Chair's Column: What happens when we all pull together?
The Royal College conducted its External Review of the Internal Medicine (IM) Program in early November 2023. As noted in my October Chair’s Column, we were hopeful that the massive amount of work that had been done to address the Royal College’s ‘Areas for Improvement’* would result in full accreditation of this flagship residency training program. By now, you will likely have heard the good news: indeed, this was the case! The recommendation to the Royal College from our reviewers is: Full Accreditation with 2-year External Review. Hurray!! While the program’s status will be officially determined by the Royal College Governing Council in May 2024, we are confident of a successful outcome.
Let me take this opportunity to thank and congratulate our IM Program Director, Dr. Jeannette Goguen, for her outstanding leadership over what has been a tremendously difficult period. Let me also thank the Internal Medicine team and program leadership, Sarah Jung, Asia Ferrara, Sawan Tate, the DoM Postgraduate team, and the PGME Accreditation Team, including Laura Leigh Murgaski, Nina Chana & Linda Probyn. Thanks, too, to our IM Accreditation Task Force and Implementation Team members. I think it’s fair to say that the outcome was worth the effort.
Although we have not yet received the official review document, in these troubled times, a little good news and positive feedback is always welcome. So, I’d like to highlight here the key messages that Drs. Goguen, Kumagai and I received from the Royal College reviewers (Dr. Thomas Maniatis, General Internal Medicine, McGill University; Dr. Delilah Fortin, Surgery, Western University; and Dr. Karan Vats (Resident, Anatomical Pathology, University of Saskatchewan) at the end of their three-day visit. Please keep in mind, this feedback is preliminary!
What was very apparent to the Royal College reviewers was that the transformation they were seeing was due to a true team effort. They were genuinely impressed by the tremendous collaboration between stakeholders - faculty, residents, staff, hospital leadership, PGME, and more – that had enabled the changes required to happen, despite a global pandemic. One reviewer said they had never seen such major changes in such a short time period, another simply described it as ‘unprecedented.’
In particular, the reviewers commented on the remarkable changes that had been made to our Clinical Teaching Units (CTUs), and that it was evident that residents now feel supported while on CTU. These changes were a result of the creation of resident independent units, hospitalist programs, a new academic position description, the Academic Clinician, recruitment of additional faculty members, and full implementation of the GIM Redesign, which had been launched in 2015. No small feat!
We were absolutely thrilled to learn that the IM residents with whom they met stated they know where to go for assistance when they have a problem and feel well supported. And, they described the many avenues available to them to communicate feedback about program structural or rotation issues.
Other clear strengths included the high level of faculty engagement in and support of the program – not just in General Internal Medicine but across the subspecialties. They also praised Dr. Goguen, the IM Site Directors, and Chief Medical Residents (CMRs) for their support of the residents and expressed that the IM Site Directors are a major strength of the program.
The depth and breadth of clinical opportunities and superb formal teaching, which was well-tailored to each stage of training, were also highlighted, as was our efforts to recognize and value our clinician teachers.
Although not part of the formal review process, one reviewer made a point of acknowledging that the Royal College’s decision to place our IM program on intent to withdraw accreditation must have taken a large toll on us all. We described the impact – we were heard.
Despite the program’s many strengths, there were also identified ‘areas for improvement.’ These included better resident orientation to the hospital sites, speedier response to resident requests for time off, and greater transparency regarding assignment to learning sites and rotations. The reviewers also raised concerns about Fly-in-Call for first year residents – how challenging this can be due to variability in how things are done across sites. Additionally, they noted that for more senior residents, Fly-in-Call from a subspecialty rotation detracts from their experience on the subspecialty and should be minimized. With respect to Competence By Design (CBD), they highlighted the need to improve consistency across Academic Advisors and clarity regarding decision making at the competence committee. This feedback is incredibly useful and will help us move forward.
At the end of this month, Dr. Goguen will pass the IM PD baton to Dr. Pete Wu, currently Deputy IM PD, while we re-launch our search for Dr. Goguen’s successor. In this issue of DoM Matters, we celebrate the many accomplishments of Dr. Goguen and wish her well. We will be posting the position of IM PD soon with a deadline in the new year. It has never been more evident to the department how critical this role is to the entire function of the Faculty of Medicine. Interested parties are welcome to reach out if you have questions about the position.
Over the next few weeks, I hope you will be able to spend some time with family and friends – to get some rest. To those of you who will be caring for patients over this holiday season, we are most grateful - thank you!
Let me close with this: Congrats on a job well done. See you in 2024!
* Supervision – Residents reported a lack of adequate supervision, especially at some sites during weekends.
Learning Climate - Residents reported reluctance to give feedback to the program because of fears of retaliation.
