Dr. Tinmouth, Amal Ga’al, Dr. Norris, Sophie Weiss, Dr. Daneman

Dr. Mireille Norris knows firsthand about the unique disadvantages Black and Indigenous students experience while pursuing careers in medicine.

“I struggled as a Black woman who navigated the medical system,” she says, citing isolation due to the lack of Black representation in the field as well as racism and its resulting sense of unworthiness as just a couple reasons for her challenging path. “I’ve been shouldering a lot more than many of my peers throughout my career, and that has affected my academic productivity.”

With just over *2 per cent of Canadian physicians identifying as Black and less than **1 per cent of physicians identifying as Indigenous, similar issues continue to manifest in the newer generation of aspiring Black and Indigenous physicians.

“They really struggled with mentorship, representation, access to research and experiencing discrimination,” says the geriatrician, speaking of the Black medical students she’s encountered in recent years. Reflecting on their circumstances, she says, “I felt that I really needed to build the pipeline.”

Introducing SPARK

After brainstorming with her colleagues and friends Dr. Jill Tinmouth and Dr. Nick Daneman, and after expedited planning and approvals, the Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students — also known as SPARK — was born.

“The idea driving SPARK is to provide various opportunities,” explains Dr. Tinmouth. “We identified strong mentors and research projects, and another key element was to provide financial support throughout the program.”

SPARK, which is in the midst of its pilot year, is providing four Black and Indigenous medical students with an opportunity to engage in meaningful and fairly-paid research externships at Sunnybrook.

Dr. Norris explains this is a unique opportunity that many Black and Indigenous students typically would not be able to access.

“Residency is very competitive. There’s a disproportionate weight given to research experience. If you have a research opportunity, it reflects well on your resume. The students more likely to access these externships are those with parents and other connections in the medical community, which is not always the case for students who are Black and Indigenous,” says Dr. Norris of medical residency applications.

She adds, students are likely to face financial strain as research externships are often unpaid positions, leaving them with the difficult decision of choosing between an unpaid or low-paying research position and a part-time job to support their education.

In addition to addressing disparities in research access and its accompanying financial barriers, SPARK also equips students with networking opportunities by providing participants with three individualized mentors, including a Black or Indigenous physician who will help the student navigate being under-represented in the field.

Mentorship, allyship and embracing the students

“Many of the challenges that may go unnoticed to other people can be shared and discussed between myself and an Indigenous physician,” says Sophie Weiss, an Indigenous SPARK participant, of the benefits of having an Indigenous mentor. “It just creates the opportunity to ask questions from another person that’s in a similar position, but who is ahead of you in terms of their career. It can really provide that guidance.”

Passionate about geriatric medicine, Sophie, who is one of just two Indigenous students in her second-year medicine class at the University of Toronto, is working with Dr. Norris and Dr. Barbara Liu to understand how the COVID-19 pandemic has impacted the geriatric fall prevention program.

“I feel very in control of my own project, which is really, really exciting,” says Sophie. She notes that one of SPARK’s goals is to support students as leaders in their research projects, which may lead to additional opportunities such as becoming co-authors of a manuscript, thus strengthening their residency applications.

Of her supervisors allowing her to have autonomy over her work, she says, “I felt like they wanted me there, rather than me really hoping they would accept me.”

Amal Ga’al, a fellow SPARK participant who is working with Dr. Daneman on the COVID-19 expansion to outpatients project (COVIDEO), shares the same sentiments as Sophie when reflecting on her project and research mentor.

When prospective SPARK supervisors applied to take part in the program, they had to submit a statement of intent, sharing their personal stories and reasons for wanting to be involved.

For example, in his submission, Dr. Daneman discussed how racial equality was always important to him. He was born in South Africa during the apartheid, but was brought to Canada by his parents as an infant so that he could be raised in a more just society. He grew up idolizing Nelson Mandela and says he’s excited to be a part of SPARK, something that will help contribute to “true, equal opportunity for justice, education, health and happiness.”

“Being able to have supervisors and physicians actually share of themselves and explain why they were excited about the program sets you up with a feeling of not just being accepted, but very much embraced and brought into the fold,” says Amal.

This sense of mutual respect and collaboration, versus the typical supervisor-to-student power imbalance you might find in other research environments, is an intentional part of this innovative program.

“There is an injury that comes from being racialized,” says Dr. Norris. “When you have faculty who say, ‘I see you, I know you, I feel for your struggle,’ it helps bridge that experience and heal the wound.”

Amal, who is a member of U of T’s Black Medical Students Association, says that with the rise of conversations surrounding anti-Black and anti-Indigenous racism, some engagement can seem performative and disingenuous. But both she and Sophie agree that the efforts made by SPARK to enhance their communities have been genuine, self-reflective and welcoming — qualities that Dr. Norris is proud to see in both racialized SPARK supervisors and allies who’ve supported the program.

Dr. Tinmouth echoes this, specifically giving kudos to all those who enthusiastically helped financially.

“We could not have pulled this without the quick support of the organization, the Sunnybrook Department of Medicine and the Sunnybrook Research Institute,” she says. “It was remarkable, and we were able to start the program this summer.”

“I think it’s really fantastic the way the Sunnybrook community answered the call,” says Dr. Norris.

The long-term impacts

While SPARK is aimed at helping students elevate their educational opportunities and medical careers, its impact will be felt beyond the program, through the work that students will go on to do in the community.

“I have a very large interest in Indigenous health, and I plan to do lots of outreach and really form my future practice around that,” says Sophie.

She also notes that Indigenous people are highly represented in the Toronto patient population but very poorly represented in the physician population — characteristics that she wants to change.

“Representation is so important,” she says. “I know that I can make an impact.”

Amal says she’s still figuring out what her medical career will look like, but she’s grateful that SPARK has exposed her to physicians with all kinds of different paths.

Regardless of where her medical career goes, Amal says, “I’m really interested in inequality — how do you address that, and why does poverty exist in society? Why are certain people marginalized?” Looking forward, she says, “I want to be involved in addressing and alleviating some of those issues.”

While Amal and Sophie move toward those goals, they will continue working on their SPARK research projects, transitioning from full-time summer hours to part-time hours throughout the school year.

As for Dr. Norris, Dr. Tinmouth, Dr. Daneman and the rest of the SPARK team, they will continue advocating for Black and Indigenous medical students by seeking to secure the support and funding to allow SPARK to continue and grow beyond this pilot year.

“My hope for SPARK is that other hospitals will follow Sunnybrook’s footsteps,” says Dr. Norris. “SPARK exemplifies transformational actions from the hospital’s leadership team that will bolster the future of Black and Indigenous learners for success in medicine, which will lead to greater representation, fairer opportunities and better care for all.”

*Black physician stats: https://www.utoronto.ca/news/we-need-ensure-cultural-shift-u-t-s-onye-nnorom-why-canada-needs-more-black-physicians 
**Indigenous physician stats: https://globalnews.ca/news/4769750/access-aboriginal-doctors-struggle-indigenous-population/

The post Introducing SPARK: The Sunnybrook Program to Access Research Knowledge for Black and Indigenous Medical Students appeared first on Your Health Matters.

1. Is my stress level is normal?

We all experience stress from time to time, but this stress does not necessarily impact on our day-to-day functioning. This is normal stress. When stress starts to get in the way of our lives (e.g., work, school, relationships, daily responsibilities, social life, etc) or it occurs at level that we find too distressing, that is when we begin to classify the stress as being “maladaptive”. When it comes to the way in which our stress or anxiety affects our performance on various tasks, research shows that having some anxiety can actually be beneficial.

Having some anxiety about how you will perform on a test will likely lead to you studying and taking the time you need to prepare for the test. But, having too little or too much anxiety may actually hinder performance.

2.       What can I do to reduce my stress level?

There are many things that we can do to help manage our stress levels. General self-care is very important when we are experiencing stress. Things like getting enough sleep, exercise, balanced and healthy eating, and social engagement can all help modulate our stress levels. It is also important to make sure that we get a good balance of engaging in activities that make us feel productive (e.g. doing work, paying our bills, chores, etc) and activities that we find pleasurable and fun (e.g. hobbies we like, being with family/friends, playing sports, etc). If you’ve tried these strategies and it feels as though your stress level may still be difficult to manage, it can be helpful to speak to a professional who may be able to provide you with additional strategies to help manage your stress.  We have proven effective psychological and medical treatments for those experiencing more clinically significant stress.

3.       My mom says I should do yoga or take some deep breaths – will that help me feel less stress?

Yoga and deep breathing can be quite helpful for stress. Deep breathing is one type of relaxation strategy that involves taking deep breathes through your diaphragm. Research shows this type of breathing can reduce feelings of anxiety. There are other relaxation strategies that can be helpful as well, such as progressive muscle relaxation. This exercise requires you to tense and relax various muscle groups throughout your body and train yourself to notice the difference between the tensed and relaxed states.

4.       Does exercise help?

Yes, there is research to suggest regular exercise of at least a moderate intensity is associated with improvements in anxiety and depression. To achieve health benefits, Canada’s physical activity guidelines recommend that adults aged 18-64 engage in at least 150 minutes of moderate-to-vigorous aerobic physical activity (i.e. exercise that makes you sweat) per week.

5.       Are there any foods or drinks that might make me feel better or worse?

Eating a balanced and healthy diet can be helpful for managing stress. It is also important to limit use of alcohol and caffeine. Beverages that include alcohol and caffeine can affect our sleep and impact our body’s stress response.

The post When the going gets tough – Tips for dealing with stress appeared first on Your Health Matters.

Take a moment today to say thank you. Whether it’s a preceptor, colleague, supervisor, instructor, mentor, or your care provider — let your them know you appreciate how much they have helped you to learn and grow.

Send them an e-apple of thanks via this link.

The post Thank a special Sunnybrook teacher appeared first on Your Health Matters.

Australian Amy being a good Canadian!

We were so impressed by this piece that we wanted to ask Amy a few questions about herself and about her ideas regarding communication; here are her answers.

1.     Who are you? 

I moved to Toronto from Australia last year to take up as position as a Clinical Fellow in the University of Toronto’s Neonatal-Perinatal Medicine fellowship training program.  Whilst I already have my specialist qualification as a Neonatologist in Australia, I wanted to gain further clinical and research experience, as well as have the experience of living overseas.  My partner, Jeff, came along with me to Canada and he has been a fantastic support, especially when the homesickness hits or when I need to be told to go to bed after a 24 hour in-house call shift!

2.     Why did you feel compelled to write your article?

It really was listening to two former NICU parents that inspired me to write. What they said stayed with me and formed the basis of the article.

Communication is an area I feel passionate about and I believe all health care professionals can, and should, continue to develop and improve their communication skills throughout their careers.  What we say or don’t say to families can have a huge and lasting impact.  Writing the article gave me an outlet to express my thoughts about what I feel is such an important, and sometimes, neglected area.

3.     What kind of response have you had to your article?

I have been excited by the response I have had to my article.  The positive feedback and emails I have received from colleagues has been fantastic – the themes the article touched on seems to have resonated with many of my colleagues who work in the NICU.  The article was also featured as a leading article on 99nicu.org, an internet forum for people working in Neonatology, which was pretty exciting.  Being asked to answer these questions for the Sunnybrook NICU blog has also been a highlight – it means a lot to have had the article so well received!

4.     Where do you think you learned the most about communication? In your piece you mentioned communication skills training courses; does any particular training stand out to  you as most effective?

I have learned communication skills from watching other people communicate well, which is probably what most people do with varying results!  The best training though was a fantastic communication skills workshop back in Australia.

The most useful way to learn I have found is by role-playing, after having learned about various communication techniques – by trying out new skills in a simulated environment.  I am still learning though and make mistakes – having the self-awareness that you still can and should be learning about effective communication is vital.

5.     Why do you think there’s a disconnect between what medical professionals say and parents hear?

I think, as medical professionals, we sometimes forget the complete and utter shock the NICU experience can be.  No one plans for their child to need intensive care and I continue to be amazed at how well our families do cope and how strong they are.  Some of the things we have to talk to parents about are extraordinarily difficult and I think at times are almost too hard to hear.  I have had families say to me that they have heard what we have said but that it was just too soon and too hard to hear at that time.  Being accessible and present for all the families that you care for is one way to ensure that the lines of communication remain open.  At other times though, it is because the communication from the medical professional is not clear and this is where I truly believe communication skill training can be extraordinarily useful.

6.     Why did you choose neonatology?

Neonatology is such a fantastic specialty and I knew that after working as resident in my Neonatal Unit back home for the first time back in 2008, it was what I had been looking for – it was what I was ‘meant to do’.  I am extremely fortunate to be able to work in a field that I love, to care for families and know that I will continue to learn throughout my career.

7.     What kinds of communication errors do you hear regularly?

Calling infants a boy when they are a girl and vice-versa is a pretty common mistake.   Some people probably don’t think it is a big deal but I think to many families it is.

False reassurance is another communication error I hear from time to time.  We all want to reassure families that “everything will be alright” but for some situations in the NICU we simply do not know.  I truly believe there is a way to communicate to families that you do care and are also hoping for the very best outcome but sometimes we do not know what the future will hold.  Telling a family “everything will be ok” when it may not be does not help to establish trust.

8.     Do you have any communication tips for NICU parents?

Always ask questions!  Write them down and some parents also find writing down the answers to their questions can also help.  The NICU is full of people to ask questions of – never be shy to ask questions.  If you find a particularly great person to ask questions of –  ask to speak to them again.  Always know that you can ask to speak to your baby’s doctor or nurse practitioner if you haven’t managed to catch up with them that day.

9.     What is the most important thing you have learned from NICU parents?

The strength of spirit NICU parents have continues to amaze me.  Over the years, I continue to learn more and more about what a great job this is – by far my best experiences in Neonatology have been because of the families I have gotten to know and care for.

10.     If there was one thing you could tell a new NICU family, what would it be?

You are the best advocates for your child. Ask questions of all members of the team and draw support from the team – we are there to help and guide you through this journey.  Never be afraid to question someone or something.  Get involved with as many aspects of care of your baby (or babies) as you can.

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Thank you Amy for taking the time to respond to our questions, and for the tremendous work you do with NICU families! 

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