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What can you learn from the Montreal model?

MOC Tip of the Month

Patient-centered care has gained a lot of currency in the last two decades. But what does this model of care look like? How involved can (or should) patients be? And what are the implications for medical education?

The answers might surprise you.

The Centre of Excellence on Partnership with Patients and the Public, based out of the University of Montreal, has quickly become a world leader in patient-physician partnerships. In less than a decade, co-directors Dr. Philippe Karazivan and Mr. Vincent Dumez, along with Dr. Antoine Boivin and Dr. Marie-Pascale Pomey, are proving that patient experience and knowledge are essential to the evolution of the health care system and to medical education.

“What’s surprising is that when you start to work with patients I thought that it was going to be more difficult, the solutions would be more complex, we’d have to change more things; but it was exactly the opposite,” said Dr. Karazivan. “You realize the problems you identified are not always the problems that are most important for patients, and the solutions may be simpler.”

New and old ways of thinking about patient engagement

The centre’s expertise is in the methodology of working with patients. Their full-integration approach is different than usual forms of patient engagement and it took a while for their colleagues to adapt.

Dr. Karazivan explained, “People are used to thinking that engaging a patient [in medical education] is inviting a patient into a curriculum or course that’s already fully built.”

In contrast, they work to bring faculty and patients to the same table to co-construct a course or presentation together.

“That’s the key difference,” he said, adding, “One of the main risks we have is tokenism. Showcasing patients but with no intention of learning from them or openness to change. Some people just want patients to say what they want; that’s not what we do.”

The solutions aren’t always difficult

Beyond medical education, involving patients as partners has had significant results in clinical settings. Dr. Karazivan gave this example.

“We were invited to a hospital to help them think about ways to reduce wait times. They wanted to work with patients on a solution. Around the table were doctors, managers and staff. We were coming up with all kinds of really complex solutions. Finally, one of the patients said, ‘Can I just tell you about my experience? Of course we would like to wait less, but waiting is okay. You know what’s not okay? Not knowing how long we’re going to wait. That has all kinds of implications for my work and for my home.’ The hospital realized that this one change could improve the patient experience.”

The origins of the Centre of Excellence

Mr. Dumez has a background in finance and management. He is also a severe hemophiliac. Through his former consulting firm, he met the dean and several vice-deans of the Faculty of Medicine at the University of Montreal.

“They knew me as a consultant, but very quickly they learned to also know me as a patient. We all agreed that because of chronic disease, the democratization of access to information on the net and so on, the behaviour and expectations of patients were changing. This has to impact how we train doctors. We need to prepare them so that they don’t take it as a threat if a patient comes into their office with a self-diagnosis, for example.”

The dean at the time tapped on Mr. Dumez to start the patient partnership program. That was in September 2010. It was the first model of its kind.

As Mr. Dumez described it, it was “like a patient driving a faculty unit.”

Dr. Karazivan, a family physician and medical education researcher, came on board a bit later after meeting Mr. Dumez at a conference.

“To be completely honest, I was quite skeptical at the time,” he explained. “I was not sure about this whole patient-as-partner movement. I wondered about the educational, theoretical, conceptual and epistemological basis of it. But Vincent and I started to talk really honestly about all kinds of issues related to care, education and research — myself as a doctor and him as a patient. It was something quite new for me, even though I’m a physician and I see patients all the time.”

Role models of success

Today, as co-directors of the centre, Mr. Dumez and Dr. Karazivan and their two colleagues lead a team of close to 20. They are in charge of a full curriculum that runs from the first to third year of specialization. It focuses on collaboration, ethics (clinical, research), communication and professionalism. All the contents are co-created with patients and delivered with patients as trainers. They have more than 200 carefully recruited patient-trainers who also collaborate with other inter-professional disciplines.

“It’s not about finding the good patient for the good project; it’s finding the good duo [patient with professor],” said Dr. Karazivan.

Half of the centre’s activities are linked with the University of Montreal and hospitals in Quebec. For the last five to six years, they have been sought out by the Canadian Institutes of Health Research and other linked research networks in Canada. They are also helping interested universities deploy similar models, including overseas in Italy, France, Belgium and Switzerland, and recently in the United States.


Dr. Karazivan and Mr. Dumez were featured speakers at this year’s Fellowship Affairs Summit, which was held June 7-8, 2018, in Gatineau, Que. The Fellowship Affairs Summit is a biannual event that brings together the Royal College’s Fellowship Affairs Committee and its subcommittees (Awards, History and Heritage Advisory, Regional Advisory) to discuss/provide feedback on emerging Royal College programs and policy, and to participate in learning opportunities. The theme this year was “Connecting & reflecting: thinking differently about our learning needs, our patients, our colleagues.”

With a recently-approved strategic plan that places patients at the centre of our work, the Royal College is increasingly seeking out opportunities to learn from and engage with patients.


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Me and my MOC: Staying up-to-date with the help of my national specialty society

Dr. Stephanie Baxter, FRCSC, maintains her Royal College certification as a practising ophthalmologist and program director in Kingston, Ont. In this interview, she shares her strategy for keeping her surgical skill set razor-sharp.

Dr. Baxter

What’s your scope of practice?

I’m entering my 15th year as a practising ophthalmologist. I specialize in the cornea and other front-of-eye diseases. I’ve been a faculty member at Queen’s University for 14 years. Since taking on the residency program director role, I’d say that my clinical work occupies about 60 per cent of my time. Another 30 per cent is devoted to my program and its transition to competency-based medical education, with a small amount of time remaining for research and other departmental activities. My surgical practice consists primarily of corneal transplants, complex cataracts and other intraocular lens surgeries. I average about seven surgeries per week.

How do you fulfil your Maintenance of Certification (MOC) every year?

I have been involved with my national specialty society, the Canadian Ophthalmological Society (COS). I’ve come to rely on it for much of my MOC, particularly for my Section 3 assessment credits. I have been a reviewer for its journal but more recently I’ve participated as both a student and a teacher at its wet lab workshops (skills transfer courses) during its annual meetings.

Stephanie has participated in the Canadian Ophthalmological Society’s Surgical Skills Transfer Courses for several years and reports the feedback she receives as Section 3 MOC credits.

How has your MOC changed over the years?

Since becoming a program director, it has become important to be efficient and strategic with the ways I keep my surgical skills up-to-date. I find the Surgical Skills Transfer Courses offered every year at the COS annual meeting are an excellent way to do this. The courses are inexpensive, have a low teacher-to-student ratio and utilize hands-on wet labs (surgical simulation) for practice and instruction. There is usually a brief introductory didactic portion to the session that involves instruction and videos to demonstrate the technique to be learned. Then two students (usually practising ophthalmologists) work with one expert teacher, who provides feedback and instruction while the students practice the technique. I’ve been doing these courses almost every year for several years and report the feedback I receive as Section 3 MOC credits.

What exactly did you learn at the wet labs?

When I completed my fellowship 14 years ago, I graduated knowing only one way to perform corneal transplants and one method to manage displaced intraocular lenses. Today, thanks to these skills transfer courses, I have learned a variety of newer techniques that have allowed me to keep my skills current, fresh and on the cutting edge.

Stephanie performs a procedure in her Kingston, Ont., practice that she learned at her national specialty society’s annual meeting. Her MOC tip is to look to your own specialty society for opportunities to obtain the various types of MOC credits, including valuable Section 3 credits.

How did this MOC opportunity make you a better doctor?

The skills transfer courses give me an opportunity for extra practice, with feedback from my colleagues. They supplement my skills and boost my confidence to allow me to go ahead and start performing these newer techniques as part of my practice. This, in turn, allows my patients to receive the most current surgical techniques and standards of care for their surgeries. These courses have also introduced me to a network of colleagues to contact later if I need more advice as I transition to a newer surgical procedure. As a sometimes teacher at these courses, it is nice to give back as I have had the occasion to teach colleagues who once taught me.

What would be your MOC tip to other Fellows of the Royal College?

From my perspective, a national specialty society meeting is a fantastic place to get all sorts of MOC credits. The Surgical Skills Transfer Courses were very ground-breaking and, for its ingenuity, the COS was recognized in 2014 with a Royal College Accredited CPD Provider Innovation Award. But the concept of offering one-to-one training at an annual meeting is very transferable to other disciplines. I’d encourage anyone to contact their own national speciality society and start a conversation about how it might be possible to integrate similar hands-on learning opportunities in their specialty. I promise you, it’ll become the highlight of your annual meeting!

Ophthalmologists practise new techniques and receive feedback at their annual meeting’s wet labs. The learning they acquire can be reported as Section 3 MOC Assessment credits.

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Council elections for 2019

By now you should have received an email notification about the 2019 Royal College Council Elections. These elections will be taking place at the Annual Meeting of the Members (AMM) on February 22, 2019.

There are 14 upcoming region- and division-specific councillor vacancies, and another eight vacancies that include public members, Fellows-at-large and the resident member.

What we’re asking of you

1. Save the date for the AMM: This year’s meeting will be on Friday, February 22, 2019, from 1:30-2:30 p.m., ET, at Royal College headquarters (774 Echo Drive, Ottawa, Ont.) The official notice of the AMM will be issued on January 25, 2019. Attend in person or via webinar.

2. Consider the nominees: Please thoughtfully consider the nominees selected by the Royal College’s Nominating Committee to fill the upcoming vacancies on Council.

3. (Optional) Submit a nomination: Members may also submit additional nominations for the region- and division-specific Council positions before January 11, 2019, using the official nomination form [PDF].

4. Learn more: You can learn more about Royal College Council and how this election process will unfold on our Council elections webpage.

If you have any questions, please contact our governance staff (governance@royalcollege.ca).


Opportunity for Fellows in Quebec and Atlantic Canada

The Nominating Committee is an important committee of Council. It nominates the President-Elect of the Royal College, as well as members of Council. Nominees are needed to fill two impending vacancies on the Royal College’s Nominating Committee [PDF] in Region 4 (Quebec) and Region 5 (New Brunswick, Nova Scotia, Prince Edward Island, and Newfoundland and Labrador) for the 2019-2023 term. Nominations must be submitted by January 11, 2019, and can be made by any Fellow using the Nominating Committee nomination form [PDF].


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Debating the Bawa-Garba case and more recordings from ICRE 2018

ICRE 2018 drew more than 1,500 registrants from nearly 30 different countries to Halifax, Canada, where they took part in workshops, plenaries and paper/poster presentations.

Discussions surrounded the conference theme, The Learning Environment and Residency Education: The Evolution of Training, and included

  • a two-part live simulation scenario and debriefing; and
  • a BBC News-style panel debate, hosted by former BBC News reporter, Maxine Mawhinney.

If you missed (or want to relive) this year’s ICRE, you can now tune in to some the plenary session recordings.

Plenary recordings

Plenary recordings available:

  • SimTrek plenary – Part 1
    Speakers: Dr. Simon Fleming, Dr. Adam Garber, Dr. Glenn Posner
  • Conference plenary panel: Confronting the evolution of the learning environment: It’s all about perspective
    Panel: Dr. Avi Cooper, Dr. Romana Malik, Dr. Saleem Razack and chaired by Dr. Adelle Atkinson
  • Conference plenary debate: Learning from tragedy: The Hadiza Bawa-Garba case
    Panel: Dr. Elizabeth Elsey, Dr. Simon Fleming, Dr. Douglas Grant, Dr. Geeta Singhal, Dr. Christopher Watling and hosted by Ms. Maxine Mawhinney
  • Royal College/JGME Top Research in Residency Education
    Speakers: Dr. Lauren Cook-Chaimowitz, Dr. Nancy Dudek, Dr. Elizabeth Elsey, Dr. Stephenson Strobel, Dr. Kenji Yamazaki
  • SimTrek plenary – Part 2
    Speakers: Dr. Farhan Bhanji, Dr. Marcia Clark, Dr. Simon Fleming, Dr. Adam Garber
  • Conference closing plenary session: Call me by my name: Seven habits to create a positive learning environment
    Speaker: Dr. Teri Lee Turner

ICRE 2018 was not only well attended in-person, but also saw its strongest social media presence yet, garnering over 38 million impressions and more than 12,000 tweets under the hashtag #ICRE2018. Relive the great conversation through our Twitter Moments.


Be a part of ICRE 2019 in Ottawa, Canada!

Have cutting-edge insights to share related to residency education and training? Interested in our 2019 theme, Diversity in Residency Education: Training in a World of Differences?

Mark your calendars for upcoming submission deadlines:

  • Call for pre-conference workshop proposals
    NOW OPEN
    Deadline: January 4, 2019
  • Call for in-conference workshop proposals
    NOW OPEN
    Deadline: January 25, 2019
  • Call for abstracts
    Process opens: January 2019
    Deadline: March 1, 2019
  • Call for Residency Education Awards nominations
    Process opens: January 2019
    Deadline: April 5, 2019

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Quebec specialists: MOC cycles are changing — here’s what you need to know

The Collège des médecins du Québec (CMQ) recently approved a new regulation, known as the Règlement sur la formation continue obligatoire des médecins. It will require all Quebec licensees to report their continuing professional development (CPD) activities to the CMQ — and more thoroughly than before.

If you are a Fellow or a Maintenance of Certification (MOC Program) participant licensed in Quebec, rest assured that the Royal College’s MOC Program will help you meet these requirements and you will not have to report activities twice.

Working with the CMQ for an easy transition

The new regulation comes into force on January 1, 2019, and marks the first mandatory CPD program in Quebec. We are working with the CMQ to ensure an easy transition.

As a first step, we are mapping our MOC Program requirements to those in the CMQ program (credits to hours). Next, we plan to expand MAINPORT ePortfolio’s capabilities to seamlessly report MOC data in alignment with the CMQ’s requirements and platform.

In short, you will be able to fulfil your new obligations to the CMQ through MAINPORT ePortfolio.

Your new MOC cycle will retroactively start on January 1, 2019

This work is in progress and depends in part on the CMQ’s own technology platform, which is still under development. However, we plan to provide all Fellows and MOC Program participants practising in Quebec with a new five-year MOC cycle that is backdated to January 1, 2019. We will also allow you to carry forward credits from your current cycle to this new cycle, to honour under the MOC Program the learning that you’ve already reported to date. These decisions were made by the Royal College to ease the transition for you when you begin your first CMQ cycle on January 1, 2019.

Two ways to get ready

We will keep you posted with progress updates, such as when your new cycle is ready. In the meantime, please claim credits as normal leading up to the January 31, 2019, MOC Program reporting deadline.

We also recommend the following actions:

  • Log in to MAINPORT ePortfolio to see how many credits you have. Once your new cycle is ready, you will be able to carry forward up to 25 credits per MOC Program section.
  • Contact your provincial medical regulatory authority to authorize the creation of a Medical Identification Number for Canada (MINC) if you don’t already have one.

Have questions?

We’re here to help if you have any questions. Please contact our Royal College Services Centre or the CMQ using the coordinates below:

Royal College Services Centre
1-800-461-9598, 613-730-6243 (Ottawa region)
cpd@royalcollege.ca

CMQ
dae-dpc@cmq.org


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Members in the news

Doctor walking down a hospital hallway

“Receiving support from family and friends can actually protect you from possible major depressive disorder,” Vincent Agyapong, MbChB, FRCPC (“Mental-health problems hit hard at survivors of Fort McMurray fire,” The Globe and Mail).

"Do we have a real need for this sort of medication in practice in Canada? From reading the literature, [I] don't see it as a big benefit," Daniel Bainbridge, MD, FRCPC (“Canadian doctors urge caution after FDA approves controversial new opioid pill,” CBC News).

“Our health-care system should provide free access to life-saving antiretroviral drugs. It's a matter of human rights and public health,” Joseph Cox, MD, FRCPC (“Opinion: HIV patients should not face financial barriers,” The Province).

“It’s really just a throw of the genetic dice that we don’t have a Spanish flu that’s yet popped out,” Gerald Evans, MD, FRCPC (“100 years ago, the Spanish flu killed millions. Could it happen again?Global News).

“All of the public health officials acknowledge that under-detection is virtually certain. I mean, that’s not a surprise. But the magnitude of how under-detected it was hadn’t been described in Canada,” Ralph Hawkins, MD, FRCPC (“Research shows Lyme disease under-detected across Canada,” Toronto Star).

"This is just a general statement. I mean, the devil will be in the details," Vladimir Iakovlev, MD, FRCPC (“THE IMPLANT FILES: Health minister vows to strengthen oversight of medical devices after investigation reveals problems,” CBC News).

"I think it's a great starting point to begin to get information about your body and how it handles medications. But don't consider it the answer as to, you know, absolutely what drug you should be taking," James Kennedy, MD, FRCPC (“Pharmacies selling DNA tests to help patients pick best medications,” CBC News).

“Ninety per cent of the patients said that controlled their pain, they didn’t need the narcotics script filled,” Ken Leslie, MD, FRCSC (“STOP Narcotics protocol takes scalpel to opioid prescribing for surgical patients,” Saskatoon Star Phoenix).

"Just like people have different shoe sizes, their bladders may have different capacities as well," Michael Leveridge, MD, FRCSC (“How Often Should You Pee?HuffPost Canada).

“As a surgeon, I want to be alerted about patients who have complications. I can’t fix anything I don’t know about,” Susan McDonald, MD, FRCSC (“After surgery, 15 per cent of B.C. patients rush back to hospital, mainly due to pain, bleeding or infections,” The Province).

“I’ve been in practice for 25 years, and this double setup I haven’t encountered until this time. What amazed me most was the ability of all the team members to co-ordinate together and to perform almost two simultaneous operations,” Suvro Sett, MD, FRCSC (“Halifax medical teams join forces to save newborn with rare heart tumour,” The Star Halifax).

"It doesn't seem that in a public health-care system that I should be marketing myself, that I should be protecting my reputation and paying an independent private company to do that work,” Sukhbir Singh, MD, FRCSC (“Who's rating doctors on RateMDs? The invisible hand of 'reputation management'CBC News).

“We as a society are constantly wringing our hands about hockey players and football players getting dementia from head trauma, but [domestic violence] is a source of head trauma which is real, which is out there, which is painfully common,” Donald Weaver, MD, FRCPC (“THE LONG VIEW: Studying the potential link between dementia and domestic violence,” The Globe and Mail).

Awards and accolades

Congratulations to James Arnold H. Dosman, MD, FRCPC, and Jacalyn Mary Duffin, MD, FRCPCinductees to the Canadian Medical Hall of Fame for 2019. Dr. Dosman is known as the “father of agricultural medicine,” and Dr. Duffin is a hematologist and historian.

Congratulations to Marc Ruel, MD, FRCSC, a 2018 Order of Ottawa recipient. He is “a pioneer in the field of heart surgery, where he has distinguished himself as a top surgeon, researcher, educator, and administrator.” (Read more: Order of Ottawa inductees honoured on Ottawa.ca)


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In memoriam

Stethoscope

William (Bill) Davidson, MBChB, FRCPC, died on September 14, 2018, in Mississauga, Ont., at age 88. Dr. Davidson was certified by the Royal College in Pediatrics in 1965. Among his professional contributions, he served as a pediatric volunteer in the Vietnam War where he cared for orphans. Read more about Dr. Davidson.

Graham Wilfrid Chance, MBChB, FRCPC, died on October 23, 2018, in Goderich, Ont., at age 85. Dr. Chance was certified by the Royal College in Pediatrics in 1984. For many years, he worked in the NICU at St. Joseph’s Hospital. He is remembered for his kindness, empathy and humane care. Read more about Dr. Chance.

Alexander Charles Allen, MDCM, FRCPC, died on October 25, 2018, in Halifax, N.S., at age 84. Dr. Allen was certified by the Royal College in Pediatrics in 1984. He earned his medical degree at McGill University in 1959.

Eusebio Chua (E.C.) Young, MD, FRCPC, died on October 10, 2018, in Carmel, Indiana, USA, at age 84. Dr. Young was certified by the Royal College in Internal Medicine in 1969. He worked at the Community Hospitals in Indianapolis before retiring in 2001 after more than 40 years in practice. Read more about Dr. Young.

Jules Eli Harris, MD, FRCPC, died on October 12, 2018, in Tucson, Arizona, USA, at age 84. Dr. Harris was certified by the Royal College in Internal Medicine in 1965. Dr. Harris worked as a hematologist in Tucson. He earned his medical degree at the University of Toronto in 1959.

Claude Mercure, MD, FRCPC, died on October 3, 2018, in Laval, Que., at age 83. Dr. Mercure was certified by the Royal College in Pediatrics in 1965. After starting his career at l’hôpital Sainte-Justine, he joined the Collège des médecins du Québec where he worked for more than 40 years. Read more about Dr. Mercure.

Ralph Bilefsky, MDCM, FRCPC, died on September 22, 2018, in Montreal, Que., at age 81. Dr. Bilefsky was certified by the Royal College in Internal Medicine in 1967. With a deep love of learning, he spent over 15 years studying at McGill University: Psychology, Pathology, Nephrology and Internal Medicine. Read more about Dr. Bilefsky.

Kenneth Zachary Cantor, MDCM, FRCPC, died on September 21, 2018, in Montreal, Que., at age 80. Dr. Cantor was certified by the Royal College in Internal Medicine in 1969. He graduated from McGill University with his medical degree in 1963. For many years, he practised Cardiology in Montreal. Read more about Dr. Cantor.

Colin Duncan B. Cunningham, MBChB, FRCPC, died on October 15, 2018, in Renfrew, Ont., at age 77. Dr. Cunningham was certified by the Royal College in Diagnostic Radiology in 1975. He previously worked at the Renfrew Victoria Hospital and the St. Francis Memorial Hospital; he is remembered for his dedication and conscientiousness. Read more about Dr. Cunningham.

Marcelo Kremenchutzky, MD, FRCPC, died on October 1, 2018, in London, Ont., at age 55. Dr. Kremenchutzky was certified by the Royal College in Neurology in 2010. A leading expert in multiple sclerosis, he worked at the London Health Sciences Centre and on faculty at the Schulich Medicine & Dentistry at Western University. Read more about Dr. Kremenchutzky.

William Roy St. Clair, MBChB, FRCPC, died on September 24, 2018, in Kelowna, B.C., at age 94. Dr. St. Clair was certified by the Royal College in Internal Medicine in 1953. Among his accomplishments, he pushed for the development of the Cardiac Stress Testing Unit at the Grey Nuns Hospital in Edmonton, Alta., where he was also chief of staff. Read more about Dr. St. Clair.

Beverley C. Trask, MDCM, FRCPC, died on September 9, 2018, in Sydney, N.S., at age 89. Dr. Trask was certified by the Royal College in Internal Medicine in 1960. He practised as an internist for more than 40 years at both the St. Rita and City of Sydney hospitals. He later worked at the Cape Breton Regional Hospital and at the local office of Veteran’s Affairs. Read more about Dr. Trask.


 

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