Video explores rural healthcare in Canada

Earlier this year, I shared with you my experience attending a national summit on rural healthcare in Ottawa. We had the opportunity at that time to see an excellent video about the opportunities and challenges of rural healthcare in Canada. I’m sure you will appreciate, as I do, the great Saskatchewan presence in the video! It’s available online, and my purpose with this short blog is to share it with you.

Please take a moment to watch this excellent video, Rural health in Canada—it’s just 11 minutes long, in both English and French. For further reference, I share with you my blog, Improving rural healthcare, from this past February.

As always, I welcome your feedback.

 

Great Week for Research

Last week was a wonderful week for research at the CoM, with two major celebrations in our D-Wing atrium.

Kudos to Dr. Marek Radomski and our research office for organizing a celebration on Monday for all of the recipients of Tri-Council (Canadian Institutes of Health Research (CIHR), Natural Sciences and Engineering Research Council (NSERC), Social Sciences and Humanities Research Council) awards.

But the real kudos go to our successful researchers, listed below. It was truly inspiring listening to each describe his or her research with such enthusiasm. And the diversity was quite remarkable—from biomedical discovery work at the bench to community-engaged research in northern Indigenous communities.

CIHR Project Grant
Dr. John Howland
Dr. Jim Xiang
CIHR Catalyst Grant
Dr. David Cooper
Dr. Vivian Ramsden
CIHR Planning and Dissemination Grant
Dr. Sylvia Abonyi
Dr. Caroline Tait
CIHR Training Grant: Indigenous Mentorship Network Program, Saskatchewan
Dr. Caroline Tait
NSERC Discovery Grant
Dr. Dean Chapman
Dr. Troy Harkness
Dr. Oleg Dmitriev
Dr. Erique Lukong
Dr. Scott Napper
Dr. Scot Stone
Dr. Peter Howard
Dr. Kerri Kobryn
Dr. Maruti Uppalapati

Great science is required for all Tri-Council awards. However, CIHR grants are exceptionally competitive, and seem to be more so every year. The two CIHR grants by Dr. John Howland and Dr. Jim Xiang were in a national competition that saw only 16.5 per cent of applications succeed. In addition, Dr. Deborah Anderson and Dr. Franco Vizeacoumar did well with their CIHR applications and the CoM was able to provide them with bridge funding this year. Our CIHR success is great evidence of progress in research at the CoM.

One thing I noted was the number of researchers who highlighted that their CoMGRAD grant or their Saskatchewan Health Research Foundation (SHRF) grant was instrumental in getting preliminary data or making other progress that led to their national award. It has been part of my elevator speech with our partners and funders that great people (researchers, grad students, post-doctoral fellows), great facilities and local funding are all essential to achieve success in Tri-Council competitions and with other national granting agencies.

On Tuesday, the CoM hosted our partners, SHRF and Heart & Stroke (Canada and Saskatchewan), as we announced and celebrated the renewal of Dr. Mike Kelly’s Saskatchewan Research Chair in Clinical Stroke Research for another five years. Particularly inspiring was the description provided by recovered stroke victim Don Bickerdike and his wife of the great care they received from the entire stroke team in our Saskatoon Health Region.

Mike—with an MD, neurosurgical training and a PhD—is a true bench-to-bedside researcher, who is from our college and university, and is changing care in Saskatchewan. In fact, his stroke research relies heavily on the synchrotron, taking advantage of key local resources. The CoM is very pleased to provide $100,000 per year over five years towards a total award of $1.5 million. Given the impact of the first five years of this chair, it was clear our partners at Heart & Stroke and SHRF were equally enthusiastic about Dr. Kelly and the great work he and his team are doing in stroke research and care.

Congratulations to our successful researchers. I know their success will be an inspiration to all, and we can look forward together to next year and seeing even more applications and more success!

As always I look forward to your feedback.

Advancing social accountability at our college

Guest blog from the Division of Social Accountability

Social accountability is not a new concept here at the College of Medicine. It continues to be a principle and lens that guides our actions. It permeates discourse in medical schools both nationally and internationally. Much has changed in the past year in terms of social accountability within our college.

Every student, every faculty and staff can support social accountability in the college. We are doing a great deal already.  Among our national and international colleagues working in this area, our college is looked upon as a leader in the area of social accountability, and we aspire to continue to measure up to our reputation. At the same time, we recognize that there is still much more to do. The division continues to collaborate and support college-wide strategies for building a culture of engagement and social accountability, working in partnership with our internal and external stakeholders towards integrating social accountability into the four areas of CARE. An overview of activities supported by the Social Accountability Committee was shared at the college’s May 2017 Faculty Council meeting.

Much work has been put into assisting the college through the accreditation process, particularly in light of the new CACMS accreditation element 1.1.1. Social Accountability. We have been working closely with the accreditation team to identify sources of information and outline processes for 1.1.1. (as well as other accreditation elements with social accountability components) and began the process of drafting measures of social accountability to capture progress to date and long-term impact. We look forward to sharing progress on those measures at the upcoming September 2017 Faculty Council meeting.

This past year, the team has been working closely with various internal units in the College of Medicine to advance social accountability. We were excited to see the college approve implementation of a Diversity and Social Accountability Admissions Program, put forward by the Admissions Committee after consultation with the division and the Social Accountability Committee. We received valuable feedback at the pilot of the Social Accountability Lens at the December Curriculum Retreat and continue to work with the UGME Curriculum Committee and its subcommittees to build social accountability into the foundation of the curriculum. We drafted an annual communique identifying priority health needs rooted in social issues, which was distributed to course chairs for integration into curriculum planned. A masters of public health practicum research project that began last summer is continuing into phase 2 this year with an appreciative inquiry of how Canadian medical schools are putting social accountability into action. The division continues to engage internally to expand capacity and understanding of social accountability in theory and in practice, co-presenting at grand rounds with various departments. Further, the division was fully engaged on many of the working groups and full-day sessions for CoM strategic planning and was enthused to hear such a strong emphasis on social accountability from numerous attendees.

Other areas of focus and activity have included global and Indigenous health opportunities in partnership with the Global Health Committee and the Indigenous Health Committee. We continue to manage the Making the Links global health certificate program with fifteen positions for first-year medical students each year. The two-year program was recently expanded to support students interested in an Indigenous Health Stream. With the help of the college’s Aboriginal Admissions Coordinator, Val Arnault-Pelletier, we expanded our community partnerships last year to include Kawacatoose First Nation in southeast Saskatchewan and rural and remote Indigenous communities in Townsville, Australia. We also partnered with various internal and external committees to put on numerous global health events this year, including our fifth annual student-led Global Health Conference: Sustain the Gains, a documentary screening of On the Bride’s Side, and community and on-campus conversations with speakers Dr. Ted Schreker and Dr. Eric Lachance. The Global Health Travel Awards Subcommittee updated the award program this year to better align with learner, faculty and college needs and now runs two award cycles per year. We have also been working to identify opportunities for mutually beneficial community-university partnerships and collaborations (e.g., SPRP/Health Region Poverty Reduction Strategy Consultation; YXE Connects).

On the people side of the division, in December, we welcomed back Carlyn Seguin, who had previously been away on maternity leave. We said goodbye to division head, Dr. Ryan Meili, and welcomed Dr. Eddie Rooke as acting director.  Erin Wolfson, Lisa Yeo and Joanna Winichuk all celebrated their one-year anniversaries with the division.

We continue to build a greater understanding of the ever-changing needs of the college and the larger community it serves. Reflecting our commitment to being responsive, relevant and accountable to our communities locally and globally, we expanded the roles within the Division of Social Accountability. This will allow the college to build on its existing strengths, programs and commitment to meaningful engagement, locally and globally. Some of the DSA staff roles and responsibilities have changed to reflect this commitment, and we share our staff information here to ensure you can connect effectively with us (contact information):

  • Carlyn Seguin continues to lead the management of the Making the Links – Certificate in Global Health (MTL-CGH) Program amongst various global health activities, in the position of Global Health Manager.
  • Lisa Yeo continues to provide strategic leadership, planning and project support in the Social Accountability Strategist position, serving as a resource to many areas of the college with a keen focus on measurement and evaluation.
  • Erin Wolfson has recently moved into the role of Community Engagement Specialist, expanding the college’s capacity and commitment to ethical collaboration and authentic engagement with communities. This involves enhancing and building community-university relationships and interdisciplinary collaborations that build health equity and respond to priority health concerns of partners and communities.
  • Joanna Winichuk, as Clerical Assistant, continues to provide invaluable administrative support to the team and to the MTL-CGH program, with an expanded focus on communications in the upcoming year.
  • Eddie Rooke has taken on the role of Acting Director, promoting and expanding capacity in social accountability throughout the college, teaching undergraduate and postgraduate students, and liaising with internal and external partners to advance the vision of health equity.

Our division was established in 2011 to promote and support the college’s social accountability promise – a promise to direct its Clinical, Advocacy, Research and Education (CARE Model) activities towards the priority health needs of the communities we serve. We see this promise reflected in the 2017-2022 College of Medicine Strategic Plan and mission statement of our college. It’s a promise to address community health needs, but it’s also much more than that.

There is still much more to be done. With a focus on accreditation in preparation for our college’s full accreditation visit in the fall, the team continues to respond to incoming requests. We continue to engage with our partners internationally and some of the team recently attended the Social Accountability World Summit (check out the social accountability blog page in the coming weeks for learnings and invaluable resources from the summit).

We are excited for all that is to come and look forward to continuing to support the CoM in meeting the needs of the people of Saskatchewan and achieving health equity. We thank Dr. Ryan Meili, our former division head, who helped advance social accountability here for more than 10 years.

For more on the division, visit our webpage!

Medical education at the CoM

I attended events last week here at the College of Medicine that were great examples of medical education expertise and scholarship and, for me, inspire great confidence in our college.

On Thursday night, I attended Surgical Grand Rounds. Drs. Cole Beavis of the Saskatoon Health Region and Gordon Kaban of the Regina Qu’Appelle Health Region combined to do a great presentation at Saskatoon City Hospital on the use of simulation in surgical education. They covered the pedagogy and tools of effective simulation, including a discussion on debriefing. They provided many great examples of hi-tech simulation tools and more frugal approaches, including a trip to Rona to construct a simulation tool for emergency cricothyrotomy (emergency airway puncture).

In the Health Sciences Building, we have secured space for a surgical simulation facility and our advancement team is working with Drs. Beavis and Ivar Mendez (unified head of our Department of Surgery) to raise funds for simulation equipment. RQHR has had the advantage of the Dilawri Simulation Center since 2012, due to a generous donation from the Dilawri Foundation.

On Friday, the Department of Medicine had its Resident Research Days. I have had a chance to review the abstracts for the posters and oral presentations. They were excellent and I am told the quantity and quality have improved dramatically this year. Congratulations to the residency program director, Dr. Karen LaFramboise and the assistant program director for research for the Internal Medicine Residency Program, Dr. Terra Arnason. The Department of Medicine had its Research Day for faculty earlier in the week, on Tuesday.

The week was capped off for the Department of Medicine with its Research Days Banquet & Faculty Awards at Marquis Hall on Friday. There was a great turnout of faculty and residents on a beautiful evening on our campus. Many awards for both faculty and residents were handed out. I would like to highlight four awards Dr. Sam Haddad, the unified head of medicine, has instituted, and their recipients from the Department of Medicine:

  • Researcher of the Year – Dr. John Gordon, Dr. Debra Morgan
  • Teacher of the Year – Dr. Anne Paus Jenssen
  • Clinician of the Year – Dr. Hassan Masri
  • Administrator of the Year – Dr. Erik Paus Jenssen

The evening was capped off as all of the finishing postgraduate learners in year 3 were introduced along with their next program and destination that will see them complete their postgraduate education. Congratulations also to these residents and the department for its huge success in the Canadian Resident Matching Service!

Finally, this past Friday was our first annual Medical Education Research and Scholarship Day. This initiative was led by our Director of Faculty Development, Dr. Cathy Maclean, who with her usual energy, enthusiasm and organization, did a fabulous job. We had over 50 participants, as well as guest speaker Dr. Doug Myhre from University of Calgary, 16 posters, 45 abstracts, three oral presentations and various workshops. It was a great day and a great example of our strategic priority to improve medical education scholarship and research here at the College of Medicine.

After those two days of seeing such commitment to the College of Medicine and so many dedicated researchers and educators doing great work, I felt I really deserved a great weekend’s rest. I was bacheloring it this weekend as my wife Jane and our dog Murphy are at the Canadian Association of Emergency Physician’s meeting in Whistler where Murphy is sitting by a research poster that documents the impact of a therapy dog in the Emergency Room! So my “rest” was cleaning and painting my garage!! I hope you all had a better weekend than that. But if you want to see a really neat garage, come by anytime.

As always I welcome your feedback.

 

 

Two-Eyed Seeing in Medicine

I recently attended the Canadian Conference on Medical Education (CCME) in Winnipeg. This meeting is an increasingly significant event for collegial interaction with peers across the country, faculty development and dissemination of medical education scholarship. It’s a collaboration of the Association of Faculties of Medicine of Canada (AFMC), the College of Family Physicians Canada, the Royal College of Physicians and Surgeons of Canada, the Medical Council of Canada and the Canadian Association of Medical Educators. The CoM was well represented throughout the meeting (which for me also entails two days of AFMC Board meetings—part of the price one pays for these jobs!).

On the other hand, a highlight was dinner with eight members of our Student Medical Society of Saskatchewan, who were in Winnipeg for meetings with the Canadian Federation of Medical Students. I congratulate these students for their leadership on the national scene of undergraduate medical education.

The opening plenary session at CCME is always the Wendell J. MacLeod Memorial Lecture. MacLeod was our college’s first dean and the first president of the precursor to the AFMC. This year we heard an extremely thoughtful and moving address on the history of residential schools and the work of the Truth and Reconciliation Commission (TRC) by Ry Moran, Director of the National Centre for Truth and Reconciliation.

The AFMC devoted a half-day of the board meeting to the AFMC’s and each medical school’s response to the Truth and Reconciliation Commission. We were joined by many faculty members, medical education leaders, partner organizations, learners, and Indigenous faculty, learners and leaders.

While it is clear that we have so much more work to do in addressing the TRC recommendations and serving our Indigenous communities in Saskatchewan, I can also say that the U of S and the CoM are seen as national leaders in this mission. In fact, one of the breakout group questions was about incorporating Indigenous Health in our mission statement, and I was able to share the great work we have accomplished with our very inclusive and collegial strategic planning process in the last year.

I call your attention to the plan on our website, and provide here our new Mission statement:
As a socially accountable organization, we improve health through innovative and interdisciplinary research and education, leadership, community engagement, and the development of culturally competent, skilled clinicians and scientists. Collaborative and mutually beneficial partnerships with Indigenous peoples and communities are central to our mission.

And as one of our seven strategic priorities, we declare on Indigenous Health that we will:
Respond to the Calls to Action in the Truth and Reconciliation Report and work in a mutually beneficial and collaborative manner with the Indigenous peoples of Saskatchewan to define and address the present and emerging health needs in their communities.

As many will know, we now have 73 self-identified Indigenous graduates of our MD program and 19 of those physicians have taken up faculty appointment with our college. Of the 143 UGME students identified in all Canadian medical schools, the U of S and the University of Manitoba account for nearly 50 per cent!

I was both proud and extremely impressed as our alumnus and Metis physician Dr. Alika Lafontaine, MD Class of 2006, provided the keynote address to this very important discussion. Alika was extremely articulate in describing his work on the history of engagement with Indigenous communities and I know we all learned a great deal from him. And more importantly, we understood that we need to both learn and do a lot more for Indigenous communities and Indigenous Health.

In that regard, with members of our Indigenous Health Committee, we will further develop our strategic priority of Indigenous Health at our senior leadership retreat later this month. At a very profound pipe ceremony led by Knowledge Keeper Bob Badger, the search for our Chair in Aboriginal Health was launched earlier this year.

So this meeting confirmed for me the importance of what we are doing on Indigenous Health, but it was really reinforced by the book I am currently reading: Determinants of Indigenous People’s Health in Canada: Beyond the Social. I am learning a lot from the book, written primarily by Indigenous scholars from across Canada, and am particularity intrigued by the concept identified in the chapter titled Two-Eyed Seeing in Medicine.

This concept is elegantly explained in an essay by Murdena Marshall and Albert Marshall, who are described as deeply valued Elders from the Mi’kmaw Nation, and Cheryl Bartlett, a former Tier 1 Canada research chair in integrative science. All three were at Cape Breton University, the leading university in Atlantic Canada in serving Indigenous peoples and the five First Nations in Cape Breton. From that essay:

 “Albert is the person who coined the phrase “Two-Eyed Seeing”/Etuaptmumk as a guiding principle for collaborative work that encourages learning to see from one eye with the strengths of Indigenous knowledge and ways of knowing, and from the other eye with the strengths of Western knowledge and ways of knowing, and learning to use both these eyes together for the benefit of all.”

While recognizing the absolute importance of the social determinants of health, the book explains that the determinants of Indigenous Health go much further, to include connection to the land and geography, language, self-determination, reconciliation and so much more! I highly recommend the book to all.

As we continue on our mission to serve our Indigenous communities in Saskatchewan, I hope I and the CoM learn to see with two eyes. As always, I welcome your feedback and look forward to your thoughts.

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.

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