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.

Since this was a practice run, I have to compare it to marathon training where one does at least three or four “long runs” (32 kilometres) in the few months prior to the marathon. If those runs are easy then you would never finish the 42.2 kilometres of a marathon. If they are tolerable, then you would not do any better than you did in your last marathon. And if they are hard (or even better, really hard) then you are likely to have a successful marathon or even a PB (personal best).

When it comes to accreditation, we are planning for a PB!

So, as many know, we had a “mock accreditation visit” from February 5-8—from Sunday evening through Wednesday at noon. Dr. Tom Marrie, former dean at both the University of Alberta and Dalhousie who guided both schools off probation, and Dr. Cam Enarson from University of North Carolina, who has done 37 full accreditation visits over his career, did the work! They were incredibly thorough (tough, even) and tremendously helpful.

As a reminder to all, our full accreditation visit is October 29 to November 2, 2017. The process, as dictated by the Committee on Accreditation of Canadian Medical Schools (CACMS), began with a medical student-led Independent Student Analysis (ISA) 18 months before the visit. Our students were extremely engaged and did a great job on the ISA in the spring of 2016.

The next step was populating the first draft of the Data Collection Instrument (DCI), which is a series of questions and data requests regarding each of the 12 standards subdivided into 94 elements.

An Accreditation Steering Committee led six task forces that then divided up the 12 accreditation standards into key areas of focus – administration, admissions, curriculum, educational resources, learning environment, student services – and reviewed the DCI. An iterative process followed by which issues uncovered were fixed, the DCI was updated and a draft submitted to our mock accreditors in mid-December 2016 for review. This process of continuous improvement will continue. For example, Faculty Council passed some policies on admissions just last week which will require an update to the DCI. We have until mid-June to rewrite and polish our DCI before submitting the final version to CACMS.

A mock has never been done before at our college but has become standard practice at all Canadian medical schools over the last three years. Other medical schools have found it invaluable—and all have found it terrifying, as they discovered work yet to be done.

The mock was a dress rehearsal, a fact finding mission, and a reality check. All three are important. An external review by people we employ to find all the gaps that we may be blind to is incredibly valuable. I joked on the final day of the visit that if Tom and Cam were here to find all of our weaknesses, we got incredible value for money!

Let me expand on the reality check. If the real visit were next week, we would have a negative outcome. The accreditors reminded us that this isn’t an exercise in how far we have come; it is an exercise in determining if we meet the standards on the day of the visit.

Overall, I am optimistic. While I now know we still have an incredible amount of work to do—in fact, more than I thought—the good news is we know where to focus our efforts.

On the positive side, Tom and Cam were fully aware of the scope of the transformation underway at the CoM and felt we were going in the right direction. In fact, they noted that we are at a turning point and for the first time in many years the CoM has the potential to be the medical school Saskatchewan deserves! They thought we had the right team in place with: UGME leadership; department heads; the dean’s office; unit, course and clerkship leads; faculty; and staff. They were very complimentary of our faculty, staff and learner engagement in the visit. They were also very positive about the support and commitment from the health regions.

So in summary: right direction, unique opportunity, great team and great engagement.

On the negative side, while our visit logistics worked perfectly for the accreditors, there is work to do on the internal logistics. (On behalf of the team that was working very hard and rapidly behind the scenes, our apologies for some of the confusion in our communication and scheduling.) Also, our DCI had gaps, from broken hyperlinks, to some missing information or weak responses. We took copious notes, and these will all be fixed.

Another challenge is communication. The mock accreditors said not enough people knew and understood all the things going on at the CoM in terms of changes that have been made and processes and progress on accreditation.

So count on plenty more accreditation and CoM progress updates.

While all who met the team were very engaged, more preparation is needed. But it is on the accreditation team and dean’s office to ensure every individual and every team who meet with the accreditors in the fall have the preparation they need. Our team has learned a lot about visit organization, and we will improve. We already are making plans for assisting everyone in their preparation for the real visit early in the fall. We will ensure you are ready. And if you don’t think so, call us on it before the visit.

Some of the remaining issues we must address are big. Not all our students know where to turn in cases of mistreatment and are not entirely confident their concerns will be addressed. We will fix this! Let me assure all students the CoM, UGME team, faculty and staff are committed to a safe learning environment. Let me be clear: this is a very big accreditation issue!

I believe, and the mock accreditors confirmed, our greatest strength—other than great faculty, staff, and learners—is the transformation underway at the CoM. However, accreditation is a data-driven business and so our greatest challenge is having data that demonstrates the transformation is succeeding. This is big, so we will need your help, especially from our students, as we will be doing a follow-up student survey.

There is no doubt that we have had great financial support from the province in the past, but the accreditors made it clear that we are still in the middle of transformation. We are all aware of the current provincial fiscal challenges, but we have conveyed to our government partners the need for a restoration of required funding, and are in constant discussions with them about the college and its critical role in the health care system of the province. However, it was clear to Tom and Cam that if the needed financial support is not available that the transformation and accreditation will be difficult to achieve. This is really big!

And finally, we need to abandon our humble Saskatchewan ways. We were told it is time to assert our excellence and emphasize the things at which we are really good. I will give you a good example.  On the elements for diversity and social accountability, I was asked on Sunday how many Indigenous faculty we have, and while I knew personally some of our Indigenous faculty, I could not answer the question. So on Monday I asked Val Arnault-Pelletier if she would match our list of 73 self-identified First-Nation and Metis medical graduates with our list of faculty appointees. I now know we have one PhD and 21 MD Indigenous faculty appointees, and a number of them are in leadership positions! Tom and Cam were blown away by this information and emphasized we have lots to brag about. Now is the time to start.

I thank Tom and Cam profusely. We are really in their debt. I need to thank and compliment Dr. Athena McConnell, assistant dean quality, and Marianne Bell, accreditation specialist, as well as Dr. Pat Blakley, associate dean UGME and Dr. Kent Stobart, vice-dean education and the great team that backed them up. You know who you are.

Most importantly, I thank all who participated in the mock accreditation. Your engagement is inspiring.

However, the work ahead is daunting. Accreditation is our collective first priority after our patients, learners, and research! There will be more requests for information, opinion, surveys, policy development and meetings. We have all been working on multiple high priority initiatives over the past few years and are entering a time period through the fall where we will have to focus our efforts on UGME accreditation. I am committed to removing barriers for our entire CoM team to work on this, as our highest priority. I am also counting on all of you and know that, when asked, you will step up to the plate and be the great team players you have been leading up to, and during, this mock visit.

Remember, while success in marathon running depends very much on the individual, accreditation success depends on a team effort. As I’ve said many times, it’s a team sport! Thank goodness for that, as we will need many contributing to the work ahead, and we have a great and committed team.

I think of teaching, research and patient care as the fun parts of our collective work. A PB in accreditation will free us all up to have more time for the fun stuff!

And, as always, I am here to listen.

Last week was an exciting week here at the College of Medicine. The week started with introductions to my new boss! Dr. Tony Vanelli will join the University of Saskatchewan as our new Provost and Vice-President Academic in August. He comes to us from the University of Guelph where he served as the very highly regarded Dean of Engineering for two terms, and prior to that was at the University of Waterloo. We got to interact over a day and a half at a U of S senior leadership summit. Tony is very interested in the CoM and anxious to learn more over the next six months to support us on our journey to be one of the best Canadian medical schools.  The University and the CoM have had incredible support from both Acting Provosts, Ernie Barber and Michael Atkinson, but I know both are thrilled to pass the baton to a new permanent leader in the Provost role. This is an important step forward for the U of S.

On Wednesday night I was on hand with our President, Peter Stoicheff, and our Board Chair, Lee Ahenakew to welcome the Prime Minister Justin Trudeau to the U of S, the Health Sciences Building and the CoM. The town hall was extremely interesting to observe as the PM responded to a variety of questions with some appropriate emphasis on Indigenous concerns, although some controversy arose regarding some of his comments. On the other hand, the town hall was less raucous than some were across the country.

Even more important on Wednesday evening was the Faculty Council support for two major policy initiatives at the CoM. First congratulations to Dr. Keith Ogle on receiving support for the Policy and Procedures for the appointment of medical faculty. While our transition to a One Medical Faculty model as part of an overall united One Faculty model has been well discussed here in the past, this step was an important formal step in realizing this ambition.

Further congratulations to our Admissions Committee and Dr. Barry Ziola as Faculty Council voted to support a new admissions policy that designates six of our UGME seats for students from socio-economically disadvantaged background. The evidence is that the average family income of a Canadian medical student is at least 3 times that of an average Canadian family. I recall many years ago doing a CaRMS interview and being amazed by this individual’s academic prowess, grade 12 piano by the Royal Conservatory of Music, provincial tennis championship and stellar list of volunteer contributions. I knew two things for sure: this applicant would be an incredible doctor, and this applicant was rich! I recall thinking I wonder how many bright compassionate people never get the chance, and this is a big step towards fulfilling our mandate to be socially accountable and in ensuring our student body reflects the people we serve.

And then on Thursday we had the wonderful announcement of the recruitment of Dr. Michael Levin to the Chair in MS Clinical Research. Dr. Levin comes to us from the University of Tennessee and is an accomplished MS neurologist and clinician scientist. Dr. Levin joins Dr. Valerie Verge in the Cameco MS Neuroscience Research Centre, Dr. Katherine Knox in PM&R and other neuroscience researchers at the U of S. Furthermore the CoM and the health region have been successful in recruiting Dr. Ilia Poliakov, a neurologist who just finished an MS Fellowship at U of C. We will also be recruiting an RN and a Nurse Practitioner to further enhance the care in the MS clinic. Almost overnight we will revolutionize MS care and research in the province!

While the CoM took the lead on the recruitment this could only come to pass with incredibly important partners including SHR and the MoH. Of huge importance was the MS Society, the community of MS patients and their families and friends and the Saskatchewan Health Research Foundation. However the endowment that underpins the Chair was raised by Saskatoon City Hospital Foundation ably led by its Board and the ever enthusiastic CEO, Mr. Steve Shannon. Thank you!

I find this story very inspiring as this money was raised in the community, at events, and one small donation at a time. The province of Saskatchewan has the highest MS rates in the world and this is a perfect example of working with the community to be a socially accountable medical school and change care for MS immediately here, and through our research around the world.

Finally, this Sunday evening we start our mock accreditation. We will be visited by Dr. Tom Marrie, my former dean at Dalhousie University, and Dr. Cam Enarson from the University of North Carolina. This visit is an essential step in our preparation for the full accreditation visit October 29 – November 3. The ‘mock’ will serve as a dress rehearsal for many. We have dramatically increased the team of faculty and staff supporting UGME and most have not been through an accreditation before so rehearsal is good. But more importantly it is a fact finding mission. We already know of things that must be fixed by the fall and have been working very hard for two and a half years on those. By engaging experienced accreditors to do a rigorous review we hope, to paraphrase Mr. Rumsfeld, find the gaps in accreditation standards that are the unknown unknowns.

So as I have said many times accreditation is a team sport and we look forward to your active participation in the mock accreditation. More importantly we will need to all work hard together with the feedback from our mock accreditors to prepare for the fall.

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