Feature Researcher: Dr. Stephanie Fisher

Dr. Stephanie Fisher is a Clinical Associate Professor in the Division of General Obstetrics & Gynaecology. For four years Dr. Fisher was the Medical Director of the Reproductive Medicine Program at BC Women’s Hospital + Health Centre (BCW), which is comprised of the Recurrent Pregnancy Loss (RPL) Clinic and Early Pregnancy Assessment Clinic (EPAC). Dr. Fisher’s medical expertise and passion for enquiry and implementation of evidence-based care have made EPAC the ideal model of evidence-to-practice.

We recently interviewed Dr. Fisher to discuss her time as Medical Director and her vital role in sustaining research within the Reproductive Medicine Program at BCW.

How do you develop your research ideas? (i.e. from the bedside)
My research ideas primarily stem from ongoing quality assurance in the clinic. This is particularly true for EPAC. Management of early pregnancy loss has traditionally been based in the community often with little quality evidence to inform practice; much of our practice was based on what we would now consider poor quality evidence or the abortion literature which is not always applicable to our population. The EPAC model provides a package of care for women in a central clinic. This allows care to be protocol driven and lends itself to critical appraisal in a way that had not been possible in a dispersed model of care. It enabled us to move away from dogma and develop truly evidenced-based protocols of care.

What would you like your research to achieve?
I want to provide the best possible care for women by making practice evidence-based and by informing changing practices going forward.

You are a champion in the Department with learners and in particular, Residents. What is the biggest reward of working with Residents?
I like to get residents to question what they do every day. They are surprised to find that much of what is in their text-books is not supported by rigorous evidence – and is done simply because it was always done that way or because it is convenient for the care-provider.
Certainly this is not what we expect in an evidence-based, patient-centred practice model.
I love to see residents get enthusiastic about research and evidence-based practice. For me it is rewarding to have the residents ask – why do are we doing it this way? Is it the best way for the women in our care?

The time that you have made for mentoring resident in research and evidence-based care has been very much appreciated. We reached out to residents that have worked with you and this is what they had to say:

Dr. Fisher is a clinical super-power. She is sharp, up to date, and an incredible teacher for the residents. Not only that, but patients absolutely adore her. She is the kind of clinician that manages to be a positive role model in the work place and research setting, all while remaining approachable and fun to work with. We are so lucky to have her. 🙂

Dr. Fisher has been extremely supportive as a research supervisor. Despite her various work commitments; she patiently guided me through starting a project when I approached her in my first year of residency with very limited research experience. I found the research questions that Dr. Fisher is investigating academically interesting and clinically relevant.

What do you find are the biggest challenges in pursuing research while being a clinician?
Time! As a clinician in university affiliated academic health care centre the demands on your time are high. In addition to patient care there are teaching, administrative and research responsibilities. While there are structures in place to support teaching and administrative duties, there are not similar institutional structures to support clinician-led research and the academic model and the fee-for-service model are not particularly compatible. You have to be especially driven to make time for research and find supports outside of the traditional faculty, departmental or divisional structures.

What are the greatest supports for your research?
BC Women’s Hospital + Health Centre is fortunate to have the Women’s Health Research Institute (WHRI) directly integrated into the campus. As a WHRI Member, I have been provided ongoing research facilitation support – from onboarding of learners (Residents, FLEX Students), to navigating institutional approval processes, to database creation, data collection, data analysis and knowledge translation. WHRI support has made it possible for me to work productively with residents to establish evidence to improve clinic function and clinical care.

You’ve been successful in establishing a sustainable evidence-informed clinical practice model- what advice would you give to others who are embarking on this journey?
It is important to set your priorities and decide early how and where you want to spend your time.
Also, mentorship is crucial. Having someone who has first-hand experience and advice on how to balance clinical, research, teaching and administrative responsibilities is invaluable.

When you aren’t busy being a clinician and a researcher – what do you do?
Life is busy! I have three very active children that play soccer, volleyball and hockey.
I also row and am a road cyclist.