Our aim was to compare the incidence and outcomes of civil legal cases in Canada involving international medical graduate (IMG) physicians to physicians who graduated from medical schools in Canada or the US.

We conducted a retrospective cohort study with multilevel, multivariate modelling of civil legal cases against physicians licensed to practise in Canada.

We used the Canadian Medical Protective Association’s national repository of medicolegal case data.

We extracted data on physicians’ demographic characteristics, geographical characteristics and undergraduate medical education.

Outcomes included physician medicolegal case rates (the number of civil legal actions a physician is involved in per year) and case outcomes (when a case proceeds and is either dismissed, settled or proceeds to trial). Our multilevel models examined associations between physician factors and the rate of civil legal actions and the distribution of civil legal outcomes.

The case rate model included 433 038 physician-year observations from 98 960 physicians (2015–2019), with 7657 civil legal cases (mean case rate per physician-year 0.0221; 98% had no cases). Case rates did not differ significantly between IMGs and Canadian/US graduates (p=0.0516). The case outcome model included 8046 cases (2016–2023). Unadjusted, cases favoured the plaintiff slightly more often for IMGs (39.1% vs 36.6%, ² (2, N=8046)=14.03, p

Our study suggests that where physicians receive their medical degree has no effect on their level of medicolegal risk in civil legal actions in Canada.

To address the growing prevalence of sedentary behaviours among older adults and their associated adverse health outcomes, there is an urgent need to prioritise effective and accessible interventions. Mobile health (mHealth) delivers healthcare services and health-related information through portable electronic devices, enabling interventions to be administered directly in home settings. However, the evidence on the effectiveness of mHealth interventions in reducing sitting time among older adults remains inconsistent. To derive literature-based estimates of the effectiveness of mHealth interventions, we will systematically review and meta-analyse the impact of these interventions on sitting time in adults aged 55 years and older.

An electronic search of PubMed, Embase, Web of Science and Cochrane will be conducted from database inception to March 2025 to identify randomised controlled trials evaluating the effects of mHealth interventions on sitting time during waking hours, excluding sleep duration. Subgroup analyses will explore potential moderators (eg, participant characteristics, intervention specifics). Studies from all settings (eg, community, long-term care facilities, etc) will be considered. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines will be explicitly applied for structuring this report. Methodological quality will be assessed using the Cochrane Handbook tool. Two independent reviewers will screen the studies and extracted data, with methodological quality to be assessed using established criteria. Meta-analyses will be performed using Review Manager v.5.4 software.

This study uses secondary data and, therefore, does not require ethics approval. The findings will be communicated through presentations at international conferences and published in peer-reviewed journals. The results will inform the development of future mHealth interventions aimed at reducing sedentary behaviour in older adults and provide benchmarks for the effectiveness of technology-driven public health strategies. This protocol adheres to the PRISMA guidelines and follows the Cochrane Handbook for Systematic Reviews of Interventions for methodological rigour.

CRD42023443926.