Tracey Hillier

Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative mortality. Several gaps in data exist regarding global differences in surgical morbidity and mortality for Indigenous populations based on geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative outcomes between Indigenous and non-Indigenous populations. This systematic review and meta-analysis was conducted in accordance with PRISMA and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n = 31, North America n = 36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients had 1.26 times odds of post-operative morbidity (OR = 1.26, 95% CI: 1.10–1.44, p<0.01) and 1.34 times odds of post-operative infection (OR = 1.34, 95% CI: 1.12–1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times odds of reoperation (OR = 1.33, 95% CI: 1.02–1.74, p = 0.04). In conclusion, we found that Indigenous patients in North American and Oceania experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there is a low proportion of high-quality research focusing on assessing surgical equity for Indigenous patients in these regions, despite multiple international and national calls to action for reconciliation and decolonization to improve quality surgical care for Indigenous populations.

Indigenous Peoples across North America and Oceania experience worse health outcomes compared to non-Indigenous people, including increased post-operative morbidity and mortality. No data is available on global differences in surgical morbidity and mortality between geographic locations and across surgical specialties. The aim of this study is to evaluate disparities in post-operative morbidity and mortality between Indigenous and non-Indigenous populations. This scoping review and meta-analysis was conducted in accordance with PRISMA-ScR and MOOSE guidelines. Eight electronic databases were searched with no language restriction. Studies reporting on Indigenous populations outside of Canada, the USA, New Zealand, or Australia, or on interventional procedures were excluded. Primary outcomes were post-operative morbidity and mortality. Secondary outcomes included reoperations, readmission rates, and length of hospital stay. The Newcastle Ottawa Scale was used for quality assessment. Eighty-four unique observational studies were included in this review. Of these, 67 studies were included in the meta-analysis (Oceania n=31, North America n=36). Extensive heterogeneity existed among studies and 50% were of poor quality. Indigenous patients worldwide had 1.26 times higher odds of post-operative morbidity (OR=1.26, 95% CI: 1.10-1.44, p<0.01) and 1.34 times higher odds of post-operative infection (OR=1.34, 95% CI: 1.12-1.59, p<0.01) than non-Indigenous patients. Indigenous patients also had 1.33 times higher odds of reoperation (OR=1.33, 95% CI: 1.02-1.74, p=0.04) and longer hospital stays (SMD=0.09; 95% CI: 0.02-1.08; p=0.05). In conclusion, we found that Indigenous patients experience significantly poorer surgical outcomes than their non-Indigenous counterparts. Additionally, there remains a paucity of high-quality research focusing on assessing and improving surgical equity for Indigenous patients worldwide, despite multiple international and national calls to action for reconciliation and decolonization to improve access to quality surgical care for Indigenous populations.

Medicine’s social mandate recognizes the importance of introducing changes to systems and practices to meet the healthcare needs of marginalized populations. Social accountability efforts encompass a wide array of actions, including equity, diversity and inclusion initiatives, and adapting knowledge relevant to practice across education, research, and clinical domains. To influence change in education, ongoing structures and processes are needed to ensure adequacy, relevance, and effectiveness of curricular coverage. In support of this, we created an innovative and creative approach to developing curricular modules to prepare medical students to provide care that is responsive to the cultural, economic, and psychosocial realities of diverse patient populations. The DISCuSS model (Diversity, Identify, Search, Create module (with community engagement), Sustainability, Social accountability) provides a community-engaged, iterative approach to curriculum development relevant to social accountability. Over the past 5 years, we have created nine curricular modules focused on health-related inequities and social concerns, including modules on Indigenous and refugee health, sexual and gender minority health, human trafficking, and addiction. AFMC Graduation Questionnaire results have shown a statistically significant increase in our students ‘preparedness to provide care to diverse populations.’ The DISCuSS model, which continues to evolve, can be adapted and used in other settings.

Team-based learning offers an active learning strategy that provides a structure for measurement of learning and feedback to the students. Aggregating these results provides a longitudinal pattern of student performance. In this study, we analyzed results from a sequence of assessments related to TBL IRAT and GRAT assessments and traditional quizzes in a second-year musculoskeletal course in an undergraduate medical education program to determine if there are any measurable patterns, or performance trends, that students demonstrate in the course. Analyzing results from four academic years, we found evidence supporting there is predictability in student’s future week’s performance based on past performances across teaching modalities. We hypothesize that students are moderating their own effort regarding weekly low-stake assessments in prioritizing their academic efforts. The results from this study highlight the role of self-efficacy in medical education and suggest a new area of research for assessment of student performance patterns. Future studies could investigate whether these performance patterns are replicated in other assessment modalities and whether the same pattern holds for high-stakes assessments.

Introduction: The Objective Structured Clinical Examination (OSCE) is used globally for formative and summative purposes. The objective of this study was to examine the impact of tablet-scoring on sources of validity evidence for an Internal Medicine residency OSCE. Methods: We compared paper-scored OSCEs from 2014 to tablet-scored OSCEs in 2015 for missing data, amount of comments, and time to pass/fail decision. We then examined in 2016 the impact on learning of showing residents their score sheets and asking them to write an action plan immediately after an OSCE. Results: Tablet-scoring significantly reduced stations with missing data from 1.8 to 0.2%, and stations without comments from 42 to 28% with an increase in word count per comment. Time to official results reduced from 3 weeks to 12 h with tablet-scoring. Residents who wrote a learning plan after reviewing their OSCE score sheets were more likely (with medium to large effect sizes) to pursue further studying and/or change their behavior (e.g. history taking or physical examination) in the clinical environment. Conclusions: OSCE tablet-scoring improved many sources of validity evidence, especially educational impact with timeliness of feedback supporting a change in behavior, a hard to achieve goal of educational interventions.