Lessons from the "non-critical" patient during a pandemic: developmental-behavioural pediatric populations & COVID-19

Seemingly overnight, in March 2020, the world was turned upside down by the global SARS-CoV 2 (novel coronavirus) pandemic. As COVID-19 affected all aspects of clinical care, Canadian ambulatory clinics for any service deemed "non-urgent" or "non-critical," were suspended for several months. When outpatient care slowly resumed during the summer and fall of 2020, the backlog of patients in these areas and subsequent requests for follow-up significantly outpaced the number of available appointments. In fact, it became apparent that certain patients' needs had grown in unprecedented ways during the pandemic, even though their issues had previously been given low priority during the acute crisis period. Among these groups were youth with underlying mental health conditions, those with chronic but non-life-threatening illnesses, and the subgroups seen in Developmental-Behavioural Pediatrics. In Montréal, they were among the least likely to have their needs met as the waves of COVID-19 moved through the community, and many still struggle to find relevancy in the discussions about the hidden impacts of the coronavirus pandemic, even one year later. What can the experiences of these marginalised youth teach us about what our system labels less relevant care in the context of an acute health care crisis? A short narrative presentation will demonstrate insights gleaned from 2020 & early 2021 to underscore the often unrecognised challenges faced by these populations and their families.

How to think about pain with the whole person in mind

Too often, pain is reduced to a simple symptom of illness or injury – a puzzle piece to fit into the differential diagnostic jigsaw. Pain reports that fit the emerging pathoanatomical picture are validated and treated accordingly. But many reports don’t fit this picture, and the widespread stigma associated with persistent pain is most commonly directed toward these individuals, whose symptoms aren’t well explained by known pain mechanisms. A root problem is not seeing the person in pain or the suffering they experience. This presentation aims to help participants develop a more comprehensive perspective on pain that better integrates its complexities within clinical practice. Participants will be introduced to the Multi-modal Assessment model of Pain (MAP; Wideman et al, Clinical Journal of Pain 2019; 35(3): 212). MAP offers a novel framework to understand the fundamentally subjective natures of pain and suffering and how they can be best addressed within clinical practice. MAP aims to help clinicians view pain, first and foremost, as an experience (like sadness), which may or may not correspond to specific pathology or diagnostic criteria (like clinical depression). MAP aims to facilitate a more compassionate approach to pain management by providing a rationale for why all reported pain should be validated, even when poorly understood. Viewing pain in this manner helps highlight the central importance of listening to patients’ narrative reports, trying to understand the meaning and context for their experiences of pain and using this understanding to help alleviate suffering.

need for alternative solutions when caring for patients with language barriers

Barriers to quality communication increase the risk for misunderstanding, negatively impact the thoroughness of health investigations, and can lead to delayed diagnoses and increased readmissions. In addition, language barriers disproportionately affect the most vulnerable populations; thus, a lack of appropriate interpretation services promotes health disparities and increases the vulnerability of the underserved minority populations. According to the Act Respecting Health Services and Social Services of Quebec, health organizations need to take into account the distinctive linguistic and sociocultural characteristics of each region and, “foster […] access to health services and social services through adapted means of communication for persons with functional limitations”. A language barrier is a form of functional limitation that patients face when accessing healthcare services. Despite a clear policy, the current use of professional interpretation services is limited in our healthcare facilities, thus increasing obstacles in accessing healthcare services for patients with language barriers. It is thought that by identifying how language barriers present in our healthcare system and by highlighting the tools available to mitigate their consequences, healthcare workers, including medical students, may be better placed to serve the non-French and non-English speaking community. A group of medical students from the Universities of Montreal and McGill who are part of MedComm researched the problematic, most specifically in Montreal, in the hopes of emphasizing the need for alternative solutions to the current state of affairs in regard to offering optimal care to patients with language barriers.

Where there's smoke: digital storytelling for healing

Columbia University School of the Arts’ Digital Storytelling Lab, in collaboration with Columbia’s Department of Narrative Medicine, developed Where There’s Smoke, a story and grief ritual that mixes interactive documentary, immersive theatre and online collaboration to invite healthcare providers and others into resonant conversations about life, loss and memory, and to imagine how stories can be used to create empathetic healing spaces. When Robert Weiler was diagnosed with terminal colon cancer, the complexity of healthcare and ensuing grief for the family, led his son Lance, a storytelling pioneer, to realize that a straightforward story wasn’t enough to explain and explore the experience, so he created Where There’s Smoke. Where There’s Smoke premiered in 2019 at the Tribeca Film Festival where it was hailed as an “absolute can’t miss” (Backstage). However, when COVID-19 submerged the world in loss, uncertainty, and isolation, Lance reimagined the piece as an online experience. He also combined the piece with protocols of Narrative Medicine as provided by faculty, Deborah Starr. The piece traces a heartbreaking journey through end-of-life care and grief, embracing grief as nonlinear and immersive, grief as an escape room with no escape. Participants sift through artwork, videos, and conversations and are provided with immersive moments for individuals, pairs and groups to have opportunities for self-discovery, unexpected intimacy, and ensuing healing. This is a personal yet universally relevant narrative, which gradually reveals itself to be something more…the possibility of immersive storytelling to create space for empathetic healing, grieving, and connecting.

Brief online mindfulness training for medical students: a randomized control study

BACKGROUNDMedical students experience high levels of stress during their training. Literature suggests that mindfulness can reduce stress and increase self-compassion levels in medical students. However, most mindfulness training programs are delivered face-to-face and require significant time commitments, which can be challenging for rurally-based students with heavy academic workloads and limited support networks. PURPOSETo evaluate the feasibility and efficacy of a brief online Mindfulness training program for medical students based in rural areas, with regards to reducing stress, increasing self-compassion, mindfulness and study engagement. METHODSThis is a non-registered randomised control trial. Participants included both urban and rural medical students from UWA, University of Notre Dame and the RCSWA from 2018-2020. Participants were randomised to the intervention group, an 8-week online mindfulness training program, or the control group. Using quantitative-qualitative mixed-methods approach, we measured the frequency, duration and quality of the participants mindfulness meditation practice, and assessed changes in their perceived stress, self-compassion, mindfulness and study engagement levels. Further, the intervention group recorded a weekly reflective journal documenting their experience of the program. RESULTS114 participants were recruited to the study. 61 were randomised to the intervention, and 53 to the control. Quantitative analysis of the frequency, duration and quality of mindfulness meditation practice and changes in stress, self-compassion, mindfulness and study engagement is currently being conducted. Preliminary qualitative results reveal that participants experienced increased self-awareness, more mindfulness of their day-to-day activities, improved emotional regulation and increased productivity, while also facing difficulties with making time for their mindfulness practice. CONCLUSIONWe anticipate that this study will demonstrate that an online mindfulness training program tailored to reach rurally located medical students is feasible and effective in modifying their stress levels and psychological wellbeing.

Training interprofessional faculty in humanism and professionalism: a qualitative analysis of what is most important

Introduction: The capacity of healthcare professionals to work collaboratively influences faculty and trainees’ professional identity formation, well-being, and care quality. Part of a multi-institutional project*, we created the Faculty Fellowship for Leaders in Humanistic Interprofessional Education at Boston Children’s Hospital/ Harvard Medical School. We aimed to foster trusting relationships, reflective abilities, collaboration skills, and work together to promote humanistic values within learning environments. Objective: To examine the impact of the faculty fellowship from participants’ reports of “the most important thing learned”. Methods: We studied participants’ reflections after each of 16 1½ hour fellowship sessions. Curriculum content included: highly functioning teams, advanced team formation, diversity/inclusion, values, wellbeing/renewal/burnout, appreciative inquiry, narrative reflection, and others. Responses to “What was the most important thing you learned?” were analyzed qualitatively using a positivistic deductive approach. Results: Participants completed 136 reflections over 16 sessions–77% response rate (136/176). Cohort was 91% female; mean age 52.6 (range 32-65); mean years since completion of highest degree 21.4; 64% held doctorates, 36% master’s degrees. 46% were physicians, 27% nurses, 18% social workers, 9% psychologists. 27% participated previously in a learning experience focusing on interprofessional education, collaboration or practice. Most important learning included: Relational capacities/ Use of self in relationships 96/131 (73%); Attention to values 46/131 (35%); Reflection/ Self-awareness 44/131 (34%); Fostering humanistic learning environments 21/131 (16%). Discussion: Results revealed the importance of enhancing relational capacities and use of self in relationships including handling emotions; attention to values; reflection/self-awareness and recognition of assumptions; and fostering humanistic learning environments. These topics should receive more emphasis in interprofessional faculty development programs and may help identify teaching priorities. *Supported in part by a multi-institutional grant from the Josiah Macy, Jr. Foundation (Dr. Branch as PI; Dr. Rider as site PI).

Peer support for adolescent girls living with scoliosis: finding a digital community

Introduction : Scoliosis in a condition where a curve develops in the spine. Adolescent girls affected by scoliosis are significantly more likely to require treatment such as bracing or surgery than their male counterparts. Curvy Girls is a peer support group for adolescent girls with scoliosis that allows them to engage with each other in a safe environment. Objectives : This study endeavours to explore the experiences of adolescent girls living with scoliosis who are Curvy Girls members and understand how this peer support group has affected their experience. Approach : Sixteen participants were recruited through a senior board member of Curvy Girls. Data was gathered through semi-structured interviews with open-ended questions, transcribed verbatim, and analyzed using an applied philosophical hermeneutic approach, a practice of uncovering insights from transformational conversation. Findings : We found that the participants’ sense of belonging to Curvy Girls did not depend on their level of involvement with the group. Whether they were leaders in their in-person local group, or simply following the organization on social media, seeing themselves represented allowed the participants to feel like they belonged to the group. Future Directions : These findings may help clinicians, healthcare professionals, and peer support organisations deepen their understanding of the perspectives of this specific population. This transformed understanding could lead to the instauration of care and services that are better adapted to this population’s needs, resulting in lessening the burden of the condition on the individual and their support system.

Queering whole person care in a pandemic

How can health care providers (HCPs) working with 2SLGBTQ+ patients enact a whole person care approach during the SARS-CoV-2 pandemic and its aftermath, and in such desperate times, is it even reasonable to expect them to? In this presentation, a nurse/nursing educator and a health care researcher/frequent patient discuss their observations and experiences of whole person care during the SARS-CoV-2 pandemic. The conversation highlights that in the immediate chaos early on, and in the face of exhaustion, trauma, and burnout as the pandemic progressed, attending to the whole personhood of patients was/is paramount for HCPs and for the people they treat. The presenters reflect on the amplified significance of a whole person approach for 2SLGBTQ+ people who may have had negative health care experiences in the past, and may fear that they will not receive equitable care in the chaotic context of a pandemic. A whole person care approach is perhaps most necessary when it is also most difficult. In a period of such profound distress, a deeper sense of connectedness to patients may help HCPs manage feelings of helplessness they are likely to encounter, and surely helps the people they treat. The goal of this presentation is to begin a discussion about the ways that whole person approaches benefit 2SLGBTQ+ patients as well as their HCPs, with the hope that it will spark ideas for attendees to develop in their own practices.

Kintsugi mind: clinicians can emerge from the pandemic whole

The Japanese practice an ancient art called Kintsugi. A craftsperson repairs broken pottery with gold or silver rendering it more beautiful than in its original state. Can clinicians engage in “Kintsugi Mind” and thereby emerge from this pandemic integrated and whole? Yuan et al. (2021) conducted a meta-analysis including 88 studies of post-traumatic stress disorder (PTSD) following earlier pandemics and COVID-19. Health care professionals had the highest prevalence (26.9%) compared to infected cases and the public. Another type of trauma is called secondary or vicarious; it occurs when a person bears witness to suffering and death but remains powerless to change it; countless clinicians have experienced this over the past year. It manifests as emotional depletion, anxiety, insomnia, and impaired interpersonal relationships. How can clinicians heal from their exposure to the pandemic? Post-traumatic growth (PTG) is defined as positive psychological changes following trauma. PTG manifests in five areas: appreciation of life, relating to others, personal strength, recognizing new possibilities, and spiritual change. A transformation in the person’s world view and their place in it ensues. For health care professionals who are experiencing emotional distress, insomnia, or manifest PTSD symptoms they may heal by engaging in the six “Rs.” These are: relating, resourcing, repatterning, reprocessing, reflecting, and rituals. Both PTG and these six practices may contribute to Kintsugi Mind. While this appears to place the onus on individuals, it is crucial that leaders in the health care system implement programs enabling HCPs to be restored, rather than broken by this crisis.

gamified sleep intervention for veterans: an overview

A good night’s sleep is well known to be imperative for maintaining one’s overall wellness. Yet, about half of Canadian adults struggle with falling asleep or maintaining sleep. The impacts of insufficient sleep are wide-ranging, from physiological correlates such as diabetes to mental correlates such as depression. Effective treatments for sleep-related issues exist: for example, online interventions for insomnia have been found to be effective. As a medicine and a health psychology student at, respectively, Sherbrooke University and McGill University, we worked on the MissionVAV health promotion program during the COVID-19 pandemic, providing free gamified interventions for Canadian Veterans and their families. Over the course of several online interventions related to physical health, we observed that a large proportion of our participants were dissatisfied with their sleep. Consequently, we have developed an 8-week online sleep intervention to address this primordial element of primary prevention. The intervention aims to better our participants’ sleep through providing weekly readings on the following topics: age-related changes in sleep, proper sleep hygiene, varied relaxation techniques as well as the relationship between sleep and chronic pain, menopause, shift work, rumination, exercise and light. To promote healthy sleep hygiene habits, daily self-assessment questions are provided and are incentivized through points and storytelling. Furthermore, health coaches trained in sleep medicine follow participants throughout their journey to provide support and reinforcement. Ultimately, the intervention aims to shed light on the importance of sleep within preventative medicine, tackling it systematically in an engaging, gamified fashion.