Doctor's Review: Medicine on the Move

December 6, 2021
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In the same boat

When a ship is your CME classroom,
the world is your oyster

Many hard lessons are learned in the havoc of war, but some of these lessons can make a valuable difference when facing challenging situations in the future. This has certainly been the experience in Dubrovnik, Croatia. Damaged during the civil war following the breakup of the former Yugoslavia, this ancient city on the Adriatic Sea has now recovered from its previously devastated state. Following its reconstruction and designation as a UNESCO World Heritage Site, Dubrovnik has even become a popular port of call on Mediterranean cruise itineraries.

Most passengers waiting to step ashore look forward to exploring the city's many architectural wonders, cloistered as it is by heavy ramparts, filled with narrow streets and steep alleys overlooked by tile-roofed shops and cafés.

Yet, for the Canadian doctors perched on the top deck of the Celebrity Millennium as it angles towards the picturesque harbour, it is the opportunity to share Dubrovnik's hard-learned lessons that captures their interest. Thanks to a unique travel itinerary offered by tour operator CME at Sea, these physicians will have the chance to meet with the doctors who bravely provided primary care during the war, particularly to pregnant women under high degrees of stress.

How are the experiences of doctors working in conflict zones on the other side of the world relevant to Canadian physicians? "Canada has many people who fled their country in times of persecution and conflict," explains Dr Paul Martin-Smith, the Medical Director for CME at Sea, a division of Cruise Connections Canada. "Imagine trying to have a baby during the war. The Dubrovnik doctors had a fascinating program of delivering primary care, of dealing with the medical issues of pregnancies and fetal care, and the psychological implications of people who had lived as neighbours for centuries and were suddenly fired up by age-old hatreds. These doctors can share great insight. And there's something about being there and actually hearing from them in person that can't be reproduced at a distance."

Though the academic focus of the cruise, Medical Issues in Pregnancy, is rewarding, the luxurious ambience onboard the Celebrity Millennium along with the scenic and cultural appeal of this 13-day Mediterranean itinerary is an equally important draw for participating doctors.

With only two full days at sea, participants board the ship in Venice, sailing first to Dubrovnik, then on to Katakolon and Santorini in Greece, followed by Naples, Rome and Florence in Italy and Nice in France before disembarking in Barcelona, Spain. While this particular cruise includes the encounter with Dubrovnik doctors, every CME cruise typically incorporates a special program that is unique to the destination.

Two weeks prior to their embarkation date, participants receive their itinerary, tickets and luggage tags, plus an outline of the material that will be covered during the course. Once on board, they are given binders with detailed academic programs and print-outs of the speakers' slides, plus copies of three to five recent articles from the medical literature of their specialty. As there is a fair bit of reading, the schedule allows time for doctors to review the work on board.

CME at Sea has crafted a schedule that still allows plenty of time for sightseeing and relaxation. On port days with late arrivals, educational programs take place early in the morning. On port days with early departures, programs are tucked in before dinner, while sea days feature various programs scattered throughout the day. Participants can also expect at least two private cocktail parties and various surprise events that may include, say, outdoor dining in Santorini or an onboard scavenger hunt.

For those under the impression that the vast majority of educational conferences -- whether held at a resort or on a luxury ship at sea -- are secondary to the holiday experience, Sanjay K. Goel, President of Cruise Connections Canada; would like to set the record straight. "Our mission is to offer the best medical education in the world, while exploring its most beautiful places." To date, all of CME at Sea's conferences have been fully accredited by the Canadian College of Family Physicians. "All our content is Canadian-designed, with the Canadian physician in mind," he says.

In addition, CME at Sea's signature Mind, Body and Soul sessions are an intrinsic part of the educational approach. The Mind element focuses on the most recent evidence-based medical advances in a particular field, presented by leading practising clinicians and featuring preparatory readings and slide handouts. A counterpoint speaker then examines the same medical issues through the eyes of ancient or alternative therapies that may include nutritional and herbal medicine, yoga and meditation, relaxation training and stress management, biofeedback and acupuncture, and Oriental medicine.


"The absence of scientific validation often presents Western physicians with challenges in integrating these therapies into practices," Goel explains. "Our physician presenters have expertise in these areas that will help heighten the understanding of how to integrate traditional and alternative medical treatments."

The Body component comprises two distinct programs. Practice management sessions, including the application of modern business principles, help doctors understand how they can cut down on time spent on administration, leaving more time for patients and family. Wealth management sessions focus on financial planning tools to help manage savings, investment and insurance portfolios. Finally, the Soul focuses on a physician's physical, mental and spiritual well-being, including sessions on addiction, substance abuse, suicide, depression and marital disharmony.

If the program sounds esoteric, it can have a profound impact, says Dr John Fernandes, 35, who sailed in March 2004 on a diabetes-focused cruise with his wife (a retired teacher who now runs his office) and two little girls, aged three and seven. Fernandes is a Calgary-based family physician who combines a private practice with a nursing home and palliative care practice, plus a surgical practice focusing on breast tumours, vasectomies and lymph node tumours at the Foothills Hospital.

He was drawn to this cruise, featuring diabetes expert Dr Greg Kline, by the opportunity to complete the professional development hours required for licensing to be a fellow of the Royal College. "It's increasingly hard, because I work an average of 70 to 90 hours a week. So it's a sacrifice to take additional time away from my family or practice to attend a lecture."

"I felt confident this would not be a waste of time," Fernandes says. "And I actually changed my practice as a result. The speaker presented approaches to treating certain diabetic conditions based on his experience as a specialist. Some were so new they hadn't been published. Bottom line: I changed how I modify insulin dosing based on a very specific calculation. I also changed how I screen for obesity and how I treat it."

And Fernandes points out another significant incentive. "CME gave me the luxury to attend with my family, knowing the children were having a wonderful time in supervised programs. My wife -- when she wasn't taking a cooking course or swimming -- found the lectures useful too, because she communicates with the patients."

Did he appreciate the Mind, Body and Soul concept? "Yes. That approach is increasingly important. Doctors work so many hours a week that we feel pressure that can lead to physician burnout. After looking at my life objectively for 10 days during the cruise, I made changes to my practice that will hopefully help me regain equilibrium."

With all the perks of a CME cruise, it's easy to understand Dr Fernandes' enthusiasm. Besides private daily fitness programs, exclusive sightseeing excursions typically offered at highly reduced rates, and fully paid gratuities for all delegates and family members, there are private cocktail parties and opportunities to dine with the speakers or members of CME's Medical Advisory Board, such as Dr Paul Martin-Smith. A practising internist in Orangeville, Ontario, Dr Martin-Smith is renowned for organizing a project with the NORTH Network that electronically connected some 50 remote sites in northern Ontario with Sunnybrook Hospital, effectively bringing virtual doctors to under-serviced communities.

A major bonus for travelling companions is CME's optional Partners Program. These sessions run parallel to the delegates' programming and may be inspirational, for instance art tours or private cooking lessons from the chef, or educational -- promoting understanding and practical solutions to handle the often-difficult lifestyle of medical families. As many spouses today are involved with the physician's practice, useful sessions include practice management, such as storing electronic medical records. One fun session gives tips on how to express the phrase "Get over it" with body language, a boon for communicating pleasantly with agitated patients in a waiting room.

Throughout the entire voyage, a CME cruise ultimately aims to help physicians see themselves as integrated beings. "Western medicine has been hugely advantageous to our knowledge and practice," says Goel, "But it doesn't necessarily help our minds and spirits. The essence of Mind, Body and Soul is like putting us back together again. Like Humpty Dumpty after a fall."


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