If you work in an acute care setting, you know how fast-paced and overwhelming it can be to treat patients in crisis. You also know the difference that a rapid and coordinated team response can have in helping to save patients’ lives.

Optimizing Crisis Resource Management to Improve Patient Safety and Team Performance is a new book that was developed by the Royal College with international experts in clinical and behavioural sciences. Its purpose is to help acute care professionals optimize their crisis resource management skills and those of their team.

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“Modern medicine and the inherent complexities of acute care require skilled individuals who are effective in a team. Our ability to work together can make the difference between a patient surviving or not,” says book co-editor Peter Brindley, MD, FRCPC, a critical care doctor at the University of Alberta Hospital and a professor of Critical Care Medicine, Anesthesiology and Medical Ethics. “Our goal in developing this book is to equip teams with a more sophisticated understanding and mastery of skills needed to manage a patient in crisis.”

Focusing on skills-development in six areas
Optimizing Crisis Resource Management includes theoretical and practical examples that will help health care providers hone their skills in

• situational awareness,
• decision-making,
• verbal communication,
• task management
• leadership and followership, and
• teamwork.

“Evidence increasingly shows that being able to effectively manage a crisis matters just as much as factual recall or manual dexterity,” says Pierre Cardinal, MD, FRCPC, book co-editor and a professor of Medicine at the University of Ottawa. Dr. Cardinal is also a senior clinical educator with the Royal College. “Rather than offering a one-size-fits-all approach, the book’s examples and insights will help users adopt and translate new behaviours that will build resilience, improve performance and patient safety.”

Its concise, easy-to-access format can be used in acute care settings around the world. The e-version is now available free of charge on the Royal College website. It can also be purchased in hard copy on Amazon.

Acknowledgements
Optimizing Crisis Resource Management was created by the Royal College’s Practice, Performance and Innovation unit. It is part of a bigger initiative focused on patient safety. We gratefully acknowledge the work of co-editors Dr. Brindley and Dr. Cardinal, the many content contributors, the Canadian Association of Critical Care Nurses and the Canadian Critical Care Society for their assistance in referring authors and peer-reviewers for this publication. Questions or comments: ppi@royalcollege.ca.

As a medical student and resident, you probably remember receiving lots of valuable coaching. But how many opportunities for mentorship do you have now?

I teamed up with four colleagues to study how we could get more coaching and mentorship opportunities throughout our practice. Since we work in different locations, we could not just directly observe each another. Instead, we set out to discover (in a pilot study being published soon):

1. whether peer-based video evaluation in practice would be feasible and;
2. whether it would be acceptable as a CPD activity (MOC Program Section 3 Assessment credits).

(Spoiler alert: it is!)

Here’s what we learned:

Video can give you a deeper appreciation of the way you practice.

It was not just about what we did and how, but also our body language, our approach and the extent to which we were actually addressing our patient’s concerns. From the way I arrange furniture, to where I seat my patient, to how I capture their information — I do all of these things differently now as a result of watching videos of myself in practice.

Feedback is all the more powerful when paired with replay.

We used software developed at the University of British Columbia that allowed us to annotate feedback at specific time stamps in the videos. We wrote free-text notes, such as “You did a great job here advising the patient there may be a problem with their lab test” or “You explained the patient’s exam findings here in a very helpful way.”

Sometimes the best feedback is constructive.

I learned, for example, that I spend too much time looking at screens and typing, which disengaged my patients. Now that I am aware of this tendency, I am trying to correct it and I have made changes to how I engage with patients as a result.

To be effective, you must have a “commitment to change”

After reflecting on the feedback we received, each of us completed a “commitment to change” form with three questions (which are very similar in spirit to the outcomes we are prompted to document in MAINPORT ePortfolio):

1. What information did you find useful from the feedback?
2. Did the feedback highlight any gaps in your current practice?
3. As a result of the feedback, what will you change in your current practice?

Be prepared - all of this evaluative work is very time intensive, but so worth it!

My colleagues and I have mentored each other throughout this process and we’re developing exemplary consultation skills as a result. Not only is video assessment a great way to claim MOC Program Section 3 Assessment credits, I promise you will be inspired to change your practice and improve the way you interact with patients.

Why not team up with one or more trusted colleagues and try it for yourself?

Read more about the original study by Dr. Kherani and his colleagues in their abstract from the 2017 Canadian Conference on Medical Education.

Dr. Raheem Kherani

Contributor: Roxanne Deevey, ABC

This past May I visited Santiago for the first time. I was there to attend the Latin American Conference on Residency Education, a regional spinoff of the Royal College’s popular International Conference on Residency Education (ICRE). This was the third edition of LACRE and the third time the college was co-hosting.

I was there to work with our local partners to better understand ways we can promote LACRE and our International Medical Education Leaders Forum in Chile and Canada. But most importantly, it was an opportunity for me to witness first-hand the impact of our Royal College volunteers at international activities such as conferences and workshops.

After a year and a half of working at the Royal College as director of Communications and Marketing, it was important for me to better understand why the Royal College extends its reach beyond Canada’s borders.

What I found was a conference that is a pillar for medical education in Latin America.

My highlights from LACRE 2017

• Making connections: Conference co-chair, Dr. Linda Snell, FRCPC, told delegates: “You should take three things back home from a conference: a new idea, a new project and a new friend.” With 403 delegates from 15 countries and a full program, you’d have to be actively avoiding people not to achieve that list. The excitement was palpable.
• Formalizing a bond: In the conference opening, Royal College Honorary Fellowship was conferred to the dean of the Pontificia Universidad Católica de Chile (PUCC), Luis Ibañez. I had the opportunity to meet Dr. Ibañez last year at ICRE and found him to be a humble and soft-spoken man who deserves the esteem he has earned from colleagues. He has contributed significantly to the field of bariatric surgery and has been instrumental in the PUCC Faculty of Medicine’s successful receipt of institutional accreditation by the Royal College. He is a great addition to our Fellowship.
• Getting on the same page: As a communications professional, I could appreciate the way McGill’s Yvonne Steinert, PhD, encouraged delegates to develop a common nomenclature for faculty development. She demonstrated that English, French, Spanish and even Dutch (her native tongue) have very different ways of describing professional development. In her view, we need to develop a common understanding in order to describe what we do in more accurate terms. Formal learning is crucial because “without reflection, learning from experience may not occur.” She went on to say that faculty development should lead to change not only in the individual, but also in the organization — an important ripple effect.
• Take the opportunity: Dr. Jeffrey Wiseman, FRCPC, conducted a variety of workshops at LACRE – often in partnership with colleagues from PUCC. In his workshop about improving clinical teaching skills, he showed a slide to illustrate a teachable moment. The image is now hard to forget. It was of a grizzly bear hanging over a waterfall, waiting to capture a salmon, as another observant bear is standing by. This was a metaphor to demonstrate how the opportune moment to coach someone on specific skills can come and go very quickly. A clinical educator shouldn’t wait for the perfect occasion to teach skills. Sometimes the “not so great patient case” is the best opportunity for teaching skills.

The final word: hungry for knowledge
Being a world away in Canada, it’s sometimes difficult to remember that our medical education system is quite advanced and something we should all feel ownership of and pride in. LACRE is a small – but impactful way – that some of our knowledge is being shared with colleagues in Latin America and hopefully having a powerful ripple effect.

Ultimately, what made LACRE stand out for me was the passion of the attendees and the volunteers who came together to share their experiences and ideas for ways to improve clinical practice and patient outcomes. In fact, when I asked Dr. Wiseman his perception of LACRE 2017, he described the delegates as “hungry for knowledge” and his experience as a Royal College volunteer at LACRE as “a breath of fresh air.”

On the plane ride home, I couldn’t help feeling that I’d witnessed something quite remarkable. I’m already reflecting on ways we can further support our Latin American colleagues.

Ms. Deevey has worked in communications for over 20 years, including a past life as a journalist. Since the fall of 2015, she has been director of Communications and Marketing at the Royal College. LACRE 2017 was held from May 24-26 in Santiago and organized by the PUCC, the Royal College and the Pan American Health Organization.

Contributor: Cheryl Barnabe, MD, FRCPC

Arthritis is the most common chronic condition affecting Indigenous Peoples in Canada.

Research by members of the Canadian Rheumatology Association has highlighted disparities in care access and outcomes for Indigenous patients with inflammatory arthritis conditions. Two solutions proposed by Indigenous patients to close these care gaps are to

1. deliver innovative patient-centered models of care with timely access to diagnosis and follow-up, and
2. ensure that the rheumatology workforce is prepared to provide culturally safe health care.

These solutions are a direct reflection of the Truth and Reconciliation Commission of Canada (TRC) Calls to Action in Health. In fact, recommendation #19 calls for closing gaps in health outcomes, #23 calls for cultural competency training for all health care professionals and #24 calls for skills-based training in intercultural competency and anti-racism pedagogy.

The Optimal Care Committee is leading the response strategy for the Canadian Rheumatology Association.

• In partnership with the Arthritis Alliance of Canada, the Canadian Rheumatology Association has developed several tools to facilitate the development, implementation and evaluation of inflammatory arthritis models of care.
• A community engagement framework for rheumatology teams is under development to assist with building respectful relationships with Indigenous communities and ensuring sustainability of the models of care.
• An initiative to provide postgraduate and continuing medical education in cultural competency was also launched. For example, at the association’s Annual Scientific Meeting in February 2017, members completed an online cultural competency course and participated in a skills-based workshop led by Dr. Lynden Crowshoe (MD, CCFP).

These educational opportunities have been well received and have triggered several rheumatology training programs (University of British Columbia, McMaster University) to require the completion of cultural competency training by their residents. Indigenous health sessions will also be delivered at the Basic Skills Week for incoming rheumatology residents and into the academic educational days for several other training programs (University of Calgary, University of Toronto). Next, the Optimal Care Committee is collaborating with the Education Committee, the Annual Scientific Meeting Committee and the ‘Educating for Equity’ program to develop advanced skill development modules that will be offered in 2018.

The response strategy aligns with the Royal College’s Indigenous Health Advisory Committee recommendations to foster understanding, dialogue, action and positive change in Indigenous health.

Guided by the “Indigenous health values and principles statement” and the “Proposed directions to move from ideology to action” (available at www.royalcollege.ca/rcsite/health-policy/initiatives/indigenous-health-e) the Canadian Rheumatology Association will continue to seek new collaborations and opportunities to redress health inequalities for Indigenous peoples across Canada.

Dr. Barnabe is an associate professor, Departments of Medicine and Community Health Sciences at the University of Calgary, and a rheumatologist with Alberta Health Services.

Apply for our Dr. Robert Maudsley Fellowship for Studies in Medical Education.

This one-year fellowship supports specialists seeking to acquire knowledge and skills in the field of medical education through formal graduate training.

• Learn more or apply for this grant »
• Deadline: September 13, 2017

Please direct particular questions to researchgrants@royalcollege.ca.

Call for Strategic Grant - Letters of Intent. Theme: Advancing Competency-based Medical Education across the Continuum.

We’re accepting applications for research to advance competency-based medical education in priority areas. Funding is to a maximum of $35,000 per project for a two-year period.

• Learn more or submit a letter of intent »
• Deadline: September 13, 2017

For more information contact strategicgrants@royalcollege.ca.

Contributor: Canadian Medical Protective Association

Physicians face many challenges in their first few years of practice.

To help new physicians prepare for and address areas of potential medical-legal difficulty, the Canadian Medical Protective Association (CMPA) has identified the following top risk areas for physicians in their first 5 years of practice.

Top risk areas

• Office management
• Patient communication
• Diagnostic error

Strategies to help address risk

• Focus on office management. For example, be familiar with the policies and procedures of your clinical workplace and ensure, to the degree possible, that they are consistent with your College’s policies.
• Communicate effectively with patients. For example, provide patients with appropriate follow-up and clear instructions (verbal and/or written), including symptoms and signs that should alert them to seek further medical attention and how urgently to do so.
• Conduct a thorough diagnostic assessment. For example, when necessary, ask a colleague for advice or review the literature for information on unfamiliar diagnoses, medications, devices and products.

For a full list of tips, read the CMPA’s June 2017 issue of Perspective.

Each year, we welcome some of the world’s top researchers and educators in health care training to present at our Simulation Summit.

• Read full speaker bios (or preview them below).
• Register for the 2017 Simulation Summit (early bird deadline is Sept. 15, 2017).

OPENING PLENARY

Dr. Rhona Flin

Her work examines human performance in high risk work settings, such as health care, aviation and the energy industries, with studies focusing on leadership, safety culture, team skills and cognitive skills…

SIMULATION AND INNOVATION PANEL

Dr. Robert Amyot

He cofounded VIMEDIX Virtual Medical Imaging Training Systems, which was acquired by CAE Healthcare. The CAE VIMEDIX ultrasound simulator is now used in leading medical centres around the world, including the Mayo Clinic…

Dr. Susanne Lajoie

She explores how theories of learning and affect can be used to guide the design of advanced technology rich learning environments in different domains, i.e. medicine, mathematics, history, etc.…

Dr. Jake Barralet

Professor of Surgery; vice chair Surgery (Research), Department of Surgery; director of Research, Division of Orthopaedics (McGill University). His interests include nanomedicine and 3D Printed Bioceramics.

SIMULATION AND HEALTH SYSTEMS PANEL

Dr. Fabrice Brunet

Among his accomplishments: the development of a Clinical Research Program in Critical Care and a Cardiac Surgery Centre in Paris, the design of a private hospital project in Saint Petersburg and the creation of an academic Critical Care Department in Toronto...

Dr. Gerald Fried

He established Minimally Invasive Surgery (MIS) as a clinical and academic program at McGill. McGill’s simulator-based program to teach and assess fundamental skills in MIS is now a requirement for certification in surgery by the American Board of Surgery….

Dr. Arvind Joshi

With 15 years of past experience as director general and CEO at St. Mary’s Hospital Center in Montreal, he is currently completing the mandate entrusted to him by the Minister of Health and Social Services: to look at the future of the McGill Health Network...

CLOSING PLENARY

Dr. Carlos Gomez-Garibello

As the assessment and evaluation academic lead of postgraduate medical education at McGill, he works with physicians, residents and other colleagues to enhance assessment practices across the university’s residency programs and fellowships…

Dr. Viren Naik

His career has focused on integrating simulation into CanMEDS for postgraduate education and continuing professional development. Among his successes, he established the University of Ottawa Skills and Simulation Centre and was its first medical director…

Dr. Randolph Steadman

The founding director of the UCLA Simulation Center, he is editor-in-chief of the American Society of Anesthesiologists Editorial Board on Simulation-Based Training, which evaluates simulation programs for ASA endorsement. Since 2008, it has endorsed 49 programs...

Connect with us:

Visit www.royalcollege.ca/simulationsummit for more conference details.

@RC_SimSummit | @doc4brains (Conference chair) | simsummit@royalcollege.ca

Arrive early in Quebec City and build your practical skills through ICRE’s pre-conference workshops:

- Half and full-day sessions

- From Tuesday, October 17 to Thursday, October 19, 2017

- Explore research writing, big data and leadership education

- Hands-on learning with time for skill-building, in-depth evaluation and discussion

View the full ICRE 2017 pre-conference schedule and program lineup, and register today!

Join the conversation:
@ICREConf | @CIFRConf | @drjfrank (Conference Chair) #ICRE2017

We announced our newest award winners. Together, they are doing some cool work to provide greater access, understanding and support for Indigenous students and patients. What’s more – you can read a personal impact story from a doctor (it involves bannock and if you look in the comments you may find a link to a recipe…) Read more.

Competence by Design launched on July 1 for new residents in Anesthesiology and Otolaryngology – Head and Neck Surgery. This is a big deal! How big a deal? Well, we rank it among the biggest changes in medical education history. Did you see the other moments we picked in our timeline? Check it out and maybe see CBD with new eyes... Read more.

We’re still accepting applications and nominations for a group of national awards and grants. The deadline is September 8. Do you qualify? Do you know someone who is a great fit that you should nominate? It’s easy enough to find out! Read more.

Are you interested in creating and implementing a patient safety and quality improvement curriculum plan? Look no further than ASPIRE. This four-day workshop has been called “one of the most valuable faculty development events in my career” by Dr. Adam Moir of NOSM. Get all the details. The next workshops are this fall. Read more.

Last month’s feature article on mindfulness got people buzzing. Can it really reduce stress and help you focus and sleep better? Read on and decide for yourself. Plus, Dr. Rachel Carson, FRCPC, wrote in and recommended some resources for West Coast Fellows that we’ve added to the end of the article. Read more.

“Much more health care is moving into the home,” - Rajesh Aggarwal, MBBS, FRCSC (“Fake apartment shows real results at McGill medical school,” CTV News - Montreal).

“Our worry is that because it is made legal, people may think it is not a problem,” - George Carson, MD, FRCSC (“'Just because it is legal doesn't mean it is good': Obstetricians worry about marijuana law,” Ottawa Citizen).

“When we talk to Indigenous communities in our area they tell us that their big struggle is to keep students engaged all the way through high school so they can go on to have the prerequisites to get into med school, or any other of the health professions,” - David Eidelman, MDCM, FRCPC (“McGill medical school to reach out to Indigenous, low-income students after missing diversity goals,” The Globe and Mail).

“Papers like this are really important to demonstrate the manner in which we as physicians are not doing our jobs well enough and not saving the use of antibiotics for the times when it's only needed," Daniel Flanders, MD, FRCPC (“Pink eye needs 'to run its course,' say ophthalmologists advising against antibiotics,” CBC News - Health).

“Dr. Andrew Furey [MD, FRCSC] has personally travelled to Haiti more than 20 times where together with Team Broken Earth volunteers has made significant contributions to improved healthcare capacity including education and training for local medical professionals,” - Rhonda Kenney (“Red Cross announces humanitarian awards for Newfoundland and Labrador,” The Telegram).

“It’s one of the most gratifying things you could ever imagine feeling, I think,” – Michael Kelly, MD, FRCSC (“Stroke research position renewed for Michael Kelly, 'one of the most important doctors in Canada',” Saskatoon Star Phoenix)

“Each of us can make a difference by starting a dialogue with the youth in our lives. Together we can begin to turn the tide on this crisis happening in our communities,” – Perry Kendall, MBBS, FRCPC (“B.C.’s top doctor urges parents to talk to kids about opioid overdoses,” Times Colonist).

“It’s unfortunate there are these vaccine myths out there but there’s more evidence by far for their safety than for everything else people are given in hospitals,” Shelly McNeil, MD, FRCPC (“METCALFE: Remedy for infection: Lyme disease and the case for vaccines,” Chronicle Herald).

"We are delighted with the CLL research and clinical work that Dr. [David] Spaner [MD, FRCPC] and Sunnybrook are undertaking to improve the quality of life for this largest group of blood cancer patients," - Shelagh Tippet-Fagyas (“Dr. Spaner at Sunnybrook Research Institute receives prestigious UFCW Canada Award for Leukemia Research,” CNW).

“With deep brain seizure activity like Sara’s, we need a SEEG procedure to tell us more because it allows us to reach areas of the brain that are off limits with less invasive forms of monitoring,” David Steven, MD, FRCSC (“London epilepsy patients first in Ontario to benefit from robot-assisted neurosurgery,” CTV News – London).

John Donald Anderson, MBChB, FRCPC, died on April 20, 2017, in Vancouver, B.C., at age 82. Dr. Anderson was certified by the Royal College in Medical Microbiology in 1981. Read more about Dr. Anderson.

Barry Bertram Caplan, MD, FRCSC, died on June 2, 2017, in Winnipeg, Man., at age 84. Dr. Caplan was certified by the Royal College in Urology in 1964. He is remembered as a fine surgeon and friendly man. Read more about Dr. Caplan.

Joseph Joachim Carroll, MDCM, FRCSC, died on April 9, 2017, in Hamilton, Ont., at age 91. Dr. Carroll was certified by the Royal College in General Surgery in 1958. From 1957-1996, he practised in Hamilton - principally at St. Joseph’s Hospital. He continued to assist with surgeries until he was 75. Read more about Dr. Carroll.

Eleanor Jeanne L. Deinum, MD, FRCPC, died on June 7, 2017, in London, Ont., at age 84. Dr. Deinum was certified by the Royal College in Psychiatry in 1960. She once worked at the London Psychiatric Hospital, serving as its medical director from 1978 to 1983. She also travelled extensively, visiting close to 260 countries. Read more about Dr. Deinum.

Mostafa M. Elhilali, OC, MBChB, FRCSC, died on April 29, 2017, in Florida, USA, at age 79. Dr. Elhilali was certified by the Royal College in Urology in 1969. An officer of the Order of Canada, he is credited with making the McGill Division of Urology one of the best, and for mentoring and training many specialists. Read more about Dr. Elhilali (plus, McGill Tribute).

David Herman Harder, MD, FRCSC, died on May 4, 2017, in Oyama, B.C., at age 84. Dr. Harder was certified by the Royal College in Orthopedic Surgery in 1969. He was deeply respected and admired by colleagues and patients, who remember him as an “inspiration,” and “fun-loving” and “magnificent surgeon.” Read more about Dr. Harder (in this creative, rhyming obituary).

Edward Richmond Harrigan, MDCM, FRCPC, died on May 21, 2017, in Toronto, Ont., at age 97. Dr. Harrigan was certified by the Royal College in Diagnostic Radiology and Therapeutic Radiology in 1950. For 26 years, he was head of the Radiology Department at St. Mary’s and Porcupine general hospitals in Timmins. He lived “a full life well lived,” pursuing various hobbies including welding and windsurfing. Read more about Dr. Harrigan.

H. James King, MD, FRCSC, died on May 1, 2017, in Thorndale, Ont., at age 76. Dr. King was certified by the Royal College in Obstetrics and Gynecology in 1972. For 37 years, he was a member of the Department of Obstetrics & Gynecology at the University of Western Ontario. He even originated the department’s Urodynamics unit. Read more about Dr. King.

James Donald Longley, MDCM, FRCPC, died on May 7, 2017, in Salt Spring Island, B.C., at age 89. Dr. Longley was certified by the Royal College in Diagnostic Radiology in 1959.

Surya Kumar Master, MBBS, FRCSC, died on June 1, 2017, in Campbelton, N.B., at age 88. Dr. Master was certified by the Royal College in General Surgery in 1974. He is remembered as a very kind and compassionate doctor whose name “will live on in the North Shore for generations.” Read more about Dr. Master.

George Hamilton Morrison, MD, FRCPC, died on June 1, 2017, in Thunder Bay, Ont., at age 90. Dr. Morrison was certified by the Royal College in Internal Medicine in 1958. Until 1995, he was a partner in the Fort William Clinic. He also served in various other roles, including as chief of staff at several hospitals and as President of the College of Physicians and Surgeons of Ontario from 1990-1991. Read more about Dr. Hamilton.

Peter Donald Newbigging, MD, FRCPC, died on June 5, 2017, in Toronto, Ont., at age 77. Dr. Newbigging was certified by the Royal College in Internal Medicine in 1969. For 38 years, he worked at the Etobicoke General Hospital - William Osler Health System. Read more about Dr. Newbigging.

René Pion, MD, FRCPC, died on March 15, 2017, in Quebec, Que., at age 90. Dr. Pion was certified by the Royal College in Psychiatry in 1957. He formerly worked at the Hôpital de l’Enfant-Jésus. He is remembered as a charming, kind, compassionate and generous doctor. Read more about Dr. Pion.

Navdeep Singh Gill, MD, FRCPC, died on March 6, 2017, in Irvine, CA, USA, at age 49. Dr. Gill was certified by the Royal College in General Pathology in 1999. He received his medical degree from the University of Alberta and completed a residency in Anatomic and Clinical Pathology at the University of Pennsylvania. At the time of his death, he was working as a pathologist in Irvine.

Harold Alfred Swanson, MD, FRCPC, died on May 6, 2017, in Calgary, Alta., at age 87. Dr. Swanson was certified by the Royal College in Diagnostic Radiology in 1959. A former president of the College of Physicians and Surgeons of Alberta (1981), he was also director of Diagnostic Imaging at the Calgary General Hospital for many years. Read more about Dr. Swanson.