Dr. Matt Sibbald: Using Technology to Reduce Diagnostic Errors

A novice physician working in a busy emergency department in the middle of the night may be challenged to diagnose a patient presenting undifferentiated symptoms.

An electronic differential diagnostic (EDS) support system could assist by providing diagnostic hypotheses for the physician to consider – but only if the system is easy to use and fits into the clinician’s workflow.

Dr. Matt Sibbald, associate professor of medicine at McMaster University and cardiologist at Hamilton Health Sciences and Niagara Health System, led PSI Foundation–funded research to examine whether technology and artificial intelligence could improve diagnostic accuracy and when it should be used.

“With the challenge of busy clinical environments, technology might have something to offer to make our lives simpler as clinicians and bring more value and be more effective for patients,” says Dr. Sibbald. “Technology and artificial intelligence could leverage clinicians’ expertise and extend their cognitive capacity. But it needs to be accessible at the point of care without physicians having to modify their workflow.”

EDS support systems have been available for decades and have the potential to reduce diagnostic errors by providing a list of diagnostic hypotheses for the physician to consider. However, the value of the technology has always been limited by the amount of time that physicians needed to spend inputting data into the system – ranging from 20 minutes to even hours per patient.

A platform called Isabel may have greater potential to fit within clinicians’ workflows. After the clinician inputs the patient’s age and just a couple of key symptoms, taking only a minute or two – though Dr. Sibbald notes that this still represents a significant amount of a typical seven-minute emergency department triage visit – the system provides a list of the most common diagnosis differentials.

“It helps with quick decision-making around undifferentiated illness to make sure that you’ve at least thought about the different possibilities,” says Dr. Sibbald. “Some of these hypotheses might not be relevant to the patient in front of you, but that’s for the clinician to dismiss. A system like this is expected to diagnose, but to suggest.”

In 2020, Dr. Sibbald and his team received PSI funding to examine the Isabel EDS system under “sterile” conditions, not a working clinic, as a first step to gauge whether the system could improve the diagnostic process. Clinicians with different levels of experience completed cases through an online platform, with half using EDS early in the process, when only the main patient complaint was available, and half using EDS later, when all patient information including medical history and a physical, was available.

The research team found that the system increased the number of diagnostic hypotheses and the likelihood of the correct diagnosis being included in the list. When Isabel was used early, it generated significantly more diagnostic hypotheses, and when it was used later, the correct diagnosis was included more often in the list of hypotheses. But, ultimately, the researchers found that the system improved the diagnostic process regardless of when it was used and who was using it, though novices benefited the most.

“Electronic differential diagnosis does contribute to physician diagnosis. It adds rigor and length to the differential, and it adds different things for a physician to consider,” says Dr. Sibbald. “We actually saw the most benefit with simplest diagnoses for relatively novice clinicians. We expected that the system would be most helpful with the complex cases, but it helps by pointing to things that you know but haven’t necessarily thought of in the moment.”

Following these positive results, published in BMJ Quality and Safety, Dr. Sibbald and his team have continued to examine how EDS could be used in real-life clinical settings where physicians see patients with undifferentiated illness, such as primary care and the emergency department. They recently published a follow-up study that examined EDS in the context of the emergency room, with a research associate using the technology to simulate how the system could be integrated into the workflow. The results of this study, published in JMIR Human Factors, suggested that the technology needs to be customized to account for the scope and context of the emergency department and the clinician’s experience.

Though there is still a lot of work to be done before EDS is routinely used in clinical settings, Dr. Sibbald says that the potential value of these systems in reducing diagnostic errors is worth the effort. And funding from PSI has been key to the work they have done so far.

“It’s important for PSI to have a broad mandate and scope and to support this type of research that might not be top of mind on the needs spectrum but is still vital for our health care system to grow and adapt,” says Dr. Sibbald. “We can’t keep doing things the same way we’ve been doing them. There’s so much to challenge and to change, and this field can be a key part of that change management. But it needs to be driven by scholarship, research and understanding.”

Alice Cavanagh: Understanding How Physicians Learn About Intimate Partner Violence

As a volunteer at a sexual assault crisis centre before starting medical school, Alice Cavanagh would occasionally accompany people who had experienced sexual violence to access emergency health care. While health care professionals’ roles include the important and difficult tasks of collecting samples and evidence, their interactions with the survivor were very different from hers as a volunteer trained primarily to listen and be supportive.

“I became interested in what physicians are actually learning in the course of their professional training about intimate partner violence and sexual violence, and how that shapes their practice,” says Cavanagh. “There is research that quantifies how much education Canadian medical students get on intimate partner violence, but I was really interested in looking at the impact of that education. How are physicians experiencing that training and what are they taking from it?”

When Cavanagh started the MD/PhD program at McMaster University a short time later, she was able to examine these questions, receiving a PSI Research Trainee Award to support her research. With supervision from Dr. Meredith Vanstone and mentorship from Dr. Harriet MacMillan, she led research on how physicians learn about intimate partner violence (IPV) and how that affects the support they provide to patients, and recently defended her dissertation.

In the first part of the study, Cavanagh examined policy and training materials for physicians related to IPV. She then collaborated with the RISE project, a study funded by the Public Health Agency of Canada examining the family violence learning needs and preferences of Canadian social workers and physicians, interviewing physicians and residents across Canada from five medical specialties (emergency medicine, family medicine, obstetrics and gynecology, psychiatry and pediatrics) about their IPV education and the support they provide to patients. She also interviewed health and social service providers outside of medicine about their perceptions of the IPV training that physicians receive.

Physicians often feel unprepared to support people experiencing violence

Cavanagh’s analysis of physician’s training materials found that IPV has become increasingly medicalized, where it is often viewed solely as a health issue, instead of a structural issue with many facets, including poverty, racism, ablism and other forms of oppression. She also found that physicians are taught to identify patients experiencing IPV, provide them with support, and direct them to resources.

At the same time, physicians and residents revealed during the interviews that, while they understood IPV is important to their patients’ health, they largely felt unprepared to support their patients. However, they also spoke about how much they valued experiential learning, which Cavanagh says may offer opportunities to collaborate with IPV experts in other fields to learn directly from patients and other IPV experts.

Interviews with experts outside of medicine confirmed that physicians need to understand IPV and be prepared to support their patients. But they also highlighted that physicians need to be more aware of power dynamics in intimate partner violence, both in terms of the power dynamics between the person who is enacting violence and the person experiencing violence, but also the power that physicians hold in society to make a difference for individual patients and in dismantling the structures that uphold violence.

“It’s not just about understanding, it’s also about engaging with power to move from knowledge to action,” says Cavanagh. “This is a problem that can’t only be addressed by the health care system. By creating opportunities for health care providers to learn about IPV as an issue that is complex and connected to lots of different facets of people’s lives, my hope is health care providers will have opportunities to engage with the type of collective action that is critical to address complex, structural issues like IPV.”

PSI support was instrumental to kickstarting research career

With her dissertation complete and one more year of medical school remaining, Cavanagh is looking forward to continuing research that will improve health policy.

“My goal for my career is to be able to use my clinical work to look at questions about policy and health and to be able to use my research skill set to answer and think through those questions,” she says. “I really believe in the value of clinician-scientists, including those who work outside traditional bench-to-bedside research, and funding from PSI was really instrumental to me in being able to do my work and kickstart my career.”

Cavanagh says the PSI Research Trainee Award provided important financial support during her studies, and PSI meetings gave her important opportunities to connect and collaborate with other researchers.

“In very practical ways, being a part of the community has been really helpful to me in finding and developing new opportunities to grow, which is so important at this stage of my career,” she says.

Cavanagh hopes that the results from her research will help to inform medical education about IPV, particularly in developing opportunities to collaborate with experts from other fields and fostering physicians’ connections with community resources and services to support people experiencing IPV. With more than one quarter of women worldwide having experienced violence, she emphasizes that this issue affects people from all communities, including physicians.

“Violence and structural oppression are pervasive and touch every corner of our lives,” she says. “In health care, if we can have more sensitive conversations about these issues that acknowledge that this isn’t an issue that only affects ‘other’ people, that it affects everyone, I think that we can come toward creating safer places for both patients and providers.”

PSI Profiles: Meet the PSI Team 

Behind the scenes and beyond the hardworking committees and volunteers who contribute to our organization, PSI Foundation is currently run by a tight-knit team of five staff.

Here is a glimpse into each of our team members’ roles, and what we do to deliver funding opportunities to our grantees who contribute their expertise in order to better the health of Ontarians.

Samuel Moore: Executive Director

How long have you worked at PSI?

I have been working at PSI since 2010, so 12 years.

What are the main responsibilities for your job?

To keep staff, physicians, and happy, and to keep everyone (e.g. Board, all Committees, and staff) pulling in the same direction, all working towards meeting PSI’s goals. I focus on both big picture small details, which is always a new challenge. I am expected to evolve in my role as Executive Director.

What is your favourite part of your job as Executive Director at PSI?

My favourite part is working with great people, and working in a wide variety of areas at PSI. For example, I’ll focus on finance one day, then move on to grants the next, then on to governance. Working to make a difference and constantly learning and innovating is another favourite.

What are the most memorable moments from your career?

The most memorable moments are getting PSI to be the first non-American member to join the Health Research Alliance (HRA) , and launching our Knowledge Translation (KT) fellowships.

What did you study in post-secondary?

History, with an emphasis on the history of medicine in Canada.

What are your future plans for PSI as Executive Director?

To see our new PSI strategic plan executed and implemented, as well as to enhance physician-researcher involvement to create an even deeper pool of experts. We are constantly innovating PSI’s current grants programs to meet our goals. Seeing PSI evolve from a smaller regional organization to a larger funder is my ultimate goal.

Jessica Haxton: Grants Coordinator

How long have you been working at PSI?

I have worked at PSI for 11 years.

What are the main responsibilities for your job?

My responsibilities include screening applications, finding external peer reviewers, and getting application ready for internal Grants Committee review.

What did you study in post-secondary?

I studied Molecular Biology and Art History.


Heather Bruder: Administrative Coordinator

How long have you worked at PSI?

I have been working at PSI for 4 years.

What are the main responsibilities for your job?

Representing business as first point of contact for all enquiries, support grants funding program activities, by managing external peer review requests, tracking and processing peer reviews. Manage grant payments, including following up with grantees and maintaining payment schedule. Providing administrative support to the Executive Director, Board and Committee members. Organize and coordinate and facilitate several annual meetings and other events with internal/external stakeholders.

What did you study in post-secondary?



Asumi Matsumoto: Programs Coordinator

How long have you worked at PSI?

I’ve been working at PSI at since September 2016 – so 6 years!

What are the main responsibilities for your job?

My responsibilities adapt depending on the needs of PSI, however, my current ones include:

  • Coordinate the application process for salary support awards
  • Manage the post-award process for all funding streams
  • Maintain PSI’s communication channels
  • Prepare committee meeting material, including dashboards and reports
  • Assist with special projects as assigned

What did you study in post-secondary?

I received my undergraduate degree in Nutritional Sciences and Psychology at the University of Toronto.

Eunice Lee: Administrative and Communications Assistant

How long have you worked at PSI?

I worked at PSI since May 2019, so for 3.5 years.

What are the main responsibilities for your job?

My job involves designing visuals and writing for PSI through reports, infographics, and social media management, as well as administrative tasks for post-meeting cleanup and our grants system (SmartSimple).

What did you study in post-secondary?

I majored in Journalism with a minor in English.

To read more about PSI’s history, funding, Board of Directors and Management, click here.

Dr. Aaron Gazendam: Helping Patients Manage Pain Without Excess Opioids

Over the past several years, and particularly during the COVID-19 pandemic, opioid use disorder has been taking a significant toll on Canadians. According to the Public Health Agency of Canada, between January 2016 and December 2021, more than 29,000 people in Canada died from apparent opioid toxicity, and more than 30,000 hospitalizations were related to opioids.

As evidence has grown in recent years about the risk of opioid use, health care providers are being more careful and deliberate in prescribing opioids to reduce the risk that patients will become long-term opioid users. But this has been a particular challenge in orthopedic surgery.

Research has found that orthopedic surgeons prescribe more opioids than any other surgical specialty. Most patients receive an opioid prescription after surgery, often for more than they need.

“Recovery from these surgeries can be very painful, and as surgeons, there’s a fear that you’re sending patients home with not enough pain control and that they may end up in a pain crisis,” says Dr. Aaron Gazendam, an orthopedic surgery resident at McMaster University. “There’s also been a lack of high-quality research to prove that we can manage this pain without a lot of opioids.”

While working on a Master of Science in Health Research Methodology at McMaster during his residency, he co-led a clinical trial to examine the effectiveness of an opioid-sparing post-operative pain protocol following arthroscopic shoulder and knee surgery.

“Previous research has shown that there is a pretty strong correlation with that initial opioid prescription and the proportion of people who go on to develop chronic use,” says Dr. Gazendam. “We wanted to do an impactful study, and we felt that the results could be implemented after the study to support patients beyond those enrolled in trial.”

In 2021, Dr. Gazendam received a PSI Resident Research Grant to support the Non-Opioid Prescriptions after Arthroscopic Surgery in Canada (NO PAin) randomized controlled trial.

The research team, which included orthopedic surgeons and residents, enrolled 200 patients from three clinical sites in Canada who were undergoing outpatient shoulder or knee arthroscopic surgery. The patients were randomly assigned to one of two groups: the control group received the same prescriptions for opioids that they would typically receive outside of a trial, while the experimental, or “opioid-sparing,” group received a prescription for non-steroidal anti-inflammatories (NSAIDs) and acetaminophen, a “rescue prescription” for a small number of opioid pills they could fill if needed, and education about the risks of opioid medications.

At two and six weeks after the surgeries, the research team asked the patients how many opioid pills they used, how much pain they had, and how satisfied they were with their pain control.

They found that patients in the opioid-sparing group were prescribed and consumed significantly fewer opioids than the control group, yet patient-reported pain and patient satisfaction with pain control were not significantly different between the two groups. Importantly, only two people in the opioid-sparing group needed a refill on their opioid prescription, demonstrating that the opioid-sparing protocol was an effective way to manage pain.

“We included patients who were having major surgeries like ACL reconstruction and rotator cuff repairs, so we were in uncharted territory and unsure of how many refills we were going to get during the study,” says Dr. Gazendam. “Leaving patients without access to adequate pain control is a major concern for surgeons, so the fact that only a couple of people needed to refill their opioid prescription was a pleasant surprise.”

The research team now plans to publish the results and work with orthopedic and arthroscopy associations to develop guidelines and position statements that provide evidence-based information about pain management.

As Dr. Gazendam finishes his residency, he plans to specialize in orthopedic oncology and continue studying opioid use in oncology patients, who have very different medication needs and opioid use.

“The question for this project came directly out of our clinical experiences with patients. Being able to investigate questions that come up clinically that have little or no evidence is very rewarding,” says Dr. Gazendam. “The funding from PSI for the NO PAin trial has given me the opportunity to do meaningful and hopefully impactful research that I wouldn’t have had the opportunity to do otherwise.”


Dr. Tavis Apramian: Resident’s Research Highlights Barriers Residents Face in Learning Advanced Care Conversations

“Learner-directed funding is critical to build skills in team leadership and direction and to create unique projects that tackle issues that learners themselves experience. I’m grateful to PSI for having the foresight to develop the next generation of scientists and education scientists in a deliberate way through the Resident Research Grants.” – Dr. Tavis Apramian

As both a learner and a researcher examining medical education, Dr. Tavis Apramian says he sometime felt as though he was navigating two worlds. During his residency in family medicine at McMaster University, he led research investigating how family medicine residents learn how to advance care planning conversations, with the goal of eventually improving education and training around this skill set.

“Studying medical education while acting as a learner is a little bit like living two lives at once,” says Dr. Apramian, now a palliative care fellow at the University of Toronto. “It helps me put some of the challenges I face into a broader systemic perspective, but it can also be challenging when I know that more evidence-based educational practices are available, but they might not be applied in a given situation.”

Dr. Apramian has long been interested in learning patient and physician stories and using storytelling to improve patient care. He studied English and biology at Carleton University and Narrative Medicine at Columbia University. He then focused his career on research and medicine, completing a PhD and MD at Western University.

When Dr. Apramian started his family medicine residency at McMaster University in 2019, he wanted to undertake research on medical education to try to affect positive change in how medicine is taught. He was specifically interested in how learners gain skills in advance care planning conversations, which require a complex skill set and are not typically taught in medical school.

Advance care planning conversations are often iterative conversations meant to help patients, typically with serious illness, understand the course of their disease, consider their values as they relate health care and make decisions about their future care.

Research has shown that fewer than 40% of family doctors regularly have these conversations with their patients with life-limiting illness, which suggests that residents may have limited opportunities to observe or participate in these conversations during a family medicine residency.

In 2020, Dr. Apramian received a PSI Resident Research Grant to investigate how family medicine residents learn to approach advance care planning. Working with Dr. Erin Gallagher as mentor and Dr. Michelle Howard as senior author, Dr. Apramian and the research team interviewed residents about their experiences to better understand if and how residents are learning these skills during their training and the factors that shape how they are taught these skills.

Residents face unique barriers to learning advanced care planning skills

Previous research has found that advance care planning conversations are challenging even for experienced physicians. These conversations are time-consuming and may take place over several appointments, and physicians often lack the time or flexibility in their schedules or access to clinical records to have these conversations effectively. In addition, physicians and patients often have cultural aversions to conversations about death and dying.

In the interviews led by Dr. Apramian’s team, residents described facing these same barriers, plus some specific to residency: lack of authority to shape clinic flow and schedules, short-term relationships with patients, navigating their preceptors’ clinical priorities, lack of encouragement from their preceptors, and limited opportunities to practice.

“The interviews demonstrated that the preferences and principles of family medicine preceptors affected how much time, energy, willingness and supervision that family medicine residents had to practice this skill set,” says Dr. Apramian. “These are really complex skills that require iterative and adaptive conversations. There’s certainly no training on advance care planning in medical schools, and little didactic or deliberate practice in the workplace once medical students reach residency, which is concerning.”

Importantly, the research team noted that, without this training in the primary care setting, many residents shifted to learning related skills during emergency department or internal medicine rotations through practising goals of care conversations, which are focused on an immediate clinical decision in a time of acute crisis.

“You can’t have conversations about values when patients are scared and uncomfortable and with physicians they don’t know or trust,” says Dr. Apramian. “I hope that what we found in our study will lead to more deliberate thinking about how to help residents practice the skill of building illness understanding and eliciting patients’ values in a family medicine setting.”

With the team now publishing and presenting the results, Dr. Apramian hopes that more awareness of the gaps in education will lead to changes in training that dedicate more time to practising this skill to increase future physicians’ comfort in leading these conversations and ultimately helping patients experience health care more aligned with their values. In his fellowship at the University of Toronto, he is planning to continue this research to examine advanced care planning in other clinical domains, including pain management.

Dr. Apramian says that the funding from PSI Foundation was critical to his research and has helped him to build a research program focused on medical education and the dynamics between learners and their supervisors.

“Having my own funding allowed me to hire team members to move the research forward while doing my residency,” he says. “Getting this grant allowed the research to continue and improve over the course of my residency in a way that wouldn’t have otherwise been possible.”


2022 PSI Symposium Recap – Improving the Health of Ontarians: Past, Present, and Future

After two years of pandemic push back, PSI opportunely welcomed back our grantees, committees, and doctors to the 2022 PSI Symposium. This year’s symposium included a full day of PSI activities, including a resident presentation by Dr. Raed Joundi, open-floor and roundtable discussions, and three certified and accredited educational presentations* by Dr. P.J. Devereaux, Dr. Deborah Cook, and Dr. John Marshall. 

The day commenced with PSI president Dr. Robin Walker giving his opening remarks for the first ever in-person symposium since 2019, updating attendees on PSI’s 2021 impact report and activities during the COVID-19 pandemic. Notably, PSI began a COVID-19 funding stream to maintain support for our researchers during the pandemic, all the while giving a one-year blanket extension on all research funded during that period. PSI also increased grants funding support salaries through the PSI Graham Farquharson Knowledge Translation (KT) Fellowship award. 

PSI’s focus on Equity, Diversity and Inclusion (EDI) was discussed by Ms. Giselle Bodkin. Commenting on the state of EDI at PSI, Ms. Bodkin stated: “if you don’t consciously include people, you unconsciously exclude them” – our slogan to intentional inclusion as a research grants provider in the Ontario healthcare space. Ms. Bodkin walked us over the steps PSI has taken so far, including having grantees self-identify in order to analyze the statistics and fill in any missing diversity gaps with such data. With the newly instated EDI committee, PSI hopes to create a more inclusive, diverse space for our grantees.  

PSI Governance Committee Chair Dr. John Drover presented a governance update, including what the committee will be focusing on for the next year. Dr. Drover’s focus is on revitalizing the governance committee to be more effective in support of research in Ontario. In regards to revitalization, Dr. Drover told the symposium that “we’ve been focusing on [next steps] to move us into the future.” This will be achieved in partnership with external firm Overlap Associates by utilizing strategic planning exercises in the upcoming months.

Our first presenter, Dr. P.J. Devereaux of McMaster University, focused on his Perioperative Care Program. 

Dr. Devereaux discussed perioperative cover (silent) stroke and its association with perioperative and 1-year outcomes, understanding the effects of perioperative aspirin, and research for the relevance of atrial fibrillation and chronic incisional pain. 

Our second presenter, Dr. Deborah Cook of McMaster University, gave a heartfelt presentation on how opportunities for early career investigators make a difference in their career: including how PSI helped to fund one of Dr. Cook’s studies early on in her career. “In most studies, the same senior investigators do the work. PSI focuses on enabling new investigators – I was one of them. It was the first validating grant I’ve received,” she noted. 

Dr. Cook commented on PSI’s support for her over the years, stating that groups have an organizational culture. “I think of the way a personality is to an individual, organizational culture is to a group,” she said. “I was struck early on by the open-minded, communicative approach of [Executive Director] Sam Moore through PSI, and learned a little more of the organizational culture beyond the myth and the vision that is being actively refreshed.” 

Dr. Cook then focused on three women physician-led PSI funded studies that made impactful changes in the critical care realm: including Dr. Jennifer Johnson’s study on probiotics in the immunocompromised, Dr. Joanna Dionne’s study on diarrhea, and Dr. Brittany Dennis’ study on end-of-life care during the pandemic. 

PSI Resident Research grantee, Dr. Raed Joundi, presented his 15-year study on temporal trends in stroke incidence and outcomes in Ontario. Dr. Joundi thanked PSI for the support he received, which he ascribed as vital to establishing his career early on. 

Presenter Dr. John Marshall of University of Toronto spoke about PSI’s three decades of support in his research, and how, as he stated: “support from PSI Foundation has been critical to allow [him] to move forward” in his research since the early 1990s. His presentation included the topic of how biomedical research in critical care can change medical practice and patient lives. Dr. Marshall’s first funded research project looked into the role of gut liver axis in the pathogensis of Multiple Organ Failure. “I see PSI as the seed that can allow grant visions to take shape…my first funding came from PSI Foundation,” he said. 

Dr. Marshall spoke of the importance and “extraordinary power” of collaboration; especially that of PSI’s collaboration with grantees, peer reviewers, and researchers; and how it is vital to furthering the world of medical research. With the analogy of the Hubble Space telescope and an “unprecedented collaboration of scientists,” Dr. Marshall connected PSI’s grants funding streams to how PSI has helped further research – especially during the COVID-19 pandemic. 

A panel discussion was then hosted by panelists Dr. John Marshall, Dr. Andrea Gershon, Dr. Naana Jumah, Dr. Ishrat Husain, and Dr. Deborah Cook. This discussion was based on key guiding questions, such as ‘what the future of physician-led medical research should look like,’ ‘what role physicians should play in shaping the future of medical research,’ andwhat the greatest challenges and opportunities facing clinician researchers are now and moving forward.’ PSI has taken into account the feedback provided to us from these needed discussions, and plan to integrate it into our organization moving forward.

We thank all who attended our symposium this year. PSI will continue striving towards fulfilling our mission of improving the health of Ontarians, through the support of physician-led research and education in the years to come.

Check out our YouTube playlist for exclusive video content from the PSI 2022 Symposium.

*This event is an Accredited Group Learning Activity as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Continuing Education and Professional Development Office at the Northern Ontario School of Medicine. 

Dr. Laureen Hachem: Clinical Experience in Neurosurgery Provides Valuable Perspective for Lab-based Research

Dr. Laureen Hachem has long been interested in neurosurgery and the potential of endogenous stem cells to repair spinal cord injuries. She started her research career in her last year of high school, volunteering in the lab of Dr. Charles Tator, a researcher and neurosurgeon at Toronto Western Hospital, and she continued working in Dr. Tator’s lab throughout her undergraduate and medical school education at the University of Toronto.

In 2017, she graduated from medical school and started the Toronto Neurosurgery Residency Program, which combines clinical and lab-based research training.

“When I’m on clinical service, I see questions or problems that I can critically analyze and think about how I would address them in a systematic, hypothesis-generating way,” says Dr. Hachem. “When I go back to the lab, I have an important perspective because I’ve seen what is relevant and feasible in the clinic, and the patient is always top of mind.”

In 2020, she started her PhD research, supervised by Dr. Tator and Dr. Michael Fehlings, continuing her studies of endogenous stem cell regeneration, with the aim of identifying therapies for spinal cord injury.

She had previously found that high levels of the neurotransmitter glutamate activate the AMPA receptor, which stimulates a response from endogenous stem cells. With a PSI Resident Research Grant, she began to look for clinically relevant methods to therapeutically activate AMPA receptors to stimulate endogenous stem cell regeneration, focusing on a class of drug called ampakines.

Ampakines bind to AMPA receptors to improve neuron signalling and have been used in neurodegenerative diseases, such as Alzheimer’s disease and Parkinson’s disease and in the setting of opioid-induced respiratory depression, and have been tested in clinical trials for some neuropsychiatric conditions. But until Dr. Hachem’s research, ampakines had not been examined for their potential in enhancing endogenous spinal cord stem cell regeneration.

Dr. Hachem says that PSI’s Resident Research Grant is a valuable tool for residents to develop their own research program and gain valuable skills early in their career.

“Because this grant funds residents as principal investigators who are asking the questions and leading the work, it gives residents ownership over the project,” she says. “It sets you up for the future in developing your career as a scientist and your own research program.”

Repurposed drug shows promise for neural stem cell regeneration

With PSI funding, Dr. Hachem used a clinically relevant rodent model of spinal cord injury to test whether an ampakine drug could stimulate the AMPA receptor to regenerate endogenous stem cells and restore function.

She found that the treatment increased the growth and division of endogenous neural stem cells and the production of beneficial growth factors, which was associated with increased neuron survival, reduced inflammation and improved functional recovery.

Dr. Hachem notes that other more invasive strategies – including stem cell transplantation – have been studied to repair spinal cord injuries, and while they show promise, her research is the first to show that ampakines have potential as a less invasive approach to regenerate neural stem cells.

“With this work, we’re trying to harness the body’s own regenerative potential with these stem cells. Since the discovery of these cells, it’s been a long-standing question of how we can actually use them to repair the spinal cord after injury, and this study is a critical step in answering that,” she says. “The relevance of the therapy and translation to the clinic is always top of mind, and ultimately the goal is to translate this drug and this approach of positively modulating these cells to patients in a clinical trial.”

With these first results, Dr. Hachem is continuing her research to understand the mechanisms at work, as well as examining the use of ampakines in chronic spinal cord injury. She plans to continue pursuing lab-based research along with clinical care to build a career that ultimately improves care for patients with spinal cord injury.

“Funding from PSI Foundation allowed me to do this first critical experiment to show the feasibility and efficacy of the drug, as well as optimize drug dosing, timing and duration, and this work paves the way for larger scale studies and ultimately clinical translation to patients,” says Dr. Hachem. “This line of research has really grown with me throughout my medical education. Looking forward in the future, I aim to have a career where I can integrate my research interests with my surgical practice.”

Frequently Asked Questions (FAQ): PSI Mid-Career Knowledge Translation (KT) Fellowship

In March, PSI announced a new funding opportunity: the 2023 PSI Mid-Career Knowledge Translation (KT) Fellowship. Through this award, we aim to provide salary support for a mid-career physician researcher in Ontario to conduct high-impact knowledge translation research with a goal of improving the health of Ontarians.

In this article, we cover the most frequently asked questions that we have been receiving to clarify our application requirements and award expectations. We hope you find this article helpful in determining whether this award is suitable for you. We will continue to update this article frequently as we receive new inquiries, until the Letter of Intent (LOI) submission deadline of June 1st, 2022 at 5pm EST. We encourage you to revisit this page to help you until you prepare your application and submit your LOI.

If your question is not answered here, or if you have further questions, please get in touch with us; we are more than happy to assist you.

FAQs for the 2023 PSI Mid-Career KT Fellowship

About the Award:

Is this a one-time funding opportunity? Will PSI have this funding opportunity again next year?

The PSI Grants Committee will review this topic of whether PSI should continue this funding stream and hold annual competitions.

What is the success rate of this funding stream?

Since this is PSI’s first time launching this award, we do not have data for approval ratio.

Application Process:

Can you clarify the application process, including the different stages and timeline?

Below is an outline of the different stages and timeline of this competition:

PSI Mid-Career KT Fellowship – Application Process

Submission of Letter of Intent (LOI)

  • The submission deadline is June 1st, 2022 at 5pm EST.
  • LOI must be submitted via PSI Grants Management System at https://psifoundation.smartsimple.ca/. Emailed applications will not be accepted.

Initial screening of LOI

  • PSI staff will screen all submitted LOI for eligibility and completeness.

(if needed) Revision of LOI by candidate

  • If your LOI needs revision or clarification, then PSI staff will contact you via email.

PSI Grants Sub-Committee Review of LOI

  • PSI Grants Sub-Committee will review each LOI submitted at their meeting in July/August 2022.

LOI decisions sent

  • Decision on whether you are invited to proceed to the next stage will be sent via email in August 2022.

(If LOI approved) Full application submission

  • If you are invited to submit a full application, then you will receive an email with instructions on how to access the online application form.
  • Full applications must be submitted via PSI Grants Management System at https://psifoundation.smartsimple.ca/ by November 4th, 2022 at 5pm EST.

Initial screening of full application

  • PSI staff will screen all full submitted applications for eligibility and completeness.

(If needed) Revision of full application by candidate

  • If your application needs revision or clarification, then PSI will contact you via email.

PSI Grants Committee review of full applications

  • The full PSI Grants Committee will review each full application submitted at their meeting in December 2022.

Final funding decisions sent

  • Final funding decisions will be sent within 10 business days from the December 2022 PSI Grants Committee meeting.

Is there a limit to the number of applications that can be submitted per institution or faculty/department?

There is no limit to the number of applications that can come from a specific institution or faculty department.

I currently hold/am applying for a PSI operating grant (e.g. Health Research grant). Can I still apply?

PSI allows principal investigators (PI) to concurrently hold one PSI operating grant and one PSI salary support award. Hence, you are welcome to apply.

How many candidates will PSI invite to submit a full application? How many awards will be given out?

PSI does not have a pre-determined number of candidates that we will invite for full application submission. The number of candidates to move on to the next process, as well as the number of awards given out depends on the PSI Grants Committee’s review of the quality of the applications received and their fit with PSI’s mandate.

Eligibility of Candidate:

Are leaves of absence (e.g. maternity leave) taken into account when counting the number of years since the first academic appointment?

Yes, PSI will take into account any leaves of absence when determining the number of years since the candidate’s first academic appointment.

I obtained an MD but I do not practice clinically. Can I apply?

Unfortunately, in addition to being within 5 to 15 years of your first academic appointment, you must also be a CPSO-licensed practising physician in Ontario. PSI must be able to confirm your CPSO license at CPSO – Find a Doctor.

Eligibility of Proposal:

My research involves cancer patients, but the research itself is not about cancer. Can I apply?

As outlined in the funding guidelines, PSI will not accept applications involving research in the areas of cancer, heart and stroke, and pharmaceutical drug development studies.

If you are not sure whether your research falls under PSI’s areas of non-support, then please email us with a brief summary of your research prior to submitting an application so that we can assess whether you are eligible for funding.

What if my research involves sites outside of Ontario? Can I still apply?

While we will accept applications with research involving some sites outside of Ontario, since PSI’s mission is to “improve the health of Ontarians”, the majority of your research should be conducted in Ontario. Your application should demonstrate the relevance of your knowledge translation research to the health of Ontarians. The PSI Grants Committee will review each application and its alignment with PSI’s mandate.

Application Policy/Requirements:

Do I need to obtain matching funding and submit a letter of confirmation in the Letter of Intent (LOI)?

You do not need to provide confirmation of matching funding at the LOI stage. If you are invited to proceed to the next stage, then matching funding should be confirmed in the full application, within the letter of support from the sponsoring institution.

Can my matching funding come be in the form of in-kind support or from other grants from external funding agencies?

Matching funds may not be an in-kind support from the institution nor come from another salary support fellowship/award, operating grant, nor project specific funding.

What if I can’t obtain matching funding?

A lesser amount in matching funding is admissible with explanation from the applicant and institution.

If a sponsoring institution is unable to provide matching funds, then the candidate may obtain matching funds from another source. In this case, please provide an explanation.

Application Content:

What are the formatting requirements for the documents to be uploaded?

PSI prefers all uploaded documents to have 0.5 to 1-inch margins, single spaced, and 12-point font size in a legible font.

For LOI, can I add references to the documents to be added?

You may add an additional page of references to any documents uploaded in your LOI.

Am I required to submit any letters of support or letters of references with my LOI?

At the LOI stage, you are not required to submit any letters.


If I am awarded, what are my requirements as a PSI Mid-Career KT Fellow?

The funding recipient guidelines for the PSI Mid-Career KT Fellowship is available for download at Grant Recipient Guidelines – PSI Foundation. This document outlines what is required as a PSI Mid-Career KT Fellow.

Dr. Brad Petrisor and Dr. Sheila Sprague: International study builds understanding of orthopedic patients experiencing intimate partner violence

Screening women for intimate partner violence (IPV), which includes physical, sexual, and emotional violence, may not seem to fall under the scope of an orthopedic or fracture clinic. But orthopedic surgeons and researchers who recently led an international study on IPV prevalence among orthopedic patients explain that the fracture clinic can actually be a good setting to address this issue.

“In the fracture clinic, you often see patients with injuries frequently during the first few weeks to months. Follow-up often continues for months and sometimes longer,” says Dr. Brad Petrisor, an orthopedic surgeon and professor at McMaster’s Department of Surgery. “You get multiple snapshots over the course of the year after their injury, so this is a major opportunity to ask about and understand intimate partner violence in people’s lives.”

Dr. Petrisor, Dr. Sheila Sprague, Associate Professor in the Department of Surgery, Dr. Kim Madden, Assistant Professor in the Department of Surgery, Dr. Mohit Bhandari, Chair of the Department of Surgery, along with a large multi-disciplinary team, are leading a research program that is generating more awareness of IPV among orthopedic specialists and equipping them to address it with their patients.

As part of her PhD thesis, Dr. Sprague led one of the early studies of IPV among orthopedic patients, the PRAISE (Prevalence of abuse and intimate partner violence surgical evaluation) study. The research team examined the prevalence of IPV among 3,000 women attending orthopedic fracture clinics in Canada, the US, the Netherlands, Denmark and India. They found that one in six women had experienced IPV in the year before the injury, and one in three had experienced IPV in their lifetime. The study was published in The Lancet in 2013.

In 2015, Dr. Petrisor and Dr. Sprague received funding from PSI Foundation to expand on those results with the PRAISE-2 study, which examined reporting rates of IPV among orthopedic patients during the first year following the injury and how IPV affects outcomes such as return to function, complications from the injury and health-related quality of life.

The team assessed IPV disclosures and clinical outcomes of 250 women from Canada, the Netherlands, Spain and Finland at the first visit to the orthopedic fracture clinic and at one, three, six and 12 months after the first visit.
They found that 33% of the patients disclosed IPV during their first visit, and an additional 12.4% who did not disclose IPV at the first visit did disclose IPV at some point during the 12-month follow up.

The team also found that women who disclosed IPV were slower to return to their pre-injury level of function, experienced more complications from their injury and had lower health-related quality of life during the follow-up period. The results were published in the Journal of Bone and Joint Surgery, the field’s most prestigious journal.

“These kinds of statistics can help inform education so that surgeons know to ask about IPV, not just once but at each visit, because you could be missing a significant number of people who could be helped,” says Dr. Sprague. “And knowing that patients who experience IPV have a more difficult recovery is helpful so that the surgeon can intervene earlier with referrals to appropriate services.”

The research team’s work over the last decade has helped to change the perspective of orthopedic specialists from viewing IPV as outside their scope of practice to feeling better equipped to help patients experiencing IPV. They have published papers in top journals and delivered presentations at major orthopedic trauma meetings, and their work has led to positional statements by the Canadian Orthopedic Association recognizing IPV as a significant determinant of morbidity and mortality.

Importantly, Dr. Sprague, Dr. Bhandari, and their colleagues have used the results from the research program to develop a program called EDUCATE, an open access website for orthopedic surgeons and fracture clinic staff that provides knowledge and skills to assist women who are victims of IPV. By the end of 2021, the EDUCATE program had trained more than 150 health care professionals, and they hope to eventually broaden the program to include more health care fields.

“It teaches them how to optimize their fracture clinic and how to ask about IPV. And it also describes the resources that are available and referrals that health care providers can give,” says Dr. Sprague.

As a practising surgeon, Dr. Petrisor says that the research program has changed his own approach with patients.

“When we started this program of research, there was a lot of discomfort among orthopedic surgeons: how do you ask people about IPV, how can the environment in the fracture clinic be conducive to asking about it, and if a patient discloses, what do I do about it?” says Dr. Petrisor. “Knowing that more than one third of women in the clinic disclose IPV has definitely changed my approach in how I interact with patients. In the same way we ask about smoking, alcohol or drugs without judgment, we can ask about IPV and know what to do after a disclosure.”

Dr. Kamila Premji: Health Policy Research Aims to Improve Access to Primary Care

“It can be hard for physicians who practice in the community to get research off the ground because they don’t have access to traditional funding streams… I look at the community setting as a real-life lab for doing research, and it’s so beneficial to have funding from PSI that supports physicians in this setting.” – Dr. Kamila Premji

Dr. Kamila Premji, a family physician practising in Ottawa, has been interested in research throughout medical school and residency—with a particular interest in health care policy and access to primary care. Now a PhD candidate in Family Medicine at Western University, she has had the opportunity during her training to lead research that has provided important information about challenges with Ontario’s current system of physician compensation.

“I have been able to use my clinical practice experience in the community, see what my patients were struggling with and look for answers to those problems,” she says. “Research was such a natural path to explore those interests and make a difference in health care policy to help improve access to care.”

Dr. Premji had been working at her community practice for a few years when she decided to pursue a master’s degree, which would give her the skills to undertake more rigorous research, and soon transitioned into the PhD stream.

Early in her graduate training, Dr. Premji was part of a team led by Dr. Richard Glazier that examined whether the physician access bonus led to better patient care.

Ontario introduced the access bonus in 2004 as part of several pay-for-performance incentives in primary care. The access bonus is meant to reward family physicians who organize their practices to be more accessible by providing higher bonuses to physicians whose patients seek less external care, such as walk-in or after-hours clinics. Emergency department visits and specialists are not counted as external care.

However, the access bonus has been a controversial incentive, particularly because patients in urban and rural communities have different access to external health care services. With patients in rural communities often relying on emergency departments, it results in bonuses that may not accurately reflect whether physicians are making their practices more accessible.

“The access bonus creates all kinds of unintended consequences for the way services are delivered, and it can even impact the patient-physician relationship at times,” she says. “It’s such a big part of the dominant payment model in Ontario, so it seemed like something that warranted further exploration.”

In 2019, the team including Dr. Premji published a study that linked administrative data about patients’ health care use with their physicians’ access bonuses. The study found that physicians who earned the highest access bonuses were more likely to practice in rural or small urban areas and have higher proportions of patients with less complex health care needs; but these physicians did not necessarily offer more after-hours care, and their patients had higher rates of emergency room use.

PSI Research Trainee Award project suggests access bonus is not working as intended

Dr. Premji wanted to examine the results in the urban setting more closely, as well as consider a different measure of patient access. With a PSI Research Trainee Award, Dr. Premji and the team examined the access bonus for physicians in large, medium and small urban centres from the perspective of whether it improved patients’ experiences and perceptions of access.

“This is such an important part of understanding what the access bonus payment does from a patient perspective,” she says. “From their perspective, are patients experiencing a better level of service and access with this bonus? Is the bonus doing what it is meant to do?”

The team used data from the Health Care Experiences Survey, a patient experience survey conducted quarterly and funded by the Ontario Ministry of Health, and health administrative data from ICES. They were able to link patients with their physicians and family health teams and find associations between patient perceptions of access and their physicians’ bonuses.

The team found that in large and medium urban centres, where walk-in clinics and after-hours care are easily accessed, patient-reported experiences of access were positively associated with their physician’s access bonus. But this association did not hold in small urban centres, and as in the previous study, higher bonuses did not actually mean that patients experienced better access to their physicians.

“In large and medium urban centres, the higher the bonus, the more satisfied patients were with their access, which suggests that the bonus may be motivating physicians and clinics to organize their services in a way that improves the patient’s experience of access,” she says. “But the availability of resources and patients’ choices are still driving the bonus and having more of an impact, and these are out of physicians’ control.”

The results of both studies suggest that the access bonus is not necessarily doing what it is meant to do and may need to be redesigned to account for the differences in geography and patient experience. The results were published in the Canadian Medical Association Journal in November 2021 and have been presented to stakeholders including the Ontario Medical Association and the Ontario Ministry of Health.

The PSI Research Trainee Award concluded in 2020, but Dr. Premji is continuing research in primary care access while she finishes her PhD and cares for her patients.

“I find myself more alert to what my patients are experiencing that could be answered through policy solutions and through research. These areas fuel each other,” she says. “My clinical care fuels my curiosity, and my interest in research leads me to do these projects that then may have an impact on my patients.”

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