Last week was of tremendous importance in Canadian history with the release of the recommendations of Chief Justice Murray Sinclair, Chair of the Truth and Reconciliation Commission. It was also a great week at the CoM, as we celebrated convocation for the Class of 2015 – a class which included 10 First Nations and Metis graduates.

Further context for me was my first visit to the northern village of Ile-a la-Crosse. As a week, it was both a moment to take pride in what we have accomplished, and a painfully stark reminder of how much further we have to go.

First, I must congratulate the Class of 2015!  They celebrated a remarkable set of accomplishments and I was honoured to celebrate with them. They have great pride in their class and in the college, and clearly have great ambition to make the world a better place. This class has contributed greatly to the CoM as we have gone through a major period of transition.

As I said, this class of 84 students had 10 Aboriginal graduates. This is the highest number of Aboriginal graduates in our history – maybe the highest in Canada – in absolute terms; and surely the highest in relative terms.  My comments on this at the Graduation  Banquet received great applause, and lots of Tweets.

Yes we have come a long way, but our population is 16% Aboriginal, and growing at a fast rate.  We still have a long way to come before we can truly say we have a representative faculty and staff. It is also worth noting that despite our efforts, we have failed to recruit a Chair in Aboriginal Health, even after 4+ years of trying.  So lots more to do – we must commit to a collective effort to ensure we have better representation of Aboriginal people in all parts of our CoM.

Justice Sinclair has two recommendations specifically directed at medical schools. Recommendation 23 focuses on increasing the number of Aboriginal healthcare providers, and Recommendation 24 calls for education on Aboriginal health, the legacy of the residential schools, and cultural competency for all of our learners.

Justice Sinclair said “A knowledge of history leads to understanding, and understanding leads to respect. Reconciliation follows.”  Another powerful statement he made was: “We are the best, we are the brightest, we are the future, we are the change…”

Clearly, our curriculum, and our policies should be informed by all of the recommendations in the full report when it becomes available.

Our Making the Links program is the envy of many medical schools, as are our inner-city student-run clinics. But these do not reach all students.  Val Arnault-Pelletier (our Aboriginal Student Coordinator in the CoM) does a fabulous job in supporting and advocating for our Aboriginal students, but we do not yet have Aboriginal space in our Health Sciences Building.

Go to the Northern Ontario School of Medicine, and you’ll see all signs represented in English, French and Ojibway.  Every NOSM student spends a month in an Aboriginal community in first year.

We have great efforts in Aboriginal health research by people like Caroline Tait, Mark Fenton, Vivian Ramsden and others, but our placement of Aboriginal Health as one of our three research priorities is more aspirational than real. Lots more to do!  Remembering we must work together collectively and collaboratively to support Aboriginal Health initiatives in our college and asking ourselves what our collective responsibility is.

So how do I tie in Ile-a la-Crosse? Well, so far I have visited 10 of 13 health regions, and as of last Friday, all three Northern Health Regions. In all, I have seen beautiful landscapes, people who love their homes and take great pride in their community.  And yet, I hear painful stories of social and health inequity, and injustice.

I was invited to Ile-a la-Crosse by MLA Buckley Belanger and Mayor Duane Favel. I spent the day with them as they proudly showed me their community, and their considerable efforts to improve the health and socioeconomic status of their people. I met with Elders; two of our graduates, Drs. Reid and Darcy McGonigle,  who live and work there; some of our students; Keewatin Yatthe Health Region personnel – including CEO, Jean-Marc Desmeules; an RCMP officer; and many community members.  I toured the Integrated Services Centre – an incredibly beautiful new building that houses the hospital, ER, Primary Care Clinic, community health services, long term care facility, daycare, community employment agency and high school!  It was an amazing facility.

We talked at length of their aspirations of having all of their doctors living in their community; the desperate need for mental health services; the number of people struggling to manage their diabetes and other chronic illnesses in the absence of full services; and poignantly, the challenges of driving five hours to Saskatoon for dialysis three time a week.

But the moment that really brought me up short, was our discussion about the challenges with alcohol and drug addiction, and access to care. We toured their four-bed detox unit, and discussed the challenges faced by patients in immediately returning to their often even more remote community, without on-going care. They told me there was once a 28-day treatment program – I would see where it had been housed when we finished the tour of the town.

We later drove by a boarded up old building which had housed that alcohol and addiction treatment program. They said with grim irony: “Yeah, before that it was the residential school.”

Well it felt like I had been punched in the stomach!

It illustrated for me, in an instant, all that Justice Sinclair has had to say in the last week.  That residential school only closed in 1971, which is not that long ago.

Not all of the North is Aboriginal, and we need to be cognizant that Aboriginal people throughout the province need a CoM that meets their needs.

We are doing some great things in the North. We have great student placements, a family medicine residency program in La Ronge, and have done some outstanding public health research led by Dr. James Irvine.

Dr. Ivar Mendez and Dr. Lorna Butler of the College of Nursing are pioneers on the use of robots in providing remote-presence care, and are doing the research to back that up. This year, Dr. Mendez will represent the only medical school in the world – USask – to be invited to a World Health Organization conference on remote health care.

Dr. Tanya Holt in paediatrics is doing innovative work providing remote consultation and care using the robot in Pelican Narrows  and will soon start using Nursing’s robot to do the same in Ile-a la-Crosse. For years the CoM has operated Northern Medical Services, ably now led by Dr. Veronica McKinney, who provide doctors for the North.

The visit has certainly inspired me to ask: how can we leverage NMS, the interests of our faculty and our learners, our focus on Aboriginal Health research, and our immense and beautiful North to be national and world leaders in Northern and Aboriginal healthcare?  I believe we must commit to delivering on Justice Sinclair’s TRC Recommendations, always mindful of what the community needs and resources are. As always, I am interested in your ideas and opinions.

The trip to Ile-a la-Crosse was great in other ways too. I got to bring along my new camera and lens to do some aerial photography on the way (don’t be looking in National Geographic anytime soon), and in the afternoon they took me fishing. So, I got to cap off my first year in Saskatchewan catching my first Walleye and Northern Pike (but don’t look for any prize winning fish just yet as well!).

So I learned in the week of the release of the TRC Recommendations that we still have a long way to go at the CoM in serving our Aboriginal partners.  We must commit to resources, dialogue and initiatives that make a difference for our collective good, but most certainly for our Aboriginal demographic, youth, leadership and those yet to come.

And through Convocation, I saw the results of all the great work all of you do. Congratulations again to the Class of 2015.

Preston

This blog is an opportunity for me to “catch up” with faculty, staff, and students after an incredibly busy spring. Speaking of spring, I must say I have had an incredible introduction to the “harsh prairie winters” and my family and friends in the Maritimes may still have snow in the woods!! Of course I know I may regret tempting the weather, but I figure enjoy it when I can!

In April and May, I have been away on a number of CoM activities.  Here’s a quick recap:

• I chaired the full accreditation visit at Western University (formerly UWO).  This was a lot of work, but an incredible learning opportunity, especially for our full visit in 2017.
• I hosted alumni events in Calgary, Victoria, and Vancouver. They were well-received as alumni seem pleased with the direction at the CoM, and some seem inclined to increase their support. Many thanks to all of those who turned out and to our excellent event organizer and advancement team.  I encourage all alumni to consider coming to Highlights 2015.
• I attended the AFMC Board meetings, and the Canadian Conference on Medical Education. More on that below…
• I also managed an unexpected diversion to the Maritimes for a family emergency. I would like to express great gratitude for the concern and well wishes expressed to Jane, Marie and me by so many of you. My mother is recovering nicely. I regret if it has been difficult to meet with me lately or if I cancelled a meeting or missed your event.

The CCME was very instructive, as usual, with lots of great faculty development. Of great concern is the shrinking number of PGME spots across the country, and the increasingly competitive CaRMS environment. I have assumed the position of the AFMC Dean representative on the Board of CaRMS, and hope to contribute constructively to these challenges.  A concern to the deans is some of the inconsistency in the approaches and policies of our PGME programs across the country particularly with regards to selection. I look forward to your input on that important topic.

Another topic discussed at CCME was UGME admissions.  Some of our peers are coming up with innovative ways to recruit students from historically under-represented groups, including those from lower socio-economic backgrounds, LGBTQ community, inner city and rural communities, etc.  Here’s the latest news from U of M:

http://www.winnipegfreepress.com/local/U-of-M-looking-to-make-changes-to-medical-school-admission-in-2016-303522391.html

While I think we have made some progress with our Aboriginal and rural students, I think we still have room to go to ensure our student body reflects the whole Saskatchewan population. Again, I look forward to your advice.

The abrupt trip to the Maritimes was even more abruptly ended by a rush back here to participate in the UGME accreditation visit. I mention this to give kudos to our event team and the IT teams here and at Dalhousie.  They created a superb back-up plan for me to participate fully in the accreditation visit by high-end VC equipment (acquired here just in time for the visit) from The Moncton Hospital!! “Ain’t technology great!”

I am very pleased to say our UGME accreditation visit went well, and kudos to all, but especially to Dr. Athena McConnell (our Assistant Dean, Quality), and Kevin Siebert (our Accreditation Specialist). Our briefing book was completed and edited to perfection well in time, the mock visits carried out smoothly with full preparation and participation by faculty members, and the logistics of the visit handled flawlessly.  The results will be heard in the fall, but the exit interview expressed progress or resolution of many of the 13 standards in question. It needs to be noted, however, that our primary focus for preparation is in fact the full visit coming in 2017.

Speaking of 2017, I hate to be a pain going on about this, but we also need to remind ourselves that our performance in the upcoming year and the responses from our graduating students on the Canadian Graduate Questionnaire in June 2016 will be the primary data for the full accreditation visit of 2017. I believe we have made great progress on many fronts with regards to accreditation, and soon this issue will be permanently behind us. We just aren’t there yet!

Finally, I write this blog on the plane back from Ottawa and on my way to Regina to meet with government, RQHR, and our faculty.

I hope you enjoyed a spectacular Saskatchewan weekend.  I went out Saturday on my motorbike to Watrous to meet with some of our rural faculty at SnoDocs.

Preston

I would like to introduce Sinead McGartland as our guest blogger this week. Sinead is our Senior Project Leader and she comes to us after three years of experience as the Executive Director of the Saskatchewan Academic Health Sciences Network. Many in the province tell me attracting Sinead to this position is quite a coup for our college. We are on a big change agenda on many fronts, and we need a strategy for implementing that change. I have seen great success with the adoption of an organization-wide approach to project management. Sinead brings all of the skills and experience to accomplish this work, a deep knowledge of the heath education and healthcare systems of Saskatchewan, and a great network throughout the province.

I’ve asked her to outline how a Project Management approach will benefit the work of the college.  Here’s what she has to tell us:

Have you ever worked on a project and you had no idea why you were doing it; you weren’t sure how your piece fit into the bigger picture; there were last minute changes or surprises?  Maybe you had to just get something done, but new tasks kept getting added, and your project seemed to never end.   Frustrating!

Using an active project management approach takes away the frustration.  It means we take the time to design and plan a project so we can properly execute and achieve the desired results.  Following the methodology helps us know in advance: what we want to achieve (the desired outcome); who needs to be involved; how to manage the schedule, budget, communications, risk and quality metrics; success measures; evaluation and learning.

For the College of Medicine, Distributed Medical Education (DME) is a prime example of an unplanned project.  This is not a criticism, and in fact, the college has seen many DME successes – despite not having an overall planned design.  To meet the needs of our increasing undergraduate and postgraduate student body, the college dove right into distributing programming across the province.

We are now taking a step back in order to develop a truly strategic plan for DME, including the design of a DME structure required to move the college forward.  As a result of this approach, the College of Medicine will:

1. Learn from the experts:

• Establish a Task Group to recommend a governance model that identifies who has the authority, what the DME models and growth plan will be, and the operational business plan.  This Task Group  will have representatives from the college, the current DME sites, the Ministries of Health and Advanced Education, and Regional Health Authorities
• Research what other Canadian medical schools have done with DME

2. Learn from reality:

• Complete focus groups with the existing DME sites to learn what is going well, what needs more support/ improvement

3. Understand the provincial implications:

• Host a provincial forum on June 22 and 23 to work with provincial partners to understand the implications of the DME governance plan, and to work through the components that need to be included in the business plan

4. Articulate the College of Medicine approach to DME:

• Produce a document that articulates the college’s vision and plan for DME
• Identify the operational considerations and activities needed to mobilize and implement the DME plan

Distributed Medical Education for Saskatchewan is a provincial plan.  Engagement, participation, commitment, and action are the mantra to move us forward.  I am excited to work with college members and partners across the Saskatchewan as we build on the foundation you’ve created.

For the College of Medicine, implementing a project management methodology will allow our approach to be consistent – regardless of the type and scope of project.  My long term goal is to see all college projects have a charter, a stakeholder management plan, and a lead who is the ‘motor’ to keep the project on task and on target.  Project leads will also complete the project evaluation and report on the outcomes, ensuring both transparency and accountability.

I am always interested in hearing the perspectives of the College partners to understand how any of the projects that we proceed with impact and affect them.  Please contact me for more information on the projects that I am supporting.  I am very pleased to have joined the college and look forward to the opportunity to meet and work with you.

Do you know what ‘pimping’ is in medical education or, maybe more importantly, what is its understood meaning by learners?

It was first described in the literature in 1989 as the process of an attending physician asking a series of increasingly difficult questions to a student or resident. It has since been variously described as any form of questioning in a learning setting to a line of questions that are clearly intended to reinforce the hierarchy in medical education, and embarrass or humiliate the learner. In fact students categorize it into good and malignant categories – and actually express the hope they will become “good pimpers” when they become attending physicians.

I recall being a clerk placed for two weeks on a Cardiovascular Service (a long time ago, in a galaxy far, far away) and starting each day at 7 AM in CV ICU with a faculty member who resolved all of his innermost challenges and frustrations by serially eviscerating the most junior members of his team. (I also question the pedagogic value of a CV ICU experience for a third year student, but that is an entirely different discussion.) To this day I can remember that place at the end of the bed and feel my color turn red as I relive the intentional humiliation.

I recommend for your perusal the excellent article by Kost and Chen in the January edition of Academic Medicine entitled “Socrates Was Not a Pimp: Changing the Paradigm of Questioning in Medical Education.”  They do a great job of challenging both the technique and the term of pimping, and rightfully point out that questioning when done correctly is an essential tool in clinical education.  The term itself is indeed unfortunate, and while students aspire to some day be “good pimpers,” there is plenty of evidence in life and in the education literature that we are very prone to teach the way we were taught.

So how do we change this part of our culture?

Some faculty members may see their technique as a use of the Socratic method but very few of us are Greek scholars or have ever even read any Plato. Kost and Chen point out that much questioning is fact-based done with the implication that there is only one right answer. In that case it certainly does not develop critical thinking skills, which I believe should be the first goal in clinical education particularly in the day of bedside databases on our phones. They advocate for a modern interpretation of Socratic teaching that has three components: “working collaboratively in groups, exploring interpretive questions that lack a specific answer but activate prior knowledge, and reflecting on the discussion.”[1] I do recommend the article – I found it excellent.

Why is this important to us? Preparation for our accreditation visit in May provided me the opportunity to review some data from the Canadian Graduate Questionnaire, which students from all schools complete at the end of fourth year. Approximately 53.3% of our students report being publically embarrassed, and 23.7% report being publically humiliated during their time at the U of S. These experiences are almost always in the clinical environment. The good news is that our numbers are on par with the aggregated data from all schools. The bad news is that it continues today. All medical schools will be working to change this culture and bring these numbers down, as must we!

Further evidence from Bould et al in the March issue of the Canadian Journal of Anesthesiology demonstrates “how a negative hierarchical culture can adversely impact patient safety, resident learning and team functioning.”[2] The article is entitled “Residents’ reluctance to challenge negative hierarchy in the operating room: a qualitative study”.

In the quantitative component of the study a simulation was done in which residents were told by an attending physician to give a transfusion in the OR to a Jehovah’s Witness patient against the patient’s explicitly stated wishes. The majority of the trainees did not question authority and gave the blood. In the qualitative component the authors explore the trainees reflections on that experience and the hierarchal nature of the learning environment. Both articles are thought provoking and challenge us to constantly work to improve our learning environment and enhance our teaching skills and, more importantly, our culture as we strive to have the best medical education programs in the country.

As always I am interested in feedback and dialogue. You can respond directly to the blog, stop me in the corridors and my door is always open.

[1] Academic Medicine, Issue: Volume 90(1), January 2015, p 20–24

[2] Can J Anaesth. 2015 Mar 20. [Epub ahead of print]

After nine months into my deanship here at the CoM, I wanted to take a step back with our team to see how we are doing and where we are going. Personally, I feel tremendous support, energy and enthusiasm for our programs and our direction; but a desire to accomplish much more change even faster. I wanted to validate these impressions and ensure our leadership team was on board for the next phase.

Last fall, I had arranged for two very experienced deans – Dr. Brian Postl from the University of Manitoba and Dr. Catharine Whiteside, who just finished as dean at the University of Toronto – to visit and review our college.

Between them, they have nearly 20 years of decanal experience, and have been through reviews and accreditation visits at most medical schools in Canada. I asked them to review our strategic plan, The Way Forward, and our operations – the business of running the medical school – as well as our research enterprise.  This had nothing to do with accreditation per se and nothing to do with curriculum or our education programs.

Drs. Postl and Whiteside spent two days with us on February 2^nd and 3rd. They were provided all kinds of advance reading and had many interviews with the deanery, department heads, administrative leadership, health region leadership, government partners and senior university leadership. I’m told their questions and insights were very perceptive and helpful.

In essence their advice was:

• you are on the right track
• your overall plan is consistent with the way Canadian medical schools are organizing themselves
• you need many more clinical faculty with dedicated time
• you need to distribute budget and accountability to education units and departments
• you need to implement your strategic plan for research (Toward 2020)

Bottom line, we have a great college, substantial resources and great opportunity.

Using their advice and The Way Forward as background, we convened a Senior Leadership Retreat on Feb 26 & 27. On Thursday evening, we had dinner with Mr. Dan Florizone, CEO of SHR, as keynote speaker. He spoke very strongly of his commitment to the academic mission of SHR, a strong partnership with the CoM, and our education and research mandates. Also of note, It was a great start.

On Friday morning, we focused on our strategic plan and our operations and a great turnout of over 40 people including deanery, department heads, administrative leaders, and representation from our campuses in Regina and Prince Albert. It was encouraging to see representation from across the province and I am hoping to grow this level of involvement at future events.  I also want to be sure we do more to encourage involvement from community physicians and build engagement with them by actively seeking their perspectives.  I provided some remarks on academic leadership and we got down to work.

We had focused discussions on the One Faculty Model, Medical Leadership and Processes, Medical Education Resources and Methodologies, and RHA/MoH Relationships. There was great support for moving to the One Faculty Model, improving and extending the academic leadership throughout the province, a distributed model of budget and accountability and above all a message of let’s get on with it!

In the afternoon we were joined by seven  of our leading researchers. Dr. Gordon McKay, Interim Vice-Dean, Research, led off followed by short vignettes by each of the researchers about their programs. We then had a presentation about progress and plans for research at U of S by Dr. Karen Chad and after the break, continued with small group work on ideas for advancing our research mission.

The event demonstrated that we are doing a lot in research and certainly more than we receive credit for. On the other hand, there were lots of ideas for change and investments brought forward that will need to be done if we are to succeed in our goal of becoming the best small medical school in Canada in the next 5 years.

Overall the event was a tremendous success.

I have participated in a lot of these events and I have never seen this level of enthusiasm, energy and engagement. Don’t get me wrong – there was discussion and debate and not everyone agreed with everything. As I have said, as we move forward we must be both relentless and flexible. But for me the most exciting thing I saw was a team united around a direction and enthusiasm to get on with it.

If you want more details talk to your colleagues that were there or stop me in the halls to discuss. Remember my door is always open.

I also need to say this was the best organized retreat I was ever at. It will become an annual event. In that regard I must congratulate and give great praise to my entire administrative team but in particular Sinead McGartland, our Senior Project Leader who planned both the deans’ visit and the retreat,  Darla Wyatt, our Events Coordinator, and our Facilitator, Laura Saporio. And thanks in particular to Mr. Dan Florizone from SHR, Dr. Dave McCutcheon and Carole Klassen from RQHR, and all of the great participants.

Of course we do all this while continuing to diligently prepare for our May 10-12 accreditation visit. I say this to remind everyone we need your active participation and efforts as we prepare.  Athena McConnell, Kevin Siebert and others are working hard to prepare the documentation. In particular, I want to congratulate the Department of Medicine on the scoreboard they have up tracking compliance with knowledge of objectives, timely feedback and completion of assessments.

We’re on our way – let’s get on with it!

We are! And the exciting research done by our own Dr. Mike Kelly and its recent publication in The New England Journal of Medicine is proof.

The College of Medicine – together with the Saskatoon Health Region, the Regina Qu’Appelle Health Region and each Regional Health Authority in the province – create an Academic Health Sciences Network.

A very dated concept is the idea of medical school and a small group of core faculty members partnered with a single “teaching” or “University” hospital.

A national task force of universities and health care organizations has described this evolution:

Evolution to Academic Health Sciences Networks (AHSNs): With the emergence of new health care organizations with broad regional responsibilities for health as well as health care combined with emerging trends in academic medicine such as distributed medical education, eLearning, and collaborative inter-professional models of care across a broader range of organizations and institutions, the National Task Force embraced the new model of the Academic Health Sciences Network (AHSN), for which it developed the following definition: “a set of formal partnerships created by health sciences universities, academic healthcare organizations and other provider organizations with the goal of improving patient and population health outcomes through mechanisms and structures that develop, implement and advance integrated health services delivery, professional education, and research and innovation. At the core of this network is the AHSC, working closely with other academic healthcare organizations who focus, in whole or in part, on the care-teaching-research mandate.”

What do they do?

AHSCs deliver three related missions: (1) providing Canadians with timely access to advanced patient care services; (2) training the next generation of health care professionals; and (3) conducting leading-edge research and making it available to clinicians, administrators, policy makers and the public. It is the integration of patient care, education and research that uniquely defines the AHSC mission and differentiates it from other organizations in the health system that focus predominantly or exclusively on the provision of health and health care services. Each mission serves to reinforce the other two, with the objective of providing Canadians with access to world-class patient care, well-trained health care professionals, and state-of-the-art research

Dr. Mike Kelly, MD, PhD, is from Saskatchewan and a CoM graduate from 1999 who also did his Neurosurgery residency here in Saskatoon.  Very importantly, the RUH Foundation contributed to Dr. Kelly’s extra and specialized neurosurgical resident and fellowship training.  At Cleveland Clinic and Stanford University, Dr. Kelly learned endovascular surgical techniques for repairing CNS clots and aneurysms.  Upon return to Saskatoon in 2008 to the Division of Neurosurgery,  Dr. Kelly finished his PhD in 2010 from thesis work entitled “Using synchrotron imaging techniques to solve problems in neurosurgery” that he had started earlier during his residency program.

In 2012 he began work as the Saskatchewan Clinical Stroke Research Chair at the College of Medicine, with a research program supported by the Saskatchewan Health Research Foundation and the Heart and Stroke Foundation of Canada.  The Saskatchewan Clinical Stroke Research Chair allowed for the implementation of dedicated stroke research infrastructure that previously did not exist.

The research that resulted in publication in the NEJM proved that endovascular treatment for the acute management of stroke is now the gold standard. This was an international study and Saskatoon was one of 11 Canadian centers that participated.  Saskatchewan’s participation in this exciting research would never have happened if the research infrastructure had not already been in place. We were very honoured to have been included as one of the first study sites in Calgary’s ground-breaking study.

This is in itself a remarkable accomplishment for any early career academic, and by all accounts, Dr. Kelly is a remarkable clinician, teacher, researcher and leader.  But Dr. Kelly does more than that – he shows us all what we can accomplish at our Academic Health Sciences Centres here in Saskatchewan.  Because of Dr. Kelly’s specialized expertise, ischemic stroke patients are already receiving endovascular treatment.

I have heard some say we are not an Academic Health Sciences Centre/Network, and that given our clinical burden, we cannot do it all  – and so we should leave the research to others. I say they are wrong.  Dr. Kelly is but one example of many health leadership accomplishments in Saskatchewan.  Those by Dr. Sylvia Fedoruk also come to mind.

For me, the two highlights of this story besides Dr. Kelly’s contribution, are key aspects of an Academic Health Sciences Centre/Network.

First the whole community was part of the process that led up to Dr. Kelly being in a position to do this research.  The University, SHR, RUH Foundation, Heart and Stroke Foundation of Saskatchewan, SHRF, among others.  The second point is that we saw knowledge creation here in Saskatchewan that led directly to application and benefit to the people of Saskatchewan.

This is how it is supposed to work and why we all benefit in growing our Academic Health Sciences Centers and Network.

Originally published in the Saskatoon Star Phoenix, January 29, 2015

The U of S College of Medicine is ambitious and focused on delivering success for the people of our province.  As Saskatchewan’s only medical school, we have nearly 90 years of history, almost 4,000 proud alumni, and a renewed determination to finally move forward.  

Despite recent comments that “twenty years later, the college of medicine remains plagued with problems”, the students, teachers, researchers and partners today are making aggressive gains to rebuild the college.  Our efforts are producing results.

Graduates say the most important test of a medical school’s success is the quality of training.

One measure of quality is student success in national licensing exams. In 2013, scores improved. In 2014, our grads earned a 100 per cent pass rate. Continuing this trend, and to help prepare students for the redesigned national exams, we’re rolling out a new curriculum this year with an increased emphasis on clinical knowledge and skills.

But measuring quality goes beyond test scores. Are graduates recognizing and treating disease superbly; promoting health and prevention effectively; demonstrating a caring and compassionate manner?  In this regard, Saskatchewan’s College of Medicine holds a great reputation.  

U of S medical grads are welcomed with open arms at residency training sites across Canada.  At Dalhousie, I chaired the selection committee for five years, seeing thousands of medical student applications.  U of S graduates were as good or better than the rest. I supervised U of S graduates in Family Medicine.  Again, they were among the best.

For detractors who say too many of our grads are leaving: in 2014, 63% of our graduating class stayed in Saskatchewan for residency training.  

As for accreditation, the majority of Canadian medical schools have had accreditation challenges over the last 10 years.  We’re already preparing for another visit this May, with planning lead by an Assistant Dean, and an accreditation specialist.  These are new resources and they’re demonstrating excellent progress.

Accreditation is an eight-year cycle – our next regular full visit is in 2017.  We’ll learn the results of the May visit next fall.  Even if all goes according to plan, the college may still stay on probation until 2017 – that is simply how it works. 

Besides teaching, the other half of a medical school’s role is research.  Most medical schools bring in 50 per cent of their university’s research dollars.  The key to success is having MD researchers to provide linkages between basic scientists and the healthcare system. 

So, we’re actively recruiting more MD researchers, restructuring our basic science departments and building stronger relationships with our healthcare partners.

There is enormous potential in Saskatchewan and we’re capitalizing on state of the art biomedical science laboratories, the advantage of having all health professions on campus, along with the veterinary college, Canada’s only synchrotron, and VIDO-Intervac.  

We are doing research to change lives and, more importantly, this research is improving care for Saskatchewan patients.

For the U of S, there is a singular over-riding factor that led to challenges with both accreditation and research productivity: shortage of faculty.

Compared to similar medical schools, we’re running with less than half the physician time available to our peers. 

We teach our learners patient care comes first. When our MD faculty must choose between patient care, education and research – they choose patient care. The best question is not ‘why we are on probation’ but ‘how have we done as well as we have’.

Together with the province and health regions, we’re developing a new Provincial Academic Clinical Funding Plan – the most commonly used approach for engaging and compensating academic physicians. A new approach will be used in rewarding over 1,000 community physicians across Saskatchewan who are contributing to our mission.

Saskatchewan is a ‘have’ province with our provincial economy remaining amongst the strongest. We are attracting doctors and retaining our own graduates. The College of Medicine is well-resourced.   

Our strategic plan, The Way Forward, maps out the required change agenda.  I don’t think any medical school in Canada has gone through the intense soul-searching, consultation and debate, research on best practices, and comprehensive planning as the U of S College of Medicine between 2012 and 2014. 

Change is always hard and much is still needed. Everyday, I see opportunity and momentum. Wherever I go, the prevailing wind is “let’s go, we’re ready”.  Stakeholders and partners echo “we are behind the College of Medicine”.  With this level of support and pride, my 16 dean colleagues across the country are envious, I’m sure.

Watch us. We’ll make you proud too.

So we’re a few weeks in to the New Year, and I would like to offer my best wishes for 2015 to all of our learners, faculty and staff here at the CoM, and all of our partners and stakeholders at the university, the healthcare system and across our fine province.

2015 promises to be an auspicious and ambitious year for the CoM and at the U of S.  At the university, we will select and welcome our new president in 2015.  Our Interim President, Dr. Barnhart, and Interim Provost, Dr. Barber, have done a great job of leading us after a challenging 2014, and the university is clearly ready to move forward. I have the privilege of serving on the search committee for the new president and while its proceedings are of course confidential, I welcome your input and advice.

There are a number of priorities I intend to focus energy on this year.  Speaking broadly, I would characterize each of these priorities under a theme of momentum. While it may be hard to recognize significant change from day to day, there truly is a sense of momentum here in our CoM.  A year from now in January 2016, when we look back on 2015, I want us all to be astonished and proud of how far we’ve moved forward.

So, on that note, here are a few of my priorities for us in 2015:

Top of everybody’s mind is the accreditation visit scheduled for May 10 – 12. Dr. Athena McConnell, our Assistant Dean Quality, and Kevin Siebert, our Accreditation Specialist, are working hard in preparation – as are many of you.  You’ve heard me say this before: accreditation is peer review on a national scale, and our CoM belongs among the best. Accreditation must be a team sport for our college to be successful, and I call on everyone to work with us as we prepare to demonstrate to our peers how far we have come.  Even more importantly, I want to show how far we intend to go.  You will be hearing much more from us over the next four months.

In terms of accreditation we are continuing to advance our expertise.  Dr. Sheila Harding has been asked by the AFMC, our national body of medical schools, to be a representative on the Committee of Accreditation of Canadian Medical Schools; we plan to send a group of approximately 20 key people to a workshop at the Canadian Conference on Medical Education in Vancouver this April; and I Chair the accreditation team visiting the Schulich School of Medicine & Dentistry at Western University in April.  So we are preparing for our own visit, but more importantly, we are developing a team and a culture to ensure accreditation success well into the future.

2015 will be a big year for our colleagues in the School of Physical Therapy on two huge fronts.  They are well on their way to preparing for their accreditation visit and have already submitted their documentation. The visit is planned for February 23 to 25.

Much more importantly, this is the School’s 50^th anniversary year.  A celebration and reunion weekend is in the works for September 11 – 13.  I attended the School’s graduation celebrations this year, and have had the opportunity to meet with students, faculty and alumni, so am looking forward to being part of the anniversary. The School of Physical Therapy is clearly one of the shiniest jewels in our crown at the CoM, and we look forward to celebrating with them in 2015.

2015 will be a big year for PGME as the full accreditation for all of our programs takes place in November.  We had an internal review of the “A Standards” done in December by Dr. Mark Walton from McMaster University, and we look forward to using this information as our preparations proceed.  I know all programs are working hard to prepare.

In December, I attended a retreat here with the Department of Medicine, and another in Moose Jaw for Family Medicine where PGME accreditation was a key theme.  Repeatedly we were reminded what clinical teachers can do on a daily basis to ensure accreditation success are the following: ensure you and your residents know the objectives; provide timely and effective feedback; complete evaluations on time; and do all you can to ensure a safe, positive and constructive learning environment.  And thank you to all of you who do this every day without the dean’s reminders!!

My first task given to Dr. Steven Harrison, our Chief Operating Officer, on day one was “to make the trains run on time” at the CoM. This fall we have been busy assembling the team to achieve this goal.  I’ve been meeting with Sinead McGartland, our new Projects Manager and we have planned the launch of four big projects.

As promised, we will be embarking on strategic planning for Distributed Medical Education and I envision over the next three years, we will establish five rural sites for longitudinal integrated clerkships;  two more FM residency sites; three new RCPSC programs based in Regina; and additional rotations in PA.  The second project, also as promised, is the complete revision of the compensation strategy for our faculty who are paid on a stipend or fee for service basis. Third, we will continue the process to restructure our basic science departments.

With regards to the fourth project, my former dean and mentor, Dr. Tom Marrie, was always very willing to ask for advice. Despite being one of the best clinicians I ever knew, he always said asking for a second opinion was always a great opportunity to learn.

It is common for departments, centres and institutes to have external reviews, although maybe less common for deans or medical schools to do the same. Accreditation is an external review, but highly successful medical schools need to do far more than pass accreditation.

I have invited two very experienced deans, Dr. Catharine Whiteside (who just stepped down at the University of Toronto) and Dr. Brian Postl, (University of Manitoba), to come and review our strategic plans, our resources and our operations. Many of you will have an opportunity to meet with them when they visit February 2-4. This is a strictly internal review, advisory to myself (and thus independent of accreditation) and I look forward to their feedback and sage advice.

At the leadership level, we have five major national searches underway.  Professional search firms have been engaged for two vice-deans and three department heads, as well as a Director of Finance.  We are doing several assistant dean searches internally. I look forward to having a full leadership team in place, but also recognize and appreciate the hard work currently being done by those in acting positions.

We continue to work in partnership with our provincial government.  This fall, we established a tri-party table between the CoM and the Ministries of Advanced Education and Health.  These discussions have proven very beneficial and I am encouraged to know they will continue in 2015.

We also continue to work with the province and the health authorities on the first ACFP.  Progress is being made. I have up to a dozen potential recruitments on my desk, and many are ideally suited for the ACFP, and are keen to contribute to clinical care and academic work in Saskatchewan. The Provincial Physician Resource Plan should be completed in 2015.

I continue to work with my Co-Chair on the Council of Health Science Deans, Dr. Lorna Butler, to renew that organization, and advance team science and inter-professional education here in the Health Sciences Building, and across the healthcare system.

Other projects I am keen to see move forward in 2015 are our simulation strategy, including a surgical skills laboratory, the development of our medical education unit, a plan for fundraising, and many more….

As always, my door is open. Let me know what you think.

So as Dr. Suess said, “You’re off to great places!”  Welcome to 2015.

As 2014 draws to a close, I want to take a moment to express my thanks to all of our learners, educators, researchers, and staff for all the great work you do. And to all our College of Medicine stakeholders and partners, thank-you for your engagement and your support.

On a personal level, I have to thank all of you for the incredibly warm welcome and great support Jane, Marie, and I have received since arriving in Saskatoon. That goes for Murphy too.  He’s now a certified pet therapist and official member of the volunteer workforce at RUH (picture on his name tag and all!).

However, as a college community, we have an especially important thank-you to express to Martin Phillipson as he finishes his role as Vice-Provost, College of Medicine. Martin has made an amazing contribution to our College of Medicine over the last three years and has done it all with remarkable good cheer!  Today, he presented an update on The Way Forward to University Council.

Martin was asked to assume this role in July 2012 and lead, with the dean, the renewal and restructuring of the College of Medicine.  I can assure you one could probably count on one hand the number of senior university leaders across the country willing to embark on such a daunting task. As the old joke goes, if a university president or provost keeps waking up in a cold sweat, it is probably due to a recurring nightmare he or she has two colleges of medicine.

Change is always hard and no medical school wants to think there is need for renewal. Martin took up this challenge with great determination and enthusiasm. While challenging the status quo he always took time to search out multiple perspectives and listen to diverse opinions. And he was always building relationships and endeavoring to bridge divides.

The creation of the Dean’s Advisory Committee opened up the CoM to our many stakeholders. Martin put together the many working groups that contributed to various parts of the strategy that became The Way Forward. I can’t emphasize enough the endorsement this document has received from our university leaders, our funders, our partners and in particular, our accrediting  bodies.

Another old saying is that when you have seen one medical school, you have seen one medical school. But Martin believed there had to be many best practices we could learn from our peers. He did his research and visited nearly all the other 16 medical schools. I often say, and truly believe, Martin knows more about how medical schools are run in Canada than many of the deans and most of the faculty at those schools.

Martin’s work and relationship skills have been particularly effective in growing our stature in the university and it was not without criticism he promoted us as the “Flagship College” at the U of S. It is a worthy and lofty goal that is assumed by many of our peers. He also promoted us as a foundation of the provincial healthcare system.  That vision – more than any other factor -drew me to Saskatchewan. Through that vision, and Martin’s great relationship skills, we have established a strong working relationship with our government partners.

Finally, I want to recognize and thank Martin for his support to the interim deans (which in itself is no easy task) and to me.  For the last seven months, Martin has been an invaluable source of history (almost as good as Kathy Kalyn), and a great advisor. The business world calls this period “on-boarding” and universities are not known for being good at it, but my transition has been remarkably smooth. My personal thanks (and a good bottle of Scotch) go to Martin.

Martin is going on a well-deserved one year administrative leave, but will be here on campus and be with us from time-to-time to assist on some ongoing projects such as the provincial ACFP.

I keep saying in the short term we can be the best small medical school in Canada. While challenging at times, Martin’s and your hard work over the last three years has prepared the foundation for achieving that goal. I firmly believe we are ready and able to “fly on our own”. However, I would like us to pause and thank Martin for his enthusiasm, determination, hard work, warmth and good cheer in contributing to our journey.

Jane, Marie, and I would like to wish all of you the best this wonderful holiday season can bring – with plenty of rest, time with family and friends, and the occasional indulgence! We hope for you and your family, and the College of Medicine, a warm (figured out to live here I must always mention the weather), rewarding, and prosperous 2015.

Many scientists, clinicians, staff and learners at the CoM make enormous contributions to our worldwide community every day.  Community service is an incredibly important thing that defines what universities do and certainly that is so here at the CoM.

I had done an earlier blog on the contributions to our community by our students. However this fall one particular contribution stands out in my mind as quite remarkable and deserving of our acknowledgement and collective thanks and admiration.

Dr. Bruce Reeder from our Department of Community Health and Epidemiology spent this fall in Liberia working with Medecins Sans Frontieres helping control the outbreak of Ebola in that country.

Below is Bruce’s brief and modest account of his courageous and significant contribution to the health of our global community.

This fall, from Sept 23 – Nov 4, I worked as a medical epidemiologist with Medecins Sans Frontieres in the rural northern region of Liberia on the effort to control the outbreak of Ebola Virus Disease. 

I joined a team of 25 international and 250 national staff delivering a comprehensive control program in the county in conjunction with personnel from the Ministry of Health.  We provided clinical care in a 100 bed Ebola treatment centre; an outreach team focused on case detection and transportation, the provision of safe burials, the reinforcement of existing health structures; others of us detected the contacts of confirmed cases and ensured they were monitored for the 21 day incubation period of the disease; a community engagement team worked closely with community leaders to provide accurate, culturally sensitive information on the disease, its treatment and prevention. 

The work was intense: 7 days a week from 7 am to 9 pm most days, but the team was of excellent caliber and everyone’s motivation was high to get on top of the outbreak.  In this region of the country, in fact the incidence of the disease has steadily declined since September.  Smiles are returning to the faces of local residents and you again hear music in the streets.

I was pleased to play a small part in this international effort.  Canada is playing a prominent role through the development and testing of potential vaccines, the provision of BSL 4 laboratory support, and supply of volunteers like myself.  The spread of the epidemic is now decreasing throughout Liberia, but continues to grow at an alarming rate in Sierra Leone and is not yet under control in Guinea.  Intense efforts will almost certainly be required for at least another 6-12 months, and in the long term, solid support is needed from the international community to reinforce health systems and infrastructure throughout the region.

Regards,
Bruce

Centers for Disease Control and Prevention
Morbidity and Mortality Weekly Report – Early Release/Vol.63
November 14, 2014