Annual Report Feature

Dr. Ola Kajetanowicz and her mentor, Dr. Meghana Toal, in Saint John

Pathology residents gain confidence and independence through community rotations

RESIDENTS IN THE DEPARTMENT OF PATHOLOGY periodically pack up their bags and head to a hospital outside Halifax for a new learning experience. In so doing, they gain insight into the diverse nature of community pathology practice, expanded opportunities for self-directed learning and inspiration about where they want to work and how they want to practice when their residency is finished.

“Dalhousie Medical School has a mandate from the Nova Scotia government to increase learning opportunities outside HRM, for both medical students AND residents,” says Dr. Erica Schollenberg, program director for residency training in Diagnostic and Molecular Pathology (previously known as Anatomical Pathology). “Every resident is required to complete at least ten per cent of their training blocks in other Maritime centres, amounting to roughly seven months of their residency.”

Doing four-to-eight week rotations at smaller hospitals in Truro, Moncton, Saint John, Fredericton, Charlottetown— and soon, in Sydney, Cape Breton—shows residents a new view of pathology practice that is not available to them working in a tertiary centre like the QEII Health Sciences Centre.

“In community practice, residents see cases where people have not presented with symptoms previously anywhere else, so they are the ones to make the initial diagnosis,” notes Dr. Cheng Wang, program director for resident training in Diagnostic and Clinical Pathology (formerly known as General Pathology). “In tertiary centres, patients have already been worked up and diagnosed, and now pathologists and residents are looking to refine the diagnosis. It’s a very different perspective and set of skills required.”

As a senior resident in Diagnostic and Molecular Pathology, Dr. Ola Kajetanowicz has completed three community rotations: in Truro, N.S., in second year; in Charlottetown, P.E.I. in third year; and in Saint John, N.B., in fifth year.

“It has been a great way to consolidate my learning in my final year,” says Dr. Kajetanowicz of her recent experience in Saint John. “You see such a wide breadth and variety of cases come across your desk in a community setting, compared to the more specialized and sub-specialized workloads you see in Halifax, and you get to work really independently when you’re a senior resident. It’s been an incredible review of all my learning to date and has really helped boost my confidence heading into final exams and my future role as a staff pathologist.”

Her community rotations have been such positive experiences for her during her residency training, Dr. Kajetanowicz is moving forward with plans to work in a community setting in Nova Scotia after she graduates.

“I feel really well prepared to enter community practice and I know I will enjoy it,” she says. “I’m glad I’ve had so many opportunities to see what it’s like to work as a pathologist at a smaller centre.”

According to Dr. Meghana Toal, a staff pathologist at the Saint John Regional Hospital and assistant professor in the Department of Pathology, having residents coming from Halifax on rotation helps keep her and her colleagues in Saint John up to date with the latest developments in the fast-evolving world of pathology.

Diagnostic and Molecular Pathology resident, Dr. Ola Kajetanowicz

“It’s very much a two-way street,” says Dr. Toal, who supervises about three residents a year. “The residents are learning how we conduct our investigations here, while we are picking up all of the updates from them.”

As a Dalhousie graduate herself, who also did rotations around the Maritimes during her residency, Dr. Toal says that having residents do community rotations strengthens ties among pathologists across the region, fostering collegiality and collaboration.

“Pathologists in Halifax who did community rotations understand how our practice is different in smaller centres in terms of equipment and the kinds of cases we see, and of course we understand how the system works in Halifax because we trained there too,” explains Dr. Toal. “And more of us know each other personally, having worked together on rotation, which makes it much easier to pick up the phone to consult on a challenging case.”

Dr. Yu Chen and Marilyn Garcia, who work with residents in Fredericton

Community rotations offer residents a breadth of experience and degree of independence that is hard to come by in a larger centre. This is partly because there is less specialization, and also because there are fewer learners on site at any given time.

“We only have one learner at a time in Fredericton,” notes Dr. Alexandra Pettit, a Dal graduate who is now a staff pathologist at the Everett Chalmers Hospital and assistant professor in the Department of Pathology. “As a result, that learner has access to a wide array of learning opportunities and can tailor their experience precisely to fill in the gaps in their EPAs, the entrustable professional activities they must master as they progress through their training.”

Residents on rotation in Fredericton have unique access to all of the pathologists and lab staff at the hospital, and opportunities to gross patient tissues (study them with the naked eye), examine cancer cells from all tumour sites under the microscope, and perform autopsies/ prepare the report of findings for the coroner, who determines the manner of death. This differs from Nova Scotia, where a medical examiner conducts the autopsy and determines both the cause and manner of death.

Dr. Derek Minney is another Dalhousie pathology graduate who found his professional home in a smaller town after doing a rotation in Truro during his residency. “Doing a rural placement in Truro helped me get the job here after I graduated,” he says. “Team dynamics and personality fit are that much more important in a smaller centre. After working here on rotation, the team knew me and I knew them, which gave me confidence that I would like it here.”

Residents in Truro gain exposure to both a high volume and wide variety of cases. “We examine everything but brain tissues here,” Dr. Minney notes. “We see some very unusual cases as well, and get to work through our caseload on our own schedule. It’s a very flexible style of practice here, which is great when you have a family.”

The Queen Elizabeth Hospital in P.E.I. hosts one or two pathology residents a year, who have the opportunity to work closely with a team of seven pathologists, a hematopathologist, medical microbiologist and two clinical chemists, utilizing a recently installed suite of new equipment.

“We cover the entire island and work very closely with our clinical colleagues in surgery, obstetrics and gynecology, cardiology and other specialties,” says Dr. Heidi Paulin, a Dalhousie graduate and head of Pathology and Laboratory Medicine for P.E.I. “Residents are exposed to a wide range of cases, including a lot of cancers and forensic cases. We see interesting and unusual things every day.”

For Dr. Paulin, supervising residents is not only stimulating for her and her colleagues: it’s a way to give back. “The opportunity to train residents is exciting for us,” she says. “It is important to stay humble and be involved in training the next generation of pathologists. There is a growing need for pathologists in the region and it is a privilege to be part of building that capacity.”

For their part, residents are grateful to have such a dedicated group of teaching faculty in the distributed learning centres. “Our residents consistently report excellent learning experiences in community settings,” says Dr. Cheng Wang. “They benefit tremendously from these rotations, which ultimately translate to better care for people all across the Maritimes.”

Dr. Alexandra Pettit and medical lab technologist Lauren Emms in Fredericton