CREMS SUMMER RESEARCH PROGRAM
2015 PROJECTS – PART II
PLEASE READ CAREFULLY
The following catalogue represents the projects that are available for the 2015 CREMS Summer Research
Program. You must use the contact information provided in order to set up an appointment to discuss the project
in more detail with the supervisor.
While you may contact multiple supervisors, you can only submit ONE application. Some supervisors have
multiple projects in their lab but you must choose ONE and submit an application for that.
Contact the supervisor on the project you are interested in. Once the supervisor confirms that you are the
successful applicant you must complete the 2015 Summer Research Student Application. Please request
this form from once you are the confirmed choice. We will not be giving out applications until you have been
chosen by the supervisor.
The completed application form is due by 5 pm on Friday March 27, 2015.
The application form must be sent via email ONLY to crems.programs@utoronto.ca
Good Luck!!
Medicinal Intervention (xxxx) for neck pain: A Cochrane Systematic Review
Update
Supervisor Name: Shaun Segal
Hospital/Research Institution: Community – GSH Medical
Email: shaun.segal@utoronto.ca
Department: Family & Community Medicine
Brief Project Description
Research Question: To assess if *Medicinal Intervention (xxxx) improves pain, function/disability, patient
satisfaction, quality of life, and global perceived effect in adults with acute/subacute/chronic neck pain with or
without cervicogenic headache or radicular findings.
1. Background update: burden of illness, biological rationale for therapy use and dosage options, brief review of
reviews
2. literature search update (3 year period) – conducted by a research librarian
3. screen and select articles using pre-piloted forms
4. extract data on pain, function, global perceived effect, satisfaction and quality of life and dosage factors for
laser therapy
5. internal and external validity assessment, assessment of clinical applicability
6. assist with input of data and synthesis
7. assist with final recommendations
8. update review
Expected Student Involvement:
1. 9. background update – burden of illness, other review articles
2. 10. extract data, internal (risk of bias) and external validity (grade) assessment, clinical applicability
assessment
3. 11. data entry into revman, analysis and synthesis
4. 12. assist with final recommendations
5. 13. submission of final manuscript in revman format to Cochrane
6. 14. create abstract, produce poster and present on Research day and prepare manuscript for course
deliverables.
* We will be collaborating with Anita Gross on McMaster Faculty. She has the Botox review mounted onto Revman and
is accepted as a Cochrane Review (see appended). Other medical interventions include: nerve blocks, prolotherapy,
epidurals, lidocaine infusions etc.
Mapping the primary care research capacity of every country
Supervisor Name: Frank Sullivan
Hospital/Research Institution: NYGH / Dalla Lana / ICES
Email: frank.sullivan@nygh.on.ca
Department: Family & Community Medicine
Brief Project Description
A strong primary care system underpins Universal Health Care. Although even basic health care for all is often considered
an idealistic goal that remains out of reach for all but the richest nations, Amartya Sen has recently cited what has been
achieved in Rwanda, Thailand and Bangladesh to refute that argument. Recent work by Parks in the Robert Graham
Centre in Washington has mapped the strength of primary care in every country in the world. This has demonstrated
significant variation which is, in part, due to the research capability of primary care in that country. This project will
extend the Geographical Information System developed by Parks to determine the research capability of each country.
The research methods will be focused on a web-based search strategy to identify electronically published materials related
to the main question: country level description of primary care research capability. Peer reviewed research is housed and
catalogued online. Additionally, gray literature, personal web-logs or organizational web-pages are avenues through
which people communicate information about their work. This does not suffer the lag time of books or peer-reviewed
literature. Organization web pages and blogs do not always overlap with the traditional medical research infrastructure.
Including this type of method in the search strategy is critical to ensure valuable information is included. Additionally,
there exist valuable repositories of information that would not be captured in a Pubmed search. This includes the
American Academy of Family Physicians(AAFP) Global Health workshop database of presentations Family Medicine
Digital Research Library (FMDRL) and World Organization of National Colleges, Academies and Academic
Associations of General Practitioners/Family Physicians. (WONCA) membership pages.
This work will be supervised by Prof, Frank Sullivan with input from Dr. Katherine Rouleau, Program Director, Global
Health Program. Several conference presentations and at least one impactful peer reviewed publication are expected to
result from this work.
A Greater Toronto Area Obstetric (GTA-OBS) Network Standardized Protocol for
the Care of Pregnant Women with a Short Cervix in Pregnancy
Supervisor Name: Nan Okun / Gareth Seaward / Jon Barett
Hospital/Research Institution: Mt. Sinai / Sunnybrook / St. Michael’s
Email: nokun@mtsinai.on.ca
Department: Obstetrics & Gynecology
Brief Project Description
The University of Toronto Division of Maternal Fetal Medicine has recently formed a GTA-wide Network to improve the
care of pregnant women across the region (LHINs 5 to 9). As well as prospective research projects, the GTA-OBS
Network will develop standardized evidence-based protocols for care of women with complications associated with
increased adverse outcome. Premature birth remains the most common cause of severe perinatal mortality/morbidity, and
a short cervix by ultrasound is a strong predictor for preterm birth. The CREMS student will work with the supervisors to
review the literature, consult with key experts within the GTA-OBS Network and nationally/internationally to develop a
protocol that can be recommended throughout the region. The student will choose key performance indicators that can be
measured before and after institution of the protocol to evaluate its’ effect on standardization of practice, and on perinatal
outcomes. The student will work with the GTA-OBS Network section of the Better Outcomes Registry and Network
already in place to use currently existing data and introduce new fields as need to house the prospectively collected data.
The student will prepare a presentation to the GTA-OBS in addition to relevant research days, and prepare a manuscript
for submission to a peer reviewed journal, either in OBS/Gyne or health policy fields.
Discovery of hidden clinical and metabolic genetic syndromes in neuropsychiatric
patients
Supervisor Name: Joyce So
Hospital/Research Institution: Fred A. Litwin Family Centre in Genetic Medicine / UHN / Mt. Sinai
Email: joyce.so@utoronto.ca
Department: Medicine (Adult Genetics)
Brief Project Description
We hypothesize that a sub-population of patients with psychiatric impairment with medical or developmental comorbidities has underlying genetic conditions. The overall goal of this study is to define the types and prevalence of
genetic syndromes within this population, therefore potentially revolutionizing the management and treatment of selected
individuals with psychiatric impairment. The specific aims are:
Aim 1: Establish a clinical database of phenotypic correlates in order to delineate the highest-yield data that lead to the
most effective and efficient diagnosis of genetic syndromes in patients with psychiatric disorders. We are recruiting and
collecting medical and family history information from individuals who have psychiatric conditions along with other
medical findings, such as congenital anomalies, neurological disorders, dysmorphic features, developmental delay or
autism spectrum disorder.
Aim 2: Delineate novel adult phenotypes in genes associated with known genetic syndromes. This aim will be achieved
by attaining genetic diagnoses in patients either by clinical or research testing means, followed by genotype-phenotype
analyses of the clinical database and molecular and/or biochemical results.
Aim 3: Discover novel genetic syndromes in patients with neuropsychiatric phenotypes. This aim will be achieved by
performing high-resolution SNP microarray and whole-exome sequencing in patients for whom a genetic diagnosis could
not be achieved by clinical means. Bioinformatic analysis of the array and sequencing data will aim to determine the
pathogenetic relevance of variants found in any given individual.
Aim 4: Educate primary care physicians, patients and families about the important implications for surveillance,
management, treatment and family planning once a genetic diagnosis is made in psychiatric patients with co-morbid
conditions. This will be achieved through direct communication with physicians, patients and families, as well as
educational initiatives in the form of rounds, seminars and publications.
Students may be involved in any or several of the project aims.
Hyperbaric Oxygen Therapy in Fibromyalgia Full Sample: Effect on Global
Funtion
Supervisor Name: Rita Katznelson
Hospital/Research Institution: Toronto General Hospital
Email: rita.katznelson@uhn.ca
Department: Anesthesia
Brief Project Description
Fibromyalgia (FM) is a chronic pain condition affecting several millions of Canadians. Although the etiology and
pathophysiology are poorly understood, there is a well-recognized association between muscular pain in fibromyalgia and
muscular hypoperfusion, hypoxia, abnormal muscle metabolism and oxidative stress. Currently there is no cure for FM.
Pharmacological and non-pharmacological strategies are directed to control symptoms such as pain, fatigue, nonrestorative sleep and depression. Hyperbaric oxygen therapy (HBOT) is an intermittent inhalation of 100% oxygen in a
hyperbaric chamber at a pressure higher than 1 absolute atmosphere. Physiological effect of HBOT is based on a dramatic
increase in the amount of dissolved oxygen carried by the blood which enables oxygenation of ischemic areas with
compromised circulation. It also activates oxidant-antioxidant system, stimulates angio- and neurogenesis, modulates
inflammatory response, induces brain neuroplasticity and possesses analgesic effect.
While some interventions offer benefit for some patients, additional treatment alternatives are needed for patients with
FM in whom currently available options are either ineffective or poorly tolerated. Given its physiological effect, HBOT
could be considered as a potential therapy for treatment of underlying muscular hypoxia, optimizing oxidant antioxidant
system and controlling FM symptoms. HBOT is a safe and reliable non- pharmacological intervention that potentially can
alleviate muscle hypoxia and oxidative stress and improve pain and functional capacity in FM patients. The current study
seeks to answer several questions: First, whether hyperbaric oxygen therapy is an effective treatment for pain in patients
with fibromyalgia; Second, does hyperbaric oxygen therapy improve patients' quality of life (as assessed by a series of
questionnaires measuring depression, fatigue, and sleep quality); Third, are there any structural or functional changes seen
on magnetic resonance imaging.
A global assessment of infant feeding guidelines & practice in the context of
maternal HIV
Supervisor Name: Mona R. Loutfy
Hospital/Research Institution: Women’s College Hospital Research Institute (WCRI)
Email: mona.loutfy@wchospital.ca
Department: Medicine
Brief Project Description
In 2010 the World Health Organization (WHO) issued updated Guidelines on HIV and infant feeding. While executive
formula feeding indisputably eliminates the risk of perinatal transmission in the postpartum period, the WHO
acknowledges that replacement feeding must be acceptable (A), feasible (F), affordable (A), sustainable (S), and safe (S)
(AFASS Criteria). The AFASS criteria present a clear distinction between resource-rich countries (RRC) and resourcelimited countries (RLC). Despite this, it is often difficult to provide counseling on the risks and benefits of various infant
feeding options when recommendations differ across borders and patients are aware of such discrepancies due to
migration. As such, the Women and HIV Research Program at Women’s College Research Institute will undertake an
environmental scan (ES) in partnership with Women for Positive Action (based in London, UK), a global initiative
established in response to the need to address specific concerns of women with HIV and those involved in their care. The
primary objective of the ES is to identify national and international guidelines on infant feeding to inform practice and
policy-making on a global scale. The project will utilize ES methodology developed by Morrison (1992) to
comprehensively compare and analyze Guidelines that are available in published literature in addition to grey literature
from global health and AIDS service organizations. The student will also develop tools (surveys, telephone interview
guide) to gather information from key informants and experts in the field. As such, the CREMS candidate should be able
to: 1) Conduct literature researches using databases, reference lists and web-based resources; 2) Critically analyze and
conceptualize information using multiple lenses including social, technological, economic, environmental, and political
(STEEP); and 3) Present information according to academic standards (protocols, manuscripts, abstracts, posters). The
candidate must also demonstrate and interest in HIV research, knowledge synthesis, translation & exchange.
Evaluation of Baseline and Experienced NNRTI Resistance in a Large Urban Clinic
Setting
Supervisor Name: Mona R. Loutfy
Hospital/Research Institution: Women’s College Hospital Research Institute (WCRI)
Email: mona.loutfy@wchospital.ca
Department: Medicine
Brief Project Description
The Maple Leaf Clinic (MLMC) is a multi-specialty clinic that phases II-IV clinical research to improve the lives of their
patients living with HIV/Hepatitis C and those at increased risk of acquiring these viruses. This summer CREMS project
focuses on assessing non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance in the MLMC cohort of HIVpositive patients. Current first generation NNRTIs are associated with the development of resistance mutations (ie.
K103N, Y181C) that severely impact on the selection of second generation NNRTIs for salvage therapies. In addition,
first and second generation NNRTIs are associated with dietary restrictions and side effects which impose limitations on
their long term usage as standard first line treatments and salvage therapies. As such there are many benefits to a novel
their generation NNRTI with pre-clinical success against NNRTI-transmitted mutations, and in clinical pharmacology
studies, usage as a once a day dose with no food restrictions. In our MLMC cohort of HIV-positive patients we will assess
the utility of a third generation NNRTI. Our HIV-positive patients will be stratified into two groups: 1) an antiretroviral
therapy (ART)-naïve group with baseline genotyping available and 2) an ART-experienced group with genotyping.
Objectives in group 1 are to assess the presence of baseline drug resistance (particularly NNRTI and accompanying nonnucleoside reverse transcriptase inhibitors (NRTI) and objectives for a group 2 are to assess the incidence and prevalence
of resistance development following some course of ART. The selected candidate must possess skills in : a) critical and
academic writing for research and knowledge translation and exchange (i.e., research analysis plans, manuscripts,
abstracts, posters, and research snapshots), b) cross-sectional and descriptive analysis and study design and c) literature
searches. The selected candidate must demonstrate an interest in HIV clinical research, primary HIV care, and drug
resistance from previous research activities and/or class assignments/activities.
Assessment of cardiovascular risk scores and factors in HIV-positive patients in
2007-08 versus 2012-13 who started antiretrovirals in the prior 5 years
Supervisor Name: Mona R. Loutfy / Frederic Crouzat
Hospital/Research Institution: Women’s College Hospital Research Institute (WCRI) / Maple Leaf Medical Clinic
(MLMC)
Email: mona.loutfy@wchospital.ca
Department: Medicine
Brief Project Description
The Maple Leaf Medical Clinic (MLMC) is a multi-specialty clinic that conducts phases II-IV clinical research to
improve the lives of their patients living with HIV/Hepatitis C and those at increased risk of acquiring these viruses. This
summer CREMS project focuses on cardiovascular disease (CVD), a prominent concern for persons living with HIV. Precombination antiretroviral therapy (cART), markers of inflammation, worse HIV outcomes and traditional CVD risk
factors (i.e., metabolic syndrome) are all CVD concerns. The prevalence of CVD risk factors and risk for CVD were
higher in HIV-positive persons compared to HIV-negative persons. Post-cART, CVD were more elevated in cARTtreated persons versus untreated persons and the risk of CVD was higher among those on cART compared with HIVnegative and treatment naïve HIV-positive persons. Different antiretroviral (ARV) drugs and classes, and different
metabolic, inflammatory, and other systemic pathways have bene shown to lead to increased incidence and/or prevalence
of CVD. However, the evolving field of cardiovascular health for persons living with HIV warrants further investigation
and specifically characterizing CVD in the MLMC population to improve their primary HIV care and assess CVD risk
and incidence. The primary objectives of this project are to compare: 1) Framingham and 2) DAD cardiovascular risk
scores for HIV-positive patients from 2007-08 and 2012-13 treatment era. Secondary objectives intend on exploring CVD
risk factors, outcomes, and medication use as well as lipid profiles. The selected CREMS candidate must possess skills in:
a) critical and academic writing for research and knowledge translation and exchange (i.e., research analysis plans,
manuscripts, abstracts, posters, and research snapshots), b) cross-sectional and descriptive analysis and study design and
c) literature search. The selected candidate must demonstrate an interest in HIV clinical research, primary care of persons
living with HIV, CVD health from previous research activities and/or class assignments/activities.
The Impact of a Hereditary Colorectal Cancer Education Intervention for Family
Physicians and Patients: A 10-year study
Supervisor Name: June C Carroll
Hospital/Research Institution: Mount Sinai Hospital
Email: jcarroll@mtsinai.on.ca
Department: Family & Community Medicine
Brief Project Description
Colorectal cancer (CRC) is the second and third highest cause of cancer death in Canadian men and women respectively.
Family history is a significant CRC risk factor, playing a role in 15-30% of cases, particularly if a first-degree relative is
affected. CRC screening has been found to reduce mortality for average and high-risk individuals, however screening
rates for average-risk individuals are <20%. Educational tools were developed for this study to address family physicians’
(FP) reported lack of knowledge and confidence with hereditary CRC, and to educate patients on appropriate screening.
In Phase I which commenced in 2005, participating in FPs recruited from Ontario and Newfoundland received a baseline
questionnaire, and our CRC Risk Triage/Management tool. They were asked to use the tool for 3 months and to recruit 5
patients. Participating patients received a baseline questionnaire, and an information booklet. The post-intervention
questionnaire was sent to FPs and patients. The CRC point-of-care tool was associated with improvements in FPs’ CRC
risk assessment, screening and genetics referral recommendations for clinical vignettes.
In 2009 FPs and patients received a follow-up questionnaire (Phase II). Those who completed the questionnaire were
asked if they could be re-contacted to participate in Phase III.
The purpose of Phase III is to determine the CRC screening recommendations of FPs and screening behaviour of patients
10 years after the initial educational intervention and to determine what factors are associated with appropriate CRC
screening. This proposed CREMS project, Phase III of our 10-year study, would require a medical student to conduct an
updated literature review; mail questionnaires to FPs and patients; enter data; assist with analysis; write a report and
prepare a presentation. Ethics approval will be received from Mount Sinai Hospital and Memorial University in
Newfoundland by April 2015.
A Novel, Multidisciplinary, Transitional Pain Service (TPS) Designed to Manage
Moderate to Severe, Acute Postsurgical Pain, Reduce Hospital Length of Stay,
Facilitate Opioid Weaning and Prevent the Transition to Chronicity Following
Major Surgery
Supervisor Name: Hance Clarke
Hospital/Research Institution: Toronto General Hospital / UHN
Email: hance.clarke@uhn.ca
Department: Anesthesia
Brief Project Description
Chronic postsurgical pain accounts for 22% of patients presenting to pain clinics. Patients who develop chronic
postsurgical pain are at increased risk for persistent opioid use. Ontario data shows that after surgery 50% of patients are
discharged with opioid analgesics and 3% of previously opioid naïve patients continue to take opioids 6 months later. The
Transitional Pain Service (TPS) is a team of pain specialists: anesthesiologists, family physicians, nurse practitioners,
psychologists, and physiotherapists/acupuncturists. This novel service is designed to improve in-hospital pain care (reduce
pain intensity, hospital stay, increase patient satisfaction), enable successful transition to the community, facilitate opioid
weaning, and reduce the incidence/intensity of chronic postsurgical pain. The TPS will address the large gap in patient
care that is responsible for unrelieved pain, hospital re-admission, and ongoing opioid use in complex pain patients. Novel
psychoeducation programs, non-opioid pain strategies and other approaches will be examined. Post-discharge follow-up
with pain clinicians who liaise with surgeons and primary care physicians will improve pain control and enable faster
return to pre-surgical function.
The objectives of the Transitional Pain Service are to determine whether the implementation of this world first
multidisciplinary service can 1) improve patient care for patients with complex chronic pain following major surgery 2)
improve acute pain care, reduce in-hospital length of stay and patient satisfaction 3) improve communication between 1°
and 3° care following major surgery and 4) determine whether the TPS can successfully facilitate opioid analgesic
weaning after major surgery and reduce the development of Chronic Post-Surgical Pain (CPSP) .
The student will work with the TPS team to evaluate the effectiveness of the TPS based on the objectives presented above.
The data will enable the development of predictive algorithms and treatment guidelines for patients at risk for the
development of CPSP.
Optimizing Case Based Learning: An Experimental Study
Supervisor Name: K. (Mahan) Kulasegaram
Hospital/Research Institution: Wilson Centre, TGH
Email: mahan.kulasegaram@utoronto.ca
Department: Family & Community Medicine
Brief Project Description
Teaching cases are used in medical education in many different formats and curriculum designs including case-based
learning, problem-based learning, e-learning modules, and very often accompanying or within traditional lectures. While
there is near universal agreement that cases are ‘useful’ the actual evidence on how cases are best constructed and the
fostering optimal learning is not well understood. This study examines how cases can be designed to trigger interactions
that promote deep, meaningful learning of conceptual knowledge during undergraduate training. In a 2x2 experimental
design we will compare the impact of presentation order (case before didactic and case after didactic teaching) as well as
case design (traditional case vignettes vs. embedded concept cases). The outcome measures will examine impact on
diagnostic reasoning in the form of retention (recall of concept facts) and transfer of knowledge (application to novel
virtual patient cases). We hypothesize that while presentation order does not change the learning experience, embedded
concept cases are more likely to promote transfer of learning across clinical contexts and new patient problems. The
outcomes of this study will inform case construction principles that will be applied to the new pre-clerkship curriculum.
Students involved in this project will be trained in cognitive theories of learning, experimental design, statistical analysis,
assessment of learning, and introduced to the field of medical education research. Matched funding will be provided by
the supervisor via the Department of Family and Community Medicine. Intended products will include an international
presentation and a publication in a medical education journal.
Teaching cases are used in medical education in many different formats and curriculum designs including case-based
learning, problem-based learning, e-learning modules, and very often accompanying or within traditional lectures. While
there is near universal agreement that cases are ‘useful’ the actual evidence on how cases are best constructed and the
fostering optimal learning is not well understood. This study examines how cases can be designed to trigger interactions
that promote deep, meaningful learning of conceptual knowledge during undergraduate training. In a 2x2 experimental
design we will compare the impact of presentation order (case before didactic and case after didactic teaching) as well as
case design (traditional case vignettes vs. embedded concept cases). The outcome measures will examine impact on
diagnostic reasoning in the form of retention (recall of concept facts) and transfer of knowledge (application to novel
virtual patient cases). We hypothesize that while presentation order does not change the learning experience, embedded
concept cases are more likely to promote transfer of learning across clinical contexts and new patient problems. The
outcomes of this study will inform case construction principles that will be applied to the new pre-clerkship curriculum.
Students involved in this project will be trained in cognitive theories of learning, experimental design, statistical analysis,
assessment of learning, and introduced to the field of medical education research. Matched funding will be provided by
the supervisor via the Department of Family and Community Medicine. Intended products will include an international
presentation and a publication in a medical education journal.
Raters & Biases in Admissions Assessment
Supervisor Name: K. (Mahan) Kulasegaram / Mark Hammon
Hospital/Research Institution: Wilson Centre, TGH
Email: mahan.kulasegaram@utoronto.ca
Department: Family & Community Medicine / Psychiatry
Brief Project Description
Admissions interviewing is the standard method of evaluating medical school applicants for inter-personal skills and other
intrinsic attributes such as communication, ethical reasoning, and reflective ability. This process necessarily requires
faculty and student raters. However, increasing evidence in medical education and cognitive psychology suggests raters
are prone to many universal, systematic, often unconscious biases when making social judgments of others. Research in
evolutionary psychology suggests that perceived attractiveness of faces exerts a strong influence on judgments of
competency, trustworthiness, and ability. Specifically, physical characteristics such as facial symmetry and perceived
healthiness can influence perceptions of attractiveness and thus can play role in decision making. The proposed research
builds on a previous study to investigate how the physical characteristics of faces related to attractiveness influence rater
decision making on competency and suitability for medical school. The method for this study will borrow an experimental
paradigm from evolutionary psychology. Participating faculty raters (males and females) will complete an online module
where they will be asked make judgments of mock medical school applicant profiles (presented with pictures). These face
images will be manipulated for attractiveness using a validated protocol and special software with raters randomized to
varying manipulated face image conditions. Differences in ratings of attractiveness manipulated profiles versus control
profiles will be analyzed. Medical school admissions is a critical assessment point for all physicians. Ensuring fairness
and valid assessment is a practical and ethical imperative but threatened by unconscious biases. The results of this study
will inform our understanding of rater bias and suggest avenues to limit bias. Participating students will learn about rater
based assessments, experimental design, statistics, and evolutionary psychology. They will be asked to contribute to all
stages of the research process, help collect data, and analyze the outcomes.
Reducing Unnecessary Imaging for Thromboembolic Disease in the Emergency
Room: Choosing Wisely
Supervisor Name: Michelle Sholzberg / Kieran McIntyre / Lisa Hicks
Hospital/Research Institution: St. Michaels’ Hospital
Email: sholzbergm@smh.ca
Department: Medicine, Division of Hematology-Oncology
Brief Project Description
Patients presenting to Emergency room with unexplained dyspnea occasionally require investigations to exclude
potential life threatening venous thromboembolism (VTE). The necessary tests of CT angiography or ventilationperfusion (V/Q) carry the risks of radiation exposure to our patients and significant cost to our healthcare system.
The Choosing Wisely campaign has identified a number of areas in which patients are receiving unnecessary
diagnostic testing; imaging of patients with suspected VTE and low pre test likelihood with negative d- Dimer
results has been one of the areas marked for improvement.
Through the use of validated scoring tools, patients can have a pre-test probability (PTP) score generated in real time
and in conjunction with the results of highly sensitive d-Dimer assays, avoid unnecessary radiation without
compromising care. Estimates are that up to one in three patients undergoing investigations for VTE may have
unnecessary ionizing radiation that could be safely avoided through the application of PTP scoring tools.
At St. Michaels hospital, an urban tertiary care center with approximately 75 000 annual Emergency Room visits,
this would represent approximately 1500 patients being investigated for VTE (patients with high PTP would not be
considered in this cohort) and could represent up to 500 patients undergoing unnecessary testing.
The role of the summer student would be to assist in the collection and analysis of data pertaining to the
implementation of validated VTE-PTP screening tools (one for lower limb VTE and another for pulmonary
embolism). The student would assist in the implementation of the screening tools as they roll out through the
Emergency room, monitoring compliance by tracking usage and by reviewing the number of cases undergoing
unnecessary testing (low PTP and negative d-Dimer). Data would be collected with intention of publication, a
background or knowledge of statistics and data collection forms would be helpful but not absolutely necessary.
Low or Very Low serum Anti-mullerian Levels (AMH) as a Predictor of Pregnancy
outcome in the Infertile Population
Supervisor Name: Prati Sharma
Hospital/Research Institution: Create Fertility Clinic
Email: pratibhasharma.md@gmail.com
Department: Obstetrics and Gynecology
Brief Project Description
Background: There is an age-related drop in oocyte quantity and quality (Nelson et al., 2013) which typically results in a
decline in success after fertility treatment (Oudendijk et al., 2012). Heterogeneity in the size of the ovarian reserve at any
given age results in marked inter-individual variation in ovarian response (Wallace and Kelsey, 2010). A variety of
ovarian reserve tests have been developed and their predictive capacity for ovarian response examined. Recent systematic
reviews show that anti-Müllerian hormone (AMH) has been confirmed as the current best biomarker for prediction of
poor and excessive ovarian response (Broekmans et al., 2006; Broer et al., 2009, 2011, 2013; Nelson et al.,
2009; Anckaert et al., 2012). However,
a recent meta-analysis of 1008 patients undergoing fertility treatment demonstrated a weak association of AMH with
ongoing pregnancy (Broer et al., 2013). . Oftentimes, women with low AMH levels are counselled to proceed with
aggressive fertility treatments such as IVF to improve the chances of pregnancy. However, it is unclear what is the best
fertility treatment is for women with low and very low AMH levels.
The aim of this study is to define the importance AMH levels in fertility patients, to correlate levels with age, and
pregnancy outcome, and to determine the optimal fertility treatment strategies for women with low/very low level of
AMH.
Methods: This retrospective case-control study will be conducted at Create fertility center. Experimental group: infertile
patients with low/very low ovarian reserve, undergoing different fertility treatments, such as NC (natural cycle +/IUI/TDI (intrauterine or donor insemination), Femara +/- IUI/TDI, Clomid +/- IUI/TDI, FSH +/- IUI/TDI, and IVF (in
vitro fertilization). The control group will be infertile patients with normal ovarian reserve undergoing the same type of
fertility treatments.
We will compare age, body mass index (BMI), prior pregnancy outcome, infertility etiology, semen analysis results,
hysterosalpingogram results, and other laboratory parameters such as AMH, FSH, antral follicle count and treatment
protocols. The association between AMH levels and fertility treatment outcome will be evaluated by looking at pregnancy
rate, implantation, spontaneous abortion and live birth rate). Multi-variant regression analysis will be undertaken after
controlling for age, and causes of infertility.
Quantitative Spinal Cord MRI in Radiologically Isolated Syndrome Patients: A
Prospective Study
Supervisor Name: Jiwon Oh
Hospital/Research Institution: St. Michael’s Hospital / Keenan Research Centre of the Li Ka Shing Knowledge Institute
Email: ohjiw@smh.ca
Department: Neurology
Brief Project Description
Radiologically isolated syndrome (RIS) is a relatively newly-described clinical entity where individuals have lesions on
MRI highly suggestive of multiple sclerosis (MS), but do not have any accompanying clinical features. Currently, there
are no guidelines regarding the best clinical care of these patients, and it is unclear whether treatment with diseasemodifying agents typically used in MS is required. We would like to identify individuals who are at high-risk for
conversion to MS, since these patients would benefit from earlier treatment.
Advanced MRI techniques in the SC have demonstrated increased sensitivity to underlying tissue microstructural
properties in comparison to conventional MRI techniques, and a number of prior studies have demonstrated that these
techniques can provide new insights into the extent and type of tissue damage mediating clinical disability in MS tissue.
The major objective of this study is to use advanced, quantitative MRI measures in the SC in RIS patients and healthy
subjects to assess if quantitative SC MRI measures can predict which RIS patients will eventually convert to MS.
The MRI in MS Research Program at St. Michael’s Hospital is currently looking for a full time summer student from late
May- August 2015. Summer student duties will include but not limited to a number of roles within this project, including:
patient recruitment, coordination of study visits, data entry, image processing, and data analysis.
Quantitative Spinal Cord MRI in MS patients with Sexual Dysfunction
Supervisor Name: Jiwon Oh
Hospital/Research Institution: St. Michael’s Hospital / Keenan Research Centre of the Li Ka Shing Knowledge Institute
Email: ohjiw@smh.ca
Department: Neurology
Brief Project Description
Sexual function is an important component of health related quality of life (HRQoL). While often overlooked, the
prevalence of sexual dysfunction (SD) in Multiple Sclerosis (MS) is estimated to be between 40-80%. SD has been shown
to have detrimental effects on the mental and physical aspects of HRQoL in MS patients. Individuals with SD report
poor outcomes in all major dimensions of wellbeing, including health, achievements, and personal relationships.
While SD in MS is certainly multifactorial, it appears to be, at least in part, mediated by damage to the spinal cord and its
autonomic connections4,7,9.
To date, only one study (n=30) has examined the association between spinal cord atrophy and SD in MS. The spinal cord
(SC) is a compact structure with a functional anatomic organization that makes it an ideal substrate to study structurefunction relationships in MS. Despite these benefits, the SC has been challenging to study using conventional, lesionbased MRI measures due to limited clinical-radiological correlations and technical difficulties.
Advanced, quantitative MRI techniques in the SC, including diffusion tensor imaging (DTI) and magnetization transfer
imaging imaging ratio (MTIRI) have demonstrated increased sensitivity to underlying tissue microstructural properties in
comparison to conventional MRI techniques, and have the potential to provide clinically relevant information on
microstructural tissue integrity beyond that which can be obtained from conventional MRI measures alone. These
techniques may be of significant utility in better understanding the pathological substrates of SD in patients with MS.
The purpose of this study is to describe and quantify the SD in patients with MS, and to determine whether there is a
correlation between the presence and severity of SD and quantitative SC MRI measures in MS patients.
The MRI in MS Research Program at St. Michael’s Hospital is currently looking for a full time summer student from late
May- August 2015. Summer student duties will include but not limited to a number of roles within this project, including:
patient recruitment, coordination of study visits, data entry, image processing, and data analysis.
Structural and functional changes in the adolescent rodent brain in streptozotocin
induced type 2 diabetes mellitus
Supervisor Name: Andrea Kassner
Hospital/Research Institution: The Hospital for Sick Kids / PGCRL
Email: andrea.kassner@utoronto.ca
Department: Medical Imaging
Brief Project Description
Type 2 diabetes mellitus (T2DM) was formerly a disease associated with adulthood and old age. However, due to the
increase in high fat diets and decrease in physical exercise, it is now recognized to also affect younger populations. Type 2
diabetes is a form of insulin resistance associated with serious long term complications including vascular disease,
neurodegeneration and cognitive impairment, although the underlying mechanisms and dynamics are not well understood.
By using an established high fat diet/Streptozotocin (HFD/STZ) rodent model of T2DM, we will be able to investigate the
cerebral pathophysiology while controlling for genetic and environmental factors. We will focus on an adolescent rat
population and use MRI to quantify changes in cerebral structure, blood brain barrier (BBB) integrity and hemodynamics.
These changes will be correlated with cognitive decline, as measured with the Morris Water Maze. We will also assess the
potential therapeutic effect of L-argenine (known to increase the bioavailability of nitric oxide). Post-mortem studies will
enable us to assess inflammation and perform neuron counts. Our aim is to provide a thorough pathophysiological profile
across T2DM in adolescent rats offering insight into the physiological mechanisms which underlie this disease.
Comparison of diagnostic accuracy of Saline Infusion Sonohysterogram (SIS),
Transvaginal sonography (TVS) and Diagnostic hysteroscopy
Supervisor Name: Prati Sharma
Hospital/Research Institution: Create Fertility Clinic
Email: pratibsharma.md@gmail.com
Department: Obstetrics & Gynecology
Brief Project Description
Infertile patients have a high incidence of uterine cavity lesions such as endometrial polyps, submucosal fibroids, uterine
malformations, and intrauterine adhesions. Detection and treatment of uterine cavity abnormalities are important for
fertility treatment success. There are many methods for assessing the uterine cavity: transvaginal sonography (TVS),
saline infusion sonohysterogram (SIS), and diagnostic hysteroscopy. TVS is considered a simple and innocuous
examination with good accuracy for most uterine cavity lesions. SIS is a more involved and possibly more accurate
modality for diagnosing uterine cavity lesions. Its performance would be indicated in situations in which conventional
TVS is not able to assure uterine cavity normality or in which TVS detects an abnormality but is incapable of defining its
nature. Diagnostic hysteroscopy (with directed biopsy, if necessary) has nearly the same accuracy as histopathologic study
of the organ itself and is considered the gold standard diagnostic procedure for assessing the uterine cavity, however it
requires sedation and is a more invasive procedure than the other modalities. In this study, our objective is to compare the
accuracy of TVS, SIS and diagnostic hysteroscopy for diagnosing uterine pathology among infertile women.
Methods: This retrospective case-control study will be conducted at CREATE fertility center. Experimental group:
infertile patients undergoing conventional TVS, SIS, and diagnostic hysteroscopy. We will compare diagnostic ability to
detect polyps, fibroids, uterine malformations and intrauterine adhesions by TVS, SIS and hysteroscopy. Sensitivity,
specificity, positive and negative predictive values (PPV and NPV, respectively), and 95% confidence intervals will be
calculated and compared between groups.
Differences in Cord Gas Values in Neonates of Mothers with Sickle Cell Disease to
Neonates of Non-Affected mothers
Supervisor Name: Ann Kinga Malinowski
Hospital/Research Institution: Mt. Sinai Hospital
Email: amalinowski@mtsinai.on.ca
Department: Obstetrics & Gynecology (Maternal-Fetal Medicine Division)
Brief Project Description
Pregnancies of women with SCD are at risk of adverse fetal outcomes, the vast majority of which are placentallymediated, owing to pathologic effects sickling exerts on the placenta, and its ability to provide adequate fetal oxygenation.
This is a retrospective cohort study of pregnant women with SCD attending the Special Pregnancy Program (SPP) at Mt.
Sinai Hospital (MSH) between 2004-2014. The primary objective is to determine whether there is a difference in
umbilical cord gases in neonates of mothers with SCD compared to neonates of non-affected mothers. Study subjects will
be identified through Health Records and SPP database queries. Inclusion criteria consists of SCD diagnosis. Exclusion
criteria consists of fetal malformations and multiple gestation. The outcome of interest, cord gas values, for study subjects
will be compared to a control group established through delivery records at MSH in a 1:2 ratio, matched by delivery date
corresponding to study subject’s delivery date +/- one month. Controls will be matched further by: age (ten year
intervals), body mass index [BMI], (5 kg/m2 intervals); parity (nulliparous vs. multiparous); gestational age at delivery (in
weekly intervals); type of cesarean section (labor vs. no labor); and type of vaginal delivery (assisted vs. spontaneous).
There are no other pre-specified inclusion criteria for controls. Exclusion criteria consist of chronic medical conditions,
major fetal malformations, and multiple gestation. Chart data will be abstracted to case report forms. Analysis will be
performed using SPSS version 22 and will include descriptive statistics (means and standard deviations or medians and
interquartile ranges), evaluation of dichotomous variables using Chi-square or Fisher’s exact test (if the expected number
in any cell is less than five), and examination of continuous variables using Student’s t-tests. Multiple logistic regression
will assess confounding variables potentially associated with abnormal blood gas results.
3D valve printing as a teaching aid to practice aortic valve sparing procedure
Supervisor Name: Massimiliano Meineri
Hospital/Research Institution: Toronto General Hospital / Anesthesia Perioperative 3D Cardiac Imaging Center
Email: massimiliano.meineri@uhn.ca
Department: Anesthesia & Pain Management
Brief Project Description
The aim of this project is to use intraoperative 3D trasesophageal echocardiography images to create 3D printable models
of normal and pathologic mitral and aortic valves.
The project will take place in the Anesthesia Perioperative 3D cardiac imaging Center.
The first stage of the project will consist in familiarizing with cardiac valve anatomy by analyzing existing 3D datasets
acquired on real cardiac surgical patients. The student will also observer real cardiac surgical operation to correlate the 3D
images with the surgical anatomy and valve orientation. A series of high quality 3D datasets will be chosen to create the
3D models. They will include: for the mitral valve: normal anatomy, stenosis, restrictive regurgitation, localized and
extensive prolapse; for the aortic valve: normal anatomy, stenosis, dilatation, prolapse. In the second stage of the project
the student will learn how to create a three dimensional model using the Mimicstm software
(www.biomedical.materialise.com/mimics). Models of different phases of the cardiac cycle will be created (valve open
and valve closed) as well as a moving model of normal aortic and mitral valves. The models will be posted in the
Anesthesia Perioperative 3D cardiac Imaging Center as part of a cardiac anatomy teaching module. The models will be
printed using different combinations of plastic material using the open source Prusa printer (http://reprap.org/wiki/Prusa)
and used for teaching medical students, residents and fellows.
The main outcomes of they projects will be:
Learn 3D normal and pathology cardiac valve anatomy
Learn how to create 3D models from 3D echocardiographic datasets using Mimics software.
Create on line 3D models of cardiac valve pathology (on line publication).
Evaluate the 3D printing workflow of from intraoperative 3D TEE datasets (abstract and publication).
The workstation, software and material is funded by the Peter Munk Cardiac Center Foundation
A 10 year review of the Early Pregnancy Assessment Clinic (EPAC) in a
Community Hospital
Supervisor Name: Modupe Tunde-Byass
Hospital/Research Institution: North York General Hospital
Email: mbyass@rogers.com
Department: Obstetrics & Gynecology
Brief Project Description
The EPAC was opened at North York General Hospital in August 2005.
The majority of referrals were from the Emergency room, Family Physicians and Obstetricians &
Gynecologists.
The clinic offers Dilatation and Currettage or Misoprostol as treatment options (in addition to conservative
management) to patients with intrauterine pregnancy losses.
The aim of the study is to compare the total number of visits for each treatment option.
This information may help patients decide on the option suitable for them.
Non-Invasive Assessment of Aortic Coarctation through Computational Fluid
Dynamics
Supervisor Name: Laura Jimenez-Juan / Andrew Crean / Piero Triverio
Hospital/Research Institution: Sunnybrook Health Sciences Centre
Email: laura.jimenezjuan@sunnybrook.ca
Department: Medical Imaging
Brief Project Description
Background: Coarctation of the aorta (CoA) is responsible for 4-6% of all congenital heart disease cases. Even after
successful repair, the probability of re-coarctation can be as high as 60%. Pressure gradient across the stenosis is a key
parameter in the diagnosis and follow-up of aortic coarctation and re-coarctation. Currently, cardiac cathetherization is the
gold standard to measure the pressure gradient. Unfortunately, being an invasive technique, catheterization comes with a 1
in 1000 risk of death or serious injury. Computational Fluid Dynamics (CFD) has been proposed as a non-invasive
alternative to extract pressure gradients from standard MR or CT angiography images with essentially no risks to patients.
While early studies demonstrated the feasibility of this approach, a comprehensive validation is still unavailable.
Objective: The objective of this project is to assess the accuracy of CFD-based measurements of pressure gradients in
CoA using catheterization as the gold standard. Based on preliminary studies, we hypothesize that CFD will provide an
accurate estimation of the pressure gradient in CoA. We hope that this study will contribute to a faster development of
non-invasive computational methods for the assessment of CoA severity.
Methods: Suitable cases of CoA will be extracted from an institutional database. The geometry of the aorta will be
reconstructed from the MR angiography images using state-of-the-art software (Vascular Modeling Toolkit, Orobix srl,
Bergamo, Italy). The reconstructed geometry will be then used to generate a computational mesh. CFD simulations will
be performed with the support of engineers specialized in computational techniques (Prof. Piero Triverio, University of
Toronto, and Prof. Gianluigi Rozza, SISSA Mathlab, Italy). This project is exciting also in that it represents a fledgling
collaboration between the Departments of Medicine and Engineering at the University of Toronto.
Student role: The student will be an essential part of an interdisciplinary team. He/she will identify suitable CoA cases,
collect clinical and imaging data, and perform the geometrical reconstruction of the vessels. He/she will then help
simulation specialists to interpret the CFD results. Due to the project nature, a bachelor in engineering, physics, or
similar discipline is required. The project will expose the student to current research trends in the use of engineering
methods to manage cardiovascular problems.
Investigation of the prevalence and size of the Blake’s Pouch Cyst in Fetuses during
the Routine Anatomy Scan
Supervisor Name: Kirsten Weind Matthews
Hospital/Research Institution: Mount Sinai Hospital / JDMI (Joint Department of Medical Imaging)
Email: Kirsten.weind-matthews@uhn.ca
Department: Medical Imaging
Brief Project Description
It is standard of care in Canada for all pregnant women to undergo a routine fetal anatomy scan between 18 and 22 weeks.
It is stated by the Society of Obstetrics and Gynecology of Canada that preforming this ultrasound provides the best
opportunity to diagnose fetal anomalies and to assist in the management of prenatal care.
The Centre for Excellence in Obstetrical Imaging (CEOU) at Mount Sinai Hospital, is a major referral centre for potential
anomalies identified during the routine 18-22 week anatomy scan done in the community. Through these referrals it has
come to our attention that a normal transient anatomic structure, Blake’s Pouch Cyst, within the developing posterior
fossa of the fetus is being identified more readily on routine anatomy scans, presumably due to advances in sonographic
technology and is being misinterpreted as an abnormal posterior fossa fluid collection with potential for poor neurological
prognosis of the fetus.
Literature exists describing Blakes Pouch Cyst as a normal transient structure anatomic structure with the normal outcome
of Blake’s pouch being to fenestrate down to the inferior recess of the fourth ventricle and essentially collapse and
disappear, with the exception of its neck which becomes the foramen of Magendie, a communication between the cisterna
magna and the fourth ventricle. However the timing of the fenestration is less clear and there is no study evaluating how
often it remains visible at 18 to 22 weeks gestation nor its normal size parameters.
We propose to evaluate this structure prospectively in the routine posterior fossa image obtained during the anatomy scan
in low risk women to determine the prevalence and size of this normal anatomic structure at the time of the routine
anatomy scan. Ultimately, this work should help to alleviate patient anxiety and decrease unnecessary referrals to tertiary
care centres caused by labelling a normal structure as potentially abnormal.
A Randomized Controlled Trial to determine the optimal method for triggering final
oocyte maturation during In Vitro Fertilization for patients with low, medium or
high ovarian response
Supervisor Name: Clifford Librach
Hospital/Research Institution: CReATe Infertility Clinic
Email: cliffl@ican.net
Department: Obstetrics & Gynecology
Brief Project Description
IVF patients’ classification as ‘low’, ‘normal’ or ‘high’ responders is a fundamental step in their clinical evaluation and management
prior and during IVF cycles. Each group has unique characteristics, such as higher risk for ovarian hyperstimulation syndrome
(OHSS) among high responders, and reduced pregnancy and delivery rates in poor responders. An additional population with unique
characteristic and challenges are the young ovum donor patients. Studying the oocyte donor population is a powerful tool to
discriminate possible effects of treatment on the implantation process from those attributable to the oocyte cohort.
Optimizing treatment for each sub-group of patients is challenging and efforts are continuously being made worldwide to achieve
better pregnancy outcomes, together with reduced procedure risks, multiple pregnancy rates and costs. One significant advance during
the last years has been the introduction of new, safer protocols that utilize short protocols using GnRH antagonist ovulation
suppression, together with dual triggering with a GnRH agonist (GnRHa) and low dose human chorionic gonadotropin (hCG)g. This
regimen results in a simultaneous LH and FSH surge by the GnRHa which resemble the physiologic ovulation triggering, together
with the sustained LH-like activity afforded by the hCG which helps the corpus luteum to excrete sufficient progesterone for
endometrial support. Dual triggering has become popular due to outstanding preliminary results in retrospective studies. However,
Randomized Controlled Trials (RCTs) showing a difference in outcome from single GNRHa triggering vs. dual triggering are lacking.
The objective of the current project is to compare the safety and efficacy of dual vs. single triggering in high, medium and low
responders. Some important outcome measures to be examined, include rate of OHSS, oocyte maturation rate, number of embryos
developed and pregnancy outcomes.
Prospective Cohort Study on Use of Rocuronium Bromide and midazolam
pharmacokinetics as a marker of transplanted liver function
Supervisor Name: Marcin Wasowicz
Hospital/Research Institution: Toronto General Hospital
Email: marcin.wasowicz@uhn.ca
Department: Anesthesia
Brief Project Description
Liver transplantation (LT) is a life-saving treatment for patients with end stage liver failure or advanced hepatocellular
carcinoma and is a major medical achievement in the last half-century. Unfortunately, 30% of patients awaiting the
transplant die before a suitable organ becomes available. In spite of great advances on perioperative management of
patients receiving LT our assessment of metabolic function of newly transplanted liver is very limited. The objective of
this work is to combine the recent achievement of our research team to provide precise information describing metabolic
status of the transplanted liver. This translational research will provide a description of pharmacokinetic profile of
medications commonly used for LT: rocuronium (ROC), and midazolam. Since these medication are metabolized by liver
our approach will allow us to use their pharmacokinetic profile as a marker of liver function.
Primary objective: Investigate the application of ROc (muscle relaxant) and midazolam metabolism analyses
(pharmacokinetics-PK) as a marker of function of newly transplanted liver.
Study design: This clinical study is designed as prospective, cohort study.
Clinical studies: ROC, midazolam, their metabolites plasma concentrations together with other indices of liver function
(marker of liver function) will be determined on samples obtained from 23 living related liver recipients, 23 patients who
received liver graft from cadaveric donors and 23 patients receiving liver from donation after cardiac death (DCD donors).
In total we will recruit 76 patients (assumed attrition rate of 10%). We will use the same plasma samples to measure
biomarkers identified during earlier stages of the project.
Eliciting patient-preferences for maternal-fetal health states arising from the use of
anticoagulation in pregnancy
Supervisor Name: Rohan D’Souza
Hospital/Research Institution: Mount Sinai Hospital
Email: rd’souza@mtsinai.on.ca
Department: Obstetrics & Gynecology
Brief Project Description
Patient-preferences are seldom incorporated into medical decision-making in high-risk pregnancies, as little is known
about the trade-offs pregnant women with high-risk pregnancies are willing to make in order to have a successful
pregnancy. This project aims to elicit patient and familial preferences for combined maternal-fetal health states arising
from the use of anticoagulation in pregnancy. One hundred pregnant women with medical disorders, from diverse sociodemographic backgrounds, attending the special pregnancy program clinics at Mount Sinai Hospital will be approached
and asked to participate in the study. Upon obtaining consent, each participant and identified family member(s) actively
involved in the pregnancy, will be interviewed – first independently and then together - and asked to score seven
combined maternal-fetal health states using three direct measures used for eliciting health-state utilities. These measures
(a visual analogue scale, standard gamble and time trade-off) are simple to employ and have been widely used in other
fields of medicine and surgery. The interview process is expected to take 60-90 minutes. Estimating two or three recruits
per day, 100 patients will be recruited in approximately eight or ten weeks, allowing two to four weeks for analysis and
write-up. Health-state scores for each interview obtained by the three measures will be compared using analysis of
variance (ANOVA). Scores from the three interviews (pregnant woman, family member and combined) will further be
compared using ANOVA. The final result will be presented as a ‘utility score’ for each health-state and the published
results will later be used to develop a decision-analysis model to answer an important clinical question thereby directly
improving the quality of patient-care. This study will serve as a reference guide for eliciting patient-preferences in
obstetrics and put the University of Toronto at the forefront of patient-preference studies in pregnancy. The medical
student will have co-authorship on this publication.
Molecular mechanisms of neurodegeneration in Parkinson’s disease
Supervisor Name: Lorraine Kalia
Hospital/Research Institution: Toronto Western / UHN
Email: lorraine.kalia@utoronto.ca
Department: Medicine (Neurology)
Brief Project Description
Parkinson’s disease is a common neurodegenerative condition characterized by disabling motor symptoms, including
bradykinesia, rigidity, tremor, and postural instability. Symptomatic treatments are available for patients to alleviate these
symptoms. Yet, there is an absence of therapies which modify disease progression by slowing or stopping the
neurodegenerative process. I am a clinician-scientist with a research program in Parkinson’s disease. My lab’s major
research objective is to elucidate the critical molecular mechanisms responsible for neurodegeneration in Parkinson’s
disease and related disorders. One of my strategies to discover novel pathways involved in neurodegeneration is to study
rare genetic conditions associated with Parkinson’s disease symptoms. There is a growing list of genes that, when
mutated, can be associated with many of the features of Parkinson’s disease. Examples include SNCA, GBA, SCA2, SCA3,
POLG, SPG7, and SPG11.
The proposed project for the student will be to determine how specific mutations in one of the above genes may contribute
to neurodegeneration. The specific aim of the project will be to study the effects of the mutated gene on cell function and
cell survival. DNA plasmids will be used to overexpress the mutant protein in mammalian cell culture systems or patientderived cells will be used. The student will examine relevant cellular processes (such as protein aggregation, proteasomal
or lysosomal function, mitochondrial activity) and susceptibility to cell death. This project will be a critical component of
a larger project in the lab focused on characterizing the proteins that are encoded by genes which are mutated in patients
with familial Parkinson’s disease or with Parkinson’s disease-related symptoms.
My lab is located within the Krembil Discovery Tower at the Toronto Western Hospital which is a new state of the art
research building with an open-concept lab design to support interactions between different research groups
Assessing variability in the reporting and recommended management of lung
nodules detected on computed tomography scans: what are the determinants of
guideline adherence by radiologists?
Supervisor Name: Ravi Menezes
Hospital/Research Institution: UHN
Email: ravi.menezes@uhn.ca
Department: Medical Imaging
Brief Project Description
Background/rationale
Lung nodules are a relatively common finding on clinical chest computed tomographic (CT) scans; the majority of such findings turn
out to be benign. The Fleischner Society guidelines (FSG) have been developed by a consortium of thoracic radiologists to assist
physicians in determining whether, when and how often to perform surveillance imaging. Because nodule management relies largely
on the contents of the imaging report, clarity of nodule reporting and inclusion of an appropriate management strategy by the
radiologist have the potential to impact clinical care. Few studies, however, have examined the way radiologists report nodules and
whether these reports contain recommendations that adhere to guidelines that are widely recognized and endorsed.
Objectives
The study objectives are to (i) describe how lung nodules are reported in selected chest CTs, (ii) summarize nodule management
recommendations made by radiologists, and (iii) examine factors associated with radiologists’ adherence to guidelines.
Methods
Study activities performed by the student will be carried out under the guidance of the research supervisor and collaborating
radiologist.
Reports for non-oncology, outpatient chest CTs performed at the University Health Network will be reviewed for nodule
characterization and management recommendations. Additional details will be collected related to patient demographics,
clinical/smoking history and radiologist experience. Descriptive analysis will be used to summarize lung nodule features,
demographics and clinical history. Additional analyses will examine management recommendations and identify determinants of FSG
adherence.
Study implications
The results of the study will help identify variability in the reporting and recommended management of lung nodules, as well as
factors associated with adherence to guidelines. They can be used to determine the need for training and quality improvement
initiatives involving radiologists and referring physicians.
Advanced Diagnostic Imaging Patient Care Maps for Renal Colic
Supervisor Name: Bruce Gray
Hospital/Research Institution: St. Michael’s Hospital
Email: grayb@smh.ca
Department: Medical Imaging
Brief Project Description
Background: There is some empirical data to suggest that advanced diagnostic imaging (ADI) may be overused,
underused, and inappropriately used. Rates of computed tomography (CT) vary as much as 5 times across provinces.
Overuse occurs when patients are referred to ADI without an adequate assessment of the clinical indications that would
justify the imaging. Overuse may be contributing to the longer than necessary wait times for patients that need imaging.
The use of CT for otherwise healthy ED patients (<50 years) with known or suspected kidney stones is one suspected
cause of overuse and misuse. This study will determine if CT is being used appropriately for renal colic patients at St.
Michael’s Hospital.
Purpose: Create a methodology for conducting a study of appropriateness in ADI. Develop an intervention to increase the
appropriateness of ADI for adult patients with renal colic and optimize imaging patterns and radiation dose.
Methods: Review the imaging appropriateness standards set by the Canadian Association of Radiologists (CAR) and the
American College of Radiologists (ACR) for imaging patients with renal colic (suspected renal stones or appendicitis).
Conduct a retrospective analysis of all patients imaged at St. Michael’s for renal colic. Create a database of patients and
the imaging they have received along with estimated cumulative radiation dose (for computed tomography). Use the
Radiology Information System (RIS) to determine the demographic and clinical characteristics that can be used to
categorize patients according to the appropriate imaging standards. Determine current practice paradigms for patients by
category and evaluate these practices in reference to appropriate imaging standards. Conduct a structured interview with
referring physicians and radiologists to understand current practice. Develop an educational intervention to demonstrate
current practice as compared to optimal imaging patterns and develop a prospective data analysis to demonstrate the
effectiveness of the educational intervention.
A comprehensive clinical database for women with BRCA mutations
Supervisor Name: Barry Rosen
Hospital/Research Institution: Women’s College
Email: michelle.jacobson@medportal.ca
Department: Obstetrics & Gynecology
Brief Project Description
Women with BRCA germline mutations are referred to the Hereditary Ovarian Cancer Clinic at WCH. This clinic is
focused on both cancer prevention ( prophylactic salpingo oophorectomy) and aftercare of women undergoing this
procedure. Surgical specimens undergo very specific pathologic analysis, and some women will have precancerous
lesions in their fallopian tubes and up to 6% will be diagnosed with an early cancer. It is important that this information be
collected on all women so that we can better define risks and benefits of surgery.
Surgery is the currently the prevention method of choice. Women with BRCA germline mutations are offered
surgery after age 35 and most will undergo it by age 40. A surgical menopause is a big concern for these women
because it has can affect their helth in many different ways including an increased risk of heart disease,
osteoporosis, changes in their sexuality and as well there are implications related to memory loss and possible risk
of early Alzheimers. All these clinical manifestations are being investigated with research in Toronto.
The WCH/UHN/MSH collaborative Hereditary Clinic is the first of its kind in Canada, and one of only a few in
the world. Prior to establishing this clinic patient care was often fragmented. This clinic offers the opportunity to
provide comprehensive care to all women with BRCA germline mutations. We are also planning to link directly
with the breast cancer prevention program at WCH and discussions are underway.
We plan to develop a comprehensive database over this summer and will hire a summer student to help us get REB
approval, get patient consent for data collection and to initiate the process of data entry. This databse will capture
information from the initial patient encounter, her surgery and postop care as well as her post surgery or aftercare.
The search for a genetic cause for idiopathic premature ovarian insufficiency
Supervisor Name: Wendy Wolfman
Hospital/Research Institution: Mount Sinai
Email: bkelakis@mtsinai.on.ca
Department: Obstetrics & Gynecology
Brief Project Description
While 1% of women undergo premature ovarian failure (menopause before age 40), the cause for over half of
these is unknown. We intend to bank blood for women with family history or personal history of idiopathic
premature ovarian insufficiency (other causes excluded) and microarray the X chromosome looking for
common snrps. The CREMS student will have a role in recruiting patients and collecting the results. There will
be opportunity for publication.
Validating an electronic medical record search algorithm of health professional
contacts across UTOPIAN sites
Supervisor Name: Andrew Pinto
Hospital/Research Institution: St. Michael’s Hospital
Email: andrew.pinto@utoronto.ca
Department: Family & Community Medicine
Brief Project Description
Existing work using Ontario administrative data has found that investments in primary health care have not necessarily
resulted in increased access or improved quality. Concerns have been raised that wealthy and more highly educated
patients have received most of the benefits of primary care reform. This study will use electronic medical record (EMR)
data to “look inside” different family practices. We will validate algorithms that track encounters with different members
of the health care team. This will help assess the cost of providing primary care, beyond physician payments, and identify
which Ontarians have benefited most from investments in primary care. Building on work done at the St. Michael’s
Hospital Academic Family Health Team, demonstrating that our algorithms are feasible and reliable, we will work with
partner DFCM sites through UTOPIAN to evaluate the application of these algorithms. This study will engage practices
that use PS Suite and participate in EMRALD. The role of a student will be to help extract data from various UTOPIAN
sites, in close collaboration with UTOPIAN practice facilitators. Specifically, this project will entail analyzing a random
selection of charts from several sites to evaluate the number of encounters with different health professionals during a
specific time period. We will then compare this “gold standard” data to that generated by a number of pre-specified
algorithms. This project has the support of Dr. Frank Sullivan and the UTOPIAN administrator. A Practice Facilitator
employed by UTOPIAN will assist the student. This project will lead to a peer-reviewed publication and teach the student
about health economics and the application of these methods within primary care. This study will lead to the development
of a general costing tool that will assist in advancing our understanding of the primary care system in Canada.
Building community economic resiliency: Evaluating the feasibility of a time bank
in St. James Town
Supervisor Name: Andrew Pinto
Hospital/Research Institution: St. Michael’s Hospital
Email: andrew.pinto@utoronto.ca
Department: Family & Community Medicine
Brief Project Description
Since the 2008 financial crisis, it has been increasingly recognized that the current economic system fails to provide
adequate protection for many. In particular, new immigrants, those with low educational attainment and those living in
poverty are at high risk of having precarious employment, having low levels of savings and being at risk of being unable
to pay for basic necessities. This has a significant impact on the health of such communities. Financial insecurity is likely
a key mechanism that links living in poverty and poor health. Few strategies have been proposed to improve the economic
resiliency of communities. One novel strategy is the concept of “fiscal localism” whereby financial assets and capacity
that reside within individuals is pooled and serves as a buffer against crisis. Within St. James Town, Low Income Families
Together (LIFT), a grassroots community organization that has been active in the St. James Town community for many
years. LIFT is interested in launching a “time bank” in the St. James Town community. Time banking (paying for services
using time rather than money) aims to develop community resilience and connectedness, build supportive networks, and
promote equality. The student’s role in this project will be to bring the lens of health promotion to bear by assisting with
LIFT’s feasibility and preliminary background work needed to start up the time bank. Specifically, the project will entail
coordinating and carrying out three focus groups with different sets of residents, as well as surveying volunteers that work
with St. James Town service providers. The student will also form links with organizations that use time banking,
including the Toronto Time Bank, Parkdale Co-op Cred and the Centre for Social Innovation. The outcome will be a peerreviewed publication and reporting to LIFT in order to assist with advancing the proposed time bank.
The Role of Thombophilia in Venous Thrombotic Events in Children
Supervisor Name: Leonardo R. Brandao
Hospital/Research Institution: The Hospital for Sick Children
Email: leonardo.brandao@sickkids.ca
Department: Pediatrics
Brief Project Description
Background: Previously considered a disorder of adulthood, venous thrombotic events (VTE) are becoming increasingly
recognized in children. Nevertheless, the impact of inherited and/or acquired thrombophilia on the occurrence of provoked
VTE remains unclear.
Rationale: Recent meta-analyses have suggested that thrombophilia traits [antithrombin (AT), protein C (PC), and protein
S (PS) deficiency; factor V Leiden (FVL) and prothrombin gene (PTG) mutation and lupus anticoagulant antibody
(LAA)] increase the risk of first/recurrent VTE in children (Young, Circulation 2008; Kenet, Sem Thromb Hemost 2011).
Nonetheless, there are some important limitations in these studies that require further investigation. Firstly, there is a lack
of differentiation between unprovoked and provoked (secondary to a central venous catheter [CVL]) events, precluding a
better understanding of the role of thrombophilia in these two polar settings. Secondly, the impact of age was not
evaluated, which is relevant as VTE outcomes are likely age-dependent. In sum, the role of thrombophilia in relation to
VTE outcomes [VTE resolution, VTE recurrence, and occurrence of post-thrombotic syndrome (PTS)], requires proper
investigation, taking into account age and presence of a CVL.
Objective: To investigate the role of inherited/acquired thrombophilia in children aged 0 to 18 year with CVL-related
VTE.
Methods: A retrospective review of patients diagnosed with image-proven upper and/or lower limb VTE will be
conducted. Data will be extracted from the Thrombosis Database between Jan/2000 to Jan/2015. Descriptive analysis of
the population will use measures of central tendency and dispersion, as appropriate. Univariable and logistic regression
model statistics will be entertained to examine the potential associations between thrombophilia and VTE-related
outcomes.
Potential impact: Our findings will help develop a more rationale approach to submitting children with provoked VTE to
thrombophilia investigation, hopefully selecting only higher risk groups to whom this practice may be better justified.
Comparison of ovarian reserve, controlled ovarian hyperstimulation regimen and
IVF cycles outcomes between females with Fragile X associated primary ovarian
insufficiency (FXPOI) and those with other causes of primary ovarian insufficiency
Supervisor Name: Prati A. Sharma
Hospital/Research Institution: Sunnybrook & Women’s College Hospital, CReATe IVF Program
Email: pratibhasharma.md@gmail.com
Department: Obstetrics & Gynecology
Brief Project Description
Fragile X syndrome (FXS) is the most common form of inherited intellectual disability and results from the expansion of
the CGG trinucleotide repeats (>200 repeats) in the Fragile X (FX) gene. Premutation expansion of the FX gene (55-200
CGG repeats) occurs in 1/148 females. Female premutation carriers are at risk of developing FX associated primary
ovarian insufficiency (FXPOI). Female FX premutation carriers with early onset FXPOI are often diagnosed when they
present with infertility, oligomenorrhea, or perimenopausal symptoms. There is currently no published literature regarding
the type of controlled ovarian hyperstimulation (COH) regimen and IVF treatment outcome and success for these women.
Most fertility practitioners will extrapolate from studies of women with other causes of primary ovarian insufficiency.
We hope to compare and report the various strategies and COH regimens used in this cohort of patients from IVF centers
in Ontario versus their age matched counterparts with other causes of primary ovarian insufficiency. Our study group will
be female FX premutation carriers with FXPOI who have undergone fertility treatments and the control group will be age
matched females with decrease ovarian reserve due to other causes who have undergone fertility treatments. Inclusion
criteria will be females between 21-40 years old with a diagnosis of decrease ovarian reserve/primary ovarian
insufficiency caused by either FX premutation or a known cause. The participants in the study group and control group
will be matched for age, anti-Mullerian hormone level and FSH level. The COH regimens between the study and control
groups will be compared to fertility treatment outcomes measured by number of follicles stimulated per cycle, number of
oocytes retrieved, number of fertilized embryos and rate of successful pregnancy. This information may help us to
determine the most optimal COH regimen and strategy for female FX premutation carriers with FXPOI and provide more
comprehensive reproductive counselling regarding fertility treatment outcomes.
Ovarian reserve in young women with Recurrent Early Pregnancy Loss
Supervisor Name: Sony Sierra
Hospital/Research Institution: Women’s College Hospital
Email: sony.sierra@wchospital.ca
Department: Obstetrics & Gynecology
Brief Project Description
Pregnancy loss is a common reproductive experience, as we know that 30-50% of all pregnancies do not progress beyond
the first trimester. Earlier studies on early loss, have documented that 70-90% of these early losses are due to “random
genetic bad luck” or aneuploidy. As reproductive age advances, the chance of aneuploid losses in early pregnancy also
increases, due to a decrease in oocyte spindle function.
Recurrent early pregnancy loss affects 3-5% of couples trying to start a family. In couples with 2 or more losses, we can
find a treatable etiologic factor in almost 50% of cases; however half are likely due to unexplained factors.
Based on observational data in a cohort of women seen for Recurrent early pregnancy loss, a hypothesis is proposed
regarding the etiology of losses in young women. We typically do not expect to see aneuploid losses on a recurrent basis
in women <35, as ovarian reserve or oocyte function is typical ideal in this age group. Recurrent pregnancy loss in young
women, without other known factors, may be due to diminishing ovarian reserve therefore increasing the risk of oocyte
aneuploidy or aneuploidy in early mitotic divisions early in embryogenesis.
This project will be the first documented attempt to assess ovarian reserve in women < 35 with a history of REPL. We
will use day 3 FSH levels, antral follicle count assessment with ultrasound, and AMH (AntiMullerian hormone levels), to
assess ovarian reserve, and compare to a cohort of women <35 without a history of REPL or infertility. The study design
will be a retrospective chart review, for analysis of data of eligible cohorts.
Pulmonary Function post Pulmonary Embolism in Children
Supervisor Name: Suzan Williams
Hospital/Research Institution: Hospital for Sick Children
Email: suzan.williams@sickkids.ca
Department: Haematology / Oncology
Brief Project Description
The Pulmonary Function post Pulmonary Embolism in Children Project involves clinical research in the
Hemostasis/Thrombosis Program at the Hospital for Sick Children.
Pulmonary thromboembolism (PTE) is increasingly recognized in children. There are several registries and small studies
reporting pediatric thromboembolic events that have been published. However, the data reported in these registries and
cohorts to date, has concerned incidence, bleeding complications, recurrence, and death. Studies to date have not largely
reported on functional outcome following childhood PTE. There is evidence from the adult literature, of acute and
potential chronic implications following PTE, including pulmonary arterial hypertension, chronic pulmonary
thromboembolic disease and impairment of the pulmonary function parameters of the small airways.
There is an ongoing study on pulmonary function following PTE in children at SickKids, which involves completion of
clinical assessment, pulmonary function testing, exercise testing and echocardiographic markers of right ventricular
function. As PTE in children often occurs in children with co-morbid conditions, the PTE patients are matched to control
patients with similar underlying disease, of similar age and height.
The student project would involve assisting with:
-
-
recruitment of control patients at SickKids
compiling and summarizing the study data
o chart review for diagnosis, current health status, confirmation of prior PTE for subjects or no prior PTE
for control subjects
o results of study investigations
data analysis, with guidance from a statistician
The student would be integrated into the Thrombosis Clinical and Research Program, interacting with physicians, nurse
practitioner, clinical research associates.
The student would attend:
- weekly Thrombosis clinics to learn more about pediatric thrombotic disorders, their diagnosis, management and outcome
-weekly Thrombosis clinic review meetings for multipdisciplinary discussions
-summer Hemostasis/Thrombosis Lunch and Learn Rounds (weekly rounds to highlight and educate around pediatric
hemostasis and thrombosis issues).
Improving the quality of oncofertility decision-making among young women at risk
of infertility during cancer survivorship
Supervisor Name: Nancy Baxter
Hospital/Research Institution: St. Michael’s Hospital, Li Ki Shing Knowledge Institute
Email: batxtern@smh.ca
Department: Surgery
Brief Project Description
The objective of this study is to modify an existing oncofertility decision aid (DA) for young women with breast cancer
previously developed in Australia for the Canadian setting. We will use information generated from previous work
conducted (interviews with health care providers, survivors and prototype review with stakeholders in focus groups) to
modify the existing DA using a systematic process as outlined by the International Patient Decision Aid Standards
(IPDAS).
The student will review findings from work previously conducted and identify appropriate modifications to the existing
DA with the study research team. He/she will include additional information such as fertility preservation costs, fertility
referral and support services available in Ontario. The new product will be used for training during practitioner web-ex
training sessions, which the student will help organize at the end of the summer. He/she will require independent thinking,
superb written and oral communication skills and attention to detail.
The student will have the opportunity to work amongst an interdisciplinary team of surgeons, medical oncologists,
decision-makers and research staff to develop a decision aid ready for piloting in the Canadian setting. The student will be
supervised primarily by the Research Program Manager and Dr. Nancy Baxter.
Optimized Quantification of Magnetic Resonance Imaging (MRI) Assessment of
Myocardial Fibrosis
Supervisor Name: Bernd Wintersperger & Marshall Sussman
Hospital/Research Institution: University Health Network
Email: bernd.wintersperger@uhn.ca / marshall.sussman@utoronto.ca
Department: Medical Imaging
Brief Project Description
Background:
Cardiac magnetic resonance imaging (MRI) provides valuable information for therapy decisions in ischemic heart disease
(e.g. myocardial infarction) and various cardiomyopathies. These decisions are primarily based on cardiac MRI's ability to
delineate myocardial fibrosis. Current methods rely on the fact that MRI contrast agents accumulate in areas of fibrosis
based on accompanying changes of the extracellular space. However, a limitation with current conventional methods is
that they sometimes fail to detect fibrosis that is diffusely distributed throughout the myocardium. Recently, more
sophisticated quantitative methods(e.g. “mapping) have been proposed to provide increased sensitivity to diffuse
interstitial changes and fibrosis. These quantitative methods will be the focus of this project.
Objectives/Aim:
Currently, quantitative methods for assessing diffuse myocardial pathology/fibrosis are adequate for discriminating
pathology within a population. However, they have so far not proven adequate for characterizing diffuse fibrosis in
individual patients. The reason for this is because current methods are lacking in accuracy and precision. The objective of
this project is to optimize the accuracy and precision of our quantitative myocardial technique. We hypothesize that the
optimized technique will allow better discrimination of normal and abnormal myocardium in individual patients.
Student Role:
The student will be essential in regard to all development and data analysis. Knowledge of statistical and data analysis
techniques will be required. Basic skills in Matlab programming are also required for implementation of image postprocessing tools. Knowledge of MRI would be an asset. This project is intended for publication as an original work.
Transitioning between Electronic Medical Records in a large community based
Family Health Team: a descriptive study
Supervisor Name: Michelle Greiver
Hospital/Research Institution: North York General Hospital
Email: mgreiver@rogers.com
Department: Family & Community Medicine
Brief Project Description
The North York Family Health Team (NYFHT) is the largest Family Health Team in Toronto. It includes 72 family
physicians and over 40 Allied Health Professionals, working out of 18 clinical locations. It serves 70,000 patients, with
over 540,000 clinical encounters per year.
Over 220 users access the Electronic Medical Records used at NYFHT; NYFHT has been involved in multiple research
and quality improvement projects using EMR. It is a leading organization for the meaningful use of EMRs and of EMR
data in Canada. The organization currently uses two different EMRs accessed via several different servers. It will start to
transition to a new, integrated system this year. This represents one of the largest transition projects in Canadian primary
care.
This applied research project will use mixed methods, including qualitative interviews of key informants and surveys to
study the transition and its effect on patient care. As part of the project, we will also study efforts to improve data and
standardize processes during the transition, including the generation of process manuals to support the transition.
This will be of interest to students interested in EMRs, use of data in heath care and primary care transformation.
Through this opportunity the CREMS student will have an opportunity to work with a multi-disciplinary team of
clinicians and researchers and researchers. S/he will learn basic skills related to both qualitative and quantitative study
design as well develop content knowledge in the emerging topic area of EMRs and of EMR data in Canada. Given the
applied nature of this project, there will also be excellent opportunities to observe and study at the practice level that may
be of particular value to medical learners who are interested in family and community practice.
From Resident to Staff Surgeon – Understanding the stresses of independent
practice
Supervisor Name: Tulin Cil
Hospital/Research Institution: WCH/PMH & The Wilson Centre
Email: tulin.cil@uhn.ca
Department: Surgery
Brief Project Description
The transition period between training and independent practice is a time that can be stressful for new surgeons.
It is unclear what issues newly graduated trainees face upon moving from their roles as residents to independent
practitioners. The goal of this study is to elucidate some of the challenges, stresses and issues that new
surgeons face during this transition. A mail and email survey will be developed and sent to recent surgical
graduates (within that last 5 years) from all general surgery residency programs across Canada. It will include
an assessment of stress and burnout using the Maslach Burnout inventory. This will give us an indication of the
extent of stress and burnout in this population. Furthermore, the results will also serve as a needs assessment to
determine what educational interventions may be delivered in order to address the challenges that new surgical
graduates face.
Environmental Scan of Ambulatory Surgery at the University of Toronto
Supervisor Name: Nicole Woods
Hospital/Research Institution: Centre for Ambulatory Care Education / Women’s College Hospital
Email: nicole.woods@wchospital.ca
Department: Surgery
Brief Project Description
Canadian health care is shifting towards community-based chronic care management and increasing rates of ambulatory
surgery. It is the responsibility of medical schools to ensure that the formal and informal curriculum appropriately
prepares future physicians and surgeons to practice in ambulatory settings. As the first of a series of environmental scans,
the objective this project is to systematically catalogue the learning opportunities in ambulatory care available at the
undergraduate and postgraduate levels. By collating formal learning activities, teaching sites, courses and assessments
that target ambulatory care we anticipate that we will gain an understanding of types of learning experiences that might be
best-suited to ambulatory environment. This data will be used to set a future research agenda that will evolve to include
the best practices for education and safeguards for high-quality care and patient-safety.
Phase 1 - A curriculum map of the ambulatory surgery content within the undergraduate curriculum at UofT will be
generated using the software, CMAP. This process will document the teaching content, the temporal placement of these
curricular components and the methods of assessment. The first level of the map will consist of the specific components
of the formal curriculum and the interrelationship among these components. A second level will consist of a detailed
analysis of content on a course-by-course basis. Completion of these steps will generate a 3-dimensional matrix of the
existing undergraduate curriculum in ambulatory surgery. Phase 2 - To capture the remaining informal elements of the
undergraduate curriculum and the postgraduate level we will use two forms of data collection: 1. Review of curriculum
planning documents 2. Interviews with Surgical Directorate and Residency Program Directors to discuss optional and
informal training and specific surgical procedures. The interview findings and map will be used to address educational
gaps and form the basis for ongoing research.