Friday, October 25


0745 – 0845

Welcome and Opening Remarks

0845 – 0900

Dr. Sohail Gandhi, President, Ontario Medical Association

The Burnout Crisis: How Can We Heal the Healers?

0900 – 1030

Facilitator: Sharona Kanofsky, PA-C, CCPA

Panelists: E. Ann Collins, BSc, MD, President-elect Canadian Medical Association;

Kirsten Luomala, CD, MPAS, CCPA;

Third panelist TBC

Professional burnout, among clinicians and beyond, is reaching crisis levels. Among Canadian physicians, more than one in four doctors report high levels of burnout and one in three screened positive for depression.

Unfortunately, much less is known about how burnout is affecting Canadian PAs, both in the public health system and the military, where PAs serve in unique and stressful environments. However, we do know that burnout across all health professions, is linked to increased medical errors, increased health care costs, and poor patient outcomes.

In this opening plenary, physician and PA leaders will share their candid thoughts on the influence of team dynamics, scope of practice, and role ambiguity on one’s job satisfaction. They will also discuss what it will take to reverse these trends and how health professionals can come together to pursue a better path to wellness.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Define burnout and discuss how it is affecting Canadian health care professionals

2. Differentiate between individual and systemic factors that negatively affect PA health

3. Explain how burnout affects patient outcomes

Resiliency Skills for Healthcare Providers

1035 – 1125

Dr. Leslie Nickell, Medical Director, PA Program, University of Toronto and Shayna Kulman-Lipsey, Manager, Counselling Services, Health Professions Student Affairs, Faculty of Medicine, University of Toronto

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Recognize the importance of the resilience continuum that can impact well-being

2. Describe the seven key behaviours that support an ‘upward spiral’

3. Identify challenges/opportunities for resilience in your working environment

Practicing Evidence-Based Medicine while Respecting Indigenous Healing Beliefs and Culture

1035 – 1125

Amy Montour BScN, MSc, MD, CCFP, Clinical Professor, McMaster University 

Wake up its time to talk about Sleep Apnea!

1035 – 1125

Emily Murphy MPS, PA-C; Assistant Professor and Director of Clinical Education, University of Pittsburg; Jamie Hammond MS, MPAS, PA-C, Assistant Professor, University of Pittsburg

One half of US adults report sleep disturbances with only 30% of adult Americans report obtaining sufficient sleep. The prevalence of sleep apnea 20 to 30 percent in males (1 in 4) and 10 to 15 percent in females (1 in 10). Symptoms include excessive daytime fatigue, insomnia, lack of energy, morning headaches, difficulty focusing, frequent nocturnal urination , mood changes including irritability and depression, waking up with breath holding, gasping or choking, habitual snoring or breathing interruptions which are noted by bed partner.

Comorbidities often include obesity, treatment resistant hypertension, arrhythmias, heart disease and history of stroke and myocardial infarction.

Short-term physiologic and psychological effects of sleep apnea include impaired daytime cognitive functioning, irritability, difficulty concentrating, lack of motivation, depressed mood, difficulty with work, school and driving and heightened perception of pain. Long term physiologic and psychological effects of sleep apnea include glucose intolerance, obesity, impaired immune responses, accelerated atherosclerosis and increased risk of cardiac disease and stroke.

Simple and validated screening tools include STOP-BANG and Epworth Sleepiness Scale can be easily utilized by providers to identify patients who should be tested. Gold standard for diagnosis is in a lab or home polysomnography.

Treatments include weight loss, oral appliance, positive pressure airway therapy, medical implant and surgery.

Sleep apnea is easy to screen and treat and has a huge impact on the patients overall health and comorbidities with proper treatment and monitoring.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Discuss the etiology, presentation, and diagnosis of obstructive sleep apnea

2. Review strategies for management of obstructive sleep apnea

3. Explain the long-term physiologic and psychological effects of sleep-wake disorders

Networking Lunch with Exhibitors

1125 – 1240

Urology: A Quick Clinician Guide A to P

1245 – 1335

Todd Bryden, CCPA

This presentation will cover common Urologic conditions, emergencies, investigations and treatments. The presentation will include topics such as Hematuria (Micro & Macro/Gross), Acute Urinary Retention, Kidney Stones, Epididymitis/Orchitis/Orchialgia, Testicular Torsion and Fournier’s Gangrene and the important clinical features of each that would require immediate Urology consult. If time permits, some of the commonly encountered problems of inserting Urinary Catheters will be addressed.

Attendees will increase their knowledge and comfort level when dealing with the various common Urological complaints and emergencies that present to clinics, emergency rooms and hospital wards that are seen on a regular basis.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Recognize true Urologic Emergencies

2. Treat/Investigate Common Urologic complaints

3. Recognize difficult Foley Catheter insertions

Initiating Insulin in an Outpatient Setting

1245 – 1335

Elizabeth Roessler, MMSc., PA-C, Assistant Professor, Yale University

Type 2 diabetes mellitus is a chronic, progressive disease characterized by multiple defects in glucose metabolism and associated with insulin resistance and slowly progressive beta-cell failure. By the time that Type 2 diabetes is diagnosed in patients, up to one half of their beta-cells are not functioning properly. Due to this, patients with Type 2 diabetes often don’t meet treatment goals and may need insulin to augment therapy. Furthermore, studies have shown that on average, as many as 40-80% of patients with Type 2 diabetes will need insulin within 10 years of diagnosis. Since most of these patients are cared for primarily in Primary Care outpatient settings, initiation of insulin therapy should be routine in any practice. However, it is not surprising that the initiation of insulin is one of the most difficult aspects of managing patients with Type 2 diabetes. Challenges of initiating insulin therapy are two-fold. First is the patients fear of and reluctance to begin insulin. Second, and more significant, is clinicians’ hesitancy due to lack of knowledge and the view that initiating insulin is a complex and time consuming process, a treatment of last resort. This presentation will review the challenges of initiating insulin in the outpatient setting and provide clear, evidence-based guidelines related to the management of insulin therapy.

Learning Objectives

At the conclusion of this session, the particiapnt will be able to:

1. Identify current Canadian Diabetes Association Standards of Care, Hgb, A1C and glucose goals

2. Review and understand the current diabetes treatment algorithms

3. Explain how to calculate and initiate insulin and maximize oral medications

4. Summarize when and how to intensify insulin therapy

Workshop: Frozen Shoulder – Anatomy, Management, Injections, Risks, and Exercise Therapy

1245 – 1430

Daniel Avrahami, BPHE,DC, MSc, PA and Kim Scott, BSc, PA 

Frozen shoulder is a poorly understood condition that typically involves substantial pain, movement restriction, and considerable morbidity. The lifetime prevalence of frozen shoulder is estimated to be 2 to 5 percent of the general population. Full recovery can take up to 3 years. However, if diagnosed and treated early an episode of Frozen Shoulder can be significantly shortened, and possible reversed. The aim of this presentation is to provide a framework for the assessment and management of Frozen Shoulder. Included in the presentation is a review of relevant anatomy, patient management strategies, injection skills, and patient self-management strategies. A hands-on workshop on corticosteroid injections for the glenohumeral and subacromial joint will be provided.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Clinically identify Frozen Shoulder

2. Recommend how to manage a patient with Frozen Shoulder and patient self-management strategies

3. Practice glenohumeral and subacromial joint injection skills

Intermittent Fasting as An Approach to Metabolic Syndrome and Insulin Resistance

1340 – 1430

Andrea Lombardi, HBA, MBA, BHScPA, CCPA

The Intensive Dietary Management (IDM) Program is one that focuses on meal-timing, time restricted eating (TRE) and intermittent fasting (IF) in the treatment of patients and clients with metabolic syndrome (MetS) and insulin resistance (IR).  The IDM Program was founded in June 2012 as a physical clinic in serving the Greater Toronto Area, and has now expanded to an online program serving clients worldwide.  Founders, Dr. Jason Fung and clinical researcher Megan Ramos have become world-leading authorities on the topic of therapeutic fasting.

The IDM Program seeks to investigate the significance of meal timing, rather than composition of the meal itself.  Many patients with MetS and/or IR, such as pre-diabetes, T2 diabetes, non-alcoholic fatty liver disease, and polycystic ovarian syndrome, have attempted some kind of dietary program or regimen, but continue to struggle with their metabolic disease.

Since its inception, the IDM Program and has worked with over 8000 patients and clients world-wide on various fasting protocols, primarily and IF.  This presentation seeks to demonstrate that when one eats matters just as much as how one eats.  It will explain the physiology of IF as well as commonly used protocols to treat various metabolic disorders.  It will also share up-to-date research on IF in the treatment of MetS as well as clinical data collected from the IDM Program, including a new case series on the use of IF in the reversal of T2 diabetes published in the British Medical Journal in 2018.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Explain the physiology of time-restricted eating and intermittent fasting

2. Identify time-restricted eating and intermittent fasting as approaches to metabolic syndrome and insulin resistance (with or without the concurrent use of medication)

3. Prescribe basic protocols to patients with various metabolic disorders (with or without the concurrent use of medication)

Thoracic and Lumbar Spine Disorders in a Primary Care Practice

1340 – 1430

Tom Gocke, DMSc, PA-C, DFAAPA, Orthopaedic Educational Services Inc.

Managing Thoracic & Lumbar Spine Disorders by the Primary Care Physician Assistant lecture is designed to enhance the diagnostic skills in the evaluation of non-traumatic Thoracic & Lumbar spine conditions.  Attendees’ will enhance their ability to recognize normal radiographic anatomy of the thoracic & Lumbar spine. Attendees will use this knowledge to master skills needed for the evaluation and management of common non-traumatic Thoracic & Lumbar spine conditions seen by the Primary Care Physician Assistant. Using physical examination review and clinical case study attendee’s will be able to demonstrate their abilities to recognize common conditions of the Thoracic & Lumbar spine.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Determine and accurately communicate radiographic image results of Thoracic and Lumbar Spine conditions to patients and supervising physician(s)

2. Describe physical exam techniques necessary in the assessment of Lumbar spine conditions in a primary care patient

3. Describe the diagnosis and determine appropriate management techniques for a primary care patient with Lumbar Spine conditions

Networking Break with Exhibitors

1435 – 1455

Common Pediatric Overuse Injuries and Growth Plate Fractures

1500 – 1550

Adam Moore, MHS, PA-C, ATC, Assistant Professor, Salus University

Children are becoming more active in sports and physical recreation and at earlier ages than ever before. Per the United States Center of Disease Control ( “More than 2.6 million children 0-19 years old are treated in the emergency department each year for sports and recreational-related injuries.”

The goal of this lecture is to cover in detail the most common pediatric overuse injuries and growth plate fractures and treatment of each. The etiology, pathophysiology, clinical presentation, diagnostic testing, and treatment options for conditions including Sever’s Disease, Osgood-Schlatter Disease, Sinding-Larsen Johannson Syndrome, Little League Shoulder, elbow medial epicondylitis, torus fractures, and Salter Harris I fractures will be discussed. All of the information is relevant to those physician assistants providing care to children in both the primary care and orthopaedic realms.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Recognize and diagnose common pediatric overuse musculoskeletal injuries

2. Discuss the treatment of common pediatric overuse musculoskeletal injuries

3. Identify and treat common pediatric growth plate fractures

Implementation of a PA-led Patient Centered Goals of Care Consultation Service in a Community Hospital

1500 – 1550

Monica Monchis, CCPA, Royal Victoria Regional Health Centre

This presentation will highlight a program implemented at a community hospital that was designed to identify hospitalized patients at high risk of dying and ensure that their treatment preferences for end-of-life care were aligned with their values and goals of care. The program also assessed the feasibility of using an intensive care unit (ICU) physician assistant (PA) to implement this advance care planning (ACP). Findings from the program demonstrates the impact that PAs can have in ensuring that patients are making informed decisions about their care and the value this will add to our health care system.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Show the unique role of an ICU physician assistant engaging in advance care planning discussions with hospitalized patients and collaborating within an inter-professional team

2. Outline a systematic approach for eliciting hospitalized patients’ values and goals of care surrounding life sustaining therapies

3.  Illustrate the demand for an integrated advance care planning service that ensures patients can provide informed consent and appreciate the value this will add to the health care system

The Past, Present and Future of Orthopaedic Surgery PAs in Canada: A Panel Discussion

1500 – 1550

Anne Dang, BHSc (PA), BHSc. (Hons), CCPA;

Ohood Elzibak, BHSc.(PA), MPAS, CCPA;

Deanna Groenestege, BScPA, BASc Kin.(Hons), CCPA;

Andrew Lim, BHSc (PA), BASc. (Hons), CCPA

Orthopaedic Surgery is one of the key areas for PA practice and growth in Canada. In 2016, The Conference Board of Canada published a report identifying orthopaedics as one of top three practice areas that hold the most promise for increased productivity by greater use of PAs. The Canadian Institute for Health Information also released a report showing that 3 of the top 5 most commonly performed surgeries in Canada are orthopaedic procedures. As more orthopaedic PAs enter the workforce, it is important to discuss practice trends and avenues for professional growth and development.

This session is aimed at practicing orthopaedic surgery PAs and students or current PAs looking to transition into a role in orthopaedics.  The session is moderated by an orthopaedic surgery PA with a near-decade experience in the field and will provide insight from three expert panelists who practice in diverse orthopaedic settings and are actively involved in professional advocacy.  Topics explored during the question-answer session include the orthopaedic PA job market, current clinical roles in orthopaedics, challenges affecting practice growth and strategies to overcome them.  Additionally, the panelists will provide insight and recommendations related to funding/billing, role expansion and professional advocacy.  This session is interactive and audience members will have the opportunity to participate in live polling as well as pose questions to the speakers.

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Appraise the growth of the orthopaedic PA role in Canada over the past decade

2. Outline the diverse roles and responsibilities of an orthopaedic surgery PA in outpatient vs. inpatient and trauma vs. elective practice settings

3.  Outline the current status of the orthopaedic surgery PA job market and identify strategies to assist PAs in securing employment in orthopaedic surgery

4. Identify challenges faced by orthopaedic PAs in clinical practice and strategies used to overcome them

5. Explore the future of the orthopaedic PA profession in Canada and brainstorm initiatives to help propel the profession forward in matters related to funding, role expansion and professional advocacy

CAPA Annual Members Meeting

1600 – 1730

Leslie St. Jacques, CCPA, CAPA President; Patrick Nelson, Executive Director

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Recall the progress that the association has made for the organization and PA profession within the past year

2. Recognize the issues the association and PA profession is currently facing

3. Identify next steps for sustainability of the association and advancement of the PA profession

Provincial Member Forums:

1735 – 1815
Provincial Directors for Ontario, Pacific, Atlantic, Prairie and Quebec

Learning Objectives

At the conclusion of this session, the participant will be able to:

1. Recall the progress that has been made for the Physician Assistant (PA) profession within the region in the past year

2. Recognize the issues specific to the geographic area that the PA profession is currently facing

3. Identify next steps for advancement of the PA profession in that area