Critical Care: Learning in our Current Landscape with Dr. Laurent Brochard, Interdepartmental Division Director of Critical Care, Temerty Medicine
Collaborating across four departments, Temerty Faculty of Medicine’s Interdepartmental Division of Critical Care is the largest critical care training program in Canada, with faculty and learners training across Medicine, Surgery, Anesthesia and Pediatrics.
From the front lines of patient care during the height of the COVID-19 pandemic to being a key support to specializations across our hospitals – critical care is an integral piece of our healthcare system.
Dr. Laurent Brochard is the Director of the division and has been with the University for close to ten years. Having trained across Europe and North America, Dr. Brochard says Toronto’s critical care training program is truly unmatched.
“The ability to collaborate with faculty and learners across departments is an advantage unique to Toronto,” says Dr. Brochard. “The ease with which we are able to cross-collaborate has led to such an incredibly impressive output of academic work and research that has been impactful not only locally, but on a global scale.”
Education, research and quality and innovation (QI) are cyclically intertwined in critical care. Dr. Brochard’s specialization in mechanical ventilation is a prime example of this relationship.
Mechanical ventilation takes over the function of breathing when a patient is either partially or completely unable to – a medical intervention routinely utilized for the sickest of COVID-19 patients. Research developments from the front lines of the pandemic on respiratory distress and mechanical ventilation have already been implemented in the division’s curriculum and training.
“Our goal as critical care intensivists is to understand how we can support the best possible patient outcomes in the intensive care unit (ICU) and beyond,” Dr Brochard says. “The learnings we obtain in clinical practice are directly applied to our curriculum which then improves the overall quality of care and outcomes for our patients.”
Dr. Brochard stresses the importance that equity and diversity play within the division. “Our international fellowships and collaborations allow the knowledge we’ve built in Toronto to have a global impact. Ensuring an equity lens is applied to all the work we do and the research we conduct, allows for its translation and application across the world.”
COVID-19 demonstrated the value of Toronto’s collaborative approach to critical care training and clinical practice. During peaks in patient volume and acuity when adult ICU capacity became overwhelmed, space was opened in pediatric ICUs to accommodate an overflow of adult patients – a partnership that came naturally to the division, Dr. Brochard says.
When asked about the role the division plays in tackling the continued crisis in our hospitals and across our health care system, Dr. Brochard says the approach is manifold. “As many of my colleagues across nursing and allied health have said – the solution doesn’t begin and end with adding more beds.”
The function of critical care is a partnership between physicians, nurses, physiotherapists, pharmacists, and other allied health professionals. For the function to work, all parts of the team need to be supported while being on the front lines, treating the sickest of patients.
“The current crisis we’re facing in our hospitals has been particularly taxing on our nurses and allied health partners,” says Dr. Brochard. “As physicians and partners in healthcare it is our job to be vocal about this and to speak up. The burnout is very real. At the divisional and the broader departmental level, we play an important role in advocating in allyship with our healthcare partners and colleagues.”
Many faculty in the division have played active roles in advocating at the provincial level – they are a collaborative group and want to have a positive impact in solving problems on the front lines, Dr. Brochard says.
Despite the challenges of the last few years, Dr. Brochard remains excited for the future of the field and the division: “Every year, I have the privilege of interviewing candidates for our training program and am reminded of the collective goal we share of constantly seeking to improve upon the care we deliver – not only for the immediate outcome, but for the long-term quality of life of our patients. While tiring at times, critical care is an incredibly rewarding and fulfilling field of work.”
Wellness and supporting learners and faculty remains a priority in the division. Dr. Shelly Dev, who has written and spoken publicly as the daughter of immigrants from India and about her struggles with mental health, has been appointed Director of Mentorship and Wellness within the division. “There is room for everyone in critical care,” Dr. Brochard says. “Diversity and representing the populations we serve is critically important to our work. We have an incredible academic program that trains the best intensivists – I couldn’t be prouder to lead this division.”
