Every Day Heroes: Dr. Diane Reid

Dr. Diane Reid Nominated for her pivatol role in initiating CBD and for years of clinical excellence

Dr. Diane Reid joined the faculty of McMaster University as a Part-Time Assistant Clinical Professor in the Department of Surgery, Division of Otolaryngology – Head & Neck Surgery in July 2001. Promoted to Associate Clinical Professor in 2013, Dr. Reid has served as director of the Otolaryngology – Head & Neck Surgery residency training program since 2009. Her commitment to academic excellence and effective leadership played an integral role in that program obtaining full accreditation from the Royal College of Physicians and Surgeons of Canada in 2012, for the first time in its history. During her tenure as program director, Dr. Reid has made a number of significant contributions to residency education, including the implementation of new policies and evaluation/assessment tools, additions to the curriculum, and the development of a Temporal Bone Lab, among many others.

C

ounted among Dr. Reid’s most recent and singular accomplishments is the key part she has played in ensuring a successful transition to Competence By Design (CBD) in the Otolaryngology – Head & Neck Surgery residency training program.

That program was one of the first two at McMaster University to implement the Royal College’s CBD initiative in July 2017.

It is with great pride and pleasure that the Department of Surgery honours Dr. Reid as an “Every Day Hero” for the ongoing high level of leadership and guidance she has provided to the Otolaryngology – Head & Neck Surgery residency training program as it navigates the challenging process of transitioning to competency- based medical education.

Dr. Reid has overseen the demanding process of change management, curriculum mapping, the creation of new assessment and evaluation tools, as well as the critical task of engaging both faculty and residents in the new initiative, and providing faculty development opportunities to assist in that process. She has been, and will continue to be, invaluable to the Department of Surgery as its other residency training programs transition to CBD over the next few years.

We thank her for her ongoing record of dedicated clinical service, academic excellence, and leadership.

Here, Dr. Reid fields a few of our questions about her career, her experience with CBD, and what it means to be named an Every Day Hero.

You have been given Every Day Hero honours for your pivotal role in initiating the Competence By Design (CBD) program at McMaster.

Have you ever paused to consider how important CBD might be for the future of surgical care, and do you ever feel proud of your involvement with it?

The goal of CBD is to ensure competency among all trainees across Canada by standardizing their educational curriculum and evaluation process. A well-defined learning path with four stages of progression to prepare for independent practice was created with outcomes that residents must achieve.

It comprises a list of Entrustable Professional Activities (EPAs) with their associated milestones. Training programs must still teach and evaluate the same, but the new mindset is to use EPAs not only to verify competency, but also to use them for learning. Surgeons have been observing residents in the OR for decades, providing teaching and feedback to learners in those situations. Now with CBD, the number of observations with feedback is more frequent with more meaningful discussion about performance. In other words, residents are told what they did well or not so well, and what they still need to work on.

Having more frequent assessments will help residents adjust their learning plan, track their progress, and better define their strengths and weaknesses.

Therefore, there is an undeniable need for feedback and coaching in CBD. Surgeons are now adopting the role of academic coach (just like top athletes, singers,

musicians, etc.) in the CBD model. Coaches can help an individual perform a task better, develop a skill they do not yet possess, or achieve a specific goal. Coaching helps a learner understand what adjustments and modifications will allow them to progress to the next level of competency.

A coach’s priority is to promote improvement. An important shift in thinking is to use assessment for learning as a big part of the change required for CBD to work. This paradigm shift will take time and our program is still working in that direction.

As part of the CBD mindset for resident education, in the near future, I envision that surgeons in practice will have someone come to their OR to assess their performance and provide feedback for improvement. Surgeons will be coaching other surgeons. Essentially, coaching is not only for maintaining your surgical skills but also for improving a surgeon’s performance.

So, yes, I am very proud of my involvement with CBD. It was an honour for Otolaryngology – Head & Neck Surgery to be the first surgical program to launch CBD and to be a part of it. Working with other program directors was a great experience on a personal and professional level. For most of the program directors, we did not know too much about CBD at first, and it took time to understand the concept and the rationale behind it. In Ottawa (as part of several Royal College Otolaryngology - Head & Neck Surgery Specialty Committee workshops on CBD), we had to make important decisions about the content of the new curriculum and the

work-based assessments within CBD. After Ottawa, I had to bring all of this information to our home program and work it out, and be ready for implementation on July 1, 2017.

In addition to your important work on CBD, you are also being acknowledged for your clinical excellence over the years. What are the challenges associated with balancing clinical and academic responsibilities, and how do you continue to do it with such apparent ease?

For me, the challenges around balancing clinical and academic responsibilities include being able to effectively manage your time and meet deadlines; having the resources available to you to help you succeed, including adequate funding, sufficient numbers of faculty, and admin-istrative support; being surrounded by an engaged team; the availability of opportunities for continuing education or faculty development in order to continuously enhance your skills and knowledge; and lastly, ensuring that you are able to maintain your health through adequate levels of sleep, opportunities for relaxation, etc.

Among the attributes that I feel are critical to success in a role like mine are determination, organization, dedication, an excellent work ethic and a passion for the job. This brings to mind the following words of wisdom from Maya Angelou that I feel apply here: “Whatever you want to do, if you want to be great at it, you have to love it and be able to make sacrifices for it.” She also said, “A leader sees greatness in other people. He nor she can be much of a leader if all

she sees is herself.” Most importantly, I needed my family’s support to do it all.

I came to McMaster because I was told that the University’s Otolaryngology – Head & Neck Surgery service wanted to establish a residency training program. That was really the deciding factor in my accepting a faculty position here. I love the academic side of my work. It is so very gratifying watching a resident progress through his or her training from start to finish, and knowing that, at the end of it all, you have been part of their achievements and successes. Watching them leave the nest, establish a career for themselves, and hearing back from them at some point is always rewarding for me.

As a surgeon and surgical educator, do you ever stop to acknowledge the heroism of your work… helping the sick and injured, and empowering others to help them as well?

Or, has it all kind of become routine over the years?

Not really, I look at it as a job. I do not give it too much thought. Patient care becomes natural over the years of work.

For me, though, equality of care, respect, listening to a patient’s problems, making sure patients understand their illness or problem, respecting their choices and values, and ensuring safety and well-being remain very important.

It is critical as a surgical educator to set a good example. I really hope that residents and medical students continue learning, and continue to be inspired and enthusiastic about their career and their involvement in patient care.

Do any moments from your career stand out to you as a time you were able to fully recognize the magnitude of being a healthcare professional? Perhaps it was a gracious family, a patient whose life you saved, a practice-changing discovery, or a trainee of yours who went on to do great things in the field?

As the surgical airway experts, we are often called upon to deal with an acute airway obstruction needing immediate attention. These are stressful moments at work, and we always hope for the best outcome in each patient.

A memorable case involved a baby in airway distress from possible aspiration of a popcorn kernel. Four siblings were on their parents’ bed watching a movie and eating popcorn.

The baby was walking around the bed, found some popcorn on the floor, ate some and proceeded to choke. Pediatric General Surgery was called and needed some help. The baby was at a community hospital emergency department located 45 minutes away. I was very worried. Time was a critical factor, as the baby needed to be transferred urgently to a MUMC OR. The OR team got all set up (anesthesia, nurses, surgeons, residents, equipment), and was ready in the OR waiting for the baby to arrive. While waiting, the team rehearsed the steps and the procedure. All went well — the baby survived with no complications. Later on, I saw the baby in the outpatient clinic for ear infections. The mom was so grateful that her baby was saved and was fine.

My first OR case at MUMC, on my first call during my first

C

ounted among Dr. Reid’s most recent and singular accomplishments is the key part she has played in ensuring a successful transition to Competence By Design (CBD) in the Otolaryngology – Head & Neck Surgery residency training program.

That program was one of the first two at McMaster University to implement the Royal College’s CBD initiative in July 2017.

It is with great pride and pleasure that the Department of Surgery honours Dr. Reid as an “Every Day Hero” for the ongoing high level of leadership and guidance she has provided to the Otolaryngology – Head & Neck Surgery residency training program as it navigates the challenging process of transitioning to competency- based medical education.

Dr. Reid has overseen the demanding process of change management, curriculum mapping, the creation of new assessment and evaluation tools, as well as the critical task of engaging both faculty and residents in the new initiative, and providing faculty development opportunities to assist in that process. She has been, and will continue to be, invaluable to the Department of Surgery as its other residency training programs transition to CBD over the next few years.

We thank her for her ongoing record of dedicated clinical service, academic excellence, and leadership.

Here, Dr. Reid fields a few of our questions about her career, her experience with CBD, and what it means to be named an Every Day Hero.

You have been given Every Day Hero honours for your pivotal role in initiating the Competence By Design (CBD) program at McMaster.

Have you ever paused to consider how important CBD might be for the future of surgical care, and do you ever feel proud of your involvement with it?

The goal of CBD is to ensure competency among all trainees across Canada by standardizing their educational curriculum and evaluation process. A well-defined learning path with four stages of progression to prepare for independent practice was created with outcomes that residents must achieve.

It comprises a list of Entrustable Professional Activities (EPAs) with their associated milestones. Training programs must still teach and evaluate the same, but the new mindset is to use EPAs not only to verify competency, but also to use them for learning. Surgeons have been observing residents in the OR for decades, providing teaching and feedback to learners in those situations. Now with CBD, the number of observations with feedback is more frequent with more meaningful discussion about performance. In other words, residents are told what they did well or not so well, and what they still need to work on.

Having more frequent assessments will help residents adjust their learning plan, track their progress, and better define their strengths and weaknesses.

Therefore, there is an undeniable need for feedback and coaching in CBD. Surgeons are now adopting the role of academic coach (just like top athletes, singers,

musicians, etc.) in the CBD model. Coaches can help an individual perform a task better, develop a skill they do not yet possess, or achieve a specific goal. Coaching helps a learner understand what adjustments and modifications will allow them to progress to the next level of competency.

A coach’s priority is to promote improvement. An important shift in thinking is to use assessment for learning as a big part of the change required for CBD to work. This paradigm shift will take time and our program is still working in that direction.

As part of the CBD mindset for resident education, in the near future, I envision that surgeons in practice will have someone come to their OR to assess their performance and provide feedback for improvement. Surgeons will be coaching other surgeons. Essentially, coaching is not only for maintaining your surgical skills but also for improving a surgeon’s performance.

So, yes, I am very proud of my involvement with CBD. It was an honour for Otolaryngology – Head & Neck Surgery to be the first surgical program to launch CBD and to be a part of it. Working with other program directors was a great experience on a personal and professional level. For most of the program directors, we did not know too much about CBD at first, and it took time to understand the concept and the rationale behind it. In Ottawa (as part of several Royal College Otolaryngology - Head & Neck Surgery Specialty Committee workshops on CBD), we had to make important decisions about the content of the new curriculum and the

work-based assessments within CBD. After Ottawa, I had to bring all of this information to our home program and work it out, and be ready for implementation on July 1, 2017.

In addition to your important work on CBD, you are also being acknowledged for your clinical excellence over the years. What are the challenges associated with balancing clinical and academic responsibilities, and how do you continue to do it with such apparent ease?

For me, the challenges around balancing clinical and academic responsibilities include being able to effectively manage your time and meet deadlines; having the resources available to you to help you succeed, including adequate funding, sufficient numbers of faculty, and admin-istrative support; being surrounded by an engaged team; the availability of opportunities for continuing education or faculty development in order to continuously enhance your skills and knowledge; and lastly, ensuring that you are able to maintain your health through adequate levels of sleep, opportunities for relaxation, etc.

Among the attributes that I feel are critical to success in a role like mine are determination, organization, dedication, an excellent work ethic and a passion for the job. This brings to mind the following words of wisdom from Maya Angelou that I feel apply here: “Whatever you want to do, if you want to be great at it, you have to love it and be able to make sacrifices for it.” She also said, “A leader sees greatness in other people. He nor she can be much of a leader if all

she sees is herself.” Most importantly, I needed my family’s support to do it all.

I came to McMaster because I was told that the University’s Otolaryngology – Head & Neck Surgery service wanted to establish a residency training program. That was really the deciding factor in my accepting a faculty position here. I love the academic side of my work. It is so very gratifying watching a resident progress through his or her training from start to finish, and knowing that, at the end of it all, you have been part of their achievements and successes. Watching them leave the nest, establish a career for themselves, and hearing back from them at some point is always rewarding for me.

As a surgeon and surgical educator, do you ever stop to acknowledge the heroism of your work… helping the sick and injured, and empowering others to help them as well?

Or, has it all kind of become routine over the years?

Not really, I look at it as a job. I do not give it too much thought. Patient care becomes natural over the years of work.

For me, though, equality of care, respect, listening to a patient’s problems, making sure patients understand their illness or problem, respecting their choices and values, and ensuring safety and well-being remain very important.

It is critical as a surgical educator to set a good example. I really hope that residents and medical students continue learning, and continue to be inspired and enthusiastic about their career and their involvement in patient care.

Do any moments from your career stand out to you as a time you were able to fully recognize the magnitude of being a healthcare professional? Perhaps it was a gracious family, a patient whose life you saved, a practice-changing discovery, or a trainee of yours who went on to do great things in the field?

As the surgical airway experts, we are often called upon to deal with an acute airway obstruction needing immediate attention. These are stressful moments at work, and we always hope for the best outcome in each patient.

A memorable case involved a baby in airway distress from possible aspiration of a popcorn kernel. Four siblings were on their parents’ bed watching a movie and eating popcorn.

The baby was walking around the bed, found some popcorn on the floor, ate some and proceeded to choke. Pediatric General Surgery was called and needed some help. The baby was at a community hospital emergency department located 45 minutes away. I was very worried. Time was a critical factor, as the baby needed to be transferred urgently to a MUMC OR. The OR team got all set up (anesthesia, nurses, surgeons, residents, equipment), and was ready in the OR waiting for the baby to arrive. While waiting, the team rehearsed the steps and the procedure. All went well — the baby survived with no complications. Later on, I saw the baby in the outpatient clinic for ear infections. The mom was so grateful that her baby was saved and was fine.

My first OR case at MUMC, on my first call during my first

week at work also comes to mind. The case, which had already been bumped two days in a row, involved a child transferred from Waterloo/ Kitchener with mastoiditis complicated by large sigmoid/transverse/superior sagittal thrombophlebitis. He was ataxic, dizzy, experiencing nausea and vomiting, was diplopic, and I was quite worried at the time. Fortunately, the day after surgery, he was up in the play room, smiling and much improved.

Every Day Heroes is a Department of Surgery initiative that strives to ensure our faculty’s daily heroics do not go unnoticed. Who were your Every Day Heroes when you were an aspiring healthcare professional and who are the heroes that you work with now? What makes them heroes, in your eyes?

When I was in training as a resident, two of my professors were my Every Day Heroes.

My program director, Dr. Ngo,

“”

was one of only a few women in the position of PD at that time. She is the one who gave me the courage and motivation to become a PD myself one day, as I was attracted to the responsibilities and work involved in education and leadership. She was very helpful throughout my residency.

Dr. Rouleau, an otologist, was a talented, meticulous surgeon. In the OR, he would give residents lots of opportunity to operate and, as we progressed, he would let us troubleshoot in a safe way. It boosted my confidence, increased my skills and my interest in ear surgery, and helped ensure I was ready for practice.

There are several heroes that I work with at McMaster, and one of those is Dr. Susan Reid. I particularly remember hearing an inspiring talk she once gave about her journey as a woman in surgery and how she got to the position she now holds as Chair of the Department of Surgery. A good start for a woman is to get involved and participate,

and to say yes when someone is looking for help. Getting involved helps you climb that ladder to success. Dr. Mark Walton recommended that I speak with Dr. Parveen Wasi and Dr. Karen Finley when I first became program director. Dr. Wasi was the first person I met to discuss my new role, when I needed advice after picking up a residency training program that was in jeopardy. She gave me great advice. Dr. Finley was also very kind, and shared advice and documentation with me related to things such as Royal College accreditation and maintaining a resident’s file.

So, what makes someone a hero in my eyes? Being caring, selfless, and humble in all you do.

What makes someone a hero in my eyes? Being caring, selfless, and humble in all you do.

–Dr. Diane Reid