Research capacity building underway

Guest blog by Marek Radomski, Vice-Dean Research

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I would like to thank the dean for an opportunity to share news from the Office of the Vice-Dean Research (OVDR).

Over the early months of my appointment, the OVDR team has been working on a number of fronts to support the research community in the College of Medicine.

It became clear to me, right from the very beginning, that the funding of our basic and clinical research in the College of Medicine would be a very urgent and challenging task. Recent turmoil around the Canadian Institutes of Health Research (CIHR) application process, low rate of success for the University of Saskatchewan, and the fact that our provincial funding is the lowest in Canada highlights the need to mobilise available resources in our university and college to support our faculty and graduate students in their research endeavours.

What have we accomplished so far to increase funding opportunities for our faculty?

  • We planned and carried out the College of Medicine Research Awards (CoMRAD) grant scheme. The scheme was initiated thanks to the foresight of our dean and the leadership of Steve Milosavljevic, the acting vice-dean research. We funded 28 out of 66 applications to the tune of $693,691. It is important to emphasize that basic and clinical researchers equally benefited from this scheme and 40 per cent of funded applications went to early career researchers.
  • In collaboration with the Office of the Dean of Graduate Studies, we will shortly be announcing the College of Medicine Graduate Awards (CoMGRAD) grant scheme to increase funding opportunities for our existing pool of graduate students.
  • We have engaged with the Saskatchewan Health Research Foundation and are working on a bridge grant scheme to increase the rate of success of College of Medicine researchers in Tri-Council competitions such as CIHR grants.

During introductory meetings with the departments, clusters and individual faculty members, I promised to conduct an external review of the status of research in the College of Medicine. As you may remember, the objective of the external review is to help us reflect on the College of Medicine research Strengths, Weaknesses, Opportunities and Threats (SWOT). I am very happy to report that this promise will very soon become a reality as the review and the site visit will take place next week from October 31 – November 1, 2016.

Our reviewers are all distinguished biomedical academics who work for Canadian and American medical schools. Indeed, Dr. Gail Annich, MD; Dr. Gautam Chaudhuri, MD, PhD; Dr. David Thomas, PhD; Dr. Lorne Tyrrell, MD, PhD; and Dr. John Wallace, PhD, bring a wealth of high personal academic achievement, experience and interdisciplinary expertise, ranging from basic research via clinical research, to successful research and development.

A good academic practice employed in the external review process is to prepare the self-assessment document and make it available to reviewers prior to the site visit. The OVDR team is leading the process of preparing the self-assessment document which includes an analysis of indices of research-relevant output as well as individual SWOT assessments from departments and clusters. I would like to take this opportunity to thank all of you who have been involved to date in the preparation of this very comprehensive document.

The second element of the review is the site visit. We are planning for reviewers to meet with a cross-section of the research community in the College of Medicine and tour our research facilities in the Health Sciences Building and on the U of S campus. At the end of site visit, the reviewers will be asked to brief us on the main findings of the external review and will later submit a formal report with a SWOT analysis and recommendations.

The ultimate goal of the external research review is to consider its findings when designing the 2017‑2022 College of Medicine Strategic Plan. The OVDR team is delighted to contribute to this process.

I feel that the outcome of our external review and the preparation of the 2017-2022 College of Medicine Strategic Plan will be important factors in increasing the research fortunes of our college. Of course, the findings, recommendations and documentation of the external review will be made available to the College of Medicine community and relevant stakeholders.

Advocacy and HIV in Saskatchewan

Andre Picard’s headline in yesterday’s issue of The Globe and Mail states: Saskatchewan should declare HIV-AIDS public health emergency.

The article was precipitated by the courageous call for action by a group of Saskatchewan physicians and CoM faculty members and their coalition of patient and clinician colleagues. These physicians include Dr. Steve Sanche, Dr. Kris Stewart, both infectious disease specialists, and Dr. Ryan Meili, family physician.

Picard writes, “The rate of HIV-AIDS in Saskatchewan, particularly in First Nations communities, is so high that the province should declare a public health state of emergency.”

In fact, the HIV infection rate in Saskatchewan is 13.8/100,000 which is almost double the national rate of 7.8/100,000. Even more troubling is the rate among our Aboriginal population on reserves, where the rate is 64/100,000. And these are all likely underestimates, as, although testing has increased somewhat, many at risk people remain untested.

Furthermore, we are not even coming close to reaching treatment goals as “in Saskatchewan, once again, the HIV-AIDS death rate is 3.1 per 100,000, four times the national average of 0.7 per cent. Most troubling of all may be the fact that, last year, three babies were born HIV-positive in Saskatchewan, even though mother-to-child transmission is entirely preventable.”

Drs. Sanche, Stuart and Meili, in today’s Star Phoenix, call on the province to adopt the UNAIDS 90-90-90 strategy. Star Phoenix reporter Charles Hamilton includes in his story, “The United Nations recommends increased testing so 90 per cent of people with HIV know their status; making sure 90 per cent of those patients receive the proper anti-viral drugs to treat the disease; and ensuring that 90 per cent of those people have “repressed viral loads” so infection doesn’t spread.”

These CoM faculty physicians are not the only ones calling on the province for action. Canada and Saskatchewan were in the spotlight in July at the 21st International Aids Conference in Durban, South Africa. Dr. Stuart Skinner, an infectious disease specialist and CoM faculty member in the Regina Qu’Appelle Health Region (RQHR), advocates for improved HIV testing and care in an earlier article in The Globe and Mail.

Dr. Alex Wong, another Infectious Disease Specialist, researcher and CoM faculty member in the RQHR presented The Developing World in Our Own Backyard: Concentrated HIV Epidemics in High Income Settings in 2015 at the International AIDS Conference on HIV Pathogenesis, Treatment and Prevention in Vancouver. According to Maclean’s Magazine, he sometimes calls this presentation Africa on the Prairies.

What these physicians are saying is incredibly important for the people of Saskatchewan, those at risk for or suffering from HIV-AIDS and our Aboriginal communities, which are disproportionately affected by this horrible disease. They are also being incredible role models for our learners.

CanMEDS, our national medical curriculum framework, was first advanced by the Royal College of Physicians and Surgeons and is increasingly being adopted around the world as the basis for medical curricula.

canmeds-flower2

One of the seven essential roles of physicians is that of health advocate. As stated by the Royal College, “As Health Advocates, physicians contribute their expertise and influence as they work with communities or patient populations to improve health. They work with those they serve to determine and understand needs, speak on behalf of others when required, and support the mobilization of resources to effect change.”

The CoM has had a long history of advocacy, starting with our first dean, Dr. Wendall McLeod, who was a great supporter of Tommy Douglas and the birth of Medicare in Saskatchewan. Our college is replete with current demonstrations of health advocacy: our Global Health Certificate, our Making the Links program, our Department of Continuing Medical Education and our Division of Social Accountability with our refugee health conference this spring, and many more examples. Our students demonstrate the same commitment to advocacy with their student run clinics, SWITCH and SEARCH, and the amazing student led conferences on Global Health and Health Innovation and Public Policy.

Kudos and thanks to all of these physicians for their work in health advocacy and thank you for being such excellent role models for our students and residents. It is moments like this that I know we are a great medical school and an incredibly important asset to Saskatchewan.

As always, I welcome your feedback and thank all for their commitment to the CoM.

 

Great Summer – Busy Fall!

First and foremost I would like to welcome our new medical students and residents. The new academic year is always refreshing, and I have always been especially energized by the excitement and enthusiasm of first-year students and residents. This year, I had an opportunity to speak to our new Aboriginal students as well as the whole class of 2020. All had a wonderful welcome to the college and the Aboriginal students heard from Michif Elder Norman Fleury and First Nations Elder Louise Halfe about connection with their community.

As I have just come back from my 35th medical school reunion, I emphasized to the whole class what a wonderful journey they were on with the classmates around them and the important role they will play as clinicians, leaders and team players in the future Saskatchewan healthcare system. In that regard I was really pleased to see today’s headline in the Star Phoenix: Next decade could see the rise of homegrown Sask doctors and the great interview with Dr. Joanne Siverston, alumnus, Prince Albert physician and SMA Vice-President.

I also reminded the students that the Olympics come around quickly and, despite the hard work in front of them, when the Japan summer Olympics open they will have been residents for a month! And I pointed out that all of us at the College of Medicine and our healthcare partners are here to see them succeed.

I hope you all have had a great summer of rest and renewal. I certainly did. It started with a northern Saskatchewan fishing trip with Dr. Keith Ogle, our vice-dean faculty engagement, which included flying in to his lake on a DeHavilland Beaver (built before I was born) and a fabulous and highly successful introduction to fishing Northern Pike.

The medical school reunion back in the Maritimes was an excellent opportunity to reconnect with some wonderful friends, including a class mate I discovered I could now keep up with who was easily the best runner in our class! Around the reunion, we packed in visits with family and friends, Atlantic salmon fishing on the Miramichi and time at beach-side resorts in PEI and NS. It was a great summer.

Miramichi fishing

And now we embark on an incredibly ambitious and important fall. As you know, much of the work of the last two years has been implementation of The Way Forward, leadership recruitment and faculty restructuring. This fall, we will complete a college-wide strategic planning process. We all know we want a highly successful College of Medicine, but what does that look like? What are our strengths? What are our priorities in education, research and community service? Your engagement is essential, and you will be hearing much more about this project.

You may have received an invitation to our accreditation launch event. A full UGME accreditation visit takes place at the end of October 2017. Like the silent phase of a fundraising campaign, many faculty and staff led by Dr. Athena McConnell (Assistant Dean Quality) and Kevin Siebert (Accreditation Specialist) have already been working very hard. The launch is an opportunity for all of you to get engaged in our accreditation preparation. As you have heard me say many times, accreditation is a team sport. The College of Medicine can only succeed in putting accreditation challenges behind us if all of you are involved. I hope you can come out to one of our launch celebrations on September 12 at our Regina and Saskatoon campuses. We are still working on scheduling an event in Prince Albert.

The team working on restructuring our biomedical science department and developing new undergraduate biomedical science programs based in the CoM will make important progress this fall. Substantial development of our “one faculty” model is underway and will lead to one pathway for appointment and promotion of MD faculty.

Following on last year’s successful College of Medicine and research awards (COMRAD), we will place increasing emphasis on research. In that regard, Dr. Marek Radomski has initiated an external review of our research programs and we will be visited by five internationally renowned medical researchers from October 30 to November 1, 2016. Their review and recommendations will be an important step in the advancement of our research agenda and will inform our strategic plan.

And speaking of research, congratulations to Dr. Deb Morgan on the $2.3 million Foundation Grant from the Canadian Institutes of Health Research that will fund research over seven years to improve dementia care resources for rural healthcare providers. This is very important work; it’s estimated that 47 million people in the world live with dementia.

So when asked, “What is going on at the College of Medicine?” my answer is: accreditation, accreditation, accreditation, strategic planning, biomedical science renewal, one faculty, research, research, and accreditation!! Did I mention accreditation?

Seriously, accreditation is simply superb medical education and research in the context of a great clinical setting. And we will demonstrate that to our peers with the 2017 accreditation visit.

All of the work and plans above are important, as are many other college initiatives (Aboriginal health, social accountability, simulation, Inter-professional Educational Initiatives, and more). I thank you for all of your hard work to date and look forward to your support, advice and engagement as we embark on this ambitious fall agenda.

As always, I invite your feedback.

Working Together on our CoM Strategic Plan

I trust you are having a wonderful summer so far and have had, are having or will soon have some holidays complete with time to rest and rejuvenate. I have just returned to work this week after an amazing break and feel ready once again to take on the incredible opportunities and important challenges of our College of Medicine. I always am excited to see September come around to launch a new academic year and I look forward to all of us coming back together from the summer with renewed energy and fresh perspectives.

The reason this is so important this year is the CoM is embarking immediately—at the end of this month—on a college-wide strategic planning process in which all members of our community have a voice, should you choose to share it. I strongly encourage you to do so. Why? Because everything we have been through in recent years, which has been difficult and at times even painful, has helped set the stage for our college, now, to move forward in the best possible way.

I am looking for a shared commitment to doing this work together. With all of our community’s individual voices coming together to create a pool of knowledge and experience of the CoM, we have our best shot at creating a plan that will reflect the diversity of our work, needs and aspirations at a grassroots level—to ultimately elevate our students’ experience, our teaching excellence, and the reach and impact of our research.

The strategic plan development process will follow a rapid timeline – we plan to have the full college consultation and information gathering process completed between the end of this month and the end of this year. That’s just four months to gather a vast array of detail, input and knowledge from a large group—all of our faculty, staff and students. Accreditation requirements necessitate this timeline, but we will work to engage with you in this timeframe through a range of methods for you to share your perspectives and suggestions: focus groups, online surveys and other discussions and meetings.

Why are we embarking on this planning process now, and on this timeline? We are at the natural point in time, in terms of our planning cycles. The President has initiated a process to renew the vision, mission and values at the U of S and will be embarking on a new 8 year strategic plan. Our 5 year plan that will take us from 2017 to 2022. will fit into that plan. Currently, our School of Physical Therapy is developing its own five-year plan. Starting in 2013 the College did tremendous work creating the strategic vision document, The Way Forward which in many ways was primarily a strategy for restructuring the College of Medicine. We have worked very hard over the last 2 years and most of that plan has been done or is well underway. It is now time to set our aspirations on what the College of Medicine can do to become one of the best medical schools in Canada and a College all of us can be proud

At a high level, the next four months will look like this: during September, two task groups will cover the areas of teaching and learning, research and innovation, as well as separate engagement forums to review and discuss clinical care service and community engagement, governance and partnership, and administration. If you are interested in participating in any of these discussions please let us know. In October and November, these task groups will lead engagement forums for your participation, including visioning and prioritization events, focus groups, and so on. Ultimately, we will arrive at a draft plan early in 2017 that will need to be ratified by the College of Medicine Faculty Council.

The outcome of this work will be a new vision, mission, values and priorities for the CoM. At that stage, there will also be tremendous opportunity (and a healthy dose of encouragement from myself and other leaders across the college) for your involvement in the very important work of implementing our plan and its deliverables. The implementation of our college strategic plan will be decentralized in nature, with broad participation and support an absolute necessity.

We will be sharing information about the planning process through: high level information targeted primarily to external audiences on our website through a CoM Strategic Plan page, more detailed internal information and content to come later, and likely through further blogs, as well as various reminders, dates and news through our internal, weekly E-News.

I’ll close by reiterating how much I hope for your involvement and input in, and support of, the planning process I’ve outlined here. Working together now to shape the next five years in the history of the CoM will be well worth the effort!

As always, I welcome your feedback.

Summer Blog

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

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

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

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

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

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

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

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

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

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

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

Biomedical Sciences Chooses Two-Department Model

As I mentioned in my October 2015 blog, Shaping Biomedical Sciences, when we started this project, a biomedical sciences program managed by the College of Medicine (with options/streams to ensure students, upon graduation, are well prepared to enter health professional programs, pursue research endeavours, or enter the work force in their area of specialized training) is critical for our college. There are so many avenues for Saskatchewan to be a leader in the biomedical sciences, and this is our opportunity to be creative and stretch ourselves.

Nearly a year of hard work, meetings and much discussion culminated recently with a vote by the faculty of the Division of Biomedical Sciences on their governance model going forward. As many of you know, the biomedical faculty voted on whether it would move toward a two-department or school governance structure for the future. The vote was in favour of the two-department model, with nearly 70 per cent making that choice. This provides a clear decision by the faculty for a two-department model, and we now begin the work to make this happen.

Conceptual departments, under working only titles of Department of Cellular and Integrative Biomedical Sciences and Department of Microbial and Molecular Biomedical Sciences to enable discussion and understanding, will enable faculty members an opportunity to self-identify which of the two proposed departments they would be likely to join.

In terms of next steps, the Biomedical Governance and Programs committees will begin to flesh out details of the restructuring and the undergraduate program streams. It goes without saying that we need the continued commitment and involvement of our faculty in this work. A Notice of Motion is expected to go forward to the College of Medicine Faculty Council and when that motion has been debated and approved, the next step would be for it to go forward to University Council for approval.

As we move forward with developing the structure to more effectively support these goals, it’s important to note that our current undergraduate and graduate students will be able to complete their programs, which will continue to be honoured and valid, and we certainly need our faculty and staff to reassure all current students of the value of their existing programs.

I want to extend my appreciation to everyone in the basic science departments for your work and commitment to this process over the past nine months, as you’ve organized and participated in many consultations, discussions and town halls. I look forward to continuing to work with you as we take our Biomedical Sciences program to a new level.

CoM reaches physician engagement milestone

We have reached a significant point in our journey toward a new conceptual model of physician engagement in the CoM’s academic mission. May 31 marked the deadline for those approximately 130 faculty members involved in the transition that we began last August. This transition, as you know, involved a voluntary severance package for eligible CoM faculty members in-scope of USFA, with the option to move to new forms of engagement through an Academic Clinical Funding Plan (ACFP) or contract.

I am aware of how varied in nature this process has been for those faculty members involved; that it has been relatively straightforward for some, and has been very difficult for others. People are at different stages of their career and have their own unique set of goals and preferences. We are one team, but within that we are individuals whose situations and choices are unique.

The nature of an ACFP (or contract) is such that the work since last August needed to be carried out on an individual-by-individual basis. This created challenges, as many know. It meant handling communication with care and consideration to ensure appropriate privacy of those directly involved.

Nonetheless, I continue to firmly believe that what we are moving toward is both better and necessary. We must have physicians across the province engaged with the college and involved in our academic mission. We must get to a place where academic time is safeguarded and appropriately valued, if our college is to survive and thrive. We have made an important step in that direction now.

Our transition team has been working very hard to support and inform our faculty members throughout this process, and those efforts were especially elevated in the days leading up to and after May 31. I have great confidence in this team and have seen firsthand their commitment and the lengths they have gone to in supporting and assisting our faculty through the transition. I extend a heartfelt thank you to our transition team members for your diligence and perseverance in this incredibly important work for the College of Medicine.

I also thank our faculty members for their perseverance through this process. Information wasn’t always available immediately for you, and in some cases, details are still being worked out. Your patience and faith in light of this is certainly appreciated.

Our work is of course not finished with May 31. We will continue to strive to engage physicians in Saskatchewan in the work of our college. Note that our transition team needs the month of June to ensure that the work associated with the May 31 deadline is completed and therefore won’t begin additional ACFPs until July. This team will remain in place as we move into the next stage of adding more and more detail to the new model. In addition to the transition team, don’t hesitate to take your feedback and questions to your UDH, and of course Keith Ogle, vice-dean faculty engagement, is also available.

I have heard from our UDHs and many of you that you want unification, you want to be included and you want to focus on our future. I couldn’t be more pleased to hear this, as I want—and our College of Medicine needs—those same things.

As always, I welcome your feedback.

Why Research?

The mandate of a medical school is the triple mandate of education, research and clinical care, all supported by adequate resources, engaged partners and effective administration. Still, occasionally, I hear that we are a small medical school and we cannot be expected to do it all, so why should we be trying to do (or grow) research?

Simple explanations—like our curriculum needs to be supported by biomedical scientists whose entire careers are devoted to research; or that UGME and PGME accreditation require that education be in an environment where research takes place; and learners must have the opportunity to participate in research—are not always convincing to politicians, hospital administrators running a deficit, or even some of our clinical colleagues.

Researchers I have known are motivated by an insatiable curiosity, a passion for research itself and a huge ambition to make that discovery that changes everything (or at least, saves lives or improves the lives of many)! Learners want to participate in research to maybe one day become a researcher or to enhance their CV in ways that will open other doors.  Deans and university leaders want to see rankings improve and reputations grow. Unfortunately, not all are swayed by these arguments for growing biomedical, clinical and population health research.

In medical schools there is a widespread belief that both education and research improve the quality of care and, thus, health outcomes. At the macro level, that is obvious. Though the greatest reductions in mortality over the last 150 years have been from population interventions like sanitation, clean water, improved nutrition and vaccines, all of these were due to research.

However, in the last 30 years our country has seen a steady decline in the national rate of avoidable mortality from 373/100,000 in 1979 to 185/100,000 in 2008. These improvements have been attributed equally to high-tech invasive treatment, pharmaceutical innovation and behavior change (e.g., smoking cessation), all of which are due to research.

Unfortunately, these national reductions in avoidable mortality are not evenly distributed across our country. We can all speculate on many reasons why that may be so.

One argument goes like this: “Fine—research saves lives; we will simply adopt others’ research.” Again, because “we are too small, or too busy clinically, or too resource-challenged to play in that game.”

What if you knew that the volume and quality of biomedical, clinical, and population health research done locally had a direct impact on the quality of care delivered to you, your children or your parents?

Zwicker and Emery from the School of Public Policy at the University of Calgary explain exactly that in their discussion paper, How is Funding Medical Research Better for Patients?, from August 2015. They compare provinces that have substantially invested in medical research (Alberta, British Columbia, Ontario and Quebec) with provinces that have not (Manitoba and Saskatchewan) and correlate that with reduction trends in mortality from potentially avoidable causes (MPAC).

The results are disturbing. At one point they argue that in 2011 Alberta had 62.2 fewer deaths per 100,000 people from potentially avoidable causes than Saskatchewan. And they are able to correlate these variations in the trends for reduction of MPAC with the provincial investment in research across six provinces. They appropriately point out the limitations to their study and concede that rates such as MPAC are multifactorial.

Much of the last 10-20 years in the world of health research has been preoccupied with the challenges of “translational research” and “implementation science.” These authors make an eloquent argument that local investment in research is an essential ingredient to the local adoption of health innovation and, in this case, reduction in mortality from potentially avoidable causes.

I highly recommend you read it. And the next time you have a great health system outcome, also thank a researcher!

As always, I welcome discussion and feedback.

Physician Leadership and Health System Transformation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Busy Days

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

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

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

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

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

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

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

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

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