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Online Bridging Program for new international palliative medicine fellows: development and evaluation
  1. Hanan Al-Mohawes1,
  2. Madelaine Amante2,3,
  3. Breffni Hannon1,2,4,
  4. Camilla Zimmermann2,3,4,
  5. Ebru Kaya2,3 and
  6. Ahmed al-Awamer1,2,3
  1. 1Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
  2. 2Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada
  3. 3Division of Palliative Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  4. 4Division of Medical Oncology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  1. Correspondence to Dr Ahmed al-Awamer, Department of Supportive Care, Princess Margaret Cancer Centre, University Health Network, Toronto, ON M5G 2C1, Canada;{at}


Objectives International medical graduates (IMGs) who pursue additional training in another country may encounter unique challenges that compromise their learning experience. This paper describes the development of an Online Bridging Program in the Division of Palliative Care at the University Health Network Toronto and examines its effectiveness in improving IMGs’ readiness for Canadian fellowship training.

Methods The annual Online Bridging Program was developed to help new IMGs transitioning to Canadian palliative fellowship using Kern’s framework for curriculum development. Following a needs assessment, eight online modules with weekly live sessions were developed and underwent external content validation and usability tests. After each iteration, the programme was improved based on participant feedback. Evaluation was conducted first through an online survey immediately on completion of the programme and then through qualitative interviews 6 months into the fellowship. The interviews were analysed using Braun and Clarke’s model for thematic analysis.

Results Nine IMGs participated in the Online Bridging Program from 2018 to 2020. All nine participated in the survey and eight in the interviews. Responses to the online survey were almost unanimously positive, suggesting its effectiveness in assisting the IMGs’ transitions into fellowship. The interviews revealed four major themes: the importance of combining online modules and live sessions, reducing the fellows’ anxiety and easing the transition into their new role, an improved overall learning experience and recognising online format limitations.

Conclusion The Online Bridging Program effectively eased IMG palliative medicine fellows’ transition into training and enhanced their learning experience.

  • education and training

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  • HA-M and MA contributed equally.

  • Contributors Aa-A, BH, CZ and EK developed and facilitated the programme curriculum. HA-M conducted the interviews in the qualitative evaluation of the programme. MA and Aa-A cleaned and analysed the quantitative data, and performed the thematic analysis. All authors discussed the results. MA, Aa-A and HA-M drafted the manuscript with input from all the authors. Aa-A is the guarantor.

  • Funding This project was supported by the ‘Art of Possible’ Education Scholarship Grant (2018), Department of Family and Community Medicine, the University of Toronto.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval This project was completed following approval from the University Health Network Research Ethics Board (18–6061).

  • Provenance and peer review Not commissioned; externally peer reviewed.