PGY-2 Family Medicine – University of Toronto
My name is Marina Abdel Malak, and I am a second-year resident at University of Toronto (UofT), Mississauga Hospital Site. I live in Mississauga and obtain my Bachelor of Science in Nursing at McMaster University, got my Nursing license, and then applied to Medical school about a year later after being a nurse.
I went on to study medicine at the University of Toronto, Mississauga Site – and remarkably, got into Residency at UofT as well!
Why I chose Family Medicine
I chose Family Medicine because of the opportunities it allows for practice. I am passionate about providing patient-centered care and developing therapeutic relationships with my patients.
Family Medicine is a great discipline that allows physicians to provide patient education, promote health, and empower patients. I also love teaching medical students – and family medicine offers many opportunities to do so. I enjoy being able to engage in ongoing learning, quality improvement, and initiatives that allow me, as a physician, to impact health policy, systems, and care.
What does a typical day of clinical duties involve?
What kinds of rotations are required in your program?
We have a set of rotations that are completed in PGY-1 and PGY-2. For all rotations, however, we have 3 ½ days at Family Clinic. This allows for continuity of care with our family medicine patients. For example, in PGY-1 we may be in a Psychiatry rotation doing some days clinics, and some days in the emergency room for psych consults. Then, we would have one fully day of family medicine clinic, and one afternoon of clinic as well.
We do rotations in internal medicine, OBGYN, psych, pediatrics, ER, surgery, and neurology. We also have plenty of elective time to pursue our interests, such as dermatology, research, public health, or specialty clinics.
We are required to complete a quality improvement project in year one, and a research project in second year. These are great opportunities to seek out issues in family medicine that we believe can be improved or are interested in, and contribute to scholarship.
Which of your personality characteristics are particularly helpful in your field?
I am an empathetic and committed individual, and this allows me to develop therapeutic relationships with my patients. Being able to talk to patients about what is occurring in their lives and health, and working together to make plans of care that focus on their needs/resources is extremely important in family medicine. Utilizing communication skills, as well as integrating this with evidence-based medicine, is essential to primary care.
My organization skills are also an asset, as it can be difficult to stay up-to-date with my family medicine patients at the same time as my patients on specific rotations.
What are the best aspects of your residency?
Working with friendly and supportive colleagues, physicians, and administration team members has been the highlight of my residency. I really enjoy being surrounded by a group of people that are passionate about healthcare, patients, and physician wellness. The group at Summerville is always around to help residents. On different rotations, preceptors are interested in giving Residents autonomy and encourage us to learn about topics that will be relevant to us in our Family Medicine clinics. Also, having a roster of my own patients has been incredible – I have worked with my patients on their health, and seeing their progress is humbling. Being able to teach medical students at the same time, as well as engage in research, has truly provided me with a wholesome experience and has taught me so much!
What are the most challenging aspects of your current role?
Time-management can be difficult as a Family Medicine resident. Being able to navigate our time around our roster of patients, while at the same time managing patients on our other rotations, can be challenging. At times, this can be as simple as reviewing lab results and calling patients to follow-up; but at other times, it can mean arranging urgent tests, counselling patients for longer periods of times, waking up early to round in the hospital, etc.
The trick I’ve learned – is to organize my time around what is most urgent, and what can wait. I also ensure that I have reminders up, and I write my tasks in my agenda. However, none of this would be possible if I didn’t take care of myself. Ensuring I eat well, sleep adequately, move my body, and relax with loved ones gives me the stamina and motivation to keep doing what I love – being a Family Medicine Resident!
What is one question you’re often asked about your decision to pursue a non-clinical career?
I am often asked how as a family physician; we balance all the requests of our patients. This can be challenging, as patients do present with multiple issues. As a family medicine resident, I might have a patient booked for a diabetes check, but they want to discuss how their mental health has been challenged because of increasing work stressors. Of course, this is important to address – but finding enough time to do so within limited appointments can be difficult. I am still learning, but one thing that I have noticed is that prioritizing issues with patients and ensuring that things are addressed in a timely manner, is critical. In the example I posed above, I would have to determine how critical this stress was. If it wasn’t putting the patient at risk of harm, I would discuss booking another appointment to discuss that issue in greater detail and provide some resources in the meantime. At other times, I would book a phone-call appointment with the patient later in the week to check on them. Each situation is different – the important part of navigating these situations is knowing what a priority is, what can wait, and how to follow-up when needed.
Can you describe the transition from clerkship to residency?
Moving from clerkship to being a resident was a unique experience for me, as I became a resident at the same site where I was a clerk. This was fortunate, as I knew many staff member already. However, from a clinical/academic perspective, it was still anxiety-producing! One day I was a ‘clerk’, and suddenly – I had patients of my own. This was humbling. At first, I noticed that I took longer to take patient histories and do my physical exams. I often forgot that I could sign my own orders and prescriptions! However, the more exposure I got in my clinic and on rotations, the more confident I became. I became more efficient, as well, and learned how to balance my own wellness with my clinical duties.
What are your future practice plans?
In the future, I would love to be working in a health team that consists of physicians, nurses, and other care provides. I believe having a repertoire of professionals in a team allows for the best patient care possible! My interest in teaching also means that I’ll be dedicating time to mentoring medical students and future residents as they train through their studies. I’d also love to continue the quality improvement initiatives I’m involved in, such as ethical dilemmas, curriculum planning, patient safety tools, etc. Finally, I’m very passionate about mental health and wellness, and abdicating for this on a community level – such as being part of committees, is something I’d love to continue to do.
What are your fellow residents like and how do you interact with each other?
The residents I work with are truly amazing. We are a cohort of about 22 residents, 10-11 in PGY-1 and the same in PGY-2. This means that we get to know one another on a fairly good level. We are all a great group of residents who interact with one another, go out to dinner occasionally, and can chat about anything on our mind. We are also willing to help one another with patient tasks, urgent call duties, etc. Our Program Director and Scheduling Assistant have both made our Family Medicine Teaching Unit (FMTU) a safe space for residents to feel welcomed and appreciated – and that makes a huge difference!
What are your academic interests?
I’m very interested in mental health and patient empowerment/wellness, as well as medical education. In terms of mental health, I strongly believe that health means being well physically, mentally, emotionally, socially, and spiritually. To empower patients means to understand that each of these aspects affects how patients present with concerns, navigate through challenges, decide on treatment options, etc. Being available to patients and guiding them through these situations can be challenging – but very rewarding. In my residency practice, I integrate my trainings in counselling in order to empower patients to make goals that align with their values. This allows us to work together to promote their overall health.
In terms of medical education, I’m involved in curriculum planning and execution with the University. This includes teaching students, but also working on how we can make improve the learning experiences for Residents. I’m very passionate about using a quality improvement lens in order to facilitate education for all medical learners and foster a sense of curiosity and excitement for knowledge acquisition and application.
What is your work-life balance like, and how do you achieve this?
Being a resident can get very busy! The best way to balance this, for me, has been to realize that I can’t ‘do it all’. I can’t be in five places at once – and I don’t have to be perfect. To care for others requires that I cafe for myself, too. I make time to nourish my body, mind, and soul. I enjoy practicing yoga, winding down by reading my a good novel, or watching a movie with my family. It’s also important to talk to others whom we trust about our experiences, to de-stress, and to take time to be something other than a ‘medical resident’. When I’m at work, I focus on work and my patient duties. But once I’m done, it’s time to care for everything else in my life. And when I need someone to help with something, I can be confident that I have supportive loved ones and colleagues to provide assistance. Recognizing that we, as physicians, are humans too has been a learning curve for me, but it has helped me to take care of myself so that I can be the best resident I can be!