COVID-19

Dr. Eberhard L. Renner
Dr. Eberhard L. Renner
Head – Department of Internal Medicine




COVID-19, the pandemic caused by the new Corona virus SARS COV-2, is holding us all firmly in its grip. Canada and, in particular, Manitoba seem only at the very beginning of the SARS COV-2 spread. SARS COV-2 affected first China, jumped then to Europe where it spread catastrophically in Italy, and more recently causes a health care crisis in the US, especially in some large US metropolitan areas.

We are bracing ourselves for the things to come. We are preparing for what we witnessed unfolding in other places around the globe. We were early with introducing social distancing measures, but it is too early to say whether we were early enough.

If not the spread of SARS COV-2, social distancing has slowed down or completely stopped daily life as we know it. Many outside the health care industry have lost or fear losing their jobs. Uncertainty is everywhere, causes angst, and triggers irrational behavior.

In the relentless stream of fast paced news it is difficult to discriminate information from misinformation. Rumors spread and we risk drowning in an ocean of unnecessary E-mails, memos, and bulletins that are already outdated when they are sent off.

How should we deal with this? Neither ignorance nor panic can be the answer. We need to stay calm, prepare rationally for the worst, but hope for the best. We all need to continue to do our work the best we can under the circumstances and continue to strive to deliver the highest quality of care to our patients.

We may see each other less in person and more virtually, but we are all in this together. If we stick (virtually) together, we will come out together (in person).

Some changes of how we do business, forced upon us by COVID-19, such as virtual clinic visits may have already been eye openers for how we can deliver care in a more patient friendly way. There is lots of opportunity to learn and preserve what has proven worthwhile for the time after COVID-19. And that time will come, the question is not whether, only when.  

Building Elite Academic Medical Teams…lessons from the NHL

Teams are fundamentally important in academic medicine, as they are in most other highly complex endeavors in today’s rapidly moving world. Although academic medical teams are often compared to each other, or to teams in other knowledge-based enterprises, a useful analogy is to compare these teams to professional sports teams. In Manitoba, we have witnessed the development and evolution of a highly competitive NHL franchise, the Winnipeg Jets. Many members of our academic medical community are avid hockey fans, and faithfully follow the Jets through their inevitable ups and downs, wins and losses, player development and retirements, etc. Everyone has an opinion on how to get them better. It is a fun, and potentially illuminating exercise to compare academic teams in our complex academic medical organization to a professional sports franchise such as the Jets.

Consider this: The Jets need to have strong offensive output that results in consistent goal scoring, while at the same time playing sound defense that prevents goals from being scored on them. The formula is a simple one…score more goals than are scored on your team, and you win the game, win more games than you lose, and you become one of the “elite” teams that are perennial contenders in a highly competitive league. Have all of this come together, along with a generous amount of luck, and you might occasionally win that coveted championship, the Stanley Cup. Even Gary Bettman would agree with this simple analysis!

One can think of an academic medical team’s offensive output in terms of research and scholarly productivity (papers, grants, highly visible presentations, etc.). These serve as the academic “goals”, and the recognized metrics by which academic units everywhere are measured. In terms of defense, the delivery of excellent and cost-effective clinical care in a highly complex tertiary setting is an apt analogy. Breakdowns and weaknesses in this area can be thought of in terms of the “goals against” category and is a widely accepted metric used by policy makers, and the public at large. Elite academic medical teams accomplish both without sacrificing one for the other. How do we develop and support such elite teams?

As with the Jets organization, our academic medical teams have veteran players, rookies, a farm system, and a management “front office”. Our veteran players are easily recognizable, and an occasional fortunate one is destined for the “hall of fame” in their careers. Most of these veterans focus their careers on either the offensive or defensive side of the game. Expecting a “50 goal scorers” who brings in a ton of CIHR funding and publishes in high impact journals to also “kill penalties” and “block shots” when the team is shorthanded will predictably impact on their ability to score goals (yes, I know superstars like the Jets’ captain Blake Wheeler do this on a regular basis, but he is the exception). Ultimately, given enough frustration, the academic snipers may even choose to move to another team that better recognizes what they do best. In contrast, veteran players who choose a defensively oriented career by upholding excellence in tertiary clinical care cannot be expected to also score the team’s academic “goals” on a regular basis. They too may ultimately choose to play on other teams with whom their role is better defined and their skill set is better utilized. A team that overemphasizes and rewards only the offensive or the defensive part of their game will never become an elite academic team and will perpetually need to fill in their respective gaps.

How are these gaps filled? The approach adopted by the Jets organization is to draft and develop. Such an approach for an academic institution like ours would be based on identifying and developing promising medical students, residents, and fellows to ultimately have a meaningful and well-defined role on the academic medical team. Early in their career development, their role on the team needs to be sufficiently well defined to allow them to focus, while having enough flexibility to develop other parts of their “game”. Mentorship from veteran players, be they primarily offensive or defensive players, is critical for their development. Their level of responsibility on the team increases incrementally at a pace that allows them to develop their niche on the team and contribute consistently. Some may be destined to become snipers but few, if any, can score 50 goals early in their careers (a handful of generational players such as Teemu Selanne have done this at the NHL level). Others will specialize in defensive play and, based on our analogy, become experts in complex clinical care. Occasionally, we may witness the development of a gifted “two way” player, but to expect this as the norm for of all of our rookies is a recipe for failure.

Alternatively, we can try and entice superstars from teams at other organizations…say the “Leafs” or the “Bruins”. Often these are snipers with a well demonstrated ability to consistently score goals…sustained grant funding, publications, and notoriety. The problem is…everyone wants them. In turn, as with NHL hockey players, they are “expensive”. Although this is not necessarily in the form of their own personal income, but in academia, expensive is about finite institutional resources, a “cap” of sorts. Almost invariably this type of recruitment will take away opportunities from our rookies who are struggling to find their identity and niche. This leaves our academic organization with tough choices…sacrifice developing a potential future superstar for a veteran sniper who can help the academic mission today and raise our institution’s “impact factor”.

Ultimately, a key characteristic of elite teams is their ability to consistently play as an integrated team and overcome adversity together. The team’s coaching and management structure has a lot to do with this. In our academic organization, this is Section Heads, Program Directors, Department Heads, Deans and Faculty, and senior hospital administrations. They all have a role to play in our academic medical teams becoming elite. For those of us who have worked in an academic medical organization for a long time, it would be stating the obvious to suggest that each of these “front office” components are typically working from a different “playbook”. If we are to develop and sustain elite academic medical teams within our organization, this will likely need to change in a fundamental way.

Go Jets go!

Guest Blog from

Hani El-Gabalawy MD FRCPC FCAHS                                                                                               Professor of Medicine and Immunology Endowed Rheumatology Research Chair University of Manitoba

On Learning Environment

Eberhard Renner, MD
Head – Department of Internal  Medicine

“Learning Environment” must be amongst the strongest candidates for the (academic) buzz word of the year. It has all the ingredients for becoming the winner: short, easy to remember – and ill defined. No wonder it is part of everybody’s vocabulary at appropriate and less appropriate occasions.

Don’t get me wrong, I do not believe that we shouldn’t pay attention to the circumstances in which our trainees are held accountable for improving their knowledge and skills, nor do I believe they shouldn’t be asked about their perception of these circumstances. That said, I find it interesting that trainees seem today to be the only ones that are asked for their opinion, and their perception is often taken as the most important, if not sole source of truth when it comes to so important things as program accreditation.

Also, have you ever heard somebody talk about the teaching environment? Have you ever been asked as a teacher how you perceive the circumstances you have to teach in? Has anybody ever attempted to put the two sides of the coin – learning and teaching environment – together into a more holistic view before jumping to conclusions? Who is making efforts to develop solid, evidence based instruments and metrics to gauge the circumstances in which learning and teaching can proceed in the most effective way?

Along the same line, how do we measure teaching quality? It cannot be that we simply rely on immediate trainee feedback which inherently risks reflecting simply a teacher’s popularity. I would respectfully submit that a teacher’s popularity is not necessarily congruent with the quality of his/her teaching. In particular not if the trainee is contemporaneously asked. If we look back, most of us will judge the value of certain learning experiences differently in retrospect than at the time we were in the midst of them. It is also highly unlikely that the number of words a teacher uses in a written feedback on a trainee’s performance multiplied by some fudge factor has anything to do with teaching quality, regardless of whether the resulting score is given with two decimal points suggesting an objectivity and accuracy that can hardly be there.

In academic research, peer review processes are well established and used since a long time to judge quality. When I was in high school the school principal used to sit from time to time as an unscheduled observer in our class to assess the teacher’s quality. This was admittedly a long time ago, and I am not sure whether it still happens today. But why are no such (or other) peer-review processes involved in measuring the quality of academic teaching activities?

Even more importantly perhaps, does anybody track whether and to what extent our trainees grow mid and long-term into the academic and/or community roles and positions they were meant to be trained for, and whether doing so they successfully serve the societal needs, i.e. whether our training programs produce down the road the desired end-products?

Granted, this is all more complex than simply asking for contemporaneous feedback by trainees and for their subjective perception of the “learning environment” (whatever that means). But it would likely yield a more meaningful measure of the quality of our teachers and training programs, i.e. would give us a more solid basis for actions aimed to improve the current state, a goal we should always aspire to!

Doctors Manitoba 2019 Awards

Our sincere congratulations are extended to Dr. Kenneth Kasper recipient of the Health or Safety Award, and Dr. Terry Colbourne recipient of the Resident of the Year Award. The awards were presented at the May 3, 2019 Doctors Manitoba Annual Awards Gala.


Health or Safety Promotion Award

For contribution toward improving and promoting the health or safety of Manitobas specifically or humanity generally.

Dr. Kenneth Kasper

“Dr. Ken Kasper’s efforts to streamline, standardize and improve access to quality HIV care in both the tertiary and primary care setting led to the establishment of the Manitoba HIV Program in 2007 and he has been the HIV Program Director ever since. The Manitoba HIV Program is a true partnership between primary and specialized care and established a centralized referral system to link patients to care quickly and has set standards and quality monitoring processes to ensure people living with HIV in Manitoba are receiving quality HIV care. Dr. Kasper has supported primary care providers at the HIV Program Community Site, Nine Circles, and he has worked to build partnerships with collaborating primary care providers throughout the Province.

Dr. Kasper travels to Churchill regularly to provide care in collaboration with local primary care practitioners. He has made countless trips to Brandon, Swan River and other communities in need to provide direct patient care and education which continues to build capacity and help patients receive care in their own communities. Dr. Kasper’s efforts have led to the establishment of a satellite site of the Manitoba HIV program in Brandon in 2016 and continues to create strong primary care partnerships throughout Manitoba. Since 2011, Dr. Kasper was also the Inaugural ID specialist to develop a relationship with Manitoba’s Stony Mountain federal penitentiary where he spends time now in a developed clinic on site, treating HIV and other Infectious diseases twice per month.

In addition to providing direct clinical care, he has been a strong advocate for patients living with HIV and has been a consultant to the primary care practitioners who provide HIV care in the community at Nine Circles Community Health Centre.Dr. Kasper is an assistant professor in the Department of Internal Medicine at the University of Manitoba and an infectious disease specialist working at Winnipeg’s Health Sciences Center hospital and Nine Circles Community Clinic. He is also the director of the Winnipeg Regional Health Authority HIV Program and the Manitoba HIV Program. His research interests include both medical education with a focus on HIV and an HIV Industry based research program where Manitobans get the opportunity to try the latest HIV medications in phase 3 trials. Dr. Kasper has been a member of the Faculty of Medicine at the University of Manitoba since 1999. He maintains a busy clinical practice in Internal Medicine/Infectious Diseases with his focused HIV care in both the inpatient/ outpatient department at Health Sciences Centre.”

Source: Doctors Manitoba 2019 Annual Awards Program

Resident of the Year

For excellence in academic and clinical training and noteworthy contributions to the resident’s home program/specialty or residency program.

Dr. Terry Colbourne

“Dr. Terry Colbourne always has a fresh and unique viewpoint on multiple different issues regarding resident training and practice. Nationally, he is a leader in advocating for resident privacy and resident input into the accreditation process. He has played an integral role in the development of national principles regarding resident data collection, accreditation and competency based medical education (CBME). These principles serve as the voice for Canadian residents and are used by various policy makers. He has represented the interest of Canadian residents at many tables including sitting on the CaRMS Board and several Royal College Committees. He has also participated in multiple accreditation site visits as a resident surveyor, most recently at the Dalhousie University accreditation in November 2018.

Dr. Colbourne has been actively involved with the Resident Doctors of Canada Board (RDoC) throughout his entire residency. He served a term as Vice President for the organization, on the Board of Directors and as a member and co-chair of their Training Committee for multiple years. He is currently serving as the Training Committee co-chair.

Dr. Terry Colbourne is a final year resident in Respiratory Medicine at the University of Manitoba, having completed his core internal medicine training at the same institution. In addition to his work provincially and nationally, Dr. Colbourne is an excellent respirology fellow. He was selected and served as chief resident for both the internal medicine and respirology programs in his senior years, and has always been regarded as one of the hardest working residents.”

Source: Doctors Manitoba 2019 Annual Awards Gala Program

Dr Jean Eric Ghia Recipient of Outreach Award

Drs Jean Eric Ghia and David T. Barnard holding award
Drs Jean Eric Ghia and David T. Barnard

Congratulations are extended to Dr. Jean-Eric Ghia who  received a University of Manitoba Outreach Award at a special reception on  November 13, 2017.

In addition to his successful research activities at the University of Manitoba with the Department of Internal Medicine – Section of Gastroenterology, and the Department of Immunology, Dr. Jean Eric Ghia has been involved in  scientific community outreach with Crohn’s and Colitis Canada (Seven Oaks Wellness Center, Reh-fit). In addition, he has become a media personality and regular contributor on CBC’s Radio Canada with a biweekly radio spot promoting researchers and their research conducted at the University, and a monthly French TV spot presenting research done in Western Canada in a segment called   “Qu’est-ce qu’on cherche?”

As noted by Dr. Charles Bernstein, clinician-scientist, Section of Gastroenterology, Jean Eric Ghia is a wonderful example of success when clinical and basic science departments collaborate. Since his appointment at the University of Manitoba, Dr. Ghia’s research investigations and collaborations, grant success, publication record, teaching, mentoring, and service activities have been outstanding. He has been extremely successful in bridging basic science to future clinicians.

As reported in the linked article below “Dr. Ghia has mastered the art of presenting the rigours of science in an easily understandable and entertaining format on various media platforms.”

See link to the university related to the outreach award below

http://news.umanitoba.ca/sharing-their-passion/

Congratulations to Dr. Ghia on this well-deserved recognition.

Dr. J. Bellas Recipient of National Educator Award

Dr. Jonathon Bellas, Section of General Internal Medicine, received the 2017 PA Educator Award               at the Canadian Association of Physician Assistants (CAPA) President’s Gala on October 28, 2017 in Ottawa.

This national award honours an individual who has made a significant impact on the education of Physician Assistants in Canada in both the clinical and academic components of the program and in the advancement of PA education in Canada.

Dr. Bellas is the Medical Director of the Master of Physician Assistant Studies (MPAS) Program at the University of Manitoba.

On behalf of Dr. E. Renner, Dr. N. Hajidiacos and the Department of Internal Medicine we extend our congratulations to Dr. Bellas  on receipt of the 2017 PA Educator Award.

http://news.umanitoba.ca/professor-recognized-as-outstanding-pa-educator/