1. Teaching Clinical Urology to Learners as “Generalists in a Rural Setting”
Emmanuel O. Abara MB FRCS(C) FACS FICS Assistant Professor, Surgery (Urology)
Division of Clinical Sciences
Northern Ontario School of Medicine
Richmond Hill Urology Practice and Prostate Institute
4. Background & Geography
•Northern Ontario
–Northeastern Ontario
–North of North Bay and Sudbury –”Highway 11 Corridor North of North Bay”
–Sites- Timmins, Iroquois Falls, Cochrane, Smooth Rock Falls, Kapuskasing, Hearst, Hornepayne, Matheson, Ramore, Kirkland Lake, Englehart, Matachewan
5. Northern Ontario School of Medicine
•2002- Dean Roger Strasser arrived in Sudbury
•2005- first intake of students
•2009-First Set of MD Graduates
•2014- Moving & Marching forward
Northern Ontario
Southern Ontario
In, by and for Northern Ontario
7. 2015 and Beyond
•Well established 21st century medical school
•Moving and marching forward
•Driven by Technology & Innovation
•Delivering Quality Health Care& Professional Education
•Emboldened with strong social
8. Early Beginnings of this Network of Rural Urology Practice
•1989, from Timmins, Ontario
•Case Scenario
Past midnight, 80 year old gentleman arrives via air ambulance
Acute retention; rural staff unable to insert catheter
“lone” urologist on call 24/7 – out in thick winter, through snow covered roads to St. Mary’s Hospital – Timmins
Quick assessment- acute retention
Catheter inserted; stabilized; back into helicopter ambulance to his home community
10. Thoughts & Needs Assessment
•Needs of Rural dwellers & health practitioners
•Skill sets for quality health care
•Establishment of clinics
•Patient-centered Urology care, information sharing with locals, etc.
•Underserviced area program and Ministry of Health, Ontario Supportive
11. Core Values & Development of Services and Programmes
•Establishment of out-patient clinics
•Provision of low risk surgery
•Information sharing with local Health Care Practitioners through rounds, small group discussion, lectures
•Learners from NOSM and other medical schools, universities
•Support from MOH- underserviced area program
•Community Engagement
12. Learners over the past 25 years
•Who?: Premed students, medical students, residents, others (nursing, pharmacy)
•What Institutions from?: NOSM, Toronto, Hamilton, London, Ottawa, Others
•Time Lag
–Prior to 2005- students from outside Northern Ontario whose parents and relatives lived and worked in the North
–After 2007- Predominantly NOSM Learners
14. Learners in the Clinics
•Exposed to clinical care early in their training
•Good History and talking
•Physical examination (General and focused)
•Treatment/care plan team
15. Results
•Excellent opportunities early in training
•Enrich Learners’ clinical skills
•Gain confidence on patient interviews, and history taking
•“One to One” Learner/Faculty Interactions may result in enriched learning
•Knowledge base- when to treat and maintain care, when to treat and refer , when to refer expeditiously
16. Learners in Operating Room
•Urological instruments
–Parts of a cystoscope
–How to use and care for a cystoscope and other surgical equipment
•Assisting at Procedures
•Be first assistants at procedures
•Learn basic surgical skills, eg. Tying knots, use of endoscopic equipment; wound care, etc.
•Review the anatomy of various parts of the Human body
•Learn good ethics and best practices in the Operating Room
18. Learners: Learning and using ancillary tools in the care of Urological Patients
•Intravesical BCG for bladder cancer patients
•Use of Voiding diary in voiding disorders
•Prostate symptom score (IPSS) in BPH
•Sexual and erectile assessment protocols
•Others
Reviewing Voiding diary
Learner reviewing CT
19. Learners and Clinical Research and Care Review
•Case reviews and reflections
–2-3 cases seen at the clinic
–Involves a Pubmed and/or Google Search
–A short summary submission post rotation
–Discussion/email review with faculty
–Out of 20 learners reviewed 19/20 returned/completed the review
20. Learners & Clinical Research
•Case reports
•Review of a cohort of patients
•Original community based research
•New Horizons and Innovations
*Some learners have been presenters at meetings and published in peer review journals
Discussion group; journal club.
21. Faculty/Learners and Community Engagement
•Learners become part of CME Events eg: Northeastern Ontario Urology Update: assist with registration of attendants
•Designing posters, etc. for educational events eg: “Bringing prostate out of the Closet.”
•Establishment of Prostate Support Groups and other support groups
•Participation in review of Hospital procedural policies
•Others
22. Opportunities of Teaching Specialty Urology to “Learners” as Generalists in a Rural Setting
•The need is there
•Clinical cases abound for the benefit of the learner
•Enrichment of the skills of the Learner
•Ability to impact the practice of Generalists- beneficial to the patient population
•Safe and ethical practice enhanced eg: appropriate and timely transfer
•Develop a good level of Confidence in managing, post- op. urology patients
•Faculty is able to make tangible contributions in the Health of the Community
23. Challenges of Teaching Specialty Urology to “Learners”
•As Generalists in a rural setting
•Human resources
•Medico-legal issues
•Lack of proper equipment sometimes
•Workload issues and time management for the Urologist
24. Opportunities and Challenges Teaching Specialty Urology to “Learners”
•What is important?
“Not Technology, but basic clinical skills”
Ultrasound
Palpation
Auscultation
Ultrasound
25. Core values of Rural Practice
•Knowledge of specialty Urology among “Generalists” may contribute to retention of physicians to enjoy the life style of the rural communities:
Moose Hunting
Fishing
Snowmobile
26. Core Values of Rural Practice
Enjoy local festivals i.e Lumberjack
Snowshoeing
Otters and lakes
•Busy practice
•Lots of fun
•Professional bonds with patients and staff
•Opportunities to serve the community
•“A home of innovations”
•“Thinking outside the box”
•Piloting new ways of health care delivery
•Getting things done with limited resources
27. Jewels of Rural Practice that may result
•Increased confidence among Generalists re: Urological conditions, post-op care and referral criteria, disease detection
•Increased and enriched clinical skills
•Increased level of comfort in Handling and supervising delegated urological procedures eg Intravesicle BCG
•Interprofessional development program to enrich a patient-centered care
28. Information Technology driving change
•Internet, web based knowledge
•Telemedicine
•Virtual rounds
•Small group discussions
•Journal clubs
•Interprofessional education events
•Avenues of imparting knowledge of Urological surgery
29. Learning the Value of Collaboration and Community Engagement
Learner/Faculty
•Learner/Hospital staff
Learner/Community groups
30. Summary
•Teaching Urology to Learners training as Generalists in rural setting can be rewarding
•Essential to medical graduates especially those with an eye on rural practice
•Aligns along with CanMeds roles
–Collaborator-working with teams for optimal patient care
–Manager- determining resource allocation and enhancing effectiveness of health system
–Advocate- identifying needs and working to improve the health of patients and communities
–Scholar- reflective learning, creating and dissemination of knowledge
Has been a fulfilling venture in a 25 year clinical urology practice
31. References
•Evaluation of a blended learning surgical skills course for rural surgeons. Halverson AL, DaRosa DA etal. Am.J Surg 2014 Jul; 208(1)136-42
•Improving Access to Urologic Care for Rural Populations through outreach clinics. Uhulman MA, Grug TS, Tracy R, Bing MT, Erikson BA. Urology 2013.Dec 82)6)1272-7
•Steward GD, Khadra MH. The continuing medical education activities and attitudes of Australian doctors working in different specialties and practice locations.
•Curran VR, Keegan D, Parsons W et al. A comparative analysis of the perceived continuing medical education needs of a cohort of rural and urban Canadian Family Physicians Can J. Rural Med. 2007 Summer; 12(3):161-6.
32. Acknowledgments
•To all the students and “Learners” that have benefitted from “Teaching Urology to “Learners” Training as Generalists”
•Deans, Associate Deans, Staff of NOSM for support to present this treats at the Muster 2014
•My office staff for secretarial and administrative support
33. (c) Emmanuel Abara, Richmond Hill Urology Practice & Prostate Institute. 2014. All rights received.
