Faculty of Medicine451 Smyth Ottawa ON K1H 8M5613-562-5800www.medecine.uottawa.ca

Table oF conTenT

We teach to heal! | Winter 2010 No. 4

Newsletter of the Faculty of Medicine

Accreditation 101Background:

All MD programs in Canada and the U.S. are accredited by the American Liaison Committee on Medical Education (LCME) which collabo-rates with the Committee on Accreditation of Canadian Medical Schools (CACMS). For Canadian medical schools, judgments are made by both accrediting bodies. The maximum cycle for the accreditation process is eight years.

Purpose of accreditation: • Accreditation provides a mechanism to

ensure that a given school meets certain prescribed standards in the provision of its program of undergraduate medical education. The 131 standards, outlined in the LCME document Functions and Structure of a Medical School have been developed and accepted by medical educators, the Canadian Medical Association (CMA), the Association of Faculties of Medicine of Canada (AFMC), the American Medical Association (AMA) and the Association of American Medical Colleges (AAMC). The uniform standards are applied

to all medical schools in the United States and Canada.

• Accreditation fosters an institutional reflection called Institutional Self Study (ISS), and evaluation of ongoing activities (collated within a database) within the Faculty of Medicine. This process allows the institution to review its strengths and weaknesses and to make recommendations to help it achieve its goals. This process can ultimately help the Faculty further define and revise its strategic plan, and shape its direction in the short and long-term.

our accrediTaTion chair

and coordinaTor ...............2

our accrediTaTion

TiMeline ..................................2

resulTs.....................................3

areas oF parTial

or subsTanTial

noncoMpliance ..................3

FaculTy inTerpreTaTion

oF The Findings ....................4

Thank you ..............................5

Message FroM The dean

A+ Accreditation Results

Dear colleagues and staff,

By now, you have heard either from reading the last MedFlash, or from other sources, that the outcome of the 2010 Undergraduate Medical Education Program is the best we have ever had and among the very best overall. We’ve received approval for the longest possible period (eight years) with only four standards deemed non-compliant out of a total of 131. On behalf of the Faculty of Medicine, Drs Moineau, Marshall and I would like to congratulate you. We also want to thank you for all your hard work and support. We are extremely proud of the work that our Faculty, students and support staff put forth for this accreditation.

We thought that it would be most appropriate to dedicate this winter edition of MedPoint to the accreditation results. This edition of Medpoint will provide you with more details

of the results we obtained and the process involved in obtaining them. It will give you a sense of perspective (especially for those of you who were not directly involved) of the exciting but intense adventure of accreditation. You can take great pride and satisfaction in knowing that our preparations began almost two and a half years ago. Nevertheless, after the rejoicing and celebrations are over, we’ll get right back to business — continuing our good work and addressing those few outstanding issues!

One last point. As you all know, on June 1, 2011, Dr. Geneviève Moineau, our Associate Dean UGME will be assuming the position of Vice-President at the Association of Faculties of Medicine of Canada (AFMC), where she will be responsible for the full education portfolio for the secretariat of the Canadian accredita-tion bodies. As one of our top leaders, who steered the undergraduate program through a successful curriculum renewal and through a most successful accreditation, who else could be better qualified for this AFMC position? We are all very proud of you Geny.

Jacques BradweJnDean

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Our Accreditation Chair and CoordinatorChair of the Institutional Self-Study Task Force:

Geneviève Moineau practices Pediatric Emergency Medicine at CHEO and, since 2005, has been Associate Dean of Undergraduate Medical Education. She takes great pride in having been named Honorary President for the 2004, 2009 and 2010 gradu-ating classes. Last year she was chair of the Canadian Conference on Medical Education (CCME) Program committee. As of June 1, 2011, she will be taking on a new position as Vice-President Education at the Association of Faculties of Medicine of Canada (AFMC) and secretary to the Committee for Accreditation of Canadian Medical Schools (CACMS) and the Committee on Accreditation of Continuing Medical Education (CACME).

Accreditation Coordinator:

Ken Marshall joined the Faculty of Medicine in 1972. He was active in researching and teaching about the nervous system until his retirement in 2003. He was on the steering committee for the curriculum reform of 1992, Chair of the Physiology Department for over 10 years, and Vice-Dean Research in 2002-03. As an emeritus professor, he has continued to teach, and was on the steering committee for the recent curriculum revision. He has been on accreditation team visits to four other Canadian medical schools. Ken will continue as Accreditation Coordinator for the MD program, and will coordinate our responses to the accreditors regarding non-compliance issues.

Geneviève Moineau MD, FRCPC, Associate Dean Undergraduate Medical Education

Kenneth Marshall PhD, Emeritus Professor

A+ smiles: Drs Bradwejn, Moineau and Marshall.

Our Accreditation TimelineWritten by Dr. Geneviève Moineau

Dr. Bradwejn appoints Dr. Ken Marshall, an emeritus professor of the Faculty as Accreditation Coordinator.

Construction of the database begins, requiring input from every component of the Faculty and from the teaching hospitals.

Ms. Meral Hussein is hired as Accreditation Project Manager.

The Institutional Self-Study Task Force is formed.

Seven subcommittees of the Task Force are formed, involving almost 100 faculty, residents and students. A separate committee of students is formed to carry out and analyze an extensive survey of student opinion on the MD program.

An accreditation web-page is created, providing background infor-mation on the accreditation process.

The survey is sent to all students.

The subcommittee reports and the student survey analysis are presented to the Task Force and Department Chairs at a retreat. Many issues are identified as representing possible grounds for non-compliance, and a vigorous action plan is put in place.

Most of the issues identified in October during the retreat are successfully addressed.

The final editing of the database and the ISS report is accomplished by the accreditation leadership. Our student coordinator provided the independent student survey report. The full stack of material – 20cm (8 inches) high – is shipped to the accreditors. The ISS report and the student survey are added to the web page.

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A follow-up student survey is carried out and demonstrates that several problems identified by students in the initial survey have been resolved.

A supplementary student survey, with some additional updates (e.g. student evaluations of courses in the revised curriculum), is sent to the survey team.Drs. Moineau and/or Marshall meet with every person or group who is scheduled to meet with the accreditation team, and offer briefings on what to expect, with example questions.

The accreditors visit our school. The six member team includes medical education deans from across the country, a medical student and an American member of the LCME, who acted as chair. The visit comes off without a hitch despite many requests to vary the schedule, add or remove participants and provide new documentation. The visitors grill everyone from the Dean to the

CEOs, Department Chairs, UGME leaders, staff and most importantly, our students. The team has an exit interview with President Rock, Vice President Academic Houle, and Drs Bradwejn, Moineau and Marshall. The news is judged to be very good, with only seven of the 131 standards indicated as being judged non-compliant. We can be cautiously optimistic…

The survey team report is considered by the CACMS in late September and by the LCME in early October, and the consolidated results are received on November 1. The committees have reduced the number of non-compliant standards to four, with three In Transition items. The news is even better than expected!

The Faculty must provide an update report showing that the issues have been resolved, or that substantial progress has been made.

Results (From the letter from the LCME and CACMS; received November 1, 2010)

Under the leadership of the Dean and Associate Dean for Undergraduate Medical Education, the school has successfully executed its strategic plan: designing and implementing a revised curriculum that provides a balance between directed and independent study, integrates across disciplines, eliminates redundancy, and addresses all core competencies. Carefully constructed learning objectives guide all aspects of curriculum delivery, student assessment, and program evaluation.

The University of Ottawa has a highly motivated and engaged student body, which actively participates in the ongoing evaluation and modification of the curriculum.

The Anglophone and Francophone programs function side by side in an integrated and cohesive manner, providing equivalence in educational experiences and evaluation.

The students have ready access to a wealth of electronic resources. Medtech provides superlative support for student computing needs, as well as providing very capable support for the electronic curriculum, including the in-house development of Case Based Learning (CBL) and Self Learning Modules (SLM) materials.

To read the entire letter from the LCME and CACMS, click here.

Areas of Partial or Substantial NoncomplianceThe survey team also noted the following items where it believes the school is not in full compliance with accreditation standards:

Standard IS-14-A. Medical schools should make available sufficient opportunities for medical students to participate in service-learning activities, and should encourage and support student participation.

Finding: Although Community Health and Advocacy Group activities are encouraged and informally supported by the faculty, these activities appear to be entirely student driven. Worthwhile as they may be, they lack the formal structure that characterizes service learning, such as intentional integration into the curriculum and structured opportunities for reflection on the students’ experiences during these activities.

Standard IS-16. Each medical school must have policies and practices to achieve appropriate diversity among its students, faculty, staff, and other members of its academic community, and must engage in ongoing, systematic, and focused efforts to attract and retain students, faculty, staff, and others from demographically diverse backgrounds.

Finding: The current approach to demographic diversity is not sufficiently comprehensive. The faculty has demonstrated success in its mandate to graduate physicians for provision of care in Francophone settings. However, there remains a lack of overall diversity among the faculty and staff, and within the clinical environ-ments in which students learn.

Standard ED-24. Residents who super-vise or teach medical students, as well as graduate students and postdoctoral fellows in the biomedical sciences who serve as teachers or teaching assistants, must be familiar with the educational objectives of the course or clerkship and be prepared for their roles in teaching and evaluation.

Finding: At the time of the survey, the Residents as Teachers (RATs) course or its equivalent was not yet fully implemented across all residency programs. There has been

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no comprehensive assessment of the impact of the programs designed to improve residents as teachers.

MS-31-A. Medical schools must ensure that the learning environment for medical students promotes the develop-ment of explicit and appropriate profes-sional attributes (attitudes, behaviors,

andidentity) in their medical students.

Finding: There has been no systematic assessment of the learning environment across major clinical sites designed to identify positive and negative influences on the maintenance of professional standards and conduct, leading to the development of appropriate strategies to enhance the

positive and mitigate the negative influences on students. Current efforts to ameliorate negative aspects are reactive and not sufficiently preventative. Current affiliation agreements do not create a shared expectation of proactive management of the learning environment, with attendant monitoring of improvement over time.

Faculty Interpretation of the Findings Written by: Dr. Ken Marshall

The following four passages in quotes are excerpts from the Accreditation report submitted to the Faculty of Medicine in November 2010, and the text in italics is the Faculty’s interpretation as written by Dr. Marshall:

• “Under the leadership of the Dean and Associate Dean for Undergraduate Medical Education, the school has successfully executed its strategic plan: designing and implementing a revised curriculum that provides a balance between directed and independent study, integrates across disciplines, eliminates redundancy, and addresses all core competencies. Carefully constructed learning objectives guide all aspects of curriculum delivery, student assessment, and program evaluation.”

It is noteworthy that the curriculum revisions were required by the results of the last ac-creditation in 2003. The early progress on this was limited due to the major turnover in administration of the curriculum and of the Faculty in 2005-2007. For this reason, it is remarkable that such an effective revised curriculum has been put into place in the available time.

• “The University of Ottawa has a highly motivated and engaged student body, which actively participates in the ongoing evaluation and modification of the curriculum.”

We didn’t need an external team to tell us this!

• “The Anglophone and Francophone programs function side by side in an integrated and cohesive manner, providing

equivalence in educational experiences and evaluation.”

It appears that the survey team came expecting to find that our two language streams could not possibly work, and they did express surprise at how effectively it did work. The UGME office and the Bureau des Affaires Francophones, in particular, deserve credit for this remarkable achievement.

• “The students have ready access to a wealth of electronic resources. Medtech provides superlative support for student computing needs, as well as providing very capable support for the electronic curriculum, including the in-house development of Case Based Learning (CBL) and Self Learning Modules (SLM) materials.”

Again, we already knew this, but it is particularly satisfying to have it so clearly recognized by a prestigious group of external assessors.

On standard IS-14-A:

This is a recent standard, effective July, 2008. Our students do have many opportunities to engage in service-learning activities, but we will need to initiate greater Faculty involvement, and potentially create links to other components of the curriculum.

On standard IS-16:

This is a brand new standard, effective July, 2009, and we are the first Canadian medical school to be subjected to it. In our dialogue with other schools, there is considerable uncertainty about what is expected to meet

this standard. One probable factor in our case was that we failed to identify any Aboriginal faculty members, though we have a formalized contingent of Aboriginal students in the undergraduate program. The Faculty was searching for a new director for the Aboriginal program at the time of the visit, and has since recruited Dr. Darlene Kitty, an Aboriginal graduate of our own medical program. We should also build an improved database on diversity within our faculty and staff, perhaps through a voluntary survey, to be able to better respond to this standard.

On standard ED-24:

Until this year, the expectation was that residents would follow the Residents as Teachers (RATs) program in the second year of their residency. The exposure should be in the first year of residency, and we must document the training that residents receive in the RATs course and/or the many departmental and Faculty programs for teacher training. We must also ensure that residents who teach are evaluated by the students, and that they receive effective feedback on their teaching.

On standard MS-31-A:

Again, this is a recently introduced standard, effective July, 2008. Responding to this issue will undoubtedly be the most complex activity, since it necessar-ily involves the cooperative efforts of the undergraduate and postgraduate program administrations as well as those of our affiliated teaching hospitals. A challenge here will be to devise a mechanism to effectively assess the learning environment, and establish systems for improving it.

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Thank YouOur deepest thanks and most sincere gratitude goes out to more than 100 faculty, students and staff who worked so tirelessly on our accreditation. Our success would not have been possible without your extraordinary efforts. Thank you to:

Institutional Self Study Task ForceDr. Craig Campbell Dr. Lynn Casimiro Dr. Arlington DungyDr. Wylam Faught Dr. Max HinckeDr. Sue Humphrey-Murto

Meral HusseinDr. Buu-Khanh Lam Anthony ManeraDr. Jean MichaudDr. Rama C. NairDr. Carrol Pitters

Dr. Jean RoyChris SheasgreenVanessa SuttonDr. Michele TurekDr. Jeff TurnbullHannah Weinstangel

Dr. Phil WellsDr. Sharon WhitingDr. Homer Yang

Other contributors (subcommittee members, student committee members, those who attended meetings with the survey team)Michael AbunassarAusma AhmedDr. Jonathan AngelDave ArmstrongLynn AshdownDr. Dominique AugerJean BartkowiakDr. Robert BellYudy BengoaMichel BilodeauDr. Issack BiyongDr. Leonard BloomAndrew Boozary Dr. Pierre BourqueDr. Paul BraggCharles BreauDr. Earl Brown Samantha Calder-SprackmanDenyse CampeauDr. Jackie Carnegie Dr. Alan ChaputLinda ChenardCrystal CheungDr. Marie-Hélène ChomienneDr. Shirley ChouDr. Heather ClarkJulie Clavelle,Dr. Martin CorstenDr. Jocelyn CôtéDr. Robert Cushman Margaret CzesakJoseph Del PaggioStéfan DeLaplanteDr. Alison DuganDr. Lucie FilteauDr. Melissa ForgieDr. Pierre FortierDr. Jason FrankNicole FreemanDr. Martin FriedlichDr. Mike Froeschl

Dr. Karen Fung-Kee-FungOwen GagnéDr. Antoine GagnonErin GallagherDr. Steven GilbergDr. Katharine GillisDr. Gail GrahamDr. Doug GrayGeorge GrayDr. Rishi GuptaLisette HaddadDr. Pippa HallDr. Stanley HamstraDr. Megan HarrisonDr. David Harvey Jasmine HasselbachDr. Richard HébertDr. Paul HendryDr. Gary HollingworthJennifer Holyoke Dr. Laura HopkinsDr. François Houle, Vice-President Academic ProvostDr. Alireza JalaliDr. Bernard Jasmin Dr. Mary JohnstonDr. Jolanta KarpinskiDr. Marilyn KeaneyStephanie KennyDiane KharoubaDr. Michael KirlewDr. Jack KittsDr. Frank Knoefel Joshua KoczerginskiBenoit LajeunesseDr. Karl-André Lalonde Monique LalondeJohn Lammey Dr. Odette Laneuville Michel LapointeNina Lebel

Dr. John Leddy Dr. Elliot LeeDr. Jonathan LeeDr. Stéphane LegaultJean-François LemayDr. Jacques LemelinNathalie LeVasseurDr. Geraint LewisDr. Julian LittleDr. Heather LochnanDr. David LohnesDr. Laurie McLeanDr. Thien-Fah MahJaqueline MaletteTravis Marion Dr. Jean-François MarquisLeslie MartinDr. David McCoubreyDr. Ian McDowellEric McGillisLucie Mercier-Gauthier Dr. Alain MichonLindsay MillsKareem MorantDr. Paul Moroz Dr. Matthew MulliganJoanne MyreDr. Sarah NikkelDr. Lawrence OppenheimerDr. Martin PelchatLucille PerreaultDr. Lynn PitreFrancois Pomerleau Dr. Beth PotterDr. Éric Poulin Dr. Barbara PowerDr. Catherine Elizabeth PringleDr. Derek PuddesterDr. Debra PughDr. Nikhil RastogiLauren Reid

Dr. Joe ReismanChantal RenaudGuylaine RenaudAllan Rock, PresidentDr. Mary-Clare RoyleDr. Samir SalibDr. Lindy SamsonGérald R. SavoieDr. Mark SchweitzerDr. Farid ShamjiShawn MondouxAlex Yi-Hao ShenYajur ShuklaDr. Chris SkinnerDr. Ruth SlackDr. Alena SpacekDr. Marcia Spooner Dr. Mireille St. JeanDr. Stephanie Sutherland John TavaresDr. Jean François Thibert Dr. David TobinDaniel TrottierDr. Eve TsaiDr. Jean-Philippe VaccaniMélanie WaiteGeorge WeberDr. Brian Weitzman Dr. Tim WillettDr. Nadine Wiper-Bergeron Dr. Si-Ann WoodsDr. Krista WoollerDr. Jim WorthingtonJordan WronzbergDr. Zemin YaoDr. Roger ZemekMaryna ZhukDr. Marc Zucker

We would also offer our thanks to the Medical Education Office staff and our Hospital Coordinators who have facilitated much of the work performed by our school in meeting the required standards.

A special thank you is extended to Dr. Ian McDowell for his extensive and expert editorial review of all documents. A final deeply felt thank you to Meral Hussein, our Accreditation Project Manager, who came to us with impressive experience and kept us organized and on target. We wish her well in her new endeavours.