Ciara Parsons

Fei-Fei Liu is the chair of the department of radiation oncology at the 91�Թ�’s Faculty of Medicine. She is also a professor in the departments of medical biophysics, otolaryngology, the Institute of Medical Science and the department of radiation oncology, and is the chief of the radiation medicine program at the Princess Margaret Cancer Centre.

She also served as the chair of the medical advisory committee at the University Health Network from 2018 to 2020.

Liu recently spoke to Faculty of Medicine writer Ciara Parsons about how the pandemic has affected patients with cancer and how the Princess Margaret Cancer Centre has responded.

Can you tell me about your role as the chief of radiation medicine at the Princess Margaret Cancer Centre?

As the chief, I help to manage and operate one the world’s largest single-site radiation departments. We have a team of about 350 highly dedicated professionals, and the world’s largest collection of cutting-edge equipment for radiation therapy.

At the Princess Margaret, we deliver more than 11,000 courses of radiation to patients each year.

How has cancer care changed in the face of COVID-19?

The way we deliver radiation therapy to patients has changed. Traditionally, radiation therapy is delivered to patients over several weeks. The patient comes in every single working day to receive their treatment.

However, when COVID-19 hit, we started to think about how we could change this process so that patients have less exposure to hospital settings, especially for our older patients.

Emerging research has shown that we can actually treat patients using a much shorter radiation regimen, reducing the total time from the traditional five weeks, down to three weeks, or even one week in some instances.

Our team at the Princess Margaret worked extremely hard on modifying the processes in switching to this shorter delivery method, and have pivoted rapidly because of the pandemic. In mobilizing this approach, we are ensuring that we can still deliver the safest and highest quality radiation care for our cancer patients, but in a much shorter time period.

What are some ways COVID-19 has impacted patients with cancer?

One of the major ways COVID-19 has impacted patients receiving cancer care is the deferral of radiation and other treatments. This was done so that we could limit patients’ visits to the hospital and keep them at home, unless it was absolutely necessary for them to come in.

As part of our role, we look closely at the window of time that we have between patients’ surgery and the time when we must start the radiation treatments and try to optimize that interval. We need to ensure that care is delivered safely. We also need to make sure it’s done within the appropriate time frame and that it will ensure the best clinical outcome for our patients.

This can be challenging sometimes because some patients do not wish to defer their radiation treatments, even if it’s safe to do so. I remember having a challenging conversation with a patient who wanted to have all of her radiation treatments over with and was upset at the idea of having to defer her care despite COVID-19.

However, when patients need treatment urgently, we will treat them immediately.

What has your experience with virtual care been like?

Since we are trying to avoid asking patients to come into the hospital for appointments, we have rapidly switched much of our care to a virtual format, and are now having these appointments either through video or phone calls. Right now, approximately 50 per cent of the activities we perform in our clinics are being done virtually. To deliver virtual care, we have been using the Ontario Telemedicine Network (OTN).

The OTN has been around for a long time, but with COVID-19 there has been a massive shift in our use of this platform. When we first switched to virtual care, there were a few technical issues to work through, but we have now landed on other solutions that also work well for our group of providers.

Virtual care is a good solution to delivering cancer care under the right circumstances. However, there are some aspects of in-person care that it cannot replace.

For instance, seeing new patients whom I have never met before and explaining radiation treatment to them is different when this meeting is now being conducted over the phone or on video calls. You cannot see the patients’ body language or have as acute a sense of their anxiety or fear.

I think this is difficult because the rapport that we have built with our patients over time has been developed based on face-to-face connections and this type of virtual interaction, particularly with new patients who have never met us, might potentially impact their sense of trust in us as physicians.

There can be benefits, though. For patients with whom I already have established relationships, virtual care is proving to be very effective and follow-up clinics are a lot easier for these patients since they no longer have to come down to the hospital.

What have you learned during the pandemic?

Pre-COVID-19, we used virtual care mostly for patients who lived far away from the hospital.

Our use of virtual care has increased during the pandemic – in a good way. Everyone sees value in continuing with virtual care and integrating it as part of our routine workflow in a post-pandemic setting. This approach streamlines a lot of the care we deliver, and is definitely easier for patients.

Of course, there are limitations to virtual care in that phone calls and video visits do not replace the type of in-person care that patients would normally receive. There is no question that for patients who are sick or who need to be examined, in-person care is the only way to properly assess and care for them.

Do you think the pandemic has highlighted any specific issues?

I think the pandemic has underscored the harsh realities of health disparities.

With data showing that specific populations have been more affected by COVID-19, it’s clear that socio-economic status and geography play a large role in health outcomes.

In cancer care as well, we sometimes see that patients who are economically disadvantaged might experience more distress as they may not have access to the necessary supports or resources they need.

Fortunately, at the Princess Margaret Cancer Centre, we do provide access to social supports for our patients who require these services. As a health-care leader, it is really important to me that we address these gaps successfully and ask what we can do to help.

I also believe the pandemic has shone a light on the racism that exists in our society. At the beginning of the pandemic, we heard a lot of concerns about how COVID-19 had spread globally, which led to a lot of anti-Asian racism.

As an Asian physician, I want people to know that there are a lot of Asian health-care leaders and front-line providers who have been working extremely hard in treating patients during these very challenging COVID-19 times and trying our best to mitigate the effects of this pandemic on all of our patients.

Loss of medical services and anesthetic care widening health gaps for rural communities: 91�Թ� researcher

Christopher.Sorensen — Tue, 28 Jul 2020 14:57:48 +0000

Loss of medical services and anesthetic care widening health gaps for rural communities: 91�Թ� researcher

Christopher.Sorensen Tue, 07/28/2020 - 10:57

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(photo by kupicoo via Getty Images)

Topic

Research & Innovation

Researchers from the 91�Թ� researcher and Queen’s University say Canada needs a national strategy for improving anesthesia services in rural and remote regions due to a lack of anesthesia care providers in these areas.

Beverley Orser, chair of the department of anesthesiology and pain medicine at 91�Թ�’s Faculty of Medicine, and Ruth Wilson, a professor emeritus at the department of family medicine at Queen’s University, explain that rural and remote regions are losing surgical and obstetric services, partly because there are not enough health-care providers who can offer anesthesia services.

“We know that if a person lives in a rural or remote part of Canada, they have a higher chance of dying if they experience trauma or a major illness,” says Orser. “Canadians living in rural and remote communities tend to have more health concerns and have poorer health outcomes, compared with those who live in cities.

“Rural and remote communities need more anesthesia care providers, and we wanted to identify solutions on how to address this gap and improve access to care.”

The researchers commentary was published in the Canadian Medical Association Journal.

In the report, Orser and Wilson explain that, nationally, Canada has a shortage of anesthesia providers who care for patients undergoing surgery and assist with perioperative pain management.

The researchers say the problem is aggravated in rural and remote areas due to a lower number of anesthesia care providers. Some patients must travel hours to receive care in urban centres because there are no health-care providers who can provide these services locally.

“Pregnant mothers should not have to travel hundreds of kilometres to receive maternal care from regions that previously offered maternity care. Everyone in Canada should have access to the basic care services they need, as close to home as possible,” says Orser.

“It’s time to address the gaps in health outcomes that people in rural and remote communities are experiencing by developing a strategy to remove the barriers they face.”

Rural and remote areas are some of the most underserved regions in Canada in terms of their access to health care, the researchers say. They add that, while almost 18 per cent of Canada’s population lives in rural and remote areas, only eight per cent of Canada’s workforce of physicians serve this group.

They also note that less than one per cent of the Canadian Institute for Health Research’s funding is awarded to the study of rural research and that Indigenous communities are disproportionately affected by a lack of access to anesthesia care providers. The report calls for better workforce planning and studies to measure the gap between what services are now available and what services are needed, with Orser and Wilson identifying different solutions to encourage more anesthesiologists to practise in remote and rural areas.

For example, researchers say that medical licensing authorities should consider a national medical licence that would allow physicians unrestricted access to practise throughout Canada, replacing the regional licensing systems currently in place.

“Getting a medical licence in each province and territory is a lot of work. There’s tremendous barriers, such as cost and administrative issues,” says Orser.

“If we had a national medical licence, physicians might be able to form special relationships with various service regions that would allow for better models of support for these communities. Unrestricted access to practise across Canada could encourage more physicians to take their expertise to rural and remote areas.”

Another solution would be to create better mentorship and continuing professional education opportunities for physicians providing anesthetic care in rural and remote regions.

“Physicians working in rural areas need to be supported,” says Orser. “So, we need to think about how we can appropriately integrate them into the broader anesthesia community so they have opportunities for retraining, networking and places to get support when conducting highly detailed work with limited resources.”

Professional associations and academic health centres must take an active role in creating programs that support longer-term peer mentorship amongst physicians providing anesthesia services and specialty trained anesthesiologists, according the researchers. This will help retain physicians in rural areas, they say.

Medical schools and residency programs can also play a key role in helping to address the issue of providing adequate care to rural and remote regions. The researchers say that the goal of providing more trained anesthesia-care providers in rural areas may mean developing new educational strategies like admitting more medical students from rural areas. Medical schools should also be engaged in providing meaningful rural medical education experiences that are supported by rural mentors, say the researchers.

“Institutions like universities play an important role in helping to promote social accountability and offering leadership to identify long-standing problems in our health-care systems,” says Orser. “We need to structure our health-care systems so that we are solving the problems experienced by vulnerable people, and those who have poor health outcomes.”

91�Թ� students, faculty help expectant parents navigate COVID-19 with Pandemic Pregnancy Guide

Christopher.Sorensen — Wed, 06 May 2020 15:58:30 +0000

91�Թ� students, faculty help expectant parents navigate COVID-19 with Pandemic Pregnancy Guide

Christopher.Sorensen Wed, 05/06/2020 - 11:58

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Created by 91�Թ� experts, it's hoped the Pandemic Pregnancy Guide's evidence-based approach will ease the worries of expectant and postpartum parents during COVID-19 (photo by damircudic via Getty Images)

St. Michael's Hospital

Women's College Hospital

Experts from the 91�Թ� are helping expectant parents navigate pregnancy and the postpartum period during the COVID-19 pandemic.

Doctors Tali Bogler, Eliane Shore and Sheila Wijayasinghe, as well as medical students Sepand Alavifard and Sarah Freeman, have come together to create the Pandemic Pregnancy Guide (PPG), a virtual hub focused on pregnancy and COVID-19 related information on Instagram.

With less in-person time with maternity care providers, pregnant patients are finding themselves with many unanswered questions, says Bogler, who is a family physician and chair of the family medicine obstetrics program at St. Michael’s Hospital. She hopes that the platform’s multidisciplinary and evidence-based approach will ease the worries of expectant and postpartum parents and empower them with information.

Faculty of Medicine writer Ciara Parsons recently spoke with Bogler, a lecturer in the department of family and community medicine, about why the team was motivated to create the Pandemic Pregnancy Guide, how the pandemic has impacted expecting parents, and the type of content the team has planned for the future.

What was the motive behind creating the Pandemic Pregnancy Guide?

As COVID-19 began to surface, I realized there was an obvious need in my practice to answer questions about how the pandemic may affect pregnancies, especially because I care for a lot of expectant parents in my family practice obstetrics practice.

Expecting parents can feel overwhelmed during normal circumstances, especially first-time parents – but with the added stress of the COVID-19 pandemic and all the uncertainties that come with it, these individuals are all feeling a lot more anxiety.

Our group decided to create the Pregnancy Pandemic Guide because COVID-19 has led to expectant parents having fewer one-on-one sessions with their maternity-care providers, and an increase in virtual care appointments. There’s also been the cancellation of in-person supports like prenatal classes, hospital tours and breastfeeding classes. We wanted to make sure that patients seeking information had a place to go where they could learn more.

The Pandemic Pregnancy Guide uses social media, specifically Instagram, to operate as a virtual hub of information about pregnancy, and a place where people can ask questions. It’s kind of like a virtual prenatal class, but with a focus on COVID-19 and pregnancy.

The team behind the Pandemic Pregnancy Guide. From left to right: Sheila Wijayasinghe, Sepand Alavifard, Tali Bogler, Sarah Freeman and Eliane Shore.

What types of care are being converted to virtual care?

We are limiting in-person appointments to keep patients and their families safe. For example, for low-risk pregnancies, we’re trying to have every other appointment completed by virtual care, either by phone or video call.

During these virtual appointments, we ask about things like the baby’s movements, which is a great way to assess fetal viability, or if the patient has signs or symptoms of high blood pressure. Additionally, we might ask about the parent’s weight, blood pressure and if they can measure the size of their growing uterus from home.

How do you choose what information you’ll include on your social media accounts?

We create content based on the types of questions we are hearing from our patients and Instagram followers. The content is also based around current emerging research related to pregnancy and COVID-19 and includes Q&A interviews with experts from different specialties. For instance, Dr. Wijayasinghe recently interviewed Dr. Mark Yudin, an obstetrician who specializes in infectious disease and pregnancy.

We have also had interviews with our pediatrician, midwifery and pelvic floor physiotherapist colleagues, as well as prenatal mindfulness movement classes with a doula and yoga instructor. In the future, we plan to include insights from lactation consultants, psychiatry and social workers in our upcoming Q&A interviews.

Do you think that having resources like this helps to fight misinformation about pregnancy during the COVID-19 pandemic?

There is so much misinformation out there about COVID-19 and how it may affect pregnancies. With so many different articles and resources available, expectant parents don’t know which resources to trust or where to turn for guidance. It can be overwhelming to try and sift through the information to determine what is legitimate.

From the feedback we’ve received on our social media page and from our patients in the clinic, it seems that our audience is thankful to have a fact-checked, evidence-based information source to turn to. We spend a lot of time curating our content before we post anything to make sure it is as up-to-date and accurate as possible.

What are some of the biggest impacts or disruptions pregnant patients may face during this pandemic?

Patients are being impacted by COVID-19 at all stages of their fertility journey, including pregnancy-planning, pregnancy and postpartum period. Many hospitals and clinics are restricting partners from attending ultrasounds and routine visits, which is typically an exciting time for patients and their families. Limitations around support persons during labour are a huge concern for many expectant parents, as many sites have restrictions in place limiting visitors (primarily only one support person if labouring individual and partner screen negative for COVID-19) to optimize patient and provider safety.

As physicians and health-care providers, all we can do at this time is provide the best care we can under these exceptional circumstances and make the process feel as supportive as possible for patients.

The perinatal time is one that often builds community for individuals. During the pandemic, many have voiced that they feel isolated. Beyond the medical information we are sharing, we hope that this virtual platform will also allow for a sense of community and sharing of stories to help people feel less alone during this incredibly important time in their lives.

'We care and are here for them': 91�Թ� students help seniors cope with distancing during COVID-19

Christopher.Sorensen — Thu, 16 Apr 2020 15:34:19 +0000

'We care and are here for them': 91�Թ� students help seniors cope with distancing during COVID-19

Christopher.Sorensen Thu, 04/16/2020 - 11:34

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From left to right: Geoffrey Sem, Monisha Persaud and Daniel Lee are leading the push to recruit volunteers for a program that aims to reduce social isolation among seniors during the COVID-19 pandemic (photos courtesy of Faculty of Medicine)

Topic

Medical students at the 91�Թ� have re-launched an online and phone program to reduce social isolation among seniors during the COVID-19 pandemic.

The students are helping to keep seniors connected with their communities by maintaining social relationships through weekly phone calls, improving health literacy with regards to COVID-19 and providing information about relevant community resources.

The program, called the Student-Senior Isolation Prevention Partnership (SSIPP), expands on a collaboration launched in early 2019 by medical students and Drs. Sabrina Akhtar, Tia Pham and Dominik Nowak.

Students Monisha Persaud, Geoffrey Sem and Daniel Lee are leading the new push for volunteers, which has attracted about 270 health-care students – more than 200 of whom are part of the MD program at 91�Թ�.

“In a crisis, there’s a constant barrage of bad news and fear in the media,” says Sem. “What isn’t as well captured is the enormous goodwill and kindness that people are willing to give.

“We were blown away by the number of volunteers who want to help, and we are so thankful for their selflessness.”

The team recently expanded volunteer duties and equipped students to answer frequently asked questions about COVID-19, complementing existing information on financial resources and mental health supports.

“In light of the current COVID-19 pandemic, heightened physical distancing measures and visiting restrictions on long-term care facilities, social isolation is more prevalent than ever in our elderly populations – especially among those who are homebound or don’t speak English,” says Persaud.

The program normally matches volunteers with seniors on a longer-term basis, Persaud says. However, the approach has been adjusted as volunteers with the program’s COVID-19 response are only expected to be involved for the duration of the pandemic.

Seniors with an interest in the program can be referred by any member of their health-care team or by their long-term care homes.

The students note that social isolation was one of the most prevalent issues faced by seniors today, even before COVID-19.

“Not only does social isolation weigh heavy on the mental health of seniors, but it can have a drastic impact on their quality of life,” says Persaud. “It’s linked to an increase in vulnerability to health conditions such as chronic lung disease, cardiovascular issues, greater hospitalizations and mortality.”

With the help of program’s executive team, which consists of fellow medical students Tory O'Driscoll, Laura Diamond, Nitish Dhingra and Sumana Naidu, the goal of the group is to expand the program in Toronto and to assist with the formation of new chapters. So far, students have begun new chapters at more than 12 schools across Canada including Western University, University of Ottawa, University of Alberta, University of Manitoba, McMaster University, Northern Ontario School of Medicine and the University of British Columbia.

“We hope to show our seniors across the country that we care and are here for them,” says Lee. “Initiatives like SSIPP help to foster a sense of community, which is important for instilling hope in everyone during these uncertain and grim times.

“Volunteers build a sense of solidarity and collaboration, and together we are working to create a society that is socially accessible to everyone.”

91�Թ� researcher and Toronto Public Library form partnership to make face shields with 3D printers

Christopher.Sorensen — Wed, 01 Apr 2020 15:29:44 +0000

91�Թ� researcher and Toronto Public Library form partnership to make face shields with 3D printers

Christopher.Sorensen Wed, 04/01/2020 - 11:29

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With the help of the Toronto Public Library, which loaned its 3D printers, a 91�Թ� researcher in the Faculty of Medicine is helping churn out thousands of reuseable face shields for health-care workers during the COVID-19 crisis (photo by Nick Iwanyshyn)

Topic

University Health Network

As the COVID-19 pandemic rages on and personal protective equipment supplies dwindle, one 91�Թ� researcher is working on a novel solution for front-line workers in the city.

Thanks to a partnership between 91�Թ� and Toronto Public Library, Azad Mashari, an assistant professor in the Faculty of Medicine, will be making reusable face shields using 3D printers the public library system lent to Toronto General Hospital, part of the University Health Network.

“Face shields are really simple pieces of personal protective equipment to make,” says Mashari. “They’re needed in large quantities right now during the COVID-19 pandemic by health-care workers and those working in essential service positions.”

The library loaned 10 of its 3D printers, previously used by library card-holders, to Mashari and his team at the Lynn & Arnold Irwin Advanced Perioperative Imaging Lab (APIL). The machines have to be repurposed for medical use and will be running around the clock to churn out the badly needed protective gear.

“The 3D printers in our lab and at our collaborating sites have the capacity to run pretty much 24 hours a day, and have the potential to print tens of thousands of face shields, if not more,” says Mashari.

Azad Mashari, an assistant professor in the Faculty of Medicine, says 3D printers lent to Toronto General Hospital by Toronto Public Library will be running “pretty much 24 hours a day” to make reusable face shields (photo by Nick Iwanyshyn)

With the COVID-19 virus being spread through respiratory droplets and close person-to-person contact, face shields have become a critical piece of personal protective equipment for health-care staff. They are thin pieces of plastic that act as a barrier to protect the wearer’s face from bodily fluids and airborne debris.

The shortage of personal protective equipment, including N95 masks and rubber gloves, is a serious challenge faced by health-care workers on the front lines of the COVID-19 pandemic – one that Mashari says is exacerbated by the often disposable nature of the gear.

“A problem that is faced in health care is that most items are designed to be single-use. Not only does this create a lot of environmental waste, but it causes difficulties with supply levels during crises when large volumes of critically important equipment are required,” Mashari says.

Mashari says his team at APIL is working alongside researchers at Glia Inc. to create, design and distribute face shields to front line health-care workers. Founded by Dr. Tarek Loubani of Western University, Glia develops high quality, open-source medical devices.

(photo by Nick Iwanyshyn)

The Glia and APIL team used face shield designs from existing open source blueprints as a basis for their face shields, which are now available online and free for use.

“The beauty of open source development is that you don’t have to reinvent the wheel. So, we looked online for open source designs, reached out to the developers and then started making modifications to the designs and testing them,” Mashari says.

The reusable face shields are made from plastic, mylar and elastic. Each one costs about $10 to create, says Mashari, which is about twice the price point of most single-use face shields currently available. They are compliant with Health Canada regulations, as Glia is an approved device-maker for this type of medical equipment, says Mashari.

Approximately 2,000 face shields have been ordered and are actively being distributed across Ontario, he says.

Currently, the shields are intended for use by health-care workers. However, Mashari says they may be distributed to other essential service workers in the future.

“We’ve received inquiries from grocery chains for example – so there is potential to expand the project, but we are supplying hospital networks first.”

91�Թ�'s Trey Coffey on how to support health-care workers when they need help themselves

Christopher.Sorensen — Wed, 05 Feb 2020 17:31:57 +0000

91�Թ�'s Trey Coffey on how to support health-care workers when they need help themselves

Christopher.Sorensen Wed, 02/05/2020 - 12:31

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Dr. Trey Coffey of 91�Թ�'s Faculty of Medicine is involved in a peer support initiative at SickKids to help health-care workers who are experiencing mental health challenges (photo courtesy of Trey Coffey)

Ciara Parsons

Topic

Our Community

Faculty of Medicine

Hospital for Sick Children

Mental Health

Thanks to advocacy efforts and public outreach campaigns, mental health issues have shed much of the stigma they once carried.

Health-care providers have played an integral role in helping to transform the mental health-care system and educate the public about the importance of accessing services when they require care.

But who do doctors and other health-care providers turn to when they are experiencing mental health difficulties? In a field based around competency and that requires a high degree of resiliency, asking for help may not feel easy for some physicians.

In an effort to break down social barriers around mental health, health-care and academic institutions have looked to workplace-based peer support programs to help employees access care.

Dr. Trey Coffey, an associate professor at the 91�Թ�'s Faculty of Medicine, pediatrician and medical officer for patient safety at the Hospital for Sick Children, spoke to writer Ciara Parsons about the importance of initiatives like SickKids' peer support program; the notion of the “second victim,” or how health-care providers suffer after being involved in a mistake or other adverse event on the job; and how to be an ally to those facing difficulties in the workplace.

What is the Peer Support and Trauma Program at SickKids?

The program officially launched in January 2018. The goal is to help improve staff members’ psychological health and safety and to provide them with a support system through a network of trained peers.

The program is open to anyone who wears a SickKids badge and can assist with a range of issues one might be encountering in a health-care setting, such as burnout, second victim distress and traumatic stress while also providing support for personal or family issues.

SickKids’ Peer Team is comprised of cross-disciplinary staff who volunteer their time to the program and act as supporters to their colleagues. Before taking up their roles as peer supporters, volunteers receive specialized training and certification in assessment, communication skills, trauma principles and trauma response.

Those who have experienced a traumatic or distressing event may engage in a critical incident debriefing enabling them to confidentially share and decompress about the incident. The role of the peer in these situations is to allow participants to process thoughts and reactions about the event, to validate and to provide information on common responses and self-care. If preferred, one-to-one support is available to colleagues. For staff requiring more assistance, a variety of professional counselling options are available.

The second phase of this program, which began in the spring of 2018, focuses on physician peer support.

What is a second victim?

The idea of the second victim refers to a physician or health-care worker who has been involved in an adverse event on the job. Second victim responses can sometimes spur feelings of guilt, distress, anxiety, fear and insufficiency.

Research focused on second victim responses explains that there are six stages of progression within the second victim phenomenon. They include:

Chaos and accident response: Error realized, distracted, possible need for others to take over treating patient
Intrusive reflections: Loss of confidence in self, feelings of inadequacy
Restoring personal integrity: Help is sought, but there is fear of how others will react
Enduring the inquisition: Internal investigation, fears about employment outcomes and litigation
Obtaining emotional first aid: Seeking and receiving professional support
Moving on: Dropping out, surviving or thriving

This research also suggests that second victims require formal support at the department or unit level, which is why peer support programs are often recommended to help assist with second victim responses.

How did you become involved with this program?

Before the launch of our Caring Safely initiative, where we brought patient and employee safety together under one umbrella, I knew there were issues with trauma to health-care workers, but I had a volume of patient safety problems to work on and felt like maybe employee safety was someone else’s issue to deal with.

However, learning more about incredibly high rates of health-care worker harm and injury, along with my own direct experience being involved in a serious safety event, helped to change my perspective. These two things made me want to have more of a hand in directly supporting the peer support program at SickKids – and I think that sometimes the best way to support a program is to get involved and participate in helping to bring about change.

Why do you think physicians are hesitant to ask for help?

I think the major reason physicians are hesitant to ask for help, whether we're conscious of it or not, is that we’re preoccupied by reputation and we're kind of socialized to be somewhat “invincible.” We pass a lot of tests and go through medical training to demonstrate that we can withstand the rigours of medicine and go through things that society might deem “extreme” – and that’s a source of pride.

So to fit this idea in which we have of ourselves, sometimes asking for help to handle difficult situations you are going through might be thought of as risky, because of how we think others might perceive us as maybe not being up to the challenges that we face in the workplace.

How can someone spot a colleague in need of help or distress?

People should be aware that it can be hard to spot someone in need of help or distress – especially within medicine, where we are trained to appear confident and competent in the workplace. Every time you have a moment of self-doubt, you can't show that as a doctor – and we're pretty good at pushing through these moments and ignoring them. That's a very adaptive thing to do in many situations.

The other thing that's really tricky is that some people will just kind of withdraw from a lot of things they normally would engage in when they’re in a situation of psychological distress and or emotional distress – this is a more visible sign that someone is not OK. But others undergoing the same types of distress may appear to be unaffected because they are acting in line with how they regularly do, so this is why it is hard to pinpoint specific behaviours that might flag that someone is distressed.

What are some tips you can give about how to be an ally in the workplace?

I’ll give an example of what meant the most to me when I was struggling with an unexpected event and what helped me get back on track.

I found that being recognized as a valuable member of the team helped me to get back on track. Sometimes when you’re in these situations, where you’ve experienced a safety event or something of that nature, you can have a very distorted view of yourself and think that everybody perceives you as a failure. There have been times over my career when somebody has made a remark like, “You know, everybody knows what a hard worker you are” or, “Well, we all know how much you care about this stuff and how seriously you take it.” These are seemingly minor remarks, but they can make a big difference – especially when you are a physician or a health-care provider going through a crisis of self-doubt from something like a safety event or burnout.

It can be helpful to acknowledge that everyone has a turn with these types of issues or feelings – they aren’t just things that affect some minority outlier population. I think, in this regard, it is necessary to treat these events as part of life so that seeking treatment can be normalized and individuals can recover. These are important messages that educators and leaders should be sharing.

How do you think the field of medicine can embrace a new culture around self-care and wellness?

I think the medical community has steadily come to embrace the rhetoric around self-care and wellness. It remains to be seen how deeply and sincerely we will commit as a profession, though. I have noticed that the younger generations have been talking about self-care and wellness more openly and share a different mindset about it in terms of how they prioritize things like occupational wellness and work-life balance, and I hope that will be a driver for implementing better self-care and wellness in our community. However, there are some major barriers and so I would be naive to think that they are easy to solve.

What would some of these barriers to wellness look like?

Well, some of the barriers are structural and would include things like duty-hours and the strenuous working conditions that medical professionals and trainees face.

You can acknowledge that some of the working conditions are beyond what would be considered healthy, but that doesn't mean that overnight you can have the resources and the restructuring to re-engineer the health–care systems that we currently work within.

A change-maker in the making: Remembering 91�Թ� student Mohammad Asadi Lari

Christopher.Sorensen — Fri, 10 Jan 2020 18:13:34 +0000

A change-maker in the making: Remembering 91�Թ� student Mohammad Asadi Lari

Christopher.Sorensen Fri, 01/10/2020 - 13:13

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Mohammad Asadi Lari, an MD/PhD student, was on the plane with his sister, Zeynab Asadi Lari, who was a student at 91�Թ� Mississauga (photo via STEM Fellowship)

Topic

The 91�Թ� community is remembering students who were passengers on Ukraine International Airlines Flight PS752, which crashed on Jan. 8 outside of Tehran, Iran. Over the coming days, 91�Թ� News will share stories about the students and their legacies. We will update the stories as new information becomes available.

Mohammad Asadi Lari was one of two students who studied at the Faculty of Medicine – both known for their curiosity and commitment to discovery. The other was Mohammad Amin Jebelli.

"On behalf of the Faculty of Medicine, I extend my deepest condolences to the family and friends of Mohammad Asadi Lari and Mohammad Amin Jebelli,” said Professor Salvatore (Sal) Spadafora, acting dean of the Faculty of Medicine.

“They made an indelible mark on the life of this faculty and the world has lost two remarkable individuals."

Asadi Lari is remembered by his peers as a deeply compassionate individual who was known for lifting people up when they were feeling down. Active in many projects and organizations, it was clear to many that Asadi Lari was a change-maker in the making.

An MD/PhD student at the Faculty of Medicine, Asadi Lari was in the second year of the eight-year program. He was traveling back to Toronto after visiting family in Iran aboard Ukraine International Airlines Flight PS752 when it crashed. Also with him was his sister, Zeynab Asadi Lari, who was a student at 91�Թ� Mississauga.

Among his many accomplishments was helping to found the Canadian Association for Physician Innovators and Entrepreneurs (CAPIE). Reflecting on Asadi Lari’s legacy, Dr. Alexandra Greenhill, Board Chair of CAPIE, said “…his incredible mind, heart and energy will be missed. Being a truly gifted forward-thinker and systems-thinker, we know he would want us to focus on the future, on innovating and on contributing – so let's remember him for all the ‘can-do’ and ‘must-do’ attitude he brought into the world.”

Youth mentorship was also dear to Asadi Lari and an activity he was actively engaged with – he even gave a TEDxTalk last February about the ways in which we can empower youth. Since 2015, he served as the managing director of STEM Fellowship, which is a youth-led non-profit organization he co-founded that works to create mentorship and experiential learning opportunities for young STEM researchers and innovators.

“Mohammad Asadi Lari was a remarkable young man who touched many in his short life. He always gave much more than he ever expected in return. It is a great loss for all of us and for his family who have lost two of their children,” said Dr. Patricia Houston, vice dean of the MD program at 91�Թ�.

Asadi Lari was involved in numerous youth-focused activities through his efforts with the Canadian Commission for the United Nations Educational, Scientific and Cultural Organization (UNESCO), the Canadian Institutes for Health Research, the Canadian Red Cross, Science World British Columbia, the non-partisan, civic-engagement group Apathy is Boring and the World Economic Forum – to name just a few of the many organizations he served over the last few years.

On campus, Asadi Lari was the vice-president of global health with the 91�Թ� Medical Society and helped to advocate for matters of international health, aid and equity.

Asadi Lari‘s accomplishments were recognized with numerous national and international scientific Olympiad medals, a 3M National Student Fellowship, a Governor General’s bronze academic medal, a University of British Columbia Faces of Today Leadership award, a Society for Scholarly Publishing Fellowship and being included as a 2018 Royal Bank of Canada (RBC) Top 25 Immigrant Finalist.

Feeling distressed? Find someone to talk to right now – and if there is an immediate risk, call 911.

Round-the-clock support:

Students can speak to a trained crisis worker at any hour of the day.

91�Թ� My SSP for students 1-844-451-9700. Immediate counselling support is available in 35 languages and ongoing support in 146 languages.

Other 24-7 supports available to students include:

Good 2 Talk Student Helpline 1-866-925-5454. Professional counselling, information and referrals for mental health, addictions and well-being.
Gerstein Crisis Centre 416-929-5200
Distress Centres of Greater Toronto 416-408-HELP (4357)
The Centre for Addiction and Mental Health at 250 College Street
Anishnawbe Health Toronto Mental Health Crisis Line 416-360-0486

The following services are available to students on all three campuses:

St. George campus: Health and Wellness Centre (416-978-8030), located at Koffler Student Services
91�Թ� Scarborough: Health & Wellness Centre 416-287-7065
91�Թ� Mississauga: Health & Counselling Centre 905-828-5255

Faculty and staff have access to 24-7 support through:

The Employee & Family Assistance Program (EFAP), offered through Homewood Health, online and by phone at 1-800-663-1142

Study by 91�Թ�, St. Michael's Hospital researchers reveals concussion-related injuries still present one year later

Christopher.Sorensen — Mon, 18 Nov 2019 14:45:26 +0000

Study by 91�Թ�, St. Michael's Hospital researchers reveals concussion-related injuries still present one year later

Christopher.Sorensen Mon, 11/18/2019 - 09:45

Cutline

The study involved 146 athletes, both men and women, who competed for 91�Թ� in various sports, including lacrosse (photo by Jimmy Wang)

Topic

Research & Innovation

St. Michael's Hospital

In the first longitudinal evaluation of its kind, researchers from the 91�Թ� and St. Michael’s Hospital have discovered that one year after the event of a concussion and receiving medical clearance, signs of concussion-related injuries can still be observed in the brain.

The findings were published this fall in the journal Neurology.

“The objective of our study was to understand how the underlying brain physiology is changed after injury, and how long it takes to recover afterwards,” said 91�Թ� alumnus Nathan Churchill, a researcher at St. Michael’s Hospital and the study’s lead author.

“Looking at brain activity, blood flow and structure, we saw that many of the things that were disturbed at the early stages of concussion were still present after being medically cleared to ‘return the play.’”

Using magnetic resonance imaging (MRI) technology, the concussed brains of 24 athletes from 91�Թ� sports teams, assessed previously at the David L. MacIntosh Sport Medicine Clinic, were scanned at regular intervals: an average of four days after injury, after medical clearance to return to play (RTP) and one year after RTP. A control group of 122 athletes without concussions were also imaged to act as a reference cohort for the concussed athletes.

Of the 146 athletes included in this study, men and women were equally represented in both groups and competed in sports like water polo, lacrosse, hockey and football. All athletes also completed baseline assessments of symptoms and cognition.

By evaluating different aspects of brain physiology, including function, connectivity, blood flow and structure, researchers found that some components demonstrated different patterns of long-term recovery, while others showed non-significant concussion effects at the one-year marker after return to play.

“We found it interesting that even one year later, with no other intervening concussions or medical issues present, there were still lingering effects in the brains of previously injured athletes,” said Tom Schweizer, a senior corresponding author on the paper, associate professor with the division of neurosurgery at 91�Թ�’s department of medicine and interim director of the Keenan Research Centre for Biomedical Science at St. Michael’s Hospital.

“Particularly, we observed persistent long-term effects like a reduction in cerebral blood flow and an increase in white matter mean diffusivity.”

The researchers suspect that reduced cerebral blood flow (CBF), which is needed to deliver oxygen and nutrients to brain tissues, may be linked to subtle long-term decreases in grey matter volume after concussions. Grey matter tissues play specialized roles in the brain and are involved in planning and decision-making skills, as well as temporal areas associated with language and memory.

(image courtesy of Nathan Churchill)

The increased presence of white matter mean diffusivity is also concerning because it demonstrates that concussed athletes may still be experiencing microscopic signs of swelling – possibly a sign of inflammation in the brain – suggesting that longer than a year may be required for it to return to normal function.

“It’s important to remember that the athletes in this study are in the ‘clear,’ as they’ve received full medical clearance to return to play and they’re not complaining of any effects,” said Schweizer. “So, it’s not as though they’re walking around with a bunch of symptoms and they’re not well. The brain is fantastic in terms of how it is able to fix itself and adopt a new normal,” .

This is one of the reasons that the researchers believe more investigation into the effects of concussion-related brain injuries is required.

Speaking about the impact of this study, Schweizer said: “Traditionally, a concussion has been defined as a mild injury to the brain. But we now know there are potential long-term effects from concussions, which is knowledge we didn’t have before. We’re starting to realize that with concussions, even if someone is asymptomatic, there can still be effects present in the brain that are long-lasting. This is important to know and treat seriously.”

As a followup to this novel research on concussions, Churchill and Schweizer are working on new studies that serve to examine the brain over a longer timespan.

The research was supported by the Canadian Institutes of Health Research and the Canadian Institute for Military and Veteran Health Research, among others.

#UofTGrad19: Meet rehabilitation science's newest graduates

noreen.rasbach — Tue, 05 Nov 2019 05:00:00 +0000

#UofTGrad19: Meet rehabilitation science's newest graduates

noreen.rasbach Tue, 11/05/2019 - 00:00

Cutline

Clockwise from top left: Mary Boulos, Thi-Ut Nguyen, Daniela Chok, Janany Jeyasundaram, Sahar Panju and Sanjana Shellikeri

Ciara Parsons

Topic

Our Community

Convocation 2019

Rehabilitation Sciences Institute

Speech Language Pathology

Newly minted graduates of rehabilitation sciences programs at the 91�Թ� will walk across the stage at Convocation Hall on Tuesday to receive their degrees. The Faculty of Medicine’s Ciara Parsons asked soon-to-be alumni of occupational therapy, physical therapy, speech-language pathology and the Rehabilitation Sciences Institute to share why they are passionate about their fields and what drives their professional and academic work.

Here are their responses:

Thi-Ut Nguyen
Master of Science in Physical Therapy

I worked as a personal support worker with a 54-year-old patient who was involved in a horrific car accident. When I started working with him, he was at five months post-injury. He had a tracheostomy and a gastrotomy tube. He was fully dependent for bed mobility and transferred via a lift. I worked with him for a period of one year. By the time he was discharged, he was walking and moving about independently with a walker.

Witnessing his extraordinary recovery journey sparked my interest in physical therapy. I was impressed by the impact early intensive physical therapy has on neuro-motor rehabilitation and I was fascinated by the concept of movement as medicine. Determined to pursue a career as a physiotherapist, I went from being a working mother with no high school degree, to being accepted into the transitional year program at the 91�Թ� and I never looked back.

I think it’s important to continue to set goals that are almost dreams for my own personal growth.

Mary Boulos
Master of Science, Rehabilitation Sciences Institute

One of the most memorable moments of my program was working with the Fred Victor agency in Toronto. Our lab’s clinical arm, the Telerehab Centre for Acquired Brain Injury, strived to provide neuropsychology services to individuals in the justice system experiencing brain injury and mental illness. There is an incredibly high prevalence of brain injury in the justice system; however, access to neuropsychology services is almost non-existent.

By collaborating with Fred Victor, we were able to begin addressing this gap by connecting clients with neuropsychology services and raising awareness of the need for services and support during the justice process. Having the opportunity to advocate for increased awareness and support of brain injury through presentations to clinicians, judges and lawyers has inspired me to continue advocacy work throughout my career.

Now, as a first-year medical student at McMaster University, I hope to bring forward the lessons I learned from the individuals I worked with during my [master of science] training at the 91�Թ� and continue advocating for increased access to mental health care, home care and assisted living supports for patients across Canada.

Sanjana Shellikeri
Doctor of Philosophy, Rehabilitation Sciences Institute – speech-language pathology stream program

My mother was diagnosed with amyotrophic lateral aclerosis (ALS) in 2010 and passed away in March 2019. I met Yana Yunusova through my mother in 2012, as she was a research participant in one of her speech studies. I was a recent undergraduate in neuroscience at the time and was very interested in contributing to the medical field. Although I didn’t have much knowledge in speech-language pathology, I was drawn to the idea of research in a disease that was so close to my heart. After meeting Yunusova and learning about her work, I knew this line of research would be a great fit for me.

I hope to follow the academic path as an independent investigator and contribute research to the study of neurodegenerative diseases, such as ALS, Parkinson’s disease, Alzheimer’s disease and other dementias. I am currently pursuing a postdoctoral research fellowship at the University of Pennsylvania’s Frontotemporal Degeneration Center and aspire to improve the lives of people with neurodegenerative conditions and work towards a real-world impact.

Daniela Chok
Master of Health Science in Speech-Language Pathology

As social beings, a person’s quality of life can be drastically affected by their ability to effectively express themselves and understand others’ messages. I was attracted to the speech-language pathology program because I wanted to work with people with communication disorders to enhance their quality of life. This is a rewarding field where I can work with others to establish and maintain meaningful relationships.

Through completing this program, I have learned that every situation and person is unique. As speech-language pathologists, we need to keep in mind both the diagnoses we are working to address and the patients themselves. Two people with the same diagnosis may have very different clinical presentations. The ability to integrate my classroom knowledge while recognizing the person’s unique situation is the beauty of balancing the art and science that exists within this field.

Janany Jeyasundaram
Master of Science in Occupational Therapy

As the daughter of refugees, I have a strong sense of being between two worlds – the world of my parents in their homeland, which I have imbibed and internalized, and the world I was born into, where I do not fully belong. I have witnessed legacies of trauma both in my personal circles and in my role as an occupational therapy student. Throughout my occupational therapy education, I actively sought opportunities to further my understanding of equity and move the profession towards greater inclusion of vulnerable populations.

As a contextually situated practice, occupational therapy can advance healing work that benefits both individuals and communities. For many culturally diverse populations, individual healing is contingent upon the healing of families and communities. My occupational therapy education challenged me to reflect on client values by developing a greater appreciation for interdependence and interconnectedness. I feel better equipped to disrupt the notion of self-care in the traditional sense and expand our understanding of what it means for vulnerable populations to collectively heal from histories of trauma.

Sahar Panju
Master of Health Science in Speech-Language Pathology

Through the speech-language pathology program, I’ve learned a lot about what it takes to be a good clinical therapist, but, more importantly, what it takes to be a good partner in care, as there is so much more to rehabilitation than just therapy. Being present for what is happening in a person’s life, beyond their impairment, has been an incredibly valuable lesson, both personally and professionally.

As a graduate of the program, I hope to continue to add to the foundation I’ve built and grow as a clinician. I recognized that one of the most important aspects of being a clinical therapist is to remain flexible and make yourself available to understanding new and sometimes challenging ideas. With the profession changing on a daily basis, continuing education is especially important. The program may have finished, but my education certainly hasn’t.

Ciara Parsons

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91�Թ� researcher and Toronto Public Library form partnership to make face shields with 3D printers

91�Թ�'s Trey Coffey on how to support health-care workers when they need help themselves

A change-maker in the making: Remembering 91�Թ� student Mohammad Asadi Lari

Study by 91�Թ�, St. Michael's Hospital researchers reveals concussion-related injuries still present one year later

#UofTGrad19: Meet rehabilitation science's newest graduates

Thi-Ut Nguyen Master of Science in Physical Therapy

Mary Boulos Master of Science, Rehabilitation Sciences Institute

Sanjana Shellikeri Doctor of Philosophy, Rehabilitation Sciences Institute – speech-language pathology stream program

Daniela Chok Master of Health Science in Speech-Language Pathology

Janany Jeyasundaram Master of Science in Occupational Therapy

Sahar Panju Master of Health Science in Speech-Language Pathology

Thi-Ut Nguyen
Master of Science in Physical Therapy

Mary Boulos
Master of Science, Rehabilitation Sciences Institute

Sanjana Shellikeri
Doctor of Philosophy, Rehabilitation Sciences Institute – speech-language pathology stream program

Daniela Chok
Master of Health Science in Speech-Language Pathology

Janany Jeyasundaram
Master of Science in Occupational Therapy

Sahar Panju
Master of Health Science in Speech-Language Pathology