Guest blog by Erin Prosser-Loose, on behalf of the Diversity and Inclusion Working Group

Intentional action to promote diversity and inclusion in the workplace leads to increased productivity, more creativity, new discoveries, and is the right thing to do. In the context of the College of Medicine, diversity refers to having a broad range of personal characteristics and life experiences represented across our faculty, leadership, students, and staff; this diversity is reflected through our policies, programs, and practices. But having a diverse group is not enough if people are not happy and thriving in the workplace. Inclusion takes it a step further, and ensures people feel safe, welcomed, valued, and free from harassment and discrimination.

The College of Medicine is showing its commitment to diversity and inclusion through the formation and ongoing contributions of the Diversity and Inclusion Working Group. While this group is focused on faculty and staff, we know that students are positively impacted when they have diverse mentors and role models among leadership, faculty, and staff. Diversity among the student population in the college is being addressed through a number of units, including Admissions and Student Services. These units provide services for Indigenous students, as well as initiatives around mentorship for Indigenous individuals, LGBTQ2 people, and opportunities for students to act as mentors for youth who come from underserved areas in partnership with Big Brothers and Big Sisters of Saskatoon.

The Diversity and Inclusion Working Group is currently planning initiatives around the four designated groups defined by the Employment Equity Act: Indigenous peoples, women, visible minorities, and persons with a disability. However, we also recognize that diversity extends beyond these four designated groups; one example being LGBTQ2 people. The working group is specifically planning strategies to make recruitment and outreach, retention and advancement, and representation on committees more inclusive, and we are also planning for education and training opportunities. Gathering data and evaluating the success of the initiatives will be a focus for the group.

Each and every person in the College of Medicine has a role to play in achieving true inclusion. Small things make a difference in contributing to a positive workplace and improved morale. Here are some small actions we can all take:

• Look around in meetings and ask yourself, who is missing from this conversation? Is there anyone whom you could invite to improve the diversity of perspectives at the table?
• On the other hand, recognize when certain people are being asked to sit on numerous committees and attend many meetings, and ask if and how you can help relieve their burden
• Include your pronouns of choice in your email signature and/or online profile
• Begin speaking engagements with a land acknowledgement
• Schedule meetings within regular working hours, so that everyone with commitments outside of work has a chance to participate
• Think about providing childcare at events, or welcoming children to join the audience
• Ensure meetings and events are held in wheelchair accessible spaces, and have accessibility services to those who are hearing or vision impaired
• Aim for flexibility in your workplace, as this is linked to the attraction and retention of diverse talent
• Test and acknowledge your own unconscious biases: Implicit Association Test
• Be an ally and speak up if you witness someone being mistreated or treated unfairly
• Take advantage of training opportunities and community events to learn more about diversity and inclusion

It is okay to not always know the right thing to say or do, and to acknowledge that you are still learning. Making the effort is an essential contribution to a healthy, thriving, and inclusive culture within the College of Medicine, and to ultimately getting the best out of the talented people who work here.

Resources for more information:

• Indigenous Peoples: Reconciliation at the U of S, Canada’s universities take steps toward reconciliation
• Peoples with Disabilities
• Women in Academia
• USSU Pride Centre
• OUT Saskatoon

The Golden Rule: treat others as you wish to be treated.
The Platinum Rule: treat others as they wish to be treated.

Well, the weather has turned and already the schedule is getting very crowded! Fall is here!

First of all, I would like to welcome the Class of 2022! One of my favorite moments of the year is the opportunity to welcome our first-year undergraduate medical students. The energy and excitement is always palpable. I also had a chance to welcome the returning second years. September is a good time to remind everyone that the students – medical, biomedical, population health, graduate and residents – are the real reason we are here and the most important members of our team.

For both groups I emphasized what a winning team we are here at the College of Medicine and reminded them of the successful accreditation results we had achieved this past year. I also highlighted the incredible improvement in our ranking on the national licensing exam results by the Class of 2018 (the first graduates of our new MD curriculum), which had followed the excellent CaRMS outcomes for Postgraduate Medical Education and the Class of 2018, not to mention our improved success in the last two rounds of CIHR grants where we matched the national success rates.

It has been a good year. A big highlight for me was the opportunity last week to be in Basel, Switzerland at the huge meeting of the Association of Medical Educators of Europe to accept on your behalf the ASPIRE Recognition of Excellence in Education Award in the category of Social Accountability. It was humbling to see our CoM recognized publicly at a meeting of 4,000 medical educators from more than 100 countries!

First, a little background. ASPIRE awards were created about six years ago to recognize excellence in education at medical, dental and veterinary schools. It was noted then that research had high profile awards for excellence, starting with the Nobel Prize of course. However, excellence at the institutional level in education often went unrecognized other than possibly dubious school “rankings.” A blue-ribbon board of medical educators were assembled and six categories of criteria-based, peer-reviewed awards were developed. Those categories are social accountability, student engagement, faculty development, distributed medical education, simulation and curriculum.

The World Health Organization has defined the social accountability of medical schools as “the obligation to direct their education, research and service activities towards addressing the priority health concerns of the community, region, and/or nation they have a mandate to serve. The priority health concerns are to be identified jointly by governments, health care organizations, health professionals and the public.”

ASPIRE requires we not only do that but are able to document outcomes that demonstrate impact and success in those endeavors. If one goes back to our beginnings in the early ’50s, it is clear that social accountability was in our genes! However, in the last 10 years the advent of our Division of Social Accountability (DSA) and the commitment of many great staff, faculty and students achieving great things through a myriad of programs and initiatives provided us all the evidence we needed to demonstrate success. Examples include our student-run clinics (SWITCH in Saskatoon and SEARCH in Regina), our Making the Links – Certificate in Global Health, social pediatrics and the St. Mary’s Clinic here in Saskatoon, poverty simulation day in our Medicine and Society class, our highly successful Aboriginal Admissions Program, and most recently our Diversity and Social Accountability Admissions Program. This is just a sampling.  I highly recommend perusing the DSA’s annual report to see the many amazing things our team is making happen across Saskatchewan!

DSA was incredibly well led initially by Dr. Ryan Meili, who did much of the pioneering work of the division. Since Ryan’s departure to the world of politics, Dr. Eddie Rooke has been our DSA director. Unfortunately for us, Eddie is moving to Vancouver, but we appreciate his leadership, especially leading to our submission for this award. Dr. Anne Leis, department head of Community Health & Epidemiology, is now leading a search for our new director of social accountability.

There is so much great work that goes on behind the scenes in the CoM that I fear many do not know about, so I want to highlight here our staff in DSA: Carlyn Seguin, global health specialist; Erin Wolfson, community engagement specialist; Joanna Winichuk, administrative assistant;  and Erin Walling, social accountability strategist (covering for Lisa Yeo, on maternity leave).

Like so many things in medical schools, the limelight goes to students and faculty, but the place would grind to a halt without our staff. In the case of this award, Erin Walling spent three months completing our submission, composed of 27 pages, plus 54 appendices and four student letters of attestation. The following quote demonstrates what we all accomplish together but also the incredible job Erin and the team in the DSA did in representing our collective efforts.

“Your application to Aspire-to-Excellence clearly shows that your school is an excellent school which demonstrates long standing strong commitment to social accountability. The province of Saskatchewan is distributed over a wide area with diverse and vulnerable populations including First Nations communities. The need for improved health care and social medicine was at the core of the founding of the medical school. The partnerships with the community, local and provincial government were exceptional. The application evidences a number of innovative partnerships which illustrate a culture of stakeholder engagement that is commendable. In summary we noted: the University of Saskatchewan College of Medicine’s social accountability is evident in all aspects of the application, from admission of students from Saskatchewan, to innovative rural focused medical education and vocational training programs, to research directed to improve the health of the people of Saskatchewan.”

So thanks to DSA and all of the staff, faculty and students who contribute to social accountability at the CoM!

As always I welcome your input and look forward to an excellent 2018-19 academic year.

There are many great things about my job as Dean of Medicine here at the U of S, and it starts with the great students, staff, faculty and partners I work with every day. However, this time of year I really welcome the usual summer slow-down for a chance to reflect, recharge and enjoy the amazing Saskatchewan summer!

I wish all of you a great summer and hope you find time for family, friends and sunshine! First, though, I want to take this opportunity to send you off with some additional positive news to enhance your summer vacation.

First and foremost, of course is our successful undergraduate accreditation. My last blog highlighted this wonderful accomplishment, achieved through the contributions of so many people. We are planning an event in September where we can come together and celebrate in a more formal fashion. Stay tuned for details.

As I noted in my blog, we do have some follow-up reports to provide the Committee on Accreditation of Canadian Medical Schools. An obvious one are the results of the Medical Council of Canada (MCC) exams—this past May our Class of 2018 was the first cohort from the new curriculum to take the exam.

We have preliminary results and they are exciting! Several years ago, it was not unusual for the U of S to be among the national leaders, but in more recent years this has not been the case, and this exam data played a large role in instigating and shaping our curricular reform.

The great news is that our Class of 2018 exceeded the national mean on the MCC exam! As well, the national exam failure rate was more than double that of our grads. Congratulations to the Class of 2018 and congratulations to all of those who led and implemented the new curriculum, the staff who managed it and all of the faculty who taught our students. This is real evidence that all of our collective efforts are benefitting our learners and ultimately the people of Saskatchewan.

There is additional good news. Seven of our PGME programs have undergone internal or external reviews in the last few months. Some of these were in follow-up to the full PGME accreditation of 2016. Much work and effort by faculty, staff, residents and the PGME office resulted in great improvements to these programs and very successful results were achieved by all. As well, three PGME programs are live with Competence by Design: anesthesiology, emergency medicine and surgical foundations.

Just a few days ago, on July 1, our biomedical sciences restructuring came into effect with our Department of Anatomy, Physiology and Pharmacology with interim head Dr. Thom Fisher, and our Department of Biochemistry, Microbiology and Immunology with interim head Dr. Bill Roesler.

Finally, we have had ongoing success in research! Last week the Saskatchewan Health Research Foundation announced the Establishment Grants and four of our researchers were successful. Congratulations to Dr. Gary Groot, Dr. Michael Levin, Dr. Scott Widenmaier and Dr. Yanbo Zhang. Just scroll through our recent CoM website news stories to see more on this and other recent research successes.

So again, I wish you all a great summer and thank everyone for all you do for the CoM. You deserve a break! Enjoy it!

And I will have another great news story to share at the end of August, when we all return for another promising academic year.

As I am sure everyone knows by now, we have achieved accreditation of our Undergraduate Medical Education program. This is indeed great news and a key turning point in the history of the CoM!

Congratulations to all in the college and my profound thanks to all of our students, staff, faculty, leaders and partners who have worked so hard to see this great day. It has been truly a team effort and I am inspired by the collaboration, collegiality and camaraderie demonstrated as we pulled so hard together over the last two years.

In fact, this work has taken place over the last five years, as the CoM faced its challenges head-on and embraced the changes mapped out in The Way Forward. This attitude and determination is what inspired me to come to the University of Saskatchewan and today I could not be prouder of what you have all accomplished. This is a great team and a winning team.

I hesitate to pick out any individuals, as so many people have gone above and beyond to see this success. However, I must emphasize the great work by our students and their leaders in producing the Independent Student Analysis and their role in meeting with our accreditation team.

I must single out Dr. Athena McConnell, our Assistant Dean Quality, who led the process with incredible hard work, diligence and attention to detail—all done with equanimity (sometimes when the rest of us were panicking) and an incredible sense of humour. Our UGME team was led by Dr. Pat Blakley, who did incredible work engaging with our students, and all were ably supported by Dr. Kent Stobart, our Vice-Dean Education, who brought as much accreditation experience to our team as can be found at any medical school in the country.

Accreditation is about the quality of medical education and the student experience, and obviously the faculty are critical, but none of this would have happened without our administrative team. By the time we were done, we had provided CACMS with over 3,500 pages of documentation and at the visit 215 people met with the accreditation team, and all had preparation and rehearsal meetings ahead of that. In fact, the only complaint I heard was someone said they were over-prepared! Marianne Bell took on the challenging role of Accreditation Specialist 10 months before the visit and did an incredible job. Sinead McGartland, Director of Projects and Planning, led the visit preparation and showed us all what can be accomplished with the superb application of expert project management!

There are so many others whose role was critical. Unfortunately, you would never read all of this blog if I recognized everyone. Two other groups deserve special mention. The ultimate teacher in medical education is the patient and we could never run our education programs without those patients and the healthcare system that cares for them. The Saskatchewan Health Authority and its predecessors and their leaders have been tremendously helpful and supportive.

Finally, the University of Saskatchewan and its leaders have had our back every day. When medical school deans gather, a common complaint is the university doesn’t understand the medical school! I must say I know of no medical school that has had greater engagement or support from its university and its senior administration than us. Thanks to our many U of S colleagues who supported us.

The report from CACMS is very great news, and is very positive. Like virtually all medical schools that have a successful accreditation, there are some elements that will require follow-up. The great news is that CACMS has asked for written reports and does not require a follow-up visit! After eight visits from 2002 to 2017, we could actually go eight years without a visit! This is a huge vote of confidence in our college and our team.

However, if you read the good news story on the front page (above the fold!) of the Star Phoenix today, you would have read that I said we must be committed to continuous quality improvement and we must understand that the moment we stop changing we will stop being a winning team!

And we have lots more to do! Our Postgraduate Medical Education division has had great success and has great leaders and now faces the huge challenge of implementing competency-based medical education. The same success and great leadership is true of our Continuing Medical Education division, but we are aware that as the “system” looks for more ongoing professional development for doctors, we must respond.

The strategic plan we have created together clearly demonstrates we have important priorities that go beyond our medical education programs. Certainly Indigenous health and social accountability (some good news on that front later this summer) remain very important for our college.

We are well along with the important work of restructuring our Division of Biomedical Sciences and we are in the early stages of the very important work to develop an undergraduate biomedical sciences degree program delivered within the CoM. The importance of strong undergraduate and graduate programs in the Division of Biomedical Sciences within the College of Medicine cannot be overstated.

Research success is what will ultimately drive our reputation and will do the most to improve the health of the people of Saskatchewan and the world. Research success will provide the return on investment needed by our university and our province, and ultimately the future financial stability of our college. Research success will enhance recruitment of the brightest and best students and faculty. And research success will be the ultimate reward for our clinical researchers and our biomedical and population health scientists.

While writing this blog, lines from Dr. Suess’s Oh, the Places You’ll Go! came to mind. Another Dr. Suess quote also seems apt: “Today was good. Today was fun. Tomorrow is another one.”

I’ve said before that we are on our way. With this result, while we have much to do, we know that as a team working together under extraordinary pressures of workload, deadlines and expectations, we delivered.

Guest blog by Keith Ogle, outgoing Vice-Dean Faculty Engagement

I’ve been honoured to serve as Vice-Dean Faculty Engagement for the College of Medicine since June 1, 2016. Prior to that time, for a period of about eight months, I did some organizational work for the college in the same administrative area. Now, effective June 1, 2018, I have retired from my administrative role and am heading out to explore very different landscapes.

You might think that by this time, I’d have a fairly good idea about the ins-and-outs of faculty engagement. You would be wrong! It has proven to be a fairly complex subject and for me, at least, several minor mysteries remain. Why are some faculty completely engaged? Why have others withdrawn? Why do some choose to never become more than minimally engaged? What do engaged faculty have in common? How are they different from each other? How do we measure engagement? How should we acknowledge and reward engagement? And in fact, what is engagement?

I have the impression that my most highly engaged colleagues would also struggle with these questions. For the most part, they probably don’t give it much thought. It’s not like they are following some carefully defined career plan, or that they’ve always dreamed of being medical teachers, researchers or administrators. I might be wrong about the researchers – maybe being engaged is, in fact, about following their dreams. But for most physicians, being engaged as a member of faculty is all wrapped up with both their personalities and their engagement in clinical work. An observation: actively engaged, high-performing medical faculty tend to be actively engaged, high-performing clinicians. They are recognized in both the academic and clinical worlds as consistent and valuable contributors.

Another observation: the timeline for engagement, on average, tends to be bimodal. There are obvious exceptions, but newly appointed faculty who are also embarking on new clinical careers, tend to get more involved initially than they might later on. Perhaps it is due in part to not knowing exactly what they’re getting into, but I suspect it also has something to do with energy and optimism. Later on, during the mid-career stages, academic engagement tends to drop off, probably for a number of reasons. Life gets busy with kids, mortgages, landscaping, debts to pay off, and multiple other real-life complications. Then, in late-career, there’s more time again. Memories of perceived mid-career injustices are held in balance with a sense of gratitude for one’s own education and a different understanding of one’s personal role in achieving the greater good.

A third observation: actively engaged faculty show up as being in the game for more than themselves. They tend to be outward-focused but intrinsically rewarded—they find joy in simply being involved, and they don’t over-think it. This seems most obvious, to me, with good clinical teachers, but I see it right across the academic spectrum. Again, there are obvious exceptions. We have all seen examples of self-serving engagement where recognition is the goal and self-sacrifice the persona.

My replacement will be tackling many of these questions and will be looking to faculty for the best answers. That individual will have continued support from an outstanding set of forward-looking leaders, and ongoing support from an expanding cohort of passionate and engaged faculty. As the college’s role in the community, the university and the health care system continues to evolve, our faculty will undoubtedly show us what true engagement means, and why it contributes to satisfaction and meaning in our professional lives.

Guest blog by Kent Stobart, vice-dean medical education

The 2018 Canadian Conference on Medical Education (CCME) was a great event for our college, with eight oral presentations, seven posters and one workshop provided by members of our faculty, students and staff. The conference also serves as an opportunity to highlight medical education achievers. From the CoM, Dr. Maryam Mehtar, program director and assistant professor in the Department of Pediatrics, received the Canadian Association of Medical Education (CAME) Award of Merit, and Dr. Brent Thoma, assistant professor in the Department of Emergency received the Association of Faculties of Medicine of Canada (AFMC) Young Educator Award.

The conference was held in Halifax at the end of April. It’s the premiere Canadian meeting on medical education, is held annually, and is the initiative of five partners: the AFMC, the College of Family Physicians of Canada, the MCC, the Royal College of Physicians and Surgeons of Canada, and the CAME. And it is a wonderful exchange—members of the CoM were there both as providers and recipients of knowledge, and information on best practices and opportunities to improve our methods.

Other highlights of the conference, where we from the CoM were on the receiving end of this exchange, include the opening plenary delivered by Margaret Trudeau. She spoke candidly about her life and her personal struggle with her mental health issue. Dr. Eric Holmboe, senior vice-president with the Accreditation Council for Graduate Medical Education provided a serious look at the relationship between academic health science and competency based medical education (CBME). His story of an elderly gentleman who was passed from clinical service to clinical service and eventually left to die was made all the more powerful when he shared that his own father recently died while in the United States’ health care system. He provided an understanding of how patient safety and CBME can lead to better health outcomes.

Though not the holy grail, CBME is one component of improved patient outcomes; this was at the heart of a session featuring a debate between Dr. Jonathan Sherbino, a McMaster University emergency doctor, and Dr. Pim Teunissen from Maastricht University in the Netherlands. The conference was closed with Dr. Ian Bowmer’s farewell speech, as he leaves his position as executive director of the Medical Council of Canada (MCC) after 11 years, in which he shared his valuable insights on change as it impacts medical education and health care.

Every year, the CCME keeps academic leaders and administrators apprised of national and international developments in medical education. As the CoM strives for continuous improvement in the quality of our teaching and learning, this conference is an important cornerstone of our knowledge and development. The conference both supports and is evidence of Canada’s status as an international leader in medical education.

Saskatchewan people, as well as many across Canada and beyond, rallied around the Humboldt Broncos and all those affected by Friday’s terrible highway accident. We extend our condolences to the families and friends who lost loved ones, and our thoughts and prayers are with those injured and their families and friends. Many are grieving and feeling this loss deeply, but I hope have found comfort in the incredible, heartfelt and widespread support of our province, our nation and the world.

A number of our medical faculty, residents, students, physical therapists and alumni were directly involved in providing care following the accident. To each of you, to the other care providers and direct responders, I and the College of Medicine offer our humble thanks and appreciation.

Many in the CoM are directly impacted through other connections beyond our work and learning roles—Saskatchewan is such a small, connected and close-knit community. I add my voice in reminding you that others are ready to provide you with support in the wake of a very difficult weekend. Find specific information below.

CoM students:

• CoM Office of Student Affairs
• U of S Student Wellness Centre
• In the UGME office, Dr. Pat Blakley, Dr. Meredith McKague, your Year Chair or Sherry Pederson.

CoM residents:

• Resident Wellness

For CoM faculty, staff, residents and students:

• Employee and Family Assistance Program at the U of S

Assistance is also available to physicians through the Saskatchewan Health Authority and the Saskatchewan Medical Association. I, and all in the dean’s office and in leadership roles in the CoM will also help in any way we can. Please do not hesitate to reach out to us.

This tragedy is a reminder of how suddenly our lives can change and that the people in our lives are so incredibly important. We can lose sight of that in the day-to-day rush of things. The outpouring of support that began Friday evening and continues now underlines just how needed and valued our family, friends and community are to each of us.

Thank you, once again, to our faculty, alumni, residents and students for all you have done since Friday, and continue to do, to care for and support our patients, their families and friends.

Guest blog by
Jo-Anne R. Dillon (Lead, BMSC Merger and Governance)
and
Scott Napper (Lead, Undergraduate BMSC Program Development)

The university-level approval process for merging the departments in the Division of Biomedical Sciences (BMSC) is underway. This merger will result in the division moving from five to two departments. Currently, the five BMSC departments are: Anatomy and Cell Biology; Biochemistry; Microbiology and Immunology; Physiology; and Pharmacology. The proposed new structure will bring these units together as: the Department of Biochemistry, Microbiology and Immunology (BMI); and the Department of Anatomy, Physiology and Pharmacology (APP).

The merger was initiated in May 2016, when the biomedical sciences faculty voted to move to a two-department structure. There were several reasons for this:

• enhancing multi-disciplinary approaches to effectively investigate and understand complex biology, to facilitate research and training, and to generate new and collaborative research initiatives
• the two groupings are natural, reflecting joint interests, and will increase critical mass in each new department
• more engaged faculty, supported by better use of resources for teaching and research
• increased opportunity to recruit postgraduate students
• opportunities to update and enhance the biomedical sciences undergraduate curriculum

Since May 2016, the department heads and individual departments of the BMSC Division have consulted regularly regarding the merger. The proposed governance follows that of all university departments, with the department heads reporting to the dean. The dean has clearly stated his support by confirming that faculty numbers will be maintained and that two new department head positions will be recruited after the merge. The merger proposal has been outlined in a draft governance document that has been approved by the individual BMSC departments, the CoM’s Faculty Council (January 2018), and the Planning and Priorities Committee (PPC) of University Council (March 2018). We expect it will be considered for approval at the April 19 University Council meeting.

The target date for the transition to two departments is July 1, 2018. The affected departments have begun to meet as combined departments to discuss transition and collegial processes. Interim department heads will lead the departments, with a plan to recruit new heads for July 1, 2019.

The further key component of the new BMSC structure involves the renewal of the BMSC undergraduate program and ultimately the transfer of the associated degree programs to the College of Medicine from the College of Arts and Science. These proposed changes to the undergraduate BMSC programs have been developed with strong support from the College of Arts and Science. At the present time, it is envisaged that first-year students would enter the program through Arts and Science and then transfer in their second year into the CoM. They would ultimately be granted a BSc in Biomedical Sciences, with specializations in Biochemistry, Microbiology and Immunology, Anatomy and Cell Biology, Physiology and Pharmacology, Neuroscience, or Interdisciplinary Biomedical Sciences. The latter two specializations represent two exciting new majors. It is anticipated that these programs will involve 800 or more students, providing opportunities for honours projects, summer recruitments and eventually recruitments to graduate studies, the medical doctor program and other professional schools across campus.

An updated biomedical science program, building on the considerable achievements of the BMSC platform, will provide our students with a number of academic advantages. The BMSC departments in the College of Medicine were early adopters of a multi-disciplinary approach to teaching. A coordinated effort by all of the BMSC departments in 2009 resulted in the creation of a mandatory “Biomedical Science (BMSC) Platform,” which has over the past 10 years provided a strong interdisciplinary foundation for our undergraduate BMSC students.

The new two-department structure will enable expansion of the multi-disciplinary platform into the third year of study. For each of the new APP and BMI departments, faculty have identified and/or developed core third-year courses that reflect critical skills and knowledge that exist at the interface of the respective disciplines of each new department. A new Course-based Undergraduate Research Experience (CURE), providing students with an authentic research experience where they must develop and test a research hypothesis, has been developed and will have its first student intake (microbiology and immunology) in January 2019. This CURE represents a considerable departure from traditional laboratory-based classes.

We will continue to bring you information and updates as the BMSC transition progresses.

I again had the wonderful opportunity this week to provide opening remarks at the 2018 Health Innovation and Public Policy Conference. Ever since arriving at the U of S I have been astounded at the initiative of our College of Medicine students and their colleagues across the health science programs in promoting change and improvement for marginalized and disadvantaged individuals and communities.

Again this year the students owned and led an incredible conference with expert speakers from across Canada and the U.S. on an amazing spectrum of topics: the opioid crisis, legalization of marijuana, Indigenous health, the HIV crisis in Saskatchewan, health for refugees and the uninsured, and social media and health advocacy. I would like to congratulate these student leaders and the 400+ participants. Our students inspire all of us.

In my opening remarks I alluded to the three A’s of awareness, advocacy and activism. One of my favourite stories of activism is that of Dr. John Snow and the Broad Street pump. During the London cholera epidemic of 1854, Dr. Snow mapped the cases of cholera to the neighbourhood of the Broad Street water pump. For this work he is known as one of the fathers of modern epidemiology. He became an activist when he successfully advocated for the removal by local authorities of the handle on the pump!

A more personal example is the New Brunswick family physician, a former colleague, Dr. Stephen Hart, who very early in his career led the charge to establish seat belt legislation in that province in 1983. Both are examples of advocacy that led to important change. But are physicians restricted to advocacy only on medical issues?

This brings me to my recent blog supporting Indigenous members of our community following the decision in the Gerald Stanley trial into the death of Colten Boushie. I appreciate all of the personal and public feedback I have received since that time, and have made time for further reading, reflection and conversation as a result.

One of the biggest surprises from the feedback was the perspective expressed by some that a dean of medicine has no place commenting on a legal matter or for that matter any public controversy that was not medical or education-related! This view doesn’t align with a free society, and more importantly it contradicts all we teach about patient-centred care, student-centred education and patient-oriented research. We do not need to be experts to be advocates.

In light of our teaching about the impact of the social determinants of health on our patients and our communities, I believe as physicians we always must place ourselves somewhere on the continuum of awareness to activism. Awareness is a bare minimum! In fact, many have argued in numerous situations involving inequity and injustice that those who are knowledgeable and well-intentioned but silent are, in fact, a barrier to change and progress.

“We must always take sides. Neutrality helps the oppressor, never the victim. Silence encourages the tormentor, never the tormented.”   – Elie Wiesel (Romanian-born American-Jewish writer, professor, political activist, Nobel laureate and Holocaust survivor.)

Finally, in my reading, I found the statement: “ally is a verb,” which led to even more reflection, and to this blog’s title. Another blogger, Liz Goodwin (on therapeuticjustice.blogspot.ca), wrote under the same title and used a metaphor I could understand: running! She said seeing oneself as an ally, in the noun sense, is like running on a sunny temperate day on a flat course.

“Yeah,” I thought, “that is what life is made for!”

But the real runner in me knew if I was to be in the race, I must run hills and intervals, do speed work, and run in rainy weather, on cold days and snow-packed trails, and keep going even when I was too exhausted to do so.

To live the verb form of ally means ongoing learning and self-reflection, listening, focusing on those who do not have my privilege, removing bias and barriers, taking action when appropriate (keeping firmly in mind “nothing about us without us”), and speaking out.

Thanks again for all those who provided feedback. It was appreciated. And I reiterate the College of Medicine’s support to our Indigenous patients, colleagues, and learners as we work to face truth and build reconciliation.

As I had mentioned in my first blog of 2018, Competence by Design (CBD) is a key topic on my mind as we move forward with the strategic priorities of our college.

One of the changes in the ongoing reform of medical education is a shift towards Competency-Based Medical Education (CBME). CBD is a multi-year transformational change initiative aimed at implementing a CBME approach to delivery of residency training and specialty practice in Canada, led by the Royal College of Physicians and Surgeons of Canada. The underlying rationale is that physicians will be better equipped to meet evolving societal needs and to provide better patient care. CBME is an outcomes-based approach to education delivery where learners must demonstrate that they have acquired all competencies required for unsupervised practice of medicine. It ensures that both learning and assessment are focused and individualized.

Our residency programs have been adopting CBME in a phased manner. Family Medicine has been reforming its residency program since 1998, with a focus on workplace-based assessment and curriculum reform through triple C competency-based curriculum: comprehensive care and education; continuity of care and education; and centered in Family Medicine. Specialty training has been based upon competency framework(s). However, the formalization of the CBD initiative by the Royal College of Physicians and Surgeons of Canada is relatively recent.

Although not a paradigm shift, CBD comes with its own language and vocabulary, such as: entrustable professional activities – a key task of a discipline in a clinical setting that can be delegated to a resident who has demonstrated sufficient competence; milestones – a marker of an individual’s ability along a developmental continuum; competency – observable ability that develops through stages of expertise from novice to mastery; and other terms describing stages of development. The key change with this approach is an emphasis on direct observation and feedback. The preceptor’s role shifts to coaching (assessment for learning) from the earlier position of judgment requiring pass/fail decisions (assessment of learning).

The PGME unit, under the leadership of Associate Dean Dr. Anurag Saxena, is leading the implementation of CBD at the CoM using three guiding principles: collaborative endeavor, distributed leadership and change tailored to developmental readiness. Organization-wide ownership, including by our learners, is at the heart of CBD. The individualized approach to implementation for each residency program requires coordination of efforts, consistent stakeholder engagement and appropriate resources.

Lessons from earlier and ongoing implementation of triple-C curriculum in Family Medicine are particularly informative and I am glad to see these are being applied, along with involvement of our provincial head of Family Medicine, Dr. Kathy Lawrence, in CBD implementation for specialty programs. Fluid coordination between PGME and Faculty Development, led by Dr. Cathy MacLean, also positively reflects how we leverage our strengths in a strategic manner to achieve our goals. Our provincial heads are crucial to success in this implementation and I know they are involved at the outset in CBD implementation in their departments.

Anesthesiology was the first program at our institution to go live with CBD, doing so in July 2017. Being first out of the gate, this program has been instrumental in clearing the path for others to follow. Emergency Medicine, Nephrology and Surgical Foundations are preparing for a July 2018 launch.

I am aware of the challenges inherent in balancing innovation and creativity with delivery of results in a timely manner, and I’m confident that our PGME unit and residency programs will make this transition successfully. CBD implementation in our college is a fine example of integrating academic and administrative leadership in instituting change across our programs, and CBME offers an opportunity to evolve through reflection on our own practices in teaching and learning.