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IntroductionWith thousands of new medical trials released every year, health care policymakers must work diligently to incorporate new evidence into clinical practice.Although there are some broad conceptual frameworks for knowledge translation in the emergency department (ED), there are few user-centered studies that illustrate how local policymakers develop and disseminate new policies.ObjectivesOur study sought to evaluate the process by which new departmental policies are formed in ED, how new evidence was integrated into this process, and to explore barriers to implementation.MethodsSemi-structured interviews were conducted with local administrators from nine major hospitals in Ontario, Canada. Interviews were transcribed and qualitative data was analyzed using constructivist grounded theory.ResultsFive broad steps in the policy creation process were identified: 1) Problem identification and motivation for change; 2) building a policy team; 3) policy construction; 4) implementation and monitoring of new departmental policies; 5) actively addressing barriers to the ED policymaking process. Common sub-themes in each of these categories were highlighted. Four main themes also emerged regarding barriers experienced in policymaking: Education and knowledge transfer; lack of a change culture; resource limitations; and cumbersome bureaucratic structures.ConclusionOur study identified common facilitators and barriers that policymakers face in their ability to create health policy in the ED. While local context influences the policymaking process, a standardized framework would ensure a more systematic approach for policymakers and allow scientists to better understand how evidence is integrated at the local level.

Background In recent decades, the gender makeup of Canadian medical residents has approached parity. As residency training years coincide closely with childbearing years and paid parental leave is associated with numerous benefits for both parents and children, it is important for there to be clarity about parental leave benefits. Objectives We aimed to conduct a comprehensive review of maternity and parental leave policies in all residency education programs in Canada, to highlight gaps that might be improved or areas in which Canadian programs excel. Methods We searched websites of the 8 provincial housestaff organizations (PHOs) for information regarding pregnancy workload accommodations, maternity leave, and parental leave policies in each province in effect as of January 2020. We summarized the policies and analyzed their readability using the Flesch Reading Ease. Results All Canadian PHOs provide specific accommodations around maternity and parental leave for medical residents. All organizations offer at least 35 weeks of total leave, while only 3 PHOs offer extended leave of about 63 weeks, in line with federal regulations. All but 2 PHOs offer supplemental income to their residents, although not for the full duration of offered leave. All PHOs offer workplace accommodations for pregnant residents in their second and/or third trimester. Conclusions Although all provinces had some form of leave, significant variability was found in the accommodations, duration of leave, and financial benefits provided to medical residents on maternity and parental leave across Canada. There is a lack of clarity in policy documents, which may be a barrier to optimal uptake.

Background: Free Open-Access Medical education (FOAM) use among residents continues to rise. However, it often lacks quality assurance processes and residents receive little guidance on quality assessment. The Academic Life in Emergency Medicine Approved Instructional Resources tool (AAT) was created for FOAM appraisal by and for expert educators and has demonstrated validity in this context. It has yet to be evaluated in other populations. Objectives: We assessed the AAT's usability in a diverse population of practicing emergency medicine (EM) physicians, residents, and medical students; solicited feedback; and developed a revised tool.