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Gordon Giddings. Editorial Fellow, CMAJ.Gordon Giddings, is the outgoing CMAJ Editorial Fellow (2013-14)

 

It’s likely that you will hear many different responses from colleagues when you announce to them, after having been in practice for several years, that you are undertaking a medical editorial fellowship with CMAJ. Some of the responses that I received when I announced this to my palliative care colleagues were

“You’re gonna be a paper doctor!”

“Oh my goodness! I hope everything is okay.”

“Interesting. How much does it pay?”

Colleagues were not the only ones uncertain about this career step. When I explained to the CMPA rep what I would be doing for the year, they could not figure out what category of coverage to put me in, repeating “I’ve never heard of this. So you’re not going to be seeing patients there then?”

In fact I did continue to see patients on a semi-regular basis, but my full time job as an editorial fellow was based at the offices of the CMA in Ottawa. I commenced my fellowship just over one year ago. It was somewhat ironic, given that my least favorite aspect of residency was journal club. However in the years since that time, I came to develop a great respect for the medical literature, and to rely on it, not only in my clinical and academic roles but also in administrative ones. I also hoped to find a way to combine medicine and literature in my career, whatever that might lead to.

It was not surprising that my CMPA representative had not heard of the editorial fellowship. There were not even 10 fellows that had completed the CMAJ fellowship in its history, and only 3 or 4 other journals had a similar program (in fact, as the world of medical editing is relatively small, I would go on to become good friends with the current editorial fellows from the New England Journal and the British Medical Journal). It was certainly somewhat intimidating initially, given the combined international editorial, academic and clinical experience of the CMAJ editorial team. As well, many of the previous CMAJ fellows have gone on to very distinguished international careers that span editing, research and clinical medicine. Would I measure up? Would I be good enough?

One element that made my introduction to CMAJ a bit more relaxed was the fact that my fellowship supervisor, an experienced editor trained at the BMJ, had only arrived a few weeks before I had, and was similarly getting familiar with her new surroundings; however, we both quickly found our bearings. Within the first couple of months of the fellowship I was already a regular voting contributor at weekly research manuscript meetings, and had undertaken additional study in epidemiology at the University of Ottawa, with plans to attend several conferences throughout the year.

After the initial stint in the Research section for CMAJ and CMAJ Open, I rotated through the Practice, News, Humanities, Commentaries and Analyses sections before having a final ‘consolidative’ month where ‘anything was fair game’. In addition to this, I had the opportunity to contribute 2 editorials to the journal, which gave me some of my first experiences with physician advocacy in an international forum.

Though a visiting elective experience with the BMJ in February had to be cancelled (due to the arrival of my son), I feel as though I have received a world class education in the skills of critical appraisal and scientific writing. I am also very proud to have my CMAJ supervisors and colleagues as mentors and friends. I will be continuing with CMAJ in the role of Associate Editor, and I expect I will spend the next couple of years attempting to strike the right balance between editing and practice. I have a couple of exciting projects on the horizon in both editing and clinical medicine, and I realize that having undertaken this fellowship has given me additional confidence in both of these roles (in this era of evidence based medicine), as well as a desire to continue learning.

Next week, CMAJ welcomes its new editorial fellow, who will bring her own unique set of experiences and perspectives to the role, and I’ll take this opportunity to officially welcome her. I would also like to acknowledge CMAJ for being one of the few journals in the world to offer the experience of gaining the editorial skillset for both physicians just starting out and those already in mid-career phase. I encourage all physicians to continue to enhance their critical appraisal skills, not necessarily through editorial fellowships, but through courses, journal clubs (yes, I said it), opportunities to peer review, or through individual reading. Perhaps a good way to start would be by going to cmaj.ca and checking out the newest research article or commentary - or maybe acting as a contributor yourself.

As any editor worth his salt, I am conscious of my word limit. Regards and thanks to all for making this a year I will not soon forget.

Gordon Giddings. Editorial Fellow, CMAJ.by Gordon Giddings, Editorial Fellow (2013-14), CMAJ

One of the benefits of attending conferences is in getting to share knowledge and in meeting colleagues—seeing how things are done in other places and settings. It is, however, less frequent that we have the benefit of direct patient experience at these conferences. It should not be underestimated how powerful that is.

I had the distinct pleasure of meeting Canadian classical guitar legend and multiple Juno Award winner Liona Boyd at the General Practitioner in Psychotherapy Association Annual Conference in Toronto on May 24. Liona was one of the keynote speakers and opened the morning session with a talk on focal dystonia. This was a very personal story for her as someone who had reached the heights of an internationally celebrated career, having played for England’s royal family and American presidents, and living a jet-set lifestyle in Beverly Hills. She began to notice several years back that she was having increasing difficulty in playing some of the more difficult passages on her guitar, specifically a technique called ‘tremolo’, a way to produce a sound likened to 2 or 3 guitars playing at the same time. Her fingers were not painful, but stiff, and wouldn’t seem to want to do the tasks that she had so effortlessly done over the years before.

She was subsequently diagnosed with focal dystonia, a diagnosis that she resisted for several years, as she was told that it was incurable. The implications of this for her were immense, as the guitar had defined her career, livelihood, aspects of her marriage, and in a very broad sense, her life as a whole. After struggling through several performances, she stepped down from the professional guitar stage at the level she had been performing. She moved to Miami, and after a period that she refers to as ‘la vida loca’, began looking at potential treatment options, for other ways to further her career, and ultimately to re-engage with her life.

To a large extent she has done that, by launching a singing career with multiple vocal recordings to her credit, moving back to Canada (yay!) and picking up the guitar again and giving concerts, albeit with a different technique and the assistance of a guitar partner who often accompanies her during live performances.

Liona stated during her 90-minute talk that this was the first talk (and PowerPoint presentation) that she had ever done. It was indeed a very admirable and inspirational presentation. However, her presence did bring something else—a reminder of the reasons why we travel to conferences and spend endless hours on continuing education, read numerous journal articles and immerse ourselves in rigorous research and scholarship.

The experience reminds me to immerse more fully with patients in their experience. Physicians often control what transpires during a patient visit. This may have the effect of rendering them more passive in their health care experience. It is important to remember to see patients as more than just their disease, but placing their experience in the context of their lives. Specifically looking at:

How is this illness affecting your life?

What do you think is causing it?

Why do you think that is happening?

What are you concerned that it might be?

What were you hoping we might be able to do for this?

Liona spoke of the difference for her in being seen by medical professionals who truly wanted to understand her illness experience and see how they could improve her condition. What proved most successful for her was a transdisciplinary approach that acknowledged the limitations and losses that she had experienced, but that also gave her a sense of hope and purpose. Though she still suffers from focal dystonia, she is optimistic about her diagnosis and her future. As well, myself and 100 other physicians who heard her speak that morning were enriched for it. Thank you Liona!