Dialogue

Vol. 16, No. 3 — March 2016
Welcome to Dialogue, your link to the Royal College

THIS MONTH’S HEADLINES


Down, but not out: How point-of-care ultrasound is challenging the stethoscope’s reign

Point-of-care ultrasound is changing care. We list 8 benefits of this machine, and why stethoscopes and POCUS are more allies than rivals.


Time to give back: What it takes to volunteer in Haiti

Dr. Robson took his third trip to Haiti in December. Learn how he prepared for his volunteerism; plus, how to judge if you’re well-suited for similar work.


Online refresher on distinguishing normal/abnormal heart murmurs

Technological advances may be challenging when and how the stethoscope is being used, but it’s still a valuable diagnostic tool. Test or refresh your core auscultation skills with this free online program.


MOC Tip of the Month: Triple your conference learning this spring

Will you be attending an accredited conference this spring? With a little bit of planning, you can multiply your conference learning…



PLUS, MORE NEWS


Helping to launch a national CME/CPD program in Qatar

This new program is a great success for the country. The Royal College has been working with the Supreme Council of Health in Qatar on this project for the past two years.


News bites – February 2016

Bite size news on our New President Elect, important progress on CBD, research and global health ethics, ASPIRE, ICRE award nominations and social media.


News from Council

Your Royal College Council met last month. Get the scoop on top news and decisions from that meeting.


Plan to attend ICRE 2016: New conference track on “Leadership Education”

Why does “leadership” matter in medical education? Find out what track chair, Dr. Ming-Ka Chan, has to say.


Exclusive Q&A: SimSummit co-chairs explain why you should attend this year’s “extreme” event

Dr. Noel O’Regan had a terrifying introduction to his Anesthesiology career. Find out why summit co-chairs believe simulation education can help others avoid a similar experience.


Members in the news

In memoriam


 

Top

Down, but not out: How point-of-care ultrasound is challenging the stethoscope’s reign

Down, but not out: How point-of-care ultrasound is challenging the stethoscope’s reign

A 12-year-old girl enters the Emergency Department via ambulance.

Her mother says she has been sick all week, running a temperature and getting progressively worse. An x-ray taken earlier that day confirmed she has pneumonia. She started on ibuprofen and antibiotics but woke up at around 8:30 that night screaming.

Her teeth were chattering, she was uncontrollably shaking and she was cold to the touch. When the paramedics arrived, her skin was mottled and pale and her mouth, tinged with blue. Her temperature was over 40 degrees Celsius.

A parent’s nightmare, Sari recently lived this experience with her daughter Hannah. Luckily, Hannah’s health improved quickly upon arrival at The Hospital for Sick Children (SickKids) in Toronto— thanks, in part, to point-of-care ultrasound (POCUS).


How POCUS is changing care

“When you compare what point-of-care ultrasound is, in its new ultra-portable way, I can tell you that it gives you much more information and a much clearer picture of what’s happening inside the body than a traditional stethoscope,” said Mark Tessaro, MD, FRCPC, staff physician in Paediatric Emergency Medicine and research lead in the POCUS Program at SickKids.

Point-of-care ultrasound projects soundwaves into the body. These waves are received back by the machine as pictures. These pictures let doctors see how a patient’s organs are functioning in real time inside their body. Dr. Tessaro estimates that POCUS provides visual access to 90% of the organs a doctor would want information about, including previous hard-to-access places like the lungs.

When pathology is detected, further tests will still be ordered. The benefit is that POCUS enables doctors to more efficiently, effectively and confidently diagnose and make decisions.

While POCUS is relatively new to Paediatric Emergency Medicine, the tool itself builds on ultrasound technology already familiar to specialists in Radiology, Obstetrics and Gynecology and Cardiology.

“It’s really an old technology that we’re using in a relatively new way,” explained Charisse Kwan, MD, FRCPC, staff physician in Paediatric Emergency Medicine at SickKids and education lead in the hospital’s point-of-care ultrasound program.

“Just like the cellphone was a disruptive technology to the telecom industry, portable ultrasound is something that’s disrupted the way we are thinking about the physical exam, about taking a patient history and about how we actually approach a patient.”

That’s not to say that stethoscopes are obsolete.


Dr. Tessaro and Dr. Kwan with the POCUS. (Photo courtesy of SickKids).

Dr. Tessaro and Dr. Kwan with the POCUS. (Photo courtesy of SickKids).



POCUS and stethoscopes: More allies than rivals

Is the stethoscope dead? Not if you ask Dr. Tessaro or Dr. Kwan. They both agree that POCUS has enhanced benefits but it is still not the perfect fit for all patient complaints. Also, the machine requires special training. It will take time for this device to be used globally.


When to start with POCUS, when to start with a stethoscope

“I would flip the thinking from point-of-care ultrasound being a diagnostic test that you choose to use or not use after you take a history and physical, to being an extension of the physical exam,” Dr. Tessaro said.

He explained that a child complaining of abdominal pain would benefit from this technology in combination with palpation, auscultation and inspection.

“[With POCUS] I’d be getting much more accurate information about the kidneys, the liver, free-fluid, the bladder, the bowel and the bowel wall. Not only can I keep that child safe by not potentially missing a problem, but I can help make our system more efficient by targeting and choosing wisely on the next steps and the next consult that I activate.”

Dr. Kwan agreed, but added, “I personally think that there are still some things that the ultrasound can’t pick up. The stethoscope will still have its utility.”

She gave the example of a child presenting with wheezing. Use of a stethoscope would still be the recommended first step, perhaps supplemented with POCUS afterwards.


How to train on POCUS

POCUS requires varying levels of training, depending on the intended use.

“I would liken it to the stethoscope,” Dr. Tessaro added. “There are some things that are very easy for anyone to learn, for example, do you hear breath sounds or are they absent? But to take it a step further and distinguish certain types of heart murmurs requires intense training.”

With this in mind, Drs. Tessaro and Kwan have been taking a soft approach to training nurses in the Paediatric Emergency Department on the use of these machines for basic tasks like checking a patient’s urine level before sending them to Radiology.

More intense training would be for people learning more advance techniques. This kind of training would focus on several pieces, according to Dr. Kwan:

“It’s more multi-step and user-dependent,” she explained.

SickKids is currently the only hospital in Canada offering a Paediatric Emergency Medicine POCUS Fellowship. The hospital’s Paediatric Emergency Medicine team is also training their faculty.

“It’s no longer a case of how long it takes to train someone but how long it takes the individual to reach competency,” said Dr. Kwan, who predicts POCUS will explode in the next five years.

“We’ve seen centres of excellence beginning to rise in North America. They’re predicting that this is going to be something that’s used by everyone in the future as a pocket device,” Dr. Tessaro added in agreement.

“Why didn’t they think of it sooner?” That’s the question Hannah’s mother asks.


Dr. Tessaro with the POCUS machine. (Photo courtesy of SickKids).

Dr. Tessaro with the POCUS machine. (Photo courtesy of SickKids).



8 benefits of point-of-care ultrasound:

  1. Ease of use: While the technology is admittedly user-dependent, the tool itself is relatively easy to train on and use. Doctors are also starting to gain familiarity with ultrasound earlier in their careers. This is likely to simplify in-depth training later on.

  2. Portability and availability: Ultrasound machines haven’t always been this portable. The POCUS machines that are in use at SickKids are cart-based. Cost-effective, hand-held ultrasounds are also becoming popular and are an emerging, growing market.

  3. Effective decision-making, faster: POCUS devices support more informed and well-rounded care decisions on-the-spot.

  4. Holistic view of the body: POCUS has been readily adopted in emergency and general medicine because its imaging modality can access many organ systems, including previously restricted areas like the lungs.

  5. Patient safety: POCUS machines are seen as one of the safest diagnostic imaging tools. Since they can access and gather information from more organs in the body, they can support thorough patient examinations and reduce the risk of the doctor missing something crucial. This is especially useful for patients who are pre-verbal, such as young children. Also, the machine does not expose patients to radiation; its soundwave technology has been in use for years without known health risks.

  6. Improved communication and trust: POCUS helps open the lines of communication with patients and their families. The visuals help promote interaction. Doctors can more easily communicate what the problem is or may be. The enhanced interaction helps build trust that a full examination has been done.

  7. Sharing the work: Basic tasks that only require a visual cue (such as checking a patient’s bladder volume before a trip to Radiology) can be done by nurses, for example, using the machine.

  8. Health system resources: With more information and more informed decision-making, doctors can reduce the use of unnecessary tests and treatments. The visuals from the machine can also help doctors talk to doctors about the necessity of certain tests.

 

Top

Time to give back: What it takes to volunteer in Haiti

Photo of Haitian child courtesy of Dr. Robson.

Photo of Haitian child courtesy of Dr. Robson.



I believe that someday soon the world will unite in a common cause. We will be obliged to unite because as the world becomes progressively smaller, we will not be able to escape the recognition of our similarities. Differences will no longer drive the equation. Common cause will bind us together. I think this is why helping out in Haiti is so important. (Excerpt from Dr. Robson’s blog post: “Finding Common Cause,” December 14, 2015)

You can never fully prepare yourself for what you will see and experience on your first trip to Haiti, explained Lane Robson, MD, FRCPC, a pediatrician in Calgary, Alta. In fact, no matter how many trips you take, you might never feel ready.

Dr. Robson took his third trip to Haiti this past December where he worked at the Hôpital Albert Schweitzer Haïti. His experiences there kept him on his toes, both professionally and personally. Here, he shares how he prepared for his volunteerism; plus, how to judge if you’re well-suited for this kind of work.


First visit and rookie mistakes

Haiti is the poorest country in the western hemisphere. The 2010 earthquake rattled what little infrastructure existed and the country is still rebuilding. While there has been visible progress in getting the temporarily homeless back into houses and dismantling tent cities, a feeling of hopelessness and despair persists.

Dr. Robson first felt compelled to volunteer as a pediatrician in a poor country in the early 1970s, but it wasn’t until the 2010 earthquake that circumstances and opportunity coincided.

“The name of my first blog post is ‘Time to give back’ and that’s how I felt.”

Dr. Robson volunteered to be the physician representative for a group of physiotherapists headed to Jacmel, a coastal community in Haiti. While there, he primarily worked out of a damaged hospital in a United Nations tent alongside teams from other countries and nongovernmental organizations. He also spent three days working out of an airport-turned-hospital in Port-au-Prince on his way home.

That first visit taught Dr. Robson some important lessons:

And that’s exactly what he did.


Preparing for the unexpected

I left Haiti with very mixed emotions. I had done my best. My mind is filled with too many images of misery, helplessness, and poverty. Two weeks in Haiti is a long time. I’m not yet certain whether I would like to go back but if I do, next time I need to be better prepared. (Excerpt from Dr. Robson’s blog post: “Disaster Relief Pediatrics in Haiti,” April 2, 2010)

Trips to Nicaragua

To build his confidence and to gain more experience treating Central American-Caribbean-tropical illnesses, Dr. Robson began visiting Nicaragua in between his visits to Haiti.

In 2014 alone, he went six times. He organized each trip himself. Once he hit the ground, he would go and scout places to help. After a few visits, he began consistent work at a community clinic where he was named medical director. That work was particularly fulfilling, he explained. More than just “being another body,” he developed a community outreach program that introduced concepts like blood pressure and diabetes screening.


A refreshed blog

Dr. Robson also expanded his blog. Instead of simply being a record of his trip experience, he began documenting his reading. When preparing for a trip, he researches and writes entries on different diseases and illnesses he might encounter. For example, he wrote a blog post on tetanus before his most recent visit to Haiti. When a young boy presenting with symptoms of tetanus came in, he was able to use his internet connection to review his notes.

“I could have looked things up on other sites, too, but I had my own electronic resource. I’d reviewed the CDC site and a bunch of papers to write it. It helped that I’d written it as what I thought I should do if I came across a case.”


Community support

Dr. Robson also continues to involve his Canadian patients in his trips. They have donated toys and clothes, for example. Other doctors and pharmacists in Calgary have also donated equipment and medications.

Medication is especially valuable since first line medications that are common in Canada are generally not available in Haiti or Nicaragua. For example, they might use a medication that has an 80 per cent control as opposed to a 95 per cent control because of cost differences.  


Professionally prepared for work in Haiti

Without two prior trips to Haiti, this first day might have been overwhelming. Nothing like experience! (Excerpt from Dr. Robson’s blog post: “First Day,” December 15, 2015)

Buoyed by these experiences, Dr. Robson took his second trip to Haiti in 2012 where he worked in an American-run hospital in Port-au-Prince, Haiti’s capital. He visited the country for the third time this December where he worked at the Hôpital Albert Schweitzer Haiti in Deschapelles.

With each trip, he felt more professionally prepared than the one before; although, there are still personal challenges with the visible poverty, destitution and day-to-day realities of life for the average Haitian.

“More than any other trip, this trip I was immersed in Haiti,” Dr. Robson said of his recent visit. “The other trips I was immersed in western NGO international relief efforts. This trip had a distinctly different flavor. But no matter how much it overwhelms you emotionally or physically or professionally, it’s a very good thing to do. We have so much in Canada and they have so little. It’s important to give back.”

To read more about Dr. Robson’s experiences in Haiti and Nicaragua, visit his blog at www.helpnicaraguachildren.blogspot.ca/.


Are you ready for Haiti? Dr. Robson’s 5 instructions

The patients who arrive in the outpatient clinic often wait for hours to be seen but without any good reason. The child is there. The physicians are there. But the clinic nurse does not give the chart to a physician. I keep asking the interpreter to ask for a chart but I cannot seem to make this process speed up. There is an inherent slowness to the system. No one seems to be concerned. The patients wait in silence. I do not understand this. (Excerpt from Dr. Robson’s blog post: “So Many Absurd Situations,” December 23, 2015)

Dr. Robson has learned a lot from his trips to Haiti and Nicaragua. Here, he shares some of his top advice for other medical professionals interested in pursuing similar work.

  1. Leave your expectations at home: “If you go to one of these places you shouldn’t have any expectations that anybody’s going to help you or support you or that it’s even going to be remotely like Canada.”

  2. Hone your problem-solving skills: “You should be prepared to do things on your own and with your own initiative. Nothing will go right because they don’t do things the same way. You have to be prepared to problem solve every step of the way.”

  3. Be tolerant: “You should go with an open mind and a lot of patience and tolerance.”

  4. Brush up on your knowledge of local illnesses: “You should read about the illnesses that you’re more likely to see and refresh your knowledge.”

  5. Be prepared to nudge the system: “If you’re a complacent person – don’t go! If you don’t actually push the system, wherever you are in these places, nothing is going to happen.”

 

Top

Online refresher on distinguishing normal/abnormal heart murmurs

Online refresher on distinguishing normal/abnormal heart murmurs

“The program we created is useful not just for students but for practising physicians who want to go back and refresh their knowledge,” said John Finley, MD, FRCPC.

Dr. Finley is a staff cardiologist at the Adult Congenital Heart Clinic at the Halifax Infirmary. He is also a professor of Pediatrics at Dalhousie University and a member of Royal College Council.

For the past several years, he has been working to improve teaching and learning on how to distinguish between normal and abnormal heart murmurs. This is a core but challenging skill.


Committing sound to memory using computer game training

John Finley, MD,  FRCPC

John Finley, MD, FRCPC

Traditional teaching on detecting heart murmurs consists of teacher-led listening to patients’ hearts, but this method is limited by patient volume and variability. New technology provides a solution: recorded sounds that are accessible online in a digital format.

“The key in being able to interpret heart murmurs is to have a memory of what normal and abnormal hearts murmurs sound like,” explained Dr. Finley.

“To get that in your memory, you need to hear a new sound about 500 times. You also need to compare normal and abnormal repeatedly, which cannot be done with typical recordings of heart sounds.”

Using funds from a medical education grant, he and his team have developed a computer game that walks learners through a series of exercises where they listen to a random selection of heart murmurs. Users must correctly distinguish between the normal and abnormal heart murmurs to move onto the next level. At the end of the one-hour training, students will have listened to about 1200 normal and abnormal heart murmurs — above-and-beyond what is necessary for short-term memory retrieval.

The team has also developed a shorter 15-minute reinforcement test aimed at practising physicians who want to refresh their skills.

“The idea is to make it freely available to everyone who wants to use it.”


Is it time to retire the stethoscope?

The Washington Post published an article in early January on the future of stethoscopes (the same article also ran in the Guardian). While the stethoscope’s fate, in light of new technological advances, continues to be debated; there was agreement by proponents on both sides that there is an art to auscultation and that this skill risks declining over time.

“The appearance of this article in two top newspapers should emphasize how important it is for medical educators to reinforce the teaching of auscultation,” said Dr. Finley.

Read: Heart doctors are listening for clues to the future of their stethoscopes,” Lenny Bernstein, January 2, 2016, Washington Post



Study provides strong evidence-base for tool’s effectiveness

Dr. Finley’s program is backed up by a research study that tested the effectiveness of this tool with students in Halifax and in Perth, Australia.

The results showed that students who completed the course developed a high-level of accuracy in identifying normal and abnormal murmurs (over 90 per cent of the time). The study also validated the worth of doing the 15-minute reinforcement test every few months to hone their skills.

The course is currently in use in medical schools in Halifax, Edmonton, Perth and Melbourne, Australia.

All of the materials are available online at http://teachingheartauscultation.com under “Learning Programs” (Program 1).


Cardiologists – take your learning a step further

Cardiologists are called to decipher a broader range of heart murmurs. Dr. Finley developed a more involved learning series on abnormal heart murmurs related to congenital heart disease. These are packaged on the above website as case scenarios (Program 4). They include heart sounds with questions, answers and discussion about diagnosis and possible treatment options.

 

Top

MOC Tip of the Month

Shahid Ahmed, Region 2 CPD Educator

MOC Tip of the Month  -  Shahid Ahmed, Region 2 CPD Educator

Triple your conference learning this spring

“Will you be attending an accredited conference this spring? With a little bit of planning, you can multiply your conference learning by adding a personal learning project (PLP).

For example, attending an accredited conference is a group learning activity that will earn you one credit per hour. However, if you take that learning further and apply it toward a PLP, you can maximize your knowledge and increase the number of credits you can claim: one credit for each hour of the conference plus two credits for each hour spent on your PLP.

Here is my five-step process for turning your conference learnings into a PLP:

  1. Develop your question. Start by reviewing the learning objectives and description of the conference sessions you are interested in attending.

  2. Develop a learning plan. Read any pre-circulated material and other relevant resources.

  3. At the conference, learn with intent. Keep your question in mind as you attend the plenaries and group activities. I also recommend that you discuss your question informally with your colleagues as you network. Collegial discussions at breaks are wonderful opportunities to seek feedback and be inspired.

  4. After the conference, reflect and define your outcomes. Ask yourself if you learned enough at the conference to answer your question. If not, consider modifying your learning plan and exploring additional resources to complete your answer.

  5. Document your PLP in MAINPORT ePortfolio. I encourage you to document your PLP while it is still fresh in your mind. At the same time, you can check your MAINPORT ePortfolio Holding Area. If the conference administrators have uploaded your participation at the conference, all you need to do is complete the final step of recording your learning outcome to apply the credits to your account.”

For more information on how you can use personal learning projects to reflect your practice needs, contact your local CPD Educator.


Email Shahid Contact your local CPD Educator

Fellow readers, do you have a MOC tip that you would like to share with others? Contact communications@royalcollege.ca with your tip. If we use it, we will send you a free piece of merchandise from our Insignia collection.

 

Top

Helping to launch a national CME/CPD program in Qatar

Helping to launch a national CME/CPD program in Qatar

Jennifer Gordon, Mya Warken and Dr. Craig Campbell led the Royal College team.


The State of Qatar launched its new National Continuing Medical Education/ Continuing Professional Development (CME/CPD) program in early March. The Royal College has been working with the Supreme Council of Health in Qatar on this project for the past two years.

“In the success of this project, Qatar has strengthened its health care system by setting a high standard for educational support and lifelong learning by health practitioners”, said Royal College CEO, Andrew Padmos, MD, FRCPC, FACP, who was in Qatar for the celebratory presentation.

This new program is a great success for the country. It is a tangible step forward in their work to guarantee an outstanding medical workforce in Qatar, part of the Qatar National Vision 2030 and National Health Strategy goals.


In the news: About the new program


The Royal College’s international Continuing Professional Development Accreditation project team has been working closely with the Qatar Council for Healthcare Practitioners’ Accreditation Department. The new national program is a landmark in professionalizing CME/CPD in the country. All licensed health care practitioners in Qatar (about 25,000) will now be under one regulatory authority for their continuing education. They will be required to participate in this CME/CPD program for the renewal of their licensure.

 

Top

News bites – February 2016

News bites – February 2016

 

Available on this page:

 
 


Your new Royal College President-Elect is Dr. Françoise Chagnon

Françoise P. Chagnon, MDCM, FRCSC, officially started her appointment as Royal College President-Elect on February 18, 2016. Dr. Chagnon works in Montreal as an otolaryngologist and voice specialist. She is a longtime member of Council and is well-regarded for her leadership and management skills.

Get to know your new President-Elect:

“I want Royal College Fellows to understand and recognize the importance of Fellowship,” said Dr. Chagnon. “Our profession is evolving towards a competency-based model of medical education and continuous learning. … I want the Royal College to be a go-to place for professional guidance and mentorship….”


Top


Progress on Competence by Design

Our CEO released a new message on February 24. This month’s message focused on progress on the Competence by Design initiative. Find out what “big news” he shared, planned next steps and concrete outputs from this work to date.

Read "Here’s how Competence by Design is taking shape"


Top


Research Ethics 101: The Ethical Conduct of Research (video seminar)

Looking to refresh your knowledge on research ethics? Watch this video presentation by Charles Weijer, MD, FRCPC, Canadian Research Chair in Bioethics at Western University.

This introductory presentation focuses on the ethical principles that govern research and some of the moral roles that help inform those principles.

Don’t have an hour? The video is broken down into short, discrete, sections; watch it in full, or skip to the parts of interest to you. For more information contact researchunit@royalcollege.ca


Top


We want your know-how on global health ethics!

We’re looking to expand our online bioethics curriculum on ethical issues or concerns related to global health.

Interested in proposing a case? Curious, but want more information? Visit: http://www.royalcollege.ca/rcsite/bioethics/call-for-proposals-e

We’re specifically seeking cases that illustrate or address


Top


Now available: Preliminary program for the 2016 ASPIRE workshop

The preliminary program for the 2016 ASPIRE (Advancing Safety for Patients in Residency Education) workshop is now available online. Check it out and register today.

Participants at this spring’s workshop will create a curriculum proposal, with help from workshop faculty, related to patient safety, quality improvement and resource stewardship. Their work will also link to recent CanMEDS updates and Competence by Design.

When:        May 10-13, 2016
Where:       Royal College in Ottawa, Ont., Canada
Who:          Medical educators, physicians and residents
Register:    Register for ASPIRE by April 26, 2016.

For more information, visit www.royalcollege.ca/aspire or contact aspire@royalcollege.ca.


Top


2016 Residency Education Awards: Seeking nominations by April 1

If you know an outstanding medical educator or an innovative resident leader, don’t miss your chance to nominate him/her for one of our ICRE 2016’s Residency Education Awards!

The deadline for this year’s nominations is April 1, 2016.

We are seeking nominations in the following categories:

Visit the ICRE awards page to find out more.


Top


Social chatterFacebookTwitter


Top post (likes, comments, shares)

Top post (likes, comments, shares)


Top five tweets

Top five tweets


Top

 

Top

News from Council

News from Council

The Royal College Council held its winter meeting on February 18-19, 2016, at the Royal College in Ottawa, Ontario. Highlights from the meeting are being shared here with Fellows.


Conferral of four Honorary Fellowships

Council selected four distinguished individuals upon which to bestow Honorary Fellowship. In accordance with the regulations for the selection and admission of Honorary Fellows, the selected individuals are being contacted and will be invited to receive their Honorary Fellowship at an appropriate venue.


Structure field testing of Competence by Design

Council was reminded of the shift in the timeline for Cohort One disciplines implementing Competence by Design (CBD) – in response to feedback from our partners, we made the decision to slow down the full-scale launch of CBD for Cohort One disciplines – Medical Oncology and Otolaryngology– Head and Neck Surgery – originally scheduled for July 2016. Moving forward, CBD will adopt a more co-creative and iterative approach which will include field testing aspects of CBD with Cohort One throughout 2016. Council was also informed that the Royal College remains fully committed to CBD, and that ongoing preparation and implementation work continues with disciplines working to adopt CBD in 2017 and on. A presentation was delivered to Council to demonstrate at a more practical level how assessment will work within CBD, including its effect on the learner and faculty. Council underscored the importance of maintaining momentum, and discussed strategies to help ensure the program stays on target.


Action plan to address disruptive and harmful behavior in the learning and medical care environment

Council continued its discussion from last October on the issue of disruptive and harmful behavior, such as harassment and intimidation, in the learning and medical care environment. Council discussed the need to cultivate a culture where it is understood through all stages of a physician’s career that this type of behavior is not acceptable. It was recognized that collecting data, although needed, will not be sufficient. Council supported the development of an action plan that uses Royal College levers to help foster culture change, and reinvigorate views on professionalism and leadership.


Project to address learning needs related to medical aid in dying

Council was briefed on the project plan of the Ethics Committee to develop an educational strategy related to medical aid in dying. The project’s work will closely align with that of the Canadian Medical Association to support physicians in practice, and will aim to ensure residents can demonstrate competence in this emerging area. While the Federal Government has until May 2016 to determine if new legislation on assisted dying is required, patient requests for medical aid in dying are already being received. Council agreed with the project plan and encouraged the priority development of educational materials for residents that closely aligns with the work of the Canadian Medical Association, the College of Family Physicians of Canada and other key partners.


Approval of a new national standard for support of accredited CDP activities

Council approved a new national standard for support of accredited continuing professional development activities in Canada jointly developed by the Royal College, the College of Family Physicians of Canada and the Collège des médecins du Québec. The standard describes a set of ethical standards and expectations relating to sponsorship support that physician learning activities must meet in order to be accredited. It addresses previous concerns regarding private sector influence on accredited learning activities, and presents a single unified standard for specialty and family medicine. A two-year transition phase will provide organizations with time to align to the new standard that will be officially launched on January 1, 2018.


Budget approved for the new financial year

Council reviewed and approved the proposed 2016-2017 annual operating budget and capital asset budget. The approval of the budgets was contingent upon Fellows’ agreeing with the proposed Royal College annual membership fee of $880 for the April 1, 2016, to March 31, 2017, financial year. The proposed annual membership fee was approved at the Annual Meeting of the Members on February 18, 2016. The budgets will be implemented for April 1, 2016.

The next Royal College Council meeting will take place June 16-17, 2016, in Ottawa. Questions relating to Council activities can be directed to governance@royalcollege.ca

 

Top

Plan to attend ICRE 2016: New conference track on “Leadership Education”

Plan to attend ICRE 2016: New conference track on “Leadership Education”

Fostering leadership will be the focus of a new Learning Track at the annual International Conference on Residency Education (ICRE).

The “Leadership Education” track will address all aspects of leadership education, including

Visit www.royalcollege.ca/icre to learn more about ICRE 2016 that will be held September 29 – October 1, 2016, in Niagara Falls, Ont. Registration will open in April 2016.


Why leadership matters in medical education

A “Leadership Education” learning track aligns with the 2016 conference theme, Advancing Quality: Aligning Residency Education and Patient Care.

“If we think about heath care leadership from the lens of the patient, then it only makes sense that advancing quality of patient care will inherently require leadership education,” said track chair Ming-Ka Chan, MD, FRCPC, Royal College clinician educator and associate professor in the Department of Pediatrics and Child Health at the University of Manitoba.

“Ultimately, this is the health care work we do every day. Leadership education will only help us and our learners do this work better – it will benefit our patients, our practices and our systems.”

This track is also timely due to the increased dialogue in the medical education community around the newly-titled CanMEDS Role, “Leader” — changed from “Manager” as part of the CanMEDS 2015 refresh process (Read: CanMEDS 2015: From Manager to Leader).

“There is increasing recognition of the underlying importance in developing leadership competencies in ourselves and in our learners as a means to achieve this improvement in patient care and in our systems of care,” said Dr. Chan.


Other leadership-oriented forums at ICRE 2016

In addition to core programming, ICRE will host a number of other leadership-oriented forums in conjunction with the conference.

The full list of workshops, sessions and preconference programming taking place during ICRE 2016 will be available once registration opens this spring.

 

Top

Exclusive Q&A: SimSummit co-chairs explain why you should attend this year’s “extreme” event

Exclusive Q&A:  SimSummit co-chairs explain why you should attend this year’s “extreme” event

Noel O’Regan, MD, FRCPC, will always remember treating his first cardiac arrest patient – mostly, because he was terrified.

“I was by myself in rural Newfoundland with a paramedic who was more scared than I was,” he said. “I had never done chest compressions, defibrillated, given ACLS drugs, or intubated before that code. It was a scary way to start my anesthesiology career, but this story is not uncommon: it was often expected that PGY1s run the code teams with little or no experience.”

To prepare physicians and health care professionals for practice using simulation-based learning and training has long been the focus of the Royal College’s Simulation Summit. In 2016, the conference will explore this work in the context of extreme medical scenarios.

In this exclusive Q&A, summit co-chairs Dr. O’Regan and Adam Dubrowski, PhD, reveal their thoughts on the importance of simulation education to avoid situations like the one above and to support teamwork. These assistant professors at Memorial University also talk about extreme conditions and why you should register for the 2016 event.


What first sparked your interest and involvement in simulation education?

Dr. Dubrowski (AD): I obtained my PhD in Kinesiology from the University of Waterloo. After completing NSERC-funded postdoctoral work in the area of neuroscience, I joined the Wilson Centre for Research and Education in 2002 as a scientist and with an assistant professor appointment at the University of Toronto. In the early 2000s, simulation was just starting to become a field of scholarship. I felt that I had the right skillset as a methodologist, and understanding of theories as a scholar, that were a perfect match to what the field needed at the time.  

Dr. O’Regan (NO): I’m an anesthesiologist living in St. John’s, Newfoundland; a former Royal College Examiner for the Anesthesiology Exam Committee, and an assistant professor at the Memorial University of Newfoundland. My program academic chair convinced me to take a simulation instructors course in 2007 at Harvard University’s Center for Medical Simulation and it opened my eyes to the world of simulation-based medical education. After nine years of clinical practice, I was convinced to take a fulltime academic position in 2009 and start a simulation program for our residency program. The program became very successful. It expanded from occasional sessions to monthly scenarios based on core curriculum topics.


Noel O’Regan, MD, FRCPC   Adam Dubrowski, PhD

Noel O’Regan, MD, FRCPC

 

Adam Dubrowski, PhD


Why do you think simulation-based education is crucial in the training of health professionals in the 21st century?

AD: In addition to the ethical considerations that go along with not practising on live people, as a scholar, I believe that simulation-based education provides an opportunity to standardize teaching. These standards are rooted in theoretical models where application is tested rigorously at all levels – from pilot testing to implementation – resulting in a solid foundation upon which to build expertise though subsequent encounters with real patients.  

NO: After using simulation-based education for nine years, I have heard many anecdotal stories about how a simulation activity helped prepare learners for very difficult situations. As we continue into the 21st century, the ability to simulate high-risk clinical situations in a low-risk setting is invaluable. Simulation fills gaps in a resident’s clinical experience, provides a modality for competency assessment, and allows us to understand how we can educate medical professionals better.


The theme for the 2016 Simulation Summit is Extreme Sim – can you tell us a bit about the significance of this theme and why it was chosen?

AD: Simulation has many uses, from being an introductory-level educational tool for junior trainees to providing opportunities for seasoned health professionals to refresh their low-frequency, high-stakes encounters. Imagine being a rural doctor who is transporting a critically-ill pediatric patient to an urban hospital. Mid-way through the flight, the patient needs to be intubated — a skill that the doctor performed 10 years ago. With nowhere to land, a harsh climate with winds up to 150 km/h and -40 °C temperatures, omitted resources, environmental stressors such as noise and confined space… how safe is it? Newfoundland and Labrador is a rural and remote province. This scenario is very realistic.  

Extreme Sim may also have a slightly different meaning. Given the environmental extremes, and rural and remote nature of our health care system, we also need to ensure that technology meets our needs. Clearly, there is no room for a computerized mannequin being pulled behind a skidoo in a sleigh. To meet the same learning objectives, our simulators need to be different: sustainable and resilient to the extreme environment.  

NO: Newfoundland and Labrador has a number of unique challenges because of the extremes of our geography and climate. We have found that many of these challenges affect the delivery of education. Our medical school is very distributed across the province, so we have to think, ‘how can simulation be provided in remote locations?’ ‘With limited resources, how can we do more with less?’ Our patients seek medical attention as a result of our extreme environment and over extreme distances. Many centres and educators face similar challenges. It just made sense to examine the various ways we use simulation in extreme situations.


Do you think that simulation and training is best examined in an environment where attendees/speakers come together from across all health care disciplines?

AD: The ultimate goal of all professionals involved in health care is optimal patient outcomes. We know that interprofessional care results in improved outcomes. Because education forms one of the pillars of health care, it is important that it be interprofessional.  Simulation is a great way for all health professionals to come together and learn from, with and about each other in a safe environment.  

NO: The Simulation Summit is a conference to share ideas. Unlike other conferences, we have attendees from across the spectrum. Sharing different points of view really opens opportunities for enhancing your own learning; however, this is something we don’t often take advantage of. Despite the fact that we all work in teams, we rarely train in teams. An interprofessional conference promotes networking and cross pollination of ideas. It brings us all together to start the dialogue of how to train together.

Find out more about this year’s Simulation Summit in St. John’s, Newfoundland and Labrador, October 14-15, 2016: www.royalcollege.ca/simulationsummit

 

Top

Members in the news

Members in the news

 

Available on this page:

 
 


Advice, expertise and opinion

Scott Klarenbach, MD, FRCPC (Internal Medicine, Nephrology), David Armstrong, MBChB, FRCPC (Internal Medicine, Gastroenterology): Dr. Klarenbach and Dr. Armstrong were quoted in an article about new Canadian recommendations for colorectal cancer screening. Dr. Klarenbach is a professor and clinician scientist at the University of Alberta. He was part of the Canadian Task Force on Preventive Health Care that released these, and other, new guidelines. Dr. Armstrong is a gastroenterologist at McMaster University Medical Centre and president elect of the Canadian Association of Gastroenterology. Read more in the Winnipeg Free Press »

Molyn Leszcz, MD, FRCPC (Psychiatry) and Marshall Korenblum, MD, FRCPC (Psychiatry) and Lesley Wiesenfeld, MD, FRCPC (Psychiatry, Geriatric Psychiatry): Drs. Leszcz, Korenblum and Wiesenfeld recently contributed to a panel discussion on depression and suicide. Dr. Leszcz is psychiatrist-in-chief and Dr. Wiesenfeld is deputy psychiatrist-in-chief at Mount Sinai Hospital; Dr. Korenblum is psychiatrist-in-chief at Hincks-Dellcrest Centre for Children and Families. Read more in the Canadian Jewish News »

Lawrence Matrick, MD, FRCPC (Psychiatry): Advice from Dr. Matrick on what people should do following a motor vehicle accident was the focus of a CBC News article. Dr. Matrick, a psychiatrist who performs independent psychiatric evaluations for accident victims, recently wrote a book on the subjectRead more or link to the audio interview »

Abinav Sharma, MD, FRCPC (Internal Medicine, Cardiology): Dr. Sharma has recently started writing for the Huffington Post with a focus on the field of Cardiology. Dr. Sharma is completing a PhD through the University of Alberta and clinical-research fellowship through the Duke Clinical Research Institute in North Carolina. Read Dr. Sharma’s articles to date »


Top



Research, technology and innovation

Sébastien Hotte, MD, FRCPC (Internal Medicine, Medical Oncology): Dr. Hotte is one of the cancer researchers involved in promising new research to use immunotherapy to fight cancer. Dr. Hotte is a medical oncologist and associate professor in McMaster University’s Department of Oncology. Read more in the Toronto Star »

Arya Sharma, MD, FRCPC (Internal Medicine, Nephrology): Research by Dr. Sharma that claims modest weight gain is not excessively harmful was cited in a feature article on the rise in obesity — crisis or stage of evolution? Dr. Sharma is a professor and Chair in Obesity Research Management at the University of Alberta. Read more in the National Post »


Top



Profiles and achievement

Jack Jhamandas, MD, FRCPC (Neurology): Dr. Jhamandas was appointed vice president, Research, for the Association of Faculties of Medicine of Canada. Dr. Jhamandas is a neurologist and neuroscientist, with a strong research record. He is also a professor in the Division of Neurology, Department of Medicine, at the University of Alberta. Read about his new responsibilities »

Giuseppe (Joe) Pagliarello, MD, FRCSC (General Surgery): Dr. Pagliarello received a lifetime achievement award from the Trillium Gift of Life Network. The award honoured his contributions redefining Canada’s organ donation system and expanding the eligibility criteria for potential donors. Dr. Pagliarello is site chief of The Ottawa Hospital’s Civic Campus Intensive Care Unit and co-chair of the hospital’s Organ Donation Advisory Committee. Read more on CBC News and link to the audio interview »

Ernesto L. Schiffrin, MD, FRCPC (Internal Medicine): Dr. Schiffrin is the new editor-in-chief of the American Journal of Hypertension. Dr. Schiffrin is physician-in-chief at the Jewish General Hospital and a Tier 1 Canada Research Chair in Vascular and Hypertension Research at the Lady Davis Institute for Medical Research. He is also a professor and vice-director for Research in the Department of Medicine at McGill University.

Linda Snell, MD, FRCPC (Internal Medicine): Congratulations to Dr. Snell! She was named the 2016 winner of the Ian Hart Award for Distinguished Contribution to Medical Education. This award is given each year by the Canadian Association for Medical Education. It honours senior faculty who have had a positive impact on medical education through their academic careers. Dr. Snell is a professor of Medicine and core faculty at the Centre for Medical Education at McGill University. She is also a Royal College clinician educator who continues to make many valuable contributions to the organization. Read the news release »

Stanley Zlotkin, OC, MD, FRCPC (Pediatrics): Dr. Zlotkin was the focus of a feature article speaking about his work bringing mineral and vitamin supplements to children in the developing world. Dr. Zlotkin is a senior scientist and chief of the Centre for Global Child Health at the Hospital for Sick Children. Read more in the Canadian Jewish News »


Top


Suggestions for “Member in the news” can be emailed to communications@royalcollege.ca.

 

Top

In memoriam

In memoriam

J. G. Raymond Archambault, MD, FRCPC, died on January 7, 2016, in Ottawa, Ont., at age 82. Dr. Archambault was certified by the Royal College in Diagnostic Radiology in 1965. He worked as a radiologist at the Montfort Hospital in Ottawa for 30 years before his retirement. Read more about Dr. Archambault »

Carl Allison Bradley, MD, FRCPC, died on January 15, 2016, in Oakville, Ont., at age 59. Dr. Bradley was certified by the Royal College in Psychiatry (1986) and Child and Adolescent Psychiatry (2013). He died after a brave battle with cancer and will be remembered for his good humour, patience, kindness and devotion. Read more about Dr. Bradley »

Jacques Brière, MD, FRCSC, died on November 2, 2015, in Montreal, Que., at age 82. Dr. Brière was certified by the Royal College in General Surgery in 1962. He formerly worked at l’Hôpital Maisonneuve. He is remembered for his keen intelligence, analytical mind and respect for others. Read more about Dr. Brière »

Jules Charron, MD, FRCSC, died on December 7, 2015, in Montreal, Que., at age 86. Dr. Charron was certified by the Royal College in Urology in 1961. For 35 years, he worked at Notre-Dame Hospital. He was also a valued former member of the Royal College Urology Examination Committee (1967-1972, 1978-1984). Read more about Dr. Charron »

Jeffrey Francis Chung, MBBS, FRCSC, died on January 4, 2016, in Drumheller, Alta., at age 73. Dr. Chung was certified by the Royal College in Obstetrics and Gynecology in 1974. Born in Jamaica, he moved to Alberta and settled in Drumheller after his residency. He worked tirelessly until his retirement in 2012. Read more about Dr. Chung »

Maurice Charles Crocker, MBChB, FRCPC, died on January 10, 2016, in Winnipeg, Man., at age 84. Dr. Crocker was certified by the Royal College in Anesthesiology in 1971. He worked at the St. Boniface Hospital as an assistant professor at the University of Manitoba and as chief of Anaesthesia at the Victoria General Hospital until his retirement. Read more about Dr. Crocker »

Bernard Gauthier, MD, FRCSC, died on November 28, 2015, in Montreal, Que., at age 94. Dr. Gauthier was certified by the Royal College in Orthopedic Surgery in 1952, shortly after earning his medical degree at the Université de Montréal in 1947. Read more about Dr. Gauthier »

Gordon Robert Greenberg, MD, FRCPC, died on January 8, 2016, in Toronto, Ont., at age 69. Dr. Greenberg was certified by the Royal College in Internal Medicine and Gastroenterology in 1975. His research helped advance understanding and management of inflammatory bowel disease. Dr. Greenberg was also a professor of Medicine, Division of Gastroenterology, at Toronto General Hospital and, more recently, Mount Sinai Hospital. Read more about Dr. Greenberg »

Richard Laughlin Kidd, MD, FRCPC, died on January 14, 2016, in Boca Raton, FL, at age 77. Dr. Kidd was certified by the Royal College in Dermatology in 1968. He moved to Florida in 1974 to practice Dermatology and Pathology. There, he maintained a private practice, taught at the University of Miami Medical School and was on staff at Holy Cross, Imperial Point and Northridge hospitals. Read more about Dr. Kidd »

Katherine Marlene Maguire Manders, MD, FRCPC, died on January 29, 2016, in Halifax, N.S., at age 37. Dr. Maguire was certified by the Royal College in Psychiatry in 2013. Diagnosed with fascioscapulohumeral muscular dystrophy at age 12, she inspired many with her tenacity and determination. She was a staff psychiatrist at Dalhousie Student Health Services. Read more about Dr. Manders »

Thomas Reynolds Martin, MD, FRCSC, died on February 4, 2016, in Chilliwack, B.C., at age 81. Dr. Martin was certified by the Royal College in Obstetrics and Gynecology in 1968. Over his career, he practised in Halifax, Vancouver, Chilliwack and Pakistan. Dr. Martin was also a former and valued member of the Royal College Obstetrics and Gynecology Examination Committee (1974-1978, 1987-1988). Read more about Dr. Martin »

Gerald Millward McDougall, MD, FRCPC, died on December 31, 2015, in Calgary, Alta., at age 81. Dr. McDougall was certified by the Royal College in Psychiatry in 1965. He was a pioneer in the care of patients with mental illness in Alberta and a former director of Medical Education at the University of Calgary. A longtime and active volunteer of the Royal College, he sat on the Credentials Committee (1980-1996) and Clinician Investigator Program Implementation Committee (1993-1995), among others. He was also a member of Royal College Council for consecutive terms (1988-1996). Read more about Dr. McDougall »

James Desmond McDowell, MBChB, FRCPC, died on January 4, 2016, in Winnipeg, Man., at age 90. Dr. McDowell was certified by the Royal College in Internal Medicine in 1955. He came to Canada in 1954 and worked at The Winnipeg Clinic for the next 50 years. He also took on other roles, including chief of medicine at the Grace General Hospital and clinical director of its Intensive Care Unit. Read more about Dr. McDowell »

John Kirk McKenzie, MBChB, FRCPC, died on January 15, 2016, in Winnipeg, Man., at age 83. Dr. McKenzie was certified by the Royal College in Internal Medicine in 1989. He moved to Canada from New Zealand in 1969 and worked at the University of Manitoba and the Health Sciences Centre in Winnipeg. He is remembered for his integrity, hospitality, kindness and commitment. Read more about Dr. McKenzie »

Paul Ernest Perry, MD, FRCPC, died on January 14, 2016, in Fredericton, N.B., at age 80. Dr. Perry was certified by the Royal College in Psychiatry in 1965. He moved to Fredericton in 1976 where he was the first head of the Department of Psychiatry and Chief Psychiatrist at the Dr. Everett Chalmers Hospital. He was also a former president of the New Brunswick Psychiatric Association. Read more about Dr. Perry »

Karl Theodore Riese, MD, FRCSC, died on November 30, 2015, in Winnipeg, Man., at age 85. Dr. Riese was certified by the Royal College in General Surgery in 1958. He worked for many years in Winnipeg, including as a professor of Surgery and chief of Surgery (later, medical director) at St. Boniface General Hospital. Dr. Riese was also the founder and first president of the Canadian Surgical Oncology Society. Read more about Dr. Riese »

Kenneth R. Stewart, MD, FRCPC, died on February 4, 2016, in Pointe-Claire, Que., at age 89. Dr. Stewart was certified by the Royal College in Internal Medicine in 1959. He was the founder of CANADA INDIVISIBLE — a group that promoted Canadian values — as well as a dedicated and caring physician. Read more about Dr. Stewart »


Suggestions for “In memoriam” can be emailed to communications@royalcollege.ca.

 

Top