Study will help determine ways to improve utilization of a costly resource

Increased public awareness of the risks associated with concussions has led to a surge in patients visiting emergency departments — and statistics Canada reports some 30,000 concussions or related head injuries are recorded annually in Canada for patients 12 to 19 years old.

While most minor head injuries don’t require hospitalization, some can involve further monitoring and even surgery. A computerized tomography (CT) head scan is a primary diagnostic tool used by emergency room doctors to determine the scope and immediacy of medical treatment.

However, it’s not without hazards as exposure to ionizing radiation can lead to a patient’s increased risk of cancer, says Dr. Mike Ertel, clinical instructor with the department of Emergency Medicine at Kelowna General Hospital (KGH).

Enter the Canadian CT Head Rules, a quick checklist to determine the best candidates for scanning. Though proven to be a valuable resource, a lack of adherence to these rules in emergency departments has been identified as the number one priority by the Canadian Association of Emergency Physicians.

As part of the UBC Okanagan Faculty of Medicine’s Summer Student Research Program, Hannah Duyvewaardt is working with Ertel to identify roadblocks and improve adherence levels.

Duyvewaardt, a second-year medical student, spent the summer reviewing KGH patient data logged through the Canadian Hospitals Injury Reporting and Prevention Program.

“The guidelines are well known, but not necessarily well followed,” says Duyvewaardt. “We are trying to understand why and then look at ways improve their usage by emergency physicians.”

As part of their research, Ertel and Duyvewaardt have introduced a checklist that emergency room physicians should use before ordering a CT head scan. Duyvewaardt is continuing her involvement by helping to distribute educational resources and monitoring their impact. With increased education, they expect to see significant improvement in adherence levels, better utilization of resources, and reduced radiation exposure for non-qualified patients.

“We are collecting the reports from every CT scan taken at KGH,” explains Duyvewaardt. “From this pool we are able to cross reference with all patients who have been examined for minor head injuries. The ‘checklist’ is staying with the patient’s chart, allowing us to determine if it was used and, if so, correctly.”

Their research findings will be presented at the next CAEP conference and contribute to best practices for concussion diagnosis and management on a national level.

“CT imaging is a limited and costly resource and it’s important to assess its value within the context of concussion patient care,” says Ertel, who is also Chief of Staff at KGH. “There are also increasing concerns around unnecessary radiation exposure to patients, especially the young.”

Based on the recommendations made in a number of influential reports on the future of medical health in Canada, the UBC Faculty of Medicine initiated the Dean’s Task Force on Curriculum Renewal to review our curriculum. The renewed curriculum embraces all of these recommendations, in addition to addressing previous accreditation feedback.

The curriculum has been designed to increase flexibility of learning for students; embed opportunities for inter-professional education; and move towards a competency-based, spiraled, integrated educational approach. The end goal of Curriculum Renewal is to produce graduates who will meet both the current and future health care needs of British Columbians.

The launch of Year 1 of the renewed curriculum started in August in Vancouver and begins in early January at the Southern Medical Program. The Class of 2019 will be the first cohort to experience the renewed curriculum at every stage of their studies.

Teachers in particular, whether a tutor, session instructor or preceptor, play a key role in the transformation of the MD Undergraduate Program.

• For tutors … you will move from problem-based learning to case-based learning, and have increased opportunity to provide formative feedback and assessment for student learning.
• For session instructors… you will have more clarity around how your lecture fits within the overall curriculum.
• For family practice preceptors and clinical skills tutors … you will have increased opportunity to provide formative feedback and assessment for student learning.

Although much of the content will remain the same, it will be structured and delivered in different ways. The renewed curriculum in Year 1 is made up of fewer, more integrated courses that developmentally spiral content. The spiral-based curriculum means that concepts will be periodically revisited, reinforced, and built upon so that students can absorb information in a more meaningful way. From an assessment perspective, the renewed curriculum will be assessed in a coordinated way with a defined set of assessment methods. Each method is well suited to assessing certain types of competencies and brings unique and important information about performance. We have also embedded processes for continuous quality improvement to enable our curriculum to continuously improve year after year.

Flexible and Enhanced Learning (FLEX)
FLEX is a new, innovative series of three courses in the renewed curriculum. It offers students unique opportunities to pursue a variety of scholarly activities within a defined learning space. FLEX enables students to explore individual learning interests in greater depth. The FLEX course is designed to foster innovation, creativity, and critical thought.

Workplace Based Assessment (WBA)
WBA involves the direct observation of students performing relevant physician tasks in both clinical and non-clinical settings. WBA tracks students’ progress in integrating clinical knowledge and skills as a basis for safe and effective clinical judgments and decision-making. It also assesses how students deal with patients and the ability to work productively in a team of health care professionals.

Portfolio
Portfolio has both developmental and assessment activities where, students build foundational reflective learning skills in Years 1 & 2 and then apply these skills in their clinical environments during Years 3 & 4. Students are then assessed on their reflective activities, in a variety of topics, such as professionalism and communication.

Progress Tests
Progress Tests are comprised of multiple choice questions that sample the complete knowledge domain expected of an MD graduate. These exams occur repeatedly through the four years of the program and provide formative feedback about performance across subjects to guide learning.

For Years 2 to 4, more information and updates will be provided in the months ahead. For questions specific to Year 1 teaching, please contact Allison Gilbert, Years 1 & 2 Program Manager at allison.gillbert@ubc.ca. For information about the Renewed Curriculum process, please visit http://www.cr.med.ubc.ca/.

We are entering an exciting new chapter for the Southern Medical Program (SMP) with the implementation of the Faculty of Medicine’s renewed curriculum. The SMP Class of 2019, our program’s fifth cohort, are the first to delve into this new learning model that will guide and challenge them along their path to becoming physicians.

Over the past four years, we have fostered outstanding educational and clinical learning environments serving well both SMP students and those from across UBC’s distributed MD Undergraduate Program. It is because of our success in building this robust academic network that we have the utmost confidence in our ability to embrace and adapt to the renewed curriculum for years to come.

We must continue to acknowledge the dedicated work of our faculty leaders, clinical faculty, and administration who are critical to our program’s long-term sustainability. Also, our community members who welcome and support students and residents as part of their medical care in the Interior’s hospitals and clinics.

This past year has seen the graduation of our inaugural class, the opening of new educational facilities in Vernon, and the creation of a new rural family medicine residency program in the Kootenay Boundary. We are humbled by the continued growth of clinical faculty with over 1,000 health professionals across the region involved with medical teaching.

Looking forward to the year ahead, we will be participating in the Faculty of Medicine’s accreditation review by the Committee on the Accreditation of Canadian Medical Schools (CACMS) in February 2016. A critical process that will certainly recognize many of our program’s collective achievements, but also acknowledge areas that require further development. A recent independent student analysis has provided exceedingly positive feedback on the experience of SMP students across all four years of the program.

As each new academic year comes to a close, we are excited to celebrate another wave of SMP graduates heading off to their residencies in BC and across the country. We are eager to follow along as they complete their training and fulfill their personal and professional goals. While the trajectory of a medical student to practicing physician is considerable, we firmly believe our efforts reflect and support our social responsibility to the health care needs within the Interior and across the province.

Dr. Allan Jones
Regional Associate Dean, Interior, UBC Faculty of Medicine
Associate Vice-Provost, Medical Sciences, UBC Okanagan

Vernon Unit Crew (Credit: Denan Busk)

Eyes burning, nose running, and plenty of coughing. Just another day at the office for Colby Finney’s summer job.

Finney, a second-year medical student at UBC Okanagan, has spent the past three summers battling wildfires with the BC Wildfire Service. Born and raised in Kelowna, he returns to UBCO this August to continue his studies with the Southern Medical Program.

Colby Finney, second year Southern Medical Program student

“I originally saw an ad in the library at UBCO as they recruit a lot of university athletes for the seasonal positions,” says Finney. “Having spent lots of time in the backcountry and in reasonably good shape, I decided to apply.”

The BC Wildfire Service staffs over 1100 Type 1 firefighters and specialized personnel. All new recruits undergo an intensive week-long bootcamp on wildfire management including both classroom sessions and field training. Finney completed his intake training in 2013.

Nearing the end of another busy fire season, over 1700 wildfires have been reported and close to 300,000 hectares burned thus far.

The province’s initial attack crews are typically the first on-scene to address new wildfires. When a fire requires more resources beyond the initial suppression efforts, a 20-person unit crew is brought in as reinforcements.

As a member of the Vernon Unit Crew, Finney has been stationed mostly in the southern half of the province battling wildfires in Osoyoos, Oliver, Keremeos, Joe Rich in Kelowna, West Kelowna, and Salmon Arm.

A fire’s behaviour and the surrounding terrain often dictate the approach taken by the unit crew towards containment. Difficult terrain, hot temperatures, and smoky air conditions are commonplace. The work itself is grueling, but the safety of crew members remains paramount.

“In most cases, we work to stop the spread of the fire by cutting a hose trail and removing fuel as close to the fire’s edge as possible,” says Finney. “We can then lay hose along the trail and get a steady source of water on the fire.”

Once the crew is able to get a handle on the fire, there is great sense of accomplishment. Finney acknowledges the camaraderie and daily conversations with the colourful personalities within his team as some of the best job aspects. Also, his deeper appreciation for the natural beauty tucked away within some of the BC’s most remote regions.

As Finney returns to university to pursue his ultimate career path, he acknowledges his teamwork battling wildfires as a key translational skill to his future profession.

“In medicine, you have to coordinate with multiple different professions and family members in order to construct a balanced and holistic approach for the patient’s care,” says Finney. “Similarly on the fire line, you’re coordinating with operations, multiple crews, heavy equipment, air tankers and your fellow crew members. The plan has to be organized and articulated so that everyone can achieve their objectives in a safe and timely manner.”

Meet some of our Southern Medical Program students heading back to school for the 2015-16 academic year.

Name: Amelia Stegeman
Hometown: Not disclosed
Program Year: 3

What excites you the most about the 2015/16 school year?

My rural placement in Salmo this October. I’ve never been there, but I’m excited to spend some time in a rural community. Plus I’ll have a new backyard to explore for a month.

What do you expect will be the most challenging part of this year?

Learning the ropes of the hospital. So far my experience has been mostly at school and in the close supervision of family doctors around the Central Interior.

What do you hope to achieve academically this year?

I hope to remember my student cards, stethoscope, and iPhone every day. I figure showing up with the right gear and the right attitude every day is a good start to a challenging year.

How will you spend your down time? What is your favourite thing to do in your site region?

At the SMP there is unlimited outdoor recreation. I’m trying to narrow in on developing my skills in climbing (maybe lead trad this year), backcountry skiing, and mountaineering.

Name: Greg Costello
Hometown: Abbotsford
Program Year: 4

What excites you the most about the 2015/16 school year?

All of the diverse and interesting electives I’ve set up for myself over the next few months – I get to gain knowledge and experience critical to my future career in rural general practice without the stress or responsibility of being a physician or resident yet. This is an opportunity that will never come along again!

What do you expect will be the most challenging part of this year?

Juggling CARMS preparation, a research project, keeping up with associated (and unassociated) reading/writing while also getting as much experience and knowledge out of each elective as I can!

It’s going to be a busy, but very fun year!

What do you hope to achieve academically this year?

I want to put muscle on the body of clinical knowledge I built last year, and the end goal for Year 4 is a CARMS residency spot in Rural Family Medicine!

How will you spend your down time? What is your favourite thing to do in your site region?

I like to read and write about my experience as a medical student, and enjoy hiking and photography when I get the chance. I also like cooking and hitting the gym in my off time, all while listening to podcasts on topics ranging from pharmacology to business and finance.

Wine touring is the official pastime of the Okanagan, and that has to be my favorite thing to do in the region, but paddleboarding on the lake takes a close second!

Name: Taran Main
Hometown: Armstrong
Program Year:  1

What excites you the most about the 2015/16 school year?

Getting the opportunity to finally pursue my dream of becoming a physician after all these years of preparation!

What do you expect will be the most challenging part of this year?

Balancing school, hobbies, friends and family and personal health and fitness.

What do you hope to achieve academically this year?

I hope to do the best that I can and to come out with no regrets.

How will you spend your down time? What is your favourite thing to do in your site region?

I will spend my down time fishing my brother, hiking with my fiancé, painting and enjoying everything the Okanagan has to offer.

(Story by Kerry Blackadar)

Only a short time ago, Mark Szynkaruk had never been to Trail, B.C., let alone the communities of Nakusp, Castlegar or Salmo.

But, over the next two years, he’ll come to call the region home. And it’s not just the bends of the Slocan River, or the peaks of the Selkirk Mountains that he’ll come to know. As a new family medicine resident in Kootenay Boundary, Dr. Szynkaruk will be working alongside local physicians and health care providers to gain ‘in practice’ experience on his road to becoming a rural family physician.

“The community has been so supportive and is incredibly invested,” says Dr. Szynkaruk, reflecting on his first few weeks of residency. “From the first day, I could feel the energy.”

As a recent graduate of the University of Toronto’s medical school, Dr. Szynkaruk is now embarking on the next stage of his medical career, joining three other residents as part of the first cohort of UBC’s newly-launched rural family medicine residency in Kootenay-Boundary.

Over the course of his two-year residency, Dr. Szynkaruk, alongside family medicine residents Drs. Alana Benes, Gabe Krahn, and Gretchen Snyman will take on a range of traditional rotations, from surgery and cardiology through to pediatrics, in addition to family practice rotations in Trail and Nelson. They’ll also spend time serving patients in smaller centres, including Christina Lake, Grand Forks, Nakusp, Castlegar and Salmo.

Filling a need

Dr. Cheryl Hume

According to the site director, UBC’s Dr. Cheryl Hume, who has served as a rural family physician in Trail for close to three decades, the new training site represents a significant development for Kootenay Boundary.

“With the arrival of these new residents, access to physician services will be enhanced, helping to improve patient care in our region,” says Dr. Hume.

Next year, the site will take on four new residents, bringing the total number to eight residents across the two-year program by July 2016.

But the Kootenay Boundary site, which joins UBC’s Family Medicine Residency Program as the 17th family medicine training location, is not just about filling short-term needs — it’s about long-term investment in the health of communities in the region.

“We hope to see this site help support future physician recruitment and retention to our area,” says Dr. Hume, who has been at the forefront of recruitment and retention efforts in the region for many years and also serves as the director of UBC’s Integrated Community Clerkship in Trail, a program designed to give third-year medical students a taste of clinical and hospital experience in a rural setting.

“This new training site in Kootenay Boundary will give medical residents the opportunity to experience how gratifying it is to practice medicine in a rural area and encourage them to consider a future career in rural family practice,” she adds.

According to Dr. Allan Jones, the Regional Associate Dean, Interior, the new site will also open up more opportunities for students of UBC’s Southern Medical Program, based in Kelowna, to continue training in the Interior, inevitably supporting the long-term recruitment and retention of physicians across the region.

New arrivals bring new hope

For Dr. Szynkaruk, who grew up on a cattle farm outside of Kamoka, northwest of London, Ontario, the prospect of completing his residency in a rural area is very attractive.

“I really like the rural lifestyle and feeling part of the community. That’s what really drew me to rural family practice — I want to know my patients, and really contribute by offering support to people in my community, not only as a physician, but as a friend over time,” says Dr. Szynkaruk.

Back row (L-R): Dr. Mark Szynkaruk, Dr. Gabe Krahn, Mayor of Trail Mr. Mike Martin, Mayor of Rossland Ms. Kathy Moore, Site Director Dr. Cheryl Hume, Mr. Don Nutini (LCCDTS).Front row (L-R): Medical students Kara Perdue, Mikaela Forkheim, Jennifer McCormack, then Dr. Alana Benes, Dr. Gretchen Snyman and Castlegar Recruitment officer Cheryl Gnyp. Image Credit: Submitted

It’s a sentiment echoed by his fellow residents, including Dr. Alana Benes, who grew up in Surrey and completed her Bachelor of Medical Laboratory Science and MD at UBC.

“I want to be the kind of family doctor that is really involved, spending time in my clinic, as well as following up with my patients when they’re in hospitals and extended care facilities, and picking up shifts in the emergency department, and delivering babies,” says Dr. Benes. “Rural family practice really offers a much broader scope of practice — it’s my style of medicine.”

And, given the incredible response from the local communities of Kootenay Boundary, gaining a wide range of experience, and building close connections won’t be difficult.

“Everyone is so excited about the arrival of the new residents,” says Dr. Hume. “The response has been overwhelming.”

It was this same enthusiasm — and dedication from local physicians, who played a vital role in the site’s development — that first encouraged Dr. Willa Henry, the Program Director of UBC’s Family Medicine Program, to select Kootenay-Boundary as the home of the program’s next rural training site.

“It was an easy decision to choose the Kootenay Boundary as a site for our rural residency program,” says Dr. Henry. “For many years, the area’s physicians have shown a dedication and enthusiasm for training future physicians.”

“We are delighted that the expansion and distribution of postgraduate medical education to Kootenay Boundary is warmly embraced by the local region as we strive to meet the health needs of communities within Interior Health,” adds Dr. Roger Wong, Associate Dean of Postgraduate Medical Education.

 And the response from the community has not gone unnoticed by the residents.

“I feel a bit like a local celebrity,” says Dr. Benes. “My patients all seem to know who I am.”

“I didn’t realize how much the community was behind this program,” adds Dr. Szynkaruk, who says he could envision himself staying in the region to practice after his residency wraps up.

For now, with a few more years left before reaching his goal of becoming a rural family doctor, Dr. Szynkaruk plans to embrace all the learning opportunities he can get, while getting to know the bends of the Slocan River a little better.

 The expansion and distribution of postgraduate training sites is part of the University of British Columbia Faculty of Medicine’s goal of increasing the number of doctors in training, and placing them in communities where they are needed most. This summer, in addition to the family medicine residency in Kootenay Boundary, a new four-year pediatric residency on Vancouver Island accepted its first two residents.

The Southern Medical Program is recruiting our next cohort of Master Teachers. The Master Teacher Certificate Program supports clinical faculty seeking to enhance their teaching and mentoring skills. The program offers a monthly lecture series, small group discussions, longitudinal project, and peer teaching assessment. In addition, the group will help design the curriculum for the 2016-17 Master Teachers. Our next edition of the program commences in September and runs till June.

Our featured lecturers bring a wealth of teaching experience and are carefully selected to share their masterful teaching techniques. Lecture topics are selected after a detailed needs assessment and build on foundational teaching skills taught in the ABC Primer Series offered through UBC’s Faculty Development Program.

The lecture series is open to all Interior Health staff, while all other program components are designed for registrants only including the opportunity to interact with each of the presenters during the small group sessions. Lectures are held in the Clinical Academic Campus at Kelowna General Hospital and videoconferenced to Vernon Jubilee Hospital, Penticton Regional Hospital, Royal Inland Hospital, and Kootenay Boundary Regional Hospital. Maintenance of Proficiency (MainPro) and Maintenance of Certification (MOC) credits are awarded for participation.

To register, contact Jacqui Oshaski at 250.980.1310 or jacqui.oshaski@interiorhealth.ca.

The UBC Faculty of Medicine’s Admissions Office and Southern Medical Program (SMP) are expanding the number of medical school seats available to students interested in rural, remote, or northern medicine. These changes are being implemented in an effort to help address the need for more doctors practicing in rural or remote communities in particular within the BC Interior.

Beginning with the 2015/16 admissions cycle, up to 10 of the 32 annual seats within the SMP will be designated for students with rural, remote, or northern backgrounds. BC Interior applicants are encouraged to complete the Remote and Rural Training section as part of their online application. The Remote and Rural Training section currently used in selection of students for the Northern Medical Program (NMP) will be used to help identify suitable students for these 10 SMP positions each year.

For more information, visit the Prospective Students section at www.smp.med.ubc.ca.

Dr. Cheryl Holmes and Dr. Gary Goplen presents Dr. Andy Kluftinger with his award.

Dr. Andy Kluftinger, Clinical Instructor with the UBC Department of Surgery has been recognized for his exceptional teaching with third year Southern Medical Program (SMP) students at Kelowna General Hospital (KGH). Dr. Kluftinger is the recipient of the 2014 KGH Surgery Teaching Award, an award administered by the KGH Department of Surgery which recognizes excellence in clinical teaching.

Comments from SMP students about Dr. Kluftinger:

He was always interested in teaching but also ensuring students would have a meaningful experience.

He would go above and beyond to support us if it was at all possible.

A very patient teacher, and is conscientious of your stage of learning as a student when it comes to teaching points and asking you questions.

Passionate. Dedicated. Humorous. Memorable.

Dr. Kluftinger was recently acknowledged for his teaching efforts along with fellow nominees Dr. Josh Wiesenthal, Dr. Mike McLeod, Dr. Kim LeFevre, and Dr. Barry Sullivan. Congratulations to Dr. Kluftinger and fellow nominees.