A new model for medical education — by way of Chilliwack

Integrated clerkship student Caylib Durand checks in with patient Henry Burrows at Chilliwack General Hospital.

The conventional method for educating medical students, particularly in the third and fourth years, is the rotation: a few weeks immersed in one specialty (let’s say pediatrics) and then a few weeks spent in another specialty (let’s say gastroenterology), followed by a few weeks in another, until all of the bases — theoretically — are covered. But there has been a move toward a more holistic view of what it means to practice medicine and a more genuine understanding of what the patient is experiencing. UBC is one of the pioneers in this movement, having created a so-called “integrated clerkship” in Chilliwack that has since become a model for similar programs in five other B.C. communities. Students are assigned for a year to a family physician with both an office practice and responsibilities for patients at a local hospital, and follow patients through the health care system, supplemented by academic sessions with local and visiting specialists. So instead of seeing a patient briefly as they pass through the hospital and then perhaps never seeing him or her again, they might seen an expectant mother each week at a pre-natal clinic, help deliver her baby at the hospital and then provide follow-up exams. It can be stressful for some students, because it means learning many things at once, but it helps them see the “commonalities among all disciplines,” in the words of Mark MacKenzie, who oversaw the Chilliwack program for five years before going on to oversee all such programs throughout the province. Read more about UBC’s role in re-thinking medical education in the spring 2012 issue of UBC Medicine magazine.

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Extending psychiatric care — and training — to Fraser Health

L-R: Psychiatry resident Charlena Chan discusses patients with Clinical Assistant Professor Anson Koo

Five years ago, Fraser Health’s psychiatrists were stretched to the limit. “We were undergoing a demographic explosion, and had the second-lowest psychiatrist-to-population ratio in the province,” says Anson Koo, a Clinical Assistant Professor of Psychiatry and Division Leader of Fraser Health’s Adult Mental Health Programs. If nothing changed, the situation was likely to worsen, thanks to the impending retirement of a large cohort of psychiatrists. So Dr. Koo and his colleagues convinced the Faculty of Medicine and the Ministry of Health to create a full, five-year psychiatric residency program based in Fraser Health. Now entering its third year, the program brings in six new psychiatric residents a year, who complete their training — and care for patients — in the health authority’s wide array of hospitals, residential mental health facilities and outpatient clinics. In the most recent CaRMS residency match, all six positions were filled in the first round. And the presence of aspiring psychiatrists in Fraser Health has also attracted more experienced ones, drawn by the growing academic culture, with its promise of more frequent contact with students and residents and greater opportunities for research. As a result, the months-long waits for outpatient mental health services are becoming increasingly rare, and more specialized services are more available. It’s a great example of UBC’s educational needs dovetailing with the public’s health care needs. Read more about it in the spring issue of UBC Medicine magazine.

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Making hospitals healthier places

Tuberculosis has made an alarming comeback, and among the people facing the highest risk of contracting the disease are health care workers — especially those in the developing world. But the vulnerability of those on health care’s front lines has been largely overlooked. Enter Elizabeth Bryce (left), a Clinical Professor in the Department of Pathology and Laboratory Medicine and Annalee Yassi (right), a Professor in the School of Population and Public Health. The duo started working with each other during the SARS epidemic of 2003. After the outbreak subsided, they set about determining what protective measures should be used by health workers, depending on a patient’s symptoms, the procedure being done and the setting. While SARS hasn’t returned, they have parlayed their knowledge in the fight against TB, especially in South Africa — where most people have the latent form of the disease (the bacteria is in in their lungs but isn’t spreading or causing symptoms). They introduced a web-based system for tracking incidents, exposures, risks, immunizations and infection, developed a workplace audit that enables workers to evaluate their facilities and identify problems, and produced an online tutorial to train health workers about personal protection. Read more about their efforts in the spring 2012 edition of UBC Medicine magazine.

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An injection of humanity

Patients are supposed to be the centre of attention for students preparing to work in one of the health professions. But somehow, in the rush to learn all there is to know about treating, curing and healing, students rarely get a chance to know patients in any meaningful way — the choices they have to make, the barriers they confront, the frustrations they encounter. Now, thanks to the Interprofessional Health Mentors Program, the learning process will get an injection of humanity. It has matched small groups of students with a mentor grappling with some kind of chronic condition — some have a spinal cord injury, others have multiple sclerosis, still others have arthritis, epilepsy, HIV/AIDS or mental health problems. Their meetings take place during a 16-month period—a virtual epoch in the frenzied, “if it’s Tuesday it must be anatomy” whirlwind of becoming nurses, occupational therapists, dentists, physicians and pharmacists. UBC borrowed the idea from Thomas Jefferson University in Philadelphia and Dalhousie University, but reworked it to give students and mentors more control. “We obviously set some objectives, but we didn’t want to constrain the learning,” Towle says. “We wanted to see what would happen.” To find out what is happening, read about it in the March issue of UBC Reports.

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Attention all employees: Live longer

Imagine your boss coming to your cubicle and, in the course of dumping yet another assignment on your desk, says, “Oh, and one more thing: Eat more fruits and veggies. You’ll thank me for it. Carry on!” A more subtle version of that scenario is unfolding at three universities in B.C., thanks to research by Carolyn Gotay, a professor in the School of Population and Public Health. An expert in cancer prevention, Dr. Gotay is leading “Be Well at Work,” a three-year experiment aimed at getting people to live healthier lives by winning their hearts and minds at the workplace. The three research sites — UBC’s Okanagan campus in Kelowna, the University of the Fraser Valley in Abbotsford, and Thompson Rivers University in Kamloops — are using three different programs to encourage employees at those institutions to pursue better nutrition and more exerise. One program is focused on individuals, another is focused on group activities, and a third is a blend of the two. The general premise makes sense, given how employees are such a captive audience — more than two-thirds of Canadians spend 60 percent or more of their time at work. The data will come through health risk questionnaires that employees will be asked to complete at various points during the campaigns. It will be interesting to see whether our bosses are any better than our mothers at getting us to eat our veggies. Read more about “Be Well at Work” in UBC Medicine magazine.

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Innovation squared

The best innovations often arise from the joining of two distinct, independently developed innovations. Two members of the Faculty of Medicine are on their way to proving that principle yet again. Peter von Dadelszen, a specialist in high-risk pregancies, has devised a model for diagnosing pre-eclampsia (high blood pressure during pregnancy) that is geared toward developing countries. Mark Ansermino, an anesthesiolgist, is co-inventor of a mobile phone-based pulse oximeter, which uses a probe fitted over a patient’s finger to measure blood oxygen levels, and is perfectly suited for use in low-resource health care settings. The latter invention has many potential applications, and one of them happens to be detecting pre-eclampsia. So, in one of those cases of interdisciplinary fusion, Dr. von Dadelszen and Dr. Ansermino have joined forces to customize the mobile pulse oximeter for pre-eclampsia detection. Their proposal was deemed so compelling that it won a seed grant of $250,000 from an international competition, “Saving Lives at Birth: A Grand Challenge for Development” — one of just 19 chosen from among 600 applicants. (The backers include the Bill & Melinda Gates Foundation, Grand Challenges Canada, the U.S. Agency for International Development, the World Bank and the government of Norway.) The doctors will use the funding to test the application and hardware in Zimbabwe and South Africa, comparing results with clinics that aren’t using the technology. Read more about their ingenuity in the fall issue of UBC Medicine magazine.

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Boiling things down

The biggest challenge facing life scientists — beyond curing disease, of course — is explaining what they do. Most of them are labouring on molecular mysteries that are difficult to visualize and involve a cascade of processes, and thus elude easy comprehension by the general public. And in these attention-deficient times, if it’s not easily understood, people move on. But explaining those mysteries and cascades to people outside the lab is crucial if scientists hope to continue to get support for their work. That was probably why the University of Queensland in Australia created the “Three Minute Thesis” competition. The 3MT, as it’s called, is a geeky version of “American Idol”: graduate students get up before a panel of judges and have three minutes to explain the breadth and signficance of their research to a non-specialist audience, in (you guessed it) three minutes. They can use only one slide and can’t use any electronic media or props. UBC held its first 3MT last spring — the first North American university to do so. To find out what it was like for one of the finalists, read her first-person account in the latest issue of UBC Medicine magazine.

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Flashes of brilliance

The Verisante Aura detects melanomas. The VELscope highlights oral cancers. The PortaMon looks for bladder disease. Three distinct devices, but all three are examples of UBC researchers developing or deploying various forms of light to find pathologies that elude old-fashioned examination with the naked eye.

  • The Verisante Aura (demonstrated in photo at right by one of its co-inventors, David McLean, a Professor and former Head of the Department of Dermatology and Skin Science) exploits a phenomenon known as the Raman shift — the change in energy when light is scattered by a chemical bond, in this case, the bonds found in tissue molecules. “The shift tells you something about the chemistry of the skin,” says Harvey Lui, Head of the Department of Dermatology and Skin Science, and one of the device’s co-inventors.
  • The VELscope generates “blue light” that, when reflected and viewed through optical filters, can distinguish between healthy tissue (which emits a greenish glow) and cancerous tissue (no glow). UBC researchers are now leading a trial on 400 patients at nine sites across Canada to evaluate its effectiveness in reducing the recurrence of oral cancer.
  • The PortaMon measures how much near-infrared light bounces back from the bladder wall when projected through the skin; the resulting data reveals oxygen levels and blood flow that indicate whether the organ’s muscles are functioning properly. A UBC team has found that the cellphone-sized device is as reliable as the current “gold standard” tests, urethral and rectal catheters, which are stressful and painful for patients.

Read more about these inventions — and UBC’s role in making the most of them — in the latest issue of UBC Medicine magazine.

 

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Setting a global dragnet

It’s not terribly difficult to spare a woman from the dangers of pre-eclampsia, the sudden onset of high blood pressure during pregnancy. She must be hospitalized so that her blood pressure can be managed, her seizures prevented and her delivery induced, which is the only sure treatment. But in the developing world, identifying women who are at risk for pre-eclampsia and getting them to a hospital is hardly a given, and that’s why pre-eclampsia is the world’s second leading cause of maternal death. Peter von Dadelszen (pictured on left), an Associate Professor in the Faculty of Medicine, calls it a “social equity issue.” And he is determined to bring some balance to the situation through a multi-pronged, multi-year project that has received $7 million from the Bill & Melinda Gates Foundation. It will seek to monitor, prevent and treat pre-eclampsia in Africa, Latin America, South Asia and Asia-Oceania, tailoring the strategies to the particularities of each locale. One prong of that project will seek to create a “treatment pipeline” from remote villages to properly-equipped medical facilities in urban centres. Read more about Dr. von Dadelszen’s mission in the spring issue of UBC Medicine magazine.

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Applying algorithms to anesthesia

Mark Ansermino (on left) is an anesthesiologist, whose job is to protect patients from pain or complications during surgery. Guy Dumont (on right) is an electrical engineer, whose specialty is control processes for wood pulp processing. Not a whole lot in common — at first glance. But these two UBC professors have been working together for years to make anesthesia safer through computing. One of their inventions precisely and instantly calibrates the amount of anesthesia to a patient’s level of consciousness. Another invention looks for patterns coming from more than 70 different sensors, teasing out signs of danger. They have even developed a vibrating belt that converts the data and warnings into something the anesthesiologist can feel, as well as as see on a monitor or hear through an audible alarm. Now Dr. Ansermino and Dr. Dumont are turning their attention to the developing world, where monitoring of patients under anesthesia is often limited to keeping a finger on someone’s pulse. Their work earned them the prestigious Brockhouse Canada Prize, which recognizes collaborations between scientists in engineering and the natural sciences. Read more about their work in the spring issue of UBC Medicine magazine.

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