Mock accreditation – how did it go?

Since this was a practice run, I have to compare it to marathon training where one does at least three or four “long runs” (32 kilometres) in the few months prior to the marathon. If those runs are easy then you would never finish the 42.2 kilometres of a marathon. If they are tolerable, then you would not do any better than you did in your last marathon. And if they are hard (or even better, really hard) then you are likely to have a successful marathon or even a PB (personal best).

When it comes to accreditation, we are planning for a PB!

So, as many know, we had a “mock accreditation visit” from February 5-8—from Sunday evening through Wednesday at noon. Dr. Tom Marrie, former dean at both the University of Alberta and Dalhousie who guided both schools off probation, and Dr. Cam Enarson from University of North Carolina, who has done 37 full accreditation visits over his career, did the work! They were incredibly thorough (tough, even) and tremendously helpful.

As a reminder to all, our full accreditation visit is October 29 to November 2, 2017. The process, as dictated by the Committee on Accreditation of Canadian Medical Schools (CACMS), began with a medical student-led Independent Student Analysis (ISA) 18 months before the visit. Our students were extremely engaged and did a great job on the ISA in the spring of 2016.

The next step was populating the first draft of the Data Collection Instrument (DCI), which is a series of questions and data requests regarding each of the 12 standards subdivided into 94 elements.

An Accreditation Steering Committee led six task forces that then divided up the 12 accreditation standards into key areas of focus – administration, admissions, curriculum, educational resources, learning environment, student services – and reviewed the DCI. An iterative process followed by which issues uncovered were fixed, the DCI was updated and a draft submitted to our mock accreditors in mid-December 2016 for review. This process of continuous improvement will continue. For example, Faculty Council passed some policies on admissions just last week which will require an update to the DCI. We have until mid-June to rewrite and polish our DCI before submitting the final version to CACMS.

A mock has never been done before at our college but has become standard practice at all Canadian medical schools over the last three years. Other medical schools have found it invaluable—and all have found it terrifying, as they discovered work yet to be done.

The mock was a dress rehearsal, a fact finding mission, and a reality check. All three are important. An external review by people we employ to find all the gaps that we may be blind to is incredibly valuable. I joked on the final day of the visit that if Tom and Cam were here to find all of our weaknesses, we got incredible value for money!

Let me expand on the reality check. If the real visit were next week, we would have a negative outcome. The accreditors reminded us that this isn’t an exercise in how far we have come; it is an exercise in determining if we meet the standards on the day of the visit.

Overall, I am optimistic. While I now know we still have an incredible amount of work to do—in fact, more than I thought—the good news is we know where to focus our efforts.

On the positive side, Tom and Cam were fully aware of the scope of the transformation underway at the CoM and felt we were going in the right direction. In fact, they noted that we are at a turning point and for the first time in many years the CoM has the potential to be the medical school Saskatchewan deserves! They thought we had the right team in place with: UGME leadership; department heads; the dean’s office; unit, course and clerkship leads; faculty; and staff. They were very complimentary of our faculty, staff and learner engagement in the visit. They were also very positive about the support and commitment from the health regions.

So in summary: right direction, unique opportunity, great team and great engagement.

On the negative side, while our visit logistics worked perfectly for the accreditors, there is work to do on the internal logistics. (On behalf of the team that was working very hard and rapidly behind the scenes, our apologies for some of the confusion in our communication and scheduling.) Also, our DCI had gaps, from broken hyperlinks, to some missing information or weak responses. We took copious notes, and these will all be fixed.

Another challenge is communication. The mock accreditors said not enough people knew and understood all the things going on at the CoM in terms of changes that have been made and processes and progress on accreditation.

So count on plenty more accreditation and CoM progress updates.

While all who met the team were very engaged, more preparation is needed. But it is on the accreditation team and dean’s office to ensure every individual and every team who meet with the accreditors in the fall have the preparation they need. Our team has learned a lot about visit organization, and we will improve. We already are making plans for assisting everyone in their preparation for the real visit early in the fall. We will ensure you are ready. And if you don’t think so, call us on it before the visit.

Some of the remaining issues we must address are big. Not all our students know where to turn in cases of mistreatment and are not entirely confident their concerns will be addressed. We will fix this! Let me assure all students the CoM, UGME team, faculty and staff are committed to a safe learning environment. Let me be clear: this is a very big accreditation issue!

I believe, and the mock accreditors confirmed, our greatest strength—other than great faculty, staff, and learners—is the transformation underway at the CoM. However, accreditation is a data-driven business and so our greatest challenge is having data that demonstrates the transformation is succeeding. This is big, so we will need your help, especially from our students, as we will be doing a follow-up student survey.

There is no doubt that we have had great financial support from the province in the past, but the accreditors made it clear that we are still in the middle of transformation. We are all aware of the current provincial fiscal challenges, but we have conveyed to our government partners the need for a restoration of required funding, and are in constant discussions with them about the college and its critical role in the health care system of the province. However, it was clear to Tom and Cam that if the needed financial support is not available that the transformation and accreditation will be difficult to achieve. This is really big!

And finally, we need to abandon our humble Saskatchewan ways. We were told it is time to assert our excellence and emphasize the things at which we are really good. I will give you a good example.  On the elements for diversity and social accountability, I was asked on Sunday how many Indigenous faculty we have, and while I knew personally some of our Indigenous faculty, I could not answer the question. So on Monday I asked Val Arnault-Pelletier if she would match our list of 73 self-identified First-Nation and Metis medical graduates with our list of faculty appointees. I now know we have one PhD and 21 MD Indigenous faculty appointees, and a number of them are in leadership positions! Tom and Cam were blown away by this information and emphasized we have lots to brag about. Now is the time to start.

I thank Tom and Cam profusely. We are really in their debt. I need to thank and compliment Dr. Athena McConnell, assistant dean quality, and Marianne Bell, accreditation specialist, as well as Dr. Pat Blakley, associate dean UGME and Dr. Kent Stobart, vice-dean education and the great team that backed them up. You know who you are.

Most importantly, I thank all who participated in the mock accreditation. Your engagement is inspiring.

However, the work ahead is daunting. Accreditation is our collective first priority after our patients, learners, and research! There will be more requests for information, opinion, surveys, policy development and meetings. We have all been working on multiple high priority initiatives over the past few years and are entering a time period through the fall where we will have to focus our efforts on UGME accreditation. I am committed to removing barriers for our entire CoM team to work on this, as our highest priority. I am also counting on all of you and know that, when asked, you will step up to the plate and be the great team players you have been leading up to, and during, this mock visit.

Remember, while success in marathon running depends very much on the individual, accreditation success depends on a team effort. As I’ve said many times, it’s a team sport! Thank goodness for that, as we will need many contributing to the work ahead, and we have a great and committed team.

I think of teaching, research and patient care as the fun parts of our collective work. A PB in accreditation will free us all up to have more time for the fun stuff!

And, as always, I am here to listen.

 

 

 

 

 

 

 

 

 

 

 

 

A week of progress… and back to accreditation!

Last week was an exciting week here at the College of Medicine. The week started with introductions to my new boss! Dr. Tony Vanelli will join the University of Saskatchewan as our new Provost and Vice-President Academic in August. He comes to us from the University of Guelph where he served as the very highly regarded Dean of Engineering for two terms, and prior to that was at the University of Waterloo. We got to interact over a day and a half at a U of S senior leadership summit. Tony is very interested in the CoM and anxious to learn more over the next six months to support us on our journey to be one of the best Canadian medical schools.  The University and the CoM have had incredible support from both Acting Provosts, Ernie Barber and Michael Atkinson, but I know both are thrilled to pass the baton to a new permanent leader in the Provost role. This is an important step forward for the U of S.

On Wednesday night I was on hand with our President, Peter Stoicheff, and our Board Chair, Lee Ahenakew to welcome the Prime Minister Justin Trudeau to the U of S, the Health Sciences Building and the CoM. The town hall was extremely interesting to observe as the PM responded to a variety of questions with some appropriate emphasis on Indigenous concerns, although some controversy arose regarding some of his comments. On the other hand, the town hall was less raucous than some were across the country.

Even more important on Wednesday evening was the Faculty Council support for two major policy initiatives at the CoM. First congratulations to Dr. Keith Ogle on receiving support for the Policy and Procedures for the appointment of medical faculty. While our transition to a One Medical Faculty model as part of an overall united One Faculty model has been well discussed here in the past, this step was an important formal step in realizing this ambition.

Further congratulations to our Admissions Committee and Dr. Barry Ziola as Faculty Council voted to support a new admissions policy that designates six of our UGME seats for students from socio-economically disadvantaged background. The evidence is that the average family income of a Canadian medical student is at least 3 times that of an average Canadian family. I recall many years ago doing a CaRMS interview and being amazed by this individual’s academic prowess, grade 12 piano by the Royal Conservatory of Music, provincial tennis championship and stellar list of volunteer contributions. I knew two things for sure: this applicant would be an incredible doctor, and this applicant was rich! I recall thinking I wonder how many bright compassionate people never get the chance, and this is a big step towards fulfilling our mandate to be socially accountable and in ensuring our student body reflects the people we serve.

And then on Thursday we had the wonderful announcement of the recruitment of Dr. Michael Levin to the Chair in MS Clinical Research. Dr. Levin comes to us from the University of Tennessee and is an accomplished MS neurologist and clinician scientist. Dr. Levin joins Dr. Valerie Verge in the Cameco MS Neuroscience Research Centre, Dr. Katherine Knox in PM&R and other neuroscience researchers at the U of S. Furthermore the CoM and the health region have been successful in recruiting Dr. Ilia Poliakov, a neurologist who just finished an MS Fellowship at U of C. We will also be recruiting an RN and a Nurse Practitioner to further enhance the care in the MS clinic. Almost overnight we will revolutionize MS care and research in the province!

While the CoM took the lead on the recruitment this could only come to pass with incredibly important partners including SHR and the MoH. Of huge importance was the MS Society, the community of MS patients and their families and friends and the Saskatchewan Health Research Foundation. However the endowment that underpins the Chair was raised by Saskatoon City Hospital Foundation ably led by its Board and the ever enthusiastic CEO, Mr. Steve Shannon. Thank you!

I find this story very inspiring as this money was raised in the community, at events, and one small donation at a time. The province of Saskatchewan has the highest MS rates in the world and this is a perfect example of working with the community to be a socially accountable medical school and change care for MS immediately here, and through our research around the world.

Finally, this Sunday evening we start our mock accreditation. We will be visited by Dr. Tom Marrie, my former dean at Dalhousie University, and Dr. Cam Enarson from the University of North Carolina. This visit is an essential step in our preparation for the full accreditation visit October 29 – November 3. The ‘mock’ will serve as a dress rehearsal for many. We have dramatically increased the team of faculty and staff supporting UGME and most have not been through an accreditation before so rehearsal is good. But more importantly it is a fact finding mission. We already know of things that must be fixed by the fall and have been working very hard for two and a half years on those. By engaging experienced accreditors to do a rigorous review we hope, to paraphrase Mr. Rumsfeld, find the gaps in accreditation standards that are the unknown unknowns.

So as I have said many times accreditation is a team sport and we look forward to your active participation in the mock accreditation. More importantly we will need to all work hard together with the feedback from our mock accreditors to prepare for the fall.

As always I welcome your feedback, and my door is always open.

Summer Blog

Despite two days of rain it is quite clear at the College of Medicine that summer is here as the halls are decidedly quiet.  As I eagerly anticipate vacation starting on Saturday, I wanted to take an opportunity to let you know about the CoM activities.

We have had an incredibly busy year – a fact I realized while putting together the report for my annual review with the Provost and Vice-President Academic. I won’t go through all the details but I would like to highlight three major accomplishments.

First our team is in place. We now have recruited three vice deans, a chief operating officer, four new department heads, two associate deans, two assistant deans, and an almost entirely new management team in the Dean’s Office.  I am really excited about the team we have in place. I believe our leadership bodes well for the future.

We have come through the faculty transition with 100 of our 130 USFA MD faculty making the transition to ACFP’s or alternate engagements with the CoM. Congratulations and thanks to the team of people from the college, the Saskatoon Health Region, the Regina Qu’Appelle Health Region and the Ministry of Health who led this work. It was an Herculean and incredibly complex task and, while difficult at times, I believe was done in a very respectful manner. Many things are good about the ACFP from a CoM perspective, especially the clear definition of academic deliverables. Having said that, much work still needs to be done to clarify deliverables, processes, governance, etc. The CoM is committed to working collaboratively with our partners, the unified department heads, departmental mangers (who have a crucial role in administering the ACFP) and the faculty participating with the CoM under the ACFP to ensure we maximize the service to our learners, our research programs and the academic careers of those MD faculty.

Late in June, Dr. Anurag Saxena, Associate Dean PGME, Dr. Kent Stobart, Vice Dean Medical Education and I attended meetings in Toronto with the accreditation committees of the Royal College of Physicians and Surgeons of Canada and the College of Family Physicians of Canada. Overall our PGME accreditation was successful. Some programs have some work to do but there is already a plan in place to resolve any deficiencies and all of our programs are accredited.  Congratulations and thanks to all faculty, program directors, staff and residents who supported this effort. In particular, our PGME office staff received high praise from the accreditation team that visited. Kudos to Dr. Saxena and the PGME staff.

Much other work is underway as we continue to work on restructuring the Biomedical Science Division, which voted for a two departmental model, as we launch the Saskatchewan Center for Patient Oriented Research, as we develop our One Faculty model and, of course, as we continue the ongoing roll out of our new curriculum. The agenda we are on is truly ambitious but with the dedicated team of learners, faculty and staff at the CoM that I have the privilege of working with, it is an agenda I am confident that we will complete.

In late June, I had the unique opportunity to join a U of S delegation to northern Norway. The delegation included several USask leaders, Chancellor, Blaine Favel, Board of Governors Chair, Lee Ahenikew being among them. We visited Sápmi, the homeland of the indigenous people of northern Scandinavia and eastern Russia, who are known as the Sámi. We visited the University of Tromso, which has a medical school similar in size to the CoM and face similar challenges such as distributed medical education, clinical care in northern and sparsely populated regions and service to their indigenous population.

We visited the Sámi University College, the Sámi Parliament, and the northernmost community in the world with streets and a permanent population, Longyearbyen on Spitsbergen Island in the Svalbard archipelago, which also has a university center. The University Centre in Svalbard (UNIS) is the world’s northernmost higher education institution, located at 78º N. It is unique in that all students are required to do fieldwork in all of their courses and, to do so, must take a safety course and learn to use a rifle–that last is due to the polar bears!

Norway is indeed a beautiful country but the real purpose of the visit was to explore their service to the Sámi people. We learned a lot and found a real inspiration to continue on the mission of “indigenizing the university” as advocated by President Peter Stoicheff.

Well, as I said, I am looking forward to my vacation which starts Saturday as I go fishing up North for four days and then head to the Maritimes. I look forward to attending my 35th medical school reunion (how time flies!) in St. Andrews by-the-Sea, New Brunswick, salmon fishing on the Miramichi River and relaxing ocean side in Nova Scotia and PEI.

I hope you all enjoy your summer and have an opportunity to get some rest and relaxation. As always my door is open and I welcome your feedback.

Physician Leadership and Health System Transformation

I have been at two remarkable meetings that have reinvigorated my faith in the profession of medicine. This past weekend I was at the meeting of the Canadian Society of Physician Leaders (CSPL) for the first time. This meeting, co-sponsored by the CSPL and the Canadian Medical Association (CMA), had an incredible line-up of leading academics and physicians focused on healthcare system transformation and the critical role of physicians in leading change.

Key themes were that real change can only succeed with physician leadership, that we all have a role, and that leadership can be learned and developed. Another recurrent theme at practically every meeting I go to these days is that the Canadian healthcare system is among the worst in comparable western countries, given ours is one of the most expensive systems, yet challenged by poor performance and outcomes in quality, access, timeliness and safety. We are only exceeded by the USA for worst-place (see chart below, from The Commonwealth Fund 2014 Update: Mirror, Mirror on the Wall – How the Performance of the U.S. Health Care System Compares Internationally, by Karen Davis, Kristof Stremikis, David Squires, and Cathy Schoen).

 Mirror, Mirror on the Wall - How the Performance of the U.S. Health Care System Compares Internationally

Mirror, Mirror on the Wall – How the Performance of the U.S. Health Care System Compares Internationally

Despite intense effort in patient safety, adverse events have flat-lined at about 10 per cent in hospitals in our country, leading some to claim that healthcare system adverse events are third among leading causes of death. Sometimes I hear, “Why change?” If this is not a burning platform in healthcare, then what is?

Saskatchewan was well-represented among about 500 attendees (including 75 students), including our own Dr. Dennis Kendel, CEO of saskdocs and one of the founders of the CSPL, who moderated a slightly tongue-in-cheek debate about politicians as the barrier to healthcare reform. One of our students, Paule Bertholet, was sponsored to attend by saskdocs. Thank you, Dennis!

One of the world’s foremost names in leadership development, Barry Z. Posner, PhD from Santa Clara University in California, emphasized that leadership is a learned skill in his book, Learning Leadership: The Five Fundamentals of Becoming an EXEMPLARY LEADER. He offers these five core pieces of advice:

  • believe you can (you need a growth mindset)
  • aspire to excel (the importance of looking forward)
  • challenge yourself (fail fast, fail often)
  • engage support (develop confidence and competence)
  • and practice deliberately (greatness is a habit, not a birthright)

Tim Magwood, “Master Storyteller and Culture Catalyst” from Toronto, spoke about the links between leadership and innovation, while being an incredibly innovative entertainer at the same time.

Jeffrey Braithwaite, Professor and Director of the Australian Centre for Healthcare Resilience and Implementation Science—think about all that is contained in that name!—taught us how to reconcile “work as imagined” (by planners and leaders) and “work as done” (by frontline clinicians), with the only solution being our collective engagement. He also reminded us that trying to do what we do today better is not the transformation needed, and finished with that oft-repeated Henry Ford quote, “If I had asked people what they wanted, they would have said faster horses.”

Anne Snowden, PhD, from the International Centre for Health Innovation at the Richard Ivey School of Business, talked of global trends in healthcare innovation that included: empowered consumer; digital world; value focus; wellness focus; transparency; and outcome-focused funding models. She echoed Henry Ford with her final quote from R. Buckminster Fuller, “You never change things by fighting the existing reality. To change something, build a new model that makes the old model obsolete.”

In one workshop, we were asked about our optimism that physicians would engage in and provide leadership to healthcare system transformation. I was in the glass-three-quarters-full part of the room. Despite some bad spots, such as the acrimony between the Ontario and Nova Scotia governments and their physicians, I see many physician organizations putting forward very progressive positions. This includes the CMA and the great changes led by former president Dr. Jeff Turnbull and subsequent presidents since, which are spreading across our country.

Nowhere is this more evident than with our own Saskatchewan Medical Association (SMA), where we have had tremendous leadership by past-president, Dr. Mark Brown, current president, Dr. Intheran Pillay, CEO Bonnie Brossart, and her new leadership team. I attended the SMA’s Representative Assembly (RA) in Regina May 6-7 and provided an update on the College of Medicine.

One of the themes of the RA was modernization of the health-care system. The proceedings included a panel discussion on the topic and an in-camera session where physicians grappled with challenges relating to making Saskatchewan the best place to practise medicine.  In preparation for the RA, the SMA circulated a discussion paper titled The Future Physician Role in a Redesigned and Integrated Health System (scroll down in link to find the start of the paper), which I want to bring to your attention—it’s a remarkable paper, and was tabled and discussed at the meeting. This is incredibly important reading for everyone in the College of Medicine. You will see many of the same themes as at this past weekend’s CSPL meeting.

The question at that CSPL workshop is very relevant. Are physicians able and willing to lead? It is important we all engage. I believe we are nearing the point of changing from horses to cars and the healthcare system of 2030 will look nothing like that of 2016.

By the way, I would suggest you look up the CSPL or consider attending their meeting next year. Many of our faculty would already qualify for the Canadian Certified Physician Executive credential.

As always, I encourage discussion and debate and would love to hear from you. I would be happy to meet with you and welcome invitations to department meetings or any other venue.

Busy Days

Today’s blog provides an update on the many things going on at the College of Medicine. An upcoming blog will provide a “report card” on how far we have come in implementing The Way Forward.

In the past month, we have welcomed three great leaders to the CoM. Dr. Marek Radomski has joined us from Trinity College Dublin as our Vice-Dean, Research. In addition to his incredible energy and enthusiasm, he brings a wealth of experience, having set up research programs all over the world, with more than 250 publications in pharmacology to his name, an h-index of 61, and as a mentor to numerous students. Dr. Sam Haddad has started as the Unified Department Head of Medicine for the college and Saskatoon Health Region. He is an accomplished leader, cardiologist, researcher and scholar who joins us from the University of Ottawa and the Ottawa Heart Institute. Greg Power has started as our Chief Operating Officer and brings extensive experience as a leader in business, public and university sectors, with credentials in information technology and accounting. He was most recently Director of MedIT at Dalhousie University and has extensive experience with distributed medical education. At the recent Canadian Conference on Medical Education in Montreal my old friends from Dalhousie greeted me with the usual warmth, but a definitive “damn you!” I am thrilled to attract all of this great talent to the CoM.

Just this week I was pleased to announce Dr. Keith Ogle as our Vice-Dean, Faculty Engagement. Keith is well known to many as an experienced and talented family doctor, ethicist and former Department Head of Academic Family Medicine. Keith has worked as a hospitalist in recent years at St. Paul’s Hospital, has many connections in the physician community throughout the province, and considerable experience as a university leader. Keith is enthused to take on this role and lead us as we build our One Faculty model, which includes all faculty who contribute to our teaching and research mandates. We had a number of strong candidates come forward during the search process and their participation and interest is testimony to the commitment that exists to our college.

Another round of CaRMS has been completed. Our students have done well in competing for medical residency positions across the country. Sixty per cent of our students have chosen to complete their residency program here in the province, which bodes well for our efforts to train the right doctors for the right communities in Saskatchewan. Nationally, concerns continue about the number of residency positions, with about two per cent of Canadian graduates unmatched after the second round. Here, two of our students were not matched after the second round. Our education team has created a formal program for these students to complete in the upcoming year to prepare them for success in next year’s match. This has also motivated us to respond to our students request for enhanced career counselling. Congratulations to our PGME team, who filled all of our residency positions, and in particular the Family Medicine program, one of the few programs in the country that filled completely after the first round.

We expect our next accreditation visit will take place in the fall of 2017. Preparation is underway and a steering group is hard at work under the leadership of Vice-Dean, Education, Dr. Kent Stobbart and our Assistant Dean, Quality, Dr. Athena McConnell. One key component is the Independent Student Assessment (ISA) and our students, led by ISA co-chairs Nolan Rau and John Dickinson and the SMSS, are hard at work, currently completing their own 166-question survey to inform the ISA. Two experienced accreditors, Dr. Tom Marrie, former dean of medicine at Dalhousie and Dr. Cam Enarson from the University of North Carolina have agreed to come and do a mock accreditation survey in February 2017. A communications strategy for accreditation is being prepared and over the next two years there will be a steadily increasing stream of information about accreditation coming to you. We all must be deeply knowledgeable about our MD program, as the accreditation team can ask anyone in the formal meetings or even in the hallway, “What should a student do if they get a needle stick?” or “What are the objectives for your rotation?” or ……!!  As I have said before, accreditation is a team sport and we need everyone at the CoM engaged. As we reach out to faculty, staff and students in our preparation I must emphasize the importance of that work and thank you for your participation.

Senior leaders and some faculty members of our college gathered last week for a full day that included an excellent presentation by Dr. Jack Kitts from the Ottawa Hospital on developing an organization that supports faculty engagement. This was followed by some excellent group work and discussion around faculty engagement and how we move forward in this critical area.

I am excited to have Dr. Carol Suddards visiting our three campuses in Saskatoon, Regina and Prince Albert. She has published and presented on the importance of the learning environment and students’ education. Carol is meeting with some of our medical students who volunteered to share their experience at each of our campuses, including student classrooms and, more importantly, clinical services. Her work will help us prepare for the upcoming full medical school accreditation in late 2017. Questions will be about interactions with patients, working inter-professionally and opportunities for medical research. We are also looking at the learning environment by reviewing students’ experience with student support and wellness.

An important town hall meeting takes place this week with our biomedical sciences faculty members, myself and Provost Ernie Barber. Dr. Jim Thornhill has been working steadily with our faculty members and department heads on developing a new undergraduate biomedical degree program based in the CoM, as well as looking at various governance options. I have gone to meet with all five biomedical sciences departments and have listened carefully to their feedback. The town hall will give the entire group the opportunity to discuss the model that will best serve the biomedical scientists in a “new world” of our own degree program and team science.

This is but a sampling of the great work being done by the dedicated faculty, staff and students at the CoM. As always, I welcome your feedback.

Social Accountability, Advocacy and Systemic Racism

The College of Medicine has always been a recognized leader in social accountability; our Social Accountability Committee was established in 2004, leading to our Division of Social Accountability, created in 2011. This team has been ably led by Dr. Ryan Meili and is best known for its Making the Links program, which educates students in advocacy and provides them with experiences in local and global socio-economically deprived communities. This year, we have added resources to the division to allow for the expansion of Making the Links and the addition of an Indigenous stream.

I challenged Dr. Meili to develop a plan for advancing social accountability at the College of Medicine to the next level. He has consulted widely over the last six months and is now ready to bring forward that plan, the College of Medicine Social Accountability 2016-2020 Strategic Plan.

Some data collected as part of the background, demonstrating the level of need provincially, is startling, in particular:

Just under 100,000 (10.1% of the population) Saskatchewanians were living in poverty in 2010 and 64% of First Nations and Métis children are living below the poverty line in our province (Plante & Sharp, 2014).

On March 21, we were fortunate to have Dr. Robert Woollard, Professor of Family Medicine from UBC, former chair of the Committee on Accreditation of Canadian Medical Schools and world-renowned scholar and advocate for social accountability, at the college as a guest speaker. Dr. Woollard will assist us as we develop social accountability in medicine in Saskatchewan.

Last week, our health science students hosted the third annual Health Innovation and Public Policy conference. We had superb presentations by our own Dr. Kish Wasan, Dean of the College of Pharmacy and Nutrition, Dr. Danielle Martin, Vice-President Medical Affairs and Health System Solutions at Women’s College Hospital and founder of Canadian Doctors for Medicare, Dr. Cindy Forbes, President of the Canadian Medical Association and Dr. Naheed Dosani, Palliative Care and Family Physician at William Osler Health System and Inner City Health Associates, McMaster University.

Our students are fabulous role models in advocacy, as demonstrated by their organization of this conference. Physician advocacy is now a competency mandated in the new CanMEDS guidelines. In their article, Building a Generation of Physician Advocates: The Case for Including Mandatory Training in Advocacy in Canadian Medical School Curricula, doctors Tahara Bhate and Lawrence Loh make a compelling argument for mandatory training in advocacy in Canadian medical schools.

In a further example of advocacy, one of our own residents was asked on completion of his residency, “What would you change?” He spoke passionately about the numerous times he witnessed both intentional and unintentional racism directed towards Indigenous patients. His courage was impressive and the examples he provided were distressing. I’d like to bring to your attention to an excellent paper by the College of Family Physicians of Canada (CFPC), Health and Health Care Implications of Systemic Racism on Indigenous Peoples in Canada prepared by the Indigenous Health Working Group of the CFPC and the Indigenous Physicians Association of Canada—our own Dr. Veronica McKinney was one of the principal authors.

This is a great document for all of us to read and then reflect on what we can do to eliminate systemic racism in health care, and how we teach and act as advocacy role models for our learners. For me, the greatest reminder of how far we have to go came from the authors of the Truth and Reconciliation final report. They wrote: “For over a century, the central goals of Canada’s Aboriginal policy were to eliminate Aboriginal governments; ignore Aboriginal rights; terminate the Treaties; and, through a process of assimilation, cause Aboriginal peoples to cease to exist as distinct legal, social, cultural, religious, and racial entities in Canada.”  This quote illustrates so clearly how we got here and how far we have to go in eliminating systemic racism in health care.

As always, I welcome your feedback.

 

 

 

 

 

 

 

 

Clinician Scientists and Academic Health Science Networks

Aside

This past week was all about health research, as I attended two very informative conferences. The first, at Western University, was the Consensus Conference on Clinician Scientist Training in Canada. It was hosted by Dr. Michael Strong, the Dean of Medicine at Western and a very well-regarded clinician scientist. He also has an ongoing active research program in Amyotrophic Lateral Sclerosis (ALS or Lou Gehrig’s Disease).

The Future of Medical Education in Canada Postgraduate Project has as its first recommendation: “In the context of an evolving healthcare system, the PGME system must continuously adjust its training programs to produce the right mix, distribution, and number of generalist and specialist physicians—including clinician scientists, educators, and leaders—to serve and be accountable to the Canadian population.”

Clinician Scientists are those clinicians (MDs in our case, but from all health professions) who have advanced research training (MSc, PhD, CIP) and devote a considerable percentage of their time to research. They may be involved in the full spectrum of research, from the wet lab to population health, or medical education research. Their role as bridge from bedside to laboratory is essential for our health research enterprise. The role of the clinician scientist is a challenging one in a world where competing clinical demands are infinite and research funding is declining. The situation in Canada is dire, according to some observers, given that many established clinician scientists are aging and, just recently, the CIHR withdrew support for MD-PhD programs. The purpose of the meeting was to develop recommendations to enhance the training of and train more clinician scientists. I will be happy to share those recommendations with anyone interested when the report from this conference is completed.

The College of Medicine five-year plan and The Way Forward call for the addition of 10 clinician scientists. We are now embarking on some of that recruitment. Our own MD-PhD program has been under-subscribed and we are working with medical students and the research office on its enhancement. However, the greatest thing we can do as a college to support clinician scientists and grow research is changing our culture. The famous old question frequently encountered by these hard-working scientists is from their MD colleagues, who say, “Are you coming to work today or you going to your lab?” Our clinician scientists need our support, and that may be through sharing research ideas, recruiting our patients to trials, respecting protected time for research, and cheering their successes.

The next conference, in Ottawa, was the Academic Health Sciences Network National Symposium 2016. This annual meeting is co-sponsored by the Association of Faculties of Medicine of Canada and HealthCareCAN. The latter is an organization of the large teaching hospitals in the country. I have previously blogged about academic health science centres and networks and their crucial role in teaching, research and the success of medical schools. The College of Medicine will never achieve its goals without such a partner. While we’ve made great progress in our partnerships here in Saskatchewan, our healthcare system does not have a membership in HealthCareCAN. Given the tremendous success of the U15, HealthCareCAN has now developed its own lobby group, the H10. The only two unrepresented provinces are Saskatchewan and Alberta.

The symposium this year had excellent presentations on the changing political environment, using research to enhance patient safety in teaching hospitals and more discussion on training to support clinician scientists. We also heard from the leaders of the major funding agencies: CIHR, CFI and Genome Canada. Overall, it was an excellent meeting.

At the end of the day we had an opportunity to meet Dr. Kirsty Duncan, federal Minister of Science, and lobby for research funding. We were also asked to provide input into the development of a Chief Scientific Advisor position by the federal government. It remains to be seen whether we are entering “sunny ways” for health research but the mood in the room was positive and the consensus was that things were unlikely to get worse!

As always, I welcome your feedback.

Minister Duncan and colleagues from the AFMC

Minister Duncan and colleagues from the AFMC.

 

Biomedical Sciences

Aside

 

One of the key initiatives in The Way Forward was renewal for the Biomedical Sciences at the College of Medicine. Last summer I asked Dr. Jim Thornhill to lead this important initiative in collaboration with the five departments of the Biomedical Sciences.

Important progress has been made. The work has been divided up into programming and governance. A committee of faculty members from all five departments has looked at undergraduate programing in the biomedical sciences. Visits to Western, Queen’s and Dalhousie have taken place. Much information has been obtained and significant work on the principles that should guide our program planning has been done. I believe there is growing consensus to support the development of a combined medical sciences degree based in the CoM.

Recently, I have been meeting directly with the basic science department heads and we have had excellent discussions about the options before us. As many will recall proposals in the past had been put forward for a 1-department model and a 2-department model. In terms of further information gathering we recently had a very informative videoconference with Dr. Mike Adams of Queens University who are several years into a single department of biomedical sciences model.

While many options for a future governance model have been proposed, two models are now on the table: (1) a single “School of Biomedical Sciences” within the CoM that would work very much like the current School of Physical Therapy or (2) two departments. The “School” would have a vice-dean or associate dean as leader and would function with its own collegial governance structures.

Most recently I have been meeting with the departments to hear from individual faculty members and I would like to thank all for their participation and their candor. Rest assured I am listening with great interest and while I may have had a personal preference when this started, I am determined to be open to the options before us.

One question that I would like to address is “why change?”. I guess my first response is some surprise. The Way Forward was endorsed by Faculty Council and University Council and clearly called for the restructuring of the biomedical sciences into one\ or two units. As I review The Way Forward document today, I believe there are even greater reasons why we need to change than when it was adopted.

My personal goal is to see a unit(s) of the biomedical sciences as among the most successful faculty members and scientists on campus. My frequently stated goal of seeing us become the best “small” medical school in Canada is impossible without thriving biomedical scientists and superb education and research programs. Biomedical sciences have always been foundational to the success of medical schools. (Of course in the early years of medical schools there was not much clinical science worth knowing! J)

I see the “why” in terms of research success, education success, and financial success.

On the research front the world has already dramatically changed. Our biomedical scientists now work in multi-disciplinary labs and in research clusters. Many research resources, traditionally managed by departments, are now managed through the Health Sciences Council. Team-based (collaborative) science is now the norm and is certainly the only path to competitive funding. Throughout science and universities, disciplines are getting increasingly blurred and, depending on definitions, I wouldn’t be surprised if our current five departments don’t already have within them more than a dozen disciplines. None of this is either good or bad – it just is. So in a rapidly changing world which structure supports research most effectively?

In terms of further change within the college, we are restructuring our clinical departments so that they may grow and succeed. Our five-year financial plan calls for recruiting 10 new clinician scientists. The School of Physical Therapy wants to grow to include Occupational Therapy and Speech Language Pathology. What structure facilitates both collaboration and competition for resources across the CoM and across the U of S?

On the education front I firmly believe we must have an undergraduate program(s) that achieves three goals:

  1. Prepare students for a career in science and thus attract some of the best to our own graduate programs. I believe this degree will excite many top high school students and attract them to our college. The experience elsewhere confirms this. I also believe the breadth of such a degree provides graduate students with a “bigger toolbox” to pursue their passion in one of the biomedical sciences. (Reference: Page, Scott E. (2007). The Difference: How the Power of Diversity Creates Better Groups, Firms, Schools, and Societies. Princeton, NJ: Princeton University Press. p. 456. ISBN0-691-13854-0.)
  2. Provide students with the best possible preparation for the health professions. In the eternal debate about the art vs. the science in medicine I am increasingly convinced doctors (and other health professions) need greater scientific preparation than in the past.
  3. Provide students with a biomedical science degree that can lead directly to the job market or other graduate programs (health administration, public health, bio-medical engineering, etc.). At Dalhousie and other Canadian universities job market research showed that, with the addition of a couple of social science courses and one pathology course, the interest from industry in these graduates increased dramatically.

Finally, financially the university is moving to responsibility-centered management and the TABBS model of budget allocation. The former means we will have more autonomy (and the attendant risk) over how we spend our resources and the latter means that future budgets will in part be influenced by tuition revenue. It is well known that professional schools are not always well-served by the TABBS model because professional enrollments are fixed externally. It is imperative that we develop science educational programs that are based in the CoM and that those programs are highly competitive. Again, the experience elsewhere is that a combined biomedical sciences degree is highly attractive to high school students.

Success also takes resources. I am committed to supporting a creative and innovative group of biomedical scientists who work with us to find the best possible solutions. I hope for a future when we are adding faculty and staff positions in the biomedical sciences to support research success and education program growth.

So to paraphrase somebody: change is always hard but better is always change. My goal is better. I am listening to all perspectives and look forward to your feedback.

 

 

 

 

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