family medicine matters - Faculty of Medicine

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WINTER 2014 • VOLUME 1, NUMBER 2
FAMILY MEDICINE MATTERS
1
INSIDE
Message from the Chair 3
Undergraduate Program 4
Postgraduate Update 5
Family Medicine Emergency Medicine
6
Faculty Development 7
STORIES AND SUGGESTIONS:
We welcome your comments and
suggestions. If you have stories
you would like to share or think are
of importance to family medicine,
please feel free to contact Patti
Research by Marshall Godwin 8
Teaching and Learning Family Medicine 9
McCarthy at [email protected]
Family Medicine In Haiti 10
or 709 777 2494.
Have You Ever Wondered 12
Comings and Goings 13
Keeping Track 15
New and Noteworthy 16
RMEN update19
Research By Jacqueline Fortier
20
Undergraduate Community Engagement
21
The Benefits Of Community Engagement
22
Postgraduate Reflections23
History in Family Medicine Project
24
An Interprofessional Lens25
Family Doctor Specializes In Elderly Care
26
Leading The Way 27
On The Road28
Award Ceremony Honors Doctors
32
Complications Of A Molar Pregnancy
34
Contacts 35
WWW.MED.MUN.CA/FAMILYMED/
2
FAMILY MEDICINE MATTERS is
published by the Discipline of Family
Medicine, Faculty of Medicine,
Memorial University of Newfoundland.
Co-ordinator:
PATTI MCCARTHY
[email protected]
709 777 2494
Editor:
SHARON GRAY
[email protected]
709 777 8397
Graphics and Layout:
Jennifer Armstrong, HSIMS
Photography:
John Crowell, Terry Upshall, HSIMS
Thank-you to Luanne Agriesti-Cleary,
Trish Penton and Barbara Morrissey
for their help in collecting information
for this newsletter and to those who
authored particular stories in this issue.
Printed by:
MUN Printing Service
Med-087-09-2014-100-JA
MESSAGE FROM THE CHAIR
By Dr. Cathy MacLean
This has been a busy year with many challenges, changes and competing
demands. In the dead of winter, in the midst of a good snowstorm as I recall,
faculty and senior staff pulled together a strategic plan. This defined for the
Discipline of Family Medicine a direction – here are some highlights from the
strategic plan which was distributed this fall:
• Developing Streams – a distributed model of delivering our residency
across NL that is appropriately resourced. Our current resident
templates are based on streams allowing residents to spend the
majority of their training in one region of the province. We are also
strengthening the academic program within the residency.
• In our undergraduate program we want to attract more students to
family medicine as a career choice and more students matching to our
family medicine training program at MUN.
• Clinically we are implementing the Patients Medical Home model into
our clinics (check out www.cfpc.ca/A_Vision_for_Canada/)
• Increasing our research and scholarship
Our success will depend on effective teamwork and this strategic plan
gives us clear goals. We need to view this as the common purpose for the
discipline. We will also work on improving communication – so it is great to
have the newsletter in place!
Over the past year, I have found staff and faculty to be actively engaged
in many of the various initiatives we have undertaken, which has been very
much appreciated. I have been very impressed by how hard everyone is
working and the mutual respect I have seen demonstrated amongst staff and
faculty. These are also key ingredients to effective teamwork. We have new
faces joining us and will be sorry to see familiar faces move on. It is a time of
transition but also one that is exciting with new opportunities as we face the
challenges ahead.
Thank you for all you are doing and I look forward to working with each of
you. We know where we have to go; now we will sort out together how we
are going to get there!
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3
UNDERGRADUATE PROGRAM
By Drs. Norah Duggan and Lyn Power
There are a lot of exciting changes taking place in the undergraduate realm.
We ask you to join us in thanking Scott Moffatt for his leadership and vision as
Family Medicine’s undergraduate director for the past six years. As he passes the
reins over to me, I hope I will be able to continue to build the presence of family
medicine in the undergraduate curriculum. Scott will continue to have a key role
in the undergraduate realm both as assistant dean of Student Affairs and as cochair with Kath Stringer for the Community Engagement courses II and III which
occur in Phase II and III of the new spiral curriculum.
Please also welcome Lyn Power into the position of clerkship director for
the eight-week core clerkship in Rural Family Medicine. I am certain that her
experience and perspective will bring further growth to this course, which
continues to be the most highly rated of the core rotations, due in no small
part to our dedicated rural preceptors in Newfoundland and Labrador, New
Brunswick, Prince Edward Island and the Yukon Territory.
In pre-clerkship, students are offered the opportunity to shadow physicians from
all fields of medicine to gain more insight into real life practice. We hope to
offer students more information on our community preceptors by developing
practice profiles that allow students to see the range of learning experiences our
preceptors offer.
The Rural Family Medicine rotation will see the addition of an on-line teaching
module on the Rourke Baby Record 18-month well baby visit developed by Dr.
Leslie Rourke and her team. This case-based module will enhance students’
learning around the domain of a well-child visit, particularly for children with
concerns regarding achievement of developmental milestones.
We are actively seeking new sites for both pre-clerkship and clerkship
undergraduate clinical learning. With the expansion of the class size from 64 to
80 students, we will need the involvement of more dedicated, enthusiastic family
physicians for both our rural and urban clinical experiences. We are also sad to
say good-bye to a long time preceptor and a phenomenal teacher and physician,
Tony Rockel, and wish him well in his retirement.
In August we had three students do the Progression to Postgrad (P2P) program in
Sites in Newfoundland and Labrador, New Brunswick and Prince Edward Island.
P2P is a fourth-year med school course which is 12 weeks long, encompassing
the 12 week selective time. In this longitudinal program, students follow a patient
panel through multiple encounters with multiple health-care professionals,
including allied health-care professionals, to gain exposure in the continuum of
disease. These three sites are new to P2P with students having previously been
placed in Goose Bay and Burin. This is an exciting opportunity to gain exposure
to various areas of medicine and further enhance the skills learned in clerkship.
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Table of Contents
POSTGRADUATE UPDATE
By Dr. Danielle O’Keefe
CARMS 2015
The CaRMS interview dates
are January 21-23, 2015.
We are advertising four
separate matches in CaRMS
this year: Eastern, Central/
Western, Northern – Goose
Bay and Northern – Iqaluit.
Preceptors from our Eastern,
Rural and Northern streams will be involved with the
file reviews, interviews and candidate ranking.
Canadian Medical Graduates (CMGs) will have the
option to apply to the four streams. In addition to the
application, all candidates will complete one interview.
Candidates will then rank the streams in order of
personal preference when they submit their rank list to
CaRMS.
International Medical Graduates (IMGs) will apply
to one stream. These candidates will indicate
their rank order preference in their personal letter.
IMG candidates will also complete a clinical skills
assessment on the day of their interview.
STREAMS PROPOSAL
The Streams Proposal has been submitted to Dr.
Rourke! Many thanks to those involved with the
proposal.
Committees are working hard to revamp our
curriculum objectives. These documents are still works
in progress.
We are continuing with our field notes and the
requirement for residents to have one field note/
half day. The field notes are to document learning
and feedback. There is the option to complete these
field notes on paper or electronically; the electronic
field note is preferable as it allows for the creation
of individual field note reports for the residents. We
appreciate your ongoing support with this as the field
notes are playing a bigger and bigger role in resident
assessment and evaluation.
RESIDENT LEAVE – VACATION, SICK LEAVE,
CONFERENCE, OTHER
Residents are entitled to 20 days of vacation
leave per year. Ten of these days are to be taken
before Christmas and ten days are to be taken after
Christmas. Residents are to complete leave request
forms for any vacation time and submit them to the
Family Medicine Postgraduate Office for processing
and final approval. Residents are also entitled to
Sick Leave, Conference Leave, Family Leave and
Compassionate Leave. All residents have access to
the appropriate leave forms on One45 and on the
USBs that they were given at Orientation. Please follow
up with Susan Carter ([email protected]) for further
information and for a master copy.
RESIDENT TEMPLATES
Resident templates have been designed around
training streams this year: Eastern, Central/Western,
Northern. A number of residents will have an
opportunity to complete a portion of their training in
New Brunswick.
Templates based around streams allows for residents
to travel less and to complete a large proportion of
their training in one area. We hope that this will result
in residents getting to know their home base well,
embracing where they are living and becoming part of
your communities.
CURRICULUM AND ASSESSMENT
Our Curriculum and Evaluation and Promotions
EMAIL ADDRESSES FOR STAFF IN THE POSTGRADUATE
OFFICE
We have moved away from emails going to
the personal email accounts of the Staff in the
Postgraduate Office. The only exception to this is the
Program Coordinator, Susan Carter. We’d appreciate it
if you could change your saved contact information to:
General Inquiries: [email protected]
Curriculum: [email protected]
Evaluation: [email protected]
Many thanks for all of the teaching and guidance
that you provide to our residents. You are vital to the
success of our residents’ training!
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5
FAMILY MEDICINE
EMERGENCY MEDICINE
By Dr. Peter Rogers, Dr. Mike Parsons and Ms. Patricia Penton
Greetings from the Family Medicine/Emergency Medicine
Program. Here’s an update for the 2014-15 academic year:
After a rather competitive CaRMS match, we were very pleased to
match the following residents:
Cliona O’Brien, Memorial University
Brooke Saunders, Queen’s University
Lindsey Woods, McMaster University
Kenzo Saito, University of Toronto
There are many exciting changes in the works for the program
this year. With the new Clinical Learning and Simulation Centre
(CLSC), we are developing a more robust simulation program.
We also plan to use this resource to offer high-fidelity procedure
training. In conjunction with the Standardized Patient program,
we will keep residents on their toes with even more challenging
simulated patient encounters.
Our Point of Care Ultrasound (POCUS) program is now in its
third year. The FM/EM residents are trained in a multidisciplinary
POCUS course offered in July. By the end of the year, they
should have received enough training to challenge a national
standardized exam in order to obtain Independent Practitioner
status.
The recent establishment of the Discipline of Emergency
Medicine has also greatly enhanced our program. It has facilitated
the appointment of more full and part-time faculty who can
dedicate more time and energy to academics. Several faculty
have started work towards masters’ degrees in medical education.
In addition, the combined research expertise of Kris Aubrey and
Adam Dubrowski has resulted in more faculty both being involved
in research and even initiating their own projects.
From left to right are Drs. Mike Parsons (Enhanced Skills/EM Assistant Director)
and Peter Rogers (Enhanced Skills/EM Director) and the EM residents: Drs.
Lindsay Woods, Cliona O’Brien, Brooke Saunders, Kenzo Saito
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Table of Contents
BATHE Technique
By Dr. Leslie Rourke
The BATHE technique
serves as a quick
screening test for
anxiety, depression,
and situational stress disorders. It consists of
four specific questions about the background,
affect, troubles, handling of the current
situation, followed by an empathic response.
It incorporates some patient reflection and can
thus help patients handle aspects of their life in
a constructive way.
The BATHE Procedure
Background: “What is going on (in your life)?”
– To get the context of the problem. If already
discussed, go directly to Affect.
Affect: “How do you feel about that?” or “How
is it affecting you?”
Trouble: “What troubles you the most about
this?” to get at the symbolic meaning of the
situation for the patient. Ask the question with
the emphasis on “most”, then stop and wait
for the patient’s answer. You know the patient is
reflecting if there is a pause before they answer.
I find that this question is the most helpful part
of the BATHE technique.
Handling: “How are you handling that?” – To
assess the patient’s resources and responses to
the situation.
Empathy: “That must be difficult for you.” –
reflects an understanding that the patient’s
response is reasonable under the circumstances.
When NOT to Use the BATHE Technique
• Patient is in severe pain or life-threatening
circumstances
• Patient resistance with suspiciousness or
hostility
• Suicidal patient, battered spouse, sexual
abuse victim or substance abuser – as
empathy alone is not enough. Further
exploration and possible action may be
needed.
• Psychotic and borderline personality
disorder patients
• May need to modify with developmental
disorders, physical handicaps, different
cultural backgrounds, language barriers.
Taken from: Prim Care Companion J Clin
Psychiatry.1999 April; 1(2): 35–38.
www.pubmedcentral.nih.gov/articlerender
fcgi?artid=181054
FACULTY DEVELOPMENT
By Dr. Cheri Bethune
The times they are
a changing! Faculty
development finally emerged
as the new focus of the
College of Family Physicians
of Canada Council of
Teachers at the 2014 Family
Medicine Education Forum.
NEW FRAMEWORK FOR TEACHING COMPETENCIES
The Working Group on Faculty Development is a college
committee that has been charged with addressing the
need for the CFPC to take leadership in addressing the
needs of all our teachers! I have had the privilege of
working on this committee for the last two years.
The framework of teaching skills was launched at the
Family Medicine Education Forum which is the Wednesday
before the FMF in Quebec City this November.
The Framework is an articulation of the teaching
competencies for family medicine teachers and has been
created to assist all teachers(from novice to expert) in their
continued development as teachers and to help faculty
developers throughout the country build a curriculum and
tools to assist us as teachers in developing those skills.
DISTRIBUTED FACULTY DEVELOPMENT
The challenge of keeping new and old teachers excited
and creative about enhancing their teaching skills in a
highly distributed program means that we must use many
strategies. Our vision is to work towards enhancing the
local skills through identifying a site lead in each region
for faculty development. Using PBSGL (Problem-based
Small Group Learning) faculty development modules is a
good start in helping to nurture and create true learning
communities in each and all of our teaching sites.
DEVELOPMENTS
New Modules
This past year we have enhanced some tools for faculty
development trying to Train the Trainers by building
teaching modules for full time faculty to utilize when they
visit sites for faculty development. We have built these
modules around the competency-base framework of the
CFPC with teaching modules in teaching and assessing
Clinical Reasoning and Selectivity (part of the six skill
dimensions of the Evaluation objectives of the CFPC).
These modules are ready for use and we hope that fulltime faculty will utilize them in their outreach faculty
development to distant and community-based sites. The
development of other modules in teaching and assessing
professionalism, communication skills, patient centred
clinical method and procedure skills are planned.
Video on Role of Faculty Advisor
We have developed and launched a video on the evolving
process of the role of the faculty advisor relationship in
competency-based family medicine education. As we
move to greater emphasis on in-training evaluation and
assisting learners to be active participants in navigating
their learning plans, we are developing resources to
help teachers and residents understand the path to
competency.
6 for 6 Research Skills Program
We have been delighted with the enthusiastic uptake
of the 6 for 6 program in its first year. We had difficult
choices to make in selecting six candidates from many
applicants. Our first class are highly motivated and
enthusiastic representatives from a variety of teaching
sites. They are progressing well with their selected research
project. We are currently in phase two of recruitment for
the second iteration of the 6 for 6 program, which will
begin in April, 2015. For further information about this
please contact Patti McCarthy via email to 6for6@med.
mun.ca or phone at 709 777 2494.
FINALLY, FAREWELL
After 10 years or more at the helm of family medicine
faculty development I am delighted to be passing the
baton to Vina Broderick, who will take faculty development
at Memorial’s Discipline of Family Medicine to new heights.
It has been a privilege and honour to work with all of you
in this capacity.
Sincerely,
Cheri Bethune
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7
RESEARCH
By Dr. Marshall Godwin
I was asked to draft an update on research in family medicine or a family medicine,
research-focused story for the newsletter. There are stories, but I thought I would
do something different. First I thought I would talk about all the places research
has taken me over my career. Like Jerusalem in 1989, Bosnia 26 times between
1998 and 2010, Prague, Sydney Australia, every province in Canada, the arctic,
and to many U.S. states. But instead I thought I would play a “Did you know that?”
game based on some of the results of research I have done.
DID YOU KNOW THAT?
There is a guideline on the approach to fatigue of less than six months duration.
www.ncbi.nlm.nih.gov/pubmed/?term=fatigue+godwin++CFP
Roots (growing up in a rural community) are more important than clinical exposure (spending time in a rural
rotation) when it comes to medical graduates eventually practicing in a rural location.
www.ncbi.nlm.nih.gov/pubmed/?term=rural+background+easterbrook
The severe pain of painful diabetic neuropathy can be the first indication that a person is diabetic. \
www.ncbi.nlm.nih.gov/pmc/articles/PMC2018503/pdf/11398716.pdf
Only a third of the family medicine residents who say they plan to do intrapartum obstetrics at the
beginning of their residency still say at the end of their residency that they plan to include intrapartum
obstetrics in their practice. But those who at the end of residency say they plan to do deliveries, almost
always do.
www.ncbi.nlm.nih.gov/pubmed/?term=godwin+hodgette+cohort+intrapartum
Practicing physicians, even newer graduates, generally don’t have a lot of critical appraisal skills.
www.ncbi.nlm.nih.gov/pubmed/?term=godwin+seguin+critical+ontario
If a patient with hypertension is well controlled on medications, seeing him/her every six month maintains
BP control as well as seeing them every three months.
www.ncbi.nlm.nih.gov/pubmed/?term=godwin+birtwhistle+equivalence
Thirty percent of people in a family practice between age 30 and 80 years who do not have a diagnosis of
hypertension do have prehypertension.
www.ncbi.nlm.nih.gov/pubmed/?term=godwin+pike+jewer+prehypertension
Low-intensity exercise (walking) has a significant effect on blood pressure.
www.ncbi.nlm.nih.gov/pubmed/?term=low-intesnity+Hua+godwin+autonomic
A protocol-based approach to achieving blood pressure control works better than what we usually do. www.ncbi.nlm.nih.gov/pubmed/?term=godwin+birtwhistle+protocol-based
Only 2.5% of diabetic patients are at target for all three of BP, LDL, and HbA1c in eight family physician
practices in St. John’s, NL.
www.ncbi.nlm.nih.gov/pubmed/?term=godwin+mccrate+attainment
Automated office BP measurement(BpTRU) correlates much better with 24 hour ambulatory monitoring
than manual office BP measurement and the ‘normal’ cutoff for BpTRU is 135/85 not 140/90.
www.ncbi.nlm.nih.gov/pubmed/?term=Godwin+birtwhistle+awake+automated
Low glycemic diets improve LDL control.
www.ncbi.nlm.nih.gov/pubmed/?term=fleming+godwin+low+glycaemic
I guess I am trying to make the point that family medicine research can provide information/evidence that
informs practice and health care delivery. And it’s fun!
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Table of Contents
TEACHING AND LEARNING
FAMILY MEDICINE
By Dr. Michael Jong
We have an obligation to our profession to assist in training new physicians
who will become our future colleagues and eventually replace us. In my
experience, teaching and learning has allowed our group practice to provide
a high standard of care and the ability to recruit and retain the best physicians.
Teaching and learning family medicine has personally offered me tremendous
job satisfaction.
AN INCREASE IN
PRIMARY CARE
PHYSICIANS IS
ASSOCIATED WITH
IMPROVED HEALTH
OUTCOMES FOR ALL
CAUSES INCLUDING
CANCER, HEART
DISEASE, STROKE,
INFANT MORTALITY,
LIFE EXPECTANCY
AND SELF-RATED
HEALTH.
Involvement in teaching currently starts as residents. Learning how to teach
is now part of the curriculum for residents. Our younger colleagues, who are
used to teaching medical students, will expect to become involved in medical
education when they get into practice and this opportunity will continue
to grow as medical education becomes more distributed. Work is currently
underway with the Future of Medical Education in Canada project to develop
a competency framework for all clinical teachers. Faculty development on
teaching is ongoing for most of us who teach, both rural and urban. It will likely
become part of the expectation for all of us who are in clinical practice.
It is well accepted that primary care leads to better health outcomes and at a
lower cost. An increase in primary care physicians is associated with improved
health outcomes for all causes including cancer, heart disease, stroke, infant
mortality, life expectancy and self-rated health. We are just beginning to see
an increase in the percentage of medical students choosing family medicine as
their first choice at CaRMS; it is still below 40 per cent and the goal is to reach
50 per cent. For medical students to embrace family medicine as career choice,
family physicians need to offer greater presence in undergraduate medical
education and be role models. Longitudinal clerkships where students spend
at least several months of their clerkship with family docs, will offer greater
opportunities for role modeling with family physicians who provide the full
scope of family medicine including obstetrics and inpatient care.
Students who graduated from longitudinal clerkships with family physicians
as their main preceptor do better in their LMCC exams and have higher skill
sets coming into residency. Having higher clinical skills on entry to residency is
particularly useful when adding depth into the two year rural family medicine
program.
The sustainability of publicly funded health care is being threatened by
escalating costs. Health care is currently consuming 40 per cent of the
provincial budget and is escalating. Training more family physicians to provide
the full scope of family medicine is one of the solutions for maintaining the
sustainability of health care. Teaching and learning family medicine will have an
increasing importance.
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9
FAMILY MEDICINE IN HAITI
FAMILY MEDICINE IN HAITI
By Drs. Jill Allison and Stephen Lee
The Discipline of Family Medicine has been involved
in two productive and educational trips to the Bas
Limbe region of Northern Haiti in 2013 and 2014.
Faculty and residents from the Discipline of Family
Medicine worked in collaboration with Haitian
colleagues at Haiti Village Health, a small NGO
started by MUN medicine graduate Dr. Tiffany
Keenan.
The mission of Haiti Village Health is to provide
sustainable health care for the Bas Limbe region
in northern Haiti by employing local medical and
support staff and providing them with the training
and tools to be self-sufficient. As stated in the
mission and goals of the organization, their objectives
are to provide out-patient medical care through
general medical clinics, ensure access to clean water
and sanitation for all households in the Bas Limbe
region, decrease childhood mortality and improve
maternal health.
The first trip to the region consisted of a team
lead by Dr. Dick Barter from Emergency Medicine
along with Discipline of Family Medicine faculty, Dr.
Stephen Lee, and Dr. Greg Sherman. Dr. Norman
Lee from MUN’s Student Health Services was
along as another team member. The team was
10
accompanied by Dr. Jill Allison, the
Global Health Coordinator in the
Faculty of Medicine. Dr. Allison has
significant knowledge of the region
and provided the teams with predeparture briefings on topics such as
historical influences, local customs,
common health issues and spiritual
beliefs. Family medicine residents
on the first trip included Dr. Sarah
Hann, Dr. Laura Edwards, Dr. Janelle
Schneider, and Dr. Naila Debbache.
A second team visited the region in
March, 2014 lead by Dr. Tia Renouf
from the Discipline of Emergency
Medicine. Dr. Stephen Lee was also
on this trip along with an emergency
medicine colleague from Saskatchewan, Dr. James
Stempien. The family medicine residents on the
second trip included Dr. Kelly Carew, Dr. Stephanie
Hynes and Dr. Danika Kung-Kean. Dr. Jill Allison
was also on the second trip and again did the predeparture briefings and post –trip debriefing for the
team.
Both teams held outreach clinics in several villages in
the region. Hundreds of children were seen on each
trip. A variety of medical problems including scabies,
malnutrition, malaria, pneumonia, and parasitic
infections were seen and treated. All children
were dispensed vitamins and worm prophylaxis if
indicated.
Each team worked collaboratively with Haitian
healthcare providers. Our residents gave
presentations on various topics related to primary
care and the Haitian health care providers returned
the favour by providing us with valuable insights
into common local medical problems as well as the
medical challenges they face in an under-resourced
area.
The discipline looks forward to continuing this
exciting collaboration with Haitian health care
providers in this beautiful but under serviced area of
Northern Haiti.
Table of Contents
A FAMILY PHYSICIAN’S EXPERIENCES IN HAITI
MY HAITI EXPERIENCE
By Dr. Janelle Schneider
By Dr. Stephen Lee
I don’t think I was prepared for the heat! Leaving a particularly cold July
in Newfoundland certainly did not prepare me for the blast of humid air
on arrival in Port-au-Prince, Haiti.
I’ve been fortunate to do a fair bit of travelling in my life but in July
2012, I combined my love for travel with a global health experience by
joining Team Broken Earth on their fourth mission to that devastated
country. I worked as one of three physicians in the emergency
department doing eight-hour shifts and triaging in a 10x10 foot space
with a tin roof and a sheet for a door. I will never forget the cases I saw
there: 40-year olds with strokes due to untreated hypertension, children
with a myriad of infectious diseases and malnutrition and the unending
trauma.
The most memorable thing for me however, was how quickly the
members of the team bonded and pulled together. I saw incredible
work done by team members from Newfoundland that I had never met
before. Many of them are now lifelong friends because of our shared
experiences.
I’ve been able to return to Haiti on two other occasions working in
the north of the country treating children with the organization Haiti
Village Health. On these trips I worked elbow to elbow with eight of our
incredible family practice residents as well as nurses from Eastern Health
and the US. The preceptor/resident/nurse roles melded as we picked
each others’ brains, improvised and sweated together!
I’ve discovered that family physicians have an amazing skillset that
can be applied anywhere in the world. We can work in tertiary care
institutions with MRIs and on a dirt floor in a schoolroom in Haiti. I’m
looking forward to my next trip!
Our pediatric elective in Haiti
last October with Haiti Village
Health (HVH) proved to be both
inspiring and challenging. Our base
community, Bor De Limbe, welcomed
us warmly, with a smiling child always
waiting to hold our hand, swim, or
play soccer as soon as we stepped
out of the accommodations.
The clinical experience was equally
rewarding. Setting up clinics in
churches and schools in a different
community every day, we saw
everything from scabies to malaria.
A case in particular that stands out
in my memory was that of a twomonth-old baby, weighing less a
newborn. Severely malnourished, she
had subsisted on crackers and water
primarily, provided by her sister. As
a few of us began rehydrating the
baby, others from the team delved
further into the social circumstances
that led to this baby’s condition. We
discovered that the child’s mother
worked long hours at the market in
order to support her large family.
While she understood the gravity of
her baby’s condition, she was torn in
her duty to provide for the rest of the
family. We urged the mother to bring
her daughter to the hospital and
organized transport. The prognosis
was bleak. Our spirits were lifted;
however, when we learned that the
March team had found this very baby,
plump and healthy.
While this clinical experience has
its challenges (namely the heat!), I
strongly encourage residents, staff,
and nurses to volunteer with HVH.
Not only did we get to play a positive
role in the lives of a few children in
these communities, we also had the
opportunity to connect and build
friendships with other teams as well
as our own.
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11
HAVE YOU EVER WONDERED?
By Dr. Gina Higgins
Have you ever wondered
what Semmelweis might
have felt? First, the
triumph of a discovery
that would prevent
the needless deaths
of countless women
and babies. Then, the understanding that humans
as a whole are not early adopters of changes that
imply that we were wrong. He went from being
a conscientious and compassionate physician to
one haunted by obsession and despair, anger and
righteous passion, and then to irrationality. How
can we hope to understand the immeasurable
bitterness, the shattering sorrow and horror, and the
desperation of the need to numb those senses tuned
to empathy and ethics? How can we comprehend
what it is to dwell alone among friends and family?
To understand, to the core of one’s being, that
even those whose lives have been spared could not
comprehend the intensity, the immediacy, of the
need for change. Perhaps even more cutting, the
dawning realization that his colleagues, his family in
spirit, had deserted him.
I imagine this visionary seeing a beautiful healthy
baby nested in its mother’s arms, protectively
encircled, and feeling at once an intense kinship and
an irreconcilable gulf between himself and the rest of
humanity. And I see him having a drink to numb that
intolerable sense of betrayal and loss, and another to
sooth the intensity of that fury and the impotence of
railing against the universe for the sheer unfairness
flaunted at so many levels. I imagine his death
coming to claim him; his pain and fear and isolation
and his newborn faith in the faithlessness of his fellow
man. Perhaps even his relief.
Can you imagine how Semmelweis might have felt?
Semmelweis was a visionary; ahead of his time and
willing to stand firm behind his beliefs. Traits that
enabled him to recognize an atrocity, to accept his
part in its perpetuation, and to then devise a solution
are common among physicians. Our colleagues are
moral, ethical and empathic people who practice
evidence-based medicine and who have a desire to
help others that often supersedes their own needs.
12
Our colleagues face daily systemic and individual
barriers and behaviors that they know will result in
harm to somebody’s mother, father, son or daughter.
Although they will pour their energy into attempts to
rectify these problems, most of those attempts will
seem ineffective.
Semmelweis was a physician; his experience was
a matter of degree. It saddens me that so many of
our colleagues can understand through their own
experiences some of what Semmelweis might have
felt.
Ignaz Philipp Semmelweis) was a Hungarian physician
of German extraction now known as an early pioneer
of antiseptic procedures. Described as the “savior of
mothers”, Semmelweis discovered that the incidence
of puerperal fever could be drastically cut by the use
of hand disinfection in obstetrical clinics. Puerperal
fever was common in mid-19th-century hospitals and
often fatal. Semmelweis proposed the practice of
washing with chlorinated lime solutions in 1847 while
working in Vienna General Hospital’s First Obstetrical
Clinic, where doctors’ wards had three times the
mortality of midwives’ wards. He published a book of
his findings in Etiology, Concept and Prophylaxis of
Childbed Fever.
Despite various publications of results where handwashing reduced mortality to below one per cent,
Semmelweis’s observations conflicted with the
established scientific and medical opinions of the
time and his ideas were rejected by the medical
community. Some doctors were offended at the
suggestion that they should wash their hands and
Semmelweis could offer no acceptable scientific
explanation for his findings. Semmelweis’s practice
earned widespread acceptance only years after
his death, when Louis Pasteur confirmed the germ
theory and Joseph Lister, acting on the French
microbiologist’s research, practiced and operated,
using hygienic methods, with great success. In 1865,
Semmelweis was committed to an asylum, where he
died at age 47 after being beaten by the guards, only
14 days after he was committed.
Table of Contents
COMINGS AND GOINGS
DR. ROB BOULAY visited the faculty in June, 2014 to
discuss the LIC plans at MUN. Rob is a past president
of the CFPC, is very involved in primary care renewal
in New Brunswick and in the Patiente’s Medical Home
Model. He is a rural family physician in Miramichi.
DR. JANICE BALL was here visiting the Discipline of
Family Medicine in July. She is the CEO of Western
Australia General Practice and Training Inc.
STEVE LAWLOR joined the
Discipline of Family Medicine as
discipline manager on Aug. 18, 2014.
This is a new position for us and we
are excited that he has joined the
DFM team. He comes with a lot of
experience at MUN as a manager in
the School of Graduate Studies; he
has an MBA and will be a great overall addition to the
Discipline of Family Medicine.
JENNIFER RIDEOUT is our new
senior secretary in the Chair’s Office,
Discipline of Family Medicine.
Jennifer comes to us from the
Association of Registered Nurses of
Newfoundland and Labrador. Her
e-mail address is DFMadmin@med.
mun.ca. Jennifer will be able to assist
you with preparing and managing appointments,
maintaining and updating both GFT and parttime faculty files for promotion and appointment
processes as well as providing support for the
Discipline of Family Medicine General Faculty and
Executive Committee meetings. Please join us in
welcoming Jennifer to the discipline!
Let’s welcome
CHANTAL FROUDE
(left) and SHENOA
WHITE, new staff in
the postgraduate
office. Chantal is
our intermediate
clerk and she can
be reached at [email protected]. Shenoa
White is our intermediate clerk stenographer and she
can be reached at [email protected].
ERIN BENNETT, a locum at the Ross Clinic, Miller
Centre is currently on maternity leave. LISA BARNES
has joined the team as a locum during Erin’s absence.
Changeover in roles in undergraduate family
medicine program:
• Many thanks to SCOTT MOFFATT for his years of
service in his role as the director for undergraduate
family medicine. Scott is now leading significant work
in the Student Affairs office through his new role as
the assistant dean of student affairs.
• NORAH DUGGAN is now the new director for
undergraduate family medicine; she has also taken on
the role of site director for Shea Heights.
• LYN POWER is now the clerkship co-ordinator.
• VINA BRODERICK is in a new role as the CPD
director and will be chairing the faculty development
committee for the Discipline of Family Medicine.
The Discipline of Family
Medicine would like to
extend our best wishes
to GEORGE HURLEY
who retired this year from
the MUN Department
of Psychology. In his
role of director of
the MUN Counseling
Centre, George has
personally taught and
supervised training
for hundreds of family
medicine residents in
Dr. Gary Tarrant (left, Lead
for the residency Behavioural
the topics of counseling
Medicine curriculum within the and psychotherapy.
Discipline of Family Medicine)
with Dr. George Hurley (right). In recognition of his
dedication to our
program and his excellence in teaching, the
Discipline of Family Medicine has instituted the Dr.
George Hurley Award. This award will be presented
each year to a non-physician teacher who is
recognized for exemplary contributions to leadership
and teaching of Family Medicine residents in our
program. It is very fitting that the inaugural award
went to Dr. Hurley.
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13
LUANNE AGRIESTI-CLEARY finished up in the Discipline of Family Medicine on Aug. 29, 2014. As many of you
know, Luanne played a huge role in Discipline of Family Medicine. She certainly was instrumental in keeping
things on track and paid attention to the finest details. She will be greatly missed in our discipline.
SONYA MCLEOD, intermediate clerk stenographer in the Chair’s Office has started a new position as secretary
in Professional Development and Conference Services. Thank-you Sonya for everything you done for the
Discipline of Family Medicine and we wish you well in your new position.
CHERI BETHUNE and BOB MILLER – we say good-bye to two of our faculty who
were so intimately involved and passionate about our educational endeavors within
family medicine. Bob and Cheri will be officially retiring later this year. The farewell
get together for Bob and Cheri was held at Marshall Godwin’s house on July 5. It
was an absolutely beautiful day and well-attended, including some of our retired
faculty, John Lewis, Paul Patey and Carl Robbins. Cheri wasn’t able to attend, but
it was fun to Skype her in! Bob and Cheri are getting settled into their beautiful
northern Ontario home and enjoying time
with their family. They will be missed by many
people in the Discipline of Family Medicine –
we wish them well in their ongoing educational
adventures and retirement!
14
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KEEPING TRACK
Changes to CFPC’s Mainpro program
The Mainpro program has been restructured and will
launch July 1, 2015. The new system is expected to
have the following enhanced features:
• an easier and more intuitive system
• new reporting categories – earn credits for a
variety of practice activities
• Increased access though smart phones and tablets
• For more information please visit the following
link: www.cfpc.ca/MAINPRO/ or watch
the following video: www.youtube.com/
watch?v=HOLQnOoQp7s
Triple C video:
For those looking for information on Triple C
Curriculum Animated video whereby a resident and
his preceptor demonstrate a Triple C competencybased approach to assessment: http://youtu.be/
zEALBcfjCow
Sabbatical Leaves: The following faculty will be on or
starting leave over the next year
• Wanda Parsons is on sabbatical until Aug. 31,
2015. Russell Dawe is covering Wanda’s practice at
the FPU which is always a huge help
• Bill Eaton is on sabbatical until June 30, 2015
• Dave Morgan will be going on sabbatical starting
Jan. 1, 2015 – January 1, 2016
PriFor 2015: Patient Oriented Research That Matters
will be held at the Sheraton Hotel, St. John’s on June
29-30, 2015. Mark your calendars now! Here is a link to
the forum details: www.med.mun.ca/phru/prifor.aspx.
Staff retreat: Stay tuned for the details on the staff
retreat the Chair’s Office is organizing. They are
currently trying to settle on a date.
The Chair’s Office has invited Wayne Weston to return
to do Crucial Conversations Training.
A research exchange group in primary care has been
organized through the NL Centre for Applied Health
Research and its first meeting was held on Sept. 12,
2014. Please contact NLCAHR (Rochelle Baker) for
more details on this group: Rochelle.baker@med.
mun.ca.
The next Residency Core Content dates are March
9-13, 2015.
Research Exchange Group in Primary Care Update:
A research exchange group in primary care has
been organized through the NL Centre for Applied
Health Research and its first meeting was held on
Sept. 12, 2014. Please contact NLCAHR (Rochelle
Baker) for more details on this group: HYPERLINK
“mailto:[email protected]” Rochelle.
[email protected]
INTERESTED IN BECOMING FURTHER INVOLVED WITH THE POSTGRADUATE PROGRAM?
We are looking for preceptors to join our committees – Curriculum, Evaluations and Promotions and
Remediation. There are also opportunities to get involved with practice SOOs and Core Content
workshops. Please contact Susan Carter if you are interested: [email protected]
Table of Contents
15
NEW AND NOTEWORTHY
LEAN PROGRAM
Many of our full time faculty, staff, part-time
physicians, locums and interprofessional colleagues
work in the academic teaching sites have completed
Eastern Health’s LEAN program. At the last Strategic
Planning Workshop in February, many faculty
referenced their increasing workload, competing
demands on their time, and a lack of adequate
resources. Lean training was suggested as a useful
tool and generated quite a bit of interest. The Lean
concept is based on the Toyota Way – to help people
streamline processes, identify areas of “waste” and
build a culture of continuous improvement. There has
been a lot of positive feedback associated with this
program. If you are interested in knowing more about
this program, please contact [email protected].
CONTINUOUS QUALITY IMPROVEMENT
Dr. Cheryl Levitt from the CFPC is a family medicine
researcher and expert in quality in primary care; she
visited in August, 2015. She provided some helpful
resources on best practices on how to engage in
continuous quality improvement (CQI) activities.
Marshall Godwin, Barb Morissey and Patti McCarthy
are working on the development of a continuous
quality improvement project that involves all five
teaching sites in the St. John’s area. Upon completion
of the CQI project, the results as well as suggestions
for how best to conduct CQI at your site will be
shared with all.
JOHN ROSS COMMEMORATIVE WALK
Our annual John Ross Commemorative Walk in
memory of our founding chair of the Discipline of
Family Medicine, John Ross as held on Sept. 11, 2014.
There was a good turn for the hike which took place
starting at Cape Spear, hiking to North Head and
returning to Cape Spear!
An application to add an ENHANCED SKILLS
PROGRAM IN CARE OF THE ELDERLY IN FAMILY
MEDICINE is currently being developed and will be
submitted to the CFPC for consideration at their
January 2015 meeting.
16
SOCIAL WORK PRESENCE IN FAMILY MEDICINE:
The DFM is working with Jim Oldford (social worker
and clinical lecturer in psychiatry) to create an
expanded social work presence in the DFM. Stay
tuned for more details as this process unfolds.
PRIMARY CARE NEEDS OF ADULTS WITH
DEVELOPMENTAL DISABILITIES: The DFM hosted
a meeting of interested parties on the primary care
needs of adults with developmental disabilities on
Aug. 13, 2014. This was a follow-up on some previous
work completed in this area and to determine what
steps are needed to enhance primary care services for
this population in NL. We will circulate information on
work in this area as it arises.
MASTERS THROUGH WESTERN UNIVERSITY
John Campbell, Annabeth Loveys, Gina Higgins, Kath
Stringer and Amanda Pendergast are all doing their
masters of clinical science through Western. This is a
huge endeavor and we wish them all the success in
their program.
DFM WELLNESS PROJECT
We are looking for interested staff, faculty and
residents who would like to work on a DFM Wellness
project. We want to make our work environment
a little more fun and healthy, ways to walk in the
building in winter to get 10,000 steps, healthy snacks,
etc.
Looking for ideas or suggestions on what we could do
too! Those interested can contact Cathy MacLean or
pop in to the Chair’s Office.
CFPC RESIDENT STUDENT AWARDS
The Discipline of Family Medicine congratulates
students and residents on receiving the following
awards:
Medical Student Scholarship: Sarah Small
Medical Student Leadership Award: Nicole
Stockley
Family Medicine Resident Leadership Award:
Raie Lene Kirby
Family Medicine Resident Award for Scholarly
Achievement: Joshua O’Hagan
Table of Contents
Launch of Rourke Baby Record (RBR) – 2014 edition
Authors: Leslie Rourke, Denis Leduc and James
Rourke
The 2014 edition of the Rourke Baby Record (RBR)
was launched on June 25th, 2014 at the Canadian
Pediatric Society annual Conference in Montreal. Here
is a link to the news release on the launch of RBR.
http://bit.ly/RBR2014
GERARD FARRELL JOINS FPU
On Sept. 9, 2014 Gerard Farrell
opened a new clinic for patients
requiring cancer surveillance in the
Family Practice Unit, Health Sciences
Centre. The clinic is intended for
cancer patients who have completed
their acute care (surgery/chemotherapy/radiation),
are not being followed by a medical or radiation
oncologist, but still require surveillance for cancer
recurrence. This clinic is intended to complement
the care provided by the medical oncologists at the
H. Bliss Murphy Cancer Centre. It is not intended
to replace care provided by cancer patients’ family
physicians. Patients wishing to avail of this service may
be referred by their physician by calling 709 777 7795.
BUILDING OUT SPORTS MEDICINE AND PALLIATIVE
CARE EXPERTISE AND TEAMS: Jessica Wade is
currently working in the area of sports medicine.
Cheryl Tobin is working in palliative care with Bill
Eaton, Lisa Barnes and Russell Dawe. This palliative
care team has grown quite a bit over the last number
of years. We are pleased to see the expansion of
this team and an enhancement of expertise in sport
medicine.
LOW RISK MATERNITY TEAM (LRMT): We want to
send out a special mention regarding the LRMT who
have been working very hard to keep things going
since Bob Miller has retired from clinical practice.
Thank-you Norah Duggan, Susan Avery, Amanda
Pendergast, Russell Dawe and Raie Lene Kirby (until
December).
HEATHER PITCHER IS LEADING THE WAY IN
HEALTH COACHING
Heather has a new role as a Nurse Practitioner (NP)
Health Coach in the Family Practice Unit, Health
Science Centre, St. John’s, Newfoundland. She has
been in the nursing field for 24 years and has recently
established a clinical practice. She will receive patient
referrals from physicians within the Family Practice
Unit and other medical clinics. She has also opened
her practice for self-referrals, as well as those from
community members and other health professionals.
Heather is now accepting new patients. If you are
interested in learning more about Heather and her
work and/or would like to make a referral for coaching
please let her know by emailing her at:
[email protected] or calling the Family
Practice Unit at 709 777 7795.
u
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17
BABY ANNOUNCEMENTS
Erin Bennett, a locum at the Ross Clinic, Miller Centre in St.
John’s, had her baby boy Tannis Yegappan on Sept. 5 at 8:56
a.m. at 6 pounds 13 ounces. Congrats to Erin and her family on
the birth of their son.
t
Jodie Bennett, clinical receptionist at the HSC site, welcomed Cassie
Bennett into the world on Nov. 21. Cassie weighed in at 6 pounds 2
ounces and is the third little girl to join the Bennett family in five years!
Mom and baby are home safe and sound and doing well.
u
HALLOWEEN FUN!
These are our front line staff
at Shea Heights who got
into the Halloween spirit!
Rhonda Hooper - sitting
Shelly Yetman - standing
t
These are some of
the staff at the Family
Practice Unit having some
Halloween fun!
Shenoa White
Sonya McLeod
Chantal Froude
u
18
Table of Contents
RMEN UPDATE
By Dr. Mo Ravalia
While the mandate of the Rural Medical Education Network office remains
unchanged there have been some recent changes with respect to the RMEN
office. Mohamed Ravalia (assistant dean) continues to work out of his office
in Twillingate however he now has an office located within the UGME suite of
offices of the new Medical School. Maureen Kent (co-ordinator of RMEN) will
be retiring from her position in October 2014 and Tina Dwyer is acting coordinator in her absence. The St. John’s RMEN office has moved to the new
Medical Education Centre and is now located in the UGME office suite.
I WILL SOON BE
TAKING ON MY
OWN LEARNERS –
AND NOW, MORE
THAN EVER, I HOPE
THAT I INSTILL
IN THEM THE
LESSONS THAT I
KNEW BY ROTE
COMING THROUGH
MEDICINE AND
RESIDENCY, BUT
WHICH ONLY REALLY
STRUCK HOME
WHEN I WAS ON
THE OTHER SIDE OF
THE CURTAIN.
Physician Leads are still working out of their respective regions with
administrative support staff in three of those regions. Physician Leads for each
of the regions are: Eastern Region - Drs. Blaine Pearce and Stacey Saunders;
Central Region - Drs. Lynette Powell and Carmel Casey; Western Region - Drs.
Erin Smallwood and Dennis Rashleigh and Labrador-Grenfell Region- Dr. Karen
Horwood. The administrative contacts for each region are as follows: Western
Region –Lavinia Chin, Central Region –Minerva Hanlon and the Eastern Region
– Cassandra Ingram. Contact information is available on the RMEN website
(www.med.mun.ca/rmen).
RMEN staff are working in collaboration with Mariette Byrne (accommodations
co-ordinator) to address the accommodations issues we are currently
challenged with. Ms. Byrne is currently developing a “Rural Accommodations
Housing Policy” to address housing issues and it is anticipated that this policy
will be approved later in the fall. In conjunction with this policy a “Rural
Accommodations Housing Handbook” is also being developed. With the
implementation of both documents it will clarify the Faculty of Medicine’s
policies, procedures and standards for the selection and provision of housing
accommodations for rural medical education learners.
The infrastructure fund and preceptor payment policies are currently under
review and need to be updated on the Faculty of Medicine website; however
the monetary amount still remains the same. Payments for the infrastructure
fund are normally made twice a year following receipt of an invoice at the Rural
Medical Education Network office.
The RMEN office is coordinating with HSIMS (Health Sciences & Information
Media Services) to develop a database of all active physicians in the regions
and we hope that eventually we will be better able to track all preceptor
teaching and payments.
The new office contact information is as follows:
Rural Medical Education Network
Health Sciences Centre, M2M101
St. John’s, NL Canada A1B 3V6
Tel: 709 864 06367, Fax: 709 864 6362
[email protected]
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19
RESEARCH
By Jacqueline Fortier
EXPERIENCES OF A GRADUATE STUDENT IN THE PRIMARY HEALTHCARE
RESEARCH UNIT
I moved from Victoria, BC to St. John’s in January of 2013 to start my M.Sc. in
clinical epidemiology at Memorial University. I’d never been to Newfoundland
before, and my background was in life sciences, so I wasn’t entirely sure what
to expect when I started. There was definitely a lot to learn and a lot to adjust
to (particularly the weather!) but from the start I found the environment in
the Discipline of Family Medicine to be welcoming, engaged in research and
committed to supporting its students.
For my thesis, I wanted to measure the relationship between certain aspects
of lifestyle, such as diet and exercise, and quality of life among adults living in
in St. John’s. I needed dozens of surveys completed, and my sample had to
include people of all different ages, household incomes, levels of education,
and lifestyle habits. The academic family medicine clinics were ideal places to
recruit participants, and the clinicians, staff, and patients at each clinic I visited
were supportive, friendly, and extremely accommodating. They were interested
in the research I was doing, and very willing to help however they could. It was
really encouraging as a student – and as someone planning a career in health
research – to have such a positive experience working with the family medicine
clinics.
With Dr. Marshall Godwin as my thesis supervisor, I also had the opportunity
to work at the Primary Healthcare Research Unit (PHRU). Learning about
research techniques in lectures will only take you so far, and gaining handson experience as a research assistant at the PHRU has been invaluable. I’ve
assisted with research projects at all stages, from ethics applications to data
analysis to manuscript write-ups, and throughout I’ve always been able to rely
on my supervisors and more experienced colleagues for help when I need it.
My experience as a graduate student has been overwhelmingly positive, and
I’m grateful to be studying and working in this environment.
20
Table of Contents
UNDERGRADUATE
COMMUNITY ENGAGEMENT
By Dr. Kath Stringer
The new Community Engagement course forms an integral part of all three
phases of the new medical school curriculum. The objectives of this course
include the promotion of community-based generalist practice; the Discipline
of Family Medicine and the Division of Community Health and Humanities have
joined forces to achieve this.
In keeping with the new spiral curriculum, the community experiences aspects
of the course allow students to transfer the knowledge learned within virtual
families and communities to real life situations and topics specific to each
discipline are revisited in an iterative manner throughout the three phases.
The Community Engagement course uses both medical school and community
based teaching to meet its objectives. The three community based teaching
experiences are spread throughout the three phases beginning with the
Community Visit in Phase 1.
The Community Visit is a two-week rural experience focusing primarily on the
community health aspects of each specific community a student is placed in.
The clinical importance of these community health aspects are emphasized
during two days spent with a family physician in their clinic.
The next two-week community experience, the House Call, is completed at the
end of Phase 2; each student has now completed their clinical skills training
and didactic community health sessions. The family physician centred clinical
focus is increased with the students spending three days each week in a family
physician’s clinic and two days each week completing a community health
profile specific to the urban or rural community and linked to their clinical
experience.
Lastly in Phase 3, immediately prior to clerkship, the Black Bag continues, as
it was previously, to be a majority family physician clinical experience with one
day each week still focusing on the urban or rural community.
A major change in the new community engagement courses has been
the combined approach of both community health and family medicine
disciplines in an attempt to highlight the importance of collaboration within the
community. Joint planning meetings ensure smooth transitions through each
phase and the reflection of both disciplines objectives simultaneously.
Feedback and experience from the first Community Visit was very positive
and constructive with some practical changes already planned for next year.
We are in the final stages of planning for our House Call visit which begins in
mid-September; we are very grateful to all our community preceptors who have
offered even more of their time to help introduce our medical students to family
medicine in this new course.
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21
THE BENEFITS OF COMMUNITY
ENGAGEMENT
By Drs. Stephen Darcy and Lisa Bishop
Community engagement is a relatively unusual thing in the life of a medical
clinic. Generally, physicians operate within their office space and do not engage
with the community at large. Even for academic physicians and pharmacists,
this is not the norm. In 2012 when some of their patients expressed a concern
in the community, the clinic decided to reach out to the community for a
solution.
Our project became community based, and it quickly became clear to us
that we needed to engage our community on various levels if we were to be
successful in our research. To that end, we have endeavoured over the past
year to attend the significant events in the life of the community – both the
celebratory and the sad. Remembrance days, folk festivals, Christmas parades,
winter fests and vigils have all been attended by members of the research
team. We think this has raised our profile and forged a greater link with the
community. This helps not only with the participation in our research but with
our day to day clinical encounters.
The next step of our research is to hold a community event to disseminate the
findings from our exploratory studies and solicit direction on how we can move
forward with developing a community-based wellness program. The research
team was successful in obtaining a grant from the Quick Start Fund for Public
Engagement, with the purpose to facilitate knowledge exchange between the
research team and community, who have ground-level knowledge and potential
solutions for the issue.
One of the four principles of family Medicine is to be a ‘resource to the
community.’ It is our experience that community engagement in and of itself
increases our effectiveness as a resource to the people we serve. As physicians,
we appreciate that our patients have a life outside of our encounters. One
objective of the patient–centered method is to gain some understanding of
this for each patient. So too, our communities have “lives” that we can only
see when we participate. Participation in the life of the communities in which
we serve is beneficial, not only to our practice as physicians, but can enrich our
personal lives as well.
Stephen Darcy is with the Discipline of Family Medicine; Lisa Bishop is with the
School of Pharmacy, cross-appointed to Discipline of Family Medicine.
22
Table of Contents
POSTGRADUATE REFLECTIONS
By Dr. Amy Pieroway
I WILL SOON BE
TAKING ON MY
OWN LEARNERS –
AND NOW, MORE
THAN EVER, I HOPE
THAT I INSTILL
IN THEM THE
LESSONS THAT I
KNEW BY ROTE
COMING THROUGH
MEDICINE AND
RESIDENCY, BUT
WHICH ONLY REALLY
STRUCK HOME
WHEN I WAS ON
THE OTHER SIDE OF
THE CURTAIN.
I had a “full circle” experience recently, when I was admitted to hospital for
surgery. I was visiting St. John’s, during the power outages in the winter, and
woke one morning (after a joyful night of wine and steak with old medical
school friends) with a stabbing pain in my epigastrium. Why I decided not to
go to the hospital at this point, I’m not sure. It could have been that there
had been a storm the night before, and I would need to dig a path out of the
house, or it could have been that I suffer from, what a lot of us would recognize,
fear of appearing silly by going into the emergency department and finding
out that there is nothing wrong. Two hours later, still decidedly alive, the
pain migrated to my right upper quadrant, and I realized that I was having a
gallbladder attack. It was my first one, and when it didn’t pass, I decided to dig
myself out of the snow storm from the night before and head to the HSC ER.
While waiting for the Toradol to kick in, I flashed back to a class in my first year
of medical school, being told that the tetrad for cholecystitis was female, forty,
fertile and fat. In medical school, I had always viewed illness from the safe
place of a young, healthy, athlete, who would never get sick. Unfortunately, I
was merely a mortal, who had not taken good enough care of her body though
the rigors of residency – 3 a.m. snacks from the hostel vending machine and
celebratory beer after a particularly trying call shift at St. Clare’s.
I was then admitted into a four-bed ward. I had been here before, but always
on the other side of the curtain. I thought I knew about the lack of privacy, body
odour and noise of a surgical ward, but in hindsight, knew nothing about the
real patient experience until I was one myself. Then came morning rounds; a
well-meaning pair of clerks came to see how I was doing; they pulled back the
blue curtain, did not introduce themselves, and proceeded to prod my very
tender abdomen without asking. I knew the lessons taught in first year clinical
skills – I had been there! I looked back at my student self and asked, “Was that
me? Had I done that too?” and to be honest, I’m sure I had at some point. I
felt badly for those patients, because my clinical skills teacher had been right, it
felt pretty invasive.
Never had I been so glad to get my surgery completed, and to get out of the
hospital. A place I had, at one point, considered (deludedly) home.
I am now just finished my first year of practice as a family physician in Corner
Brook, NL. I still feel like I am floundering, and drowning in paperwork, and
that I will never know enough. It has been getting easier though; I look at
my schedule in the morning, and know 90 per cent of the names there, and
generally what to expect. Though I am still female, fertile, fat and getting ever
closer to 40, I am working on what I can change. I will soon be taking on my
own learners – and now, more than ever, I hope that I instill in them the lessons
that I knew by rote coming through medicine and residency, but which only
really struck home when I was on the other side of the curtain.
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23
HISTORY IN FAMILY
MEDICINE PROJECT
By Dr. Cathy MacLean
The medical school at MUN celebrates 50 years in
2017. As a new chair, I have been interested in the
history of the Discipline of Family Medicine at MUN.
We are at a critical point in our history as the original
leaders of family medicine age and there will be
missed opportunities if we don’t capture this history
now.
Unfortunately Gus Rowe passed away last year.
Our pending move to a new location in the Health
Sciences Centre also creates an opportunity to clear
out old materials from hiding places long forgotten
and make sure they are preserved. We have also been
working with Stephanie Harlick, the medical school
archivist, who has been doing a great deal of work to
go through our old records and files.
Our past is a story that has many amazing players,
events and accomplishments to celebrate. We had
historian Allan Byrne working on the project briefly this
past winter. He is now working full-time at The Rooms.
Several people have brought in mementos, pictures,
tapes, stories and documents. I have met with past
chairs including Carl Robbins, John Lewis and Paul
Patey. We have had a visit from David Moores last
summer and talked about the discipline’s history.
The Archive Committee will be up and running again
this fall. If you interested, join us! We could use
your help. Our goal will be to have a history of the
Discipline of Family Medicine done in time for the 50th
anniversary of MUN’s medical school.
BOOK REVIEW
By Dr. Paul Bonisteel
Clinch. The pillar of
Trinity, by Edmund
Burry.
DRC Publishing, St. John’s
NL. 2011. ISBN 978-1926689-35-7
Any of you who have
visited the community of
Trinity may have seen the small plaque outside St.
Paul’s Anglican Church erected by Historic Sites and
Monuments Canada to John Clinch (1749-1819)
surgeon, Anglican priest, customs officer, justice of
the peace and magistrate. Clinch is credited with
being the first to introduce the Jenner smallpox
vaccine to British North America.
Jenner and Clinch knew each other since the age
of 13, both first apprenticing with Daniel Ludlow,
pharmacist and surgeon, in Chipping, Sodbury,
South Gloucestershire. At age 20, they began
further studies under John Hunter (1728-1793)
British physiologist and surgeon who founded
surgical pathology. In 1775 Clinch left England for
Trinity and Jenner remained to continue his work
which included 20 years of work in developing his
smallpox vaccine.
Jenner’s work was based on the widespread
common knowledge among milkmaids, but
not among more learned persons, that if one
contracted cowpox it rendered one immune to
smallpox. It speaks to the systematic observation
of diseases, their spread and consequences
later elaborated by William Pickles, author of
Epidemiology in General Practice (1939).
Author Edmund Burry, husband of celebrated St.
John’s visual artist Elizabeth Burry, is determined
to bring the many achievements of this man, Dr.
John Clinch, to life in this historical novel. The book
is enlivened by actual letters exchanged between
John Clinch and Edward Jenner and other historical
documents.
Clinch himself survived smallpox as a child but his
twin sister Sarah did not. His continued spiritual
connection with his deceased sister and the support
given him through that runs through the book. At
215 pages it is a quick and satisfying read.
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AN INTERPROFESSIONAL
LENS
By Dr. Denise Cahill
A home-based primary care model that provided acute and
ongoing preventative care to frail seniors within an organized team
based care model was developed at the Ross Clinic in 2007. This
model was created to reduce primary care service gaps by utilizing
an interprofessional collaborative approach to seniors’ complex
medical requirements. The team consisted of physicians/residents,
nurse practitioner, and a clinical pharmacist, and utilizing the
community social workers, occupational therapist, physiotherapist,
community health nurses and dieticians to complete the circle of
care.
FEDERAL COURT
JUDGMENT
DECLARES
FEDERAL
GOVERNMENT
CUTS TO
REFUGEE HEALTHCARE UNLAWFUL
AND UNCONSTITUTIONAL
By Dr. Pauline Duke
The shared goals or vision of the program were to reduce
emergency room visits, hospitalizations, improve quality of
life, access to care, patient safety reduce caregiver burden and
improve health care expenditures. These common goals/vision
and an understanding of each other unique roles (role clarity) and
perspective fostered an environment of trust and appreciation of
the unique perspective that each health professional brought to the
table. The case load was shared and open communication between
all members was established via formal/informal conversations.
Canadian Doctors for Refugee Care
(CDRC) formed in 2012 to challenge the
cuts made by the federal government to
the Interim Federal Health (IFH) program
for refugees.
As the nurse practitioner I organize a shared caseload among
all team members as care is required which ensured an equal
distribution of workload and sharing of responsibilities. Our team
and program have been very effective in creating a team culture
that fosters mutual respects, equal voices where differences are
valued, and team members are encouraged to express their
knowledge, skill and experience.
The IFH program previously paid for
basic health care for refugee claimants
until they left Canada or became eligible
for provincial health care. Without notice
or consultation, the federal government
abolished the program in June 2012,
and replaced it with a program that
denies basic, emergency, and life-saving
medical care to thousands of refugee
claimants who have lawfully sought
Canada’s protection.
These team strategies promoted an environment of patient centred,
comprehensive care that was accessible, timely and focused on
promoting wellness for the patient/family. The home study that we
completed revealed that although the numbers of hospitalizations
remain unchanged are patients were identified as having more
co-morbid conditions and complex care issues. Families revealed
a reduction in care given burden and improved quality of life of
the patient and residents performing the house calls with team
reported it as a positive learning experience. We are adapting
this mode/ interdisciplinary approach for a new program starting
in January to provide primary health care to patient living with
developmental disabilities.
In 2013, CDRC along with the Canadian
Association of Refugee Lawyers and
other partners challenged the legality of
the IFHP cuts before the Federal Court
of Canada.
On July 4 this year, Justice McTavish
of the Federal Court in her judgment
declared the federal government
cuts to the IFH Program unlawful
and unconstitutional. The federal
government is appealing the decision.
For the full decision see http://cas-ncrnter03.cas-satj.gc.ca/rss/Bulletin%20
T-356-13%20Cdn%20doctors%20july-042014%20ENG.pdf.
“Never doubt that a small group of thoughtful, committed people
can change the world.
Indeed. It’s the only thing that has ever has.”
Margaret Mead
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25
FAMILY DOCTOR SPECIALIZES
IN ELDERLY CARE
Dr. Susan Mercer (Class of 2010) is a part-time faculty member based at the
Miller Centre who works with Eastern Health’s Rehabilitation and Continuing Care
Program. As a family physician who has added competence in care of the elderly,
her work is largely based on referrals from other family doctors.
“THE ULTIMATE
GOAL IS A GREATER
CLINICAL PRESENCE
IN GERIATRICS IN
THIS PROVINCE SO
THAT THE NEEDS
OF THE AGING
POPULATION CAN
BE MET,”
“Right now I do not have a primary care practice,” she explained. “My time is
taken up as a consultant and I take referrals for dementia assessment, falls and
other geriatric issues. As a consultant I can take extra time to evaluate the patient
and do a comprehensive geriatric assessment.”
Following graduation, Susan did her family medicine residency at Memorial;
at the end of her first year as a resident she did a one-month elective at the
University of Alberta, where there is a well-established program in geriatrics. She
enjoyed the experience and following her residency she went back to Edmonton
and completed a one-year Care of the Elderly Diploma Program. Hot link: www.
familymed.med.ualberta.ca/Home/Education/ThirdYear/Elderly/diploma.cfm
Susan said that given the way the population is aging, many family doctors have
a large proportion of their patients who are 65 years of age or older and have
complex medical issues. Her work also includes visiting long-term facilities.
With support from Roger Butler, Susan is becoming involved in research. During
the Care of the Elderly Diploma Program at the University of Alberta she was
involved in a project investigating the knowledge and attitudes of physicians in
our province regarding medical fitness to drive. In 2013 she authored an abstract
titled Care of the Elderly Training in a Family Medicine Residency Program: an
Evaluation Based on Residents’ Perceived needs published in the Canadian
Geriatrics Journal and presented at the Canadian Geriatrics Society Conference.
She is interested in continuing research in medical education and models of care
in geriatrics.
In addition to her clinical and research work, Susan is becoming involved in
teaching in the Family Medicine Residency Program as well as the Undergraduate
Medical Education Program. She hopes that through increasing exposure to
geriatrics more students will become interested in pursuing further training in
the area. “Her presentation to the Family Medicine Interest Group was very wellreceived,” commented Cathy MacLean, chair of the Discipline of Family Medicine.
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LEADING THE WAY AS A NURSE
PRACTITIONER HEALTH COACH
Heather Pitcher has a new role as a nurse practitioner (NP) health coach in
the Family Practice Unit at the Health Science Centre. She has been in the
nursing field for 24 years and has recently established a clinical practice. She
will receive patient referrals from physicians within the Family Practice Unit and
other medical clinics. She has also opened her practice for self-referrals, as well
as those from community members and other health professionals.
“THIS INITIATIVE
WILL EXPAND
THE INTERPROFESSIONAL
MODEL IN PRIMARY
HEALTHCARE AND
FILL A VITAL GAP
FOR INDIVIDUALS
SEEKING A
MEANINGFUL
GOAL ORIENTATED,
HEALTH
PROMOTING
APPROACH TO
THEIR HEALTH AND
WELLBEING.”
Heather brings an extensive combination of experience and training to the
Family Practice Unit that make her uniquely qualified for this exciting new
position. Over the last four years, she has worked with Dr. Marshall Godwin
at the Primary Healthcare Research Unit (PHRU) to carry out a randomized
control trial investigating whether a health coaching intervention delivered by
a certified health coach is an effective strategy to influence lifestyle behaviour
and prevent/delay the onset of disease, specifically diabetes and high blood
pressure. Study outcomes will be forthcoming over the next year or so as the
data is analyzed and translated to literature.
“This ground-breaking new health coaching role focused on health promotion
in a primary care practice,” said Heather. “This initiative will expand the interprofessional model in primary healthcare and fill a vital gap for individuals
seeking a meaningful goal orientated, health promoting approach to their
health and wellbeing.”
Heather is a primary healthcare –nurse practitioner (NP) and in addition
she has completed her coaching certification training through the Newfield
Network at the University of Calgary in 2009. She has achieved over 1,200
hours of coaching through both group and individual work and has recently
been successful in obtaining her Professional Coaching Certification (PCC)
designation with the International Coaching Federation (ICF). The ICF is a
coaching association of more than 20,000 coaches across the globe.
As an extension of Heather’s fee-for-service clinical practice, she will be
pioneering within Memorial University’s learning environment as well. She has
been granted a part-time appointment as a Clinical Assistant Professor in the
Discipline of Family Medicine, Faculty of Medicine at Memorial University.
If you are interested in learning more about Heather and her work and/or
would like to make a referral for coaching please let her know by emailing her
at [email protected] or calling the Family Practice Unit at 709 777
7795.
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27
ON THE ROAD
During June 2014, MUNMED editor Sharon Gray and HSIMS photographer John Crowell visited
rural teaching sites in Twillingate, New World Island, Botwood, Grand Falls and Burin. Here are some
highlights from the trip.
TWILLINGATE
Twillingate is well-known for its scenic beauty, especially
the icebergs that crowd the harbour in late spring
and draw tourists (see cover photo). What is not so
well-known is that the community’s Notre Dame Bay
Memorial Health Centre is a model rural teaching site for
Memorial’s Faculty of Medicine.
Medical students and residents come to Twillingate to
learn about rural medicine, and some residents spend
up to a year in the community as part of their training.
Marilyn Rideout, administrative
assistant (Twillingate) for
the Rural Medical Education
Network (RMEN) and
Mohamed Ravalia, assistant
dean for RMEN and senior
physician at the Notre Dame
Memorial Centre.
Under senior physician Mohamed Ravalia, the four doctors on staff are all
MUN graduates. “Dr. Rav,” as he is known around the hospital, is engaging
and fully committed to Twillingate and to rural medical education. Originally
from Zimbabwe, he came to Newfoundland following postgraduate training
in the United Kingdom and settled in this small rural community 30 years ago.
He’s created a warm and inviting educational environment, and Twillingate is a
favourite place for rural electives.
Mike Keough, who earned his MD at Memorial in 2008 and finished his family
medicine residency in 2010, has been working in Twillingate ever since. “I was
here as a resident and loved the community – Dr. Ravalia is a great preceptor
and creates a comfortable, supportive environment.”
A diverse practice that includes outpatient clinics and emergency room
coverage is all part of Mike’s life. He is also a teacher for medical students and
residents. “I love the teaching and the students get to do a lot of procedures
that they wouldn’t get to do in an urban setting. After four years here I know I’ve
made a great decision.”
To hear more about what Mike Keough has to say about life in Twillingate, visit
http://youtu.be/SXA2I0-W2VI
Colin Newman, is another Memorial graduate who has settled in Twillingate.
He finished his family medicine residency in 2012 and has worked at the Notre
Dame Memorial Centre ever since. “The work is challenging, but we all feel like
we are using all our skills. It can be daunting at times, but it is a huge learning
experience.”
An interview with Colin Newman is at http://youtu.be/yCwOx_OOELU.
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As well as Mike and Colin, the other two physicians on staff are also graduates
of Memorial – Andrew Hunt and Jason Mackey, who both earned their MD at
Memorial in 2009 and settled in Twillingate after their family medicine residency.
“After three decades, our hospital is now fully staffed with doctors trained at
Memorial,” said Mo. “This is a great example of the success of the medical school’s
program, which encourages medical students and family medicine residents to
do much of their training in rural communities and then set up practice in rural
Newfoundland and Labrador.”
Victor Shea, director of health services (Central Health) for the Isles of Notre
Dame, said one of the reasons he enjoys his job is that Twillingate is a teaching
centre. He noted that Central Health and Memorial University work together to
provide accommodations and facilities for medical students and residents, as well
as dedicated space for study and internet connection with the medical school
curriculum.
Victor, who was born in Twillingate and began his career as a social worker, worked
in the health care field in Manitoba for many years before deciding to return home
in 2009. “I wanted to take on the challenges facing rural Newfoundland. While
we’ve succeeded in attracting new graduates Memorial to Twillingate, we still need
to find a way to attract doctors to more isolated communities like Fogo Island,
which depend heavily on international medical graduates who do not stay long in
the community.”
Victor has nothing but praise for Dr. Rav. “He has worked tirelessly for 30 years
to bring our own medical students and residents to Twillingate and give them a
positive experience. He understands the challenges of rural health – right now we
have the oldest demographic in a province that has the highest aging population
and the highest rate of diabetes. People need consistency in their health care
providers – we’ve been able to do that at the Notre Dame Memorial Health Centre
and now it’s time to extend that success to other rural communities.”
It takes a team – doctors, nurses
and allied health professionals work
closely together at the Notre Dame
Memorial Hospital in Twillingate to
provide the best care possible to
patients.
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29
NEW WORLD ISLAND
Just a short drive from Twillingate in New World Island, family doctor Dan
Hewitt and nurse-practitioner Tony Richards staff the local clinic. Dan would
like to see more medical students and residents choose electives in New World
Island.
From left: Dan Hewitt and Tony
Richards
BOTWOOD
The Dr. Hugh Twomey Health Centre celebrated 25 years on June 18, 2014.
Jody Woolfrey http://youtu.be/hQmyvtMUP8c has worked at the centre for
17 years. After finishing his residency he was looking for a practice location.
He visited the Dr. Hugh Twomey Health Centre and fell in love with the place.
Today he enjoys teaching medical students across the spectrum as well as
family medicine residents doing longitudinal training, particularly in specialized
geriatric care. Jody described the work as challenging but rewarding; he
appreciates working with great colleagues and the support from a wonderful
team of health care professionals. To hear what Jody has to say visit.
Another physician at the Dr. Hugh Twomey Health
Centre is Alfred Goodfellow http://youtu.be/
NR8fMGG4BFs , originally from New Brunswick, who
earned his MD at Memorial in 2009 and followed that
with a distributed residency (he was one of first to do a
distrusted learning residency in Grand Falls. He visited
the centre at Botwood for a week and liked it, and is now
on staff.
Dr. Jody Woolfrey at the 25th
anniversary of the Dr. Hugh
Twomey Medical Centre in
Botwood.
Tim McKay http://youtu.be/jcIzRVh50zw is also in
practice in Botwood. He grew up in Victoria, B.C., and
he and his wife did their MDs at University College Cork
and matched back to Memorial for their family medicine residencies. He enjoys
the range of practice and challenges of working in Botwood.
Residents enjoy their time in Botwood. Hear what Kashmala Qureshi http://
youtu.be/Gg0tLi_9fBQ and Raie Lene Kirby http://youtu.be/-yBHJbazfH4 have
to say.
GRAND FALLS-WINDSOR
Developing a model for maternity care
In Grand Falls-Windsor, a hard-working group of obstetrician/gynecologists and
family physicians are working together to provide the best and safest care for
pregnant women and their families.
Steve Parsons, who graduated with his MD from Memorial in 2000 and went
on to complete a residency in obstetrics and gynecology at Memorial in 2005,
has worked in Grand Falls-Windsor ever since. “One of my greatest concerns is
that perhaps over the years doctors and nurses have not done the best job of
educating women about the risks of C-sections,“ he said.
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With emergency physician John Campbell and other members of the team,
Steve is spearheading an education module that can spread the word. Hear
what Steve Parsons http://youtu.be/h21di_AOBUo and John Campbell http://
youtu.be/2fq7LqapDyU have to say about this project, listen to
An interest in wellness
One of the hard-working family doctors in Grand Falls-Windsor is Gina
Higgins, http://youtu.be/YREd4rox66Y who has a particular interest in wellness
issues for physicians and medical students. Originally from Salt Pond, Burin,
she did her MD and family medicine residency at Memorial before moving with
her family to join the enthusiastic group of physicians in the town.
Gina Higgins
Kris Luscombe
Jackie Spencer, academic
program administrator for PERRT
in Burin.
Stacey Saunders is the PERRT lead
in Burin.
A psychiatrist’s perspective
As a psychiatrist practising in Grand Falls-Windsor, Kris Luscombe http://
youtu.be/3SwnPVwLhDc and his colleagues cover a catchment area of 100,000
people, roughly 20 per cent of the population of the province. Where 12 to
16 psychiatrists are recommended for a region this large, there are only eight
in the area. But they have looked at innovative ways to deliver services by
strengthening and supporting family doctors in a collaborative care approach.
“We’ve built a strong partnership with Memorial, especially the Discipline of
Family Medicine, and we offer one of the few psychiatry rotations for family
medicine resident,” he said. “It’s an exciting way to practice.”
BURIN
Lyn Power http://youtu.be/PBCZToBuqNA grew up in
Southern Harbour on the isthmus of Avalon; both her
parents were from Burin. She knew she wanted a rural
practice and in 1998 she set up practice in Burin, where
she is now a full-time faculty member in the Discipline of
Family Medicine. She says Memorial trains family doctors
to do the whole gamut of general practice. “Burin is
a great place to use all your skills and I like teaching
students from this province and others who come on
electives.”
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Lyn Power
31
AWARD CEREMONY HONOURS DOCTORS
The 2014 Family Medicine Education Forum, an annual education event offered in partnership with the
Discipline of Family Medicine at Memorial University and the Newfoundland and Labrador Chapter of the
College of Family Physicians, was held in St. John’s Oct. 1-2. The following awards were presented at the
Awards Dinner.
is a retired professor of psychology
whose work with the MUN Counselling
Centre in the early 1980s helped
develop, with Cheri, a communications
skills course for medical students. In
presenting the award, Cheri noted
that the model developed is still used
today. This new award recognizes
people who contribute to medical
education but who are outside the
Faculty of Medicine.
DR. JODY WOOLFREY, senior medical
officer at the Dr. Hugh Twomey Health
Centre in Botwood, was presented
with the Family Physician of the Year
Award by Dr. Jackie Elliott, president
of the NL College of Family Physicians
of Canada. The Family Physician of the
Year awards recognize outstanding
College of Family Physician of Canada
(CFPC) members who exemplify the
best of what being a family doctor
is all about. Each of the CFPC’s
provincial chapters select a Family
Physician of the Year and these
individuals were also honoured
nationally during the Family Medicine
Forum 2014, which was held in
Quebec City, Nov. 13-15.
A new award was presented for the
first time during the 2014 Family
Medicine Education Forum. The
George Hurley Award in Family
Medicine Education was presented by
Cheri Bethune to the man the award
is named after. GEORGE HURLEY
32
Another new award, the BILL EATON
Family Medicine Humanities Award,
went to the doctor it is named after.
Dr. Eaton received a bound copy of his
columns in MUNMED from 1991-2014.
Always the entertainer, Bill accepted
the inaugural award and delighted the
audience with his musical stylings.
The 2014 Dr. Craig Loveys Award
to ETIENNE VAN DER LINDE, site
chief of emergency medicine at the
Dr. G.B. Cross Memorial Hospital in
Clarenville. The award was presented
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by Danielle O’Keefe. Originally from
South Africa, Etienne has worked
in emergency medicine on three
continents, including rural Africa, prior
to his arrival in rural Newfoundland
14 years ago. He describes himself as
“passionate about rural medicine.”
The Dr. Craig Loveys Award is
presented annually by the Discipline
of Family Medicine to a specialist in
recognition of excellence in teaching
family medicine resident.
PATRICK O’SHEA, who has practiced
family medicine in St. John’s for three
decades, received the Dr. Yong Kee
Jeon Award, presented by Norah
Duggan. This award is presented
annually to a family physician for
excellence in teaching family medicine
residents. Patrick completed his
residency training in family medicine at
Memorial University in 1982. He recalls
that he was Bill Eaton’s first resident
32 years ago at the Shea Heights
Clinic. He is a clinical associate
professor of family medicine and was
named Family Physician of the Year in
2007. He has been a member of the
Newfoundland and Labrador Medical
Association Board of Directors and
prior to being elected president (June
2010-June 2012) he served as the
board chair (2009-10) and honorary
treasurer (2008-09).
Dr. Hillman arrived at Memorial
University in 1976 after a nearly 20-year
association with McGill where she
advised the Kuwait Medical School on
postgraduate training, and taught at
the University of Nairobi. For 13 years
she served in Memorial University’s
Faculty of Medicine as professor
of pediatrics and as director of
ambulatory education at the Janeway
Child Health Centre.
An Award of Excellence from the
NL College of Family Physicians
was presented to MARSHALL
GODWIN, director of the Primary
Healthcare Research Unit, by Charlene
Fitzgerald. These awards recognize
CFPC members who have made
an outstanding contribution in a
specific area including patient care,
community service, college activities,
teaching, research or other elements
of the academic discipline of family
medicine. Marshall said that the
research part of this job defines him
and he appreciates being recognized
by colleagues and peers.
While at Memorial, Dr. Hillman was
also the first female president of the
Medical Education Council of Canada
(1981). Together the Hillmans directed
CIDA-funded programs in Kenya and
Uganda, served as medical consultants
in Kuwait, Zambia, Tanzania,
Singapore, Laos, Malaysia, South
Africa and Bhutan and completed
Canadian Executive Services
Organization (CESO) projects in
Kenya, India, Guyana, the Philippines
and Pakistan, as well as working as
senior medical officers for UNICEF in
Uganda.
Medical student Joanne Delaney,
right, received the 2014 NL CFPC
Medical Student Oration Award. The
essay, which she read aloud, was
based on her Black Bag experience as
a medical student.
Other awards recognized during the
2014 Family Medicine Education
Forum include The Gus Rowe
Teaching Award went to Gabe
Woollam, chief of staff in Happy
Valley-Goose Bay and director of the
Northern Family Medicine Education
Program. Gabe was unable to attend
the ceremony. The recipient of the
award is chosen each year by family
medicine residents to physician
teachers in the program who are
exemplary physicians, laudable
teachers, and have an interest in
sharing those aspects of their skills
and ideals which are particularly
pertinent to good family practitioners.
A Janus Research Grant to Stephen
Darcy for the project A CommunityBased Participatory Research Project
Addressing Youth Mental Health
and Addiction in a Small Urban
Community: Research that Matters.
Carl W. Robbins and Robert
J. Williams, both of St. John’s,
were named Life Members 2014
Newfoundland and Labrador.
Kristian Green, a family medicine
resident, received a Norlien
Foundation Grant for Addiction
Education.
This beautiful quilt was presented
to DR. NORAH DUGGAN, left, for
her “passion and hard work” with
the NL Chapter of the College of
Family Physicians of Canada. The
presentation was made by Drs.
Jackie Elliott, right, and Dr. Charlene
Canadian pediatrician DR. ELIZABETH
HILLMAN was named an Honorary
Member of the College of Family
Physicians of Canada. This national
award honours those who have made
outstanding contributions to family
medicine over their career. Along with
her husband, Dr. Donald Hillman,
Dr. Elizabeth Hillman received the
Order of Canada in 1994 for her
work in international child health and
development.
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33
COMPLICATIONS OF A MOLAR PREGNANCY
By Dr. Gina Higgins
Such an intense maelstrom of
emotion, is that little pink strip
on a stick. It can be the initiating
event for breathless hopeful joy,
or breathless stomach-churning
fear. It can be the trigger for
every scintillating emotion on that
spectrum; alternating or all at once.
The effects that that chemical
reaction induces in the amygdala
rarely looks the same after they
have had the chance to evolve
under the competing pressures of
human caring, love, stress, logic…
under the pressures of life. Maybe
this is especially so when the pink
strip is not planned.
Sometimes, what emerges from
this storm is a warmly enveloping
sense of welcome and anticipation
of a new life to hold and cherish
and teach and love; the more
precious for its unexpectedness.
Mei came to my office in her
first trimester of an unintended
pregnancy. On paper, she is a
26-year-old lady of Asian descent,
from Ontario, a G1P0 and healthy.
In reality, she is certainly this,
but also is layered with a unique
intelligence and humour; a maturity
that belies her years but which
has been hard won. She had been
having spotting.
On the first visit for this at 11
weeks, it was only a trace of pink
on the tissue. She was up to
date with her Pap smears, and
had no other symptoms. Pelvic
examination was normal. Her
first two visits had been routine.
A fetal heartbeat could not be
auscultated; she was early to
expect to hear this, but still wanted
to try.
Two days later, Mei was back in
the office. Her trace pink spotting
34
was now bright red spotting, but
without cramping or again, without
any other symptoms. She was
worried. Her Beta HcG was higher
than expected for her gestational
age, but her blood work was
normal otherwise. The radiologist
was called and an ultrasound
arranged for that afternoon.
alone in the room. It was not overt
in her words, but everything else
screamed pain. Tone. Posture. The
tension with which she held herself.
Her eyes which focused only
inward and could not meet my own
while speaking. Virgil could not
have more eloquently expressed
the depths of her personal hell.
This discussion is always a
difficult one. This young lady
had the capacity to intellectually
comprehend the differential
diagnosis, but of course her
understanding came layered with
acute emotion. Her unintended
pregnancy had evolved within her
world; it was now, to Mei, a baby.
Of course she understood that any
pregnancy at this point would be
just beginning to form features, to
develop anything identifiable as
‘human’. However, her perception
of her conception had defined it on
its own terms. It was a baby.
We talked for a while. It helped
a little for her to know there was
nothing that she did to have
caused this. It didn’t help enough.
She didn’t cry. She did hug me,
and I reciprocated – not only as
her family physician but as another
human who sees the intensity of
suffering and wants her to know
she is not alone. She still didn’t cry.
That evening, I was on call, and
was paged by the radiologist.
There was a molar pregnancy,
and it could not be determined
whether it was partial or
complete. She needed to see
the gynecologist for evacuation.
I asked her to come down to the
outpatients department where I
already was.
When I discussed with her the
results, her face looked like she
had been told someone she loved
had died. I held her hand while
explaining that what she had
thought of as a baby was actually
a genetic anomaly that could act
similarly to a cancer.
She sat on the gurney, with the
babbling hectic ever-present
emergency room cacophony
underlying her thoughts. We were
Table of Contents
I stayed with her in the operating
room while the molar pregnancy
was evacuated. Such a leaden
weight of sorrow and loss that
drags at the mind and the heart,
evoked by seeing that thick mess
of bloody tissue in a suction tube.
Life and emotion and humanity in
surreal reality.
You know what? There is nothing
that can be said in the face of
losing a baby that can make it any
better. There would be nothing
helpful for Mei in ‘at least it was
caught early’, or ‘you can always
try again.’ All I had to offer as a
clinician, after years of education
and experience, was the human
connection of a hug.
The on-call rota I was on that night
was for obstetrics. Introspection
is a luxury. In the meantime, there
were babies to deliver.
Afterward, I cried.
Table of Contents
35
Dr. Dennis Rashleigh
Dr. Erin Smallwood
Dr. Carmel Casey
Dr. Lynette Powell
Dr. Karen Horwood
RMEN Site Leads - Central
RMEN Site Lead - Labrador-Grenfell
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Health Sciences Centre
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TBA
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SUPPORT
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Chair
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