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The Gasette
Anesthesia Newsletter
February 2024
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As we welcome 2024, it’s important that we take a few moments to reflect on our accomplishments over the past year. Working together, as Department members and key partners, we achieved many successes to advance our patient care and academic mandate in the field of anesthesia, pain management and perioperative medicine. Thank you to all those who supported us this past year! We look forward to another productive year ahead.
In this issue, we highlight some of our recent achievements in research, education and patient care. We introduce an innovative research project exploring the administration of regional anesthesia in a microgravity environment. We highlight our practice ready assessment program which assesses internationally trained graduates for practice in the province and helps them secure a license. In addition, we provide an overview of our participation in the surgical waitlist strategy and showcase our new Research Accountability Program.
I hope you find this issue to be insightful and uplifting.
Wishing you a wonderful year ahead.
Dr. Janice Chisholm
Head, Department of Anesthesia, Pain Management and Perioperative Medicine
Central Zone, Nova Scotia Health Authority,
Professor, Dalhousie University
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Testing the Feasibility of Anesthetic Methods in Microgravity | |
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The team (from left to right): Drs. Matthew Mackin, Mathew Kiberd, Jon Bailey, Regan Brownbridge
(Not in photo): Drs. Sally Bird, Dan Werry, and Garrett Barry
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For many, the notion of surgery in space is unfathomable. But as travel into the relatively unknown increases, so too does the chance of serious injury. Where a broken arm on earth might mean some discomfort and a trip to the emergency room, a broken arm in space would not only mean suffering for an untreated astronaut but could also compromise the mission and safety of other team members. The administration of general anesthesia for pain is limited by the technical and physiological challenges of outer space. Other pain medications could compromise cognition and even decrease drive to breath, which could mean death during earth atmosphere re-entry.
Together with his team of anesthesiologist colleagues Drs. Mathew Kiberd, Regan Brownbridge, Garrett Barry, Matthew Mackin, Dan Werry and Sally Bird, Dr. Jon Bailey is evaluating the viability of using ultrasound-guided perineural injections to administer regional anesthesia, a technique used to numb a specific part of the body, in a simulated microgravity environment. In this case—underwater. The Canadian Space Agency has utilized deep water for space exploration simulations for years, but no studies have been conducted in this setting to evaluate regional anesthesia.
The team conducted two studies. In the first, they tested how well a dye works in meat models simulating nerves. They injected 30 meat models and scored for the ease of interpretation and accuracy. In the second study, the team used 40 meat models to evaluate the administration of regional anesthesia in two conditions: microgravity analogue and normal earth gravity. Results in the first study showed the meat model worked well, with assessors correctly identifying dye positions most of the time. In the second study, they found that giving anesthesia in space is possible, but placing needles is trickier in microgravity compared to normal gravity. This work has the potential to pave the way for the development of medical techniques that will ensure the safety of astronauts and the success of space missions.
Dr. Bailey’s research is the inaugural recipient of the Orlando Hung Innovation Fund (OHIF) Award, named in honour of Dr. Orlando Hung and dedicated to supporting early ideas that can develop best practice models and procedures.
"Having the award named after me is a tremendous honour, and I am truly grateful,” says Dr. Orlando Hung. “It is my hope that this award will contribute to the development of early studies of clinical, educational, research, or administrative innovations with the aspiration of how we can always do better,” says Dr. Hung. "I would like to congratulate Dr. Bailey and his team for this award to support their exciting project. I wish I could participate in their microgravity study because I missed the opportunity to conduct an Airway Management in microgravity study some years ago.”
Part of the Department of Anesthesia’s Anesthesia Research Fund Awards, the OHIF aims to facilitate systemic change and remove barriers that may hinder the timely development, assessment, and implementation of medical innovations that improve patient lives.
“Dr. Hung has been an inspiring clinician, researcher, and humanitarian and I’m very grateful that our department has such strong support for research and innovation,” says Dr. Bailey. “This has allowed us to have an outsized impact nationally.”
Dr. Bailey plans to engage in a collaborative effort with the Health Beyond Initiative of the Canadian Space Agency in order to advance and expand the research on the administration of regional anesthesia in microgravity settings. Enthusiastically looking ahead, he aims to further explore the model established in this project by involving personnel without anesthesia expertise, potentially revolutionizing healthcare delivery in remote and extreme locations, including military and rescue operations.
Read the full story here.
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Practice Ready Assessments as a Pathway to Licensure
There is a shortage of licensed anesthesiologists in Nova Scotia, as well as nationally and internationally. One way that the Department contributes to building anesthesia human resources in the province is by delivering a Practice Ready Assessment (PRA) to international medical graduates (IMGs). Supported by the Government of Nova Scotia and the College of Physicians and Surgeons Nova Scotia, this 12 to 16 week assessment program enables IMGs who don’t otherwise qualify for licensure to demonstrate that they have the required competencies and skills to practice, thereby increasing the availability of specialists in the province.
In 2023, the Anesthesia Office of Education provided practice ready assessments to two internationally trained anesthesiologists in the Central Zone, Nova Scotia Health and the IWK Health Centre. Upon successfully completing the assessment, they obtained medical licensure to practice in Yarmouth and Sydney respectively. “The PRA program gives well-trained international anesthesiologists an opportunity to provide anesthetic patient care to under-serviced communities in Nova Scotia. They get to put their training to use in Canada and our population gets the medical care they need,” says Dr. Ben Schelew, Assistant Professor and preceptor of the two IMGs.
Dr. Slav Hrytsay was one of the individuals who recently completed his PRA program in in Halifax. “Before starting the practice ready assessment, I thought it was an exam that needed to be taken to get licensed. Instead, when I participated in the assessment, I got to work under the supervision of different anesthesiologists, who were eager to share their experiences with me,” says Dr. Hrytsay.
Though anesthetic procedures in Germany, where Dr. Hrytsay was trained, are the same as in Canada, the organization of work and the ‘philosophy’ of the anesthesiologist's job differs. “While an anesthesiologist's practice in Germany is governed by the standard operational procedures of the hospital they work in, Canadian anesthesiologists have more autonomy in deciding how to approach each case, allowing them greater flexibility in applying their expertise,” says Dr. Hrytsay.
Through the assessment program, Dr. Hrytsay was able to observe how Canadian anesthesiologists organize their day and approach each patient case. The program also provided him the opportunity to safely try new approaches and medications that he hadn’t experienced in his country of training. “I consider the PRA not only a pathway to licensure, but also a valuable experience in a transition to practice in a new country and working environment.”
Dr. Hrytsay began working as an anesthesiologist in Sydney, Nova Scotia in January 2024. He is looking forward to applying his anesthesia skills in an area of need, as well as to contributing to the medical care and well-being of the local community. “I would encourage IMG anesthesiologists who are interested in practicing in Nova Scotia and Canada to consider applying for a PRA, as it is a great way to familiarize themselves with the Canadian system and transition more smoothly to independent practice,” says Dr. Hrytsay.
"As a Department, we have come together to provide a safe environment to nurture the candidates in what must be a very stressful assessment period,” says Dr. Schelew. “Many of our staff have contributed significantly to the success of this program, and the ultimate beneficiaries are Nova Scotians. Thanks to everyone involved.”
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Improving Patient Access to Surgery | |
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As members of the perioperative team, anesthesiologists are very aware that many Nova Scotians are waiting too long for surgery. And want to be a part of the solutions to improve patient access and experience. Since fall 2023, the Department has been participating in the Government’s Surgical Access Premium Payment Initiative to address surgical waitlists and backlogs. In keeping with Nova Scotia Health’s Surgical Access and Improvement Strategy and IWK’s quality improvement plan, this initiative is one of many actions undertaken to help patients get the surgeries they need sooner. The initiative was approved in the recent physician contract and provides remuneration to extend operating rooms beyond their typical hours of operation wherever possible.
Since November, our anesthesiologists have staffed six additional OR days on weekends and on one holiday at the QEII Victoria General and Halifax Infirmary sites, as well as the Dartmouth General Hospital. Additional surgeries on weekends are also planned for the months ahead.
“A sincere thank you to our scheduling team and our clinical faculty for their work to make this happen. We know that patients are waiting too long for surgeries and are pleased to advance efforts to increase timely access to patient care” says Dr. André Bernard, Department Associate Head.
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Anesthesia Research Accountability Program
In response to the changing landscape of research deliverables, the Department has launched the Research Accountability Program (RAP). The new program addresses the need for enhanced accountability of research protected time while expanding the evaluative scope of research outputs. The RAP aims to recognize excellence and support the diversity of research within the Department.
Dr. Heather Butler, PhD, Managing Director of Research, and Dr. Richard Hall, Professor Emeritus, co-led the 2-year development of the program. As a testament to the Department’s commitment to equity, transparency, and accountability, a wide variety of stakeholders and department members were engaged in the process through surveys and individual interviews. Data collected from Department members was triangulated with the results of an environmental scan of current global practices of assessing research productivity. The resulting framework combines traditional and novel components that both resonate with department members and align with global standards of best practices.
Recognizing the complexity of research assessments and evolving best practices, the Research Accountability Program is unique both in its assessment tool and evaluative processes. A significant component is a values-based point allocation of research outputs that distinguishes research activities that have demonstrated value and relevance to our Department. While the tool includes traditional outputs such as grant capture and publication, it also incorporates novel narrative components that researchers can tailor to demonstrate research relevance and impact on clinical practice. The tool recognizes and supports Open Science initiatives, facilitates assessment at a much more detailed level, and is flexible to levels of experience. The evaluation process is multi-disciplinary, involving a committee of researchers and members from the broader community.
The Research Accountability Program aims to govern a streamlined application process, a novel assessment tool, and an equitable and transparent annual review process. The evidence-based program design will inherently allow for on-going program evaluation and adaptation with evolving best research and clinical practice. For more information and questions about the program, please contact Dr. Heather Butler, PhD at Heather.Butler@nshealth.ca.
“This is an impressive piece of work by the Anesthesia Office of Research” says
Dr. Chisholm. “I would like to express my gratitude to the co-leads for their outstanding efforts on this program. Additionally, I would like to acknowledge the significant contributions made by the Working Group, consisting of Drs. Christian Lehmann, Allana Munro, Allen Finley, Jason McDougall, Adam Law, and Vishal Uppal.”
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