UCALGARY
SUMMER 2012
MEDICINE A UNIVERSITY OF CALGARY FACULTY OF MEDICINE PUBLICATION
Dean’s Edition
A familiar face in a new role Dr. Jon Meddings will assume his new role as dean on July 1
Master teachers: the face of the medical school Training great doctors requires the guidance of great teachers
LINDSAY, virtual human A new software program is redefining interactive learning
UCALGARY
MEDICINE Vol 4 Issue 2 | SUMMER 2012
UCalgary Medicine is published three times a year by the University of Calgary Faculty of Medicine, providing news and information for and about our faculty, staff, alumni, students, friends and community. For more information contact:
MANAGING EDITOR Kathryn Sloniowski T 403.220.2232 E kjslonio@ucalgary.ca
Copy Editor Amy Dowd
Dean
Dr. Thomas E. Feasby
Vice Dean
Dr. Jon Meddings
Senior Associate Deans
Dr. Richard Hawkes, Research Dr. Benedikt Hallgrímsson, Education Dr. Ronald Bridges, Clinical Affairs
Associate Deans
Dr. Anthony Schryvers, Undergraduate Science Education Dr. Bruce Wright, Undergraduate Medical Education Dr. Jennifer Hatfield, Global Health and International Partnerships Dr. Doug L. Myhre, Distributed Learning and Rural Initiatives Dr. Joanne M. Todesco, Postgraduate Medical Education Dr. Frans A. van der Hoorn, Graduate Science Education Dr. Jocelyn Lockyer, Continuing Medical Education Dr. John Reynolds, Basic Research Dr. Michael Hill, Clinical Research Dr. Janet de Groot, Equity and Teacher-Learner Relations Dr. Kamala Patel, Faculty Development
Design and Production Imagine
Photography
On the cover: Kidneys as seen in LINDSAY, Virtual Human
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Summer 2012
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CONTENTS
SUMMER 2012
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14
A time of transition
Impressions from rural Laos
MESSAGE FROM THE DEAN Stepping down as another steps up.
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EDUCATION
Master teachers: the face of the medical school
Training great doctors requires the guidance of great teachers.
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PHILANTHROPY
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How some friendly competition can go a long way.
Discussing elective cesarean
SERVICE TO SOCIETY
A lecture of a lifetime
Not short on experience or opinions, Dr. Tom Noseworthy was chosen to give this year’s Lecture of a Lifetime.
SERVICE TO SOCIETY
A familiar face in a new role
Dr. Jon Meddings will assume his new role as dean on July 1.
COVER STORY
10 ALUMNI
All eyes on alumni Back to the future with Dr. Douglas Hamilton.
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EDUCATION
LINDSAY, virtual human
Meet LINDSAY, a new software program that is redefining interactive learning.
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Dr. Robert Lee recently travelled to Laos as part of the University of Calgary-Laos partnership project.
Classes go headto-head for a good cause
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SERVICE TO SOCIETY
WE WANT TO KNOW WHAT YOU THINK OF THE MAGAZINE! Fill out the survey for your chance to win a swag bag!
SERVICE TO SOCIETY
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research
Breaking new ground The Experimental Imaging Centre has finally found a permanent home.
18 NEWS
In the news
• Fast food salt levels vary between countries • Mood matters during pregnancy • Doctors find new way to predict recurrent stroke
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SERVICE TO SOCIETY
Final words with Dean Feasby
medicine.ucalgary.ca/survey
http://medicine.ucalgary.ca/magazine/
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Message From The Dean
A time of transition Stepping down as another steps up. Summer is a unique time of transition at the Faculty of Medicine. We bid farewell to our graduating medical and health science students and welcome new cohorts, collectively celebrating success as we eagerly anticipate fresh challenges. While summer always brings change at the Faculty of Medicine, this year it also signals the end of my term as dean. I’ve learned a great deal during my term, and have thoroughly enjoyed being a part of the tremendous growth and development we as a Faculty have experienced over the past five years. As of July 1, Dr. Jon Meddings will be taking on the role of dean of the Faculty of Medicine at the University of Calgary. I have worked very closely with Jon over the years, and in this special Dean’s Edition of UCalgary Medicine, I felt it was important for people to have the opportunity to get to know him a bit better. On pages 8 and 9, Jon shares some personal and professional insight about his life and his career thus far, and some of his plans for the Faculty of Medicine moving forward. He will be a fine leader for the Faculty. In addition to getting to know Jon, I also felt it was important to highlight another one of our Faculty members, Dr. Tom Noseworthy. Tom was chosen to deliver the fifth annual Lecture of a Lifetime at the University of Calgary. The university senate launched the series to honour well-loved professors who teach and mentor students. For those of you unfamiliar with the premise of this lecture, the general idea is to craft a talk containing the wisdom you would impart to the world if you knew it was your last chance. Tom did an exceptional job, and I believe we are all the wiser for having had the privilege to be in the audience. We’ve included an excerpt for you to enjoy on page 7. In this edition we have also included a profile of our Master Teacher Program on page 6, which is a unique initiative to bring more clinical educators to the Faculty of Medicine. We also share with you, on pages 10 and 11, a profile of LINDSAY Virtual Human–anatomy software developed here at the Faculty to provide our students with access to increasingly more diverse learning opportunities throughout their studies. These are just a few of the great stories you will find on the pages that follow. When I reflect on these stories and the many others that have developed during my tenure as dean, I am proud to have been a part of it all and I am very grateful for the opportunity to share our stories with you over the past five years. As I step down, and Jon steps up, I look forward to seeing, hearing and reading about what great things this Faculty will accomplish next.
Tom Feasby, MD Dean, Faculty of Medicine University of Calgary 4
Summer 2012
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Philanthropy
Classes go
head-to-head for a good cause
How some friendly competition can go a long way. By Alison Myers If there is a common spirit amongst medical graduates, it’s likely the desire to help people be healthy and live well. Usually it manifests itself in the form of physician-to-patient treatment, but there’s another commonality amongst this crowd–one that’s giving rise to the perfect altruistic project for medical alumni. “Most people who go into medicine are usually competitive,” admits Dr. Lynne MacKean, a 1989 alumna who specializes in physical medicine and rehabilitation, and sports medicine on Vancouver Island. “So if you set up some sort of competition for us, it’s quite appealing.” In honour of their 20-year reunion, MacKean raised the idea of having her class establish a Flamingos Class Bursary and wondered how to spur contributions. She worked with the fund development office to find an enticing project and the Class Challenge was born. This friendly contest between the Flamingos (Class of ’89) and the Dugongs (Class of ’99) aims to see who can bring in the most support for a student bursary. The goal is for each class to raise enough money to establish a class bursary that will provide financial aid to an undergraduate medical student. “I thought it was a great idea,” says Dr. Lara Cooke, a grad from 1999. Cooke is now a neurologist and associate professor in the University of Calgary’s Department of Clinical Neurosciences. “Our class was incredibly tight-knit so I thought it was very likely that the Dugongs would rise to the occasion.” Both Cooke and MacKean say it wasn’t hard to convince their classmates of the need to give back.
UCALGARY MEDICINE |
“Collectively, we agreed that access for future students, regardless of their financial encumbrances, seemed like a really worthy cause,” Cooke explains. “Hopefully this initiative will raise enough funds to support a bursary in perpetuity, but I know we still have a little ways to go.”
students get to name the first-year class. They can choose whatever animal they want and often go with something more comical than empowering.
Dr. Janice Heard, executive director of alumni affairs for the Faculty of Medicine, hopes other classes will be drawn into a similar competition. She says the idea might be even more enticing for students who were one year apart.
The hope now is to channel that healthy spirit in a way that gives future students the same opportunity to learn in such a positive environment.
“You get to know the class above and below you,” she says. “That kind of camaraderie can help spur the competitive spirit.” Heard points out that the second-year
“It can be pretty competitive from that point on,” says the lifelong Emu of ’84.
“I benefited so much from my time at the University of Calgary’s medical school,” MacKean says. “It was a positive time in my life that helped me develop my career to what it is today. It’s important for me to give back, especially when I know it will help someone else have a similarly rewarding experience.” ✦
Giving the past a future Families who have experienced the tragedy of loss are turning to memorial awards and bursaries as a way of paying tribute to their loved ones. Here are just a few examples of memorial gifts that are providing support to future generations of doctors: The Robert Wickson Memorial Award was established to offer financial assistance to a continuing undergraduate student entering third year in the MD program. The award is meant for a student interested in either rural medicine or pharmacology, in honour of Dr. Wickson’s dedication to his work as a doctor in the town of Strathmore, Alberta. The Dr. Martin T. Spoor Memorial Bursary helps a student entering their first year of undergraduate training in the MD program. The award is granted to a new student every three years and is renewable for two additional years if the student successfully completes the previous year’s studies. This bursary was established in memory of Dr. Spoor, who died in a plane crash while on an organ transplant mission. The Nicolle Sabine Zaslavsky Memorial Fund offers support to a graduate student who hopes to pursue a medical specialty in pediatric oncology. The award is in honour of Nicolle, who lost a 27-month battle with brain cancer at the age of eight. From an early age, Nicolle knew she wanted to be a doctor. Her parents established the fund in the hopes that her benevolence would inspire and help others to achieve the same dream.
http://medicine.ucalgary.ca/magazine/
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Education
Master teachers: the face of the medical school By Kathryn Sloniowski
Training great doctors requires the guidance of great teachers. Fulfilling this mandate is exactly what a unique initiative at the Faculty of Medicine has set out to do. The Master Teacher Program was created in 2007 in response to the rapid growth of the medical school and the subsequent need for skilled clinical educators. With only 10 instructors in its infancy, the program has expanded to include 34 active instructors and has the potential to expand further as the need arises. “We were going through, and are still going through, a large medical school class expansion,” says Dr. Bruce Wright, associate dean of undergraduate medical education. “We were concerned with who would teach small group and clinical skills education when we are limited by group size.” Traditionally, medical students at the Faculty of Medicine have been taught by either full-time University of Calgary faculty, or clinical faculty−practicing clinicians who are employed part-time by the university, primarily to teach. Typically, these instructors are specialists and only teach in their area of expertise; cardiologists for instance, usually teach cardiology components. Recognizing that the teaching structure would potentially need to change to meet the increasing demand for instructors,
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Dr. Heather Baxter instructs a course as part of the Master Teacher Program.
the Master Teacher Program was created with the idea of embracing family doctors and other generalists as educators. While such doctors were already included in the teaching curriculum, the intent was to harness and utilize their knowledge to a much larger extent. “The principle is, for instance, that cardiology doesn’t necessarily need to be taught by cardiologists,” says Wright. “A lot of the time we just don’t have enough specialists for the number of small groups. I consider the program to be a partnership−there’s a necessary place for both.” Currently, while the Master Teacher Program extends recruitment opportunities to all specialties, approximately half of the participants are either family doctors or other generalists. As the faculty has a mandate to increase the number of graduates pursuing careers in family medicine, the program has the added advantage of maximizing the exposure of medical students to family medicine as a potential career option. According to Dr. Heather Baxter, director of the Master Teacher Program, since the program has been implemented, the school has seen an increase in the number of medical graduates choosing to pursue a career in family medicine. But, as the mandate involves a multitude of initiatives, it’s not possible to determine if the program has definitively influenced that increase. “I have, however, received many positive comments and feedback from students indicating that the
mentorship of family doctors is part of why they chose to go into family medicine,” says Baxter. Baxter is confident that medical education as a whole has benefitted greatly from the implementation of the program. For instance, master teachers are given much broader teaching scopes than many of the faculty’s clinical educators−they teach across all curriculum of the three-year undergraduate medical program. This gives them the opportunity to evaluate the curriculum over time. “A specialist will typically only teach a course component for a short duration of time−sometimes as little as five to seven weeks,” she says. “We’ve been able to do more curriculum evaluation and revision because we can now see the course across time. A master teacher also sits on every course committee to ensure a generalist view is represented.” Student success in response to the Master Teacher Program has also been regarded as a top priority. To be proactive in ensuring this success, each master teacher, in his/her first year, is required to partake in a faculty development course focusing on practical teaching skills. Regularly thereafter, each teacher is evaluated by students to ensure quality teaching standards. “You cannot stay in the Master Teacher Program unless you consistently get good teacher ratings,” says Wright. “By definition, students are happy with their teachers based on their evaluations. Master teachers have very much become the face of the medical school.” ✦
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Service to society
A lecture of a lifetime
W
ith a career spanning 40 years–so far–Dr. Tom Noseworthy, a professor of community health sciences, has worn many hats: highly respected and dynamic teacher, graduate student supervisor, mentor, researcher, administrator, and foremost, physician. Not short on experience or opinions, as the man himself freely admits, he certainly had some compelling material to draw upon as the 2012 University of Calgary Lecture of a Lifetime designate. “The Lecture of a Lifetime is at once a daunting proposition and an incredible honour,” he said as he began his lecture on April 18. “I invite each of you to be in my shoes; you would understand that there is on the one hand a wealth and a world of things that one might choose to speak on, yet paradoxically it’s difficult to know what to say.” What follows are just a few excerpts from Noseworthy’s 2012 Lecture of a Lifetime. To view the lecture online in its entirety, please visit: http://medicine.ucalgary.ca/ magazine
On lifetimes: “Here are my thoughts on lifetimes. Simply put, each lifetime has three basic parts: a birth, a death and the life in between. So we start with the birth. Birth is about the gift of having parents and being parents. Our most critical time for human development in the formative first few months of life is a time over which we as individuals surprising exercise absolutely no control; none whatsoever. Yet remarkably this period and what happens in it shapes our long-term future health and well-being.”
how the two act in combination, life’s path is forever altered and prescribed for us.” ••• “Whether as a faculty member, a physician or administrator, there is one feature of a lifetime that doesn’t get much discussion, whether or not it should. That is the failures that one inevitably encounters. Missing the mark is common; sometimes it’s of no consequence, sometimes it is, or at least feels as if it is. I do not have my own 62-year-old balance sheet, but I bet I’ve had more failures than successes, at least for those things in which I have competed or tried to be first. But I’ve finally figured out that while the early bird may get the worm, it’s the second mouse that gets the cheese.”
On health care: “What’s included in our health system? Canada started on a high note in 1971 but regrettably has failed miserably in modernizing the answer to this question. Can you answer the question? What can I reasonably expect from my health-care system? Can you answer? Should you be able to? You can’t answer, regrettably.
Should you be able to? Of course. It’s the country’s largest employer, it’s one of the largest public expenses that we bear; it can get you elected, it can get you thrown out; it has an impact on every one of our lives at one time or another.”
On being a professor and department head: “The single largest deliverable as a department head is to advise on and guide lives, and as a department head, this includes students, but particularly applies to those who supervise and teach them, faculty, and you hope in turn they pass it on.” ••• “Though now I am no longer a department head, I still enjoy the exchanges and the counseling even more than I ever did before, actually. Interactions with others don’t consume my energy, they actually fuel it and there is little that is as fulfilling as having a positive impact on a young or formative mind.” ✦ Lecture of a Lifetime was originally inspired by Dr. Randy Pausch’s widely publicized “Last Lecture” at Carnegie Mellon University in 2007. The university senate launched Lecture of a Lifetime at the University of Calgary in 2008.
••• “The genetic endowment given to you by your parents meets the environmental conditions that they provide for us. Period. If we get it wrong, either one, or
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http://medicine.ucalgary.ca/magazine/
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Service to society
Dr. Jon Meddings will assume his new role as dean on July 1.
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Summer Winter 2012
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Service to society
A familiar face in a new role
Growing up in Fort Saskatchewan, Alberta, Dr. Jon Meddings, the Faculty of Medicine’s new dean, attended medical school and residency at the University of Alberta. He went on to complete his additional training in New Zealand and Texas, and for 20 of the last 25 years, the gastroenterologist has called Calgary home. “I was recruited here by some very strong researchers who were trying (and succeeded) to develop a very strong gastrointestinal research group,” he says. “Calgary is a wonderful city, and the medical school has always done nontraditional things very well.” Having spent many years in Calgary, Dr. Meddings sees the value of the Calgary community, and during his tenure as dean he plans to focus on community engagement. “Having a medical school is an advantage to Calgarians. The academic environment attracts much better clinicians to the city,” he says. “Calgary does some notable things−we do some things extremely well. If you’re going to have a stroke or a heart attack, Calgary is the place to have it. “We have attracted really strong clinicians and have some of the best clinical outcomes in Canada.” With all the new responsibilities that come with being dean of medicine, Dr. Meddings will need to cut down on his time spent in clinical care and on research. “I hope to still dedicate a half day per week in the clinic,” he says. “I’ve already cut my research back the last
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few years. I have a small lab I share, and I work on collaborative studies going on around the world right now, but I’m not running my own self-designed experiments like I used to.”
“Calgary is a wonderful city, and the medical school has always done non-traditional things very well.” Despite a busy schedule, Dr. Meddings is committed to being available to all staff, students and researchers in the faculty. “I want to be visible, to know what’s going on and to have involvement,” he says. “I want to know about the issues researchers and students are facing.” Career achievements Dr. Meddings started his academic career at the University of Calgary in 1987 as an assistant professor. In 2000 he was appointed head of the Division of Gastroenterology at the University of Calgary, and chief, Division of Gastroenterology at the Calgary Health Region. In 2004, he went back to the University of Alberta to serve as chair of the Department of Medicine, but returned to the University of Calgary in 2009 to serve as the vice-dean of the Faculty of Medicine, and later as interim vicepresident (research) from 2010-2011. Much of his career has also focused on research and leadership. In addition to having published more than 100 papers in his field, inflammatory bowel disease
http://medicine.ucalgary.ca/magazine/
By Marta Cyperling
and celiac disease, he has served on the editorial boards of journals and has been a grant reviewer with the Medical Research Council of Canada, the National Institutes of Health, the Alberta Heritage Foundation for Medical Research, and the National Academy of Sciences, amongst others. In 2010, Dr. Meddings was honoured for his work with an induction into the Canadian Academy of Health Sciences. What you might not have known It might surprise some people to know that not only did the new dean of medicine once consider a career in astronomy, but besides medicine, he has another passion: photography. A large framed photograph capturing the wildebeest migration in Tanzania spans the wall in his office alongside two other Alberta landscape photos. His appreciation for the art form and its technical aspects is evident, as he eagerly answers photography questions when asked. “I love photography. I love figuring out the optics side of the hobby, what ‘hyper focal focusing’ is; how to blend exposures and so on. All of that appeals to me,” he says. “Almost everything I’ve done or love doing has had a visual aspect to it. Gastroenterology is a visual specialty−we see and make diagnoses through scopes. I love taking pictures, I love composition− even astronomy is visual. Things I can put together in a visual way have always appealed to me.” ✦
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Education
LINDSAY, virtual human By Kathryn Sloniowski
Meet LINDSAY, a new software program that is redefining interactive learning.
“When you view the heart using LINDSAY Virtual Human software, it’s not just a heart−it’s a 3D pumping heart,” says Christian Jacob, PhD, director of the LINDSAY project. “When you learn about anatomy, there’s always the desire to know more.” LINDSAY is a state-of-the-art anatomy and physiology teaching tool, allowing for an interactive and detailed exploration of the human body. Designed for use on touch interface technologies such as the iPad, iPhone and touch tables, users can rotate, flip, zoom in and essentially “fly” through the human body in real time, all the while observing how specific organs and mechanisms function. The idea to create LINDSAY was born of the desire to construct the medical equivalent of a flight simulator, the difference being, rather than a pilot navigating an aircraft, medical professionals and students navigate the human body. The software is anticipated to be available for download as an app this summer−first, exclusively to medical students and staff at the Faculty of Medicine, and ultimately to a more mainstream audience through Apple’s App Store. In addition to the visual interactive capabilities for the individual user, there are other components of LINDSAY which position the software to be utilized as an interactive teaching tool. LINDSAY Presenter, for instance, is similar to PowerPoint, the difference being that it’s attached to an anatomy database, which makes it possible to create 3D slides. Since the fall 2011 release of the LINDSAY Presenter prototype, some anatomy modules are currently utilizing the software; however, with its official Faculty of Medicine launch slated for
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July, Jacob says he anticipates more instructors will adopt LINDSAY into their classrooms. Furthermore, he hopes staff and students recognize the added advantage of the software development happening within the faculty. “We are really able to tailor and customize the software to meet the needs of undergraduate medical education,” he says, adding that because the heart of the software is within the Faculty of Medicine itself, valued feedback is within arm’s reach. “We have all the necessary people here−we have medical and teaching experts and students. Volunteers are lining up to test the software to help us understand what works best for students.” A touch table is already available for trial use in the Health Sciences Library at the University of Calgary. Jacob, who is a professor in the departments of biochemistry and molecular biology, and computer science, says there are several ideas circulating on how LINDSAY could be utilized to enhance medical education in the future. For instance, it could potentially be found alongside simulators in the simulation labs, or have a place in anatomy labs. As well, in recognizing that we’re in an era of social networking, Jacob hopes to augment the software with the introduction of a distribution network−similar to a social network− around teaching modules. The hope is that students will eventually be able to collaborate and share ideas through the program, much as they do with modern social network technologies. “Eventually, we’d like to see content being shared so that if someone creates a new simulation, then it would be updated for everybody who has access to it.” In addition, Jacob recognizes that current
Summer 2012
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EDUCATION
LINDSAY Virtual Human’s representation of blood coagulation.
teaching tools such as textbooks have their downfalls, and he hopes that the LINDSAY software, because of its ability to be interactive, timely and more cost effective, will eventually replace them. “Ideally, we’d like everyone who enters medical school to be required to have an iPad so they can use this software,” he says, adding that while there are a lot of interesting ideas being dreamed up, only time will tell if they actually work. “Right now it’s a lot of, ‘Let’s build a prototype and see how it works.’ That comes back again to the advantage of having the medical school here−we can get instant feedback.” ✦
LINDSAY Virtual Human was named after medical student Lindsay Kimmett, who tragically passed away in a car accident in 2008. Staff and students wanted to honour her legacy in some way, and with the concept of the then-unnamed software in its infancy, it seemed like the perfect opportunity. A proposal was made to Lindsay’s parents, and with their full support and several successful fundraisers held in her name, LINDSAY Virtual Human has evolved into what it is today.
More information on LINDSAY can be found at: http://lindsayvirtualhuman.org
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http://medicine.ucalgary.ca/magazine/
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ALUMNI
All eyes on alumni Back to the future with Dr. Douglas Hamilton Having worked for NASA for 14 years, Dr. Douglas Hamilton is back at the University of Calgary to pursue research and teaching. A graduate from the medical class of 1991−the year of the yak−and a recipient of a PhD in physiology in 1992, there’s no question that Dr. Hamilton has had an incredible career thus far, and there is much more to come.
What was your role with NASA? I was there as what’s called a flight surgeon. A flight surgeon is a physician responsible for maintaining the health and performance of the crew members, before, during and after space missions. We’re around when the astronauts are selected and during their training. We help them suit up and when they land we extract them from the spacecraft and make sure they’re healthy, and we help rehabilitate them back into the pool of astronauts to be selected for future missions. How did you monitor the astronauts while they were in space? I had private video conferences with them and examined electronic reports from the exercise and medical equipment in space. For short shuttle durations we would talk to them every day. For the space stations, I had a scheduled, typically 20 to 30 minute, private video conference with them every week, more so if needed. We would go over health related issues, family issues−anything they wanted to talk about; however, they also had private psychiatrists they could talk to. We trained some crew members onboard to be medical technicians, but I basically followed their health throughout the mission, which helped me prepare for their care when they came back. What kinds of things would you prepare for?
Canadian astronaut Dr. Robert Thirsk (left) with Dr. Douglas Hamilton (right).
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If there were any problems of any kind, I would make sure they had what they needed. Or, if they had a craving for pizza, we’d make sure it happened. Shuttle astronauts in space have called pizza places, given their orders, and then asked us to pay and pick it up for them, for when they land. It doesn’t all have to be serious.
Being around astronauts so much, did you ever want to be an astronaut yourself? Before my time at NASA, I actually did go through a Canadian astronaut selection. There were 5,300 applicants and I was one of the final 10. I was pleasantly surprised to get that far and then incredibly disappointed, but it opened up a lot of doors. My original plan was actually to be a flight surgeon, but when they had this competition I threw my hat in, not thinking I’d get as far as I did. How did you get your job as a flight surgeon? I answered an ad that wanted folks to go to Star City in Russia−the top secret Russian training centre (which is no longer top secret). So I worked there training astronauts for the first space station (which hadn’t been built or launched yet). You’re also an engineer. how did you find being an engineer influenced your medical career at NASA? I’ve got a master’s degree in electrical engineering. It was always an interesting fit being an engineer working in medicine, but at NASA I was surrounded by engineers and almost turned into the translator for all the other flight surgeons and vice versa for the engineers. I also designed a lot of hardware for the space shuttle and space station, and helped plan several versions of future Mars missions. What would you say the overall experience at NASA was like? It was an amazing experience. You’re working with the top professionals in the field. You go to these meetings and the people in the room know more about the
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ALUMNI
heart, kidneys, lungs and eyes. The astronauts using it had no training, yet we were able to remotely guide them to get the image we needed and found that it worked really well. Accordingly, Dr. Andrew Kirkpatrick (head of trauma at the Foothills Medical Centre) and I developed and tested trauma protocols in the very northern reaches of Nunavut, enabling fetal wellness and obstetrical ultrasound exams to be remotely telementored from Ottawa. My logic was, I’ve seen some of these problems in space with intracranial pressure, and if I can do a remotely guided ultrasound examination on an astronaut’s eye going 17,000 miles around the Earth, why can’t I do a fetal wellness exam on a mother in Nunavut? What do you hope will be next for this initiative?
Dr. Douglas Hamilton (left) practising CPR in zero gravity with a colleague.
topic of discussion than anybody else in the world. I had to do U.S. military training to get my flight surgeon “wings” for my NASA aeromedical certification and I got to see the military in action and see how they do things “by the book”. And just seeing all the technology−you go to the shuttle launches at Kennedy and you’re sitting on the roof of fire trucks in the very front of the line, or Soyuz launches at Kazakhstan in a field next to the pad. It’s the best view in the house. You’ve been back at the Faculty of Medicine since October 2011. What are you focusing on now that you’re back? I’ve been brought back to do about two-thirds research and one-third clinical medicine and teaching. I’m working under the Libin Cardiovascular Institute of Alberta’s research lab with Dr. John Tyberg, and the Institute for Public Health
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in the Ward of the 21st Century. We are sort of changing the direction of Dr. Tyberg’s lab to combine cardiovascular hemodynamics with cerebral spinal fluid dynamics and pressures. Some of this interest comes from what has been happening to the astronauts after they return to Earth with raised intracranial pressure and permanent vision changes, and how much it has in common with similar disease states on Earth. There’s also a remote telemedicine initiative which I used with NASA to examine crews in orbit. I want to get this concept going with the Institute for Public Health to help serve our vulnerable populations in northern Canada. What is the remote telemedicine initiative? I worked on a project with the Canadian Space Agency where we developed remotely telementored ultrasound for the space station to get images of the
http://medicine.ucalgary.ca/magazine/
The next phase of this project, which is a University of Calgary initiative, is to develop numerous protocols in Alberta, and then take those protocols and remotely guide them in northern Canada so we can actually start delivering diagnostics−so a woman who is seven months pregnant doesn’t need to fly for several hours in a small plane for a wellness exam−we can do it right here. We can do remotely telementored trauma exams and decide in real-time if the victim needs a LifeFlight. Through this communication technology, you could have a virtual radiologist come to you−I think we need to bring the health care to the patient and not drag the patient to the health-care center. How do you feel that your background with NASA has prepared you for where you are now in your career? I find that it has helped me focus my research and my objectives. These days I do nothing unless I can identify a requirement. Identifying an unfulfilled requirement is the first step to effective innovation. The University of Calgary prepared me for NASA and NASA prepared me to come back home. It’s great to be back to the future. ✦
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Service to society
Dr. Robert Lee, professor emeritus in the Department of Clinical Neurosciences, recently travelled to Laos as part of a University of CalgaryLaos partnership project. He shares his experience through this blog.
In January of this year, my wife and I spent one month in Laos as part of the University of Calgary-Laos partnership project to improve medical education and train family doctors to serve in the rural areas of Laos. The family medicine training program has been very successful and has now produced more than 100 new family doctors in Laos since its inception in 2006. Most of my time during this visit, my 16th trip to Laos since 1999, was spent in the southern city of Savannakhet (SVK), one of the provincial training sites for the family medicine program.
Impressions
from rural Laos Since a substantial part of this training takes place in rural villages and district hospitals, we were particularly interested in visiting some of these sites. For three days in late January, we travelled to the eastern regions of SVK province with Dr. Phetvilay, a remarkable young woman who was one of the first graduates from the program and who now serves as the coordinator for family medicine training at the SVK provincial hospital. Our first stop was at Phalansay, Phetvilay’s hometown, about two hours east of SVK city. This is the place where dinosaur footprints and some fossils have been discovered in the past. We learned that it was Phetvilay’s father who actually first discovered the footprints and arranged for French paleontologists to start investigating. From there we headed farther east to Phine. There is a district hospital
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there seemed to be only one man in the village who spoke Lao and was able to communicate with Phetvilay. The poverty was even more obvious than what we have seen in other parts of rural Laos. We had a long discussion about this after we left, and I asked Phetvilay what she would do if she were a senior government official and had a lot of money to improve the standard of living in villages like this. Without any hesitation she said she would put it into education. She said that as long as people in villages like this remain uneducated things will never change. Our next stop was Sephone where there is a good district hospital which has been renovated with assistance from Belgium. We met the director who took us on a tour of the hospital–an impressive facility.
there, which has been renovated with funding from the Canadian International Development Agency. It’s very clean and well maintained with mostly single rooms and en suite toilets for the patients–something we have not seen before in Laos. The hospital director is the only doctor but he has three medical assistants working with him, one of whom has some training in anesthesia, so they are able to do cesareans and other emergency surgery. It would be an ideal place for a family medicine grad to start working. The next day we travelled up part of the old Ho Chi Minh trail, to a town called Virabouly, where there is a district hospital. Along the road, we passed several Lao Teung villages, one of the ethnic minority groups in that part of Laos. We stopped at one of these villages to look around and take some photos. It was interesting to note that
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From there, we headed towards the Vietnamese border. Along the way we had an interesting lesson from our driver on the different types of development assistance. The road from SVK city to Sephone is in terrible condition–full of potholes and broken pavement. From Sephone to the Vietnam border the road is as good as the Trans-Canada Highway from Calgary to Canmore. Our driver told us that the eastern section had been built with assistance from Vietnam who sent in their own engineers to supervise the construction. The section from Sephone west to SVK city was built with assistance from Japan, which gave the money to Laos and let them do it on their own– draw your own conclusions! The district hospital at Songkhone, a town about 70 km south of SVK city, is a fairly new hospital built about five years ago with funding from JICA (Japan). One of the family medicine program graduates is working at this hospital. An extensive tour revealed yet another impressive facility, much like the hospital at Sephone. They do about 50 deliveries and 20 surgical procedures a month, and have a busy out-patient clinic. Both hospitals would be great training sites for family medicine residents. Phetvilay thinks that with the program expanding to three years it might be a good idea to add one or two more district hospitals as training sites–I fully agree.
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Discussing elective cesarean When Dr. Magnus Murphy published his first book in 2003, Pelvic Health and Childbirth−What Every Woman Needs to Know, he knew his journey as an author was not yet complete. As a urogynecologist specializing in the treatment of pelvic floor disorders, which can, at times, be a complication of vaginal child birth, Murphy aspired to write a book about why he believes elective cesarean sections−cesarean sections performed at the request of the mother− should be a respected choice available to all women. In his new book, Choosing Cesarean−A Natural Birth Plan, Murphy has been able to express that opinion. Released
in March of this year, the book, which was co-authored by British investigative journalist Pauline McDonagh Hull, explores the controversial issue through scientific and anecdotal analysis. Here we discuss the book with Murphy−the book he hopes will challenge the paradigms of both the public and the medical community alike. Q: What inspired you to write this book? A: Through the years I’ve really noticed how the choice of receiving an elective cesarean section has not been given to women, and the potential benefits of that choice have not been brought to light. Q: What are some of the benefits of receiving a cesarean section? A: We believe that in the hands of a skilled surgeon, there are fewer and less serious risks than those associated with a vaginal birth. No choice is without risk completely, it’s just different risks. For example, wound infection is a risk of cesarean section and pelvic floor injury is a risk of vaginal birth. Q: What is a pelvic floor injury? A: Pelvic floor injuries result from damage to the pelvic muscles that support organs such as the bladder and uterus, resulting in conditions such as uterine prolapse and urinary incontinence. While pelvic floor injuries can occur in women who have never had children or have only ever had cesarean births, it is our belief that the risk of these injuries is increased with vaginal childbirth. Q: Are there currently any indicators that could identify women at risk for pelvic floor complications as a result of childbirth?
Dr. Magnus Murphy is a clinical assistant professor in the Department of Obstetrics and Gynaecology.
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A: Unfortunately there are no real indicators that have been identified, but we hope this will change as our understanding of genetics improves. Where there can be some indication
however, is in the size of the baby−the bigger the baby, the bigger the risk. Q: Do you feel all women should undergo cesarean sections? A: No. We are advocating for women to have informed choice in the matter. They should be able to discuss all of their birth options, including elective cesarean sections, with their physician to make the decision that is best for them. There are definitely women for whom receiving an elective cesarean section is not the best choice and in that case, their physician should explain why. Q: In Canada, how is a woman received by doctors if she wishes to have an elective cesarean section? A: Currently in Canada, there is no protocol and no common understanding when it comes to elective cesarean sections. If a woman’s physician is pro-choice regarding the practice and supports her decision she could receive one; however, if her physician does not believe in elective cesarean sections, she may not have the option. It’s pure luck. Q: Why do you feel women should have the choice? A: I’ve had thousands of women write to me, and see women regularly in my clinic about pelvic floor problems, which are invariably related to childbirth. There is scientific evidence, which is presented in this book, demonstrating that this option may be safer for some women. For this reason, I feel it’s unethical to not give them the choice. Women need to know all of their options.
Did you know? While elective cesarean rates in Canada are not formally recorded, it’s estimated that between two and five per cent of Canadian women receive one.
RESEARCH
Breaking new ground The Faculty of Medicine’s Experimental Imaging Centre (EIC) has finally found a permanent home. By Kathryn Sloniowski
“The new space located in the basement of the Teaching Research and Wellness Building will allow us to expand and bring in new technologies to increase our research productivity and capacity,” says EIC director Jeff Dunn, PhD, a member of the Hotchkiss Brain Institute (HBI) and the McCaig Institute for Bone and Joint Health. Home to a variety of imaging technologies such as MRI machines, brain mapping devices and technologies
capable of thermal imaging and microscopy, the EIC originally opened in 2002 with the arrival of Canada’s first 9.4 Tesla MRI machine−an MRI with a magnetic field six times stronger than clinical MRI machines, which allows for highly detailed imaging. These technologies are used to explore several diseases such as cancer, epilepsy, arthritis, dementia and vascular diseases. While the EIC, which is strictly a research site, primarily focuses on animal models of these diseases, the intent is to eventually translate the research to humans. “We have a range of some very high tech tools,” he says. “The package as a whole is certainly unique in Canada.” Because of a lack of consolidated space, using the equipment has previously required that it be taken to various research sites in Calgary as demand dictated. However, with the new location, Dunn hopes that will soon change. “The idea is that eventually, researchers will come to the facility to conduct their
Research associate Jon Jimenez with a brain mapping device.
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Jeff Dunn, PhD, a professor in the Department of Radiology, and adjunct professor in the departments of physiology and pharmacology, and clinical neurosciences, with the 9.4 Tesla MRI machine.
research,” he says. “Another advantage to having the equipment here is that we’re not in a hospital environment. For this reason, it really can be used for technology development and research.” ✦
The EIC was a collaboration between the University of Calgary and the National Research Council−Institute for Biodiagnostics.
The EIC strives to apply technology to research trials and to develop new health technologies, operating under the mandate to provide state-of-the-art technology to the research community, and to translate imaging technology to the clinic.
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NEWS
Doctors find new way to predict recurrent stroke New research from the University of Calgary’s Hotchkiss Brain Institute (HBI) shows that using a CT (computerized tomography) scan, doctors can predict if patients who have had a minor stroke, or transient ischemic attack (TIA), with neurological symptoms such as weakness or speech issues, are at risk for another more severe stroke. This vital information can help doctors decide if stronger medications should be used to prevent future episodes, or if a patient can be safely sent home. Currently, doctors can use a brain MRI (magnetic resonance imaging) scan to predict if a TIA patient is at high risk for a second stroke. Unfortunately, MRI machines are not immediately available for most of Canada’s population. However, most health-care centres, including rural hospitals, have CT scans more readily available. The study sought to determine whether a CT scan would be as effective at predicting stroke risk as MRI. “Many physicians may not have access to an MRI machine to see what is happening in the brain,” says HBI member and lead author on the study Dr. Shelagh Coutts. “Therefore, this study could allow medical interventions to be more widely available than in just the specialized centres that have access to MRI.” In order to assess stroke risk, Coutts and colleagues used an injection of dye to visualize the blood vessels from the heart all the way to the brain. This test is called a CT angiogram, which can easily be administered as part of a routine CT scan. The researchers found that patients who had evidence of blockages or narrowed vessels on their CT scans were at high risk for a recurrent stroke. Further, they found that the CT angiogram scan was able to predict the recurrence of stroke with the same accuracy as an MRI. Dr. Shelagh Coutts is supported by Alberta Innovates – Health Solutions.
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In the news Fast food salt levels vary between countries An international team of researchers from Australia, Canada, France, New Zealand, the United Kingdom and the United States found that salt levels in similar fast food items vary between countries. The Faculty of Medicine’s Dr. Norman Campbell, who is also a member of the Libin Cardiovascular Institute of Alberta, was one of the co-authors on the study and says he and his colleagues observed a marked variability in the reported salt content of products provided by major transnational fast food. They observed that fast food in Canada and the U.S. contains much higher levels of sodium than in the U.K. and France. For instance, in Canada, McDonald’s Chicken McNuggets contained two and a half times the amount of sodium per 100g serving compared to the same size serving in the U.K. The authors say this is an opportunity for widespread reformulation of products to contain lower levels of salt. Too much dietary salt has been linked to high blood pressure and other adverse health effects and estimates show that reductions in salt intake could result in a significant reduction in deaths. The fast food companies included in the study were Burger King (known as Hungry Jack’s in Australia), Domino’s Pizza, Kentucky Fried Chicken, McDonald’s, Pizza Hut and Subway. They looked at savoury breakfast items, burgers, chicken products, pizza, salads, sandwiches and french fries.
Mood matters during pregnancy New research from the Faculty of Medicine suggests that while pregnant, women should pay particular attention to their mood. Gerry Giesbrecht, PhD, a psychologist and member of the University of Calgary’s Alberta Children’s Hospital Research Institute for Child and Maternal Health (ACHRI), was lead author on a study that discovered that in pregnant women, while cortisol levels naturally fluctuate over the course of the day, as negative mood increases, cortisol levels increase as well. “It goes without saying that depression or anxiety affects the pregnant mom but we have mostly paid attention to these effects during the post-partum period. Knowing that mood changes a woman’s physiology in ways that have implications for the fetus tells us that health-care providers need to start paying attention to mood during pregnancy,” he says. Giesbrecht says while they don’t currently know what the consequences are when exposed to too much of the hormone, the study has paved the way for further research on the topic. Cortisol is a hormone that occurs naturally in the body in both males and females. While its primary roles are to manage blood sugar levels, to suppress the immune system and to aid in the metabolism of specific nutrients, it also plays a unique role during pregnancy. Cortisol levels increase greatly during the final gestational weeks to ensure the baby’s lungs are prepared for birth. It is also vital for fetal brain development.
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Final words with Dean Feasby
Your proudest accomplishments as Dean…. There have been a few. One major accomplishment was acquiring the $40million in funding required to complete the fit-out of the TRW and HRIC buildings at a time when it was a priority for neither the university nor the government. I’m also very proud of the creation of the Faculty’s seventh research institute−the Institute for Public Health. The institute was created under the leadership of Dr. Tom Noseworthy, and speaks specifically to the opportunities for population health research and health services research, and responds to the opportunities which are being promoted by the provincial and federal government. I was also a part of successfully managing the major, 50 per cent, expansion of our undergraduate medical program and the subsequent expansion of our post-graduate medical education program−in particular our expansion of the family medicine training program, under the leadership of Dr. Bruce Wright, Dr. Joanne Todesco and Dr. Cathy MacLean. This expansion included the creation of our new theatres three and four, and the remodeling of the Health
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Sciences Library. During my tenure, the Faculty also faced some difficult times, imposed by the recession beginning in 2008, the abolition of the Calgary Health Region and creation of Alberta Health Services, and the challenging transition from the AHFMR to AIHS. I’m pleased to say that the Faculty came through these challenges in good shape. I’m also happy about the development and implementation of the Celebration of Excellence, and the fact that we now have a system in place to recognize faculty achievements and awards, under the leadership of Dr. V. Wee Yong. What you’ll miss most…. The excitement of the job, the great people to work with, within the Faculty of Medicine and the University of Calgary and with our partners, and the fun of seeing the students learn and thrive. It has been especially enjoyable to be involved in student activities and projects, from attending the Med Show to discussing plans for the Student Run Clinic.
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The first thing you’ll do after your last day as Dean…. Take a deep breath, be thankful for my wonderful experiences, and look for my golf clubs. Your future career plans…. I’m taking a one year administrative leave which will involve some travelling. I’ll be pursuing some research interests in the area of the appropriateness of health care interventions and in particular, overuse. I am already involved in two projects and will look for more. I’ll do a little more clinical work, including returning to work in the Calgary Neuromuscular Disease Clinic. I’m also looking for opportunities to contribute at the University of Calgary and in the community where my experience might be useful. Your advice to students…. Enjoy this wonderful time in your life, look for opportunities and plan ahead. You can achieve almost anything with diligence and persistence. ✦
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minds that matter The 2012 Gairdner Lectures Oct. 23, 2012 2:30pm-4:30pm Libin Lecture Theatre, HSC
Lorne Babiuk
2012 Canada Gairdner Wightman Award ‘for his national leadership in vaccine development and research on human & veterinary infectious disease control.’
Michael Young
2012 Canada Gairdner International Award ‘for his pioneering discoveries concerning the biological clock responsible for circadian rhythms’
Howard Cedar
2011 Canada Gairdner International Award ‘for pioneering discoveries on DNA methylation and its role in gene expression.’
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