Conscious learning at BC Children’s Hospital in Vancouver

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BC Children’s Hospital is British Colombia’s major treatment, teaching and research facility for child health, caring for patients from birth to age 19. Children’s is home to many specialized pediatric services not available anywhere else in the province.

Surgical heads at BC Children’s set out to create the ideal learning environment in the early 1990s. At the time, fellows worked up to 80 or 90 hours a week and were on call one out of three or one out of two days per week. Fellows at BCÊChildren’s Hospital are now on call one day a week, one weekend in six, and also cover one afternoon per week.

“You can’t learn if you’re fatigued,” said Dr. Stephen Tredwell, Head of the Paediatric Orthopaedics department at BC Children’s Hospital in Vancouver. “If the purpose of having a fellow spend a year with us is to fine tune their skills to a sophisticated, high-end tertiary level, and if we also want those fellows to be actively involved in the treatment of patients under our care, the last thing we want to do is work them to the point of exhaustion.

“These people have already invested an average of 13 years to get their degree and complete their residency requirements, they’re good to go out and practice,” said Tredwell. “They are now investing an additional year or two to achieve a high level of expertise in a given area of medicine.

“What you do want to do is provide an environment that’s complex enough that they’re going to see the cases and learn the skills that they need for their chosen specialty,” he said. “Not just the technical skills, but the skills they’ll need to do a proper patient assessment, how to talk with families about their children, and especially how to talk to the children themselves.”

One beneficiary of this approach is BC Children’s newest orthopaedic surgeon Dr. Kishore Mulpuri. Having done fellowships with a private clinic specializing in sports orthopedics in Melbourne, the Women’s and Children’s Hospital in Adelaide as well as Royal Children’s Hospital in Melbourne, he can attest to the benefits of having both the time to do his own research as well as time with family, while also getting sufficient opportunities to master specific procedures.

“In Australia there was less hands on experience for spine surgery as in most places it was a two surgeon operation,” said Mulpuri. “One of the doctors in Adelaide recommended that I do a fellowship at BC Children’s, partly because of the international reputation of the surgeons, and partly because the learning opportunities were a fit with my aspirations.”

“All the pediatric orthopedic surgeons here at BC Children’s have a sub-specialty interest, so there’s a wealth of knowledge to impart to fellows so we don’t have to learn from our own mistakes. The doctors here are very approachable; they treat fellows like junior faculty. You do hear of other hospitals with more challenging service and research demands. I feel very fortunate that I was accepted for a fellowship here.”

Dr. Heather Jackman had just finished her residency in her hometown of St. John’s, Newfoundland, when she started her fellowship at BC Children’s last August.

“I knew I wanted to study at a Canadian pediatric teaching hospital. Colleagues and residents I know who have been here said good things, and the expectations around research and on-call duties were much more reasonable than at some of the other teaching hospitals I looked at,” said Jackman.

“The demands are very fair,” she said. “There’s enough free time for research as well as maintaining and expanding my academic knowledge and experience with two areas I’m interested in: Ilizarov limb-lengthening procedures and pelvic osteotomy. I don’t think a heavier service requirement would result in a more valuable learning experience; I think they have struck the right balance here at BC Children’s Hospital.”

Children’s typically has two fellows in orthopedics, two in general surgery, and one in ophthalmology at any given time. Children’s is also developing fellowship programs for urology, ENT, neurology, and plastic surgery, with a fellow in place every two years. Anyone interested in a fellowship at BC Children’s is encouraged to contact the individual department.

“We want the best possible care for our kids,” said Dr. Tredwell. “My hope is that doctors who come here to Children’s to do a fellowship leave with some of our passion for helping children, because that’s ultimately what our work is all about.”