Dr. Jill Shainhouse wrote the following article for the Ontario Association of Naturopathic Doctors on her experiences developing a shadowing program for naturopathic interns at Sunnybrook Hospital:
Improving the Clinical Experience of Naturopathic Interns in Adjunctive Care
Dr. Jill Shainhouse, ND
In the fall of 2013, I was invited along with Dr. Daniel Lander, ND to do a Grand Rounds Presentation at Sunnybrook Hospital by Dr. Ellen Warner. Dr. Warner is an experienced medical oncologist who specializes in breast cancer. She is the founder and director of the PYNK program, a specialized clinic for women 40 and under with breast cancer that recognizes the unique and complex needs of this age group. I originally learned of the program after editing an information piece on PYNK that was written for the Cancer Knowledge Network and became interested in learning more about the multidisciplinary approach that they offered. Many patients in this age group seek out naturopathic care and I brought this to Dr. Warner’s attention. She was curious about what naturopaths had to offer in addition to the lifestyle recommendations she and her colleagues were already conveying to patients. The purpose of the Grand Rounds was to introduce conventional practitioners of all sorts (physicians, pharmacists, social workers, nurses, dieticians, etc.) to Naturopathic Medicine, and discuss how an ND with clinical experience in adjunctive cancer care approaches a case to improve the patient experience and overall outcome. The presentation reviewed two main scenarios: 1) How an ND might help to manage a patient with curative intent and 2) How an ND may provide care in a palliative situation to improve quality of life. The lecture was well received.
A short time after the Grand Rounds presentation, Dr. Warner approved my request to begin a shadowing program during her outpatient clinics in the Louise Temherty Breast Cancer Centre, a branch of the Odette Cancer Centre. I was at the time, working as a supervisor the Adjunctive Cancer Care Program at the Robert Schad Naturopathic Clinic (RSNC) at the Canadian College of Naturopathic Medicine. At Sunnybrook, I attend as a teaching clinician and support the interns so that they learn both conventional and naturopathic aspects of care. The outpatient oncology clinic of a teaching hospital is the perfect environment to enrich the clinical experience of naturopathic interns. The clinics are extremely busy and interns have the opportunity to see a large volume of patients in a 3-hour morning. At a typical clinic shift lasting 6.5 hours at the RSNC, interns may see an average of 2 patients. At the hospital, they may see 15 or more patients between the hours of 9 am and noon. They also get the opportunity to converse and collaborate with residents, fellows, medical students, nurse practitioners, nurses, physician assistants and social workers.
The goals of the observation program include the following:
1) Improve the clinical experience, confidence and knowledge base of the interns.
2) Improve communication and collaboration between Naturopathic Doctors and other health care providers in the hospital setting.
Prior to the start of a clinic shift at the hospital, I meet my interns or residents 30 minutes before the first patient appointment. I provide an updated ‘mini-review’ of the conventional treatment of breast cancer. I realize that prior to their shifts at Sunnybrook, each intern has had different experiences in their clinical year. Some have seen several patients with breast cancer, while others have not seen a single case.
Dr. Warner arrives by 9 am and we begin to review the day’s cases as a group. Interns are able to review pathology reports, clinical notes, blood work and radiology reports and ask questions. Files are reviewed and explained by the medical oncologist, a clinical fellow, physician assistant or myself. While reviewing cases, I will prompt the students to tell me what they know about the pathology, the surgery the patient may have had, the drugs prescribed, associated side effects and how some of these adverse reactions may be mitigated with evidence based naturopathic therapies. Once the students have a good understanding of the patient file and have reviewed all pertinent information, the patient is seen and assessed by the medical oncologist or fellow along with myself and the naturopathic interns. We are often asked for our input on dietary, supplement or other naturopathic recommendations. This in turn, provides a learning opportunity for the hospital staff.
One of the naturopathic profession’s biggest criticisms is that interns do not obtain enough clinical experience, and that how and what they learn is not comparable to that of a medical doctor. I would love to see this improve. I believe that we should be working to build meaningful professional relationships and provide more opportunities for naturopathic interns in the hospital setting. I am currently working to begin a neuro-oncology rotation at the Odette Centre which will hopefully begin in fall of 2019. This will be my sixth year at Sunnybrook Hospital. While the program is a solely an observation program, ideally one day it could grow into a truly collaborative union.