The Southern Medical Program officially welcomed the SMP Class of 2023 to UBC Okanagan in early January. Meet first-year student Tanelle Smith.

Name: Tanelle Smith
Hometown: Born in Dawson Creek, BC

Why did you choose a career in medicine?
I chose a career in medicine largely because I wanted to be in a position where I can help people. Other than directly working with people, I also hope to be involved in research and outreach to help bridge gaps that exist between various populations. Beyond the impact that I hope to make, I also am drawn to medicine for the challenge I feel it promises and that will force me to grow, learn and improve. I chose medicine because I felt there was no other profession that could give me the same excitement to push myself while also the ability to help and feel fulfilled

What do you like to do in your spare time?
In my spare time I enjoy rock-climbing, hiking and pretty much any other activity that gets me outside. Indoors, if I am not studying, I mostly spend my time playing games with family or cooking up some concoction that I unfortunately can never quite replicate.

If you could travel anywhere, where would you go and why?
There is a long list of places that I still have on my list, but I think the next place that I would like to go is the Borneo side of Malaysia. When I visited Malaysia previously this was an area that I never made it to, but constantly heard of the great diving experiences that it offered. One of my passions outside of medicine is tropical marine ecology and so I would really just love to visit and spend a some time geeking out over tropical fish in the warm weather.

What are you most looking forward to about training with the Southern Medical Program?
I am looking forward to being a part of a smaller class size and really get to know my peers as well as the faculty. That is one of the main things that drew me to a distributed site besides the closeness to family.

Southern Medical Program Student: Parm Khakh, Class of 2021
Research Supervisor: Dr. Jasmine Grewal, Clinical Assistant Professor, UBC Department of Medicine, Division of Cardiology

What’s your research about?

The pathophysiology of Fontan-Associated Liver Disease is not well-documented aside from the state of chronic passive congestion caused by the disturbance in the liver’s blood supply and drainage. Studies have shown that these patients commonly develop histological liver abnormalities; therefore, effective screening methods need to be in place to ensure the patients experiencing these complications are identified early to facilitate quicker treatment and decrease morbidity associated with this condition. There are no robust guidelines in the utilization of the biomarker Alpha-Fetoprotein (AFP), and its requisition varies widely between physicians. Currently, the Pacific Adult Congenital Heart (PACH) Clinic at St. Paul’s Hospital, does not utilize AFP until there is an identified abnormality on imaging, which is most often assessed by abdominal ultrasonography (US). Due to substantial inter and intraobserver variability in abdominal US and the reduced sensitivity in patients with early-onset liver disease, it is understandable why clinical examination, laboratory data, and imaging, with or without histological evaluation, are essential in ensuring hepatological complications are not overlooked.

Although the Fontan procedure has significantly reduced early childhood mortality for these patients, it is also important to avoid premature death in adulthood. Therefore, this retrospective chart review assessed and compared patients’ current age, liver enzymes (alkaline phosphatase (ALP), gamma glutamyl transpeptidase (GGT), aspartate aminotransferase (AST), alanine aminotransferase (ALT) from 2014 to present, as well as AFP and imaging studies completed over the same time frame.

What were your findings?

The retrospective chart analysis showed that there were a number of patients that were not getting the full workup during their annual visits. Of the one-hundred and two patients included in the study, nine patients had clinically elevated AFP levels, but only three had diagnostic imaging studies done. Ten patients had abnormally high levels of AFP, and only one had gotten a diagnostic imaging study, which was completed more than five years ago. There were nineteen patients that had never had an AFP level assessed. This finding indicated that a large proportion of the individuals were not getting adequately worked up, and potential complications of the Fontan procedure were not being investigated. Of these nineteen patients, none had received diagnostic imaging studies. All of this information together, strongly indicates that hepatic complications could be occurring in these patients, but no evaluations were being done to explore this potentially deleterious outcome. Of these patients, thirteen had abnormal liver US findings, indicated by hepatic cirrhosis, hepatic congestion, hepatocellular carcinoma or chronic liver disease. This finding correlates with the literature which emphasizes that liver enzymes are not an accurate reflection of abnormal US findings and why more workup needs to be assessed. Only twenty-two of the 102 patients have had diagnostic imaging done in the last six years, with seventeen of them having them done in the last three years. This shows that active liver surveillance is improving as physicians’ protocols become more similar, but a lot more work needs to be done to ensure that every patient with this complex circulatory system is getting adequately monitored.

Once the patients with inadequate evaluations were identified, it was decided to have them followed up to ensure that important findings were not missed. Nineteen patients were given imaging requisitions due to the combination of their elevated AFP and abnormal liver enzymes; the imaging study requested was a triple phase CT scan of their livers. Nineteen patients were given lab requisitions to ensure there AFP levels were assessed, so they too could have diagnostic imaging studies should they be necessary. The QI study showed that although active steps are being made to ensure every patient follow-up is similar and consistent, a more thorough assessment of these patients is necessary to ensure their long-term well-being.

This research project was supported through the Southern Medical Program studentship program.

Dr. Robyn Hutching, Assistant Dean, Student Affairs

Dr. Robyn Hutchings has been appointed Assistant Dean, Student Affairs for the Southern Medical Program (SMP). Dr. Hutchings is a pediatric emergency medicine physician at Stollery Children’s Hospital in Edmonton and a Clinical Instructor with the UBC Department of Pediatrics. For the past two years, Dr. Hutchings has served as the SMP Director, Faculty Development and led numerous faculty development initiatives. She has co-chaired the Regional Associate Dean’s Task Force on Student Mistreatment to support the learning environment for SMP students across the Interior Health region. Dr. Hutchings also serves as a clinical skills preceptor in addition to Portfolio Coach and SMP Portfolio Lead.

Dr. Hutchings will work alongside Dr. Melanie Reed, the outgoing Assistant Dean, until February 1, 2020 to ensure a smooth transition process. During the same timeframe, Dr. Hutchings will complete her faculty development duties including the SMP Teacher Certificate Program.

Sadly, we must soon say farewell to Dr. Reed. For the past four years, Dr. Reed has served as a tremendous champion and advocate for SMP students throughout the BC Interior. She has worked tirelessly to ensure our students have exceptional personal and academic support, mentorship, and career guidance. She will be greatly missed by our students, faculty, and staff.

The Southern Medical Program relies on community members to help support the education and training of our students. Meet Matt Scaife, one of our Volunteer Patients that helps with clinical skills sessions at the Clinical Academic Campus at Kelowna General Hospital.

Name: Matt Scaife

Occupation: Retired Mortgage Broker

How long have you been a Volunteer Patient? 7 years.

Why did you decide to volunteer? As a liver transplant recipient, I’ve been very well looked after by all the involved medical professionals. Because of that I wanted to be a help in any way I could. Being available to share my story or be a body they can practice procedures on when ever needed.

What do you enjoy most about being a Volunteer Patient? My favorite part is when the students figure out something new and I can see the light turn on. Plus it’s a pleasure to meet and interact with our future medical professionals.

What is the most interesting thing you have learned?
I am always stunned by how much knowledge the students acquired so quickly into their training.

To learn more about how to get involved, visit https://smp.med.ubc.ca/community-engagement.

A new pilot project with the Faculty of Medicine Centre for Chronic Disease Prevention and Management (CCDPM), Interior Health, and the Kelowna General Hospital Foundation brings together healthcare professionals within Interior Health, UBC researchers, and private donors to foster new research and quality improvement (QI) solutions.

Virtual reality (VR) has recently emerged as an innovative and cost-effective therapy option for stroke patients recovering in hospital. While research shows VR can help improve physical and functional recovery, there is limited research on its effects on mood and patient activity levels.

Through support from the KGH Foundation, a VR unit was acquired for the rehabilitation unit at Kelowna General Hospital (KGH).  The use of this VR technology piqued the interest of rehabilitation staff, but they needed assistance to conduct a thorough research investigation.

“Depressive symptoms and lack of activity are common issues after stroke, especially during in-patient rehabilitation,” says Megan Helgason, Health Services Director, Medicine, Rehabilitation, and Women and Children’s Services at KGH. “We want to address these issues and examine the potential benefits of virtual reality for our patients.”

The research idea fit perfectly with the CCDPM’s new Clinical Research and QI Incubator program. Interior Health staff reached out to UBC researchers and graduate students to complete a needs assessment, literature review, and ultimately developed a research study to explore the potential use of VR therapy for stroke patients at KGH.

“If we can improve the mood of stroke patients during their treatment in hospital, it may offer additional benefits to their recovery and lead to better clinical outcomes,” says Dr. Brodie Sakakibara, CCDPM Assistant Professor.

Over the next year, researchers and IH staff will examine the effects of a VR gaming program on mood and activity levels. Patients will participate in a range of interactive games including relaxation, leisure, and adventure programming that simulate real-life scenarios and tasks.

“These types of small ideas or questions have the potential to turn into research projects that can offer tremendous benefits for patients and healthcare delivery,” says Dr. Kathleen Martin Ginis, CCDPM Director. “We welcome opportunities to work with Interior Health to help accelerate research and QI projects in the region.”

“From a patient quality perspective, this has been an ideal partnership,” says Dr. Devin Harris, Interior Health Executive Medical Director, Quality and Patient Safety. “Interior Health clinicians and staff wanted to evaluate the impact of the VR unit on patient-centered outcomes, and CCDPM provided the research leadership. Our patients and families will benefit from the incredibly positive partnership between Interior Health, the KGH Foundation, and the CCDPM.”

What: Free naloxone training and education workshop
Who: Southern Medical Program student, volunteers with Okanagan Naloxone Training
When: Monday, November 25 at 6 p.m.
Where: UBC Okanagan, Reichwald Health Sciences Centre, Room 260, 1088 Discovery Avenue

Ariel Smith, a Southern Medical Program at UBC Okanagan has seen first hand the impacts of the opioid overdose crisis on Okanagan communities.

During the height of BC’s public health emergency in 2016, Smith volunteered as part of the naloxone training team with Helping Out People Exploited (HOPE) Outreach—an organization that supports homeless and exploited women in downtown Kelowna and Vernon.

For a year and a half, Smith visited homeless shelters and downtown locations. There, using naloxone kits, she trained some of the most vulnerable populations how to prevent opioid overdoses and save lives. Naloxone, if used promptly, can reverse the effects of an overdose from narcotics such as fentanyl or OxyContin.

While volunteers made great strides in education and training in the downtown cores, Smith quickly realized the general public was still largely unaware of the risk factors and how they could potentially help in an emergency.

“Through conversations with family and friends, I recognized a huge knowledge gap still existed in our community,” says Smith. “Especially, considering the majority of opioid overdose deaths in BC happen to people living inside a private residence.”

Now in her second year of studies at UBCO, Smith recently launched Okanagan Naloxone Training as part of the Faculty of Medicine’s FLEX (flexible and enhanced learning) course.

In partnership with HOPE Outreach, Smith offers free naloxone training sessions to people, businesses or volunteer organizations in the Okanagan.

“There is still a large stigma associated with opioids and naloxone training,” says Smith. “In our workshops, we create a safe learning environment for people to ask questions, learn to recognize the signs of an overdose and practice with real equipment.”

Smith is organizing an event at UBCO on November 25. Each participant receives hands-on training, a certificate of completion and a free naloxone kit. This event is free and open to public. To register email: hello@oknaloxone.ca.

For more information about Okanagan Naloxone Training, visit https://oknaloxone.ca.

Dr. Neil Hanon has been appointed Clerkship Site Director, Kelowna General Hospital (KGH) for the Southern Medical Program (SMP). Dr. Hanon is the Department Head of Psychiatry at KGH and Clinical Assistant Professor with the UBC Department of Psychiatry.

Dr. Hanon completed his medical degree and residency with the University of Alberta. From the early beginnings of the SMP, Dr. Hanon led the development of the psychiatry rotation for third-year students at KGH. Since 2008, he has served as a Discipline Specific Site Leader for the SMP and an excellent preceptor for UBC medical students and residents. Dr. Hanon was recently recognized for his contributions to UBC with the Faculty of Medicine’s 2018 Clinical Faculty Award for Excellence in Clinical Teaching.

At this time, the SMP would also like to thank Dr. Vincent Arockiasamy for his dedication and contributions to the continued growth of the Kelowna Clerkship Program. Dr. Arockiasamy will continue his work with the Faculty of Medicine in his new provincial role as Director, Student Assessment.

Southern Medical Program Student: Darren Guenther, Class of 2021
Research Supervisors: Drs. Delia Sauciuc and Siavash Atrchian, BC Cancer – Kelowna

What’s your research about?

Esophageal and esophageal junction cancers are some of the most rapidly increasing causes of cancer death worldwide. While longer wait times from diagnosis to treatment increases the theoretical risk of cancer related complications, previous research on wait times in esophageal cancer is sparse.

Furthermore, the small amount of research on this topic may underestimate the negative impact of long wait times. Consequently, the current study investigates the relationship between wait time and survival via a retrospective chart review of esophageal cancer patients treated at BC Cancer. Apart from determining the effect of wait time on survival, the study also explores the effects of wait time on other important cancer related outcomes, such as: treatment completion rates, cancer recurrence rates, surgical outcomes, pathological findings, and usage of PET scans for staging.

What’s the potential impact?

This project aims to provide a better understanding of the effects of wait time in esophageal cancer survival outcomes. Currently, certain jurisdictions worldwide have established guidelines regarding maximum wait time from diagnosis to treatment. However, no such guidelines exist in BC. As such, the question remains uncertain whether setting maximum waiting times is necessary or valuable for patients with esophageal or esophageal junctional cancers. By further understanding the effects of wait time on survival outcomes, local healthcare administrators will be more informed when creating policies such as maximum wait times. Ultimately, we plan to publish our findings with the hope that empiric evidence will guide medical professionals everywhere as they seek to provide optimal care for their patients.

Thanks to the Colin & Lois Pritchard Foundation for supporting this student research project. 

Drs. Taran Main and Ashandeep Sandhu, recent Southern Medical Program (SMP) graduates, are the 2019 recipients of the BC College Family Physician’s Medical Student Scholarship. The annual scholarship is awarded to two fourth-year medical students entering UBC’s Family Practice Residency Program.

Nominated by Dr. Marjorie Docherty, SMP Clerkship Site Leader for Rural Family Practice, both graduates were recognized for their advocacy and passion for family practice. Dr. Sandhu is currently completing her first year of residency with the Abbotsford-Mission family practice site and Dr. Main with the Rural Okanagan site in Kelowna.

I am honoured to have been selected to receive the BCCFP medical student scholarship and humbled to have the nomination come from Dr. Marjorie Docherty. I am also excited that the co-recipient was a fellow Kelowna graduate!  Family medicine, and more specifically addictions medicine, has always had a special place in my heart, and I look forward to continuing my training in Kelowna.

– Dr. Taran Main

I was fortunate that I knew early on that I was interested in pursuing a career in family medicine. Therefore, I was able to get involved in a variety of clubs and activities, which helped further enrich my family medicine experience. It’s an honour to receive this scholarship and I am very grateful to Dr. Docherty for the nomination.

– Dr. Ashandeep Sandhu

Sarah Hanson, Program Coordinator for the Faculty of Medicine’s Integrated Community Clerkship Programs is now certified as a Canadian Medical Education Administrator (CMEA) with the Canadian Administrators in Medical Education Operations (CAMEO). Based at Vernon Jubilee Hospital, Hanson has supported and advocated for ICC programs in Vernon and across the province since 2011.

Hanson successfully demonstrated the skills, knowledge and experience for the CMEA certification, which is centred on the Royal College CanMEDS competencies for administration. She was also acknowledged by the organization for her pursuit of life-long learning and professional growth.

“The process of obtaining my CMEA has allowed me to reflect on and honour the work that I do,” says Hanson. “I am very fortunate to be involved in medical education and work with amazing colleagues across the province.”