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About Sickkids
About SickKids

Kathy Boutis, B.Sc, M.Sc, MD, FRCPC

The Hospital for Sick Children
Staff Physician
Paediatric Emergency Medicine

Research Institute
Senior Associate Scientist, Child Health Evaluative Sciences
Research Institute

Research Ethics Board

University of Toronto
Professor of Paediatrics
Department of Paediatrics

Phone: 416-813-8982
Fax: 416-813-5043
Email: kathy.boutis@sickkids.ca

Brief Biography

Dr. Kathy Boutis graduated from the University of Toronto medical school in 1991. She completed a residency in paediatrics in 1998 and a fellowship in paediatric emergency medicine in 2001 at the Children's Hospital in Boston, Harvard University. In 2008 she completed a Master’s degree in Health Research Methodology at McMaster University. Dr. Boutis is currently a staff physician in the emergency department at The Hospital for Sick Children (SickKids), a Senior Associate Scientist in the Child Health Evaluative Sciences Program at SickKids Research Institute, and a Professor of Paediatrics with the University of Toronto. In 2009, she developed and an emergency department-based student volunteer program and lead the operations of this program until 2018. From 2012-2018, she was Research Director in Paediatric Emergency Medicine and since 2015 she is the Vice-Chair of the Research Ethics Board.

Clinical Care Activities

Dr. Boutis' clinical practice spans both patient care and educational responsibilities in paediatric emergency medicine. Although she practices and teaches on any problem that relates to paediatric emergency medicine, her specialty areas are in the emergency diagnosis and management of paediatric injuries and medical image interpretation.

Academic Background

  • B.Sc, University of Toronto
  • M.Sc, McMaster University
  • MD, University of Toronto
  • FRCPC Pediatrics, Royal College of Physicians and Surgeons
  • Pediatric Residency, Children's Hospital Boston, Harvard University
  • Pediatric Emergency Medicine Fellowship, Children's Hospital of Boston, Harvard University

Research Interests


Dr. Boutis has become an internationally recognized thought leader in paediatric emergency medicine whose research on musculoskeletal injuries has challenged dogma and is transforming practice. She links her core research area to child abuse, radiation exposure, and how trainees learn. Her established work on learning curves and the interpretation of diagnostic images combines scholarship in education theory, decision-making, and implementation science and resulted in an innovative on-line learning platform called ImageSim (www.imagesim.com).

Research Activities

Emergency Management of Pediatric Injuries: This clinical research program focuses on the emergency management common minor paediatric fractures, abusive injuries, and paediatric concussion. Specifically, this program conducts research to answer important questions that derive innovative cost-effective diagnostic and management strategies for common minor fractures, improve detection of abusive fractures, and address diagnostic consistency for concussion.  

Deliberate Practice of Pediatric Medical Image Interpretation: This medical education research program combines the theoretical frameworks of cognitive simulation, decision-making, deliberate practice, and performance-based competency with screen-based on-line learning. This research defines the learning outcomes and mathematics of learning curves of varied expert levels and with different learning conditions during medical image interpretation. The team has also implemented learning analytics that could be applied to on-line learning platforms to better define where and how participants make mistakes, not just how often. Research in this area provides a validated framework for implementing competency-by-design for clinical skills amenable to cognitive simulation. 

Innovation in Education

The foundations derived from her medical education research program were successfully translated into a powerful, fully automated, on-line learning platform called ImageSim (www.imagesim.com). ImageSim has been implemented in over 30 post-graduate training programs as a core part of the curriculum and offers international-level continued professional development (CPD) with level 3 CPD credits. ImageSim has also partnered with Médecins Sans Frontières and the Global Health team at the Hospital for Sick Children to offer its courses in Pakistan, the Middle East and Africa. ImageSim was the 2019 recipient of the University of Toronto Fred Fallis Award for Excellence and Innovation in on-line learning and the Hospital for Sick Children CPD Award for course design

Future Research Interests

In the future, Dr. Boutis will be continuing to derive evidence that optimizes paediatric injury diagnosis and management at the bedside and undertaking medical education studies focused on the web-based learning of image interpretation

External Funding

Dr. Boutis has successfully sustained funding of her research programs for the duration of her career as a scientist. Specific agencies that have granted Dr. Boutis funds include Physicians’ Services Incorporated, Canadian Institutes of Health Research, Royal College of Physicians and Surgeons, SicKKids Foundation,and the University of Toronto.


Five Most Recent Significant Publications

  1. A Big Data and Learning Analytics Approach to Process-Level Feedback in Cognitive Simulations.
    Pecaric M, Boutis K, Beckstead J, Pusic M: Acad Med. 2017 Feb;92(2):175-184.
    Significance:  Collecting and analyzing large amounts of process data for the purposes of education can be considered a big data/learning analytics (BD/LA) approach to improving learning and the measurement of skill acquisition. However, in the education of health care professionals, the application of BD/LA is limited to date. In this paper, we discussed the potential advantages of the BD/LA approach for the process of learning via cognitive simulations. Using the lens of a cognitive model of radiograph interpretation with four phases (orientation, searching/scanning, feature detection, and decision making), we used process data from a cognitive simulation of pediatric ankle radiography where 46 practitioners from three expertise levels classified 234 cases online. We highlighted data available in a digital environment (time-stamped, click-level process data). We illustrated learning analytics using algorithmic computer-enabled approaches to process-level feedback. Overall, we demonstrated that the augmented collection and dynamic analysis of learning process data within a cognitive simulation can improve feedback and prompt more precise reflection on a novice clinician’s skill development of visual diagnosis.
  2. Radiograph-Negative Lateral Ankle Injuries in Children Occult Growth Plate Fracture or Sprain?
    Boutis K, Plint A, Stimec J, Miller E, Babyn P, Schuh S, Brison R, Lawton L, Narayanan G: JAMA Pediatrics. 2016;170:e154114.
    Significance:  For over 50 years, physicians have thought that growing children "do not get sprains" since it is the growth plate is assumed to be weaker than the relatively stronger adjoining ligaments. As a result, when a child presents with an ankle injury and x-rays that do not show a fracture, the traditional teaching is to place these children in a cast and refer to an orthopedic surgeon since they may have a growth plate fracture we can't see on radiographs. Our research changed this dogma. We enrolled 135 children who received MRI to identify the precise pathology and we demonstrated that in fact growth plate injuries in this clinical scenario are rare but ankle sprains are in fact very common.  Importantly, regardless of what the specific MRI injury was, children recovered well when treated with support and return to activities as directed by the children's symptoms. Implementation of the evidence will spare many children unnecessary casting and orthopedic follow up and will permit a faster return to activities.
  3. The Diagnosis of Concussion in a Pediatric Emergency Department
     Boutis K, Weerdeburg K, Koo E, Schneeweiss S, Zemek R: J Pediatrics. 2015 May;166(5):1214-1220.
    Significance: International expert and consensus-based guidelines on the diagnosis of concussion have been developed to ensure appropriate treatment of this important brain injury. In this study, we determined the frequency of pediatric emergency physician diagnosed concussion and compared it to the occurrence of this injury diagnosed by applying the diagnostic criteria in the Zurich 4th international consensus guidelines. We also determined the clinical variables associated with a pediatric emergency physician diagnosis of a concussion. We found that pediatric emergency physicians diagnosed concussion significantly less often relative to diagnostic criteria recommended in international consensus based guidelines.  Further, clinical variables used to make this diagnosis by emergency physicians were not as inclusive as current recommendations.  Thus, pediatric emergency physicians may be missing cases of concussion and the corresponding opportunity to provide critical advice for cognitive and physical rest to ensure prevention of repeat concussions  and optimal brain recovery.
  4. Effect of the Low Risk Ankle Rule on the frequency of radiography in children with ankle injuries
    Boutis K, Grootendorst P, Willan A, Plint AC, Babyn P, Brison RJ, Sayal A, Parker M, Mamen N, Schuh S, Grimshaw J, Johnson D, Narayanan U: CMAJ. 2013;185(15):E731-8.
    Significance:  The Low Risk Ankle Rule (LRAR) is a validated clinical decision rule that has the potential to safely reduce ankle radiographs in children with ankle injuries.  We performed a phased implementation of the LRAR and evaluated its effectiveness on reducing the frequency of ankle radiographs among children. We enrolled 2,151 children with ankle injuries, 1,055 of these at intervention and 1,096 at control hospitals.  Implementation of the LRAR reduced the frequency of ankle radiographs was reduced by 21.9%.  Further, the sensitivity of the LRAR was 100%, while the specificity was 53.1%. Thus, implementation of the LRAR in several different emergency department settings reduced the rate of pediatric ankle radiographs significantly and safely, without an accompanying change in physician or patient satisfaction.
  5. Parental Knowledge of Potential Cancer Risks from Exposure to Computed Tomography.
    Boutis K, Cogollo W, Fischer J, Freedman SB, Ben David G, Thomas KE: Pediatrics. 2013 Aug;132(2):305-11
    Significance: Studies have highlighted a lack of patient awareness of potential increased cancer risks associated with computed tomography (CT) scans in adult patients and in non-urgent settings. However, little is known about parental awareness of these risks in an emergency setting. Of the742 enrolled parents in this prospective cohort study, 357 (46.8%) of the participating parents were aware of the potential increased lifetime malignancy risk associated with head CT imaging. Nevertheless, the majority of parents underestimated the potential cancer risks from CT scans in an emergent setting. While risk disclosure moderately reduced willingness to proceed with recommended testing, almost all parents preferred an informed discussion prior to CT testing.