Galleries

New Curriculum Committee draws more faculty and site clinicians to the table

NOSM’s MD program has reorganized their functioning with the creation of a new sub-committee, the Undergraduate Medical Education (UME) Curriculum Committee. The committee’s task is to govern the entire MD program curriculum. Their focus is on unified curriculum content and program-wide integration, while the business and operations side remains the work of the UME Committee (UMEC).

“It really allows us to focus on curriculum across the whole program,” says Dr. Tara Baldisera, co-chair of the new Curriculum Committee. “While curriculum discussions happened at the various theme and phase committees, now it is easier to connect all of these discussions and ensure an improved continuity of our medical education program.”

In the past, both operations and undergraduate program curriculum oversight were governed by UMEC. With the creation of the new Curriculum Committee, its mandate and terms of reference are focused only on curriculum with an emphasis on curriculum review, integration, renewal and bringing more faculty voices to the table to discuss specific curricular pieces regarding structure and content.

“Our focus is to also address our unique curriculum concerns here in the North,” adds co-chair Dr. Alain Simard. “The Committee is structured in a way to support our uniqueness as a distributed medical education program.”

By looking at the program as whole, the group is able to analyze the curriculum across the entire program, including and all years and phases.

“Now we have the opportunity to have some of our site liaison clinicians from our phase two (third-year) Comprehensive Community Clerkship communities at the Curriculum Committee,” says Dr. Baldisera.

“We also have representation from our six core disciplines in phase three (fourth-year) together with our theme faculty and curricular management support. We bring everything together so that we can have those focused discussions around the table,” says Dr. Baldisera.

The types of curriculum discussions the committee is hearing are diverse but include hot-button topics such as climate change. Recently the committee also discussed review of content about nutrition and ways to deliver it.

“The student program evaluation report told us that students have been asking for more exposure to nutrition content which runs across all phases and themes, which makes discussion at the Curriculum Committee important” says Dr. Simard.

Palliative care and advanced care planning curriculum content was also recently discussed, as were updates to curriculum for Indigenous and Francophone health.

“The committee’s role is to facilitate discussion and inclusive decision-making about revisions and direction of the program,” says Dr. Baldisera.

UMEC is now focused on the non-curricular matters of the school including policy, governance and regulation, including student leave or health and safety policies.

Dr. Simard says this new structure is expected to function efficiently between the two separate, yet active committees: “It’s a good example of how different disciplines can work together to improve upon the foundation and reflect the broader goal in a more focused way.

New Curriculum Committee:

  • addresses management, evaluation and enhancement of curriculum
  • members include Theme, Phase, Division and Discipline faculty, site clinicians, students and UME directors, managers and instructional designers
  • oversees curricular revision and reviews program evaluation to maintain and enhance the quality of our medical education curriculum 
  •  ensures that courses address all medical education program outcomes 
  • optimizes clinical experiences and settings

Undergraduate Medical Education Committee (UMEC):

  •  addresses non-curricular matters such as operational, business-related decisions
  • members include executive leaders, administration, faculty representatives (Themes, Phases and Divisions) and students
  •  oversees policy, governance, and regulation, e.g. student leave policies, health and safety policies (process and regulation)

 

Telemedicine proven effective for treating opioid addictions in the North

A leading addictions specialist is surprised by the results of a study showing telemedicine is improving addiction treatment outcomes in the North.

“The assumption was that telemedicine was an inferior alternative to in-person care, but that is not the case,” says Dr. David Marsh, NOSM Professor, leading addictions researcher and member of an opioid emergency task force for the province.

“We started studying telemedicine to see if outcomes using telemedicine were in fact worse. We were quite surprised to find out that patients in addictions treatment who were seen via telemedicine did as well, or better, than the patients seen in person,” Dr. Marsh explains.

According to the study The effectiveness of telemedicine-delivered opioid agonist therapy in a supervised clinical setting, “telemedicine patients demonstrated a retention rate of 50% at one year, whereas in-person patients were retained at a rate of 39%.” It concluded that telemedicine “may be an effective alternative to delivering in-person OAT [Opioid Agonist Therapy], and it has the potential to expand access to care in rural, remote, and urban regions.”[1]

“Because I see my patients frequently, often every month for years, I’m still able to get to know them pretty well by video conference,” says Marsh.

Videoconferencing systems and other virtual care tools are a convenient way to connect patients who otherwise may not have access to clinicians and specialists across Ontario, or who may have to travel great distances to see them in person.

According to the research paper Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network, “Telemedicine is often used to provide mental health services to patients, especially those residing in underserved rural and remote communities with limited access to in-person services. Praxia reported that 54% of utilization in Canada in 2010/2011 was for addictions and mental health. In our study, 62% of utilization was for mental health and addictions services … we suggest that telemedicine helps compensate for the lack of medical specialists with practices in northern and rural areas, thus realizing monetary and environmental benefits associated with reduced patient or provider travel as well as the potential health benefits of increased access to medical care.”[2]

According to the Ontario Telemedicine Network, “2017-2018 saw over 30 new telemedicine systems distributed to Indigenous communities with over 120 systems active across the province. In 2018, OTN improved access to care to remote First Nation Nursing station sites in North Caribou Lake, Wunnumin Lake, Poplar Hill and Cat Lake.”[3]

Marsh says telemedicine offers a good balance, in that it allows the patients to have access to physicians more readily and closer to their home. “Opioid addictions care is structured around the treatment, providing support and the monitoring helps patients improve their physical mental health, reduce their drug use, and get directed towards more positive social activities,” he adds.

Those frequent, small social interactions complement telemedicine appointments and treatment, which may be part of the explanation for better outcomes.

 “I think for some patients, video conference actually helps because a lot of our patients have significant mental health concerns, especially histories of trauma. Telemedicine sets a boundary and context within which the interactions occur. I think that helps the patient feel safe, especially the ones who may have had trauma in the past and have difficulty seeing physicians,” says Marsh.

However, Marsh says there are other topics that his research data has not yet captured when it comes to measuring opioid addiction treatment strategies for the North, for instance: the need to learn more about the rates of unstable housing, homelessness, links to criminal charges or interactions with the criminal system, and the social context. He says he is hopeful that more tools come to light with ongoing research.

“We have a paper that’s currently in the process of peer review that looks more broadly on health system outcomes. For instance, when patients are on methadone and Suboxone treatment their all-cause mortality was reduced by 55%. Also, we saw significant reductions in admissions to hospital and visits to the emergency department with treatment. We’re also looking at how mental health services affect treatment.”

“Stigma is definitely a major problem for people who use drugs regularly. It prevents them from getting health care and prevents them from getting treatment.” Marsh believes that by offering teleconferencing options, patients to have a broader range of access to physicians more readily, and closer to their home.

Sources:

[1] https://www.sciencedirect.com/science/article/pii/S0376871617302077

[2] https://www.liebertpub.com/doi/full/10.1089/tmj.2015.0166  Clinical Telemedicine Utilization in Ontario over the Ontario Telemedicine Network, 2016.

[3] https://otn.ca/wp-content/uploads/2017/11/otn-annual-report.pdf