Annual Report

Department of Medicine 2004-2005

Submitted by Dr. David Eidelman Department of Medicine Annual Report, 2004-2005

Index

Page

I. Overview of the Department……………………………………………… 2

II. Highlights………………………………………………………………… 3

III. Strategic Overview……………………………………………………… 6

IV. Successes……………………………………………………………… 8

V. Undergraduate Report………………………………………………… 10

VI. Postgraduate Report…………………………………………………… 10

VII. Graduate Student Report……………………………………………… 11

VIII. Research Performance……………………………………………… 14

Appendix I – Honours, Awards and Prizes……………………………… 15

Appendix II – Consulting Activities………………………………………… 22

Appendix III – 2004 MUHC Publications………………………………… 23

Appendix IV – 2004 JGH Publications…………………………………… 112

Appendix V – Finestone Report…………………………………………… 141

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I. Overview of the Department

The Department of Medicine is the largest department in the Faculty of Medicine and one of the largest in the University with more than 800 faculty members, of which 423 are full-time. Of these 423 members, 247 of them hold clinical professorial positions (GFT-H). As a clinical department, Medicine is based in McGill’s teaching hospitals, primarily the McGill University Health Centre (MUHC) and the SMBD-Jewish General Hospital.

The McGill Department of Medicine is organized into 13 Divisions, encompassing all aspects of internal medicine and its subspecialties. The academic Divisions are Allergy and Immunology, Cardiology, Dermatology, Endocrinology, Gastroenterology, General Internal Medicine, Geriatrics, Hematology, Infectious Disease, Nephrology, Respiratory Medicine and Rheumatology. In addition to these divisions, we have the Division of Experimental Medicine that provides graduate students with supervision and training in collaboration with the Faculty of Graduate Studies. Several additional Divisions are hospital based and exclusive to the MUHC (Clinical Epidemiology, Critical Care, Human Genetics, Medical Biochemistry, Medical Oncology, Palliative Care and Rehabilitation Medicine). In addition to the Divisions, the Department boasts a series of large centres that carry out specialized research or provide highly specialized clinical care (e.g. McGill AIDS Centre, McGill Bone Centre, Meakins-Christie Laboratories, McGill Centre for Tropical Medicine, the Centre For Neurosciences in collaboration with the McGill Department of Neurology and Neurosurgery and the Centre For Host Resistance in collaboration with the McGill Department of Microbiology and Immunology).

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II. Highlights

Appointment of a new Chair

On July 1, 2004, Dr. David Eidelman succeeded Dr. David Goltzman as Chair of the Department. Dr. Goltzman, an internationally recognized authority in the field of calcium and bone biology, stepped down after a decade of outstanding leadership. Under Dr. Goltzman the Department successfully overcame many challenges, including the successful merger of the Montreal General Hospital and Royal Victoria Hospital Departments of Medicine. Dr. Goltzman’s term was marked by considerable growth and enhancement of the Department’s academic activities. Dr. Goltzman was particularly successful in increasing the research productivity and grant support through aggressive recruitment of excellent basic and clinical scientists.

Dr. Eidelman comes to the position of Chair after having served for 6 years as Director of the Division of Respiratory Medicine at McGill and the MUHC. Dr. Eidelman’s clinical background is as a respiratory medicine specialist with interests in airway diseases and obstructive sleep apnea. His scientific interest lies in the pathophysiology of airway disorders such as asthma and cystic fibrosis. Trained as a pulmonary physiologist, Dr. Eidelman began his career developing and studying animal models of asthma. His recent research work has focused on the role of nitric oxide and oxidative stress in asthma and cystic fibrosis. Dr. Eidelman has also been and organizer and teacher of pulmonary physiology at the medical school and graduate student levels.

Appointment of a new Associate Physician-in-Chief

Approximately three-fourths of the academic activity within the Department of Medicine is focused at the MUHC, where the Department Chair also fulfills the role of Physician-in-Chief. Given the scope of this position, it is necessary to

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appoint an Associate Physician-in-Chief to assist with the many leadership responsibilities. This position was previously held by Dr. Timothy Meagher, whose outstanding administrative work and clinical leadership greatly contributed to the success over the last administration. Dr. Meagher has gone on to become the Director of Clinical Development at the MUHC. In seeking a successor to Dr. Meagher, it was hoped that we could find an individual who could help support the Department’s educational mission, particularly with regard to the teaching of clinical medicine. We were extremely fortunate to recruit Dr. Linda Snell as Associate Physician-in-Chief in September 2004. Dr. Snell, previously the Director of the Division of General Internal Medicine, is an international authority on medical education. In addition to her responsibilities as Associate Physician- in-Chief, Dr. Snell will continue to be active in the Centre for Medical Education. She has been given a specific mandate to assist with the improvement of the teaching programs at the undergraduate and post-graduate levels.

Unfortunately, during the last year we were still without a permanent leader of the Department at the Jewish General Hospital. Nevertheless, Dr. Rubin Becker ably fulfilled the role of Acting Physician-in-Chief at the JGH, while continuing his responsibilities as Director of the JGH Division of General Internal Medicine. It is hoped that the coming year will see an exciting new leader for JGH Department. Dr. Todd McConnell completed another year of exceptional leadership of the Department at St. Mary’s Hospital. At the urging of his colleagues and the hospital administration, Dr. McConnell has agreed to undertake another term in this important role.

At the divisional level, following a highly competitive search process Dr. Dick Menzies was selected as McGill and MUHC Director of the Division of Respiratory Medicine to succeed Dr. Eidelman. Dr. Menzies comes to the position with a long history of administrative experience as a former pavilion manager for the Montreal Chest Institute, as well as the Director of the Respiratory Epidemiology Unit. An international authority in the fields of

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tuberculosis and the sick building syndrome, Dr. Menzies is an outstanding clinician scientist. In the Division of Hematology, Dr. Pierre Laneuville stepped down after nearly a decade of hard work and dedication as MUHC and McGill Director. A search for his successor is ongoing. In the Division of General Internal Medicine, Dr. Laurence Green of the Montreal General Hospital has taken on the role of Acting Director while a search continues for a replacement for Dr. Linda Snell. In addition to changes in divisional leadership, this year saw the review and reappointment of three Divisional leaders, all of whom had completed their first term: Dr. Jacques Genest, Cardiology; Dr. Henri Ménard, Rheumatology; Dr. Denis Sasseville, Dermatology.

The past year saw a number of important recruitments to the Department. This is most significant in the MUHC Division of Medical Oncology. After numerous departures from this Division, particularly at the RVH site, we were finally able to increase our staffing levels back to where they had been 5 years ago. In addition to Drs. Marie-Claude Gouttebel and Thierry Alcindor at the MGH site, we recruited Drs. Martin Chasen and Catalin Mihalcioiu at the RVH site. We successfully recruited Dr. Don Sheppard to the Division of Infectious Disease at the RVH following completion of his research training in the field of mycology. Dr. Lisa Koski joined the Geriatrics Division at the RVH, where she will study novel methods of rehabilitation of stroke patients. Dr. Lucy Opatrny rejoined the Department in the Division of General Internal Medicine at the RVH, where she will work on clinical studies of thromboembolic complications of pregnancy. Dr. Gershon Frisch was recruited to the Jewish General Hospital. Dr. Arnold Kristof was recruited to the Respiratory and Critical Care Divisions as a recipient of a Canada Research Chair investigating the cellular and molecular mechanisms that control gene transcription during pulmonary infection. There were also two recruits to the Gastroenterology Division. Dr. Ernie Seidman, a joint recruit to Pediatrics and Medicine, will establish a research program in inflammatory bowel disease. Dr. Kevin Waschke will work as clinician teacher and provide expertise in specialized endoscopic techniques. The past year also saw important

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departures. Two long time members of the MGH Department of Medicine Dr. Allen Gold and Dr. Mansour Jabbari retired after long and productive careers. Dr. Elliot Alpert left the RVH Department this year to take up opportunities in his native United States.

III. Strategic Overview

In his first year as Chair of the Department, Dr. Eidelman has focused a variety of strategic issues, with the goal of positioning the department for the challenges presented by changes in the educational and health care systems, as well as the pending move of part of the MUHC to a new campus in Glen Yards. The following initiatives build on the already excellent programs in undergraduate and graduate education, and our outstanding research base.

Postgraduate Training

Clinician-teachers and clinician-scientists constitute the backbone of the academic faculty of a Department of Medicine. As with most such Departments, a large proportion of our faculty is made up of former residents (medical post- graduate trainees) who have gone on to advanced training before returning to the Department. Because of restrictions on immigration and the difficulty in attracting clinical recruits from outside Quebec, recruitment of former trainees is particularly important at McGill. To ensure that our training program attracts the best students, the Department has begun to re-evaluate our core programs to ensure that we continue to provide the best possible training to residents. A first class training program helps to ensure that we attract the highest quality trainees who will eventually form our faculty.

Changes in the health care system have created major challenges to the maintaining excellence in post-graduate education. The development of regional

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plans for medical manpower has resulted in marked restriction in hiring of physicians in the Montreal area. While the goal is to improve the medical staffing in regional centers, a side effect has been the decreased attraction of specialty programs, including internal medicine, for graduating students. Fortunately, while our sister Quebec schools have seen a decline in application and unfilled slots, McGill has continued to attract applicants from Quebec and elsewhere. This appears to reflect the very high quality of our training program which continues to be highly competitive with those in other institutions within Quebec and across Canada.

Another challenge comes from the decision by the government to require internal medicine trainees to spend several months in regional centers. Although this provides trainees with an excellent opportunity to experience practice in rural or other underserved areas, it effectively reduces the number of residents available to cover clinical services in the teaching hospitals. This effect is compounded by changes in the nature of the wards, where most medical training traditionally occurred, leading to residents spending a greater proportion of their time in non- traditional settings such as the outpatient clinics. The net effect has been to increase the chance that residents will spend a disproportionate amount of time in service work. In order to address this problem we are revising the way in which our wards and other clinical teaching services function.

Network Development and Complementary Services

The Ministry of Health and Social Services has created a series of health care networks, centered on Quebec’s four medical schools. The McGill Réseau universitaire intégré en santé (RUIS) is based at the MUHC and encompasses activities at the Jewish General Hospital, St. Mary’s Hospital and the Douglas Hospital. The concept behind the RUIS is for tertiary referral centres to provide specialized services to outlying regions. The McGill RUIS, which includes a population base of 1.7 million, covers approximately 63% of Quebec’s land area

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stretching from downtown Montreal, through the western half of the island, through part of the Montérégie, into the Gatineau region, up through Abitibi- Temiscamingue, across the Cree Territories into Nunavik in Northern Quebec. This catchment area includes city dwellers, suburbanites, country folk and two separate aboriginal populations.

Although the driver for the establishment of the RUIS is clearly clinical need, this presents the Faculty of Medicine and the Department of Medicine in particular with extraordinary educational and research opportunities. To capitalize on these, it is essential that coordination and cooperation among teaching hospitals be optimized. Accordingly, the past year has seen an effort to increase cooperation and interchange between the two large components of the Department, the MUHC and the JGH. Henceforth, development of major clinical or research programs will be carried in a manner that avoids unnecessary duplication and competition within the McGill community.

IV. Successes

The Department was very successful in terms of grant funding this year as outlined in the attached data. Highlights of this success included a large number of salary awards. In particular, we are proud that 4 or the 9 chercheurs nationaux awards presented by the FRSQ were given to members of this department (Drs. Alan Barkun, Qutayba Hamid, Dick Menzies and Erwin Schurr). In addition, Dr. Vidal Essebag and Dr. Emil Nashi, who will join our staff in the next couple of years, were awarded Phase I Clinician Scientist Awards. Dr. Donald Sheppard, who has just returned to McGill, was a recipient of a highly competitive Phase II Clinician Scientist Award. FRSQ Chercheur boursier Junior I awards were received by Drs. Gillian Bartlett-Esquilant, Dr Sasha Bernatsky (who will join the Department in September 2005) and Dr. Maida Sewitch. Chercheur boursier Junior 2 awards were given to Drs. Jamie Engert and Christina Haston. Dr. Kostas Pantopoulos received a Senior award. Chercheur

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boursier clinicien Junior awards were obtained by Drs. Kaberi Dasgupta, Antonio Vigano and Christina Greenaway. Chercheur boursier clinicien awards were obtained by Drs. Susan Khan and Kevin Schwartzman.

Another highlight was the extraordinary success of Dr. Barry Posner, who along with his colleagues was awarded $16M from Genome Canada/Quebec in a grant that goes to 2007. In addition, together with Dr. Lawrence Rosenberg and 28 other investigators Dr. Posner was awarded another $14M from CFI for the Montreal Diabetes Research Center.

Dr. Alan Tenenhouse was made Professor Emeritus capping an outstanding scientific career. Other landmarks included Dr. Margot Becklake being named as a Woman of Distinction of the YWCA. Dr. Sam Benaroya was named a recipient of the Canadian Society of Internal Medicine 2004 Osler Award and Dr. Hugh Bennett was named to the Canadian Pacific Chair of Biotechnology. Dr. Phil Gold was awarded the Edwin F. Ullman Award of the American Society for Clinical Chemistry and Dr. David Goltzman has been named recipient of the Distinguished Service Award of the Canadian Society for Clinical Investigation. New recruit Dr. Ernie Seidman was named to the Kaufman Chair in Inflammatory Bowel Disease. Two members of the Department, Dr. Erwin Schurr and Dr. Qutayba Hamid were cited in Quebec Science for having each one of the top 10 scientific discoveries of the year. Dr Schurr was recognized for his work in recognizing leprosy susceptibility genes, and Dr. Hamid for the identification of a new target in the control of asthma. One of our outstanding clinical teachers, Dr. Suzanne Morin has received two important awards. In addition to being name to the Faculty Honor List for Educational Excellence, she received the Certificate of Merit from the Canadian Association of Medical Education. Dr. Joyce Pickering was named Associate Dean for Undergraduate Medical Education, succeeding Dr. Don Boudreau. Dr. Boudreau, also of this Department, has been appointed Director of Curricular Development.

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V. Undergraduate Report

The Department is one of the largest contributors to the undergraduate program of the medical school, providing instructors in all parts of the Basis of Medicine course. Our clinical teaching takes place both at the MUHC (Royal Victoria and Montreal General Hospitals) and the Jewish General Hospital. The Department is largely responsible for the Professional Skills course, which provides basic training of students for physical diagnosis and history taking, as well as the Introduction to Internal Medicine (pre-clerkship) course which provides basic introductory training in medicine. Finally, all medical students are required to complete an 8-week clerkship rotation on the medical wards as part of the Practice of Medicine. An innovation this year was the Patient Partner in Arthritis Program, which was provided to students in the pre-clerkship phase at the Royal Victoria Hospital. It provided students an opportunity to more effectively learn their musculoskeletal examination techniques. This pilot project was well received by medical students and it is hoped that in the future, we can offer these teaching sessions at all of our teaching sites.

VI. Postgraduate Report

The Department maintains a large number of post-graduate training programs for residents. The entry point for this program is the core McGill Internal Medicine Training Program. Entry to this program is highly selective. In 2004 the program received approximately 240 applicants, interviewed approximately 140, and accepted 19 candidates from all across Canada through the Canadian Resident Matching Service (CaRMS).

An important challenge for post-graduate medical education has been the creation of new guidelines from the Collège des médecins which, as of July 1, 2004, require that Internal Medicine Residents complete 3 months of rural Internal Medicine prior to the end of their third year of residency. The Training

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Program has spent much of the last year developing its links with community internists, and organizing select rural sites such that they can receive Internal Medicine Residents on a regular basis. With this in mind, the Training Program has established links with seven sites in Quebec: Amos, Thetford Mines, Hull, Gatineau, Cowansville, Valleyfield, and the Magdalen Islands. The redistribution of Internal Medicine Residents to rural sites has been a significant challenge for the Training Program, but this shift will no doubt ultimately broaden the exposure of more junior trainees to the possibility of community practice and careers in general internal medicine.

The Training Program successfully prepared for an Internal Review, which occurred in October of 2004. This process served to highlight the many significant strengths of the Program, including a very strong Resident Research program with a large number of publications in peer-reviewed journals by its residents. As part of this process, the Training Program has committed to increasing the number of program-wide academic activities over the next few years. This process served as a stepping-stone for the Royal College accreditation which will occur in April of 2006.

The coming year will lead to increased numbers of trainees, reflecting recent increases in medical school enrolment. The post-graduate training program in Internal Medicine remains highly competitive in the Canadian context and is expected to continue to attract high quality residents from Quebec and across Canada.

VII. Graduate Student Report

The Division of Experimental Medicine, providing graduate programs in the Department of Medicine, has completed its first full academic year under the directorship of Dr. Hugh Bennett with headquarters in room 101 of the Lady Meredith House.

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Highlights for the academic year 2004-2005

Two major policy changes were implemented during the academic year 2004- 2005.

a) Implementation of the Graduate Student performance tracking policy drawn up by the Graduate and Postdoctoral Studies Office (GPSO). The Division of Experimental Medicine instituted its own mechanism of tracking graduate student performance some 25 years ago. This involved the assignment of an Academic Advisor for each student and the holding of annual thesis meetings to assess progress, flag problem areas and approve the thesis format prior to submission. The second thesis meeting was a formal “Comprehensive Examination”, a pass being required for continuation in the program. The GPSO tracking system made mandatory for all graduate programs in 2004-20005 consists of a multi-page assessment of student performance and was designed to protect the interests of both student and supervisor. Approximately 20 academic advisors now track the performance of Experimental Medicine graduate students across the various research institutes associated with the Department of Medicine. They incorporate elements of both the old and new systems in their thesis meeting reports.

b) Establishing an M.Sc. program in Experimental Medicine. The Division of Experimental Medicine has always had an M.Sc. program as an option for those graduate students that fail their comprehensive examination or who wish to leave the graduate program early. The Executive Committee of the Division approved the establishment of a full M.Sc. program for a number of reasons including the fact that several Federal and Provincial bursary programs target both M.Sc. and Ph.D. programs and our students were losing out on some funding opportunities. Establishing the formal M.Sc. program was also a recognition that an increasing number of our students have begun to use the current M.Sc option. Starting in September, 2005 all graduate students will enter

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at the M.Sc. level (except those who already hold an M.Sc.) and the comprehensive examination will constitute the point where approval will be given by the thesis committee to “fast – track” into the Ph.D. program. In making this policy change the Division of Experimental Medicine falls in line with most other graduate programs offered at McGill University.

Graduate student and faculty member statistics for the academic year 2004-2005

Student registered in Experimental Medicine: 211

12 (Graduate Diploma in Clinical Research) 11 (M.Sc. – Bioethics Option) 188 (M.Sc. and Ph.D. in Experimental Medicine)

Students graduated (2004-2005): 35

2 (Graduate Diploma in Clinical Research) 1 (M.Sc. – Bioethics Option) 8 (M.Sc. in Experimental Medicine) 24 (Ph.D. in Experimental Medicine)

Students admitted to Graduate Programs (for September 2005): 48

12 (Graduate Diploma in Clinical Research) 6 (M.Sc. – Bioethics Option) 19 (M.Sc. in Experimental Medicine) 11 (Ph.D. in Experimental Medicine)

Faculty Members of Experimental Medicine (potential supervisors): 220

134 (Full Members)

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47 (Associate Members – McGill University) 35 (Associate Members – Université de Montréal, primarily from the Institut de recherches cliniques de Montréal) 2 (Associate Members – Institut Armand Frappier) 2 (Associate Members – Pharmaceutical Companies)

VIII. Research Performance

Given the size of the Department, research productivity is best highlighted by the large number of publications (901 in 2004) and substantial research support (over $40 million in 2004-2005). In addition, our members continue to demonstrate enormous success in personal support competitions. Notwithstanding this level of success, we have instituted a general review of our research progress that is expected to be completed during the coming year. This will allow us to identify areas of weakness and possible targets for strategic recruitment.

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