We are happy to bring you July’s edition of Resident Spotlight! This month, we chatted with Dr. Skye Crawford, a PGY-4 Emergency Medicine Resident. She has completed the Ironman triathlon, is a UBC Resident Wellness Site Representative—as well as having been a presenter at CAEP 2017! In this edition, Dr. Crawford talks about her experiences balancing triathlon training and advocacy with her residency, her decision to take on a palliative care fellowship, and her hopes for the future of Resident wellness.
You recently did the Ironman Triathlon, and placed in the top 5% for your age group in the world. Congratulations! Can you tell us a bit more on how it was training for and competing an event like that, especially when balancing it with your busy schedule as a Resident?
The first time I learned about an Ironman race, I knew I would do it one day. As a naïve teen, I recited the distances which include a 4.1k swim, 180km bike ride, and a marathon, and thought ‘how hard could this be?’ Seventeen years later, and as a second-year Emergency Medicine resident, it was time to turn this daunting undertaking into a reality.
I was a competitive swimmer for most of my life including while attending university, so I was prepared with the training discipline that I would need. What I did not anticipate was the countless scheduling conflicts, sacrificed time with loved ones, and the sheer physical exhaustion that my 10 months of training and 20-25 hours of workouts per week would involve.
My home in the Okanagan was the perfect setting for my refreshing early lake swims, waterfront runs, and sweltering bike rides in the rolling hills of Osoyoos. I completed the Coeur d’Alene Ironman in third place at a time of 11 hours, 28 minutes, and 37 seconds, and my family and husband were there to cheer me on and greet me at the finish line. I felt overwhelming gratitude to my loved ones who had supported me no only through Ironman preparation, but also in my other life aspirations.
Training and completing this race changed my belief system of what I am capable of. I try to take this attitude with me to every new opportunity. Achieving this personal challenge puts other experiences into perspective, and now I have more conviction in myself, but equally important, I believe in the capabilities of others.
You are doing a year of added competency in Palliative Care. As an Emergency Medicine Resident, what made you decide for this additional training, and how do you think it will impact your future practice?
My first exposure to the field was as a hospice volunteer before beginning medical school. I met people who were facing their own mortality, but the interactions were rich with meaning and hope. In medical school, I discovered that the high energy and collaborative setting of the Emergency Department was the best fit for my personality, however, I still missed these longitudinal interactions that I had discovered years earlier as a volunteer.
I find breaking bad news to be one of the most challenging parts of my work in Emergency Medicine. It’s difficult to have these conversations with patients and families following traumatic accidents, when emergency investigations reveal a new and life-changing diagnosis, and when resuscitations are deemed futile and terminated. I know that palliative medicine training will better prepare me for these encounters and encourage me to discuss goals of care in a more meaningful and useful way.
Palliative training also focuses on the management of symptoms such as pain, nausea, and dyspnea, which are common ED presentations even in non-palliative patients.
After graduation, I intend to work as an Emergency Physician with a parallel palliative medicine practice in the hospital, community, and at hospice. This enhanced training will allow me to pass this knowledge onto others in Emergency Medicine, and hopefully improve emergency care for palliative patients.
Early in the enactment of MAiD legislation, you developed a policy for your Emergency Department, and presented at CAEP 2017 with a “What You Need to Know” session. Can you talk more about your involvement with MAiD, and your process with putting this policy in place?
As a first-year resident, I was interested in how the introduction of new legislation of MAiD would affect Canadian Emergency Departments. After multiple presentations for grand rounds and hospital ethics committees, I became knowledgeable about this controversial topic at the early stages of its inception.
Shortly after MAiD was enacted in Canada, I noticed the lag in educational resources available for Emergency Physicians. I decided to put together a policy to address common questions about MAiD including links to resources as well as physician rights and responsibilities as outlined by the CPSBC. By raising awareness, I hoped that patients presenting to the Emergency Department in crisis would be able to access the resources they needed, and have their questions answered.
Finally, at CAEP 2017, I gave a presentation on the history of MAiD and discussed ethical dilemmas associated with the topic. I was the resident representative on a MAiD panel where we reviewed difficult patient cases. The panel and the audience discussed the logistics of MAiD, legal factors, and moral quandaries.
In addition to being a UBC Resident Wellness Site Representative, you coauthored a position statement earlier this year on Resident Wellness in Emergency Medicine that was published in the Canadian Journal of Emergency Medicine. The article discussed several topics including resident burnout and resiliency training. What was your experience like working on this statement, and what are your hopes for the future of Resident wellness?
During residency, I experienced elements of burnout myself and have seen emotional exhaustion and a sense of clinical detachment in my colleagues and friends in medicine. Reading the most recent literature on burnout made me increasingly aware of the true scale of this issue, and the ramifications on residents personal, professional, and psychologic health. My involvement in this project was enriching because it provided an opportunity to promote resident values, and advocate for hard working residents who don’t always have a voice.
I have seen improvements in the work environment and resources available for residents including crisis counselling; but we still have work to do. For the future of resident wellness, I hope that we can improve timely access to non-urgent counselling. I also believe we should improve resident career mentoring, as well as provide more guidance for transition to practice. Finally, I hope that we can promote the best practices for scheduling residents, especially for call shifts and shift work with an emphasis on ample notice and reasonable flexibility.
Thank you to Dr. Crawford for taking the time to speak with us!
We look forward to seeing you all once again for August’s Resident Spotlight.
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