Hello. Bonjour. Aaniin. Boozhoo.

These two weeks have taken me to Thunder Bay several times and meetings around Ontario, with more plans to travel to where NOSM must be represented; including communities further north, and at the Council of Ontario Faculties of Medicine, and the Association of Faculties of Medicine of Canada and the Colleges.

It is critical that NOSM is seen in all these places, because NOSM is truly unique. No other voice can adequately represent the Northern perspective on health-care education. If not, we risk being unheard or left out of competing province-wide decisions and national strategies in resource allocation and policy-making. No other school of medicine has a mandate such as NOSM, and no other part of Ontario suffers the health disparities and inequities as the North.

NOSM was the first medical school in Canada established with an explicit social accountability mandate. This means that NOSM is dedicated to addressing the priority health concerns of the people and communities of Northern Ontario. The health factors that make the North unique are difficult issues to highlight but in the next five years I intend to keep the “pedal on the metal” to ensure that progress is made. I intend to reopen our definition of social accountability. I will be asking all of you  What do you think it really means to be socially accountable?  That mandate, in my humble opinion, needs to be opened up to reinvest in aggressive advocacy, influencing policy and the renewal of our commitment to the North.

The HARD Facts: The needs of the North are different. So are our doctors.

Northern Ontarians have shorter expected lifespans than people in Southern Ontario, and are far more likely to die prematurely (before age 75) from suicide, heart disease or respiratory disease. Northerners have less access to primary care providers, and higher rates of suicide, complex chronic diseases, obesity and are more likely to report having multiple chronic conditions.[1]

Mental health and addictions in the North are some of its greatest challenges. The youth suicide rate of Indigenous people is six times higher than non-Indigenous youth in Canada.

The northeast and northwest have the first- and second-highest rates of opioid-related deaths in the province, which poses intimate, heart-wrenching challenges for the well-being of families, workplaces, and communities in the North. Children and youth are presenting at emergency departments with opioid addictions every day.[2]

Delivering health care in the North involves navigating between two systems of health services by two levels of government. One is provincially funded and the other is federally funded. Our learners and graduates must maneuver a complex system depending on where they choose to work. Are they prepared for this?

Northern and rural physicians must have a uniquely northern skill set – this must be intentionally taught and it must be properly remunerated. Northern docs have 24/7, 365 day workloads, inadequate specialty support and increasing numbers of unattached patients. Advocacy is required for sustainable workforce planning and appropriate payment models.

Social Determinants of Health

The North of Ontario has unique social determinants of health. Climate change is affecting these in the most powerful way, but where is this taught in our curriculum?

What we’re noting as a collective academic medical community are the new, emerging social determinants of health that I’ve mentioned before, including: barriers to nutritious food, lack of clean safe water, lack of safe housing and threats to personal safety. For example, climate-related changes including wildfires, flooding and shorter seasons of ice road access have a direct impact.

Chronic disease – such as diabetes is endemic. And is not only limited to an aging population but children and adolescents are severely affected. I met with our TBRHSC Department of Pediatrics faculty last week and they expressed grave concerns about their ability to meet the growing needs of the children of the North.

These are unique social determinants of health and realities for communities in the North of which NOSM learners must be familiar. NOSM must push the boundaries of curricular change to prepare rural physicians. To this end, NOSM will be developing a new pathway- the rural generalist pathway – with defined sets of competencies and expectations for physicians who practice here.

So, Here’s the Bottom Line

Since 2011, there are 214 NOSM-educated family physicians and 31 NOSM-educated specialist physicians now practising in the North. We strive to increase these numbers.
Being unique is a strength. We admit applicants who, in most cases, already have a lived experience and deeper understanding of the North. For physicians to become “agents of change,” our curriculum must prepare them for the unique challenges of practice in the North.

As medical academics, we are a key voice at the table of health care transformation. These are exciting times as provincial and federal policy-makers and influencers recognize that we have evidence-based knowledge and appropriate solutions that are unique to the North and that work. Having just been at the Canadian Medical Association Health Summit this week, and hearing Dr. Mike Kirlew speak eloquently about Indigenous health, I hope that by raising our voices on behalf of the North at policy forums and at meetings and conferences, we will bring attention to our needs for medical school expansion, innovation in models of education and advocacy for our challenges in health care delivery.

Hello. Bonjour. Aaniin. Boozhoo.

Since my last blog, I’ve met an incredible number of new people. I had the honour of meeting NOSM’s Indigenous Reference Group (IRG) and Ogichidaang Gagiigatiziwin — NOSM’s Circle of Elders and Traditional Knowledge Keepers — on July 19. I’d like to extend my gratitude to the IRG and the Elders for the Welcome Ceremony and the Eagle Feather that they gifted me. As well, I met with Monique Rocheleau, Chair of the Francophone Reference Group on July 9. I shall cherish the trust and kinship that these meetings generated for us all.

We were fortunate to host a meeting in Sudbury at our School with the Federal Minister of Health, the Honourable Ginette Petitpas Taylor, and MPs Paul Lefebvre and Marc Serré last week. We discussed NOSM’s unique social accountability mandate and our potential to push that mandate to the next level. We talked about barriers to equitable access to care, the disparity between rural versus urban health care, the greater opportunities for Federal support and partnership, critical health human resource issues, health-care delivery issues and building capacity. I’m happy to say that our messages were direct, clear and were heard. NOSM is positioned to be a resource to the Federal government in solutions to health human resource planning, policy in social determinants of health, addictions and Indigenous and Francophone health.

With great pleasure over the last two weeks, I met NOSM staff and visitors at the Meet and Greets, and at the graduation ceremony for the Northern Ontario Dietetic Internship Program. I’ve recently also had chats with medical student leadership, clinician-teachers from Sioux Lookout, Marathon, the union leadership, and I have many more people to meet with including political and academic leaders.

For me, there’s nothing better than putting a face to a name. Forging relationships and friendships in person, feeling the unique chemistry that arises when you have a chance to see someone’s face responding to their reactions and to one another’s words—that’s where the true connection happens. Maya Angelou said it best: “I’ve learned that people will forget what you said, people will forget what you did, but people will never forget how you made them feel.”  You’ve all made me feel like I’m at home with family.

I have taken some time to reflect on the thoughts you’ve shared with me, in person, by email and other ways. I thank you for your stories and honest conversations. NOSM has achieved so much and, I’ve duly noted, you are all enthusiastically looking forward to a future where NOSM could do better. If I could summarize in one sentence what the common theme of this discourse has been, it would be: “Please refocus NOSM’s attention to the North, to the needs of partner communities, and please rekindle the passion we all felt when we came together to originally build the medical school.”

I’m not one to shy away from tough conversations and so I intend to also challenge you all to this: We must start facing the root issues that adversely affect the health of Northern communities. A few of these issues are human rights, systemic racism, youth suicide, the opioid crisis, the absence of clean water, the health impact of climate change and extreme floods and forest fires, higher rates of chronic disease, long-standing issues in food security and food prices, intergenerational trauma, and fear for personal safety and their impacts on social determinants of health.

I highlight these issues, because they lead me to dig deeper into what it truly means to be socially accountable as a medical school. To truly prepare our learners to care for people in our communities, we must model genuine compassion. We must create environments of safety and caring. We must also make it a priority to become stewards and advocates of change. We must have a “culture of kindness.”

I believe NOSM can be a major player, indeed a leader in Canada, for innovation in health systems and health-care delivery addressing the disparities and the difficult challenges. We can address the fact that rural physicians (who are also NOSM faculty) face unique challenges in providing health care. That may mean different approaches to remuneration and health teams. NOSM’s social accountability mandate is to become a resource for faculty, patients, learners, staff and governments in providing answers to these emerging constructs. What social accountability might really look like for NOSM is a force for change; we can become leaders when it comes to stable health services, food security, water security and personal safety. We can be advocacy leaders for system-wide cultural change.

Social accountability might also mean opening the door to difficult conversations around anti-discrimination and mistreatment of one another. We know racism permeates beyond individuals, affecting entire societies and communities. We also know that learner mistreatment is a concern for everyone. In fact, students, staff and faculty have told me that maintaining a safe and healthy learning and working environment is a top issue for them.

The MD standards of accreditation say:  “A medical school ensures that the learning environment of its medical education program is: a) conducive to the ongoing development of explicit and appropriate professional behaviors in its medical students, faculty, and staff at all locations; b) one in which all individuals are treated with respect.”  In my humble opinion, NOSM must strive higher than ‘respect’, we must have a culture of professionalism that is safe and kind to all – learners, teachers and staff. Do you have ideas on how to effect that change? Let me know what you think.

As well, with all great change comes opportunity, which leads me to mention the career opportunities for faculty and staff that are coming up at the School. This week we have sent out the call for applications for the Associate Deans of Postgraduate Medical Education and of Research, to be followed by searches for the Associate Deans of Undergraduate Medical Education, Faculty Affairs and CEPD and a new Associate Dean position dedicated to Equity, Diversity and Northern Affairs. Please consider joining my team. I intend to leverage the social accountability mandate when it comes to promoting and hiring. When it comes to recruiting the leadership, we will look within the North. When it comes to promotions, we will make every first effort to promote from within. My reason is straightforward — to truly embody our social accountability mandate, we must build our dream team with the same values and in the same spirit that NOSM was founded on.

As usual, you are invited to follow my journey on Twitter @ddsv3 using #WhereisDrVerma. If you have feedback or ideas about how I can better communicate with you, please let me know by emailing me at dean@nosm.ca or by taking a quick survey here at any time.

Hello. Bonjour. Aaniin. Boozhoo

Here we are. It is hard to believe two weeks can pass so quickly. Thank you to everyone who made time to meet with me and share your perspective on NOSM. I look forward to continuing these conversations in the coming year, as your opinions are crucial to framing our future planning.

I am also deeply moved by the friendliness and kindness of everyone – thank you. Moving to two new cities (Sudbury and Thunder Bay) is a whole new world for me—and not easy—but you have made it a wonderful experience. I have been introduced to new people, restaurants, roads and places. Northern Ontario is breathtakingly beautiful, especially during this glorious summer.

Since my last blog, I’ve had the pleasure of greeting NOSM’s postgraduate residents who also started at NOSM on July 1st and I hope their entry has been just as smooth as mine. On July 9th, I met an eager group of high-school students who attended NOSM’s 14th annual CampMed in Sudbury. Today, I’ll meet CampMed attendees at the Lakehead University campus in Thunder Bay. For those who don’t know about CampMed, I encourage you to check out this video. It’s a great opportunity for youth entering grades 10 and 11 from rural areas in Northern Ontario to experience and learn about health care careers.

As these students contemplate their future, I want to assure you that we all have a stake in shaping the future of NOSM. I encourage you to continue to dream big and put forward grand ideas. As Einstein said: “Creativity is intelligence having fun.” I want to hear everyone’s ideas, as we will soon begin strategic planning for 2020-2025.

We must consider the rapid changes that are happening in the province and across the country. With Ontario Health expected to roll out this fall, and Ontario Health Teams at the helm, we will be working within a shifting system. We must prepare our learners for these realities.

And with the changing landscape across Canada in response to the Truth and Reconciliation Commission, and the Final Report on Missing and Murdered Indigenous Women and Girls (MMIWG), we have a deep responsibility to be socially accountable to Indigenous communities in Northern Ontario—both First Nations and Métis—as well as the Inuit we work with through our partnerships in Nunavut.

We find ourselves in a different place in terms of technology, too. Just think, five years ago Uber didn’t exist. It’s possible that in five years from now we may see significant changes in the way we deliver NOSM curriculum. Perhaps we’ll move to app-based platforms and or web-based classrooms. The possibilities are limitless.

Meaningful engagement with all faculty members, staff, learners and teachers is a key priority for me. As your Dean, President and CEO I wish to understand your concerns and discuss the steps that NOSM can take to strengthen your roles. A culture of ‘wellness’ that respects “life-work “balance is extremely important for your well-being and for the sustainability of the profession.

As we head into August, many of you will be taking a well-deserved vacation. Please breathe, and rest. Meanwhile, I will be preparing for the arrival of our latest MD class joining us on September 3rd and focusing on preparing for the Undergraduate Medical Education accreditation taking place April 26-30, 2020.

I wish to thank the team who have made this transition with me, as some will be finishing their term this year. We will be in full search mode in September for several new leadership positions. Please contact me or my office if you are interested in taking on a new exciting career in academic medicine. More on this is coming soon.

You are invited to follow my journey on Twitter @ddsv3 using #WhereisDrVerma.

If you have feedback or ideas about how I can better communicate with you, please let me know by emailing me at dean@nosm.ca or by taking a quick survey here at any time.

Now that the ticks and black flies are dying down, I am off to learn about northern mosquitos…