Five-year strategic plan approved

As many of you may have heard, last week faculty council approved a new five-year strategic plan for our college. This exciting milestone marks our progress on implementing The Way Forward. Our success there has enabled us to move from that change initiative focus back to a strategic planning framework. Our new plan will guide us to 2022.

We will be rolling out the high-level plan document next week. With the inclusive and consultative process followed to develop this plan, many of you will already have a good sense of our direction and priorities. I believe that you will see in this plan our shared aspirations for our college. Additionally, we developed the plan to mesh effectively with the university’s approach on its own vision, mission and values, and it will align with the university’s current strategic planning process underway this year.

While there is much work before us, we truly are on our way!

I will give you, here, an initial glimpse into the College of Medicine’s 2017 Strategic Plan.

In it, we have identified our vision, mission, values and principles, as well as seven strategic priority areas. The plan speaks to our important leadership role in the health of the people of Saskatchewan, as well as the world. It speaks to how we will conduct ourselves as a socially accountable organization engaged in our communities. We determined that those same values and principles that our university holds dear are our values and principles.

We identified seven strategic priorities. They emphasize that research, education, social accountability and community engagement, Indigenous health, and being a province-wide college integrated and aligned with our health system and strengthened by an empowered and engaged faculty, are critical in achieving our mission.

Further work will be done to fill in more detail in the plan’s priorities in the weeks to come, but we have strongly defined what we will focus on across key areas for our college for the next five years.

Finally, this was a team effort. To our students, faculty and staff, and key stakeholders and partners, I extend my sincere thanks for your engagement and valuable participation in this plan’s development. We started this work together last August and kept the process and our tight timeline on track with your support.

I look forward to further developing and carrying out our new plan alongside all of you. Watch for the plan through further communication next week.

As always, I welcome your feedback.

Accreditation: what happens now?

Guest blog by Kent Stobart, Vice-Dean Medical Education

I’m pleased to say that “what happens now” is in fact already happening. Several people are progressing on the work we have before us to ensure a successful accreditation outcome this fall. There is still a great deal to do, however.

First, though, I want to emphasize some basic, but very important, messages with regard to UGME accreditation:

  • Our program is not on probation.
  • Our program is fully accredited and always has been.
  • We are confident that we will not be on probation after the 2017 full site accreditation visit.
  • For the 2017 accreditation visit, our goal is to achieve a full eight-year accreditation, the best possible result – we are shooting for a “PB” (personal best), as the dean wrote in his recent blog just after the mock visit.
  • Our ultimate goal, however, is a quality UGME program, and accreditation is a means of keeping us accountable and structured in achieving our goal.

Please help your college out by sharing the above messages at every opportunity!

Also, some further clarification regarding our college’s accreditation history: we have been on accreditation probation twice in the past, but we are not on probation now and haven’t been since October 2015. Probation does not mean “not accredited.” It’s a warning status that indicates accreditation is at risk. Medical education programs remain fully accredited when on probation, but must work to resolve the accreditation issues that have resulted in the probationary status. Thus, though we have been on probation twice in the past, our school has always been fully accredited.

Now, back to the work we have to do between now and the full visit.

That work will include improvements in how we do things and we will be sharing these improvements and our progress towards a successful accreditation visit with you on a weekly basis. We will also be doing more to prepare all our visit participants well in advance of the visit. Ensuring that our students have current and useful information to support their success and that our faculty have the information and resources needed to do their jobs are part of this work. We can’t achieve this in a vacuum, though—we need your help. If there is a problem, we need to know.

Generally, much of the information that supports our students and faculty in their roles is found on the college website as well as in One45. For students, important information to be familiar with to support your success in the UGME program includes curriculum information, program and learning objectives, the Student Information Guide and the Student Guide to Clerkship, syllabi and student policies. For faculty, knowing curriculum information and processes, program objectives, collegial processes and policies and procedures are key areas that support your success. Undeniably, we have ongoing improvements to make in our processes and how we communicate with you to support your roles.

So, how are we approaching the accreditation-focused work of the next several months?

We have a plan in place and people identified to lead all of the areas of work.

There are some clear priorities we must set, as we have a pressing deadline to meet: we must update and submit our Data Collection Instrument (DCI) by June 19, 2017.

Our students have played an important role already in our post-mock work with their recent completion of a Modified Student Survey. The level of participation from our students—80 percent!—was extraordinary given the timelines involved, so a huge thank you to all our medical students for your support through completing the survey. It will supplement the Independent Student Survey (ISA) completed last spring by providing updated information from our students in key areas.

We have an Accreditation Executive Team (AET) that is meeting to discuss and update progress three times a week from now until the accreditation visit, and is composed of: myself; Athena McConnell, assistant dean quality; Pat Blakley, associate dean UGME; Marianne Bell, accreditation specialist; Greg Power, chief operating officer; Sinead McGartland, Senior Project Leader; Alyson Rees, executive assistant to the dean; and Kate Blau, communications specialist. The dean joins us at these meetings, as well.

Focus areas for improvements and leaders for each have been identified. They are:

  • Curriculum Improvements – Regina Gjevres, assistant dean curriculum
  • Learning Environment/Student Services – Bindu Nair, assistant dean student services
  • Educational Resources – Meredith McKague, assistant dean academic
  • Faculty – Sheila Harding
  • Admissions – Barry Ziola, director, admissions
  • Administration – Greg Power
  • Modified Student Survey – Athena McConnell
  • Student Improvements Resulting from the ISA – Pat Blakley
  • Quality Accreditation Visit – Sinead McGartland

Our June submission deadline is approaching fast! That means you may be hearing from one or more of our focus area leads or others as we work together to ensure we have solid information pulled together in the DCI. Please, support all requests effectively and efficiently and be sure to ask for more information if you need it, in your work to respond.

We have identified certain accreditation elements as critical and we will tackle these first. Next, we will focus on elements deemed urgent, followed by those deemed high priority. Communication about progress towards our accreditation visit will be shared with you through weekly updates in our college e-news, in this blog, through monthly Medical Student Updates, and through college website news stories that will serve to highlight involvement of different participants in this work. General information is also provided on the UGME accreditation web page on our college website.

For our actual visit participants, we will provide you with significantly more time, support and focused preparation. Watch for information coming directly to you via email—as few and as streamlined as possible; we have several improvements already planned here—that includes save-the-date information, invitations with automated RSVPs for both preparation sessions and actual visit meetings, and orientation materials. With some exceptions, actual visit participants will be primarily those who participated in the mock accreditation visit last month.

Finally, questions can be directed to me, to Athena McConnell and to Pat Blakley, as well as our focus area leads and any member of the AET.

I thank the dean for providing space to me for this message.

Creating and Supporting Safe Clinical Learning Environments – What Can I Do?

I was invited to speak at the Dalhousie Postgraduate Medical Education professional day for program directors and program administrators. The title above was one of the talks I was asked to present.

What is the “learning environment?”

The “learning environment” has been defined as “everything that is happening in the classroom or department or faculty or university.”1,2

In our work, where at least two-thirds of our medical education takes place in the clinical setting, our learning environment extends to the entire province. In fact, we have a responsibility to ensure our students have a safe learning environment anywhere—even when taking electives out of province.

So if that is the learning environment, what is a safe learning environment? For me, a safe learning environment is a place you (or your son or daughter) would like to go to medical school. I believe excellent clinical education is dependent on a safe clinical learning environment.

In my talk, I divided the characteristics of a safe learning environment under five headings: Physical, Program, Learning, Clinical, and Behavioral. I provide here my presentation from that day.

Physical includes obvious things like safe house calls by residents, for example. Program includes things like fair and transparent promotion policies. Learning includes things like learning objectives that are attainable. Clinical includes very important principles, like appropriate graduated responsibility and supervision of learners.

The Behavioral heading gets complicated and the discussion at my talk in Halifax developed into a long list. I believe many of us of a certain age were exposed to teaching techniques that are unacceptable today.

I recall an experience in my clerkship with a supervisor who was a fan of scotch and jazz. Tradition was for the house staff to gather in his office late on Friday afternoon, share a “wee dram;” give an assignment to the two clerks to find an obscure piece of trivia about jazz; and share plenty of male jocularity! The irony was that he was an incredible clinical teacher, but the behavior was inappropriate even then. (I am not that old!)

Accreditation is highly dependent on student feedback through the Independent Student Analysis and the Canadian Graduation Questionnaire. Historically, the CGQ documented both locally and nationally that about 30 per cent of students reported mistreatment over the course of four years. The Association of Faculties of Medicine of Canada no longer provides the national comparator on the basis of the fact that zero mistreatment is the only acceptable goal.

Unfortunately, we are not yet down to zero. While the pre-clinical learning environment is not immune, most reports are in the clinical environment. The source is most often clinical faculty but also includes hospital staff, residents and fellow students.

The most common form of mistreatment is public humiliation. This could be shaming over an incorrect diagnosis or public fact-based questioning of increasing difficulty. I include a link to my previous blog on “pimping.” Distressing to me were incidents of racially based comments directed at students.

I know the vast majority of faculty abhor any form of student mistreatment. On the other hand, I am also sure some instances are unintended and that sometimes people are simply unaware of their impact on learners.

We encourage students to come forward with concerns and we guarantee their confidentiality. We can only fix what we know about.

I believe the CoM must be proactive in eliminating mistreatment. I believe it is incumbent on all of us to work every day to ensure our students have the educational experience we would like to have ourselves.

Among my final words at Dalhousie was that we all must be prepared to speak truth to power in addressing these issues.

The CoM has plenty of experienced faculty who can provide faculty development or lead workshops for departments, etc. We have invested more in Faculty Development and welcome the opportunity to assist in making this college a place where zero tolerance for mistreatment is not simply a belief, but also a result.

As always, I look forward to your feedback.

[1] Genn JM. AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education – a unifying perspective. Med Teach. 2001;23(5):445–54.  [PubMed]
[2] Roff S, McAleer S. What is educational climate? Med Teach. 2001;23(4):333–34.  [PubMed]

Maximizing the Impact of Lectures

Two weeks ago, I undertook a course at the Harvard Kennedy School in Cambridge, Massachusetts. HKS is Harvard’s school of public policy and public administration. I’ve had the good fortune to now have completed five professional development programs at Harvard University over the last six to seven years—some at the medical school, but others affiliated with the business school, the education faculty and now two at HKS. I must say I have experienced some of the best classroom teachers in my life at these programs.

This time the course was Leadership Decision Making. As many of you may know, I have quite an interest in the neuroscience of decision making, especially as it applies to how we teach diagnostic reasoning. This course used the same fascinating research to review how leaders can optimize decision making. One very interesting aspect was an afternoon in their Decision Science Laboratory that provided me feedback on my own decision making.

Dr. Jennifer Lerner, the leader and founder of the course, was an incredible teacher and an inspiring leader. Jenn is a professor of Public Policy and Management at HKS, with a PhD in Psychology from U of C – Berkeley. She describes her role as scholar/practitioner and has held numerous roles advising leaders at the highest levels of government, business and military, around the world. The other faculty were equally impressive, and the 60 participants were fascinating people from around the world.

Part of our preparation for the course was a reference (I’ve provided a link below). Jenn surprised me on day one, when she appealed to all participants to not use laptops. Her reasons included the obvious distractions that these tools entail, but primarily focused on the research that shows students taking notes on laptops retain less material than those who do it the old-fashioned way!

Careful perusal of this paper will reveal that there is more to it than that. The evidence is that most people can type faster than they can write but written notes outperform laptops! While overall pen and paper notes outperformed laptop notes, in fact within and across both groups, note takers who took concept-based and summarizing notes outperformed learners who took verbatim notes.

So we should do all we can with our pedagogy to avoid conditions that promote verbatim note taking.

As with most blogs for the rest of this year, I will bring you back to accreditation of our undergrad program. One area of student concern that was very clear to our mock accreditors was the issue of lectures. The two concerns raised were those lectures where the slide deck was not available before the lecture and those that were not recorded.

Making the slides available before the lecture allows students to prepare for the lecture and actually plan their note taking. The research clearly shows that the opportunity to reframe the content, move from words to concepts and summarize the material leads to deeper learning. Furthermore, we know one of the reasons students attend lectures in person or by viewing a recording is concern that material in the lecture will be on the exam. In those lectures where the students know there is no recording, they are obliged to revert to verbatim note taking.

We also know that students doing review of recorded lectures are predominately doing focused repetitive review of specific segments of the lecture, usually on complex topics and often to complement the notes taken in the lecture. This review is done as much by the students who were in the room as those who were not.

I do know it is disheartening as a lecturer to work hard to prepare a lecture and deliver it to a sparsely populated room. However, students tell me that the prime driver of lecture attendance is actually a well-designed unit or course where all the curricular components—including the lecture—tie together and, most importantly, an excellent lecturer who cares about the students. They all speak glowingly of the hematology module as an example of excellence, and they asked our accreditors why all units or modules could not learn from that module.

Recall that we do not make lectures mandatory and there are many quite legitimate reasons for being unable to attend a lecture. Besides, students always have options. Just Google “YouTube, heart failure.” Wouldn’t we all hope they were watching our lectures?

I know that it is at our faculty member’s discretion to pre-circulate lecture slides and/or record the lecture. However, our students have repeatedly put forward this request. I think there is research supporting the benefits of both of these best practices in providing lectures and lecture materials. I would appeal to all faculty members to consider our students wishes and honour their beliefs in what is best for their learning.

The Pen Is Mightier Than the Keyboard: Advantages of Longhand Over Laptop Note Taking

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

Improving rural healthcare

I had the pleasure of attending a national summit on February 22, 2017 in Ottawa dedicated to improving healthcare access and equity in rural communities in Canada. The event marked the launch of the Rural Road Map for Action, which provides 20 recommendations to enhance rural healthcare.

It was held at the award-winning Wabano Centre for Aboriginal Health, which provides a wide range of medical clinics, social services and support, and youth programs for Ottawa’s nearly 40,000 Aboriginal people. I really was impressed by their facility, which was a beautiful space, but also really reflected their vision statement:

We envision a world in which all First Nation, Inuit and Métis people have achieved full and equitable access to the conditions of health including: pride in ancestry, cultural reclamation, peace, shelter, education, food, income, a stable environment, resources, and social justice. And where the gifts and wisdom of First Nation, Inuit and Métis cultures are recognized as valuable, distinctive and beautiful.

The Wabano Centre was a superb venue for a very productive day that united national leaders in education, practice and human resource planning, as well as physicians of rural and Indigenous communities.

Advancing Rural Family Medicine: The Canadian Collaborative Taskforce was created in 2014 as a joint taskforce of the College of Family Physicians of Canada (CFPC) and the Society of Rural Physicians of Canada (SRPC). Key leaders on this taskforce include our own Tom Smith-Windsor, SRPC President, and Kathy Lawrence, CFPC Past-President.

The taskforce worked collaboratively over the last two years leading up to the summit and the launch of the Rural Road Map for Action, which outlines four directions that aim to:

  • reinforce the social accountability mandate of medical schools and residency programs to address healthcare needs of rural and Indigenous communities
  • implement policy interventions that align medical education with workforce planning
  • establish practice models that provide rural and Indigenous communities with timely access to quality healthcare
  • institute a national rural research agenda to support rural workforce planning aimed at improving access to patient-centered and quality-focused care in rural Canada

The summit focused on how the recommendations can be translated into actions that are coordinated, comprehensive, measurable and sustainable. The aim is to engage all stakeholders in applying these recommendations to future policy-making and planning, as well as to identify roles in addressing issues related to healthcare equity for rural Canada.

The College of Medicine had a prominent role in the day. In addition to the leaders mentioned above, we were very well represented in a video about rural healthcare and rural education shown early in the day. I can also say we are making progress or have already implemented some of the recommendations.

I highly recommend you check out the road map document and look at the 20 recommendations. As always, I would love to hear your feedback.

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.

One Medical Faculty

Last night we marked a major turning point in the journey to make the College of Medicine one of the best medical schools in Canada and a pillar of healthcare in Saskatchewan, with Faculty Council’s support of our proposed new policy and procedures for the appointment of medical faculty at the University of Saskatchewan. Further to this step, the policy will proceed through the required approval path at the university level.

As you will recall, a major premise of The Way Forward is that the university recognize that “(medical) faculty represent a unique category of university appointees.” As many also know, the College of Medicine has been seriously handicapped by a historic and deeply embedded town-gown divide and structural inequities—these contributed to our total physician engagement in the academic mission of teaching and research being about half of that at similar-sized medical schools.

The good news over the last few years is that more and more of our physicians have become more engaged with the CoM at our two main campuses in Saskatoon and Regina and throughout the province. Many have stepped up to important leadership roles. This is likely primarily because physicians know that their practice, quality of care and professional satisfaction are enhanced by engagement in teaching and research. Repeated surveys of students and residents demonstrate over 75 per cent want an academic component to their career. And increasingly our graduates and residents are staying in Saskatchewan and taking up faculty appointments. This is all good!

Last night’s support is one step in formalizing the recognition of all medical faculty as equal colleagues in supporting the mission of the CoM. In fact, we know that 1,500 (more than half) of the province’s doctors have appointments with the CoM. In the new model, this is a university appointment. Given appropriate qualifications and circumstances, these medical faculty can apply for and hold research grants and supervise graduate students in addition to medical students and residents, and we will work with the university to facilitate further opportunities for these faculty members in this area. The model provides equity with all university appointees.

However, confusion remains, as many are still rooted in the historical language. One of the defining characteristics of the new model is that compensation is separated from appointment. All medical faculty will follow the same procedures for appointment with the U of S and all appointments will have the same rights and privileges. However, there will be several models of compensation.

Those who choose an Academic Clinical Funding Plan (ACFP) will have defined annual compensation and defined academic and clinical deliverables for which they will be accountable to the CoM and the health authority through their department head. The real advantage for them is that the compensation for academic and clinical time is equal. If they choose to leave the ACFP and go to fee-for-service (FFS) or other compensation models they will retain their appointment and look to the CoM for one of the other compensation schemes. The health authority appointment is not linked to the university appointment in any way. On the other hand, one does need to do clinical work to do clinical teaching!!

Others who want to remain in an FFS model, but want to do substantial academic work, may choose to enter into a contract with the CoM. Reasons for this—not the least of which is FFS rates in some specialties—include partnership obligations, group dynamics or simply personal preferences. These contracts will also have defined academic deliverables and, as in any contract, there will be accountability for those deliverables. While this compensation will be fair, there is no guarantee the CoM will be able to match FFS rates in all contracts. That is simply the reality of university funding.

Finally, the vast majority of our faculty who primarily do clinical teaching will receive compensation through a stipend model done on a fee-for-service basis. We have had widespread consultation with these clinical teachers. We have proposed rates that are at the middle of the range across the country. We continue to work on the administrative efficiency of this process and the timeliness of payment. Unfortunately, further improvement is largely dependent on improving our information systems, which is also in our work plan.

Remember, this is all a work in progress. There is great interest in ACFPs and we hope to see a number of existing faculty move to ACFPs in the next six months. Limitations here are the work required to develop these on an individual basis and, of course, funding. Please bear with us as we work with our partners in the health authority and the Ministry of Health. All are in agreement that the ACFP will be an increasingly important model for both the university and the health system as we move forward. Many new graduates prefer this model, with its inherent predictability and the protected time for academic work.

In many other jurisdictions, academically oriented groups of physicians have banded together over time to enter into group ACFP agreements with their university/health authority/province. For example, at Queen’s, virtually all of the physicians in Kingston are on the same AFP. The group ACFP is administered by a practice plan governed by the physicians. This model combines the independence and business models physicians are used to with the collegial trade-offs of clinical and academic work typical of an academic environment. I have made it clear that I would like to see our ACFP model evolve in that direction. In that regard we are developing such a model for the family medicine faculty in our two family medicine teaching units in Saskatoon and Regina.

As I said, this is a work in progress. Our goal is to meaningfully engage as many Saskatchewan doctors as possible in one appointment model and offer compensation models that are fair and transparent. Without a doubt, we have made mistakes already and we will continue to make adjustments. The province’s financial reality is one with which we must contend. But the goal of One Faculty is that we suspend the historic language and don’t listen to rumours – ask questions!!

As always, I welcome your feedback and I sincerely thank all who contribute to the CoM.

Happy Holidays!

I would like to wish everyone at the College of Medicine a happy, safe and restful holiday. I also want to thank you for all of your work during this very busy fall, and throughout 2016. We have accomplished a lot and the holidays provide a great opportunity to step away, rest and rejuvenate for an exciting new year in 2017—just around the corner.

We have made strides across many important initiatives, from UGME accreditation and college strategic planning to our biomedical sciences restructuring and building our research capacity. Our work to re-engage our alumni included a fall 2016 edition of Connective Issue.

We gathered and cheered resident and student achievements at events including the PGME Celebration Night, Fall Formal and the White Coat Ceremony. We worked and built relationships with our students serving on the SMSS. Although not completed, we have thus far navigated the student double cohort, thanks to the efforts of faculty, students, staff and partners in healthcare to make this as smooth as possible.

All in all, throughout the past year, working together we have developed stronger relationships across the college, and will continue to do so. We have much ahead of us, and I look forward to working alongside all of you in 2017.

But first, enjoy a very well-deserved break!

This Week at AAMC: Mourning and Resilience!

I wrote this blog in the Seattle and Vancouver airports as I returned home from the annual meeting of the American Association of Medical Colleges (AAMC), Learn Serve Lead 2016.  AAMC is the pre-eminent American meeting on medical education and research.

For me, personally, it was a profound week that combined the American election result, Remembrance Day (I still shiver thinking of the sacrifices made by so many Canadians, including an uncle, and of all those cold November 11 mornings I spent as a Boy Scout and Air Cadet!), and the death of Leonard Cohen. It is a good week to remember many of Cohen’s lyrics, but the one that stands out for me now is, “There is a crack in everything; that’s how the light gets in.”

My experience attending American medical education meetings has left me with the impression that many medical educators there lean to the Democratic side. But this meeting was remarkable! Attendees numbering 4,000—and the vast majority were in mourning!! Of course, we were also in a blue state on the left coast, so the newspapers and talk on the street also reflected the mood at the meeting. I said to some friends, “It feels like we are at a wake.” Since I am now acclimatized to Saskatchewan, the daily rain didn’t help!

The meeting began with a plenary by Doris Kearns Goodwin, an author, historian and scholar of American presidents best known for her biography of Lincoln: Team of Rivals. Lincoln was exceptional in many ways but this biography focuses on his leadership, and his strategy to hire his rivals to key cabinet positions. It is an interesting contrast to the current presidential transition underway! And while Goodwin led off with a historian’s confirmation that this election was truly an aberration, her message included many great stories and a reminder all politicians are people with histories, families and a dream of leaving the world a better place. I am sure the conference organizers had no idea their first plenary speaker would be so appropriate for the time!

Dr. Darrell Kirch, the president and CEO of AAMC and an academic leader I have always admired, was somber as he advocated that now more than ever it is important that academic medicine pursue its mission of caring and advocating for the marginalized and the underprivileged. He told an inspiring story of “White Coats for Black Lives,” that described advocacy led by medical students at the University of California, San Francisco. In paraphrasing a politician, he said, “When they go low, academic medicine goes high,” and quoted Lincoln as he called on academic medicine “to be the better angels of our nature.”

Another excellent plenary was delivered by Dr. Atul Gawande, well-known Harvard surgeon, researcher, author and columnist for The New Yorker, and advocate for patient safety. While he led off even more soberly with a definite opinion on the election, he quickly moved on to remind us of the complexity of medicine with 60,000 diagnoses, 6,000 drugs and 4,000 interventions! He described three stages of improvement, with the message that only the third one is proven to work consistently.

1. You should do x (education)
2. You must do x (guidelines, regulation, etc.)
3. Systemize x

Gawande illustrated this point with his work on surgical checklists. One study in Scotland over four years showed a 26 per cent reduction in mortality with 9,000 lives saved – more than had died in motor vehicle accidents. But he brought us back to the present by noting that in the USA, surgical checklists had the lowest uptake in hospitals serving rural, poor and black populations! He described an initiative on a checklist for the prescription of opioids for chronic pain and noted that more people (often marginalized) are dying now from overdoses than from AIDS at that epidemic’s peak! His latest book, Being Mortal, is about end-of-life care, and he noted research shows few people are offered end-of-life discussions by clinicians, with the least likely to receive them being men, those without college educations and marginalized groups.

Overall, his message was that academic medicine can make a difference if we always uphold our values in our clinics, hospitals and medical schools. Read more about his perspective in this week’s short essay in The New Yorker: Health of the Nation.

There were many fantastic seminars and workshops about medical education, concluding with an incredible plenary on advocacy for mental healthcare by psychologist and Johns Hopkins Professor of Psychiatry, Dr. Kay Redfield Jamison. She has been both the co-author on the definitive textbook on bi-polar illness, Manic-Depressive Illness, and sufferer of the same since early adulthood. She has also written extensively for the public, including a memoir, An Unquiet Mind, which describes her experience with mania and depression.

She talked about the stigma of mental illness and described the history that any Johns Hopkins faculty member, staff or learner needing surgical care would seek out a Johns Hopkins surgeon, but those needing mental healthcare would go anywhere but Johns Hopkins due to the stigma of a mental health issue. Dr. Jamison talked about wellness and mental health in particular for clinicians and learners. She talked about how we all had to learn to deal with the paradox that we must all provide care and receive care, and made the link between excellent mental healthcare care for the clinician and patient safety.

Learn Serve Lead 2016 was a great educational meeting, but also a personal experience I will not soon forget. I was struck by three things: the shock and mourning that people were experiencing; the resilience in focusing on what we all can do now to improve healthcare; and the number of shared values with the College of Medicine and our great commitment to social accountability.

And now, I am really glad to be back home.

As always, I have an open door and welcome your feedback, discussion and debate.