Physicians are duty-bound to advocate for the health safety of the people of the communities they serve. It is in the Code of Ethics and Professionalism (Physicians and Society – clauses 37-44) of the Canadian Medical Association, and it is represented in three of the seven CanMEDS roles: health advocate, leader and professional.

It starts in medical school, where we teach advocacy to our students. So it is ingrained in all physicians from early in their training that as professionals they have an important role in advocating for the good health of not just their own patients, but the general public, as well. I believe that we wouldn’t want it any other way.

Our medical doctors are fulfilling their ethical obligation to the public through their advocacy and guidance on our pandemic response. And it seems reasonable that our doctors would be supported in this. For the most part, my experience has been that we doctors are supported in this advocacy role.

But as Saskatchewan struggles in this fourth wave of the pandemic, I am seeing more and more comments and conversations that suggest a lack of understanding of this professional duty of medical doctors. I think of the many physicians on the front lines of care, as well as public health experts and physician leaders, who, on top of all their other work, are doing media interviews—sometimes on a daily basis—to ensure that important information on the pandemic and how to stay safe reaches the public. Their efforts are heroic and deserve our support.

It’s a year since the Maclean’s magazine opinion piece by Canadian physician and writer Dr. Jillian Horton, about “staying in your lane” and the need for doctors to “flood the freeways,” was posted. She reminded us that non-objection is tantamount to silent agreement. As physicians, our role as health advocates compels us to voice our concerns, and I applaud our physicians, physician leaders and medical health officers for their advocacy and leadership through these incredibly hard recent days and weeks, and from the very beginning of this pandemic.

I also want to acknowledge the extensive advocacy and knowledge sharing efforts of our public health experts, epidemiologists and scientists. I extend my heartfelt thanks to all of you, as well as all healthcare workers on the front lines of care, including our medical faculty, students and residents, for all you have done and are doing.

Guest blog by Dr. Athena McConnell, Director, Quality and Accreditation

The word “accreditation” can have an almost immediate effect on people who have had good or bad experiences with the process in higher education. I must admit, as a bit of an accreditation nerd, I love it—which is probably a good quality to have given my role! While accreditation standards and elements are the minimum requirements necessary for medical schools to graduate caring and competent physicians, we can use the same bar to continually improve in how we achieve that mission.

I have been working in accreditation in the College of Medicine since 2010, and the landscape has changed in the past 11 years. In an ideal world, we would have conducted our Interim Accreditation Review (IAR) in 2013, as it was exactly at the midpoint of our 8-year accreditation cycle. Unfortunately, we were in the midst of preparing for a limited site visit from the accreditors. The 2013 visit was just one of the many accreditation activities stemming from the 2009 full site visit.

We held our last full site visit in 2017 and the preparation was extensive, including a mock accreditation visit. The hard work paid of and after two follow-up status reports our medical school has one of the best accreditation ratings among medical schools in the country. Across all 96 elements on which we are reviewed, we are fully satisfactory on 94 of them with the accrediting body.

On October 4 and 5, the college completed its first IAR, since we are now again halfway between site visits. This IAR was completed through a lot of hard work by students, faculty, and staff in the college. The results of an IAR are not submitted to the accreditors. IARs are formative internal reviews intended to find areas the school will need to work on in advance of their next site visit; they allow schools to be proactive in making changes rather than reactive.

Overall, we have done very well in keeping our eye on the ball and keeping that ‘A’ word in mind, which is reflected in our IAR results. Do we still have some areas that require closer attention and maybe a little extra care? Yes. However, we have also identified some areas of strength that have not skipped a beat since the 2017 visit. This is very encouraging and means that regardless of past negative connotations of the ‘a’ word in the college, there has been a significant shift in culture that is showing in our results.

Everyone in the college should give themselves a pat on the back for all of their hard work. The Undergraduate Medical Education (UGME) team in general have worked very hard to ensure that accreditation is front of mind for all staff, faculty, and leadership. Under Dr. Pat Blakley and now Dr. Meredith McKague in the associate dean UGME role, the UGME team has not missed a beat. Some specific groups have continued to excel over the past four years and deserve a special shout out:

• The UGME Curriculum Committee and all its subcommittees. These groups have really incorporated accreditation into all their endeavours.
• The Admissions team has been aware of the accreditation requirements and monitoring processes even during an admissions renewal process.

The next full site visit will occur in the spring of 2026. That means that documentation will start to be gathered in the fall of 2024. The IAR results will guide our work from now until then. Based on the level of engagement in the college, I have complete confidence that we will use the upcoming years to ensure a successful 2026 visit.

I want to make everyone in our college aware of work we have begun with the Saskatchewan Human Rights Commission (SHRC). Our college has invited the SHRC to review and analyze the current state of equity in our institution.

The work was prompted by concerns within our own college community and by broader societal issues like the inhumane treatment of the late Joyce Echaquan in Canada and George Floyd in the United States. This proactive and collaborative review will inform initiatives we will undertake in our college to address issues of systemic inequity. We have engaged SHRC to provide an objective, external point-of-view, and will benefit from their experience in this area from a Saskatchewan context, as well. We recognize this work should have started long ago and now hope to harness the momentum that currently exists in our environment.

We know inequity exists, but at this stage we are conducting research to ensure we have as complete an understanding as possible of the particular issues within our college and to ensure broad stakeholder input. A group, including the CoM’s EDI specialist, Dr. Erin Prosser-Loose, and director of the Division of Social Accountability, Dr. Manuela Valle-Castro, have met several times with members of the team at SHRC, who have been conducting some early research, and are now ready to move forward with stakeholder engagement.

The next step will be a series of interviews with a wide range of people across learner, staff and faculty groups at the CoM to get first-hand information on the direct experiences of members of our team with regard to equity within our college. This is a comprehensive review of our entire college, including but going well beyond things like diversity of the college’s leadership team.

Initiatives will be prioritized by both the external research and literature in this area, and what is learned by SHRC as they conduct the interviews. Once the SHRC has completed its review, the college will receive a report on its findings. This report will be shared with all staff, faculty and students of the CoM, and will be reviewed by college leadership as we work with the SHRC on next steps to prioritize initiatives.

Ultimately, we are intent on making the CoM a better, more equitable and diverse working and learning environment for all.

Next week, from October 4-5, our medical school marks a significant milestone—the interim accreditation review of our Undergraduate Medical Education (UGME) program.

Reminders and deadlines are important in moving anything forward. So it is with accreditation—it provides those critical reminders and deadlines for work that makes us a better medical school. We’ve had such great success not only in our last full UGME accreditation review, but in our recent reviews for both Continuing Medical Education and the School of Rehabilitation Science. Postgraduate Medical Education has been doing great work in preparation of its upcoming review, as well.

Of course, the twenty-first century for our college has been a lot about overcoming challenges and making the needed improvements in our UGME program. That work did not end with the successful outcome of our 2017 full-site accreditation visit. In fact, it is every bit as critical as ever, with the wonderful difference that now we are positioned to a much greater degree to improve and respond proactively rather than reactively. And that’s a lot more fun than the alternative!

When we achieved an eight-year accreditation result, we marked a major turning point. But as accreditation goes, we really are just around the bend from those difficult days and must continue to reinforce our improvements and new ways of doing things to ensure we continue on the right track.

Some context: this review is required by the Committee on Accreditation of Medical Schools (CACMS), but CACMS does not participate in it or review outcomes at this point. More importantly, and as medical schools across the country can attest, this interim review is a very important checkpoint on our way to our next successful full accreditation review. It enables us to identify areas for growth with enough time to make needed changes.

In the past decade, our college (and medical schools across the country) have improved our approach to accreditation, adding structure and devoted resources to support this important work. We created the role of Director of Quality to lead undergraduate accreditation about seven years ago, and that position has been capably filled by Athena McConnell ever since. We have an accreditation specialist supporting the quality lead, and both, as you can imagine, have been working diligently behind the scenes in preparation for this interim review, as have so many others on our team both within and beyond our undergraduate program.

So this interim review, while mandatory, is truly proactive in nature. It will involve two days of meetings—similar though not as extensive as those conducted at our 2017 accreditation visit, and of course virtual rather than face-to-face—with an external reviewer who is here to help us objectively assess our program.

Of course, medical schools are complex organizations, and that means we always have areas that need extra attention. One of the most important aspects of this review will be gaining perspective on how the UGME program can demonstrate collaboration across campuses and sites in order to duplicate each other’s successes and ensure learners in the medical doctor program have a comparable education and experience no matter where they learn.

We are one CoM, and we have great opportunities to improve how we work together as a unified team for Saskatchewan. This is more important than ever as we prepare for all years of the MD program being based from both Saskatoon and Regina starting in August 2022.