Info-Morsels

Contributor: Dr. Alison Baker

1. Indirect Patient Care Activities (IPCAs) include documentation, updating electronic medical records, managing orders, reviewing results, prescribing medications, and completing paperwork, i.e. all the work done outside of a face-to-face visit.
2. The workload of IPCAs has been increasing and is a major source of trainee and physician burnout.
3. IPCAs have not traditionally been given significant focus in residency training, even though this is a major part of a physician’s career. Explicitly and intentionally teaching on IPCAs demonstrates their value.

Key Message

Recognizing, structuring, teaching, and integrating IPC explicitly into office workflow improves patient outcomes, learner development, and physician sustainability.

Practical Strategies for Preceptors

References & Further Reading

1. O’Toole D. Indirect Patient Care in Primary Care Practice. Discussed on The Curbsiders Podcast. https://tinyurl.com/t53nm55y
2. O’Toole D, Sadik M, Inglis G, Weresch J, Vanstone M. Optimising the educational value of indirect patient care. Med Educ. 2022 Dec;56(12):1214-1222. doi: 10.1111/medu.14921. Epub 2022 Aug 29. PMID: 35972822.
3. https://fmf.cfpc.ca/wp-content/uploads/2023/11/T214_Postgraduate-Curriuclum-Development_Contextualizing-curricula-across-distributed-sites_handout2.pdf

Contributor: Dr. Cindy Donaldson

Summary:

Embracing uncertainty boosts resilience, sharpens decision-making, and improves patient outcomes. Approaching patient encounters that are not clear cut (so many!) with a sense of curiosity and a willingness to look beyond initial impressions helps us manage vague descriptions and conflicting information. Managing uncertainty is a skill that improves with practice and reflection, enhancing what we do, making us better advocates for our patients.

Infographic:

This infographic highlights strategies for managing clinical uncertainty, including a useful mnemonic to help find certainty within uncertainty.

Contributor: Dr. Karthiha Raveenthiran

Asynchronous e-learning modules offer an efficient way to teach our learners important concepts, allow educators to reach more learners, and provide flexibility for learning.

Summary:

E-learning designers should develop clear goals relevant to their learners, engage in thoughtful selection of the learning platform, incorporate interactive modules and provide opportunities for learners to continue their learning beyond the module. This article explores 12 tips that can help medical educators use best practices to design, develop, implement, and continually improve e-learning modules.

Infographic:

Link to Resource:

Paniszyn, L., Daddario, S., Colocci, I., Ibikunle, O., & Schwartz, A. W. (2026). Twelve tips for creating asynchronous e-learning modules in health professions education. Medical Teacher, 48(1), 25–30. https://doi.org/10.1080/0142159X.2025.2505120

Contributor: Dr. Nadine Abu-Ghazaleh

Why this matters
Disability is a common human experience. A 2021 Canadian Medical Association survey found that 22% of physicians report a disability or chronic health condition, most of which are non-apparent. Yet medical education continues to be shaped by a “selfless superhuman” ideal that assumes unlimited stamina, constant availability, and no need for accommodation. This narrative fuels internalized, cultural, and systemic ableism—and creates barriers for learners and faculty alike.

What is the “selfless superhuman”?
Medical culture continues to reflect an outdated “selfless superhuman” ideal that prioritizes endurance over wellbeing. We must challenge the stereotype that a “good doctor” is endlessly resilient, requires no rest, never gets sick, and consistently places personal needs last. By questioning how we define, model, and reward excellence, we can begin to recognize not only the systemic roots of this problem, but also the ways internalized ableism is perpetuated through our own clinical practices, teaching behaviours, and evaluative feedback.Creating space for this reflection is essential to fostering psychologically safe environments for learners, faculty, and all health-care allies. 

What can you do?

Medical educators hold real power: in evaluation, scheduling, curriculum design, and culture-setting. Moving from reactive accommodationto proactive accessibility is a necessary step toward equity, wellness, and sustainable medical practice.

Practical Take-aways for Educators:

• Reflect on your own assumptions about competence, efficiency, productivity, and “fit”
• Use inclusive language and respect identity-first or person-first preferences when speaking about patients or colleagues 
• Model self-care (e.g., taking sick days, attending medical appointments, setting boundaries)
• Learn the language and pathways: understand key terms (disability, ableism, accommodation, accessibility) and know where to direct learners for support, rather than expecting them to navigate systems alone (see below).
•  Know your accommodation policies—and advocate for clearer, more transparent ones where gaps exist
• Design proactively: clear expectations, flexible teaching methods, and transparent scheduling
• Approach learners with curiosity and compassion, not suspicion, when challenges arise

Key Take-away:
Accessibility is not about lowering standards—it’s about removing unnecessary barriers so people can meet them.

Key Definitions:

• Disability: A broad and diverse experience that may be physical, mental, cognitive, neurodevelopmental, sensory, episodic, temporary, or permanent—and intersects with other aspects of identity.
• Ableism: A belief system that values certain bodies and minds as the “gold standard,” consciously or unconsciously positioning disabled people as less capable or less worthy.
• Accommodation: An individualized adjustment that enables equitable participation. It is not a favour, preference, or guarantee of success—but a [human] right grounded in a functional need.
• Accessibility: A proactive process of identifying, removing, and preventing barriers so environments work for everyone—not just those who request accommodations.
• Internalized ableism: The process by which individuals—including health professionals—absorb cultural norms that equate worth, competence, or professionalism with productivity, endurance, and independence, often leading to shame, self-silencing, or unrealistic expectations of oneself and others.

Resources:

• The Office of Resident Affairs – McMaster University: https://pgme.mcmaster.ca/resident-affairs/  
  -Offers confidential support, at arm’s length from programs and PGME, including support to navigate personal, academic or workplace issues that emerge during training, and offers wellness counselling. To view availability and book a virtual appointment visit: https://macmdstudentresidentaffairs.janeapp.com/ or reach out to their confidential email at pgaffair@mcmaster.ca
• Supports for Trainees with Chronic Illness or Disabilities:
  Academic Accommodations for Disability:  
  see under resources section of Resident Affairs website or on medportal https://pgme.mcmaster.ca/resident-affairs/wellness-resources/. The confidential contact for trainees can be reached at pgaccomm@mcmaster.ca with any questions about accommodations, whether trainees have determined they require them or not.

References:
Canadian Medical Association. (2021). National physician health survey.
https://www.cma.ca/our-focus/physician-health-and-wellness/national-physician-health-survey Ontario Human Rights Commission. (n.d.). Policy on ableism and discrimination based on disability.
https://www.ohrc.on.ca/en/policy-ableism-and-discrimination-based-disability
Jain, N. R. (2022). The capability imperative: Theorizing ableism in medical education. Social Science & Medicine, 315, 115549.
https://doi.org/10.1016/j.socscimed.2022.115549
Centers for Disease Control and Prevention. (2023). Disability and health overview.
https://www.cdc.gov/ncbddd/disabilityandhealth/disability.html

Contributor: Amie Davis

1- DECREASE INTRINSIC LOAD – “COMPLEXITY OF NEW INFORMATION”
• Use a spiral curriculum where learners are introduced and re-introduced to increasingly complex topics and encounters
• Encourage continuity with patients over time (allowing familiarization with complexity)
• ”Chunk” or “Sort” encounter into smaller pieces (e.g. Sort information by system)

2. DECREASE EXTRANEOUS LOAD – “UNNECESSARY AND DISTRACTING INFORMATION”
• EXTERNAL EXTRANEOUS LOADS
Optimize learning environment: Decrease interruptions (pages, message alerts, voice interruptions) during a tasks. Ensure all equipment is available and ready including technology and charting equipment. Clearly mark/hold times for tasks that can be seen and respected by others

• INTERNAL EXTRANEOUS LOADS
Manage fatigue – Micro-breaks between tasks to allow re-focus, allow time for nutrition and “bio-breaks”, ensure adequate time held in the day for the tasks needed (so that can be present and not focused on “what comes next/feeling rushed”), wear clothing that is comfortable and adjustable to temperature throughout the day

3. INCREASE GERMANE LOAD – “LINKING NEW INFORMATION WITH CURRENT/PREVIOUSLY STORED INFORMATION SCHEMAS”
• Introduce learning aids (e.g. Mnemonics, rhymes, common links, pattern recognition)
• Link to similar previous presentations or patients seen in the past (also increases spiral learning)
• Use low-fidelity simulation to high fidelity (patient encounters) when possible (e.g. Practice first)

References:
1. Atkinson,R.C and Shiffrin, R.M.(1968). Human memory: A proposed system and its control processes. The psychology of learning and motivation Vol.2 (89-195)
2. Baddeley, A.D. Working Memory. Phil. Trans.R.Soc.Lond.B. Vol 302,311-324(1983)
3. Steven E Roskos, Laurie Fitzpatrick, Bengt Arnetz, Judy Arnetz, Shiva Shrotriya, Elizabeth Hengstebeck, Complex patients’ effect on family physicians: high cognitive load and negative emotional impact, Family Practice, Volume 38, Issue 4, August 2021, Pages 454–459,https://doi.org/10.1093/fampra/cmaa137