Summer Book Recommendation

Better: A Surgeon’s Notes on Performance

Author: Atul Gawande

“Better is possible. It does not take genius. It takes diligence. It takes moral clarity. It takes ingenuity. And above all, it takes a willingness to try.”

Dr. Atul Gawande, surgeon at the Brigham and Women’s Hospital, describes the effort and diligence required to maintain exemplary performance as a medical professional, from accounts of the polio outbreak in India to the delivery rooms in Boston. A collection of Gawande’s twelve published essays, the novel illustrates an insightful look into struggles – from ethical dilemmas to financial burdens - faced by physicians in their endeavour to perform at the very best for their patients.

Author of The Checklist Manifesto and Being Mortal.

This Won't Hurt a Bit: (And Other White Lies): My Education in Medicine and Motherhood

Author: Michelle Au

Anesthesiologist and blogger, Michelle Au, writes a witty and fun account of “how she grew up and became a real doctor.” She recounts the journey of learning to handle two full-time occupations – that of being a physician and a parent – after she and her husband have a child early in their careers, while completing their residencies. Many physicians can relate to her struggle of juggling the responsibilities to her patients with the responsibilities to her family.

"As anyone who reads her blog knows, Michelle Au is a gifted writer...Her witty observations …give both physicians and patients a fresh, insightful look at how medicine is practiced today. "Kevin Pho, MD, creator of KevinMD.com.

Article Recommendation

Results of a Formal Mentorship Program for Internal Medicine Residents: Can We Facilitate Genuine Mentorship?

Brian M. Cohee, MD, Stephen A. Koplin, MD, William T. Shimeall, MD, MPH, Timothy M. Quast, MD, Joshua D. Hartzell, MD
Journal of Graduate Medical Education: March 2015, Vol. 7, No. 1, pp. 105-108.
Retrieved from: http://dx.doi.org/10.4300/JGME-D-14-00315.1

Background: Mentorship programs are perceived as valuable, yet little is known about the effect of program design on mentoring effectiveness.

 

Intervention: We developed a program focused on mentoring relationship quality and evaluated how subsequent relationships compared to preexisting informal pairings.

 

Methods: Faculty members were invited by e-mail to participate in a new mentoring program. Participants were asked to complete a biography, subsequently provided to second- and third-year internal medicine residents. Residents were instructed to contact available mentors, and ultimately designate a formal mentor. All faculty and residents were provided a half-day workshop training, written guidelines, and e-mails. Reminders were e-mailed and announced in conferences approximately monthly. Residents were surveyed at the end of the academic year.

 

Results: Thirty-seven faculty members completed the biography, and 70% (26 of 37) of residents responded to the survey. Of the resident respondents, 77% (20 of 26) chose a formal mentor. Of the remainder, most had a previous informal mentor. Overall, 96% (25 of 26) of the residents had identified a mentor of some kind compared to 50% (13 of 26) before the intervention (P<0.001), and 70% (14 of 20) who chose formal mentors identified them as actual mentors. Similar numbers of residents described their mentors as invested in the mentorship, and there was no statistical difference in the number of times mentors and mentees met.

 

Conclusions: Facilitated selection of formal mentors produced relationships similar to preexisting informal ones. This model may increase the prevalence of mentorship without decreasing quality.

 

Intervention to Promote Physician Well-being, Job Satisfaction, and Professionalism

A Randomized Clinical Trial

Colin P. West, MD, PhD1,2; Liselotte N. Dyrbye, MD, MHPE3; Jeff T. Rabatin, MD, MSc4; Tim G. Call, MD5; John H. Davidson, MD1; Adamarie Multari, MD6; Susan A. Romanski, MD1; Joan M. Henriksen Hellyer, RN, PhD7; Jeff A. Sloan, PhD2; Tait D. Shanafelt, MD5

JAMA Intern Med. 2014;174(4):527-533. doi:10.1001/jamainternmed.2013.14387.

Retrieved from: JAMA Journal of Internal Medicine.

Importance: Despite the documented prevalence and clinical ramifications of physician distress, few rigorous studies have tested interventions to address the problem.

 

Objective: To test the hypothesis that an intervention involving a facilitated physician small-group curriculum would result in improvement in well-being.

 

Design, Setting, and Participants: Randomized clinical trial of 74 practicing physicians in the Department of Medicine at the Mayo Clinic in Rochester, Minnesota, conducted between September 2010 and June 2012. Additional data were collected on 350 nontrial participants responding to annual surveys timed to coincide with the trial surveys.

 

Interventions: The intervention involved 19 biweekly facilitated physician discussion groups incorporating elements of mindfulness, reflection, shared experience, and small-group learning for 9 months. Protected time (1 hour of paid time every other week) for participants was provided by the institution.

 

Main Outcomes and Measures: Meaning in work, empowerment and engagement in work, burnout, symptoms of depression, quality of life, and job satisfaction [were] assessed using validated metrics.

 

Results: Empowerment and engagement at work increased by 5.3 points in the intervention arm vs a 0.5-point decline in the control arm by 3 months after the study (P=0.04), an improvement sustained at 12 months (+5.5 vs +1.3 points; P=0.03). Rates of high depersonalization at 3 months had decreased by 15.5% in the intervention arm vs a 0.8% increase in the control arm (P=. 004). This difference was also sustained at 12 months (9.6% vs 1.5% decrease; P=. 02). No statistically significant differences in stress, symptoms of depression, overall quality of life, or job satisfaction were seen. In additional comparisons including the nontrial physician cohort, the proportion of participants strongly agreeing that their work was meaningful increased 6.3% in the study intervention arm but decreased 6.3% in the study control arm and 13.4% in the nonstudy cohort (P=. 04). Rates of depersonalization, emotional exhaustion, and overall burnout decreased substantially in the trial intervention arm, decreased slightly in the trial control arm, and increased in the nontrial cohort (P=.03, .007, and .002 for each outcome, respectively).

 

Conclusions and Relevance: An intervention for physicians based on a facilitated small-group curriculum improved meaning and engagement in work and reduced depersonalization, with sustained results at 12 months after the study.

 

Atul Gawande on the end game

Leadership Series: The Washington Post on Leadership.

Surgeon and writer Atul Gawande talks to the Post's Lillian Cunningham about how his two professions intersect, and how he juggles them. (Lillian Cunningham, Kyle Barss, Julio Negron and Jayne Orenstein/The Washington Post).

To read the full interview and Cunningham’s other interesting talks with leaders, please visit The Washington Post on Leadership.

Q. What does leadership in medicine look like to you?
A. Leadership in medicine has changed enormously. Go back just 20 years and health systems were kind of like real estate companies. They provided space for a doctor to tend to a patient, and some nursing staff, but the doctor’s autonomy was the priority. In a way the doctor was the client, not the patient. That’s changed.

Because we’re all specialists now — even the primary-care doctors only have a piece of the care — the health system has to be responsible for ensuring that we are all working together. That means leadership in medicine is about making functioning teams, and hiring doctors from the very beginning who are willing to be part of those teams.

Q. You wrote a great piece in the New Yorker about getting a coach to be a better surgeon. I’d love to hear more of your thoughts on coaching, and if there are any other techniques you found useful to borrow from other fields that aren’t as common in medicine.
A. […] You’re never going to learn unless you have a coach all along the way. I’m an avid amateur tennis player, and I watched how tennis professionals have coaches even when they’ve reached No. 1. Novak Djokovic has a coach. In medicine, we have the ‘you learn, you get licensed and you’re good to go’ method. Yet I realized when I was in the mid point of my career that I had kind of plateaued. What I wondered was, what would it be like to bring a coach into my operating room?

So I brought one of my colleagues into the operating room to tell me what I was doing well and what I wasn’t doing well. And it was amazing the things I hadn’t recognized. I wasn’t using the lights well. I hadn’t set up the field as well as I could have. There were these little things that he saw that helped me. […]

 

MENTOR OF THE MONTH

Dr. Debjani Grenier, MD, FRCPC

Why is Dr. Debjani Grenier Mentor of the Month?

Dr. Grenier is a medical oncologist and a clinical research investigator at CancerCare Manitoba and holds academic appointments in the Department of Medicine, Section of Medical Oncology and Hematology at the University of Manitoba.

She is the Program Director for the Medical Oncology Training Program at the University of Manitoba and the previous Chair of the Medical Oncology Examination Board of The Royal College of Physicians and Surgeons of Canada.

Her research interests include identifying and characterizing cardiotoxicity of cancer therapies and risk factors for breast cancer. She is also involved in determining ways of effectively communicating with cancer patients by means of decision aids and audiotapes. She is the site principal investigator of multiple phase III breast cancer trials and is the local representative for several national and international clinical trial co-operative groups, including NCIC and NRG.

Dr. Grenier received immense mentorship during her Breast Cancer Medical Oncology Fellowship Training at Women’s College Hospital, University of Toronto, with strong role models that she continues to mirror in her own professional life.

Dr. Grenier was nominated by Dr. Leathia Fiorino: “During my time as a resident, I was fortunate to work with Dr. Grenier. She is a strong female mentor with an impressive professional academic career in addition to being a dedicated teacher. She provided me with knowledge and guidance in medical oncology as well as patient centered care and career planning. Dr. Grenier is truly someone to emulate.” – Dr. Fiorino (Fellow, BC Cancer Agency).

 

Nominate a Mentor or Mention an Accomplishment for Next Month!

AlinC and WinC provide a platform to increase visibility of great mentors on an international level. If you have someone in mind that has been an important mentor to you or people you know OR if you have achieved a new accomplishment, please email our Project Manager at This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it. .

 

NEWS

Oncologist in the Hot Seat: Dr. Marshall Pitz

Dr. Pitz is a medical oncologist at CancerCare Manitoba where he treats breast cancer and brain tumours and is Chair of the CNS Disease Site Group. He is also the Chief Medical Information Officer at CancerCare Manitoba, working to improve the use of the electronic record and of cancer informatics. His research interests include clinical outcomes-based studies in breast and lung cancer and conducting investigator-initiated clinical trials. He is currently working on developing a pan-Canadian brain tumour clinical database.

Have a burning question related to work-life balance, leadership, mentorship, or career development?

Send your great questions to This email address is being protected from spambots. You need JavaScript enabled to view it.

SAVE THE DATE: 2015 WinC & AlinC Annual General Meeting

Join us for an exciting evening at the 2015 WinC/AlinC Annual General Meeting on May 1st, 2015, at ORO restaurant in Toronto, from 6:30- 9:00 PM. Come and connect with fellow oncologists as keynote speaker, Mr. Nicholas Boothman, shares with us his tips on "How to Connect in Healthcare in 90 Seconds or Less!"

RSVP to This email address is being protected from spambots. You need JavaScript enabled to view it. or This email address is being protected from spambots. You need JavaScript enabled to view it. ">This email address is being protected from spambots. You need JavaScript enabled to view it.

New Online PMI Physician Leadership Course, “Effective Communication”

CMA is offering a new 6-week online course this year on April 27-June 7, September 14-October 25, and November 2 - December 13. This six-week facilitated online course focuses on developing enriched communication skills. The course will also help participants gain a greater understanding of their communication style and its effect on situations and other individuals.

For this year’s PMI courses register here, https://www.cma.ca/En/Pages/pmi-physician-leadership-courses.aspx

 

UPCOMING CONFERENCES

• March 30, 2015
  Leadership Summit for Women: Leading the future of Academic Medicine and Healthcare
  Ann Arbor, MI, USA
  
  
• April 24-25 2015
  The 2015 Canadian Conference on Physician Leadership
  Sheraton Wall Centre - Vancouver, BC, Canada
  
  
• April 30 2015
  The CAMO 2015 Annual Scientific Meeting
  Eaton Chelsea - Toronto, ON, Canada
  
  
• May 29 – June 2, 2015
  2015 ASCO Annual Meeting
  McCormick Place - Chicago, IL, USA
  
  
• October 15-16, 2015
  Global Cardio-Oncology Summit
  The Hilton Nashville Downtown – Nashville, TN, USA
  
  
• October 22-24th 2015
  International Conference on Residency Education
  Vancouver, BC, Canada
  
  
• November 6-8, 2015
  ESMO Summit Americas: Oncology Updates — From Evidence to Practice
  Fontainebleau Hotel - Miami Beach, FL, USA