Background: Canadian medical school curricula have traditionally been limited in their exposure to ophthalmology. A Medical Student Symposium (MSS) was developed to introduce students to the specialty, teach clinical skills, and help students to seek future opportunities within ophthalmology. Our aim is to provide a model for other specialties to meet the evolving and diverse educational needs of medical trainees. Methods: Medical students were invited to participate in a 3-hour free in-person symposium held at the Canadian Ophthalmological Society (COS) Annual Meeting in June 2023. The symposium was divided into three sections: a 30-minute keynote speaking session, hands-on workshops, and resident mentoring sessions. A cross-sectional quality improvement survey was administered to medical students who attended. Descriptive statistics were used to analyze the survey responses. Results: In total, 70 participants attended the symposium. Of these, 61 participants (87.1%) responded to the survey. The majority of attendees (67.8%) of participants expressed that attending the COS MSS would enhance their applications to ophthalmology residency. With regards to knowledge acquisition, 85.3% and 75.4% of students noted that the MSS improved their didactic and procedural knowledge of ophthalmology, respectively. An overwhelming majority of attendees (95.1%) stated they would recommend the COS MSS to medical students interested in ophthalmology, and 91.6% noted they would attend again. Conclusions: Our study demonstrated that a MSS is a valuable platform to enhance medical students’ exposure and knowledge of the field of ophthalmology. The MSS model can be applied as a novel medical education opportunity to increase exposure to medical specialties and inclusion of junior trainees at national conferences.

Background and Objective: There have been efforts to define appropriate training standards for bronchoscopy skill acquisition over the decades. Towards the end of the 20th century, the prevailing paradigm focused on numbers-based standards for trainee skill acquisition. Multiple societies recommended set procedural numbers for trainees and practitioners for verification of competency in bronchoscopy. As understanding of procedural training has evolved, educators have concluded that a numbers-based approach is insufficient for training as well as for assessment of competency. Educators have realized that there is variability across performers and solely relying on numbers of procedures performed is inadequate. Hence, focus has shifted towards structured curricula that can incorporate multiple educational modalities to supplement technical bronchoscopic skills acquisition. These modalities include educational modules, simulation training and assessment tools. The primary objective of the narrative review is to detail the history and evolution of flexible bronchoscopy training strategies. In this review, we will aim to discuss the educational theory that underpins these strategies. While the training recommendations have been reviewed elsewhere in the published literature, the discussion of the educational theory has been limited. We aim to delve into the educational theory that supports these training strategies. Methods: Literature search in the PubMed and MEDLINE databases was performed. Our literature search included the time-period from January 1, 1964 to May 1, 2023. Search was restricted to articles available in standard English. Key Content and Findings: This narrative review will contain historical recommendations for standardization of bronchoscopic training and how they have changed over time. We will review the current training standards and the educational theory that underpins them. The findings support focusing on bronchoscopic competence metrics rather than a solely number-based approach. Conclusions: Within the modern curricula, learners have access to training and assessment tools which have been validated for bronchoscopic education. These tools include educational modules, low and high-fidelity simulation models, and validated assessment tools. Training programs need to work to implement these tools and techniques in their educational framework to provide learners with the most optimal learning processes in bronchoscopy education.

Background: Thrombotic thrombocytopenic purpura (TTP) is a medical emergency manifested by a pentad of thrombocytopenia, microangiopathic haemolytic anaemia (MAHA), renal impairment, fever, and neurological symptoms such as confusion and seizure. TTP is precipitated by conditions such as vasculitis, pregnancy, cancer, drugs-induced, solid organ or stem cell transplantation, and infections with a background deficiency of a disintegrin and metalloproteinase with a thrombospondin type 1 motif member 13 (ADAMTS13). TTP in pregnancy is not uncommon, however, acute vision loss is a rare presenting sign of TTP. Case Description: A 17-year-old primigravida woman of Murut ethnicity presented with an acute vision loss at 32 weeks of gestation. She had no known medical illness with uneventful antenatal care. Her physical examination revealed bilateral visual loss with reduced visual acuity to finger counting over right eye and light perception over left eye, correlated with bilateral exudative retinal detachments in a fundoscopic examination. Her blood investigations showed MAHA and thrombocytopenia with a reduced ADAMTS13 activity at 10% reported later. Unfortunately, her pregnancy was complicated with intrauterine death. She was treated with plasma exchange and high dose intravenous corticosteroids with a complete resolution of symptoms. Conclusions: TTP is one of the complications in pregnancy which requires urgent management. It can masquerade as various manifestations including vision loss and require good clinical acumen to ensure timely diagnosis and management.

Anderson Gomes Nascimento Santana, Gyl Eanes Barros Silva, Jairo Rodrigues Santana Nascimento, Francisco Sérgio Moura Silva do Nascimento, Antonio Augusto Lima Teixeira Júnior, Rafael Campos Silva, Jose de Ribamar Rodrigues Calixto

Background: Phyllodes tumours (PTs) are rare neoplasms of the breast with similar clinical and radiological features to fibroadenomas. The presence of invasive carcinoma within a PT occurs in less than 1% of cases. Furthermore, the presence of invasive lobular carcinoma (ILC) within a borderline PT has only been reported once before in a female under the peak incidence age of 45 years, making the case presented here exceedingly rare. The incidental finding of ILC highlights the importance of the multidisciplinary team’s (MDT) collaborative expertise and rigorous investigative work-up where inconsistencies in the breast triple assessment are identified.

: Esophageal cancer is an aggressive malignancy. Many patients are found to have metastatic, unresectable disease at the time of diagnosis. Surgery is generally necessary as part of a multimodal treatment approach to non-metastatic esophageal cancer, but is associated with significant potential morbidity. During the operation, the surgeon must achieve an adequate cancer resection and then perform concomitant reconstruction of the gastrointestinal tract, which contributes to the high complexity of esophageal cancer surgery. The operation typically requires access to multiple body cavities, including some combination of the thorax, the abdomen, and the neck. Several options to accomplish esophageal resection and reconstruction exist, including Ivor Lewis esophagectomy, McKeown (three field) esophagectomy, transhiatal esophagectomy, and thoracoabdominal esophagectomy. The optimal approach for a specific patient will be dependent on patient, cancer, surgeon, and institution characteristics. This clinical practice review will explore the general epidemiology, work-up, and overall treatment of esophageal cancer, as well as outline the factors that impact surgical approach selection. The review describes the details as well as the advantages and disadvantages of each possible approach, and gives an overview of the spectrum of possible postoperative complications. An improved understanding of this topic can allow non-surgical specialists to better support their patients.