CPD In Practice

In this episode, emergency physician and cognitive load researcher Dr. Adam Szulewski explores how cognitive load affects clinical reasoning and performance in busy practices. He explains how limited working memory, interruptions, fatigue, and information overload can influence decision-making and shares practical strategies to help clinicians manage these demands.Dr. Szulewski discusses approaches such as pre-briefing, mental simulation, pausing to recap and reprioritize, and using checklists and cognitive aids appropriately. The conversation also looks at how electronic health records can add unnecessary cognitive burden and why recognizing cognitive load can help clinicians create more space to think clearly.Guest: Dr. Adam SzulewskiHost: Dr. Chris Morrow, Associate Dean, UBC CPDProducer: Julia DonahueMusic: "“Flight of the Starbird” by Andrei and Mike Diaconu of Cosmic MansionsEpisode Timestamps00:00 — Introduction and what cognitive load means01:58 — Intrinsic, extraneous and germane cognitive load04:17 — Translating cognitive load theory into clinical medicine06:02 — Interruptions, competing priorities and busy clinical practice08:42 — Working memory, expertise and mental schemas12:22 — Expert vs. novice attention: the ruptured AAA simulation example15:47 — Fast and slow thinking, cognitive error and knowing when to slow down18:40 — Pre-briefing and mental simulation before high-stakes care21:46 — Applying structure and preparation in primary care22:16 — The medical pause: recapping, slowing down and reprioritizing25:22 — Checklists, cognitive aids and when they help27:24 — Research on cognitive load in clinical practice and CanMEDS31:40 — Electronic health records, extraneous load and the potential role of AIResources:Szulewski A, Howes D, van Merriënboer JJG, Sweller J. From Theory to Practice: The Application of Cognitive Load Theory to the Practice of Medicine. Academic Medicine. 2021;96(1):24–30.https://academic.oup.com/academicmedicine/article-abstract/96/1/24/8346681Young M, Szulewski A, Anderson R, Gomez-Garibello C, Thoma B, Monteiro S. Clinical Reasoning in CanMEDS 2025. Canadian Medical Education Journal. 2023;14(1):58–62.https://journalhosting.ucalgary.ca/index.php/cmej/article/view/75843Kahneman D. Thinking, Fast and Slow.https://www.penguinrandomhouse.com/books/89308/thinking-fast-and-slow-by-daniel-kahneman/Lee JY, Donkers J, Jarodzka H, Sellenraad G, van Merriënboer JJG. Different effects of pausing on cognitive load in a medical simulation game. Computers in Human Behaviour. 2020;110:106385.https://www.sciencedirect.com/science/article/pii/S0747563220301382Lee JY, et al. The medical pause: Importance, processes and training. Medical Education. 2021.https://asmepublications.onlinelibrary.wiley.com/doi/full/10.1111/medu.14529KeyLIME+ Podcast. Adam discusses KeyLIME+ near the end of the episode as a medical education podcast focused on the stories and practical implications behind research and policy.https://keylimepodcast.libsyn.com/ The Vancouver Fraser Medical Program and the Vancouver Academic Campus of the University of British Columbia are situated on the traditional territory of the Musqueam, Squamish and Tsleil-Waututh peoples. The Southern Medical Program and the Okanagan Academic Campus of the University of British Columbia are situated on the territory of the Syilx Okanagan Nation. The Northern Medical Program and the University of Northern BC are situated on the traditional territory of the Lheidli T’enneh, part of the Dakelh (Carrier) First Nations. With respect to the Lekwungen peoples on whose traditional territory the Island Medical Program and the University of Victoria stand, and the Songhees, Esquimalt and WSÁNEĆ peoples whose historical relationships with the land continue to this day.We acknowledge our traditional hosts and honour their welcome and graciousness to the students who seek knowledge here.All rights reserved. Reproduction and distribution of this presentation without written permission from UBC Faculty of Medicine is strictly prohibited.© UBC Medicine Learning Network 2026 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Guest: Dr. Jason Hitkari Host: Dr. Chris Morrow Producer: Craig Ferguson Music: "Stand With Me" by Adrian Walther licensed via SoundStripe Episode Timestamps [00:00] – Introduction and episode overview [00:29] – Guest introduction: Dr. Jason Hitkari [01:05] – Declining fertility rates in Canada and BC [03:54] – The rise of egg freezing and its exponential uptake [05:20] – Elective vs. medical egg freezing (oncofertility) [05:51] – Cost of egg freezing and lack of MSP coverage [06:44] – CFAS guidelines on egg freezing: who and when [07:32] – The primary care provider's role in egg freezing counselling [08:05] – When to investigate infertility: age-dependent timelines [09:46] – The basic infertility workup in primary care [10:51] – AMH testing: what it is and how to interpret it [11:53] – Pelvic ultrasound and tube assessment (HSG) [13:44] – Who should be referred to a fertility specialist [14:17] – Approaching the "fertility assessment" request in primary care [15:44] – Overview of fertility treatments: IUI, IVF, and ICSI [17:43] – Male fertility: lifestyle factors and semen analysis [21:21] – BC's new MSP IVF funding: eligibility and coverage [23:00] – The IVF waitlist and what patients can expect [23:39] – How patients access the funded IVF program [24:03] – Equity and access: financial, LGBTQ+, and legal barriers [25:21] – Rural access to fertility care in BC [27:05] – Key takeaways for primary care providers [28:24] – Knowledge nugget: a brief history of fertility [30:18] – Credits and CME information Studies & Research Mentioned Janecka M, Mill J, Basson MA, et al. Advanced paternal age effects in neurodevelopmental disorders—review of potential underlying mechanisms. Transl Psychiatry. 2017;7:e1019. doi:10.1038/tp.2016.294 Janecka M, Haworth CMA, Ronald A, et al. Paternal age alters social development in offspring. J Am Acad Child Adolesc Psychiatry. 2017;56(5):383–390. doi:10.1016/j.jaac.2017.02.006 Grossman DC, Curry SJ, Owens DK, et al. Screening for Ovarian Cancer: US Preventive Services Task Force Recommendation Statement. In: StatPearls. Rockville, MD: Agency for Healthcare Research and Quality; 2018. https://www.ncbi.nlm.nih.gov/books/NBK442158/ Practice Committee of the American Society for Reproductive Medicine. Fertility evaluation of infertile women: a committee opinion. Fertil Steril. 2021;116(5):1255–1265. https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-evaluation-of-infertile-women-a-committee-opinion-2021/ © UBC Faculty of Medicine All Rights Reserved The Vancouver Fraser Medical Program and the Vancouver Academic Campus of the University of British Columbia are situated on the traditional territory of the Musqueam, Squamish and Tsleil-Waututh peoples. The Southern Medical Program and the Okanagan Academic Campus of the University of British Columbia are situated on the territory of the Syilx Okanagan Nation. The Northern Medical Program and the University of Northern BC are situated on the traditional territory of the Lheidli T’enneh, part of the Dakelh (Carrier) First Nations. With respect to the Lekwungen peoples on whose traditional territory the Island Medical Program and the University of Victoria stand, and the Songhees, Esquimalt and WSÁNEĆ peoples whose historical relationships with the land continue to this day.We acknowledge our traditional hosts and honour their welcome and graciousness to the students who seek knowledge here.All rights reserved. Reproduction and distribution of this presentation without written permission from UBC Faculty of Medicine is strictly prohibited.© UBC Medicine Learning Network 2026 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Guest: Dr. Randal Mason Host: Dr. Chris Morrow Producer: Craig Ferguson Music: "Stand With Me" by Adrian Walther licensed via SoundStripe Episode Timestamps [00:00] – Introduction and episode overview [00:58] – Rethinking the abstinence-only model: harm reduction and patient-defined goals [03:04] – How reduced drinking can meaningfully lower health risks [04:08] – When abstinence remains the right goal [05:04] – Pharmacological approaches: naltrexone and acamprosate [06:37] – Choosing between naltrexone and acamprosate [07:24] – Are anti-craving medications underutilized in primary care? [09:28] – Other options: gabapentin, topiramate, and psychosocial supports [10:36] – Multimodal treatment: combining pharmacotherapy with motivational interviewing [11:04] – Effectiveness of anti-craving medications and reasons for hope [12:38] – Addressing clinician nihilism and burnout around AUD [14:13] – Alcohol withdrawal: identifying risk and using the PAWSS score [15:35] – Outpatient vs. inpatient withdrawal management [17:37] – Gabapentin as a withdrawal management tool [18:37] – Detox: common misconceptions and finite resources in BC [20:06] – Personalizing the withdrawal and detox plan to patient goals [21:44] – A difficult scenario: rural ED, no detox beds, patient wants to go home [24:13] – Practical middle-ground approaches for harm reduction [25:02] – Closing reflections and final thoughts from Dr. Mason [26:50] – Knowledge nugget: animals and alcohol [27:51] – Credits and CME information Studies & Research Mentioned Province of British Columbia. High-Risk Drinking and Alcohol Use Disorder. BC Guidelines; 2024. Accessed January 29, 2026. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/high-risk-drinking-and-alcohol-use-disorder Wood E, Bright J, Hsu K, et al; Canadian Alcohol Use Disorder Guideline Committee. Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. CMAJ. 2023;195(40):E1364–E1379. doi:10.1503/cmaj.230715. https://www.cmaj.ca/content/195/40/E1364 Canadian Centre on Substance Use and Addiction (CCSA). Canada's Guidance on Alcohol and Health. 2023. Accessed January 29, 2026. https://www.ccsa.ca/en/guidance-tools-resources/substance-use-and-addiction/alcohol/canadas-guidance-alcohol-and-health BC Centre on Substance Use; Canadian Institute for Substance Use Research. Canadian Operational Guidance: Managed Alcohol Programs. Appendix 9: Alcohol Use Disorder Screening and Assessment Tools. BCCSU; 2023. Accessed January 29, 2026. https://www.bccsu.ca/wp-content/uploads/2023/07/Resource-Alcohol-Use-Disorder-Screening-and-Assessment-Tools.pdf UBC Continuing Professional Development. Alcohol Use: Screening, Determining Risk, and Evidence-Based Treatment. Accessed January 29, 2026. https://ubccpd.ca/learn/learning-activities/course?eventtemplate=724-alcohol-use-screening-determining-risk-and-evidencebased-treatment © UBC Faculty of Medicine All Rights Reserved The Vancouver Fraser Medical Program and the Vancouver Academic Campus of the University of British Columbia are situated on the traditional territory of the Musqueam, Squamish and Tsleil-Waututh peoples. The Southern Medical Program and the Okanagan Academic Campus of the University of British Columbia are situated on the territory of the Syilx Okanagan Nation. The Northern Medical Program and the University of Northern BC are situated on the traditional territory of the Lheidli T’enneh, part of the Dakelh (Carrier) First Nations. With respect to the Lekwungen peoples on whose traditional territory the Island Medical Program and the University of Victoria stand, and the Songhees, Esquimalt and WSÁNEĆ peoples whose historical relationships with the land continue to this day.We acknowledge our traditional hosts and honour their welcome and graciousness to the students who seek knowledge here.All rights reserved. Reproduction and distribution of this presentation without written permission from UBC Faculty of Medicine is strictly prohibited.© UBC Medicine Learning Network 2026 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Guest: Dr. Randal Mason Host: Dr. Chris Morrow Producer: Craig Ferguson Music: "Stand With Me" by Adrian Walther licensed via SoundStripe Episode Timestamps [00:00] – Introduction and episode overview [01:09] – The scale of alcohol-related harms in BC and Canada [02:21] – Why screening remains inconsistent in clinical practice [04:10] – Screening at every point of care [04:32] – Clinician discomfort and workflow barriers [05:42] – New guidance on alcohol-related risk [07:36] – Understanding risk thresholds: cancer and cardiovascular disease [08:16] – Patient reactions and clarifying misconceptions [09:03] – BC guidelines compared with Canadian guidelines [10:28] – Screening tools: SASQ, AUDIT, AUDIT-C, DSM-5 criteria [12:30] – Treatment approaches for high-risk drinking vs. diagnosed AUD [13:21] – Challenges for rural and remote patients and providers [15:13] – Considerations for Indigenous patients and culturally safe care [20:34] – Using frameworks like the Five A's in clinical conversations [21:20] – Closing remarks and preview of Part 2 [21:31] – Knowledge nugget: the history of alcohol and the origin of "toasting" [22:10] – Credits and CME information Studies & Research Mentioned • Province of British Columbia. High‑Risk Drinking and Alcohol Use Disorder. BC Guidelines; 2024. Accessed January 29, 2026. https://www2.gov.bc.ca/gov/content/health/practitioner-professional-resources/bc-guidelines/high-risk-drinking-and-alcohol-use-disorder • Wood E, Bright J, Hsu K, et al; Canadian Alcohol Use Disorder Guideline Committee. Canadian guideline for the clinical management of high‑risk drinking and alcohol use disorder. CMAJ. 2023;195(40):E1364‑E1379. doi:10.1503/cmaj.230715. https://www.cmaj.ca/content/195/40/E1364 • Canadian Centre on Substance Use and Addiction (CCSA). Canada’s Guidance on Alcohol and Health. 2023. Accessed January 29, 2026. https://www.ccsa.ca/en/guidance-tools-resources/substance-use-and-addiction/alcohol/canadas-guidance-alcohol-and-health [ • World Health Organization. AUDIT: The Alcohol Use Disorders Identification Test: Guidelines for Use in Primary Care. 2nd ed. WHO; 2001. https://www.who.int/publications/i/item/WHO-MSD-MSB-01.6a • U.S. Department of Veterans Affairs. Alcohol Use Disorders Identification Test – Consumption (AUDIT‑C). Updated March 2021. Accessed January 29, 2026. https://www.hepatitis.va.gov/alcohol/treatment/audit-c.asp • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed, Text Revision (DSM‑5‑TR). American Psychiatric Association; 2022. Information and updates available at: https://www.psychiatry.org/psychiatrists/practice/dsm • UBC Continuing Professional Development. Alcohol Use: Screening, Determining Risk, and Evidence‑Based Treatment. Accessed January 29, 2026. https://ubccpd.ca/learn/learning-activities/course?eventtemplate=724-alcohol-use-screening-determining-risk-and-evidencebased-treatment © UBC Faculty of Medicine All Rights Reserved The Vancouver Fraser Medical Program and the Vancouver Academic Campus of the University of British Columbia are situated on the traditional territory of the Musqueam, Squamish and Tsleil-Waututh peoples. The Southern Medical Program and the Okanagan Academic Campus of the University of British Columbia are situated on the territory of the Syilx Okanagan Nation. The Northern Medical Program and the University of Northern BC are situated on the traditional territory of the Lheidli T’enneh, part of the Dakelh (Carrier) First Nations. With respect to the Lekwungen peoples on whose traditional territory the Island Medical Program and the University of Victoria stand, and the Songhees, Esquimalt and WSÁNEĆ peoples whose historical relationships with the land continue to this day.We acknowledge our traditional hosts and honour their welcome and graciousness to the students who seek knowledge here.All rights reserved. Reproduction and distribution of this presentation without written permission from UBC Faculty of Medicine is strictly prohibited.© UBC Medicine Learning Network 2026 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Guest: Dr. Elizabeth Baerg HallHost: Dr. Chris MorrowProducer: Craig FergusonMusic: "Stand With Me" by Adrian Walther licensed via SoundStripeEpisode Timestamps• [00:00] - Introduction and episode overview• [02:03] - Life transitions and when ADHD becomes visible in adults• [04:14] - How ADHD can be masked by structure and support systems• [05:21] - Red flags for ADHD in primary care settings• [08:54] - Who can diagnose ADHD and what tools are available• [12:05] - The importance of impairment in diagnosis and avoiding overdiagnosis• [16:36] - Common comorbidities: Anxiety, depression, and bipolar disorder• [19:39] - ADHD and substance use disorder• [21:26] - Barriers to diagnosis and treatment: Stigma and misconceptions about stimulants• [24:07] - Inequities in access to care, including Indigenous patients• [26:26] - Challenges for rural patients and older adults with ADHD• [29:00] - Resources and support in BC: CADRA, Shared Care, and Skills for Success• [30:56] - ADHD pathways and UBC CPD educational opportunities• [32:59] - Closing remarks and conference information• [33:52] - Knowledge nugget: The history of psychostimulantsStudies & Research Mentioned• CADDRA – Canadian ADHD Resource Alliance. Canadian ADHD Practice Guidelines, 4.1 Edition. Toronto, ON: CADDRA; 2020. Accessed January 13, 2026. https://adhdlearn.caddra.ca/wp-content/uploads/2022/08/Canadian-ADHD-Practice-Guidelines-4.1-January-6-2021.pdf• Centers for Disease Control and Prevention. Diagnosing ADHD. Updated 2024. Accessed January 13, 2026. https://www.cdc.gov/adhd/diagnosis/index.html• The MTA Cooperative Group: A 14-Month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder (ADHD) . Arch Gen Psychiatry 1999;56:1073-1086.• The MTA Cooperative Group: Moderators and mediators of treatment response for children with attention-deficit/hyperactivity disorder (ADHD). Arch Gen Psychiatry 1999;56:1088-1096.• Molina BSG, Kipp HL, Joseph HM, et al. Stimulant Diversion Risk Among College Students Treated for ADHD: Primary Care Provider Prevention Training. Acad Pediatr. 2020;20(1):119-127. doi:10.1016/j.acap.2019.06.002• National Institute of Mental Health. The Multimodal Treatment of Attention Deficit Hyperactivity Disorder Study (MTA): Questions and Answers. Revised November 2009. National Institute of Mental Health website. Accessed January 13, 2026. https://www.nimh.nih.gov/funding/clinical-research/practical/mta/the-multimodal-treatment-of-attention-deficit-hyperactivity-disorder-study-mtaquestions-and-answers• Ramtekkar UP, Reiersen AM, Todorov AA, Todd RD. Sex and age differences in attention-deficit/hyperactivity disorder symptoms and diagnoses: implications for DSM-V and ICD-11. J Am Acad Child Adolesc Psychiatry. 2010;49(3):217-28.e283.(C) 2025 UBC Medicine Learning Network The Vancouver Fraser Medical Program and the Vancouver Academic Campus of the University of British Columbia are situated on the traditional territory of the Musqueam, Squamish and Tsleil-Waututh peoples. The Southern Medical Program and the Okanagan Academic Campus of the University of British Columbia are situated on the territory of the Syilx Okanagan Nation. The Northern Medical Program and the University of Northern BC are situated on the traditional territory of the Lheidli T’enneh, part of the Dakelh (Carrier) First Nations. With respect to the Lekwungen peoples on whose traditional territory the Island Medical Program and the University of Victoria stand, and the Songhees, Esquimalt and WSÁNEĆ peoples whose historical relationships with the land continue to this day.We acknowledge our traditional hosts and honour their welcome and graciousness to the students who seek knowledge here.All rights reserved. Reproduction and distribution of this presentation without written permission from UBC Faculty of Medicine is strictly prohibited.© UBC Medicine Learning Network 2026 Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.