During stressful times we tend to focus on the challenges and the struggles. It is important to not lose sight of the positive in our lives and to give gratitude.
Over the past few weeks, I have witnessed many amazing people stepping up to help everyone. Thank you, Sue Jones and Kelly Hassall, for your ongoing dedication and leadership to help RTs through Respiratory Therapy Society of Ontario (RTSO). Thank you, Gino Luigi De Pinto and Sue A., for keeping the RTSO website up to date with the latest resources.
Thank you, Thomas Piraino, for putting together the great resource on your website, and answering questions live on social media.
Also, a big thank you to Carolyn McCoy, Andrew West, Carole Hamp and Kevin Taylor for your ongoing hard work in the background.
Thank you to RT programs for lending your ventilator to hospitals, and taking your third-year students out of clinical rotations to keep them safe.
Farzad Refahi March 23, 2020 www.Respiratory.Blog/gratitude/ [End]
I first heard of Mr. Gino De Pinto through other Respiratory Therapists (RTs) and indirectly through social media interactions. At the 2018 Vancouver Canadian Society of Respiratory Therapists (CSRT) conference, I had the opportunity to meet him in person. During the 2018 Respiratory Therapy Society of Ontario’s (RTSO) Leadership Summit, and through my discussions with him, I recognized his genuine care and passion for our field. When I spoke to one of his past students, he appreciated Gino’s evident care for students. His past and current students have commented on Gino’s direct and open communication, and his wiliness to stand by and for students in our field. I personally got to witness and appreciate his character as a fellow RTSO volunteer. He has brought enthusiasm to our board of directors and has re-energized our student engagement committee. I am happy to share my interview with Gino below.
Gino, thank you for taking the time to answer my questions. Let’s go to the beginning. How did you get involved with the field of respiratory therapy?
With the respiratory therapy profession having a low profile on television and in the media compared to the nursing, physician and paramedic fields, finding out about the profession was by accident. Going back to high school I enjoyed taking science courses and I was always fascinated with the cardio-respiratory system. My title for my final presentation for OAC Biology was “Exploring the World of the Blue Bloater and Pink Puffer”. A strong interest in science led me to the University of Waterloo where I received my Honours Degree in Science. During my final year at Waterloo, like many other RRTs I came to the realization that I needed to further my education if I wanted a career. Having both a brother and sister working in healthcare I started exploring opportunities. I applied to both the Medical Radiation Technology program and the Respiratory Therapy program at Fanshawe College. I was accepted into both programs. After going back and forth on a decision that would affect the rest of my life. I reached out to a family friend that was working as a RRT at the Timmins and District Hospital and I made arrangements to spend the day with a RRT to help with my decision. I spent the day with Susan Boisvert who showed me all the roles of the profession from PFTs to managing a patient on a ventilator. That was all I needed to make my decision and later that day I accepted my offer to Fanshawe College in the fall of 2000.
The graduating class of 2003 all faced the same challenge of entering a profession with much uncertainty. A few months from graduating, healthcare in Canada was dealing with the SARS crisis. As RRTs we were front line workers dealing with an infectious respiratory disease that people knew little about. Infection Control practices changed immensely since 2003. My students can testify how much emphasis I put on infection control practices during competency testing and I can trace that influence back to working in the aftermath of SARS. Since they were limiting visitors to hospitals during that time, I was offered a telephone interview for a temporary full-time job at Grand River Hospital. I was not able to set foot in the hospital but accepted the offer of employment as I thought it was a tremendous opportunity. During my time at Grand River Hospital I had some great mentors like Deb Bester and Jocelyn Hurst who helped mold my career. They set a high standard for patient care and for being accountable. Within a couple of years, I was able to take on a role as Resource Respiratory Therapist where I was able to learn how to create and maintain Policies and Procedures. I was a member of ICU council where I was able to use my voice as a RT to help with VAP protocols, help establish the RRTs role with the Critical Care Response Team and give my input into the design of the new ICU. This is where I could really see the importance of the interprofessional model that is so important with the patient-centered approach to medicine. After 16 years I continue to work at Grand River Hospital as a casual RRT. I have far less influence on the department as a casual but the position allows me to keep current with practice.
Thank you to Susan for introducing Gino to our field! Since graduation you have been involved with various roles, activities, and volunteering positions. Can you share with the readers some of your memorable roles so far?
I also had an opportunity to work at St. Mary’s General hospital on a
part-time basis for 4 years. Working at a cardiovascular hospital gave me a new
perspective on the profession. Working with great mentors like Danny Veniott
and Rob McGivern exposed me to how a great work ethic and positive attitude can
dramatically change a culture of a department. With their leadership the role
of the RT grew dramatically. Inserting of arterial lines became the norm, establishing
an Anesthesia Assistant program and a Weaning centre of excellence were just a
few highlights that I witnessed firsthand that influenced my career. Never
satisfied with the status quo of the profession are lessons that I learned from
my time at St. Mary’s. This is where I first met Lori Peppler-Beechey whose professionalism,
positive attitude and leadership skills were evident early. After working with
her for a years she resigned from St. Mary’s to start a new RT program at
Conestoga College. On one of her last shifts I told her if she ever needed
anyone to teach part-time to give me a ring. I thoroughly enjoyed being a
Preceptor for students at the bedside and thought this would be a great
opportunity. The phone rang a few months later and an opportunity to teach in
the lab presented itself.
Teaching part-time for the first 2 years of the program was stressful and
exhilarating. Going back to the textbook to refresh on content to ensure I was
teaching concepts appropriately was nerve racking but rewarding. Students came
with a tremendous passion to learn about respiratory therapy which made the
stress all worth while. After teaching part-time for 2 years there was an opportunity
to teach on a full-time basis with the focus of teaching and facilitating the
clinical year of the program. After finally having a regular full-time job at
St. Mary’s another difficult decision crossed my path. Do I leave a stable
full-time job for another full-time job at a College with a program that was
yet to be accredited? With the support of my wife, I made the decision to take
the job. The decision was made a bit easier knowing that I would be working
with great people like Lori Peppler-Beechey, Tim LePage, Kelly Hassal and Karl
Weiss. With this great team we were able to attain full program accreditation
During my first years of teaching at Conestoga College I am most proud of
the relationships formed with our clinical partners. Ensuring all stakeholders
had a voice in the education of RTs from Conestoga College positioned our
students for success and eventual employment. Helping establish and integrating
clinically immersive simulation into the program was another career highlight.
Working with a mentor like Karl Weiss on the design and implementation of
simulation into our curriculum was stressful and gratifying. Then being able to
present our findings at the 2013 CSRT conference in Niagara Falls allowed us to
showcase all our hard work. Another highlight was working with Karl Weiss on
developing our pediatric/neonatal hybrid rotation. With a bottleneck of
pediatric rotations shared with other college programs. We had to create a
clinical immersive simulation in combination with a traditional hospital
rotation to best prepare our students to meet those neonatal/pediatric competencies.
At that time, I was able to work with amazing subject matter experts like Gary
Tang, Ernie Matchett, Cathy Trocchi, Tami Tesseyman, Catherine Burke-Trembley and
Pam Hall. Collaboration was the key to success and their input and expertise
made for a great learning environment for the students and faculty.
Four years ago I transitioned from a full-time professor responsible for
the clinical year to a more traditional teaching position in the classroom.
During that time the program said good-bye to Lori Peppler-Beechey as she took
on new roles in leadership. Currently I have the pleasure of working with Pam
Hall who is now the program coordinator. Seeing the passion she has for
teaching her students is infectious. She is a tremendous leader, passionate for
the profession and a hard worker that has inspired me to be a better teacher in
In the context of a clinical setting, which area did you enjoy the most? Also, how can RTs be better clinicians?
I enjoy working in Critical Care the most. Learning about and applying new ventilator strategies is what makes our profession unique. Being at the bedside and looking back at the past 16 years of optimizing the patient while on the ventilator, I can look back and reflect on the trends. I have worked with mostly adults and seeing the adoption and implementation of ARDSnet, the use of APRV, HFO, prone ventilation, tracheal gas insufflation and the use of inhaled prostaglandin are just few examples of different strategies used to help patient’s breath. Being a patient advocate in my opinion is the best quality an RT can have. Being able to speak up and provide suggestions to help our patients is key. Recognizing that patients don’t all fit in the same box is the first step in ensuring your patient will receive the best possible care. Looking at waveforms, interpreting blood gases, looking at chest x-rays and providing evidence informed literature are all keys to making appropriate suggestions at the bedside. If you continue to advocate and look for solutions, you can sleep better at night knowing you tried all possible treatments to help your patient with their specific disease process.
Seems like the decision to become an instructor was not at random. Can you expand on that? Also, any advice for RTs who may want to get involved with this role?
As I mentioned earlier, I always enjoyed being a Preceptor to a student.
Being able to showcase your expertise and help students apply theory to patient
care was always rewarding. For those of you who are interested in teaching I
recommend that you respect the learner, this will ultimately create a positive
learning environment. Look for teaching opportunities within your organization
like becoming a BCLS or NRP instructor. Build your resume by going to
conferences and participate in webinars. When meeting educators express an
interest in teaching, gather their contact information and send them your
resume. When an opportunity presents itself be flexible and accountable. This
will help ensure you do not miss on future teaching opportunities.
What advice do you have for RTs and
preceptors to better assist students in their growth? What advice do you
have for students to maximize their learning and growth?
Having students can present challenges. Listening and reframing your
question will better assist a student with their growth as a professional. Do
your best to be patient and try to remember what is was like when you were a
student. Students come to the hospital or home care setting wanting to do their
best. If a student is struggling with a certain topic try to remember what
stage of the clinical rotation they are at. Is it their first day or have they
been in the rotation for a couple of weeks? Knowing this will help you determine
how to best guide your student. Do they need to see a procedure for the first
time or an additional time? Do they need to review pharmacology or
pathophysiology so they can best understand treatment modalities? Once you have the answers to these questions
you can determine the appropriate feedback that will stimulate connections to
theory and help them grow as a learner.
Advice I give to students to maximize their learning is to be flexible.
Having multiple Preceptors can add stress to a student’s learning and growth as
a practitioner. At this point in your educational journey you would have had
multiple teachers with different teaching philosophies and styles. Not all the
teachers would have resonated with your learning. The same can be said about
Preceptors, but as a student if you respect what they want to teach you and
appreciate the time they are taking to demonstrate a practical skill will help foster
a relationship. By building relationships and trust, preceptors are more likely
to invest in your learning. If a preceptor invests in your learning you will
maximize all learning opportunities that present themselves.
Your contributions to the field include
holding few past and present volunteering roles. Can you expand on that? Also, this is a good time for me to ask about
your involvement with RTSO.
When I was a student at Fanshawe College I had great teachers who all volunteered their time outside the classroom. Paul Williams, Dennis Hunter and Sandy Annett led by example and all were volunteering with different aspects of the profession. For myself, helping establish a new respiratory therapy program for the first 8 years of my teaching career was very busy. Now that the program successfully navigated through two accreditations and has graduated over 10 classes, I am able to find time to give back. Our program had developed great relations with CRTO and CSRT. The next step was to build a strong relationship with RTSO. I had the pleasure of meeting Dilshad Moosa at the CSRT conference in Vancouver a couple of years ago. This meeting led to an opportunity to gain a position as a Co-chair of the student affairs committee. Once in that role I was able to see the importance and need of connecting the Ontario Respiratory Therapy programs with the RTSO. The RTSO plays an important role providing a voice to the profession. Being able to connect with great leaders like Sue Jones, Sue Martin and Nancy Garvey have given me a great perspective on the profession and where it is going. Once in this position I was approached to be on the Board and was happy to take on this new role. Since taking on this role I have had the pleasure to work with the Ontario colleges to increase student membership and provide contributions to the RTSO Airwaves. At this point I am more than happy to give a shout out to Shawna MacDonald editor of RTSO Airwaves who continues to provide excellent resources for the RT community and remember if you are an RRT in Ontario #MembershipMatters. Being able to model leadership traits in the profession to my students will hopefully encourage them to be great leaders when they graduate.
It is interesting how we are positively influenced by the
great work of others. I was a student
when RTSO held an educational day at The Michener Institute. I volunteered and was very impressed by the
leadership and professionalism of its president at the time, Mr. Jeff
Dionne. I also enjoyed and looked
forward to Airwaves (thank you Shawna!).
The decision to join RTSO and volunteer with the organization was an
easy one. As I mentioned in the
introduction, I am impressed and appreciative of all of your contributions to
I am going to take a step back to talk about the bigger image of our field. How do you see our field changing over the next few years? Also, what changes do you hope to see?
The role of the community RT has changed dramatically over the past
decade. More patients are at home needing support with their oxygen needs,
tracheostomy care and home ventilation. The government has funding to support
theses new initiatives so hopefully we will see continued support from leaders
in our profession to take advantage of these opportunities and promote our
profession. I am hoping we can learn from our Paramedic friends who are now
offering their services to patients in the community. Community Paramedicine
(CP) programs provide opportunities for Paramedics to apply their training and
skills in the community outside of their traditional 911 emergency response
role. CP programs promote Paramedics to
work in collaboration with other health care professionals and community
agencies to connect patients with needed health and community services. These
connections assist patients to participate in their care, maintain independence
and promote involvement in their communities. I see a real opportunity for RTs
to take on a similar role in the community and I hope to see initiatives like
this trickle down into our profession.
Outside of work and volunteering, what do you enjoy doing?
I love spending time with my family.
I have a wonderful and supportive wife named Judit and 3 beautiful children who
keep me busy. I love basketball and I am a die-hard Raptors fan. From watching
Alvin Robertson drain the first points in franchise history at Skydome to
watching this magical run of the Raptors hoisting the Larry OB has been a dream
come true. Now I patiently wait for the release of the next season of Stranger
Before we end this interview, do you have any final words to
share with the readers?
Farzad, it has been a pleasure knowing and working with you
over the past couple of years. I am hoping the passion and dedication that you
have for the profession spreads through our wonderful community. I appreciate
your inclusiveness while advocating for the profession. Keep doing what you are
Thanks Gino. The credit really goes to all the wonderful RTs out there, like yourself, who perform quality work and push to raise the bar despite all the obstacles along the way. I have simply been lucky enough to share my journey of learning and discovery with my followers.
Once again, thank you Gino for sharing your insights with me and the followers. Also, thank you to the followers of this blog for taking the time to read this interview. Hope you enjoyed this interview as much as I did.
This post is put together by Farzad ‘Raffi’ Refahi and made available online by the support of John Meloche of the Melotel company.
Lynard Higoy is a Registered Respiratory Therapist (RRT) whose presentation I attended at the 2019 Canadian Society of Respiratory Therapists’ (CSRT) annual conference. He was energetic and passionate about the topics he presented. He works as a community RT, covering a vast area. His role greatly depends on interprofessional collaboration. I wanted to find out more about his work, and the work of independent or community RTs, so I connected with him over many emails. Thank you Lynard for sharing your perspective. Also, a big thank you to CSRT for exposing me to many amazing speakers at your conferences, such as Lynard.
Please join me as I interview Lynard:
I have a great interest in hearing about the spark or series of events that shape people’s decision to study respiratory therapy. How did you find out about the Respiratory Therapy field? Why did you choose to study RT?
It was pure accidental! I did not get in to the pharmacy program so I went to U of M’s school of Med Rehab open house. My original plan was to attend the open house for the physiotherapy program. Then I remember seeing different types of ventilators, Intubation kits, Jackson-reese and a pig lung. It was love at first sight and the rest was history.
You have been practicing for some time now. Can you share with us some of your memorable roles so far?
First one is when I was invited to be a speaker in the previous CSRT conference held in Niagara Falls. And also, when I was part of the Deer Lodge Centre Pulmonary Rehab Team In Winnipeg that won the 2014 Commitment to Care and Service Award, Collaborative Team Initiative.
I love the rural practice because you can spread your wings and maximize your scope of practice! Everyday is a different challenge! I may not be flying with STARS or part of the transport team, I may not be assisting with intubation in the trauma room but the acknowledgment and appreciation of my clients made me think that I’m a very valuable asset in the community. Since I’m the only respiratory therapist in Vegreville , Two Hills and Lamont employed by Alberta Health services, I have the feeling of accomplishment whenever doctors value my recommendation. The most memorable in my role as a community RT is when I was in doing some grocery shopping and my former pulmonary rehab client approached me with her daughter and told her “ This is the guy that helped me breathe better! Without him and his breathe easy program I won’t be here.” that is the most memorable moment for me so far as a community RT.
I think most of us go through the RT program thinking of the acute care aspect; Appreciating the immediate life and death decision making that can impact patients. With experience and exposure to patient care, we realize that there are multiple dimensions to patient care. Each role or setting is unique and vital to patient care. Seems like you have had the opportunity to experience and contribute to patient care in various settings. I have a quick question about the location. How did you end up covering Vegreville, Two Hills and Lamont ? Are you originally from that area or moved there for work? If you moved there for work, what contributed to that decision?
So I’m originally from Manitoba (U of M alumnus) and practiced there for 3 years. I followed my heart and moved to Alberta to be with back with my then girlfriend and now my Fiancée. It was a challenge to find a fulltime job in Edmonton especially as a community care RRT. I got a job offer in the private sector (Lakeland Respiratory) in Vegreville which is approximately 100 km east of Edmonton. The selling factor for this job was I’m going to run a pulmonary rehab in the town hospital so I said yes and took the offer. Then after 8 months my current position opened and I applied for it. I been in this position for 2 years now and liking it every single day. : )
Because of my current and previous work settings, I have had in person RT support within seconds to minutes away. Your experience has been different. Can you tell me about the planning, consideration, thinking framework, challenges and opportunities when working by yourself?
My piece of advice when you are in rural practice and working by yourself….. Don’t be scared to ask for help! I think this is when Inter professional collaboration comes in as a very important tool to be successful. I don’t work in my own silo anymore, I welcome ideas and expertise from other healthcare professionals such as OT, Physios, Exercise Specialist. Recreation, Social Work, Therapy assistants, Sleep Language Pathologists, Nurses and Admin assistants. At the end of the day, we all wanted one goal and that is to improve the well-being of our clients. My CSRT presentation “Screening for Dysphagia in COPD assessments” was a product of collaborating with our community SLP to reduce the rates of COPD exacerbations due to aspiration Pneumonia. The camaraderie of healthcare professionals working in rural areas are something that I admire, they are always there to help you all the time.
Also, working alone makes you realized how your research methodology course back when you were an undergrad is not to be discarded. Consider research journals as your friend if you have to work alone. If doctors asked me a respiratory question and I don’t know the answer, I’ll either contact my professional practice lead or search the Web for evidence-based practice research that can support my ideas.
Interprofessional efforts, communication, collaboration and trust are important part of patient care, as you have already mentioned. Was that the culture in place when you began working there, or was it something that had to be worked on?
The answer is both! The culture was in place before I started working here but just like every other worksite, you have to earn your keep. You have to prove that you are trustworthy, easygoing, that you value not only your job but the rest of the team and that you are not just there for the money but rather to always put your heart in what you do.
You mentioned articles and journals as one of your references. Do you have any favourite resources that you can share with us? Also, how do you support your growth? What’s your approach to continuing education? Beside teaching patients and their families, do you get the opportunity/train other healthcare providers?
Yes, The CJRT, Pubmed, Science direct, and others. I’m a big fan of everything as long as it came from a reliable source. I totally support professional growth and continuing education. I’m currently pursuing my post baccalaureate diploma in Leadership and Management through Athabasca University, Faculty of Business which is one of my prerequisites for the MBA program. If time permits, I attend workshops, read journals, webinars and seminars that will help me with my everyday practice.
Yes, because of the nature of my work since I’m the only Community RT in my rural area, I serve as a respiratory clinical resource and I cross train other healthcare disciplines with RT work such as oxygen therapy, emergency trach changes, lung volume recruitment strategies and many more.
What’s your approach to teaching students and staff? What advice you have for RTs to be better preceptors? Also…what advice do you have for students to maximize their opportunity to grow and learn? In your opinion, what are some qualities that makes one a quality RT?
My advice, don’t be a smart aleck! I’m a big advocate of transformational leadership in healthcare. In order for them to succeed, you have to motivate them, inspire them and let them grow away from judgment and intimidation. Also, being a role model for students in order to raise interest and understanding with the stream that you work. Allow them to know their strengths and weaknesses so they would be able to self-reflect on their performance. You know you did a good job if one day they came back and say.. Hey you’re my RT hero and I’m following your footsteps. A quality to say this RT is the best?? I would say……. Being able to look beyond self-interest to the common good.
What has attracted you to the Leadership and Management? What made you decide to pursue MBA?
Management is where I have wanted to be since I was an RT student. I know as a community RT I am helping respiratory clients with my respiratory expertise such as smoking cessation, pulmonary rehab etc., but I think I want to work and be a catalyst for change in the management/senior leadership level. In this level, I would be able to work upstream and be involved in health policies that can substantially improve not only the respiratory health of Canadians but rather the whole Canadian healthcare system.
How do you see the future of our field?
I want to see more RRTs stepping into management and senior leadership roles. I mean not just respiratory therapy managers but management roles that have been dominated by other healthcare professionals. With our RRT skills such as juggling multiple tasks, time management, grace under pressure and resiliency, I believe we would be successful in these roles.
Outside of work, what do you enjoy doing? What are your hobbies?
If I’m not at work, either you’ll see me at the gym or at the lake. I like working out pretty much every day. I love both fishing and ice fishing. I also love to explore the world with my fiancée.
Any final words?
Keep the Respiratory Therapy Passion burning!
Thank you Lynard for opening my eyes to more unique perspectives. Also, thank you for your dedication to our field and the interprofessional team that looks after the patients. By sharing your views and experiences, you have helped to further represent our field and the work of respiratory therapists across all the healthcare settings. Congratulations on your engagement and good luck with your studies. I expect that the RT community will hear more about your achievements in near future.
A special thank you to the followers of this blog. Thank you for supporting a stronger RT presence!
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