Christmas Break

Christmas is one of my favourite times of year.  Unfortunately, it is too often an exhausting, over-commercialized pressure to buy everyone that "perfect gift."  So, I try to ignore that extra stress!  For me, Christmas provides an opportunity to spend time with family and friends, time to relax and time to reflect on what is really important in life.  And, it cannot come soon enough!

I have to admit that I was naive about the energy required to consistently give my best to patients with chronic health care issues.  Burn-out can become a reality very quickly if not anticipated and prevented (The age old phrase, "Physician heal thyself" is so important).  I realize now that my expectations of being a naturopathic clinician were primarily based on my limited experiences as a patient.  As such, I projected much of how I thought being a clinician would be like by attempting to put myself in the health care professional's shoes so-to-speak.  But I am just one type of patient and I do not have any chronic debilitating conditions or diseases.  Needles to say, I have made some adjustments to the understanding of my job description.

For those of you interested in becoming a naturopathic doctor, as the style of practice varies substantially from one ND to another, do not base your expectations on one particular style of practice or patient group.  Although it is impossible to know exactly what to expect, and even what type of practice you want to have, getting as much experience with several different primary health care providers will also help you understand what it will be like to be an ND.

Have a refreshing holiday and Merry Christmas!

Continual Improvement

The format of the 4^th year internship at CCNM gives the interns more patient interaction compared to some of the other naturopathic medical schools (where the supervising ND does the initial patient intake and the interns only do follow-up visits or work in pairs instead of alone).  Although the supervisor does make an appearance during the visit at CCNM, is available for consultation and is ultimately responsible for the patient, there is still a lot of responsibility on the intern to gather the correct information to guide treatment.  As such, I remember the anxiety walking into that very first visit.  It actually took several months for that apprehension to turn into excitement to see a new patient.

New changes at CCNM are following the format other schools have done to progressively integrate students into clinical patient experience.  This experience will help the intern build the confidence required to be ready for that first and subsequent patients.  Already, the 1^st years have been doing an observation shift and the 2^nd years sit in on patient visits and have the opportunity take patient vitals.  Starting in January, the 3^rd years, under the direction of the 4^th year intern, will have the opportunity to perform physical exams, and help with diagnosis and treatment plans. Although the CCNM academic team met some resistance from the 4^th years in terms of our extra roles and extra responsibilities as mentors, I think the change will ultimately benefit CCNM graduates.  Additionally, the patient gets the benefit of a team approach to their health concerns. 

Peer mentorship, at the student level, is not well developed at any medical school yet but is an upcoming area of improvement in medical education.  Doctor as teacher is one of my favourite naturopathic principles and I believe is exemplified at CCNM in these new changes.

CCNM Christmas Play

Come out and support the graduating class of 2011 who brings you the original holiday play, Jingle Bell Rock - A CCNM Holiday Tale, on Thursday Dec. 2, 2010 and Friday December 3, 2010. Doors open at 7pm with the play starting promptly at 8:00pm (Location: Canadian College of Naturopathic Medicine). Tickets on sale at CCNM for $10 in advance and $15 at the door. VIP tickets are available for $25, which includes premium seating, wine and cheese during the performance. See you all there for an epic evening of Rock and Roll and Holiday Spirit!

Resisting Burn-Out

As my  posts have slowly dwindled to a monthly endeavor, I feel the need to come clean about the toll this program has taken on my enthusiasm for extracurricular - even naturopathic related - activities.  Nearly every day for the last month or so seems to be a struggle to resist burn-out.  Unfortunately, it appears as if this is a common theme with this years' graduating class possibly due to several new program requirements.  Even within the last week, one of my colleagues started a new club where we have the opportunity to support each other and discuss ways to make positive changes.

I met a transfer student the other day who did one year of naturopathic medicine at Bastyr University and I was surprised to hear that the students there are possibly more stressed-out than at CCNM.  I didn't think that was possible!  How does the school maintain enrollment?  I am sure that Bastyr's campus located within a state park is helpful.  The thought of a state park...as great as the Paracelsus Herb garden is, and the Don Valley located across the street from CCNM, they are not a substitute for a state park.

I think Christmas will be my solace and I am certainly looking forward to a couple of weeks of bliss away from the busyness of Toronto. 

Here to Stay

Today I took my family to the Royal Agricultural Winter Fair in Toronto.  It was at least 15 years since I was there last, at that time with my siblings and parents.  The fair is a celebration of agriculture in Ontario where awards are presented to the finest specimens of farm produce and animals and includes a number of fantastic animal shows.  Complementing the food and agricultural theme this year was the “Journey to Your Good Health” educational presentations. Although much of the fair was the same as I remembered it from years ago, I was also aware of increased visibility of natural health products slowly permeating the conventional world and was happy to see a naturopathic doctor answering questions as part of a forum of health professionals.

Remember, we vote with our dollar.  So, support those small, local, environmentally conscious agricultural companies when you can - ensure they are here to stay.

Maintaining Mentorship

Most highly skilled professions have some framework of mentorship set in place to ensure that things which are not easily picked up in the classroom, or from reading a book, are taught in a practical setting. Naturopathic Medicine is no different. Mentorship maintained naturopathic medicine in the United States in the years following the 1910 Flexner Report when naturopathic schools could not afford to operate (the Flexner Report also shut down many "diploma mills" and substandard medical schools which was a positive outcome. Unfortunately though, the recommendations were to only fund schools with a pharmacological and technological focus).

Mentorship at CCNM begins in 1st year as new students are introduced to the teaching clinic with days spent shadowing their supervisor. Second and third year students get more involved with patients each year as clinical supervisors and 4th year interns take mentoring roles. There are certainly times where patients are surprised at the additional students that come into the treatment room and occasionally, the 4th year intern is inadvertently put in the hot-seat with all eyes on her or him. At these times, there is the potential for everyone involved to share an awkward moment.

My love for teaching and background in instructing usually dissolves my concerns about others watching me in clinic. Additionally, I recognize that I am not perfect at this yet and I may say the wrong thing or make a small mistake with someone else watching. However, as the mentor, it can still be an additional source of stress.

I wonder if this change in dynamic is currently making it very difficult for some students to fulfill another type of required mentorship called preceptorship. This is where students spend time with a ND, DC, MD or physiotherapist in their private practice (or hospital). If you are currently a student in naturopathic medicine, here are a few points to consider when being mentored:

1. Firstly, if at all possible, pick a mentor who's style of practice you like. This is very important for preceptoring and will eliminate many unforeseen disharmonies and make for a much more enjoyable day.
2. Recognize your mentor's strengths. Certainly there are times when you may learn how NOT to practice but try to glean the best of what the mentor is offering.
3. Show appreciation. This is so important in order to successfully continue a constructive and receptive attitude towards mentorship and maintain the philosophy of passing down knowledge to the betterment of the profession.

Residency is another type of mentorship offered to naturopathic graduates and I hope to write about this at a later date.

Slow Down!

Three years ago my wife flew into Toronto from Calgary (while I was finishing my undergraduate degree) and she picked the apartment we would be living at during the next 4 years of school at CCNM. On arriving a month later, I was so impressed with her choice as she selected a location with the beautiful Don Valley literally off our balcony. The Don Valley has hiking trails, mature maple forests and the Don rivers. It could be the most beautiful place except the high traffic brings in unappreciative guests. My wife and I spent many of our first hikes with a garbage bag in hand just attempting to clean up our little area. However, the Don Valley was still my temporary substitute for the wilderness I enjoy.
Recently though, my wilderness substitute seems to be mirroring my cumulative impressions of the largest city in Canada. Even nature seems to be telling me it is time to move on as the Black Swallow Wort (a predator invasive species) has multiplied beyond control choking out the indigenous plant species and my enjoyment of the valley at the same time. Also, the poison ivy proliferated exceptionally well this year and seems to be telling me that my time in the Don Valley is over.

The city of Toronto has many forms of exceptional entertainment including cultural & educational experiences. While living here, I have tried to take in as many of these things as possible. Too often though, I find people are in a rush. What's worse is it is often an angry rush! This was highlighted in recent research that demonstrated the traffic conditions in Toronto are negatively contributing to people's health.

If you are beginning to notice the rush, I want to tell you about the Evergreen Brickworks Slow Food Picnic. This event pairs local producers with Toronto's healthy minded food retailers & restaurants. Chefs cook gourmet food right in front of you to sample in a savory environment of appreciation for good food (Watch for this event next year and be sure to get a ticket). Below is a picture of me representing Mountain Lake Bison Range with Chef Maxine and Dave & Mario of the Healthy Butcher. This event reminded me that it doesn't matter where you are, where there are good people and a good cause, there can be moments of solace even in the largest city in Canada.

Thorough Competency

Over the last three years of writing this blog and speaking with potential students, I have had many people express their fears about the unknown journey into naturopathic medicine. How difficult is the program? Since you learn so many things, is it possible to be effective at anything? Is it really harder than conventional medical school? Do you learn enough science? Is the art of medicine still taught?

I understand where these questions stem from as I certainly had many of them before entering the program. Although there is absolutely no substitute for experience, and everyone’s experience is different, one of my supervisors recently showed us five categories of competencies expected from naturopathic doctors by the American Association of Accredited Naturopathic Medical Colleges (AANMC). I found it interesting to see AANMC sum up everything we do into 5 areas and I thought I would share them with you.

Here is the Professional Competency Profile of a Naturopathic Doctor:

1. Naturopathic Medical Expert

• Integrate naturopathic philosophy, theory and principles with naturopathic medical knowledge in the care of patients and case management including the assessment, diagnostic and treatment phases.

• Develop, maintain and value a comprehensive knowledge base in naturopathic medicine.

• Conduct an assessment to formulate a naturopathic medical diagnosis.

• Effectively provide and manage patient care.

2. Naturopathic Manager

• Develop and maintain relationships in practice and the community consistent with the philosophy and principles of naturopathic medicine.

• Establish, develop and manage a practice.

• Exhibit strong personal management skills.

3. Naturopathic Professional

• Utilize knowledge of naturopathic history, principles and philosophy to guide professional engagement and development.

• Demonstrate ethics and integrity in professional practice and personal conduct.

• Serve the public through ethical practice, health promotion and disease prevention.

• Ensure professional competence through ongoing self-assessment and professional development.

4. Naturopathic Health Scholar

• Exemplify the principle of doctor as teacher in every patient and public interaction.

• Maintain and enhance professional competence through ongoing learning activities.

• Critically evaluate medical information.

• Educate patients, colleagues, other health-care providers and the public.

• Advance the practice of naturopathic medicine through the development, critical assessment and dissemination of research and information.

5. Naturopathic Health Advocate

• Promote the principles and philosophy of naturopathic medicine in advocating for sustainable, healthy environments and lifestyles for patients and society.

• Reflect a knowledge base that enables effective health advocacy.

• Influence others in accepting naturopathic medicine as an essential element in health promotion and disease prevention.

New Beginnings

As I came in to the school this week I saw a sea of new faces excitedly awaiting their journey in naturopathic medical school. CCNM is now set to graduate the most students per year of all the accredited naturopathic colleges in North America. I clearly remember how exciting that first month of school was and how it was such a paradigm shift for many people depending on their background. Very soon though, it becomes a lot of stress and an unbelievable amount of work. Even with the added responsibility that comes with treating patients as an intern, I would not trade those 1st year students places for anything!

As the summer comes to a close, it is easy for me to nostalgically look backwards instead of looking forward to the new beginnings I have too. For me, this is the last September I will ever be in school as next year my wife and I will be busy preparing to set up our practice. Also, next Monday the 4th year interns begin a series of new classes (ethics/jurisprudence, practice management, in office procedures) that prepare us to write our final board exams and ultimately for practice. More importantly, the fall brings many new patients to the clinic who either felt better through the warm, sunny months or obligations and distractions delayed them from addressing their health concerns until now.

Choosing the ND Generalist

Naturopathic Doctors in Canada (and the States where ND’s are a regulated practice) have worked hard to maintain a large scope of practice that includes extensive training in conventional biomedical sciences as well as alternative medical techniques. Until recently I have always wondered why someone would want to give up that freedom for a focused discipline that often requires the same years of post secondary schooling, like a registered dietitian or a chiropractor, when these modalities and corresponding scope of practice are already included within naturopathic medicine.

I realize that there are many good reasons (too many to write about here) why people choose to become a focused health care practitioner, not least of which is a positive personal experience with a certain health care professional or the goal of helping people with specific health concerns. Also, many students may not know their options including the fact that most just do not know what naturopathic doctors are trained to do. Although I am very proud of the ND’s scope of practice, and recognize the privilege to have my training, I now perceive one potential advantage to being a focused specialist... Might the patient’s problems be simpler?

This may not be the case at all but in the last month I have developed a small degree of wishful envy for practitioners who see patients that are presenting with concerns associated with a particular health focus, be it dietary, musculoskeletal problems or emotional issues. It just seems like it might not be as messy! Maybe that is part of the appeal?

In contrast, and without going into specific details, people visiting naturopathic doctors may have anything wrong with them - anything; and it may be somewhat illusive even to conventional medicine. Dr. Bernard Lown, MD writes in his book The Lost Art of Healing; Practicing Compassion in Medicine, “At present, about 25 percent of patients who visit an American doctor are successfully treated. The other 75 percent have problems that scientific medicine finds difficult to resolve. After being shuffled among a bevy of specialists and subjected to costly and invasive technologies, many patients, frustrated, turn away from conventional medicine.”

There is certainly an important place for every practitioner and every patient deserves the opportunity to be treated in the way that is best for them. Coincidentally, I am beginning to understand that with a large scope of practice comes the potential for patients with a greater degree of complicated health problems. This is the challenge of helping these people that puts those brief moments of wishful envy into perspective. Thank God I love reading because I certainly spend a lot of time researching for my patients! And, sometimes simple solutions do work even for the complicated problems.

If you or anyone you know is struggling with a health issue, do not wait until conventional medicine becomes frustrating to see a naturopathic doctor. It is important for ND’s to be able to work with conventional medicine where appropriate to the best benefit of the patient. It doesn’t matter how complicated your case might seem, ND’s will take the time investigate your concerns including asking the right questions and listening to your answers.

Book Review 10

Confessions of an Rx Drug Pusher by Gwen Olsen.

As more provinces in Canada, and states in the U.S.A., grant naturopathic doctors prescription rights, and after seeing several patients after only 2 months in clinic with side effects from prescription medications, I decided to read another book on the topic of pharmaceutical drugs.

This book is an autobiographical account of how drugs, both pharmaceutical & recreational, have permeated society with nearly a complete disregard to their consequences. As a former pharmaceutical sales rep for 15 years, Gwen Olsen discloses enough inside knowledge about the pharmaceutical industry to put the broad spread dependence on prescription drugs, especially those for depression and other mental illness, into serious question. The book is very well referenced with an abundance of evidence including heart wrenching patient cases and scientific research.

As an autobiography, the author openly recounts the horrific events in her life, including messy family dysfunction and mental illnesses, that gave her a first hand experience on the receiving end of many of the medications she was trained to believe would help people. Her ultimate conversion to a traditional view of wholistic medicine, and occasional moments of over disclosure, may give some ardent Big Pharma believers an illegitimate excuse to discard the authors' perspective based on character weakness. However, the book still stands on its own as another beacon of light uncovering the damaged path left by years of unabated over prescribing and the lack of public safety with regards to medications.

Another book outlining some of the corruption in the pharmaceutical drug industry is, The Truth About Drug Companies by Marcia Angell, MD. This book, in contrast, is written from a MD's perspective in completely unemotional prose by the former editor in chief of the New England Journal of Medicine.

Schooled by an MD!

I recently watched a debate on the effectiveness, safety and merits of complementary medicine. The panel included a medical doctor and a scientific sceptic on the con side, and two naturopathic doctors for the pro side. It was apparent to me early into the debate that the conventional medical community has a serious lack of understanding of what ND's actually do. ND's know what MD's do, and for the most part are familiar with the conventional medical school of thought, but so much of the time MD's really misunderstand what naturopathic doctors do.

There are some explanations for this. Certainly, there are some naturopathic doctors who muddy the waters and represent the profession in a way not typical of the profession as a whole. But, what makes naturopathic medicine most complicated is that the scope of practice is so large that some ND's may have an entirely talk-therapy based practice and on the other end of the extreme, some ND's may do primarily a sports medicine based practice.

One interesting point made by one of the naturopathic doctors was that, currently (because of the relatively few ND's by comparison), the largest population of doctors that practice natural medicines and therapies are actually medical doctors. This hit home when Dr. Lawrence Palevsky, MD came up from New York and gave a guest lecture on Pediatrics at CCNM earlier this week. It was fascinating to hear his perspective on the antecedents to conventional medical thought and its methodology for the treatment of childhood diseases. It was almost shocking to hear a Medical Doctor use every naturopathic tactic possible to avoid prescriptions of antibiotics, acetaminophen (Tylenol) and even present an informed choice on vaccines. I was reminded of the necessity of childhood fevers and shown, in tremendous detail, the great harm in handing out fever suppressing drugs like candy - and I learned this from a medical doctor! There is hope for much more integration of conventional and naturopathic medicine in the near future.

“Eat food. Not too much. Mostly plants."
Michael Pollan - In Defense of Food

The [CCNM] Hour

As an ND intern, I have the privilege to spend an hour visit with my patients. Initially, I thought this would allow ample time to ask all the pertinent questions, perform a relevant physical exam and ensure the proper care was provided for the patient by the end of the visit. Although this may be true in some straight forward cases, I have found that patients often see us as a last resort and have an extensive story and medical history to share. Furthermore, I think patients find some therapeutic value in just being able to freely tell me their story, in full, without me limiting their responses or cutting them off to one or two concerns per visit.

As such, I have already listened to (while carefully charting) some extremely complicated cases and the hour flies by before unearthing all the potential contributing factors to the person's current state. And, I still need to remember to at least take the person's blood pressure! However, when I review the patients case, I recognize the tremendous value of the information I gathered to point me towards treatment options and areas where I need to research. Furthermore, I have realized that most patients with complicated cases (that have stumped other health professionals) do not expect me to have an exact solution by the end of one hour. Although that would be nice, my assurance that a health improvement - at the very least - in the near future is possible is more important.

Meet the New Naturopathic Interns

Come on down to the Canadian College of Naturopathic Medicine (click for directions) on Monday June 14th at noon to meet the new interns. After 4 years of university and 3 years of naturopathic medical education, we are now entering our 12 month internship and are accepting patients. CCNM has one of the largest naturopathic teaching clinics in North America which has over 26, 000 patients visits per year.

During the event there will be an opportunity for everyone to learn more about naturopathic medicine through several short presentations including:

1) Brief intro to naturopathic medicine
2) Overview of services offered at RSNC
3) Pediatrics overview
4) Sports medicine overview
5) Adjunctive Cancer Care

Also, there are information tables and interns will be available to answer your questions.

The first clinical impression

Keeping in mind that my first impressions of clinic are highly influenced by the kinds of health care issues the patients I have seen thus far have presented with, my first thoughts traveling home after my clinic shifts were much more melancholy than I was expecting. Some people are really in need of a significant amount of help. Another realization I have been continually reminded of is the critical state of our current health care system and the luxury naturopathic doctors have to spend sufficient time with their patients. We have the time to ask the detailed questions and actually listen to the answer (I truly believe that most family doctors do not prefer to spend so little time with their patients but are forced to do so in order to survive under the provincial health care billing system).

So far, my aspirations of the valiant hero who swoops in with the naturopathic coup de grace and instantly changes the person's health future have been shifted, I believe positively, to recognize that pacing myself will be critical. This is a learning process - it is called a "practice" for a reason! Even if I do have all the answers in a particular case, delivering those answers in a way in which patients will comply is an art in of itself. There are so many new realities now in clinic and it is a very steep learning curve. As such, the first couple of weeks have been somewhat overwhelming.

However, we do have a great amount of support at the teaching clinic. Each intern has at least 4 different supervisors, and is therefore exposed to 4 different styles of practice and patient case management. Additionally, we have a variety of health professionals available for consultation on site at the clinic including Laboratory Technicians, ND's, Chiropractors and a Psychologist. So, there is help when we need it.

This was just a first impression and is subject to change!

Quote of the Month

“If you are traveling down a path without obstacles, it probably doesn't lead anywhere."

~Unknown Author

NPLEX Nastalgia

As Dr. Anderson's Naturopathic Physicians Licensing Examinations (NPLEX) prep course wrapped up here at CCNM for the 2nd year students, I clearly remembered last summer and a small part of me wished I could do it all again. Even though some of the same material was tested in my undergraduate, after 2 months of extensively studying the basic medical sciences, last summer was the 1st time I really felt like I knew what I was taking about!

In fact, last summer's studying was the highlight of my naturopathic journey until I entered clinic this May. I was my own boss, I could build up my weaker areas and dig deep into the areas that interested me the most.

Some words for the wise. If you are writing NPLEX 1 this summer (I write NPLEX 2 after graduation in August 2011), remember that no matter which one of the accredited schools you are in, the curriculum only sets a foundation to learn from. The exams are much, much more detailed and require extensive self study. The areas of anatomy, microbiology, immunology, food metabolism and pathophysiology are foundational to naturopathic primary care doctors and are one of the things that separate the accredited schools from the unaccredited schools.

Since the NPLEX format changed in August of 2009, there has been a heavy weighting on pathophysiology. Therefore a good pathophys textbook is a necessity. As a visual learner, another one of my favorite books is, "Metabolism at a Glance" by J.G. Salway (third ed). I also took Dr. Anderson's (systems based and focused more on Nutritional Biochemistry) & Dr. Grossman's (focused more on Anatomy & Microbiology) courses and enjoyed both. However, they are intended to remind you of the breadth of information required to know and indicate areas where you need extra studying. Furthermore, keep in mind that these review courses can not teach at the depth of knowledge required to pass NPLEX 1.

Just 3 study tips:

1. If possible with your school's schedule, take at least 2 weeks off after your final exams before starting to study for NPLEX 1.
2. Slowly build up to 8 hours of studying per day and take Sundays off to rest your brain (try for a minimum of 6 weeks of studying).
3. Take the day before the exam off completely. The NPLEX is a mental marathon, and like any athlete who has peaked for a performance, you need to rest the day before.

All the best!

A New Leaf

Today we completed the first of two days of clinic orientation. While biking to school this morning, the routine was so familiar, and our final exam marathon still so fresh in my mind, that I did not feel ready to be back at school. However, after the morning introductions, I realized that although the setting was the same, everything was different now. We are not only students, we are now health care providers. In fact, we were informed that 44% of the patients that visit the clinic here at CCNM reported that their ND intern was their primary health care provider. What a phenomenal responsibility!

We are turing over a brand new leaf in our journey. I understand that we are forever students and our next step is a 12 month long internship with 1035 clinical hours, case management documents, competency checks, more assignments, and still a few required classes. Even so, our focus has now shifted from excelling in class and passing exams to getting people to feel better. And, they do! We were shown some encouraging data that CCNM is accumulating, which reinforces what we all have known to be true: naturopathic medicine helps many people.

Quote of the Month

“We are indeed much more than what we eat, but what we eat can nevertheless help us to be much more than what we are."

Adelle Davis

One Last Push!

Six final exams down and 5 to go! The full-time 4-year naturopathic program at CCNM is not for the faint of heart and may not be advisable for anybody intending to keep one foot in the 'real world' and the other in naturopathic school (note: more part-time options are becoming available).

Focused curiosity is everything! Nearly every day I made a short list of things that were 'interesting' to me and I researched them. Also, I found that I had no choice but to live, breath, eat, talk, sleep, and dream naturopathic medicine for the last 3 years in order to keep the vast breadth of knowledge I learned applicable and current in my memory. This meant that my wife (and family and friends when I saw them) have had to put up with about three-quarters of the conversations ending up being something about medicine.

As a male, I will never be able to fully appreciate the experience of having a baby. Although, I have been at my wife's side twice (most recently two weeks ago) so I do have a better idea than some. As such, I am going to make a small leap here and say that I feel that there is just one last push remaining in this school year, with all the effort, the pain and eventually joy that accompanies the experience. Thank God for the joy!

Calm before the final storm

There is only a week and a half to go before the final exams of 3rd year. This will be the last set of final exams we will write. Sure, after graduation next year there will be licensing exams and provincial exams, which may be very difficult, but this is a huge mile stone. Beginning on April 19, our grand finale is 11 exams in 9 days.

I'm hoping to begin to live more of a balanced life once clinic starts in May. These past 3 years have been a tremendous sacrifice for my family and sadly my health to some degree as exercise was too often put low on the priority list. I really do understand now that becoming a ND is a calling and not just a profession.

Recently, I was talking with a prospective student who was debating between conventional medical school and naturopathic medicine. She told me her opinion of the strengths of each but explained that she had heard that naturopathic medical training was more difficult than conventional because of the additional types of medicine we learn. As such, she was concerned about the intensity of the program. Although I am unable to directly compare from personal experience, I can be fairly certain that if a person believes naturopathic medicine will be easier than conventional medicine, they may take a serious blow to their perceived academic ability. This is why I believe the "calling" has kept me going. If it was "just a profession" I would have stuck to my day job!

Quote of the Month

“Wellness is not a race but a journey."
~Unknown

TCM and Acupuncture Progress

As would be expected before entry into clinic, completing 3rd year means completing quite a few practical exams. Still remaining is our emergency medicine practical, in-office procedures practical, manipulation (chiropractic) practical, and the one that I am studying daily for, the Asian medicine acupuncture practical.

I did not know until recently that not all the accredited Naturopathy schools offer Traditional Chinese Medicine (TCM) and Acupuncture as part of the curriculum. Well, CCNM has a very intensive TCM and acupuncture program. Just to give you an indication, here is how the final exam will happen. First, we are presented with a case and need to determine a correct TCM diagnosis based on symptoms as well as pulse and tongue diagnosis. Then, we are required to select points that correspond appropriately to the case. We are required to know the actions and indications for about 225 of the approximately 400 total acupuncture points we have learned. Finally, we are required to locate and correctly needle 5 indicated points (within half a fingernail width of their specific location on the body) all within a 15 minute time frame. I would have never thought this was possible when I started in first year!

OSCE Follow-up

What an experience! If it wasn't for the nearly crippling anticipatory anxiety, I could almost say it was fun - the kind of exhilaration that happens during an important performance. Being sequestered in a meeting room for an hour, in a group of nine, prior to the official start of the exams did not help. However, I heard many other groups used much better coping tactics than mine did and they were able to laugh off some of the tension. I will never forget the walk down the stairs to the clinic. Our group walked in silence and I felt like I was in the movie Gladiator right at the scene where they were waiting to get rushed out into the Colosseum.

However, once I entered the first room and began talking to the patient, things began to flow more naturally. All the hours of preparation and studying pathologies, redflags for life threatening conditions and physical exams was integrated into somewhat of a smooth patient experience.

The OSCE's at CCNM consist of 3 patient visits that are each 18 minutes long. Then following each case we have 5 minutes to write up how the case would be appropriately managed and answer questions on our understanding of the patient's condition. Although 18 minutes is certainly not enough time to investigate the root cause of many diseases, it is sufficient time to rule out whether the patient has an emergency situation. As the first principle in our oath is, "First do no harm," having the ability to quickly evaluate the severity of a patient's symptoms and provide a medical diagnosis (Primary Care responsibility) and management plan is essential to every ND's training.

OSCE Time

Next week, the third year class will undergo the Objective Structured Clinical Examinations (OSCE). Passing the OSCE's are another one of those checks we require before entering into clinic in May...a really, really big check!

These exams were implemented 3 years ago as part of the continued progress towards ensuring ND's are ready for the field of being a Primary Care Doctor. The exams are the summation of all of our Primary Care knowledge up to this point and also tests our ability to clearly and effectively interact with patients. Although I am certainly under a lot of pressure right now, I can say that I'm proud that Primary Care is taken so seriously.

More on this topic after I pass!

The Learning Curve

As most of my colleagues in 3rd year at CCNM will be simultaneously pounding out the last details of their Relevant Clinical Inquiry Assignment (RCIA) due tomorrow morning, I have paused for a moment to reflect on the journey. Maybe I'm pacing myself, or still recovering from burn-out, but I just needed to take a moment and see the forest through the trees.

At this point in 3rd year, the focus is about checking off mandatory requirements before clinic in May. Number of clinic observation hours complete- check; number of patients - check; case management file - check; preceptorship hours - check; Gynecological practical exam - check; Male Genitourinary and DRE exams - check; RCIA - check. Check, check, check...It took a lot of planning ahead and coordination to get those checks while still managing to study and go to classes and I have certainly gained a tremendous amount of experience in the process.

Looking back, last year I needed to believe that 3rd year would be easier. Now it wasn't really easier, especially this final semester, but the learning curve was different. When I talk to my second year colleagues, I realize that the learning curve in second year is the steepest and sets a high standard of work ethic that just makes third year more manageable. Third year fills in the details and is the clinically relevant stepping stone that is required before we begin our internship in May. It is more practical and if I can relax enough to admit it, it is more fun! And, on that note, I have school work to get back to.

Quote of the Month

“Practice does not make perfect, or necessarily improvement, but rather practice makes permanent. Only perfect practice results in perfection."
~A Wise Coach

Integrative Health Institute

Last week I had the privilege to preceptor with Dr. Walker who is a co-founder and clinic director of the Integrative Health Institute (IHI) on King and Sherbourne downtown Toronto. I believe the model of care established to be one of a kind so far in the Toronto area, if not Ontario. Although there are other multidisciplinary clinics that revolve around a Chiropractic approach or a Medical Doctor's paradigm, the IHI is based on a unique collaborative of patient centered care. The practitioners are able to coordinate appropriate treatments for their patients based on a therapeutic order of intervention and utilizes Registered Massage Therapists, Chiropractors, an Osteopath, Clinical Counselor, and Medical Doctor.

To book an appointment at the Integrative Health Institute call, 416-260-6038 or visit their website at www.integrativehealthinstitute.ca

Who Owns the Podium?

I absolutely love the Olympics. My wife and I personally know several Olympic athletes and know first hand the dedication and perseverance it takes to struggle through many hardships in order to realize their dreams. Additionally, as an exercise physiologist and coach, I have tremendous appreciation for what the human mind and body can do in sports.

Although I certainly realize the necessity for their funding, one thing that slightly taints my experience of watching the games is the irony of the largest sponsors: Coca-Cola and McDonald's. What is problematic, from a public health perspective, is that these sponsors are much more than indirectly associated with the sports (like cigarette brands were to car racing). Rather, the perception portrayed is that they are directly a part of the athletes lives. It would seem that a McDonald's breakfast, lunch and supper contributes to gold medals. The athletes appear to be eating there every day and they even bring their parents! Are Coca-Cola and McDonald's really the meals of champions? Unfortunately, I do realize that the answer is yes for some athletes (along with Kraft Dinner and other nutrient void foods) because Canada's athletes are often not able to afford the quality of foods they would like to purchase. And that is an entirely different topic...

But, it is not the athletes I am worried about since they do enough exercise to negate many of the side effects of a fast food diet (Also, it is highly unlikely their diet constitutes fast food to the degree that we are led to believe by the commercials). Instead, the youth are the real targets here. The movie, "Supersize Me" highlights some of the psychology behind fast food marketing - it's quite amazing.

Check your provincial association for Naturopathic Doctors who work with performance athletes for a thorough investigation of nutritional measures for competition, recovery and rehabilitation.

Beyond Compartmentalization

This semester has the largest spectrum of health philosophies I have encountered yet as a CCNM student. On the one hand, we have courses that teach scientific best practices and algorithms like Emergency Medicine, Primary Care, Radiology and Phlebotomy, and on the other there is the "energetics" of Homeopathy and Traditional Chinese Medicine. It is enough to make anybody's head spin!

Although one way to deal with this disparity is to compartmentalize the information and put up walls between the modalities, I find that selecting and assimilating a patient centered approach from what works from each modality is ideal - best practices first of course. For example, the most important skill I have learned from homeopathic medicine is the art of interviewing. Hands down, there is no better or more thoroughly investigative interview process than in homeopathy. The techniques are so involved that many critics credit the process to the cases of success.

This is a situation that is most likely unique to naturopathic medical school and I believe it will ultimately give ND's a corresponding unique approach to health care.

Quote of the Month

“Some people find fault like there is a reward for it."
Zig Ziglar

Intensity of 3rd Year Practicals

Third year comes with a heightened responsibility & increased level of difficulty in the practical sessions that only the pressure of clinic around the corner could apply. Last week we performed acupuncture on the "difficult" points including inside the orbit of the eye (ST 1), above the inner canthus of the eye (UB 1) as well as beside the carotid (ST 9, LI 17 & 18) and radial arteries (LU 8 & 9). Then, today we did our 1st phlebotomy (blood drawing) on each other.

It is interesting how some people have more anxiety about performing these particular tasks as the doctor and others have more anxiety being in the patient's position. Either way, I think it is a matter of conditioning and not any indication of competency or ability to be successful with certain treatments. Originally, it was protocol at CCNM that every male needed to lie down when having their blood drawn because statistically men were the most prone to passing out. I'm happy to say that I didn't pass out (and even watched my partner insert the needle and change tubes) however, I was kindly asked to lie down - the bigger they are the harder they fall!

Need an Adjustment?

Before beginning university, and before I knew about naturopathic doctors, I originally considered becoming a chiropractor. As I had several sport injuries, I was the patient of quite a few chiropractors across Canada.

This year's manipulation classes finally allow us to complete the final thrust involved in performing a spinal adjustment (or any other joint). Until now we have set the foundation and framework in place by learning: anatomy, physical medicine, orthopedic tests and motion palpations, observed manipulations but did not get to perform the actual adjustment on each other.

The teaching assistant for my practical group sessions is a chiropractic doctor and she busted the myth that it takes a strong male to have good adjustments. Instead, technique is everything! I find getting that perfect adjustment is instant gratification for both practitioner and patient.

I personally know several excellent chiropractic doctors and revere them as musculoskeletal experts much in the same way that a family doctor might revere an orthopedic surgeon. In the future, any difficult musculoskeletal case that I came across, I would not hesitate to refer my patients to them.

What I like about receiving adjustments from a naturopathic doctor (in comparison to other practitioners that can adjust) is that we are well trained in the adjustments that are required for the most common musculoskeletal conditions, take ample of time with each patient, and are not limited to only one form of treatment. Metaphorically, we do not need to hammer something that instead needs a different tool.

A Learning Environment

There are occasions where I am reminded of how privileged I am to be in a learning environment where education rather than egos are encouraged. I was reading a story in a conventional medical email newsletter about how hierarchy is maintained by embarrassing (or worse) the new MD residents. Maybe it is because my school is 80% women but I have to say that I was again impressed by the atmosphere maintained during potentially awkward clinical requirements.

Earlier this week, I completed my first gynecological exam under the supervision of a practicing ND. I was politely interrupted to stop once or twice to perfect my technique and kindly given a reminder when I hesitated or forgot the next step. Maybe it is because most ND's are female that ND students are taught a very thorough, yet patient centered gynecological assessment, where each step is performed with maximal patient comfort in mind. I realize it is not neurosurgery but it is enough to remember the first time through, given the circumstances!

My point was not that we are sheltered, because where safety is concerned the standard is strictly maintained, but that we were presented with the best atmosphere, free from unnecessary attitude in which we could learn a skill.

Quote of the Month

"Negative feelings are like stray cats. The more you feed them, the more they hang around."
Joyce Rupp