More Food for Thought

Dr. Eberhard Renner
Head – Department of Internal Medicine

Medical training is a somewhat funny hybrid: part studying biomedical sciences, part practical learning through an apprenticeship. The former requires books, lectures, small group session and the like, the latter gaining practical experience by doing things, and being allowed – within reason – to make mistakes. A pianist will not achieve mastery just by studying the notes; knowing the latest facts from reading publications maybe necessary, but is not sufficient to become an expert physician.

It goes without saying, that it is stressful having to play a piano concerto without being confident to get comfortably through the most difficult passages; it is stressful to practice medicine without being confident to apply comfortably one’s knowledge in a difficult situation. And only if there is this technical mastery the pianist can focus on interpretation, the physician on the interaction with the individual patient (and family) in front of him/her.

On the other hand, once one has technically mastered it, playing the same tune over and over again will at some point become boring routine and negatively impact the quality of the pianist’s interpretation. Boring routine after serving in the same role for many years, may similarly impact, at least potentially, the quality of a physician’s interaction with his/her patients, families, trainees, colleagues, and/or other health care professionals. 

Training of pattern recognition and of decision making reflexes requires physician learners to be exposed to a sufficient volume of clinical situations. While what represents a sufficient volume may vary a bit between individuals, the learning curve is a well-established phenomenon, not only in interventional disciplines, and depends on case volume. Simulation may help cutting the required case volume down, but cannot fully replace real life experience and does not readily pertain to all aspects/areas of medicine.

The total duration of our residency training has not changed in decades. However, the exposure time to clinical case volumes has steadily decreased due to introduction of things such as regulations (i.e. shortening) of trainee working hours incl. compensation for on call time, and mandatory formal teaching activities such as academic half days. The implementation of CBD will, at best, not aggravate this further – although the jury is still out.

I am not arguing to turn the wheel back to the times when interns spent every second night in-house on call and worked 48 (or more) straight hours through. I have also no illusion that anybody would want to pay for prolonging training to make up for the lost clinical exposure time.

That said, maybe we should simply accept that after residency training (and even after a fellowship), additional supervised – albeit perhaps more loosely – exposure time is required to gain the experience necessary to comfortably function as an independent consultant or attending who is competent in all aspects of one’s specialty? Maybe we should start discussing models in which the clinical roles of junior and more senior faculty are no longer the same, but rather distinct, the more senior faculty member serving as a clinical mentor for a few junior ones. In such a model, the more senior faculty member would no longer be the primary attending on a ward, but rather serve as resource for and round once or twice weekly with junior attendings on their wards. Maybe this would not only help easing junior faculty into their new position, but also make it more interesting again for the more senior ones, who would take on a new challenge after routine starts to sink in and burn-out lures around the corner? Such models exist elsewhere; their feasibility in our funding model may be worth exploring – some food for thought.     

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/