A different kind of return

As we return for another academic year in 2020, how we work and learn continues to be impacted by our important efforts to ensure safety and do our part to reduce COVID-19 transmission risks. For many, this year will not be a return to campus in the usual sense. Nonetheless, I do want to welcome everyone back, whether you are learning and working remotely or are present in clinical or other settings around Saskatchewan.

On the medical education side of things, our Undergraduate Medical Education Program team has been working hard to find ways to engage our incoming first-year MD students in our college in various ways. Most recently, this has been planning and executing the online orientation that took place last week. Our whole college welcomes our MD Class of 2024!

Our residents started their new year of training at the beginning of July. The annual resident boot camp for our new first-year residents was handled differently this year, of course, but I have heard wonderful things about how it went in an online format. Kudos to the teams in PGME and ICT for their great work.

The School of Rehabilitation Science welcomes its incoming class in the Master of Physical Therapy program in September, with classes starting September 8. And of course students in graduate studies in our college, across biomedical and health sciences, and population health, continue their path towards completion of their MSc and PhD programs with the fall term starting in September. A Fall Welcome for Graduate Students is planned for September 11 to kick the year off for our graduate students and graduate studies programs.

For our researchers, some have worked with the university and our college for a return to campus guided by processes for safety and physical distancing. Others continue to work remotely. All are being well-supported by our team in the Office of the Vice-Dean Research at the CoM.

Most of our administrative staff continue to work remotely, and based on what we know so far, this will continue for the majority of us into 2021. There is a good possibility that for many who can work remotely, the full academic year for 2020-21 will be managed in this way.

I hope you have found time to enjoy summer and gotten away from work in safe and physically distanced ways, or if not yet, that you have time planned for a break. We still have some great summer weather ahead!

Finally, I want to provide some additional encouragement for everyone as we continue to navigate challenging times. Be sure to access university and college wellness services and personnel for support, if needed. Whether you are among those beginning to return to campus and other work and learning spaces, or if you continue to work remotely, stay safe and be diligent in your physical distancing measures.

A look back

Thinking back to early March of this year is more of a strain on the memory than it should be. So very much has happened in such a short time. It’s hard to believe that only four months ago, we were all heading into our normal places of work and study, visiting stores, restaurants, bars, all kinds of public places, often multiple times daily, without giving it a second thought.

The reality behind these changes remains of primary importance, of course. Many people became critically ill with COVID-19, and globally, the number who have died from it is staggering. The circumstances are grave, indeed. This blog is by no means a suggestion that we are out of the woods, or even on our way out of the woods. That is still some time away, and requires some pretty significant achievements in science, as well as continued changes in human behavior.

In this blog, though, I do want to recap some of the truly significant efforts and transitions that have been made at the CoM. Most of us don’t like change, and we tend to push back when it’s forced on us. So all that has happened in a few short months really is amazing, and in no small part is due to the incredible responsiveness of everyone on our team (and beyond!) in making some big, previously unimagined adjustments in your work, studies and lives. These times we’ve been through together have been tough, but we have pulled together and supported one another, and that’s made it easier than it might have been.

Toward the middle of March, and inside of less than a week, we went from communicating some early changes to campus activities at USask and our college, to sending almost everyone home. Our team planned and supported how we would shift what we could for our learners to remote access. Our Year 3 and 4 clerkship students were barred from clinical learning. While our Year 4 clerks were minimally impacted given the timing, our Year 3 clerks suddenly found themselves removed from almost all their learning. And what they did next was impressive and inspiring. They volunteered in multiple ways to help patients and healthcare workers, to do their part as best they could, outside of clinical medicine. They helped gather PPE, they played a big role in contact tracing, they supported isolated senior citizens, they fundraised for La Loche and other northern communities.

In postgrad, our residents continued to play their important dual role as learners and workers in our health system, in alignment with their level of training. Many volunteered to transition to other areas of care to support the greatest needs. Our learners received amazing assistance and support from our UGME and PGME teams, and many others.

Our medical faculty were also on the frontlines of care, ensuring that they, their teams and facilities were prepared. Researchers stepped away from important projects, many of which were critical to progress in tenure and their career path aspirations. Many members of faculty, and all of our staff suddenly found themselves working from home while trying to stay connected with one another and, remotely, keeping the college moving forward in our mission and our own important roles related to the pandemic.

Beyond all that, our team was part of many other initiatives: our faculty provided public health and medical expertise to support pandemic decision making; education and information was provided to the health system and beyond by our Continuing Medical Education Division; a new program of online support for people with Multiple Sclerosis, Parkinson’s disease and spinal column injuries was offered; Dr. Hassan Masri provided weekly Facebook videos answering COVID-19 frequently asked questions; Dr. Carrie Bourassa was named Indigenous health lead for Canada’s national COVID-19 Immunity Task Force; Dr. Malcolm King assisted with improved mask design for pre-symptomatic COVID-19 patients; and Drs. Joyce Wilson, Kerry Lavender and Cory Neudorf received funding through the CIHR’s rapid response program for COVID-19.

Our research and graduate studies teams worked to support researchers and graduate students through changes and difficulties. We worked together to create an online spring 2020 graduation celebration that we hope filled some of the gap of our usual convocation and banquet celebrations. We found additional virtual ways to support and participate in PRIDE week.

These truly are among the most unusual times most of us have experienced. We have learned important lessons about what we can do when pressed, as well as things we could and should have been doing all along. Our return to a “new normal” needs to be thoughtful and we do need to embrace some permanent change for the better.

As we start a new term, we have gained valuable insights and experience that will guide our continuing efforts to lead improvements in the health and well-being of the people of Saskatchewan and the world.

COVID-19 research successes, and return to research

Exciting news was announced Thursday this week that three of our CoM researchers and their teams have received funding for work on COVID-19 from the Canadian Institutes of Health Research. Congratulations to Dr. Joyce Wilson, Dr. Kerry Lavender and Dr. Cory Neudorf on their successful applications!

Each is leading, respectively, projects that will: investigate the re-purposing of currently approved drugs to treat COVID-19 patients; rapidly evaluate some highly promising therapeutics against COVID-19; and help prepare for future outbreaks by gathering information on the best interventions public health officers have developed across the country. This last project, led by Dr. Neudorf, is also being funded by the Saskatchewan Health Research Foundation.

You can see the full announcement with more information about each project on our website.

Our Office of the Vice-Dean Research (OVDR) at the CoM has provided support to our researchers, with a total of $120,000 in rapid response funds—half from the OVDR and half from the CoM’s Respiratory Research Centre—to catalyze small-scale, time-sensitive research projects focused on contributing to the response to the COVID-19 pandemic. Congratulations to the recipients of this funding, who are listed on the OVDR website.

We are also working closely with the university on steps to bring some research activities and researchers back to campus. There have certainly been a large number of requests from researchers to return. We continue a very robust review process to ensure we consider applications carefully to maintain the safety of all our people accessing campus facilities.

I know many of our researchers are feeling significant urgency to return to campus. In my role on the university’s Pandemic Response and Recovery Team (PRT), I have been part of work to review these requests against provincial requirements; the return-to-research framework has been developed by the university alongside the Saskatchewan Re-Open plan, of course.

Those who can work remotely will continue to do so. The university needs your co-operation in this regard, so that limited resources can be best used to support necessary and critical on-campus research and teaching and learning work.

More information from the university can be found at:

 

What COVID has taught us about public health capacity

Guest blog by Dr. Cory Neudorf

Dr. Neudorf is a professor in the Department of Community Health and Epidemiology at the USask College of Medicine, and a former chief medical health officer for Saskatoon

The first half of 2020 has proven to be one of huge challenge for the health system and society at large. However, it may yet prove to be a year of huge opportunity born out of tragedy and resiliency. As I write this, COVID-19 has stretched health system capacity in many jurisdictions. Interventions to slow the virus have disrupted the economy, while disproportionately impacting the most vulnerable in society and those working in health care and other sectors deemed essential.

Global pandemics have been overcome in the past, but both the scale of COVID’s impact and the response to date have been unprecedented in most peoples’ lifetimes. However, part of the health system was established and specifically trained to do outbreak prevention and management in the wake of pandemics of cholera and influenza in past centuries. The public health system was expanded and entrusted with learning what causes these outbreaks. Public health was funded to train and hire the staff to deal with outbreaks, and given legislative authority to act in the best interests of public safety, well-being and security through broad measures such as quarantine, mass testing, immunization and contact tracing and prevention. In short, public health is here to ensure we are not left vulnerable through delays in decision making in the critical early stages of a pandemic.

Between large outbreaks, these same approaches are used to manage smaller-scale outbreaks and prevent more common communicable diseases, which together improves population health. In the past 100 years, a legacy of improvements  through public health have followed, including routine childhood immunization, workplace safety laws, health inspection of our food, water, air and soil, family planning, and efforts to improve healthy behaviours and the social determinants of health (see History of Public Health – 12 Great Achievements).

One improvement was the creation of pandemic plans at all levels of government, with the mandate to update them continuously as they are tested over time. These reviews resulted in recommendations to invest in stockpiles of personal protective equipment (PPE), ongoing training of staff in the appropriate use of these supplies, and improvements to institutional infection prevention, control processes and infrastructure. As well, strategic improvements have included strengthening public health and primary care systems with adequate surge capacity, and making the pandemic response lead role of the medical health officer clear through legislation.

However, with pressures mounting to cut taxes and shrink budgets, public health and other community investments in prevention may be at risk. Ironically, neglect in funding prevention and the determinants of health can in turn add to the pressures on the acute care system and the need to respond to other health and social downstream effects. Recommendations to re-invest in public health and other evidence-informed upstream health and social programs have been strong and consistent in the wake of smaller crises like water-born outbreaks in Walkerton and North Battleford, SARS (2002/3) and H1N1 (2009/10), and have resulted in small gains in some cases. However, the most recent rounds of budget cuts and re-organization across the country have reversed these gains in many provinces, leaving us vulnerable once again. (See The Weakening of Public Health)

The net effect is Canada has experienced mixed results in our response to the COVID crisis so far. While some residual legacy products of past crises have stood us well, cutbacks and re-organizations have had unintended negative consequences on our ability to be as prepared as we may have hoped in parts of the country. The Public Health Agency of Canada and the Chief Public Health Officer position created in the wake of SARS have certainly helped us respond to COVID nationally. Investments in Saskatchewan in better information systems for communicable disease surveillance and more inspections and immunizations have been helpful.

Thanks to a good initial response to public health measures, the first wave of COVID-19 has been blunted, giving the system time to prepare for a possible second wave or future stressors. Now is the time to prioritize investment in a strong and unified public health system. In the near future, public health must plan for heightened surveillance for signs of setbacks as we gradually loosen early restrictions, and respond with aggressive testing and contact tracing to contain new clusters and outbreaks. Later, a mass immunization program may be needed on the heels of the seasonal flu immunization campaign, with the spectre of a possible second wave of COVID.

Meanwhile, other essential public health services cannot be put on hold indefinitely, as this leaves us vulnerable to other outbreaks caused by low routine immunization levels, an overburdened outbreak control team, or delayed health inspections. Other gains in health promotion and social determinants of health need to continue. Public health and community partners need to also respond to the unintended consequences of the pandemic, including rising overdoses, increases in family violence and homelessness, setbacks in healthy living strategies, and health inequalities.

Now is the time to invest in prevention and surge capacity. We have been given the gift of time. Let’s not waste it.

Standing together against racism

My May 8 blog was about how the pandemic was hitting people in minority, under-served and disadvantaged groups harder than others, supported by research conducted by members of our own team here at the CoM. The pandemic was very much top-of-mind in that blog, as it has been for nearly three months.

In the past week, racism and its dire impact on the well-being of so many is the top story of our news outlets and top-of-mind for me, as it should be.

I want our Black learners and colleagues to know that their dean, their leaders, their colleagues, and many, many others, recognize the heavy toll in sadness, anger and despair of the way George Floyd died. For our Indigenous learners and colleagues, this is an all-too-familiar and heartbreaking situation.

I know that I do not have all the answers and that we need to do more as a college to eliminate racism from our workplace. But in this moment, I hope it helps in some small way to know that your College of Medicine stands with you.

Plan time off this summer

With warmer days upon us and outdoor activities starting to add a boost to our moods and general wellness, I want to use this blog to remind everyone to plan for some safe, physically distanced downtime for yourself in the coming months. We all need vacations, even if these are staycations this year. (On the plus side, coming from the Maritimes, I highly recommend Saskatchewan in the summer!)

For some, days have been extra-long, as we strive to maintain the many organizational needs supporting education, research and clinical service during COVID-19. This type of schedule is not sustainable, as I’ve experienced firsthand. I realized recently that I was exhausted and needed to take some time away. I made the Victoria Day weekend into a four-day mini-vacation of sorts, complete with many hours of outdoor gardening. This was a significant construction project resulting in raised garden beds. The construction was fun—moving four yards of topsoil less so! But now, between online meetings, I can go outside and check on what seeds have germinated. In the last two days, Swiss chard and beets have started.

Other ways I’m enjoying downtime include doing more cooking for Jane and Marie on the weekends. While I have no races to train for, I continue to enjoy my running. And I frequently watch my grandchildren on FaceTime.

We’ve all experienced a high degree of change in how we work, whether working remotely or due to changes in healthcare delivery. There has been stress and change in other ways, including work slowing down or transitioning to a different focus. These realities understandably come with stress and uncertainty. Add to that the changes in our communities and economy, with closures and new requirements for simple things like getting groceries, and this year taking breaks that help us with stress management and escape are especially important.

I encourage our administrative staff and faculty to get away, whether by actually going away from home if you can do so safely, or by ensuring that you find ways to make home purely a place of relaxation for periods of time. Whether this is in the form of some extra, shorter breaks from work, or by stepping away entirely for a few weeks of vacation, we all need this balance.

I encourage everyone to plan for and commit to vacation and breaks from work, and ask supervisors to support their teams in planning for this. It’s all too easy to let the demands of work take over, but we really can’t be at our best when we allow this to happen. We are doing right by our employer, colleagues, families and ourselves when we effectively balance work with time off.

So, another beautiful, sunshine-filled Saskatchewan summer lies ahead. We have had a tough spring and we all deserve some peace and relaxation. For myself this summer, I plan more landscaping projects, including my hobby from back in New Brunswick of growing roses. (Wish me luck!) As well, I am buying new golf clubs and hope to golf more.

What are you doing this summer? I’d love to hear about your plans or ideas for time away from work!

 

The vital role of our residents

As frontline caregivers, our residents are essential members of the healthcare workforce as well as learners. This dual role means they were significantly and directly impacted by COVID-19.

Our residents have risen impressively to the challenge. While managing the impact of the pandemic on their own learning, many residents volunteered for additional work in high-risk situations, including the intensive care units and teaching our undergraduate medical students. While some of the residents had to self-isolate, others pitched in to address the gaps in clinical coverage.

Our Postgraduate Medical Education (PGME) office, led by Dr. Anurag Saxena, has also done excellent work in supporting our residents and the health system, and navigating through these troubled waters. The PGME office quickly developed the plans and processes to ensure that residents could continue to support patient care and gain learning experiences. I’ve mentioned a number of times, but will say it again, our college is highly committed to training and graduating physicians for our province. The PGME team is doing its critical part very effectively in this important work.

Our PGME team has been quick to respond and strived to stay a step ahead, despite uncertainties. Focused on mitigating this pandemic’s adverse impact, our residents have been supported in many ways. This includes, voluntary exemption from clinical duties for high-risk residents, provisions for carrying over vacations, additional funding and resources for counselling and well-being initiatives, and support during on-call duties. Residents have access to additional funding and resources for COVID-19 and patient-oriented research. Our program directors are admirably leading individual residency programs to adapt to the continuing uncertainty and ambiguity, and providing alternate learning experiences to ensure timely completion of residency.

Our residents have worked through disruptions in training with both redeployment and delayed licensing, impacting their plans and careers. I am sure the tone of support and teamwork set by Anurag and PGME, which ensured that residents had input into decisions impacting them, played a role in our residents expressing appreciation for the support they’ve experienced. The Resident Doctors of Saskatchewan (RDoS) and PGME (and the CoM) are aligned and work together to navigate this crisis. We even heard from RDoS that our province is the best place to be a resident!

The integrated teams in our university and in the Saskatchewan Health Authority (SHA) have done an amazing job navigating the additional work and planning required to support transitions related to redeployment and licensing for those who were completing their training this year. All parties involved were doing this while, of course, also managing the added pressures and stress of the pandemic.

The system-wide work to support residents has included our clinical department provincial heads (who work for both the CoM and SHA), area leads from SHA, and residency program directors and program administrative assistants who work directly with residents “on the ground.” Our college’s administrative team leaders have been integral in supporting transitions to virtual learning, with agile responses to financial and human resource considerations.

These leaders are working cooperatively with many of our external partners including SHA, the SMA, College of Physicians and Surgeons of Saskatchewan (CPSS), other PGME offices in the country under the auspices of the AFMC and the national bodies (the Royal College of Physicians and Surgeons of Canada, the College of Family Physicians Canada, the Medical Council of Canada, and Federation of Medical Regulatory Authorities of Canada) on system issues around admissions, national certification examinations, licensing, and planned launch of Competence By Design. Dr. Kent Stobart, vice-dean education, leads in an exemplary fashion within and across organizational boundaries and creates conditions for the success of our PGME program. It has been a true team effort underlined by effective collaboration and impressive leadership.

Great work is being done to ensure continued support for resident wellness, with resources available from our college and university, SHA and RDoS. I share some details of these here:

Finally, kudos to our residents and all involved in supporting them in their important roles as learners and medical doctors!

Return to clerkship

Our medical doctor Year 3 students return to clerkship on May 25, a date we arrived at working together with the Saskatchewan Health Authority.

That is coming up very quickly and—just as with our shift to learning remotely and stepping away from undergraduate clinical rotations in March—the efforts to coordinate and support this transition again show the dedication and stellar capabilities of our team. Thank you to all those students, staff, faculty and academic leaders, as well as our partners in the health system, who are working to make this happen!

Before we had a date, we had two working groups, one composed of learners, the other of staff and academic leaders, develop proposals for what this return could look like. Their work was exceptional, and positioned us well for the work that’s now been done by our clerkship committee on a clinical rotation plan that will enable our current Year 3 students to complete years 3 and 4 of their degrees for a June 2021 graduation and July 1, 2021, residency start date.

For our clerks and those working in the health system, as you know, much has been done in Saskatchewan’s health system already to address safety in the delivery of care in light of COVID-19, and our college will also be working with our learners, the health authority and other health system partners to align with safety measures for a safe learning environment and an excellent clinical learning experience. As with all areas of life right now, the return to clerkship is not a “return to normal,” but a return to the new normal since the pandemic became part of our daily reality.

As well, our undergraduate and student affairs offices will be working closely with our clerkship students to support their return and help address individual circumstances.

One of our college’s biggest commitments to our learners and our province is this continuous progression of learners through our undergraduate and postgraduate medical doctor programs every year. Keeping these physicians of the future moving through the ranks of undergraduate students, then residents, and ultimately licensed physicians, ensures we can support patient care and the health system today and tomorrow. It is certainly no less important in a COVID-19 world; I think most would agree that it is more important.

With that in mind, I can’t stress enough the need for our medical faculty around the province to be involved as teachers. We need you to take learners into your practices and clinics. Our students today are your physician colleagues of the future.

Finally, I just want to reiterate how impressed I am by our students, staff, academic leaders and faculty in these extraordinary and difficult times. I am thankful for your diligence and responsiveness, and incredibly proud of the resilience and excellence of our team here at the CoM.

 

Pandemic emphasizes equity, diversity and inclusion issues

We are increasingly seeing COVID-19 hitting racialized, socio-economically challenged people and communities harder than other population groups. We are witnessing this in reports from the United States, with the heavier impact of the virus in black communities, and in an article in the New York Times yesterday raising concerns about this disparity within Latino populations, and here in our own province among Indigenous and northern communities.

COVID-19 underlines more than ever why we must face and challenge inequities in our college and beyond. At the College of Medicine, Research Equity & Diversity Specialist Erin Prosser-Loose and researcher Catherine Trask have started a study on how COVID-19 is impacting those already facing challenges related to equity and diversity. They have collected early data through a survey of our broader USask community, with plans to expand the scope to include national data in the coming weeks.

Erin is leading the study and recently walked our dean’s executive team through early findings.

The data showcases both positive and negative experiences. On the positive side, people have indicated they’ve felt well-supported with regard to information technology needs, and that mental health supports have been well-communicated. Teams are making excellent efforts among themselves to support one another, including through social connections like virtual coffee breaks.

Race-related issues included that some have found working from home has reduced their exposure to racism. While this was expressed as a positive outcome due to COVID-19 adjustments, it points to change we know is needed in our work environment. Also, racialized people expressed being disadvantaged in COVID-19-related changes impacting employment contracts and research opportunities. Some identified having witnessed racism against Asian people.

A gender-related issue identified by many was that primary caregivers, mostly women, are experiencing greater pressure managing childcare, homeschooling and work productivity.

A variety of work, career and financial impacts were brought forward. Pre-tenure faculty are concerned about research progress. It was expressed that tuition for online learning shouldn’t be as high as for face-to-face learning. International students are uncertain about their degree progress and are facing financial hardships. Rural and low-income students are disadvantaged due to internet access issues.

Generally, it was expressed that EDI and Indigenization are being sidelined because of COVID-19, with more conventional issues getting priority. Given how I opened this blog, this is clearly the opposite of what is needed now (and at all times).

Survey participants indicated that the causes of inequities being experienced were based most on power differentials, followed by race, then gender. Participants suggested solutions, including denouncing racism, acknowledging primary caregivers, placing health and wellness ahead of productivity, and extending promotion timeframes. From my own perspective, in particular we do need to denounce racism and continue work towards eliminating it; we must think about how we support and acknowledge primary caregivers, most often women; and our leadership team needs to further explore as a college how we can address issues highlighted by this survey.

Again, I do want to reiterate that information I’m sharing is preliminary. The survey is ongoing and different issues are likely to come up as the situation with the pandemic continues to change.

For our staff, students and faculty (and anyone at USask), if you haven’t already, please take the survey.

Some other information related to this blog topic:

 

Mental health during COVID-19

As the changes we are all experiencing with COVID-19 have now stretched into weeks, stress and anxiety are becoming an increasing challenge for some. Coping with staying at home, managing work and family together in that setting, and the many other restrictions associated with physical distancing are the reality for many. For others on our CoM team, going to work in our hospitals and medical clinics comes with a different set of challenges and causes for stress and anxiety.

This week, the university announced its workforce strategy due to COVID-19 and our college has begun working with supervisors and administrative employees on next steps. This is a stressful time and I remind you that university-supported services including the Employee and Family Assistance Program are available to all employees.

In light of all this, mental health is top of mind right now for many. I want to share some thoughts and resources (see end of this blog) that I hope you find helpful. Of course, I encourage you to focus on the things most useful to you in staying well and welcome you sharing those here, if you would like. Monitoring your moods, thoughts and feelings is especially important, and help is available should you need it through university and college resources, and through our health system.

In many basic day-to-day ways, our mental health is supported by work teams and colleagues maintaining contact and supporting one another virtually. Making time during video meetings for some lighter conversation and humour is helping with social connections and friendships. It certainly helps to see one another, laugh together, and share anecdotes from our lives. As one example, our dean’s office team shares information, humour, pet pictures, grandchildren pictures (I may have posted a few!), and messages of encouragement and support in our MS Teams group every day. This has been a valuable means of keeping us together as a team, along with virtual monthly meetings.

Some teams are having quick daily remote huddles, and colleagues and friends are including online coffee breaks in their schedules to ensure opportunities for the social connections we all value in the workplace. We are reminding one another to get outside for breaks, fresh air and sunshine; the weather has finally co-operated these last few weeks! Making time for exercise and relaxation is a big help in staying upbeat, and mentally and physically well.

Beyond that, at the individual level, more than ever before, our rule of thumb needs to be when we think of someone we know, we call or better yet, video call, to say hi and see how that person is doing. We can all play a role in reaching out to anyone we notice seems down or not themselves. Some of our team members are more isolated than others, and we need to keep this in mind and reach out and include one another in virtual group activities, meetings and through direct connections.

I hope everyone is benefiting from and extending support to colleagues, family and friends. I also share a variety of college, university and other resources here:

As always, I welcome your feedback, including ways you are finding to stay well.