Family Medicine Resident Wins Prestigious Research Awards
Congratulations on your awards. Tell us more about the research you are doing that is being recognized by the Faculty of Medicine.
I am working on a research project within The General Medicine Inpatient Initiative (GEMINI), which was launched to collect, standardize, and analyze internal medicine patient data at several hospitals in the Greater Toronto Area to support quality improvement initiatives. My study is focused on delirium, particularly in elderly patients. Delirium is associated with high mortality rates, incident dementia, longer hospital stays, increased readmission rates, and poor long-term outcomes. Healthcare costs for patients with delirium are more than double those of patients without. Despite its association with numerous negative health consequences, delirium is still under-recognized in the medical community and research has shown that the true number of patients affected by delirium in hospital is under-estimated in hospital administrative data.
Discharge from hospital following an admission that includes an episode of delirium is particularly high-risk, as delirium has been associated with functional and cognitive decline, institutionalization, and mortality. My project is examining the current quality of discharge summaries for patients diagnosed with delirium using a validated method of chart review, to determine whether appropriate management and follow-up recommendations for family physicians are documented. Overall, from the family medicine perspective, I am interested in transitions of care, which are often high-risk periods with up to 50% of patients experiencing a medical error or adverse drug event.
The award I received from the Faculty of Medicine, which is known as the William S. Fenwick Research Fellowship and William Cron & Jean Harris Memorial Fellowship, will be a great asset in completing the project because it provides financial support for postgraduate trainees engaged in medical research. Through this research, we hope to improve health outcomes by determining how we can improve transitions of care and communication between inpatient and outpatient physicians, create delirium-specific discharge recommendations, and assess antipsychotic use in the elderly with regards to delirium management.
Tell us about your research that recently received an award from the CFPC.
This research project focused on evaluating a telepsychiatry program for urgent mental health concerns among children and adolescents in remote areas of Ontario, including remote James Bay coastal communities. We had previously published research looking at predictors of children and adolescents who were repeat presenters for urgent psychiatric consultation, often through the emergency department. We found that many of these repeat presenters were Aboriginal youth, who were often transferred from remote community to tertiary care centres for psychiatric assessment. Several of these remote communities have high youth suicide rates and there is a significant need for increased mental services and supports. Offering services via telemedicine provides accessible support for parents and providers, without incurring travel costs. Patients and parents were satisfied with the results of the project, as it eliminated unnecessary travel, could be offered in a timely manner (within 48 hours of referral), and was not associated with a difference in outcome compared to patients assessed in-person.
Tell us more about your background and how you got into family medicine.
I did my undergraduate degree in Biology and Psychology. Before medical school, I worked in both basic science and clinical research largely focusing my research on beta blockers and anemia. Through these experiences, I was able to meet excellent mentors that have inspired me to work harder and do better for my patients, both from a clinical and research perspective.
I went into medical school at the University of Toronto, with the intention of becoming a family doctor. My clinical interests have always been in working with marginalized and vulnerable populations. During my undergraduate studies, I created a therapy program at several hospitals to help provide cognitive, physical, and social stimulation for geriatric patients with dementia.
During medical school, I was the executive director for IMAGINE, a student-run interprofessional clinic offering free comprehensive healthcare services without the need for health insurance or identification, for clients experiencing precarious status and homelessness. I launched IMAGINE’s research program to support evidence-based program development at the clinic, and I also created a longitudinal elective for medical and allied health profession students, to offer the opportunity to learn about relevant issues facing marginalized populations and non-medical interventions for poverty. My work with IMAGINE enabled me to give back to my community by helping people who may otherwise not be able to get the support that they need. It has instilled in me a deep appreciation for a team-based approach to primary care.
Why did you decide to study family medicine?
Family medicine is a truly patient-centered discipline, with a focus on building long-term relationships and continuity of care. I have had the privilege of delivering babies that are now learning to take their first steps in my office; I have worked alongside patients and families during the ups and downs of life and have learned so much from their strength and resilience.
My work with marginalized and vulnerable populations has really shown me the positive impact that primary care can have for patients and communities. Family physicians can make a significant difference by helping patients navigate a complex healthcare system and addressing social determinants of health, such as income, social supports and so on. Primary care is the foundation for the healthcare system and the focus on preventative healthcare can make a significant impact for both patients and the wider system.
What do you hope to do after you graduate?
I hope to practice comprehensive family medicine, in a setting where I can continue working with and advocating for underserved and marginalized populations. I am particularly interested in program development to address unmet needs that I see within my clinical practice and hope to incorporate my research and teaching interests.