Hello. Bonjour. Aaniin. Boozhoo.

As summer comes to an end and the leaves begin to change, we’re gearing up for yet another academic year. Of course many of us have been working throughout the summer and in fact our post graduate programs have been well into their academic year.  I hope everyone was still able to revel in the smells of sunscreen, bonfires, the lake and camp, fresh fish, and forest air. I have to say that I have never seen such bright sunsets, heard such bounding thunder, nor experienced such brilliant rainbows as I did in Northern Ontario.

To me, the mixed weather is a perfect metaphor for my first two months and mixed expectations of what’s to come with a jam-packed academic year ahead for NOSM. I’m wishing all of you a Happy Labour Day weekend – the last real weekend of summer.

Most physicians do not take too much time off. The majority seem to sprinkle their holidays between the summer and winter, depending upon their tastes. I know quite a few were involved in a new initiative to become one of the Ontario Health Teams, announced by the Ministry of Health a few months ago. Apparently, Ontario Health Teams are being introduced to provide a new way of organizing and delivering health care that will be more connected to patients in their local communities.

Under these teams, it’s expected that all the health-care professionals in hospitals, community settings, clinics, and in long-term care will work together as one coordinated team. Several organizations have come together in the North to apply to become Ontario Health Teams (OHTs) and a small list of teams were invited to provide the full application. The Northern Ontario School of Medicine is involved in many of these applications because our faculty and our sites are part of the regions where health care will be delivered by these teams.

The academic mission, especially that of training physicians, will be an integral part of what happens in these teams. Some teams who are being considered for the full application include: Équipe Santé Sudbury and Districts OHT, Algoma OHT, Near North Health and Wellness OHT, All Nations Health Partners OHT in Kenora, and the Muskoka and Area OHT. A full list is accessible here on the Ontario Health website.  The Canadian Addiction Treatment Centres has also been named as one of the innovative models that will be invited to full application. I am hopeful that many, if not all, will succeed.

This is a very exciting time for Ontario and especially for the North if we, together as a unified group, are able to accomplish all the expectations of an Ontario Health Team. NOSM stands ready through its advocacy strategy and its social accountability mandate to support any or all Ontario Health Teams in our geographic area, and to assist in studying whether this will be an initiative that will improve health care in Northern Ontario.

It’s expected that some of the improvements and integrated health care will fundamentally change how patients will experience the system. If teams are successful with the expectations that have been laid out, there will be much more opportunity to have virtual care and easy access to primary care; plus, navigating the system will be made much more flexible to allow for an open transition between health care providers.

For instance, did you know that the new apps can now read your blood pressure by taking a selfie? Or take an ECG on demand using your smart watch? As we speak, personal health data will be as easy to access as the fitness information on a FitBit.
I have often wondered why the health system is the slowest to evolve. Maybe new OHTs will be the answer?

I’m interested in how you’re going to experience these Ontario Health Teams and what you think about them. Certainly, in my opinion, they will require a significant amount of technology to share information and to provide the kind of advances in health care accessibility that I see coming down the pipeline. Also, I’ll be interested to see whether the funding models will create efficiencies. NOSM will be happy to work with our partners to study their impact and the outcomes for the people of the North.
I’m curious about your opinion. Let me know what you think.

Speaking of team work, I want to send a shout-out to the collaboration of our MD students led by Ben Lafleur (fourth year MD student), and by Dr Lee Toner, Phase 3 (Clerkship) Director and faculty member, that resulted in a 98% response rate by 2019 NOSM graduates to the Association of Faculties of Medicine of Canada’s annual Graduation Questionnaire (GQ).

As NOSM’s Senior Director Undergraduate Medical Education, John Friesen says, “Ben brought his positive and collaborative nature to the entire UME student body for the Independent Student’s Assessment which set the stage nicely for the Year 4 students to participate in the 2019 GQ report that we knew would be critical to our UME accreditation visit in April 2020.”

The GQ results are really remarkable and reflect the teamwork of the students, teaching faculty and UME leadership. Your commitment achieved the highest standards of excellence in our MD program. The GQ data released last week by the AFMC shows a major, positive shift in that direction.

By all accounts, the students reported improvements in all areas, especially in accessibility to leadership, in wellness, and with the curriculum. We noted an ongoing issue with career advising and elective choices, to which NOSM is addressing by undertaking several new initiatives. The GQ is a very good measure of the pulse of the medical student experience, and I am delighted to see that, at this time, that experience is good. Thank you to Interim Associate Dean Brian Ross, Senior Director John Friesen, our students and the entire UME team for a job well done! As everyone already knows, we are gearing up for our Accreditation visit next year and this means we are in a good position to do well.

Students, please note: The Dean’s office will be hosting a pub night meet and greet on September 30 at Spacecraft Brewery in Sudbury from 5-7 p.m. Another will be held in Thunder Bay at the Sovereign Room on October 18 from 5-7 p.m. Keep your eye out for a formal invitation.

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.

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.