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OBJECTIVE: This multi-part study aimed to revise an existing battery of physical aptitude tests for firefighter applicants. Test validity and reliability were evaluated and performance thresholds were determined. METHODS: In Part I, 49 structural firefighters rated the similarity between the physical demands of the tests and corresponding work activities. In Part II, 23 participants completed the tests on 3 separate days. In Part III, cut-scores were determined using the Bookmark method by an expert panel of 25 firefighter supervisors. RESULTS: Analysis revealed high levels of validity and reliability. The expert panel provided invaluable direction through a combination of independent and group work, leading to consensus on acceptable completion times. CONCLUSION: Rigorous processes established scientific credibility for the revised battery of tests. Expert knowledge from firefighter supervisors contributed to determining cut-scores following established scientific methods.

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BACKGROUND: It has been suggested that low back pain (LBP) is a condition with an unpredictable pattern of exacerbation, remission, and recurrence. However, there is an incomplete understanding of the course of LBP and the determinants of the course. OBJECTIVE: The purposes of this study were: (1) to identify clusters of LBP patients with similar fluctuating pain patterns over time and (2) to investigate whether demographic and clinical characteristics can distinguish these clusters. DESIGN: This study was a secondary analysis of data extracted from a randomized controlled trial. METHODS: Pain scores were collected from 155 participants with chronic nonspecific LBP. Pain intensity was measured monthly over a 1-year period by mobile phone short message service. Cluster analysis was used to identify participants with similar fluctuating patterns of pain based on the pain measures collected over a year, and t tests were used to evaluate if the clusters differed in terms of baseline characteristics. RESULTS: The cluster analysis revealed the presence of 3 main clusters. Pain was of fluctuating nature within 2 of the clusters. Out of the 155 participants, 21 (13.5%) had fluctuating pain. Baseline disability (measured with the Roland-Morris Disability Questionnaire) and treatment groups (from the initial randomized controlled trial) were significantly different in the clusters of patients with fluctuating pain when compared with the cluster of patients without fluctuating pain. LIMITATIONS: A limitation of this study was the fact that participants were undergoing treatment that may have been responsible for the rather positive prognosis observed. CONCLUSIONS: A small number of patients with fluctuating patterns of pain over time were identified. This number could increase if individuals with episodic pain are included in this fluctuating group.

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BACKGROUND: The development of competency frameworks, such as CanMEDS, has helped define professional behavior, but programs that translate their theoretical aspects into practical learning are lacking. AIM: To improve instruction of the CanMEDS framework, the University of Alberta implemented a program in which 83 first-year medical students shadowed a first-year resident for eight months. METHODS: A randomized trial compared participants' attitudes and knowledge regarding CanMEDS to controls. A concurrent-triangulation mixed methods design with questionnaires and interviews provided a comprehensive understanding of program experiences. RESULTS: Students reported increasing their understanding of CanMEDS and increased their acceptance of the framework's importance and knowledge of its contents when compared to controls. Residents also reported that their knowledge of CanMEDS had increased. Participants considered the program to be effective for learning CanMEDS and developing professionalism, especially when paired with clinical encounters relevant to given professional roles. CONCLUSION: This simple, low cost, near-peer shadowing program can be useful for teaching professional behavior.

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The preparation of medical students for clerkship has been criticized, in terms of both students understanding of their new role as clinical trainees and their ability to carry out that role. To begin to address this gap, the authors report the development, implementation, and assessment of a novel program in which first-year medical students shadow first-year residents during their clinical duties. The program matches each student to a single resident, whom they shadow for several hours, once per month, for eight months. In the programs inaugural year (2009-10), 83 student-resident pairs participated; over 70% responded to pre- and post-intervention questionnaires, which included an 18-item preparedness scale. The authors used those responses to evaluate the program. Compared to students in a control group, the students in the program assessed themselves as better prepared to learn in a clinical setting. The low-cost student-resident shadowing program described in this article provided an early and structured introduction to the clinical environment, which may help prepare students for the transition into clerkship.

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OBJECTIVES: To conduct a survey in Edmonton, Alberta, to gather information regarding concerns about the influence of environmental factors on children's health and to use the information to set an agenda for the resources of the Paediatric Environmental Health Specialty Unit at Misericordia Hospital (Edmonton, Alberta). METHODS: Two questionnaires with 28 closed-ended questions were developed to examine parents', guardians' and health care professionals' concerns. They comprised items about six environmental factors (air, water and food quality; household supplies; radiation; and waste disposal). Health care professionals were also asked four questions about their knowledge of and their needs in Paediatric Environmental Health. Parents and guardians attending the public health centres and nurses working therein received questionnaires. Physicians were surveyed by e-mail. RESULTS: After verification, the questionnaire data from 400 parents or guardians and 152 health care professionals were used for analyses. Results from contingency table, Hotelling's T² and effect size analyses revealed similarities in the levels of concern in both groups, and the results were combined. The greatest concern of both groups was with environmental tobacco smoke, followed by pesticides in water. Concerns about six additional environmental elements were also expressed. The health care professionals showed a high level of concern about the need for resources, specific training and public education regarding paediatric environmental health. CONCLUSION: A significant level of concern was consistently found between the two groups studied, regardless of professional training. The highest level of concern was with a well-documented topic (ie, environmental tobacco smoke). Less concern associated with decreased documentation calls for increasing the knowledge of society, including health care professionals, to address the adverse effects of environmental factors on children.