Dr. Danielle Stachiw, FRCSC, has been practising generalist orthopedic surgery and maintaining her Royal College certification in Yellowknife, N.W.T., for three-and-a-half years. In this interview, she explains why she really wouldn’t trade living and learning in the North for anything.
What’s your scope of practice like in Yellowknife?
I’m one of two orthopedic surgeons in generalist practice at Stanton Territorial Hospital. We serve all of the Northwest Territories and a portion of Nunavut. In generalist practice, you treat anything and everything. I obtain a lot of my Maintenance of Certification (MOC) from conferences, online webinars and self-assessment exams, and learning different techniques and styles of practice from visiting locum surgeons.
What motivated you to work up North?
The job opportunity arose when one of the long-standing local surgeons retired. I came up for a site visit during my fellowship and fell in love with the community. I enjoy the diverse patient population. About half of my patients are First Nations, Inuvialuit (Inuit) or Métis. Many still live a traditional life in very remote communities. Yellowknife itself is also surprisingly diverse and there are many highly active outdoor enthusiasts. You drive 10 minutes and you can be alone on a lake, kayaking or cross-country skiing.
How did your MOC change when you came up North?
After completing my fellowship training, where MOC opportunities were comparatively plentiful, I came straight to Yellowknife. When I first got here, I thought, ‘How on earth am I going to get all my MOC credits?’ But we’re a bit spoiled here in Yellowknife in that we are afforded 10 days a year to attend conferences.
Online learning opportunities seem to increase yearly and I like to take advantage of these resources as much as possible. The Canadian Orthopaedic Association offers online webinars. I recently listened to the foot and ankle webinar, a portion of which focused on syndesmotic ankle injuries. It was very interesting to hear tips and tricks from experts on how to treat this common yet challenging injury. In addition, the online exams from the American Academy of Orthopaedic Surgeons (AAOS) are great. I previously used them to study for my Royal College exam; now I use them for my MOC. To stay current, I rely a lot on scanning activities. OrthoEvidence is an excellent resource that summarizes new research in my discipline and the strengths and weaknesses of various studies. I also read MOC Tip of the Month and use the Royal College’s website to find accredited activities in my discipline.
What have you learned in northern practice that has made you a better doctor?
I receive a lot of great feedback from the locum surgeons who come to work in Yellowknife, which I record as MOC Section 3 Practice Assessment credits. Working with other orthopedic surgeons creates an excellent learning opportunity.
A locum surgeon and I were once repairing a distal bicep tendon rupture using suture anchors. My technique to tie down the tendon was always finicky. He showed me a different way of running the sutures through the tendon, using a pulley system to bring it down into the wound. It was awesome. I was so appreciative. It’s such a specific example, but for me it was practice-changing. Often we train in one place where everyone tends to do the same thing, but working up North with locums who maybe trained in Ontario or out East gives me the opportunity to see how things can be done differently.
What’s your advice for others considering a transition to CPD in northern practice?
Transitioning to the North is intimidating at first. You’re not in an academic centre anymore. You don’t have access to rounds or subspecialized colleagues. The biggest challenge is keeping up-to-date with the literature and getting over the fear of generalist practice.
But now that I’m here, I really wouldn’t trade it for anything. I can’t see myself giving up certain surgeries or certain patient populations and their health challenges. Every day is different and I like that.
For example, one of my patients broke their leg and bent the rod they already had in their leg from a previous break. I had never seen this before and was intimidated by the task at hand. To prepare, I went online and found a review article and case reports which provided great information regarding the management options of this unusual injury.
Practising in the North, I encounter many unique patient cases like that. You go through residency thinking, ‘Oh, that’s super rare, I’ll never see it.’ But up here, you do! All this variety can be intimidating but I’ve grown to love it. The North is beautiful and an exceptional place to practise. Some of its allure is the remote location. However, despite this, I can still engage in professional development and remain up-to-date on current practices and trends.