OMSA ASIST Workshop 2017 - Training Students In Suicide Intervention


On February 18th to 19th, 2017, OMSA held a workshop in partnership with LivingWorks for Applied Suicide Intervention Skills Training (ASIST)! 

Applied Suicide Intervention Skills Training (ASIST) is a two-day interactive workshop in suicide first aid. ASIST teaches participants to recognize when someone may have thoughts of suicide and work with them to create a plan that will support their immediate safety. Although ASIST is widely used by healthcare providers, participants don't need any formal training to attend the workshop—anyone 16 or older can learn and use the ASIST model.

30 medical students from across Ontario traveled to Toronto for the workshop over the weekend. Here are what some of them had to say.

Snapshot of Choosing Wisely Canada National Conference

André Picard, health columnist with The Globe & Mail, poses for a photo with three undergraduate medical students at the Choosing Wisely Canada (CWC) National Conference on March 30th, 2016. Bushra Kahn (McMaster), Gurmeet Sohi (University of Manitoba), and Meagan Roy (Northern Ontario School of Medicine) have been actively involved with Choosing Wisely Canada since November 2015. For opportunities to get involved, visit choosingwiselycanada.org or contact your local CWC student representative!
To learn more, please follow us on Twitter: @meaganaroy, @gksohi07, @bushramaliakhan

 

Three Nights in Emergency

As a second year medical student I am still unsure of the field of medicine that interests me the most. Shadowing physicians is a great way to get a taste for different specialties, and that is just what I’ve been doing. Emergency medicine initially appealed to me because it seemed to be a very fast-paced, hands on specialty that deals with acute crises. However, as I spent some time in the emergency department of a local hospital, I found it to be rather different from what I expected. Three patients in particular stand out in my memory. Incidentally, all of them were brought in by the police.

There was one woman who was probably in her forties or fifties; she looked really unkempt and dishevelled. This patient lost consciousness at a bar, where she had been drinking for the past few hours. When the doctor saw her, she was already conscious and alert. She was really angry at the policemen for bringing her to the hospital, because she felt she had no business being there. In a way, I agreed with her. She was still intoxicated and confrontational, but there was little for us to do. She may have needed support, maybe addiction treatment, but that is not the role of the emergency department. She had no injuries and seemed of sound mind, even though she was swearing a lot. The doctor thought the least we could do was get her home safe, but even that proved difficult, as the taxi drivers refused to take her due to her demeanour. In the end she left on her own.

There was a man who was older, probably in his sixties or seventies, seated in a wheelchair and covered by a blanket. He looked really ill and emaciated, was homeless, and there was a strong odour of alcohol about him. I got the task of interviewing him, but I was able to get very little information. The answer to most questions seemed to be “I don’t remember” or “I don’t know”. He was not aware of any chronic or acute medical conditions that he had. All he could really tell me was that his leg really hurt and he couldn’t walk. He still had his sense of humour though; to my questions about his bowel habits he raised his eyebrows in mock outrage and said “do I look like I have trouble with that?”. As the physician looked at the records of this man’s previous visits, she noticed that this patient has been here just last week, and very often before that, too. According to the records, this patient likely had an underlying cancer and dementia. It seemed clear to me that he needed continuing care, yet he was admitted and discharged several times in the past few months, sleeping on the street or in the shelter in between hospital visits. The doctor, who understandably felt really bad for the man, got me to bring him some food, and then she admitted him to medicine, once again.

There was a young woman, in her late teens or early twenties, who was brought in because of suicidal ideation. A friend of hers called the police. Before we went to see her, the physician told me he has seen her here many times in similar circumstances. There was police waiting by the room where the patient was held, and she still had handcuffs on, even though she seemed perfectly calm. The physician got them to remove the handcuffs and talked to her for some time, while I listened. The patient seemed sure that she was going to be safe if she was allowed to leave, and both her and the physician agreed that nothing positive was going to come out of her being admitted - after all, this has happened several times before, and the patient claimed the experience at the psychiatric ward was not helpful in the past. She got some juice, a taxi voucher, and went to the shelter she was staying at. I wondered how much time would pass before she would find herself in the emergency department again.

Even though these are three distinct patients, I saw several others like them in my short time in emergency. These patients belong to vulnerable populations and need ongoing regular care, yet they don’t get it. Instead, it seems, they end up in the emergency department on a regular basis, where the doctors chat with them, give them some food, and send them on their way. In the winter, especially on cold nights, some physicians will often keep these patients at the department for longer if they know there’s nowhere else for the patients to go. I admire the seemingly unlimited reserves of empathy and understanding of emergency docs; I also noticed

how knowledgeable they are about resources available in the community - they know which shelters to call and know the ones that won’t take patients with substance abuse issues. And yet, it seems like a visit to emergency is an expensive and an ineffective way to address these patients’ issues. For many of them, a lot of problems would be solved by stable counselling, and/or housing, or simply a dedicated family doctor. Although these experiences did not discourage me from pursuing emergency as a specialty, I certainly view it in a different light now. It is really a specialty that combines primary care, emergency care, psychiatry, and social work into one. 

- Polina Tsybina, Western

Finding Meaning in Medicine

From learning about the "tough, spidery and tender mothers" of the meninges, to the "gate-keeping properties" of the pylorus (pyle = gate; ourus = guardian), I have had great fun exploring medical etymologies this past year. Medicine is a veritable treasure trove of word origins; it is a discipline chock full of fascinating etymologies and hidden stories. Behind every pathology, process or treatment, it seems, there lies a tale of epic proportions just waiting to be told. Here is but one: 

Fascicles. Or, rather, 'fasciculi". The bane of medical students' existence during MSK blocks (or at least, the bane of this medical student's existence during his MSK block). We throw around the term 'fascicle' with no great sense of gravitas. It is, after all, just a building block - a necessary sub-component - cut, and cut away again from a larger, more clinically significant whole. 

A concrete subdivision of layer upon layer of fibers, made even more concrete under the magnifying lens of microscopy. But what about training our gaze on the abstract story of 'fascicle'? What can be learned from putting the story of 'fascicle' under the microscope? What hidden story lies beneath this otherwise (largely irksome) anatomical division? 

Deriving more proximally from Latin "fasciculus" - a small bundle, as of flowers, or letters - the term enjoys a fascinating journey through the history of language. The term's movement through Latin saw the affixing of its current diminutive suffix "-ule" where it came to refer to a "small part of a work, published in installments". Here, then, is my official call for us all to refer more appropriately to the Prisoner of Azkaban not as the third installment in the Harry Potter series, but rather, "the third fascicule" 

Indeed, fascicule itself derives from 'fasces" - which describes a 'bundle of rods containing with an axe, with the blade projecting outwards'. In classical times, 'fasces' was carried by those in power as a symbol of control over life and limb. The sticks symbolized the ability for power to punish: rods represented whipping; the axe head - execution. The term slowly came to be equated with "high office" and "supreme power." From here, the term's intricate relationship with the high office and supreme power of 'fascism' becomes much clearer. Indeed, the fascicle itself was the symbol of Mussolini's National Fascist Party. 

How "fascinating" (which, fascinatingly enough, is a term that has less to do with fascicles, and likely more to to do with genitalia). But that's another story for another time.

Etymology is the window into meaning. The words that occupy everyday medical parlance do not (and often cannot) exist in isolation from their historical context. They say that a good clinical history helps the physician arrive at a correct diagnosis about 80% of the time. In much the same way that a complete history is important to understanding a patient's presenting condition, a working knowledge of (or at least a curiosity for) the history of the medical terms we use can help round out our understanding of the conditions and or anatomical structures to which we are referring. 

Happy etymologizing! Or, perhaps more accurately, iatrologonomizing (that is, discovering the underlying rules and histories of medical terminology). 

Kian Madjedi, Northern Ontario School of Medicine

Something From Nothing

*To protect patient privacy, names were altered in the retelling of this story.

I entered the room behind Dr. McDonald and introduced myself to John and his wife. They were an older couple – likely in their 70s – who seemed pleasant. Dr. McDonald hadn’t briefed me about John’s background and history before we entered, so I listened and watched attentively as the appointment began.

John’s wife, Claire, responded to the questions and guided the direction of the interview while he sat quietly opposite her, providing only the rare nod. Claire inquired about a trial for a new Lewy body dementia treatment, and I was made aware of the reason for John’s visit today.

Claire had brought hope with her to this routine appointment in the form of a piece of paper with details about a medication trial. The knowledge of this trial instilled Claire with the idea of possibly stopping the progression of the disease and perhaps even bringing her husband back home to her.

The medication trial was news to Dr. McDonald, and he searched it online to learn more. Claire waited in eager anticipation, and Don continued to sit contently in his chair wearing his freshly pressed clothes, tied shoes, and ball cap – all signs of Claire’s love for him.

“You know, he’s started calling me Larry,” Claire said as Dr. McDonald scanned the reports about the drug in question. “He’s not remembering my name anymore.” She didn’t seem to expect a reply; she just needed to share.

And with one sentence from Dr. McDonald, Claire’s hope vanished from the room. “It doesn’t look like this new drug is an option for John,” Dr. McDonald said softly, knowing the impact of his words. He allowed for silence as Claire processed the statement and reflected.

“There’s only been a single twelve person clinical trial so far and recruitment is only happening at large hospitals in the States,” said Dr. McDonald, gently providing additional information and answering Claire’s questions.

I looked at Claire and John and the only question on my mind was: Why them? This disease was something they had never asked for, never expected, and almost certainly didn’t deserve. It was a single diagnosis changing the entire course of their story as it continued to progress.

I’m typically the type person who smiles my way through the day and waits until I’m behind closed doors to let the emotions flood out. However, that day, I sat in the exam room feeling tears form behind my eyes as I witnessed this couple’s journey and felt their heartbreak. Today, John was sitting in that chair, but the reality was that it could have just as easily been one of my family members or friends. So many of our lives are woven with stories of medical inflictions experienced by us or our loved ones for which relief is unattainable.

The appointment was near complete. John didn’t have any major changes, and there weren’t currently any new options to try. Dr. McDonald would see him again in three months.

“Oh, does John want to get a flu shot today?”

A vaccine was all we could offer him.

“John, do you want one?”

Sure, we had conveyed empathy during the check-up and the reassurance that nothing new had developed. But, medicine could offer nothing more – just a flu shot with varying effectiveness and potential side effects.

I briefly left the room to retrieve a vaccine from the fridge and returned to administer it. All of ten seconds, and the inoculation was complete. The extent of our “deliverables” had been reached.

All we administered was a flu shot. Would John benefit from it? Perhaps he would be shielded from the wrath of some untimely pathogens and subsequent illness and discomfort. But it would do absolutely nothing to help him – and Claire and their family and friends – better live with Lewy body dementia. It wouldn’t help him remember his wife’s name.

I felt useless. Medicine felt useless. In this field, we rejoice in the discoveries and interventions. What happens when there simply isn’t anything else to do or try?

It’s reflexive to repress the moments that don’t offer us hope.

But, those unhopeful moments, they need to be recognized; they are innumerable in medicine. I don’t think we have to fight back tears every time they happen, like I, the inexperienced and naïve medical student did. I think we can find beauty in the unhopeful moments – the beauty of humanity evolving in all of its imperfect forms. We bear witness to stories of all kinds; regardless of whether there is hope or positive news, these experiences are real and provide us with a glimpse into someone’s life. There are few things more beautiful than that.

This is all easier said than done. We strive for medicine to be equal parts comfort and care but, if required to be described by one adjective alone, could probably be summed up as uncertain. But, so is life and the stories of the patients we encounter.

I’m learning that our practice as physicians extends beyond providing treatment and striving to attain results. We are behooved to enter into the sacred story and personal narrative of each person. Our patients, and their families, are living with a diagnosis, not necessarily suffering from it. What a privilege to bear witness – as they continue living – and observe all that their life encompasses: families, friends, hobbies, jobs, and homes, among others.

In the cases when we can do “nothing” there is indeed something to do. Yes, that something could be a seasonal flu vaccine, which is an important suggestion to help prevent infection. But, after meeting John and Claire, I think that “something” is multi-faceted and involves much more. For each patient we care for, it’s acknowledging limitations, emphasizing listening, making space for connections, and, most importantly, honouring the human experience.

Megan Schlorff, McMaster University

Wellness Blog Series: Salads in a Jar

What is more enticing than the idea of a nutritious, colourful, flavourful salad? A nutritious, colourful, flavourful salad in a jar! I recently came across this idea and it has certainly revolutionized my lunches (which I frequently consume on the go). Creating and enjoying healthy meals that provide me with the nutrients and energy I need is one aspect of my daily wellness routine. I hope this idea will also inspire you to be creative---there are heaps of different combinations to explore

Here’s How:

  • Use a pint-sized mason jar for side salads and a quart-sized mason jar for main meals
  • 1st layer: Put the dressing on the bottom (~2 Tbsp/jar)
  • 2nd layer: Place items that will marinade in the dressing (e.g., meats, tofu, cooked grains, mushrooms, etc.)
  • 3rd layer: Place greens/ veggies on top (e.g., sprouts, spinach, kale, lettuce, tomatoes, yellow pepper, etc.)
  • Tip #1: Add a protein to make your salad hearty and filling (e.g., chicken, quinoa, beans, lentils, tofu)
  • Tip #2: Make sure to jam-pack jars full so things won’t shift around
  • Tip #3: A good ratio is half toppings (e.g., dressing, grains, protein) & half greens
  • Tip #4: Add seeds/nuts for an extra crunch!
  • To eat: shake salad so that dressing coats ingredients and either dump into a bowl or eat on the run!

*Adapted from "Back to her Roots" blog by Cassie Johnston

Keep Well Friends! 

Jazmyn Balfour-Boehm; MD Candidate NOSM Class of 2017 

 

 

Wellness Blog Series: 10 Tips to Improve Your Sleep

1.     Minimize screen time – Computers provide a vast breadth of information and entertainment but provide a constant drive to do more with the entire internet at our fingers. Although an important tool to study and destress, one must be careful to not overstimulate themselves before bedtime. Taking care of computer work earlier in the day and switching to reading hardcopies later can ease strain on the eyes and help prevent sleeplessness.

2.     Go to bed when you’re tired – Although it appears this is the most obvious advice, many of us push past the signs our body gives us to keep working late into the night. If you don’t feel tired after finishing work for the day it could be because you have forced yourself past the time your body wanted to sleep and have reawakened. A good night’s sleep can reenergize you to pick up the work again in the morning.

3.     Take less caffeine and take it earlier in the day – For those of us who might be more reliant on caffeine to get us through the day it’s important to realize its effects might persist to bedtime. Coffee or other caffeinated beverages should be avoided in the late afternoon or evening. If like me you just enjoy hot drinks try switching out your usual afternoon coffee for decaf or uncaffeinated teas.

4.     Improve the sleeping environment – It’s important that you are comfortable in bed in order to sleep. Darker blinds and ear plugs are ways of reducing light and noise pollution.  Adjusting the temperature to comfortable levels and investing in a pillow that suits your size and posture, are two other ways to a comfier bed.

5.     Exercise – Best done in the morning or early afternoon to wake you up and avoided right before bedtime. Staying active helps with daytime tiredness and problems falling asleep. It can be hard to incorporate the recommended amount of exercise into a busy schedule especially if you’re already feeling tired but the evidence is clear that in the long term getting in that cardio will improve productivity along with its other important health benefits.

6.     Set a schedule and stick to it – Although not always possible due to call, having a consistent sleep schedule can make sleeping through the night easier. Avoiding unnecessary alterations like sleeping in on the weekends, staying up late and then forcibly readjusting back to the work week. Try to notice your tiredness throughout the day and make long term changes. If you have trouble staying awake during the afternoon or have trouble waking up in the morning, these are signs you might need to set aside more time for sleep and move your bedtime earlier.

7.     Manage your stress – Being overly stressed or anxious can lead to difficulties sleeping or poor sleep quality. It’s important to not lay in bed restlessly trying to force yourself to sleep as this just leads to more stress. Some light reading or a not overly stimulating past time can be done until you feel tired.

8.     Seek help if necessary – New onset or worsening insomnia may be precipitated by physical or mental stressors. Problems sleeping following a significant life change or associated with other health concerns may require you to seek help from those close to you or a professional.

9.     Dealing with jet lag – Most of us have or will be flying out for residency interviews, this can mean adjusting to sleeping in a new time zone. There is evidence that taking melatonin close to when you plan to sleep is a safe way of reducing jet lag. Adjusting your bedtime and waking hours to the new time zone before your flight can help ensure you are fully awake and refreshed during your stay.

10.  Pull the all-nighter – As a last case scenario when work has piled up or you just can’t seem to feel tired you might just end up going without sleep for a night. I try to avoid this as much as possible but sometimes you just can’t help it. It’s important you judge if you’re alert enough the following day for any tasks that might be compromised or risky from a lack of alertness. Try to avoid napping during the day and take an early bedtime the following day to reset your schedule.

- Chris Yildiz, Schulich School of Medicine and Dentistry

Wellness Blog Series: Have you had your calm moment today?

Beep! - "Have you had your calm moment today?" is a message that pops daily on my phone at noon - an app I downloaded on my cell.

As the new year rolls in - enticing us to make a new years resolution, I decided to incorporate the practice of mindfullness more frequently throughout the day, rather than for just 10 minutes each day. Before entering medicine, I was always apprehensive about the future - about the uncertainty of not knowing what type of career I would be part of and about having to just "settle" in a job that I felt was not bring out my fullest potential. Being accepted into medicine has brought so much happiness and joy - that sometimes I still catch myself smiling eagerly in an anatomy lecture, for no reason other than the fact that I am so privileged to be learning this material.

But very soon - my initial apprehensiveness of an unknown career changed into an anxiety of unknown 'residency' career : what type of doctor will I be and I need to know that quick so I can plan accordingly! As I stressed about this over my Christmas break, it just hit me - as humans we always find some reason to be anxious or worry by constantly comparing ourselves to those around us no matter how blest we end up being. We worry that our colleagues are doing research or starting some awesome initiative over the summer and so we need to do the same to remain competitive. But why do we feel that way constantly?

I believe its because we allow our minds to be drawn into so many different directions that we forget to do what is most important: focus on what is and what we know "for sure" and that is - the present. I usually practice being in the present through mindfulness meditation which is the awareness of my thoughts, emotions and judgements. Applying the analogy as described by Eckhart Tolle, an author whose books I found very thought provoking - he describes our "true selves" as the sea bed. While the events in our lives are the waves on the surface. Sometimes, the waves are calm and silent, but other times are rough and turbulent (like times of sadness and conflict). However, what remains constant is the solid sea bed which just observes the waves above.

I have been practicing meditation for many years now. However, before I used to think that meditation was a method to relax. However, on the contrary, as time passes by I realize that meditation takes immense concentration and it actually is a method to concentrate because your energy is used to focus. I love the analogy of a running race to understand the value of being at peace with the present, and the importance of concentrating daily on the present. If you've ever observed an athlete sprint, they never (rarely) turn back to look at the person behind - because doing that would inadvertently take away energy and your focus. I believe the same goes for our daily lives, we must live life without turning back and comparing ourselves to colleagues or be pulled with waves in multiple directions if there is storm.

Instead, we need to be observant like the sea-bed and focus all our energy into the sprint.

Having said that, have YOU had your calm moment today? 

- Jennifer DCruz, University of Ottawa MD 2019 

Wellness Blog Series: The Art of Wellness - Perspectives of two first year medical students

After many years of hard work, you have finally been accepted to medical school. This isthe one moment you have always waited for and cherished. During the first day of orientation week, you find yourself overcome with a mix of emotions and feel anxious to begin your medical education. Within minutes of meeting your new classmates you become overwhelmed by the extensive repertoire of medical knowledge and each of their unique accomplishments. Will I have enough insight to hold meaningful discussions with my classmates? Will I be a good physician? What aspects of medicine will I pursue? How will I ensure my professional and personal development over the next four years? 

As these questions cross your mind, you are also given the opportunity to reflect the steps you will take to maintain your wellness. Wellness, both physically and emotionally is the foundation that will drive medical students to achieve their success. 

Student wellness or physician wellness is a topic talked about repeatedly throughout students’ medical training. However, it is a concept that may appear arbitrary to some. It is important to recognize that wellness is not achieved at a single point in time, but is rather a life long process only achieved if one learns how to create it. Physician wellness is a career long journey that does not start during your first day on the job, your first day of residency or the day you get your MD degree, but rather the day you open the acceptance letter. As medical schools across Ontario and our country, it is our responsibility to take every opportunity to enhance our wellness – because the art of wellness is just as important as the art of medicine. 

Join the OMSA Wellness Committee this March for the 2016 Wellness Retreat at The Briars Spa and Resort.

Tina Felfeli (University of Toronto) and Jorge-Ryan Georgakopoulos (Schulich School of Medicine and Dentistry) 

MD Candidate Class of 2019