I attended events last week here at the College of Medicine that were great examples of medical education expertise and scholarship and, for me, inspire great confidence in our college.

On Thursday night, I attended Surgical Grand Rounds. Drs. Cole Beavis of the Saskatoon Health Region and Gordon Kaban of the Regina Qu’Appelle Health Region combined to do a great presentation at Saskatoon City Hospital on the use of simulation in surgical education. They covered the pedagogy and tools of effective simulation, including a discussion on debriefing. They provided many great examples of hi-tech simulation tools and more frugal approaches, including a trip to Rona to construct a simulation tool for emergency cricothyrotomy (emergency airway puncture).

In the Health Sciences Building, we have secured space for a surgical simulation facility and our advancement team is working with Drs. Beavis and Ivar Mendez (unified head of our Department of Surgery) to raise funds for simulation equipment. RQHR has had the advantage of the Dilawri Simulation Center since 2012, due to a generous donation from the Dilawri Foundation.

On Friday, the Department of Medicine had its Resident Research Days. I have had a chance to review the abstracts for the posters and oral presentations. They were excellent and I am told the quantity and quality have improved dramatically this year. Congratulations to the residency program director, Dr. Karen LaFramboise and the assistant program director for research for the Internal Medicine Residency Program, Dr. Terra Arnason. The Department of Medicine had its Research Day for faculty earlier in the week, on Tuesday.

The week was capped off for the Department of Medicine with its Research Days Banquet & Faculty Awards at Marquis Hall on Friday. There was a great turnout of faculty and residents on a beautiful evening on our campus. Many awards for both faculty and residents were handed out. I would like to highlight four awards Dr. Sam Haddad, the unified head of medicine, has instituted, and their recipients from the Department of Medicine:

• Researcher of the Year – Dr. John Gordon, Dr. Debra Morgan
• Teacher of the Year – Dr. Anne Paus Jenssen
• Clinician of the Year – Dr. Hassan Masri
• Administrator of the Year – Dr. Erik Paus Jenssen

The evening was capped off as all of the finishing postgraduate learners in year 3 were introduced along with their next program and destination that will see them complete their postgraduate education. Congratulations also to these residents and the department for its huge success in the Canadian Resident Matching Service!

Finally, this past Friday was our first annual Medical Education Research and Scholarship Day. This initiative was led by our Director of Faculty Development, Dr. Cathy Maclean, who with her usual energy, enthusiasm and organization, did a fabulous job. We had over 50 participants, as well as guest speaker Dr. Doug Myhre from University of Calgary, 16 posters, 45 abstracts, three oral presentations and various workshops. It was a great day and a great example of our strategic priority to improve medical education scholarship and research here at the College of Medicine.

After those two days of seeing such commitment to the College of Medicine and so many dedicated researchers and educators doing great work, I felt I really deserved a great weekend’s rest. I was bacheloring it this weekend as my wife Jane and our dog Murphy are at the Canadian Association of Emergency Physician’s meeting in Whistler where Murphy is sitting by a research poster that documents the impact of a therapy dog in the Emergency Room! So my “rest” was cleaning and painting my garage!! I hope you all had a better weekend than that. But if you want to see a really neat garage, come by anytime.

As always I welcome your feedback.

 

 

I recently attended the Canadian Conference on Medical Education (CCME) in Winnipeg. This meeting is an increasingly significant event for collegial interaction with peers across the country, faculty development and dissemination of medical education scholarship. It’s a collaboration of the Association of Faculties of Medicine of Canada (AFMC), the College of Family Physicians Canada, the Royal College of Physicians and Surgeons of Canada, the Medical Council of Canada and the Canadian Association of Medical Educators. The CoM was well represented throughout the meeting (which for me also entails two days of AFMC Board meetings—part of the price one pays for these jobs!).

On the other hand, a highlight was dinner with eight members of our Student Medical Society of Saskatchewan, who were in Winnipeg for meetings with the Canadian Federation of Medical Students. I congratulate these students for their leadership on the national scene of undergraduate medical education.

The opening plenary session at CCME is always the Wendell J. MacLeod Memorial Lecture. MacLeod was our college’s first dean and the first president of the precursor to the AFMC. This year we heard an extremely thoughtful and moving address on the history of residential schools and the work of the Truth and Reconciliation Commission (TRC) by Ry Moran, Director of the National Centre for Truth and Reconciliation.

The AFMC devoted a half-day of the board meeting to the AFMC’s and each medical school’s response to the Truth and Reconciliation Commission. We were joined by many faculty members, medical education leaders, partner organizations, learners, and Indigenous faculty, learners and leaders.

While it is clear that we have so much more work to do in addressing the TRC recommendations and serving our Indigenous communities in Saskatchewan, I can also say that the U of S and the CoM are seen as national leaders in this mission. In fact, one of the breakout group questions was about incorporating Indigenous Health in our mission statement, and I was able to share the great work we have accomplished with our very inclusive and collegial strategic planning process in the last year.

I call your attention to the plan on our website, and provide here our new Mission statement:
As a socially accountable organization, we improve health through innovative and interdisciplinary research and education, leadership, community engagement, and the development of culturally competent, skilled clinicians and scientists. Collaborative and mutually beneficial partnerships with Indigenous peoples and communities are central to our mission.

And as one of our seven strategic priorities, we declare on Indigenous Health that we will:
Respond to the Calls to Action in the Truth and Reconciliation Report and work in a mutually beneficial and collaborative manner with the Indigenous peoples of Saskatchewan to define and address the present and emerging health needs in their communities.

As many will know, we now have 73 self-identified Indigenous graduates of our MD program and 19 of those physicians have taken up faculty appointment with our college. Of the 143 UGME students identified in all Canadian medical schools, the U of S and the University of Manitoba account for nearly 50 per cent!

I was both proud and extremely impressed as our alumnus and Metis physician Dr. Alika Lafontaine, MD Class of 2006, provided the keynote address to this very important discussion. Alika was extremely articulate in describing his work on the history of engagement with Indigenous communities and I know we all learned a great deal from him. And more importantly, we understood that we need to both learn and do a lot more for Indigenous communities and Indigenous Health.

In that regard, with members of our Indigenous Health Committee, we will further develop our strategic priority of Indigenous Health at our senior leadership retreat later this month. At a very profound pipe ceremony led by Knowledge Keeper Bob Badger, the search for our Chair in Aboriginal Health was launched earlier this year.

So this meeting confirmed for me the importance of what we are doing on Indigenous Health, but it was really reinforced by the book I am currently reading: Determinants of Indigenous People’s Health in Canada: Beyond the Social. I am learning a lot from the book, written primarily by Indigenous scholars from across Canada, and am particularity intrigued by the concept identified in the chapter titled Two-Eyed Seeing in Medicine.

This concept is elegantly explained in an essay by Murdena Marshall and Albert Marshall, who are described as deeply valued Elders from the Mi’kmaw Nation, and Cheryl Bartlett, a former Tier 1 Canada research chair in integrative science. All three were at Cape Breton University, the leading university in Atlantic Canada in serving Indigenous peoples and the five First Nations in Cape Breton. From that essay:

 “Albert is the person who coined the phrase “Two-Eyed Seeing”/Etuaptmumk as a guiding principle for collaborative work that encourages learning to see from one eye with the strengths of Indigenous knowledge and ways of knowing, and from the other eye with the strengths of Western knowledge and ways of knowing, and learning to use both these eyes together for the benefit of all.”

While recognizing the absolute importance of the social determinants of health, the book explains that the determinants of Indigenous Health go much further, to include connection to the land and geography, language, self-determination, reconciliation and so much more! I highly recommend the book to all.

As we continue on our mission to serve our Indigenous communities in Saskatchewan, I hope I and the CoM learn to see with two eyes. As always, I welcome your feedback and look forward to your thoughts.

As many of you may have heard, last week faculty council approved a new five-year strategic plan for our college. This exciting milestone marks our progress on implementing The Way Forward. Our success there has enabled us to move from that change initiative focus back to a strategic planning framework. Our new plan will guide us to 2022.

We will be rolling out the high-level plan document next week. With the inclusive and consultative process followed to develop this plan, many of you will already have a good sense of our direction and priorities. I believe that you will see in this plan our shared aspirations for our college. Additionally, we developed the plan to mesh effectively with the university’s approach on its own vision, mission and values, and it will align with the university’s current strategic planning process underway this year.

While there is much work before us, we truly are on our way!

I will give you, here, an initial glimpse into the College of Medicine’s 2017 Strategic Plan.

In it, we have identified our vision, mission, values and principles, as well as seven strategic priority areas. The plan speaks to our important leadership role in the health of the people of Saskatchewan, as well as the world. It speaks to how we will conduct ourselves as a socially accountable organization engaged in our communities. We determined that those same values and principles that our university holds dear are our values and principles.

We identified seven strategic priorities. They emphasize that research, education, social accountability and community engagement, Indigenous health, and being a province-wide college integrated and aligned with our health system and strengthened by an empowered and engaged faculty, are critical in achieving our mission.

Further work will be done to fill in more detail in the plan’s priorities in the weeks to come, but we have strongly defined what we will focus on across key areas for our college for the next five years.

Finally, this was a team effort. To our students, faculty and staff, and key stakeholders and partners, I extend my sincere thanks for your engagement and valuable participation in this plan’s development. We started this work together last August and kept the process and our tight timeline on track with your support.

I look forward to further developing and carrying out our new plan alongside all of you. Watch for the plan through further communication next week.

As always, I welcome your feedback.

Guest blog by Kent Stobart, Vice-Dean Medical Education

I’m pleased to say that “what happens now” is in fact already happening. Several people are progressing on the work we have before us to ensure a successful accreditation outcome this fall. There is still a great deal to do, however.

First, though, I want to emphasize some basic, but very important, messages with regard to UGME accreditation:

• Our program is not on probation.
• Our program is fully accredited and always has been.
• We are confident that we will not be on probation after the 2017 full site accreditation visit.
• For the 2017 accreditation visit, our goal is to achieve a full eight-year accreditation, the best possible result – we are shooting for a “PB” (personal best), as the dean wrote in his recent blog just after the mock visit.
• Our ultimate goal, however, is a quality UGME program, and accreditation is a means of keeping us accountable and structured in achieving our goal.

Please help your college out by sharing the above messages at every opportunity!

Also, some further clarification regarding our college’s accreditation history: we have been on accreditation probation twice in the past, but we are not on probation now and haven’t been since October 2015. Probation does not mean “not accredited.” It’s a warning status that indicates accreditation is at risk. Medical education programs remain fully accredited when on probation, but must work to resolve the accreditation issues that have resulted in the probationary status. Thus, though we have been on probation twice in the past, our school has always been fully accredited.

Now, back to the work we have to do between now and the full visit.

That work will include improvements in how we do things and we will be sharing these improvements and our progress towards a successful accreditation visit with you on a weekly basis. We will also be doing more to prepare all our visit participants well in advance of the visit. Ensuring that our students have current and useful information to support their success and that our faculty have the information and resources needed to do their jobs are part of this work. We can’t achieve this in a vacuum, though—we need your help. If there is a problem, we need to know.

Generally, much of the information that supports our students and faculty in their roles is found on the college website as well as in One45. For students, important information to be familiar with to support your success in the UGME program includes curriculum information, program and learning objectives, the Student Information Guide and the Student Guide to Clerkship, syllabi and student policies. For faculty, knowing curriculum information and processes, program objectives, collegial processes and policies and procedures are key areas that support your success. Undeniably, we have ongoing improvements to make in our processes and how we communicate with you to support your roles.

So, how are we approaching the accreditation-focused work of the next several months?

We have a plan in place and people identified to lead all of the areas of work.

There are some clear priorities we must set, as we have a pressing deadline to meet: we must update and submit our Data Collection Instrument (DCI) by June 19, 2017.

Our students have played an important role already in our post-mock work with their recent completion of a Modified Student Survey. The level of participation from our students—80 percent!—was extraordinary given the timelines involved, so a huge thank you to all our medical students for your support through completing the survey. It will supplement the Independent Student Survey (ISA) completed last spring by providing updated information from our students in key areas.

We have an Accreditation Executive Team (AET) that is meeting to discuss and update progress three times a week from now until the accreditation visit, and is composed of: myself; Athena McConnell, assistant dean quality; Pat Blakley, associate dean UGME; Marianne Bell, accreditation specialist; Greg Power, chief operating officer; Sinead McGartland, Senior Project Leader; Alyson Rees, executive assistant to the dean; and Kate Blau, communications specialist. The dean joins us at these meetings, as well.

Focus areas for improvements and leaders for each have been identified. They are:

• Curriculum Improvements – Regina Gjevres, assistant dean curriculum
• Learning Environment/Student Services – Bindu Nair, assistant dean student services
• Educational Resources – Meredith McKague, assistant dean academic
• Faculty – Sheila Harding
• Admissions – Barry Ziola, director, admissions
• Administration – Greg Power
• Modified Student Survey – Athena McConnell
• Student Improvements Resulting from the ISA – Pat Blakley
• Quality Accreditation Visit – Sinead McGartland

Our June submission deadline is approaching fast! That means you may be hearing from one or more of our focus area leads or others as we work together to ensure we have solid information pulled together in the DCI. Please, support all requests effectively and efficiently and be sure to ask for more information if you need it, in your work to respond.

We have identified certain accreditation elements as critical and we will tackle these first. Next, we will focus on elements deemed urgent, followed by those deemed high priority. Communication about progress towards our accreditation visit will be shared with you through weekly updates in our college e-news, in this blog, through monthly Medical Student Updates, and through college website news stories that will serve to highlight involvement of different participants in this work. General information is also provided on the UGME accreditation web page on our college website.

For our actual visit participants, we will provide you with significantly more time, support and focused preparation. Watch for information coming directly to you via email—as few and as streamlined as possible; we have several improvements already planned here—that includes save-the-date information, invitations with automated RSVPs for both preparation sessions and actual visit meetings, and orientation materials. With some exceptions, actual visit participants will be primarily those who participated in the mock accreditation visit last month.

Finally, questions can be directed to me, to Athena McConnell and to Pat Blakley, as well as our focus area leads and any member of the AET.

I thank the dean for providing space to me for this message.

I was invited to speak at the Dalhousie Postgraduate Medical Education professional day for program directors and program administrators. The title above was one of the talks I was asked to present.

What is the “learning environment?”

The “learning environment” has been defined as “everything that is happening in the classroom or department or faculty or university.”^1,2

In our work, where at least two-thirds of our medical education takes place in the clinical setting, our learning environment extends to the entire province. In fact, we have a responsibility to ensure our students have a safe learning environment anywhere—even when taking electives out of province.

So if that is the learning environment, what is a safe learning environment? For me, a safe learning environment is a place you (or your son or daughter) would like to go to medical school. I believe excellent clinical education is dependent on a safe clinical learning environment.

In my talk, I divided the characteristics of a safe learning environment under five headings: Physical, Program, Learning, Clinical, and Behavioral. I provide here my presentation from that day.

Physical includes obvious things like safe house calls by residents, for example. Program includes things like fair and transparent promotion policies. Learning includes things like learning objectives that are attainable. Clinical includes very important principles, like appropriate graduated responsibility and supervision of learners.

The Behavioral heading gets complicated and the discussion at my talk in Halifax developed into a long list. I believe many of us of a certain age were exposed to teaching techniques that are unacceptable today.

I recall an experience in my clerkship with a supervisor who was a fan of scotch and jazz. Tradition was for the house staff to gather in his office late on Friday afternoon, share a “wee dram;” give an assignment to the two clerks to find an obscure piece of trivia about jazz; and share plenty of male jocularity! The irony was that he was an incredible clinical teacher, but the behavior was inappropriate even then. (I am not that old!)

Accreditation is highly dependent on student feedback through the Independent Student Analysis and the Canadian Graduation Questionnaire. Historically, the CGQ documented both locally and nationally that about 30 per cent of students reported mistreatment over the course of four years. The Association of Faculties of Medicine of Canada no longer provides the national comparator on the basis of the fact that zero mistreatment is the only acceptable goal.

Unfortunately, we are not yet down to zero. While the pre-clinical learning environment is not immune, most reports are in the clinical environment. The source is most often clinical faculty but also includes hospital staff, residents and fellow students.

The most common form of mistreatment is public humiliation. This could be shaming over an incorrect diagnosis or public fact-based questioning of increasing difficulty. I include a link to my previous blog on “pimping.” Distressing to me were incidents of racially based comments directed at students.

I know the vast majority of faculty abhor any form of student mistreatment. On the other hand, I am also sure some instances are unintended and that sometimes people are simply unaware of their impact on learners.

We encourage students to come forward with concerns and we guarantee their confidentiality. We can only fix what we know about.

I believe the CoM must be proactive in eliminating mistreatment. I believe it is incumbent on all of us to work every day to ensure our students have the educational experience we would like to have ourselves.

Among my final words at Dalhousie was that we all must be prepared to speak truth to power in addressing these issues.

The CoM has plenty of experienced faculty who can provide faculty development or lead workshops for departments, etc. We have invested more in Faculty Development and welcome the opportunity to assist in making this college a place where zero tolerance for mistreatment is not simply a belief, but also a result.

As always, I look forward to your feedback.

[1] Genn JM. AMEE Medical Education Guide No. 23 (Part 2): Curriculum, environment, climate, quality and change in medical education – a unifying perspective. Med Teach. 2001;23(5):445–54.  [PubMed] [2] Roff S, McAleer S. What is educational climate? Med Teach. 2001;23(4):333–34.  [PubMed]

Two weeks ago, I undertook a course at the Harvard Kennedy School in Cambridge, Massachusetts. HKS is Harvard’s school of public policy and public administration. I’ve had the good fortune to now have completed five professional development programs at Harvard University over the last six to seven years—some at the medical school, but others affiliated with the business school, the education faculty and now two at HKS. I must say I have experienced some of the best classroom teachers in my life at these programs.

This time the course was Leadership Decision Making. As many of you may know, I have quite an interest in the neuroscience of decision making, especially as it applies to how we teach diagnostic reasoning. This course used the same fascinating research to review how leaders can optimize decision making. One very interesting aspect was an afternoon in their Decision Science Laboratory that provided me feedback on my own decision making.

Dr. Jennifer Lerner, the leader and founder of the course, was an incredible teacher and an inspiring leader. Jenn is a professor of Public Policy and Management at HKS, with a PhD in Psychology from U of C – Berkeley. She describes her role as scholar/practitioner and has held numerous roles advising leaders at the highest levels of government, business and military, around the world. The other faculty were equally impressive, and the 60 participants were fascinating people from around the world.

Part of our preparation for the course was a reference (I’ve provided a link below). Jenn surprised me on day one, when she appealed to all participants to not use laptops. Her reasons included the obvious distractions that these tools entail, but primarily focused on the research that shows students taking notes on laptops retain less material than those who do it the old-fashioned way!

Careful perusal of this paper will reveal that there is more to it than that. The evidence is that most people can type faster than they can write but written notes outperform laptops! While overall pen and paper notes outperformed laptop notes, in fact within and across both groups, note takers who took concept-based and summarizing notes outperformed learners who took verbatim notes.

So we should do all we can with our pedagogy to avoid conditions that promote verbatim note taking.

As with most blogs for the rest of this year, I will bring you back to accreditation of our undergrad program. One area of student concern that was very clear to our mock accreditors was the issue of lectures. The two concerns raised were those lectures where the slide deck was not available before the lecture and those that were not recorded.

Making the slides available before the lecture allows students to prepare for the lecture and actually plan their note taking. The research clearly shows that the opportunity to reframe the content, move from words to concepts and summarize the material leads to deeper learning. Furthermore, we know one of the reasons students attend lectures in person or by viewing a recording is concern that material in the lecture will be on the exam. In those lectures where the students know there is no recording, they are obliged to revert to verbatim note taking.

We also know that students doing review of recorded lectures are predominately doing focused repetitive review of specific segments of the lecture, usually on complex topics and often to complement the notes taken in the lecture. This review is done as much by the students who were in the room as those who were not.

I do know it is disheartening as a lecturer to work hard to prepare a lecture and deliver it to a sparsely populated room. However, students tell me that the prime driver of lecture attendance is actually a well-designed unit or course where all the curricular components—including the lecture—tie together and, most importantly, an excellent lecturer who cares about the students. They all speak glowingly of the hematology module as an example of excellence, and they asked our accreditors why all units or modules could not learn from that module.

Recall that we do not make lectures mandatory and there are many quite legitimate reasons for being unable to attend a lecture. Besides, students always have options. Just Google “YouTube, heart failure.” Wouldn’t we all hope they were watching our lectures?

I know that it is at our faculty member’s discretion to pre-circulate lecture slides and/or record the lecture. However, our students have repeatedly put forward this request. I think there is research supporting the benefits of both of these best practices in providing lectures and lecture materials. I would appeal to all faculty members to consider our students wishes and honour their beliefs in what is best for their learning.

The Pen Is Mightier Than the Keyboard: Advantages of Longhand Over Laptop Note Taking

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

I had the pleasure of attending a national summit on February 22, 2017 in Ottawa dedicated to improving healthcare access and equity in rural communities in Canada. The event marked the launch of the Rural Road Map for Action, which provides 20 recommendations to enhance rural healthcare.

It was held at the award-winning Wabano Centre for Aboriginal Health, which provides a wide range of medical clinics, social services and support, and youth programs for Ottawa’s nearly 40,000 Aboriginal people. I really was impressed by their facility, which was a beautiful space, but also really reflected their vision statement:

We envision a world in which all First Nation, Inuit and Métis people have achieved full and equitable access to the conditions of health including: pride in ancestry, cultural reclamation, peace, shelter, education, food, income, a stable environment, resources, and social justice. And where the gifts and wisdom of First Nation, Inuit and Métis cultures are recognized as valuable, distinctive and beautiful.

The Wabano Centre was a superb venue for a very productive day that united national leaders in education, practice and human resource planning, as well as physicians of rural and Indigenous communities.

Advancing Rural Family Medicine: The Canadian Collaborative Taskforce was created in 2014 as a joint taskforce of the College of Family Physicians of Canada (CFPC) and the Society of Rural Physicians of Canada (SRPC). Key leaders on this taskforce include our own Tom Smith-Windsor, SRPC President, and Kathy Lawrence, CFPC Past-President.

The taskforce worked collaboratively over the last two years leading up to the summit and the launch of the Rural Road Map for Action, which outlines four directions that aim to:

• reinforce the social accountability mandate of medical schools and residency programs to address healthcare needs of rural and Indigenous communities
• implement policy interventions that align medical education with workforce planning
• establish practice models that provide rural and Indigenous communities with timely access to quality healthcare
• institute a national rural research agenda to support rural workforce planning aimed at improving access to patient-centered and quality-focused care in rural Canada

The summit focused on how the recommendations can be translated into actions that are coordinated, comprehensive, measurable and sustainable. The aim is to engage all stakeholders in applying these recommendations to future policy-making and planning, as well as to identify roles in addressing issues related to healthcare equity for rural Canada.

The College of Medicine had a prominent role in the day. In addition to the leaders mentioned above, we were very well represented in a video about rural healthcare and rural education shown early in the day. I can also say we are making progress or have already implemented some of the recommendations.

I highly recommend you check out the road map document and look at the 20 recommendations. As always, I would love to hear your feedback.

Last night we marked a major turning point in the journey to make the College of Medicine one of the best medical schools in Canada and a pillar of healthcare in Saskatchewan, with Faculty Council’s support of our proposed new policy and procedures for the appointment of medical faculty at the University of Saskatchewan. Further to this step, the policy will proceed through the required approval path at the university level.

As you will recall, a major premise of The Way Forward is that the university recognize that “(medical) faculty represent a unique category of university appointees.” As many also know, the College of Medicine has been seriously handicapped by a historic and deeply embedded town-gown divide and structural inequities—these contributed to our total physician engagement in the academic mission of teaching and research being about half of that at similar-sized medical schools.

The good news over the last few years is that more and more of our physicians have become more engaged with the CoM at our two main campuses in Saskatoon and Regina and throughout the province. Many have stepped up to important leadership roles. This is likely primarily because physicians know that their practice, quality of care and professional satisfaction are enhanced by engagement in teaching and research. Repeated surveys of students and residents demonstrate over 75 per cent want an academic component to their career. And increasingly our graduates and residents are staying in Saskatchewan and taking up faculty appointments. This is all good!

Last night’s support is one step in formalizing the recognition of all medical faculty as equal colleagues in supporting the mission of the CoM. In fact, we know that 1,500 (more than half) of the province’s doctors have appointments with the CoM. In the new model, this is a university appointment. Given appropriate qualifications and circumstances, these medical faculty can apply for and hold research grants and supervise graduate students in addition to medical students and residents, and we will work with the university to facilitate further opportunities for these faculty members in this area. The model provides equity with all university appointees.

However, confusion remains, as many are still rooted in the historical language. One of the defining characteristics of the new model is that compensation is separated from appointment. All medical faculty will follow the same procedures for appointment with the U of S and all appointments will have the same rights and privileges. However, there will be several models of compensation.

Those who choose an Academic Clinical Funding Plan (ACFP) will have defined annual compensation and defined academic and clinical deliverables for which they will be accountable to the CoM and the health authority through their department head. The real advantage for them is that the compensation for academic and clinical time is equal. If they choose to leave the ACFP and go to fee-for-service (FFS) or other compensation models they will retain their appointment and look to the CoM for one of the other compensation schemes. The health authority appointment is not linked to the university appointment in any way. On the other hand, one does need to do clinical work to do clinical teaching!!

Others who want to remain in an FFS model, but want to do substantial academic work, may choose to enter into a contract with the CoM. Reasons for this—not the least of which is FFS rates in some specialties—include partnership obligations, group dynamics or simply personal preferences. These contracts will also have defined academic deliverables and, as in any contract, there will be accountability for those deliverables. While this compensation will be fair, there is no guarantee the CoM will be able to match FFS rates in all contracts. That is simply the reality of university funding.

Finally, the vast majority of our faculty who primarily do clinical teaching will receive compensation through a stipend model done on a fee-for-service basis. We have had widespread consultation with these clinical teachers. We have proposed rates that are at the middle of the range across the country. We continue to work on the administrative efficiency of this process and the timeliness of payment. Unfortunately, further improvement is largely dependent on improving our information systems, which is also in our work plan.

Remember, this is all a work in progress. There is great interest in ACFPs and we hope to see a number of existing faculty move to ACFPs in the next six months. Limitations here are the work required to develop these on an individual basis and, of course, funding. Please bear with us as we work with our partners in the health authority and the Ministry of Health. All are in agreement that the ACFP will be an increasingly important model for both the university and the health system as we move forward. Many new graduates prefer this model, with its inherent predictability and the protected time for academic work.

In many other jurisdictions, academically oriented groups of physicians have banded together over time to enter into group ACFP agreements with their university/health authority/province. For example, at Queen’s, virtually all of the physicians in Kingston are on the same AFP. The group ACFP is administered by a practice plan governed by the physicians. This model combines the independence and business models physicians are used to with the collegial trade-offs of clinical and academic work typical of an academic environment. I have made it clear that I would like to see our ACFP model evolve in that direction. In that regard we are developing such a model for the family medicine faculty in our two family medicine teaching units in Saskatoon and Regina.

As I said, this is a work in progress. Our goal is to meaningfully engage as many Saskatchewan doctors as possible in one appointment model and offer compensation models that are fair and transparent. Without a doubt, we have made mistakes already and we will continue to make adjustments. The province’s financial reality is one with which we must contend. But the goal of One Faculty is that we suspend the historic language and don’t listen to rumours – ask questions!!

As always, I welcome your feedback and I sincerely thank all who contribute to the CoM.

I would like to wish everyone at the College of Medicine a happy, safe and restful holiday. I also want to thank you for all of your work during this very busy fall, and throughout 2016. We have accomplished a lot and the holidays provide a great opportunity to step away, rest and rejuvenate for an exciting new year in 2017—just around the corner.

We have made strides across many important initiatives, from UGME accreditation and college strategic planning to our biomedical sciences restructuring and building our research capacity. Our work to re-engage our alumni included a fall 2016 edition of Connective Issue.

We gathered and cheered resident and student achievements at events including the PGME Celebration Night, Fall Formal and the White Coat Ceremony. We worked and built relationships with our students serving on the SMSS. Although not completed, we have thus far navigated the student double cohort, thanks to the efforts of faculty, students, staff and partners in healthcare to make this as smooth as possible.

All in all, throughout the past year, working together we have developed stronger relationships across the college, and will continue to do so. We have much ahead of us, and I look forward to working alongside all of you in 2017.

But first, enjoy a very well-deserved break!

I wrote this blog in the Seattle and Vancouver airports as I returned home from the annual meeting of the American Association of Medical Colleges (AAMC), Learn Serve Lead 2016.  AAMC is the pre-eminent American meeting on medical education and research.

For me, personally, it was a profound week that combined the American election result, Remembrance Day (I still shiver thinking of the sacrifices made by so many Canadians, including an uncle, and of all those cold November 11 mornings I spent as a Boy Scout and Air Cadet!), and the death of Leonard Cohen. It is a good week to remember many of Cohen’s lyrics, but the one that stands out for me now is, “There is a crack in everything; that’s how the light gets in.”

My experience attending American medical education meetings has left me with the impression that many medical educators there lean to the Democratic side. But this meeting was remarkable! Attendees numbering 4,000—and the vast majority were in mourning!! Of course, we were also in a blue state on the left coast, so the newspapers and talk on the street also reflected the mood at the meeting. I said to some friends, “It feels like we are at a wake.” Since I am now acclimatized to Saskatchewan, the daily rain didn’t help!

The meeting began with a plenary by Doris Kearns Goodwin, an author, historian and scholar of American presidents best known for her biography of Lincoln: Team of Rivals. Lincoln was exceptional in many ways but this biography focuses on his leadership, and his strategy to hire his rivals to key cabinet positions. It is an interesting contrast to the current presidential transition underway! And while Goodwin led off with a historian’s confirmation that this election was truly an aberration, her message included many great stories and a reminder all politicians are people with histories, families and a dream of leaving the world a better place. I am sure the conference organizers had no idea their first plenary speaker would be so appropriate for the time!

Dr. Darrell Kirch, the president and CEO of AAMC and an academic leader I have always admired, was somber as he advocated that now more than ever it is important that academic medicine pursue its mission of caring and advocating for the marginalized and the underprivileged. He told an inspiring story of “White Coats for Black Lives,” that described advocacy led by medical students at the University of California, San Francisco. In paraphrasing a politician, he said, “When they go low, academic medicine goes high,” and quoted Lincoln as he called on academic medicine “to be the better angels of our nature.”

Another excellent plenary was delivered by Dr. Atul Gawande, well-known Harvard surgeon, researcher, author and columnist for The New Yorker, and advocate for patient safety. While he led off even more soberly with a definite opinion on the election, he quickly moved on to remind us of the complexity of medicine with 60,000 diagnoses, 6,000 drugs and 4,000 interventions! He described three stages of improvement, with the message that only the third one is proven to work consistently.

1. You should do x (education)
2. You must do x (guidelines, regulation, etc.)
3. Systemize x

Gawande illustrated this point with his work on surgical checklists. One study in Scotland over four years showed a 26 per cent reduction in mortality with 9,000 lives saved – more than had died in motor vehicle accidents. But he brought us back to the present by noting that in the USA, surgical checklists had the lowest uptake in hospitals serving rural, poor and black populations! He described an initiative on a checklist for the prescription of opioids for chronic pain and noted that more people (often marginalized) are dying now from overdoses than from AIDS at that epidemic’s peak! His latest book, Being Mortal, is about end-of-life care, and he noted research shows few people are offered end-of-life discussions by clinicians, with the least likely to receive them being men, those without college educations and marginalized groups.

Overall, his message was that academic medicine can make a difference if we always uphold our values in our clinics, hospitals and medical schools. Read more about his perspective in this week’s short essay in The New Yorker: Health of the Nation.

There were many fantastic seminars and workshops about medical education, concluding with an incredible plenary on advocacy for mental healthcare by psychologist and Johns Hopkins Professor of Psychiatry, Dr. Kay Redfield Jamison. She has been both the co-author on the definitive textbook on bi-polar illness, Manic-Depressive Illness, and sufferer of the same since early adulthood. She has also written extensively for the public, including a memoir, An Unquiet Mind, which describes her experience with mania and depression.

She talked about the stigma of mental illness and described the history that any Johns Hopkins faculty member, staff or learner needing surgical care would seek out a Johns Hopkins surgeon, but those needing mental healthcare would go anywhere but Johns Hopkins due to the stigma of a mental health issue. Dr. Jamison talked about wellness and mental health in particular for clinicians and learners. She talked about how we all had to learn to deal with the paradox that we must all provide care and receive care, and made the link between excellent mental healthcare care for the clinician and patient safety.

Learn Serve Lead 2016 was a great educational meeting, but also a personal experience I will not soon forget. I was struck by three things: the shock and mourning that people were experiencing; the resilience in focusing on what we all can do now to improve healthcare; and the number of shared values with the College of Medicine and our great commitment to social accountability.

And now, I am really glad to be back home.

As always, I have an open door and welcome your feedback, discussion and debate.