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Questions to Ask:
How much teaching / training have physicians received in this area?
What are some predictable situations where a patient may react with intense emotions?
Is there any existing research addressing this topic?
Are there some simple to remember strategies when face with an angry outburst from a patient?
What are the best ways to teach and practice such strategies?

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Managing difficult patient encounters in the office.

Current State: Physicians experience difficulties responding to patients who exhibit negative emotional responses during a patient encounter. This is especially true since the COVID pandemic has resulted in severe psychosocial stress. The result is that more physicians are reporting symptoms of burnout. This is genrally not something taught to medical learners in a systematic way.

Ideal State: All physicians should feel comfortable in developing one or more strategies to manage and diffuse such situations. This will reduce one important contribution to burnout.

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Noor H- Practical evaluation criteria for sonographic skills as an accurate reflection of student's readiness for clinical practice

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Noor H- Practical evaluation criteria for sonographic skills as an accurate reflection of student's readiness for clinical practice

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Current state: Due to non-technical evaluation criteria and repeated practice on the same patients, some students are passing evaluations but we are receiving reports of lack of readiness for clinical practice by clinical supervisors
Ideal state: Sonographic evaluation criteria more accurately reflective of student's technical skills and readiness for clinical practice.
Questions to consider: What is the best way to approach this issue? Before changing evaluation criteria, how can we alter the technical education to zero in on weak points and give students more robust technical skills? How can we change evaluation criteria to more accurately reflect clinical skills without forgoing patient care and professional practice skills?

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Handling high stakes moments in Serious Illness Conversations

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Handling high stakes moments in Serious Illness Conversations

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Current state:
Fewer than a third of patients with end of life diagnoses have goals of care discussions with their physicians.  This leads to increased suffering for patients and their caregivers, and increased utilization of treatments and resources that cause harm, and provide no meaningful benefit.  Data shows when GOC discussions occur, this alters patients' decision-making, leads to improved QOL and less suffering for patients and their care-givers.
Ideal state: caregivers identify patients that have serious illness and are at risk of dying within the next year, and include GOC discussions as a standard part of their management.
Questions to consider:
there is already much known about the barriers to these conversations happening, and a significant part relates to lack of comfort and skill in handling these conversations by the treating physicians.
1. What specific scenarios cause the most discomfort for clinicians?
2. Do clinicians recognize that there is an actual skill set associated with performing Serious Illness Conversations adeptly?
3. How important is mastering Serious Illness Conversation skills to clinicians?
4. How much time are clinicians willing to commit to learning these skills?
5. What are the preferred modes of educational delivery for teaching these skills- keeping in mind there is a need for direct observation and coaching for certain aspects
6. Is there a need for "refresher" sessions, and what would be most useful or helpful with these sessions?

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Current state: We are 58,000 PAP smears behind in our region and similar state for mammograms. Family Physicians are overwhelmed and burning out.
Ideal state: Ideally screening would be above target of 60% and able to reach the populations of under and never screened. Ideally Family Physicians would be in a steady state of coping that allows preventative care calls and appointments in their regular schedule.
Questions to ask:
1. What will it take to assist Family Physicians to reach and catch up this backlog without exhausting them?
2. How can we reach the under and never screened populations using influencers?
3.What innovative resources do we have to call upon to assist us with the backlog?
4. How can we communicate and collaborate innovative successes to other Family Physicians who are struggling?
5. How can we explore the factors that are burning Family Physicians out in the community that leads to a sense of apathy/exhaustion towards screening?

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Current State: As most nurses haven’t taken a full patient history or done a comprehensive physical assessment since nursing school, newly hired nurses spend much of their training weeks re-learning basic history and physical exam skills they will need as generalized practitioners  in this setting. This takes away from supported learning time in First Nation communities. Nurses become very task focused and patient/community interactions suffer. The result is often stress for nurses and patients as they struggle to learn their new role.

Ideal State:   Nurses would have pre-orientation ‘refresher’ in history taking and physical exam skills specific to working in remote First Nation communities which would ensure all had baseline knowledge

Questions to Consider:    Is this needed?  How could this better prepare and reduce stress for new nurses who are already overwhelmed with the many challenges of the new role? How do we incorporate patient and cultural safety? As nurses are all across Canada, what are the best options to ensure active participation/collaboration? How do we evaluate them at a distance? How do we show that this ‘ideal state’ is effective? How do we ensure the ‘low tech’ learners don’t get overwhelmed?

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Louise McN-F

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Incorrect death certificates leading to incorrect death statistics

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Diabetes is managed by a variety of strategies including patient education, nutrition, exercise, and multiple medications. Current State: Discussing exercise is often not done by diabetes health care professionals due to a variety of care provider issues: time, lack of knowledge around exercise and counselling, a sense that patients do not adhere to their exerice routine, and lack of exercise amongst providers. Ideal State: Diabetes health care professionals are comfortable to and routinely discuss exercise with their patients. Questions to Consider: 1. How long does it to take to ask and counsel patients about exercise? 2. How can one counsel a patient about exercise? 3. What are common strategies for exercise in diabetes? 4. What are some strategies to improve adherence to exercise for patients?

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Adult education skills for those doing training at social service agencies

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Adult education skills for those doing training at social service agencies

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Current state: Staff in social service agencies are often asked to deliver training sessions to either clients or other staff with no background in adult education, resulting in poor quality experiences (i.e. less likely to come back) and/or low knowledge translation (i.e. they don’t learn anything).

Ideal state: Anyone asked to delivery training within social service agencies has a basic foundational knowledge of adult education principles

Questions to ask: Because adult education is a large field, I’d want to know more about my learner group in terms of what the actual “training” is they are being asked to do so I can narrow down what key info they need (as they are busy professionals, so any training they get would need to be brief and practical). So, e.g.: What are the topics and/or outcomes? Do they create the content or are they just delivering it? What do they already know in terms of adult education - either experience or previous training? What is the current feedback from participants in these training sessions in terms of what areas they like versus what could be improved?

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The obesity epidemic is not diagnosed and treated with the same urgency as other serious diseases.
WHY IS THIS IMPORTANT
Early intervention and effective treatment of obesity is needed to reduce the costs and improve the outcome  for these patients.
CURRENT STATE
Most people still think it's their own responsibility which may stop them from seeking medical help.
IDEAL STATE
Encourage patients to discuss this issue as they discuss other health conditions.
QUESTIONS TO CONSIDER
1. What is the best way to address this issue?
2. What type of digital learning tools can I use (infographic, microlearning)
3. What are the barriers?

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1)What is the focus of the learning  what are are we trying to instruct .
Who is our students and what do they expect from the instruction
What can we do having defined our goals such as in my AUB lecture
Using principles outlined in Addies can we place the objectives in order
How can we poll at our success has he bae knowledge been aquired
Using poll asking how te instrucion turned out.

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I love the variety of examples that you are all sharing. I can share a few generic questions/considerations without addressing a specific topic that I think would apply across the board. One question that is often missed is: Has this been addressed before, or has something similar been addressed before. Being able to piggy back on another's analysis/successes/failures can be hugely efficient!

And a few more broad non-topic specific questions to consider are:

Why is this learning/instruction needed? What problem it is trying to address? What is the purpose of this learning/instruction? Will this learning/instruction address the gap? What will happen if we do nothing? Is this the best solution?  Are there other factors influencing the problem? (Morrison, Gary R. Designing Effective Instruction, 6th Ed. John Wiley & Sons, 2019)

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JR - Fear of Covid and Lockdown worsening health of population

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JR - Fear of Covid and Lockdown worsening health of population

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Current State
While the world places COVID as the top health priority, overall health is suffering. People are  remaining or becoming sedentary and isolation is affecting mental health. Prolonged limited access to medical care is propagating a parallel pandemic of delayed diagnosis, increased morbidity and unmeasurable longterm health consequences.

Ideal State
Funding directed towards messaging encouraging people to;
- get OUTSIDE and participate in daily physical activity
- make good food choices
- make good sleep hygieng choices
- limit screen time
- identify and reach out to truly isolated individuals (those truly living alone, elderly with no support, long term care residents, other marginalized populations), open up volunteer programs to safely "bubble" with such individuals and give financial support to facilitate this type of outreach and relationship building
- resources for patients to assess if they need to go to the doctor vs the ER vs stay home - a hotline? a website with decision tree?
- encourage out-of-hospital facilities to offload elective surgeries

Questions to ask:
- what are the top causes of morbidity and mortality and can we compare this to the risk of dying from covid (ie covid vs morbid obesity, covid vs uncontrolled diabetes, covid vs cancer risk in a smoker/drinker etc)
- can we stratify risk of covid depending on age/demographic/comorbidities etc and compare with risk of all other things that are being exacerbated by covid changes?
- what is keeping people from making positive lifestyle modifications when this is a time when our health needs to be at its best?
- for those that have made negative changes and those that have made positive changes (in lifestyle), what is the story behind that? what are the barriers? what are the knowledge gaps?

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Why don't children wear helmets toboganning?

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Why don't children wear helmets toboganning?

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Current state: Children do not wear helmets when on a toboggan hill in Canada.

Ideal state: All children up to age 18 should wear a helmet tobogganing.

Questions to ask?:Why do parents and children think that toboganning is OK to do without a helmet. Helmets are mandated on ski hills and on bikes but not when careening down a snowy hill often between trees. Would need buy in from parents about number and types of injuries and need for helmets especially in young children where the fulcrum of injury and cervical spine motion is the upper cervical spine.

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current state: physicians new in practice have a higher rate of medicolegal risk
Ideal state: bring the risk for new MDs more in line with other MDs of the same type of work.
Questions to consider: What skills are missing? when is the best time to intervene - before or after start of independent practice? What is the best way to address the issue, and what are the actual gaps?

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Current state
Many patients cannot participate in virtual clinics and instead choose phone calls.

Ideal State:
Most patients are familiar with the technology required to use platforms such as Zoom, MS Teams, OTN for virtual clinics and are confident in using them.

Why is this important?
Phone calls are not adequate for meaningful and accurate clinical encounters, they are below the standard of care. Whilst video conferences are not ideal, they are significantly better than phone calls.

Questions to ask?

1. What are the barriers to virtual clinic encounters for patients?

2. Can learning technologies help when the issue is partly due to patient's lack of familiarity and confidence in using technology?

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Current State: It takes approximately 9-10 years for women with endometriosis to be diagnosed and offered treatment. Ideal State: Patients are diagnosed clinically with endometriosis and offered treatment options earlier by their primary care provider. Questions to answer: How can we educate patients best about the signs and symptoms of endometriosis so they present for treatment sooner? How can we educate primary health care providers to recognize the symptoms of endometriosis and feel comfortable initiating treatment earlier without a surgical diagnosis?

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Current State: It takes approximately 9-10 years for women with endometriosis to be diagnosed and offered treatment. Ideal State: Patients are diagnosed clinically with endometriosis and offered treatment options earlier by their primary care provider. Questions to answer: How can we educate patients best about the signs and symptoms of endometriosis so they present for treatment sooner? How can we educate primary health care providers to recognize the symptoms of endometriosis and feel comfortable initiating treatment earlier without a surgical diagnosis?

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Item-writing for Multiple-Choice Question (MCQ) exams

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Item-writing for Multiple-Choice Question (MCQ) exams

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Current State: The majority of faculty in Health Science professional programs (e.g. nursing, medicine, PT, OT) write poorly worded MCQ.

Why this is important: Poorly worded MCQ disadvantage weaker students more than stronger students; they provide an inaccurate estimate of learner knowledge; they promote rote learning rather than application of knowledge.

Ideal State: Faculty are aware of, and use, the best practices in item-writing for their in-class tests.

Questions to ask: How do faculty prefer to learn (e.g. synchronous or a-synchronous workshops)? What is the preferred method of learning (e.g. receiving feedback on their own items or generic information about item-writing)? How much time are faculty willing to spend on improving their MCQ?  For an online asynchronous course, is a "talking head" necessary or is "voice over" sufficient? How much interactivity is needed in an online asynchronous course to keep the learner motivated? How long should each "segment" be to keep the learner motivated?

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Physical exam teaching to trainees during the pandemic

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Physical exam teaching to trainees during the pandemic

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Current state: This year, 3rd-year medical students did not get the opportunity to participate in in-person musculoskeletal (MSK) physical exam sessions, where they would usually examine patients with different pathologies in large groups.
Ideal state: Medical students get the opportunity to have hands-on sessions on how to perform an MSK exam.
Questions to consider: The medical students will be graduating and starting residency without learning how to correctly perform a physical exam. This will affect patient care (misdiagnosis, delays in diagnosis). Can we perform small group sessions where they can practice on each other under supervision, keeping provincial gathering restrictions in mind? Can we do on-line sessions where patients demonstrate different pathologies?

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Public Approach to Restrictions due to COVID-19 Pandemic

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Public Approach to Restrictions due to COVID-19 Pandemic

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Current State: People have been traveling to areas where COVID-19 cases are high despite being told no "essential" travel.
Ideal State: People understand the implications of COVID-19 infections spreading as a matter of simple resource management.
Why is this important? Although chances of dying from COVID-19 if healthy is actually low compared to elderly or those with multiple comorbidities, the allocation of finite resources to tackle preventable illness alters the ability to manage other illnesses like cancer. Eg. ICU beds fill with COVID patients and thus surgeries delayed.
Gap: Public awareness of resource management

Questions to ask:
1. What do people consider non-essential vs essential travel?
2. What does government consider non-essential travel and how has this been distributedpromoted to the general public?
3. Why do people travel for government designated non-essential purposes despite warnings?
3. What do people think we use an ICU bed for?
4. For a patient to be in an ICU bed, what is needed in terms of staffing and equipment and what is the cost per day?

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Ali El Ghazzaoui - Patient education pre-op and post-op 

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Ali El Ghazzaoui - Patient education pre-op and post-op 

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Current state: Parents of children presenting to our clinic for a surgical intervention are either:
- not aware about their kid's disease
or
- they read about it through google ( which leads to wrong misconceptions about the entity)

Why is this important? Patient education is an important part of the treatment and healing process

Ideal state: Most patients are aware about their disease , its surgical treatment and the post-op expectations

Questions to ask:  How to design an educational tool for families/patients to improve their pre-op and post-op journeys.

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Current state: Vaccine hesitancy (VH) has been found to be at least 20% in Canada from a recent Angus-Reid poll. Why is this important? Without adequate "herd" vaccination of at least 70-80% of Canadians, Covid-19 may become endemic, and continue to persist as a global health issue, additionally affecting patient safety and global economies for all Canadians. Current education measures do not adequately provide VH knowledge translation implementation (KTI) tools for the general public, which are an important education strategy, as the VH population have been found to be most likely to vaccinate when provided with appropriate and adequate knowledge that addresses their ideas about disease, fears, and expectations. Ideal state: KTI strategies that help support VH populations to be vaccinated to reach herd immunity in Canada. Questions to consider: What sub-population/demographic groups (PDG) should be targeted for the KTI? What PDG groups would use online technology to learn?What types of digital learning could we use as knowledge tools e.g. microlearning, infographics, etc?  How to we motivate PDGs to access the vaccine? What barriers are there to getting the vaccine, and how can we remove them? How can we create consumer driven demand for the vaccine (e.g. targeting KTI to children so that they convince their parents to get the vaccine in younger age demographics)? What types of community of practices online/social media tools will be needed to counter pseudoscience/fake news regarding vaccines? How do we ensure health literacy and AODA compliance in our digital learning strategy?

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Current state - Due to new infection control measures many patients are by-passing the triage area and having their triage level determined by less experienced bedside RNs, leading to some questionable triage judgments.
Ideal state - All RNs regardless of experience/work area are competent in assigning a triage level.
Questions to ask - Audit some charts to confirm. Shadow some RNs. Ask them to send "tricky" cases, questions. Consider providing review material (guidelines) and then work through cases together. Consider comfort level with online triage tool, not just assessment skills and judgment.

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Kataryna N - Sample format - Current state: example. Ideal state: example. Questions to consider: Why is this instruction needed? What will happen if we don't do anything?