Council Award

Resourcefulness and Resilience in the Pandemic

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Dr. Sinziana Avramescu

Council Award Recipient: Dr. Sinziana Avramescu

For Dr. Sinziana Avramescu, adversity has always been a call to action. So perhaps it is not surprising that the past two years of managing the COVID-19 pandemic have spurred Dr. Avramescu to step up more than ever. “I’m comfortable feeling uncomfortable; I’ve often been the outsider,” said Dr. Avramescu. “I love it, I learn from it, and it keeps me going.”

As the Executive Director of the Anesthesia Department at Humber River Hospital in Toronto, she practises anesthesia, and has created a research mandate for her department. Thanks to her leadership, for the first time, Humber River Hospital will be a site for clinical trials, beginning with three studies taking place across Canada.

 Dr. Avramescu received a PhD in Neuroscience from Laval University in Quebec and she completed clinical training in anesthesia at the University of Toronto.

She was born in Romania and grew up during the harsh austerity measures brought in by government. Even basic necessities, such as food, heating, electricity and medical care, were rationed.“Most of the time there was nothing, so I just got used to creating something out of nothing,” she said. “Finding solutions has always been a welcome challenge.”

The search for solutions inspired Dr. Avramescu to help co-found the Perioperative Brain Health Centre at Sunnybrook Health Sciences Centre — the first of its kind — to develop strategies to optimize brain health for the millions of patients who undergo anesthesia and surgery worldwide each year. It inspired her to seek community outreach opportunities to increase medical literacy among patients and their families. And she became a fierce advocate for patients with acquired brain injury, working to enhance system capacity to support people with complex needs.

Most recently, adversity fueled Dr. Avramescu’s drive to find solutions by supporting overwhelmed ICU nurses. The “Physicians as Intensive Care Unit (ICU) Care Providers” program she created at Humber trained physicians to practise the responsibilities of ICU nurses — professionals with care, treatment and charting skills not shared by other nurses or physicians. The intent of the program was to help ease the provider-to-patient ratios. “We listened to the nurses to understand what they needed. That created a strong bond with the participating physicians,” said Dr. Avramescu. Now, the program is ready and waiting whenever it is needed, providing a much-appreciated relief valve for the future if ICU nurses are again outnumbered by an increased demand in the system.

“This culture of cooperation and valuing each other’s work has a very positive effect that will certainly outlast the pandemic,” said Dr. John Hagen, Chief of Staff at HRH, in nominating Dr. Avramescu for the Council Award.

At its June meeting, CPSO Council celebrated Dr. Avramescu’s contributions to medicine and research with the presentation of its Council Award. Throughout her career, Dr. Avramescu has demonstrated a commitment to service and remarkable resourcefulness. “Wave after wave, the COVID-19 pandemic emphasized Dr. Avramescu’s strong leadership abilities and passion to serve her patients, colleagues and other members of the health care team,” said Dr. Hagen.

“Dr. Avramescu is uniquely positioned to champion excellence in our health care system. Her exceptional collaboration skills have been apparent in numerous activities and beyond clinical care, including research, advocacy, education and leadership initiatives,” said co-nominator Dr. Jason Cyr.

Below we speak to Dr. Avramescu. We also have a video of her remarks 🎥 when she accepted the award at the June meeting of Council at the end of the article.

Why did you choose anesthesia?
It came down to anesthesia and neurology. Both were hugely rewarding, however, I’m a solution-oriented person, so anesthesia syncs well with my personality.

More than that, it’s truly the greatest privilege and responsibility to look after someone who is unconscious and vulnerable; to become their advocate when they can’t advocate for themselves. I have only a few moments to make a trusting connection with someone before they put themselves in my hands, whether that’s a child who I help bravely walk towards the operating room, or a CEO, used to being in charge, feel comfortable enough to give up control. I value being able to integrate knowledge from physiology, pharmacology and anatomy to put a patient to sleep and, more importantly, to wake them up as if nothing has happened. This never ceases to amaze and humble me.

Can you discuss your passion for research, education and coaching?
Research and education have been essential and constant for me. I have co-authored many peer-reviewed articles, and spent time mentoring and coaching because it’s important to me to think about how I can be part of advancing my field and patient care, rather than simply using the information that’s been provided. That’s why I’m proud of creating the Resident Research Committee in the Anesthesia Department at the University of Toronto. I also mentor a group of anesthesia residents. We regularly meet to talk about challenges while creating a human connection. As an academic coach, I help guide students through residency without an evaluative role. That way, when they struggle, they have someone to talk to.

Research has always been a focus in your career; how has that shown up through different stages?
It’s important to bridge the gaps between science, medicine, and the general public. I completed training in knowledge translation so I could express concepts in lay terms and make it relevant for the public.

While I was at Sunnybrook, research was part of my mandate as a clinician scientist. When I moved to community practice at Humber River Hospital, I took the lead in developing a research mandate for my department for the first time. It aligns well with Humber’s timing in joining the LHIN — developing research and education is part of that relationship. I helped foster partnerships with several academic centres (two in Toronto, one in Winnipeg) and now, the perioperative program at Humber will be a site for three multi-centre clinical trials involving hospitals across Canada.

In one of those studies, we plan to investigate whether lidocaine — an inexpensive, widely available, local anaesthetic — can be used systemically during mastectomy and lumpectomy procedures to decrease persistent pain three months after surgery. In the pilot study, we had promising results. It would mean that this type of anesthesia could be available to patients having breast cancer surgery anywhere (the only special skill required is to set up an IV), versus relying on larger centres where anesthetists who have special training in localized blocking are found. If it works, it would affect a huge number of patients.

How do you keep a medical team motivated and engaged in a prolonged pandemic?
It’s no secret that those of us working in health care have felt the weight of the pandemic most acutely. Considering that, I’ve been thinking a lot about growth mindset. It has been a driver for me at work and at home. It’s important to remember that not knowing or not being good at something isn’t a trait, it’s just a moment in time.

A growth mindset means that when things happen to you, they create learning and growing, rather than hiding or defeat. I think that’s why the “Physicians as ICU Care Providers” program did well for people who felt okay being uncomfortable, humble, not knowing; they welcomed the challenge to help patients and nurses, even if they were afraid they’d make a mistake.

Keeping the bigger picture in mind was the way we helped each other stay resilient through the pandemic.

Were you surprised by this nomination?
Yes, and I’m still shocked. It’s incredible that my nominators thought to do this when they had so many other things to worry about, such as COVID and its many challenges. I’m truly humbled. And then, to receive the award — that was the cherry on the cake.

I am incredibly lucky to work with smart, sophisticated and passionate people, who do great things and share my love for medicine, research and education. This award belongs to all the people in my professional life. And it belongs to my wonderful husband who is my rock, and to my two amazing kids who have learned to share my time and my attention with my many passions and projects.

Video from Council