100 Years of Alberta Medicine

YEARS OF

ALBERTA

MEDICINE

DEDICATED TO ADVANCING HEALTH THROUGH TEACHING, RESEARCH AND PATIENT CARE

Contents Timeline

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Impact

8

Value

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Advancement

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The white coat

44 Four-year-old Adelaide Radbourne received a heart transplant at the age of six months. Clinician scientist Lori West helped prepare her for transplant.

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100 YEARS OF ALBERTA MEDICINE MESSAGE FROM THE DEAN

Ideas are the engine of true innovation and, as a faculty, we are in the business of ideas — ideas designed to improve the human condition. Collectively, these ideas advance health through teaching, research and patient care.

Unlike mushrooms, ideas do not grow in dark moist CURTIS COMEAU

places. They require the light of sound knowledge. They require the nurturing of good mentorship. And they require purposeful weeding to separate the good growth from the chaff.

The University of Alberta Faculty of Medicine & Dentistry represents an ideal born more than 100 years ago. As the first medical school established west of Winnipeg, the Faculty is now at the forefront of medical education and research; is one of the topranked medical programs in the world; and is home to internationally respected researchers in diabetes, obesity, virology, cardiology, cancer, transplantation and spinal injury rehabilitation, to name a few. But what has sustained us on this century-long journey: government funding, research grants or program accreditations? No. We have advanced by and through the power of our ideas: ideas that foster new solutions such as drugs, devices and medical procedures; ideas that create new curriculum to train the next generation of skilled health-care professionals; and ideas that build strong networks and attract partnerships.

As you turn these pages, you will read the narrative of our ongoing journey of ideas through short snapshots of our work. You will read stories of the Faculty’s impact on health and the economy, of the value our work brings to society through research and education, and of our contributions that help advance our institution and our communities. But the history of our Faculty is not written in these pages or in headlines. It is a flowing narrative of events, a thoughtful dialogue and a subtle context in constant evolution. These are only a few of our stories, a mere glimpse of where we have been and where we are heading.

So step forward and join us as we enter a new century of Alberta Medicine.

D. Douglas Miller, MD, CM, FRCPC Dean Faculty of Medicine & Dentistry University of Alberta

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OUR FIRST HUNDRED YEARS 1942-45 The wartime classes are accelerated. Two extra classes graduate. 70 per cent of the graduates enlist.

1913 The University of Alberta medical school is established.

It is the only medical school created in Canada between 1883 and 1945, the first one west of Winnipeg, and the only one until 1950. Students must travel to McGill or the University of Toronto to complete their final two years of clinical training.

1923 The Nobel Prize in Medicine is awarded for the discovery of insulin. J.B. Collip, who isolated and concentrated the first therapeutically effective insulin while on a sabbatical from the Faculty of Medicine, is promoted to professor of biochemistry.

1952 1927

The McEachern Research laboratory opens as the first medical research facility at the U of A. It is funded by the Alberta Cancer Society.

The first dentistry class graduates from the University of Alberta School of Dentistry. It is the only DDS program west of Toronto until the 1950s.

1920s

1940s

1918 The U of A medical program receives accreditation from the American Medical Association.

The U of A receives a $500,000 endowment from the Rockefeller Foundation, which requires the University of Alberta to build the medical school, add the final two years of clinical training and graduate MDs.

1960s 1956

1935 1925 The U of A’s first MD degrees are granted to 11 students, including the university’s first female graduate in medicine, Leone McGregor.

She is the gold medal winner and class valedictorian.

The graduating class achieves the highest class standing on the national LMCC exams, for the first time.

1946 Residency training programs in surgery, obstetrics and gynecology, medicine and ophthalmology are established under the Royal College of Physicians and Surgeons of Canada.

The Medical Science Research Club is established at the U of A, bringing together medical and clinical scientists. The club is later named the Collip Research Club in honour of J.B. Collip.

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The first successful open-heart surgery in Canada is performed by Faculty member John Callaghan at the University of Alberta Hospital.

THE U OF A MEDICAL SCHOOL 1988 The Faculty establishes the Indigenous Health Intitives program to help correct the underrepresentation of First Nations people in healthcare professions. The school’s first aboriginal medical alumnus, Johnny Brisebois, graduates in 1993. To date, 73 aboriginal physicians have graduated from the U of A, more than half of all of the aboriginal MDs in Canada.

1962 Faculty members Ray Ulan and Lionel McLeod perform the first chronic hemodialysis treatment in Canada.

2010 The Li Ka Shing Foundation donates $28 million to the University of Alberta, leading to the creation of the Li Ka Shing Institute of Virology, and establishing the medical school as an international centre of excellence in virology research. It is the largest cash donation in the history of the University of Alberta, and is matched by the province.

1978 Faculty member Henry Shimizu and a team of surgeons perform the first successful functional limb replantation in North America.

1968 Faculty member Michael James establishes the first protein crystallography laboratory in Canada.

1980s

2000s 2000

1987 Faculty member Lorne Tyrrell and his team discover the antiviral properties of the compound lamivudine, which becomes the first drug treatment for chronic hepatitis B carriers.

Faculty member James Shapiro and his team report their successful islet cell transplants in the New England Journal of Medicine. The landmark treatment for Type 1 diabetes becomes known around the world as the Edmonton Protocol.

2013 The University of Alberta celebrates 100 Years of Medicine.

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A $2 BILLION ECONOMIC ENGINE FOR ALBERTA What is the value of a medical school to a university, to a community and to a province? A medical school trains the doctors who treat you, your children and your parents, and it attracts the medical specialists who would not practise without a university appointment.

A medical school impacts our health in many critical ways. But what is the actual dollar amount that a medical school generates through its activities?

2.5 The Faculty generates 2.5 times the value of every operating dollar it receives from the university.

For the Faculty of Medicine & Dentistry that number is about $2 billion according to an economic impact study released in May 2013. That amount is generated through operational, capital, and visitor and student spending, as well as through clinical operations and salaries and benefits. The study also showed that the Faculty creates and supports jobs for more than 13,500 Albertans and has graduated 28 per cent of the family doctors and physician specialists caring for patients in the province.

The report provides evidence of the critical role the Faculty of Medicine & Dentistry plays in fueling Alberta’s economic engine. It generates real income,

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The Faculty of Medicine & Dentistry at a glance

provides jobs, and educates doctors and dental professionals who move to communities across the province to care for Albertans. The Faculty also impacts the day-to-day lives of patients and their families through research discoveries and providing the latest world-class treatments through clinical trials.

“We are the flagship medical school in Alberta,

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departments

8

research groups

15

centres and institutes

6

undergraduate degree programs

3

diploma/certificate programs

52

medical residency programs

17

PhD programs

13

master’s programs

643

tenure-track faculty members

and we have a provincial responsibility,” says D. Douglas Miller, dean of the Faculty. “This report demonstrates unequivocally how integral we are to the province’s economic success, as well as the city of Edmonton and the University of Alberta.”

In 2012, the University of Alberta provided the Faculty of Medicine & Dentistry with an operating budget of $79.6 million. The economic impact study

1,688+ clinical academic colleagues (physicians and dentists in the

demonstrates that the Faculty generates 2.5 times

community who teach students

the value of every operating dollar it receives from

in hospitals, clinics and private

the university.

practices)

The U of A’s Faculty of Medicine & Dentistry is the first medical school in Canada to conduct an evidence-based review of its economic impact.

Tripp Umbach, the agency that authored the report,

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administrative, clinical and research staff

has compiled economic impact studies for several American medical schools.

To read more about the economic impact of the Faculty of Medicine & Dentistry, go to

www.med.ualberta.ca

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IMPACT

ANSWERING THE CALL FOR FAMILY DOCTORS THE FACULTY OF MEDICINE & DENTISTRY HAS GOOD NEWS FOR ALBERTANS WHO DON’T HAVE A FAMILY DOCTOR

If you are one of the many Albertans without a family doctor, the Faculty of Medicine & Dentistry has some good news for you.

A record 41 per cent of the medical students who graduated in our centennial year as part of the class of 2013 chose to become family physicians and have been accepted into family medicine residency programs.

Imran Raghavji (’13 MD) is a graduate who chose a career as a family doctor. Born in Calgary, he is now doing his residency at a family clinic at

Imran Raghavji (’13 MD) with patient Margaret Johnson

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the U of A. Raghavji chose family medicine for the diversity, for the ability to provide continuity of care to patients over the course of their lives, and for the flexibility to focus time and energy on a particular area of interest while still maintaining a broad family practice. He credits the medical school’s eight-week clerkship program for solidifying his interest in family medicine.

“The U of A medical school dedicates a lot of resources to family medicine. The program immerses you into the field immediately, resulting

Delivering patient care

“U OF A HAS A STRONG FAMILY MEDICINE PROGRAM AND RECOGNIZES THE VALUE OF BOTH RURAL AND URBAN EXPERIENCES”

A medical school does much more than teach future doctors in classroom and clinical settings; medical residents also care for patients. Approximately 874 residents treat patients and deliver clinical care through the Faculty of Medicine & Dentistry’s 52 residency programs. When you visit any hospital in the Capital region for a medical appointment, chances are your care is provided by a resident.

in a comprehensive and broad experience,” he says of the clerkship which places students in rural clinics for four weeks and in urban settings for the other four. “U of A has a strong family medicine program and recognizes the value of both rural and urban experiences.”

Lee Green, chair of the Department of Family Medicine, said the Academic Alternative Relationship Plan (AARP) is a major factor in this “huge increase” in students choosing to be family doctors. The AARP was established in 2005 by the Alberta government and allows academic family doctors to be compensated for teaching and conducting research as opposed to relying solely on billing for their income. In 2003, only 16.5 per cent of U of A medical students chose family medicine as their profession.

“By funding the faculty to do more teaching, it has allowed us to teach more residents and expand the program to the point where we can provide more family doctors. It’s freed the faculty to focus on education and on teaching well, and this in turn has made the program better and more attractive to potential residents.”

Lee Green

A centre of excellence for family medicine The Faculty of Medicine & Dentistry not only provides you with family doctors, it is also working to improve the care you receive when you visit that family doctor. Renowned family medicine researcher and physician Lee Green was recruited from the University of Michigan last year to chair the U of A Department of Family Medicine.

With funding from Alberta Innovates – Health Solutions, Green came to the U of A to embark upon a large-scale transformation of how primary care is delivered. The recruitment of an investigator of Green’s calibre is evidence that the U of A is becoming an international centre of excellence for family medicine.

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HELPING CHILD STROKE PATIENTS WALK BETTER

INTENSIVE PHYSIOTHERAPY PROGRAM DEMONSTRATES DRAMATIC RESULTS

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Suffering a stroke can be devastating, no matter what the situation. But stroke seems even more shocking when it happens to the very young.

Perinatal stroke occurs either just before or just after birth and usually results in disability.

Two-year old Alesandra Antipan-Delgado suffered a stroke shortly after she was born, resulting in difficulty walking, climbing stairs and balancing as she grew older. Now, Alesandra is doing all of those things like any other two-year old, thanks in part to researchers with the Faculty of Medicine & Dentistry in collaboration with the Faculty of Rehabilitation Medicine.

Left: Alesandra Antipan-Delgado practises her walking in the lab

Right: Jaynie Yang (left) and Monica Gorassini (’94 PhD) work with a young patient

Monica Gorassini (’94 PhD) and Jaynie Yang from the U of A Centre for Neuroscience are working on a cross-disciplinary research project to improve the walking of children like Alesandra who have suffered perinatal stroke.

The duo has received $1.1 million in funding to launch a larger provincial study after seeing impressive results from a pilot in which children demonstrated marked improvements in leg mobility and symmetry while walking.

Gorassini’s role is to determine whether extra leg exercises for the children, including walking on a treadmill with support, kicking, splashing and stepping on steps, are genuinely improving connections in the damaged side of the brain, and if new pathways from the brain to the spinal cord are created or restored. Physiotherapists will work with children between the ages of eight months and three years. The team will follow children involved in the study until four years of age to see if there are positive, long-term and sustained changes in their lower-limb mobility due to the intensive physical therapy sessions.

“Intensive physiotherapy could save a child from painful surgeries, and save the health-care system money,” says Gorassini. She also hopes the work will prevent deformities in the feet, ankles and legs caused by a lifetime of disuse or favouring the affected leg.

Alesandra’s mother, Rhina, an occupational therapist who works with adult stroke patients, was impressed with her daughter’s results in the pilot study and says Alesandra is achieving developmental milestones on par with her twin brother. “I feel like the focus of the study on early intervention and intense therapy was critical in terms of helping her develop normal skills,” she says.

If the larger study demonstrates similar results to the pilot, the research team will embark on province-wide in-services to share its findings and to encourage a new standard of care for perinatal

“INTENSIVE PHYSIOTHERAPY COULD SAVE A CHILD FROM PAINFUL SURGERIES, AND SAVE THE HEALTH-CARE SYSTEM MONEY”

stroke — early, intense physical therapy intervention.

The team will expand the study to children with damage to both sides of the brain to determine if early intensive training can help children learn to walk who would normally be confined to wheelchairs.

The initial study was funded by the Women and Children’s Health Research Institute and the U of A Provost’s office. The larger provincial study is funded

by Alberta Innovates – Health Solutions and the Canadian Institutes of Health Research for three years.

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GETTING PEOPLE BACK ON THEIR FEET VIVIAN MUSHAHWAR AND HER TEAM WORK TO HELP PEOPLE WHOSE LIVES HAVE BEEN TURNED UPSIDE DOWN BY NERVOUS SYSTEM INJURY OR ILLNESS When Vivian Mushahwar completed her PhD in 1996, she was in demand around the world. Her research at the University of Utah had been incredibly fruitful — she had developed a potential way to restore the ability to stand and walk in people with spinal cord injuries. But there was a lot of work to be done before the technology could be used in patients and Mushahwar had her pick of universities when it came to finding a new ‘home’ for her research.

She chose the U of A Faculty of Medicine & Dentistry, which already possessed an established reputation in neurorehabilitation. This diverse field encompasses the science and technologies needed to help people recover nervous system function that has been lost due to disease or injury. The human and financial toll of these conditions is staggering.

For traumatic spinal cord injury alone, the annual economic burden in Canada is $2.7 billion.

“The Division of Neuroscience [now the Centre for Neuroscience] was the ideal environment to move my research forward,” says Mushahwar. “We have an incredible community of basic scientists, engineers and front-line clinicians all committed to the same high standard of excellence.”

And move forward she has. Mushahwar’s team is on track to implant the very first neural prosthesis in humans. Sometime next year, it is expected that this tiny device will be surgically implanted in two volunteers who have complete spinal cord injury. The device’s hair-like micro-electrodes stimulate nerves in a specific region of the spinal cord to create the coordinated muscle contractions needed for standing and walking. “This is exploratory testing, a world first,” notes Mushahwar, whose voice vibrates with anticipation and excitement. “We’ll establish whether it’s safe, feasible and functional.”

Mushahwar is no stranger to success in developing solutions to help people with spinal cord injury and disease. She already has a product close to commercialization for pressure ulcers, one of the serious consequences of immobility. More than 80 per cent of people with spinal cord injuries develop deep pressure ulcers, which are different from sores that develop on the skin. They are very expensive to treat and can lead to life-threatening complications, even death. The estimated annual cost of pressure ulcers in Canada is about $3.5 billion.

“Existing interventions don’t target deep pressure ulcers,” explains Mushahwar. “We found that the way able-bodied people prevent them is by fidgeting, subconsciously.” This fundamental insight formed the scientific basis for Smart-ePants — custom underwear that replicates fidgeting by stimulating backside muscles via an intermittent electrical current. A phase 1 clinical trial of various Smart-e-Pants prototypes in different clinical environments will conclude this year, and has so far shown that patients and clinicians accept the garment and that it would fit into daily care routines.

Vivian Mushahwar adjusts a Smart-e-Pants device

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Mushahwar chats with patient Callum Duncan

A phase 2 clinical trial is planned to explore efficacy.

Proven medical results would allow for the adoption of Smart-e-Pants in the health-care system.

Another area of research is the rehabilitation of walking after neural injury or disease. Traditional interventions for standing and walking focus solely on training the legs. However efficient walking involves swinging the arms. Mushahwar wondered if it would be possible to take advantage of the neural connections between the arms and legs to improve walking. Her team set about designing an exercise program of coordinated arm and leg cycling. “This is the first time anyone has looked at using arms to rehabilitate legs,” she says. “We found that, regardless of how many years had passed since their injury, patients were able to substantially improve their walking speed, endurance, and balance, as

well as reduce secondary conditions like spasticity and uncontrolled spasms. It’s amazing.”

“Everyone on my team is inspired by the individuals we aim to help — fabulous people with huge potential whose lives have been turned upside down by nervous system injury or illness,” notes Mushahwar. “Whether it’s standing and walking or the prevention of pressure ulcers, our goal is to make a difference in their lives.

Slowly but surely, we are.”

MEDICAL RESEARCH INTENSITY

3rd IN CANADA

The Faculty of Medicine & Dentistry is third in Canada in terms of medical research intensity according to RE$EARCH Infosource Inc.

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NEW TECHNOLOGY FOR MAKING MEDICAL ISOTOPES PIONEERED AT U OF A CYCLOTRON FACILITY COULD HELP SOLVE WORLD’S ISOTOPE SHORTAGE

Sandy McEwan

Not being taken seriously was a new experience for Sandy McEwan. After all, his credentials demand respect: chair of the Faculty of Medicine & Dentistry’s Department of Oncology, an international leader in nuclear medicine, and developer of the largest radioisotope therapy program in Canada, among others. And yet five years ago when McEwan and his team started talking about using a cyclotron to make technetium-99m (the medical isotope used in approximately 80 per cent of all nuclear medicine tests), people did not listen.

Medical isotopes are safe radioactive tracers used primarily in imaging tests to diagnose illnesses such as cancer and heart disease. The U of A’s medical isotope team, all members of the Department of Oncology, includes cyclotron scientists Steve

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McQuarrie, John Wilson and Katie Gagnon, and radiopharmaceutical scientist Doug Abrams.

Fast forward to 2013. Not only are people listening, they’re asking him to please talk to them.

McEwan and his team from the U of A, along with collaborators from the University of Sherbrooke and Advanced Cyclotron Systems Inc. (a British Columbiabased cyclotron manufacturer), have proven the technology to make technetium in a cyclotron. They’ve put this technetium through its paces, and it works just as well in clinical trials as technetium produced in a nuclear reactor. That’s important because right now Canada’s technetium comes from two aging reactors: one in Chalk River, Ontario, that is scheduled to cease isotope production in 2016 and the other in Petten, the Netherlands, that is scheduled to shut down soon after.

Unplanned maintenance and repairs at both reactors have already caused serious worldwide medical isotope shortages. These situations have led to the focus on nonreactor-based methods to produce technetium and are one of the reasons why people are very interested in what McEwan and his team have to say.

A cyclotron uses strong magnetic and electric fields to accelerate particles, which then transform a target material into technetium. The Edmonton team developed the process in the cyclotron at the Cross Cancer Institute.

This cyclotron is used for radiopharmaceutical research as well as to manufacture isotopes required for positron emission tomography (PET) scanning. “The more work we did, the more we began to believe that this process would work,” says McEwan. “All of our theoretical calculations panned out. We achieved the purity as well as the yields of the radiopharmaceutical that we expected.”

80%

Since then, the team has is the best way to manufacture PET commissioned a new, more probes. With our facility, we’ve given powerful cyclotron in the new U of Alberta an evolutionary path to new A Medical Isotope and Cyclotron isotopes.”

The U of A cyclotron makes Facility at the South Campus (in McEwan is now preparing to take the type of medical isotope the old Balmoral Curling Club), a more active role in promoting the and will start to ramp up the cyclotron model, including meetings used in 80 per cent of all production process in the fall of with provincial and federal officials, nuclear medicine tests 2013. Commercial production could potential investors and international begin by early 2015; the facility has groups, not a typical role for an the capacity to supply the 500 doses academic. “I’m terrified, to be honest, of technetium that Alberta uses every day. but this is a once-in-a-lifetime opportunity,” he says.

The focus is now not so much on technology “We have a fantastic research facility that can involve development but rather on developing the business many disciplines — medicine, chemistry, engineering model. No decision has been made on which isotope of all kinds, nanoscience, pharmacy, and more. We manufacturing method Canada will choose, and have an enormous opportunity for training and teaching there are competing technologies and groups. because there is a dearth of radiopharmaceutical One key advantage of the cyclotron model is that it scientists and technologists across the world. And is capable of more than technetium production. “In my finally, we have the technology in Alberta to solve the mind, technetium probably has a limited future,” notes world’s looming medical isotope crisis and ensure we McEwan. “I believe the next generation of medical meet the need for new isotopes in the future.” isotopes will be probes for PET imaging. The cyclotron

McEwan working with the hot cell in the cyclotron facility

“WE HAVE THE TECHNOLOGY IN ALBERTA TO SOLVE THE WORLD’S LOOMING MEDICAL ISOTOPE CRISIS”

VALUE LEADERSHIP IN TRANSPLANTATION RESEARCH, ORGAN AND TISSUE DONATION A NEW NATIONAL TRANSPLANT RESEARCH PROGRAM LED BY FACULTY MEMBER LORI WEST COULD HELP MORE CANADIANS GET LIFE-SAVING TRANSPLANTS LIKE THE HEART ADELAIDE RADBOURNE RECEIVED

Renowned pediatric transplant cardiologist and researcher Lori West has been tasked with leading Canada’s new transplant research program — news that buoys the Radbourne family.

Adelaide Radbourne received a heart transplant at the Stollery Children’s Hospital at the age of six months and, according to her mother Chloe, is now a “busy, bossy, loving little girl” of four — a preschooler, budding ballerina and soccer player. The Radbournes must still travel from their Grande Prairie home to Edmonton every three months to meet with Adelaide’s organ transplant team, and Adelaide will need immunosuppressant drugs for the rest of her life. But according to Chloe, it is a small price to pay for the miracle of her daughter’s new heart.

West was the cardiologist who first treated Adelaide and helped prepare her for transplant.

The Radbournes are optimistic that, under West’s leadership, the Canadian National Transplant Research Program (CNTRP) will help pave the way for more families across Canada to experience miracles like Adelaide’s.

The CNTRP is designed to increase organ and tissue donation in Canada and to enhance the survival and quality of life of Canadians who receive transplants. The new program builds on the U of A’s reputation for transplant research excellence. In addition to West, Faculty researcher James Shapiro (’01 PhD) will also lead a research project as part of this national network. The program brings together

Lori West leads Canada’s new transplant research program

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“WE’VE NEVER HAD A TRANSPLANT-SPECIFIC PROGRAM WITH THE POTENTIAL TO AFFECT THE LIVES OF SO MANY PEOPLE”

105 investigators and 86 collaborators from across the country to carry out research and develop resources to help transplant patients and those waiting for tissue or organ transplants.

“This is a unique initiative,” said West. “We’ve never had a transplant-specific program with the potential to affect the lives of so many people suffering from malignancies and end-stage organ failure. The impact of transplantation as a field to Canadians with severe and chronic diseases is enormous.”

The statistics are staggering: 4,500 Canadians are on waiting lists for organ transplants, and many of these people will die before receiving one. In 2010, for example, nearly one-quarter of candidates for heart and liver transplants died without receiving transplant surgeries. In addition, 40 per cent of

Building on a proud history Leadership in transplant surgery and research is not a new role for the Faculty of Medicine & Dentistry.

The Alberta Transplant Institute (ATI), in close partnership with Alberta Health Services, brings together all of the university’s clinical transplant programs and its multiple research strengths under one umbrella. Edmonton’s multi-

Adelaide is now a “busy, bossy, loving little girl”

organ transplant program is one of the most comprehensive clinical programs in Canada and is a leader in both the numbers of transplant procedures performed and success rates in adults and children. The ATI is also home to the world’s largest islet transplant program to treat Type 1 diabetes. The science behind this treatment, the Edmonton Protocol, was also developed at the U of A more than 10 years ago.

patients with leukemia or other blood-related diseases were without bone-marrow donors.

The economic impact of transplantation is also extraordinary. For example, every kidney transplant performed saves the health system more than $60,000 per year.

The CNTRP will transform the field of transplantation by addressing the barriers to donation, therefore increasing the number of available organs, improving the quality and viability of donated organs and grafts, and improving long-term survival and quality of life of transplant patients. It is the first program in the world to unite and integrate the solid organ transplant, bone marrow transplant, and the donation and critical care research communities together in a ground-breaking national research endeavour.

The Canadian National Transplant Research Program receives support from the Canadian Institutes of Health Research in partnership with Canadian Blood Services, the Canadian Liver Foundation, Cystic Fibrosis Canada, Fonds de recherche du Québec - Santé, Genome British Columbia, the Kidney Foundation of Canada, the Canadian Society of Transplantation, Alberta Innovates – Health Solutions and Astellas Pharma.

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A KEY DISCOVERY IN THE FIGHT AGAINST ALZHEIMER’S DISEASE

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MORE THAN 1 MILLION CANADIANS ARE EXPECTED TO BE DIAGNOSED WITH ALZHEIMER’S DISEASE IN THE NEXT 30 YEARS. WHAT IF WE COULD DESIGN A DRUG TO REVERSE SOME OF THE EFFECTS OF THE DEVASTATING DISEASE? Jack Jhamandas has discovered that a diabetes drug called AC253 appears to restore the ability to remember in brain cells from animals with Alzheimer’s disease. When treated with AC253, memory was restored to levels similar to those in normal animals. Jhamandas and his team have shown that the drug can block the toxic effects of a protein called amyloid that leads to the death of brain cells. Amyloid protein diminishes memory and is found in abnormally large amounts in the memory and cognition parts of the brains of Alzheimer’s patients.

“This finding is very important because it tells us that drugs like this might be able to restore memory, even after Alzheimer’s disease may have set in,” says Jhamandas.

His team is continuing its research in this area and wants to see if the drug, when given before symptoms appear, can “stop the impairment of behaviour and cognition altogether in animals destined to develop Alzheimer’s,” says Jhamandas.

Since it is difficult for AC253 to cross the blood– brain barrier, it will be necessary to design a similar drug that penetrates brain cells more easily.

“I think what we discovered may be part of the solution, but I can’t say it will be the solution. I don’t think one drug or approach will solve Alzheimer’s disease because it’s a complicated disease, but I am cautiously optimistic about our discovery and its implications.”

The Canadian Institutes of Health Research funded the work of Jhamandas and his Faculty of Medicine & Dentistry team.

Jack Jhamandas supervises the work of student Diya Shi

$143,571,082 The total value of research funding to the Faculty of Medicine & Dentistry in 2012

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40 More than 40 faculty members have received awards recognizing their excellence in teaching.

GREAT TEACHERS TRAINING GREAT DOCTORS

AWARD-WINNING TEACHERS AT THE FACULTY OF MEDICINE & DENTISTRY USE CREATIVE METHODS TO GET RESULTS What makes the Faculty of Medicine & Dentistry one of the top ranked clinical and pre-clinical health schools in the world? What leads our medical students to score highest in the country on their medical licensing exams for the past two years in a row?

One of the key factors is undoubtedly the quality of teaching. Faculty members have garnered more than 40 awards for excellence in teaching, including five national 3M Teaching Awards, Canada’s top honour for teaching excellence at Canadian universities.

Pediatrics associate professor Sarah Forgie is one of the Faculty’s 3M teaching awardees who uses non-traditional methods to teach a sevenweek course on infectious diseases. Her teaching style, which she dubs “medutainment”, includes creating beatnik poetry about abdominal infection and performing a pop song about strep throat on

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the ukelele. She also challenges the students to come up with their own creative ways to teach their peers about infections, resulting in raps, videos, game shows and skits. It’s all geared to provide memory “hangers” to help students remember the information, a method Forgie says is proving highly effective.

Sarah Forgie uses a ukulele to help teach a class

Oncology professor Scott North is another of the Faculty’s nationally recognized 3M teachers.

Each year, he teaches a four-week course on cancer.

Instead of giving students paper-based cases, North brings in alternative-medicine practitioners or patients who are using alternative therapies. He once brought a patient dying of cancer and his wife to talk to the students about their grief process. Actors also visit the class to act out different scenarios as

patients with varying types of cancer-like symptoms.

In one exercise, North has the students practise breaking bad news to patients who have terminal cancer.

For Forgie and North and the hundreds of other top teachers at the Faculty, it’s all about training our future doctors to make them the best they can be at their chosen professions and to provide the best possible care to patients.

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100 YEARS OF ALBERTA MEDICINE ONE OF THE U OF A MEDICAL SCHOOL’S OLDEST LIVING GRADUATES REFLECTS ON A REMARKABLE CAREER AS THE FACULTY WELCOMES ITS 100TH CLASS

For a century, the University of Alberta has been training the doctors who treat Albertans and their families, and who live and work in the province’s communities. We are very proud of our first 100 years of advancing health through teaching, research and patient care and the many extraordinary people who have passed through these corridors.

Ted Aaron (‘42 MD) is one of those extraordinary people. At the age of 95, he is one of the U of A medical school’s oldest living graduates. A list of the colleagues he worked with over the years reads like a

RICHARD SIEMENS

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who’s who of medicine and research, and his resumé is littered with “firsts.” “Oh I can tell you stories,” he says of his remarkable career. “I’ve had a lot of fun.”

After graduating with his MD, Aaron trained in New York with renowned allergist Robert Cooke, one of the founders of the American Academy of Allergy. During that time, Aaron got a call from Philip Levine, one of the scientists who identified Rh factor, inviting him to observe the first procedure to exchange blood without Rh factor in a newborn who was Rh incompatible with the mother — a procedure that is now commonly used. Later, while working in Pittsburgh, Aaron conducted the original clinical studies on two antihistamines (neohetramine and thephorin) that helped lead to their use in over-the-counter cold medications; he declined compensation for this work. “I was foolish in those days,” he laughs.

To Alberta’s great benefit, Aaron turned down many job offers in the U.S. in order to return to Edmonton in 1950 to practise. One of the first trained allergists in Canada, Aaron was the first person in Alberta to administer penicillin and the first in western Canada to do Rh blood typing. He also

Ted Aaron (‘42 MD): “Oh I can tell you stories.”

1,791

The Faculty of Medicine & Dentistry’s 100th medical school class

The Faculty of Medicine & Dentistry is home to 1,791 students: 1,042 undergraduate students, 597 graduate students and 152 post-doctoral fellows.

suggested the development of the first steroid nasal spray for allergic rhinitis and nasal polyps while in Alberta; he and his partner conducted the first trials. And he came up with the idea to make a solution out of an asthma drug that was normally inhaled to use as eye drops to treat severe allergic swelling. The drops were later marketed as Opticrom.

In recognition of Aaron’s many contributions to health care in the province, he was named one of Alberta’s Physicians of the Century; in addition, he received a U of A Distinguished Alumni Award and a Queen Elizabeth II Diamond Jubilee Medal. He has maintained strong ties to the U of A over the years with various generous gifts to the Faculty. His legacy to medical students continues through prizes for achievement in allergy and rheumatology, pulmonary medicine, clinical skills and oncology.

In August 2013, the Faculty of Medicine & Dentistry welcomed the newest cohort of future doctors — the U of A’s 100th medical school class — to campus and to the halls of the Walter C. Mackenzie Health Sciences Centre. Aaron has some words of advice for the latest students to don the white coat, emphasizing the importance of innovative thinking as well as duty to patients: “You have to take good care of your patients, but new ideas are also important. If you have an idea, don’t be afraid to follow it up, to test it out. That’s where medical advances begin.”

Changing faces The composition of the 100th class demonstrates just how much the practice of medicine has changed in Alberta in the past century. More than half of the 165 class members are female — a very different profile from the school’s inaugural 1913 class of only 27 male students. The first female students did not enroll at the U of A until the following year.

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ADVANCEMENT

PUTTING DOCTORS IN RURAL COMMUNITIES THE FACULTY OF MEDICINE & DENTISTRY IS TAKING STEPS TO ADDRESS ALBERTA’S RURAL DOCTOR SHORTAGE

Serving rural Alberta’s medical needs Rural Alberta needs doctors.

It’s a simple truth but the solution is much more complex. While a strategy of recruiting more doctors to rural and remote locations in Alberta has worked as a short-term fix in some communities, it’s not considered a sustainable strategy to address Alberta’s chronic shortage of rural physicians. Over the past decade, the focus has shifted from physician recruitment to long-term solutions focused on education and training initiatives that encourage students to consider a career in rural medicine.

The Faculty of Medicine & Dentistry is on the leading edge of this change in culture. In 2006, the Faculty established the Office of Rural & Regional Health to coordinate initiatives and to support the development of new health-care training programs for rural and regional Alberta.

“We seek to weave rural and regional health through the education and training of U of A medical students and residents,” says Fred Janke, director of the office. “In the undergraduate program, we’re reaching individuals who haven’t yet made a career choice, and we’re giving them experiences that show how enriching the practice of rural medicine can be. At the graduate level, residents can complete specialty rotations in rural Alberta that build on their knowledge of rural health care. About 70 to 80 per cent of graduates from our rural residency program stay rural. We’re responding to a very real need in rural and remote communities.”

Doctor shortages are not simply a health-care issue; they affect the social fabric of communities by eroding quality of life. A 2013 report from the Alberta Chambers of Commerce noted that “With the growing physician shortage, rural communities are at risk of losing much more than the opportunity to receive local medical care.” Using figures from the College of Physicians and Surgeons of Alberta and provincial census data, the report’s authors calculated a ratio of 591 individuals per physician in rural Alberta compared to 212 per physician in urban Alberta.

To address this imbalance, the U of A established a number of programs to give medical learners an in-depth understanding of the unique challenges and benefits of working in Alberta’s rural communities.

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First- and second-year medical students can apply to shadow physicians for a weekend to experience what rural medicine has to offer. Third-year medical students complete mandatory month-long rural and regional family medicine rotations. Students and residents may also choose additional core rural and regional rotations.

A window into rural family medicine The Rural Integrated Community Clerkship (Rural ICC) Program is a core clerkship option for third-year medical students. ICC students who are accepted into the program are placed in selected Alberta rural communities for approximately 40 weeks. They participate fully in all venues of health care in their ICC communities. The Rural ICC began in 2007 with 7 students and has grown to 19 students in 2013.

11,008 11,008 of the Faculty of Medicine & Dentistry’s 13,695 graduates have remained in the province to work and to serve Albertans

Community faculty member Mike Caffaro (‘90 MD) has been practising in Hinton since 1993

Erin Côté (’09 MD) was in the first group of Rural ICC students in 2007. She did her placement in Sylvan Lake and has been practising in Hinton since 2012. “Rural medicine was always on my radar,” she says. “I’m from Swift Current, Saskatchewan, and I wanted to practise in a smaller centre like my hometown. I knew the Rural ICC would give me exposure to the type of work I wanted to do. The training was highly relevant.”

Côté says the Rural ICC is also a good option for those who are not necessarily committed to a rural practice because it gives students enough time to truly evaluate the work and the lifestyle. “People who are born and raised in small places are probably more open to going back to small places. If you grew up in a large centre, you’d naturally have concerns about your personal life. Will you make friends?

Will there be activities you enjoy doing? These are legitimate questions. The Rural ICC gives you that exposure, so you can see what it’s like to live in a smaller community.”

Erin Côté (‘09 MD) came to Hinton in 2012 to practise

Supporting the transition from theory to practice Preceptors play an important role in showing students what life is like for rural physicians.

“They give you a good look into the practice as well as the community life,” says Côté. “If they’re involved in the community and have lots of things they like to do outside the clinic, you naturally want to model your practice after them.”

Jill Konkin, associate dean of community engagement, says that clinical preceptors are vital to all rural programs, not just Rural ICC. “To be frank, we can’t run our programs without them.

We have significantly improved relationships with preceptors, and our focus now is to increase support for preceptors and help them feel part of the Faculty.”

Michael Caffaro (’90 MD) became a preceptor just a year after establishing his family practice in Hinton in 1993. “The kind of teaching we do here is somewhat different than what my colleagues do in the city. We offer a far broader experience. Urban family docs aren’t in the hospital

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Côté and Caffaro both appreciate what a small community has to offer

taking out an appendix or doing a caesarean section.

Rural docs have to be generalists.

“The bigger part of what we teach is how to listen to your patient and how to build a sense of trust in a relationship. Of course this is the cornerstone of all medicine, not just what we do. However as rural doctors, we have more of an opportunity to demonstrate that and to give students and residents a chance to try it out themselves.”

Rural communities are partners in training Peace River is an example of a community that has embraced medical education and supporting doctors in clinical learning and education. It has been a site for the Pre-Clinical Networked Education Medical (PNME) program since the program was implemented in 2010. PNME allows second-year medical students to spend four weeks in a rural community for their gastrointestinal and nutrition courses, providing them with increased clinical exposure to support their learning. The community also hosts Rural ICC students and family medicine residents.

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“As many preceptors do, the physicians had some anxiety that they wouldn’t have enough time to dedicate to the learners, but Peace River became a wonderfully productive community of learners,” says Konkin. “Everybody got something out of it. While all learners were coached by practising physicians, the residents helped the third-year students, the third-year students mentored the second-year students, and the second-year students shared what they were learning about new treatments with their preceptors.”

Studies have shown that physician shortages negatively impact the business community’s ability to recruit and retain employees. That’s one of the reasons the Grande Prairie Chamber of Commerce has become highly involved with the residency program. Grande Prairie and Red Deer are the two locations for the U of A Rural Family Medicine Residency Programs where residents learn entirely in rural/regional settings.

“WE SEEK TO WEAVE RURAL AND REGIONAL HEALTH THROUGH THE EDUCATION AND TRAINING OF U OF A MEDICAL STUDENTS AND RESIDENTS”

Partnering with communities U of A medical students and residents help deliver health care in towns and smaller cities across Alberta through the Faculty of Medicine & Dentistry’s rural medical education programs. The Faculty thanks the following teaching sites for hosting our learners in 2013-14.:

Opening minds to a rural practice When Michael Caffaro came to Hinton in 1993, he was going to stay for two to five years. He’s now in his 21st year. “This has been a good place to develop really important, deep relationships,” he says. “Not just with friends but with patients too. We continue to enjoy great support from the community and the local administration. All this has made the practice of medicine a lot of fun. I look forward to going to work every day.

“Training is a great way to gently incent people to try rural practice. Even for those who choose to go on to a speciality, they’ll know what it’s like to practise outside the cities. So when a physician calls them with a problem from a remote part of Canada, they’ll understand the challenges he or she faces.

At the very least, we can provide that. At the most, we can get people to consider — whether for a short time or a lifetime — the opportunity to practise in a place where you know your neighbours, where patients appreciate you and the community supports you, and you get to practise very interesting medicine of a wider variety than you ever could in an urban setting.”

Athabasca

Lamont

Banff

Lethbridge

Barrhead

Peace River

Bellevue

Ponoka

Bonnyville

Rimbey

Bow Island

Rocky Mountain House

Camrose

St. Paul

Cold Lake

Slave Lake

Drayton Valley

Spirit River

Edson

Sylvan Lake

Fairview

Taber

Fort McMurray

Three Hills

High Level

Tofield

High Prairie

Trochu

Hinton

Vermilion

Innisfail

Wainwright

Jasper

Westlock

Killam

Wetaskiwin

Lac La Biche

Whitecourt

Lacombe

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NORTH OF 60 AS ONE OF THE WORLD’S NORTHERNMOST MEDICAL SCHOOLS, THE FACULTY OF MEDICINE & DENTISTRY IS BECOMING THE GATEWAY TO CANADA’S NORTH

In 1923 the Rockefeller Foundation gave a $500,000 endowment to the University of Alberta to expand its medical school. It was part of the foundation’s mandate to promote the well-being of humanity through helping “strategically placed medical schools in various parts of the world to increase their resources and to improve their teaching and research.”

Now, in the centennial year of both organizations, the Faculty of Medicine & Dentistry is continuing the Rockefeller Foundation’s spirit of exploration and expansion with its own work “north of 60” — in the Canadian north. As one of the world’s northernmost medical schools, research and program delivery in northern communities is a natural fit for the Faculty.

Gita Sharma is a big part of that work. The Centennial Professor of Aboriginal and Global Health and Endowed Chair of Aboriginal Health is an internationally known expert in dietary assessment and nutritional risk factors for chronic disease in unique populations from the Canadian Arctic to the Amazon.

Sharma has worked with many populations in Canada’s north including Inuit, Inuvialuit and First Nations in Nunavut and the Northwest Territories and is the architect of Healthy Foods North, a successful nutrition and physical activity program to reduce obesity in Inuit populations in Arctic Canada. She is working in many northern communities and hopes to expand her work to more of the world’s circumpolar countries.

“The U of A is the gateway to the north and is doing a large number of interventions in cancer, diabetes, heart disease and obesity in these northern communities,” says Sharma. “The communities want programs for chronic disease prevention, not just more research. I’m working to help make the U of A the go to place in Canada for Aboriginal health research and program delivery.”

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Gita Sharma spends much of her time working in northern communities

“THE U OF A IS THE GATEWAY TO THE NORTH”

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FUTURE DOCTORS TAKE GIVING TO THE COMMUNITY SERIOUSLY Medical student Sheila Wang outfits a student in surgical gear at the Rockin’ Docs camp for kids 7 to 13 years

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MEDICAL STUDENTS SERVE COMMUNITY NEEDS THROUGH MD AMBASSADORS PROGRAMS

It’s part of what makes a doctor.

Engagement and outreach to the community are part of the broad social mandate of future medical professionals. And medical students at the U of A take these roles seriously. To foster social accountability, the Medical Students’ Association established the MD Ambassadors program.

MD Ambassadors are medical student-run initiatives aiming to promote health education and health care through outreach programs. From summer camps with a medical twist aimed at school kids from lower socioeconomic groups, to Big Brothers Big Sisters elementary and junior high programs, to an outreach program to inform rural students about careers as physicians, med students are contributing to their communities.

And it doesn’t stop there. Last year Alberta’s future physicians and dentists were also the top Movember fundraising team in Canada. Fifty students in the second-year medical and dental classes sported moustaches for the month of November and raised $21,566 to support prostate cancer research and awareness and men’s mental health.

673 There are 673 MD students in the Faculty of Medicine & Dentistry.

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TELEGLAUCOMA HELPS PEOPLE A WORLD AWAY

PROGRAM BUILDS LEADERSHIP AND CAPACITY IN SUB-SAHARAN AFRICA “When it comes to global health, there is no ‘them’... only ‘us.’”

This statement is a mantra of the U.S.-based Global Health Council, but it also summarizes the motivation behind the Faculty of Medicine &

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Dentistry’s global health initiatives. A case in point is the work of Karim Damji in sub-Saharan Africa, where glaucoma is the second-leading cause of blindness, affecting at least 4 per cent of people after age 40.

Glaucoma is typically caused by a buildup of fluid pressure in the eye that damages the optic nerve, leading to permanent loss of side vision and eventual blindness if left untreated. Glaucoma is particularly hard hitting in Africa where it is underdiagnosed and

“IT’S ABOUT BUILDING LEADERSHIP AND INSTITUTIONAL CAPACITY IN SUB-SAHARAN AFRICA, SO THAT AFRICANS CAN RUN THE SHOW”

GLOBAL The Faculty’s Office of Global Health provides students and faculty opportunities to increase their understanding of world health issues and works to address those priorities.

Karim Damji explains the optic nerve findings from a teleglaucoma exam

undertreated. After losing their sight, glaucoma patients in Africa often lose their social supports and their economic livelihoods and may also die young.

Karim Damji, a professor in the Department of Ophthalmology, started a teleglaucoma program

through the University of Alberta in 2009. The program allows glaucoma specialists to detect the ailment from a distance using a virtual eye exam. Damji and his colleagues mentored eye specialists in Kenya and Ethiopia on how to assess, treat and operate on those with glaucoma. These specialists in turn share their knowledge, empowering others.

Further funding has gone to buy equipment, such as mobile retinal cameras, and to train technicians and program managers in Africa about how to obtain basic patient information and take eye images. Then patient files are sent to the local specialists trained by Damji and his team to determine whether the people who tested positive for glaucoma need eye drops, a simple surgery to lower pressure in the eye, or a more complex surgery at a major centre. For difficult or unusual cases, the specialists in Africa consult with the teleglaucoma team at the University of Alberta.

“We hope to expand this program to other countries in east Africa,” says Damji. “It’s about building leadership and institutional capacity in subSaharan Africa, so that Africans can run the show in terms of developing international standards of care, education and research relevant to tackling the scourge of glaucoma. Ultimately, we want to detect the disease early and prevent blindness. I grew up in east Africa in Uganda, Tanzania and Kenya. I also feel very blessed to be a Canadian. I feel a real affinity for underprivileged people and am thrilled to serve in east Africa, where preventing glaucoma blindness will have an enormous positive impact on people’s quality of life.

I have a strong desire to give back and help others help themselves.”

Damji’s teleglaucoma program receives funding from Grand Challenges Canada — one of 15 grants to the country’s “rising stars in global health.”

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HEART AND STROKE RESEARCH ATTRACTS $25 MILLION GIFT

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COMMITMENT BUILDS ON FACULTY’S HISTORY OF RESEARCH AND CLINICAL EXCELLENCE

Justin Ezekowitz working with patient Ali Shawwa

The University of Alberta has a long and storied history of excellence in heart and stroke research and patient care dating back to 1956 when heart surgeon John Callaghan performed the first openheart surgery in Canada.

But engaging in world-class innovative research comes at a cost, which is why Justin Ezekowitz and his colleagues in the Faculty of Medicine & Dentistry are so gratified by the recent $25 million financial commitment from the Heart and Stroke Foundation of Canada.

“This commitment is to all our researchers in cardiovascular and vascular care within the Faculty,” says Ezekowitz, an associate professor in the Department of Medicine’s Division of Cardiology.

“Human research is complex and longitudinal, so we need that multi-year financial commitment to allow for truly transformative research to occur.” Without the security of long-term funding, researchers are compelled to split their focus between their work and securing funding, he says.

“When end-stage heart disease, also referred to as heart failure, is diagnosed, many patients are acutely ill, so the study of new medications and therapies to assist them is ongoing and involves many facets of research,” says Ezekowitz. He explains that the Heart and Stroke Foundation’s mandate of reducing Canadians’ rates of death from heart disease and stroke by 25 per cent by 2020 aligns well with the long-term research of the Faculty.

This research is carried out at the Canadian VIGOUR Centre, where Ezekowitz is a faculty member. The centre, he says, is “a mechanism for research excellence, which is what we do here at the University of Alberta.

“The Canadian VIGOUR Centre is essentially the brains of our research,” he says. “It links us with organizations and researchers around the world and includes researchers, biostatisticians, managers of projects and the infrastructure we need to complete this transformative research.” The centre allows researchers to manage their projects by providing them with the administrative and infrastructure support they need to complete long-term, in-depth analysis and determine treatments.

Now, with the financial freedom to concentrate wholly on developing new innovations in heart and stroke care, Ezekowitz and his colleagues acknowledge the generosity of the Canadians who supported the Foundation’s recent commitment.

“The Heart and Stroke Foundation has a clear mission and vision — healthy lives free of heart disease and stroke — for all Canadians, which has let a lot of research and investigations take place. “[Ours] is important work in acute clinical management of patients and without this broad collaborative network and the generosity of the Heart and Stroke Foundation of Canada and the Canadians who donate to the foundation, this type of research couldn’t happen.”

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“BALANCE IS THE FIRM FOUNDATION OF ORGANIZATIONAL ADVANCEMENT TOWARD ANY SHARED GOAL — THE FACULTY OF MEDICINE & DENTISTRY ALREADY EXCELS ACROSS ALL THE ACADEMIC MISSIONS. I AM CONFIDENT THAT CONTINUING INNOVATIONS IN EDUCATION, SCIENCE AND CLINICAL CARE WILL EMERGE AS THIS COMMITTED TEAM SEEKS TO BUILD TRUE PARTNERSHIPS FOR SUCCESS ACROSS THE FACULTIES, THE PROVINCE OF ALBERTA AND THE WORLD.” — D. Douglas Miller, Dean Faculty of Medicine & Dentistry

CURTIS COMEAU

D. Douglas Miller advises third-year medical student Irfan Kherani as he examines a patient

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The white coat A doctor’s white coat represents duty, responsibility, respect, care and compassion.

It is the symbol of the medical profession as a whole and every aspiring physician seeks to earn the right to wear it.

But that coat comes with a significant price tag. Today the cost of obtaining an MD degree is approximately $60,000 — a staggering amount of debt for a young student to shoulder.

You can help.

To encourage future physicians, the U of A Faculty of Medicine & Dentistry has established the White Coat giving program and recognition society.

Through this program, your donation of $250 will congratulate and welcome a first-year student to the medical profession with the gift of a lab coat at the annual White Coat Ceremony. Your donation will also contribute to a bursary to give those students access to much-needed financial aid in their subsequent years of study.

To find out more about the White Coat program or any type of giving to the Faculty, please call 780-492-9051.

Second-year medical student Madura Sundareswaran

Photos: John Ulan (except where otherwise indicated) Design: Lime Design Inc. Writers: Connie Bryson, Janet Harvey, Raquel Maurier, Cait Wills Printer: McCallum Printing Group Inc.

FACULTY OF MEDICINE & DENTISTRY 2J2.00 WC Mackenzie Health Sciences Centre Edmonton, Alberta T6G 2R7 P. 780.492.6621 F. 780.492.7303 www.med.ualberta.ca