Ob-gyn faculty members give medical students real-world research experience

Diya Ahmad supervised by Dr. John Snelgrove

This summer, I was fortunate enough to work on an incredibly interesting project about preterm birth under the leadership of Dr. John Snelgrove and Dr. Lennart Van Der Veeken. This project asks the question, "Antenatal corticosteroids (ACS): how do we get the timing right?" Through this experience, I learned that although clinicians are aware of the optimal window to administer ACS (48hours-7days before delivery) in cases of preterm birth to mature the baby's lungs, that rarely ends up happening in practice. Our project sought to figure out why this happens by looking at patient data from all patients treated with ACS at Sinai from 2012-2021, specifically looking at optimally given ACS% per indication and evolution over 10 years. Although we faced delays in our project, I had the opportunity to begin a scoping review and study existing guidelines for ACS administration. I've now begun sifting through patient data, to further stratify the primary, secondary, and tertiary diagnoses for such patients, providing insight into why they were administered ACS in the first place. I'm incredibly excited to continue my involvement and help expand our existing knowledge of how best to deliver this intervention that can be truly life-saving, if done so in the right way.

The CREMS program has been incredibly influential in not only developing my research skills, but better understanding the field of OB/GYN and the importance of researched that is focused on quality improvement. This program taught me to question knowledge. Once an intervention is implemented, it is still our duty to evaluate whether or not it's being used to the best of its ability. I can now see myself as a future clinician, specifically being drawn to research that addresses problems that my patients face in regular practice. I've come to appreciate the fact that medicine is iterative and it must be so to improve the way patients are cared for in their most vulnerable moments. Further, this program has further piqued my interest in OB/GYN as a specialty. I've realized that I enjoy how multifaceted the field is: how we must consider much more than just the patient's current pregnancy such as their comorbidities, their obstetrical history, and their social supports. I've learned how to review progress notes systematically and as a result, appreciated the window into patient's lives that they offer. I now look forward to continuing exploring this field through both a research and clinical lens.

Isabella Aversa supervised by Dr. Lilian Gien

This summer, I had the privilege of working on a research project with Dr. Gien and Dr. Cornel at Sunnybrook Hospital. Our project was a retrospective cohort study, focused on the management of recurrent vulvar cancer in the era of the sentinel lymph node procedure. The goal of our study was to describe the management and outcomes of local, groin, and distant vulvar cancer recurrence, among those who previously had a sentinel lymph node procedure done for their primary cancer.

Initially, my role was to work alongside Dr. Gien and Dr. Cornel to formulate a research plan. This included narrowing down our study population and inclusion/exclusion criteria. After doing a literature search, I was able to help create our research questions and choose the data we wanted to collect. Following this, I collected data from patient charts to create the dataset for our study. During this process, Dr. Gien and Dr. Cornel supported me through weekly meetings and taught me about vulvar cancer and it's management.

The CREMS program was a wonderful learning experience that exposed me to the field of ob-gyn research. Dr. Gien and Dr. Cornel were a pleasure to work with, and excellent teachers. Working with them through the CREMS program allowed me to learn about vulvar cancer, including it's epidemiology and treatment.

This project was the first exposure I had to clinical research, including collecting data from patient charts and creating a new dataset. Additionally, I was able to learn more about creating a clear research plan and methods. I hope to apply the skills I gained through this research opportunity into my future research projects as a medical student. I am so grateful for this opportunity to explore my interest in the field of ob-gyn and receive mentorship from Dr. Gien and Dr. Cornel.

Nicole Cherepacha supervised by Dr. Stefania Ronzoni

This summer, I was very fortunate to work with Dr. Stefania Ronzoni on a project that explored early detection of fetal anomalies in the first trimester of pregnancy. Studies have shown that as early as the nuchal translucency (NT) scan performed between 11-13 weeks, there is potential to identify a significant proportion of fetuses affected with structural malformations. This early identification would allow for earlier investigation, diagnostic confirmation, and earlier decision-making opportunity for families.

In 2021 at the Sunnybrook DAN Women and Babies Program, a basic anatomy checklist for all singleton and multiple pregnancies was implemented during the routine NT ultrasound. Using the checklist, sonographers indicate if structures such as the heart, spine, and limbs appeared normal, abnormal, or were not well seen within the time allocated for NT scans.

For my project, I have been looking all NT ultrasounds performed between 2019 and 2023 at Sunnybrook and extracting data from ultrasound reports, maternal obstetrical history, delivery data, and neonatal outcomes. By collecting data from scans done both before and after the implementation of the checklist in 2021, we can determine if the checklist was associated with good performance in visualizing anatomical structures, and ultimately compare the detection rates for fetal anomalies before vs. after the checklist was implemented.

Working with Dr. Ronzoni was an incredible opportunity to learn more about the field of maternal fetal medicine. Through shadowing her in the high- and low-risk pregnancy clinics and learning about her patients, I’ve gained a deeper appreciation for how MFM physicians support and guide patients throughout their pregnancy journeys and empower them through informed decision-making.

A highlight of my experience this summer was the chance to work with the interdisciplinary team at Sunnybrook, particularly the wonderful team of diagnostic medical sonographers led by Vasi Stratulat. After spending time with Vasi performing NT scans and other obstetrical sonography tests, I discovered the incredible impact that a skilled and empathetic sonographer can make in a person's pregnancy experience, whether the result of the scan is positive or difficult news.

Through this project I have gained research skills in the collection and management of large datasets, and I’m looking forward to learning about statistical analysis techniques for analyzing and interpreting our results. I will undoubtably use these skills in my career in the future, and am inspired to continue exploring research work that involves the design and implementation of protocols/procedures that improve quality of care for patients. I’m grateful to the Chair’s program, Stefania, and Vasi for this experience in clinical research!

Stephanie Dephoure supervised by Dr. Julie Thorne

This summer, I had the incredible opportunity to contribute to the project, “Evaluation of a Virtual 'No Touch' Abortion Program Implemented in the Greater Toronto Area During the COVID-19 Pandemic.” This is a continuation of work completed last summer, now focused on evaluating the experience of patients who accessed abortion care through this novel model. Alongside the team, I collected contact data for participant recruitment and launched an electronic survey to assess the feasibility, acceptability, and appropriateness of abortion care received through the program. In addition, I contributed to work on another phase of the project which aims to conduct qualitative interviews to elicit patient motivations for choosing “No-Touch” care, and how the context of the COVID-19 pandemic may have influenced this. I also had the opportunity to assist the team with preparing a new REB for a quality assessment of the “No-Touch” program, with the aim of evaluating the ongoing need for this model of abortion care beyond the COVID-19 pandemic.

I was also able to assist Dr. Thorne on the development of a patient experience survey for patients receiving abortion care or contraceptive counselling at the Bay Center for Birth Control at Women’s College Hospital, which we hope to launch shortly.

I am incredibly grateful for the opportunity to work with Dr. Julie Thorne, and the other members of the No-Touch team - their work continues to both inspire and motivate me to find ways to intersect advocacy work and medicine to improve patient care.

My participation in the CREMS program has been invaluable in demonstrating to me the power and necessity of intersecting advocacy-based efforts with clinical medicine in order to provide patient care that is meaningful, impactful, and accessible. I came into the project as a strong advocate for the necessity of accessible abortion care for all, and am leaving my summer with an even-stronger conviction surrounding the importance of this work and a motivation to incorporate advocacy-focused research into my future practice as a clinician.

In addition, the clinical shadowing experiences that supplemented my research work both humanized the care and procedures I was learning about, but further, made the purpose of our work tangible, from both the patient and clinician perspective. I look forward to creating a career where I can contribute to the well-being of patients from multiple facets: clinical care, research work and advocacy-based efforts.

Olivia Facchin supervised by Dr. Melissa Tai

Over the summer, I had the absolute pleasure of working with Dr. Melissa Tai on a quality improvement project in the Family Birthing Center (FBC) of Michael Garron Hospital (MGH). Historically, MGH has a higher incidence of obstetric anal sphincter injuries (OASIS) compared to the provincial average, and non-English speaking mothers are at greater risk of sustaining perineal trauma during delivery. To combat the communication barriers that predispose labouring mothers to OASIS, we developed and implemented a patient education module that uses diverse visual aids to help mothers understand the stages of the vaginal delivery process.

Throughout the summer, I was involved in trialing the preliminary education module with labouring mothers; I met directly with patients during the intrapartum period to facilitate the module and teach them about what to expect during their delivery, and I would follow up with them in the postpartum period to survey their perception of the module and their overall birthing experience. I worked alongside the team of interdisciplinary health care professionals in the FBC, including obstetricians, midwives, and nurses. As the module becomes incorporated into standard-of-care in the FBC, I will be involved in data analysis of birth outcomes to assess the incidence rate of perineal tears and patient satisfaction, pre and post implementation of the module.

It was incredibly rewarding to be involved in patient care and help empower women with health literacy. Moreover, in working with the FBC staff, I was able to appreciate the invaluable role that each member of a team plays in providing optimal patient care and fostering a healthy work environment. Beyond the research project, Dr. Tai generously gave me the opportunity to observe her practice in gynaecological surgery. This was an enriching experience that allowed me to further explore my interest in the speciality under the supervision of an incredible role model. Both the CREMS program and Dr. Tai’s mentorship provided me with fulfilling research and clinical experience that has equipped me with skills to excel in research, advocate for patients, and foster strong patient-provider relationships.

Kimia Ghannad-Zadeh supervised by Dr. Shiri Shinar

I participated in data collection and analysis for a retrospective cohort study titled fetal aqueductal stenosis - from prenatal diagnosis to postnatal obstetric, surgical and neurodevelopmental outcomes. This was a retrospective cohort study of neonates with prenatally suspected aqueductal stenosis, which we later expanded to triventriculomegaly, who delivered at Mount Sinai Hospital between Jan 2009 and Jan 2023. Prenatal and post-natal ultrasound and MR images and specific variables from imaging were collected as well as neonatal outcomes. The aim of this study was to describe US and MR findings diagnostic of congenital aqueductal stenosis (CAS), to describe distribution of causes of CAS and genetic testing results, and to describe neonatal developmental outcomes in infants with CAS and triventriculomegaly.

Through this project, not only did I expand my skills as a clinical researchers, I also gained a deeper understanding of fetal neurodevelopment. This experience allowed me further explore my interest in the field of maternal fetal medicine, and made me further realize my passion for neurology and neurodevelopment as a medical field.

Dr. Shinar has been a wonderful mentor, both in the clinical and research setting, and has served as a role model for me in my medical training.

I believe this experience has allowed me to further narrow down the field in which I want to practice medicine in the future, and to also realize that research, possibly in the field of neurodevelopment, is something that I would want to integrate into my practice as a core element.

Hayley Good supervised by Dr. Karen Glass

This summer, I had the pleasure of working with Dr. Karen Glass and Dr. Maya Sharon-Weiner at CReATe Fertility Centre on a retrospective study titled “18-year analysis of fertility preservation in young women with cancer in a single academic centre”. As cancers and their treatments can profoundly impact a patient’s fertility, fertility preservation is recommended prior to cancer therapy in patients who would like to have children post-treatment. Women diagnosed with cancer have been referred to Dr. Glass to discuss fertility preservation options for over 18 years. Therefore, we aimed to establish an oncofertility database for the collection and analysis of long-term patient data and outcomes. To do this, we collected various primary outcomes from 875 individuals assigned female at birth, aged 18-48 years, referred to CReATe with a diagnosis of cancer since 2006. Our collected data includes patient characteristics, cancer characteristics, IVF parameters and outcomes, and pregnancy outcomes. We are currently working on the data analysis phase of the project for which our extensive database will allow us to provide improved clinical insight and counselling around fertility preservation in patients diagnosed with cancer.

I am very grateful to have had the opportunity to be a part of the research program at CReATe Fertility Centre this summer. Through this project, I was able to expand on my previous clinical research experience and further explore my interest in the field of obstetrics and gynecology. I also had the opportunity to observe and assist in the clinical care of oncofertility patients which provided me with profound insight into the challenges faced by cancer patients in the preservation of their fertility, further reinforcing the importance of our study. I am looking forward to continuing my work on this project as we proceed with data analysis, manuscript writing, and dissemination of our findings. A sincere thank you to Drs. Glass and Weiner for their incredible guidance and support throughout this project. They truly created an excellent learning environment and taught me so much. It was an overall great experience to be a part of the Chair’s Summer Research Program this summer!

Elizabeth Hall supervised by Dr. Liat Hogen

This summer, I was very excited to have the opportunity to work on a project supervised by Dr. Liat Hogen. The aim of the project was to compare surgical outcomes after cytoreductive surgery between homologous recombination deficiency (HRD) positive and HRD negative high-grade serous ovarian cancers. My responsibilities included collecting data through a retrospective chart review. I learned how surgical complexity scores are calculated based on a patient’s disease status at diagnosis, and how these scores along with other clinical variables are used to determine whether a patient is a good surgical candidate or should receive neoadjuvant chemotherapy. I created a database with detailed information about each patient’s prognosis, pre-op levels, post-op levels, treatment course, and survival. Dr. Hogen taught me how to read CT reports, and how to formulate a statistical plan, so our data could be analyzed. I am very grateful to have had Dr. Hogen as my supervisor. Her mentorship and expertise were invaluable, and she taught me many skills for pursuing clinical research, especially in the field of gynaecologic oncology.

Participating in this CREMs project inspired my love for pursuing research in oncology. With Dr. Hogen’s support, I learned about the clinical and radiological characteristics of various stages of epithelial ovarian cancers, as well as the different treatment modalities currently in use and available. I also learned about the exciting frontier of genetic testing, and how genotype results may be combined with other clinical variables to tailor treatments to patients and ensure that each patient receives the best possible care. I believe that the opportunity to combine genotypic information with clinical data is very exciting, and offers growing opportunities for improving treatments, especially in the field of oncology. With a strong foundation of knowledge about ovarian cancers, I look forward to participating in future research projects and pursuing clinical electives in gynecologic oncology.

Nina Harris supervised by Dr. Claire Jones

This summer I had the wonderful opportunity to work with Dr. Claire Jones on a project exploring whether shift work is associated with lower ovarian reserve among fertility patients. We conducted a retrospective cohort study in which we reviewed patient charts to extract demographic data, work schedules and anti-mullerian hormone levels. Shift work is on the rise globally including in Canada and has been linked to worse health outcomes such as irregular menstruation and increased risk of requiring assistive reproductive technologies. However, few studies have examined the association between shift work and ovarian reserve. This is the first study that we are aware of investigating shift work in a fertility patient population and analyzing anti-mullerian hormone levels which is the gold standard for assessing ovarian reserve in fertility patients. This project could have implications for shift working patients who are interested in fertility preservation as well as advocacy around incentivizing employers to assist with the high costs associated with requiring fertility treatment.

The CREMS summer program was my first opportunity to conduct clinical research as my previous experiences have all been in a laboratory setting. As well as working on data extraction, I had the opportunity to shadow Dr. Jones in clinic for a few days at the start of the program. I found it gratifying to interface with the patient population we were studying and to reflect on how our research could tangibly contribute to clinical decisions in the future. I have been interested in circadian rhythms research for several years and combining it with my interests in women’s health and reproductive medicine was inspiring and engaging. I am hoping to continue this line of research in the future.

Sara Ibrahim supervised by Dr. Heather Millar

This summer I had the privilege of working with Dr. Heather Millar on a project titled “Understanding Patient Experiences of Late Terminations in a Tertiary Care Centre in Ontario.” Over the course of the summer, I conducted a literature review and assisted with the REB submission. I also had the opportunity to shadow physicians and allied health professionals at both the Bay Centre and Mount Sinai Hospital, which provided me with insight into the process of accessing termination of pregnancy care in Toronto. Further, I am currently creating a patient care guide for individuals accessing late termination of pregnancy care. This guide will outline the sequence of appointments, their respective purposes, and locations, in order to provide patients with a readily available reference to navigate their care journey.

Now that our REB has been submitted, we are hoping to begin interviewing patients in the near future. We hope to ultimately use the insights from this study to identify ways to assist with improving access to early pregnancy termination, regardless of indication. Additionally, we plan to implement changes in clinical practices to enhance patient experiences while accessing care within this program. We also hope to use our findings as a foundation to advocate for increased access to similar programs across Canada.

As the first medical student in my immediate and extended family, my familiarity with various specialties in medicine has primarily come from my own personal experiences as a patient. Through my summer research experience as a Chair’s Program Research Student, I have gained an understanding of how broad of a specialty Ob-Gyn is through my shadowing opportunities in spaces I normally would not have access to during clerkship. Being involved with this project and participating in the engaging weekly journal club led by Dr. Heather Millar, Dr. Julie Thorne, and Dr. Rachel Spitzer allowed me to develop my research and critical appraisal skills while also deepening my interest in both global health and the field of Ob-Gyn. Further, my time spent shadowing Dr. Millar has granted me a firsthand look at the implementation of a trauma-informed care approach and inclusive practices, which I aspire to incorporate into my own practice as a medical student and future physician. Dr. Millar is an excellent physician, role model, and mentor. I am grateful for the opportunity to have worked alongside her this summer while also learning more about the wonderful field of Ob-Gyn, and I am looking forward to continuing our work together!

Sofia Ivanisevic supervised by Dr. Mara Sobel

This summer I had the privilege of working under the supervision of Dr. Mara Sobel and Dr. Shirin Dason on their project titled “A prospective observational study assessing prevalence of transvaginal ultrasound features of adenomyosis in a general gynecologic population.” Our goal was to apply new criteria designed for assessing adenomyosis ultrasound features to patients who were completing a non-obstetric pelvic/transvaginal ultrasound. Our goal was to better delineate which clinical features of adenomyosis are related to specific ultrasound findings in order to validate and optimize the newly published ultrasound criteria and differentiate possible sub-types of adenomyosis. Alongside recruiting patients with upcoming ultrasounds and facilitating data collection, I had the privilege of exploring the variety of sub-specialties in the field of OBGYN when shadowing my supervisors’ fertility, obstetric, and gynaecology clinics and ORs.

The Chair’s program has provided my a special opportunity to learn more about the field of obstetrics and gynecology, reignite my passion for research, and witness the intersection of clinical research and patient care. Moreover, I had the privilege of working directly with supervisors that modelled what it means to be an outstanding teacher and physician. Through witnessing Dr. Sobel and Dr. Dason’s interactions with patients, colleagues, and learners, I learned invaluable lessons about building rapport, facilitating inter-disciplinary collaboration, and creating safe and encouraging spaces for learning. I am endlessly grateful for the opportunities the Chair’s program has provided me to not only work alongside inspiring mentors, but to engage in research that can one day improve patient care.

Amine Kaab supervised by Dr. A. Kinga Malinowski

This summer, I had the great pleasure of working with Dr. A. Kinga Malinowski on several studies aimed at investigating and describing the maternal and fetal effects of hydroxyurea usage in the pregnancy of sickle cell disease patients as part of the CREMS summer research program. Sickle cell disease (SCD) is a life-threatening genetic condition contributing to high-risk pregnancies that affect both the mother and fetus. Currently, hydroxyurea (HU) is the primary disease-modifying therapy for SCD but is contraindicated in pregnancy owing to teratogenicity concerns stemming from animal studies. This renders a subset of pregnant patients, who are ineligible for transfusion, without access to any disease-modifying treatment. However, clinical experience of hydroxyurea use during pregnancy has been reported with varying but generally favourable outcomes.

Over the summer, I conducted a retrospective chart review of patients undergoing hydroxyurea treatment in the Special Pregnancy Program at Sinai Health. I collected data on patients’ SCD complications, hospitalization, hydroxyurea urea treatment schedule, and pregnancy outcomes to capture their clinical course and experience taking HU. Additionally, I conducted a scoping review of relevant published cases, including our own, to contribute to the limited literature on the subject, explore the potential for the judicious use of HU in pregnancy, and champion its need for further investigation. I am excited to be continuing this work throughout the year under the delightful supervision of Dr. Malinowski!

My involvement in the CREMS program this summer has given me a great insight into what clinical research as a practicing physician can look like, including common challenges that may come up and how to pivot in a direction that does not compromise your goals. It also enabled me to expand my skill set by learning to use new research methods and tools, and engaging in phases of the research process that I had not previously been involved in, such as protocol development. During this summer, I learned so much about OB/GYN as a specialty and the numerous services, programs, and experts involved in supporting maternal and fetal health. Working on this project gave me hope that we will make a difference in the lives of many patients and I am optimistic that our efforts will play a role in reshaping clinical practice and perspective for the better.

Above all, I am profoundly thankful for the opportunity to work under the guidance of Dr. Malinowski. She has been incredibly supportive and accommodating, and I admire her ability to simplify complex concepts and her enthusiasm for teaching. Furthermore, I appreciate her commitment to ensuring that I had the guidance and mentorship necessary for success throughout the project. I would like to thank Dr. Malinowski for creating a wonderful learning environment for me this summer and I look forward to continuing our work together!

Robbie Kloosterman supervised by Dr. Nucelio Lemos

This summer I had the opportunity to work with Dr. Nucelio Lemos in the Department of Urogynaecology. I was working alongside Liam Doyle, another medical student, and our research focused on chronic recalcitrant cystitis (CRC) which is a complex form of urinary tract infection (UTI) often described in people with chronic lower urinary tract symptoms (LUTS). Short courses of antibiotics may initially improve symptoms in CRC, but many patients experience chronic LUTS, likely caused by bacterial spore reservoirs forming within the interstitium of the bladder. The project I worked on was a retrospective chart review evaluating the use of long-term antibiotics in patients with CRC. I learnt how to navigate and extract information from electronic medical records and import the data into REDCap, a data-management system for clinical research. This project is still undergoing, and I am excited to continue working on it throughout the year. It has been exciting to work on a study evaluating an unconventional use of antibiotics to treat a patient population that is often dismissed by the healthcare system. Over the summer I also had the opportunity to recruit patients for various other research projects and help develop a CIHR grant.

Until this summer, the majority of my research experience was in basic science. I am immensely grateful for this opportunity provided by the Chair’s Summer Student Award to explore clinical research and it has solidified my desire to be involved in research throughout my career. I also had the opportunity to shadow Dr. Lemos in the clinic and operating room where I was able to strengthen my history taking skills and some basic surgical skills. This experience has made me very excited for clerkship and has furthered my interest in pursuing Ob/Gyn as a career. I would like to thank Dr. Lemos and the urogynaecology research unit for an amazing summer and I am looking forward to working with them further!

Gabriela Leon supervised by Dr. Jamie Kroft

I had the pleasure of working with Dr. Jamie Kroft this summer on a project assessing the implementation of a new ‘single-entry model’ clinic for centrally triaging endometriosis patients in the GTA. Our project was aiming to assess whether this new model of clinic improves patient and provider satisfaction, as well as decreases wait times to see an endometriosis specialist in the GTA.

Like any good research project on a limited time frame, we spent a chunk of our time waiting for REB approval. Fortunately, there was lots of work to do in the meantime – I wrote several grant proposals for funding, created patient and provider educational materials for distribution, and worked on setting up the EMR to optimize patient flow. I learned a lot about the technicalities of setting up research projects and how much behind the scenes work must happen to create a functioning initiative. The project is now largely set up to begin seeing patients, and I plan to stay involved to collect data and analyze preliminary outcomes, to assess if this type of clinic can be effective for endometriosis care.

The CREMS program is a great opportunity for medical students to explore different types of research in a safe learning environment. This was my first experience on a quality improvement initiative. I enjoyed being able to explore an aspect of research that I had not yet encountered, and think that I would like to continue with similar projects in the future, as I was able to see how much of an impact they can make on the care that patients receive, as well as the care that clinicians are able to provide. I feel very fortunate to be able to contribute to a project that will help endometriosis patients receive faster diagnoses and higher quality care. I was also able to explore the clinical side of obstetrics and gynaecology which helped confirm that it is a field I am interested in.

I was extremely fortunate to have the opportunity to work with Dr. Kroft, who is not only an incredible clinician but also a kind, understanding and supportive mentor and role model. She has so many incredible qualities that I hope to emulate in my own clinical practice as I move forwards in my training. I am excited to continue working with her in the future and am grateful to the CREMS Summer Student Program and the Department of Obstetrics and Gynaecology for this opportunity!

Kara Ly supervised by Dr. Wendy Wolfman

I had the incredible opportunity to work under Dr. Wendy Wolfman and Dr. Meenakshi Goel on a project about the use of systemic hormone therapy for menopausal symptoms in patients over the age of 65. I had the task of contributing to a chart review featuring data from patients of The Menopause Clinic at Mount Sinai Hospital. This included data collection, data organization, and manuscript writing. I thoroughly enjoyed learning about the management of menopause symptoms, and recognizing areas where research could better inform clinical decision-making. This chart review is the first project in a three-stage study to better understand the characteristics and motivations of women over the age of 65 using systemic hormone therapy. It was an incredible pleasure to learn about the entire research process, and how such detailed studies are designed and implemented.

Both Dr. Wolfman and Dr. Goel were incredibly kind and patient in teaching me about menopause and women’s health. I loved gaining in-depth knowledge about the management of menopause symptoms, and how research plays an integral role in progressing the quality of patient care. This experience has been incredibly influential in the development of my research and critical thinking skills as a future physician. I have become much more comfortable in navigating the methodology required to ensure clinical research is performed with rigour and validity. I also gained a newfound appreciation for the joys of research and how rewarding it is to contribute to the advancement of healthcare. In addition to participating in research, Dr. Wolfman, Dr. Goel, and the entire staff at the Menopause Clinic were kind enough to introduce me to how the clinic operates and allow me to shadow their work. I’m grateful for everyone I’ve met through this experience that took the time to support my learning, development, and career.

Claire Mazzia supervised by Dr. Anne Berndl

The project I worked on for the CREMS 2023 program is called the Spinal Cord Injury, Urogenital Health and Pregnancy (SCI-UP) project. The overall goal of the project is to understand how urogenital, bowel and reproductive health are impacted by SCI in people who were assigned female at birth (AFAB). This summer we focused on our data looking at the bowel function in people with SCI who had a pregnancy after injury compared to those who have never had a pregnancy. We were interested to see if pregnancy, as well as other factors, impact bowel dysfunction in this population. Bowel function is an essential aspect of our health that has a huge impact on quality of life, and it is often affected by SCI. This summer we identified participants that fit into our case and control groups and prepared the data for analysis. I worked closely with other team members including Dr. Anne Berndl as well as a statistician and research coordinator to perform the data analysis and interpret the results. I also wrote manuscripts, conducted background research and created presentations to share our work with other experts in the field. Finally, I had the opportunity to present our research at the SOGC conference in Ottawa which was a highlight of my experience this summer. I am very proud of the work Dr. Berndl and our team have accomplished on this project.

Working on the SCI-UP project through the CREMS program has been an incredible learning experience. It has really helped me appreciate the many challenges that come with building the body of knowledge in an area of medicine where we know very little. As a medical student and future physician, it has helped me understand that improving treatment and healthcare all begins with research. I also hope to provide higher quality care to people with disabilities now that I have a deeper understanding of barriers to accessibility of healthcare services. I am grateful for the opportunity to do this work with the mentorship and support from Dr. Berndl and to share our findings with patients and healthcare providers serving with people with SCI.

Michal Moshkovich supervised by Dr. Rachel Soyoun Kim

This summer I was fortunate to work with Dr. Rachel Soyoun Kim and Dr. Sarah Ferguson on the project, “Understanding the clinical implications of MLH1 methylation in endometrial cancer.” Our goal was to determine the relationship between MLH1 methylation status and clinicopathologic features (age at diagnosis, BMI, FIGO grade, myometrial invasion, lymphovascular space invasion, lymph node status, stage and median tumor size) to understand the reason behind the worse survival outcomes associated with MLH1 methylated endometrial cancers (ECs) compared to other DNA mismatch repair (MMR) deficient or MMR intact ECs.

I contributed to the study design through the creation of a data dictionary used to classify all the study’s variables. Using REDCap, I built a registry to enter our collected clinical data for multivariable analysis. A total of 569 patients with newly diagnosed ECs (from 2015 onwards) from 3 Ontario cancer centers were retrospectively identified. I learned how to use both EPIC & EPR (UHN health information systems) to read patient charts and extract data for entry into our REDCap database. We submitted our work to the Society of Gynaecologic Oncology conference (SGO) and the Gynaecology Oncology Society of Canada conference (GOC).

I am very grateful for my experience within the CREMS program as it provided me with the opportunity to explore the OBGYN field through both bench and bedside capacities. Dr. Rachel Soyoun Kim and Dr. Sarah Ferguson were incredible mentors to me. They taught me how to tackle clinical research study design, as well as data collection, analysis, and presentation, while also allowing me to shadow their surgeries in the OR and participate in clinical encounters. I was inspired by my supervisors during patient encounters as I absorbed the way they treated each patient with the utmost empathy, supporting and advocating for them from their initial diagnosis to treatment. I plan to embody this patient-centred focus throughout my career, while also exhibiting a clinician/scientist role in advancing research for future disease management. I was also very lucky to have worked closely with Dr. Oleksandra Dzyubak on my project. She was very supportive of my learning, and always encouraged me to ask questions, which she answered with great detail and excitement. This summer was a wonderful learning experience for me, and I am excited to apply everything I have learned into practice!

Raeesha Rajan supervised by Dr. Lisa Allen

This summer I was fortunate to have the incredible opportunity to take on a retrospective chart review under the supervision of Dr. Lisa Allen, Dr. Sari Kives and Dr. Valerie Bloomfield on topic of Pediatric & Adolescent Gynecology. The aim of the project was to evaluate referrals from primary care providers for adolescents with heavy menstrual bleeding to the gynecology team at SickKids Hospital. At the time of my appointment as a full-time Summer Research Student, REB had been approved and relevant patients were identified by Decision Services. I had the chance to pilot and then conduct edibility screening and data abstraction on the identified charts, inputting all relevant data into REDCap. Through this, I had the opportunity to familiarize myself with the kinds of cases that would present to the gynecology team at SickKids and learn about the ways in which these patients were cared for, counselled and managed. I also learnt practical skills on ways to read and interpret charts when data abstracting. With this project, I engaged in preliminary data analysis, and had the opportunity to present my progress and findings to some of the pediatric & adolescent gynecology team at SickKids, as well as at the UofT OB-GYN Department Research Night. These were excellent opportunities to gain insight and feedback to be incorporated in final data analyses and manuscript write-up. I look forward to completing data abstraction and data analysis, as well as publishing and presenting our results at national and international conferences.

Engaging in research through the CREMS program has undoubtedly been one of the highlights of my medical school journey so far. By engaging as a primary contributor on this project, I built on my understanding of clinical epidemiology and gained valuable insight into the field of OB-GYN. I also had numerous opportunities to shadow in clinical and OR settings, and network with the team of staff, fellows, and residents of the Pediatric & Adolescent Gynecology team at SickKids. These opportunities were important in highlighting how research, conducted through studies similar to mine, are cornerstone to developing clinical practice guidelines that are actively utilized during patient encounters, and in determining the best course of management for patients. Given the pervasiveness of heavy menstrual bleeding among the adolescent population, seeing the way my preceptors counselled these patients and empowered them with management tools shaped the ways I hope to provide care to my future patients.

Beyond these opportunities, I am so grateful for the countless support and mentorship by Dr. Lisa Allen, Dr. Sari Kives and Dr. Valerie Bloomfield, as well as the rest of the Paediatric & Adolescent Gynaecology team throughout this summer. They have showcased great research and clinical conduct and instilled the importance of using evidence-based practice to guide clinical encounters. Importantly, they have influenced my motivation to continue to learn about the field of OB-GYN, as well as to continue to engage in research endeavours as a student and future physician.

Sabrin Sanjana supervised by Dr. Rachel Spitzer

This summer, I had the privilege of working with Dr. Rachel Spitzer on developing the Sinai SUPport clinic, a pilot program designed to meet the needs of people using substances in pregnancy. Our project's overall aim is to provide comprehensive interdisciplinary care, including high and low risk prenatal care and delivery care, addictions and mental health care, termination of pregnancy if desired, and social support throughout the care pathway, all in one clinic space where patients will have access to psychiatry and addictions medicine specialists, obstetricians, midwives, and social workers. As a summer student, alongside eliciting expert opinion on the clinic's design and implementation, I was able to shadow the labour and delivery floor, participate in obstetrics, gynecology, and termination clinics, and learn about providing care on a global health scale. I was also able to learn how to design surveys, conduct a literature review, participate in journal clubs, and collaborate with other researchers. I was very fortunate to work with other students and physicians, as well as an incredible interprofessional team, that were passionate about this field and were invaluable in supporting my learning. Mostly, I am extremely grateful to have worked with Dr. Rachel Spitzer as my supervisor. Her guidance, support, teaching, and mentorship have fostered my love for the ob/gyn field and research within it. I am very excited to be a part of this team and to continue working on this project!

Under the direct mentorship of Dr. Spitzer, the Chair's program was invaluable in my interest in pursuing a career in obs/gyn and global women's health. As someone interested in embarking on a career as a clinician-scientist, I was not only able to develop skills that will be helpful across future research endeavours, but observe first-hand the qualities needed to provide excellent care. Witnessing the incredible importance of advocating for my patients, remaining partial and supportive, and fostering longstanding patient-physician relationships has absolutely impacted the way in which I hope to conduct myself as a provider--Dr. Spitzer is an exemplar of the qualities I hope to emulate in my own career, and I am very grateful to have her mentorship. Her passion, inquisitiveness, empathy, and open-mindedness motivates me to continue to learn, continue to ask questions, and continue to be compassionate to my patients. Thank you, Dr. Spitzer, for your support throughout this summer, and for re-affirming my interest in pursuing ob/gyn and global women's health as a future career.

Neha Shah supervised by Dr. Lindsay Shirreff

Over the summer, I had the great pleasure of working with Dr. Lindsay Shirreff on a study that sought to describe ordering practices of CBC after hysterectomy as well as identify various characteristics associated with postoperative anemia. Data were collected from the Surgical Scorecard Project, which includes hysterectomy cases that have been conducted at several hospitals across Canada; the findings of this study will ultimately be used to inform quality improvement initiatives that may facilitate better resource stewardship, efficiency, and patient experiences. I was grateful to have been involved in the data analysis process and in drafting the manuscript for this paper, through which I was able to further develop my research skills and gain an appreciation for the immense collaboration that underpins successful and impactful research.

I feel very lucky to have worked with Dr. Shirreff this summer, as she has been a wonderful mentor and set a strong example for me as a future physician. I appreciate the energy, compassion, knowledge, and dedication she brought to all our meetings and work together – it made for an amazing summer! The CREMS program also provided an incredible opportunity for me to learn more about the field of obstetrics and gynaecology, and to further understand the interplay between research and medicine. I saw firsthand how research can help us both advocate for and create solutions that make a difference on both a systems-level and an individual-patient-level, which has fuelled my desire to incorporate research into my career. This summer, I feel that I have been able to improve upon and gain confidence in many of my skills – research and otherwise. I am indebted to both Dr. Shirreff and the CREMS program for creating space for me to grow and reaffirm my interest in this field!

Radha Sharma supervised by Dr. Andrea Simpson

I was fortunate to have had the opportunity to work on a project supervised by Dr. Andrea Simpson and Dr. Shirin Dason this summer. The aim of the project was to produce and disseminate resources regarding family planning for medical trainees. Dr. Simpson, Dr. Dason and other medical students created www.familyplanningfordocs.com, a resource hub for individuals about all things related to family building as a professional in medicine. My responsibilities included leading our podcast initiative called, "Thriving or Surviving", reaching out and interviewing residents, fellows and attending physicians, editing audio and transcript data, posting episodes on online platforms (i.e. Spotify), incorporating feedback to improve episodes, and assessing the episode data. I also helped curate infographics on topics related to IVF and egg freezing. I learned several topics within fertility research, and had the wonderful opportunity to learn about the careers and personal lives of physicians in various surgical and medical specialties. I created 21 episodes and have participated in the early stages of disseminating the content to undergraduate and postgraduate medical trainees. It is amazing to know our work has already been listened to, and I am excited to analyze the statistics on viewer consumption. I am excited to see how this data and programming can be used in best practice guidelines and medical curriculum. I feel extremely grateful to Dr. Simpson and Dr. Dason. They mentored me throughout the entire project and have helped me grow as a student in research.

I have gained numerous skills and perspectives as a researcher by participating in this CREMS project. Dr. Simpson and Dr. Dason provided me the opportunity to work on an extremely interesting topic related to medical education, which has now become something I will bring forward to my future clinical and scholarly practice. I learned how to navigate professional interviews and participate in knowledge dissemination for medical learners. I learned about the gap in knowledge translation when it comes to topics related to family planning in the medical curriculum, inside and outside UofT. I also had the opportunity to shadow and observe Dr. Simpson in her minimally invasive gynaecologic surgery (MIGS) service and procedures. This experience made me reflect on my interests in research, and introduced me to the incredible aspects of gynaecology and reproductive endocrinology and infertility. I am enthusiastic to take part in future research projects and in pursuing clinical electives in gynaecology and sub-specialties within OB-GYN. I believe these experiences will be integral to my growth as a student, and into practice. I am excited to pursue medical education and other research in the field of OB-GYN.

Nicole Smith supervised by Dr. Stéphane Laframboise

This summer, I had the privilege of working with Dr. Stéphane Laframboise and Dr. Karlijn Cornel on a project focused on understanding the impacts vulvar cancer diagnosis and treatment has on sexual health and well-being. Research in this area is limited, but existing studies suggest that vulvar cancer patients often experience challenges such as decreased sexual function, strained partner relationships, higher levels of depression and anxiety, and an overall lower quality of life. Our study is grounded in a biopsychosocial model of health framework and utilizes a qualitative-dominant mixed methods approach consisting of semi-structured interviews and patient reported outcome questionnaires. The aim of the study is to shed light on the impact of vulvar cancer on sexual health and well-being. Ultimately, our goal is to use this information to enhance the quality of sexual health-related care for vulvar cancer patients. I played a role in this project by assisting with participant recruitment, guiding patients through the informed consent process, and database creation and management. Throughout my CREMS experience, I gained insights into various aspects of research, including the REB approval process, informed consent procedures, data entry and management, and conducting interviews with a trauma-informed approach. Our next steps involve continuing patient interviews to gather enough data for a comprehensive analysis of themes, followed by the development of a manuscript.

One invaluable takeaway from this summer experience, that I will carry with me throughout the rest of my medical training and into practice, is the importance of genuinely listening to our patient's with curiosity, humility, and respect. In the medical field, we hold the privilege of hearing our patient's unique stories. This privilege empowers us to work hand in hand with them to improve their health and quality of life. Before I started working on this project, I had a preconceived notion that patients might feel uneasy discussing their sexual experiences during interviews for this study. However, as I conversed with patients, many opened up about their feelings of shame and stigma, and how they often find it uncomfortable to talk about their sexual well-being with their healthcare providers. This experience was a stark reminder of the pervasive stigma and shame that many women endure regarding their sexual health, reinforcing our responsibility in the medical field to deconstruct these barriers, thereby fostering improved overall health outcomes among this demographic. I feel grateful to have participated in this project and look forward to continuing to develop competency in engaging in sensitive conversations with patients in a professional and empathetic manner rooted in respect and humility. Overall, this project was an incredible experience that has allowed me to develop my professional aspirations. Thank you Dr. Cornel and Dr. Laframboise for your mentorship and support throughout this amazing opportunity!

Oishika Tarafdar supervised by Dr. Sarah Ferguson

I had the great pleasure this summer of working with Dr. Sarah Ferguson and Dr. Rachel Kim exploring outcomes for patients with atypical hyperplasia (AH) or low-grade endometrial cancer (EC) desiring fertility preservation treated with progestin therapy. Due to the complexity in care of this patient population, a specialized oncofertility program was established at Princess Margaret Cancer Centre in 2019. As the first of its kind in Canada, it provides integrated oncologic and reproductive endocrinology and infertility (REI) care following standardized, evidence-based treatment pathways. Our research aimed to describe both the oncological and fertility outcomes for the patients treated in this program.

After finalizing our list of ~200 patients, I participated in the retrospective chart review of clinicopathological variables and fertility outcomes using our REDCap database. Some data we characterized include obstetrical/fertility history, pathologic diagnosis, immunohistochemistry profiles, stage of disease, comorbidities, and long-term oncologic and reproductive data. This was guided immensely by the data dictionary we developed prior to and updated throughout the collection process. In collaboration with a biostatistician at UHN, I was able to gain insight on how a statistical plan is formulated and carried out for data analysis. It was rewarding to submit our work to the Society of Gynecologic Oncology 2024 Annual Meeting. I am extremely grateful to have been part of such a supportive team and look forward to contributing to remaining aspects of this project throughout the year.

The CREMS program has been a wonderful opportunity to immerse myself in gynecologic oncology, a field I knew relatively little about prior to this summer. I feel very fortunate to have contributed to a project evaluating and highlighting the outcomes for the novel oncofertility program to further improve care, while learning more about fertility preservation treatment for AH/EC patients in the process. I gained invaluable insight into the clinical research process to take with me in my future career, including the importance of secure data collection, developing a data dictionary, and creating a biostatistical plan. Beyond research, I am grateful to have shadowed Dr. Ferguson both in the OR and in clinic. It was amazing to witness the application of our work in the patients we interacted with and observe incredibly cool procedures (like robotic gynecologic surgeries!) I wouldn’t have experienced otherwise in pre-clerkship. The powerful work ethic and passion of Drs. Ferguson and Kim for both their research and clinical work are traits I will take with me in my future as a physician. I want to sincerely thank my supervisors and the rest of the team on our project for an enriching and exciting CREMS experience.

Megan Watson supervised by Dr. Nir Melamed

This summer, I was fortunate to work with Dr. Nir Melamed on a retrospective cohort study, looking at late onset fetal growth restriction (FGR) in twin pregnancies. The goal of the study was to develop a staging system that can be used to predict the likelihood of placenta-mediated FGR and to form a framework for the development of recommendations for timing of delivery in cases of late-onset FGR in twin pregnancies. I had the opportunity to retrospectively review the placental pathology reports of all included participants and collect data on the presence of abnormal histopathological findings. For the purposes of future statistical analysis, I extracted and organized the data in an excel spreadsheet according to three different categories of placental abnormalities: maternal vascular malperfusion lesions; fetal vascular malperfusion lesions; and chronic villitis. This project provided me with the opportunity to deepen my knowledge of placental physiology and develop an understanding of the most common causes of placental abnormalities in multiple gestation pregnancies.

Participating in the Chair’s program was an incredible experience that has stood out as a highlight of my medical education so far. I am grateful to have had the opportunity to attend the weekly OBGYN summer research rounds, during which I learned about a range of different research topics, including qualitive research, manuscript preparation, and statistics, from a variety of physicians and researchers. Dr. Melamed also taught me practical research skills, including how to formulate a good research question, organize large data sets, and effectively present study results in tables and figures. Throughout the summer, I not only developed valuable research skills, but also deepened my clinical knowledge on multiple gestation pregnancies, fetal growth restriction, and placental abnormalities. This experience has furthered my interest in the field of obstetrics and gynecology, with a specific interest on maternal-fetal medicine and high-risk obstetrical care. Through working closely with Dr. Melamed, I observed how his research work is directly applied in his daily practice as an OBGYN, further inspiring me to pursue a career as a clinician-scientist. Looking ahead, I will build on my experience this summer by continuing to engage in clinical research as a tool to deepen my clinical knowledge and inform high-quality patient care.

Megan Werger supervised by Dr. Mara Sobel

This summer I had the opportunity to work on ‘A double-blind, triple arm randomized controlled trial of 1% lidocaine paracervical block for IUD insertion’ under the supervision of Dr. Mara Sobel and Dr. Michelle Jacobson. The purpose of this study was to evaluate pain management options for a common gynaecological procedure. Through this project, I was able to combine my passion for research with the opportunity to advocate for women’s health. Improving patients’ experiences with IUD insertion will increase the accessibility of this treatment and/or contraception option for many people. As a CREMS student, my responsibilities included recruitment of participants, as well as obtaining informed consent by explaining the risks and benefits of the study and data collection. In the upcoming months, we plan to reach our sample size of 246 participants, after which I will assist in data analysis and manuscript preparation.

Working on a randomized control trial, gave me a new appreciation for the work that is required to conduct clinical research. As well, my positive experience in the CREMS program has piqued my interest in pursuing a career as an academic physician and reaffirmed my desire to work in the field of women’s health. The mentorship and support I received from Dr. Sobel, Dr. Jacobson and research nurse Anna Gryn was invaluable in my professional development as a medical student. I gained confidence in my clinical skills and a deeper understanding of diagnosis and management in the field of obstetrics and gynaecology. I look forward to continuing to work with this amazing team on this project as well as starting a new randomized control trial for endometrial biopsy pain management.