“The R5 (fifth-year resident) was sitting beside me and this colleague – who was one of my former trainees – was a peer now, at the same level as me,” said Woods.
The new physician coming off shift handed over four or five patients, described them succinctly, with spot-on evidence-based case management, and left Woods with virtually nothing left to do, beyond simply being aware of their current health status.
“I looked over at the R5 beside me and said, ‘That'll be you in a year.’ It was such a proud moment to see that yes, our (residency) program is working. We're creating excellent clinicians who are smarter than me, that I get to work beside now.”
Woods is among the roughly 80 per cent of USask medical faculty who are involved in teaching or the administration of teaching. Another approximately 15 per cent are active researchers, according to the College of Medicine’s offices of faculty engagement and research.
Pride in seeing the doctors he’s helped train meet, then surpass, his own abilities is just one of the rewards Woods and other USask-trained doctors get from being involved in teaching and research. What motivates Woods and other faculty to step outside their clinical roles caring for patients, and what advice do they have for colleagues considering doing the same?
For Dr. Mary Kinloch (MD), Saskatchewan’s first fellowship-trained gynecological pathologist, it was when much of her daily work had become “routine” that she knew she had to start getting involved in research and quality improvement projects to continue growing and learning as a clinician.
“It takes a while, but there comes a time when you realize, if I don't do something else, I am going to stagnate into this snapshot of the physician that I was,” said Kinloch, who works at Saskatoon City Hospital and is an associate professor of pathology and laboratory medicine at USask. “There’s no other way to keep current and serving your patients than by getting the most updated diagnostic information to the clinicians so that they can make informed choices about care. If you are not participating in the growth that is happening in your field in some way, then it is very difficult to keep that growth mindset going in your routine everyday practice.”
The best thing about medicine, she said, is that there are so many different directions clinicians can go to maintain that growth.
While he’s taking on fewer students these days to focus more on research, Regina nephrologist Dr. Bhanu Prasad (MD) agrees that teaching makes him a better clinician.
“When you teach, you learn,” said Prasad, a USask clinical associate professor who “guesstimates” he reads between 10 and 15 new journal articles every time he gets ready to present to medical learners. “Especially with more senior levels of teaching, you have to do a lot of reading yourself. Then you must figure out how to put what you’ve learnt in an easily understandable format. By doing that, you break it down to simpler pieces and the next time you speak to a patient, you make it that much easier for them to understand it too.”
Education and clinical work are complementary, according to Prasad. “The more we learn, the more we bring to the bedside,” he said.
Plus, if you don’t stay sharp, Woods said with a laugh, you’re going to get “R5’ed.” R5 is shorthand for the fifth-year residents who are studying for their medical exams.
“You’ll be working on shift and you’ll try to teach them something – and they’ll correct you,” said Woods, who is also director for the college’s clinician educator diploma, a program for clinicians who have leadership roles in education. “They’ll say, ‘Well, actually we read these three articles, and this has changed.’ You just put your head down and go, “Well, I just got R5’ed again.”
Medicine is always changing, and new treatments and diagnostic pathways and approaches are evolving, Woods said. “They (medical learners) keep you fresh and motivated to keep on top of things.”
Prasad, who’s considered an international expert on a rare condition called loin pain hematuria syndrome (LPHS), said it’s easy for physicians to get burnt out if they are only doing clinical practice day in and day out. He said the research he does – whether it’s related to technological innovations in the treatment of hypertension or studying fractures in patients with kidney disease – helps him stay more engaged in his own clinical practice. Over five years, Prasad and his colleagues have published 50 academic papers – 16 in the past two years alone – many of them in high-impact journals.
Kinloch said research is an opportunity to be part of advancing the knowledge in your specialty area.
“You see the gaps,” said Kinloch. “You can see where you need to go and you want to be part of the story to fill that in. That’s what we learned in science starting right at undergrad – that you are all writing the story together. So (by doing research) you’re contributing to the entire story. There’s nothing more exciting than that.”
Kinloch added her best research ideas flow from problems she and her colleagues encounter in everyday clinical practice.
Woods, whose father was a school teacher, said he’s also motivated by the desire to improve the learning experience for medical students – which ultimately leads to better physicians delivering better care to patients. During his own medical training, he had a handful of instructors with a knack for making learning easier by breaking down complex topics into understandable chunks. He said he went into medical school assuming the curriculum delivery would be perfect.
“Then you get through and you realize nobody has it all figured out and that there are lots of opportunities for us to improve how we teach things.”
Prasad suggests physicians curious about adding research to their plate seek advice from other doctors doing the kinds of studies that interest them, to learn what might be possible in their own work setting.
“I think every clinician should do some research because, by nature, we are inquisitive. That’s what got us into medicine in the first place. I don’t think we should suppress that inquisitiveness – we should explore it.”
Prasad said new doctors must beware of falling into the trap of thinking there’s not enough time for research because they have too many patients to see, too many calls to do, too many clinics to run.
“I think keeping that fire lit is good for us, Prasad said.”
It is better to wade into the research waters slowly, than to dive in and risk potential frustration or failure, according to Kinloch.
“If somebody already has a project set up that you can be a part of, then it’s just much more fun that way to work as part of a group and then later you can go on and lead your own.”
Early-career physicians eager to take on more outside their clinical duties need to be patient though, according to Kinloch.
“Allow yourself that time to transition into practice, to get to that point where you have part of your frontal lobe available to think about other things rather than being terrified every day,” she said, with a laugh.
Prasad invests countless hours in research on evenings, weekends, and even holidays. He said all the extra effort is worth it when medical advances he’s helped pioneer dramatically improve quality of life for his patients.
There’s a patient story Prasad shares that illustrates why he’s so passionate about the work he does off the side of his desk: he received a referral for a woman who had been living in pain for 13 years; she had a rare condition called loin pain-hematuria syndrome. The patient was considering the extreme measure of having one of her kidneys removed in the hopes that it would bring an end to the pain.
Based on a single case report from Italy that he’d read, Prasad requested a renal denervation be done on the woman. He hypothesized the procedure – which he typically used to treat patients with hypertension – might interrupt the pain fibres involved in loin pain-hematuria syndrome.
He can still recall the feeling when the patient told him the next day, after the anesthetic had worn off, that the debilitating pain in her lower abdomen and back were finally gone. The “high” he experienced was perhaps rivaled only by the births of his own children, said Prasad, who is now running a randomized controlled trial to better understand how the procedure relieves the pain and bleeding associated with loin pain-hematuria syndrome.
“The fact that she was pain free just a day later, off all opiates after 13 years, the feeling was just incredible. I don’t think anything can touch that. It is pure bliss.”