Catherine Patocka

Rationale: The era of Competency-based medical education (CBME) has brought with it a renewed focus on the importance of feedback. Embedded within the Competence-by-Design (CBD) framework, feedback is recognized as a catalyst for growth and learning. While recent scholarly discourse in postgraduate medical education (PGME) has focused on feedback conversations related to learner performance, there exists a noticeable gap in attention to upward feedback specifically, feedback from learner to teacher. Acknowledging the important role that meaningful upward feedback may play in the delivery of education, we require systematic understanding of the diverse ways in which upward feedback is operationalized and knowledge about the mechanisms through which it contributes to the quality of education. The objectives of this project will be to use realist methods and pattern theory map the landscape of upward feedback in one PGME program in Canada and develop realist program theory that explains its intended and actual outcome patterns.       

Precision health is increasingly viewed as a transformative approach to tackling complex health challenges. While the medical community often uses the term “precision” to describe initiatives that are individualized and data-driven, its meaning has become increasingly diffuse and ambiguous across the diverse contexts in which it is applied. For example, the University of Calgary Cumming School of Medicine’s Precision Health Program integrates a broad spectrum of focus areas—including innovation and entrepreneurship, quality and safety leadership, health professions education leadership, and precision medicine—within a single framework. This transdisciplinary programming represents a valuable shift away from traditional, technocratic, and siloed problem-solving approaches commonly seen in science and medicine. However, the lack of a clear, cohesive framework connecting these diverse fields has created challenges for educators tasked with establishing relevance and preparing graduates for future roles in healthcare.

Our project will employ a realist evaluation approach to analyze diverse data sources—including textual documents, course materials, and insights from focus groups and interviews with students, faculty, and leaders from the University of Calgary Cumming School of Medicine’s Precision Health Program. The goal is to develop a pattern system that captures how precision health is conceptualized and operationalized within the program. This pattern system, along with detailed pattern mapping, will serve as a foundation for a comprehensive curriculum review and renewal, and will guide conversations/workshops with potential and existing students ensuring the program aligns with its objectives and equips learners to meet the evolving demands of precision health.

Canadian hospitals consistently struggle to provide timely access to emergency care. Patients often encounter overcrowded waiting rooms, lengthy triage queues, and wait times that significantly exceed both Canadian Triage and Acuity Scale (CTAS) targets and patient expectations. Optimal patient outcomes and system efficiency are achieved when care is provided by the most appropriate setting by the right providers. Yet, as Emergency Departments (ED) increasingly function as a fallback for broader system deficiencies, this sets a concerning precedent. More importantly, it highlights the ED as a prime environment for implementing a Learning Health System (LHS). By leveraging real-time data, continuous feedback, and adaptive learning, an EDbased LHS can not only improve its own internal operations but also address systemic challenges across the healthcare continuum, improving coordination, optimizing resource use, and enhancing patient outcomes.

We propose that feedback is the core driver of learning, adaptation, and continuous improvement within a LHS. While feedback is widely recognized as essential to promoting evidence-based responsive healthcare, a critical and often overlooked reality is that approximately one-third of feedback initiatives result in worse performance. This underscores the need for deeper exploration to ensure feedback mechanisms are effective and lead to positive outcomes. Given the interdisciplinary nature of the ED, there are numerous system-level opportunities for feedback and improvement, such as reducing specialist consultation times, enhancing referral patterns, and identifying care that could be more appropriately provided in other settings. For this catalyst grant we will focus specifically on optimizing referrals to the ED, while simultaneously developing a scalable framework that can be adapted for broader applications in the future.

Although patients do not require a referral to access the ED, they are sometimes directed there by other physicians or healthcare providers. For patients needing immediate emergency care, timely direction to the ED can lifesaving. However, in an overburdened healthcare system, many of these recommendations may arise from limited access to resources, resulting in patients visiting the ED for care that might be more optimally provided elsewhere. As a result, patients who do not require immediate emergency treatment end up in the ED for care that falls outside the primary accountability of the ED. This creates strain on emergency services, diverting resources from true emergencies and positioning the ED as a safety net for broader healthcare system gaps. A key starting point is to develop strategies for feedback to providers who refer patients to the ED. However, we currently we lack clarity on the magnitude and breadth of patient referrals to the ED, whether referring providers receive feedback on patient outcomes, and what types of feedback they would find most valuable to improve their referral decisions