U of T Medicine — Fall 2014

The Case for Interprofessionalism and Team-Based Care

The Donnelly Centre’s Powerful Interdisciplinary Approach

Ebola: The Ethics of Fast-tracking Drugs

The Faculty of Medicine in the Great War

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FALL 2014

“Not only did this support give me the means, it gave me the confidence to passionately advocate for mental health care.”

Cindy Malachowski PhD Candidate, Rehabilitation Science Sector, 2014.

After a 10-year career in occupational therapy, Cindy Malachowski pursued her PhD because she wanted to do more for people with mental health issues.

She chose U of T for its rehabilitation science program— one of the most progressive in the world. She is inspired every day by the people she works with — and the generosity of our donors.

Your continued support will encourage more students like Cindy to help build healthier communities.

Donate or find out more at: donate.utoronto.ca/medicine or 416 - 946 - 3111 boundless.utoronto.ca/medicine

MESSAGE FROM THE DEAN

Working Together

T

Now genetic screening of children for autism-spectrum can help detect the condition early and enable successful intervention by families and health care workers that improves outcomes.

Take a chronic, debilitating condition like cystic fibrosis. I recall, during my clinical clerkship at SickKids in Toronto in the mid-1970s, seeing children with cystic fibrosis-induced chronic lung disease and persistent antibiotic-resistant pneumonia. These children had a dramatically shortened life span with many prolonged hospital admissions.

These are examples of how our basic science research, translated into clinical practise, can help unravel the complexities of chronic disease and dramatically impact the lives of individuals and their families.

Today’s discoveries are the basis for tomorrow’s cures — a profound, ongoing legacy created by the vision and dedication of our faculty and students.

HE FACULTY OF MEDICINE AT the University of Toronto has a long tradition of tackling major health problems through innovation and interdisciplinary collaboration.

In 1989, Professor Lap-Chee Tsui and colleagues at SickKids discovered the genetic mutation causing cystic fibrosis, and 25 years later in Toronto a new, effective drug that counters the underlying defect caused by this mutation is now in clinical use. The advances in managing this chronic illness have significantly improved the outcomes and the quality of life for those affected by cystic fibrosis.

Today Professor Steve Scherer, a former graduate student and post-doctoral fellow of Professor Tsui, is the Director of our McLaughlin Centre that supports innovative research in molecular medicine.

Professor Scherer is now a renowned discoverer of the genetic basis of autism-spectrum disorder.

This edition of U of T Medicine focuses on patient-centred care and on how we can improve health outcomes through interdisciplinary, team-based practise, paying close attention to the importance of individual health professionals working together.

Our health professions’ education curricula increasingly emphasize community engagement and understanding how the social determinants of health are often the key underlying cause of illness.

The chronic, complex conditions of aging must be managed by teams of community-based caregivers that bridge to specialist care when necessary and not by default.

Rehabilitation following acute illness

and prevention of disease through exercise and nutrition are often neglected by a health system and professionals insufficiently focused on disease prevention and health promotion. These are some of the greatest challenges in health care today, and our faculty and students are deeply engaged in developing new models of care that address these needs.

As Dean of Medicine, I have experienced the privilege of seeing first-hand the commitment of our faculty, staff and students to our vision of improving health through innovation in research and education.

It is our academic health sciences that advance knowledge into practise and iteratively evaluate outcomes that ensure the provision of outstanding health care for individuals and populations — both here in Canada and across the globe. I am confident that the continuing legacy of our Faculty of Medicine will provide a beacon of hope for all.

Catharine Whiteside BSc ’72, MD ’75, PhD ’84 Dean, Faculty of Medicine Vice-Provost, Relations with Health Care Institutions

FALL 2014 — 1

INSIDE THIS ISSUE

Fall 2014

Putting the ‘I’ in Team Interprofessional Education Puts Patients and Families First Page 10

2 — U of T Medicine

COVER: JACKLYN ATLAS

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ACADEMIC LEAD Sarita Verma PUBLISHER Lloyd Rang

Contents 4 Snapshots 6 News 16 Improving the Patient Experience A Patient, Caregiver and Hospital Assistant Share What Matters Most

18 Cures That Today’s Doctors “Can’t Even Imagine” The Donnelly Centre’s Powerful Interdisciplinary Approach

22 Whisper to Shout Raising the Volume on Patient Advocacy and Engagement

25 Campaign Upadate 27 Dean Whiteside Looks Back on Nearly a Decade of Change

The Digital Issue uoft.me/medmag

More Stories and Photos Online!

There is more to U of T Medicine than what you hold in your hands.

The online version of our magazine has bonus stories, videos and photos. In this issue, you’ll find: Dr. George Thibault on Reaching the Summit An interview with interprofessional pioneer Dr. George Thibault of the Josiah Macy Jr. Foundation who will be the keynote speaker at U of T’s Dec. 2 conference, Reaching the Summit: Leading the Way from Interprofessional Education to Practice.

Excellent Exercise ONLINE EXCLUSIVE Experts from across the Faculty discuss the current science on the safest and most effective way to exercise, and share their own workout routines.

29 Awarding Excellence 30 Q&A From Hospital to Home: Closing the Cracks in Care

32 Stopping Ebola?

Remembering the First World War An expanded article and more historic photos of the Faculty of Medicine’s role in the Great War to commemorate the centennial of its outbreak.

EDITOR-IN-CHIEF Heidi Singer ART DIRECTION + DESIGN Raj Grainger CONTRIBUTORS Susan Bélanger, Noam Berlin, Roberta Brown, Veronika Bryśkiewicz, Shirley Hazelden, Erin Howe, Suniya Kukaswadia, Julie Lafford, Monifa Miller, Liam Mitchell, Emily Nicholas, Jim Oldfield, Meera Rai, Edward Shorter — PUBLISHED BY University of Toronto Faculty of Medicine 6 Queen’s Park Crescent West Suite 306, Toronto, ON M5S 3H2 Phone: 416-978-7752 Fax: 416-978-6999 Facebook: U of T Medicine Twitter: @UofTMedicine Instagram: @UofTMedicine YouTube: UofTMed Email: medicine.magazine@utoronto.ca The University of Toronto respects your privacy.

We do not rent, trade or sell our mailing lists. If you do not wish to receive U of T Medicine magazine, please contact us.

The Ethics and Efficacy of Speeding Up Drug Trials

34 On the Bookshelf 36 Old School Duty Calls

Look for these icons to get bonus photos, videos and stories.

FALL 2014 — 3

FACULTY OF MEDICINE IN PHOTOS

Snapshots 01 President Gertler stops to snap a picture of Professor Gary Bader during his tour of the Donnelly Centre for Cellular + Biomolecular Research.

02 The Class of 1T8 takes the Pre-clerkship Medical Student Oath at the Winter Garden Theatre during Orientation Week.

03 Dean Whiteside welcomes the class of 1T8 at the Stethoscope Ceremony, which reminds students of the importance of listening as they embark on their journey into medicine.

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06 This year Arbor Award winners from the Faculty of Medicine were honoured for their contributions to the Physical Therapy and Occupational Therapy Alumni Association. (Left to right: Krisztina Weinacht with President Gertler, Ashley Graham, Marion Leslie-Bethune and Joan Pape.)

07 The Honourable Ed Holder, Minister of State (Science and Technology), tours the Donnelly Centre.

04 Orientation Week for the Class of 1T8 kicked off with the Bell Ringer games on the front campus lawns.

08 This fall, 2,500 health sciences students gathered in Convocation Hall for an introductory interprofessional education class on understanding the patient’s journey and working as members of an interprofessional team.

05 Students enjoying the newly opened Ruth Kurdyak Medical Alumni Student Lounge in the Student Commons in the Medical Sciences Building.

09 Medical students came together on the lawn of front campus to participate in the ALS Ice Bucket Challenge. Watch the video at youtube.com/UofTMed.

Follow @UofTMedicine on Twitter, Facebook and Instagram to see our alumni, faculty and students in action.

BONUS: VIDEO uoft.me/medmag

PHOTOS: ERIN HOWE (1–5, 8); JON HORVATIN (7); COURTESY OF DRONE ON (9).

Join the conversation by using the hashtag.

FALL 2014 — 5

FACULTY OF MEDICINE NEWS

News Promoting Peace

BONUS: STORIES uoft.me/medmag

Connecting Teens to Careers in Health THIS YEAR MARKED THE 20TH anniversary of the Faculty’s Summer Mentorship Program. The Office of Health Professions Student Affairs (OHPSA) has paired more than 700 African-Canadian and Indigenous high school students with medical students for summer mentoring and tutoring. For cardiologist Dr. Husam Abdel-Qadir, the program was the beginning of a lifelong dedication to medicine.

“I’m very grateful for SMP because it’s a big part of how I got to where I am today,” he says. “As a new immigrant, I was constantly bombarded with messages of what 6 — U of T Medicine

a young black man should be.

I didn’t have positive influences outside of my family to look up to.

The program gave me a network of great role models.”

The program continues to evolve and grow with an increasing number of Indigenous students participating.

OHPSA, with support from Rochelle Allan at the Faculty’s Office of Indigenous Medical Education, is offering a full Indigenous curriculum. SMP introduces students to the world of health care and connects them with like-minded individuals who inspire and guide them throughout their careers.

The Faculty of Medicine hosted a dozen Jordanian, Israeli and Palestinian medical students for a month-long intensive elective in international pediatric emergency medicine this summer. For more than a decade, this elective has built dialogue and understanding between future Israeli and Palestinian physicians who work cooperatively on projects and tour Toronto together. As a flagship program of the Canada International Scientific Exchange Program, the goal is to create a network of Canadian, Israeli, Jordanian and Palestinian health care professionals who are committed to cooperative development and peace. This year, most of the students from Gaza and the West Bank were unable to travel to Toronto at the same time as the others, but participated through video chat.

“Thanks to the use of communications technology, the opening ceremony went on as if everybody was physically present,” says Mohammad O. Al-Haj, a student from Jordan. “It went on with connection, sharing and learning all together, foregoing all barriers and hindrances, demonstrating an ability to find hope in a seemingly impossible situation. When there is a strong will and the power of determination, we can build avenues to peace against all odds.”

COURSE CORRECTION ALTHOUGH IT IS ONLY THE SIZE OF a box of tissues, Professor Teodor Grantcharov’s operating room “black box” could vastly improve our ability to train surgeons.

“It doesn’t mean that we will have perfect surgeries, because we are not perfect, but it means we will learn from our errors — which will make us safer. We will train future surgeons better because we can show them what the most critical situations are and how to avoid them,” says Dr. Grantcharov.

A prototype of the box is being tested in the operating rooms at St. Michael’s Hospital, as well as two hospitals in Denmark.

A New Hope for Autism

PROFESSOR LAP-CHEE TSUI was honoured with the Henry G. Friesen International Prize in Health Research for his contributions in health research at the Canadian Academy of Health Science annual luncheon.

Research led by Professor Stephen Scherer (Director of the McLaughlin Centre for Molecular Medicine) has found a formula for identifying which genetic mutations will or will not lead to autism spectrum disorder at an earlier age. This groundbreaking work will allow patients access to therapies at an earlier age than before. The research has the potential to impact our understanding of all intellectual disabilities or related medical conditions associated with brain development and cognition.

Understanding Incurable Brain Cancer in Children Professor Cynthia Hawkins (Department of Laboratory Medicine and Pathobiology) along with PhD candidates Pawel Buczkowicz and Patricia Rakopoulos identified three subgroups of Diffuse Intrinsic Pontine Glioma (DIPG), which opens the door for the team to investigate potential treatments. DIPGs are extremely difficult to treat, as the cancer cells are intermingled with normal brain cells and can’t be easily removed.

This discovery comes after 25 years with few advances in research on this type of brain cancer in children.

Want to read U of T Medicine online only?

Email us at medicine.magazine@utoronto.ca to request a digital copy of the magazine instead. You’ll be saving the environment and you can read the magazine on your phone or tablet. uoft.me/medmag FALL 2014 — 7

FACULTY OF MEDICINE NEWS

Colon Cancer and the “Western Diet”

A NEW STUDY BY ALBERTO MARTIN (Department of Immunology) has found that switching to a low carbohydrate diet could lead to a reduction in the incidences of cancer. The study found that the typical Western diet is rich in complex carbohydrates, which microbes in the intestine convert to

ALS Takes Centre Stage Professor Karim Mekhail (Laboratory Medicine and Pathobiology) discovered the function of a crucial gene called PBP1 or ATAXIN2 that is often missing in ALS sufferers. This breakthrough offers new hope for a treatment or even a cure in the next two decades.

Kenya’s First Gynecologic Oncology Fellows This summer, Kenya’s first gynecologic oncology fellows, Peter Itsura and Elkanah Omenge, passed their exams, after being trained by the Department of Obstetrics and Gynaecology through a unique partnership with Moi University.

8 — U of T Medicine

“This is an extremely important finding that may help us to better understand and target the pathways involved in neurodegenerative disease,” said Lorne Zinman, Professor of Medicine at U of T and Medical Director of the ALS/ Neuromuscular Clinic at Sunnybrook Health Sciences Centre.

metabolites that can spur on cancer growth. Switching to a low-carb diet shuts down the process and significantly reduces cancer incidences.

Martin and his lab are planning to work with clinical researchers to see if a dietary change will improve outcomes for people with colon cancer.

Evaluating Complementary Medicine How U of T is leading the investigation

By Liam Mitchell

A

LITTLE ALOE VERA TO SOOTHE A SUNBURN? How about some echinacea for a cold, or a steaming mug of fennel tea for digestion?

Three-quarters of Canadians have used some type of complementary or alternative medicine — typically on the suggestion of a friend or the recommendation of a trusted complementary practitioner. Medical professionals struggle to be part of this conversation due to the lack of evidence about the safety and effectiveness of many therapies as well as limited education about complementary and alternative medicine.

U of T is addressing that knowledge gap with the Centre for Integrative Medicine — a unique partnership among the Faculty of Medicine, the Leslie Dan Faculty of Pharmacy and The Scarborough Hospital (TSH) — to apply scientific study to health practises such as the use of Chinese medicine. The Centre’s goal is to help everyone, from physicians to patients, make evidence-informed decisions about complementary therapies.

“Because an overwhelming number of Canadians are using complementary and alternative medicines, it’s critical that we understand how these products and therapies work and how they interact with conventional care practises and medications,” explains Heather Boon, Dean of the Faculty of Pharmacy, President of the International Society of Complementary Medicine Research and the former Chair of Health Canada’s Expert Advisory Committee for Natural Health Products.

To accomplish this, scientists, physicians, pharmacists, nurses, complementary medicine practitioners and other health providers will study and practise together. A clinical hub will be established at TSH’s Birchmount campus to help patients manage their day-to-day health. It will study

disease prevention, health promotion and chronic disease management for conditions such as diabetes.

“Our aim is to put the facts about complementary and alternative medicine in front of patients and health care professionals so they can make informed decisions,” says Professor Lynda Balneaves, the Centre’s newly appointed director and KY and Betty Ho Chair in Integrative Medicine. “We want to understand if these therapies work, the potential interactions with drugs and other treatments, and how complementary therapies might be incorporated into a care plan alongside conventional treatments.”

Balneaves joins U of T from the University of British Columbia, where she led a UBC-BC Cancer Agency initiative called the Complementary Medicine Education and Outcomes Research Program. It provided evidence-based education and decision support for cancer patients and cancer health professionals.

“We couldn’t have a more distinguished leader for this new initiative,” says Dean Catharine Whiteside, Dean of the Faculty of Medicine. “Lynda has taken a leading role in supporting people living with cancer in making evidence-informed decisions about complementary therapies. She has been investigating complementary and alternative medicine for 20 years and her groundbreaking work has been frequently cited in media across Canada.”

The Centre officially launched on October 17 and has started the first phase of its development, which is focused on consulting the local community to ensure CIM serves the needs of the area. By spring 2015, the Centre will launch a series of pilot projects that will meet the needs of the TSH community, and it will be ready to announce its long-term plans. For more information on the Centre for Integrative Medicine, visit www.toronto-cim.ca.

FALL 2014 — 9

COVER STORY

Putting the ‘I’ in Team Interprofessional Education Puts Patients and Families First

By Jim Oldfield

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In Convocation Hall at the University of Toronto, 1,400 health science students have met to start the curriculum in interprofessional education (IPE).

On stage: a hospital room; an anguished woman sits with her husband, who has had radiation therapy for head and neck cancer.

“Is there anyone here to help us?” she calls out. Her husband has other concerns. “Find out when I can eat steak,” he says.

THE PATIENT AND HIS WIFE ARE actors. They’re playing patients who have met a series of health care professionals who make mistakes discharging him because they don’t communicate with each other clearly.

The students also hear from a real patient — a former nuclear medicine technologist and cancer survivor who couldn’t navigate the system well, even though she worked in health care.

First-year medical student Simran Mundi was at the event. “It’s no longer possible for one person to meet the needs of complex patients,” he says.

“Interprofessionalism is the future of health care.”

Interprofessional care brings together professionals trained to work with each other in teams to deliver better care. In “best practise” models, patients are active members of the team, and have quick access to the experts who can meet their needs.

Many recent reports — including Health Professionals for a New Century by the Lancet Commission in 2010 — have called for interprofessional PHOTOS: JACKLYN ATLAS

teams as the best way to reduce health inequities and make health systems more sustainable. There is strong evidence that teams provide safer and more cost-effective care, and better outcomes for patients.

“The move towards interprofessional care, supported by interprofessional education, can be a tremendous enabler in the move towards a patient-engaged system,” says Joshua Tepper, an Associate Professor in the Department of Family and Community Medicine, and President/CEO of Health Quality Ontario. “It allows us to think about the patient as part of the team, and to focus a lot more on the patient’s journey through the system.”

But changing the way health professionals learn FALL 2014 — 11

THE ‘I’ IN TEAM

and then practise presents huge challenges. Schools struggle to find common time and space to teach students, who still have to meet specific program and accreditation standards. Members of some health professions fear a diminished scope of practise and resist curricular changes. Many students graduate as team players but find themselves in workplaces where such models aren’t in place yet.

In Canada, U of T has been leading the drive towards interprofessional education and care. Since 2009, the IPE curriculum has been mandatory for most health science students, and the Faculty now offers four required components and more than 140 electives. The Centre for Interprofessional Education has created strong connections with hospitals and offers the university’s 3,700 health science students many interprofessional clinical placements. Students learn about team conflict together, discuss palliative care or pain, shadow other professions and interview patients. The IPE program is changing the way health professionals learn, and as the first classes graduate and take positions in clinics and hospitals in Canada and around the world, it’s starting to change how health professionals practise.

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“The idea is to flatten the hierarchy and create a circle of people, and in the centre of that circle is the patient.”

— SARITA VERMA

The Toronto Model The IPE program builds on two decades of work by pioneers at U of T. From 2005 to 2009, the Office of Interprofessional Education — led by Department of Family and Community Medicine Professor Ivy Oandasan — helped get more than $17 million in grant funding for IPE. Oandasan and education researchers in U of T’s Wilson Centre provided strong evidence to support interprofessional education and care.

Meanwhile, a key policy change in Ontario helped drive interest in IPE. In 2009, the provincial government passed a bill making it possible for health professionals — especially pharmacists, nurse practitioners and physical therapists — to share more responsibilities for patients. Maria Tassone, Director of the Centre for Interprofessional Education, recalls that many health care workers worried the government would use this change to allow role substitutions and cut jobs.

“But it soon became clear there was still enough work for everyone. Today, the question is not about why we’re moving towards interprofessionalism, but how we can do it faster,” she says.

Schools around the world have taken an interest in U of T as they set up their own IPE programs. Tassone gets many inquiries about the “Toronto Model” of IPE, and she and her colleagues have consulted and given workshops at dozens of schools.

At Indiana University, 40 educators recently gave a faculty team from the Centre a standing ovation after a workshop on the foundations of IPE.

A Bridge to Better Care? military chain of command, and care Not everyone is enamoured with the can become paralyzed anywhere Toronto Model. Sholom Glouberman is along the chain,” she says. an Adjunct Assistant Professor the But Verma says education and care Department of Health Policy, form an interdependent and powerful Management and Evaluation at U of T, system — training affects the number an Associate Scientist at Baycrest and of health professionals and how they the President of Patients Canada. work, while practise settings influence “U of T is a great place for spawning the education experience. “The idea is new ideas, but we haven’t seen much to flatten the hierarchy and create a change in how health professionals circle of people, and in the centre of practise,” he says. that circle is the patient. Then, you’re Glouberman points to a patientenhancing the possibility that health centred care program that ran for 10 care is about people.” years at one teaching hospital, but without any patients on its steering committee. He says care at many Toronto hospitals is not patient“They all knew my story friendly: people wait too long at ... They spoke the same appointments, visiting hours are language, and they inconvenient and irregular, and family trusted each other’s members aren’t brought in to the assessments … I thought, process. “The jury is still out on IPE, ‘Maybe they know what but I suspect that educating health they’re doing.’” professionals together will not prove to be the solution,” says Glouberman.

— CARRIE BARNES That’s a criticism Tassone knows well. “Interprofessional education is about more than putting learners together,” she says. “They need to interact, so they understand how others’ roles and scopes of practise affect patient care.” And U of T’s IPE curriculum has had links to practise from the beginning, in part through clinical placements — unlike IPE programs in most other schools.

Tassone adds that change takes time.

“We can’t wait a generation for interprofessional care, but it will take more than a few years.”

Education leaders at U of T say there is work to do in clinical practise. Sarita Verma is the Deputy Dean of the Faculty of Medicine and the Associate Vice Provost Health Professions Education, responsible for health professions reform at U of T. “The care model in many hospitals is still a

“Magic Happens” For Carrie Barnes, being a patient was about trust.

In the summer of 2009, the Barrie resident noticed her feet swelling every time she ran. Soon, she had swelling in many joints and needed help getting dressed, but the first available appointment with a rheumatologist was in a year.

Desperate, she visited The Arthritis Program (TAP) at Southlake Regional Health Centre.

Lorna Bain, then a Clinical Occupational Therapist, assessed Barnes and together they called the program’s rheumatologist, Carter Thorne. He heard the need and saw Barnes that day, diagnosed her with rheumatoid arthritis and laid out a medication plan: steroid injections in both wrists, vitamin B12 and weekly doses of methotrexate. The diagnosis was devastating, and Barnes at first lacked confidence in the plan.

But after meetings with TAP’s pharmacist and physiotherapist, her attitude changed. “They all knew my story because they used one chart.

They spoke the same language, and they trusted each other’s assessments,” she says. “I thought, ‘Maybe they know what they’re doing.’” Over the next few weeks, she learned about her disease and became part of the team. She was able to call the pharmacist with questions about her medication, and TAP’s occupational therapist fitted her with orthotics. By the following March she was running again.

This summer, in consultation with TAP, Barnes ran Tough Mudder — a gruelling 10-mile, obstacle-filled endurance race. “Once I realized I had a team behind me, I could fully commit to the plan,” she says. “Trust is huge when it comes to patients accepting their treatment plan.”

The Arthritis Program at Southlake FALL 2014 — 13

THE ‘I’ IN TEAM

has been interprofessional for 25 years.

The program has the highest patient intake rate in Canada, and the highest rate of disease remission. Their operating costs are low, and research suggests the program has helped many patients avoid costly care in the emergency room.

Bain, now Southlake’s Coordinator for Interprofessional Education and Care, and Zaev Wulffhart, an Assistant Professor of Medicine at U of T and Director of Medical Education at Southlake, are helping teams work interprofessionally in other clinical areas such as cardiac care. “We want to build on lessons learned in TAP to create a broader culture of interprofessional education and care,” says Bain. “Students and recent graduates quickly adopt the habits of their workplace, so it’s critical to let them live with what they’re taught.”

The pair also teaches electives on patient safety and quality care in U of T’s IPE program.

U of T’s nine fully affiliated hospitals have also created more interprofessional opportunities for students. Sunnybrook Health Sciences Centre will offer 15 placements this year for students in the IPE program, as well as several electives.

And Sunnybrook has created an Interprofessional Care Advisory Committee, which began with clinical staff and now includes students, administrative and support staff, and patients.

The committee has helped create learning opportunities for staff, students and physicians, such as interprofessional orientation and how to optimize scopes of practise. “We’ve made a lot of headway,” says Tracey DasGupta, Director of Interprofessional Care at Sunnybrook.

“When you bring education and care together, magic happens. People come to us full of enthusiasm, ready to learn and work together.”

14 — U of T Medicine

Going Mainstream System-level changes in education could quickly make interprofessional care widespread, and some are already underway. The accrediting bodies for six health professions in Canada have made IPE a requirement.

And the Liaison Committee on Medical Education and the Committee on Accreditation of Canadian Medical Schools recently approved a new standard that requires all medical schools in the U.S. and Canada to include IPE. But many experts disagree on further changes to accreditation standards and learner competencies — some want additions that reflect interprofessional priorities, others want a complete overhaul.

As for the delivery of care, the traditional fee-for-service model — which discourages both team care and preventionbased medicine — doesn’t fully take the new approach into consideration. Governments pay hospitals based on length of patient stay more than quality or range of care. And the Public Hospitals Act requires doctors to sign off on many services that teams could handle, from patient discharges to prescription refills.

“A team allows us to do what we’re most qualified to do,” says Danielle Martin, an Assistant Professor in the Department of Family and Community Medicine, who is also Vice-President Medical Affairs and Health System Solutions at Women’s College Hospital. “This isn’t about downloading the easier tasks to ‘less qualified’ people.

Often a nurse is better than I am at lifestyle counseling, or the pharmacist knows more than I do about medication side effects.”

A similar approach could work for preventative care.

Physician assistants, nurse practitioners and pharmacists could do more to keep patients healthy. Verma suggests that “preventative health experts” could teach patients to care for themselves. She notes that preventative interventions in the U.S. that target people with a low socioeconomic status have shown improved health outcomes and system-wide cost savings.

“In Toronto we have the most spectacular living laboratory for education in the world, when you look at the diversity and size of our population, and the breadth of care across the life cycle,” she says. “And I see a real hunger to build a better bridge between education and practise.

We have an unparalleled opportunity to pilot innovative and new ideas, and lead transformation of the health care system.”

BONUS: STORY uoft.me/medmag

Better Care by Learning Together

I’M LEARNING MEDICINE WITH doctors, but I know I’ll be practising it with nurses, pharmacists and other providers. That’s why I was drawn to the Interprofessional Education (IPE) curriculum right away in my first year of medical school at U of T. So far, I’ve taken 10 elective credits — and I have to say they’ve been some of the most valuable experiences I’ve had in my medical education.

Before medical school, I worked in a long-term care centre and saw how many problems were caused by misunderstandings and miscommunications among workers on the same team.

People worked in silos.

In the IPE curriculum, I’m not only learning about medicine, I’m learning how to be part of the health care team.

Physicians of my generation accept that we’re moving towards team-based care, as the research shows better patient outcomes. We know that errors come from not understanding each other’s PHOTO: ERIN HOWE

roles and from problems in communication. And I’ve seen first-hand how patients are far better off when you sit down as a team.

I’ve learned that social workers know about resources I never knew existed.

I had no idea that speech language pathologists have expertise with eating and swallowing disorders and can provide therapy. I’ve observed that nurses are experts on their patients, holistically. I’ve learned that the patient-centred approach is ingrained in their curriculum. To be honest, I was very surprised at how demanding these other programs were, and how much earlier they get to see patients than we do.

I also realized very quickly how much I need my colleagues. I’m not alone: 96 per cent of medical students say IPE is important to their careers, and two-thirds of senior medical students say IPE has become more important to them during the four years

(Interprofessional Health Care Students’ Association Survey, May 2014).

I’ll admit not every student shares my enthusiasm for learning alongside other professions, maybe because electives are an extra burden or they don’t see the benefit. And that’s okay. I think the tide is shifting, and in future, interprofessional education will be integrated into all of our courses in a way that we can really use in practise. It seems like common sense: the more exposure you have early to interprofessional cooperation, the better you’re going to be at it. This is simply a skill today’s doctors need. — NOAM BERLIN

— Noam Berlin is a second-year medical student at U of T, interested in specializing in Internal Medicine. He currently serves as Vice-President of Interprofessional Education of the Medical Society and as President of the Interprofessional Health care Students’ Association.

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THE ‘I’ IN TEAM

A Patient, Caregiver and Hospital Assistant Share What Matters Most

Improving the Patient Experience

The Patient The language of interprofessionalism and patient-centred care is everywhere, but we’re lagging on making it happen.

And from my vantage point as a patient, it’s much simpler than it seems: improving patient care begins with more listening.

Three years ago I was a healthy 29 year-old.

I loved being active and was an avid runner, until I started experiencing severe leg pain.

After a series of misdiagnoses I learned I had a stress fracture. It seems so obvious now, but getting to that diagnosis answer was a harrowing journey through the ups and (considerably more) downs of our health care system, involving multiple surgeries, a descent into depression and many hours of physical and mental health therapy.

Being a patient in our fragmented health care system can make you feel segregated in your body, like you’re not a whole person. The experience of not being heard made me doubt my physical symptoms, which eventually led to anxiety and depression. Our system may be good at acute care, but it doesn’t help with the transition from acute care to being back in society.

In the end, what helped me the most was learning from a therapist how to care for myself, using nutrition, massage and other wellness techniques. I may never be the same as I was, but I’m more functional than ever before.

EMILY NICHOLAS lives and works in Toronto and advocates for patients.

Above: Sadhu Rai, mother of Meera Rai (The Caregiver).

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PHOTO: JACKYLYN ATLAS

The Caregiver

The Clinical Assistant

In October 2010 my mother was diagnosed with malignant, NonHodgkin’s lymphoma. I was told that the chance of survival was slim, and if she did recover, the chance of recurrence was high. Mum spent the next 10 months in hospital; I spent them by her bedside, 12 hours a day, seven days a week.

For me, being patient-centred means preserving people’s dignity while supporting their healing process.

From where I sit, the health care system is coming up very, very short in that department.

I can’t express how grateful I am that she survived, and I often ask myself how she beat such an aggressive form of cancer. It’s partly the quality of care she received from an integrated team of nurses, doctors, clinical assistants, residents, allied health professionals, cleaning staff, porters, technicians and volunteers. Their efforts were unwavering. I’d never seen that kind of teamwork before and haven’t seen it since.

But I can’t ignore the possibility that her survival is also due to my involvement in her care. I handled everything from hygiene and toileting to questioning what I felt were unnecessary procedures and demanding what I knew to be necessary ones. I cleaned her sore-ridden mouth, held the basin as she vomited for two days straight, ran to every fast food restaurant I could find so that she would eat something — anything — and take in a precious few calories. I called attention to medication errors. If I hadn’t been there with her every day, I really believe she would have died.

I’ve been a primary caregiver to my mother for three years. I often hear people use the term “sandwich generation,” a popular phrase describing those who care for their aging parents as well as their own children. I am both amused and bemused by this saying. My friends say that we’ve reversed roles and I’m now acting as the mother figure. I reject that wholeheartedly, preferring instead to be thought of as an advocate. I’ve become somebody who will speak for those who can’t speak for themselves.

There are so many things I wish we could offer our patients, even something as simple and practical as better products for hygiene and incontinence. Being made to wear a diaper, for instance, is crushing to people’s dignity. I hear patients say with embarrassment that they feel like a baby. It makes me really sad, especially when I know there are alternatives.

Good hygiene is so important; nobody thinks about it because it’s secondary to medications and wound care, but I think it makes an unbelievable difference in the healing process.

Being stuck in a hospital bed is an isolating, disconnected experience. Anything that restores some sense of normalcy is important. I once had a patient who’d been in hospital for a while and hadn’t had a proper shower in weeks. Eventually I persuaded her to let me help her shower. The moment that warm water came down her back, she was overcome; she started to sob with joy and relief. I will never, ever forget how she looked. Such a small thing — something we do and take for granted every day — did wonders for her.

Mental well-being is as important as any other aspect of health care. And it’s not just for the patients — families need to feel comfortable too. Sometimes that means giving them a pillow or blanket, but usually families are just looking for a sympathetic ear. It’s a helpless feeling to watch your loved one sitting in a hospital bed. If I can make families more comfortable, maybe their visits will be easier and more frequent. That alone would be a game-changer.

I can only hope.

SHIRLEY HAZELDEN works as a clinical assistant in Barrie and Toronto hospitals.

MEERA RAI works in Strategic Communications for the Faculty of Medicine.

FALL 2014 — 17

THE ‘I’ IN TEAM

“This Is Where We’ll Find Cures Today’s Doctors Can’t Even Imagine” The Donnelly Centre’s Powerful Interdisciplinary Approach

By Lloyd Rang

18 — U of T Medicine

West-facing facade of the Terrence Donnelly Centre for Cellular and Biomolecular Research.

IT’S NOT UNCOMMON TO SEE AN older, impeccably dressed gentleman roaming the halls of the Terrence Donnelly Centre for Cellular and Biomolecular Research, the Faculty of Medicine’s state-of-the-art hub for interdisciplinary basic science research. Occasionally, he’ll stop to chat with a student or researcher in the hallways.

What most people don’t realize is that the gentleman is none other than Terry Donnelly, the visionary philanthropist, lawyer and retired businessman whose support helped create the centre. And if you take a moment to speak to him, you’ll quickly discover he’s more passionate and articulate about the ultimate purpose of basic science than most

people outside the field. For example, he’s quick to draw the connection between the research being done in the laboratories and the clinical care being offered down the street in the university-affiliated hospitals.

“This building is a beacon of hope for the people lying in the hospital beds on University Avenue — the hope that in their lifetimes, cures will come from the breakthroughs in basic science here at U of T,” says Donnelly. “It’s because of our hope for the people in those hospital beds that we, in the fullness of time, will come up with the answers to the illnesses that plague mankind.”

The Donnelly Centre — which was built in 2005 — is like no other medical research space in the country. It’s a collaboration among the Faculties of Medicine, Applied Science and Engineering, Arts and Science and Pharmacy.

Medical researchers work alongside physicists, computer scientists and pharmaceutical scientists to develop new approaches to treating — and curing — diseases at the cellular and molecular level. It’s an approach that has attracted a number of young, talented researchers to the PHOTO: RAJ GRAINGER

Donnelly Centre in the last nine years.

“Right now,” said Brenda Andrews, the centre’s Director, “the scope of new technologies and the possibilities they present are endless. When you have people working in a collaborative, multidisciplinary space like this one, using the latest technology, the potential to do important work is just extraordinary.”

One such researcher is Sachdev Sidhu. After graduating from Simon Fraser University with his PhD in 1996, Sidhu went on to work at Genentech Inc. in San Francisco, where he spent 10 years developing antibody therapies. He joined the Faculty in 2008, attracted by the possibilities of working in the relatively new field of protein engineering at the Donnelly. Today, he runs a unique laboratory in the Donnelly Centre, is a Senior Investigator for the Ontario Institute for Cancer Research and a Professor in U of T’s Department of Molecular Genetics. Prof. Sidhu is one of a new generation of Canadian researchers making their mark in the basic sciences. His work has drawn the praise of his peers and, recently, some important funding as well.

FALL 2014 — 19

THE ‘I’ IN TEAM

“We have a man here who has restored the sight of blind mice.

The day is coming when we’ll be able to make the blind see again.”

— TERRY DONNELLY

IN AUGUST OF 2014, THE FEDERAL GOVERNMENT announced that it was investing $15 million over the next five years to fund the Centre for the Commercialization of Antibodies and Biologics (CCAB). In its description of the award, the government said that “Antibodies are the fastest growing area of therapeutics and have been used in cancer, infectious diseases and autoimmune diseases. CCAB will solidify Canada’s foothold in a $50 billion worldwide industry by validating antibody candidates, testing research tools, and maintaining antibody libraries accessible to industry. Drawing on research conducted at the Toronto Recombinant Antibody Centre, CCAB will also address issues related to manufacturing products at the quality and scale needed for commercial success.”

What this means for Sidhu and his centre is that the federal government not only recognizes the importance of his work, scientifically speaking, but sees commercial application in it as well.

“What we’re doing is looking at over 100 cell surface proteins that we know or suspect are connected to cancer.

We use antibodies to interrogate the prevalence of proteins in cancer and, from there, use the antibodies to inhibit or turn off the protein and thus inhibit the cancer itself,” says Sidhu. “So far we have around a dozen promising candidates for further research which, we hope, will result in commercialization in the next five years. This is faster than the industry standard for drug development — which is about 10 years — largely because of the infrastructure we have here at the Donnelly.”

“The dream,” Sidhu says, “is to find tailored antibodies that we can use to explicitly target specific cancers. Rather than subjecting patients to a broad, shotgun approach like chemotherapy, we can develop drugs that target specific pathways, making cancer a much more treatable disease.”

20 — U of T Medicine

It’s this kind of work that excites Andrews, who has been leading the research at the Donnelly Centre since the beginning.

“In basic science, researchers are always thinking about the eventual application of our work and how it will help patients,” says Andrews. “I think what we’re seeing in our students and our investigators these days is a growing sense of expertise and excitement for the entire endeavour.

They’re looking at the whole track from discovery through to the therapeutic treatment.”

Other researchers at the Donnelly share that sentiment. Jason Moffat — a former student of Andrews — came to the centre in 2006, following post-doctoral work at MIT and Harvard. His research focuses on cell growth, proliferation and differentiation and, in particular, how cancer cells reprogram in response to stress or altered genotype.

Moffat shares space in the Donnelly with Sidhu, and has a similar perspective on the changing nature of basic research.

“When I was an undergrad at Queen’s, I was the first student in a co-op program that placed me in an industry setting,” says Moffat.

“Today’s students see the relationship between academia and industry much differently. There is obviously still an important place for academic research, but increasingly I think we see ourselves in partnership rather than as separate entities. I think that ultimately has huge benefit for patients.”

Certainly that same notion was on the mind of Donnelly himself when he first helped create the centre, and it’s very much on his mind today, too.

“To get the benefits of research, we need to hasten the move to market,” he says. “This is closing the circle.

We’re about making a difference to the lives of people who don’t enjoy perfect health. The successful commercialization of these basic research breakthroughs will benefit the patients and also create jobs and tax revenue.”

The best way to do that, says Donnelly, is through an interdisciplinary approach.

“Six bright scientists working on the problem in different disciplines is better than six scientists taking the same approach,” he says. “It’s exhilarating to see the commitment and dedication of our researchers who toil here day and night, around the clock, searching for elusive cures to cancer, Alzheimer’s, diabetes, Parkinson’s and more. We have a man here who has restored the sight of blind mice. The day is coming when we’ll be able to make the blind see again. This is where we’re going to have body parts developed, and cures which today’s doctors can’t even imagine.”

“I think what unites everyone around the world is that we all yearn for a life that’s full and complete,” says Donnelly.

“No matter how long or short our lives may be, we want a life that is free from threat of major disease or the devastation

PHOTOS: ERIN HOWE

of a major injury. The only way that yearning can be satisfied is through research, research and more research.

And that’s why I’m at U of T, supporting institutions and organizations that have the capacity and the people to make a difference in the lives of people everywhere.”

“What we’re assembling here is a group of dedicated scientists, who, along with others around the world, are creating better health care for everyone. The payoff for the researchers is recognition that they have contributed to the wellbeing of a patient who has never heard of the researcher or the University of Toronto — but the patient knows that someone in basic science has made a difference to his or her life.”

As the Donnelly Centre begins its 10th year, that work and that unique approach is fully underway in labs like the CCAB. In the years to come, it’s the hope of everyone involved — donors and researchers, administrators and students — that the real payoff will be in the form of better patient care for people around the world.

Jason Moffat and Sachdev Sidhu in the Terrence Donnelly Centre for Cellular and Biomolecular Research.

FALL 2014 — 21

THE ‘I’ IN TEAM

Whisper to SHOUT Raising the Volume on Patient Advocacy and Engagement

BY ERIN HOWE

22 — U of T Medicine

When Gary Bloch was a young doctor, he assumed that if an illness could be treated, his patients would get better.

But years of working with low-income Torontonians have taught him that poverty is a serious barrier to good health.

“I wasn’t really seeing health improve even though I was following all the guidelines, giving patients all the right tests and prescriptions,” recalls Bloch, an Assistant Professor in the Department of Family and Community Medicine and Staff Physician at St. Michael’s Hospital.

“As I started to dive deeper into my patients’ social situations, I came to understand what they were saying.

Poverty was the biggest factor in their lives.”

Bloch has seen how sick buildings and bad air contribute to asthma, and how cheap, unhealthy food leads to obesity and heart disease — which are avoidable if you have the means to afford other options and treatable if you have the money to pay for the drugs.

Studies have shown the role income plays in many major diseases and chronic conditions like diabetes, heart disease and acute illnesses. As well, people living in poverty tend to become sick more frequently than people with more money. They also experience more accidents and trauma, and have lower life expectancies than the general population.

That’s why the family physician has become an advocate for much more than just his patients’ personal health.

These days, Bloch counsels low-income patients not just to take their medications, but also to file their tax returns to receive benefits and credits. He’s also well-versed in the intricacies of income support,

welfare and disability support systems.

These are some of the ways Bloch puts his patients at the centre of care and helps empower them to improve their circumstances. But he also believes that part of his job is to share what he knows about poverty and health with medical students, government — anyone who can make change.

“The reality is that changes aren’t going to come from the one-on-one interactions,” says Bloch. “And that’s true of anything, that’s true of smoking, of things like getting people to wear seatbelts. It’s a real public health issue and we can deal with these things on an individual level, but we also have to deal with them on the higher level.”

When he teaches, Bloch builds upon the idea that physicians should ask about their patients’ individual stories, life situations, social supports, housing and income. And he advocates for changes that could benefit low-income populations across Ontario, helping to found Inner City Health Associates, a group of doctors working with the homeless as well as an advocacy group called Health Providers against Poverty.

23 and 1/2 hours: What is the single best thing we can do for our health?

The video illustrates the benefits of just 30 minutes of daily, physical activity and has racked up more than four million views on YouTube since it was posted nearly three years ago.

His Med School for the Public on YouTube has had over 10 million views with topics ranging from hip and knee replacement to stress management to the early childhood brain.

“The reality is that we can give people all the knowledge we want, but until we engage them, it’s really hard to start the process of change,” says Evans, an Associate Professor in the Department of Family and Community Medicine as well as U of T’s first Chair of Patient Engagement in Childhood Nutrition.

The message may be timeless, but the medium is expanding from the one-directional doctor-to-patient communication to peer-to-peer health care. “Most care happens at people’s homes, not in clinics or hospitals, and I happen to think the public is our biggest missing health workforce — a workforce we need to mobilize.”

“Most of us are part of social networks, in both the old and new

“As I started to dive deeper into my patients’ social situations, I came to understand ...

Poverty was the biggest factor.”

— GARY BLOCH

senses of the word,” says Evans, who creates his videos with the help of filmmakers, designers and other experts and clinicians. “Your friend is much more likely to open a story or video that comes from you, rather than something that comes from a corporation. Stories trump data, and our task is to storify evidence in such an engaging way that people push the share button.”

“We Have a Voice We Can Do Something With” Students have proven successful at that effort. Many at the Faculty of Medicine are keenly aware of the idea that improving health extends beyond the exam table.

“Medicine doesn’t begin and end in a hospital office,” says Phillip Gregoire, a second year undergraduate medical student.

Earlier this year, Gregoire and two of his classmates started a petition

Engaging Patients Everywhere Just as there can be no “one size fits all” approach to medicine, there is a range of ways some physicians are educating and empowering people to improve their own health.

Mike Evans is encouraging people to make positive behaviour changes with health messages that reach people where they are and in engaging formats that allow people to share — what he calls healthy viruses. This includes his well-known whiteboard video series, particularly one called ILLUSTRATIONS: SHUTTERSTOCK

FALL 2014 — 23

THE ‘I’ IN TEAM

“The public is our biggest missing health workforce.”

— MIKE EVANS

asking the Toronto Police Service to stop automatically reporting suicide attempt records to the Canadian Police Information Centre.

He was inspired by the Ontario Privacy Commissioner’s request for police services across the province to put an end to the practise.

“We’d been learning a lot of about social determinants of health, and this seemed like a clear policy issue that was going to dissuade patients from receiving the care they need because of a fear that this kind of mark on their record could prevent them from doing things like cross the border or getting a job.”

24 — U of T Medicine

Recognizing that many people see health professionals as having a privileged place within society, Gregoire says he and his fellow MD students need to use their position for good.

“We have a voice we can do something with. And we should use it for a good cause,” says Gregoire.

“It’s important to step back and look at the bigger picture and ask, how are the decisions that are being made affecting this patient, and is there something I can do about that?”

“A lot of us went into medical school because we wanted to provide a service to the community and especially help people who are marginalized, or have difficulty accessing health care,” says student Emily Stewart. “So when there are opportunities to stand up for people whose voices might not otherwise be heard, it’s a rewarding reminder of why we are here.”

Stewart was one of about 30 medical students who picketed outside on one of the coldest days last winter, urging then-Health Minster Deb Matthews to fill the gap in health care coverage that resulted from federal cuts to care for refugees.

She helps teach at refugee shelters with the University of Toronto International Health Program, sharing information about how to shop for inexpensive food or how to survive winter. She has also volunteered for iREACH, an initiative launched in 2012 by medical students who wanted to help marginalized and vulnerable groups. Volunteers in that program provide translation, medical history taking and educational workshops for immigrants and refugees.

These examples of advocacy are driven largely by compassion.

But Brian Hodges, a Professor in the Department of Psychiatry, argues that while both caring and advocacy are important, each is a separate competency.

“Caring is traditionally understood by most of us as being about the patient and family relationship,” he explains. Advocacy exists at a larger level.

“There is a perception that caring is easily lost today for a number of reasons, partly because of the rise of the technical sides of health care.

The predominance of new and exciting tools, like electronic patient records, and the drive for efficiency are examples of the things that can challenge us to sustain a compassionate, caring environment.”

Hodges leads the Phoenix Project, sponsored by Associated Medical Services (AMS), a charitable organization. The five-year project’s aim is to help health professionals balance compassion and technical expertise.

The group helps professionals create more supportive teaching and clinical environments and awards grants to advance increased understanding of compassionate, patient-centred care.

As the Vice-President of Education at University Health Network, Hodges also oversees clinical education for about 6,500 students each year, and says the organization works to create an environment that models these essential elements of working in the health professions.

“To my mind,” says Hodges, “there’s no such thing, as a competent health professional who is not caring and compassionate.”

Strength in Numbers U of T Medicine’s Boundless Campaign: Made Strong by our Community of Supporters When the Faculty of Medicine launched its $500 million campaign, the target seemed attainable, but also a little overwhelming. No other faculty of medicine in Canada has ever set such a fundraising challenge. But U of T Medicine and its international community of more than 50,000 alumni are known for groundbreaking initiatives. So far, the Faculty has raised almost three-quarters of our campaign target — and more than $50 million has been donated by alumni.

As at September 30, 2014

Campaign to date: $372,688,917 Total donated by our alumni: $52, 257,663

$80 a month goes a long way at U of T Medicine One of the many areas where supporters have made a significant impact is through our annual giving program. This initiative provides important year-to-year support to the Faculty’s programs, research and students. Between May 2013 and April 2014, U of T Medicine received over $2 million in gifts — the first time annual giving to the Faculty has reached this milestone. On average, annual giving donors gave $80 per month, proving that no gift is too small to make a big difference.

May 1, 2013–April 30, 2014

$2,010,957 raised through U of T Medicine’s annual giving program Number of annual giving donors: 1773 (25% of whom made their first gifts to Medicine) The average giving per donor was $1,134 — which amounts to approximately $80 per month.

There’s still work to be done!

By Priority Area Student programming and support (12%) Faculty support (16%) Research grants (31%) Programs and research (38%) Infrastructure (3%)

With your help, we will reach our goal and transform health through our groundbreaking research and innovative education programs. Please visit boundless.utoronto.ca/medicine or call 416-946-3111 to learn more and make your gift today.

— MONIFA MILLER FALL 2014 — 25

26 — U of T Medicine

“Just Tell Them You’re Going to Make It Better for Students” Dean Catharine Whiteside Looks Back on Nearly a Decade of Change

By Lloyd Rang IT’S THE FIRST WEEK OF SEPTEMBER. NEW STUDENTS PASS Dean Catharine Whiteside’s office window in the northeast corner of the Medical Sciences Building on their way to classes and labs. They’re smiling and excited.

“When I arrived here as a student right out of high school, this building had just opened — the newest on campus,” says Whiteside.

Whiteside joined the University of Toronto as a student in biomedical sciences in 1968. She completed her degree in four years and went on to do a three-year medical degree immediately afterwards. Although she would go on to be named one of Canada’s most powerful women by the Women’s Executive Network, Whiteside says there were definitely barriers to women in the medical professions.

“At that time, there was still a quota system in place for women in medical school,” she says. “The culture of medicine was much more conservative in the early 1970s.

ORIGINAL PHOTO: DEAN MACDONELL

That said, I was given some excellent opportunities early on that helped shaped my career.”

After graduation in 1975, Whiteside went on to study internal medicine. In her second year of residency, she had her first child, took a year off and worked part time as a casualty officer in the emergency room at Toronto General Hospital, then returned to residency, completing internal medicine and nephrology.

“You know,” she says, “I really enjoyed patient care and teaching, but in my final year of training that included experience in a basic science research lab I found myself falling in love with scientific discovery and lab work.”

After finishing the required one year of clinical work and one year of research in the program, she was told that there were no jobs available for clinician scientists. Undaunted, she went back to the university and earned her PhD in the Institute of Medical Sciences (IMS). She was offered a position in the Nephrology Division at the Toronto Western Hospital and joined the Membrane Biology Group as a clinician-scientist with a basic science lab in the Medical Sciences Building.

In the early 1990s, Whiteside was approached to become graduate coordinator in the IMS, the graduate unit for the Clinical Departments in the Faculty of Medicine.

“There was a real opportunity to link graduate training to the expansion of research. From 1992 to 1998, we expanded enrollment by 300 per cent,” says Whiteside. “But the real FALL 2014 — 27

DEAN WHITESIDE LOOKS BACK

“Precision medicine and the explosion of health and biomedical knowledge will turn medicine on its head.”

1. Victoria College graduation, 1972. 2. W.T. Aikins Award in Undergraduate Medical Education Teaching, 1986. 3. In 2006, after her appointment as Dean.

4. With former Deans C. David Naylor and Arnie Aberman, 2008. 5. With Terry Donnelly, 2011. 6. With CAMH CEO Catherine Zahn, 2008.

7. With Deputy Dean Sarita Verma, 2014. 8. The Dean’s Breakfast, 2014. 9. With hockey great Mats Sundin, 2012. 10. Convocation, Spring 2014.

value for me was that I met so many outstanding students and faculty members engaged in graduate training in those years. Many of the graduates have gone on to become leaders in our Faculty and elsewhere in Canada and beyond, and I’m very proud to have worked with them during their research training.”

In the late 1990s, the Dean of Medicine, C. David Naylor, asked Whiteside to become the Associate Dean of Graduate and Interfaculty Affairs. When Naylor suddenly left to become President of the University, Whiteside was asked to step in as Interim Dean of Medicine. In 2005, she applied for the job.

“I remember asking my children what I should say during my interview for the Dean’s position. They said ‘That’s easy, Mom. Just tell them you’re going to make it better for students,’” she says. “And that became my key message in my interview and the theme of my time as Dean. I think it’s critical to provide excellent education programs and ensure the best possible student experience.”

Looking back over her decades as a student, researcher, administrator and Dean, Whiteside has seen that experience change dramatically over time.

“When I started, only 12 per cent of students in med school were women. Today, we have a student population that is truly representative of the marvellous diversity we 28 — U of T Medicine

see in Ontario. And that includes more students who come from lower-income families, thanks to a more generous bursary system,” she says.

“As well, we have students with a much broader skill set. While a person’s GPA is still important, we also look at leadership, empathy and a desire to make a difference when evaluating prospective students,” says Whiteside. “The result is a pool of talent that is deeper and broader than anything we’ve had before.

Frankly, I’m not sure that if I applied today, I’d make the cut.”

Looking ahead, Whiteside sees exciting things in store for the students walking past her window.

“Precision medicine and the explosion of health and biomedical knowledge in the past few years — particularly in collaborative spaces like the Donnelly Centre — are going to turn medicine on its head in the next few years. The science we are able to do now would have looked like science fiction in the 1970s, and the pace of discovery is still accelerating.”

“Thanks to the leaders and the decanal team we’ve assembled, I’m confident the Faculty remains in good hands. We’re gifted with a leadership that is second to none, anywhere in the world, and I am very proud to have had a hand in bringing this group together.”

ALUMNI PROFILE

Awarding Excellence From health research and innovation to serving the Faculty of Medicine community, our alumni make an impact with their leadership, discoveries and commitment both in Canada and across the globe. To reward such outstanding contributions, Dean Catharine Whiteside honours three individuals each fall for generously giving their time, demonstrating great promise, or for a lifetime of achievements.

This year’s winners stood out for their brilliance, dedication and compassion.

differences of opinion, experience and background to bring a collaborative approach to projects, causes and pressing medical issues. Whether founding U of T’s Institute for Medical Science, doing groundbreaking work in endocrinology, advising in cancer control in developing counties, or serving as the Dean of the McMaster medical program, Laidlaw was an inspiration to many people. For his tireless dedication to his profession, Laidlaw has been awarded the Faculty’s Lifetime Achievement Award.

Championing Excellence

A Rising Star

“Not Just Microbes and Cancer” DR. JACK LAIDLAW graduated from the Faculty of Medicine in 1944 and went on to become one of Canada’s great physicians, researchers and compassionate caregivers.

His conviction that health is not “just microbes and cancer” but also “society and human relationships” resonated throughout his career.

By making the patient, rather than the disease, central to his practise, Laidlaw pioneered a human approach to health care.

Over the years, Laidlaw sought out PHOTOS: ERIN HOWE

leadership and contribution to medical research, education and care, the Faculty of Medicine presented Chan with the Rising Star Award.

After completing his DPhil on a Rhodes Scholarship at the University of Oxford, DR. AN-WEN CHAN came to U of T to pursue a dermatology residency. His pioneering research and policy work to make findings from clinical trials more accessible and transparent led to his recruitment to the World Health Organization, where he established international standards for publicly registering information about all published and unpublished clinical trials so their results could reliably inform patient care.

Chan is one of only four experts in Ontario trained in a specialized surgical treatment for skin cancer.

As a clinical epidemiologist, he studies how organ transplantation increases the susceptibility for developing this disease. Chan brings his broad insight to the students of the University of Toronto as both a professor and mentor. For his

“Doing good things helps remind you of your capacity to do even more,” says DR. BARNETT GIBLON . For the last 40 years, few have done as much for U of T’s Faculty of Medicine in support of students, faculty and the university as Giblon.

He is a physician, teacher, mentor and philanthropist, supporting the Department of Family and Community Medicine and Department of Physical Therapy.

He served on many Faculty of Medicine committees, in particular nearly three decades on the Admissions Committee and over two decades for Postgraduate Education.

His long service as a volunteer has helped produce the diverse and innovating graduate population currently championing medical excellence around the world.

This year, Giblon is being honoured with the Faculty of Medicine Alumni Volunteer Award for his generous service to the Faculty and its students, and for his unrelenting commitment to this vibrant community, which he continues to shape today.

— VERONIKA BRYŚKIEWICZ

BONUS: VIDEO uoft.me/medmag FALL 2014 — 29

Q&A

From Hospital to Home: Closing the Cracks in Care “It’s not until they get home when it all comes out.”

When the sickest patients walk out the hospital door with multiple prescriptions and a discharge summary full of instructions, what happens next? Some are finding their way to the Virtual Ward: a mobile team comprising a doctor, pharmacist and two care workers who help to ease the transition for those needing it most.

Based at Women’s College Hospital, the troubleshooting team hopes to keep frequent patients out of several Toronto hospitals through home visits, help sorting out prescriptions, and more.

And they’re available by phone until 10 p.m.

Recently, the team sat down with Heidi Singer to discuss their interprofessional, patient-centred model of care.

30 — U of T Medicine

Q: How does the Virtual Ward work?

TARA O’BRIEN, MD, Medical Director: Patients are discharged to us, and we follow them for four to six weeks until they’re stable enough to be transferred to a family doctor. The care coordinator and pharmacist visit the patient in their home within 48 hours of discharge.

MICHELLE HERMAN, Care Coordinator: We make sure they can get to their specialist, their medications are reconciled, they’re getting OT, PT and a personal support worker. Because we get in so soon, we often catch things that weren’t picked up in hospital — a change in mobility, they can no longer get to the front door to let help in. It’s not until they get home when it all comes out.

JANE ASCROFT, Pharmacist: Patients may not understand the changes that were made in the hospital and go right back on the medication that put them there. Or we’ll see blister packs with months’ worth of pills and only a few missing. You learn to be a good detective.

Q: Why is the Virtual Ward needed?

HERMAN: The hospitals and community see themselves as two separate entities. We connect the two.

That just isn’t happening anywhere else.

Q: Describe your typical patient.

O’BRIEN: Most will have multiple chronic conditions: heart failure, COPD, diabetes. Some have substance

THE ‘I’ IN TEAM

abuse or mental health problems.

ASCROFT: Throw in some arthritis and dementia with an elderly spouse taking care of them.

HERMAN: Some don’t have a family doctor, or relatives to take care of them.

Some need help transitioning to palliative care because of a diagnosis they got in the hospital.

Q: How does your team function together?

ASCROFT: Very well. Everybody’s voice and opinion is respected. There’s no hierarchy. If I don’t agree with the doctor, we’ll hash it out.

Q: How did you decide on this configuration?

O’BRIEN: The Virtual Ward was developed in the UK with nurse coordinators, but the one thing they were missing was the physician piece.

So we added a doctor since CACC provides nurses to do the home care.

Having a pharmacist is a huge asset.

They go through everything in the

Q: What surprises you most about what you’ve seen?

O’BRIEN: How sick these patients are.

And how hard it is to keep them out of hospital.

HERMAN: How much can fall apart on the drive home from the hospital. It’s also eye-opening for a lot of the medical students who get to come with us to the patient’s home. They see their

PHOTO: ERIN HOWE

home, through the discharge list in detail.

discharge summary on the floor — ASCROFT: And their prescriptions unfilled!

Q: What’s next for the Virtual Ward?

O’BRIEN: Our readmission rate is 21 per cent within a month versus 24 per cent, which is not statistically significant.

To improve that, we want to have more engagement with family care. If we can engage them better, the patient will have a better transition to the community.

ASCROFT: For a lot of them, we have made a difference.

From left: Michelle Herman, Care Coordinator; Tara O’Brien, MD, Medical Director; Jane Ascroft, Pharmacist.

FALL 2014 — 31

GLOBAL HEALTH

Stopping Ebola?

The Ethics and Efficacy of Speeding Up Drug Trials

s ’ e r Thoe nvaccine forfear.

BY SUNIYA KUKASWADIA

32 — U of T Medicine

An outbreak of the Ebola virus has killed thousands in Africa, but an experimental formula could theoretically halt the spreading plague. Should it be used?

field are the ones administering the trials.”

Traditionally, clinical trials take years to conduct and scientists have access to the best resources, health professionals and facilities.

In the case of West Africa, access to even the most basic resources can be challenging.

If the answer sounds straightforward, it’s not, according to Gibson also feels it’s important to use the several U of T ethicists who have been involved in the crisis. right language when talking about these There has been a lot of discussion over how to use these agents. “The Ebola outbreak has biological agents and whether their use could detract from understandably provoked a lot of fear and other treatments people are looking for hope. It’s too early to “What we’re seeing now shouldn’t come as a surprise to call these experimental agents ‘treatments’ or anyone who has been following global health and ‘vaccines’ because we don’t know if they’ll help infectious disease over the last two decades,” says Ross or harm people. We can’t make it seem like Upshur, a Professor in the Department of Family and those participating in these trials are Community Medicine and Dalla Lana School of Public privileged in any way because we don’t know Health. what the benefit will be,” she says.

“Previous Ebola outbreaks were controlled using public “I think the nature of this problem is health interventions such as early detection and isolation, skewed,” says Jim Lavery, a JCB affiliate and monitoring and infection control procedures.

Managing Director of St. Michael’s Hospital’s This outbreak could have been stopped had there been Centre for Ethical, Social, and Cultural Risk. adequate resources and had we used the right public health “This is a crisis of undercapacity, investment measures early on.” and appreciation for what it means to have a The World Health Organization recently made the healthy public health infrastructure within a unprecedented decision to use these investigational country and what it means to properly execute interventions — previously untested in humans — to stop public health responses internationally,” the outbreak despite little information about the efficacy or he argues. side effects. Now WHO is looking to accelerate clinical Lavery agrees that this is the time to test testing of drugs, vaccines and convalescent serums derived agents that show promise, but trials should not from blood that have shown the most promise during take away from public health efforts. “I think animal testing. the likelihood that these agents will make a “The virus is spreading at an alarming rate and you can difference in this outbreak is slim, but we have only test the effectiveness of an Ebola vaccine during an to seize the opportunity to learn whether they outbreak,” says Upshur, who was involved in WHO can work. The challenge is to do this without discussions that brought together leading experts to debate interfering with fundamental infection control the ethical considerations of using investigational agents. and public health procedures because we know “It may be that these agents are the only way to bring this those work,” says Lavery. under control in the long run.”

As well, Lavery worries that conducting the Jennifer Gibson, Director of the Joint Centre for necessary trials will be extremely challenging Bioethics (JCB), says we are dealing with competing ethical due to the infrastructure and resource obligations in this humanitarian crisis. Gibson, an expert constraints in West Africa, an area trying to in organizational and health systems ethics, participated rebuild itself after years of war. “The success of in a WHO ethics working group that provided input on these trials will depend on the knowledge we potential treatments and vaccines for Ebola. “On one hand, gain for future outbreaks. I’m afraid all of our there is an ethical obligation to learn from the outbreak to efforts will be for nothing if we don’t get valid serve future patients. On the other hand, the primary data this time around.” ethical obligation of health workers in the field is to do As world leaders debate the ethics of what they can for patients with whatever resources they expedited clinical trials, the collateral damage have available,” she argues. of the outbreak is setting in. “People are scared.

“The Ethics Working Group felt it was ethical to proceed We need to work with community leaders to with clinical trials as long as they did not compromise care help reassure people. Fear is the biggest enemy to patients. We need to figure out how to manage these of infection control,” says Upshur. “There’s no competing ethical obligations if health care workers in the vaccine for fear.”

e

FALL 2014 — 33

BOOK REVIEW

On the Bookshelf

By Meera Rai

Innovating for the Global South: Towards an Inclusive Innovation Agenda DILIP SOMAN, JANICE GROSS STEIN, JOSEPH WONG (EDS.) University of Toronto Press, 2014 Health inequity is a global crisis. How do we stop the growing chasm between the haves and have-nots in accessing consistent, effective care?

The authors of Innovating for the Global South propose a novel idea: instead of developing solutions in rich countries and importing them to the so-called Third World, perhaps those living in poverty should be at the centre of the innovation agenda.

The recently published book brings together University of Toronto experts in medicine, economics, political science, engineering and global health to offer ideas on eradicating extreme poverty.

The authors look closely at health and improving the living conditions of those in low- and middle-income countries, which they term as the “Global South.”

Though the text is largely theoretical, it articulates complex challenges and emphasizes inclusiveness as the foundation for change.

Placing those in poverty at the centre of the innovation agenda is a must. We often see global health innovation as a one-way transaction — advances made in high-income nations being transported to low-income nations. But the authors note that different forms of innovation can change health care delivery in both directions, which they suggest is essential for effective international partnerships.

Lack of access to health technologies, for example, is a major contributor to health inequity. Biopharmaceutical industries in emerging markets such as Brazil, China and 34 — U of T Medicine

India, have exponentially grown their capacity to participate in the innovation process. This is crucial, as these nations are home to some of the world’s poorest people.

Focusing on children is another major objective.

Malnutrition impacts more than just health. Those who survive a childhood of malnourishment have stunted growth and compromised brain function, their poor physical health causing productivity losses and overall reduction of earnings over a lifetime. The authors, including Stanley Zlotkin, a Professor in the Department of Pediatrics, suggest that more effective knowledge translation and coordinated, multi-sectoral efforts will dramatically improve the process of scaling up life-saving nutritional interventions. Prof. Zlotkin’s leadership of the Sprinkles Global Health Initiative is a prime example of such interventions, where the end result is the ability to combat malnutrition in children through “home fortification” of complementary foods using the Sprinkles micronutrient powder.

There is acknowledged scepticism about the term “innovation” and its frequent misuse. Innovating for the Global South suggests that innovation is not about new, expensive technologies being deployed in poor countries.

It’s not about implementing complex interventions. It’s not even about outcomes. Innovation is about the process of creating scalable solutions that ease suffering and improve the health of populations worldwide.

PHOTO: SOHANA SHAFIQUE

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OLD SCHOOL

By Professor Edward Shorter and Susan Bélanger

T

HE FIRST WORLD WAR HAD A profound and lasting impact on U of T’s Faculty of Medicine. In turn, the Faculty’s contributions to the war helped shape Canadian medicine in the 20th century.

When Britain declared war 100 years ago, Canada was caught unprepared, but the Faculty began mobilizing immediately. A dozen members went to Europe with the first contingent in October 2014. In May 1915 many more followed with the University of Toronto’s “No. 4 Canadian General Hospital.” These patriotic early volunteers longed to fight under the British flag.

Medical students were also eager to serve. Norman Bethune interrupted his studies to sign on as a stretcher­ bearer, becoming the eighth person in Toronto to enlist. Frederick Banting, rejected twice for poor eyesight, ultimately served as a medical officer after graduating in December 1916 with the special accelerated class of 1917.

New initiatives arose to deal with an unprecedented number of casualties.

In 1916 Charles Kirk Clarke, Head of Psychiatry and Dean of the Faculty, recognized combat stress as comparable to serious physical injury.

He steered the military towards more compassionate treatment of its psychologically wounded veterans than other countries provided.

Physical rehabilitation medicine was in its infancy in Canada, but the first modest training programs in 36 — U of T Medicine

physical and occupational therapy began on campus during the war.

Physiotherapists were trained at Hart House, and in 1918 female volunteers — called “ward aides” — began providing vocational retraining for wounded veterans.

At the outbreak of war, Toronto’s medical school was the largest in the British Empire with the exception of Edinburgh. Yet it offered no advanced training, which still had to be obtained abroad. The war brought many changes. Donations in recognition of the university’s wartime contributions allowed the Faculty to create a full-time professorship in medicine and another in surgery. Strong ties were established with hospitals, particularly Toronto General, reflecting a greater emphasis on clinical care and training.

But perhaps the most important significance of the Great War was its bonding experience. Professors and students trooped to the colours and came back as comrades. This reduced the competitiveness that marked other faculties. Long after the war, Faculty members referred to themselves and each other by their military titles. The war strengthened the Faculty’s ties to Toronto hospitals, patient care, and to each other.

Edward Shorter is the Faculty of Medicine’s Jason A. Hannah Professor in the History

Drs. Duncan Graham, J.J. Mackenzie and Cyril Imrie in the “Pathological Tent” (i.e., the medical lab) of the university’s “No. 4 Canadian General Hospital” in Salonika, Greece, around 1915. Graham (centre) became the Faculty’s first Professor of Medicine in 1919.

of Medicine and also a professor in its Psychiatry Department. Susan Bélanger is research coordinator in the History of Medicine program. Visit uoft.me/livinghistory to view more photos or share your memories of your time at the Faculty of Medicine.

BONUS: STORY + PHOTOS uoft.me/medmag PHOTO: U OF T ARCHIVES

FALL 2014 — 37

Calling All Alumni

Stay in Touch!

To ensure that you receive invitations to Spring Reunion, as well as faculty and departmental events, please send your updated contact information to address.update@utoronto.ca.

Congratulations!

You can also follow us on Twitter, Instagram and Facebook at UofTMedicine!

The Faculty of Medicine would like to extend warm congratulations to our 2014 Faculty of Medicine Dean’s Alumni Award winners: DR. JOHN LAIDLAW Lifetime Achievement Award

DR. BARNETT GIBLON Faculty of Medicine Volunteer Award

Upcoming Event DR. AN-WEN CHAN Rising Star Award

You can find out more about this year’s winners in this issue of U of T Medicine (page 29) and view interviews online at uoft.me/medmag.

Please visit uoft.me/Medalumniawards for more information about these awards and to find out how you can nominate a Faculty of Medicine alumnus/a.

Spring Reunion 2015 Save the date for the University of Toronto’s 2015 Spring Reunion weekend, which will be taking place on May 27–31st, 2015. Honouring all alumni who graduated in years ending in 5 and 0, this is a fun weekend of lectures and lunches, dinners and drinks.

Visit www.springreunion.utoronto.ca in the New Year to see a list of all the events and activities on offer and to see photos and videos from past reunions.

FEBRUARY 7

TORONTO

Department of Otolaryngology Alumni Update and Dinner

Be sure to stay in touch for more upcoming events!

Contact Morgan Tilley, Alumni Relations/Annual Fund Coordinator at 416-978-3588 or morgan.tilley@utoronto.ca if you have any questions about alumni programming, events or volunteer opportunities.

The MD classes of 4T5, 5T0, 6T0 and 6T5, along with the graduating class of 2015, will be among the classes honoured at the Medical Alumni Association’s (MAA) Convocation Banquet in Hart House, on Monday, June 1st, 2015.

Stay tuned for more information!

If you are an MD graduate and are looking for more information about your upcoming reunion, please contact the MAA at medical.alumni@utoronto.ca.

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