Virtual innovation in brain medicine education at Sunnybrook

An innovative pilot study is underway at Sunnybrook Health Sciences Centre to help young doctors learn about the treatment of common brain disorders in a unique way.

Virtual care is being integrated in the clinical setting of the Brain Medicine Fellowship, the first of its kind, supported by the Hurvitz Brain Sciences Program.

“The aim of the pilot virtual brain medicine project is to create a hub that integrates skills for medical training,” says Dr. Sara Mitchell, neurologist at Sunnybrook, director of the Brain Medicine Fellowship program, and assistant professor in the Department of Medicine, Division of Neurology at the University of Toronto, who is also cross-appointed to the Department of Psychiatry. “The COVID-19 pandemic has accelerated the need for virtual care across the health-care system, and this pilot enables our young doctors to expand their skillset in the virtual setting with patients in addition to understanding patient care through the uniquely integrated approach of the Brain Medicine Fellowship.”

An interdisciplinary and holistic approach to brain medicine

The fellowship takes an innovative and collaborative approach when looking at how to treat a brain disorder.

“Traditionally, medical fellows become further subspecialized within their discipline of residency training. With the Brain Medicine Fellowship, they are empowered to expand their expertise beyond their specialty of origin so that they can serve as experts at integrating multiple perspectives on complex brain diseases,” explains Dr. Mitchell.

“The Brain Medicine Fellowship focuses on integrating care and incorporates expertise from various specialties with a holistic approach to diagnosis and treatment of brain disease. A fellow with psychiatry training, for instance, may work with neurologists, neurosurgeons, geriatric specialists, radiologists and other experts that they may not have traditionally interacted with during psychiatry residency. This specialized training aims to broaden experience for our fellows and create competencies to help them to provide enhanced care for patients with complex brain disorders.”

Integrating virtual care is the latest development to enhance the scope of the Brain Medicine Fellowship.

Virtual care for patients

For the study, patients with complex brain disorders receive care virtually from various experts in a clinical setting. A patient’s initial appointment is with a neurologist and psychiatrist, with access to other brain medicine specialists such as a neurosurgeon or geriatrician, if needed. The health-care team collaborates on patient progress and trainees also benefit from these interdisciplinary discussions.

“For example, if a patient comes to us with complex diagnoses of Parkinsonism, depression and concerns with their thinking and memory, instead of seeing a neurologist to focus on the Parkinsonism, and having a psychiatrist only treat depression, the Brain Medicine fellows are looking at all aspects of the patient’s conditions to help streamline patient care,” explains Dr. Mitchell.

“Having multiple specialists from brain medicine-related disciplines discussing the same patient within the brain medicine clinic means the patient doesn’t have to see different medical providers at different appointments.”

“A customized educational experience”

Dr. Sarah Levitt is a psychiatrist and is the first fellow to graduate the Brain Fellowship (completing her training in December 2020) and is now an assistant professor in the Department of Psychiatry at the University of Toronto.

“I think this approach is pretty novel,” says Dr. Levitt. “I haven’t experienced this kind of collaboration in any of my other clinical training, and that’s really exciting. It’s also a big challenge because there are very few people who are working this way.”

“As the approach is quite interdisciplinary, I have the opportunity to train outside of my specialty of origin, which is psychiatry,” explains Dr. Levitt. “I work with neurologists, radiologists, pathologists and other experts who have a greater understanding of the brain as a holistic organ. The Brain Medicine Fellowship honours the idea that the brain is an integrated system. This is important for clinicians and patients in the future because we need specialists who have some expertise in conversing in all of those different areas to better serve patients.”

Dr. Levitt now works in the Brain Medicine Clinic as the attending psychiatrist.

“Both the virtual format of the clinic and the availability of multiple brain medicine specialists allow for increased access to holistic care for patients living with complex brain disorders,” says Dr. Levitt.

Ask what a typical day in the program is like and Dr. Levitt’s answer is simple, “What makes it unique is: there isn’t a typical day.”

She says the experts and patients she interacted with virtually and in person throughout her fellowship has helped her strengthen her skillset.

“The Brain Medicine Fellowship is a customized educational experience that has allowed me the opportunity to collaborate with these different areas of expertise and offered me a new way of approaching patient treatment and care,” adds Dr. Levitt. “This knowledge helps me better assess and determine the best plan for my patients because I’m not just looking at things from one angle.”

Training next-generation leaders in brain medicine

The virtual care study is expected to be continue as a pilot until 2024. The research team is hoping 200 patients participate.

“We are in the early stages of this study at the moment to assess the needs of our patients,” says Dr. Mitchell. “The hope going forward is for patients to one day in the future have access to multiple subspecialists in one clinic for more comprehensive care, which would be a great help for patients with complex brain disease who often receive siloed care.”

This transdisciplinary care model will continue to be evaluated, including assessing the quality of care delivered to a high-needs population virtually, measuring patient experience and the education of medical trainees through virtual platforms.

In a recent announcement by the Temerty Faculty of Medicine at the University of Toronto, the Temerty-Tanz-TDRA Initiative will fund a research stream of the Brain Medicine Fellowship to further enhance the clinical-research bridge in complex brain diseases focusing on advancing understanding of the links between depression and dementia.

“This is an exciting opportunity,” says Dr. Mitchell. “To have fellows in both research and clinical streams of brain medicine is a testament to the collaborative strength of this program and will help strengthen the research-clinical bridge.”

She adds this innovative approach will help enhance integrated care pathways for the future, which will be a key element of the new Garry Hurvitz Brain Sciences Centre which is being built at Sunnybrook, “The concept of brain medicine is that we are dealing with one organ – the brain – which overlaps other disciplines and expertise, and we are dealing with it collaboratively to provide the best care and trainee education.”

Learn more about the Fellowship in Brain Medicine and how to apply

Read about the Brain Medicine Fellowship and the Garry Hurvitz Brain Sciences Centre