MEMORIES & MILESTONES The University of Toronto Department of Family and Community Medicine’s First 50 Years, 1969—2019
MATTERFRONT AcknowledgementsDedicationPreface 01 4 MeMories & Milestones: DFCM's First 50 Years 02 03 04 &LeadershipLaunch,Advocacy12 AcademicPioneeringMedicineFamily20 Innovation&Expansion32 ScholarVisionary446
5MeMories & Milestones: DFCM's First 50 Years MATTERBACK EpilogueAppendices(Coming Soon) References 05 06 07GlobalAmbassadorCollaborationFosteringBuildingTeam&64 &IntegrationPartnerships82 96 118
Dr. David White, MD, MEd, CCFP, FCFP. Professor and Vice-Chair Family Doctor Leadership, Department of Family and Community Medicine, University of Toronto
Freeman, R. Memories & Milestones: The University of Toronto De partment of Family and Community Medicine’s First 50 Years: 1969 2019. Toronto, Ontario: Department of Family and Community Medi cine.
EDITORS
6 MeMories & Milestones: DFCM's First 50 Years
Ms. Rachel Ellis: Administrative Assistant, Undergraduate Education Program (1990-2003), Office of Education Scholarship Coordinator and Executive Assistant to the Vice-Chair, Education and Scholarship Librarian, Department of Family and Commu nity Medicine (1981-2013)
Ms.(2016-present)RitaShaughnessy,
Dr. Risa Freeman, MD, MEd, CCFP, FCFP is a Professor and ViceChair Education and Scholarship in the University of Toronto Depart ment of Family and Community Medicine and a Clinician Educator Researcher at The Wilson Centre. She received her MD degree from McMaster University and completed postgraduate training, an aca demic fellowship in Family Medicine and a Master of Education at the University of Toronto. She joined DFCM as a faculty member in 1990. Her community-based clinical practice is affiliated with North York General Hospital.
Dr. Freeman teaches at the undergraduate, graduate, postgraduate and continuing professional development levels in her clinical office and at the University of Toronto. Her academic and scholarly work has focused on four main areas: medical education curricula and planning, student and faculty learning strategies, evaluation and as sessment, and faculty development.
AUTHOR
SUGGESTED CITATION
Dr. Douglas Johnson was one of the five founding members of the Department of Family and Com munity Medicine (DFCM). In honour of the de partment’s 25th anniversary, he published “The Department of Family and Community Medicine: Its First Quarter Century”1. This work captured the stories and personalities of DFCM’s early days with great respect and humour and was a very helpful starting point for this history.
Eric Letovsky, Fok-Han Leung, Aisha Lofters, Kirk Lyon, Jennifer McCabe, Warren McIsaac, Jamie Meuser, Azi Moaveni, Allison Mullin, Stu Murdoch, Claire Murphy, Melissa Nutik, Trish O’Brien, Rick Penciner, Reg Perkin, Val Rachlis, Katherine Rou leau, Warren Rubenstein, Peter Selby, Barbara Stubbs, David Tannenbaum, Ross Upshur, Sha ronie Valin, Bill Watson, Karen Weyman, David White, Cynthia Whitehead, Lynn Wilson, Shery lan Young, Heather Zimcik. I have included di rect quotes from these kind-hearted contributors whenever possible.
Rita Shaughnessy then set about mining for data through boxes and boxes of archived materials and on-line repositories. She gleaned a tremen dous amount of information from Strategic Plans, minutes of Executive Committee meetings and Retreats, Year End reports, and other archival
7MeMories & Milestones: DFCM's First 50 Years
ACKNOWLEDGEMENTS
this document draws on the mem ories of many DFCM faculty members. The fol lowing colleagues generously shared their time and recollections of DFCM’s chairs, milestones and significant contributions: Julia Alleyne, Ruby Alvi, Helen Batty, Julia Baxter, Philip Berger, Har vey Blankenstein, Jeff Bloom, Risa Bordman, Paul Cantarutti, June Carroll, Jocelyn Charles, Sudi Devanesen, Sharon Domb, Debbie Elman, Geordie Fallis, Kymm Feldman, Sid Feldman, Milena Forte, Abbas Ghavram-Rassoul, Rick Gla zier, Susan Goldstein, Allan Grill, Eva Grunfeld, Ruth Heisey, Karl Iglar, Carol Kitai, Marcus Law,
We wish to acknowledge this land on which the University of Toronto operates. For thousands of years it has been the traditional land of the Hu ron-Wendat, the Seneca, and the Mississaugas of the Credit. Today, this meeting place is still the home to many Indigenous people from across Turtle Island and we are grateful to have the op portunity to work on this land.
Special thanks to Caroline Turenko for digging in our archives and pulling out boxes of histori cal material. Thanks also to the DFCM staff who helped bring the report to life: Alicia Fung, Amy Noise, Allison Williams, Alisa Kim.
Thedocuments.restof
LAND ACKNOWLEDGEMENT
It is with genuine gratitude and warm regard that we dedicate this history to our colleague, Dr. Philip Ellison, who passed away in Toronto, Ontario, on June 15, 2022.
Dr. Ellison held many leadership positions during his career, including the role of staff family phy sician in the Department of Family and Commu nity Medicine (DFCM) at the University Health Network (UHN); Associate Professor Emeritus in the Department of Family and Community Med icine; DFCM Interim Chair 2001-02; Program Di rector – Quality and Innovation 2009-2019; and the Fidani Chair in Improvement and Innovation from 2013-2019.
Dr. Ellison completed a Master of Business Ad ministration from Joseph L. Rotman School of Management, University of Toronto, and was cross-appointed to the Institute of Health Poli cy, Management and Evaluation and the Grad
Dr. Philip Ellison — Family Physician & Associate Professor Emeritus
DEDICATION
8 MeMories & Milestones: DFCM's First 50 Years
Dr. Ellison was a practicing family physician in downtown Toronto since completing his under graduate and postgraduate training at the Uni versity of Toronto in 1980. His medical career reflected an affinity for academic medicine – in both the community and within hospital sites and spanned four decades — during which his professional practice included inpatient med icine, occupational medicine, obstetrics, and long-term care. Notably, Dr. Ellison’s leadership at St. George Health Centre was a career ex perience that illustrated his fondness for com munity medicine and a keen awareness of the potential for collaboration with other elements of the health care system.
uate Faculty of Public Health Sciences at the Dalla Lana School of Public Health. His interest in management, education leadership, and the science of quality improvement informed the development and teaching of master’s level courses in Graduate Studies: Leader ship and Management of Small Health Organizations and Improving Health Care in the Community.
9MeMories & Milestones: DFCM's First 50 Years
With his vast experience as a DFCM leader, Dr. Ellison was an invalu able contributor to this collection of memories. He had a far-reach ing knowledge of the department and its people and was personally involved in many of our history’s turbulent and exciting events. This project would not have been possible without his support.
We are fortunate to have had Dr. Ellison as our colleague a treasured, wise mentor who ably shared his passion and courage to promote education leadership and quality improvement in family medicine and primary care. His ‘belief in better’ engaged those of us who were brave enough to follow him on the journey to find sustained joy in work for our patients and us. His wise counsel will be forever missed.
Ms. Trish O’Brien Manager, Education Development
Dr. Risa Freeman Vice-Chair, Education & Scholarship
Dr. Ellison was a wise and generous mentor. Ruby Alvi fondly recalls, “when I decided to leave the comfort and familiarity of the Toronto Western to move to Mississauga, I received really wise advice from Phil, who encouraged me. He said, ‘You know what you need to do. Family comes first. DFCM is your home, and you can always come back. You don’t know what the possibilities are out there and don’t be afraid to try. You will find a way to do what you love.’”
I was invited to give the opening keynote ad dress at the DFCM’s 50th anniversary celebra tions on May 5, 2019. I felt an overwhelming sense of responsibility. How could I do justice to the stories and achievements of those who built the DFCM? How could I possibly condense 50 years of history into a 60-minute presenta tion? And then, it came to me that I could build the story around the people who led the way through our milestones, successes, and chal lenges. Each story tries to capture their vision and significant contributions and is animated with personal quotes from people who knew them. I added references to important events, culture, science, and medicine to provide con text during each period.
Since its inception in 1969, the University of To ronto (UofT) Department of Family and Commu nity Medicine (DFCM) has grown to be one of the largest and most influential family medicine departments in the world. This growth has been possible thanks to 50 years of careful and con sidered nurturing by determined, courageous and creative leaders.
10 MeMories & Milestones: DFCM's First 50 Years
PREFACE
Next, I called on Dr. Phil Ellison, another of our wise elders. Like David, Phil had held many
My personal journey with DFCM goes back 34 years to when I started my residency. If I were to do justice to the first 20 years, I would need to work with others who had been a part of the early days of our story. My first step was to enlist the assistance of Dr. David White, a dear friend and colleague with endless energy, a creative flair, and our music director. David has held near ly every possible leadership level in the DFCM, from Undergraduate Program Director, Hospital Physician-in-Chief at North York General, to Act ing Chair. David eagerly sat down with me to fill in some early details. His memories helped me develop the framework for the presentation.
After the 50th Anniversary celebrations, I was asked to create a permanent record of the pre sentation. And thus, I embarked on what has be come a labour of love over the past few years. The writing of this history has been delayed many times since the onset of the COVID-19 pandemic. I am grateful for those individuals who have supported me through these difficult years with their encouragement and generosity in supplying missing information.
Email: r.freeman@utoronto.ca
I hope you will enjoy reading about 50 years of an extraordinary department, its people, and its accomplishments.
Encouraged but needing further information, I spoke with Caroline Turenko, our Business and Administration Director. Caroline has been the captain of our ship since 2003, and DFCM would not sail without her. Caroline provided abundant historical documents, including yearend reports and external reviews. She support ed my request to enlist the assistance of Rita Shaughnessy, our librarian, from 1981 until her retirement in 2013. During her time at DFCM, Rita collected every influential journal and book regarding family medicine, medical education, and clinical research. She had written and cat alogued nearly every DFCM annual report and our monthly newsletter. She was our historian and archivist. She was also a helpful and patient teacher for generations of our students and fac ulty members. Rita kindly came out of retirement to help me fill in the fine details.
Risa Freeman MD, MEd, CCFP, FCFP. Vice-Chair, Education and Scholarship Professor, Department of Family & Community Medicine, Temerty Faculty of Medicine, University of Toronto Tel: (416) 946-7070
me for missing important details about our history and the people who have shaped the DFCM. It was a challenge and an honour to choose from the many stories of in spirational individuals and the ground-breaking education and clinical research initiatives over the past 50 years. With the help of my collabo rators, I have tried to tell DFCM’s story through the events, accomplishments, innovations, chal lenges, and changes that occurred during the tenure of our department chairs.
DFCM leadership roles and was amongst our earliest resident cohorts. His knowledge of the department was encyclopedic. He had a mind like a vault and a heart of gold. He showed me endless generosity of time and spirit as he shared his memories with me.
11MeMories & Milestones: DFCM's First 50 Years
My original presentation and this final report would not have been possible without the tre mendous contributions of Rachel Ellis. Rachel has been my administrative partner for nearly 14 years. Her creativity and perseverance made all this Pleasepossible.forgive
After all this data collection, it became clear that the presentation needed to be more than a sum mary of achievements and facts. It needed to tell the story of the people who had contributed to our department’s rich tapestry as pioneers, leaders and DFCM family members. Thus, the idea for a ‘family album’ was born. In my quest to gather these stories, I reached out to 56 fac ulty members. These wise elders and current leaders graciously shared their memories and insights about our story, milestones, and most remarkable achievements. I am grateful for their willingness to participate and the opportunity to tap into the collective wisdom of these wonder ful people.
12 1969 — 1970: launCh, leaDership & aDvoCaCY 1969 — 1970 &LEADERSHIPLAUNCH,ADVOCACY
131969 — 1970: launCh, leaDership & aDvoCaCY
In the beginning, there was Dr. Reg Perkin, our first Chair and the leader of the revolution. Reg had established a family practice in Mississauga in 1956. Thoughtful, genuine, and affable, he was the quintessential knowledgeable and skillful family doctor. He had a genuine interest in learning about everyone around him and an incredible knack for remembering people’s names and stories.
REG PERKIN Leader of the Revolution
the profession of family medicine Dr. KJR Wightman, Chair of Internal Medicine in the Faculty of Medicine at U of T, suggested bringing GPs into the medical school by creating GP clinics at sev eral hospitals. In 1966, he invited three family physicians to join the Department of Medicine to establish hospital-based departments of family medicine: Drs. Reg Perkin (Toronto Western Hospital), Fred Fal lis (Toronto General Hospital) and Lorne Laing (Wellesley Hospital). A year later, Dr. Wightman formed a committee “to study the feasibility of establishing a faculty family care program.”3 Dr. Irwin Hilliard suc ceeded Dr. Wightman as Chair of this committee and finalized the University’s proposal.
WIGHTMANKEITH
14 1969 — 1970: launCh, leaDership & aDvoCaCY
In February of 1969, Reg, Fred, Lorne, and Dr. Doug Johnson, one of the founding members of the Sunnybrook unit, presented the pro posal to Faculty Council at the Faculty of Medicine to ask for their own department. Much to their surprise, there was no resistance and great support to establish a Department of Family and Community Medicine at U of T. As Doug wrote, “With great trepidation, the Com mittee members attended the February 1969 Faculty Council Meet
FALLISFRED LAINGLORNE JOHNSONDOUG CATHCARTMURRAY SWANSONMARJORY
The College of General Practitioners of Canada was formed in 1954 to address medical school graduates’ declining interest in general practice. Between 1955 — 1965, the number of specialists increased by 94%, while general practitioners (GPs) increased by only 4%. There was also an absence of GPs as teachers in Canadian medical
Toschools.2support
ing. Our proposal for a new department was on the agenda. We were prepared for a lengthy discussion and a cliff-hanger vote. With very little discussion, the motion to establish a free-standing Department of Family and Community Medicine (DFCM) passed with a solid ma jority. Following the meeting, we stood on a street corner in a state of shock and disbelief that it had been so easy.”4
151969 — 1970: launCh, leaDership & aDvoCaCY
And so, our story began. Reg Perkin was appointed the first Chair of DFCM in September 1969.
Dr. Reg Perkin addressing the DFCM’s 50th Anniversary Gala on September 19, 2019.
REG PERKIN
In 1969, Dr. Marjorie Swanson joined the leadership team as the first female Chief of Family Medicine. She led the department at Wom en’s College Hospital until 1972.
16 1969 — 1970: launCh, leaDership & aDvoCaCY
DAVID WHITE
Soon after the new department was launched, more family medicine units opened at teaching hospitals across the U of T system: Sun nybrook, in 1967 under the leadership of Dr. Doug Johnson, and St. Michael’s Hospital in 1969, with Dr. Murray Cathcart arriving as chair in 1970. All of DFCM’s original leaders were community-based GPs. Some stayed in their community offices; some moved into the new teaching units and brought their patients with them; some started practices in their new academic homes.
I have always been in awe of Reg Perkin. He seems to be the consummate family doctor: thoughtful, genuine, caring, with deep understanding of the individual and the system. He has the ability and the courage to make major changes for the better and has done so in hospitals, the University and nationally at the CFPC. He has been a mentor to many of us for our entire career.
Reg led the new department out of a tiny room at Toronto Western Hospital. A larger space was needed, but U of T offered little real es tate. This quest for a home would become a recurring theme. DFCM accepted Women’s College Hospital’s offer of two rooms on its ninth floor, in the psychiatric wing with bars on the windows. Over the next 50 years, the departmental offices would move from Women’s Col lege to seven different locations, battling for space along the way.
The first year of DFCM saw the establishment of the core academic mission, the education of medical students and residents. DFCM’s family medicine clerkship, the first in Canada, was created by Doug Johnson to provide a longitudinal family medicine clinical experi ence (one half-day per week over 15 weeks) for 172 medical stu dents. Our two-year residency program in family medicine was also launched in 1969 with 24 first-year residents. At that time, it was the largest family medicine residency program in Canada.
1969MEDICINE
Another landmark of 1969 was the launch of the Sioux Lookout Program by U of T and the Ministry of Health and Welfare Canada. DFCM soon became involved by sending faculty members to help develop patient care services, education programs and research. Drs. Stewart Harris (Sioux Lookout Medical Director), June Carroll, David White, Brian Cornelson, Geordie Fallis and Sheila Dunn would be among many DFCM faculty members to serve as medical staff at Sioux Lookout.
» Rubella introducedvaccinationinCanada
» The Apollo 11 module landed on the Moon
171969 — 1970: launCh, leaDership & aDvoCaCY
CULTURE, SCIENCE &
» Sesame Street debuted on U.S. public television
The most poignant thing I have witnessed is Reg Perkin attending DFCM Conference and FMF [Family Medicine Forum] each year, and, well into his 90s still seen as holding the greatest wisdom about where family medicine has come from and where it needs to go from here.
DAVID TANNENBAUM
18 1969 — 1970: launCh, leaDership & aDvoCaCY
» St. Michael’s Hospital family practice teaching unit opens (first chief: Mur ray Cathcart)
» Sunnybrook Health Sciences Centre family practice teaching unit opens (first chief: Doug Johnson)
» The U of T medical school imple ments a renewed curriculum fea turing the coordination of multiple departments for system-based teaching in years two and three
MILESTONESKEY
1967
191969 — 1970: launCh, leaDership & aDvoCaCY
» Toronto General Hospital family practice teaching unit opens (first chief: Fred Fallis)
» Toronto Western Hospital family practice teaching unit opens (first chief: Reg Perkin)
1969
» Wellesley Hospital family practice teaching unit opens (first chief: Lorne Laing)
» Sioux Lookout Program opens. Stewart Harris later serves as Medi cal Director and in 2015, is awarded the Order of Canada for “contribu tions to developing strategies to manage and reduce diabetes in Aboriginal communities and other vulnerable populations.”
» Women’s College Hospital family practice teaching unit opens (first chief: Marjorie Swanson)
» Dr. Walter Rosser (DFCM Chair 19912001) is DFCM’s first resident in a pilot program that would inform the creation of the residency program. He is placed at Toronto Western Hospital under the supervision of Dr. Charles Hollenberg, then Chief of Internal Medicine.
1968
1966
20 1970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine 1970 — 1982 MEDICINEFAMILYACADEMICPIONEERING
211970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
FRED FALLIS Renaissance Man
Dr. Fred Fallis became DFCM Chair in July 1970 when the department was on a quest to prove its merit and build its reputation. He was a visionary who led the department through a time of tremendous growth.
22 1970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
Sunnybrook Health Sciences Centre family medicine resi dents and preceptors 1970. Dr. Laurel Dempsey is seated sec ond from left.
Dr. Geordie Fallis, Fred’s son and a DFCM faculty member since 1984, describes his father as kind, hard-working, and someone who earned people’s respect with his generosity of time, work ethic and a deep sense of fairness. He also notes that his father could be stub born and forthright! Fred valued camaraderie, and, as Geordie re calls, Fred would gather the chiefs regularly at the family farm for strategic planning and team building. Lively and raucous conversa tions were reported to take place during those visits.
Fred was a Renaissance man. He was an accomplished musician, studied to be a lawyer, worked in the Department of External Affairs under Prime Minister Lester B. Pearson, and served with the Royal Canadian Air Force before starting his medical training at U of T. In his later years, he was also an avid farmer.
Fred opened his North York medical practice in 1953 and continued to practice there for 20 years. He was deeply committed to his pa tients and insisted that the department’s name included ‘community’ to reflect his deep commitment to patients and the community.
CULTURE, SCIENCE & 1976MEDICINE
» Summer Olympic games held in Montréal
Fred also pioneered continuing medical educa tion and interprofessional collaboration, inviting specialists to speak via shortwave radio as part of a “Wine and Wisdom” telemedicine series for local and rural doctors, and developing for mal teaching roles for family practice nurses in the clinical clerkship. This initiative started the ongoing development of family practice nurses as members of DFCM’s educational team.
Fred was a pioneer in many areas of family medicine leadership. He led the first equity ini tiative in 1969 and hired Dr. Sharon Shafir, the first female faculty member at the Toronto Gen eral Hospital and a member of the Jewish faith. Together, Fred and Sharon started DFCM’s journey to build equity, diversity and inclusion and led the way for women and people of all faith groups.
—Doug Johnson SHARON
Doug Johnson described Fred’s budgeting process: “At annual budget time, the Fallis fam ily of six children was displaced while the din ing room became departmental headquarters. For each hospital unit, there was a pile of paper and calculations on the table. One at a time, Fred would negotiate the budget with a hospi tal chief. He always began by stating very sol emnly that it was more blessed to give than to receive. Fred not only preached that message, but he also practiced it. Nevertheless, each chief tried to negotiate as much as possible for the hungry units. Fred would then be left alone with his calculator to re-calculate.”5
231970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
“He always began by stating very solemnly that it was more blessed to give than to receive. Fred not only preached that message, but he also practiced it.” SHAFIR
During Fred’s term, DFCM Chair was still a part-time position. He first operated out of two rooms at Women’s College Hospital, one for Fred and one for his secretary, Dolores Olsen. His leadership team grew in 1970 when Mount Sinai Hospital opened a family practice unit under Dr. Nathan Levinne. Dr. Irwin Bean (a.k.a. Beano) brought the Wellesley Hospital into DFCM in 1972. Dr. Yvonne de Buda be came chief of Women’s College Hospital family practice unit in 1972.
GROWTH AND LEADERSHIP
24 1970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
LEVINNENATHAN
BEANIRWIN
Murray Cathcart said it best when he described Fred as the “consummate and dedicated administrator of the department, capable of making a large group of diverse personalities interact happily together.”6
BUDADEYVONNE
FUN FACT
Irwin “Beano” Bean, the second Chief of Family Medicine at the Wellesley Hospital, was a linesman for the MedalWilliamPhysiciansandSociety’stheQueen’sincludedhisalsoyoungerRoughridersSaskatchewaninhisdays.HewashighlydecoratedformedicalservicewhichhonourswiththeJubileemedal,CanadianCancerCitationofMerit,theCollegeofFamilyofCanada’sVictorJohnstonofHonour.
251970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
“I was the only second-year family medicine resident. My first rota tion was in the ICU. During my first week, the head nurse came up to me and said, “We all knew you weren’t too bright, but do you really have to repeat your internship?”
JOHNSONDOUG
CATHCARTMURRAY
The education programs thrived during Fred’s tenure.
Under Doug Johnson, DFCM’s first Undergraduate Program Direc tor (1969 1985), every U of T medical student rotated through a four-week ambulatory care rotation over 22 half-days. Doug also pioneered undergraduate teacher faculty development, creating the Annual Undergraduate Faculty Development Workshop, the first initiative of its kind at DFCM for faculty members from across the system to gather and share their stories, successes and challenges. The program continued to be a highly valued part of our Undergrad uate Program until 2018.
EDUCATION
Reg Perkin, DFCM’s first chair, took on the new leadership role of Postgraduate Program Director. His principal challenge would be to build a culture that understood and respected family medicine as a unique and important discipline. DFCM’s earliest residents blazed a trail for those who would follow. Dr. Val Rachlis, a resident in the first cohort at Mount Sinai Hospital, fondly remembers those early years:
LAINGLORNE
CULTURE,PERKINREG SCIENCE & 1979MEDICINE » First cases of a rare lung infection (Pneumocystis carinii pneumonia) and an unusually aggressive cancer ( SarcomaKaposi’s ) in Canada.casesdiagnosedRetrospectivelyMontréal.asthefirstofHIV/AIDSin
26 1970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
DFCM offices were housed on the 9th floor of Women’s College Hospital from 1970—1984.
Throughout Fred’s leadership, the Postgraduate Program experi enced tremendous growth. From the early cohorts of 25 first-year (R1) and 28 second-year (R2) residents in 1971, the program grew to 60 R1s and 60 R2s by 1974. When Fred retired in 1982, our Postgrad uate Program provided training to 145 R1s and 145 R2s.
» Canadarm first used on the space shuttle Columbia
CULTURE, SCIENCE & 1981MEDICINE
Though the bulk of residency training continued to be provided in large hospital teaching units, DFCM recognized the tremendous importance of training residents in community sites. In 1971, DFCM received a grant from the Ministry of Health to fund the first four community offices. These pilot sites were the start of the Teaching Practices Program, which was led by Drs. Hollister King (Midland), Don Butt (Mississauga), Cecil Craig (Don Mills) and the Sioux Look out Zone Hospital. The St. George Health Centre opened in July 1971 under Dr. Rodger Hines’ leadership. Its role was to provide a model for teaching and research in the community and establish roles for the nurse practitioner, public health nurse and social worker.
271970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
Fred recognized the importance of developing a robust research program in DFCM. Dr. Sudi Devanesen, DFCM faculty member and former chief at St. Michael’s Hospital, recalls Fred giv ing a talk called Publish or Perish. “He (Fred) explained very clearly that if DFCM was to sur vive, research needed to become a priority for every faculty member both to advance faculty promotions and ensure we were on track for evidence-based practice in primary care and make innovative contributions. I feel this talk appealed to us with his candour and humour. Research units were established within every family practice unit soon after, and every res ident was also mandated to complete a re search project. This, in my opinion, was a turn ing point in the academic advancement of the department.”
GLOBAL HEALTH
DFCM’s earliest foray into global health was made possible through Dr. Paul Roberts’ ties with Quito, Ecuador, where he developed a res idency program and established an ambulatory teaching facility. A co-founder of the Depart ment of Family Medicine at Sunnybrook Health Sciences Centre, Paul was a committed clini cian and teacher. He coordinated CME courses for family physicians throughout the 70s, 80s and 90s. Over the years, he was honoured nu merous times for his service to Ecuador, includ ing being named a Knight in the National Order of Merit.
RESEARCH
SUDI DEVANESEN
PAUL ROBERTS
INNOVATION TECHNOLOGYAND
In 1973, DFCM blazed a technological trail with the launch of the FACMIS (Family and Com munity Medicine Information System) project, which aimed to produce a standardized medi cal recording system. Drs. Fred Fallis, Fred De manuele and Rodger Hines collaborated with John Walter of U of T’s Department of Indus trial Engineering to develop this project. Phil Ellison would later lead the group to develop the Ambulatory Care Support System (ACSS), a patient information management system for the St. George Health Centre and the Toronto General Hospital Family Practice Service. The computerized Cumulative Patient Profile, which became a vital component of this initiative, re ceived its copyright in 1978.7
28 1970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
A few years later, Fred Fallis purchased his secretarial assistant DFCM’s first computer for word processing. In an effort to establish aca demic credibility, Fred hired Rita Shaughnessy to create a library and information service in 1981. By 1982, each family practice unit was given an annual allowance of $440 to set up a library.
RITA SHAUGHNESSY
» Mount Sinai Hospital family practice teaching unit opens (first chief: Dr. Nathan Levinne).
» Dr. Laurel Dempsey introduces the Resident Project at Sunnybrook. By 1980, every resident is expected to complete an academic project.
1970
» Creation of the Emergency Medicine Fellowship with two residents led by Dr. Cal Gutkin as Program Director.
KINGHOLLISTER BUTTDON CRAIGCECIL
» St. George Health Centre opens (Site Leads: Drs. Rodger Hines, Phil Ellison, Karen McArthur). It is the first community-based teaching unit affil iated with one of the large teaching hospitals.
291970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
1971
MILESTONESKEY
HINESRODGER
» First community sites are estab lished, under Drs. Hollister King (Midland), Don Butt (Mississauga), Cecil Craig (Don Mills) and at the Sioux Lookout Zone Hospital. This eventually becomes the Teaching Practices Program, led by Dr. Hollis ter King.
GUTKINCAL
30 1970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
1975
BAINSTAN
1980
» Dr. Yvonne de Buda appointed Chief of Family Medicine at Women’s College Hospital. She would later start the popular “Saturday at the University” series at the Faculty of Medicine, and establish a network of volunteer, community-based family physicians to provide undergradu ate electives.
» Broadview Community Health Cen tre opens (Site Leads: Dr. Robert Cohen)
MILESTONESKEY 1972
HILDITCHJOHN
» St. Lawrence Health Service opens (Site Leads: Drs. Howard Seiden, Irv Gora, Lee Schofield, Caroline Leon)
» Flemingdon Health Centre, a satel lite of Sunnybrook Hospital, opens (Site Leads: Drs. John Hilditch, Geor die Fallis).
1974
» North York General Hospital be comes the first community hospital to join the DFCM Postgraduate Program. Under the leadership of Dr. Stan Bain, eight community-based physicians are recruited to build teaching practises. After completing their first year at NYGH, residents are moved downtown to be “prop erly trained.” It is not until 1988 that a small cohort of four residents are permitted to stay for their second year. Dr. Risa Bordman was the first chief resident of that group and would later go on to hold many leadership roles at DFCM.
Dr. David Lawee was an early faculty member at the unit.familyGeneralTorontoHospitalpractice
311970 — 1982: pioneering aCaDeMiC FaMilY MeDiCine
Dr. Ruth Sky worked in the Family Medicine Unit of the To ronto General Hospital’s Uni versity Wing.
Sunnybrook Health Sciences Centre Family Medicine staff and residents 1973 74.
Dr. Joan Bain worked as a family physician in the early days of the Sunny brook TeachingUnit.
Opening of the Family Med icine offices at Sunnybrook Health Sciences Centre.
32 1982 — 1990: expansion & innovation 1982 — 1990 EXPANSION INNOVATION&
Wilf Palmer was an Olympian in endurance and skill. Soft-spoken and gentle by nature, he was a cardiologist by training and came to recognize the importance and impact of family medicine through the lens of a specialist. As David White recalls: “In contrast to many specialists at the time (and perhaps some still), he recognized the extraordinary breadth of the discipline as a strength and the value of relationships with patients and communities as foundational to improving the health of individuals and populations.”
WILF PALMER Olympian
331982 — 1990: expansion & innovation
Wilf was an elegant communicator with a wish to improve the communication systems across the department. He encouraged DFCM’s librar ian, Rita Shaughnessy, to transform the news bulletins into an informative newsletter in 1983. Rita remembers Wilf’s creative contributions to strategic communication: “He had a flair for writing and drawing and contributed editorials in every issue.” Wilf also had the foresight to recognize the importance of documenting our activities and initiated formal annual reports.
34 1982 — 1990: expansion & innovation
Wilf gathered an outstanding team of academ ic leaders to create innovative programs, many of which continue today. He was a passionate educator who loved to teach and had the vision to expand undergraduate and postgraduate education beyond the traditional teaching hos pitals. He was also a pragmatist. David Tannen baum remembers Wilf often uttering: “no time better than the present!” During Wilf’s term, undoubtedly because of his extraordinary pro ductivity, the position of DFCM Chair was ex panded to a full-time appointment.
“What I recall was his calm and gentleall.approachrespectfuldignified,toHewasasouland a gentleman with integrity.”
Wilf was a creative and effective teacher and mentor to many. Barbara Stubbs recalls that he was “a true mentor to me as I became a junior faculty member and took on more academic roles. What I recall was his calm and dignified, respectful approach to all. He was a gentle soul and a gentleman with integrity.”
— Barbara Stubbs
351982 — 1990: expansion & innovation
In 1982, Wilf’s desire to create information systems first took shape when St. George Health Centre (SGHC) installed an in-house infor mation system to improve efficiency and provide digital resourc es for its physicians. One of these resources was the creation of a computerized version of the CPP implemented at SGHC in 1985. Two years later, Wilf hired software engineer Eric Meddings as DF CM’s Information Systems Consultant to design a comprehensive database specifically for the needs of academic primary care. Thus, the early work around the CPP evolved into the MEDPAL system (derived from its co-creators Meddings and Palmer) and was suc cessfully launched during Wilf’s tenure. In the February 1988 DFCM newsletter, Wilf wrote that the Information Systems Committee’s stra tegic plan was to have a clinical information system in each teaching hospital. Wilf would be delighted to know that all of DFCM’s central and distributed programs now work with electronic medical records.
Dr. Doug Johnson in Malta with new trained family medicine faculty.
CULTURE, SCIENCE &
1982MEDICINE
» Canadian Charter of Rights and Freedoms accepted into the constitution
Wilf’s 1986 strategic plan demonstrated his visionary thinking. He planned to expand the clerkship to four weeks, establish a fellow ship program, and develop a collaborative program to train family physicians in Malta. He also identified five areas of focus for de partmental research: education, primary care obstetrics, clinical de cision-making, prevention, and information systems and data col lection. Seeing how his legacy and vision impact DFCM’s research today is truly amazing.
In 1984, like every DFCM Chair before him, Wilf packed up the department’s belongings and moved, this time to the fourth floor of the Toron to General Hospital’s College Wing, and then a short-lived tenancy in a spacious suite on the eighth floor of 790 Bay Street and finally a very lovely space at 444 Yonge Street, on the sec ond floor of the College Park complex. In the faded elegance of the former offices of Polysar Corporation, DFCM was able to provide office space to the burgeoning program leadership team and administrative staff members.
DFCMSTAFFOFFICE1989
Wilf was deeply committed to the education of medical students and saw a need for family medicine in the pre-clerkship years, a radical notion at the time. He created the very popular first year “Core Selective Program in Family Medicine” and designed and implemented another pre-clerkship course, “Introduction to Clinical Skills,” an unthinkable task for a department chair to take on. The clinical skills course became the template for the “Art and Science of Clinical Medicine” course, which was launched in the 1991 curriculum renewal process.
David White, the Undergraduate Program Director (1985 – 1995), fostered an academic approach to education. This led to many faculty members becoming involved in educational innovations and many publications resulted from those endeavours. David was also deeply engaged in the Faculty of Medicine curriculum reform process. It was David’s advocacy on behalf of DFCM that would lead to a long-awaited 4-week core family medicine clerkship rather than a shared rotation with ENT and ophthalmology.
THE SEARCH FOR A HOME
UNDERGRADUATE EDUCATION
790 BAY ST.
36 1982 — 1990: expansion & innovation
DAVID WHITE
Within DFCM, David advocated for two significant changes. The first was to recognize clerk and pre-clerkship teaching as essential con tributions to the DFCM academic missions within the DFCM hospital funding formula. The second was to promote the academic work of the relatively junior faculty members, particularly young women, at a time when senior and “more important” roles were held by men. This contributed to both DFCM and the Faculty taking additional steps to address equity for women in academic medicine.
371982 — 1990: expansion & innovation
Wilf was gentle, kind, and inclusive in his interactions, and exemplified this approach as a Chair. He led a rambunctious Executive Committee composed of Chiefs who treated their sites as jealously guarded “fiefdoms” and battled over limited resources. People underestimated the degree to which he moved DFCM forward in many academic realms, notably undergraduate education and research. Just as important, he modeled an approach to leadership that helped to shift the culture.
POSTGRADUATE EDUCATION
WARREN RUBENSTEIN
Among Larry’s many significant contributions was his commitment to continuing the res idency expansion into community-affiliated hospitals. He worked with three new commu nity-based Family Medicine Teaching Units (FMTUs) to ensure they were ready to take on 25 residents in 1991. With Larry’s support, the following hospitals joined DFCM in teaching residents and clinical clerks: Scarborough Gen eral Hospital (SGH) (Dr. Barney Giblon, Physi cian-in-Chief), St. Joseph’s Health Centre (Dr. Michael Szul, Physician-in-Chief) and Toronto East General Hospital (Dr. Dan Mallin, Depart ment Head). With this expansion, DFCM offered training for 145 first- and second-year residents and 13 international medical graduates. Dr. Risa Bordman, a faculty member since 1992 and a longstanding leader in faculty development, re called the impact of this residency expansion on her career, “For me, the most important mile stone was the spread to the community. When I graduated, I headed out to Scarborough and hoped to never see academia again. Unfortu nately (but really, fortunately), DFCM spread to Scarborough when they began with a family medicine residency in the 1990s. As they say, the rest is history.”
LARRY LIBRACH
38 1982 — 1990: expansion & innovation
Dr. Larry Librach led DFCM’s Postgraduate Pro gram (1982–2002) with great skill during Wilf’s time as Chair. Under Larry’s leadership, DFCM harmonized our admission policies and proce dures, leading to a central admission commit tee rather than individual hospitals running their own process. Dr. Warren Rubenstein shared an amusing memory of one such committee meet ing in 1984, “RPC [Resident Program Commit tee] would meet at TWH family medicine unit on top of Haber’s Pharmacy at Dundas and Bathurst. Each year, we would meet to select residents for the match. All paper, no comput ers, paper spread all over a huge table. Usually took eight hours or more to review. One year— late in the day—all the papers fell onto the floor just before we were done. As we picked them up, we thought, ‘what a perfect way to select residents.’ The rank list created from the pile on the floor was similar to the one we slaved over all day.”
391982 — 1990: expansion & innovation
Our first foray into faculty development and ac ademic fellowship started at Sunnybrook in the 1980s, with Dr. Harvey Blankenstein amongst the first group of learners. Helen Batty envi sioned an Academic Fellowship for all DFCM faculty members. By 1990, the first cohort of fellows began their studies with Drs. Jeff Mills and Risa Freeman as the lucky full-time guin ea pigs. They were joined by nine part-time learners who were senior career physicians from the newly-affiliated community hospitals, including Toronto East General Hospital, St Jo seph’s Hospital and Scarborough General. Bar ney Giblon, a member of that first cohort from Scarborough, would go on to have a profound impact on teaching and research in the depart ment. As the program grew, international fel lows joined the DFCM with the earliest partic ipants arriving from Israel, Japan and Taiwan. Helen held the Academic Fellowship Program Director position from 1990 to 2008.
A quiet gentleman, [Wilf Palmer] brought with him new views and ideas from a different traditional university system beyond Ontario. His sensitivity to the Canadian values of equity and diversity were important for those changing times. His respect and support for women clinician-scientists and educators particularly in the early years of their faculty careers was hugely influential for those juggling academic and family responsibilities while continuing full-time positions.
HELEN BATTY
FACULTY DEVELOPMENT AND ACADEMIC FELLOWSHIP
INNOVATIONS IN EDUCATION
» First 8000XMorotola’sphoneavailablecommerciallymobilearrived–DynaTAC
CULTURE, SCIENCE & 1983MEDICINE
40 1982 — 1990: expansion & innovation
This was a time of unprecedented innovation in DFCM, and new programs abounded. In 1984, Wilf supported the development of the Standardized Patient Program (SPP) and appointed Dr. Barbara Stubbs as Director. This program flourished under Barbara’s lead ership, and its success was recognized with the very prestigious Faculty of Medicine W.T. Aikins Award in 1985. The program would continue to thrive under the leadership of Ms. Anja Robb. Ultimately, the SPP became a resource for the entire U of T community and many external clients, and in 1999 it was moved by the Dean to a new home in the Faculty of Medicine.
The award-winning Working with Families Institute (WWFI) was also created during this period. Led by Drs. Ed Bader, a family therapist, Kathleen Wilcox and Fred Tudiver (both faculty members at Sunny brook), it was developed in 1985 to enhance the teaching of fam ily assessment and counselling skills for family medicine learners and family physicians. Dr. Lynn Wilson wrote of Ed Bader, “I think Ed helped us to study and teach about the nature of our relationships with our patients and their families, however they are defined and therefore helped impact the quality of care. This was an early exam ple of DFCM advancing excellence by interprofessional collabora tion.”
STUBBSBARBARA ROBBANJA BADERED
DUNNEARL
The Sunnybrook Primary Care Research Unit (PCRU) was estab lished in 1985 and is one of Canada’s oldest primary care research units. It was born out of several initiatives: Dr. Earl Dunn’s collabora tion with Dr. Jack Williams and others at the Sioux Lookout Telemed icine Program and the collaborative Research Methods for Primary Care work funded by a Physicians’ Services Incorporated grant and a contract with Sage Publishing. Sunnybrook faculty committed to protecting funds to encourage and support research, but struggled to gain recognition for research at the CFPC and peer universities in Canada. Drs. Peter Norton (Family Practice Chief in 1988), Earl Dunn, John Hilditch and Fred Tudiver became the main pillars of this research unit, leading the development of innovative models of care delivery and reliable primary care outcome measures.
NORTONPETER
CULTURE, SCIENCE & 1988MEDICINE » Haemophilus B. influenzae vaccine introduced in Canada
Though research at DFCM had no formal leader, Wilf’s enthusias tic support contributed to remarkable growth during the 1980s. The Family Medicine Research Index, published by CFPC in 1982, noted that between 1976 and 1980, there had been 178 studies. In 1981, there were 254 studies. Eager to contribute to the growing field of family medicine research, Wilf supported the recruitment of research assistants for all family practice units in 1989.
RESEARCH
TUDIVERFRED
411982 — 1990: expansion & innovation
1984
Although DFCM had no official global health program, seeds were being planted. Wilf’s in tention to develop a new collaborative program to train family physicians in Malta came to fru ition, and in 1987, Doug Johnson conducted a 10-month in-country course for general practi tioners. Further work on primary care reform, led by Fred Demanuele, resulted in the estab lishment of the Malta College of Family Doctors.
Doug also participated in the First International Scientific Meeting in General Practice in China in 1989. His initial work was later built upon by Drs. Walter Rosser, Peter Norton, Earl Dunn and Brian Cornelson, and contributed to the devel opment of family medicine in China.
» Yvonne Kason (Sunnybrook) develops the Medical Inter viewing Skills Course, a core course for first- and sec ond-year medical students.
1986
» Establishment of the Working with Families Institute
» Toronto General Hospital and Toronto Western Hospital merge to become the Uni versity Health Network. Phil Ellison oversees the merger of the Family Practice Teach ing Units.
» Creation of the Standardized Patient Program, led by Bar bara Stubbs
ELLISONPHIL
GLOBAL HEALTH
MILESTONESKEY 1982
42 1982 — 1990: expansion & innovation
1985
• 14 international medical gradu ates
1989
» Residency program expansion:
BIRINGERANNE
» Second-year residents are required to spend two months in a communi ty Teaching Practice.
• 145 R1s and R2s
» Launch of “A Child is Born; a Fam ily Grows,” a preclerkship course developed and taught by Anne Biringer, who was recognized with a prestigious W.T. Aikens Award.
1988
» Scarborough General Hospital fam ily practice teaching unit opens (first chief: Barney Giblon)
» DFCM grows to 253 faculty mem bers. The central office includes a manager, four administrative staff, and a librarian.
» DFCM leaders participate in the first year of the DFCM Academic Fellow ship: Drs. Pearl Arshawsky, Vivian Chrom, Barney Giblon, Geoff Isaac, Dan Mallin, Warren McIsaac, Paul Pitt and Kingsley Watts.
» St. Joseph’s Health Centre family practice teaching unit opens (first chief: Michael Szul)
1987
» Dr. Helen Batty establishes the Central Administration Research and Education (CARE) Fund to provide financial support for faculty develop ment activities. Faculty could apply once a year, for a maximum of $750 per year.
431982 — 1990: expansion & innovation
1990
» DFCM research assistants form the Research Assistants and Associates Group (RAAG). Steve Slade, Anita Lanning, Sandy Cummings, Diane Kerbel, Kevin Northrup, and Esmee Franssen are among the earliest members.
44 1991 — 2001: visionarY sCholar 1991 — 2001 SCHOLARVISIONARY
Walter Rosser came to DFCM after serving as Family Medicine Chair at the University of Ottawa and McMaster University. He was eager to engage in new initiatives and challenge the status quo – in a most jovial and collaborative manner.
451991 — 2001: visionarY sCholar
WALTER ROSSER Optimist
620 UNIVERSITY AVE. 790 BAY ST.
46 1991 — 2001: visionarY sCholar
As DFCM’s first resident many years before, Walter, with his super visor Dr. Charles Hollenberg, and Reg Perkin, informed the creation of DFCM’s residency program. During his time as chair, Walter would support and nurture the exceptional program that it had developed into.
Ever an optimist, Walter had a way of making everyone feel that any thing was possible. He led with an open-door policy and was always ready to support faculty members in their academic efforts. Walter’s laughter and encouraging words are fondly remembered by all who had the pleasure of working with him.
While he was Chair, Walter worked at the Wellesley Hospital, where he was committed to providing care for underserved populations, in cluding the growing number of patients diagnosed as HIV positive. Not one to be afraid of complex clinical issues, Walter also spent a day each week providing care at the Don Jail.
Walter was also a highly respected and widely published clinical re searcher. One of the secrets to his prolific writing career was that he wrote almost every day during his long daily commute to and from Hamilton. During his time as Chair, he made significant contributions to evidence-based, patient-centred care. With Sharon Shafir, he co-authored Evidence-Based Family Medicine—the first textbook of its kind in family medicine.8
Walter was passionate about medical education and was keen to support creativity and innovation. He expected all education lead ers to take a scholarly approach to developing and evaluating DFCM programs. Risa Freeman has often repeated Walter’s expectation: “If you create it, you must evaluate it, and then you must disseminate what you learned.” With this expectation and his unwavering encour agement, DFCM became a powerhouse of creative educational inno vations and research.
WALTER ROSSER
“[Walter] is a genius in many ways. He is a great primary care researcher. He was a modernday McWhinney who wrote thoughtfully and reflectively and was passionate that we needed to document what we do in family medicine.” – Phil Ellison
471991 — 2001: visionarY sCholar
DFCM’s very first resident!!
“The DFCM will be recognized as a leader in training physicians who meet the needs of all parts of the province. Our graduates will be sensitive to the needs of all linguistic, ethnic, and under-served populations and address the distribution of family physicians within the province.”
“The DFCM will be recognized as an international leader in the de velopment of academic Family Medicine, attracting students to its programs from around the world and sponsoring faculty members to visit other parts of the world to demonstrate and advise on the delivery of primary health care.”
48 1991 — 2001: visionarY sCholar
Like his predecessors, Walter was a visionary. In 1994, he shared a prophetic vision about what DFCM might look like in 25 years.
Author’s note: DFCM’s contributions to the understanding of generalism in un dergraduate education and the 2020 WONCA postgraduate accreditation are evidence of DFCM’s leadership in family medicine education. Our work in social accountability and equity, inclusion and diversity speak to our commitment in ad dressing these issues in our education programs.
Author’s note: The Academic Fellowship and Graduate Studies program delivers courses and degrees in teaching, leadership, scholarship and research skills to health care providers around the world. The Global Health and Social Account ability program collaborates with academic institutions, organizations and col leagues in low- and middle-income countries to share expertise in clinical prac tice, scholarship and research, knowledge support, education and health systems management.
“A group of 20-30 people within the DFCM would devote 60-70% of their time to research, thus ensuring the DFCM is a strong research department at the University of Toronto as well as being recognized nationally and inter nationally as a leader in determining the role of family physicians in the provision of health care.”
“All practices within the DFCM network will be linked to gether by a powerful computer system which will include an excellent information system. This system will provide the research base for the DFCM as well as an excellent patient database which will provide physicians with direct access to patient information should they present them selves anywhere within the system.”
Author’s note: All of our affiliated hospitals now use electronic medical records with excellent patient databases. The U of T Practice-Based Research Network (UTOPIAN) uses these databases for research across DFCM.
Author’s note: Current DFCM faculty: 45% male, 55% female. Senior DFCM leadership: 43% male, 57% female. Undergraduate students accepted to Temerty in 2020: 35% male, 52% female, 13% unreported. 2021-2022 DFCM post graduate students: 40% male, 60% female.
Author’s note: DFCM currently has 28 funded researchers.
491991 — 2001: visionarY sCholar
“The gender ratio of faculty and faculty in leadership positions be equivalent to the trainees in the program.”
RISADAVIDFREEMANWHITE
50 1991 — 2001: visionarY sCholar
GROWTH
Under Walter’s leadership, DFCM grew, and its programs flourished. The department outgrew its offices at College Park and in 1993 moved to the eighth floor of 620 University, Princess Mar garet Hospital’s north building. It was the first time that office space was renovated to suit the department’s needs and included generous of fice and meeting space.
UNDERGRADUATE EDUCATION
The Undergraduate Education Program contin ued to thrive under David White (1985–1995). In 1992, curriculum renewal in the medical school introduced an emphasis on problem-based learning (PBL) and multi-disciplinary courses. The pre-clerkship curriculum was transformed from 59 courses to six “block” courses and two longitudinal programs. The changes provided an excellent opportunity to showcase the skills of family physicians as clinicians and teachers. It also presented enormous challenges, including an explosive increase in the demand for DFCM faculty members to serve in the pre-clerkship years, such as PBL tutors, given their generalist and problem-solving expertise. Curriculum re newal also expanded DFCM faculty members’ role in pre-clerkship, including the Introduction to Clinical Skills (year 1) and Determinants of Community Health (DOCH, years 1-2). Walter was a strong advocate for DFCM’s teachers and worked with Dean Arnie Aberman to se cure funding for those eagerly engaged in the new program as tutors and course directors. An additional but welcome challenge for DFCM
formative feedback. Drs. Melissa Nutik, Daph ne Williams and student leader Dani Manis de veloped the clinical encounter feedback exer cise to provide immediate preceptor-observed feedback on actual patient encounters. The clerkship OSCE, which was led by Drs. Nabil Missiha and Ruth Heisey, and subsequently by Drs. Debbie Elman and Preston Tran assessed the student’s knowledge and skills across many domains (communication skills, organiza tional abilities, physical exam, content integra tion, knowledge base). This was one of the first OSCEs at U of T and became a leading con tributor to the establishment of the OSCE as a core component and summative evaluation in the Faculty of Medicine.
Together with Rita Shaughnessy, she brought
as a result of curriculum renewal was the place ment of the new Family Medicine Clinical Clerk ship in year three of the medical school curric ulum. It allowed medical students to explore family medicine as a career path before choos ing their residency program. Still, it meant that DFCM had to offer clinical rotations for a double cohort of 500 clerks in 1994–95. This teaching responsibility required a Herculean effort by David and his highly motivated team of hospi tal program directors. Building on the strength of the community elective program that Anne Kenney led, over 100 new community teachers and four new community-based hospital teach ing sites were brought on board as clerkship
NUTIKMELISSA HEISEYRUTHMANISDANIWILLIAMSDAPHNE MISSIHANABIL ELMANDEBBIE
Internet access became available for all uni versity community members in the mid-1990s. This caused a seismic change in how students could conduct their academic projects. It soon became clear that the entire DFCM community needed to transfer their paper-based searching skills to the online format. Anita Lambert-Lan ning, the librarian at the Toronto Western, de veloped a program to do just that.
Undersupervisors.theleadership
of Risa Freeman (1995–2005), the Undergraduate Program experi enced tremendous growth in program inno vation, evaluation and education research. In 1996, two programs were launched that would later be adopted in family medicine clerkships across the Faculty of Medicine and in other Ca nadian medical schools: the Clinical Encounter Feedback Exercise and the Objective Struc tured Clinical Examination (OSCE). The former was a response to students’ requests for more
511991 — 2001: visionarY sCholar
All was not rosy in the Undergraduate Program during Walter’s ten ure. Canada saw a noticeable decline in interest in family medicine as a career choice. In response, a tremendously motivated, energet ic and committed group of medical student leaders, led by Rahim Hirji and Jonathan Kerr, formed the student Interest Group in Family Medicine (IgFM) in 2003. As one of the first students involved in this initiative, current DFCM faculty member Dr. Heather Zimcik re calls, “Things spread like wildfire… Within a few short years, every school in Canada had a family medicine interest group, the CFPC had formed the section of students, and we were asked to pres ent at everything from local conferences to the Deputy Minister of Health.” The IgFM at the DFCM is still active today and now includes research and advocacy as part of its mandate.
52 1991 — 2001: visionarY sCholar
the very popular “Net explorations – finding the internet evidence” to the DFCM in 1996. A generation of DFCM students and faculty members are indebted to our treasured librarians for moving us into the internet age.
RAHIM HIRJI HEATHER ZIMCIK
CULTURE, SCIENCE & 1992MEDICINE1993
» Toronto Blue Jays won the World Series
David Tannenbaum became the Postgraduate Program Director in 1997 (1997–2007). He led his team through exciting curriculum innovation and growth. Over the 10 years of his time as the Program Director, the initiatives included: the redesign of the CaRMS admissions process; enhancing the behavioural science education program (including the development of an inter professional counselling program); developing robust programs of assessment and remedia tion for residents in difficulty; creating the Rural Residency / Middle Ontario Program; and ex pansion of the residency to develop many new third-year programs. On the international level, David led the team in expanding the Interna tional Medical Graduate (IMG) program and cre ating a Pre-Residency Program for this group of trainees. This program continues to play a piv otal role in integrating residents trained outside of Canada into programs across Ontario. The team also developed the VISA trainee initiative in 1999, including the work with Aramco, which necessitated designing and implementing a three-year residency program.
KIRK LYON
531991 — 2001: visionarY sCholar
Having led the first large wave of residency ex pansion into community-based hospitals, Larry Librach completed his term as Program Direc tor and handed the leadership to Dr. Kirk Lyon in 1992 (1992–1997). Kirk described the guid ing principle of his tenure as the consolidation of our strengths and resources. This included: creating goals and objectives for all core and selective rotations; redesigning the evaluation system to reflect core curricular goals; estab lishing an electronic catalogue of elective ex periences to be shared across all divisions, and further developing the Teaching Practice Program to ensure that all residents were able to complete two months of training outside of Toronto. DFCM also won a multi-year contract with Saudi Aramco to train physicians for a new system, including primary care.
POSTGRADUATE EDUCATION
During this time, the historic decision was made to eliminate the rotating internship in Canada. Implemented in all provinces by 1993, this re quired all medical graduates to choose a spe cialty as a road to licensure. This change con tributed to family medicine’s increasingly high profile in Canada.
DAVID TANNENBAUM
David led the new community-hospital expansion sites to build on the landmark longitudinal residency program he had implemented with Warren Rubenstein at Mount Sinai Hospital. David underscores the importance of this program “that centred residency training in the family medicine experience”.9
54 1991 — 2001: visionarY sCholar
The development of Family Health Teams across Ontario provided another opportunity for innovation in the residency program with greater exposure for residents to work in interprofessional teams. Recognizing that the model represented the future of primary care, David wisely developed a leadership course to prepare resident leaders for future practice. The course continues to be a popular component of the Postgraduate Program.
Walter was a most likable person. Warm and generous. He was deeply caring about his family, patients, colleagues and without any ego. He had a wide vision for what academic family medicine could do and be. He reached out into the international stage and put DFCM onto the world map. If you travel outside of Canada to a family medicine meeting, people will still ask you about Walter and smile when they do.
551991 — 2001: visionarY sCholar
FACULTY DEVELOPMENT
The DFCM Graduate Studies program was the natural extension of our Faculty Development program. It launched in September 1994, with Helen Batty as its first program director (1994–2010). Helen’s grit, determination and masterful networking skills ensured that the Master of Health Science (Family Medicine) Community Health (MHSC) was approved by the U of T School of Graduate Studies, Graduate Department of Public Health Sciences that same year. The program’s reputation as an intense and rewarding learning experience grew and soon welcomed learners from across the globe, many of whom went on to lead the health care and education systems in their home countries. Helen’s international reputation for this program is legendary. To this day, if you attend an international education program, faculty from around the world will ask you about the “Helen Batty Masters!”
BERNIE MARLOW
GRADUATE STUDIES
Another significant development during this period was the appointment of Dr. Bernie Mar low to reignite the DFCM continuing medical education program for the department. Bernie provided creative leadership for this program from 1995 until 2003.
DFCM made several significant contributions to faculty development on the international stage during this time. Helen Batty and Yves Talbot designed the highly successful Five Weekend Fellowship Program, a one-year longitudinal program meant to develop leadership skills for faculty and community-based family physicians entering academic careers. Helen describes the program’s goal as “to build a network of lead ers across Canada linking the cities and the ru ral areas of all the provinces for national family medicine.” Participants learned about our disci pline’s philosophical base and the practicalities of leadership, research, and advocacy. Helen recalls the program’s impact, as participants in cluded “medical school deans, national college presidents and more who started out from our Toronto-based program.” The Five Weekend Fellowship, offered annually for 11 years, influ enced many continuing medical education and faculty development programs across Canada.
HELEN BATTY
The Research Program was taken to a new lev el through Dr. Barnett and Beverley Giblon’s transformative gift, which established a Chair in Family Medicine Research in 1999. Short ly after that, Rick Glazier took on the Program Director leadership role (1999–2001). Rick led the program by example with his strong track record as a primary care researcher, and fac ulty members fondly recalled Rick’s gentle na ture and his role as a mentor to many. Warren McIsaac (2001–03) carried on the tradition of being a highly engaged primary care research er in the Program Director role. The “McIsaac Strep Score” was cited by many as the most influential research paper ever published by a DFCM faculty member.10
56 1991 — 2001: visionarY sCholar
RESEARCH
One of Walter’s most significant contributions to DFCM was the Funded Researcher Program. He financed this initiative by ‘creatively’ realign ing budgets. These realignments led to many a heated discussion at the Executive Committee table. But Walter’s perseverance provided the foundation for the Research Program to flour Soonish.
base for the discipline. It may sound obvious now, but then, very few saw the value to re search and scholarship in family medicine.”
MCISAACWARRENGLAZIERRICKTALBOTYVES
after appointing Dr. Yves Talbot as the first Research Coordinator (1994-99), Walter and Yves established this ground-breaking pro gram, which would protect at least 40 percent of a DFCM resaercher's time, thus enabling them to make a sustained research effort. The program began with eight researchers, with matched funding provided by hospital or grant funds. Many at DFCM consider this decision one of the most critical milestones in the de partment’s history. As June Carroll, one of DF CM’s leading researchers, wrote: “This was rec ognition of the value of developing a research
HELEN BATTY
Walter was a brilliant and complex family doctor and leader. He gleefully rode through the streets of Toronto on his bicycle in almost any weather. He said it was the quickest way to get from his university office to his clinic or the main campus for a meeting with the dean. His door was always open to any central office staff members or faculty leads who needed to talk. As a result, he was aware of intra-office situations but avoided micromanaging. He supported future leaders by designing and conducting annual peer-based performance evaluations of all his program directors and offering invaluable constructive feedback.
571991 — 2001: visionarY sCholar
ROSSBARNETTBEVERLEYUPSHUR&GIBLON
In 1999, Neil Drummond, an epidemiologist, and Ross Upshur, Da vid White, and Walter founded the North Toronto Primary Care Re search Network (NorTReN). This multidisciplinary, community-based network was designed to engage primary care practitioners in re search to answer questions deriving from primary care clinical prac tice. NorTReN was U of T’s first practice-based research network and one of the first in Canada. It was to become the foundation upon which DFCM's UTOPIAN project would be built.
CARROLLJUNE DUNNSHEILA&BIRINGERANNE
» Chicken pox vaccine licensed for use in Canada
58 1991 — 2001: visionarY sCholar
already established expertise in gender issues. In 1994, she was welcomed to the Executive Committee as the first appoint ed lead for the Gender Issues Committee. As Walter wrote in the 1993–94 Annual Report, “The committee unanimously endorsed in cluding [Gender Issues Committee] representation in an attempt to adjust the imbalance of women on the Executive Committee.”
GENDER ISSUES
CULTURE, SCIENCE & 1999MEDICINE
During Walter’s term, June Carroll formed the Gender Issues Sup port Group to unite the women of DFCM and encourage them in their roles as faculty members and potential leaders. It might seem unnecessary now, but back then, role models like Drs. Helen Bat ty, June Carroll, Anne Biringer, and Sheila Dunn were desperately Sheilaneeded.had
From the earliest days of DFCM, there were many unofficial mentors and leaders in the delivery of primary care obstetrics, such as Sharon Shafir, Jean Marmoreo and Carolyn Bennett. During Walter’s term, an official Maternity Care Committee and the Primary Care Interest Group in Obstetrics were established under the leadership of Anne Biringer. Founding members included June Carroll, Tony Reid, Kar en McArthur, Lynn Wilson and Deana Midmer. Eventually, the DFCM Primary Maternity Care Lead’s funded role was created to recognize this work’s importance. The ALPHA project (Antenatal Psychosocial Health Assessment) was developed, evaluated and disseminated by this group and many other contributors from family medicine and other disciplines. An evaluation study, led by June Carroll, showed that health care providers using the ALPHA form could detect signifi cantly more psychosocial factors for adverse postpartum outcomes, especially those related to family violence, than usual care.11 This project fundamentally changed how prenatal care was delivered in Ontario and internationally.
591991 — 2001: visionarY sCholar CULTURE, SCIENCE & 2001MEDICINE » 9/11 terrorist attacks
MCARTHURKAREN&REIDTONY MIDMERDEANA
BENNETTCAROLYN
PRIMARY CARE OBSTETRICS
60 1991 — 2001: visionarY sCholar
PATIENT EDUCATION
If you have ever met Dr. Mike Evans, you have likely experienced his boundless creative en ergy. He brought this energy to creating the Mini-Med school for the Faculty of Medicine in 2001. This popular series drew participants of all ages to hear experts talk about a wide range of health topics. Mike recalls how the se ries evolved in this way: “…all these diseases have a continuum, and so people would see the primary care end of things... the Q and A became its own session and we got more cre ative…so we would do plays and videos and in terview standardized patients etc.” These ses sions were the incubator that helped hatch the entertaining and informative whiteboard videos that have provided credible health information for millions of people across the globe. The first of many videos, “23 and ½ Hours: What is the single best thing we can do for our health?” has had over six million hits since its launch in De cember 2011.12
INTERNATIONAL HEALTH PROGRAM
MIKE EVANS
YVES TALBOTBRIAN CORNELSON
Many faculty members led important Global Health initiatives during this time. Brian Cor nelson was appointed by the World Organiza tion of Family Doctors in 1991 to do a feasibility study for family medicine training in China and spent six months in Beijing. In 1999, DFCM es tablished its first agreement with Chile’s minis try of health to deliver a training course in ca pacity building in primary care. In addition to his research responsibilities, Yves Talbot was the first International Health Program Director (1995–2011). He and Walter initiated the Bra zilian connection by introducing their course, “Curso Basico,” in Curitiba. More than 5,000 Brazilian primary health care workers including physicians, nurses, dentists, and health pro moters have benefited from this training.
INTERIM AND ACTING CHAIRS
• Extensive use of electronic medical re cords
611991 — 2001: visionarY sCholar
• Capitation payments
HELEN BATTY
• A mechanism for providing a complete basket of services to its population
The success of the “Genesis Project” at NYGH became the catalyst for the development of Family Health Networks and, eventually, Fam ily Health Teams across Ontario. Jamie Meuser recalled the earliest stages of Primary Care Re form as “the contributions of many—people like Val Rachlis and Walter Rosser spring to mind— in strongly influencing the unfolding of primary care reform in Ontario.”
Like the decades before, the 1990s was a time of tremendous debate regarding how best to provide primary care. Walter led the effort on the international stage. Val Rachlis, Chief of Family Medicine at North York General Hospital (NYGH), ignited the fire for change in Ontario. Ever eager to challenge the status quo, as evi denced by choosing to enrol in the first cohort of residents at Mount Sinai, Val developed a new primary care model that included:
The story of DFCM leadership during this peri od would not be complete without mentioning Helen Batty, serving as Acting Chair from Janu ary to June 1996. Helen was the ideal candidate for this position as she had been the Associate Chair since 1987. Her colleagues already high ly respected her leadership qualities. She had established herself as a pioneer in women’s health, women in leadership, advanced train ing in academic family medicine, fellowship studies, and graduate studies. She was eagerly sought after as a mentor among women faculty members. As Acting Chair, Helen had the du bious privilege of presiding at the male-domi nant—and sometimes unruly—Executive Com mittee meetings. Helen succeeded at this with her unique blend of strength and intelligence.
education were integral to the design of this new project.
The DFCM was fortunate to be led by Phil Elli son as Interim Chair in 2001. Phil stepped in at the end of Walter’s term to lead the DFCM un til the incoming chair arrived in 2002. Phil was an established leader at DFCM, having already held program director and hospital chief roles. He led the department during a financially chal lenging time and was able to do his magic be fore the new Chair arrived. Phil’s responsibility as the chief negotiator was not for the faint of heart. No one could have done a better job.
Researchprovidersand
• Teams of interprofessional health care
PRIMARY CARE REFORM
VAL RACHLIS
PHIL ELLISON
62 1991 — 2001: visionarY sCholar
» Launch of Women’s Health Fellow ship by Helen Batty. Claire Murphy was the first scholar.
1992
» Influenced by the Barer Stoddart report, U of T medical school cuts registration from 250 to 177 medical students.
» Bob Henderson, the Director of the Teaching Practice Program, leads a group of 28 affiliated teaching prac tice sites.
» Masters of Science in Family and Com munity Medicine (MHSc-FM) is estab lished
» Michael Roberts serves as the DFCM representative for the Faculty of Medicine pre-clerkship course entitles Health Illness and the Com munity
» Launch of Five Weekend International Fellowship
1994
MURPHYCLAIRE
» Provinces eliminate the rotating intern ship. This change required all medical graduates to choose a specialty as a road to licensure and contributed to family medicine’s increasingly elevated profile in Canada.
» First International Academic Fellow, Shlomo Monnikendam, arrives from Israel.
MILESTONESKEY 1991
HENDERSONBOB
WINDRIMTRISH
» Email and free internet searching becomes available to the whole U of T community.
1993
» Trish Windrim serves as the DFCM representative for the Faculty of Medicine Undergraduate Education Committee 1998-2018, the Mecha nisms, Manifestations, & Manage ment of Disease Course Committee 2000-2018, and the Admissions Committee 2000-2015.
» Toronto East General Hospital family practice teaching unit opens (first chief: Dan Mallin)
» Launch of The Determinants of Community Health course in the Faculty of Medicine pre-clerkship program. Michael Roberts serves as DFCM liaison.
LANNINGANITA
631991 — 2001: visionarY sCholar
HARTWICKKARL
» David White and the Undergraduate Education Committee were hon oured with a Faculty of Medicine W.T. Aikins Award for Excellence in Undergraduate Teaching: Course Development and Coordination for their work in mounting the double cohort clerkship.
» Sunnybrook Health Science Centre and Women’s College Hospital merge. Jim Ruderman, Chief of Women’s Col lege Hospital, takes on leadership of Family Medicine at both sites
1998
» Philip Hebert publishes the first edition of Doing Right: A Practical Guide to Ethics for Physicians and Medical Trainees13, a culmination of his pioneering career in medical ethics at Sunnybrook Health Scienc es Centre
» The WHO Collaborating Centre in Women’s Health is established with Helen Batty as Lead.
» DFCM grows to 640 faculty mem bers
2000
1995
1996
» Residency program now includes 175 residents 2001
» Librarians Rita Shaughnessy and Anita Lanning create the seminar “Net Explorations: Finding the Inter net Evidence” to equip many DFCM faculty and learners with online searching skills
HERBERTPHILIP
1999
» DFCM creates its first website.
» Karl Hartwick becomes leader of the Teaching Practice Program.
» DFCM buys its first electronic data pro jector at a cost of $8,000
64 2002 — 2007: Fostering Collaboration & teaM builDing 2002 — 2007 &COLLABORATIONFOSTERINGTEAMBUILDING
652002 — 2007: Fostering Collaboration & teaM builDing Louise Nasmith came to DFCM from McGill University. She was recognized as a national leader in family medicine education and used her knowledge and exceptional organizational skills to support the advancement of DFCM’s education programs. She fostered collaboration and was instrumental in standardizing the systems that grounded and coordinated the innovations from Walter Rosser’s term as Chair. LOUISE NASMITH Organizer
Louise’stable.energy
knew no bounds. An early morning runner, she would arrive at the DFCM ready to roll. During her time with the DFCM, she served as the Chair, the Interim Physician-in-Chief of Family Medicine at the University Health Network (UHN), and the Chair of the College of Family Physicians of Canada (2005 – 2006). Like Walter Rosser, she was eager to engage in challenging clinical work and joined the Family Medicine team that ran the inpatient unit at UHN. Barbara Stubbs recalls that “Louise was always ready to lend a helping hand and to make things possible for faculty leaders with the appropriate supports in place. She epitomized clinical courage.”
» SARS arrivedepidemicinToronto
CULTURE, SCIENCE & 2003MEDICINE
66 2002 — 2007: Fostering Collaboration & teaM builDing
Though soft-spoken, Louise’s grit and determination were not to be underestimated. When she arrived, she inherited what she called a “Federation” of independent hospital chiefs. Using her tremendous leadership skills, she set a standard of civility and developed a cul ture of cooperation, mutual support, and respect at the growing lead ership
In her first year, Louise took careful stock of the history of the DFCM. She began with a review of the strategic plan that Wilf Palmer had meticulously orchestrated in 1988. She asked each of the program directors and their committees to prepare a list of key issues and priorities. Through a series of consultations, visits to all eight hospital sites, executive retreats, and broad stakeholder input, she unveiled a new strategic plan in 2003. The plan identified a clear vision for DFCM scholarly activities with a focus on the “3Es” - Effective Prac tice, Equity, and Education. The 3Es were to guide the department’s clinical services, teaching, and research activities. Louise created new leadership structures and programs to support education and faculty development in these endeavours.
Early in Louise’s term, Toronto was deeply affected by the arrival of the SARS virus (2003). Everyone quickly learned the importance of Personal Protective Equipment (PPE) and how to use it. Though sup plies were very limited in the early days of the pandemic, our educa tion programs could continue without interruption.
“Louise was always ready to lend a helping hand and to make things possible for faculty leaders with the appropriate supports in place. She epitomized clinical courage.”
672002 — 2007: Fostering Collaboration & teaM builDing
—Barbara Stubbs LOUISE NASMITH
No chapter in DFCM’s history would be complete without at least one move. The year that Louise Nasmith arrived as Chair (2002), the Princess Margaret lease ended, and a new, temporary space was found at 256 McCaul Street. This was DFCM’s first home on the U of T campus. It was bright and airy, if slightly scruffy, and there was room for all the multiplying staff and leader ship. Two years later, Louise moved the department across the street to three floors of 263 McCaul Street.
Ruby Alvi led the development of the eLog, in collaboration with DFCM students and faculty, Lawrence Spero, Director of Education al Computing at the Faculty of Medicine, and Michael Tarrant at the University of Calgary. This initiative was an electronic logging system for students to record their patient encounters in the Family Medicine Clinical Clerkship. The PalmPilot-based system was the first electron ic data logging system in Canada that allowed students and faculty to
68 2002 — 2007: Fostering Collaboration & teaM builDing
263 MCCAUL St.
UNDERGRADUATE EDUCATION
256 MCCAUL St.
THE SEARCH FOR A HOME
The Undergraduate Program was led by Risa Freeman during the first part of Louise’s term (1995-2005). Through networking opportunities, she was able to build collaborations across programs in the DFCM, with other departments in the Faculty of Medicine, and with family medicine colleagues across Canada and the United Stated. Funding by the newly formed Dean’s Excellence Fund allowed the program to build strong teams of eager students and emerging leaders to launch three new education initiatives in 2002.
identify learning and address deficiencies in the learning experience. Rick Penciner later adapted the eLog for the Emergency Medicine clerkship. Shortly after that, the eLog served as the prototype for the software used to track clinical encounters across the faculty.
» Human Genome Project completed
2003MEDICINE
The Site Visit CQI and Faculty Development Program recognized the vast diversity in our community teaching settings. It sought to ensure consistency of curriculum delivery, quality of teaching, and program coherence. Rebecca Malik, Electives Coordinator, and Risa Bordman, Scarborough General Hospital Undergraduate Lead, recognized the opportunity for individualized, ‘just in time’ faculty development that could be provided during a site visit. Teachers who would not oth erwise be able to access traditional faculty development programs in downtown Toronto could have point-of-care discussions. The Site Visit CQI Program continues to this day and provides quality assur ance and meaningful, individualized resources for community-based
Productivity initiative, led by Betty Chen, was a col laboration with the Faculty Development and Research programs to enhance clinician-teacher support of student-led projects in areas of inquiry that were especially significant in family medicine. Particular attention was paid to emerging areas of importance, including genet ics and physician-patient communication. SCIENCE &
CULTURE,
692002 — 2007: Fostering Collaboration & teaM builDing
Thepreceptors.Academic
CHENBETTYBORDMANRISAALVIRUBYFREEMANRISA REBECCAMALLIK
70 2002 — 2007: Fostering Collaboration & teaM builDing
TRT continues to have an important role in our education programs. Over 800 residents have graduated from the program. Recognizing selection bias, nearly 15% of TRT graduates are now serving as DFCM faculty members, and 17 TRT graduates are DFCM program directors, hospital chiefs, site directors, and medical leaders in hospitals across our system. Additionally, the most recent version of the residency ac creditation standards for the College of Family Physicians of Canada now includes a teaching skills program requirement (CFPC Accredi tation Standard 3.2.5). The TRT allows us to meet that standard with ease.
The most extensive cross-department collaboration occurred when The Undergraduate, Postgraduate, Graduate Studies and Faculty De velopment programs came together to build the Teaching Residents to Teach (TRT) Program. TRT was designed to address decreased student interest in Family Medicine, student feedback requesting in creased exposure to Family Medicine residents to assist in career exploration, and resident feedback requesting more involvement in teaching. Through consultation with colleagues at the University of California Irvine and Columbia University, the TRT was launched in the fall of 2003. It became the template for other TRT programs across Canada.
LAWMARCUS BLANKENSTEINHARVEY NICKELLLESLIE
There was a flurry of activity in medical schools across Canada in the early 2000s in response to Health Canada’s 2001 report entitled “Social Accountability – A Vision for Canadian Medical Schools.” Undergraduate leaders across the country were charged with training an appropri ate ‘mix’ of physicians to provide a “sustainable health care system for the future.” The Univer sity of Toronto convened the Generalism Task Force, capably Chaired by DFCM faculty mem ber Leslie Nickell. Jennifer and Kymm both rep resented the DFCM in these crucial discussions. The final report published in 2005 recommend ed promoting “a positive view of generalism among University of Toronto medical students and faculty.” It served as a blueprint for the cur riculum renewal that would follow.
ship ensured that students would have the same amount of exposure to Family Medicine as to all other disciplines before choosing a residency program. In 2005, Jennifer created the role of the Preclerkship Initiatives Coordinator. Kymm Feldman was appointed to this important new position that ensured a voice for Family Medi cine at the Preclerkship leadership table.
712002 — 2007: Fostering Collaboration & teaM builDing
MCCABEJENNIFER
Marcus Law was a member of the TRT develop ment team when he was President of the Family Medicine Resident Association of Toronto. Now the Associate Dean of the MD Program at Te merty Faculty of Medicine, he recalls how grad uates of TRT “have become teachers, curricu lum developers, and educational leaders. They are our role models for our students and ambas sadors for Family Medicine.”
Jennifer McCabe became the Undergraduate Program Director in 2005 (2005 -2010). Long respected for her commitment to academic medicine and leadership at St. Michael’s Hospi tal, she refined the TRT program to become the prototype for similar programs across Canada. Amongst her many contributions to our educa tion programs, Jennifer’s role in championing the expansion of our clerkship to six weeks was instrumental in transforming the medical student experience in Family Medicine. Her success in securing an additional two weeks for the clerk
Harvey Blankenstein stepped in as interim Pro gram Director in 2004. he was uniquely suited to this role after serving as a hospital undergrad uate director for many years.
FELDMANKYMM
When Louise arrived, David Tannenbaum (1998-07) was at the helm of the Postgraduate Education Program. Under his leadership, the Postgraduate Program continued to develop, implement and evaluate the many initiatives created during Walter Rosser’s time. In addition, David led several significant innovations during Louise’s term. In 2003, a part-time training op tion was introduced that afforded residents an opportunity to pursue higher educational goals or integrate a return to the program from illness, maternity or paternity leave. Also, in 2006, Mar cus Law was appointed to serve as DFCM’s first Residency Recruitment Coordinator. He pro vided excellent leadership to this program until
number of trainees grew tremendous ly during Louise’s term with the addition of 98 residents to our third-year fellowship programs and the International Medical Graduate Pro gram (IMG) development for Ontario. Under Da vid’s leadership, the first cohort of 52 IMGs was launched in 2007. Maureen Gottesman was ap pointed as the inaugural IMG Program Director.
MAUREENLOUISEGOTTESMANNASMITH & DAVID TANNENBAUM
72 2002 — 2007: Fostering Collaboration & teaM builDing
POSTGRADUATE EDUCATION
The2012.
In 2006, The College of Family Physicians of Canada Section of Teachers Executive Com mittee established the Working Group on Post graduate Curriculum Review. David was invited to chair this group, whose task was to review Canada’s postgraduate curriculum to prepare graduates to provide effective clinical and pro fessional practice over the coming decades. David and the team’s final recommendation was to create a competency-based curriculum for postgraduate training in Canada. The new curriculum was to be comprehensive, focused on continuity, and centred on family medicine. Coined the “Triple C Competency-Based Curric ulum”, this report led to a fundamental change
(Louise Nasmith) was a highly effective mentor and sponsor. She created local and national opportunities for faculty at every career stage. In doing so, she was a great role model, particularly for the women in our department.
in postgraduate family medicine training in our country with ripple effects that have reverberated across the globe.14
732002 — 2007: Fostering Collaboration & teaM builDing
By 2006, DFCM was planning a second wave of expansion into com munity hospital sites. Archival documents from June 2006 list nine potential hospital collaborations. Ultimately, four hospitals would sign affiliation agreements to become our newest teaching sites: Royal Victoria Hospital in Barrie, Credit Valley Hospital in Mississauga, Tril lium Heath Centre in Etobicoke and Markham Stouffville Hospital in Markham.
BARBARA STUBBS
JAMIE MEUSER
PROFESSIONAL DEVELOPMENT
In a time of fiscal restraint, Louise made a courageous decision to fund hospital-based PD leadership positions that would allow initia tives to emanate from and be connected to the strong teaching and clinical work being done across all the units.
Louise was deeply committed to faculty development and ushered in a time of unprecedented growth for professional development in its broadest terms, crystallized in her “3 Es” vision. In 2003, she cre ated the Professional Development (PD) Program with Jamie Meus er as the inaugural Director (2003-11). The mandate of this program was to foster the professional and personal development of DFCM members and the broader community of family physicians. As Jamie recalls, Louise harnessed the energy of the large group of faculty members. She was focused on excellence and bringing primary care to a place of prominence in a health system ready for change.
Louise’s commitment to enhancing collaboration in all its forms enabled me and all the colleagues who have propelled Professional Development to begin to harness the incredible knowledge engine that is the DFCM.
74 2002 — 2007: Fostering Collaboration & teaM builDing
Other important achievements in Faculty Development included:
• Contributing to the DFCM discussion on faculty categories by developing a plan for supporting and validating faculty mem bers in the Clinician-Teacher category.
• Creating two new funds that faculty members could apply to develop new faculty development and CME programs and to pursue scholarly activities.
—2006
• Developing and evaluating the Professional Development Plan, a map for professional development for all DFCM faculty (new ly appointed faculty were required to outline a three-year Aca demic Development Plan with a level of activity pro-rated to the
2005MEDICINE
752002 — 2007: Fostering Collaboration & teaM builDing
With Louise’s encouragement, the collaborative and highly engaged PD Committee welcomed the challenge of finding and building on opportunities for scholarship in its work. The three-day Basics Pro gram for new faculty was among its most impactful Faculty Develop ment initiatives. This course was launched in 2005 and designed to provide new faculty with the knowledge and skills required to build teaching excellence. It also provided an orientation to the DFCM and U of T. The program was initiated following the new expectation that each DFCM faculty member would have a minimum “academic com petence” level for their faculty job category. Each was encouraged to participate in appropriate regular faculty development activities. The Basics Program was built on DFCM expertise, such as the “5 Weekends” program that Helen Batty and Yves Talbot offered to family physicians across the country and the Yves Talbot and Warren Rubenstein book that set the standards for ambulatory teaching at that time.15 The Basics Program is still the foundational entry point for our Faculty Development programs.
Committee membership was drawn from all hospitals, with addition al representation from the Teaching Practices Program and the Divi sions of Emergency Medicine and Palliative Care. The PD Commit tee’s responsibilities included: developing and implementing faculty development activities and continuing education programs; linking faculty development and continuing education activities across the DFCM; assisting leaders with organizing and standardizing evalua tions of faculty teaching performance and professional development planning; and overseeing DFCM teaching and grant awards.
• Organizing and overseeing a Mentorship Network under the leadership of Barbara Stubbs and based on the work of the Mentorship Task Force.
CULTURE, SCIENCE &
» Xbox 360 and Nintendo Wii released in Canada
• Overseeing the nomination and decision process for the DFCM Awards of Excellence, including creating and awarding a new category, “Academic Family Physician of the Year.”
• Supporting DFCM faculty members in preparing for Junior and Senior Promotion.
• Initiating a set of Professional Development Awards for DFCM faculty and groups of faculty members.
76 2002 — 2007: Fostering Collaboration & teaM builDing
The PD Committee also introduced several initiatives in clinical con tinuing professional development at this time, including mounting Primary Care Today, a large continuing education conference for pri mary care practitioners, with Dr. John Axler, DFCM Director of Con tinuing Education Projects, as planning committee chair. Additionally, a collaborative exploration, development, and scholarship initiative in continuing interprofessional education were launched to support the early clinical program development efforts of affiliated Academic Family Health Teams.
BART HARVEY
extent of their teaching commitment with the department as part of their application for an appointment).
The Centre for Effective Practice was founded in 2003 to address the growing gap between best evidence and current primary care practice. Co-directed by Jamie Meuser and Bart Harvey, this initiative produced clinical toolkits and practice aids, most notably, the fourth edition of the Family Practice Sourcebook in 2006.16 This top-rated family practice resource provided practitioners with concise, up-todate, evidence-based information about problems encountered in family practice. Published by Elsevier, Mike Evans served as Scientific Editor, supported by over 175 faculty, resident and student contribu tors. Under Jamie Meuser’s leadership, the PD Committee served as the organizing hub for the reviewing and re-writing tasks associated with the production of this text.
In addition to these increasingly popular programs, DFCM offered flexible sabbatical and visiting faculty opportunities and observer ships, as well as faculty development clinical enrichment fellowships in women’s health, care of the elderly, and sports medicine.
772002 — 2007: Fostering Collaboration & teaM builDing
Helen Batty continued to lead a cornucopia of continuing academ ic education, fellowship, and graduate studies programs. There was something for everyone in the DFCM catalogue. Helen also contin ued in the role as program director for the MHSc (Family Medicine) in the School of Graduate Studies, Graduate Department of Public Health Sciences (1994-2010), with Curtis Handford joining the pro gram in 2007 as the Associate Program Director for the Master of Science of Community Health (MScCH) in Family and Community Medicine (FCM) and Academic Fellowship Program.
ACADEMIC FELLOWSHIP AND GRADUATE STUDIES PROGRAM
The Clinical Teacher Certificate provided advanced training in Health Professions Education for all Health Sciences faculty and communi ty-based health professionals wishing to increase their teaching, ed ucation and scholarly effectiveness.
Continuing Education – Academic Programs
The Academic Fellowship Program provided rigorous continuing ac ademic education to prepare prospective faculty and experienced health professionals to become more effective and scholarly leaders of family medicine and primary care. It was designed with both do mestic and international programs.
CURTIS HANDFORD
The Interprofessional Practical Applied Teaching and Learning in the Health Professions (INTAPT) course was a broad, introductory over view of education, teaching and learning issues in health profession al training as a field of scholarly inquiry and research offered in a convenient distance accessible format.
TALBOTYVES NEWMANPETER MOINEDDINRAHIM GREIVERMICHELLE
Louise’s strategic plan outlined three objectives for the International Program: to build partner ships with universities, governments, internal agencies and the private sector interested in primary care; provide students, residents and fellows with international health placements in primary care; and to develop collaborative research in primary care, with a focus in Latin America and the Caribbean. The 2001 - 2002 year-end report noted the number of countries interested in our program had grown, and Mex ico, Colombia, China, and Albania were among our potential partners. Yves Talbot negotiated DFCM’s first collaborative agreement with the city of Bogota, Colombia, in 2004. More than 350 health care professionals (physicians, nurs es, nurse-aids, and health promoters) had re ceived Individualtraining.faculty
members continued to provide wonderful international learning opportunities for our residents, including Paul Roberts’ work in Ecuador, and Peter Newman’s medical aid pro gram in Dominica.
RESEARCH
With his usual boundless energy, Yves Talbot launched the Five Weekend Family Medicine Research Program in 2004. Based on the mod el of the Five Weekend Fellowship and funded by the Ontario College of Family Physicians, this program was designed to develop the research skills of community physicians. The inaugural 2004-2005 program was facilitated by Yves Tal bot, Michelle Greiver and Silvia Takeda.
78 2002 — 2007: Fostering Collaboration & teaM builDing
INTERNATIONAL PROGRAM
Louise’s vision of the “3 Es” also guided DF CM’s research programming. Bart Harvey was appointed as the Director of the Research Pro gram in 2003, and Rahim Moineddin was hired as DFCM’s first biostatistician. To increase re search activity in community hospitals, “com munity-based research scholar” positions were created to provide one day per week of protect ed time for one faculty member at each of the four community-based affiliated sites.
792002 — 2007: Fostering Collaboration & teaM builDing
» Canada was among the first countries to sign the ConventionUNon the Rights of Persons with Disabilities
2007MEDICINE
In Jan 2006, Louise brought forward the idea of establishing a divi sion of Palliative Care. She had met with Larry Librach, the Director of the Temmy Latner Centre for Palliative Care, and exploration of this idea began in earnest shortly after that. That kernel of an idea has grown to now provide one of the biggest palliative care postgraduate training sites in Canada.
A significant focus of DFCM activity was directed toward transforming DFCM teaching sites into Academic Family Health Teams. This transi tion was supported by a grant from the Ministry of Health and LongTerm Care for the Family Health Team Planning Forum and coordinat ed through the Centre for Effective Practice. This new practice model reformed primary care delivery. One of the most critical ingredients was the addition of allied health professionals to the teams.
PRIMARY CARE REFORM AND FAMILY HEALTH TEAMS
DIVISION OF PALLIATIVE CARE
CULTURE, SCIENCE &
• Palliative Care – Larry Librach/ Christa Jenny
• Anaesthesia – Mark Levine
MILESTONESKEY
» Sunnybrook Health Science Cen tre and Women’s College Hospital merger ended
» Marcus Law and Jennifer McCabe became Co-Directors of the Teach ing Residents to Teach program in 2005
• Tobacco use in Special Popula tions – Peter Selby
• Advanced Skills in Family Medicine Inpatient Care – Phil Ellison
• Low Risk Obstetrics – David Tannenbaum
» The POWER web-based leaner, teacher and rotation evaluation system introduced by the Faculty of Medicine.
• HIV Medicine – Brian Cornel son
» 256 postgrad learners
» 8 hospitals, 35 teaching practices, four rural practice sites, 723 faculty members (150 Full time), 2005: 20 funded researchers
» 759 faculty members
• Sports Medicine- Julia Alleyne
• Environmental Health – Lynn Marshall
• International Opportunities –Yves Talbot
2003
2005
2006
» DFCM faculty members continue to hold important roles in the new medical school curriculum. This included Michael Roberts in his longstanding role as DFCM’s rep resentative on the Determinants of Community Health course commit tee and Patricia Windrim in her long standing role as DFCM’s represen tative on the Foundations of Medical Practice course committee
» Roy Wyman was leading 16 thirdyear fellowships and 48 fellows (now known as DFCM’s Enhanced Skills Program)•Emergency Medicine – Eric Letovsky
• Psychotherapies – Allan Peter kin
» Danielle Martin established the Rural Northern Initiative Program to provide medical care to small north ern Ontario communities facing a physician shortage, and to expose DFCM residents to the exciting and rewarding work available in northern Ontario.
• International health – Sam Nutt
• Addictions – David Marsh
2002
• Care of the Elderly – Sid Feld man
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• Women’s Health – Sheila Dunn
2002 — 2007: Fostering Collaboration &
82 2007 — 2016: integration & partnerships 2007 — 2016 INTEGRATION PARTNERSHIPS&
Lynn Wilson became Chair of the DFCM in 2007 and ushered in another period of expansion and growth in all our programs. Like her predecessors, Lynn was a genuinely committed teacher, a skilled clinician, and a passionate academic scholar. She saw every challenge as an opportunity. Her talent for leading projects that require complex integration and her unique ability to establish effective partnerships set her apart.
832007 — 2016: integration & partnerships
LYNN WILSON
Lynn was a "make it happen" chair with
Lynn was a "make it happen" chair with seem ingly limitless energy. She was a creatively col laborative leader and very effective as a team builder. She knew how to bring out the best in her learners, staff, and faculty members. Her colleagues at St. Joseph's Health Centre de scribed her as a magician who could hypnotize them into taking on a new task – even when they were sure they did not want to! The central DFCM office had the great pleasure of experi
LYNN
WILSON
teameffectiveleadercollaborativewasenergy.limitlessseeminglySheacreativelyandveryasabuilder.
Her skill in these areas was tremendously im portant for the DFCM within the Faculty of Med icine. It also led to external stakeholders asking her to sit at key policy decision-making tables. The Ministry of Health was but one. In every in stance, Lynn was able to help others understand the value of family medicine in the healthcare system. Her work elevated the profile of our dis cipline and was instrumental in contributing to government investment in family medicine.
84 2007 — 2016: integration & partnerships
After completing her residency in Family Med icine at the University of Toronto, Lynn worked as a clinical teacher at Toronto Western Hospital Family Practice Unit for seven years before mov ing her practice to St. Joseph's Health Centre. Throughout her career, she provided obstetrical care for over a thousand grateful families while engaged in education and clinical research. Her experience as a clinician and then as Phy sician-in-Chief at St. Joseph's Hospital, nurtured a deep appreciation for the role and challenges of the family doctor in the community setting.
Lynn stepped down from the Chair in 2016 at the invitation of Dean Young. He asked her to bring her expertise to the Faculty of Medi cine and serve as the inaugural Vice Dean, Partnerships. When asked about this time, Lynn reflected on the transition: "How hard it was to leave this role and to spend less time with my dear friends and col leagues."
» Apple’s iPhone is released
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encing the same magic when Lynn became Chair. Kymm Feldman, Undergraduate Program Director, shared that "Lynn invested in the workplace environment. I felt lucky every day to come to work at a place where I laughed and had fun while working...it made all the difference." When Lynn was asked to describe her relationship with her Vice-Chairs and Program Directors she responded, "All of these people were a joy to work with - knowledgeable, hardworking, inno vative, and fun to spend time with." The feelings were clearly mutual.
Lynn's visionary leadership brought about many educational and re search initiatives during her term. Amongst the most significant were the creation of the Office of Education Scholarship, the DFCM Prac tice-Based Research Network (UTOPIAN), and DFCM's Quality Im provement Program. She also led the implementation of the DFCM's second wave of expansion into community-affiliated teaching hos pitals. Royal Victoria Hospital in Barrie, Trillium Heath Centre in Eto bicoke, and Markham Stouffville Hospital in Markham opened their academic programs during her term.
Lynn was committed to increasing the diversity within the DFCM. The Dean's office provided guidance for search committees regarding Human Rights and Unconscious Bias, and the expanded lens of Eq uity, Diversity, Inclusion, Indigeneity and Accessibility became part of the department's ethos.
Keenly in tune with people and technology, Lynn is as famous for her steadfast support of learners, faculty members, staff, and academic leaders as she is for her daily tweets. She was a very early adopter of social media and quickly learned the power of good that it could have. She is still one of the first people to tweet about the achieve ments of the DFCM.
CYNTHIA
Lynn had a successful track record of involve ment in education innovation and research and recognized the need to strengthen the DFCM's engagement in education scholarship. She be gan by creating the Vice-Chair Education posi tion and appointed Cynthia Whitehead to this role in 2010. The following year, supported by evidence of a decline in published family med icine education scholarship, Lynn created the Office of Education Scholarship (OES). Cynthia Whitehead served as inaugural OES Director (2012 – 2014), and Risa Freeman succeeded her as OES Director and Vice-Chair Education in support, Cynthia, Risa and the OES team and external collaborators developed a
WHITEHEAD
Like every other Chair before her, Lynn led the department to a new home. Four years into her term, DFCM moved to its beautiful current space on the third and fifth floors of the UofT Re habilitation Sciences building at 500 University Avenue. UNIVERSITY AVE.
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500
A NEW HOME
FOCUS ON EDUCATION & SCHOLARSHIP
With2015.Lynn's
RISA FREEMAN
strategic plan that included a mandate to build a community of prac tice, increase education scholarship capacity, enable a culture of recognition and support for our faculty members and invest in the education scholarship activities of our students and faculty members. One of the first initiatives of the OES was to establish the "Better To gether” consultation process, which guided faculty members as they engaged in scholarship projects. The unique model partnered a clini cian-scholar lead (MD) with an education scientist (PhD) and brought together learning science principles and real-world education imper atives to achieve meaningful, feasible and sustainable research in family medicine education.
KULASEGARAMMAHAN NYHOF-YOUNGJOYCE WRIGHTSARAH ONYURABETTY NUTIKMELISSA WOODSNIKKI FORTEMILENA BORDMANRISA
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Lynn was keen to support faculty members in building capacity in this area. Three experienced education scholars were engaged to mentor and foster development at the program level: Melissa Nutik in undergraduate education, Milena Forte in postgraduate education and Risa Bordman in faculty development. Fiona Webster was the first education scientist. Upon her departure, Nikki Woods led a team of scientists that included Joyce Nyhof-Young, Mahan Kulasegaram, Sarah Wright and Betty Onyura.
During Lynn's tenure, Dean Young struck a task force to determine how best to recognize fac ulty members for their varied academic contri butions. To meet this strategic goal, the DFCM gathered broad stakeholder input and, under the leadership of David White (Deputy Chair), Risa Freeman (OES) and Paul Krueger (Research), in troduced the Annual Academic Activity Survey in 2017. The Dean's Office has recognized this critical initiative. It now serves as an exemplar for other departments to determine how best to facilitate and value faculty members' collection of their essential and promotable academic ac tivities, including Teaching and Education, Cre ative Professional Activity, Administration and Mentorship.
EVA GRUNFELD
Collaboration: OES & Research Program
The OES introduced many successful initiatives during Lynn's term. The first, a small seed grant program, The Art of the Possible, was launched in 2015 to support education scholarship within each DFCM program. The grant's name comes from a quote attributed to Fred Fallis: The uniqueness of our discipline lies in its focus on application. It is the academic study of the Art of the possible. The popular Celebration of Education Scholarship events included lectures and seminars with internationally recognized education scientists and the Education Schol arship Planning Guide provided faculty with a workbook to guide them through the steps of designing, implementing and disseminating an education scholarship project.
For me one of the greatest privileges was working with Lynn Wilson who was Chair of DFCM when I was recruited. While I came to the department with high standards and expectations of excellence, I learned from Lynn that one can have those standards and at the same time express them in a way that is supportive and nurturing, and with unwavering integrity.
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During Lynn’s term, there was a tremendous change in the undergraduate medical school (MD Program) curriculum with a concomitant in crease in student enrollment over time. These changes translated into an exponential increase in the demand for DFCM contributions and a significant need to increase the number of fac ulty members to provide supervision across the four years of medical school.
JENNIFER MCCABE
Jennifer(2015-present).McCabe
Lynn was hugely supportive of DFCM faculty members having leadership positions at the medical school. She recognized the importance of DFCM being at the curriculum renewal table to ensure that the principles of family medicine and generalism would be incorporated into ev ery course and curb any signs of the hidden cur riculum undermining our discipline.
the Clerkship in Family Medicine, would have a breathtaking impact on the DFCM. There was an ever-increasing need for DFCM to bring in new faculty members. Jennifer led the way in taking what might be viewed as a perfect storm and transforming it into a perfect opportunity to expand DFCM’s profile in the MD Program.
The story of the undergraduate program during Lynn’s era is best told through the combined leadership efforts of three outstanding program directors: Jennifer McCabe (2005-2010), Kymm Feldman (2010-2015) and Azadeh Moaveni
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UNDERGRADUATE EDUCATION
(2005 – 2010) led the Under graduate Program during the planning phase for curriculum renewal in the Clerkship program. Her leadership was defined by her steadfast advocacy for students and her practical, inclu sive, and supportive style. She laid the founda tion for the enormous contribution DFCM would be called upon to make by the new curriculum and the rapid growth in the number of medical students. After many years of steady enrollment of 224 medical students in year 1, the number jumped to 247 in 2010. Jennifer prepared the DFCM for this jump and the next, a bump to 255 in 2011. The growth in class size, and the impending change of an added two weeks to
In addition to planning the new six-week Clerk ship in Family Medicine, Jennifer developed the Family Medicine Observership. Meant to ignite an interest in Family Medicine as a ca reer choice, Jennifer organized a one-day ac tion-packed adventure for a group of keen stu dents at the end of their first year of medical school. They travelled around the province on a bus and observed family doctors in small towns engaged in all aspects of patient care. It was lovely to see Jennifer getting on the bus with the bright-eyed students early in the morning and returning at the end of the day with tired but excited students who had seen much of what family medicine could offer as a career choice.
The landmark Future of Medical Education in Canada (FMEC) report was published in 2010.17 It recommended that schools seek to value generalism and encourage community-based teaching. U of T looked to the success of the FMLE as one opportunity to increase exposure to both requirements. Thus, FMLE became a mandatory second-year course in 2010 and introduced students to the discipline of family medicine early in their academic careers. It also enabled students to create lasting mentorship relationships with family physicians. The success of the FMLE, leading to it becoming a mandatory course for all medical students, necessitated the recruitment of 200 new fami ly physician supervisors. Susan Goldstein was appointed as the first FMLE Course Director. A unique system was created that allowed FMLE teachers to apply for an appointment directly to the Undergrad uate Education Program.
CULTURE, SCIENCE & 2009MEDICINE
» H1Ni Virus first reported in the US in April, reaching 208 countries by December
As the larger class size moved through the years of medical school and at the request of the students, DFCM began to explore options for new core clerkship teaching sites in smaller centres. In 2010, clerkship rotations were created at Southlake Hospital in Newmarket, Collingwood, Midland, Orangeville, and Orillia. In 2011, Royal Victo
In 2010, the medical school decided to implement an integrated Clerkship OSCE. As a result, DFCM lost the funding for the Family Medicine OSCE. Motivated by this sudden gap in the evaluation sys tem, a team of dedicated educators developed a new evidence-in formed summative evaluation clinical observation tool called the FMCEX. After its successful implementation, other clinical rotations in the U of T system based their clinical encounter observation process on the FM-CEX.
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There was also a growing need for Family Medicine at the planning tables for the next phase of curriculum reform, the planned overhaul of the Preclerkship. Kymm Feldman led this portfolio for the DFCM. She and Jennifer also were keen to address the shortage of family physicians in Canada and the decline of medical student interest in the specialty of Family Medicine. They developed a pilot program based on evidence that early exposure to family medicine would en courage medical students to consider a career in family medicine and that those who learn in the community are more likely to practice in the community. The program, called the Family Medicine Longitudi nal Experience (FMLE), was piloted in 2007. It gave medical students an early, one-on-one, community-based family medicine clinical ex perience in the second year of medical school.
In 2015, the medical school shared the exciting news that Faculty Council and the Committee for Accreditation of Canadian Medical Schools approved the Preclerkship renewal plan. Kymm began to wonder how we might think about this part of medical school differently. In her words: "Technology, research and other advances are challenging medical schools to stay ahead and design curricula that ensure our students have the right skills when they become physicians. There is always potential for us to learn from how other disciplines are evolving education. To stay at the forefront of medical education, we must continue to ask questions differently.
The full force of Kymm's creativity was then mo bilized into developing and leading the Break
ria in Barrie joined the program, and MarkhamStouffville followed in 2012. Student interest in being placed in these sites has remained very high over time.
With the growing pressure on clerkship ex pansion, Azadeh (Azi) Moaveni was appointed Associate Program Director in 2010. Together, she and Kymm successfully navigated DFCM through implementing the new six-week Family Medicine Clerkship. Azi recognized the need to provide students with easy access to up-to-date, relevant and distilled resources for all course objectives. In response, she developed an on line guide, and in 2011 The Hub went live. The Hub platform was later seconded to the med ical school and became a repository of online syllabi for many clinical clerkships. The Hub re mains one of the students’ favourite sources of information. Easy internet access has allowed medical students and physicians worldwide to use this great resource.
Exciting changes in the medical school contin ued at a rapid pace. The roll-out of the new Mis sissauga Academy of Medicine (MAM) in 2011 led to the placement of 54 students on that new campus. This development translated into a requirement for 54 new DFCM clerkship place ments in a community that had never taught clerks before. Recruitment efforts and faculty development (led by Jana Lazor) went full steam ahead.
Kymm Feldman (2010 – 2015) was a dynamic and creative leader, an outside-the-box thinker, and an innovator. She was supportive and val ued making personal connections with other disciplines. Like Lynn, she had strength in the integration of concepts and systems.
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KYMM FELDMAN
Amita Singwi was appointed the Electives Co ordinator in 2012. She successfully encouraged Elective supervisors to maintain their commit ment when they were also being asked to par ticipate in FMLE.
Jennifer and Kymm had worked so well together that there was a seamless transition when Kymm took on the Program Director role in 2010.
through Conference in 2015. The conference brought together 80 thought leaders from di verse fields — medicine, education, design, technology, business, media, the arts, and gov ernment - to see what medical education could learn from the 'outsider's' perspective that might better engage and equip today's medical stu dents to practice medicine. Participants were challenged to let go of assumptions about tra ditional medical education and instead think of learning experiences — whether inside or outside the classroom — that inspired them or helped them in their current careers and how these might apply to medical school. Innova tions, speakers noted, often result from thinking outside of our current paradigm and challeng ing the assumptions that constrain us. The con ference's recommendations became a vital part of the planning process for the new Preclerkshp
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from Kymm to Azi as Undergradu ate Program Director was carefully planned. Azi brought her unparalleled energy to the role. She recognized the need to expand the leadership team to ensure that DFCM could meet its grow ing contributions to the medical school with the impending introduction of the new Foundations (preclerkship) curriculum in 2016.
Thecurriculum.transition
TheMedicine.initial
work begun by Leslie Nickell and the Task Force on Generalism in 2004 was now coming to the fore, with the new pre-clerkship curriculum under development. DFCM was asked to evaluate the content of the cases in the new Foundations curriculum. A General ism scholarship group was formed and devel oped the Toronto Generalism Assessment Tool (T-GAT) in 2017 to systematically assess for the presence or absence of generalism principles in the curriculum. The T-GAT successfully offered institutional guidance to the Faculty of Medicine
Adapting the Postgraduate Program’s model, new leadership positions in Preclerkship Evalua tion – Dara Maker, Clerkship Curriculum – Shery lan Young, and Clerkship Evaluation – Sharonie Valin were created. The team was rounded out when Ruby Alvi became the Associate Program Director for Preclerkship. Her experience as an academic leader and curriculum planner facili tated the implementation of the Foundations curriculum internally and across the Faculty of
A new leadership structure was developed to manage the increasing class size and requests for DFCM faculty member participation. Amita Singwi continued in her role as Electives Co ordinator. Sofia Khan was tasked to lead the FMLE. Susan Goldstein, highly respected for her work as a community-based physician, took on the role of Faculty Development & Physician Recruitment Coordinator; she was an excellent role model for the scores of new faculty mem bers she recruited.
AZADEH MOAVENI
MAKERDARA YOUNGSHERYLANALVIRUBY KHANSOPHIA VALINSHARONIE CULTURE,
A description of this era would not be complete without mentioning the wonderful family additions that came along during this time. The Undergraduate Education Program's work continued uninterrupt ed thanks to generous colleagues who ably stepped in as Acting Program Director during four maternity leaves: Dave Wheler (2009). Melissa Nutik (2011–2012), Azi Moaveni (2014), Sharonie Valin (2014–2015) and Sherylan Young (2014–2015). SCIENCE
in implementing the new cases. It was subsequently adopted by oth er Canadian medical schools that wished to apply a generalist lens to their curricula.
& 2015MEDICINE » Truth publishedCanadaCommissionReconciliationandofreport
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COMING SOON.
QUALITY IMPROVEMENT
COMING SOON.
PHYSICIAN ASSISTANT PROGRAM
COMING SOON.
COMING SOON.
COMING SOON.
GLOBAL HEALTH
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ACADEMIC FELLOWSHIP & GRADUATE STUDIES PROGRAM
POSTGRADUATE EDUCATION
RESEARCH
PROFESSIONAL DEVELOPMENT
COMING SOON.
COMING SOON.
COMING SOON.
COMING SOON.
TECHNOLOGY
COMING SOON.
DIVISION OF EMERGENCY MEDICINE
COMING SOON.
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DIVISION OF PALLIATIVE CARE
LIBRARY
ACTING & INTERIM CHAIRS
COMING SOON.
96 2017 — 2020: global aMbassaDor 2017 — 2020 AMBASSADORGLOBAL
MICHAEL KIDD
Michael Kidd arrived in 2017 as an internationally respected leader in family medicine with a passion for global health. Flying in from Australia upon completing his three-year tenure as President of the World Organization of Family Doctors (WONCA), Michael brought an expanded point of view for DFCM’s role within the broader family medicine community.
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Unfortunately, Michael was called back to Aus tralia in 2020 to assist with the COVID-19 pan demic as Principal Medical Advisor to the Na tional Department of Health and Professor of Primary Care Reform at The Australian National University. Despite his relatively brief tenure, he left an indelible impact on DFCM, particularly in pursuit of building both our Global Health and Social Accountability Program and the Family Doctor Leadership portfolio.
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Michael held many senior leadership positions in Australia, including posts as the President of the Royal Australian College of General Prac titioners, Head of the Department of General Practice at The University of Sydney and Exec utive Dean of the Faculty of Medicine, Nursing and Health Sciences at Flinders University. His task with the DFCM was to take an exception al and established department of 1730 faculty members and solidify its status in the interna tional family medicine community. Michael ac complished this by achieving DFCM’s accep tance as the first World Health Organization Collaborating Centre on Family Medicine and Primary Care and inviting WONCA to review our Postgraduate Program - the first accreditation in North Michael’sAmerica.appointment
of additional vice-chairs, and the rebranding of their portfolios, demon strated a fresh and creative vision for DFCM’s leadership structure: Education and Scholar ship, Quality and Innovation, Global Health and Social Accountability, Research and Advocacy, and Family Doctor Leadership.
Author’s note: Some of the information in this chapter pertains to events during the 16 months between Lynn's departure and Michael's arrival. I have included it here so that this part of our history would not be lost.
MICHAEL KIDD
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KATHERINE ROULEAU
As someone deeply familiar with our discipline in all corners of the world, Michael mentioned on many occasions that he had decided to become Chair of our Department because it was unequalled not only in size but in the quality of its people and of its work. In his relatively short time in Toronto, Michael marked the evolution of the DFCM by highlighting our existing and potential role as a global contributor to quality primary care. His leadership in having the entire DFCM designated as a WHO Collaborating Centre in Family Medicine and Primary Care, not only confirmed our privileged position but also invited us all to acknowledge and act on the incredible potential of our collective efforts on quality family medicine, health equity, innovation and leadership.
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» Toronto Raptors win the NBA championship
A new initiative during this period was the development of the Es sence of Education Scholarship course. Rick Penciner designed this longitudinal faculty development program to reach out to, and meet the needs of, faculty members in the eight community-affiliated teaching hospitals. This course began as a collaborative partnership between the OES and the Centre for Education at North York General Hospital. Through a longitudinal series of workshops, customized re sources and coaching, participants were supported through the de sign and execution of an education scholarship project.
Also launched in 2017, the Education Research Investigator Awards Program provided protected time for two scientists to focus on ed ucation scholarship aligned with DFCM objectives, support educa tion research activities and build education research capacity in the DFCM.
RICK PENCINERRISA FREEMAN
CULTURE, SCIENCE & 2019MEDICINE
OFFICE OF EDUCATION SCHOLARSHIP
The Office of Education Scholarship (OES) continued to thrive, with a growing team of clinician educators and education scientists working to support DFCM faculty members and programs engaging in educa tion scholarship.
WRIGHTSARAH WHITEHEADCYNTHIA WOODSNIKKI KULASEGARAMMAHAN “Strong values and vision shine consistently across the programme. We witnessed, on the three sites visited, collaboration, respect, responsiveness and flexibility in all contexts.” — Excerpt from the WONCA Accreditation Team’s final report
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The Celebration of Education Scholarship events continued to attract interested faculty members, featuring internationally recognized key note speakers on relevant and timely themes, combined with practi cal applications by local experts, hands-on workshops, and updates on in-progress education research projects. These events were also designed to intersect with themes from the OES’s new Big Ideas Ed ucation Research Pillars: Person-Centred Care (led by Sarah Wright and Cynthia Whitehead), The Generalist Specialist (Nikki Woods), and Big Data (Mahan Kulasegaram).
Like many of the DFCM Undergraduate Pro gram Directors, Azi Moaveni (2015 – 2019) led her team through the implementation of a new curriculum at the medical school. The program was guided by three high-level goals: deliver ex cellent family medicine programs to educate fu ture family physicians and doctors who will work with family physicians; promote family medicine as the discipline of choice through integration of residents in teaching, near peer mentorships and showcasing the breadth and scope of our specialty; and develop curricular and assess ment advances informing and informed by ed ucation scholarship. Azi also led her program through a successful accreditation of the Family Medicine component of the MD Program by the Association of Faculties of Medicine of Canada.
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One of the overarching goals in the Undergrad uate Program continued to be the promotion of family medicine as the career of choice for med ical students. Ruby Alvi moved into the role of DFCM’s first Student Leadership and Engage ment Lead in 2019.
AZI MOAVENI
The Clerkship in Family Medicine continued to be a vibrant six-week experience. Approxi mately 270 third-year students were provided annually with a broad range of experiences in comprehensive primary care and selective time in enhanced skills areas such as Palliative Care, Sports Medicine, and Care of the Elderly. In her capacity as Evaluation Coordinator, Sha ronie Valin led the transition to a multiple-choice mastery exercise assessment in 2018. Shery lan Young was the Curriculum Coordinator and led several new initiatives, including formaliz ing teaching experience with interprofessional healthcare providers and adding an advocacy project. As the class size increased, the number of requests for placements in smaller communi ties was met by establishing new teaching sites in New Tecumseh and Kawartha Lakes in 2017.
UNDERGRADUATE EDUCATION
The Family Medicine Electives Program contin ued to be very popular under Amita Singwi’s term as coordinator. In 2019, an astounding 200 electives were completed in Family Medicine and 100 selectives were provided by our faculty members in the fourth year Transition to Resi dency in Family Medicine.
1032017 — 2020: global aMbassaDor VALINSHARONIE YOUNGSHERYLAN SINGWIAMITA
CULTURE, SCIENCE & 2019MEDICINE » Missing and murdered indigenous women and girls national inquiry
POSTGRADUATE EDUCATION
Stuart Murdoch became the Postgraduate Program Director in 2017. His strength as a collaborative and supportive leader moved the pro gram through two distinguished achievements during this period. In 2018, it became the first family medicine residency program in North America to be accredited by the World Organization of Family Doc tors (WONCA). One year later, the program was preparing for an ac creditation visit by the College of Family Physicians of Canada when the COVID-19 pandemic hit. Though the program could have delayed the accreditation visit, the team moved forward and became the first postgraduate program in Canada to undergo a virtual accreditation.
An important loss for the Undergraduate Program was the decision to fold the Annual Undergraduate Education Faculty Development Workshop into the DFCM Annual Conference. Though this made sense from a financial point of view, it was a loss to the large group of community-based preceptors who enjoyed coming together for this event, which was held annually for over 30 years. As Ruby Alvi recalled: “I love our UEC Workshops. It was always like coming home for so many of us.”
The program continued to be one of the largest in the world and trained nearly 400 residents across 14 core teaching sites, 4 rural sites and 40 Teaching Practice sites.
Many curricular innovations were initiated in rigorous scholarly fash ion during this time. In response to concerns by professional orga nizations and known clinical discomfort in the subject area, Carrie
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Assessment and Evaluation Portfolio con tinued to be led by Fok-Han Leung. The Family Medicine Medical Expert Assessment of Prog ress (FM-MAP) was introduced as a quarterly se ries of electronic progress testing for residents. All Canadian content questions were developed using a key features approach. This assessment supported learning preparation for the certifica tion exam, with strong validity evidence predict ing
During this period, the Enhanced Skills Program, led by Julia Alleyne and then Giovanna Sirian ni, offered sixteen third-year programs. The expanding selection of these third-year experi ences provides valuable opportunities to future family physicians, as expressed by Ruth Heisey:
with Stu to streamline both the admissions and the awards systems. The changes were met with resounding positivity. Both the Teaching Practic es portfolio and the Rural Residency Program continued to benefit from strong leadership from Erika Catford and Jeff Golisky.
Bernard, Associate Program Director, Curricu lum and Remediation, led a team of internal and external stakeholders to develop a much-need ed ethics curriculum. Core team members Eva Knifed, Nadia Incardona and Mahan Kulasega ram worked with Carrie to create a novel longi tudinal curriculum grounded in learning theory to improve residents' clinical reasoning integra Thetion.
MURDOCHSTUART BERNARDCARRIE LEUNGFOK-HAN RAMBIHARVANESSA CATFORDERIKA GOLISKYJEFF
The Quality and Innovation (QI) program for residents was modified, and a comprehensive, longitudinal curriculum for all first-year residents was instituted. Delivered by the growing QI ex pertise in each hospital site, It provided eight interactive modules focused on foundational content and principles of QI. It also included a practicum component that allowed residents to apply what they had learned.
Vanessasuccess.Rambihar,
Associate Program Director of Admissions, Awards and Recruitment, worked
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» WHO declared a public health emer gency of international concern for the novel coronavirus
Two new offerings were developed during this time. The Integrated 3-Year Family Medicine and Leadership Postgraduate Program (I3P), launched in 2017, included courses and practica that exposed learn ers to an array of health system leadership concepts and settings. Graduates of this program were expected to play an essential role in shaping and transforming health systems in Canada and interna tionally. The Family Medicine and Enhanced Skills (FAM-ES) program supported two residents per year to complete an Enhanced Skills program in Palliative Care or Care of the Elderly in an integrated, lon gitudinal fashion alongside their core training.
CULTURE, SCIENCE &
ALLEYNEJULIA
Dr. Vivian Tam, a participant in the Integrated Three-Year Program and co-president of the Family Medicine Resident Association of Toronto, commented during the accreditation: "Even after three years, I still feel like it is a privilege to train in Family Medicine at U of T. I have been so impressed by how invested our staff physicians are in en suring we learn everything we need to practice. I have been lucky to work with physician leaders whose approach to medicine and career trajectories I admire equally. I am grateful to be a U of T DFCM resi dent."
SIRIANNIGIOVANNA
2020MEDICINE
"The enhanced skills programs display the leading role that family physicians play as experts and scholars in addition to our role as gen eralists and scholars."
FACULTY DEVELOPMENT
ANTAOVIOLA PERANSONJUDITH KOPANSKY-GILESDEBORAH
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Judith Peranson and Deborah Kopansky-Giles, the DFCM leads for Health Professional Educators, worked tirelessly to develop a com munity of practice for the many non-physicians teaching medical students and residents at our academic sites. The community was designed to support these valued educators with professional de velopment, faculty status applications and the sharing of educational resources.
Under the leadership of Viola Antao (2016 – 2021), the Faculty Devel opment Committee continued to thrive and deliver highly sought-after workshops and courses. The committee also worked collaboratively with the Postgraduate Program to create modules to address the im portant emerging topics of Hidden Curriculum, Wellness and Resil ience, Competency, and Assessment. The modules were uniquely tailored to meet the specific needs of the faculty members at each of our 14 teaching hospitals.
ACADEMIC FELLOWSHIP & GRADUATE STUDIES
1072017 — 2020: global aMbassaDor ALLEYNEJULIA GHAVAM-RASSOULABBAS
The AFGS program continued to offer all courses developed during the terms of Louise Nasmith and Lynn Wilson, including the MScCH in Family and Community Medicine, the MScCH in Health Practitioner Teacher Education, and the MPH in Family and Community Medicine.
Additionally, two new initiatives were launched. One option was cre ated for physicians to complete their entire degree requirements in one academic year, an option formerly available only at Harvard and Johns Hopkins universities. The MPH in Family and Community Medicine – Advanced Standing program enrolled the first cohort in 2019. The second initiative was a pilot project to provide internation ally trained physicians with additional skills through DFCM master's degrees, allowing them to transition into non-clinical care roles in the Canadian healthcare system.
The Academic Fellowship and Graduate Studies (AFGS) program had achieved recognition within U of T as providing faculty development to all physicians, as well as health professions educators, who were preparing for academic roles. Program Director Abbas Ghavam-Ras soul (2015 – present) and Associate Program Director Julia Alleyne (2016 – 2021) led the move to more modular and online courses to include both local and international participants in the highly evaluat ed degree granting programs.
RESEARCH & ADVOCACY
Under the leadership of Vice-Chair Eva Grunfeld, and Associate Pro gram Director Paul Krueger, the Research Program was making cut ting edge discoveries that impacted patient care. It was contributing to family medicine education at all learner levels, with programs and courses designed to develop research skills in students, residents, and faculty members.
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Michael’s suggestion to add advocacy to the program’s mandate was prescient. This change was appreciated and welcomed by the pro gram leadership and the 28 faculty investigators who received fund ing to protect their research time.
The U of T Practice-Based Research Network (UTOPIAN) had grown into one of the largest and most representative primary care research networks in North America, and amongst the largest in the world. Frank Sullivan continued in the role as UTOPIAN Director until 2017 when he was called back to Scotland. He continued to provide men torship for Michelle Greiver when she took on this role in 2018.
GRUNFELDEVA KRUEGERPAUL SULLIVANFRANK GREIVERMICHELLE
Michael rebranded the name of the Quality Improvement Program to the ‘Quality and Innovation Program’ in 2017. This nomenclature was meant to align with the department’s strategic vision of ‘Advancing Family Medicine globally through scholarship, social responsibility, and strategic partnerships.’
Under Phil Ellison’s strong leadership, the program continued to pro vide exceptional programming for learners, for which it had gained a national and international reputation.
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In 2018, Tara Kiran was appointed Fidani Chair in Improvement and Innovation and Vice-Chair, Quality and Innovation. A key activity during this period was redesigning the residency QI curriculum. New content and support materials were added, and the format shifted to delivery by elearning. Tara had big shoes to fill and admirably brought her skill to develop the program further.
QUALITY & INNOVATION
ELLISONPHIL KIRANTARA
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new leadership roles. Onye Nnorom was appointed as the Equity, Diversi ty and Inclusion lead and Suzanne Shoush as Indigenous Health Faculty Lead. He also start ed developing leads for Climate Change and Health, Social Accountability, and a Patient and Family Engagement Specialist to support the in tegration of patient and family perspectives into all aspects of family medicine. He was commit ted to addressing these critical societal issues across DFCM’s academic programs. Therefore leaders of the newly created positions were tasked with supporting all programs to ensure that their unique perspectives were included in curricula and activities.
GLOBAL HEALTH & SOCIAL ACCOUNTABILITY
ROULKATHERINEEAU NNOROMONYE SHOUSHSUZANNE
Michael’s profound interest in global health and social accountability strengthened DFCM’s commitment to health equity. He created the Vice-Chair, Global Health and Social Account ability portfolio and appointed Katherine Rou leau to this role. Katherine led the development of multiple initiatives across all DFCM programs. Several educational experiences were devel oped for undergraduate students, including a Cultural Safety and Anti-Oppression workshop, Poverty and Health workshops, an equity and social accountability mentoring program, and a community-based service learning-Council Fire placement. Global health electives were of fered to family medicine residents, and a core day was dedicated to advocacy and indigenous health. Katherine Rouleau described DFCM’s growth in these critical areas: “Increasingly we are also recognized for our innovation in, and our attention to the delivery of robust, compre
hensive primary care to those affected by ad verse social determinants of health, the poor and Michaelmarginalized.”createdtwo
Michael Kidd created the new leadership role of Vice-Chair, Family Doctor Leadership, with Da vid White as the inaugural appointee. This new role, with a mandate of providing expertise and oversight in developing family medicine leaders, encompassed faculty development, academic promotions, and appointments. David worked on encouraging all levels of academic promo tions and strengthening DFCM’s faculty devel opment offerings, including programs for the new Equity, Diversity and Inclusion, Indigenous Health, and Social Accountability portfolios. He developed and facilitated the innovative Master Class Series in Family Doctor Leadership. Class es were led by prominent speakers and faculty members, who explored topics such as working with government, industry and not-for-profits, health and medical research and working with the media. Shorter leadership workshops were developed and presented for community-based family doctors, residents and graduate students.
FAMILY DOCTOR LEADERSHIP
Leslie Nickell was appointed Medical Director of the Physician Assistant Program in 2018, suc ceeding Dr. Maureen Gottesman. This program combined distance and distributed education and was primarily delivered online. Its exponen tial growth over the previous few years, making it the largest in Canada, necessitated the devel opment of a vast community base. At this time, the program had established relationships with over 330 clinical sites for student placements. In the 2018-2019 academic year, 465 applications were received for its 30 positions, demonstrat ing the high demand for this training.
1112017 — 2020: global aMbassaDor
PHYSICIAN ASSISTANT PROGRAM
DAVID WHITE
The reputation of the PA Program was flourish ing, as evidenced by requests for consultation from academics nationally and internationally. In 2017, the BScPA Program received the Canadian Medical Association's six-year accreditation sta tus. The program's leadership was collaborating with the Canadian Association of Physician As sistants on such issues as national competency standards and a new professional accreditation body for physician assistants.
LESLIE NICKELL MAUREEN GOTTESMAN
ACADEMIC DIVISIONS
New Divisions: Michael brought an idea to the Executive Commit tee to establish four new divisions within the DFCM. The notion was to provide an academic home to clinicians practicing with enhanced skills, to bring community and support to family physicians working in those areas, to encourage educational and scholarly collaboration, and to nurture new leaders in those fields. He planned to model the divisions on the existing Emergency Medicine and Palliative Care di visions and held preliminary discussions with potential leaders in four areas: Care of the Elderly (Sid Feldman); Mental Health and Addiction (Peter Selby), Hospitalist Medicine (Christine Soong) and Clinical Pub lic Health (Ross Upshur). The new divisions were established shortly after Michael returned to Australia.
MYERSJEFF LETOVSKYERIC FELDMANSID SELBYPETER UPSHURROSSSOONGCHRISTINE
Existing Divisions: Jeff Myers and Eric Letovsky continued to lead their divisions of Palliative Care and Emergency Medicine. As Division Heads, they guided communities of learners, teachers, innovators, researchers, and practitioners to improve the quality of patient care in their respective divisions, through education, research, quality im provement, and knowledge translation.
112 2017 — 2020: global aMbassaDor
INTERIM CHAIR
illustration of the rapid progress of technology at DFCM is found in the library's story. From its humble beginnings in 1981, when Rita Shaughnessy started to curate a collection of text books and journals, the dedicated DFCM librarians nurtured and supported faculty and learners for over 30 years. Providing expert instruction in online literature searches, information gathering, and rapid access to the world of scholarship at the push of a button, the librarians continued to facilitate and improve access to educational materials during this time. Sadly, the DFCM library was closed in 2018.
TECHNOLOGY
When Michael left the DFCM in March 2020, David Tannenbaum once again generously stepped in to serve as Interim Chair from the earliest moments of the pandemic. The DFCM owes a debt of grati tude to David for taking on these important leadership roles on short notice and with strong, wise and thoughtful leadership.
The role of technology in medical education and the provision of pa tient care was exploding exponentially during this time. As Sharon Domb recalls: “Overall, the biggest paradigm shift that has really af fected every aspect of what DFCM does, is the adoption of technol ogy. As a med student, absolutely everything we did was on paper - we had no laptops in class, no email to communicate with our peers/ colleagues, no social media and no cell phones. We took notes with a pen and paper, and the profs used acetates or 35 mm slides to give their Arguablylectures.”thebest
1132017 — 2020: global aMbassaDor
DAVID TANNENBAUM
Senior leadership needed to move quickly and decisively, even as the pandemic was still evolving. In a remarkably nimble response, programs pivoted to online learning, and clinicians adapted to deliv ering virtual patient care. The department developed resources to support faculty, learners, and clinicians in this challenging transition. The medical school, departmental office and hospital units worked with respect and compassion to allow faculty to continue their teach ing and patient care responsibilities. Faculty and learners showed extraordinary courage and commitment as they juggled these chal lenges while doing double-duty at testing and vaccine sites and car ing for their families.
THE COVID-19 PANDEMIC
All programs across the department were impacted by COVID-19, which urgently demanded a rethinking of traditional teaching, re search, and patient care models. Through inspiration, creativity, and technology, DFCM was able to continue to deliver outstanding pro grams during this challenging time.
The coronavirus loomed on the horizon in early 2020, beginning with news reports from China and quickly spreading to other coun tries. The implications for faculty, staff, trainees, and patients were unknown then.
One of the first decisions that DFCM leadership had to make was whether or not to hold the annual DFCM conference. The decision to cancel was made in February. In mid-March, the Faculty of Medicine paused the clinical clerkship, residents were redeployed, and univer sity administrative staff were instructed to work from home. School boards cancelled all in-person teaching, which added parenting re sponsibilities to already overburdened individuals.
114 2017 — 2020: global aMbassaDor
• 268 3rd year clerk placements
» DFCM becomes the second family medicine residency program in the world, and the first in North America, to be accredited by the World Orga nization of Family Doctors (WONCA).
» 46 central DFCM administrative staff
2017
» Undergraduate program
• 274 2nd year Family Medicine Longitudinal Experience (FMLE) placements
» 1752 faculty members
1152017 — 2020: global aMbassaDor
• 14 GTA and 7 rural sites for clerkship
• 200 electives in Family Medi cine
• IgFM group has grown to in clude 12 student leadership positions
» The last Undergraduate Education Faculty Development Workshop is held.
MILESTONESKEY
» New Tecumseh and Kawartha Lakes become core clerkship teaching sites
» First cohort of medical students in Addiction Medicine elective
» Jeremy Rezmovitz is appointed Con tinuing Medical Education lead. His Podcast Small Changes, Big Impact would debut in 2019.
REZMOVITZJEREMY
• 100 selectives in Transition to Residency in Family Medicine
» Heather Zimcik, a previous graduate of the Teaching Residents to Teach Program, becomes the TRT Course Director.
2018
2019
ZIMCIKHEATHER
» DFCM is awarded status as a World Health Organization (WHO) Collab orating Centre on Family Medicine and Primary Care.
7 Category 1 with 25 PGY3
• 16 Enhanced Skills Program:
» Dr. Onye Nnorom is appointed DFCM’s first Equity, Diversity & Inclusion Lead
2019 (continued)
» 28 funded researchers (photos on next page): Payal Agarwal, Onil Bhattacharyya, Bjug Borgundvaag, Ann Burchell, Debra Butt, June Carroll, Noah Crampton, Sheila Dunn, Richard Glazier, Ruth Heisey, Jennifer Hulme, Noah Ivers, Liisa Jaakkimain en, Tara Kiran, Jeff Kwong, Megan Landes, Bernard LeFoll, Aisha Lofters, Braden O'Neill, Aaron Orkin, Navindra Persaud, Andrew Pinto, Peter Selby, Sheryl Spithoff, Abhimanyu Sud, Deanna Telner, Karen Tu, Catherine Varner, Rachel Walsh
• 14 hospital teaching sites
• 394 residents
MILESTONESKEY
» Postgraduate program
» Dr. Suzanne Shoush is appointed DFCM’s first Indigenous Health Faculty Lead
» DFCM celebrates its 50th Anniversary!
116 2017 — 2020: global aMbassaDor
9 Category 2 for 27 PGY3
• 40 Teaching Practice sites
2020
2017 — 2020:
DFCM ADMIN, LIBRARY STAFF & RESEARCH ASSOCIATES
URSULA CATTELAN
CAROLINE TURENKO
ELIZABETH ZEIDMAN
It is impossible to discuss DFCM’s history without heartfelt gratitude to our gifted and dedicated ad ministrative and library staff and research associates. Our administrative managers, Elizabeth Zeidman, Ursula Cattelan and Caroline Turenko, have expert ly supported and guided our administrative team. They have also kept the entire DFCM ship afloat, charting a steady course for us over the years.
118 DFCM aDMin & librarY staFF
Here is just a sampling of the pictures of individuals who have brought their creativity and energy to the DFCM. Some have stayed with us for many years. Others have moved on to new challenges in different corners of the university and external organizations. Some have risen to a higher level of responsibility, like Steve Slade, now Research Director at the College of Family Physicians of Cana da. In our hospital sites, community practices, and at the central office, these individuals have made DFCM’s success possible.
119DFCM aDMin & librarY staFF
—
● 1969 1970 Reg Perkin
—
● 2017 David Tannenbaum, Inter im Chair
● 2001—2002 Phil Ellison, Interim Chair
● 2013—2014 Cynthia Whitehead, Act ing Chair
—
● 1991 2001 Walter Rosser
● 1970 1982 Fred Fallis
120 DFCM leaDership 1969—2019
DFCM LEADERSHIP 1969 2019
—
● 1982 1990 Wilf Palmer
—
DEPARTMENT CHAIRS
● 2007 2016 Lynn Wilson
● 2017 2020 Michael Kidd
—
—
We did our best to collect all of the names of our DFCM leaders but recognize that we are still missing some people and dates.
ACTING & INTERIM CHAIRS
—
● 2002 2007 Louise Nasmith
● 1995—1996 Helen Batty, Acting Chair
● 2007 Jamie Meuser, Acting Chair
● 2016 David White, Interim Chair
● 2017 present Katherine Rouleau, Global Health & Social Accountability
121DFCM leaDership 1969—2019
● 2018 present Tara Kiran, Quality & Innovation
● 2017 2020 Eva Grunfeld, Re search & Advocacy
—
—
● 1994 Doug Johnson, Deputy Chair
● 1987—1994 Helen Batty, Associate Chair
● 2010 2013 Cynthia EducationWhitehead,
● 2012—2017 Eva Grunfeld, Re search
● 2013—2015 David White, Deputy Chair
● 2013 2018 Phil Ellison, Quality & Improvement
● Doug Johnson, Associate Chair
—
● 2013 2014 Risa Freeman, (Acting) Education
—
—
—
—
● 2017 present Risa Freeman, Educa tion & Scholarship
● 2017 present David White, Family Doctor Leadership
ASSOCIATE & DEPUTY CHAIRS
VICE-CHAIRS
● 2015—2020 David Tannenbaum, Dep uty Chair, Partnerships
—
● 2015 2017 Risa Freeman, Educa tion
● 2009 Dave Wheeler, Interim
● 2014 2015 Sherylan Young, Inter im
—
● 2010 Sue Goldstein, FMLE Course Director
—
ASSOCIATE PROGRAM DIRECTORS & LEADS
● 1985 1995 David White
—
—
● 2016 present Sue Goldstein, UG Faculty Development & Physician CoordinatorRecruitment
● 2010 2015 Azadeh Moaveni, Asso ciate Program Director, Clerkship
● 2015 present Melissa Nutik, Education Scholarship Lead
● 2015—2021 Ruby Alvi, Associate Program Director, Pre clerkship
● 2015—2021 Dara Maker, Preclerkship Evaluation Coordinator
● 2015 Sofia Kahn, FMLE Course Director
● 2014 Azadeh Moaveni, Interim
● 2012 present Amita Singwi, Electives Coordinator
122 DFCM leaDership 1969—2019
—
● 2005 2010 Jennifer McCabe
PROGRAM DIRECTORS
—
—
Undergraduate Education
● 2006 2010 Kymm Feldman, Preclerk ship Director
● 2005—2006 Kymm Feldman, Preclerk ship Initiatives Coordina tor
—
—
—
● 2015 Sue Goldstein, Faculty Development and Re cruitment Lead
● 2018—2019 Claire Murphy, Interim Electives Coordinator
—
—
● 2015 present Azadeh Moaveni
● 2015 present Sherylan Young, Clerk ship Curriculum Coordi nator
● 2010 2015 Kymm Feldman
—
—
● 2011—2012 Melissa Nutik, Interim
● 2004 Harvey Blankenstein, Interim
● 2015 present Sharonie Valin, Clerkship Evaluation Coordinator
● 1969 1985 Doug Johnson
● 1995 2005 Risa Freeman
PROGRAM
● 1981—1991 Cal Gutkin ● 1991—2007 Eric Letovsky ● 2007—present John Foote
● 1970—1982 Reg Perkin ● 1982—1992 Larry Librach ● 1992—1997 Kirk Lyon ● 1998—2007 David Tannenbaum ● 2007—2017 Karl Iglar ● 2017—present Stuart Murdoch ● 2006—2009 Roy Wyman ● 2014—2018 Julia Alleyne ● 2018—present Giovanna Sirianni
123DFCM leaDership 1969—2019
DIRECTORS
Postgraduate Education DIRECTORS ENHANCED SKILLS DIRECTORS
PROGRAM
PGY3
PROGRAM
ASSOCIATE PROGRAM
PROGRAM
● 2014—2019 Carrie Bernard, Curricu lum & Remediation ● 2014—present Fok-Han Leung, As sessment & Evaluation ● 2014—present Vanessa Admissions,Rambihar,Awards & Recruitment ● 2019—present Batya Grundland, Cur riculum & Remediation ● 1970—1993 Hollister King ● 1993—1999 Bob Henderson ● 1999—2010 Karl Hartwick ● 2008—present Erika Catford RURAL PROGRAMRESIDENCYDIRECTORS ● 1999—2002 Bob Henderson ● 2002—2009 Karl Hartwick ● 2009—2012 Erika Catford ● 2012—2015 Jeff Golisky (Interim) ● 2015—present Jeff Golisky
TEACHING PRACTICES DIRECTORS
EMERGENCY MEDICINE DIRECTORS
● 2008—2015 Helen Batty MScCH, Health TeacherPractitionerEducation
ASSOCIATE PROGRAM DIRECTORS
● 1990—2015 Helen Batty, Academic Fellowship
● 2007—2008 Curtis Handford, Aca demic Fellowship Pro gram
● 2008—2016 Curtis Handford, Ac ademic ProgramFellowship
● 2017 present Abbas Ghavam-Ras soul, Academic Fel lowship and Graduates Studies
● 2015—present Abbas Ghavam-Ras soul, MScCH, Health Practitioner Teacher Education
● 2016—2017 Abbas Ghavam-Ras soul, Academic Fel lowship and Graduates Studies (interim)
● 1994—2010 Helen Batty, MHSc, Family and Community Medicine
● 2016—2022 Julia Alleyne, Academic Fellowship and Gradu ate Studies
PROGRAM DIRECTORS
● 2008—2016 Curtis CommunityMScCH,Handford,FamilyandMedicine
Academic Fellowship & Graduate Studies
● 2013—2014 Abbas tiontionerMScCH,Ghavam-Rassoul,HealthPractiTeacherEducaProgram
124 DFCM leaDership 1969—2019
● 2007—2008 Curtis CommunityMScCH,Handford,FamilyandMedicine
● 2013—2014 Abbas lowshipMedicalGhavam-Rassoul,EducationFel
● 2010—2016 Curtis Handford, Mas ter of Public Health (Family and Community Medicine)
—
Addis Ababa Academic Collaboration Family Medicine
PROGRAM DIRECTORS
—
DIRECTORS ● 1994—1999 Yves Talbot, Research Coordinator ● 1999—2001 Rick Glazier ● 2001—2003 Warren McIsaac (Interim) ● 2003—2008 Bart Harvey ● 2008—2020 Eva Grunfeld ● 2014—2017 Frank Sullivan ● 2018—present Michelle Greiver
EDUCATION LEADS
DIRECTORS
UTOPIAN
● 2012—2014 Cynthia Whitehead ● 2014—2015 Risa Freeman (Acting) ● 2015—2020 Risa Freeman ● 2015—present Risa Bordman, Faculty Development ● 2015—present Milena Forte, Postgrad uate ● 2015—present Melissa Nutik, Under graduate
125DFCM leaDership 1969—2019
● 2015—2019 Abbas Ghavam-Rassoul and Praseedha Janakiram, Co-Leads, TAAAC
Office of Education
ScholarshipResearch
● 2011 Barbara Stubbs
COORDINATORS
● Earl 1993 Bernie
● 1990 Doug Johnson (Academic Committee Lead)
—
●
● 1990 Helen Batty
—2016
—2016
Continuing Medical Education
●
2017—2020 Jeremy Rezmovitz
FacultyPROGRAMDevelopmentDIRECTORS
PROGRAM DIRECTORS
—present
● 2016 Viola Antao
2003—2016 John Axler
Marlow
Dunn ●
126 DFCM leaDership 1969—2019
Professional Development
● 2003 2011 Jamie Meuser
—2003
QualityAccountability&Innovation
127DFCM leaDership 1969—2019
1995—2011 Yves Talbot PROGRAM
● &
2011—2017 Katherine Rouleau Global Health
PROGRAM DIRECTORS
2009—2017 Phil Ellison International
● & Social
Global
● DIRECTORS
PROGRAM DIRECTORS
● 2003—2021 Eric Letovsky, Head, Division of Emergency Medicine DVISION HEADS
Division of Palliative Care
128 DFCM leaDership 1969—2019
Emergency
DVISION HEADS ● 2007—2012 Larry Librach ● 2012—2019 Jeff Myers ● 2019—present Kirsten Wentlandt Physician Assistant Program PROGRAM DIRECTORS ● 2010—2018 Maureen Gottesman ● 2018—2022 Leslie Nickell
Division of Medicine
129DFCM leaDership 1969—2019 DR. BARNETT AND BEVERLEY GIBLON PROFESSORSHIP IN FAMILY AND COMMUNITY MEDICINE RESEARCH ● 2008—2020 Eva Grunfeld Endowed Chairs ● 2009—2012 Larry Librach ● 2012—2019 Jeff Myers ● 2019—2024 Kirsten Wentlandt W. GIFFORD JONES PROFESSORSHIP IN PAIN CONTROL AND PALLIATIVE CARE FIDANI ENDOWED CHAIR OF IMPROVEMENT AND INNOVATION ● 2013—2018 Phil Ellison ● 2018—present Tara Kiran
130 serviCe to external health Care organizations SERVICE TO EXTERNAL HEALTH CARE ORGANIZATIONS DFCM faculty members have made tremendous leadership contributions to national and international health care organizations. 2 CFpC Directorsexecutive 9 CFpC presidents (including the first female president) 5 CFpC — other leadership 13 poCFpresidents 4 poMaresidents 3 editors of Canadian Medical Journals 1 pCMaresident 2 pnapCrgresidents 1 national research institute leadership 12 global health organizations leadership 2 Members of Canadian parliament
—
● 1991—1993 Walter Rosser, North American Primary Care Research Group, President
—
FRED FALLIS ERA: 1972 1982
—
● 1987 1988 Joan Bain, College of Family Physicians of Canada, President (First Woman President)
● 1994 1995 Michael Wyman, Ontario Medical Association, President
—
● 1981 1982 Reg Perkin, College of Family Physicians of Canada, President
—
● 1996 1997 Ralph Masi, Ontario College of Family Physicians, President
● 1984 1985 Rachel Edney, Ontario College of Family Physicians, President
—
● 1996 2012 Cal Gutkin, College of Family Physicians of Canada, Executive Director
● 1982 1983 Stan Bain, Ontario College of Family Physicians, President
● 1997 present Carolyn Bennett, MP, Parliament of Canada
● 1979 1980 Murray Cathcart, College of Family Physicians of Canada, President
● 1975 1976 Donald Butt, Ontario College of Family Physicians, President
—
● 1983 1984 Geoff Isaac, Ontario Medical Association, President
—
—
● 1975—1976 Fred Fallis, College of Family Physicians of Canada, President
—
—
● 1997 2007 Diane Kelsall, Informed, Institute For Clinical Evaluative Sciences, Editor
—
131serviCe to external health Care organizations
WALTER ROSSER ERA: 1991 2001
—
● 1985 1986 Donald Butt, College of Family Physicians of Canada, President
—
● (in addition, all CFPC presidents since 1972 have served as the Canadian representative on WONCA World Council)
—
WILF PALMER ERA: 1982 1990
● 1998 1999 Walter Rosser, Ontario College of Family Physicians, President
—
● 1973 1974 Hollister King, Ontario College of Family Physicians, President
● 1985 1986 Cal Gutkin, Ontario College of Family Physicians, President
—
—
● 1986 1995 Reg Perkin, College of Family Physicians of Canada, Executive Director
—
● 1977—1978 Hollister King, College of Family Physicians of Canada, President
—
—
● 2003—2004 Larry Erlick, Ontario Medical Association, President
● 2013 present Diane Kelsall, CMAJ Open, Editor
—
—
—
—
—
● 2013 2015 Rick Glazier, North American Primary Care Research Group, President
132 serviCe to external health Care organizations
—
● 2016—2017 David White, College of Family Physicians of Canada, President
—
● 2009 present Nick Pimlott, Canadian Family Physician, Scientific Editor
● 2003 2004 Peter Deimling, Ontario College of Family Physicians, President
● 2012 2013 Frank Martino, Ontario College of Family Physicians, President
● 2006 2008 Diane Kelsall, Canadian Family Physician, Scientific Editor
—
● 2008 present Diane Kelsall, Clinical, Canada Medical Association Journal, Deputy Editor
—
—
● 2011 2012 David Tannenbaum, Ontario College of Family Physicians, President
● 2011 2012 Sandy Buchman, College of Family Physicians of Canada, President
—
● 2010 2011 Anne Duvall, Ontario College of Family Physicians, President
● 2004 2005 Val Rachlis, Ontario College of Family Physicians, President
● 2006 2007 Sandy Buchman, Ontario College of Family Physicians, President
LOUISE NASMITH ERA: 2002 2007
—
● 2005 2006 Louise Nasmith, College of Family Physicians of Canada, President
● 1994 2006 Tony Reid, Canadian Family Physician, Scientific Editor
—
—
● 2014 present Ivy Oandasan, Director, Education, College of Family Physicians of Canada
● 2011 2012 Walter Rosser, Chair, WONCA Working Party on Research
● 2013 Jamie Meuser, Director Continuing Professional Development, College of Family Physicians of Canada
—
—
LYNN WILSON ERA: 2007 2016
—
● 2015—2019 Katherine Rouleau, Besrour Centre Director, College of Family Physicians of Canada
● 2013—2016 Michael Kidd, World Organization of Family Doctors (WONCA), President
● 2018—2021 Eva Grunfeld, Chair, Institute Advisory Board, Institute for Cancer Research, CIHR
133serviCe to external health Care organizations
● 2019—2020 Sandy Buchman, Canadian Medical Association, President
● 2016—2017 Eva Grunfeld, Chair, Chronic Conditions Institute Advisory Board, CIHR
● 2015—2019 Jane Philpott, MP, Parliament of Canada
● 2019 Allan Grill, Communities of Practice In Family Medicine Professional Develop ment And Practice Support, College of Family Physicians of Canada, Physician Advisor
● 2019 Dianne Kelsall, Canadian Medical Association Journal, Interim Editor
● 2019—present Roy Wyman, Certificates of Added Competence Director, College of Family Physicians of Canada
● 2018—2019 Nadia Alam, Ontario Medical Association, President
● 2018 Michael Kidd, World Health Organization Collaborating Centre on Family Med icine and Primary Care, Director
—
MICHAEL KIDD ERA: 2017 2020
Education
Expansion of DFCM programs to community-based hospitals
DFCM’S GREATEST ACHIEVEMENTS
● 2nd wave of expansion in the 2010s:
— ERIC LETOVSKY
This was the most frequently mentioned achievement by contributors.
The expansion of our family medicine program to the various community sites like Credit Valley Hospital, Trillium, Markham, Barrie, was absolutely transformational in many ways. Almost overnight, our faculty more than doubled. Along with that came a much greater influence in the Dean’s office, and greater credibility in the faculty as a whole. It also provided a much different platform for our family medicine program. We went from being top-heavy in tertiary care hospitals to having the majority of our residents now in community sites. From my perspective, this has been a great development.
1
DFCM leaders and elders were asked to reflect on what they considered to be DFCM’s most im portant milestones, and its greatest contributions to medical education, research, and clinical family medicine. Their responses are scattered throughout this document and on the following pages. Un fortunately, there is not enough room to include them all. Here are the most frequently cited achieve ments.
The first teaching site expansion, taking Family Medicine teaching to NYGH, SGH, TEGH, and St. Joe’s… continuing to express a powerful statement about where and how FM can and should be learned and taught…The other powerful thing about these two events was that it established DFCM as a leader and ambassador for the Faculty into the community teaching hospitals. Most importantly, however, it established a culture within DFCM of willingness to embrace change, and to be changed, by important forces in the external world. JAMIE MEUSER
● 1st wave of expansion in the 1980s and 1990s:
134 DFCM's greatest aChieveMents
● Expansion of Family Medicine Clerkship to a 6-week block
● The development of the Advocacy Project
● Establishment of the first Clerkship in Family Medicine in Canada
● Clerkship Objective Structured Clinical Exam (OSCE) and the Family Medicine Clinical Evaluation Exercise (FM-CEX) as objective assessment tools.
3
● Enhanced Skills Program
● Family Medicine Longitudinal Experience (FMLE)
Engagement in Foundations Curriculum teaching - Students are seeing family physicians as important figures in their medical education across the curriculum in various roles. RUBY ALVI
Postgraduate Education
135DFCM's greatest aChieveMents
Undergraduate Education
2
● Undergraduate Education Faculty Development Workshop
● The HUB
● Residency expansion
● Establishing the Longitudinal Program
● Triple C Competency-Based Curriculum
● Working with Families Institute and Counselling Skills Program
● DFCM contribution to Leadership in the Faculty of Medicine
In 2004, Mt. Sinai Hospital celebrated the 33rd anniversary of its family practice residency program. Warren Rubenstein recalled: “…we gathered… dozens and dozens of past residents who had graduated from the Family Medicine Residency Program at Mount Sinai Hospital…Doctors came from all over Ontario, from the shores of lake Ontario to the shores of James Bay. Standing in front of all those doctors-it struck me as to the incredible impact that we, as family medicine teachers, [have] in shaping health care in Ontario and the lives of future doctors.”.
WARREN RUBENSTEIN
● International leadership in Generalism and bringing a generalist lens to the MD curric ulum
● Teaching Residents to Teach Program
4
● Helen Batty and Yves Talbot’s 5-Weekend Programs
Undergraduate, Postgraduate, and Faculty Development collaboration
● Establishment of the Academic Fellowship program
● Establishment of a Family Medicine graduate degree program
The creation of the OES was an acknowledgment of the importance of systematically studying, reflecting on, evaluating and leading in best practices on our approach to training the next generation of medical doctors. RUTH HEISEY
Academic Fellowship and Graduate Studies Program
6
136 DFCM's greatest aChieveMents
Office of Education Scholarship
5
7
Edited by Jamie Meuser and published by Mosby with contributions from so many of our faculty… [the Family Practice Sourcebook] was welcomed all over the globe as a relevant practical reliable reference. HELEN BATTY
Students see family physicians as important figures in their medical education across the curriculum in various roles… JAMIE MEUSER
8
DFCM has made impressive contributions to undergraduate education and a real change in my time is the extent to which DFCM faculty contribute and lead in the (Faculty of Medicine) Undergraduate Medicine Education Program and the much more respectful vision of family medicine in the Faculty of Medicine. I think there is still a way to go, but it is dramatically different. ROSS UPSHUR
● Mike Evan’s whiteboards on YouTube
● 5 Chiefs Family Medicine Clinic Day
[The Family Practice Sourcebook] proved our ability to collaborate (as we had with teaching and research) to produce supports for better clinical practice. — JAMIE MEUSER
Family Medicine Leadership, Mentors, and Role Models
137DFCM's greatest aChieveMents
● Family Practice Sourcebook10
● Mini Medical School
Continuing Medical Education
● Saturday at the University
2 Research
138 DFCM's greatest aChieveMents
Establishment of the Funded Researcher Program (1995)
● Warren McIsaac’s “A clinical score to reduce unnecessary antibiotic use in patients with sore throat” and “The validity of a sore throat score in family practice” were published in the Canadian Medical Association Journal in 1998 and 2000 respectively.)10&18
Notable Publications
** Over half of the faculty who contributed to this history cited this work as the most influ ential piece of research in DFCM’s first 50 years.
The Cumulative Patient Profile
1
3
The strep throat score has had a major impact on primary care practice everywhere. PHILIP BERGER
I found it being used all over the world in Primary Care and has been a template for so many further clinical scoring systems. — HELEN BATTY
My favorite thing when I have a sore throat in my office after I ask the learner to tell me what they think and is there an algorithm they use, is to tell them that that score they are using is also called the Toronto sore throat score because it was developed by family medicine researchers in the DFCM. The learners’ eyes go wide, and the patients’ eyes go wider. RISA BORDMAN care genomic research led by June Carroll
Primary
4
The Better trials, under the leadership of Eva Grunfeld, was a a big idea, evidence-based and rigorous with the power to change lives and reduce the likelihood of cancer, diabetes and chronic disease across Canada by empowering men and women to complete cancer screening and choose healthier behaviors.
10
Periodic Health Review Form
● Developed and tested in a RCT by Karl Iglar and colleagues, and endorsed by the CFPC
UofT Practice-Based Research Network (UTOPIAN)
Against all odds, we created UTOPIAN, our living laboratory. LYNN WILSON
RUTH HEISEY
9
● The ALPHA TOOL11
Practice Based Research Network (PBRN)
7
Prenatal Care
8
6
Social Accountability Work
139DFCM's greatest aChieveMents
The BETTER trials
● Led by Gary Bloch, Andrew Pinto, Nav Persaud, Tara Kiran, Meb Rashid
5
Family & Partnerships
140 DFCM's greatest aChieveMents
When asked about the most important DFCM milestone, Karen Weyman (current Chief of Family Med icine at St. Michael’s Hospital) and Sid Feldman (current current Division Head, Care of the Elderly) offered that it was when Karen met Sid during their Academic Fellowship in 1991. Both Walter Rosser and Helen Batty take credit for getting them together, and both may have played an equal role. As Karen and Sid noted, “this means that the 3 most important contributions to the DFCM and society are our 3 children, Joshua, Benjamin, and Hanna.”
Many DFCM family partnerships have developed over the 50-year history of our department. Here is one example.
● 1974 North York General Hospital (chiefs: Stan Bain (Academic), Val Rachlis, Diane Delva, David White, David Eisen)
● 2010 Markham Stouffville Hospital (chiefs: Jane Philpott, John Maxted, Donatus Mutaswinga)
● 1966 Toronto Western Hospital (chiefs: Reg Perkin, Bob Angus, Larry Librach, Phil Ellis, Jeff Bloom, Camille Lemieux)
● 1988 St. Joseph’s Health Centre (chiefs: Michael Szul, Lynn Wilson, Patrick Safieh, Daphne Williams)
● 1966 Wellesley Hospital (chiefs: Lorne Laing, Irwin Bean, David Ouchterlony)
● 2009 Trillium Health Partners (chiefs: David Clarkson, Paul Philbrook (Credit Valley), Mira Backo-Shannon, Tamara Wallington )
● 1969 St. Michael’s Hospital (chiefs: Murray Cathcart, Sudi Devanesen, Greg DeMarchi, Philip Berger, Lisa Graves, Karen Weyman)
● 1968 Toronto General Hospital (chiefs: Fred Fallis, Wilf Palmer, Lorne Becker)
● 2009 Royal Victoria Regional Health Centre (chief: Stuart Murdoch)
141hospital sites
● 2009 Southlake Regional Health Centre (chiefs: Robert Doherty, Paul Cantarutti, David Ma kary)
● 1967 Sunnybrook Health Sciences Centre (chiefs: Doug Johnson, Paul Roberts, Peter Nor ton, Ray Gilbert, Jim Ruderman, Jocelyn Charles, Karen Fleming)
HOSPITAL FAMILY-PHYSICIANS-IN-CHIEF
● 1970 Mt. Sinai Hospital: family practice teaching unit opens (first chiefs: Nathan Levinne, Yves Talbot, Warren Rubenstein, David Tannenbaum)
HOSPITAL SITES
DFCM has been able to provide consistently outstanding programs across many sites only through the dedication of its hospital site leaders, faulty members, administrative staff, and learners. Each hospital site is represented on all education program committees. These important participants help to develop new educational initiatives. Often an idea will originate at a site and be brought to the central committee for consideration and development. When a new initiative is implemented across all hospitals, each site director ensures that the curriculum is delivered with sensitivity towards their site’s unique culture. This respectful and creative exchange of ideas between hub and spoke is key to DFCM’s strength as a department.
● 1991 Toronto East General/Michael Garron Hospital (chiefs: Dan Mallin, Jamie Meuser, Geor die Fallis, Kevin Workentin)
● 1969 Women’s College Hospital: family practice teaching unit opens (chiefs: Marjorie Swan son, Yvonne de Buda, Hollister King, Jim Ruderman, Ruth Heisey)
● 1990 Scarborough General Hospital (chiefs: Barney Giblon, Paul Caulford, Larry Erlick)
KAREN WEYMAN & SID FELDMAN
When a delegation of Chinese students came together in my living room with guitars and their Samsung phones to sing a song about friendship in a perfect 3-part harmony. — KATHERINE
The look on the faces of countless medical students when they reported that they wanted to go into family medicine because of some experience they had in preclerkship or clerkship family medicine.
PatientROULEAUCare
— KYMM FELDMAN
Starting at the Wellesley in 1990 and having never treated an HIV patient before meant a leap into the abyss of suffering and inevitable death. Nonetheless that work was highly rewarding but even more so when effective treatment became available in the mid 1990’s. — RICK GLAZIER
DFCM leaders and elders were asked to recall their most meaningful memories of individuals and events in our department. The responses were too numerous to print them all; here is a sampling.
142 MeMories: poignant, grateFul, FunnY
Education
There is a feeling of great joy to watch the students we have had the privilege of working and learning with go on to become extraordinary teachers and leaders within the DFCM and beyond. This brings a wonderful sense of remembering our own teachers and role models, and how the cycle will continue long after we’re gone. It gives us great hope for the future of the DFCM.
MEMORIES: POIGNANT, GRATEFUL, FUNNY
Always very moving for me to see the many incredible achievements of our residents. In my “senior” years, it is a great pleasure to mentor young physicians and graduate students both in research and work/life issues. Wonderful that the DFCM is beginning to value the role of mentor. JUNE CARROLL
The growth and diversification of the department in my approximately 20 years has been staggering. If there were something like a Rourke chart for academic departments, DFCM would be off the charts in many dimensions. The research and education programs, QI, CPD, expansion into the community have all been exceptional. I also think we have been extremely well served by leadership at DFCM central….When I think of the work of Jane Philpott, Danielle Martin, Mike Evans, Andrew Pinto, Nav Persaud and so many others (and apologies to all I have not named!) it is clear that the work of DFCM faculty is shaping the vision of medicine and medical care in Canada and beyond and making substantial contributions not only to patient care, but the policy environment. I am in awe and astonished at the sheer talent and commitment that emanates from our department.
My most poignant thoughts about the DFCM came to me in my first couple of years of my role at CFPC. As I was trying to figure out how to get important things done at the national level, I had many opportunities to reflect on the depth of talent and expertise that resides in the DFCM, and the capacity to focus collective action that DFCM’s program and unit structures facilitate. You just need to step outside the DFCM to discover how truly remarkable an entity it is. JAMIE MEUSER
DiversificationHEISEY & Leadership
— so we spread our expertise beyond our walls and reach more women across Canada.
For me it was powerful to realize that we as family physicians have a wonderful lens on ways that we can improve health care delivery. I am proud of my role in the creation of the Peter Gilgan Centre for Women’s Cancers — a partnership between the Canadian Cancer society and Women’s College
ROSS UPSHUR
Geordie Fallis (and everything he says) is singlehandedly the funniest story to emerge from DFCM. DAVID TANNENBAUM
Comic Relief
143MeMories: poignant, grateFul, FunnY
— RUTH
GEORDIE FALLIS
STANDING ON THE SHOULDERS OF GIANTS
JIM RUDERMAN
LARRY LIBRACH
Feldman expressed it best: “Looking around the room one time when I was junior faculty shortly after Lynn [Wilson] present ed the new strategic plan, and thinking about the contributions of each of the people in the room and realizing that I was really a part of something huge and important and that we as a group could make a huge and important dif ference in the world...in a standing on the shoul ders of giants kind of way.”
144 stanDing on the shoulDers oF giants
My most poignant memory of DFCM was Jim Ruderman’s funeral. He was such a wonderful mentor and truly good man. There were so many faculty at the funeral and the sadness of his passing was felt by all. At the same time there was a deep warmth among us all who were able to share our grief. He was the best boss I have or ever will have. ROSS UPSHUR
The DFCM family has included many individuals who have made an extraordinary impact on the lives and careers of faculty members. The few who are mentioned below were suggested by Perhapscontributors.Kymm
Of all the individuals suggested, Larry Librach and Jim Ruderman were mentioned most fre quently. Both are fondly remembered for their huge academic contributions, but mostly for their kindness and compassion.
Larry Librach almost single-handedly created the subspecialty of palliative care in this province; his influence lives on to this day as he inspired a generation of physicians willing to make palliative care a part of their family medicine careers, either partly or full time. ERIC LETOVSKY
Rick Glazier’s research has directly contributed to our understanding of how to best deliver primary health care services, including for marginalized populations, and of the unintended consequences of health care policy changes. AISHA LOFTERS
MELISSA NUTIK
Philip Berger has dedicated his career to advocacy and activism. He is never afraid to fight the good fight on behalf of those in need. He has led many rallies and encouraged others to join him who might not otherwise have done so. His voice has been loud and clear and we have all benefited from his energy and commitment. RISA FREEMAN
Greatest time was my first meeting with Helen Batty who saw my inner academic in me when I didn’t believe I had it. One meeting and the next thing I knew was that I had enrolled in an academic fellowship and an MHSc. I sent many of our current academics to meet with Helen and almost all came back enrolled in some graduate training program!
Cal Gutkin was a huge pioneer in the development of emergency medicine, not only in Toronto, but in Canada. He championed the role of emergency physicians with family medicine training and backgrounds. He started up the first family medicine EM program in the country. Our department has produced numerous emergency medicine leaders, and from that background, several have gone to even greater system level leadership.
— PETER SELBY
— ERIC LETOVSKY
145stanDing on the shoulDers oF giants
Anne Biringer and June Carroll have inspired and mentored countless trainees and colleagues in Family Medicine maternity care. They tirelessly promoted maternity care as an integral part of family medicine and ensured that our residents completed their training with the requisite skills. Both have had far reaching impacts nationally and internationally through their scholarship including the development and implementation of the Antenatal Psychosocial Health Assessment (ALPHA) form. Anne has facilitated training for maternity care providers in international low resource settings and June remains active in research and health policy with regard to prenatal and newborn screening.
15. Rubenstein W, Talbot Y. Medical Teaching in Ambulatory Care, Third Edition. Toronto: University of Toronto Press; 2020.
3. Johnson, p.7.
7. Demanuele F, Hines RM, Walter JW. The cumulative patient profile in family practice. Canadian Family Physician. 1977 Jul;23:41.
13. Hébert PC. Doing right: a practical guide to ethics for physicians and medical trainees. Oxford University Press; 1996.
16. Evans M, Meuser J. Mosby’s Family Practice Sourcebook: An Evidence-Based Approach to Care. Elsevier Canada; 4th edition, 2021.
6. Johnson, p.15.
17. Association of Faculties of Medicine of Canada. The Future of Medical Education in Canada (FMEC): A collective vision for MD education 2010–2015.
4. Johnson, p.8.
14. Tannenbaum D, Kerr J, Konkin J, Organek A, Parsons E, Saucier D, Shaw L, Walsh A. Triple C competency-based curriculum. Report of the Working Group on Postgraduate Curriculum Review – Part 1. Mississauga, ON: College of Family Physicians of Canada; 2011.
10. McIsaac WJ, White D, Tannenbaum D, Low DE. A clinical score to reduce unnecessary antibiotic use in patients with sore throat. CMAJ. 1998 Jan 13;158(1):75-83.
11. Carroll JC, Reid AJ, Biringer A, Midmer D, Glazier RH, Wilson L, Permaul JA, Pugh P, Chalmers B, Seddon F, Stewart DE. Effectiveness of the Antenatal Psychosocial Health Assessment (AL PHA) form in detecting psychosocial concerns: a randomized controlled trial. CMAJ. 2005 Aug 2;173(3):253-9.
REFERENCES
9. Tannenbaum DW. New "horizontal" curriculum in family medicine residency. Can Fam Physician. 1998 Aug;44:1669-75.
We also gratefully acknowledge Dr. J.R. Leitch’s 1972 history of the department: Leitch, JR. A History of the Department of Family and Community Medicine of the Faculty of Medicine at the University of Toronto. Department of Family and Community Medicine, 1972.
18. McIsaac WJ, Goel V, To T, Low DE. The validity of a sore throat score in family practice. CMAJ. 2000 Oct 3;163(7):811-5.
12. Evans M. What is the single best thing we can do for our health? 2011. https://www.youtube.com/ watch?v=aUaInS6HIGo
2. MacDermot, HE. 100 Years of Medicine in Canada. McLelland and Stewart, 1967.
5. Johnson, p.16.
146 reFerenCes
1. Johnson, DH. Department of Family and Community Medicine: Its First Quarter Century. Depart ment of Family and Community Medicine, 1994.
8. Rosser WW, Shafir MS. Evidence-based family medicine. BC Decker Incorporated; 1998.
147reFerenCes