Resident Project Day
Dr. Craig Olmstead, PGY-2 in the London Urban stream of the Family Medicine postgraduate program at the Byron Family Medical Centre, is one of many second and third year residents who will come together on June 12 to present their QI and research projects to colleagues.
Can you walk me through your chosen research project?
My project looks at screening for abdominal aortic aneurysms, a bulging of the main vessel that runs out of the heart towards the legs. This can be important to monitor as abdominal aortic aneurysms are at risk of bursting, an unpredictable occurrence which can very quickly result in death if not repaired immediately. Preventive health guidelines in Canada have recently changed to endorse screening all men aged 65 to 80 years old for this condition, though our colleagues in vascular surgery have made similar recommendations for several years now. My project reviews the charts at our clinic to look into whether or not practices within our centre have changed in the immediate aftermath of these updated guidelines compared to our practices beforehand.
A secondary goal was to look into whether there would be a role of using point-of-care ultrasound to accomplish screening for abdominal aortic aneurysms. Traditionally to screen for abdominal aortic aneurysms, we send patients to dedicated centres to have an ultrasound performed by a trained ultrasound technologist. However, as ultrasound technology improves and becomes less expensive, physicians are increasingly exploring doing some simple ultrasound scans on their own, by the bedside when they feel it is necessary. Emergency rooms have adopted this approach for several conditions, including abdominal aortic aneurysms, but it hasn't been readily employed in primary care. The demographic information from this study, including how many individuals each year are eligible for screening, helps determine whether using point-of-care ultrasound makes logistical and financial sense.
What has the experience taught you?
For one, the results of the study reaffirm that we as physicians do not change our practices quickly when guidelines change, even in the face of clear evidence supporting those guidelines. Screening rates actually decreased at our centre after the new guidelines came out. The secondary goal of looking into point-of-care ultrasound demonstrated some potential for the modality for abdominal aortic ultrasound screening, but the volumes just are not high enough to purchase the ultrasound equipment for that purpose alone.
Beyond the results of the study itself, this experience reaffirmed how important good study design is to obtaining useful information. Research studies are not a fast process to implement, with numerous hurdles to jump over, and it can be difficult to make big changes half-way through the process. That being said, no study design is without flaws and once confronted with the realities of executing that study design, some changes to the protocol are virtually inevitable. The smaller those changes need to be, the smoother things seem to go.
What are your hopes for taking the research/outcome into the future? Where do you see the research/outcome going further?
I am hoping to further look into the role of point-of-care ultrasound in the primary care setting. It's been talked about for years, but never really implemented on any significant scale for a variety of reasons, the main ones being cost and lack of established clinical utility. This study helped put the scale of the challenge into context for me. Implementing point-of-care ultrasound in the primary care setting for any one condition does not seem to be worthwhile, including for abdominal aortic ultrasound screening, but as more clinical indications become established, the shared benefits may start to outweigh the costs. That research needs to be done, however, before it becomes worth investing the time and money to make point-of-care ultrasound a mainstream technique in primary care.
Will there be notable change within your family medicine centre as a result of your project?
Since starting the project, there has been some greater awareness of abdominal aortic aneurysm screening within the centre. While the study itself showed no uptick in screening rates, once the study period ended, I started noticing more individuals going for screening. I have changed my own practices to increase abdominal aortic aneurysm screening, particularly among higher-risk individuals such as those with a history of smoking.
Dr. Olmstead's project in addition to another 40+ will be presented and shared at our annual Resident Project Day on Wednesday, June 12, beginning at 9:30 a.m., in the Western Centre for Public Health and Family Medicine.
Join the Department of Family Medicine for a day of scholarly oral presentations as we celebrate the success of our resident projects and bring our distributed teaching sites together.
NEW format for presentations this year. Instead of having poster and full length oral presentations, the Department of Family Medicine is trying something different! Each project will be presented as a five-minute “lightning oral” presentation with a five slide limit, followed by five minutes of questions. Like previous years, we’ll be seeking faculty judges for the day.
Coffee and snacks will be available, and lunch will be provided to those who register and indicate that they will be attending the lunch.
We look forward to celebrating the success of our resident projects at this annual event. Join us and register today.