The Wilson Centre

Social support is known to influence pregnancy outcomes. We explored the sources of social support available to pregnant women in a rural setting in south India. We conducted 13 focus group discussions (FGDs) among women of child-bearing age, husbands, mothers/ mothers-in-law, community health workers, and community leaders. FGDs were transcribed and analysed using thematic analysis. Support received during pregnancy were mainly in three domains; tangible, informational and emotional support. Tangible support refers to providing practical support such as cooking nutritious food for the pregnant women, helping them with household chores, and accompanying pregnant women for hospital visits. Informational support refers to measures aimed at improving awareness during pregnancy and promoting informed decision making such as advice on dietary practices and remedies for common ailments. Emotional support refers to the support provided by family members and CHWs in fulfilling women’s desires during pregnancy and allowing them a safe space to share their problems. Sources of support identified include husbands, elders in the family, friends, the local community, and health service providers. In general, perceptions were similar across participant groups, age and gender. While tribal participants sought elders’ advice and relied on traditional remedies compared to non-tribal participants, they were more likely to access nutritional aids offered by the government. CHWs provide additional support to tribal communities in identifying pregnant women, closely monitoring them and extending informal support during pregnancy and delivery by taking them to the hospital. Members of the joint family including mothers-in-law and sisters-in-law actively helped in chores, nutrition and newborn care compared to the nuclear family. In general, women felt that they received valuable support from family and community. Participants felt that support from husbands, families and neighbours had an influence on women’s health and behaviour during pregnancy. The findings were used to develop intervention modules to promote maternal health and the health of their offspring.

The day was blistering and the road shimmered with heat. I was seven years old when I asked to cross the street alone for ice cream. It was meant to be a small rite of passage, a step toward freedom. I remember my clammy hands, the scent of hot asphalt, the cicadas buzzing, and the imagined

This is the fourth and final article in a mini-series exploring the research supervision relationship. In the first two articles, the authors presented an introduction to the mentor-mentee relationship and explored some of the tricky issues involved in supporting academic writing. In the third article, the authors turned to the practical question of concrete ways in which mentors can effectively provide useful feedback to mentees about their written work. In this final paper, the focus shifts to the mentee who is on the receiving end of such feedback and offers some guidance on how to make this feedback work for them.

As medical schools rapidly expand worldwide, accreditation has become a key mechanism for ensuring and improving the quality of medical education. However, its effectiveness remains unclear due to conflicting research results and limited empirical evidence. Therefore, the aim of this critical narrative review is to synthesize and analyze the intended (planned) and unintended (emergent) impacts of medical school accreditation. We conducted a critical narrative review by systematically searching five databases: MEDLINE, EMBASE, ERIC, Global Index Medicus, and ProQuest. The literature search was conducted between October and November 2024. Thirty-two empirical studies on the impact of medical school accreditation were included. Following a subjectivist orientation, we combined deductive categorization and inductive thematic analysis for analysis. Three researchers conducted repeated coding and data extraction through a consensus process, identifying both planned and emergent processes and outcomes. The planned processes included governance reform, faculty and student engagement, infrastructure investment, data monitoring and sharing, structured curriculum reform, and the introduction of program evaluation of quality improvement systems. These contributed to improved student outcome, curriculum refinement, and enhanced institutional awareness. However, emergent processes were identified, such as navigating conflicting demands, strategically controlling data disclosure, and adapting to changes in standards. These led to emotional ambivalence among stakeholders, resources intensification, and short-term strategizing that hindered sustainable reform. These results challenge the assumption that accreditation operates linearly, emphasizing that its impact on medical schools is accompanied by both intended and unintended effects. Policymakers and institutions must recognize the dual nature of accreditation, promote sustainable engagement, and proactively address unexpected outcomes to ensure that accreditation aligns well with long-term educational goals.

Despite the growing use of unsedated transnasal endoscopy (uTNE) in pediatrics, no validated tool exists to assess competence in performing uTNE, hindering effective training and consistent, high-quality performance. Video-based assessment offers a scalable and reliable method for assessing and enhancing procedural skills. Using Delphi methodology, we aimed to identify key competencies and establish content validity evidence for the TransNasal Endoscopy Skills Assessment Tool (TNE-SAT), a video-based tool designed to assess clinician competence in performing uTNE. North American pediatric uTNE experts iteratively rated potential assessment items, on a 5-point scale, based on their importance as indicators of endoscopist competence in performing uTNE. After each voting round, items scoring ≤3/5 were eliminated, and the remaining items were re-sent to the panel for further rating until consensus was reached, defined as ≥80% of panelists rating all remaining items ≥4. Items meeting this threshold were included in the final TNE-SAT tool. Twenty-seven experts from 19 sites across North America participated. One hundred thirty items were generated through literature review, task deconstruction, and Delphi panelist input. Three rounds of surveys were completed before consensus was achieved, with response rates ranging from 85% to 9. Seven items reached consensus for inclusion in the final TNE-SAT. This North American Delphi study identified core competencies required for effective uTNE performance and informed the development of the TNE-SAT, a structured, video-based tool to assess clinician competence. The TNE-SAT offers a promising tool to guide training and support quality improvement in pediatric uTNE.

The perceived tension between service and education is the subject of frequent debate in medicine. On the basis of an apprenticeship model, residency programs are expected to balance the two, yet definitions of service and education remain elusive, and resident perspectives on this issue are not well understood in internal medicine (IM). This study aimed to explore how IM residents conceptualize service in relation to their education. From August 2023 to January 2024, semistructured, one-on-one interviews were conducted with 16 IM residents at the University of Toronto. Consistent with a constructivist grounded theory approach, data collection and data analysis were completed in parallel until theoretical sufficiency. Using constant comparison and investigator triangulation, a conceptual framework was developed to describe how residents perceive the interplay between service and education. Three key themes were identified. First, service in everyday conversation was often a catchall for negative experiences, yet most residents recognized that many tasks attributed to service are necessary for patient care. Second, education was believed to encompass a range of activities and responsibilities that can promote learning, provided they are accompanied by opportunities for autonomy and feedback commensurate to a resident's level and experience. Third, service and education were frequently acknowledged to overlap but to varying degrees, depending on attendings' practices and residents' individual perspectives. Ultimately, the perceived delineation between service and education appears to be fluid and flexible. The conceptualization of service appears to be dynamic, and the perceived interplay between service and education may be both situation dependent and resident dependent. Tension between service and education may be driven by high clinical volumes and administrative burdens, but opportunities with graduated responsibility and meaningful feedback may help reinforce the learning inherent in the service of providing patient care.

Through conversations with members of racialized communities, we aimed to: explore perspectives shared by members of racialized communities regarding the relationship between cannabis and mental health; develop a greater understanding of racialized community members’ mental health service interactions in relation to cannabis use and mental health; and examine whether various social identities interact to influence experiences with cannabis use and mental illness. From January to June 2022, we conducted semi-structured interviews with 26 members of racialized populations who were ≥18 years old, had used cannabis in the last 6 months, and had been in contact with the mental health sector across Ontario in the past year for a known psychiatric diagnosis. Many participants were 25–34 (46%), Canadian citizens (89%), and heterosexual (50%), with representation from ten different ethno-racial identities. Seventy-three percent of past-month cannabis users reported daily use. We identified five themes: experiences of the relationship between cannabis use and mental health; cannabis use in response to barriers encountered with formal mental health supports; negative experiences with mental health services related to race, gender identity, and cannabis use; adverse effects of discrimination on mental health and cannabis use; and strategies to improve mental health programs. Interviews facilitated a deeper understanding of the complex relationship between cannabis use and mental health outcomes among racialized individuals. Clinical practice guidelines and training are recommended for healthcare providers to enhance culturally sensitive care regarding cannabis use and mental health. Research exploring risks and benefits of self-medication using cannabis would enrich our understanding of its implications specifically for this population.

Pediatric transfusion medicine presents unique challenges due to differences in pediatric physiology and pathology compared to adults. Research shows that pediatric healthcare professionals have knowledge gaps in transfusion medicine, contributing to suboptimal practice. To address these gaps, Transfusion Camp, a transfusion medicine education program, was adapted to a pediatric-focused curriculum. To assess pediatric learners' knowledge uptake, we aimed to develop and validate the Pediatric Transfusion Knowledge Test. The BEST TEST-3, a previously validated transfusion medicine knowledge assessment tool, was modified by a multidisciplinary committee of content experts, using a curriculum blueprint for pediatric transfusion medicine consisting of 31 core and 42 extended topics, identified through a previously published national multi-specialty Delphi consensus study. The modified test was administered to 8 novice, 20 intermediate, and 14 expert participants in pediatric transfusion medicine. Data were analyzed using Rasch psychometric modeling to finalize test content. The finalized assessment tool included 25 multiple-choice questions, with balanced representation across the cognitive processes outlined in Bloom's taxonomy. Twenty-four questions demonstrated good fit statistics with infit average 0.99 (0.8-1.2) and outfit average 0.96 (0.78-1.22). One question required revision. Question difficulty ranged from -2.78 to 1.61 on the logit scale, with gaps observed for higher-ability test-takers. Developing the Pediatric Transfusion Knowledge Test represents a systematic approach to adapting and validating an assessment using a curriculum blueprint and ensuring alignment with educational materials. It adapts an existing assessment and incorporates evidence-based pedagogical principles. This framework can be applied to develop other assessments within medical education.

This column addresses the knotty problems and dilemmas many scholars grapple with when studying health professions education. In this article, the authors examine whether a journal is the most suitable format for disseminating research. We explore other venues that researchers have used to reach specific audiences, and we describe how to present rigorous scholarship in those venues.