwal, Ayesha Shakeel, Suffia Malik, Eleftheria Laios, Nancy Dalgarno, Wiley Chung https://creativecommons.org/licenses/by-nc-nd/4.0
A patient safety escape room simulation for internal medicine learners, based on hazards identified in local incident reports
Implication Statement Physicians at our centre have enthusiastically supported a Quality Improvement initiative aimed at achieving a high proportion of physician-submitted incident reports. We uncovered some serious safety incidents and recurring safety themes based on review of these physician-submitted reports and decided to embed these local data in a realistic simulation scenario. Our innovative escape room format for the simulation was an engaging and effective way to teach medical learners about patient safety concepts and how to recognize and respond to safety incidents. We encourage colleagues at other centres to try this strategy for delivering patient safety education!
Copyright (c) 2025 Chad Kimmitt, Jennifer Ngo, Jolene Haws, Alejandra Boscan https://creativecommons.org/licenses/by-nc-nd/4.0
Quantifying delay: modeling the impact of timeliness on narrative feedback for Entrustable Professional Activity assessments in internal medicine training using artificial intelligence
Introduction: In competency-based medical education (CBME), specifically entrustable professional activities (EPAs), timely feedback is essential because delays can distort assessor recall and performance documentation. Prior work links longer timelag to reduced feedback quality, but its effects across thresholds and outcomes remain unclear. This study examines these relationships using statistical analyses, incorporating artificial intelligence (AI) tools to standardize extraction of narrative feedback metrics. Methods: We performed a retrospective cross-sectional study of internal medicine resident EPA assessments, each including two narrative sections (‘General Feedback,’ ‘Next Steps’), entrustment scores (0-4), and completion dates. Pretrained transformer-based models estimated sentiment positivity (0-1) and Quality of Assessment for Learning (QuAL) scores (0-5). We manually refined outputs, subsequently fitting datapoints for ordinal logistic, binary logistic, and linear regression. Exploratory analyses identified timelag thresholds linked to changes in feedback metrics. Results: 301 assessors evaluated 1,147 EPAs for 111 residents, with a 7-day median timelag (IQR: 21). Longer timelag was associated with lower QuAL (OR=0.997/day; p < 0.05), fewer words (-0.07words/day; p<0.05), and higher odds of empty comments (OR=1.003/day; p < 0.01). Effects emerged sequentially: transient increases in entrustment around seven days, followed by dose-dependent declines in quality from 14 days and reductions in feedback length thereafter. Beyond 100 days, comments became uniformly brief with higher positivity and entrustment, suggesting reduced specificity and recall. Conclusion: Delayed completion meaningfully affects feedback quality, completeness, and tone. Findings support 7-14 day completion targets and flagging EPA assessments beyond 100 days as unreliable. AI-assisted extraction of narrative metrics may support standardized, scalable EPA assessment analysis in CBME.
Copyright (c) 2026 Enoch Yu, Haozhong Tian, Farida Mohamad, Karen Schultz, Laura McEwen, Stephen Gauthier, Heather Braund, Nicholas Cofie, Nancy Dalgarno, Adam Szulewski, Farhana Zulkernine, Benjamin YM Kwan https://creativecommons.org/licenses/by-nc-nd/4.0
Re-educating the surgical culture, is it possible?
Copyright (c) 2025 Imogen Sharkey Ochoa, Michael Okorie https://creativecommons.org/licenses/by-nc-nd/4.0
Improving undergraduate medical training on intellectual and developmental disabilities through clinical skills sessions
Implication Statement At the University of Toronto, in collaboration with Special Olympics Ontario (SOO), we integrated individuals with intellectual and developmental disabilities (IDD) into first-year clinical skills sessions through the existing volunteer patient program. Students reported increased confidence and communication skills, while volunteers felt respected and empowered. This initiative addresses a critical training gap by offering early, authentic exposure to a population often marginalized in healthcare. Other institutions can adopt this model to foster more well-rounded, inclusive medical trainees. Embedding individuals with IDD into clinical education improves learner preparedness and promotes equity, empathy, and patient-centered care across diverse healthcare settings.
Copyright (c) 2025 Maizy Ann MacDonald, Saim Imran, Lily Blyth, Joshua Andrusiak, Chris Gilchrist, Grant Chen https://creativecommons.org/licenses/by-nc-nd/4.0
Arts to change hearts: lessons learned from six years of arts-based cultural humility workshops with healthcare professionals in northern British Columbia
Introduction: Despite proliferation of concepts like anti-racism, allyship, and Indigenous cultural competency, cultural safety, and cultural humility in Canadian healthcare environments, including medical education, few learning opportunities about these practices attend to ways healthcare professionals and learners feel or orient emotionally to these concepts. Our research examined arts-based, anti-colonial, cultural humility training (rooted in Indigenous ways of knowing and being) to build empathetic sociocultural attunement, awareness about anti-Indigenous racism, and practical skills for cultivating culturally safer healthcare environments. Methods: Along with autoethnographic contemplations from 24+ Indigenous and non-Indigenous workshop facilitators, we collected and analyzed 82 narrative evaluations from 29 workshops with over 600 practicing healthcare professionals. Conducted between 2019 and 2025, these workshops provided cultural safety training anchored in reflective practices informed by art, storytelling, and Indigenous ways of knowing and being. Results: Facilitator reflections and participant evaluations validated that: 1) anti-colonial health humanities hold important and undertheorized potentials in combatting anti-Indigenous racism in healthcare, and 2) friendships and place-based relationships of facilitators inform outcomes of cultural humility and safety training. Conclusion: Developing new arts-based tools and practices that speak to the heart, account for people’s emotionality, and that incorporate Indigenous ways of knowing and being is vital to anyone, especially those in medical education, working to cultivate culturally safer healthcare environments. Strategies developed in our work may inform geographically specific, emotionally attuned, relationship-based, creative, adaptive, and flexible ways to combat anti-Indigenous racism in healthcare.
Copyright (c) 2026 Sarah de Leeuw, Kelsey Chamberlin, Marion Erickson, Lisa Striegler, Kung Jaadee Kennedy, Janet Ocloo, Will Georgelin, Viviane Josewski, X'staam Hana’ax Nicole Halbauer, Laura McNab-Coombs, Darian Goldin-Stahl https://creativecommons.org/licenses/by-nc-nd/4.0
"See it, Address it, Solve it” framework to support understanding and facilitate development of adaptive expertise in training and practice
Background: Adaptive expertise is crucial in generalist areas of medicine, where practitioners must navigate both routine and novel clinical situations daily. While adaptive expertise has been well described in the literature, there is a gap when it comes to concrete guidance for teaching and assessing adaptive expertise. This study aims to develop an evidence-guided model to support clinical educators and learners with understanding adaptive expertise so that it can be taught and assessed in the context of clinical training. Methods: The research team used a three-stage process to develop a model of adaptive expertise. In Stage 1, a panel of experts created a concept map to describe elements of adaptive expertise in the context of the generalist clinical workplace, followed by a scoping review of the adaptive expertise literature in Stage 2. In Stage 3, the panel integrated the original concept map with the results of the scoping review to create a model of adaptive expertise in the context of the generalist clinical workplace using consensus development panel methodology. Results: The “See it, Address it, Solve it” model illustrates how generalist practitioners move through three iterative phases: identifying gaps in knowledge or care (“See it”), engaging in innovative and context-specific problem-solving (“Address it”), and implementing and refining solutions using clinical judgement (“Solve it”). Conclusions: The “See it, Address it, Solve it” model offers a practical resource to support both understanding of adaptive expertise in the clinical workplace, and help educators identify elements of adaptive expertise to facilitate teaching and assessment.
Copyright (c) 2026 Karen Schultz, Shelley Ross, Kathy Lawrence, Nathan Cupido, Theresa van der Goes, Cherie Bethune, Alison Baker, Henry Yu-Hin Sin https://creativecommons.org/licenses/by-nc-nd/4.0
Persistent and clinically significant impostor phenomenon in postgraduate medical trainees
Background: Impostor phenomenon is common among medical trainees, affecting wellness and professional development. How it varies across the academic year remains unclear. Methods: This was a prospective repeated measures study of postgraduate medical trainees at the University of Toronto conducted between January 4, 2022 - January 30, 2024. Impostor phenomenon was measured using the Clance Impostor Phenomenon Scale (CIPS). CIPS scores of 61-80 reflect clinically significant impostor phenomenon, while CIPS scores greater than 80 reflect severe impostor phenomenon. In this study, we considered 20-point differences clinically meaningful. Participants completed the CIPS every 12 weeks for 52 weeks. Mixed model regression was used to test the association between CIPS score and time of year. Results: 110 participants (14.8% response rate) with a total of 406 CIPS scores were included in the analysis. Participants were mostly between 25-30 years old (72.7%), internal medicine trainees (45.5%), and in postgraduate year 1 or 2 (55.5%). The median CIPS score at the beginning of the academic year was 68 (IQR=17, Q1=60, Q3=77) and clinically significant CIPS scores were observed throughout the academic year with 78.6% of all CIPS scores > 60. Higher CIPS scores were documented in January, February, and May compared to the beginning of the academic year in July, but not in clinically meaningful magnitudes (January: β = 4.69, CI: 0.82, 8.55; p=0.018, February: β = 4.53, CI: 1.44, 7.63; p=0.004, May: β = 4.73, CI: 1.47, 7.99; p=0.005). Conclusion: Postgraduate medical trainees demonstrate persistent and clinically significant impostor phenomenon throughout the academic year. Supports to address impostor phenomenon should be consistently available throughout the year.
Copyright (c) 2026 Katherine M Sawicka, Dilshan Pieris , Hartley Jafine, Sharon Ng, Sabrina Chan, Esther Bui https://creativecommons.org/licenses/by-nc-nd/4.0
Rethinking how we educate our future physicians: the Queen’s-Lakeridge Health Medical Degree Family Medicine program: an innovative approach to medical education
Canadian healthcare, particularly family medicine, is experiencing a capacity crisis. To address this challenge, systems-level reform is required. Specific to medical education, there is an urgency for educational institutions to prepare the next generation of physicians to meet Canadians’ healthcare needs. This will require not only the expansion of the number of physicians trained, but consideration of the specialty mix and types of practice those physicians are prepared to undertake. Building on an existing collaborative partnership, the Queen’s-Lakeridge Health Doctor of Medicine - Family Medicine Program (QLH MD FM) launched in 2023. This initiative is designed to address the needs of Canadians through purposeful recruitment and the development of learners interested in, and committed to, careers in family medicine. This paper shares the experiences of the QLH MD FM team, and the steps taken in conceptualizing and implementing this educational initiative. A program description is provided, focusing on the six program pillars: (a) admissions, (b) curriculum, (c) faculty and staff engagement, (d) community engagement, (e) infrastructure and supports, and (f) learner experience. The QLH MD FM Program is an innovative approach to medical education that emphasizes an authentic focus on addressing the complex healthcare needs of individuals and their communities.
Copyright (c) 2025 Eugenia Piliotis, Jennifer Turnnidge, Cailie S McGuire, Nancy Dalgarno, Anthony J Sanfilippo, Arun Balasubramaniam, Michelle Gibson, Michael Green, Shayna Watson, Renee Fitzpatrick, Randy S Wax, Heidi McHattie, Nadia Ismiil, Ruzica Jokic, Natasha Aziz, Anthony Stone, Allan Grill, Richard van Wylick, Denise Stockley, Jane Philpott https://creativecommons.org/licenses/by-nc-nd/4.0
Bridging residency and practice: a final-year pediatric curriculum
Implication Statement The start of independent clinical practice is an exciting—but often daunting—milestone for newly minted physicians. To better support practice readiness, our postgraduate training program created a learner-centered, longitudinal transition-to-practice curriculum for final-year residents. The curriculum covers a spectrum of key early career topics, which are delivered through diverse educational formats. While nothing can completely prepare new practitioners for their first months of independent practice, we hope our approach offers valuable insights for other centres helping trainees to navigate this professional threshold with greater confidence.
Copyright (c) 2026 Brett Schrewe, Michaela Remington https://creativecommons.org/licenses/by-nc-nd/4.0
Bespoke to the patient: a qualitative study on learning to manage multimorbidity in family medicine
Introduction: The rising prevalence of multimorbidity poses a significant challenge to healthcare systems. However, medical education predominantly emphasizes single-disease frameworks, offering limited guidance on how learners can navigate the complexities of managing co-existing health conditions. Given the high incidence of multimorbidity in family medicine, this study aimed to explore the experiences of family medicine residents in managing multimorbidity, with the goal of informing curriculum development. Methods: We conducted a qualitative study comprising four focus groups (mean duration 47 minutes) with a convenience sample of 28 family medicine residents learning in urban and rural settings. Data were analyzed inductively using reflexive thematic analysis. We drew on generalism and adaptive expertise as sensitizing theoretical lenses to support thematic development and our final interpretation. Results: Participants described a shift from their undergraduate focus on "getting the list" of diagnoses toward a more nuanced, patient-centred approach to multimorbidity, which they characterized as "bespoke to the patient." Throughout residency, learners reported increased confidence conducting more flexible consultations—incorporating social determinants of health, the unique patient’s context, realizing and navigating how healthcare structures impact, and sometimes impede, patient care. Balancing competing priorities became a key feature of their evolving practice, supported by exposure to diverse patient populations, meaningful preceptor relationships, and varied clinical environments. Residents increasingly identified their role coordinating the patient’s care team, leveraging a generalist perspective to organize care and address complexity. Conclusions: Family medicine residents described learning to manage multimorbidity as a developmental process of acquiring generalist adaptive expertise, supported through working in a variety of learning environments. Encouraging preceptors to explicitly share strategies—such as managing limited time and navigating health system constraints—may further enhance resident education in caring for patients with multimorbidity.
Copyright (c) 2025 Martina Kelly, Kristy Penner, Aaron Johnston https://creativecommons.org/licenses/by-nc-nd/4.0
Where is the lifestyle medicine in the Canadian undergraduate medical education curricula? A content analysis
Background: Lifestyle Medicine (LM) focuses on preventing and managing non-communicable diseases (NCDs) through evidence-based behavioural and therapeutic interventions. Despite the established efficacy of LM, its integration into Canadian undergraduate medical education (UGME) remains largely unexamined. Methods: We employed a deductive and inductive summative content analysis methodology. We collected publicly available course and program descriptions for each UGME program across Canada. Further, we contacted deans/curriculum leads for additional curriculum documentation. Documents were coded according to references to various domains of LM as defined by the American College of LM and British Society of LM. Results: The sample comprised 13 UGME programs, with 1327 documents included for the final review. Notable variability across institutions was noted with reference to LM integration. LM topics were more frequently included in pre-clerkship and required courses compared to clerkship and electives. Notably, nutrition, mental wellbeing, and physical activity were most frequently referenced, while sleep health and social connectedness were less represented. Conclusions: To our knowledge, this study is the first to formally map the current practices of LM integration in Canadian UGME. Although there were some study limitations (e.g., exclusion of 25% of Canadian UGME programs), this mapping is integral to identify the current state of the curricula and inform future educational initiatives to enhance medical trainees’ LM-related knowledge and skills. This in turn, may potentially help address modifiable risk factors for NCDs and improve population health outcomes.
Copyright (c) 2025 David Vaz, Sarah Ibrahim, Aleksandra Pikula https://creativecommons.org/licenses/by-nc-nd/4.0
Problem-based and related learning approaches in family medicine residency: a scoping review of four countries
Background: Postgraduate medical education (PGME) bridges the transition from medical school to independent practice. Problem-based learning (PBL), widely used in undergraduate medical education, has emerged as a promising alternative to traditional lectures in PGME. However, its impact on family medicine training remains unclear. Objective: In this scoping review, we describe the use of PBL in family medicine PGME programs and examine its educational and healthcare-related outcomes. Methods: Using Arksey and O'Malley's methodological framework, we conducted a scoping review of PubMed, Embase, PsycINFO, ERIC, Web of Science, and ProQuest in January 2025. Two reviewers independently screened articles, extracting and synthesizing data according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). Results: Twelve studies met inclusion criteria, illustrating diverse PBL delivery methods in family medicine PGME. Programs integrated PBL as standalone sessions, an adjunct, or blended with traditional methods. Learning groups often included mixed specialties (e.g., family medicine and internal medicine) and varied learner levels (e.g., residents and attending physicians). Most studies reported high learner satisfaction and improved perceptions of topics; however, objective assessments of knowledge, pre- and post-PBL, showed no significant improvement. Limited data on behavior and patient outcomes suggested potential benefits. Conclusion: PBL in family medicine PGME appears to enhance engagement and satisfaction but shows mixed educational outcomes. Further research is needed to determine its optimal role in training.
Copyright (c) 2025 Megan Clemens, Josheil Kaur Boparai, Russell Dawe, Susan Avery https://creativecommons.org/licenses/by-nc-nd/4.0
What do new graduate nurses really need when transitioning to clinical roles?
Background: Transitioning from a student nurse to a clinical nursing role is a critical period for newly graduated nurses (NGNs), often accompanied by multiple challenges. Understanding their professional needs during this transition is essential for designing targeted supportive interventions that enhance adaptation, professional integration, and workforce retention. In this study, we aimed to explore the perceived needs of NGNs during their transition to clinical nursing roles in medical and surgical wards. Methods: We conducted a qualitative descriptive study using inductive content analysis. We recruited 21 NGNs from teaching hospitals affiliated with Tehran University of Medical Sciences, Iran, using purposive sampling. We collected data through semi-structured, in-depth interviews. We analyzed the data using Graneheim and Lundman’s five-step conventional content analysis approach and applied Lincoln and Guba’s criteria to ensure trustworthiness. Results: Our analysis yielded 792 codes, categorized into seven key themes: (1) Health Promotion Needs, (2) Organizational Support Needs, (3) Social Needs, (4) Orientation Program Needs, (5) Educational Needs, (6) Psychological Support Needs, and (7) Emotional Needs. Conclusion: NGNs encounter multidimensional and complex challenges during their transition to clinical practice for which they are not entirely prepared. Addressing these needs is crucial for improving professional integration and mitigating adverse outcomes such as burnout, occupational stress, and turnover intention. Our findings emphasize the urgent need for structured, evidence-based support programs incorporating comprehensive orientation, tailored educational interventions, and robust psychological and organizational support systems. We recommend that nursing managers and policymakers prioritize targeted strategies to facilitate a smoother, more effective transition, ultimately enhancing nurse retention and the quality of patient care.
Copyright (c) 2025 Hadi Jafarimanesh, Shahrzad Ghiyasvandian, Masoumeh Zakerimoghadam https://creativecommons.org/licenses/by-nc-nd/4.0
Dual accreditation in CPD: enhancing learning, equity, and health system integration
Background: As an accredited CPD provider, we regularly accredit programs for Royal College of Physicians and Surgeons of Canada credits and The College of Family Physicians of Canada Mainpro+ credits. Historically, program directors seeking both credit types submitted a single application for dual accreditation (i.e. assessed and reviewed for both credit types simultaneously). With evolving accreditation requirements, the ability to submit a single application has decreased. To support internal decision-making, we asked: what is the value of dual accreditation? Methods: Following ethical approval and informed consent, we conducted semi-structured interviews with program directors of dually accredited programs from 2022-2024. Interviews were recorded, transcribed, and analyzed using reflexive thematic analysis. Results: Twelve program directors participated. We identified three key themes reflecting the perceived value of dual accreditation: enriching learning by supporting intraprofessional learning and practice; promoting equity and belonging; and moving toward an integrated health system. Conclusions: Dual accreditation holds significant value. As care models become more integrated, dual accreditation supports efforts to connect practice and learning among intraprofessional teams. This study highlights the benefits of accreditation scholarship, contributing to broader insights into the practices and decisions of CPD provider organizations.
Copyright (c) 2026 Morag Paton, Maria Jennifer Estrella, David Wiljer https://creativecommons.org/licenses/by-nc-nd/4.0
What counts? Defining scholarship in continuing professional development using a national modified Delphi study
Background: In many domains within medical education, scholarship can have unique attributes. The accreditation standards for Canadian Continuing Professional Development (CPD) require scholarly output from each Office in Canada. However, it is unclear what scholarly outputs might be considered as CPD scholarship. Methods: Representatives from a national cross-section of collaborators within the Association of Faculties of Medicine of Canada (AFMC) Continuing Professional Development (CPD) network and other national organizations assisted in this project. Collaborators participated in a 3-phase, modified Delphi study from October 31st, 2023- June 17th, 2024. The three phases included: 1) Registration and Ideation; 2) Consensus Process; 3) Group Validation. Results: A total of 31 individuals registered as part of the consensus panel, and 29 individuals (93.5% response) completed the 3-stages of the modified Delphi. The endorsement of 18/31 types of scholarship, including novel forms such as Community Engagement, Testing/Pilot Approaches, and Advocacy Scholarship, reflects an important shift in how CPD scholarship is understood. Discussion: In a first for our field, the results of this study comprise a consensus-based definition that defines CPD scholarship at a national scale. The results crucially inform national accreditation processes, strategic planning exercises, and overall, in expanding the types and acceptance of activities as recognized scholarly work for those seeking recognition and promotion within the domain of CPD. We do so with the voice of our community to inspire new and emergent scholarship. Periodic reviews of these concepts should be conducted, as scholarly pursuits evolve over time.
Copyright (c) 2025 Eleftherios K Soleas, Clare Cook, Teresa M Chan, Stephen G Miller https://creativecommons.org/licenses/by-nc-nd/4.0
It takes (at least) two to tango: comparing the affordances of two learner mistreatment reporting mechanisms
Background: The affordances, or characteristics, of learner mistreatment reporting mechanisms can shape the information elicited from these mechanisms, which has an impact on how institutions understand the scope and nature of learner mistreatment. This study compares whether and how the affordances of two mistreatment reporting mechanisms elicit different information about learner mistreatment at a single institution. Methods: We conducted an interpretive content analysis of reports submitted using two mechanisms, one that elicits reports through end-of-rotation evaluations and one through a voluntary web-based system, between July 2015 and December 2021. We extracted the metadata from reports and applied a coding framework informed by the Healthcare Complaints Analysis Tool (HCAT) to the narrative descriptions in reports. Data analysis included descriptive statistics and the chi-square test on SPSS v.27. Results: We collected 90 elicited reports and 240 voluntary reports of mistreatment. Similar types of mistreatment were reported through each mechanism, but disrespectful behaviour and bias and discrimination were reported significantly more in voluntary reports. Elicited reports most frequently included incidents of learner mistreatment in clinical settings, whereas voluntary reports included incidents from a wide variety of settings and people or were issues other than mistreatment. Discussion: Utilizing multiple learner mistreatment reporting mechanisms with different affordances can mitigate the limitations of a single mechanism, help identify a more nuanced understanding of learner mistreatment, and increase reporters’ choices for how and when to report mistreatment. Increased information allows an institution to address specific incidents and develop targeted, preventive educational activities and faculty development.
Copyright (c) 2025 Christen Rachul, Jesse Garber, Joanne Hamilton, Anitra Squires, Nancy Porhownik, Jackie Gruber, Eric Jacobsohn https://creativecommons.org/licenses/by-nc-nd/4.0
Scholarly activity in Canadian Residency Matching Service criteria: do Canadian programs really care about applicant research?
Background: Residency programs across Canada evaluate applicants based on written applications, reference letters, and interviews. One key factor many institutions consider is “scholarly activity.” To improve transparency, the Canadian Residency Matching Service (CaRMS) recently revised its program description pages, adding a dedicated section outlining expectations for research and academic work. This study examines whether these changes have made program criteria clearer for applicants. Methods: For all 17 Canadian faculties of medicine, 2023 R1 entry, —internal medicine, family medicine, pediatrics, general surgery, psychiatry and anesthesiology—program descriptions were reviewed on the CaRMS website, looking for keywords related to scholarly activity. Results: Although most residency programs now include scholarly activity in their CaRMS descriptions, several programs provide vague descriptions of this requirement. In 2023, nearly all family medicine (94%), internal medicine (100%), and pediatrics (100%) program descriptions referenced requiring or considering scholarly work as part of their selection process—up from 41%, 65%, and 71% in 2019. Programs commonly mentioned scholarly activity in two or three sections of their selection criteria, with key themes including active scholarly work, scholarly deliverables, and future scholarly potential. Conclusion: Canadian medical schools should set clearer expectations for scholarly activity in residency applications to ensure transparency and equal opportunities for all applicants. Programs could also explain why research matters—whether as a core component of training or to develop critical thinking and initiative. Greater clarity would help applicants see research as more than just a “check-the-box” requirement, fostering genuine engagement in scholarly work.
Copyright (c) 2025 Asil El Galad, Hanna Van Dierdonck, Nikesh Chander, Caleb Mathai, Alyssa Palmateer, Shenna Dunn, Seddiq Weera, Larry W Chambers, Amanda Bell https://creativecommons.org/licenses/by-nc-nd/4.0
Developing a patient-educator program for adolescents with juvenile arthritis: exploring motivation sources, barriers, and facilitators
Background: Patients can be valuable contributors to medical education, offering nuanced perspective and guidance, based on lived experience. While numerous training programs have integrated adult patients in this manner, very few have engaged adolescent patients. Recognizing adolescent educators may be particularly helpful in teaching pediatric conditions, this study appraises the potential for including those with juvenile arthritis in pediatric rheumatology training. Methods: Using an exploratory qualitative approach, we conducted semi-structured interviews with adolescents with juvenile arthritis receiving treatment at two tertiary-care pediatric centres in Canada about the motivations, perceptions, facilitators, and barriers that influence their engagement as patient educators. The interview transcripts were analyzed using an iterative qualitative descriptive method. Results: Participants (n = 19, aged 13-18) identified intrinsic factors, such as learning about their condition and socializing with peers, and extrinsic factors, such as helping students learn and promoting greater disease awareness, as relevant drivers for participating as patient educators. They pointed to balancing school and medical appointments, transportation, and discomfort with sharing personal experiences in large groups as barriers. Parental support, accruing volunteer hours, and engaging health professionals in the teaching sessions were seen as facilitators that could meaningfully enhance the relevance and impact of adolescents’ contributions to medical education. Conclusion: Adolescents with juvenile arthritis are motivated to participate as patient educators. Understanding the factors that promote their involvement supports the development of training initiatives involving adolescents that are likely to be successful and sustainable.
Copyright (c) 2025 Marie-Paule Morin, Aimun Qadeer Shah, Maria Mylopoulos, Marie-Pascale Pomey, François Bowen, Lawrence Grierson, Claude Julie Bourque https://creativecommons.org/licenses/by-nc-nd/4.0
A bidirectional virtual teaching platform for postgraduate Point-of-Care Ultrasound training: a proof-of-concept study
Implication Statement Point-of-Care Ultrasound (POCUS) has become an important modality for procedural guidance and patient diagnostics. However, rural postgraduate trainees in Canada who need to acquire these knowledge and skills face barriers to accessing POCUS training, in part because of a lack of qualified onsite teaching faculty. To help address this issue, our study describes a novel, relatively easy to implement, approach to teach POCUS to postgraduate trainees who do not access to the resources at larger, more well-funded sites. This allows experienced POCUS instructors to teach remotely, which would improve access to POCUS training for both medical learners in remote sites and continuing professional development for rural physicians. Additionally, it offers a cost-effective solution that reduces travel-related expenses for both trainees and faculty. It also provides a unique approach to remote medical education and ongoing skill development.
Copyright (c) 2025 Aanchal Ralhan, Queen Jacques, Alison MacDonald, Gillian Sheppard, Peter Rogers, Jordan Stone-McLean https://creativecommons.org/licenses/by-nc-nd/4.0
Procrastination in medical students: a systematic review
Background: The purpose of this systematic review was to understand the implications of procrastination on medical students’ lives and well-being by examining its conceptualization in the medical education literature, the contexts in which it has been studied, and with which variables it has been associated. These areas were investigated to propose practical solutions to reduce medical students’ procrastination tendencies. Methods: This systematic review was completed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and the guidelines of the Association for Medical Education in Europe. We searched the PubMed, ERIC (ProQuest), and PsycINFO (OVID) databases. A total of 243 articles were identified and screened independently by two authors. Results: Based on a set of inclusion criteria, 26 articles were kept and analyzed in the review. We found that medical students’ procrastination was most often conceptualized as the voluntary delay of a given task. Medical students’ procrastination was examined in two different contexts: academic procrastination and bedtime procrastination. Procrastination was negatively related to variables such as academic achievement, metacognition, and self-esteem, and positively related to other variables such as stress, anxiety, and mobile phone addictions. Conclusions: Medical students’ procrastination is most frequently described as the intentional or voluntary postponement of a given task with the expectation of negative consequences and is most often evaluated in academic settings alongside mental health and affective variables. Future research should focus on promoting students’ awareness of their procrastination and emotional states through targeted and goal-oriented interventions.
Copyright (c) 2025 Sonia Rahimi, Tanya Chichekian , So Yeon Lee https://creativecommons.org/licenses/by-nc-nd/4.0
Copyright (c) 2026 Heather Hickey https://creativecommons.org/licenses/by-nc-nd/4.0