New PSI Funding Opportunity: 2023 PSI Mid-Career Knowledge Translation (KT) Fellowship

PSI acknowledges that mid-career can be a challenging time for physician researchers. During this phase, there are often additional academic roles and responsibilities including committee work, leadership positions, and mentoring of junior investigators, while clinical work continues. PSI recognizes the importance in supporting this phase of an investigator’s trajectory.

PSI Foundation is very pleased to announce a new funding opportunity: 2023 PSI Mid-Career Knowledge Translation (KT) Fellowship. This Fellowship is intended to provide salary support for a mid-career physician researcher in Ontario who has demonstrated the ability to successfully complete high-impact knowledge translation research. The Fellowship funds, dedicated to salary support, must protect at least 50% of the Fellow’s time to conduct such research.

Amount and Duration of Funding

Total Support

This program offers two options for a funding timeline for salary support:

A maximum of $400,000 over two years;

A maximum of $400,000 over three years.

The award is intended to protect at least 50% of the fellow’s time to undertake research, regardless of whether the award is taken over two or three years.

Matching Funding Requirements

The sponsoring institution is required to fund 50% of the total award.

For example, if the fellow requests a total support of $400,000 over two years, then PSI will fund $200,000 over two years ($100,000 per year) and the institution is required to co-fund $200,000 over two years ($100,000 per year).

Eligibility

For this competition, the candidate for the Fellowship must be:

A practicing physician in Ontario with a College of Physicians and Surgeons of Ontario licensed M.D. having direct patient care responsibilities and an academic appointment, thus eligible to apply for their own research grants as an independent investigator
Within five (5) to fifteen (15) years of their first academic appointment and have demonstrated potential for high impact research work
Dedicating at least 50% of a full-time schedule to the Fellowship

Important Information in Funding Guidelines

The Funding Guidelines contain important information regarding the award, including PSI’s definition of knowledge translation, matching funding requirements, and funding criteria. Please review this document before applying.

Please note: Knowledge translation must be the fundamental purpose of this Fellowship and must be demonstrated in the application. This is funding opportunity is not an additional PSI operating grant.

How to Apply

PSI is launching this competition through a Letter of Intent (LOI) process. Applicants are required to submit their applications directly to PSI.

We require all applicants to submit the completed LOI directly to PSI via the PSI Online Grants Management System by June 1st, 2022 at 5pm EST. LOIs will be reviewed by the PSI Grants Committee in July 2022.

PSI will invite successful applicants to submit full applications, which will undergo internal review for a final funding decision in December 2022.

Questions?

Please contact the PSI Office to discuss any questions you may have about submitting an application for funding.

January 28, 2022January 27, 2022

Dr. Amanda Mayo and Dr. Sander Hitzig – Largest Canadian Study of its kind Highlights Isolation and Loneliness After Dysvascular Amputation

“Historically this population has been underfunded, so it’s really important that PSI has funded dysvascular amputee research. We were happy to get this PSI grant, and it really built the confidence of the researchers in Ontario so that now we can work together and do bigger things.” – Dr. Amanda Mayo, Sunnybrook Health Sciences Centre

“We’re very grateful to PSI for funding this work because it really lit a spark and galvanized our research community, and it will ultimately improve the quality of life for the limb loss community.” – Dr. Sander Hitzig, Sunnybrook Health Sciences Centre

A PSI Foundation–funded grant to examine the health and quality of life of people with dysvascular limb loss has not only provided important insights into this understudied population but has also helped to develop the limb loss research field in Canada.

“Our overarching goal of is to develop collaborative research so that our patients do better, but to do this, we need to know how they’re doing and the resources they lack,” says Dr. Amanda Mayo, a physiatrist at St. John’s Rehab at Sunnybrook Health Sciences Centre who specializes in amputee rehabilitation. “This funding has allowed us to build a more cohesive and collaborative research program, but also work toward the greater aim of improving clinical outcomes for this patient population.”

Each year, approximately 1,500 people in Ontario have a major lower limb amputation due to dysvascular causes such as peripheral vascular disease or diabetes, making it the most common cause of lower limb loss in Canada. And the problem is expected to grow as the incidence of diabetes increases.

While any type of amputation can be traumatic, people with dysvascular limb loss face different challenges than those who lose limbs due to other causes, such as accidents.

“They’re a very vulnerable and frail population. They are usually older and tend to have a high number of comorbidities leading up to their amputation, in particular heart disease, arthritis and neuropathy,” says Dr. Amanda Mayo. “After the amputation, they’re at greater risk of complications, falls, depression and not being able to get back to community living.”

In 2018, Dr. Mayo and her co-principal investigator, Dr. Sander Hitzig, a scientist focused on aging and disability also based at St. John’s Rehab, received a PSI Foundation Clinical Research Grant to examine the health and quality of life outcomes of people with dysvascular limb loss – the largest study of its kind in Canada.

Study finds that physical and mental health decline post-amputation

In the study, the research team interviewed more than 230 people with limb loss about their physical and mental health, mobility, social connections and quality of life after amputation. They also interviewed 35 people from this group in more depth about their experiences of living in the community after amputation.

The study results showed some troubling trends. The people they interviewed experienced poor physical health, with an average of five comorbidities, most commonly diabetes, pain and high blood pressure. After amputation, mental health also tended to decline, and many people became more isolated; about one-third of interviewees expressed that they were lonely.

But the study also identified factors that could help people to cope better after limb loss; less impactful morbidities, a higher sense of self-confidence, and strong levels of social support were associated with better physical or mental health.

The interviews were done before the COVID-19 pandemic, but anecdotally it is likely that the pandemic has hit this population particularly hard.

“I think the pandemic has magnified how significant being socially isolated can be for anyone, and this was an isolated population before the pandemic,” says Dr. Hitzig. “We don’t have data about this yet, but they may have become more isolated and disconnected due to many of them being immunocompromised, and their physical health may have declined because of clinics being closed, not being able to get to the hospital, or surgeries being delayed.”

Results will help inform supports for vulnerable group

In addition to the interviews, Dr. Mayo and Dr. Hitzig analyzed data from a large cohort of Ontarians with lower limb amputations to understand their health care usage and the economic cost of dysvascular amputation. While this part of the project is not yet complete, early results suggest that people with limb loss are very high users of the health care system, visiting family physicians, specialists and emergency departments multiple times in the year following their amputation.

In fact, approximately 30% of people with dysvascular limb loss are admitted to long-term care and 30% die within two years of their amputation.

“These people are having significant health issues. We try to help them recover as best as possible through rehab, but many continue to decline,” says Dr. Hitzig. “There is a negative impact on the person and their family members, but there is also a health care system cost that we’re now hopefully starting to better understand.”

With a better understanding of the quality of life for people with dysvascular lower limb loss and the related social and economic costs, Dr. Mayo and Dr. Hitzig hope that the results from this project and their larger research program can be used to screen people who may be at greater risk of social isolation, as well as develop or connect people with programs to support their physical and mental health after an amputation.

“Predicting which patients are most at risk of isolation or not successfully integrating into the community would allow us to do more targeted rehab or pre-operative care,” says Dr. Mayo. “Looking at the data from this project, we see many opportunities for future collaborative research and ways to use the results to improve quality of life.”

December 21, 2021

Five Clinician Researchers Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. The PSI Graham Farquharson Knowledge Translation Fellowship – valued at $300,000 for over two or three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research in Ontario.

5 Clinician Researchers Awarded with the 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is pleased to name five clinician researchers as the 2022 PSI Graham Farquharson Knowledge Translation Fellowship recipients:

Dr. Imaan Bayoumi – Queen’s University (Recipient Biography)

Dr. Andrea Gershon – Sunnybrook Research Institute (Recipient Biography)

Dr. Shawn Mondoux – McMaster University (Recipient Biography)

Dr. Brodie Nolan – St. Michael’s Hospital, Unity Health Toronto (Recipient Biography)

Dr. Derek Roberts – University of Ottawa (Recipient Biography)

Please visit their recipient biographies for more information on each of these Fellows and how they will be using PSI funds to conduct high-impact knowledge translation research. We thank all stakeholders for supporting PSI with the 2022 competition.

About the 2022 PSI Graham Farquharson Knowledge Translation Fellowship Competition

In May 2021, PSI launched the 2022 competition through a Letter of Intent (LOI) process. This was PSI’s first time launching this award through such process, which opened up the competition to more stakeholders by allowing candidates to directly apply to PSI.

The LOIs were reviewed by an internal sub-committee in late August 2021; successful applicants were invited to submit their full applications to PSI. Full applications were reviewed by the PSI Grants Committee in early December 2021.

The Committee approved $1.5 million in new funding for the 2022 PSI Graham Farquharson Knowledge Fellowship. Samuel Moore, Executive Director of PSI Foundation, comments: “This investment of $1.5 million in five Ontario clinician-researchers represents PSI’s largest commitment to any new program in decades. This is the largest amount that PSI has ever funded for this award in a single competition.”

One of the major enhancements made to this award for this competition was the stronger emphasis on knowledge translation. Throughout announcements, guidelines, and application forms for this award, PSI had repeatedly stated that knowledge translation must be the fundamental purpose of this Fellowship and must be demonstrated in the application.

PSI Foundation’s Commitment to Funding Knowledge Translation Research

Since the launch of this award in 2012, PSI invested $5.7 million in funding the PSI Graham Farquharson Knowledge Translation Fellowship. Together with other awards including the 2020 Mental Health Knowledge Translation Fellowship, PSI has invested a total of $6.3 million in knowledge translation research, providing salary support and protecting the research time of 21 clinician researchers in Ontario.

This funding portfolio demonstrates PSI’s strong commitment to support the physician of Ontario to advance translational research in Ontario.

“I am so proud of PSI’s commitment to knowledge translation by supporting the research programs of physicians in Ontario,” says Samuel Moore. “I look forward to seeing the tremendous impact these clinician-researchers make on the health care system and for all of us through their research.”

PSI has funded research in many surgical and medical areas resulting in changes to clinical bedside practice. PSI’s investment in knowledge translation research is one of the pillars in achieving its mission of improving the health of all Ontarians.

December 21, 2021

Dr. Derek Roberts – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“Being awarded the PSI Fellowship will allow me to spend more time to build my research program on improving the quality of healthcare for the millions of Canadians with peripheral artery disease. As a new investigator, it would jump start my career by giving me the time to focus on completing some early, high-impact, and potentially practice-changing work related to this goal. It would therefore catalyze my transition from being a trained surgeon and researcher into an independent surgeon-scientist who hopes to help transform peripheral artery disease care in Canada and internationally.

Approximately 10% of Canadians have peripheral artery disease (hardening, narrowing, and occlusion of the leg arteries). People with peripheral artery disease have a high risk of lower limb amputation, heart attack, stroke, and death. Clinical practice guidelines strongly recommend providing certain blood thinner, cholesterol reducing, and blood pressure lowering medications to people with peripheral artery disease because these medications reduce the risk of these adverse outcomes. However, international studies have reported that these medications are often markedly underprescribed to people with peripheral artery disease.

As the 2022 PSI Graham Farquharson KT Fellow, I aim to conduct a multi-phased, mixed-methods study to: 1) understand gaps in the prescription of and adherence to guideline-recommended cardiovascular medications among Ontarians with peripheral artery disease; 2) identify factors that may influence the prescription of guideline-recommended medications to Ontarians with peripheral artery disease; and 3) develop a tailored and evidence-informed implementation intervention to improve medication prescription by doctors and nurses. Ultimately, this implementation intervention could then be used as a template for other provinces and countries interested in performing similar interventions. My research team and I believe these types of interventions will significantly improve the health outcomes of people with peripheral artery disease and reduce their overall health resource use.” – Dr. Derek Roberts

Dr. Derek Roberts Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Derek Roberts of University of Ottawa as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

About Dr. Derek Roberts

Dr. Derek Roberts is a vascular and endovascular surgeon and new investigator based in the Division of Vascular and Endovascular Surgery at The Ottawa Hospital and University of Ottawa. He completed a pharmacy degree (and practiced as a pharmacist) and an MD with Distinction at Dalhousie University; a residency in general surgery, the Clinician-Investigator and Surgeon-Scientist Programs, and a PhD in epidemiology with a focus on KT at the University of Calgary; the KT Canada Strategic Training in Health Research (STIHR) fellowship; and a fellowship in vascular and endovascular surgery at the University of Ottawa. The KT Canada STIHR Fellowship provided Dr. Roberts with rigorous graduate training in the science and practice of KT and made him one of the first surgeons or surgical trainees to complete formal training in KT in Canada. This training included completion of a KT-related PhD thesis and attendance or completion of monthly KT Canada seminars, twice-monthly research operations seminars, the annual KT Canada Summer Institute (two consecutive summers), and KT-related graduate courses.

Dr. Roberts was appointed as an Assistant Professor in the Department of Surgery on January 1st, 2021. He was then cross-appointed to the School of Epidemiology and Public Health at the University of Ottawa on September 1st, 2021 where he is approved to supervise MSc students and co-supervise PhD students. He currently spends 30% of his time conducting research (during which he has no clinical responsibilities) and 70% practicing vascular and endovascular surgery and providing direct patient care to patients with peripheral artery disease and other vascular surgical problems.

About Dr. Derek Roberts’ Research Program

The overarching objective of Dr. Roberts’ research program is to improve the quality of healthcare and outcomes for people with peripheral artery disease and several other vascular surgery problems. He began his career by using his research training to attempt to improve the perioperative outcomes of people with peripheral artery disease who require lower limb revascularization surgery. These surgeries are commonly-performed, high-risk, and costly procedures performed to improve quality of life and prevent leg amputation in people with peripheral artery disease. Dr. Roberts recently studied 20,988 patients who underwent lower limb revascularization surgery in Ontario. Study results were published in the prestigious British Medical Journal (BMJ). Use of neuraxial instead of general anesthesia was associated with decreased mortality, health care costs, and length of hospital stay. He is now using an integrated KT approach to involve stakeholders across Canada in the design of a multicenter pilot and then Canada-wide randomized controlled trial to test whether use of neuraxial instead of general anesthesia may improve the outcomes of PAD patients undergoing lower limb revascularization surgery.

Dr. Roberts now seeks to use his training in pharmacy, epidemiology, vascular and endovascular surgery, and KT to understand and subsequently reduce gaps in the use of guideline-recommended medications for people with peripheral artery disease. He will be conducting these studies alongside colleagues in the Division of Vascular and Endovascular Surgery at the University of Ottawa, members of the Canadian Society for Vascular Surgery, and world experts in KT at the University of Ottawa, including members of the Centre for Implementation Research ( http://www.ohri.ca/cir/) at the Ottawa Hospital Research Institute.

About the PSI Graham Farquharson Knowledge Translation Fellowship

Knowledge translation research aims at transitioning research discoveries to the real world to improve health outcomes. This prestigious fellowship – valued at $300,000 for over three years – helps protect a promising clinician’s research time, allowing the Fellow to undertake high-impact translational research.

December 21, 2021

Dr. Andrea Gershon – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“I am delighted to receive a PSI KT Fellowship that will support the cutting edge work we are doing to help patients and health care providers maintain and improve lung health. I am impressed by the PSI Foundations forward-thinking dedication to knowledge translation – not just research, as well as its commitment to innovation and new ideas.” – Dr. Andrea Gershon

Dr. Andrea Gershon Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Andrea Gershon of Sunnybrook Research Institute as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

This Fellowship will allow Dr. Gershon to further advance her research and knowledge translation program, Canadian Best Respiratory Research Evaluation and Analyst Team of Health Experts (CanBREATHE), conducting research and translating it to improved care for people with respiratory disease in Canada. She leads a diverse team of more than 70 researchers, clinicians, patients and other stakeholders to conduct such research and knowledge translation. Importantly, she also works closely with government, health districts, hospitals, health care providers and patients to translate their findings to quality, equitable care to improve lung health for all.

About Dr. Andrea Gershon

Dr. Andrea Gershon is a Respirologist and Senior Scientist at Sunnybrook Health Sciences Centre, University of Toronto and ICES. She is a well published CIHR-funded researcher as well as the COPD Associate Editor of the high impact journal CHEST.

Dr. Gershon’s award winning research investigates health outcomes, health services, and drug safety and effectiveness in individuals with respiratory disease. Her research and knowledge translation program uses real world data from millions of people to learn about the experiences of people with lung disease with a focus on vulnerable groups, including the elderly, those of lower socioeconomic status, and aboriginal peoples.

Dr. Gershon has published over 200 peer-reviewed articles. She has been an invited speaker at international meetings, universities, and medical centres worldwide. Her work is used by government and non-profit organizations where it informs international guideline and policy documents.

Dr. Gershon works with junior faculty, postgraduate fellows, graduate candidates, and other students at all levels of training. She loves supporting these future leaders, researchers and clinicians who will be central to the discovery and use of health-related knowledge to keep people well.

About the PSI Graham Farquharson Knowledge Translation Fellowship

December 21, 2021

Dr. Imaan Bayoumi – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“Poverty and other social determinants have enormous negative impacts on the health of young children and their families, which have been worsened during the COVID-19 pandemic. Based on the long-term trusting relationships primary care providers develop with families, they are in a unique position to address social determinants of children’s health. The PSI Graham Farquharson Knowledge Translation Fellowship will allow me to study primary care-embedded interventions addressing poverty, as well as the impacts of the COVID-19 pandemic on primary preventive care and health outcomes for young children.” – Dr. Imaan Bayoumi

Dr. Imaan Bayoumi Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Imaan Bayoumi of Queen’s University as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

This Fellowship will allow Dr. Bayoumi to generate and disseminate evidence about impacts of the COVID-19 pandemic on primary preventive care and health outcomes for young children and of primary care embedded
interventions (e.g. social service navigation) on parent and child health.

Poverty and other social determinants have a profound negative impact on the health of parents, children and families, contributing to substantial health disparities in parenting stress, mental health, and children’s general and social-emotional development. Primary preventive care in early childhood is fundamental to early detection and prevention of future health problems. As the first contact with the health system for most families, primary care providers are in a unique position to develop long-term trusting relationships, and to intervene to address social determinants of children’s health in clinical settings. During the COVID-19 pandemic, families have experienced increased stress with social isolation, increased food insecurity, disruptions to work, daycare and schools, and worsening parent mental health, all factors which are associated with poor child health and which create barriers to accessing preventive care.

About Dr. Imaan Bayoumi

Dr. Imaan Bayoumi is a Family Physician and Assistant Professor of Family Medicine at Queen’s University. She completed her MD at Queen’s University, Family Medicine training at McMaster University, and a Masters of Science in Health Research Methodology at McMaster University. She is an investigator with the TARGet Kids! primary care practice based research network for children ( https://www.targetkids.ca/) and a fellow at ICES. She is a member of the executive team of the Rourke Baby Record, the evidence-informed guide to preventive primary care for young children in Canada. She also co-leads Innovations for Community Resilience Equity and Advocacy (I-CREAte, https://www.queensu.ca/i-create/), a community based participatory action research initiative aimed at conducting action-oriented research to improve health and wellbeing of children and families. She is committed to collaborating with parents, community partners, professional bodies and policy makers to carry out equity oriented, meaningful research.

About the PSI Graham Farquharson Knowledge Translation Fellowship

December 21, 2021December 21, 2021

Dr. Shawn Mondoux – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“There is somewhat of a disconnect between medical training and consultant level work. While a trainee, we constantly evaluate individual performance to move clinicians towards better habits and more robust practice. With competency-based education, this focused is heightened. Yet once physicians enter practice, this formative feedback comes to an abrupt end. Providing clinicians with their individual practice data is an essential beginning yet falls short of meaningful and sustained practice change. If we are going to improve clinical practice, we must design peer exchange experiences, educational interventions and coaching which bring practice data to the next level. It is not enough to know things should change, it’s about providing clarity on how this could be done.” – Dr. Shawn Mondoux

Dr. Shawn Mondoux Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Shawn Mondoux of McMaster University as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

Through this Fellowship, Dr. Mondoux aims to change clinical practice through augmented data feedback, using interviews, peer learning methods, and clinical coaching to improve clinical care metrics.

Making healthcare safer and a doctor’s practice better starts with providing each doctor with good quality data about their medical practice. Dr. Mondoux has created such a system that compares a doctor’s practice with peer doctor who work in the same setting. But improvement needs more than data. This Fellowship will allow Dr. Mondoux to develop new education, peer coaching and data sharing programs to make sure that the data is used as best as possible.

About Dr. Shawn Mondoux

Dr. Shawn Mondoux is an Emergency Physician at St. Joseph’s Healthcare Hamilton (SJHH) and an Assistant Professor at McMaster University. He graduated with a B.Eng. in Aerospace Engineering, completed his medical training at the University of Ottawa in the Royal College stream of Emergency Medicine and completed a MSc of Quality Improvement and Patient Safety at the University of Toronto. Dr. Mondoux currently serves as the Quality and Safety Lead of the Emergency Department and is a corporate Innovation Lead at SJHH.

About the PSI Graham Farquharson Knowledge Translation Fellowship

December 21, 2021

Dr. Brodie Nolan – 2022 PSI Graham Farquharson Knowledge Translation Fellowship

“Injuries are the leading cause of death for young Canadians. Early stabilization and timely transport to a specialized trauma centre gives patients the best chance for survival. Support from the PSI Graham Farquharson Knowledge Translation Fellowship will allow me to study how we can improve our current approach to prehospital trauma care in Ontario.

Through this fellowship we will look at the creation and implementation of a Prehospital Code Blood to reduce the time to blood transfusion, explore limitations of our current trauma triage protocols, and update prehospital trauma practices to ensure they are following the most recent evidence.” – Dr. Brodie Nolan

Dr. Brodie Nolan Awarded: 2022 PSI Graham Farquharson Knowledge Translation Fellowship

PSI Foundation is delighted to announce Dr. Brodie Nolan of St. Michael’s Hospital, Unity Health Toronto as the 2022 PSI Graham Farquharson Knowledge Translation Fellow.

Through this Fellowship, Dr. Nolan aims to deliver a much-needed reform to prehospital trauma care in Ontario.

Injuries are the leading cause of death for young Canadians. Annually in Ontario, injuries result in the death of nearly 6,000 people, over 75,000 hospitalizations and almost 6 billion dollars in direct health care costs. The role of prehospital care in a trauma system is to facilitate prompt transport to a trauma centre and initiate stabilization of the patient. These are complex tasks performed by paramedics in austere environments with incomplete information and minimal therapies available. The current approach to trauma care in Ontario is outdated and worse, there is evidence that some trauma practices are leading to patient harm.

About Dr. Brodie Nolan

Dr. Nolan is an emergency physician and trauma team leader at St. Michael’s Hospital, Unity Health Toronto and a transport medicine physician for Ornge, Ontario’s air ambulance and critical care transport service. He is an Assistant Professor and clinician scientist in the Department of Medicine at the University of Toronto and a scientist at the Li Ka Shing Knowledge Institute.

Dr. Nolan completed his medical school and emergency medicine residency training at the University of Toronto. He completed his MSc in Clinical Epidemiology and Health Care Research through the Institute of Health Policy, Management and Evaluation at the University of Toronto. Dr. Nolan’s research interests are in trauma, prehospital care, and patient safety. His work focuses on improving timely access to trauma care for injured patients in Ontario and the role of the provincial air ambulance system.

About the PSI Graham Farquharson Knowledge Translation Fellowship

November 26, 2021

Dr. Carrie Bernard: New Family Medicine Ethics Curriculum Helps Learners See Ethical Principles in Everyday Clinical Work

As a community-based family physician, Dr. Carrie Bernard examines research questions that are directly relevant to her patients and practice.

“All of my research has come out of the clinical world, and for me, that’s what makes research meaningful,” says Dr. Bernard, physician at William Osler Health Centre in Brampton. “I see myself as firmly planted in the community as a physician. That is my home, and that is what matters to me. I am most interested in research that is going to help my patients in the long run.”

Since she started to undertake research projects over the last decade, she has partnered with researchers to work on projects ranging from humanitarian health care ethics to advanced care planning. One of her most recent projects, funded by a PSI Foundation grant for Medical Education Research that the Post-MD Level, focused on how ethics curriculum is taught to postgraduate family medicine trainees.

Dr. Bernard says that PSI’s support of family physicians and their understanding of their unique research approach helped her feel valued as a researcher.

“PSI felt like the right place to go for this funding because it represents who I am as a physician first and a researcher,” she says. “They understand and expect that as an MD, you will need to partner with a PhD researcher on your project. You’re not viewed as a lesser researcher because of that.”

New ethics curriculum aimed to increase confidence with challenging situations

Dr. Bernard’s transition to doing research was a gradual one. She had been practising as a family physician for several years when she volunteered on a humanitarian trip to northern Uganda with Médicins Sans Frontières (Doctors Without Borders). The experience left her with many questions about how to do humanitarian medical work ethically, but she realized she needed a research-focused education to properly answer the questions.

So, while continuing to practice family medicine fulltime, she earned a master’s degree in public health at the University of Toronto, focusing on global health and ethics.

Her master’s degree opened up new opportunities in academia, and in 2014, she joined U of T’s Department of Family and Community Medicine as Associate Program Director, Curriculum and Remediation. As part of her role, she began working with a team of physicians, ethicists and education experts to re-design how ethics is taught during family medicine residencies.

“One of the main reasons doctors run afoul with regulatory bodies is because of unprofessional behaviour and understanding how to manage these fraught and ethically challenging situations. It’s incredibly important to make sure you have strong ethical judgment to build trusting relationships with patients,” she says. Yet, “Family medicine trainees and even many practising family physicians feel underprepared and unconfident when it comes to ethics.”

Dr. Bernard worked closely on the new curriculum with Dr. Mahan Kulasegaram, director in the Office of Education Scholarship in the Department of Family and Community Medicine and an expert in learning sciences. They, along with the rest of their team, spent more than a year developing a new ethics curriculum that relied on family physicians – not trained ethicists – to teach the curriculum, as well as deliberately integrated ethical principles with the day-to-day work of family medicine.

“You can do a lecture on the principles of ethics, but if it’s not integrated within a realistic case that learners can understand in a clinical way, it seems remote,” she explains. “Our whole interest was really on grounding it in integration in family medicine and basing it on learning principles.”

Dr. Bernard and Dr. Kulasegaram then applied to PSI Foundation to evaluate the new curriculum. They worked with physician teachers at four teaching sites to teach the new curriculum, interviewed residents before and after they completed the curriculum, and evaluated the residents’ performance in the objective structured clinical examination (OSCE).

Positive pilot results help curriculum become self-sustaining

Dr. Bernard says that she and the team were “blown away” by the results. Residents from the pilot sites performed significantly better in a five-station OSCE focused on ethical issues compared to their peers who learned from the standard curriculum. And in the interviews, residents said they had greater awareness of ethical principles and could use a formal ethical deliberation process in challenging situations, which gave them more confidence to act and incorporate patients’ values into ethical deliberations.

Dr. Bernard says she was most pleased with what happened next: based on these results, the pilot sites not only continued using the new curriculum, but also supported the other training sites in implementing it. Having the curriculum become self-sustaining at the training sites was exactly the kind of result that the curriculum redesign team had hoped for.

“Now every single training site in our department is teaching it, and the original sites are acting as helpers,” she says. “We had hoped this would become a ‘train the trainer’ mentorship community of practice, and it just happened naturally that as these teachers became empowered and confident, they started teaching others.”

Having demonstrated these positive results in one department, the team hopes to generate more awareness of the curriculum results among physician teachers and residency program directors at medical schools across the country. In the long-term, she hopes that the curriculum will help more family physicians be more confident in their ethical deliberations and build positive patient relationships.

“Funding good educational research means we’re going to have good doctors in the future,” she says. “PSI’s support of this project is amazing because it directly affects the people – that is, the medical residents – who are going to make a difference in the future.”

November 11, 2021November 11, 2021

Dr. Joel Fish: Laser Therapy Improves New and Mature Severe Burn Scars in Children

“PSI Foundation It is one of the few granting agencies that funds clinical research. Its reviewers understand good science and good methodological design, but as clinicians, they also see the clinical problems. I feel that, as a clinician, I can be competitive with PSI because they understand that type of work.” – Dr. Joel Fish, plastic surgeon and Medical Director of the Burn Program at the Hospital for Sick Children, Toronto

Hypertrophic scars – thick and stiff severe scars that are often the result of burns – can affect children’s lives in many ways, interfering with a child’s growth, mobility and even confidence. And children with these scars haven’t had many effective treatment options to reduce the scar’s appearance and size.

But a new laser therapy may help to treat these scars, whether they are new or even several years old.

Dr. Joel Fish, a plastic surgeon and Medical Director of the Burn Program at the Hospital for Sick Children (SickKids) in Toronto, led a PSI Foundation–funded clinical trial that has provided some of the strongest evidence so far supporting the use of a new laser therapy to treat hypertrophic scars in children.

Lasers have been used in medical treatment for many years, particularly for cosmetic procedures, but recent research had suggested that two specific kinds of lasers, pulsed dye laser (PDL) and carbon dioxide laser, could be particularly useful for treating burn scars – even scars that are more than 10 years old.

“It’s one of the few therapies to come along in many years that has real benefits, not just on new scars but on mature scars, so it’s quite unique,” says Dr. Fish.

But more definitive research about the effectiveness of laser therapy, especially in children, was needed. Dr. Fish and his research team designed a clinical trial to determine whether laser therapy could improve hypertrophic scars in children, and received PSI funding in 2016 to conduct the trial.

Approximately 25 children with hypertrophic scars were treated with three laser therapy sessions over the course of a year. To determine whether the scars improved over the course of treatment, between sessions Dr. Fish and his team measured the scar’s height and thickness, stiffness, vascularity and colour, using validated subjective scar assessment scales and objective tools, such as conventional ultrasound and ultrasound elastography.

After all of the laser therapy treatments, the team found that the height of the scars improved, the thickness and colour improved, and the scars were less itchy, demonstrating that the therapy was highly effective.

“It really did have measurable effects, and not only were they measurable, the scars don’t go back to the way they were,” says Dr. Fish. “Once you achieve the scar being a little bit flatter or softer or less red or less itchy, it doesn’t go back.”

With these positive results, the team now plans to do further work to understand when treatment should start and how many sessions are optimal, as well as examine how the treatment works, all of which will help to refine the therapy.

SickKids has the largest pediatric burn program in the country by a large margin, and children from across the country have been treated in Toronto instead of closer to home. In fact, it is one of the few centres in Canada to use laser therapy to treat scars in children.

But Dr. Fish’s study, along with a handful of other trials, is generating interest in the health care community about the potential for this treatment. Directors of burn programs from different countries have learned from Dr. Fish’s team how to treat children with laser therapy to implement their own programs, and more hospitals across the country are beginning to invest in the technology.

“To our knowledge, this is the most comprehensive study to date that demonstrates that laser treatment leads to significant improvements in children with burn scars,” says Dr. Fish. “We hope that our findings will encourage other providers to invest in this valuable therapy for their patients.”

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