Working together through transition

I have now met with many of our MD full-time faculty members individually, in four open information settings, and in four departmental meetings. As I hope you all know, I am happy to meet with any of our faculty – individually or in groups, and once or repeatedly as required.

I want to thank those who have attended these sessions. I have listened very carefully, and would like to use this blog to emphasize some key messages and respond to some of the concerns and feedback I have received.

You are wanted, needed, valued

First and foremost, I want to be clear that we want and need all of you – current MD USFA members, as well as the 1293 Saskatchewan MDs with clinical appointments – to be engaged with the CoM.

Our college presently has approximately 50-60 MD full-time equivalents doing the teaching, research and administrative work. Our peers have at least twice as much MD time invested in their medical school.

This is our fundamental challenge as a college.

I still hear language like “the CoM is trying to get rid of people.” Nothing could be further from the truth. To be successful, our college needs everyone engaged.

Second, I truly value the great contributions of our faculty.

I took on the role of acting Vice-Dean of Faculty Engagement with the very intentional and strategic goal of getting to know our faculty. I have come to know many of you, and am absolutely impressed by your commitment to our learners, your research, your patients and our CoM.

I have heard many of you say you have felt blamed for past problems, and you now interpret the voluntary severance offer as further evidence of that blame.

If, in my efforts to explain where we are going, you have heard blame from me, I apologize. This is not my intention.

I know the past has been difficult for you and for the college, but the change process we are on now is both necessary and complex. The challenge we face is the historical engagement structure, and the number of MDs at the CoM. Our challenge is certainly not the individuals committed to the CoM whom I have come to know and respect.

About ACFPs: a fair and transparent system of remuneration for all MD work

Recall, that well before I got here, the decision was made to no longer hire physicians to tenure track university positions.

It was obvious to me that the province, the academic health science centres, and the CoM had to deliver on the long-promised provincial ACFP if we were to grow MD academic time in the college. I put great effort and time into moving the ACFP forward, and our hospital and provincial partners responded.

Increasingly, ACFPs are the preferred method for engaging academic physicians across the country.   Are ACFPs perfect?   No. No single ACFP is going to be perfect, but it is the only model to provide equal compensation for teaching, research, and clinical care.

Looking ahead, I was concerned about the increasing inequity between current MD USFA members and newcomers, as the latter would have more protected academic time and, in some specialties, more income than their more established colleagues.

I hope you will see the transition packages as incentive to explore alternative ways to continue your engagement with the CoM.

About timelines and deadlines

Many have expressed frustration over the timelines. I must emphasize the “spirit” of the agreement is to work toward a firm deadline of April 1, 2016.

The October 31, 2015 date is, in effect, a necessary milestone for expressions of interest to give the CoM and our partners the information we need to ensure adequate capacity for development of the ACFPs, or other arrangements, for all interested faculty.

This means if a faculty member expresses interest in transitioning to a new relationship with the CoM through an ACFP, they must indicate so by October 31st, but they will have until March 31st to work out the details.

The biggest over-arching concern I have heard is the capacity of the “system” (the academic health science centres, government, health regions, and the CoM) to deliver the ACFP. We have heard your concern loud and clear, and are in process to hire two additional qualified staff members to work full-time on ACFP’s over the next year. We will get this work done.

About research – grants and graduate students

Some very important concerns have been raised. Our researchers have questioned their ability to hold research grants with a clinical faculty appointment. Important groundwork in this regard was done with the research policy passed by the Board of Governors in December 2014, which allows physicians appointed in clinical departments to hold research grants.

I have the University’s commitment that physicians holding clinical appointments will be recognized by the university, and will be able to hold research grants. This change was needed long before this transition, as the intent all along has been to provide protected time for research to some people signing up to ACFPs.

To address another misconception: the ACFP will only pay for teaching and clinical work and is limited to a low percentage of academic work. In fact, the ACFP is designed to be flexible, and will support MD clinical faculty who even spend the majority of their time with research and academic work (up to 75% in exceptional circumstances).

The ACFP will provide for all three of our important missions: clinical care, teaching and research.

Another concern is the ability for MDs in clinical faculty appointments to supervise graduate students. The university is committed to ensuring faculty who already supervise graduate students can continue this important role, and new MD faculty with appropriate skills and experience will be able to do the same.

All for one…One for all

There is no doubt this is a critical point in the history of the CoM at the U of S.

We are no longer one of the smallest Canadian medical schools, able to survive with a small number of full-time MD university faculty.

We are now a much larger medical school at a growing U15 university in a thriving province.

We must engage most, if not all, of the doctors at our academic health science centres and across the province. Our peers in Winnipeg, Halifax, Kingston, and throughout Canada have this model. This is our necessary goal, and the one we will all work towards.

Medical schools have always succeeded because groups of physicians came together in their belief that academic medicine would improve care to their patients, their own careers and their communities.

I have great confidence in this community of physicians to do the same. That is why I came here and am excited to work with each and every one of you to that end.

As always my door is always open. And furthermore so is the blog – please engage in the discussion.


Patient Safety and How We Work with our Health Regions

I will never forget the moment I sat facing an experienced and shaking general surgeon as a young Chief of Staff for a large regional hospital.  The surgeon told me he had just cut the common duct! Showing my age, this was in the very early days of laparoscopic surgery. The surgeon had recently taken a short course on laparoscopic cholecystectomy, and this was his tenth case or so.

As I sat there, my thoughts were torn between the devastation to the patient  and their family, and the impact on my colleague in front of me.  But most importantly – what had we done to prevent such an incident?

Who cut the common duct that day?

I would maintain many of us were holding the instrument:

  • The company that provided the short course and “certification of competence” had a role.
  • We as a hospital had a role in providing the privilege to do that surgery.
  • The entire system had a role in our limited capacity to monitor the implementation of medical or surgical innovation.

But for sure, the patient was harmed, and the surgeon was alone on that day!

For me, this launched a major, lifelong clinical and academic interest in patient safety, and how the safety of all – patients and healthcare providers alike – is essential in our work.

Fast forward a few years.  A trusted colleague and I were doing a workshop for PGY1 FM residents on coping with adverse outcomes in our careers. Towards the end of our session, one of our best residents tells us the story of the first night on call in clerkship on Medicine.

In keeping with the “Swiss cheese” model of medical error, a scheduling error and an illness resulted in two clinical clerks (JURSI’s here) and one PGY3 Medicine resident to cover the entire tertiary hospital for the night. The resident was busy in ICU, and after some delay, the JURSI’s are sent to assess a patient who is short of breath. They recognize the diagnosis of congestive heart failure (the admitting diagnosis), but given their limited experience, fail to recognize the gravity of the situation. As things deteriorate, more calls to the resident by the nurses ensue.

As anyone who has done this in the middle of the night knows well – the patient arrests before the JURSI’s get any help.

So what happens next?

The resident arrives, runs the futile resuscitation and says to the clerks, “there are two more admissions to do – let’s go!”

And now, in the workshop two years later, I am supporting the resident  truly processing this traumatic event for the very first time. For the first time for this resident, we are teaching both the signs of impending arrest, and how we deal with our own frailties as providers.

So now let me take you to the launch of the Patient Safety initiative at Saskatoon Health Region. If you have not already had the chance, I suggest you watch this short video about Logan.

I have had the privilege of being invited by the CEO of SHR, Dan Florizone, to participate on the Oversight Committee for this incredibly important initiative.  We have been meeting with a talented group of colleagues every Tuesday morning at 7:30 for over a month. Our group is ably led by Petrina McGrath from SHR and Susan Shaw from SHR and the CoM.

While I believe SHR is very brave in the open and transparent approach to such an important initiative, I can also state unequivocally that the approach is overwhelming supported by everything written about patient safety since the publishing of “To Err is Human” in 1999.

For me personally, it is tremendously exciting to be back in the “system” and contributing directly to an initiative improving patient care.

More importantly, I believe this is where academic medicine is meant to do its greatest work – enhancing patient care. I am particularly impressed at the work of our department heads and our faculty on this initiative, and look forward to the opportunities for our residents and learners to participate.

As my examples illustrate, it is absolutely essential for the CoM and our health education systems to be part of this initiative. While our education programs must incorporate the latest in patient safety, this is also a tremendous opportunity to do research.

My own personal interest is now diagnostic error (stubbornly sticking around 7-11% despite modern diagnostic tools) and how we teach diagnostic reasoning in medical education.  This is a subject for another whole blog.

What SHR is truly doing is changing the  culture here on patient safety. And that is a journey health education and healthcare must travel together.

As always I am interested in your feedback and my door is always open.


MDs at the CoM – Shaping our future

Earlier this month, I announced Dr. Keith Ogle has agreed to take on the role of Special Advisor to the Dean on Faculty. As most will be aware, the U of S has made an offer to practicing MD members of USFA to transition to alternate means of engagement with the CoM. So there is a lot of change, and this is a critical period for our college.  The future model of MD faculty at the CoM is for us to design.

Over the last year, I have come to know many of the MDs who make great contributions to the CoM, as I acted in the role of Vice-Dean of Faculty Engagement. However, we now need more MD leadership and even more physician engagement as we work our way through this change. Keith has valuable past experience, previously as a faculty member and department head in FM, and more recently in clinical practice at St Paul’s. He is widely known in our MD community.

One of my challenges over the last year has been finding time to reach out to all of my colleagues throughout the province. Keith will work with me to extend the reach of the CoM across Saskatchewan.

I will also be launching an internal search this fall for a Vice-Dean of Faculty Engagement. Keith will support the VDFE as we continue with the transition to a one faculty model, inclusive of all those MDs contributing to the CoM.

As I have previously outlined, one of the main reasons for our challenges is that – as compared to our peer medical schools – we have had far fewer MDs involved with the CoM. To solve this problem, we must reach out to all of the MDs in our community.

I am struck at times by the history that divides the CoM from our medical community. While alumni take great pride in their alma mater, after entering practice, many see themselves on the outside. In fact this is not a Saskatchewan-only problem, but it may be more pronounced in some circles here.

Across the country, a model of distributed campuses has been adopted entirely by MD faculty who never planned on being “academics”. In 2003 there were 16 medical schools on 16 campuses. Now there are 17 medical schools on 29 campuses.

All four years of UGME and some PGME programs are being successfully taught by what we would call ‘community faculty’ in Prince George, Kelowna, Victoria, Regina (years 2,3, & 4), Windsor, St. Catherines, Waterloo, Thunder Bay, Sudbury, Sagueny, Chicoutemi, Saint John and Moncton. All of these cities – with the exception of Victoria – are smaller than our two campus cities.

Before trying it out in those cities, many MD’s said they could not see it working. In 2003, one year before the first students, the Victoria Medical Society voted against the new campus of UBC Medical School. Many in these towns were quoted as saying they chose to practice there to get away from the medical school.

I watched the Dalhousie campus in Saint John get started by a substantial group of early adopters. Within a year or two, many naysayers were now asking why they were not being given teaching opportunities. Both experienced and new practitioners have repeated this pattern at all of these campuses. In fact, we know 70% of Canadian medical school graduates now want to have teaching and research as part of their careers.

We also have evidence that doctors who teach are more up to date, and it is reasonable to assume their patients also benefit. We know doctors who teach report greater career satisfaction, and are more likely to stay in their communities.

I also recognize our CoM must be better integrated with hospitals and health regions if it is to be seen as relevant to most Saskatchewan physicians. Therefore, I have recently agreed to work on the Oversight Committee for the upcoming Patient Safety initiative. I am very excited to be involved as I have done lots of patient safety work in the past, but even more so as it allows me to get to know more about our provincial healthcare system. More to come in a future blog.

Faculty engagement is not just for our MD faculty. We have nearly 100 faculty members in basic sciences, medical education and CH&E who are all incredibly important to the mission of our CoM. In a future blog I will provide an update on the work our basic sciences colleagues are doing to restructure the basic sciences.

So, I look for your input and advice as we continue to build on faculty engagement at the CoM.  Please engage with Keith as he assumes his new role. And as always my door is open and dialogue on my blog is encouraged.