Chair’s Column: Making a global impact through research

Welcome to a special edition of the DoM Matters Chair’s Column! For the last few weeks, Dr. Gillian Hawker has been away on a research sabbatical and I’ve been the Acting Chair for the Department of Medicine until she returns on November 18. It’s been an exciting couple of weeks! On October 28 our staff officially moved from Toronto General Hospital to our new offices on the third floor of the Naylor Building on the U of T campus.

Also wearing the hat of the Vice Chair of Research, I’m excited to use this Chair’s Column to bring you an update on some of the research activities going on within the Department of Medicine.

A little over a week ago, the University of Toronto was ranked fourth globally in clinical medicine in the US News and World Report Best Global Universities Annual Review. I can say on behalf of the entire university and our affiliated hospitals, we are incredibly proud of this tremendous recognition. But given the calibre of our faculty, there is no doubt that we can do even better!

The research productivity of the DoM at the University of Toronto has been consistent over the past five years. This is something we can boast about, particularly in the face of significant reductions in peer-reviewed funding in Canada. Better engagement with private foundations and industry has allowed us to explore new opportunities, and our DDDs and PICs have worked hard to foster a collaborative spirit across our 20 divisions city-wide.

In this edition of the Chair’s Column, I want to reflect on three major platforms that will allow us to grow our research portfolio to make an even bigger impact on a global level.

1. Investment in our Future Clinician Scientists

The release of Canada’s Fundamental Science Review in 2017, commonly known as the Naylor Report thanks to being chaired by our very own Dr. David Naylor, highlighted the challenges faced by junior clinician scientists after the cancellation of the CIHR Clinician Investigator Program and the significant reduction in scientists dedicating their careers to basic investigation. Our Clinician Scientist Training Program (CSTP), including the Eliot Philipson Scholars Program, and the Clinician Educator Training Program (CETP) are the cornerstone of promoting the pipeline of the next generation of scientists and educators. To date, we have trained 102 CSTP and 15 CETP graduates. Over 80 per cent of them hold a faculty positon at a medical school, and many have gone on to leadership positions here at U of T. At present, we accept three to six trainees into these programs each year, but can only fully fund three positions. As a testimony to the quality of our trainees, four of them are currently Vanier Scholars, a prestigious honour given exclusively to Canada’s rising stars who have shown academic excellence, research potential and leadership. We have earmarked CSTP and CETP as high priority for fundraising and we have also lobbied the CIHR to reinstate the Clinician Investigator Program. As we know from the Naylor Report recommendations, research funding for our scientists, particularly trainees and early-career researchers, is critical to bolstering high-impact innovation and maintaining the competitiveness of Canada’s research landscape.

2. Recognizing Excellence in Research

The Merit Review Program, directed by Dr. Kevin Kain, is open to clinician scientists who are beyond the first five years of their faculty appointment and who do not hold a funded Chair.  This competition is adjudicated by a committee of clinician scientist professors and provides $40,000 of salary support annually for three years. The Merit Award is a potential bridge to peer-reviewed salary support, including Canada Research Chairs. We appreciate the unique challenges of junior faculty when competing with more established scientists and are developing a plan to calibrate this opportunity to faculty across the career lifespan. By providing this targeted salary support, we are supporting the work of our clinician scientists based upon their leadership, research contributions and productivity and, perhaps most importantly, the vision and direction of their research program.

We created the DoM Research Awards Committee with the goal of increasing the success rate for division-specific and major national and international prizes. We adopted the Tricks of the Trade recommendations from St. Michael’s Hospital, and all indicators point to a significant increase in our own success rates. For example, since 2017 our faculty have secured six appointments to the Order of Canada, eight appointments to the Canadian Academy of Health Sciences and several major internationally recognized awards like the Canada Gairdner Wightman Award, awarded to Dr. Frances Shepherd in 2018, and the Harold Hamm International Prize awarded to Dr. Dan Drucker in 2019, to name a few.  The real added value of this exercise has been greater representation from the Mentorship, Equity and Diversity Committee and the adoption of a line-item to address awards for all faculty that is discussed at their hospital divisional annual review. We are working with the respective hospital Research Institutes, as well as the Faculty of Medicine Research Office and the VPRI portfolio to bolster these nominations and recognize the incredible work of our researchers. It truly takes a village to make these nominations a reality!

3. Cross Institutional Multidisciplinary Collaborations and Linking Clinician Scientists (CSs) with Clinician Investigators (CIs)

Given the structure and breadth of the DoM research portfolio, particularly as it relates to the multifaceted and diverse medical system that is unique when compared to our colleagues in the top-ten global rankings, we are well-suited to build multidisciplinary research networks.  We introduced the Network Research Model in 2016 and are delighted to report on a few tremendous success stories from our ten existing networks. The Toronto Antimicrobial Resistance Research Network (TARRN), directed by Dr. Nick Daneman, has initiated three transformative projects ranging from the management of penicillin allergy to fecal transplantation with the goal of addressing the challenge of antimicrobial resistance. Through the participation of CSTP trainees and clinician investigators in quality improvement, the network has flourished and is now on the verge of launching a national initiative.

The Cardio-Rheumatology Network directed by Drs. Paula Harvey, Bindee Kuriya and Lihi Eder recently co-hosted their second annual symposium exploring the link between rheumatologic disorders and cardiovascular disease. The network model has brought frontline clinicians to novel research programs and greatly enhanced their ability to attract per-reviewed funding.

The first round of Network Research Model funding was announced in April and the awardees were:

• Education Research Network project titled How to Academic-Advisor-Resident Interactions Facilitate Learning from Assessment Data? A Longitudinal Qualitative Study of Resident and Faculty Experiences led by Drs. Lynfa Stroud, Shiphra Ginsburg and Ryan Brydges. The overarching objective of this project is to generate evidence that informs Competence by Design (CBD) implementation and advances the conceptional understanding of how the relationships between Academic Advisors and residents develop over time. This study will also inform ongoing course-corrections as CBD evolves across Canada.
• ONCO-GEMINI: Oncology Continuum General Medicine Inpatient Initiative led by Dr. Monika Krzyzanowska. This project will leverage the significant existing infrastructure and expertise previously developed to extend the General Medicine Inpatient Initiative (GEMINI) to cancer care (ONCO-GEMINI). While GEMINI currently collects information on cancer patients admitted to General Internal Medicine, many cancer patients are admitted directly to oncology wards and would be missed. Ultimately, the goal of this project is to expand ONCO-GEMINI province-wide as GEMINI expands to include hospitals across Ontario.
• Toronto Antimicrobial Resistance Research Network (TARRN) led by Drs. Nick Daneman, Derek McFadden, Susy Hota, and Susan Poutanen. This project will explore the effectiveness of Fecal Flora alternation for Eradication of Carbapenemase-producing Enterobacteriaceae Colonization Trial (EFFECT-CPE), a multisite, open-label, randomized controlled feasibility pilot trial.

Our recent external review highlighted the significant impact made by our 170 Clinician Investigators. The network model linking CSs and CIs is a good example of fostering collaborations across job descriptions that leverage strengths unique to respective faculty.  We recognize the particular challenges faced by the CI community and are committed to finding all potential avenues to support their important work. We will soon be launching a series of webinars to better engage the CI community and provide a platform to celebrate their important contributions – stay tuned for more details.

As we continue to face the challenges of limited funding and we enhance our focus on the wellness of our faculty, we remain committed to creating a diverse and collegial environment that promotes the generation of new knowledge with the ultimate goal of improving the health of our communities. Each and every one of us can make a difference, and we are committed to harnessing your creativity and passion. There is no question that we are making a global impact at a world-leading university in a great and diverse city!