This afternoon, after work, I checked my mail box and found the CTS publication between the letters. Very excited to go through it! There is something nostalgic about holding a publication in hand, to go through it page by page, and to leave little markers along the important pages. To this day, and with all the available technology, I still learn better by printing articles and writing down notes on a physical piece of paper. I also miss the printed version of Airwaves by #RTSO . I listen to audiobooks on my drive to work, and read physical books at home. The current digital audiobook borrowed from Toronto Public Library is Getting Things Done by David Allen. I have also purchased few books by Brené Brown which I am taking my time to read and to “process”. At the end of the day I am grateful of all the available resources, organizations and individuals that make it all possible. #Grateful
Every month I try to read an open-access article. After reading the article, I share the tittle and associated link with my followers. This is to encourage clinicians to read articles, stay to up to date, and continue to grow.
This morning I read this recent editorial piece on ERS:
The new haemodynamic definition of pulmonary hypertension: evidence prevails, finally!
With a passion for finding solutions and figuring out answers to complex problems, Sebastien Tessier initially had plans to attend university to study engineering in either biomedical or mechanical fields. However, thanks to a presentation by a neonatal Respiratory Therapist (RT) during his high school years, he decided to pursue Respiratory Therapy. “It was only fitting that working with complex lifesaving equipment would help fulfill that passion.”, shared Sebastien.
I had the opportunity to meet, and attend a presentation by Sebastien, at the Vancouver Canadian Society of Respiratory Therapists (CSRT) Conference in 2018. He is dedicated and driven to advance our profession. I was lucky that he agreed to answer few questions for this interview, even though he was in another country and on vacation.
With various roles and years of experience, what are some of your memorable roles so far?
I think the most memorable roles are the ones that have a deep impact on you as a growing individual. I’ve been able to advocate for French language post-secondary education in the healthcare field to members of parliament. Where this may have been memorable, it will never replace my time as a student in a pediatric code being the only person able to communicate with family. I’ve also served a national student association as President supporting and facilitating interprofessional education across the country. It’s the people, the passion and the longstanding professional relationships that made this such a memorable experience. This can easily be said from my time volunteering on the board of directors for the regulatory college and chairing the provincial conference. The roles are just titles, the experiences you have and how you evolve with them are what makes them memorable.
Your work and volunteering experience include leadership positions, including but not limited to being on the board for the professional college in Manitoba, chairing the committee for the annual MARRT conference, and involvement with other organizations such as CSRT. Can you tell us a little more about this. How did you get involved with the non-clinical side of RT? Also, what were some areas that you had to grow and improve on to better serve in these leadership roles?
It’s a bit interesting as I always considered myself an introvert growing up. Yet, as an RT, you quickly learn that you have to speak up, being the one at the head of bed and managing airways and all. This is where I first struggled but quickly championed, becoming an extroverted introvert. Is that a thing? I am incredibly passionate, as I’m sure you can appreciate from our past encounters. It can be considered an attribute, but I sometimes see it as a fault, because if I don’t have the answer, I can guarantee you I’ll be spending endless hours trying to figure it out. It all didn’t go unnoticed and I was invited to meet with others that shared similar passions. Being exposed to other initiatives outside of clinical had me engaged and invested. My goal as an individual is to contribute something that goes beyond the bedside. I am incredibly thankful for the impact we have on individuals lives and their families (families are also just as important), but for some reason it just isn’t enough for me. I want to be able to have a positive impact directly and indirectly. Again, probably another fault of mine.
Your clinical experiences include working with newborns, pediatrics, and adults. What has helped you become an effective RT in these various patient populations? Also, what advice do you have for RTs who want to expand their skillset and knowledge to work with different patient populations?
I think the biggest impact comes from experience. It’s not to say that I’ve seen everything there is to know about the profession. How you process the experiences you have is what will make a good RT in every scope of our profession. Experience doesn’t just come from you, it derives from successes and failures of others, research and evidence-based care, conferences and networking opportunities where we connect with each other. The one piece of advice I have for those interested in working with different patient populations comes from paper that I sadly wasn’t able to locate and reference for this post, but here it is (roughly): “We often fail to understand the ventilation applied to the lung. The best way one can appreciate the pressures experienced in another’s lung is to experience it themselves.” Also known as, blowing air into another person’s lungs or mouth to mouth.
Any advice for RTs and volunteering? How would one approach an organization they are interested to volunteer at?
I’m a strong believer that those who succeed at what they do, are able to do so in an environment that fosters and supports them. This means that those that are interested in being involved need to acquaint themselves with those that are involved. There is never anything wrong with reaching out to someone with an honest question. I don’t think I know anyone that would turn someone down that is interested in getting involved. I’ve oddly enough had RT’s ask the very question and have been happy to help. Again, I don’t always have the answers but can surely get them on track to where they want to go. This creates a network that is so powerful in the RT world, you’ll never look back.
Let me ask you a question about the bigger image. What is the next big growth area that you see for the RT profession?
Another tough one. I feel that the profession has grown so much in the last five decades. RT’s went from being technical to therapeutic. We used to be able to work in all areas of the hospital and now that each of those areas has become a world of its own, its hard to keep up. Academically, I think I’ve seen this in a few of your interviews, we are due to contribute more to evidence-based care. Not by practice, but by leading with research in our area of expertise. Lastly, I think this goes beyond the scope of your question, but I have this vision of the future where we don’t really ventilate patients at all. Ventilation is so abusive to the lung, which is why there’s so much emphasis on protective strategies and if we don’t need to be intubated… we extubate. What if ventilation wasn’t the life saving measure it is today?
I am always interested in people’s sources of inspiration and role models. What can you share with me?
I think my biggest inspirations are those that are working closely around me. There are a lot of good people working within the profession, clinicians, researchers, managers and beyond. I particularly look back to others success as an inspiration. It is all a matter of environment, and everyone that I’ve looked up to say the same thing. They work in a place of encouragement, where they are able to contribute and allow their passions to grow indefinitely.
How have you been successful in creating a work-life balance? How do you effectively deal with stress related to work? Any advice for RTs to better achieve physical and psychological wellness?
It’s not easy. I honestly cannot say that I have mastered the work-life balance. I’m still writing emails and doing school work while on vacation as I write this to you. Part of me wants to just put it all away, the other part of me just doesn’t want to shut off. I’m thankful that I have good people looking out for me and they help keep things in check. If you can’t admit the truth to the matter you will never be able to reflect and appreciate where you are in life.
We work with people everyday, in all aspects of life. Being personable to patients, colleagues and families I think is what takes a lot of the stress away. Being able to have difficult conversations with others rather than keeping them to ourselves. If you forgot something or did something that needs to be addressed, you will feel 100% better answering the doubt in your mind than wondering when you’ve gone. I feel that we are able to have a better appreciation of ourselves, by taking the time to reflecting. Taking a look at the big picture goes a long way. Sometimes it even takes a large blank canvas (or whiteboard) to put all your thoughts out there.
Any final thoughts?
I do want to thank you Farzad for taking the time in providing RT’s with different perspectives from different people. I always feel like learning from others is enriching because they offer a completely outside perspective. For those that don’t have the opportunity to either network at conferences or via different organizations can hopefully appreciate the insight you are providing them with this blog. I never write about myself in this manner, it is a bit challenging to share the same passion you have in person over a keyboard. But it did allow me to reflect and appreciate where I am, what I’m doing and where I’m going. So for that, thank you.
Thank you, Sebastien, for taking the time to answer my questions and to share your insights and experiences with the RT community!
Thank you for taking the time to speak with me, Marco. I have been looking forward to this interview and have some specific questions to ask you. First, I am going to take a step back and ask a general but important question. How did you find out about the Respiratory Therapy field? I initially attended CEGEP in Montreal at Vanier College to complete pre-requisite courses to be applicable to a technical program. Truth be told, once I completed those pre-requisite courses, I applied to the coolest sounding professional program I could find “Respiratory and Anaesthesia Technology.” As I began my classes, I found myself enjoying each and every course more and more.
Since graduation, you have been involved with various roles, activities, and volunteering positions. Can you share with us some of your memorable roles so far? There’s not a single role that I believe is more memorable than the last. I genuinely think that every position I take will teach me something and that something will serve to better my practice. I truly enjoy those unique (non-traditional) roles that RTs can fill. Some of my examples would be organizing and participating in some humanitarian trips, conducting research and program development in McGill’ centre of medical education, teaching ACLS to allied healthcare professionals and residents and participating as a simulation trainer
You have been practicing as an Anesthesia Assistant (AA) for some time now. Can you tell me a little about that? The concept of the AA is quite different from where I am situated in the province. Here in Quebec, training in the OR is mandatory for licensure in Quebec. Once we obtain licensure, individuals who desire to work in the OR simply apply for the position and receive extra training. The decision to work in ICU versus the OR is similar to you choosing to work in adults or pediatrics. It is mostly dependent on job availability and interest. Because of this, the Quebec model of an anesthesia care team is always one RRT and one anesthesiologist per operating room. As you can imagine, this allows many RTs the opportunity to work in the OR without the necessity of higher education. I chose to seek out the AA accreditation because of my involvement with the CSRT and an inherent desire to lead by example that Quebec RTs are arguably as equivalent as AAs.
What were the other factors that lead you to study AA? There are many reasons why I chose to work predominately in the OR. I enjoy being a proceduralist and I appreciate the science behind resuscitation. In the OR we have a significant role in all aspects, from fluid management to pharmacology. Furthermore, I wanted to work in close proximity with the physicians to learn from them. Imagine working one-on-one with great physicians at a collegial level. They tend to challenge your thinking in a unique way that ends up improving the care you eventually provide to patients. While I do love the OR, I am not close-minded towards any other unit. My practice is a mix of critical care and anesthesia.
With regards to your volunteering experiences abroad, what can you share with us? I’ve volunteered numerous times with Team Broken Earth in Haiti in clinical work with the Montreal General Hospital and with Thompson Rivers University in Peru organizing conference workshops for locals and clinical rotations for TRU students. Volunteer work in underprivileged areas is the most humbling and amazing work I’ve done. It’s humbling to see the stark contrast to what you are used to as a standard of care. It definitely puts life (and healthcare for that matter) into perspective when you want to complain about something trivial in your daily work routine. It’s also amazing to learn about how the local professionals deliver care with the equipment that they have at hand. I’ve learned a great deal for which I apply techniques in my own practice.
Can you give me an example of a case, scenario, a perspective that really stood out for you? A case that stood out for me was one where the team performed an open + closed reduction & internal fixation of a C4-C5 unilateral facet dislocation with an anterior cervical approach. The thing that struck me was the resourcefulness and comradery of the team present. The first part of the case was the closed reduction, so the patient has to stay awake so we can monitor for potential disc herniation. So we performed the closed reduction by weighting down a halo brace with 2 L jugs of water. Once we achieved the closed reduction, the next step was to intubate the patient awake (again to monitor potential disc herniation), unfortunately we had little in advanced airway equipment. So, the entire team rallied behind the airway. The surgical resident performed passive oxygenation with the bag-mask, the anesthesiologist performed as many airway blocks as the patient could tolerate, and I was able to intubate the patient with a portable video-laryngoscope that was generously donated to me for this trip. Finally, we secured his airway and the complicated spine surgery was uneventfully completed. This surgery (from the airway to the surgery itself) was successful because of the team involved at that time.
What advice do you have for those who want to volunteer and travel to areas who need help with patient care/education and staff training? First, be sure you want to do it. Going to these places is not a vacation, and it is not your right as a healthcare professional to impose your knowledge on locals. Your desire to help needs to stem from empowering locals which may mean you teach much more than you work (for example). To get involved I would merely get informed; e-mail organizations, e-mail individuals who have gone for advice. Once you get some contacts, sell yourself. Showcase your skills in a way that makes you essential to the team rather than a passive member.
“It is not your right as a healthcare professional to impose your knowledge on locals” is a very interesting framework and approach to the situation. Can you expand on that? Or any advice on how one could approach the situation with that framework? The keyword to approach this framework is local! You need to tailor your care and education to what they need to provide care to the local population. Before our trips, we contact local chief-residents to determine what they want to learn. This allows us to tailor our education. There’s the added benefit of Montréal’s French language, which allows us to better transmit our knowledge.
You have been involved with various organizations to support and to advance their processes and practices. Can you give us some insight about your experience and reflections? A global highlight is really seeing how the organizations work. My personal mission is to learn from everyone because I believe that good ideas can come from anyone and anywhere. By understanding how organizations work you have the capacity to make helpful suggestions at other organizations to truly impact your profession, and this is why I stay involved. My advice to those interested is similar to getting involved in volunteer work; you need to showcase your skills for others to see you as an asset rather than a passive member. When you do achieve any opportunity, however trivial it may seem it is your duty as a professional to complete the task to the best of your abilities. Anything worth doing is worth doing right, be a perfectionist. People will recognize and respect that
It wouldn’t be right if I have an interview with you and not talk about your multiple years as the CSRT Airways Olympics champion or champion team! I try to attend the CSRT annually, the weekend of the CSRT is where ideas that shape our profession are conceptualized. These ideas can be generated in a formal round table discussion by the executives or over a drink between colleagues between provinces. Professionals in other areas of the nation are doing some unique things, and it would be foolish not to learn from them. The first time I participated in the airway Olympics was strictly by chance, a student at the time (now colleague) asked me to join, and I thought it seemed fun. I enjoyed the atmosphere of it. It was competitive yet very supportive. I was not nervous at all during the process because I have learned to trust and fear the airway. There are VERY few people in fact, who are airway experts. A difficult airway is actually a combination of factors such as the context, the equipment, the patient, the providers. The same airway in two different hands can be interpreted in two very different ways (Frerk et al. 2015. Hung, Murphy, 2010). For this reason, a good laryngoscopist respects the airway and thinks of every alternate airway plan before the patient even enters the room. A word of wisdom for practicing airways is just to get involved. Ask to manage the airway, whether you are in the OR or ICU. The worst that can happen is the physician says no. As you practice, you’ll begin noticing the subtleties of people’s airways and how to react appropriately. Compound this with simulation training, crisis resource management and situational awareness, and you’ll be a force to be reckoned with. If all else fails, you have the duration of the conference to practice at the sponsor’s booth.
I would like to hear your bigger picture of our field. What is the next big growth area that you see for the RT profession? I’ll answer this question with two lenses’ of focus — the first in anesthesia. I think the next growth area for AA’s is to get them OUT of the OR. One thought could be as a part of the chronic pain clinic/rounds. Their pharmacological expertise allows them to adopt this role well; furthermore, they understand the surgery as a whole, so they can better understand pain management. Another area that has a growing body of literature are vascular access teams and AA’s leading them. Vascular access teams deal with the insertion, management, removal and correct use of central venous catheters (CVC), radial arterial lines or peripherally inserted central catheters (PICC) often guided by way of the ultrasound. AA’s are exposed to many facets of line insertion and ultrasound usage. Small, context-specific studies have begun showing a benefit in patient care. (Hunter, 2003. Johnson, et al. 2017) The second lens is as a scholar. The fundamentals of respiratory therapy as a profession is based in critical-care medicine, however, over the last 50 years, our role has exploded outwards to include everything from home-care to innovation. However, the literature that supports our profession is lacking. In critical care medicine, the majority of our evidence-based practice is extrapolated from medical and nursing research. As we become stronger clinicians, we must also become stronger scholars. This will allow us to ask and answer questions that are specific to our scope of practice. Doctorly-trained RRTs would facilitate this.
I am going to make my last question a personal one. You are open with your body art. Tattoos to be specific. In the past, there was a slightly negative stigma with having tattoos. Those views and beliefs are changing. I personally have tattoos but they are all covered when I wear my scrubs, so I am curious to hear your perspective.
Have you felt any resistance from an employer or experienced a negative situation by a patient or fellow colleague about your choice to have tattoos on visible body parts? And on the flip side, How have tattoos helped you with your practice and in connecting with other staff and patients? I’ve never had any resistance from my tattoos; the hospital has a powerful union backing their employees so as long as your job is done well, then it doesn’t matter. Many of my colleagues have even more than I do. The stigma is slowly fading, even in the literature. A cool study by Cohen et al. (2018) looked at patients perceptions of emergency physicians with or without tattoos regarding physician competence, professionalism, caring, approachability, trustworthiness or reliability and found no difference. I feel that my tattoos actually helped my career when I first started. I was always referred to as “the RT with tattoos,” and more and more nurses and physicians would remember the work I did because it was associated with my tattoos. I tend only to cover my tattoos when I present a lecture just because I want the audience to focus on my slides or voice versus being distracted by what I look like. Finally, the best comment I received from a patient was a little 80-year-old COPD patient who exclaimed that she loved my tattoos because it brought some colour and brightness to her day stuck in the hospitals.
Thank you Marco for your dedication, passion, and contributions to the field of respiratory therapy!
Reference (provided by Marco).
Cohen, M. Jeanmonod, D. Stankewicz, H. Habeeb, K. Berrios, M. Jeanmonod, R. (2018). An observational study of patients’ attitudes to tattoos and piercings on their physicians: the ART study. Emerg Med J. doi:10.1136/ emermed-2017-206887
Frerk, C. (2015). Difficult airway society 2015 guidelines for management of unanticipated difficult intubations in adults. BJA: British Journal of Anaesthesia, 115; 6: 827-848. DOI: https://doi.org/10.1093/bja/aev371
Hung, O. Murphy, M. (2010). Context-sensitive airway management. Anesth Analg; 110:982-3
Hunter, MR. (2003). Development of a vascular access team in an acute care setting. J Infuse Nurs. 26(2):86-91
Johnson, D. Snyder, T. Strader, D. Zamora, A. (2017). Positive influence of a dedicated vascular access team in an acute care hospital. JAVA. 22:1 DOI: dx.doi.org/10.1016/j.java.2016.12.002
Interesting study of barbers doing BP monitoring.
Reminds me of Community Paramedics stepping up to assist patients in Toronto.
Where do you see the future of community RT? Homecare companies doing home visits to do Spirometry and assess Puffer techniques?
Marijuana health and safety education part of driving license requirements?
If you are a preceptor, educator, team lead, manager or leader, you can greatly benefit from this video by Simon Sinek. He talks about empathy, perspective, and a better understanding of our current younger generation. Watch it to gain another perspective, or perhaps another tool for your leadership tool box. It will help you to guide your team to be the best they can be and in turn, they will better serve the values and interest of your company/organization.
I recall that as a child I was always fascinated by Kinder Surprise products. The excitement of having milk chocolate and building my own toy! I would put the parts together, and then pull them apart to study the design behind it. Functioning toys despite the limited space and parts! The creative and engineering design behind these creations is amazing. Even as an adult, I am still curious about what companies and people go through to present a performance, a product or a service.
I come to learn that many Respiratory Therapists have a similar interest in understanding processes. Perhaps that’s what makes us skilled troubleshooters, innovators, and effective team players in interprofessional settings.
One way to nurture this strength is to ask questions. As children we were more curious and comfortable asking questions. We need to revive that sense of curiosity to promote growth.
Here are my 5 personal views and advice on asking questions.
Create a supportive space for learning
I remember on my first day of clinical rotations at my base-site hospital, our Practice Lead said: “You know the saying that there is no such a thing as a stupid question?… Well, that’s wrong”. I looked around the room and saw that the same expression of shock and surprise on the face of my fellow classmates. I hope you have a supportive culture at work or school which encourages a safe space for growth and learning. Allow your students and new hires to ask their “stupid” questions before they resort to “trial and error” on real patients.
Asking questions is a not a vulnerability but an indication of caring.
Whether you are a student or experienced RT, put egos and feelings aside and ask questions. Asking questions is not a sign of weakness but demonstrates a willingness to learn. There is danger in the mentality of “fake it until you make it”. Confidence comes with competency. We should ask questions to learn and to better master the knowledge or skillset. Learn, incorporate new learning in practice, evaluate with feedback, modify and repeat.
Questioning a routine practice is a growth opportunity and not a threat.
When questioned about a routine practice and the answer you come up with is “that’s the way we have always done it”, know that you either need to review the support for that guideline/process or you need to re-evaluate how it is done.
I have had staff RTs express that they used to follow the advice of experienced RTs and that “younger” RTs need to question everything before they do something. Please don’t view this as a criticism, threat or laziness. This is a learning framework for younger generations who have a lot more available resources and opportunities to be involved in decision making.
Timing of questions
Asking questions, just like any other form of communication, can be impacted by the timing, tone, intent, importance, and perception. If you are watching your preceptor in the middle of a complicated code and you notice a unique LMA insertion technique, the question about the technique probably can wait until the patient is more stable and/or during the debrief. If you are asked to put a BIPAP on an unconscious patient and you have valid reasons to be worried about airway protection, then your questions require more urgency.
As always, be kind to others and ask questions to learn something and not to show off your own knowledge or to make a statement.
Talk to people outside of your team, unit, hospital, and even profession. You will be surprised about the different perspectives on a subject matter. This is one of the reasons why I enjoy attending conferences that are intended for RTs and those that for various Healthcare professional audiences.
“Science is fun. Science is curiosity. We all have a natural curiosity. Science is a process of investigating. It’s posing questions and coming up with a method. It’s delving in.”
-Sally Ride (American astronaut, physicist, and engineer).
These are my personal opinions and views. Now let me ask you! What are your thoughts? How have you created a safe learning environment for your students, new hires and experienced staff? What advice do you have to share with others about asking questions? Do you have a story to share about how an inquiry helped with patient care? Leave a comment and let me know!