BLOG: Designing the future of medical education

By Dr. Alison Fox-Robichaud, director, medical education

On July 1, Hamilton Health Sciences welcomed a new cohort of physician residents: bright, talented, curious and ready to put their medical knowledge into practice. It’s a distinguished path trekked by young doctors for centuries as they transition toward becoming full physicians.

But unlike those who came before, members of this group are riding a sea change in the way physicians are trained and evaluated across Canada.

Arguably the biggest change to medical education in 100 years, these pioneers will be assessed through a new program called competency-based medical education (CBME). It was designed by the Royal College of Physicians and Surgeons, the regulatory college that oversees medical education of specialists in Canada.

The focus of the training is now on outcomes, not the process of getting there.

The difference? In the previous system a resident needed to log a certain number of hours to complete a rotation, like emergency medicine or intensive care. Although skills and knowledge were evaluated, the focus was on time spent rather than how competent the resident was at each task. CBME is all about demonstrating competency in specific clinical tasks or activities required in a department, such as resuscitating a patient or suturing a wound. Residents will only proceed if they can show that they’re capable of performing these tasks.

This means that some will be able to move through their training faster than their predecessors, while others will progress at their own speed. It allows residents to take full responsibility for their learning, which will build confidence in their abilities as they grow in their practice. Medical faculty members will provide coaching along the way.

From a patient-care perspective, CBME is a progressive step forward. The focus of the training is now on outcomes, not the process of getting there. It puts patients at the centre by bringing efficiency to medical learning. Most importantly, by adding certainty to the training, CBME provides a consistent way to measure clinical skill.

Let’s be clear: the Canadian medical training system has always ranked among the globe’s top tier. It has produced generations of world-class physicians, surgeons, researchers and innovators who continue to improve the health care we benefit from today. However, as health care and patient needs constantly evolve, so must our training. We’re confident that CBME will place our future physicians at the forefront of clinical excellence for the next century and more.

To our new residents, welcome to our hospital. We look forward to working together and learning from one another. Best of luck on this next stage of your medical journey.

 




BLOG: From medic to med school

by Blair Bigham, flight paramedic at Ornge air ambulance and emergency physician resident at Hamilton Health Sciences

I opened my Facebook this morning only to find a video that made me feel nostalgic. Ambulances racing through the streets, paramedics attending to people in need, and lifesaving equipment being deployed by skilled hands and astute minds. Ahhh, to be a paramedic again.

It’s Paramedic Services Week, and I’m reminded of the career I had before becoming a resident doctor. Whether responding to emergencies in helicopters, ambulances, or vehicles that could generously be described as pick-up trucks – how else are you going to get to someone lost in Algonquin park with a broken leg? – my days as a paramedic were some of my best.

Often, people say “you’ve moved up!” when they hear I made the leap to be a physician.

Watching that video, produced to celebrate the work paramedics do every day (and night), I was reminded of my transition from medic to med school and now into the emergency department as a resident doctor in Hamilton.

Often, people say “you’ve moved up!” when they hear I made the leap to be a physician. I correct them, politely, that I merely changed scenery and adjusted my role. Moving up is hardly correct – after all, the helicopter pad is on TOP of the building! But in all seriousness, in many ways, being a paramedic was harder than being a physician.

At times, paramedics are sadly thought of as lesser-than other healthcare professionals, because their work chronologically comes before ours. In fact, without their work, we wouldn’t have any. Paramedics provide a skill set that is missing from emergency departments. They can rapidly extricate accident victims from scenes exported right out of Hollywood movies. They can act before they have much – if any – information, and put together puzzle pieces to deliver the emergency department team a clear picture of what’s happened. Their skills are formidable – not many physicians have intubated a patient hanging by a seatbelt in an upside down car in the ditch on a February night. And, they can communicate with patients (and their barking dog or curious cat) in such a way to instantly earn their trust and bring order to their chaos.

I often look back at my time as a paramedic and wonder if I made the right choice to leave a career I love. The transition from medic to physician has been exciting and rewarding, but the challenge of solving puzzles in the field – and the rewards of reassuring patients in their moment of chaos – are the moments of the job of a paramedic that I truly miss. But, those experiences are some of my greatest assets as a resident doctor

To all my paramedic colleagues, happy Paramedic Services Week.




Blog: Past, present and future at West Lincoln Memorial Hospital

By Rebecca Repa, Vice President, Clinical Support Services and Community Surgery, and Executive Lead, West Lincoln Memorial Hospital

The past, the present and the future are all important and interconnected here at West Lincoln Memorial Hospital (WLMH). Within a single day we’re simultaneously thinking about how best to meet current community needs while planning our vision for the future. And somewhere along the way we’re bound to be reminded of the incredible history of this little hospital in the Niagara North West community.

It’s the future that is getting most of the attention these days. Hamilton Health Sciences is part way through a planning exercise for the care we’ll provide and the facilities we’ll need for the next 20 years. As part of that plan, we propose redeveloping our Hamilton General and Juravinski campuses, and rebuilding WLMH with a focus on community medicine and day surgery.

Here at WLMH, our long-time integrated primary care model is one of our greatest assets, and foundational for the population of our community. It means that if you need to be in hospital, your family physician admits you and remains responsible for your care. It lessens the chance of gaps in service and awkward transitions as people move in and out of hospital care. This model is something from our past and our present that we very much intend to keep into the future.

The past, the present and the future are all important and interconnected here at WLMH, but it’s the future that is getting most of the attention these days.

Along with community medicine and day surgery, we propose having 24-hour emergency care, maternal and newborn care for low-risk births, and specialty outpatient clinics. We will continue to be strongly integrated with programs and services at the other hospitals of Hamilton Health Sciences, transferring patients from WLMH who need more specialized care than we can provide here.

The linchpin to our future planning for WLMH is a new facility, which our Niagara North West community has had its heart set on for years. In the recent provincial budget HHS received a commitment that its redevelopment projects are in the queue for capital funding. This doesn’t mean we have approval, but it’s definitely good news, and a very positive vote of confidence in the direction we’re heading. We are on track and on schedule with our planning process.

Even as we plan for the future we still need to pay attention to quality and safety measures for our patients and staff today. A good example is the new electronic health record system, which allows diagnostic and lab results to be more quickly and accurately communicated among the care team across any HHS site.  This is a significant project for us and is being implemented over the next few months, beginning in the Emergency Department.

Improving patient safety: Electronic health record implemented at WLMH

Hamilton Health Sciences’ vision to achieve the best care for all requires us to plan for the continuous improvement of everything we do to meet the evolving needs of patients across all of our hospitals.

At West Lincoln Memorial Hospital, one of the most recent investments to improve the standard of care is the implementation of an electronic health record (e-record).

The hospital already uses electronic health information technology to communicate and report diagnostic tests and lab results. The expansion of the e-record will give staff, midwives and physicians access to more of the information they need to inform care decisions.

This is a significant advance in how we care for patients

It tells the patient story in real-time and patient information is immediately available in an easy-to-read and organized electronic chart. It also makes it possible to standardize documentation processes across all disciplines and clinical areas across HHS, and supports the sharing of information between units and health care providers when patients are being transferred or when a consult is required.

“This is a significant advance in how we care for patients,” says Cindy MacDonald, Director of Community Programs at WLMH. “It will improve access to vital information by members of the healthcare team so that informed decisions can be made about care delivery for each patient. The e-record will also make it possible for staff and physicians across HHS to collaborate in planning care regardless of a patient’s location.”

The implementation of the e-record started in April with patients admitted through the Emergency Department. Over the upcoming weeks, the e-record will be phased in across all programs at WLMH.




BLOG: Government commitment brings hospital redevelopment one step closer

By Rob MacIsaac

Last week our community received some very good news in the provincial budget. The government’s capital spending plan for hospitals over the next 10 years now includes the major redevelopment of Hamilton Health Sciences.

We’ll be one of five hospital systems in Ontario to share in a newly-pledged $9 billion for renewal and rebuilding, and our proposal is the largest of the bunch. Hamilton Health Sciences is recommending changes that will transform the way we provide care – and although there is still much planning and discussion ahead, this early commitment by the government is a tremendous vote of confidence in the direction we’re pursuing

Two years ago, Hamilton Health Sciences began developing a 20-year vision for the future of our organization. Late in 2016, with the input of patients and families, service partners, our staff and physicians, as well as the public at large, we made a series of bold recommendations to the provincial government.

This includes redeveloping existing facilities and designing new ones to improve our reach in the communities we serve. We are also thinking long-term about the growing significance of our many specialty programs, in terms of local economic stimulus, provincial health care planning and global research impact.

This includes redeveloping existing facilities and designing new ones to improve our reach in the communities we serve.

Hamilton Health Sciences’ specialty programs are among the highest  quality, and highest volume in Ontario. People travel province-wide to Hamilton to receive the care we provide for cancer, pediatrics, neurosurgery, rehabilitation, burns, stroke, trauma, cardiology and vascular. 

We foresee a need to cluster these programs at our Hamilton General and Juravinski campuses, in order to maintain the best patient experience and to ensure fast access to emerging, high-cost medical technologies. We propose to build a new Children’s and Women’s Hospital at the General campus and to relocate programs at St. Peter’s Hospital to new, custom-built space at the Juravinski campus. The West Lincoln Memorial Hospital in Grimsby would also be rebuilt on its existing site, with a focus community medicine and day surgery.

These changes would create a new platform for our hospital care, designed for the next generation of patients and families, health care needs and medical technologies.

we’re going to need 50 per cent more hospital space than we occupy today

This plan does mean major change – positive change that will allow us to increase the number of beds we have and the number of people we can serve. We know we’re going to need 50 per cent more hospital space than we occupy today because of population growth and the need to enhance privacy, accessibility and infection control standards. This investment will be significant and that’s why we’re so grateful to know that Hamilton Health Sciences is in the Government of Ontario’s queue for capital funding to support our redevelopment.

Hamilton Health Sciences is also working hard with community partners to design ways  to prevent people from needing hospital care in the first place.

However, robust hospital services are only part of our vision. Hamilton Health Sciences is also working hard with community partners to design ways  to prevent people from needing hospital care in the first place.

Today, many of our patients come to the hospital for care not because of medical issues, but as a result of social circumstances. If you don’t have a roof over your head, nutritious food to eat or a family member to catch you when you fall, you are very likely to become a frequent user of hospital services. This is a particular problem in Hamilton’s urban core, where hospital usage is the highest of any city area in Ontario.

Hamilton’s unique health determinants, combined with the impact across Canada of aging and an accompanying rise in the incidence of chronic disease, means that business as usual will not be good enough to meet the needs of this community. Hamilton Health Sciences’ plan is a careful balance between reimagined facilities and community-based services that will create the best health services for the people we serve.

I am tremendously proud of our teams at Hamilton Health Sciences, and the care we provide to people and families from our local communities and from across Ontario. Last week’s announcement brings us one step closer to securing that care for generations to come.




BLOG: Our fast-growing Children’s Hospital will need a new home

McMaster Children’s Hospital, emergency department, childrens healthcare, mcmaster university medical centre, hamilton ontario, community, hamilton general hospital, our healthy future, dr. peter fitzgerald

Imagining a new hospital in a new location

By Dr. Peter Fitzgerald, President, McMaster Children’s Hospital

As any parent knows, kids grow up fast. One  minute you’re snapping them into a onesie and the next, they’re asking for the car keys.

I often get the same feeling about our McMaster Children’s Hospital. It seems like yesterday we were celebrating an official designation as Ontario’s newest children’s hospital; now, our 30th anniversary is only a year away. And talk about growing before your eyes: We are the fastest-growing of any children’s hospital in the province and are now second only to the Hospital for Sick Children in size (for number of patients and level of acuity).

During the last five years at our Children’s Hospital, we’ve seen an overall 25 per cent growth in inpatient activity, with a particular growth spurt in the Emergency Department (ED), where the number of visits ballooned by 120 per cent. The McMaster Children’s Hospital ED is now the busiest in our HHS family of hospitals.

As busy as we are today, we’re also thinking ahead to how we’ll serve the next generation of children and youth. Over the last two years we’ve been working on a long-range plan for all of Hamilton Health Sciences, called Our Healthy Future. The plan forecasts the services we’ll provide, and the facilities we’ll need, over the next 20 years.

“It seems like yesterday we were celebrating an official designation as Ontario’s newest children’s hospital; now, our 30th anniversary is only a year away.”

We have a bold and exciting vision for McMaster Children’s Hospital. Over the next 20 years we will see an increase of 1.2 million children in Canada, which equals the current population of Manitoba! So we know the growth we’ve seen will continue as the population of Hamilton and surrounding areas continues to rise. Although our services are by no means limited to inpatient care, let’s look at our projected bed counts as a simple example of predicted growth: today we have 161 Children’s Hospital beds and in 20 years we expect to need 231.

So, when we look down the road, we envision a new facility that is designed specifically for the needs of children and their families, and including women’s health services such as our high-risk obstetrics program. We see this new facility being located adjacent to the Hamilton General Hospital campus.

McMaster Children’s Hospital, emergency department, childrens healthcare, mcmaster university medical centre, hamilton ontario, community, hamilton general hospital, our healthy future, dr. peter fitzgeraldThere are many reasons why this location would be ideal – expectant mothers who need acute care services will have them immediately at hand, while children and their parents will benefit from close proximity to our beautiful new Ron Joyce Children’s Health Centre, with its extensive list of outpatient programs for children and youth with special needs.

“Best of all, we’ll have room to grow and develop.”

Best of all, we’ll have room to grow and develop. Our current location at McMaster University Medical Centre, where we share space with the university, just can’t handle the long term needs we foresee. I’m excited about our vision for the future of our Children’s Hospital and I look forward to sharing more information as planning continues.

We envision a new Children’s Hospital to meet our community’s needs – one designed specifically for kids and their families.




BLOG: “Our Healthy Future” vision deserves time and scrutiny

By Kelly Campbell, Vice President, Corporate Services and Capital Development

Kelly Campbell is vice president of corporate services and capital planning at Hamilton Health Sciences.

The size and scope of Hamilton Health Sciences means our capital redevelopment planning process is both complex and lengthy.

We’re following the five-step capital process required by the Ministry of Health and Long-Term Care (MOHLTC) for any hospital seeking major redevelopment funding. As a multi-site operation, we must plan as a system of hospitals and demonstrate how our programs and services across all sites are well-integrated for the best patient care. This makes perfect sense – but it makes our planning process a logistical feat involving countless people both within and outside our organization.

At HHS the planning initiative we call “Our Healthy Future” has involved more than 2,000 people to date and together, we have created an exciting vision for the future. We propose focusing our acute care services at the Hamilton General and the Juravinski. The Hamilton General site would include a rebuilt Children’s and Women’s hospital.  Purpose-built space for the programs currently located at St. Peter’s Hospital would be developed at the Juravinski or the General, or both. We want to rebuild West Lincoln Memorial Hospital. And we see more HHS outpatient services being provided in community settings, often enabled by partnerships with other health and social service organizations.

This vision – the formation of which was the very first step in our planning process – was tabled last June with the Hamilton Niagara Haldimand Brant LHIN and the MOHLTC for review. We anticipate the LHIN board approval sometime in 2017. LHIN approval would give the green light to HHS to continue planning in this direction – it does not indicate  approval for a specific project within our vision.

Our vision is big and bold and it deserves all the time, scrutiny, participation and effort that we can collectively bring to it.

Coming up to our second anniversary in this planning process, we are now on part two of the first stage, which will take us until approximately the end of 2017 to complete. Most hospitals in Ontario do the first and second part of stage one at the same time, but HHS is so big that we needed to separate them out.

Charting our course for the future – with the programs we’ll provide and the facilities we’ll need – is indeed a lengthy undertaking. But when you think of the fact that we serve a population base of 2.5 million people, have 700,000-plus ambulatory visits and admit 52,000 people annually– it’s hard to imagine doing our long-range planning any other way. Our vision is big and bold and it deserves all the time, scrutiny, participation and effort that we can collectively bring to it.

To learn more about Hamilton Health Sciences’ long-term vision, visit ourhealthyfuture.ca.




Health research in Hamilton – improving lives, today

katie-porter-web-size-6-preferred-nov-2016
Katie Porter, director, Research Administration, Hamilton Health Sciences

By: Katie Porter, Director of Research Administration, Hamilton Health Sciences

“And what do you do at Hamilton Health Sciences?” the woman at the Juravinski Cancer Centre asked politely, pointing at my ID badge. I launched into my usual response – I’m a health care administrator, I support the research mandate at HHS, etc., while she nodded.  I pointed to a poster recruiting patients for a clinical trial and said, “There’s an example of a research study my team supports.”

“Clinical trials!” she exclaimed. “I’m alive right now because of a medication I’m receiving in a clinical trial. Thank you.”

I walked away feeling even more proud of my mission at Hamilton Health Sciences, but also wondering how we – those who work in and support health research – can do a better job of communicating the direct and personal impact that research has on our patients and their families.

Too often, we view research as something that happens behind closed doors in laboratories, or as something that takes decades to improve patients’ lives.

This perception needs to change. Research is not only about unlocking new possibilities for tomorrow’s patients; it is also about improving the health of our patients today, helping them live longer, healthier lives.

Changing lives, today

Examples of this abound across our organization. Hamilton Health Sciences has more than 2000 research studies happening at any one time at our various sites and centres. Right here and now, we’re tackling real-life, close-to-home Hamilton issues that are having a positive effect on our patients, families and our community.

Our researchers are improving health care for patients and families facing life-threatening illness. We’re helping our local patients with heart failure have a safer transition to home. We’re joining forces with our community to raise awareness of intimate partner violence and the recognition of associated injuries, and we’re working with our aging population to prevent, and even reverse, clinical frailty. And, because we know that Hamilton has some unique needs in terms of population health, our “Making the Race Fair” study is engaging families in Hamilton’s highest-needs communities to help prevent child and adolescent behavior problems, supporting our city’s vision to help make Hamilton the best place to raise a child.

Too often, we view research as something that happens behind closed doors in laboratories, or as something that takes decades to improve patients’ lives. This perception needs to change.

And while we know that not every research study results in a better outcome for an individual patient, there are other benefits, including a better understanding of their condition, and finally, the satisfaction of making valuable contributions to medical research that may help others down the road.

For those of us who work in research, these benefits are clear. They’re why we do what we do. We know research makes a difference in people’s lives. But how do we shift the common perception that research is only for the future? How do we help our friends, our family members and our neighbours understand that we have world-class research happening right here in our own backyard, and that that research is affecting health outcomes right here, right now?

Making research relatable

Those of us who work in health research must do a better job of de-mystifying research activity and clearly explaining its value in a way that patients can engage with and respond to. We need to establish research as a joint venture between patients, researchers and the community. We must have regular conversations with our patients about research and the fundamental role it plays in the delivery of their own treatment, and remind them that best care evolves out of research and education.

In Hamilton, research is in our community’s blood – its growth and impact as a key industry in our city is undeniable, and only increasing.

Finally, we must continue to conduct research inspired by the needs of our patients, our health professionals and our community. With this approach, we can make discoveries that improve patient care and quality of life – not just for generations of the future, but also for those of us who are here today.

In Hamilton, research is in our community’s blood – its growth and impact as a key industry in our city is undeniable, and only increasing. We have one of Canada’s most research-intensive communities in our own backyard. Last year alone, Hamilton Health Sciences conducted research valued at over $150 million dollars. We’re on track to exceed this amount in 2016.

The story I shared earlier isn’t a rare case. Research is changing our communities every day, for the better, but it often flies under the radar.

There’s so much more of this story to tell.

To learn more about how health research is contributing to a healthier, wealthier and smarter Ontario, visit healthierwealthiersmarter.ca.




The problem and promise of diabetes

by: Yvonne Mullan, advanced practice dietitian and Dr. Hertzel Gerstein, endocrinologist

Why do people get diabetes?

Many believe people develop type 2 diabetes solely because they have made the wrong diet and lifestyle choices. That isn’t true.

Type 2 diabetes currently affects about one in nine people over age 20 in Hamilton and about one in five people over age 75. It is now the most common chronic disease in Canada and causes many serious health problems that can reduce the length and quality of someone’s life. But we still don’t fully understand why some people get diabetes and others don’t.

Here’s what we do know:

• The tendency to get type 2 diabetes is inherited. People with a father, mother, brother or sister with diabetes are much more likely to get it than people with no affected relatives.
• Lifestyle and environment affect whether someone who is susceptible to diabetes ends up getting it.
• A number of things contribute to those lifestyle and environmental factors including how easily we can access physical activity, the variety, portion size and affordability of food in our area, how much sleep we get, and whether we live in poverty.

Some of these risk factors are difficult to control, and unfortunately, many are connected to socioeconomic status.

So you’re at risk. What now?

Luckily, there are simple tests that can let people know whether they’re at high risk for diabetes. With that knowledge in hand, we can help people reduce their risk.

Modifying your diet, increasing your physical activity, improving your mental health and taking the right medications can reduce the negative effects of diabetes.

Making moderate changes to diet and increasing physical activity is a good place to start prevention. There are also a variety of medications that can lower your chances of getting diabetes.

It takes a village

The benefits of these lifestyle changes and medications aren’t limited to prevention. Modifying your diet, increasing your physical activity, improving your mental health and taking the right medications can reduce the negative effects of diabetes. The Boris Clinic Diabetes Care and Research Program at Hamilton Health Sciences takes a interdisciplinary approach to treating diabetes because we know that people have better outcomes when they tackle all aspects of the disease. Anyone with diabetes can refer themselves to the program.

The more we know about diabetes, the better we can treat it, both on a personal and global level. In the Program, we’re working hard to study the causes of diabetes and the effectiveness of different treatment approaches. On a personal level, you can empower yourself by identifying your risk for diabetes and learning about different ways to prevent or manage it.

We can all play a hand in defeating diabetes.