Rural Family Practice Clerkship in Qualicum, BC
By Rob Trasolini, third year Southern Medical Program student

Imagining life as a small town family doctor has always been a fun pastime for me but, this summer I was lucky enough to spend a month in Qualicum Beach learning what the real thing is like.

I knew I would enjoy my time right off the bat as the weather was great, the ocean was beautiful and, thanks to small town hospitality, I was able to stay in a beachside apartment on the cheap. Within a week I even took a boat trip down the straight of Georgia and delivered my first 13-pound salmon from the water and onto a dinner table. After work, bike rides and strolls down the beach became part of my routine.

The doctors were incredibly welcoming and the patients were all very excited to have learners in their community. More than a few locals even eagerly asked when I would start taking new patients!

I spent most days in the office, which was a full service family practice. I saw patients ranging from pregnant women and children to complex care geriatrics and really had a chance to practice all of the procedures and clinical skills I’d spent the last two years honing. With such a broad range of patients I never got bored and learned something new every day. As time went on, my preceptor gave me more responsibilities and one of the highlights of the trip was getting to a point where I was making diagnoses and management plans with only minimal supervision. It was a really great way to start third year.

Another great part of the trip was that I got some insight into life as a family doctor and saw some of huge range of options for practice. My primary preceptor spent weekends in the urgent care centre and did a lot of in-office procedures, another doctor did addictions medicine and was doing some incredible work with under-serviced populations. All of the doctors played an active role in designing their local healthcare system and invited me to one of their meetings to see how decisions are made.

Overall, I was thoroughly impressed with the interesting challenges and opportunities of family medicine in a small town and so grateful to the town of Qualicum Beach and all the doctors I worked with.

Dr. Carmen Larsen, Family Physician and Clinical Instructor with the UBC Department of Family Practice is the new Site Director for the Vernon Integrated Community Clerkship (ICC) program. For the past five years, Dr. Larsen has been in practice working in urgent care, corrections, and completing numerous locums in family practice clinics in and around Edmonton. She relocated to Vernon in 2013 to continue her practice which includes locums and on-call surgical assists at Vernon Jubilee Hospital (VJH).

Vernon ICC students will have a new space to call home later this year. The new space in the Polson Tower at VJH will include centralized education areas, a clinical skills room, two videoconferences rooms, as well as an on-call sleep area, lounge, and lockers for medical students.  It will also provide a venue for professional development programs for family physicians and specialists in Vernon and surrounding communities.

Dr. Bill Nelems, UBC Professor Emeritus has co-authored a new book titled Evolution of Thoracic Surgery in Canada. The book provides an in-depth look at Canada’s contribution to innovation, knowledge gains, and new standards for today’s field of thoracic surgery. Dr. Nelems is a world-renowned thoracic surgeon based in Kelowna and actively involved in teaching medical students and residents at Kelowna General Hospital. His co-authors include Dr. F. Griffith Pearson, a pioneer in thoracic surgery and Dr. Jean Deslauriers, a world leader in the surgery of lung cancer.

500 limited edition copies signed by the co-authors and 500 standard editions are available. All proceeds from the book sales go towards the Pearson/Nelems/Deslaurier Canadian Thoracic Surgery Foundation for Research and Education. To purchase a copy, visit http://www.canadianthoracicsurgeons.ca/evolution-of-thoracic-surgery-in-canada. A copy has been purchased for the Henderson Library at the Clinical Academic Campus.

Since the official launch of the SMP in September 2011, our program has experienced exponential growth.

• More than 900 health professionals across the Interior involved with teaching UBC medical students and residents.
• 128 students now enrolled with the SMP with our inaugural class graduating next spring.
• Over 50 education leads and admin staff helping deliver our program across our distributed sites.

With so many people and lots of kilometres in between, it’s tough to share all of the remarkable opportunities to live, work, train, and study in one of the most desirable regions in the world. So we asked our faculty, staff, and students to help showcase what we are all about in the MedEd in the BC Interior photo contest.

Congrats to the top entries in our four photo categories: Student Life, Best Commute, Faculty & Staff Life, and Scenic who each won a $25 iTunes gift card.

Student Life Winner Entry – Bethany Woodrow (Photo Above); Caption: 75% of the Trail ICC cohort on our first group ride in Rossland.

Student Life Honourable Mention – Adriel Lam ; Caption: Rock Climbing at Mount Boucherie.

Scenic Winning Entry – Kurt Hoskin; Caption: Enjoying the beauty and serenity of Lake Okanagan.

Scenic Honourable Mention – Adriel Lam; Caption: Scenic Nature Shot.

Scenic Honourable Mention – Jim Huang; Caption: A scenic send off after a year of clerkship on Kalamalka Lake in Vernon.

Best Commute Winning Entry – Christabelle Bitgood; Caption: A hike in Peterson Creek Park in Kamloops.

Best Commute Honourable Mention – Donna Russo; Caption: Daily lakeside trek to UBCO from Oyama.

Faculty & Staff Life Winning Entry – Carri Folk; Caption: Finn atop Pin Cushion Mountain in Peachland.

Faculty & Staff Life Honourable Mention – Allison Gilbert; Caption: MD 2019 Candidate studying for the MCAT.

The UBC Faculty of Medicine is celebrating ten years of distributed medical education across the province of BC. In recognition of this milestone, we take a look back at some of the key people and stories involved in the development of the Southern Medical Program (SMP) leading up to the graduation of our inaugural class.

Dr. Connie Hull completed her medical degree and family medicine residency training at Memorial University of Newfoundland. Upon completion of her residency, she continued her involvement with the University for the next 17 years, eventually serving as a tenured Associate Professor. She left Memorial in 2002 relocating to Vernon with her family, leaving behind her esteemed post as Assistant Dean of Student Affairs.

Fast forward to April 2005, Premier Gordon Campbell first announced to the province that UBC’s medical school would be expanding to include a fourth site in the Interior. At the time, Dr. Hull was working in a family practice clinic in the small community of Lumby when her aspirations to return to academia serendipitously coincided with the government’s planned expansion. A few short months later, Dr. Hull was recruited as Clinical Education Leader to help lead the charge for UBC.

“My job in the beginning was really to promote the idea of a medical program coming to the Interior and recruit interested physicians as a core group of educators,” says Dr. Hull. “Starting small by creating new fourth year electives was seen as the best approach to introducing the notion of a new regional medical program and establishing a culture of teaching”.

So for the next four years, Dr. Hull travelled extensively to recruit preceptors, set up new electives, and build new relationships with key players at UBC, Interior Health, and the local physician community.  Her travels crisscrossed the region multiple times per year to hospitals and clinics in Kelowna, Vernon, Salmon Arm, Kamloops, Penticton, Trail, Nelson, Cranbrook, and many towns in between.

The devil in the details, when developing each new elective she created learning objectives for the clinical experience and provided faculty development for every new preceptor.   “Developing so many new electives from scratch was a huge challenge, but also part of the fun,” says Dr. Hull. The end result was the creation of over 70 new electives for UBC and the initial groundwork for the creation of the SMP.

With the hiring of Dr. Allan Jones, Regional Associate Dean in April 2009, together they set off on a new path leading the initial development of two new Integrated Community Clerkship (ICC) programs in Vernon and Trail. Both ICC programs were officially launched in September 2011 and have since become actively sought after by third year medical students across the province.

In June 2011, Dr. Hull transitioned to her next challenge and current role as Assistant Dean of Student Affairs, a position she once held and cherished at Memorial. Now into her second term, she has played a key role in developing new programs for SMP students to provide them with a high level of support.

This past summer, Dr. Hull was acknowledged for her dedication and work in medical education with her promotion to Clinical Professor with the UBC Department of Family Practice.

“It’s a rare opportunity to take part in the creation of a new medical program,” says Dr. Hull. “Looking back from where we started to our inaugural class graduating next spring, the SMP has been a huge success story and I am proud to have played an integral role in its development.”

Dr. Scot Mountain has been recognized with the UBC Faculty of Medicine’s Award for Excellence in Community Practice Teaching. The award acknowledges faculty members who have demonstrated exceptional teaching skills while making an educational impact in their community.

Dr. Mountain is an Internist and Intensivist, Medical Director of the Intensive Care Unit at Kootenay Boundary Regional Hospital, and Clinical Assistant Professor with the UBC Department of Medicine, Division of Critical Care. Originally trained in Family Medicine, he returned to UBC for an Internal Medicine residency followed by a fellowship in Critical Care.  Dr. Mountain is one of the key faculty leads involved in the development and continued operation of the Southern Medical Program’s (SMP) Integrated Community Clerkship (ICC) in Trail. The ICC program which launched in September 2011 has been a real positive for the hospital and the Greater Trail community.

“We have been lucky to have some extremely talented and motivated students come and train with us,” says Dr. Mountain. “It has forced the teaching clinicians to remain on top of their game and up-to-date with their clinical and academic knowledge. I believe the students have benefited from learning in a community setting, where they get to see and interact with patients on a one-to-one basis from their first day in the program.”

Dr. Mountain has been an active teacher over the past 10 years both as a resident and while in practice. “I believe this award is a recognition of everything our community of physicians has put into the ICC program in the last few years, and of the quality of education we have been able to provide for the students,” says Dr. Mountain.  “We are hoping to continue to reap the benefits of training students in Trail down the line, when they finish their post-graduate training, and hopefully consider coming back to our community to work.”

Walk n’ Talk for Your Life is a collaborative, community health research study designed to increase socialization and healthy lifestyles among seniors. The program is led by UBC Okanagan faculty, staff and students from the Southern Medical Program, Nursing, Human Kinetics, Social Work and Psychology.

Dr. Charlotte Jones, Associate Professor of Medicine with the UBC Southern Medical Program is the principle investigator of the research study. Walk n’ Talk for Your Life has partnered with Global Fitness to host a free 10-week program facilitated by professional fitness trainers and assisted by UBC Okanagan students.  The role of the students will focus on interacting with participants, assisting in exercise programs, teaching education modules, and collecting and evaluating data.

For more information, contact Chella Percy, UBC Okanagan Project Coordinator @ 250-807-8042 or chella.percy@ubc.ca.

Trail Integrated Community Clerkship program expands

The Southern Medical Program’s Integrated Community Clerkship (ICC) program in Trail continues to grow with UBC increasing the number of places available for third-year medical students where they can complete a full-year of clinical training at Kootenay Boundary Regional Hospital and the Trail community.

The ICC program, started in 2011 as part of UBC’s distributed medical education model, is designed to increase the number of medical students completing their clinical training in smaller, rural communities across the province. This year, instead of two students, which has been the case for the past three years, four third-year medical students will be at Trail for the academic year.

“We are thrilled to offer more opportunities for students to learn medicine with our program and encourage them to immerse themselves in what Trail and the Kootenays has to offer,” says Dr. Cheryl Hume, ICC Site Director for Trail.

Nicole Gill, a Rossland native, is one of four new students entering the Trail ICC program. Gill who completed her undergraduate degree at UBC Okanagan and is currently enrolled with the SMP is excited for the opportunity to return to her hometown to begin her clinical training.

“I hope to one day practice as a family physician in rural BC,” says Gill. “Although I have a relatively thorough understanding of the rural lifestyle, I am interested in gaining insight into what it is like to practice medicine in a small community.”

The Trail ICC program continues to receive strong support from the medical community, Interior Health, as well as the citizens of Trail, Rossland, Fruitvale, and surrounding areas who allow the students to take part in their health care.

Next summer, the UBC Department of Family Practice is expected to launch a new, two-year family medicine residency program.

New director, space, and students for Vernon ICC program

Meanwhile, SMP’s ICC program in Vernon is set to welcome its fourth cohort of third-year medical students this September. And there are new faces and new spaces.

Dr. Carmen Larsen, Family Physician and Clinical Instructor with the UBC Department of Family Practice, recently joined the SMP as the new Site Director for the Vernon ICC. Part of her role will be to lead the program’s operations and future development in Vernon.

“I am looking forward to building on the program’s successes at Vernon Jubilee Hospital and in our community clinics,” says Larsen. “The medical community, Interior Health, and the citizens of Vernon continue to be key partners in our ability to offer this program to our students now and in the future.”

Each year, two third-year medical students, who have a keen interest in practicing medicine in small, rural communities complete their academic year at the Vernon ICC program. And later this fall, students will have a new space to call home in the Polson Tower at Vernon Jubilee Hospital. Construction is underway in the previously shelled-in fifth floor to create a new administrative and student space for the ICC program. The space will include centralized education areas, a clinical skills room, two videoconferences rooms, as well as an on-call sleep area, lounge, and lockers for medical students. It will also provide a venue for professional development programs for family physicians and specialists in Vernon and surrounding communities.

Summer Student Research: The Efficacy of Methadone in Managing Cancer Pain

Researchers at the BC Cancer Agency’s Centre for the Southern Interior are providing clinical research experience for SMP students during the summer break.

Second-year medical student Matt Mittelstadt has teamed up with Dr. Gillian Fyles, medical leader of the Pain and Symptom Management/Palliative Care Program at the BC Cancer Agency’s Sindi Ahluwalia Hawkins Centre in Kelowna. Fyles is also research leader at the Oncology Palliative Care for the BC Cancer Agency. Together, Mittelstadt and Fyles are examining the efficacy and safety of methadone treatment in managing pain for ambulatory cancer patients.

“Methadone is most commonly known in the public sphere as a medication used in harm reduction to treat patients with drug addiction,” says Mittelstadt. “However, as an opioid, it has also shown to be an effective tool in managing cancer pain.”

Mittelstadt is currently compiling data, dating back to 1999, on more than 700 cancer patients who were prescribed methadone by the BC Cancer Agency. His research focuses on each patient’s treatment plan leading up to and during the use of methadone; the cancer treatments received such as chemotherapy; and the associated side effects. The research will also address if any drug combinations were utilized in conjunction with methadone.

“Matt’s research is helping us collect data specifically on the responses to methadone in reducing the pain and the side effects experienced,” says Fyles. “This information will assist us in caring for our patients better.”

Mittelstadt’s research project is made available in part by a donation from The Colin & Lois Pritchard Foundation. A total of nine SMP students are involved in summer research projects ranging from local clinical-based research within the Okanagan to global health research abroad. Funding is also provided by the UBC Faculty of Medicine, SMP, and Interior Health.

New faculty

Carmen Larsen, Site Director, Integrated Community Clerkship, Vernon

Dr. Carmen Larsen is a family physician in Vernon and Clinical Instructor with the UBC Department of Family Practice. Dr. Larsen completed her medical degree at Dalhousie University and Family Medicine residency at the University of Alberta. She also holds a Master of Education in Educational Psychology and Special Education from UBC. For the past five years, Larsen has worked in urgent care, corrections, and completed numerous locums in family practice clinics in and around Edmonton. She relocated to Vernon in 2013 to continue her practice which includes locums and on-call surgical assists at Vernon Jubilee Hospital.

Social Media Channels

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BC Health Minster Terry Lake and Dr. Craig Montalbetti (centre) are joined by the six family medicine residents who have begun their training with the new UBC Family Medicine residency training site in Kamloops.

A high-resolution version of photo can be downloaded at:

http://universityrelations.ok.ubc.ca/News2014/Whats_new/Terry_Lake.jpg

Dr. Cheryl Holmes is the recent recipient of the prestigious University of Illinois at Chicago, Masters of Health Professions Education 2014 “Best Thesis” Award. Her thesis entitled Harnessing the Hidden Curriculum in Clinical Clerkship:  A Four-Step Reflective Competency Approach was informed and inspired by her role as Site Director for Kelowna with the Southern Medical Program (SMP).

Dr. Holmes was one of the first faculty appointments to help lead the charge in developing the SMP’s third-year clerkship program at Kelowna General Hospital (KGH). Since joining the program in 2008, she has overseen the evolution of the clerkship program for its early rotation pilots to a now steady state of 24 students.

Dr. Holmes is a Clinical Associate Professor with the UBC Department of Medicine and has practiced in the Intensive Care Unit at KGH for the past 13 years. She is highly regarded for her teaching skills both at the beside and for leading a critical care outreach session utilizing patient simulation held during the SMP third year clerkship retreat.

Summer Student Research Project

Researchers at the BC Cancer Agency’s Centre for the Southern Interior are providing clinical research experience for Southern Medical Program (SMP) students during the summer break.

Second year medical student Matt Mittelstadt has teamed up with Dr. Gillian Fyles, Medical Leader of the Pain and Symptom Management/Palliative Care Program (PSMPC) at the BC Cancer Agency Sindi Ahluwalia Hawkins Centre for the Southern Interior in Kelowna and Research Leader, Oncology Palliative Care for the BC Cancer Agency for a two-month research project. Together, they are examining the efficacy and safety of methadone treatment in managing pain for ambulatory cancer patients.

“Methadone is most commonly known in the public sphere as a medication used in harm reduction to treat patients with drug addiction,” says Mittelstadt. “However, as an opioid, it has also shown to be an effective tool in managing cancer pain.”

The prescribing of methadone is closely monitored by medical colleges across Canada. BC physicians must apply to the BC Methadone Program, managed by the College of Physicians and Surgeons of BC, to obtain a special license to have the ability to prescribe methadone to their patients.

In managing pain for cancer patients, there is no one-size-fits-all approach. Patients can experience pain from both their cancer as well as the medical interventions utilized in efforts to eradicate the disease. Drugs such as morphine, fentanyl, hydromorphone, codeine, oxycodone, and other non-opioids are commonly used, each with their own side effects. Considerable variability with each patient in regard to the type of cancer and treatments utilized will dictate the types of medication administered to minimize cancer pain while lessening the associated side effects including nausea, dizziness, and constipation among others.

Mittelstadt is currently compiling data, dating back to 1999, on over 700 cancer patients prescribed methadone by the BC Cancer Agency. His research focuses on each patient’s treatment plan leading up to and during the use of methadone, the cancer treatments received such as chemotherapy, and the associated side effects. The research will also address if any drug combinations were utilized in conjunction with methadone.

“Matt’s research is helping us collect data specifically on the responses to methadone in reducing the pain and the side effects experienced,” says Dr. Fyles. “This information will assist us in caring for our patients better.”

The research project is providing Mittelstadt with great insight into the types of medications applied in treating cancer pain and the rationale for their uses. He is also provided time to work with Dr. Fyles and her colleagues in the Pain and Symptom Management Palliative Care Clinic gaining a glimpse into possible future career paths.

“Before entering third year later this summer, I wanted to get my feet wet in research and explore all of the different avenues that I can learn and grow,” adds Mittelstadt. “This research project has been incredibly valuable and a wonderful experience.”

Mittelstadt’s research project at the BC Cancer Agency’s Centre for the Southern Interior is made available in part by a donation from The Colin & Lois Pritchard Foundation. A total of nine SMP students are involved in summer research projects ranging from local clinical-based research within the Okanagan to global health research abroad. Funding is also provided by the UBC Faculty of Medicine, SMP, and Interior Health.