Paul Atkinson

Background: Workers’ compensation was created as an inherently compassionate social institution: a collective response to the human, health, and economic consequences of work injury. This founding purpose can be obscured by administrative complexities. Objective: To re-establish compassion as a foundational principle in workers’ compensation medicine and provide practical ways to operationalize this in system design. Methods: This commentary examines relevant historical and contemporary literature to inform the principle of compassion in workers compensation, synthesize the ideas, and develop recommendations for system design to better integrate the historical principles of Canadian workers’ compensation to enhance worker experiences, return to work, and compassionate communication. Results: The historic compromise embodies compassion through collective protection, no-fault support, and security following injury. That purpose can be made visible in modern systems through understandable communication, transparent reasoning, timely coordination, and differentiated supports for workers facing language, literacy, psychological, or disability barriers. Implementation requires resources and evaluation rather than an assumption of zero cost. Conclusions: Compassion is not an optional addition to workers’ compensation but a return to its foundational purpose. Stewardship and compassion can be mutually reinforcing when reforms are co-designed and evaluated for worker outcomes, equity, administrative burden, and long-term system costs.

Emergency physicians are increasingly utilizing transesophageal echocardiography in the emergency department (ED) when caring for critically ill patients. Simulation-based transesophageal echocardiography training has been shown to be an effective learning tool. This study evaluated whether a brief asynchronous learning module combined with simulation-based practice is effective for emergency physicians who are already experienced in point-of-care ultrasound (PoCUS). We conducted a prospective study of emergency physicians with PoCUS experience at a single ED. Participants viewed a 30-min asynchronous module on transesophageal echocardiography in the ED and reviewed a four-view resuscitative protocol. They then completed a baseline simulation assessment, a brief guided practice session, and a post-intervention assessment. All views were recorded. The primary outcome was the proportion of successful transesophageal echocardiography views, scored by two blinded reviewers. Twenty emergency physicians completed the study. The mean age was 39 years, 6 participants (30%) were female, the median clinical experience was 5.5 years, and all participants had PoCUS experience. The percentage of total successful views increased from 63% (95% CI 52-72%) at baseline to 93% (84-97%; p < 0.001) after guided practice. A brief 30-min asynchronous module combined with focused simulation-based training was effective in immediately improving the acquisition of core resuscitative transesophageal echocardiography views among emergency physicians with PoCUS experience. Future studies are needed to determine whether this approach leads to sustained skill retention and improved integration of resuscitative transesophageal echocardiography into clinical practice.

Objective This study aimed to determine the five most influential publications on first-trimester pregnancy point-of-care ultrasound (POCUS) and the five most influential publications on scrotal POCUS from an emergency medicine perspective. These two POCUS applications were selected, because they address time-sensitive clinical conditions in which early diagnosis is critical for appropriate management. Methods An expert panel of 15 emergency physicians was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. All participants had completed fellowship training in POCUS or possessed equivalent expertise, were actively engaged in scholarly work, and held leadership roles at the institutional or national level. A structured three-round modified Delphi process was conducted to achieve consensus. In each round, panelists independently nominated and ranked papers based on their perceived influence in informing us on how to use POCUS in clinical practice. Responses were discussed and refined across subsequent rounds until agreement was reached. Results In round one, panelists nominated 40 papers focused on first-trimester pregnancy POCUS and 31 papers on scrotal POCUS. Following round two, 13 papers remained for first-trimester pregnancy POCUS and 10 for scrotal POCUS, with one additional paper added to each category after panel discussion. The final round produced ranked lists of the five most influential papers in each category. These papers emphasize the diagnostic value of POCUS in confirming intrauterine pregnancy and excluding ectopic pregnancy, its role in the timely recognition of testicular torsion, and its contribution to improving efficiency while reducing emergency department length of stay. Conclusion This expert consensus provides a focused reading list of foundational literature in first-trimester pregnancy and scrotal POCUS. The compilation serves as a practical educational resource for clinicians and trainees and as a framework to support future research, curriculum development, and evidence-informed POCUS implementation.