Pediatrics at MUN

I ❤PEDS

Faculty of Medicine

WINTER 2012

From the Program DirectorBy Dr. Anne Drover

Welcome to the first Memorial University Discipline of Pediatrics Newsletter. As program director, it is my pleasure to share with you some of the great things happening in our Pediatric Residency Program. The group of dedicated health care professionals at the Janeway Children’s Health

and Rehabilitation Centre work hard to provide excellent care for the infants, children and youth of our province. Faculty and staff also create an atmosphere of teamwork and cooperation which is welcoming to all learners.

We have decided to highlight features of our pediatric program using the CanMEDS framework, an educational framework formally adopted by the Royal College in 1996. This framework identifies and describes seven roles that lead to optimal health and health care outcomes: medical expert (central role), communicator, collaborator, manager, health advocate, scholar and professional.

MUN Peds is an excellent medium-size Pediatric Residency Program. We have a track record of success in Royal College Accreditation, having received full approval in 2010 and in previous accreditations. We also have a great track record of success in Royal College Examinations and achieving fellowships for our residents who choose that route. The strength of our program is in the diversity of opportunities open to graduates of the MUN Peds program. Our graduates work in a variety of settings from community pediatricians with hospital-based practice to others who have fellowships and are working in

large centres in Canada and the U.S. All graduates say that the high level of responsibility early in their training, coupled with ready access and supervision by attending staff, prepared them for their chosen career.

We hope that this newsletter will give you a snapshot of the pediatricians and staff of the Janeway Children’s Hospital and helps you in your difficult decision of choosing a post-graduate residency program.

Message from the ChairBy Dr. Cathy Vardy

As chair of the Discipline of Pediatrics I am pleased to highlight a few of the many positive aspects of our program.

Our Residency Training Program has maintained approval with the Royal College of Physicians and Surgeons of Canada over a number of accreditation cycles. Dr.

Anne Drover, whose focus is medical education, is our current program director. She is building on a strong foundation laid down by previous program directors, the most recent being Dr. Tracey Bridger. We feel confident our program will continue to grow and improve under her leadership.

We have acquired a new research director, Dr. Roger Chafe, who has been with our discipline for just over a year. Dr. Chafe joins Dr. Leigh Anne Newhook in providing

leadership to our discipline’s research endeavors. Dr. Chafe has had a positive impact on research teaching to our residents and providing faculty development. Many of our faculty, including our new recruits, have an interest and are active in research.

Our Residency Program is fortunate to have strong academic teaching provided by our faculty. Both full-time and part-time faculty members are very committed to the training program and quick to offer support no matter what the task.

Our academic team, consisting of Dr. Drover as program director, Dr. John Martin as clerk co-ordinator, Dr. Denise Hickey as clinical skills co-ordinator, Dr. David Buckley as pediatric course co-ordinator and myself are very supportive of faculty development. As one means of faculty development we plan retreats to enhance our faculty’s knowledge in different areas.

The Residency Training Program and the Discipline of Pediatrics has the support of Dr. Ken Henderson, the clinical chief of child health with Eastern Health.

Administrative SupportMemorial’s Faculty of Medicine highly values its post-graduate programs. The Discipline of Pediatrics has the support of two full-time administrators who assist with schedules, electives, evaluations, Objective Structured Clinical Exams etc. Dr. Anne Drover said Jackie Doran and Blair Brush are the hub of the pediatric academic program.

Ms. Doran is the academic program administrator and she provides administrative support to the Pediatric Residency Program and the Pediatric Clerkship Program and also oversees the daily operations of the Pediatric Medical Education Office.

Ms. Brush is the academic program assistant and she provides administrative assistance primarily to the undergraduate program but also helps assist with the residency program for the Discipline of Pediatrics.

ACKNOWLEDGMENTS

Many thanks to the following individuals for their help with

the production of this publication:

Residents, faculty and staff of the Discipline of Pediatrics,

particularly Drs. Anne Drover and Laura Vivian; Sharon Gray,

communications co-ordinator, Faculty of Medicine; Alison

Carr, graphic artist, Health Sciences Information and Media

Service; John Crowell and Terry Upshall, photographers,

Health Sciences Information and Media Service

Cover photo:

Dr. Lisa Goodyear and children Seamus, Claire and Aiden;

residents Dr. Ritkin Patel and Dr. Amanda Hogg

Printed by MUN Printing Services: Med-025-01-2012-100-AC

Jacqueline Doran Blair Brush

CommunicatorBy Dr. Paul Dancey

The establishment of a healthy patient-physician relationship through effective communication is central to the role of physicians. There are unique aspects to communication in a pediatric setting.

As a key competency, the communicator role involves developing

rapport, trust and ethical therapeutic relationships with patients and families. The pediatrician must be able to accurately elicit and synthesize relevant information from patients at various ages and stages of development and convey relevant information and explanations to both parents and the child or teen. This is a skill that you begin to learn in medical school and you continue to develop through residency and in clinical practice. There is really no endpoint to this learning as every patient and clinical encounter is unique and will present its own challenge.

Throughout your pediatric residency you will develop the skills you will need to listen effectively and develop awareness of, and responsiveness to, non-verbal cues.

There are many ways to learn good communication. Important lessons occur from listening to the bedside manner of your colleagues and determining what style works best for you in particular situations. Invariably there are times as a physician when you will feel that communication could have been better. Recognizing and learning from those situations is critical, and having someone to talk to about those difficult moments can often help.

If an issue about communication or any other aspect of life arises, having a mentor to connect with is helpful. The Medical Mentorship@MUN Program involves medical students, residents and physicians working together in mentorship teams to facilitate training and professional growth. Interested residents can be assigned to a faculty mentor, or can choose to be a mentorship group leader.

If you are interested in learning more about the Medical Mentorship@MUN program, visit the Office of Student Affairs in the Faculty of Medicine or email mentorship@med.mun.ca.

Resident FellowshipsOur residents have ample opportunity to do electives at the various children’s hospitals across the country. They have always been successful in obtaining the fellowship of their choice. Our current fourth-year residents have all been accepted for fellowships which will start in July 2012. Erin Peebles is doing pediatric intensive care through the University of Toronto; Lana Soper is doing developmental pediatrics through the University of British Columbia; Anjali Kamra is doing hematology/oncology through the University of Alberta; Andy O’Keefe is doing allergy/immunology through McGill University; Alison Haynes is doing allergy/immunology through the University of Toronto; and Lorine Pelly will be studying pediatric infectious diseases through the University of Winnipeg.

Medical ExpertBy Dr. Anne Drover

The medical expert role is crucial to a successful residency program. The Royal College of Physicians and Surgeons ensures attention is paid to the curriculum provided by a residency program and the assessment methods used. These items are reviewed carefully at the time of the accreditation visit. Happily, we can report that MUNPeds has full accreditation for the next six years. Our learning objectives are based on the Royal College pediatric specialty objectives and CanMEDS roles. The rotations chosen ensure that all the main objectives are covered; in addition we provide each resident with the opportunity to do rotations in pediatric psychiatry and pediatric surgery within the core schedule. We also encourage individuality by allowing for a greater number of electives either at the Janeway or elsewhere. We recognize that electives allow for broadening an area of interest or allowing exploration of a potential fellowship.

The Royal College objectives are also met through the dedicated teaching time, the Academic Half Day. This weekly three-hour block of protected teaching time ensures all the major subspecialty and general pediatric topics are reviewed over the course of three years. In addition, each week small groups attend an unseen simulation scenario on one of our human patient simulators. These scenarios are completed in situ, either in the Emergency Department, Pediatric Intensive Care Unit, or Inpatient Unit, with nurses and respiratory therapists who will respond to a real code. We feel this interdisciplinary model provides excellent learning for the whole team. Debriefing occurs immediately following the scenario by one of our simulation instructors. Proficiency in clinical skills is one of the strengths of the MUNPeds program thanks to the clinical skills teaching of Dr. David Buckley. All residents receive this small group teaching weekly on the various aspects of the pediatric physical exam.

Teaching objectives are covered via subspecialty rounds, Canadian Pediatric Society guideline rounds, neonatal rounds, grand rounds and team rounds. All of these sessions occur weekly. Journal Club is held on a regular basis throughout the year at a local restaurant or home of one of the staff. Medical expert objectives are

also sometimes covered at the annual Pediatric Resident Retreat. The residents take the lead on choice of topic for this out of town retreat.

Assessment is an important part of becoming a competent pediatrician. At Memorial, we use the in-training evaluation report, OSCEs (Objective Structured Clinical Examinations) and American Board Exam as assessment tools.

Overall, residents in pediatrics at Memorial learn by doing. There is a tremendous amount of hands on learning and early but supervised responsibility. We feel that this increases confidence and expertise; and the results speak for themselves.

Residents learn by doing in the Simulation Laboratory. Dr. Heather Power, PGY-2, is at the left side of the bed with Dr. Alison Haynes, PGY-4 on the right (top) and Dr. Jennie Morrison, PGY-1.

Sitting: Drs. Anjali Kamra and Alison Haynes. Standing (from left): Drs. Andy O’Keefe, Erin Peebles, Lana Soper and Lorine Pelly

ManagerBy Dr. Sandra Luscombe

When I started my pediat-rics training in 1995 little did I know what my life would be like in 2012! Currently I am employed by Eastern Health working in the areas of develop-mental pediatrics and child protection. During 2011 I was particularly busy as in June I became president of the New-

foundland and Labrador Medical Association (NLMA). As well, I am as well a clinical assistant professor with the Faculty of Medicine which allows me to participate in the training of medical students, residents, social workers and police.

By the way, I have three children ages 9, 11 and 14 years who are all very active in music and sport. My 88-year old mother lives with my family. My husband has an equally busy career in law.

How do I manage all of this? Well some days better than others! It all comes down to deciding what you really want to do, prioritizing your commitments, thinking outside the conventional ways of working and making sure that you have fun while taking care of yourself, your family and your patients.

Several years ago I decided that I did need more time at home and reduced my work time to 80 per

cent (during the day), which allows me to be very involved in my children’s after-school life. I also take days off to attend appointments with my mother. This requires advance planning in my schedule and a wonderful administrative assistant to help me schedule appropriately to allow for the other commitments in my life. This year has been especially challenging due to being president of the NLMA. Again, the help of my assistant is key in keeping free times to move patients if an emergency arises. I have also found that being open and honest with my colleagues and patients has resulted in increased understanding of my less predictable schedule. It is also extremely important to know your limits and learn to say no to some opportunities no matter how interesting they may sound. Every day I have

to decide what must be done today versus what can wait until tomorrow. What patients do I

need to reach today and which ones can wait until later in the week? Who in my

department or which colleague could help me achieve what needs to be

done?Balancing my busy clinical

and medical manage- ment roles while still being a good daughter, wife and mother is a rewarding challenge. It doesn’t hurt that I have the best cleaning lady in the world, my mom cooks dinner twice a week and my

husband is a fabulous life partner who shares all the

responsibilities of managing a busy family.

Life in 2012 isn’t what I would have predicted but it sure is fun!

Academic ResidentAn important component of residency training is medical education. The academic resident rotation gives senior residents the opportunity to teach clinical clerks and junior residents on common pediatric topics. Teaching sessions generally consist of interactive and didactic learning centered around medical conditions that will likely be encountered during the pediatric rotation. Another

component is to perform witnessed history and physical examinations with the clinical clerks and junior residents. Residents are also responsible for completing an academic project in their area of interest. Overall, this rotation allows senior residents time to research the most recent evidence based medicine practices as well as develop their skills as medical educators.

CollaboratorBy Dr. Laura Vivian

At the Janeway being a collaborator is extremely important. We have many multidisciplinary teams which work together to provide exemplary patient care. One such example is our Cerebral Palsy clinic team. The team is com-prised of a general pedia-trician, a developmental pediatrician, a pediatric

neurologist, a pediatric orthopedic surgeon, a nurse co-ordinator, a physiotherapist, an occupational therapist, a speech language pathologist, a recreation specialist and a social worker.

Over the course of two days each patient has the opportunity to meet with each of the team members and discuss their current management and any issues which the patient may be facing. Each member offers their expertise to the patient and their family. At the end of the second day the team meets as a group to discuss each patient, their issues and what the team may do to facilitate better care for that patient.

At the Janeway this team-centered approach is used in many different clinics including diabetes, eating disorders, cerebral palsy and cystic fibrosis. Each of these teams may have many different members but each brings their expertise to the table in order to provide the optimal patient care for our patients and their families.

Members of the Cerebral Palsy Clinic Team (front to back): Dr. Jennifer O’Dea, pediatrician; Debbie Lynch, RN; Gail Eldridge, speech language pathologist; Shawna Sparkes, physiotherapist; Virginia McHugh, licensed practical nurse; Margaret Tibbo, recreation specialist; Dr. Tyna Doyle, developmental pediatrician; Charlotte Akerman, social worker; and Christina Powell, occupational therapist.

It all comes down to deciding

what you really want to do, prioritizing ... and

making sure that you have fun while taking care of yourself, your

family and your patients.

ScholarScholarly research in the Discipline of Pediatrics is greatly facilitated by the Janeway Pediatric Research Unit (JPRU), located on the fourth floor of the Janeway Hostel. The JPRU conducts clinical and applied health research and there are over 50 active projects in different

stages of completion on a range of childhood diseases.Dr. Roger Chafe is director of the JPRU and Dr. Leigh

Anne Newhook is medical director. The unit provides

office space for pediatric faculty, a research co-ordinator, research nurses and other research staff, plus secure storage room for research files.

Current research projects cover a wide range of topics and in the last year there have been peer- reviewed publications in areas such as diabetes; breast-feeding; childhood obesity; arthritis; access to cancer drugs; pediatric Crohns Diseases; vitamin D insufficien-cy in newborns, children, and pregnant women living in Newfoundland and Labrador; and seasonal variation of maternal vitamin D in Newfoundland. The JPRU is also a local training centre for the Canadian Clinician Scien-tist Training program and is responsible for the research training of pediatric residents at Memorial University.

Leadership Award for ResidentDr. Melissa Langevin, who completed her pediatrics resi-dency at Memorial in June, was selected as one of two re-cipients of the 2011 Resident Leadership Award from the Royal College of Physicians and Surgeons of Canada. The leadership award was for her significant contribution to Memorial’s Pediatric Simulation Program during her resi-dency. Dr. Langevin also received the award for Best Re-search Presentation at the Discipline of Pediatrics 2011 Residents Research Day

Dr. Langevin was one of two recipients of the 2011 Resident Leadership Award, established to recognize a resident who has demonstrated leadership in Canadian specialty education and encourage the development of fu-ture leaders in medicine. Dr. Langevin is presently doing a pediatric emergency fellowship at the Children’s Hospital of Eastern Ontario, Ottawa.

Health AdvocateBy Dr. Tracey Bridger

People often comment on how difficult it must be to be a pediatrician. While it is hard to see children suffering, those in pediatrics know how truly fortunate we are. As pediatricians, we take care of a wide variety of children with many complex issues from birth up until adulthood. One of the most rewarding things is watching our patients grow up. Pediatricians take care of kids when they are sick; we also offer preventative care and guidance to keep them healthy. It is very rewarding to know that the influences we have on a child’s health today often impact their health decades later as well.

Over the years, a career in pediatrics has evolved to include even more advocacy for children. The Canadian Pediatric Society states that “Every day … we make a difference in the lives of children and youth — one child at a time. We also possess significant (though often untapped) public policy influence.” There are so many things that influence the health of children that becoming their advocate can seem like a daunting task. Where do we start when so much has to be done?

When I first moved back to the province in 2001, I remember feeling completely overwhelmed. I was seeing so many children with complications secondary to their

obesity or lifestyle factors; helping them on my own in the clinic didn’t seem to be enough. Though I wasn’t sure exactly how to start, I knew something else had to be done. In addition to having a clinic and program, there was also a need to help develop preventative strategies as well.

What I’ve discovered over the years is that obesity is a complex condition with an even more complex etiology. Genetic factors influence the susceptibility of an individual to our obesogenic environment. Some people are more at risk than others, though we are all at risk. We often hear about the medical risks associated with obesity, but don’t always think of the serious psychological consequences. Children who are obese are more likely to have poor self-esteem, are at higher risk for depression, and are more likely to be teased and bullied. What makes it worse are the weight bias and social stigma suffered by many people with extra weight on. Many in society believe that a person’s increased weight is due to their lack of willpower or laziness. While we now know that this is untrue, it is often difficult to convince people otherwise.

Along with a great group of colleagues, I’ve been fortunate to help start a treatment program for children with obesity. The success of this program has allowed us to expand to include other children of all body sizes who have a medical condition, such as family history of cholesterol problems, high blood pressure, polycystic ovarian syndrome, liver disease, high blood sugars or type 2 diabetes, that may benefit from some lifestyle intervention.

Being an advocate for children with obesity — and for healthy active living for all children — has led to numerous other opportunities as well, including work at the regional, provincial, and national levels. As my work in this area continues, one of the most important aspects that I try to convey is that children and youth of all shapes and sizes deserve to be treated the same way we all wish to be treated — with kindness and understanding, dignity and respect.

Dr. Tracey Bridger is an associate professor in the Faculty of Medicine at Memorial and the medical director of the Lifestyle Program at the Janeway Child Health Centre.

Members of the Janeway Lifestyle Program include back (from left): Dr. Tracey Bridger; Anne Wareham, psychologist and clinical co-ordinator; and Charlene Edwards, recreational therapy development specialist. Front (from left): Susan Baird, physiotherapist; Lisa Dooley, dietitian; and Tammy Power-Gauci, social worker. Unavailable for photo: Holly Grant, policy planning research analyst; Natalie Rideout, administrative assistant; and Sarah Critch, physiotherapist.

Dr. Langevin received her award at the National Resident Leadership Summit in Quebec City in September 2011. From left: Dr. Jonathan Sherbino, Dr. Melissa Langevin, Royal College President Dr. Louis Hugo Francescutti; and Royal College Director of Education Dr. Ken Harris. Photo by Danielle Giguère.

Moving to St. John’sBy Dr. Shasta Moser

When I found out on match day that I would be moving to St. John’s to start my pediatric residency at MUN, I was both excited and nervous. Once I arrived at the Janeway for my orientation, I felt very welcomed by the residents, staff, nurses, our program director, Dr. Anne Drover, and others within the MUN community.

Everyone was so nice and went out of their way to help me get used to my new surroundings. There were several social events for the new residents so that we could get to know everyone. Fortunately, I got along with my fellow PGY1s right away, which was a relief. Now we’re close friends and we spend time together outside of the hospital regularly.

On my first day of work as a resident, I was on-call that night. I was scared, but fortunately I had a buddy resident, which we have for our first month of call at the Janeway. That night I didn’t feel alone, and now, even though I do call on my own, I still don’t feel alone. This is because the staff and senior residents always encourage me to call them, no matter what time, if I’m worried or if I’m not sure what to do. Then when I do call them at 3 a.m., they are always kind and supportive. This support extends outside of life at work. The senior residents still ask how things are going and are concerned about how the new residents are doing. Dr. Drover is also concerned for our general well-being and is very accessible and easy to talk to.

When I arrived in St. John’s and found my new apartment, I was happy to see there was a large lake nearby and several trails, within walking distance, that I could run on. It turns out that there are trails all over the city. There is also beautiful hiking on the East Coast Trail, which consists of a 540 km trail along the coast. The trail runs through the city, so you can easily hike during the afternoon then go to one of St. John’s great restaurants

for dinner, or hit up George Street for a drink. This is something that I really enjoy about living here. I also appreciate that my commute to work is 15 minutes and downtown is a five-minute drive. St. John’s is big enough that there is lots to see and do, but small enough that you’re not spending your day trying to get from one place to the next.

Now that I’ve been here for four months, I am settled in and I’m happy to be a part of the Janeway and St. John’s communities. When speaking to other candidates last year on the CaRMS tour, some people weren’t considering moving to St. John’s due to its location within Canada. However Newfoundland has such a unique culture and a rustic beauty that everyone should experience it. Given this and the fact that we have a strong pediatric program, I would encourage all pediatric applicants to consider MUN. I’m very glad I did!

Professionalism: Residents Support Each OtherBy Dr. April MacPhee and Dr. Colleen Nugent, co-chief pediatric residents

The best part of belonging to a small residency program is getting to know the people that we work with. As a group we are very social; enjoying potluck meals, drinks, dinners out and different activities such as hiking

the East Coast Trail are regular occurrences. Although work and studying keep us busy, we try to have fun and keep a balanced life. Recently we participated in the annual Janeway Christmas Rounds, which provides the staff with an opportunity to poke fun at all us residents and then the residents have a go at doing the same. Typically the residents outperform the staff, and this year was no different thanks to the participation of all the residents with brainstorming ideas, filming videos and even writing songs! Following rounds we all enjoyed lunch together at a local restaurant and completed our secret Santa gift exchange.

One of the most enjoyed activities is our two-day resident retreat, which takes place each fall. The retreat serves as a great opportunity for bonding and learning

amongst all the residents and some staff members too. It is the one time of the year where we are all off the call schedule together so needless to say it is a thoroughly enjoyed event! Typically, our retreats are held out of town in a picturesque Newfoundland setting, far away from the noises of the Janeway Children’s Hospital.

However, there are stressful times too during residency — sick patients who have poor outcomes, the pressure of call and sleep deprivation, and meeting deadlines for various presentations and projects etc. Having a great rapport with our approachable and friendly staff, as well as a supportive environment amongst our fellow residents makes surviving residency possible. Many of us are “come from away’s” (Newfoundlandism for “Not born in Newfoundland”), and have found that our fellow residents are not only close friends, but also our surrogate family. Often one of the residents will host Christmas dinner for all the CFAs who are working during the holidays, so that everyone feels included and welcome. We know we can rely on each other for support and help when it is needed. Newfoundland hospitality has a way of making everyone feel at home and we are very fortunate to belong to a residency program that makes us all feel very much the same.

Annual Resident RetreatThe theme for this year’s retreat was Transition from Residency to Practice. The residents took an escape from the city to a cottage on the southern shore. The day was filled with sessions delivered by accountants, financial advisors, and physi-cians offering information relevant to starting a practice and planning for the fu-ture. The retreat was an opportunity for the residents to learn the financial and practical aspect of transitioning into practice. As the learning sessions ended, the residents welcomed staff to the cottages to begin the social events of the evening. A special thanks to all presenters, staff, and residents who attended and to the second year residents for organizing another successful retreat!

Colleen Nugent and April MacPhee

DISCIPLINE OF PEDIATRICSHealth Sciences Centre, St. John’s NL

709 777 4699jaqueline.doran@med.mun.ca