On Professionalism and Creativity

Professionalism is an “in” word these days. It stands for more than political correctness. When googling it, one can find “professionalism  is the skill, good judgment, and polite behavior that is expected from a person who is trained to do a job well”.  Alistair Cooke (1908-2004), who was a well-known British-American journalist, television personality and broadcaster, is quoted as having said ”a  professional is someone who can deliver his/her best work when he doesn’t feel like it”. The latter, of course, is hard, but, I guess it is what separates the wheat from the  chaff.

Creativity on the other hand can be defined as “the ability to transcend traditional ideas, rules, patterns, relationships, or the like, and to create meaningful new ideas, forms, methods, interpretations.”  Creativity is the basis of every innovation and as such is indispensable for sustaining the success of any business in an ever changing environment. This holds particularly true for our Department’s situation in the middle of the ongoing health care reform in our Province.

Creativity is easily mistaken to mean disorganized spontaneity with little or no accountability, and to be incompatible with professionalism which stands for predictability and trust. However, creativity and professionalism, as defined above, do not only go well hand in hand, but, are, in fact, mutually complementing each other. A creative professional finds new solutions to challenges, brings them respectfully forward and acts in a way that always has the greater good in mind. This does not mean having to enter a popularity contest or having to abandon (constructive) criticism, but to be mindful of one’s own (unconscious) biases and always respect a dissenting counterpart.

The best solutions are not owned by a single individual/party, but created through respectful argumentation between engaged – albeit initially dissenting – professionals.  Engagement is key here, our Department needs yours!

Dr Richard Warrington Honoured by Royal College

  • Dr. Richard  Warrington was recently honoured for his  long and continued service to the Royal College. Without volunteers like Richard Warrington – the Royal College could not fulfill their mandate.

When asked about a time while volunteering for the Royal College when he felt that his contribution had made a tangible impact Dr Warrington recalled that “During an oral examination, a candidate became ill. There were apparently no regulations as to what to do, so we sent the candidate to Emergency to be assessed. When the candidate was considered recovered by the ER physician, with the candidate’s permission, we continued the examination successfully.”    He stated that it is important to the College, to the medical profession, to the trainees and to the public  to give back to the medical profession through  work with the Royal College.

Thank you Dr. Warrington for your over 30 years of dedication and service to the Royal College.

 

GRANTS

Project:  “Integrating clinical data systems to improve the capacity, performance, & value of Manitoba’s healthcare system”

Nominated Principal Applicant: Ryan Zarychanski

Principal Applicants: Marshall Pitz, Alan Katz, Josée Lavoie, James Bolton, Lisa Lix, Terry Klassen

Principal Knowledge Users:

Clinicians: Piotr Czaykowski, Alex Singer, Jitender Sareen, Thomas Mutter

Decision-Makers: Deborah Malazdrewicz, Jeanette Edwards

Collaborators: Dan Skwarchuk, Brock Wright, Sri Navaratnam, Frank Krupka

Funding Source: Canadian Institute of Health Research (CIHR); Operating Grant: SPOR iCT Rewarding Success, Idea Brief

Funds Awarded: $100,000 Duration:  1 Year

 

TRAINEE GRANTS!

Project:  Reducing transfusion whilepreserving Canada’s blood supply: The use and effectiveness of tranexamic acid in     major non-cardiac surgical procedures at high-risk of bleeding

Principal Investigator: Brett Houston (PhD candidate)

Co Applicants from the Department of Internal Medicine: Ryan Zarychanski (Supervisor), Allan Garland

Funding Source: Manitoba Medical Services Foundation (MMSF)

Funds Awarded: $29,613 Duration:  1 Year

 

Project:  Intravenous immune globulin in septic shock: A Canadian national survey

Primary investigators: Murdoch Leeies (MSc Candidate), Ryan Zarychanski (Supervisor), Faisal Siddiqui

Co-applicants from the Department of Internal Medicine: Anand Kumar, Allan Garland, Bojan Paunovic, John Embil

Funding Source:   Anesthesia Oversight Committee Operating Grant. Winnipeg Manitoba.

Funds awarded: $10,000 Duration: 2 years

 

 

GRANTS

Project : Effect of an Exercise Rehabilitation Program on Symptom Burden in Hemodialysis: a Randomized Controlled Study

Principal Investigator:  Clara Bohm

Co-investigators: Todd Duhamel, Mauro Verrelli, Claudio Rigatto, James Zacharias, Jenniefer MacRae (University of Calgary),  Navdeep Tangri

Grant Funding Source: Kidney Foundation of Canada 2018 Biomedical Grant Competiti

Amount: $99,973.                 Time period:  2 years July 2018-June 2020

 

Project:  “Workplace Diesel Exhaust Exposure: Defining a Biosignature to Support Prevention”

Co-Principal Applicants: Neeloffer Mookherjee, Section of Proteomics and Systems Biology – University of Manitoba, and Chris Carlsten, University of British Columbia.

Funding Source:  Research and Workplace Innovation Program (RWIP), Workers Compensation Board Manitoba

Funds Awarded:  $198,400 Duration:  2018 – 2020.

 

2018 MMSA TEACHING AWARDS

At the 2018 Max Rady College of Medicine Teacher Recognition and Manitoba Medical  Students Association (MMSA) Awards Dinner,  the following Internal Medicine faculty   members, were  recipients of the following teaching awards:

 Med 1

Innovation Award:  Dr. Clarence Khoo (Section of Cardiology)

Med II

Innovation Award:  Dr. Donald Houston (Section of Hematology/Oncology)

Best Med 2 Teaching in Small Group:  Dr. Pam Katz (Section of Endocrinology)

Best Med 2 Course:  Urinary Tract 2 (Dr. Keevin Bernstein – Section of Nephrology)

Med III

Med 3 Award for Attending Professionalism:  Dr. Jillian Horton

Med 3 Award for Attending Clinical Teaching:  Dr. Michael Semus

Med 3 Award for Attending Mentorship:  Dr. Aditya Sharma

Drs. Horton, Semus and Sharma – Section of General Internal Medicine

Congratulations!

 

On Survival and Responding to Change

I recently stumbled across the following sentence: It is not the strongest of the species that survive, nor the most intelligent, but the one most responsive to change.” The line is attributed to Charles Darwin and struck me as pertaining to our current situation as busy providers in a health care system which seems to change at (too) many levels simultaneously and at a pace that makes one wonder whether there is still a system – if there ever was one in the first place.

Working hard as a provider caring for patients in the middle of all these changes makes one feel powerless, generates anger and frustration which, in turn, carry the danger of leading to apathy and disengagement, potentially ending in burn-out. There are at least two other options: to leave or to speak up. While leaving for greener pastures, if there are any, may be a solution for an individual, it does not help those who cannot afford to quit for whatever reason and have to stay behind. The latter and the system as a whole need those who speak up; not for their own self-interests, but in order to improve the greater good and make our (health care) world a better place. This requires not only resilience and courage, but also the willingness to take on responsibility, and the ability to choose the right moment for the right message targeted at the right audience, i.e. patience paired with persistence; not an easy task.

And then – and that’s where Darwin comes into play – we, as individuals, need to be willing to make an effort and adapt to an ever changing environment. Not just trying to find the hair in the soup, but tasting the flavor; not just getting stuck with pointing out the problems, but finding solutions; not always comparing with the past, but creating the future. This needs optimism, looking at the glass half full, always attempting to find ways to fill it up even higher. It also requires to listen and observe before judging, to swallow and reflect before talking, and to stay humble, always keeping the greater good in mind.  If we accomplish this, we will not only make our health care world a better working place, but also survive into the future to provide the best possible care to our patients.

Let’s do it, together we can!

Nick Anthonisen Award of Excellence

 

The Nick Anthonisen Award of Excellence was created in 2015 thanks to a very generous sponsorship from Astra Zeneca.

This is one of five awards that Astra Zeneca funds across Western Canada with the goal of creating a network among Respirologists in Western Canada.

The award consists of a plaque as well as a one thousand dollar monetary award to be used towards an academic pursuit of the recipient.

Dr. M. Ainslie, Dr. N. Porhownik

Each year a member of the adult respiratory division who contributes significantly to the academic mission of the division is selected by the selection committee. This year the selection committee has chosen a member who contributes to the adult respiratory division’s educational mandate and is the current Program Director – Dr. Nancy Porhownik.

Dr. Porhownik has a busy clinical load with areas of expertise in sleep medicine, cystic fibrosis, and lung transplant.  She is currently the Medical Director of the Lung Transplant Program, and under her guidance our program has become affiliated with the Edmonton Transplant program. This affiliation has resulted in a significant increase in lung transplant recipients in Manitoba. She is the current Program Director and is currently overseeing and guiding the program towards implementation of CBD – which will be the biggest change in post grad education since the introduction of CANmeds. Thanks to Nancy’s leadership the program will be able to smoothly introduce CBD.

Nancy Porhownik works tirelessly for her trainees and for the program and is a role model not only with respect to clinical care, but also to her work/ life balance.

Please join us in congratulating Nancy Porhownik on being this year’s recipient of the Nick Anthonisen Award of Excellence.

Interventional Cardiology Fellowship

We are delighted to announce that the Section of Cardiology’s application for AFC (Area of Focused Competency) for accreditation for the Interventional Cardiology fellowship has been successful and has been approved and accredited by the RCPSC. This will help the Section of Cardiology attract strong future candidates and validates the strength of  the training program.

Clinical Fellowships allow trainees to obtain further skills and knowledge in various subspecialties. Traditionally there has been no accreditation for this training. In recent years, the Royal College started the AFC (area of focused competency) diploma program to allow training programs in recognized disciplines to become accredited and allow trainees to obtain Royal College diplomas.

We would also like to emphasize that this is the first accredited and approved AFC program in the PGME department at the Max Rady          College of Medicine at the University of Manitoba!


Congratulations are extended to  Dr. Basem Elbarouni, Program Director for Interventional Cardiology, who was the lead for the AFC submission.

CIHR Grant Awarded to N. Mookherjee, PhD

Project Title:   Innate Defence Regulator (IDR) peptides: Regulatory Mechanisms in the Control of Asthma”

Term: 5 years              Approved total funding amount:   $661,725.

Principal Investigator (PI): 

Neeloffer Mookherjee PhD,  Section of Proteomics & Systems Biology

    Abstract:   Asthma is the most common chronic respiratory disease, characterized by inflammation in the lungs and narrowing of the airways, which makes it difficult to breathe. Nearly 3 million Canadians suffer from asthma. The direct and indirect cost related to asthma in Canada is around $2.2 billion annually. Nearly 10% of patients do not respond to available steroid therapies and have severe uncontrolled asthma. These patients represent the major burden of asthma and associated healthcare costs. Moreover, commonly used steroid therapies can increase the risk of lung infections, which results in worsening of asthma. Therefore, there is an urgent need to develop new therapies that can control asthma, without compromising a patient’s ability to resolve infections. Dr. Mookherjee’s study focuses on new molecules known as innate defence regulator (IDR) peptides, which are designed from natural molecules that play a critical role in the immune response. IDR peptides can control both inflammation and infection in the lung, with the potential to overcome side effects associated with current therapies. We have shown that IDR peptides improve breathing capacity in an animal model of asthma, and can control cellular processes linked to steroid unresponsiveness. This project is aimed at the development of IDR peptides as a new therapy for asthma. This project will identify the changes that occur in lung cells after they are treated with IDR peptides. We will also study the biological effects of IDR peptides in the control of lung inflammation and fibrosis, in a mouse model of asthma. The results from these studies will allow us to identify new drug targets with the potential to alleviate unresponsiveness to steroid therapies, a condition for which there is currently no effective treatment. This project will directly support the development of a new IDR peptide-based therapy for asthma, which will have the added benefit of countering steroid-refractory asthma and controlling lung infections

    Congratulations Dr. Mookerjee!

     

    CBD – The Good, the Bad, and the Ugly

    Educating and training the next generation of physicians – for academia and community – is likely the most noble obligation of any academic physician. During the past decades medical education has emancipated itself from an apprenticeship type of supervised learning-by-doing and emulating-a-role-model (that was supposed to be the professor) to a pedagogical enterprise of its own. This comes of course with its inherent ups and downs, twists and fashions, the perception of which depend among others on one’s own past learning experiences.

    I started medical training at a time when the “master” (the professor) decided based on his (almost never her) perception of the trainee’s performance in an oral/practical exam whether and when the trainee was competent. Soon after I had started, this was discredited as entirely subjective (which it was) and everything shifted towards written multiple choice type exams with identical questions to be answered by trainees, such as myself, at the same time around the entire system, and graded according to objective statistical criteria. While this may be able to somewhat objectively assess knowledge, skills, both professional and interpersonal, can hardly be assessed that way – and these skills are at least as important for a physician caring for patients as the knowledge about diseases. The OSCE type standardized practical exams were therefore added in an attempt to more objectively assess knowledge and skills in a simulated practical clinical situation. But actors are not patients and OSCEs remain a somewhat artificial onetime event distant from a physician’s daily practice setting. Today, we have come almost full circle with a worldwide movement towards so called competency based education or Competency by Design (CBD) to use the Royal College’s branding term.

    What is CBD and what does it aim for? Well, the ultimate goal of CBD, as that of any serious medical education, is to train physicians that are competent in delivering the services they are expected to deliver in their practice, i.e. have all the knowledge, professional, and interpersonal skills required to perform all the tasks they are expected to serve the public with. That’s the Good, hard to disagree on this one, isn’t it?

    In what does CBD then differ from the current and past educational paradigms? Well, current and past paradigms are largely based on time spent in specific courses/rotations; but there are faster and slower learners. Current/previous systems offer limited opportunity to further the faster learners beyond what has been established as the minimal standard learning aims and to help the slower ones achieving the required goals in time. Competency based education in its pure form, defines broad tasks that a professional needs to be able to independently master in order to competently provide the service he/she is expected to provide in his/her future practice (so called entrustable professional activities or EPAs); these are composed of several smaller building blocks (or milestones). Once a trainee has demonstrated in several (directly to indirectly) observed instances to be competent in an EPA, he/she moves on to the next one, irrespective of the time required to reach the competency level. Of course, this completely time independent, pure competency based education paradigm makes scheduling difficult and may create conflicts with service needs – and that’s the Bad.

    The Royal College’s brand of competency based education, CBD, takes this into account and effectively is a hybrid which adopts the principles of competency based education, i.e. milestones and EPAs, but maintains the PGY time structure. Groups of EPAs are arranged in sequence starting with introduction to discipline and ranging up to transition to practice. Thus, if, let’s say, a PGY1 resident has fulfilled all his/her required milestones and EPA’s already after 6 months, he/she will be remain a PGY1 resident for service purposes, but will be given additional learning tasks.

    Sounds great on paper, you may say, but how will this translate into my busy daily practice where I am already stretched beyond tolerable levels and pulled in different directions by ever increasing service and academic demands? The repetitive observations and assessments required in CBD will add further to my work load, but I simply cannot deliver more; and neither our health care system nor the university has signaled increases to resources. So how to cope? Moreover, what is broken and what are we trying to fix with CBD?  Most importantly, how do we assess success or failure of this major restructuring of our medical education system?

    While those questions – the Ugly – are all well taken, they seem to me to miss the point. Fact is that the CBD train has long left the station. It will come our way regardless of whether we want it or not. Never fight the problem, solve it! The point is how to implement CBD without negatively affecting the quality of service delivery and with the resources we control in our Department, and acknowledging that some reallocation of resources towards CBD will be required.

    We are not alone in tackling the tasks associated with CBD implementation, departments in the College of Medicine, and at the Departments of Medicine at Universities across the country face similar challenges. Let’s become engaged and learn from those who are ahead of us. Let’s refrain from trying to re-invent the wheel, let’s use our energy to learn from the experiences of others and make it better.  And most importantly, let’s be present at the tables of the various Royal College subspecialty committees where planning of CBD role out in the different subspecialties happens. It is mandatory that our PGME directors attend these meetings. If our seat is empty at those tables, we forfeit our opportunity to contribute to shaping the future – which is inexcusable and inacceptable! We all want the Good to prevail, let’s do it – together!