The Practicum

Dr. Praseedha Janakiram is a Family Physician at Women’s College Hospital Crossroads Refugee Clinic. Her primary care practice is focused on the care of refugees and community-based HIV primary care with special interests in refugee and global health education, as well as capacity-strengthening initiatives and partnerships.

Supervisor: Dr. Katherine Rouleau 

Mentor: Dr. Joyce Nyhof-Young

Through leadership of an international steering committee of women family physicians, this work aims to co-design a virtual leadership program for early to mid-career family physicians, who identify as women, in low/middle income countries. This program aims to support women in strengthening effective personal, team, institutional and organizational leadership skills to serve their global family medicine community.

Abstract

Family medicine leadership growth opportunities for early and mid-career women has consistently been a request emerging from recent global health education offerings at the DFCM.  While more women are practicing family medicine than ever before, many early/mid-career female physicians face gender-based barriers to professional and academic success as they strive for leadership positions.  This practicum aims to identify key leadership domains of need identified by our global women family physician colleagues through a needs assessment exercise executed in 2023. Through this practicum, Dr. Janakiram will support and co-chair a steering committee of international women family physician leaders with the multiple aim of co-creating and delivering a live and virtual DFCM workshop to engage DFCM faculty and colleagues in addressing this issue. This workshop was successfully delivered in-person and virtually in May 2023. Additionally, Dr. Janakiram will co-chair the steering committee with the aim of identifying and co-developing the virtual leadership program course plan, modules, objectives for women in family medicine with a specific focus on emerging women physicians in low and middle income countries.

Dr. Chung Kit (Jacky) Lai is a family physician at Royal Victoria Regional Health Centre. Dr. Lai’s current clinical focus is family medicine and palliative care.

Supervisor: Dr. Jeff Myers

Establishment of a division of Palliative Care within the Department of Family Medicine at Royal Victoria Regional Health Centre through the use of knowledge and skills learned through the MScCH(FCM) program.

Abstract 

A growing desire and need for a Division of Palliative Care within Royal Victoria Regional Health Centre (RVH) was identified. There is limited published literature or resources available to guide the creation of a division of care. Engagement of stakeholders including prospective division members, other division and department leads within the hospital organization, and palliative care division leads in similarly sized community hospitals assisted in establishing priorities and objectives of a division of palliative care through qualitative feedback. Frequent communication between prospective division members and hospital executive leadership was valued. The methodology in creating the Division of Palliative Care at RVH between May 2022 to February 2023 may be used as a framework to guide similar endeavours.

Dr. Iwona Baran is a Paediatric Emergency Medicine physician at the Hospital for Sick Children and Program Director of the Royal College PEM fellowship at UofT since 2016. She has an interest in skills transfer and growth mindset in relation to medical training. 

A curriculum was designed for PEM residents at the Hospital for Sick Children to train them in providing virtual care to patients. The new curriculum includes: 1) an online module; 2) a skills session; 3) simulated cases; 4) an OSCE; and 5) supervised virtual shifts. The novel curriculum was launched in the Fall 2022 and will soon be evaluated via resident interviews. Based on program evaluation, changes will be made for the next cohort of trainees. 

Abstract: 

The Hospital for Sick Children (HSC) was the first pediatric emergency department in Canada providing virtual visits. PEM residents receive no specific training in providing virtual care and were concerned about their ability to provide safe and quality care to patients virtually once they become staff. While there is increasing published literature related to teaching telemedicine (Afshari, 2019; Hayden, 2021), there are no standard recommendations regarding components of an effective and highly rated virtual care curriculum (Basu, 2010; Stovel, 2020), and no PEM specific curricula exist.  

The primary goal of this practicum project was to develop a competency-based, outcomes-oriented curriculum for PEM residents training at HSC in conducting virtual emergency medicine care.   

The curriculum is grounded in educational theory, with initial learning objectives aligned with the CanMEDS framework, based on expert opinion, and published medical education literature. The learning objectives of the curriculum explore and focus on three domains: scope and standards of care, “webside” manner, and virtual clinical interaction.  

The curriculum includes five parts: 1) a self-learning portion with reading and access to online resources via online course module; 2) a hands-on introductory skills session with the virtual care software; 3) simulation of the virtual patient encounter with reflection and small group discussion; 4) an observed structured clinical examination (OSCE); and 5) virtual shifts with oversight from staff PEM physicians.

Evaluation of the program will be undertaken shortly. We will elicit curriculum feedback from residents via interviews. The residents’ interviews will seek to offer insights into how the trainees experienced the curriculum, strengths identified and areas for potential improvement. Furthermore, the interviews will aim to capture any unintended processes or outcomes as a result of the curricular experience (Frye, 2012; Cook, 2010; Haji, 2013). This feedback will help to shape future iterations of the curriculum.

Dr. Eileen Nicolle is a family physician at St. Michael’s Hospital. Dr. Nicolle is currently working in inner city health with a focus on vulnerable patients.  

Supervisor: Dr. Ashley Aimone 

Mentor: Dr. Paula Braitstein 

This practicum revolves around the writing of a case study which highlights the co-benefits of prescribing nature for both people and the planet. The case study is intended to be potentially used in an MPH course. 

Abstract 

Featuring the Parks Rx program in Canada, this case study details how a program that integrates medical care with the natural environment can have positive effects on both human health and ecosystems. This case study begins by contextualizing the current epidemics of non- communicable diseases such as obesity, hypertension, and diabetes both in Canada and globally. It then considers how these health issues are related to planetary crises. The benefits of Indigenous activism around planetary health and Indigenous values are highlighted, with a focus on how learning from Indigenous ways could help address the unique challenges faced in the Anthropocene. The case study delves into how prescribing nature can benefit human health and outlines an approach to addressing non-communicable diseases through nature prescriptions, emphasizing the connection between human and environmental well being. In doing so, it considers the barriers and challenges that people experience in trying to access nature, including those related to the social determinants of health. It looks at how these barriers and challenges can be overcome through collaboration between communities and health teams in order to address important health threats as well as create a culture that values and protects the natural environment on which health is dependent.