Charting our Course: A look at where the Department of Medicine is going for the next five years
“The Department of Medicine already has many strengths. We are highly engaged and driven for excellence in care, teaching and research. We are persistent, adaptable and resilient. We value each other and we like each other, and we have an insatiable desire to foster progressive change, equity, fairness and diversity. We have accomplished so much over the past five years – and we’re committed to going even deeper and further over the next five.”
This was the overarching message of our Department of Medicine retreat on September 23 and 24, 2019. Over a day and a half, Division Directors, Physicians in Chief, patients, Vice-Chairs and other partners and guests spent focused time reflecting on our accomplishments, strengths and our deepest aspirations for the next five years. We drew on the conversations our leaders had across all of our divisions, as well as the ideas of other system thinkers. We explored how far we have come on each of our eight guiding principles, where these principles are now embedded, where we still need to act, and how to evolve our focus for the next few years to have the greatest impact. We reflected on the attention we have placed on putting our patients first and reaffirmed that this makes sense. After all, it’s why we became physicians. We invited two patient guests to share their stories at the retreat, and with their perspectives front and centre, it was clear that having patients with us as we chart our course and execute our plan is the logical next step.
Over the next few weeks, we will be shaping what came out of the retreat into a crisp strategic framework, and we will be creating opportunities for everyone to integrate our departmental priorities into their work. In the meantime, I want to share with you some of the insights and aspirations that really resonated with me.
Culture & Wellness
There was collective pride expressed as we talked about how our department has helped to shape the evolution of work across the Faculty of Medicine and, in many cases, nationally, in equity, diversity and inclusion (EDI), professional behavior, humanism in medicine and, more recently, physician wellness and job satisfaction. We have a strong desire to continue deepening our existing strengths, while adding an explicit role of advocacy for equity, wellness and sustainability. There was agreement that we have made important steps towards laying the foundation to enable EDI, promote professional behavior, celebrate accomplishments and engage patients more meaningfully. And we are truly benefitting from a greater diversity of voices and experiences around our departmental leadership table. But we need to consolidate this good work and evaluate uptake and impact. Put simply by Dr. Shelly Dev, who spoke on the subject of wellness, we want to continue to move towards creation of “a workplace culture where we look after one another.”
One of the concepts that came up is purposefully shifting our practice to human-centred care, acknowledging that our own wellness matters and that we should be learning from and with our patients and trainees. This means not positioning ourselves as the experts imparting wisdom in a unidirectional way. It also means ensuring that our processes, including recruitment, promotion and recognition, are driven as much by living our values as by traditional academic measures of impact.
Mentorship Across the Lifespan
We have made important investments in early career development, which is bearing fruit as we see successes at CFAR and Senior Promotion. We are also seeing a greater number of Clinician Teachers seeking promotion! But, we felt that greater effort is required to support our mid- and later career faculty members, especially the growing number of Baby Boomers who are making the sometimes difficult transition to retirement. We also discussed and recognized the tremendous efforts of our front-line clinicians and teachers. We need a cadre of academic physicians whose focus is to role model exemplary clinical care. This is important not only for our learners, but also to facilitate a better balance of clinical and academic responsibilities.
Generating and Translating New Knowledge to Impact Health
Our scholarship is truly world-class; there is no question that the rising rankings of U of T overall and in clinical medicine specifically are related to the outstanding efforts of our department. With relatively small investments, city-wide inter-disciplinary networks have been established and are thriving. Now is a good time to take a look at where we might want to strategically leverage our collective assets to create new networks.
There was a sense that we have done a good job of shifting the perception of scholarship from research alone to a broad array of activities that generate new knowledge that impact health and health care, and that this cannot be sacrificed. Our faculty are more frequently telling their stories and this has enabled dissemination of their good work through the media. But, we acknowledged how challenging our faculty are finding it to balance their clinical and academic responsibilities, and that major efforts to raise funds are required to ensure the sustainability of the physician scientist pipeline of which we are so proud.
Finally, our faculty and partners have built the infrastructure to use big data to provide feedback to physicians on their care – GEMINI, iCORE and others – we talked about how we can leverage these tools to advance care delivery and outcomes.
Training for the Future
The importance of supporting our programs in Competency-Based Medical Education implementation and Royal College accreditation was echoed by all. This is clearly of paramount importance. But we cannot lose sight of our aspirational goal of ensuring that our training programs are providing residents and fellows with the skills and knowledge they will need to provide the highest quality care to patients in the future. The world of health and science is rapidly evolving and we need to prepare our trainees for that. Specifically, do they understand the role of artificial intelligence in health and clinical decision making? What about use of digital technologies? Will they be equipped to care for a more diverse population than ever before, the widening gaps between the rich and poor, and the overarching impact on mental health that accompany these social determinants of health?
Making Choices in the Context of Fiscal Restraint
We are increasingly being asked to do more with less. So we must ensure a laser-focused plan.
We spent much time considering how best to balance our aspirational goals, like our insatiable desire to be innovative and launch new initiatives that address climate change, reach out to underserved populations, address the recommendations of Truth and Reconciliation, and more, with our operational responsibilities.
In his keynote address, Dr. Kevin Smith, President and CEO of UHN, challenged us to carefully consider where we see our department as needing to lead and where we could take a more nuanced role as partner, or even as follower. He proposed:
"Doing less but being more impactful. And by less, I don’t mean less impact or less quality…I mean learning to say ‘no’ so we can sharpen our focus, be more strategic and be a high-caliber follower when needed.
“There is tremendous value in mastering the art of saying ‘no,’ knowing when to say yes and what that means. We all know what we need to do to sustain academic medicine based on experience and the literature.”
Dr. Smith also challenged us to become more active in the political discourse about health care and training. We have individuals in our department who work closely with key decision makers at the Royal College, Ministry of Health and Long-Term Care, Ontario Medical Association, federal government and others, but as a department we have not had a voice at these tables. While every day we feel the inadequacies of our system, could we, or should we, be playing a more coordinated and active role in health system transformation? We explored what it would mean to fully step into our role as system leaders, and in which areas we might focus our advocacy. For example, we explored setting goals for our own reduction in our carbon footprint.
Hopes for the Next Five Years
The retreat was inspiring and powerful. We are an amazing force – one I’m grateful for every hour of the day. Despite the intense pressures posed by clinical demands, fiscal restraints and rising scrutiny and expectations from all sectors, you remain committed to providing the very highest of patient care, you are passionate teachers and mentors, and you are inquisitive and determined scholars.
It is truly exhilarating to be in such company! Together, we will generate the culture change to which we aspire.