Teaching the doctors of tomorrow

A look at the future of healthcare with one of Ontario’s top teaching doctors

By Joel Wittnebel

The rubber torso lies still on the operating table.

A hand lifts the baton and places the ultrasound against the cold, unyielding fake flesh. When contact is made, a screen on the wall above turns from black to a moving mass of shapes showing the inside of a living human being.

A button is pressed, a kidney stone appears, another button is pressed and it disappears. Press another one and the screen suddenly shows that the fake human torso is in fact pregnant.

This is just one of the many teaching tools that is being used inside the LHEARN Centre at Lakeridge Health in Oshawa, Ontario, one of the most sophisticated teaching centres for medical professionals in this province.

The hospital is on the cutting edge of teaching young doctors the skills and knowledge that they will need in order to succeed as doctors in the ever-evolving field of medicine.

Standing at the head of the class is Dr. Randy Wax.

Creating sophistication

Prior to the year 2000, simulated training for doctors was a rare thing in Canada.

Throngs of doctors were taught surgical techniques using a system of “see one, do one, teach one.”

However, down in the United States, things were progressing beyond the old mantra.

Dr. Wax, moving on from his medical studies at the University of Toronto, spent two years at the University of Pittsburgh, one of the top-ranked hospitals in America for decades. The multi-billion dollar health enterprise is known for its medical innovations, including the polio vaccine developed by Jonas Salk, the pioneering of CPR, and big steps in field of organ transplantation.

During his two years of critical care specialty training there, Dr. Wax picked up a few innovative techniques of his own as he found himself learning different skills through simulated procedures.

It wasn’t long before his home province called him back.

Returning to the Greater Toronto Area where he was raised, Wax found a role with Mount Sinai Hospital in Downtown Toronto.

“I brought back technology and educational strategies from the United States that we didn’t have in place in some of the downtown hospitals,” Wax says.

Using what he learned in Pittsburgh, Wax helped set up a large simulation centre at Mount Sinai one of the first of its size in Ontario’s biggest city and the country.

Wax spent 10 years at the downtown hospital. All the while, Lakeridge Health, the largest healthcare network in Durham Region, just east of Toronto, was preparing for large expansion of its own teaching facilities.

It’s an expansion that Wax would play a critical role in developing.

Sophisticated mannequins at the Lakeridge Health LHEARN Centre allow for students to practice a wide variety of surgical procedures. (Photos courtesy of Lakeridge Health)

Learning at Lakeridge

Today, hundreds of students and medical professionals can be found learning and practicing inside the walls of Lakeridge Health in Oshawa. Whether it’s through the use of sophisticated simulation centres, telemedicine conferences or classes, there’s an urgency that can be felt inside the walls of the hospital like an electrical energy.

However, it wasn’t always like this.

In 2010, what would become the hub for medical learning in Durham Region was nothing but empty space and dark rooms, an area set aside for a future medical training centre. However, the emptiness did not portray the full story.

“It’s important to note that there were phenomenal things happening here for education before 2010, before I came, but I think everybody was ready to take it to the next level,” Wax says. “Somebody had a really good vision where they actually blocked off a bunch of space in the hospital that was specifically going to be dedicated to education,” Wax says.

It’s a way of thinking that was essential to meet the growing need for more health professionals in Durham Region, now one of the fastest growing areas in Canada.

Following a massive fundraising effort from the Lakeridge Foundation, the hospital’s fundraising subsidiary, along with a $1 million donation from Queen’s University, the Lakeridge LHEARN Centre was born.

Now, with all the technology and resources in place, the hospital has become one of the go-to educational stops for doctors and medical institutions across the country. Currently, the centre has three simulation labs equipped with recording technology in order to review procedures with classmates after the fact. These labs can teach a wide variety of procedures including everything from line insertion and CPR to more complex situations like various resuscitation scenarios, co-morbidities and seizures. The high-tech mannequins, of which Lakeridge has a variety of simulated sexes and ages, include a pregnant mother and two newborns, and also allow for simulated control of things like breathing, blood pressure and heart rate. There’s even simulated blood.

More than 1,600 students use the facility on an annual basis.

“It created a real hub for education here at Lakeridge Health and that’s actually been helpful working with some of our academic partners to increase the education activities because, you know the old saying, if you build it they will come. Well, we built it and they’re coming.”

The LHEARN Centre has worked to transform the community hospital.

“When I came here we were more of an importer of education. Other people would teach things and we would either go to them or they would come here and teach us,” Wax says. “More and more what we’re finding is we’re actually teaching other people. Whether it’s other people coming to visit us for conferences with our healthcare providers teaching them, or we even use technology now.”

For Wax, now the Director of Clinical Education for Lakeridge, who also specializes in critical care, dealing with very sick patients and those on life support, being able to share the knowledge of people who work at Lakeridge Health is one piece of the reward of such a facility. However, it’s also allowing the resources of Lakeridge to be used to save lives across the country.

“I find it extremely rewarding when I go to visit other parts of the province and I bump into someone who trained here and they tell me of how they saved someone’s life or made someone’s life better and they say, ‘I did it because of something I learned at Lakeridge,” Wax says. “That’s an amazing statement to make.”

To date, the LHEARN Centre has played host to nearly 600 research studies across almost every clinical program the hospital offers, and has partnered with more than 80 post-secondary institutions.

While in some cases, the professionals come to learn and take their expertise back to their home hospital, Lakeridge is also looking at ways to create programs that will encourage doctors to stay in Durham, with many of these options geared to the students.

Through the hospital’s family medicine program, medical students do their residency with Lakeridge and undergo two years of training in order to become family doctors. According to Wax, at least half of the students involved in the program have decided to stay after its over.

“This has been a huge tool for recruiting new physicians into the region, particularly family physicians, as we know, we can always use more family physicians,” he says. “In healthcare, it’s not just who you hire, it’s who you keep. So the fact that we’ve added this whole new layer of career satisfaction and opportunity for people helps keep them in Durham Region.”

However, in the years ahead, hospitals across Ontario will be dealing with challenges never seen before, and for Wax, he knows that all medical professionals need to be prepared.

Serious demand with the same resources

Aside from giving birth, the top reasons Canadians visit hospitals include heart attack, heart failure, COPD, and pneumonia, according to information from the Canadian Institute for Health Information for 2016 and 2017.

“A lot of the severity of illness of people who get admitted to hospital is much higher than it used to be,” Wax says. “So people that used to be looked after in hospital, many times, are done outside of the hospital. So, the only people that are in the hospital, really need to be here and are really sick.”
It’s a troubling statement, especially when it’s combined with the fact that Canada’s healthcare system has some of the worst wait times in the world. A study from the U.S.-based Commonwealth Fund, along with the Canadian Institute of Health Information, found that among a number of countries, including Australia, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the United States, things did not look so bright for Canada.

The Great White North was literally the worst in a number of areas, including the ability to get same-day or next-day appointments, the wait times for treatment in emergency departments, the wait to see a specialist and the wait times for elective surgery.

It’s a crisis that may only get worse as the population continues to grow and age, and it’s not just in one place.

“The population is exploding in various areas, Durham Region is one of the fastest growing areas in Canada,” Wax says. “So, many of the things that we took for granted, that would would not have to be responsible for with healthcare and sending (patients) to Downtown Toronto or other places, we can’t do that anymore.”

It’s an issue that is not new and one that healthcare organizations, governments and advocates have grappled with for years. However, while discussions around the issues generally turn to government funding and more resources, Wax says the responsibility can also fall to the hospitals themselves.

“The responsibility for making the healthcare system better can’t just depend on people at high levels of administration or government, because the best ideas come from the front line,” he says. “If you’re on the front line you have the best chance of seeing new ways of doing things that will allow us to be that much better.”

For that reason, teaching the doctors of tomorrow to identify and be able to deal with these changes is now a crucial responsibility for Lakeridge and all hospitals.

The medical practice of the future

The doctors sit around a table. It’s not an operating table, but nonetheless they are discussing the correct method of care for a patient and the best path forward for treatment. The catch is, some of those doctors are sitting in Oshawa, some in London, Downtown Toronto and even as far away as Thunder Bay.

Today, many people are accustomed to staring at screens for hours on end, much of that time the source of that screen coming from the powerful machine the majority carry around in their pocket on a daily basis.

The future of healthcare may be no different.

Already, Lakeridge is involved in telemedicine programs and conferences, where the hospital can be linked up with medical professionals from across the province. For Wax, it’s only the start of a trend that will continue in the coming years.

“When I trained, I didn’t really have any formal training on how to be a doctor on the other end of a video screen,” he says.
Now, it’s about figuring out what new technology medical students will be faced with in the years ahead, and making sure they are prepared to use those technologies to save lives.

“We have to look for opportunities to say what is healthcare going to look like in the next 10 to 20 years and how do we prepare people to work in
that kind of environment so they’re comfortable with technology, comfortable with a different kind of relationship.”

For that reason, new programs are being developed to fully immerse doctors-to-be in the hospital environment so they can pick up and learn all they need to in order to be successful medical professionals and be present for any of those developments as they emerge.

At Lakeridge, a new program is looking to do just that as the hospitals Longitudinal Integrated Clerkship pilot program prepares to become active in January 2019.

The program will see medical students in the final phase of their training spend 11 months straight in the Durham Region, seeing cases from start to finish and working with active doctors in real situations.

“What we’re really trying to teach them in those 11 months is how to be a doctor, that’s really what it’s about. How do you take your book learning and turn it into, ‘I’m going to be a doctor, I’m going to see patients and look after them, and what are the skills I need to have,’” Wax explains. “That goes beyond book knowledge, that’s about how do I talk to patients, how do I problem solve and how do I choose treatment options.”

Along with that, it also comes full circle to help the hospital in dealing with any potential shortfall of resources as they deal with the potential burnout from doctors taking on too much.

“The challenge of trying to do an amazing job of looking after patients, and at the same time looking after education and teaching people, we have to be careful that have to be careful that we’re not overloading people with responsibility,” Wax says, adding that with the medical students at the forefront, it gives all those doctors an added level of support and in many cases, added expertise.

“Instead of having one doctor look at your case, you’ve got five doctors thinking about your case at the same time. Some of them may be junior, but what I can tell you is that many of the newer learners that are coming through, they may not necessarily have as much experience under their belt, but I can tell you they’re incredibly smart,” Wax says. “When you’re out in a community like this, you really get to see the real world and what it’s like. So if you can learn in the real world context, it’s going to make it that much easier when you get out there to understand what life is like, how to navigate it.”

On the right path

Recently, Dr. Wax received the 2018 Certificate of Merit award from the Canadian Association of Medical Education, recognizing his commitment to medical education.

“Randy is extremely passionate about teaching and has devoted much of his career to generously sharing his knowledge and expertise with others,” says Dr. George Buldo, the VP of medical and academic affairs at Lakeridge. “He has been a major driving force behind our academic mission and the growth of our cutting-edge LHEARN Centre and I can think of no one more deserving of this recognition.”

For Wax, the award is reassurance for not only him, but the entire team at Lakeridge that the teaching they are providing is critical in the years ahead

“It’s always a pleasant surprise when you find out that you’ve been recognized by your peers for something that you’re doing because you love it…It’s not just my contribution, but I think that represents the partnership within Lakeridge Health, within Durham Region, with all our academic partners to be able to move it forward because without everybody working together we wouldn’t have accomplished as much as we did,” he says. “Award or not, for me, the big reward is actually seeing how far things have come and the potential for where we’re going, moving it forward.”