Despite both the strong, growing demand from medical students and the changing societal forces that call for better global health training, Canadian medical school curricula are not well positioned to address these needs. Improving global health opportunities in Canadian medical school curricula will likely require national leadership from governing academic bodies.

Over the last decade, a massive increase in data collection and analysis has occurred in many fields. In the health sector, however, there has been relatively little progress in data analysis and application despite a rapid rise in data production. Given adequate governance, improvements in the quality, quantity, storage and analysis of health data could lead to substantial improvements in many health outcomes. In low- and middle-income countries in particular, the creation of an information feedback mechanism can move health-care delivery towards results-based practice and improve the effective use of scarce resources. We review the evolving definition of big data and the possible advantages of – and problems in – using such data to improve health-care delivery in low- and middle-income countries. The collection of big data as mobile-phone based services improve may mean that development phases required elsewhere can be skipped. However, poor infrastructure may prevent interoperability and the safe use of patient data. An appropriate governance framework must be developed and enforced to protect individuals and ensure that health-care delivery is tailored to the characteristics and values of the target communities.

T he coronavirus disease 2019 (COVID-19) pandemic is the largest public health crisis in over a century. 1 As of Jan. 15, 2021, COVID-19 has resulted in over 113 million infections and almost 2.5 million deaths globally. 2 The global crude mortality rate among patients diagnosed with COVID-19 is about 3%, but some countries have reported rates that are up to 3 times higher. 2,3 Factors explaining these variations include population differences in demographics, health status and socioeconomics, as well as system factors such as the availability of testing, pandemic preparedness and response, with others yet to be uncovered. 4,5 There is an urgent need for high-quality, populationlevel data to understand modifiable risks for disease severity

CLINICIAN'S CAPSULE What is known about the topic? Goals of care discussions (GOC) are critical to reflecting patients' preferences in the provision of acute care, yet these discussions can be challenging to have in the emergency department (ED) setting. What did this study ask? What are emergency physicians' perspectives on barriers and facilitators to GOC discussions? What did this study find? In this survey of emergency medicine attending and resident physicians, the majority reported feeling comfortable and adequately trained to conduct GOC discussions. However, they identified time constraints, environmental factors, and patient expectations as barriers. Fifty-four percent of respondents believed that it was primarily the responsibility of admitting services to conduct GOC discussions. Why does this study matter to clinicians? This study suggests that dedicated ED resources for palliative care, such as a palliative care ED pathway, and addressing structural factors, such as a way to dedicate time and private space to GOC discussions, would be promising avenues for improvement. Training did not appear to be a barrier.