Moments of pandemic resilience in our Ob-Gyn Department community

"Put me in, coach!" Residents step up to an intense new challenge

Dr. Olga Kciuk, PGY5 resident

Residency in obstetrics and gynaecology is a demanding venture in the best of times. Residency during a global pandemic brought a whole new and unexpected set of challenges. There were many uncertainties at the start of the pandemic: Would there be enough personal protective equipment to keep ourselves safe? With elective surgeries on hold, how could we ensure our surgical training did not suffer? How does one prepare for licensing exams that might change formats or be cancelled entirely?

In the constant flux of those early pandemic months, coming to work and continuing to care for patients provided a sense of grounding and social connection. Despite upended rotation schedules and resident redeployments to medicine wards and ICUs, the overwhelming feeling was one of teamwork. Residents spearheaded advocacy projects to address inequities highlighted by lockdowns, such as food insecurity, access to contraception, and increases in domestic violence. A text I received from a co-resident early in the pandemic sums it up: “Put me in, coach!”

Our sense of connection has also been strengthened by the ability to pivot academic and social activities to a virtual setting. Online academic half-days allow for flexibility of learning styles and settings. The annual Resident Retreat became a successful virtual event where we enjoyed a cooking class and fruitful conversations. The intranet COVID-19 Home Page and Virtual Town Hall meetings, once scheduled weekly and now as needed, provide us with the opportunity to discuss questions and concerns, learn updated information, and share resources for both work and life.

Over 18 months into the new reality of our residency training, our group has celebrated engagements, weddings, and babies. We have been busy carrying out projects and presenting virtually at conferences in dizzying time zones. We have welcomed two new cohorts of residents, one following an entirely virtual CaRMS process; two classes have graduated virtually and moved onto the next phases of their careers. If the pundits are right, this will not be the last pandemic. We are gaining valuable lessons to lead our communities through these future challenges – an unexpected but important twist on the Royal College Residency Objectives.

Disseminating reliable knowledge to the public in innovative ways

Dr. Eliane Shore, assistant professor and obstetrician-gynaecologist at St. Michael's Hospital

Building community through COVID

Dr. Modupe Tunde-Byass, assistant professor and obstetrician-gynaecologist at North York General Hospital

On March 11, 2020, the WHO declared a pandemic. Most of us have never lived through one and I thought that life would be back to normal within a year maximum. The COVID-19 pandemic has created a life-changing experience for me as a community-based physician. It feels like the whole world is at war with a virus but the battalions are divided and are not taking orders from the general. Questioning science was much easier to do than change our ways of life.

At the beginning of the pandemic, there was not enough PPE; wearing two masks for the whole day was an unthinkable act that would have led to reprimands pre-pandemic. Public health updates were too frequent to keep up with. The university withdrew all learners, and most office appointments were rescheduled to virtual care. Assessment centers for COVID-19 testing were erected, pandemic protocols were in place, operating rooms were subjected to negative pressure and elective/low-grade cancer surgeries were on hold indefinitely. The roads were empty. It took half the time to commute to work every day and healthcare workers were seen as heroes.

Visitor restriction meant heartbreaking separation for new families after delivery. The devastation of COVID-19 was real as I witnessed it when I was deployed to a medical floor. Additionally, transferring an unvaccinated pregnant patient from our ICU to a tertiary center during the third wave exemplified the danger of excluding pregnant and breastfeeding individuals during Phase 1 and 2 trials of the vaccine development.

All community hospitals have worked hard to maintain a high standard of care, even as we have navigated the intense challenges of the pandemic. At North York General, we achieved an accreditation score of 99.8% despite COVID-19's effects. In the end, our goal remains unchanged: to provide the best care to our patients we can.

And as a Black physician, the disproportionate effect of COVID-19 on the Black community has encouraged me to reach out to my community through media, webinars, town hall meetings and as a vaccinator, increase vaccine confidence and uptake. It has been a truly remarkable and rewarding experience for me.

Making lemonade out of lemons: CME's pivot to the virtual space

Elizabeth Gan, CME administrative course director

On Wednesday, May 13, 2020, in the early days of COVID, when things were scary and there was no vaccine on the horizon, we ran a first Zoom live webcast, the 29th Annual New Developments in Prenatal Diagnosis and Medical Genetics. With each subsequent webcast, we learned what worked and what needed to improve and in the ensuing twelve months (Sept 2020 – June 2021), the Dept. of Obstetrics & Gynaecology successfully hosted fifteen online postgraduate programs educating a total of 6,375 participants on a broad range of topics related to women’s health.

How has COVID changed our approach to post-graduate education?

• Many full-day programs have shifted to half-day programs (9:00 am - 12:30 pm)
• Talks have become shorter and more focused (usually 15 to 20 minute talks)
• The audience has expanded numerically - a program that once would have attracted 300 registrants now attracts over 500 people
• The audience has expanded geographically - some programs have had representatives from fourteen different countries - but perhaps even more significantly, our programs are now accessible to communities through Ontario (Sioux Lookout, Wawa, Thunder Bay etc.) and across Canada
• Audience expectations have shifted - with online webcasts, everyone asks questions and there is the expectation that all questions will be answered (this is significant when you realize that some programs have had over 350 questions posted in the Q and A box!)
• All programs are recorded so people can go back and watch certain lectures an excellent learning tool for reinforcing learning and amazing for busy clinicians who sometimes have to miss lectures because of work responsibilities

What does this mean for the future? It is likely that some facets of COVID will remain even after the end of the pandemic, though it is difficult to know exactly what this will look like. The pandemic forced us to change the way we deliver postgraduate education and we will continue to adapt to a future hybrid program that ensures accessibility and enrichment for faculty members.

The admin team at 123 Edward steps up

Salvo Candela, business manager

When we returned from the holiday break in early 2020, we at 123 Edward prepared for the familiar cycle of the coming winter term, unaware of what was to come. I myself had just spent three weeks in Italy, celebrating the Christmas and New Year holidays with family while nursing a strange and nagging dry cough the entire time. This was well before “COVID-19” entered the lexicon, and I was blissfully unaware that Italy was about to become a global pandemic hotspot.

Each day, we on the administrative team support hundreds of physicians on the front line, in operating rooms and clinics across the GTA, and doing so is a great privilege. As COVID-19 established itself in Toronto through February, we became more and more concerned as Ob-Gyn faculty and trainees—our colleagues and friends—shared their news of how the pandemic was impacting their work in the hospitals. From our perch on the 12th floor of 123 Edward, and later from our living rooms and kitchen tables, we sprang into action, pivoting our Department’s operations in light of new restrictions and doing our best to clear the way for physicians to focus on the pandemic effort.

And pivot we did! Clerkship training was abruptly halted, with block schedules impacted for a full year afterward. All global health activities ceased, and the regular flow of colleagues between U of T and Moi University in Kenya came to a halt. Our residents were redeployed all over the city, with an associated disruption to months of careful administrative planning, rotation scheduling, and fulfilment of curricular requirements. After months of preparing for Research Day 2020, we were forced to cancel the event with only six weeks’ notice, with over 120 abstracts already submitted. Graduation was initially cancelled, but we decided to attempt a Zoom version with a couple of weeks to plan it. “Rise to the occasion” was a phrase we found ourselves constantly repeating.

Much to our dismay, as those first months of the pandemic transitioned into the 2020-2021 academic year, we realized that the pandemic would be measured in years, not weeks or months as we had initially hoped. Words cannot fully express how proud I am to lead a team of such dedicated, supportive administrators, in spite of all this. At the end of this academic year, with the pandemic still raging, I am amazed every day by the level of teamwork and camaraderie displayed by our staff, even as our interactions have been confined to the Brady Bunch lens of endless Zoom calls.

We have now pulled off virtual versions of CaRMS interviews, Academic Half-Days, OSCEs and clerkship exams, interhospital rounds, and countless committee meetings. We have managed to pull our community together for online versions of Research Day, Faculty Professional Development Day, and Graduation. We have onboarded new colleagues who have never set foot in our physical offices, and have warmly welcomed them to the team. We have demonstrated flexibility and empathy as we each react to the demands of childcare and eldercare amid the pandemic.

And most importantly, we have continued to do the job we are most proud of: ensuring that our Department continues its track record of excellence in all facets of academic medicine, advocacy and in clinical care.