Chair's Message

Dear Colleagues,

The Department of Family and Community Medicine (DFCM) is one of the world’s great centres of academic excellence in family medicine. Over the past few months I have visited each of our academic sites in Toronto and rural Ontario and had the privilege of meeting with each of our family medicine chiefs, many of our 1,500 faculty members, researchers and teachers, our support staff, and many of our residents, graduate and undergraduate students. 

As a result of these meetings and consultations, we will be restructuring DFCM into five academic units: Research and Advocacy (led by Eva Grunfeld), Education and Scholarship (led by Risa Freeman), Quality and Innovation (led by Phil Ellison), Global Health and Social Accountability (led by Katherine Rouleau), and Family Doctor Leadership (led by David White).  David Tannenbaum will continue as Deputy Chair and will be responsible for our partnerships with our academic sites, government, and our divisions of palliative care and emergency medicine. The details of my vision for the future of family and community medicine at the University of Toronto are outlined in the accompanying video.
 
We have also released our Department Report for 2014-2016, which showcases the wonderful achievements and contributions of some of the people who make up our extraordinary academic department. I look forward to working together to strengthen family and community medicine at this university and to further enhance our global impact.

 

 

 


Shorter Segments

 

Michael Kidd
Chair
Department of Family and Community Medicine

 

Full Transcript 


The Future of academic family medicine at the University of Toronto


Like you, I am a passionate advocate for family medicine and the role that we can play as family doctors, and as members of family health teams, to transform health care delivery and health outcomes for the people in the communities we serve.

The Department of Family and Community Medicine is an energetic and inspirational academic department based in one of the world’s great centres of academic excellence, the University of Toronto. Over the past few months, I have visited each of our academic sites; our 12 sites based in the Greater Toronto Area, our sites in Barrie and Newmarket, and our four lead sites in rural Ontario. I have had the privilege of spending time with our family medicine chiefs at each site.  I have met many of our faculty members, our researchers and teachers and support staff, our residents, and our postgraduate and undergraduate students. Each day over the past three months I have met for the first time a faculty member or a resident or a medical student or a staff member who is doing amazing work, as a clinician, as a researcher, as a medical educator, as a community member, as a local, national or international leader in their field.

The members of our department are extraordinary family doctors. They include 2 federal cabinet ministers, 2 recent Rhodes Scholars, 7 holders of endowed chairs, 1 current college president and many past presidents, a former astronaut, multiple internationally-renowned research leaders, media personalities, award-winning authors, world-class educators, government advisors, community leaders making up the 1550 extraordinary family doctors, who together, are striving each day to meet the health care needs of the people who trust them for their health care and advice.

I have also looked closely at the department’s strategic plan and the directions you worked together to set for this department in 2014.  I am not able to criticise a strategic plan that seeks to “advance family medicine globally through Scholarship, Social Responsibility and Strategic Partnerships”. The five key areas in the plan are as relevant today as they were three years ago, but I want to sharpen the focus of our activities and enhance our local, national and global impact.

Clearly, we need to continue to build on our strengths in education, and innovation, and scholarship.  We need to continue to strengthen our research activity, embed research into everything we do, and expand the impact of our practice-based research network, called UTOPIAN.  We need to strengthen the links between our important quality improvement work and research.  We need to expand our global impact and reputation.  And we need to continue to enhance our commitment to social accountability, including our commitment to Indigenous health.

The Department of Family and Community Medicine at the University of Toronto is home to one of the largest family medicine residency programs in the world. We are training about 40% of Ontario’s future family doctors and 25% of Canada’s future family doctors. But the department is more than just a large family medicine residency program.  Research has always been a hallmark of this academic department, through the work of individual internationally-renowned experts in family medicine research, and more recently, through the establishment of one of the world’s largest Family Practice Research Networks, called UTOPIAN.

And global health has clearly been an area of influence, perhaps most importantly through the support provided by this department to the establishment of family medicine residency training in Ethiopia, and the leadership support provided to the Besrour Initiative of the Canadian College of Family Physicians. 

But, as I have learned since arriving here, this department’s global health activities are much deeper, especially focused on the social determinants of health and on addressing health inequities here in Toronto and across Ontario, as well as around the world.

It has also become clear when I arrived that everyone is very busy, and that sometimes, in our busy-ness, we don’t look up and see what is happening elsewhere in the department. Early on, I set our vice chairs and program directors the challenge of meeting with each other, to work out ways we can work across areas to complement and support each other’s work, and foster innovation. 

We are a leading academic department and we need to embed the culture of research and innovation into everything we do.  We are also a global leader and we need to think about the global implications of everything we do. In short, we need to focus the way we look at family and community medicine at the University of Toronto.

And there are many opportunities. I am impressed that seven of our faculty have chairs supported by generous philanthropic donations, some funded directly through the University, some funded through hospital foundations. And I am pleased that several of our chiefs are working with their hospital foundations to create more supported positions in family medicine and primary care research. I want to set a target of five more chairs funded directly through the University, and to work with you, and our Advancement Officer, on determining what areas they should be in.

One of the first things that caught my attention when I arrived was the name of our department.  Why are we called the Department of Family and Community Medicine, when the other Canadian academic departments are simply departments of family medicine or family practice (or in the cause of the three francophone departments in Quebec, family medicine and emergency medicine)?

Community medicine meant something different in the 1960s when this department was created. If we are going to retain Community Medicine in our title, and I think we should, then I think we should be embracing our contribution to the community.  I think this is appropriate in the early 21st century, as family medicine starts to expand further out into the community and integrates even more with other community services to improve the care we provide.  I think our current name is also appropriate if we are seeking for family medicine to take a lead in the development of people-centred health care.  It is time to really put the “community” back into the Department of Family and Community Medicine.

I was also surprised to find a number of programs and roles in the department which didn’t appear to have a logical home within our structure.  This means we may be losing out on opportunities for integration and value-adding between components of our department. I will be seeking to find a happy home for everyone in our academic family within this new structure.

Underpinning all our work will be our administrative staff, led by our Business and Administration Director, Caroline Turenko.  Together we need to ensure the financial stability of our department and our capacity for further growth. What are the innovative ideas that will generate the income to enable us to grow and continue to innovate? What do we stop doing?  How do we use our communication platforms, including social media, to strengthen our advocacy, our visibility, and the impact of our work? 

To support our work in the future, I plan to refine the structure of the department with a focus on education and scholarship, research and advocacy, quality and innovation, global health and social accountability, family doctor leadership development, and key partnerships.

I expect, given our discussions over the past months, that most of what I outline won’t come as a surprise to you but I acknowledge that there will be some anxiety about proposed changes and new areas of focus.  I don’t envisage that these initiatives will change what happens at our academic sites, at least in the short term.  I also don’t envisage that these initiatives will change the current delivery of our programs or our staffing, again at least in the short term.  We have time to implement and refine and get things right so that they work optimally for our programs and our academic sites.  But I do hope these innovations will create many more opportunities for our faculty and our residents and our staff. 

So, first up, I plan to rename our Research area as Research and Advocacy.  Eva Grunfeld will continue to be Vice Chair although her second term in this role will conclude at the end of 2018 so we will shortly be starting to recruit into this position.

We need to continue to focus on our research activity, grow our research income and our research outputs, and increase the recognition of the important research taking place across this department.  Our faculty include some of the global leaders in family medicine research and I want to build links with other great centres of family medicine research around the world, as well as strengthening links with other areas of clinical medicine and public health here at the University of Toronto.

We need to build on our strong base.  I want all our residents to be research competent on completion of their training.  I want all our faculty to be at least research aware and open to involvement in research activity.  I want to work with the university’s graduate schools to grow the opportunities for more enrolments in Master and PhD programs for family medicine residents and family doctors and those who would like to do research with us including welcomed visitors form overseas.

We also need to be using our research for advocacy. Advocacy for the role of family medicine as the foundation of health services in Canada. Advocacy for the need for greater investment, both in clinical family medicine services and in family medicine research.  Advocacy for family practice as the ideal research location to generate the evidence for the delivery of 21st-century health care. An advocacy for how we translate the findings of our research rapidly into clinical practice. You and I know that family practice systems are a natural place for health and medical research and exploration, and we need to let the rest of the world know that too.

Fortunately, we are already a long way down this path.  UTOPIAN is one of the world’s largest practice-based research networks and we should be a site for an increasing number of clinical trials.  And the aggregation of electronic medical records from our UTOPIAN practices provides an incredible resource to enable us to understand the health and health care needs of our population, and to inform policy makers and focus health service investment.  I would like to see all our faculty members engaged with UTOPIAN, their practice-based research network.

I would like to be even more strategic in looking at how we use the UTOPIAN resource. I would like to work with you to create the Annual Toronto Health Report, using UTOPIAN and other data sources, to produce an annual report on the state of health of the 6.4 million people of the Greater Toronto Area, highlighting the contribution of family medicine to the health and wellbeing of all the people of our city, and tracking over time to see the impact of government policies and innovations and changes in health practices on the health and wellbeing of the population we serve.

Our library, one of the few stand-alone collections of family medicine and primary care literature in the world and will sit under research and we will look at ways our librarian can expand contributions to support the research mandate of our department.

I have asked Eva to work with our research leaders on what makes research of the DFCM distinctive and to determine those areas of primary care research where we are the leader.  What are the great global health and medical research questions that we can help to answer?  How can we improve knowledge translation into daily clinical practice?  What are the questions that we can answer, that others cannot?

I am keen to also increase opportunities for research partnership with industry. I said that I was keen to see at least five new endowed chairs and I am keen to hear from you about what the areas of focus should be, for example in global expansion of family medicine, the prevention and management of chronic disease and mental health and comorbidity and complexity, our contributions to healthy ageing, opportunities to expand clinical trials in primary care, the role of innovations in digital health and genetics in family medicine.

I plan to rename our Quality Improvement area as Quality and Innovation. Phil Ellison will continue as Vice Chair but has announced he will be retiring mid-2018 and so we will be seeking a new Fidani Chair to lead the internationally renowned work that Phil and his team have established in improving the quality and safety of family medicine. I am keen to build on our leadership in quality improvement in family practice and expand our impact across Canada and around the world.

I want to reinforce the vibrant program in quality improvement which has been embedded across our residency training. I want to expand the translation opportunities of local quality improvement initiatives through more publications and presentations and research to improve the quality and safety of family practice across Canada and around the world.

Eventually, it may be appropriate to bring our quality programs and our research programs into a single family medicine innovation powerhouse to further integrate our important work in both areas.  How can our quality improvement discoveries inform our research programs, and how can our research discoveries inform our quality improvement activities?

I plan to rename our education area as Education and Scholarship, and Risa Freeman will continue as Vice Chair.  My hopes for education and scholarship at DFCM are simple, and build on the great program that has been developed over many years.  Simply, I want the medical education at the DFCM to be the most innovative and exciting in the world.  

So how do we become the most innovative centre of family medicine education in the world?

A century after Flexner, and 30 years after the introduction of problem-based learning, I believe that medical education is ready to be transformed once again, to ensure that our graduates are equipped to meet the health care challenges of the present and the future, and, in my view, family medicine education can, and should, be leading the way.  Our medical education needs to embrace true person-centred care.  Our medical education needs to adapt to new technology, both used by clinicians and by the people we serve.  Our medical education needs to be incorporated into our daily work, so that we learn while we work, and have our daily activity presented back to us for reflection, and new technology and clinical decision support provides the capacity to do this.  Our medical education needs a global perspective, as many of our graduates will work all around the world.  Our medical education needs to acknowledge and respect diversity and human rights.  Our medical education needs to be rooted in ensuring safe, high quality and appropriate health care.

We also have a strong presence in the medical student MD training at Toronto.  I want to continue to promote family medicine to our medical students as an exciting and rewarding career opportunity. I would like to see an increase in the number of University of Toronto medical students putting our family medicine residency program as their number one choice.  We will do this by ensuring that every medical student has positive inspirational experiences working with excellent clinician role models who make up our faculty.

I also want to strengthen our commitment to scholarship in medical education. I want this department to be a centre of excellence in family medicine education, with increased opportunities for Master and PhD enrolments by residents and recent graduates, increased opportunities for higher degrees in family medicine education research and increased publications and presentations on our family medicine education research scholarship.  We have just had our very first MD/PhD student awarded his PhD, and this is something I really want to grow.

In order to better integrate our Physician Assistant education program, and allow opportunities for this program to benefit from innovations elsewhere in the department, and to inform developments elsewhere, I plan to locate this program as well within our Education and Scholarship area.  

And, as part of our focus on the continuum of family medicine education from the education of our medical students to the lifelong learning of family doctors across Toronto and Canada and around the world, I plan to locate our continuing professional development/continuing medical education programs in our Education and Scholarship area.

One of the reasons the University appointed me to this role was to grow our global presence and our global impact.  So there will be no surprise that I wish to create a new Vice Chair on Global Health and Social Accountability and I am pleased to advise that Katherine Rouleau has agreed to take on this role. Katherine will continue to lead our global health area which will be expanded to cover Global Health and Social Accountability, and which will, among other areas, include a specific focus on our contribution to improving the health and wellbeing of Indigenous Canadians.

DFCM already does extraordinary work in supporting family medicine development around the world.  Our current programs include contributions in China, South America, the Caribbean, the Middle East and Africa, including our support for the development of family doctor training in Ethiopia. I want to grow our international offerings, and also increase the opportunities for international visitors to participate in all our programs here in Toronto.

I am also keen to strengthen our involvement with key global health organizations, including the World Health Organization.

Global health, of course, begins at home, and I want to strengthen the focus on our contributions towards addressing the social determinants of health and the work of many of our faculty in working with vulnerable and marginalised populations, in Toronto and in rural and remote Ontario.

I have been especially impressed with the focus of some of our faculty on addressing inner city health challenges, such as HIV primary care, addiction medicine, the care of people who are homeless, people who are poor, adolescents, and people who are refugees and new immigrants.  These are issues with global implications and we need to be sharing our research findings and experiences with the rest of the world.

Since arriving in Canada I have been impressed by this nation’s genuine movement towards Truth and Reconciliation with Indigenous Peoples.  As a leading academic department, we have a role to play in this process, especially in efforts to improve the state of Aboriginal health in Canada.  I want to work with you to define our role in improving Indigenous health across Canada. 

I want this department to be a safe and respectful place that embraces this nation’s Indigenous Peoples and heritage.  I want this to be the number one choice of family medicine residency training for Indigenous medical graduates (and to see if we can set a quota for entry by Indigenous students, and also students of refugee origin). I would like to have all our faculty and staff and residents be culturally aware, and culturally sensitive, and culturally appropriate.  We have an extraordinary opportunity to support these nationwide developments especially given that we have two of our faculty in the Canadian Ministry, as Canada’s Minister of Indigenous Services (the Honorable Jane Philpott) and as Canada’s Minister of Crown-Indigenous Relations and Northern Affairs (the Honorable Carolyn Bennett). 

As a newcomer to Canada, I have a lot to learn about the diverse Aboriginal peoples of Canada and I will be looking for your support in implementing these initiatives. I am pleased to advise that faculty members like Janet Smylie are keen to engage with us on this endeavour.

I want our medical students and our residents to see our commitment to social accountability in action, and I want to support preparing them to work where they are most needed, either in Canada or around the world.  This department has a great track record of commitment to social responsibility for us to build on.

Finally, I want to create a new area focused on Family Doctor Leadership and I am pleased to advise that our current CFPC president, David White, has agreed to take on this role.

I want to enhance our leadership training. I want every member of our faculty to be competent in clinician leadership skills, in basic research and education skills, in medical writing and communication, in public speaking and advocacy.  I also want to proactively boost the morale of our faculty and residents, while preparing the next generation of family medicine leaders.

Our new Family Doctor Leadership area which will focus on faculty development, academic promotion, faculty awards, leadership skills training, mentorship, equity and diversity, and the well-being of all our DFCM members.

I would like to be able to identify current junior faculty members that we can actively mentor to prepare for and take on leadership roles.  I would like to expand our commitment to supporting diversity for disadvantaged groups.  I would like to ensure that we are supporting the well-being and resilience of our faculty.

I am also pleased to advise that David Tannenbaum has agreed to continue as our Deputy Chair and will have specific responsibility for working with me and our chiefs, in supporting our partnerships with our academic sites and our government partners in Toronto and Ontario and Canada.  If we are going to be a national and global opinion leader in family medicine, this will only be achieved through effective partnerships.  We need to be a “go to” place for our health services, for government, for the media, for international visitors, and for global health organisations. 

We also provide training for much of the nation’s workforce in Palliative Care and Emergency Medicine, and David will also support our Division Heads in these two major subspecialty areas.

Finally, I need to tell you about The Big Idea.  I would like to have a Big Idea to unify our department around a common goal which will make this department great and enduring.  We need a Big Idea which contributes to our leadership of a revolution in family medicine and the contributions family medicine makes to communities and nations.

What the Big Idea will be needs your input.  I have my own ideas but I want to hear from you.

This is an extraordinary academic department, full of talented people making wonderful contributions to health and medical research, teaching, and clinical care in Canada and around the world.  I look forward to our continuing work together over the years ahead.

Thank you!

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