Today marks the end of an era in the dean’s office as we bid happy trails to a College of Medicine stalwart: Kathy Kalyn.

And if we were able to sum up the overall impression Kathy’s presence in the College of Medicine has had, it would boil down to: humour, capable, helpful, generous, and cheerful. Or at least those are the sentiments her co-workers associate with my hard-working, and perpetually friendly assistant.

As a farewell, we wanted to show Kathy how much she’s been appreciated over the years, and how sorely we’ll all miss her. So here is a small sampling…

Susan Fillo, Administrative Assistant, Council of Health Science Deans

“I support the Council of Health Science Deans which involves really all the Deans in the health science college. I always needed Kathy’s assistance to help set up the meetings – she had so much knowledge. It was so much fun working with such a generous lady with such a wicked sense of humour.

She’s such a generous person, and has the patience of Job. I understand that her job is so intense with requests coming left-right-and-centre but her utter patience was awesome.”

Doreen Stumborg, Administrative Coordinator, Research Groups

“I am very happy for Kathy. She’s worked a long time on this campus, but I’m really sad for us because she’s a great presence, a great friend. She has history and the experience, not only with this college, but with this campus – she will be sadly missed.

If I was to say anything to Kathy, I’d say it’s been such a pleasure to work in the same office as you, I’ve treasured our times together, and especially the knitting times, I will definitely miss our conversations. I know she will absolutely love retirement and she’ll be able to do all those things she wished she had the time to do now.

So I’m happy for her, and I’m sad for us.”

William Albritton, former Dean of Medicine

“When I joined they were having difficulties finding secretaries for that position, so I told them I would find my own secretary. I figured the secretary of the department of surgery would be able to handle the kinds of issues that were present – she was a little tentative about it at first, but I think she grew to like it.

Kathy can handle problem people with great grace and style, I’ve never seen anybody who was that good – she never got worked up or upset.

She kept me sane – I don’t know what I would have done without her. From what I’ve seen in those ten years there was no one else quite like her.”

Brenda Engel, Executive Assistant, Department of Surgery

“I have known Kathy for 14 years, and to me she is the most popular person in the College of Medicine and Department of Surgery. I’ve never heard one bad thing of her, she’s just so genuine, helpful, nice, and so happy all the time – the most positive person I’ve ever met.

I obviously wish her well, I know she’ll love being at home with her granddaughter, and I hope for all good things for her.”

As for myself, my first reaction to hearing that Kathy intended to retire was “Oh no, you can’t!”

But she’s at that point where she has every right to retire, and she has a growing family that she wants to spend time with, so I’m happy that she’s getting the opportunity to focus on what she loves.

But that doesn’t mean that she won’t be missed in this office.

Her wisdom has been an invaluable resource since I became dean in June.  Kathy really does know everybody and everything, and she knows how to get things done around here – which is no easy feat!  A favour asked by Kathy will always be answered with a ‘yes’, because she’s the kind of person who’s unquestionably respected.

So Kathy, thank you for being here – you made my transition to the dean’s office so much easier. And on behalf of myself and all your co-workers, past and present, we’d like to offer our best wishes for your retirement.

We’ll miss you!

Over the last six months I have had the opportunity to meet with some incredibly talented and invested researchers in our College of Medicine.  What is truly unique about the research enterprise is the unbelievably rich environment to undertake collaborative research both within the CoM and between the colleges and institutes on the U of S campus.

The infrastructure and environment within the Health Sciences Centre aims to build on the “TEAM” approach to science and discovery.  I have not had the opportunity to personally meet all of the cluster leaders, but the effort is well underway.  We are making steady progress.  The Council of Health Sciences Deans is committed to the process and, as a co-chair with Dean Lorna Butler, we will continue to support the TEAM approach to research.

At this stage, our biomedical sciences are continuing to have success at both the provincial and national levels and I have highlighted a few of their projects below.  More importantly, I am working to further support our research agenda and exploring ways of involving the dean’s office to the research enterprise.

In this regard, Dr. Gordon McKay, the CoM’s Vice Dean of Research, and his team need to be fully supportive of the researchers in the College.  We are exploring a number of ways to ensure this happens, including the embedding of the Vice Dean’s office more clearly within the research structure of the College.

As I mentioned I wanted to highlight a few of the many active projects currently underway and also a few of our successes in research funding, and awards at the College of Medicine.  This is by no means an exhaustive list.  Think of it more like scratching the surface of the research success achieved by our colleagues.  In these few highlights, I hope you will have a sense of the breadth of work being done.  These folks all deserve some recognition:

Dr. Darryl Adamko was awarded both a $120,000 SHRF Establishment Grant for his research into better diagnosing asthma and COPD, as well as a $20,000 grant from Cystic Fibrosis Canada for ‘Improved diagnosis and management of CF: A pilot study to develop a metabolomics approach to cystic fibrosis.’

A $110,000 SHRF Establishment grant was awarded to Dr. Camelia Adams for her biopshychosocial exploration of the relationship between childhood trauma, adult attachment and the severity of depression and social anxiety.

Dr. Lane Bekar received the top award in the 2014 SHRF Establishments Grant program this year. His research focuses on understanding how the immune system changes under conditions of chronic stress and its role in the increases of chronic neurodegenerative conditions seen in society today.

A Sylvia Fedoruk Canadian Center for Nuclear Innovation grant awarded to Dr. Paul Babyn and colleagues will be used to create the Saskatchewan Molecular Imaging Centre (SMIC) – a state-of-the-art research facility – to drive molecular imaging innovation. Molecular imaging is a powerful technique that is revolutionizing our understanding of the biology of living organisms by enabling real-time, non-invasive studies at the tissue, cellular, and sub-cellular level using custom synthesized short-lived isotopomers. This imaging initiative will be unique in Canada, applicable to molecular imaging in humans, animals, and plants.

Dr. Yalena Amador Canizares was awarded a SHRF Postdoctoral Fellowship to work with Dr. Joyce Wilson on her Hepatitis C research.  Her research aims to discover how Hepatitis C Virus infections are promoted at a cellular level and then use the information to develop new ways to inhibit the virus and treat HCV infected patients.

Dr. Linda Chelico was awarded a 5 year renewal of her CIHR operating grant to continue her studies of the role of the APOBEC enzymes in HIV infections.  She was also asked to continue as a member of the CIHR Virology and Viral Pathogenesis research grants evaluation committee, and was also invited to join the group of reviewers evaluating applications in Stage 1 of the CIHR Foundation Scheme: 2014 1^st Live Pilot competition

Dr. John Gordon and his research colleagues have been studying how to treat asthma, multiple sclerosis and peanut allergen-induced anaphylaxis shock using a humanized model in mice. Based on the results they have developed a strategy of treatment translatable to a clinical trial in humans.  This trial, in compliance with requirements from Health Canada, will hopefully begin within the next two years.  Dr. Gordon was awarded the 2014 SHRF Achievement Award for his scientific contributions at the local, national, and international level that have led to widespread recognition of his expertise and innovation.

Dr. John Howland won the U of S New Researcher of the Year award for 2014, and was part of a successful team grant funded by Brain Canada wherein he will receive $100,000 per year for three years.

The recent discovery of what may be a key component to understanding lung function in people with cystic fibrosis by Dr. Juan Ianowski and colleagues may lead to further discovery that will help the approximately 4,000 Canadians and countless others who suffer with CF.   Using a pig model, Dr. Ianowski et al are testing the minute layer of liquid in the lungs that normally protects the cells from attack by bacteria but reacts differently CF diseased lungs. Juan Ianowski was awarded a research grant from Cystic Fibrosis Canada of $74,000 per year for three years and was invited to be the keynote speaker at the North American Cystic Fibrosis Conference.Dr. Ivar Mendez’s work in stem cell therapy led not only to his work being featured in Scientific American Mind, but to Canadian and American patents for his Neural Transplantation Delivery.

Dr. Darrell Mousseau received widespread acclaim for his research into Alzheimer’s Disease, and the links between gender, depression, and Alzheimer’s.

A $165,000 innovation grant was awarded to Dr. Troy Harkness and his team by the Canadian Cancer Society to help continue his lymphoma research in dogs to help improve the effectiveness of similar treatments in humans with cancer.

The Canadian Breast Cancer Foundation awarded Dr. Erique Lukong and Dr. Keith Bonham a three-year foundation grant for their project on ‘Epigenetic regulation of the FRK tumor suppressor gene in triple negative breast cancers.’

Dr. Stephan Milosavljevic won an $119,000 Establishment Grant from SHRF for his ‘Walking away from low pain: One step at a time’ study.  Dr. Milosavljevic’s research focuses on investigating the use of walking as a health strategy for chronic low back pain, especially among farmers.

How do you know for sure if you have a concussion?  Up until recently you didn’t – without a very high-tech brain imaging scan. Dr. Changiz Taghibiglou and his colleagues have found that head trauma can cause a specific brain cell molecule to loosen and circulate in the blood. These researchers are working towards the development of a blood test which could result in almost instant diagnosis on the football field, hockey rink and at the scene of accidents, resulting in better and quicker decision making for paramedics, sports trainers and other first responders.  Their discovery is also applicable for screening military service personnel exposed to battlefield blasts.  A patent for the test has been filled through the U of S Industry Liaison Office.

A new five year CIHR operating grant was awarded to Dr. Joyce Wilson for studies of the replications of Hepatitis C Virus.  She was also asked to continue as a member of the CIHR Virology and

Viral Pathogenesis research grants evaluation committee, and was invited to join the group of reviewers evaluating applications in Stage 1 of the CIHR Foundation Scheme: 2014 1st Live Pilot competition.

When the last RUH Foundation campaign reached $67,000 to buy a telemetry bed, Dr. José Tellez-Zenteno commissioned the artist, Eduardo Urbano Merino, to commemorate the occasion.  The painting called “Epilepsy – Leaving the Nightmare Behind.” A second campaign intended to benefit patients with epilepsy is soon to be underway and a second painting has been commissioned.  Watch for it next year.

Please remember, this is only a small sampling, but I hope it will give you all an appreciation for the expertise of your colleagues and teachers.  As you can see, it’s been a productive year for research in our college, and there are many more deserving projects, awards, and publications that haven’t been mentioned. The work being done across the college, in all the labs, is work that has the potential to make a difference in the lives of people across the globe, and it’s research that we’re all incredibly proud of.

In the New Year and beyond, I intend to highlight more of this good work and share it broadly through my blog.  I want to hear your stories and learn about your success, so as always, please do share them with me.

In mid-November, I attended the American Association of Medical Colleges annual meeting known as “Learn, Serve, Lead 2014” in Chicago. It was my first trip to both the “Double A MC” and Chicago – what a lovely and fascinating city! Some down time included a boat architecture tour and some great jazz at a bar in place from the 30’s whose patrons included Al Capone (the Saskatchewan connection). I will be going back.

The conference had some great keynote speakers including Alan Alda who spoke on communicating science and medicine, and emphasized the importance of empathy and clarity in communicating both. http://www.centerforcommunicatingscience.org

Some of the challenges we have had provincially to get a Strategy for Patient Oriented Research initiative into CIHR relate to our challenges in communicating what science can do for our provincial healthcare system. Something else we all must work on, I believe.

Another keynote speaker was Mahzarin R. Banaji, one of the authors of Blindspot: Hidden Biases of Good People. She is a spellbinding speaker with an important message based on rigorous neuroscience and cognitive psychology research. This reminds me of the work on cognitive and affective bias in diagnostic reasoning and the work we did at Dalhousie with Dr. Pat Croskerry. I am interested in hearing from faculty members who have an interest in this topic. http://spottheblindspot.com

However, it was the workshop on Longitudinal Integrated Clerkships (LIC) that I think was a historic moment for the AAMC. I am sure many are familiar with LIC’s but for those who are not it is an entirely different model for teaching clinical medicine and for structuring third year.

While Australian’s and Canadian’s (UBC, U of A, U of C, NOSM and Dalhousie) are noted leaders in this model, it has been spreading rapidly throughout the world in the last 10 years. A number of new medical schools have gone with the LIC model as their sole method of teaching third year (e.g. NOSM).

The LIC has its curriculum organized on a longitudinal and integrated basis. It is distinguished by the absence of traditional discipline-based rotations. Models vary, but students are often based in a family practice for two  or three half-days per week and have additional clinical experiences with other disciplines and in hospitals scheduled through the rest of the week.

Students are encouraged to follow their own bank of patients over time, and benefit from the continuity of supervision as preceptors see their clinical skills develop over the entire year.

Models are often based in rural communities, but urban models are also successful (Harvard, UCSF). The salient features have been summarized as continuity of patient care, curriculum, supervision and empathy!

I have attended meetings of the Consortium of LIC’s (CLIC) since 2008.  There is no doubt there is a counter-culture aspect to this group who truly believe they are going to profoundly change clinical education. And to their credit, they have been meticulous in doing the medical education research to prove their point. Repeatedly evidence has been documented that LIC students do as well or better on objective standardized testing (and some evidence for better long-term retention).

Furthermore, these learners have better clinical skills and greater preservation of the empathy they had when they entered medical school. Anecdotally it is noted that many program directors search out LIC candidates at CaRMS time. And for our communities and our funders, there is lots of evidence LIC students choose more generalist careers and rural practice settings.

This workshop was remarkable in that AAMC and LCME (the American accrediting body) would not often be described as counter-culture. All of the above was presented together by faculty members from such disparate place as Harvard University and the University of South Dakota and summed up by Dr. Dan Hunt, a noted accreditor for the LCME and medical educator.

Dr. Hunt helped with the launch of the Northern Ontario School of Medicine where all the students do an eight-month LIC in third year.  With a red hat on, representing LCME, Dr. Hunt stated LCME “does not care” what model of clerkship a medical school uses. With a blue hat, on representing himself, Dr. Hunt wholeheartedly endorsed the LIC as an excellent and possibly better way of teaching third year.

The traditional rotation-based clerkship was certainly perfectly designed for John Hopkins Hospital in 1910 and obviously has continued to serve us well as evidenced by the personal experience of many of us. However, I do believe we are approaching a “the world is not flat moment” around the best approaches to clinical teaching in UGME.

Last year we had a pilot of an LIC in Prince Albert and we have decided to take some time this upcoming year to refine that model. We will look to our strategic plan for distributed medical education to identify where we should establish LIC’s in Saskatchewan.

I invite faculty members and students to apprize themselves of the literature on LIC’s and enter into a discussion about the role of LIC’s here in our CoM.

Are you familiar with these phrases? These are part of an international movement that I believe has the greatest potential to make our health system sustainable.

All clinicians are aware of the waste in our system and examples are plentiful.  Consider the back x-ray done for acute back pain after a weekend of yard work.

Evidence abounds that without any red flags in the clinical presentation, this x-ray is simply waste.  Often, the busy doctor knows it is waste, but does not have the time, evidence, and alternate resources for the patient, or possibly the negotiating skills to explain why the test is unnecessary.

But waste it is!

We can all find many more examples. Why is there remarkable variation in the rates for some major surgical procedures between Regina and Saskatoon?  Why is there duplication of tests by FD’s and consultants? Why are high-cost statins prescribed? How do people get antibiotics for a two-day illness consisting of a sore throat accompanied by a runny nose? Lots of evidence suggests 20% of what we do brings no benefit to our patients.

Now I know there always exceptions to these examples, but that’s why we call it clinical judgment. While making our system more efficient is essential, continuing to do wrong or unnecessary interventions more efficiently will still be waste.

The greatest potential for improving our system is changing clinical practice and models of care.  And physicians worldwide are leading this initiative.

The American Board of Internal Medicine (ABIM) launched Choosing Wisely in 2012 in the US. This led eventually to the ABIM calling on all specialty organizations to list their top 5 “Things Providers and Patients Should Question”.  http://www.choosingwisely.org/doctor-patient-lists/

So for the American Academy of Family Physicians, the back pain above is the first example. In fact, ABIM goes a step further.  In their charter, Medical professionalism in the new millennium: a Physician Charter, they state physicians have a responsibility to promote health equity when resources are scarce. When Dr. Chris Simpson, President of CMA, spoke earlier in November about the “civic professionalism” of our students, this is part of what he was talking about.

“Choosing Wisely Canada (CWC) is a campaign to help physicians and patients engage in conversations about unnecessary tests, treatments and procedures, and to help physicians and patients make smart and effective choices to ensure high-quality care.” http://www.choosingwiselycanada.org

It is led by Dr. Wendy Levinson, an internist at U of T, for the CMA and supported by the SMA. “As physicians we are stewards of our patients’ health and it is our responsibility to partner with them in making appropriate choices for their care,” says Dr. Slavik, SMA President, “Doing so will not only ensure that our patients receive optimal care, but will also ensure that we have a sustainable healthcare system.”

Earlier this month,  the Academy of Medical Royal Colleges in the UK released a report: “Protecting resources, promoting value: a doctor’s guide to cutting waste in clinical care”. One of the intriguing aspects of this report is how the potential savings of various interventions are listed in terms of both financial cost and carbon cost. It is quite sobering to see what we could do for our planet by choosing wisely! They also state “that doctors have an ethical duty not to waste.”

http://www.aomrc.org.uk/doc_download/9793-protecting-resources-promoting-value.html

Appropriateness is another common term used for the same philosophy.  Recently the province issued a call for a Physician Co-Lead, Clinical Appropriateness of Care Program. This will be a major initiative by the Ministry of Health.

And this is a major opportunity for the College of Medicine.  What can be our role?

I see three: teaching these skills to the next generation; CME for current practitioners; and doing the research on clinical practice in our province that leads to everyone “choosing wisely”.

I had the opportunity 18 months ago to participate in a conference at Harvard on how we teach the knowledge and skills to support wise stewardship of health care resources. While we have been great at teaching patient-centered communication in the last 20 years, we do not teach the negotiating skills that allow practitioners and patients to easily deal with these issues. We must provide this content to our learners and model the corresponding care.  Through CME, we must do the same for our practitioners.

The Canadian Institute for Health Research has a funding stream called the Strategy for Patient Oriented Research (SPOR) to support real-time research on clinical practice here in Saskatchewan. It is imperative our College of Medicine takes a leadership role in this important initiative and do the research on our practice here in Saskatchewan that will lead to better care and ideally to zero waste.

Please take the time to visit these websites, learn more about Choosing Wisely Canada, discuss with colleagues and friends, and tell me how we should lead at the College of Medicine.

I had the privilege to do the introduction and welcome at this week’s Health Innovation and Public Policy Conference.  I joked that I loved the words, “student-led” because I was confidant it would be high-quality with little work on the college’s part! Well, I had no idea how right I was.

This got me reflecting on the huge contribution our students make to the College of Medicine and the magnitude of the student-led activities here at the U of S. First let me comment on the conference and then come back to our students.

This was the second annual Health Innovation and Public Policy Conference and my only regret is that I missed last year’s conference. This is entirely a student-led initiative. As I noted that day, Honorable Rona Ambrose, Canada’s  Minister of Health, has created an Advisory Panel on Healthcare Innovation.  Just these past two weeks, I have worked with my fellow Deans at the AFMC to prepare a brief for that panel. I think we could have asked the U of S students to do it for us.

The quality of the speakers at the HIPPI Conference was remarkable. Dr. Chris Simpson (another Maritimer and graduate of my alma mater) who is President of the CMA, spoke of the need for transformational change that moved the system from being all about doctors and hospitals to one that was truly patient-centered and sustainable. I believe our CMA has become a national leader in calling for system change focused on the patient.

Dr. Karima Velj, President of the Canadian Nurses Association, had very complimentary messages and spoke of inter-professional care and expanded roles for healthcare providers.

Dr. Gary Bloch, a family doctor with an inner-city practice in Toronto, spoke eloquently about the need for doctors to go beyond taking a socio-economic history and treat poverty like it is a disease.

And to cap the event off, we had excellent speakers from the U of S with Dr. Veronica McKinney providing a vivid description of the healthcare challenges in our North and the good work of Northern Medical Services.  Dr. Ivar Mendez described meeting some of those challenges in our North with remote presence technology.  It was a remarkable afternoon capped off with an excellent panel discussion.

Back to our students.

All medical schools have bright students and great student leaders.  However, I think the initiative shown by our students here at U of S is more than above average!

I attended the One Health Leadership Experience late in August, which is a conference for students from all of health sciences colleges on campus.  This is sponsored by the Veterinary College and the Council of Health Science Deans and led by WCVM Dean, Dr. Doug Freeman. The speakers were amazing but the turnout and enthusiastic participation of students on the last free weekend of their summer was quite overwhelming.

In early September, the Student Medical Society organized the 11^th Annual Miles for Smiles.  http://miles4smiles.usask.ca/  This fun walk/run event took place in both Saskatoon and Regina, with all proceeds going to support the Children’s Hospital Foundation of Saskatchewan.  Although I was unable to attend personally, I understand the cool, rainy weather did nothing to dampen spirits or speeds!

On September 18, student volunteers from our School of Physical Therapy participated in Shinerama, the largest post-secondary fundraiser in Canada, which raises money for Cystic Fibrosis research and treatment. Our School has been involved in Shinerama since 1966. The students involved in Shine Day went out in the streets of Saskatoon and on the U of S campus bringing in donations by shining shoes, singing songs, dancing, and doing whatever they could to raise money for CF research and treatment.  As a profession that helps treat symptoms in Cystic Fibrosis patients, it has always been an important fundraiser. This year our campaign raised $29,474.54 for Cystic Fibrosis research!

I attended part of the Hacking Health Saskatoon weekend late in September.  http://www.hackinghealth.ca/events/saskatoon/hhsaskatoon2014/  In their words: “Hacking Health is designed to improve healthcare by inviting technology creators and healthcare professionals to collaborate on realistic, human-centric solutions to front-line problems. Our hackathons are fun, intense, hands-on events where small teams tackle tough problems in a supportive community of peers and mentors.”

Medical and other health professional students worked all weekend with computer science, business and engineering students to create technical solutions to health care problems.  Hacking Health is a national and international movement and at the conference this week one of its students leaders lobbied and convinced Dr. Simpson that the CMA should become a sponsor. It was health innovation advocacy in action and a beautiful thing to watch!!

Back in October, I was also privileged to attend another entirely student-led event, the Global Health Conference.  It was the third annual gathering and this year was focused on immigrant and refugee health.  Saskatchewan has a growing number of newcomer families, and health is a key factor in successfully settling and integrating people into our communities.  Speakers discussed language and cultural barriers in our health care system and challenges related to lack of resources, coordination and cross-culturally trained health care workers.  The event was a prime example of inter-disciplinary work and social accountability.

Of course SWITCH, is a long standing student-led initiative supported by faculty members that provides both learning and care by students from all health professions at the Westside Community Clinic.  “SWITCH was created by students in order to enrich educational experiences and to provide much needed services for Saskatoon’s core neighborhoods.”  Please visit http://switchclinic.ca  to learn more. Our College has a national reputation as a leader in Social Accountability and our students play a big role in that reputation.

In summary we have an amazingly active student body who are doing great work that matters.  Dr. Chis Simpson commented on the “civic professionalism” of our students and the hope that he has for the future of our healthcare system because of the energy, values and advocacy that the students of today will bring to the workplace.

I believe he is right.

I’ve come to recognize over the last five months that accreditation is a bit of a touchy subject here.  It doesn’t need to be.  Accreditation is about continuous quality improvement and assurance, and as a self-regulated profession, medicine has a responsibility in this regard.  In fact, we have a collective responsibility.  Now that Canadian medical schools have our own set of accreditation standards for undergraduate medical education, we have an opportunity to be even more responsive to our unique Canadian needs. As I’ve said previously, accreditation is a team sport.  Part of what I  want to do is to help everyone in the college understand how their role contributes to our accreditation success.

We have a number of accreditation surveys in the coming months.  Continuing Medical Education, the School of Physical Therapy and both our undergraduate and postgraduate medical education programs are all preparing for visits in 2015.  We don’t need to fear accreditation.  Instead, we should view our interactions with accrediting bodies as learning opportunities that ultimately benefit our college and the students, residents and practicing professionals we serve.

It’s no secret that our undergraduate medical education program was placed on accreditation with probation last fall.  I don’t want to predict how our performance will be judged by the survey team, but I do want to set realistic expectations.  I know from experience that we could be seen as demonstrating great progress in a number of areas and still remain on probation, with another limited survey in the future.  I’ve seen this scenario play out at other institutions, and it is a possibility for our college.

One strategy we are using to help strengthen our position, is to create a faculty position focused on quality.  Specifically with respect to our UGME program, I am pleased to be working with Dr. Athena McConnell, our new assistant dean, quality.  Athena has already demonstrated her deep understanding of the UGME accreditation process and she will be responsible for preparing and coordinating  our limited site survey for next May. She and I will be working together very closely, along with Dr. Sheila Harding and many others across all sites and disciplines.

To help give you a flavor of Athena’s role, I’ve asked her to guest author a short introductory piece.  Here’s what she had to say:

Accreditation is like the Black Plague these days – people try to avoid it, and shudder when they hear it. It’s unfortunate; the College of Medicine has a post-graduate accreditation visit this fall, a limited visit for the undergraduate program in the spring, a continuing medical education visit next year and a full undergraduate review in 2017.

Accreditation is not something we should fear. Accreditation is a standards-based, peer review process of continuous quality assurance and improvement of the structure, function and performance of an organization. For our medical school, accreditation is about continuously working to identify barriers or processes that hinder us from delivering the best product – competent and caring physicians. This is why the newly established assistant dean role is labeled “Quality”, not “Accreditation”.

In order for the accreditation process to work, we – faculty, students, residents, staff – all need to understand the critical roles we have to play. Accreditation is truly a team sport. 

As Dr. Harding points out, it’s difficult for a team to have a winning season if the players don’t know the plays and practice together. My daughters sing in choir. They understand that all members need to practice at home, but also need to sing as a group in order for the melody and harmony to come together.

The same applies for accreditation.  Success requires each of us to understand, in very concrete ways, how we contribute.  For example:

•             ED-30 calls for submission of grades no later than 42 days after the end of the rotation/course. In order for this to be accomplished, preceptors need to return evaluations in a timely manner and administrative personnel are required to collate the information prior to the deadline. 

Each of us in the college community is vital – everyone from the coach to the water boy has a role to play in our team’s success.

Further to what Athena has shared on ED-30, my intention is to share with you over the coming months some further thoughts on each standard.  What the standard is, what it means in our specific context and what we need to do to demonstrate compliance. We have much work to do, and I am counting on your support.

Sincerely,
Preston

Good Afternoon Med 1 students here at the College of Medicine, President Barnhart and our distinguished guests who serve as cloakers, proud family and friends, colleagues. It is indeed a great honor for me to give this keynote address to my first White Coat ceremony at the College of Medicine. This profession has been an incredible privilege for me since the very first day of medical school and I am excited to further welcome you to Medicine through this ceremony.

As a community Family Doctor and as a committed introvert I must admit I was always more of a sweater and khaki’s kind of doctor. But I vividly recall my own first white coat and the excitement and anxiety of first putting it on in front of the mirror and wondering who was this doctor look alike staring back at me.

So there is little doubt that the role of the physician in society is changing. We now work in inter-professional teams, everyone’s scope of practice is changing, and the physician’s immense knowledge base is now available to everyone on their phone!

So what does it mean to be a doctor? I was interviewed on this topic just a month ago by a consultant engaged by the Canadian Medical Forum – a high level alliance amongst all of our profession’s national organizations.

I want to talk to you today of  3 aspects of the role of the physician that I discussed in that interview: privilege and the doctor-patient relationship; becoming a doctor and professionalism along the way; and the meaning you can attach to this white coat.

By privilege I don’t mean the entitlement that comes from success or pride. In fact I mean the opposite. What I am talking about is the immense privilege we receive when our patients demonstrate their trust as they enter into the doctor-patient relationship with us.  There is a social contract between society and our profession that confers on us great benefits like profession-led regulation, autonomy and substantial personal reward and society expects in return when they are ill or vulnerable in any way we, either individually or collectively, will always act in their best interest.

I have a story from my own practice. Colin, an eighteen year old guy, ran his motorcycle into a moose one night and in an instant became a quadriplegic. His bright young girlfriend, Cathy, stuck by his side and when he left the hospital a year later they married. After that as a very young man I became their family doctor and we embarked on a remarkable 20 year journey together. Life dealt them and thus me many interesting challenges. What always amazed me was the humor and resilience they always demonstrated and the remarkable trust they showed in including me on that journey. She had obesity and early type 2 diabetes  and he had frequent UTI’s and many hospitalizations for pneumonia. Along the way I delivered two daughters one of who developed chronic kidney disease. They always visited together and every challenge was met with met with a smile or a joke.

One day they came in laughing and said have we got a story for you. As their kids grew they had got into a habit of going for a ride in their van whenever a serious family matter arose. On this occasion he said we should go for a drive and she responded that coincidentally she had something to tell him. They said Preston you are not going to believe this! First he told her their 16-year-old daughter was pregnant and then she told him their 15-year-old daughter was pregnant! And then they laughed! I was in shock but — what else were they going to do! And so I laughed too!

Looking back I am still in awe of the fact they trusted me enough not to judge and that I would be there for them through another of the unending trials life would throw at them.  I got to deliver those two babies and of course one of them developed chronic kidney disease.

This rich and unique doctor-patient relationship is to me one of the most important aspects of being a physician and always must be cherished.

Before I talk of professionalism in medical school I want to emphasize one unique aspect of our  profession.  Only physicians have both the immense breadth and depth of knowledge about the human condition and the tremendous toolkit, along with our colleagues and partners in the healthcare system, to help people in need. Doctors span genetics to geriatrics, renal physiology to population health, talk therapy to endovascular treatment of brain aneurysms, and the list goes on.

Professionalism is the second aspect of our role and essential to how we apply that knowledge and toolkit. I have another story. Last week a frustrated faculty member was telling me of a fourth year student. This student was at rounds with the healthcare team, sprawled across a chair with feet up on a desk and started his case presentation with the words: “This patient says….”. This is one of those “count how many things are wrong in this picture”. First even the most casual amongst might perceive little respect, second the patient does not have a name and finally the patient’s story is considered suspect.  Certainly not a stellar demonstration of professionalism.

But that is not what worries me the most. When challenged the student’s explanation was that he was going into radiology and not much interested in internal medicine.  I don’t know how you do radiology without immense knowledge of internal medicine but that is another discussion.  Professionalism requires respect:  respect for the knowledge you have learned, respect and understanding for how much you still have left to learn, and above all:  respect for your patients and colleagues.

Before I pass on my next piece of advice to you I would like to share some statistics. I know you are already thinking of CaRMS and our system seems biased to making you choose a specialty before even becoming a doctor. One third of you come to medical school with a firm fixed belief of your chosen field. I think a few of you can even trace this back to the seventh month of your gestation. One third of you have a good idea of what you want to be and one third of you have no idea! The important statistic is fully one half of those with an idea or a firm fixed belief will change your mind while in medical school.

So my plea to you is this:  medical school is your only chance to first become a doctor. No matter your field that breadth and depth of knowledge of the human condition is essential for every doctor-patient relationship. Keep an open mind, take it all in and first become a doctor.

So what does this white coat symbolize to me? Remember, I’ve always been a sweater and khakis doctor.  When I first went back to Dalhousie as a full time faculty member I was amazed.  The first day in the hospital I saw a senior colleague in a white coat with 6 white-coated students following in a line closely behind. I must admit being tempted to follow along, just to see if they really would follow him right into the bathroom!

Seriously this is important because some have criticized the white coat and white coat ceremonies as symbolic of entitlement and elitism. I choose to view it as a symbol of altruism. Altruism is defined as the selfless concern for the well being of others. It is a key component of the Hippocratic oath. Heroic examples abound such as the famous Canadian Norman Bethune in Spain and China who was a friend of the first dean of this college, Dr. Wendell MacLeod.  Today I think of all those health colleagues now in Africa fighting the Ebola epidemic. I don’t ask for heroism everyday but what I do ask for everyday is you always put your patients needs first.

This word privilege is interesting. Just over 100 years ago doctors were in private practice and the hospitals were for the poor and the patient faced less than even odds of benefit from approaching either doctor or hospital.  But as medicine advanced doctors needed the hospitals to help their patients and thus applied to work in the hospital. That was and still is called “hospital privileges”. So patients give us their trust and the healthcare system gives us privileges. This trust and those privileges are dependent on us putting the patient first.

As I said on your first day you are now in a new learning dynamic where the patient is as integral and essential to your education as your professors. Over the next 4 years your patients will be paying it forward in teaching you. They will be your very best teachers.  Cherish the doctor-patient relationship, embrace and practice professionalism and remember the meaning behind privilege.

So for me wearing the white coat as a learner symbolizes what we owe our patients.  And for me as a physician it is a symbol of the immense privilege we have in this profession and the trust we receive every day in every unique doctor-patient relationship.

So I wish you all the best in your journey here at the College of Medicine. I look forward to learning alongside and from you.  Remember my door is always open and I want to hear from you. And think often of the great privilege you have have been given in this profession of helping people through the doctor-patient relationship.

Our Family Medicine Residency Training Program is officially up and running in Moose Jaw.  To celebrate, we gifted our first four residents with CoM White coats on September 22.

This summer I have had the chance to tour this beautiful province and to date I have been to 6 of the health regions.  I have met committed physicians, hard working hospital and community leaders and enthusiastic learners. I have also learned of the challenges with the longstanding shortage of doctors in Saskatchewan. It has reinforced to me why we must get distributed medical education right for the people of Saskatchewan. I will start with 3 anecdotes that align with the 3 principal reasons for distributed medical education that are evidence-based. Continue reading →

To be sure, the new dean of medicine at the U of S sees many changes on the horizon for the college but Dr. Preston Smith wonders if there is a group of professionals better prepared for change than doctors.