2009 – 2010 INSTITUTIONAL SELF STUDY REPORT

OF THE

UNDERGRADUATE MEDICAL EDUCATION PROGRAM

Prepared by the Self Study Task Force

For the

Committee on the Accreditation Of

Canadian Medical Schools (CACMS)

and the

Liaison Committee on Medical Education (LCME)

FINAL.09FEB2011 UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

TABLE OF CONTENTS

LIST OF ABBREVIATIONS AND ACRONYMS ...... iii 1. ABOUT THE FACULTY ...... 2 2. INTRODUCTION TO SELF STUDY ...... 2 2.1 Progress in addressing the areas of concern and noncompliance since the 2004 Survey ...... 2 2.2 Overview of How Self-Study Was Conducted & Level of Participation ...... 5 3. LCME STANDARDS & DATA BASE & FACULTY OF MEDICINE RESPONSE ...... 7 I. INSTITUTIONAL SETTING ...... 7 A. Governance and Administration ...... 7 B. Academic Environment ...... 11 Institutional Setting Strengths and Challenges...... 18 II. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE ...... 20 A. Educational Objectives ...... 20 B. Structure of the Educational Program ...... 22 C. Teaching and Evaluation ...... 24 D. Curriculum Management...... 26 E. Evaluation of Program Effectiveness ...... 29 Educational Program Strengths and Challenges ...... 30 III. MEDICAL STUDENTS ...... 31 A. Admissions ...... 31 B. Student Services ...... 34 C. The Learning Environment...... 36 Medical Students Strengths and Challenges ...... 39 IV. FACULTY ...... 39 A. Number, Qualifications, and Functions ...... 39 B. Personnel Policies ...... 42 C. Governance ...... 45 Faculty Strengths and Challenges ...... 46 V. EDUCATIONAL RESOURCES...... 46 A. Finances...... 46 B. General Facilities ...... 48 C. Clinical Teaching Facilities ...... 49 D. Information Resources and Library Services ...... 52 Educational Resources Strengths and Challenges ...... 54 SELF-STUDY SUMMARY ...... 55 LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 ... 59

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LIST OF ABBREVIATIONS AND ACRONYMS AALAC American Association for Laboratory CH Community Health Animal Care CHI Centre for Healthcare Innovation AAMC Association of American Medical Colleges CHP Clinical Health Psychology ABIM American Board of Internal Medicine CHS Community Health Sciences AC Accommodation Committee CIHR Canadian Institutes of Health Research ACLS Advanced Cardiac Life Support CiM Careers in Medicine ADD Attention Deficit Disorder CIS Curriculum Information System ADMEG Associate Deans of Medical Education CLSF Clinical Learning and Simulation Facility Group COE Cognitive Evaluation ADSA Assistant Dean Student Affairs CPD Continuing Professional Development AE Anaesthesia CME Continuing Medical Education (now CPD) AFMC Association of Faculties of Medicine of CMO Chief Medical Officer Canada CMS Curriculum Management System AGPA Adjusted Grade Point Average COPSE Council on Post Secondary Education APGO Association of Professors of Gynecology CP Clinical Psychology and Obstetrics CPAs Comprehensive Patient Assessments APOG Association of Professors of Obstetrics & Gynaecology of Canada CPDS Central Policy Development Section (Admissions) AN Anatomy CPSM College of Physicians and Surgeons of AV Audiovisual Manitoba BC Biochemistry CRC Canada Research Council BITG Bannatyne Information Technology Group CS Clinical Skills (PreClerkship) BL Blood and Lymphatic course CSu Clerkship, Summative BMSB Basic Medical Sciences Building CTU Clinical Teaching Unit CACMS Committee on Accreditation of Canadian CV Cardiovascular course Medical Schools DENT Dentistry CAHE Centre for Aboriginal Healthcare Education DLC Deer Lodge Centre CAPE Canadian Association of Professional Educators DM Dermatology course CAPIAH Committee on Academic Professional DSM Diagnostic Services Manitoba Issues for Aboriginal Health DS Disability Services CaRMS Canadian Resident Matching Service ECP Essential Clinical Presentations CAT Critically appraised topic EM Endocrine course CCAC Canadian Council on Animal Care ER Emergency medicine CCC Core Curriculum Committee ESC Education Subcommittee (Animal care) CCE Comprehensive Clinical Exam (in ET / ENT Ear, Nose and Throat course PreClerkship) FC Faculty Council CCMB Cancer Care Manitoba FCP Federal Contractors Program CCR Co-curricular Record FEC Faculty Executive Council CES Curriculum Evaluation Seminars FGS Faculty of Graduate Studies CFI Canadian Foundation for Innovation FITER Final In Training Evaluation Report CF Clerkship, Formative FM Family Medicine CH Concordia Hospital FMIS Financial Management Information System CGQ AAMC-AFMC Medical School Canadian FOP Fund/Organization/Program Graduate Questionnaire GFT Geographic Full Time (physician)

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GH Grace Hospital MH Medical Humanities Course GI Gastrointestinal course MHIKNET Manitoba Health Information and GIM Geriatric Internal Medicine Knowledge Network GN Genetics MHRC Manitoba Health Research Council GPA Grade point average MICB Manitoba Institute of Cell Biology (Cancer GSA Graduate Students‟ Association Care Manitoba) HD Human Development MICH Manitoba Institute for Child Health HRIS Human Resources Information System MITER Mid-In-Training Evaluation HSC Health Sciences Centre MM Medical Microbiology HSL Health Sciences Libraries group MMCF Manitoba Medical College Foundation ICSC Inner City Science Centre MMI Multiple Mini Interview ICU Intensive Care Unit MMSA Manitoba Medical Students Association IECCP InterProfessional Canadian Council MSK Musculoskeletal course IM Immunology MSPE Med Student Performance Evaluation IMG International Medical Graduate MSPR Medical Student Performance Record (formerly Dean‟s Letter) IN Internal Medicine MSR Multiple Specialty Rotation IPC Infrastructure Planning Committee (for Animal care) MURTA Male Urological and Rectal Teaching Associates – CLSF IPE InterProfessional Education NBME National Board of Medical Examiners IST Information Services and Technology NE Neuroscience course ITC Introduction to Clerkship NIH National Institutes of Health ITER In Training Evaluation Reports (mid rotation self evaluation) NJMHSL Neil John Maclean Health Sciences Library JOD Joint Operating Division NMR Nuclear Magnetic Resonance (U of M, Faculty of Medicine & WRHA) NMU J.A. Hildes Northern Medical Unit JPP Jacob Penner Park NTU Non Teaching Unit KD Nephrology course OARS Optimizing Academic Resources Project LAC Learning Assistance Centre OESH Occupational and Environmental Safety & LCME Liaison Committee on Medical Education Health (Bannatyne campus) LDS Learning and Development Services, OHSE Optimization of Health Services Education U of M (distributed education work group) LETS Libraries Electronic Technologies and OP Ophthalmology Services OPAL Online Portal for Advanced Learning LGBTTQ Lesbian, Gay, Bisexual Transgendered and (curriculum mgmt system) Two Spirited OR Operating Room LIB Library ORNH Office of Rural and Northern Health LM Laboratory Medicine OSCEs Objective Structured Clinical Exams MAA Master Affiliation Agreement OT Occupational Therapy or Therapist MCAT Medical College Admissions Test PA Pathology MCCQE Medical Council of Canada Qualifying PAEP Physician Assistant Education Program Exam PARIM Professional Association of Residents and MICB Manitoba Institute of Cell Biology Interns of Manitoba MaHSSA Manitoba Health Sciences Students PC Pharmacology Association PCC PreClerkship Committee ME Medical Education PD Pediatrics MeSH Medical Subject Headings PF PreClerkship, Formative

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PGME Post Graduate Medical Education PH Population Health course SMIS Student Management Information System PMRC Protocol Management and Review SMR School of Medical Rehabilitation Committees SOGH Seven Oaks General Hospital PR Problem Solving course STEM Ministry of Science Technology and Mines PS Psychiatry TDP Teaching Development Program PSu PreClerkship, Summative TIPS Teaching Improvement Project Systems PT Physiotherapy or Physiotherapist UAC Undergraduate Advisory Committee PY Physiology UGMCC Undergraduate Medical Curriculum RD Radiology Committee RFP Request for Proposal UGME Undergraduate Medical Education RHA Regional Health Authority UHS University Health Services RHAM Regional Health Authorities of Manitoba UMFA University of Manitoba Faculty Association ROSE Resource Optimization & Service UMFOM University of Manitoba Faculty of Enhancement Project Medicine RP Reproduction course UMG University Medical Group RS Respiratory course UML University of Manitoba Libraries system RT Respiratory Therapy or Therapist U of M University of Manitoba SAAM Subsidiary Affiliation Agreement-Medicine UTS University Teaching Service SBGH St. Boniface General Hospital VGH Victoria General Hospital SCAC Senate Committee on Animal Care WISH Winnipeg Interdisciplinary Student-Run Health SF Structure and Function WRHA Winnipeg Regional Health Authority SG Surgery SIP Strategic Initiatives Program

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1. ABOUT THE FACULTY The Faculty of Medicine was established in 1883 and is the only medical school in Manitoba. The medical school and its affiliated regions provide a complete range of primary, secondary and tertiary level care for the province, Northwestern Ontario and much of Nunavut. Most of the specialty and subspecialty care is provided for this population by the academic physicians. The Faculty of Medicine comprises 27 academic departments, institutes and administrative units including School of Medical Rehabilitation, which includes Occupational Therapy, Physical Therapy and Respiratory Therapy. The mission of the Faculty is to develop, deliver and evaluate high quality educational programs for undergraduate and postgraduate students of medicine and medical rehabilitation, for graduate students and postdoctoral fellows in basic medical sciences and for physicians to practice; to conduct research and other scholarly enquiry into the basic and applied medical sciences; to provide advice, disseminate information to health professions and plan for the development and delivery of health care services, and to help improve health status and service delivery to the Province of Manitoba and the wider community. In keeping with the mission of the Faculty, three key words articulate the mission of the Undergraduate Medical Education Program: discovery, scholarship and community.

2. INTRODUCTION TO SELF STUDY

2.1 Progress in addressing the areas of concern and noncompliance since the 2004 Survey Five accreditation standards were noted for non-compliance in the 2004 survey and much work has been done towards full compliance. This is described in detail in their respective sections. Most significantly, the issue of centralized curriculum governance has been tackled, with the establishment of a new organizational structure for curriculum governance and newly created positions to manage the undergraduate curriculum. Supporting the new structure are policies and procedures and terms of reference for the curriculum committees and job descriptions to clarify roles, reporting relationships and required process. This has allowed the Undergraduate Medical Education (UGME) Program to move forward towards compliance in all areas of the curriculum.

Standards Cited in 2004:

ED-2: The school has not developed quantified criteria and strategies for tracking numbers and types of patients needed to meet its clinical objectives.

A “logbook” to allow students to track essential clinical experiences during clerkship was developed two years ago. The Clerkship Curriculum Committee, working with the Clerkship Directors, has subsequently identified the number and types of essential clinical presentations (ECP) that each student must have in each of their domains. The ECP logbook is now online beginning the first day of each rotation and is available throughout to the student and also their preceptor, allowing for ongoing tracking in real time. An ECP gap report is generated electronically through the OPAL online curriculum management system after completion of the rotation and remediation plans are developed, if required. The remediation plan is noted on the final in training student evaluation (FITER) but there are efforts currently underway to notify the director/designate that there are gaps in the ECP before the FITER can be electronically submitted. Remediation options include the use of paper cases, the use of the Clinical Learning and Simulation Facility (CLSF) or additional direct patient exposure, as appropriate.

ED-24: There is inconsistent preparation of residents for their roles as teachers and evaluators. It is not clear that the residents are consistently familiar with the objectives of the clerkship in which they participate.

During 2010, a new Teaching Development Program (TDP) was developed through the combined work of the Associate Deans and senior administrative staff of UGME, PGME, Graduate Studies and the Department of Medical Education. Prior to 2010, residents participated in the Faculty Teaching Improvement Program (TIPS) and/or program-specific education on how to teach, but this was not consistent. Sometimes, TIPS

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 training occurred at the end of the residency after teaching medical students had already occurred. Feedback from residents indicated the generic nature of the TIPS training was not meeting their needs for developing bedside teaching skills.

This new TDP is a three year program for residents, fellows and graduate students. The program is moving forward on an incremental basis with only the first year of the TDP fully implemented. Beginning in 2011, the first year residents complete the now mandatory, first year module, regardless of whether their residency program has its own teaching program. The TDP year one is mandatory for graduate students and fellows. The TIPS program is required for graduate students and fellows and recommended for residents who are interested in further education.

In the fall 2010, the Associate Dean, PGME, surveyed PGME programs and confirmed that programs have mandatory sessions on how to teach for residents. The Associate Dean of PGME has mandated that all residents receive the UGME objectives as part of their residency orientation package. The students‟ accreditation survey rated their satisfaction with resident awareness of objectives in core rotations, with ratings ranging from 63% - 83% satisfaction, so there is still work to be done to improve satisfaction.

The Associate Dean, PGME appointed a Faculty Lead for the Teaching Development Program effective January 1, 2011. The Lead will be responsible for the ongoing development of the TDP program to enhance resident, graduate student and fellow teaching skills. He will be coordinating the contribution of faculty from all of the clinical departments.

ED-30: The report notes that formative feedback rarely occurs in courses during the first two years, and mid-clerkship feedback about clinical performance is not consistent across required clerkships. The program appears to have regressed on this issue since the last progress report was accepted, and the LCME/CACMS is concerned about the seeming loss of follow-through. The content of NBME subject examinations used as final evaluations in clerkships does not always align well with the instructional objectives of those clerkships.

In PreClerkship, several methods of formative assessment have been added within the various courses, including instructional tests, self-assessments, narrative student self-evaluation (qualitative), practice questions, reflective writing, test question banks, and learning portfolios. Clinical Skills formative assessment is provided via the Mini-OSCE, at the end of Medicine I. It is held in the Faculty‟s new Clinical Learning and Simulation Facility (CLSF), a state-of-the-art facility that video- and audio-tapes the students as they perform the examination, with immediate feedback provided by preceptors.

In Clerkship, formative assessment is accomplished chiefly via the mid-point in training self-evaluation “MITER” for any rotation of at least four weeks in duration. The student completes the MITER, and then reviews it with the clerkship director (or designate), who signs off on it. The Medical Students‟ Final Accreditation Survey of June 2010 indicated that between 37-68% of students reported being satisfied with the timeliness of MITER administration. A system of central tracking for compliance has been instituted. Informal feedback is also provided by preceptors on an ongoing basis, particularly for rotations less than four weeks in length/without a MITER. This feedback is always provided in writing if significant concerns with student performances are identified.

Clerkship directors are now required to indicate on the electronic FITER (via tick box) whether the MITER was completed, as well as the date of completion, for compliance monitoring. NBME Examinations are administered after the Clerkship core rotations of Internal Medicine, Surgery, Pediatrics, Psychiatry, and Obstetrics/Gynecology. Sample NBME examinations are now reviewed regularly by all clerkship directors to ensure congruence between clerkship objectives and the corresponding NBME examinations. As an indirect

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 measure of this congruence, student performance on NBME examinations at the University of Manitoba correlates well with the corresponding discipline-specific scores that our students obtain on the Medical Council of Canada Qualifying Examination Part I.

ED-33: While there is overall general compliance with this standard, the anatomy component of the Structure and Function course is not well integrated with other elements of the curriculum. Long standing concerns about teaching in ENT, ophthalmology, radiology, and dermatology have not yet been addressed. PreClerkship Anatomy is now fully integrated in every Block except Block 2 with Anatomy sessions listed and delivered as components of other courses. There are introductory Anatomy sessions in Block I also integrated with Structure, Function and Disease Mechanisms.

Otolaryngology, Ophthalmology and Dermatology are taught in Block 6 in PreClerkship and the former two also each have four half days during Clerkship. The students identified in their accreditation report that these subjects need to be given more prominence, allowing for more appropriate content delivery and educational value. Responses to these suggestions have been received and will be implemented in the upcoming Block 6. This information will be available through a separate supplemental submission. These important subjects are also being re-examined in the Curriculum Renewal process being undertaken.

MS-8: A number of very successful initiatives and the good intentions of the Faculty have not met the Faculty's goals in achieving the desired level of diversity with respect to Aboriginal and First Nations enrollment. The Committee was unable to determine from the documentation at hand whether the support programs which were in place at the time of the last survey were still extant or whether they had in fact been discontinued.

In November 2007, following an interim Faculty progress report, the CACMS indicated the Faculty of Medicine was in compliance with this standard MS-8. Notwithstanding, new changes are intended to still further promote diversity and are described in more detail later in this document and in the MS database.

The Faculty introduced substantial changes to the Admissions policies and processes in 2008 pursuant to a process of an internal and external review, in October 2007. Broad consultations across the province were undertaken, with recommendations approved in 2008. The goal of enhancing the number of rural and Aboriginal candidates admitted to the Faculty of Medicine is a priority for the Faculty.

There are recruitment, financial and academic support programs in place at the University and Faculty level, in keeping with the U of M and Faculty commitment to diversity, with website links provided.

In September 2010, the Dean appointed an Associate Dean, First Nations, Métis and Inuit Health, whose mandate includes identifying strategies to increase admissions respecting First Nations, Métis & Inuit students within the Faculty and advising on curricular content. Also, in September 2010, the Dean expanded the role of the Associate Dean, Professionalism to include diversity, to build the resources available to support Faculty departments and programs.

A new Diversity policy was approved in the spring of 2010 that clearly defines the dimensions of diversity that the Faculty is committed to enhancing.

Work is being done to enhance the Admissions data historically collected by the Faculty, to track the diversity of our student population. This past fall 2010, a diversity survey tool, developed by McGill University, was administered to the incoming class of 2014, followed by the other three undergraduate classes. These results

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will provide a much fuller picture of the diversity of our students, excellent baseline data for future analysis including comparison to other medical schools who also implemented the McGill tool.

The Faculty benefited in 2010 from an Emergency physician completing her MBA, who chose to do her final paper on the diversity climate within the Faculty. Her results were published in June 2010. The physician has been given an appointment with the Faculty and asked by the Associate Dean, Professionalism and Diversity to help spearhead further Faculty initiatives related to diversity.

ED-46: Pursuant to a progress report submitted to LCME and CACMS on September 1, 2008, a further standard, previously considered in transition was identified as an area of non-compliance.

Beginning in 2009, a system of collection, maintenance and analysis of externally-and internally-tracked graduate outcome (long-term career) data was put in place to evaluate effectiveness of the UGME program. The position of Academic Lead, Evaluations, UGME, was created to develop the graduate survey tool and integrate internal measures including student performance on all clinical and cognitive examinations with external student performance measures such as scores on National Board of Medical Examiners examinations and Medical Council of Canada Qualifying Examination Part I. The Academic Lead works with Admissions to begin collection of baseline data even at the early stage of the application process to medical school.

2.2 Overview of How Self-Study Was Conducted & Level of Participation In June 2009, then Dean, Dr. J. Dean Sandham, initiated the hiring of a UGME Accreditation Project Manager followed by a Faculty/Self Study Lead. Terms of reference for the Self Study Task Force and Objectives of the Self Study were developed.

Starting July 2009, letters of invitation were sent from the Dean to potential stakeholder members of the Self Study Task Force, with the first Task Force meeting held in August 2009. The Dean and Associate Deans identified faculty who would be appropriate chairs of the Standards Subcommittees. The Associate Dean, UGME, met with potential chairs to discuss the role and invite their participation. Letters of invitation were sent to potential stakeholder members identified for participation on the Subcommittees. A letter was sent to the Senior Stick of the Manitoba Medical Students Association (MMSA), the President of the Graduate Students Association (GSA) and Co-Presidents of the Professional Association of Residents and Interns of Manitoba (PARIM) inviting their participation on the Task Force and Subcommittees.

Five UGME Subcommittees, one for each of the five LCME standards sections, were established to complete the associated database. These Subcommittees reported updates and issues of concern approximately monthly to the Task Force. Six Working Groups were established to complete focused work on specific standards:

i. Educational Objectives Mapping (ED-1) and Writing Objectives and Keywords (ED-1) ii. Diversity (IS-16 & MS-8) iii. Preparation of Resident/Grad Students as Medical Student Teachers (ED-24) iv. Translational Research (ED-17A) v. Service Learning Opportunities (IS-14A) vi. From the March 2010 Consult Visit re: governance recommendations, to fix curriculum governance and curricular content issues noted by the students in their survey (ED-33, 35)

To date, more than 100 persons have been involved in an accreditation committee or working group. Broad representation has been sought from UGME, PGME, clinical/basic science departments, clinical teaching sites, medical students, residents, and graduate students, the College of Physicians and Surgeons of Manitoba,

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Manitoba Health, the Council on Post Secondary Education (COPSE), the Winnipeg Regional Health Authority (WRHA), and University of Manitoba Central Administration.

The Faculty has benefited from an excellent student independent accreditation analysis which was initiated in January 2009 through the Manitoba Medical Students Association. An interim report was produced in November 2009 followed by a final report in July 2010 which has been most helpful in identifying major and minor issues of concern with student recommendations. At this time, the students are planning on completing one more survey prior to the April accreditation site survey, to solicit feedback in areas where there has been significant, focused efforts for improvement.

Consultation Visit – March 2010 In March 2010, at the request of the Dean and Associate Dean, UGME, a two day, consultation visit with Drs. Linda Peterson, Assistant Secretary, CACMS and Dan Hunt, Secretary 2010-2011 and Senior Director, LCME was held. Objectives for the visit were agreed upon with the Secretaries, who presented on new and challenging standards and met with faculty, staff, students and representatives of WRHA, Manitoba Health and the College. In addition to encouraging work in progress, they provided real clarity and focus, identifying priorities for a successful accreditation survey visit which has been particularly beneficial in moving the Faculty forward.

Mock Accreditation Visit – October 2010 The decision was made to host a Mock Accreditation Survey in October 2010, to provide a comprehensive „test run‟ with skilled, external evaluators, to provide an objective eye and valuable feedback on our perceived compliance with LCME/CACMS standards; a readiness check for the actual site visit of April 2011, allowing six months for correction and improvement of areas identified. Objectives of the mock survey were developed and agreed upon by the mock surveyors who included:

Dr. Thomas Marrie – Survey Lead; Dean of Medicine, Dalhousie University Ms. Julie-Anne Buckland – Medical Student, University of Montreal Dr. Cam Edwin Enarson – Clinical Professor, Anesthesiology, University of North Carolina Dr. Geneviève Moineau - Associate Dean, UGME, Faculty of Medicine, University of Ottawa Dr. Kent Stobart – Associate Dean, UGME, Faculty of Medicine & Dentistry, University of Alberta

The outcome of the Mock Survey was very helpful. It not only validated the approach and work done to date but also provided clear direction on the focus for the next few months. The Task Force and Subcommittee members, the members of the Deanery and administrative support staff, Department Head and the wider medical faculty gained valuable insight into the process of accreditation.

A recommendation that the Faculty engage Dr. Kenneth Marshall from the University of Ottawa was acted on and Dr. Marshall has been extremely helpful in assisting us with the final document preparation for the accreditation submissions.

The self study was undertaken to meet accreditation requirements, with the goal of more fully integrating the standards and required reports into the daily activities of the Faculty. The self study has proven to be a powerful stimulus for reflection on the state of our educational program at the University of Manitoba, Faculty of Medicine and has served to be a strong impetus for the Faculty to address many important issues.

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3. LCME STANDARDS & DATA BASE & FACULTY OF MEDICINE RESPONSE

I. INSTITUTIONAL SETTING

A. Governance and Administration

1. Describe how institutional priorities are set. Evaluate the process for and success of institutional planning efforts, and discuss how planning has contributed to the accomplishment of the program’s educational, research and clinical services missions.

Institutional priorities are set by the Dean‟s Council which is chaired by the Dean and includes the Associate and Assistant Deans, Directors of Operations and Communications and the Executive Director of the Joint Operating Division. Priorities are set in consultation with department heads through the Department Heads‟ Council.

The University of Manitoba requires each faculty to annually submit a three year business plan that identifies key priorities, existing revenue, and opportunities to increase revenue. Deans are asked to frame their business plans in relation to the University Planning Framework and the priorities contained therein. All clinical and basic science departments and the assistant and associate deans participate in the development of the business plan.

The Faculty balances University, Faculty, departmental and student priorities, in addition to responding to the ongoing provincial priorities for more healthcare personnel in rural, northern and remote communities. Building capacity within the Faculty for increased undergraduate and postgraduate enrolment, the development of a Physician Assistant Education Program, an International Medical Graduate Program and a Northern and Remote Physician initiative have become new and urgent priorities for the Faculty since the last survey, and are supported and resourced by the university administration, and federal and provincial funding agencies.

The Faculty has been successful in moving forward its priorities within the university as evidenced by many improvements since the last survey. Most notable, in meeting its educational mission, is the development of the Online Portal for Advanced Learning (OPAL) Curriculum Management System, and the 11,000 square foot, state of the art, Clinical Learning and Simulation Facility.

On May 30, 2008 a major planning forum was held in Winnipeg titled “Our Medical School: Imagine Its Potential”. Key stakeholders from across the province participated representing business; federal, provincial and municipal governments; rural, northern and urban health authorities; Aboriginal organizations; university central administration; faculty members; and students. The forum focused on how the Faculty was meeting the needs of Manitobans and what priorities the Faculty should pursue for the next five and ten years.

Enhancing our ability to admit and educate throughout the province; recruiting, retaining, supporting and collaborating more with physicians outside the metropolitan Winnipeg area; and building our research potential were major themes emerging from the forum, and continue to be priorities for the Faculty today.

Following the forum, a second Assistant Dean of Admissions, from Brandon Manitoba was appointed, and admission policies and processes were modified such that applicants with a connection to rural communities could be better represented in the medical school class. (Effective September 2010, the responsibilities of the Assistant Dean, Admissions have been incorporated into the work of the Associate Dean, Students.) The Faculty augmented its outreach and support programs geared to increasing awareness at the high school level of health profession opportunities.

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The Dean established the Optimization of Health Sciences Education in Manitoba working group, with associate deans, department heads of core clinical rotations and northern and rural senior officials, to plan how to enhance our ability to educate outside the metropolitan Winnipeg area. Needed resources were identified for extended education infrastructure, including physical education space, access to library, tele-health and tele- education; suitable faculty and administrative supervision; and identification of issues relevant to student life.

Regarding the need to build and support research, the Faculty established a Strategic Research Fund that has provided substantial support to establish new research platforms in Regenerative Medicine and in Neurosciences. In 2009, the Faculty hosted a research retreat focused on enhancing health sciences research in Manitoba that included major stakeholders throughout the Province. At the January 12, 2011 Dean‟s town hall meeting of the Faculty, the newly appointed Associate Dean of Research introduced the research planning process approved by the Dean‟s Council for creating a newly revised, strategic research plan for the Faculty. The plan will be more fully developed over the next few months, anticipated to be finalized through a series of stakeholder workshops which will run between February and May 2011.

Finally, another major theme identified in 2008 was the need to increase effective coordination and collaboration between rural and urban Health Authorities, the Faculty and Manitoba Health. In 2008, an Associate Dean, Clinical Affairs was appointed and a Joint Operating Division established to support the development of an Academic Health Sciences Network in Manitoba. The purpose of such a network will be to better integrate patient care, education and research activities amongst key stakeholders in order to enhance our ability to recruit and retain academic professionals, enhance education and research programs, and improve patient care.

2. Evaluate the role of the governance structure in the administrative functioning of the medical school. Is the governance structure appropriate for an institution of this size and these characteristics? Are there appropriate safeguards in place to prevent conflict of interest at the level of the governing board, are these safeguards being followed, and are these safeguards effective? Describe any situations that require review or approval of the governing board (board of trustees) of the school or university prior to action being taken.

The University of Manitoba has a bicameral governance structure where academic matters are vested in the Senate, and oversight of administrative and financial matters rests with the Board of Governors. The Faculty reports to Senate through the Faculty Executive Council and the Faculty Council. The governance structure is appropriate for the size and complexity of the University. In keeping with efforts at institutional review and renewal, the Office of the University Secretary is conducting a governance review. Currently, the Faculty is well-represented on Senate.

The Board of Governors approved a new Code of Conduct for Members of the Board of Governors effective June 1, 2009 that requires Board members to sign a written declaration. In response to standard IS-5, the Secretary of the Board of Governors affirmed in writing that conflict of interest requirements detailed in several University policies are being followed and conflict of interest safeguards currently in place are sufficient.

Faculty and administrative appointments require the approval of the Board of Governors, while the annual Faculty budget and decanal organizational structures are approved by the Vice President (Academic) and Provost. As well, the University Internal Auditors conduct random audits that are reported directly to the Board of Governors.

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3. Evaluate the relationship of the medical school to the university and its clinical affiliates with respect to:

a) The effectiveness of the interactions between medical school administration and university administration.

The Dean of Medicine meets monthly with the Vice President Academic & Provost and the Vice President Research, and several times a year with the President, as necessary. The Associate Deans of Medicine report that they have timely and effective access to all the University of Manitoba Vice Presidents and Vice- Provosts/Associate Vice-Presidents. Directors of research institutes within the Faculty meet monthly with the University Associate Vice President, Research. Relations between the Faculty and U of M Administration are considered by both parties to be very good. The Faculty is involved in all key decision making committees of the university from senate to parking. The convocation for the undergraduate medical students is jointly organized and held on Bannatyne campus to reflect the wishes of our students.

b) The cohesiveness of the leadership among the medical school administration, health sciences centre administration, and the administration of major clinical affiliates.

The University of Manitoba, Faculty of Medicine, is the sole medical school in Manitoba. Community and hospital-based health care services throughout the province are governed by eleven Regional Health Authorities (RHAs). The largest RHA in Manitoba is the Winnipeg Regional Health Authority (WRHA) that includes the province‟s two tertiary hospitals and is the major referral centre for rural and northern Manitoba, Northwestern Ontario and Nunavut.

Affiliation agreements exist between the U of M and the individual RHAs. In Winnipeg, a Master Affiliation Agreement (MAA) exists between the U of M and the WRHA, and a Subsidiary Affiliation Agreement- Medicine (SAAM) also exists that addresses Staff Appointments and the Program Liaison Committee (PLC). There is also a Subsidiary Agreement creating the Joint Operating Division. The PLC is co-chaired by the Associate Dean, UGME and the WRHA Senior Vice President, Clinical Services & Chief Medical Officer. The Committee provides a forum for the Faculty and WRHA to work together to enhance clinical, education and research programs.

The relationship between the Dean of Medicine and CEO of the WRHA has always been very strong. The Dean also has access to other RHA CEOs through RHAM (Regional Health Authorities of Manitoba) and other RHA Chief Medical Officers through regular meetings of these individuals. The Dean also has regular contact with the CEO of Cancer Care Manitoba (located adjacent to the Bannatyne campus) and with the Registrar of the College of Physicians and Surgeons of Manitoba (CPSM). The Dean and Associate Dean, UGME are both members of the CPSM Council, and the Registrar of the College is a member of the Faculty Executive Council.

The WRHA has established regional programs that are closely aligned with the traditional Faculty of Medicine departmental structure. The WRHA and Faculty have structured the relationship such that the Program Medical Director for a WRHA regional program is also the Department Head for the corresponding Faculty clinical department. This structure works well in ensuring that planning around clinical service delivery is coordinated with planning related to education and research programs. (The only exceptions occur in situations where the Departmental structure and the Program are not aligned (e.g. Ophthalmology is a University Department in the University structure, but is within the Surgery Program in the WRHA structure).

A new Associate Dean, Distributed Medical Education was appointed, whose responsibilities were incorporated in January 2011 into the role of the new Associate Head, Distributed Medical Education, in the Department of Family Medicine. The Associate Head also serves as Director of Rural and Northern Health for the Province of Manitoba. He is currently collaborating with the rural Regional Health Authorities, Clinical Teaching Units (Parkland/Dauphin, Brandon, Morden/Winker, and Steinbach), and all other rural preceptors to implement

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 distributed undergraduate and postgraduate medical education throughout Manitoba, including the Northern and Remote Family Medicine Residency Stream program.

The Associate Dean of Clinical Affairs is also the WRHA Senior Vice President, Clinical Services and Chief Medical Officer, which provides excellent continuity between the two organizations.

In 2008, the WRHA and U of M formed a Joint Operating Division (JOD) that is focused on better integrating clinical, education and research activities, particularly in the Faculty of Medicine, in an effort to create an Academic Health Sciences Network. The JOD is a functionally integrated joint division of both the WRHA and the University, within the portfolio of the Associate Dean Clinical Affairs/WRHA Senior VP Clinical & CMO who reports jointly to the Dean and the President/CEO of the WRHA. To date, efforts have centred on establishing a joint contractual relationship with academic clinicians (with the participation of Doctors Manitoba) and on integrating the recruitment, remuneration, contracting, performance evaluation, and related processes across both organizations.

In summary, a major strength in Manitoba is the positive relationship that exists across multiple stakeholders. The Dean has easy access to U of M leadership, RHA leadership, the Ministers and Deputy Ministers of Health, and Education, to Doctors Manitoba (who represent Manitoba physicians) and the College. There is a strong support for strengthening these relationships even further through the development of an Academic Health Sciences Network.

4. Assess the organizational stability and effectiveness of the medical school administration (dean, dean’s staff). Has any personnel turnover affected medical school planning or operations? Are the numbers and types of medical school administrators (assistant/associate deans, other dean’s staff) appropriate for efficient and effective medical school administration? Is departmental leadership stable or are vacancies rapidly replaced without detriment to departmental functioning.

Students cited in their 2010 Independent Student Analysis that all support staff in the UGME office, except for one, had turned over since 2006/7. The relative inexperience of new hires led to delays and errors in grade reporting, and delayed compilation and distribution of their Medical Student Progress Report for the 2010 CaRMS cycle. The students also raised concerns about staff shortages and a U of M imposed hiring freeze.

The Faculty acknowledges that there was significant turnover in the support staff in the UGME office. However, such turnover was necessary based on a detailed external human resources review that was completed in 2008. A number of initiatives have occurred within the UGME Office to significantly improve this situation, which is fully outlined in the Faculty Standards database.

A UGME Program Manager, with a Masters in Education, was hired in 2009, and she now manages all issues of concern brought to her attention by students and staff. She has been a very positive influence on UGME staff and on staff morale and she has led the completion of a review of all UGME job descriptions and a performance review of all UGME staff. Since May 2010, there has been no turnover in permanent, full-time UGME staff who are working directly with students. Additional funding from the Dean of Medicine has provided for four more UGME positions. The UGME staff are better equipped to handle student questions, as there is an orientation for new staff, more corporate memory, and policies and procedures which have been written for all areas of the UGME Program. With these measures, the deficiencies noted by the students have been addressed.

In September 2010, the number of associate and assistant deans was reduced and committee structures in the Faculty were streamlined by Dean Postl, following his appointment as Dean and a two month evaluation. The

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 organizational structure ensures clearer lines of accountability and responsibility and has improved decision making processes within the Faculty.

Departmental leadership has been very stable and vacancies are generally filled in a timely manner. If necessary, an Acting Department Head is appointed for a period of time to allow for an extended search process. Currently, there are only two Acting Department Heads, one for Medical Education and one for Respiratory Therapy. Department Head search committees for clinical departments are co-chaired by the Dean of Medicine or designate and the President and CEO of the WRHA, since, with few exceptions, Department Heads have responsibilities in both organizations as concurrent Department Heads and Program Medical Directors. The search process is conducted in accordance with university policy, and is very thorough with strong representation from departmental members and students. Further information is available in response to standard IS-11.

B. Academic Environment

5. Evaluate the graduate program(s) in basic sciences and other disciplines, including involved departments, numbers and quality of graduate students, quality of coursework, adequacy of financial support, and overall contribution to the missions and goals of the medical school. Describe the mechanisms for reviewing the quality of the graduate program(s) in basic sciences and comment on their effectiveness. Assess whether the graduate programs have an impact (positive or negative) on medical student education. Describe opportunities for interaction between medical and graduate students and the frequency of those interactions.

All seven departments in the basic sciences and the Department of Community Health Sciences engage actively in programs of graduate education and their graduate students are essential to the research mandate of the Faculty. All, with the exception of the Department of Pathology, have both M.Sc. and PhD programs; Pathology offers only a Masters program. The number of graduate students is relatively stable at about 300.

Regarding the quality of graduate students, the quality of coursework and adequacy of financial support, these aspects are reviewed rigorously on a seven-year rotation by the Faculty of Graduate Studies (FGS), University of Manitoba, to which they report. These reviews are thorough, involving both external and internal assessors, and their recommendations are followed up by FGS in consultation with the Dean of Medicine. All of the departmental programs have been reviewed during the past seven-year cycle and their implementation reports have been approved.

The integrity of the educational mission of the Faculty depends on a vigorous research environment and it should be noted that the Faculty of Medicine attracts more than half of the extramural research funding in the University ($110M, most of this from national and international granting agencies, as per our Faculty Research Profile, 2009 included in the Institutional Setting database). Another measure of student/program quality is the number of students (32) awarded national studentships, and 26 receive major provincial studentship (MHRC) awards, including two Vanier studentships (2009/10). Students from the Faculty also received the Distinguished Doctoral Dissertation Award for the Health Sciences and the (U of M-wide) Governor General‟s Gold Medal in 2010. In addition, there are 45 postdoctoral fellows in the Faculty. The Faculty funds a top-up program with the goals of recruiting and retaining these excellent students. Other sources of graduate student stipends include grants to investigators and departments establish baseline requirements in this regard.

The impact of graduate programs on medical student education is positive, though indirect. While graduate students are not prominent in the formal education programs of the medical classes, graduate students are primary mentorship resources for those students who elect to participate in the B.Sc. (Med) program during the summer months. The MD/PhD option and the participation by residents and post-residency trainees in graduate

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 programs are additional areas of positive interface for medical and graduate students. The Canadian Student Health Research Forum, CIHR Poster Exhibition and Canadian National Medical Student Research Forum organized annually (June) by our Faculty draw top graduate and medical students from across the country to present research, meet CIHR leadership, receive awards of excellence and network with each other. These highly-popular events (which include presentations from more than 120 Manitoba students and an equal number of students nationally) are the basis for positive professional interactions.

There are numerous opportunities for interaction between medical and graduate students. These include the casual, daily contacts facilitated by their common lounge area, the regular attendance by medical students (particularly B.Sc. Med students) at research group- and departmental research seminars, and attendance of grand rounds by graduate students. Several departments organize journal clubs that provide opportunities for intellectual exchange and mentorship. Graduate students in several departments (Medical Microbiology, Human Anatomy and Cell Science and Pharmacology) are also called on to lead medical student tutorials/problem-solving workshops in their areas of research expertise. The Faculty is also currently very interested in expanding the MD/PhD program as we recognize this stream as an important source of future clinician scientists.

6. Evaluate the impact of residency training programs and continuing medical education activities on the education of medical students. Describe any anticipated changes in graduate medical education programs (numbers of residents shifts in sites used for training) that may affect the education of medical students.

Residents in Royal College and Family Medicine residency programs contribute significantly to the education of medical students, particularly during their clerkship years. During clerkship rotations, students work as part of a team under the supervision of a combination of program medical staff and residents. Students reported in their accreditation survey that the presence of both senior and junior residents enhanced or significantly enhanced their overall learning experiences. Residents were identified as being helpful/very helpful/ the primary source of CaRMS advice for 15% of respondents. Residents were also identified by the clerkship students in the students‟ accreditation survey as modeling positive, professional behaviours occasionally or frequently e.g. show respect and compassion to patients, students, staff or other healthcare providers; exceed expectations in patient care, class, conferences or rounds.

Residency programs have been reasonably stable over time. Some residency training has shifted from the two large tertiary hospitals in Winnipeg to community hospitals in Winnipeg and rural and northern Manitoba, and to the community. This shift has been driven in part by the desire of the residency programs to provide their trainees with a perspective that is different from that of specialists working primarily in a tertiary hospital setting. It has also been driven by the need in Winnipeg to consolidate certain specialty services at fewer sites and make better use of the resources available in community hospitals. This trend will likely continue, and will be done in a manner that carefully considers the needs of medical students as well as residents.

The Faculty is in the process of establishing Family Medicine Clinical Teaching Units in Brandon, Morden/Winkler and Steinbach. This will enhance the exposure of medical students to Family Medicine residents and as such will enhance their educational experience. A new residency program in Ophthalmology, based largely at Misericordia Health Centre, will start in July 2011.

Continuing medical education activities, such as grand rounds, are attended by students who have protected time during their rotations to attend.

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7. Evaluate research activities of the faculty as a whole, including areas of emphasis and level of commitment, quality, and quantity in the context of the school's missions and goals.

The Faculty has a Strategic Research Plan that contains the vision statement “to be one of Canada's outstanding medical faculties, with world class leadership in selected areas of particular competence, respected for our capacities in health research and innovations, as well as for advancing and disseminating biomedical knowledge.” Although Faculty researchers are receiving research funds from numerous sources, represented by all four CIHR pillars, and for numerous projects, and are publishing their research in an extremely broad range of topics, we also recognize that we cannot be all things to all people, and that there are several other substantially larger Medical Schools and Universities. Thus, while overall research support is broad, the Faculty has largely concentrated their strategic efforts in a few areas, consisting of: Cardiovascular and Respiratory Sciences Cell Biology and Gene Technology Community, Family and Population Health Sciences Endocrinology, Metabolism and Nutrition Genomics and Proteomics *(emerging) Imaging and Biodiagnostics * Immunology and Infectious Diseases Neuroscience and Mental Health Nutraceuticals and Functional Foods * Regenerative Medicine and Epigenetics *

Translational research is a growing emphasis in the Faculty and numerous research groups (including neurosciences, lipids, cardiovascular, medical microbiology/immunology and cancer) foster research presentations and annual local society meetings attracting clinical and basic researchers, with their associated graduate students, residents and B.Sc. Med students.

A number of analyses have been performed to assess research quality and quantity in each of the above as well as across the entire Faculty. A comparison of departmental research support from 2007 to the 2009 year (as reported within our institution‟s Web-based searchable research portal “My Research Tools”) shows that, of the 20 departments that engage in research, 14 saw total funding increase from 2007 to 2009. Comparisons of total Faculty awarded research dollars showed a 15.4% increase from 2007 to 2009 and a complete audit performed by the then Associate Dean Research indicated the Faculty garnered about $ 110M research dollars, accounting for almost 60% of total U of M research support . Extramural support from tri-council agencies (considered the “Gold-standard”) increased from $ 13.1M in 2007 to $ 16.3M in 2009 (a 24% increase). Analysis of CIHR Operating Grant support also shows that the Faculty of Medicine garnered 38% more operating grants in the 2010 March and September competitions than in the respective 2009 competitions.

A recently-developed citation analysis tool (called “SciVal”, marketed by Elsevier and beta-tested by us a few months ago), which examines multi-level publication citations, concluded that the Faculty and its researchers place within the Top 10 World-wide in 48 of approximately 550 distinct “Competencies” (listed in response to IS-13 database). This independent analysis also concluded that the Faculty was increasing its “market share” (= relative strength) in 36 of these competencies, while losing market share in 12 competencies. Increases in market share amongst various competencies ranged from 0.18 – 27.97% (“average” [assuming equally weighted, which they are not] = 11.22%) and decreases in market share ranged from -0.6 – -8.12% (“average” = -3.81%). Thus, while there is variability in how the Faculty is performing in each of several independently- designed “Distinct Competency” areas, our research strength is growing in three times as many areas as the number of areas it is declining in, and our increases are larger than our decreases. Many of the strengthening research areas align with our strategic research focus areas.

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Some of the above Faculty research focus areas, indicated by “*”, are emerging areas of excellence with less supportive data regarding quantity and quality, and they do not appear amongst the SciVal competencies yet.

8. Assess the adequacy of the resources (equipment, space, graduate students) for research. Evaluate any trends in the amount of intramural support for research and the level of assistance available to faculty members in securing extramural support.

From an equipment infrastructure perspective, like many other institutions, there is a mix of older and newer equipment available for research. Some of the instrumentation are older models and maintaining them in working order has been challenging (e.g. electron microscopes). In addition, a number of “big ticket” or specialized equipment (e.g. peptide synthesis, IlluminaTM sequencing) are not locally available and it has been necessary to contract this type of specialized work out to other agencies. However, most laboratories, whether clinical or basic, have sufficient instrumentation for their work. In addition, funding provided by the Canadian Foundation for Innovation (CFI) has allowed substantial addition of infrastructure. During the past five years, the University has received $ 60.7M for 206 projects; $ 28.7 M for 98 health-related projects. This infrastructure has been used to equip the labs of several new, as well as established investigators and has also been used for large-scale innovative equipment e.g. Manitoba Centre for Proteomics and Mass Spectrometry; Breast Cancer sequencing infrastructure; 3-D nano-imaging; Population database enhancement; HIV vaccine development. In addition, while housed in other faculties, there is sufficient collaboration to allow health researchers to use a variety of other new instrumentation (e.g. Science received CFI support for both NMR and X-ray crystallography equipment, and Engineering has received CFI support for infrastructure that supports, among other areas, bio-engineering endeavors). Finally, Dean Postl has recently created a $2 million equipment fund to support core research platform development to address existing gaps and will be using the Dean‟s Strategic Research fund to ensure sustainable operation of these platforms moving forward.

Research space is still at a premium at the Bannatyne Campus, home to most medical researchers. To alleviate the problem, the former and current Deans, together with Heads of Departments, have been working hard to retain as much laboratory space as possible in older buildings and develop new laboratory space in new buildings. The relocation of the Department of Immunology to the fourth floor of the Faculty of Pharmacy Apotex Building in February 2009 has provided that Department with much-needed space and freed up the space on the sixth floor of the Basic Medical Sciences Building. The space formerly occupied by Immunology is being renovated for the development of new space for the Regenerative Medicine Program. Some of these development phases have been completed. Additional space for the new Neurosciences Program has also been committed by the Health Sciences Centre in the new Kleysen Institute for Advanced Medicine. This state-of- the-art facility will facilitate translational research and help improve basic-clinical interactions and integration. The faculty has invested in excess of $4 million in this development.

There are presently slightly more than 300 graduate students enrolled in the Faculty of Medicine (approximately one third are PhD-level), plus approximately one-half as many graduate students, mostly M.Sc. level enrolled in the allied School of Medical Rehabilitation. Most faculty members are willing and eager to supervise more students. However, the graduate student population is limited by the amount of support available in the form of scholarships and stipends. We have recently increased student travel fellowships to support their involvement at academic meetings.

The Manitoba Health Research Council (MHRC) is the principal health research granting agency in the Province of Manitoba and a major source of funding. The provincial government has increased the funding of the Council from $2.5 million to $6 million in 2008. The increase in funding will provide researchers in our Faculty with greater opportunities to obtain start-up funds through operating grants and establishment grants,

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 and also greater opportunities through the Regional Partnership Program and a new Manitoba Research Chairs Program, which has already recognized eight outstanding young investigators. This increased MHRC funding will greatly enhance the success of obtaining support for our research trainees.

The former Associate Dean, Research, instituted a pre-review process, in 2005, for enhancing the quality of extramural (primarily CIHR) grant applications. Every application is examined by a panel of three senior investigators (one external, one internal “expert” and one internal “non-expert”), all of whom are former or current members of CIHR Review panels. In addition, the former Dean appointed a Director of Research Enhancement in 2008. The Director organized and presented several workshops designed to assist faculty, primarily junior faculty, in the “nuts and bolts” of grant writing. (The responsibilities of the Director of Research Enhancement has been rolled into the work of the new Associate Dean, Research.) Contingency bridge funding is also available to faculty members who apprised the Dean of their research and funding situation. All of these initiatives have led to our enhanced competitiveness at the national level.

9. Assess the impact of research activities on the education of medical students, including opportunities for medical student participation in research.

The B.Sc. (Med.) program in the Faculty of Medicine gives medical students an opportunity to engage in original research, either basic or clinical, under the supervision of a member of the Faculty of Medicine. The specific aim is to develop within the student skills at experimental design, hypothesis testing, and critical evaluation of data and effective communication of results.

This program, which is unique in North America, runs during the summer recess between Years I and II and Years II and III of the undergraduate curriculum. The B.Sc. (Med.) degree is awarded upon receipt of the M.D. degree. Most projects are conducted at the Bannatyne Campus of the University of Manitoba, although some projects may be based in or include field work in rural or northern Manitoba or overseas. Students (usually 1 or 2 per year) may choose to conduct their projects at other Universities. Students from other universities may enroll but are not necessarily eligible for a stipend from the University of Manitoba. All students receive stipendiary support, presently $5,000. Only a few students participate in summer research outside the jurisdiction of this training program. The B.Sc. (Dent) program in the Faculty of Dentistry has been modeled on the Faculty of Medicine‟s very successful B.Sc. (Med) program.

This degree granting program was established over 60 years ago. Eighteen Med I students were enrolled in 2008 and 33 new students were admitted in 2009. Another 49 of 110 Med I students applied for admission in 2010 and 45were admitted. Although there is not a mandatory research requirement for all medical students, this program attracts almost one-third of the class who dedicate two summers to a formal research training program. Recognizing that some students may want to pursue research later in their medical studies, Dean Postl has committed additional resources to allow Med II, Med III and IV students to experience research training. The goal is to create a continuum of research education access for all medical trainees.

The MD/PhD Program is a recognized and nationally funded program. This program is outlined in supplementary regulations; all applicants must first be accepted as undergraduate medical students in the Faculty of Medicine. Students concurrently pursue the MD and PhD degrees and must satisfy the degree requirements of both the Faculties of Medicine and Graduate Studies. Currently the University of Manitoba is eligible for one funded position per year from the Canadian Institutes of Health Research (6.5 years of funding are awarded to the program @ $21,000/year + $1000 research/travel allowance). The program currently has five students and one other Med II student is dually registered in a PhD program. The Faculty is currently developing plans to substantially increase MD/PhD placements with assured direct entry capabilities in residency training.

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Dr. Joe Doupe formalized the B.Sc. (Medicine) program at the University of Manitoba over 60 years ago. At the beginning of every academic year, the Faculty of Medicine honors this legendary educator and celebrates research within the Faculty by inviting a former graduate of both the MD and B.Sc. (Med) programs who is an established clinician-investigator, usually at another North American medical school, to present a lecture as well as meet members of the current B.Sc. (Med) training cohort and Faculty. The 2009 speaker was Dr. David Peters (Johns Hopkins University) and in 2010 was Dr. Gregory Downey (University of Colorado). Preceding the lecture are eight selected B.Sc. (Med) program student presenters, chosen from the award winners from the formal B.Sc. (Med) program presentations. These student research talks are integrated into the combined Med I and Med II curriculum as well as open to all members of the Faculty of Medicine.

The success of these programs and the learning experiences they provide for the students helps to foster the scholarship role and spirit of enquiry that is central to an academic learning institution.

10. Describe programmatic and institutional goals for diversity. Evaluate the success of the medical school in achieving its goals for appropriate diversity among its students, faculty, and staff. Are there recruitment and support programs appropriate for the school's diversity goals? Describe how well institutional diversity contributes to the educational environment and prepares students for meeting the health care needs of a diverse society.

The University of Manitoba is committed to creating a working environment that is dedicated to excellence, equity and mutual respect; that is representative of the diverse community we serve; and that ensures that all academic and support staff are treated fairly and equitably. As a participant in the Federal Contractors Program (FCP), the U of M has an employment equity program focused on equitable representation of women, Aboriginal peoples, persons with disabilities, and visible minorities at all occupational levels. In November, 2009, the U of M initiated an Employment Systems Review (ESR) that is focused on improving employment systems in an effort to enhance diversity.

There are certain dimensions of diversity that the Faculty and its partners work to enhance. These include the four dimensions of diversity promoted by the University (women; Aboriginal; visible minorities; disabled), and persons who traditionally have not had the opportunity for university education because of economic, social, cultural reasons, lack of formal education or residence in non-urban areas.

The Faculty introduced substantial changes to the Admissions policies and processes in 2008 pursuant to a process of an internal and external review, in October 2007. Broad consultations across the province were undertaken with recommendations approved in 2008. The goal is to enhance the number of rural and Aboriginal candidates admitted to the Faculty of Medicine.

Two new admissions policy and process documents “The Essential Skills and Abilities (Technical Standards)” and “Accommodation for Students with Disabilities” were introduced for the Class of 2009-2010. These policies were particularly timely, as the Faculty welcomed in 2009, after a year of planning, the first deaf student in the MD program. She has been successful in her program and is in her second year, supported full time by ASL interpreters funded by the University Disability Services.

Also, in September 2010, the Dean appointed an Associate Dean, First Nations, Métis and Inuit Health, who chairs the newly established First Nations, Métis & Inuit Health Student Affairs, Admissions & Curriculum Working Group. The Working Group responsibilities include: identifying strategies to increase admissions respecting First Nations, Métis & Inuit students within the Faculty; developing and implementing monitoring mechanisms respecting the Faculty‟s practice on the admissions of students; and identifying strategies that

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 provide academic, professional and social supports for First Nations, Métis and Inuit students within the Faculty.

Data from Faculty and University sources show that the percentage of female students in the first year MD program and in total four year MD program is just under 50%. The percentage of declared Aboriginal students appears to continue to be increasing gradually, although not yet at a level representative of the population being served (i.e. 7.6% of all first year MD students; 5.6% of all undergraduate MD students).

In the years 2000 to 2007, on average, only 20% of our incoming classes graduated from a rural high school (historically, our only measure of rurality). After our implementation of new admission policies, about 30% of our incoming classes (class of 2013 and 2014) graduated from a rural high school, a proportion that is more representative of rural demographics of Manitoba (28.4%).

With the assistance of the University Equity Employment Office, a diversity survey was conducted in November 2010, of faculty and staff with a 66% response rate (N=1334), providing baseline data. This survey is a requirement of the Federal Contractor‟s Agreement and will be repeated regularly. The full Summary of Representation Rates for Designated Groups for the Faculty is included in the IS database, IS-16. The University‟s Office of Institutional Analysis provided the following data in November 2010 re: student diversity by gender and declared Aboriginal status.

This report shows that women appear to be well represented in the support staff category however their representation within “faculty” is only about 37%. This outcome is also demonstrated when looking at the University Office of Institutional Analysis report of full time teaching staff by faculty/school and gender, which also shows a small improvement since 2000-2001. This may indicate a need for more focused recruitment and supports to enhance the numbers of women faculty members.

Declared Aboriginal faculty and support staff numbers appear low and will require continued focused efforts to enhance their representation within the Faculty and bring closer to the percent representation in our community. Visible minorities account for about 10% of faculty and staff, which is a better representation of the provincial population we serve.

While the Faculty has no focused initiatives of its own for enhancing diversity among faculty and staff at this time, the wider university has been in compliance with the requirements of the Federal Contactors Agreement and continues to work to achieve its targeted employment equity goals.

In June, 2010, the Faculty Executive Council approved a Diversity policy that expressed the Faculty‟s commitment to “persons who traditionally have not had the opportunity for university education because of economic, social, cultural reasons, lack of formal education or residence in non-urban areas”. These dimensions of diversity are in addition to the four priority areas described above for the U of M. The Faculty diversity policy is available on the Faculty web-site. In September 2010, Dean Postl extended the role of the Associate Dean, Professionalism to include Diversity, which has heightened the importance and profile of diversity for the Faculty. The Associate Dean will assist in moving this policy forward and be a resource to all departments and programs of the Faculty.

There are recruitment, financial and academic support programs in place at the University and Faculty level, in keeping with the U of M and Faculty commitment to diversity. The University Access program provides support to individuals who have not had the opportunity for successful university experience due to social, economic, geographic and cultural barriers, or a lack of formal education, with preference given to Aboriginal people (Métis, Status, Non-Status, Inuit), residents of Northern Manitoba and low income earners.

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The Centre for Aboriginal Health Education located at the Bannatyne campus supports and enhances the potential for success of First Nations, Métis and Inuit students in the health education faculties and programs (Dentistry, Dental Hygiene, Medicine, Medical Rehabilitation, Nursing and Pharmacy). The goal of the Centre is to increase the number of First Nations, Métis and Inuit health professionals in Manitoba. The Centre website includes links to awards and bursaries available to First Nations, Métis and Inuit students.

The University and Faculty make financial support available with information about bursaries and awards available on the Faculty‟s Student Affair‟s website; gives additional weight to applicants who have a high “rurality scores” (i.e. combination of rural “roots”, rural work experience, and rural volunteer or leadership experience); provides a separate competitive pool for Aboriginal applicants; supports outreach programs to communities and schools that focuses on encouraging underrepresented students to consider health care as a career; and provides accommodation to students with disabilities.

The Faculty is also committed to an undergraduate medical curriculum that reflects the perspectives of a pluralistic society; includes discussion of historically underrepresented and disadvantaged populations; promotes understanding of health disparities; provides curricular learning experiences in a variety of settings; and facilitates service-learning experiences with diverse community groups. The role of the Associate Dean First Nations, Métis & Inuit Health Student Affairs also makes recommendations regarding curriculum content. The Faculty has recently committed $80,000 annually to support increased student involvement in service learning activities with disadvantaged populations in our surrounding area.

Data on admissions diversity has been collected for many years in relation to numbers by gender, location (rural or urban) and Aboriginal applicants and this is posted on the Faculty website. The number of Aboriginal applicants accepted into the program does appear to be increasing slightly, based on the numbers of students who have declared their status at admission, and this is supported by data collected through the University of Manitoba, Office of Institutional Analysis. However a new diversity survey administered to the incoming class of 2014, from McGill University, had a 100% response rate, and will provide a much fuller picture of the diversity of our students, and excellent baseline data for future analysis. Further, there will be the opportunity to do comparisons to other faculties of medicine who are also using this tool.

Institutional Setting Strengths

1. The Faculty of Medicine has excellent working relationships and ready access to major stakeholders in the province including the leadership of the University of Manitoba, Winnipeg Regional Health Authority (WRHA), Cancer Care Manitoba, other Regional Health Authorities, the College of Physicians and Surgeons of Manitoba, Doctors Manitoba and the Ministries of Health and Education. The Faculty involved these stakeholders in the development and implementation of the Faculty‟s strategic plan, representatives continue to be members of Faculty committees and the Dean or delegate has a seat at the table of many stakeholder committees.

2. Major stakeholders have supported the Faculty financially, so that the Faculty relies very little on tuition to fund operations. Government has funded an increase in the medical school class size and an expansion of post-graduate training, and most recently has provided funds in lieu of a tuition increase. The WRHA provides an annual grant to the Faculty of $750,000 and contributed $500,000 towards development of the Neil John Maclean Health Sciences Library. The relationship between the Faculty and key stakeholders is a significant strength.

3. The University of Manitoba (led by the Faculty of Medicine) has established a “Joint Operating Division (JOD)” with the WRHA to support the further development of an Academic Health Sciences Network. The initial focus of the JOD is to better integrate recruitment, appointment and contracting activities between the

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Faculty of Medicine and WRHA that will enhance our ability to recruit and retain academic clinicians. As well, efforts are underway to better integrate education and research activities between the two organizations.

4. Over the past several years, the Faculty of Medicine has been successful in enhancing its supports for research. Significant investments have been made in renovating and expanding research space, creating endowed chairs, increasing operating grants for research, supporting centres of excellence in areas such as regenerative medicine and neurosciences, and expanding supports for medical students to gain research experience (such as the BSc Med Program and MD/PHD Program). Under the new Associate Dean Research, this enhanced research infrastructure will be used to expand research activity in the Faculty and further develop collaborative research initiatives with local stakeholders.

Institutional Setting Challenges

1. The turnover of staff in the Undergraduate Dean‟s Office was an issue of concern to students, but from the management perspective, was necessary. The Faculty believes that the personnel changes that occurred, coupled with the recent increase in the number of staff in this area, has resulted in a more effective operation. Notwithstanding the improvements that have been made, the effectiveness of the Undergraduate Office as judged by students will continue to be monitored with supports to maintain staff.

2. There are a number of service learning opportunities available to students. However, students have suggested that Faculty members be more involved in identifying and supporting such opportunities. As well, beginning in the 2011 academic year, it will be expected that all students participate in a service learning activity. A plan to address these needs has been developed and is being led by the new Associate Dean of Students (see IS database). As well, a newly announced initiative in January 2011, led by the Deans of Medicine, Dentistry and Pharmacy, will formalize, build on and enhance the respectful relationships with our community partners and will provide new opportunities for our medical students.

3. Diversity is a new standard in accreditation which has led the Faculty to reflect on its various diversity related programs and activities. A new diversity policy was approved in the spring of 2010 that clearly defines the dimensions of diversity that the Faculty is committed to enhancing. The Faculty has yet to fully implement this policy, which has to be better communicated with action plans at all levels.

Recent surveys with the medical students and faculty and staff have provided new baseline data regarding diversity of our Faculty which will allow the Faculty to better assess if efforts to improve diversity are having an impact. As well, the medical students identified in their accreditation survey the need to balance the teaching about Aboriginal/First Nations health needs with more emphasis on teaching about “people with different health concerns as opposed to different people with health concerns”. This concern will be considered by the relevant curriculum governance and renewal committees.

Since the survey of 2004, two new Associate Dean positions have been added. One is focused on professionalism and enhancing diversity and the other one is focused on recruiting and supporting Aboriginal students and staff, and providing better care to Aboriginal patients. Enhancing diversity in the Faculty and providing better care to diverse populations will remain a strong priority.

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II. EDUCATIONAL PROGRAM FOR THE M.D. DEGREE

A. Educational Objectives

1. Describe the level of understanding of the school-wide objectives for the educational program among administrators, faculty members, students, and others in the medical education community. Do these objectives serve as effective guides for educational program planning and for student and program evaluation?

The Undergraduate Medical Education (UGME) program has recognized the importance of recent developments in the field of medical education which include the CanMEDS Physician Competency Framework, CanMEDS-FM Family Medicine report and the Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education. As well, the desire to have core competencies that transition from undergraduate to postgraduate training resulted in the objectives of the UGME program being revised using the seven CanMEDS Roles framework. The objectives were formally approved in the first quarter of the 2010/2011 academic year, along with a supporting Faculty policy on UGME curriculum learning objectives.

While those involved in these efforts are well versed in the global objectives, a broader communication strategy was required to inform faculty, students and others. The new learning objectives were widely communicated and distributed to all students, faculty, residents, graduate students and affiliated institutions both in hard copy and in e-mail, and are posted on the UGME website. The objectives are also posted in OPAL. The Dean‟s blog has proven to be a very effective means of communicating important information and his December 3, 2010 blog included reference to the new objectives with a link to the objectives. These efforts are in part aided by the fact that faculty is generally familiar with the CanMEDS competencies and therefore there is a recognition factor that aids in the communication process.

The learning objectives are used as a guide for educational program planning and student evaluation. A Faculty wide review of all current academic course and session objectives at both the PreClerkship and Clerkship levels (Curriculum Mapping Project) has been undertaken in light of the changes to the global UGME learning objectives. In addition, outcome measures have been assigned to all the newly revised educational program objectives. The first phase of mapping the new UGME learning objectives to the global course and clerkship objectives is complete. The development of a curriculum management system (OPAL) has facilitated the electronic logging of global program, course and session objectives that will form the basis for a comprehensive curriculum map, anticipated to be completed by December 2011.

2. Comment on the extent to which school-wide educational objectives are linked to physician competencies expected by the medical profession and the public. Summarize results from any associated outcome measures that demonstrate how well students are being prepared for the next stage of their training.

The linkage of school-wide educational objectives to physician competencies occurs at both the PreClerkship and Clerkship level. Outcome measures are linked to the UGME learning objectives. The responsibility for the translation of global educational program objectives into specific course and session objectives rests with the UGME Curriculum governance committees. Several initiatives have been developed to better align our assessment process with the global program, course objectives and instructional methods. These include the appointment of an academic lead for evaluation, responsible for quality control of evaluation methods, exam mark reporting and analysis of student performance data.

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Program effectiveness is monitored by internal measures (e.g. block exams, OSCE examinations) and external measures (National Board of Medical Examinations NBME, Medical Council of Canada Qualifying Examinations Part I) with comparisons made to previously analyzed student performance data.

MCCQE Part I exam scores have hovered near the median national average for the past three years with a pass rate of approximately 98%. University of Manitoba graduating students have been very successful at obtaining residency match positions (935/943, 99%) for data collected between 1998 and 2009. This data was obtained through a survey of graduates in which the survey questions were directly related to our current educational objectives.

In the CGQ 2010, 63 of 94 graduating students who completed the survey recognized their clinical training as a strength, noting specifically patient exposure; hands on learning; opportunities to perform procedures; early access to and variety of patients (ethnic, underserved populations); high level of responsibility and independence. Comments included, “Amazing clinical program” ;“Tons of hands-on experience” ; “I believe that our clerkship program is the best in the country and I feel totally confident in my day to day work because I was given the opportunity to take on responsibility.”

3. Comment on the effectiveness of the mechanisms in place for assuring that all students encounter the specified types of patients/clinical conditions needed for the clinical objectives to be met.

The monitoring of essential clinical presentations (ECP) requirements has been a noted deficiency of the medical school in the past. An extensive review of all ECP was undertaken in the last twelve months at the level of the Clerkship Curriculum Committee. Key developments include: 1. Complete review of the all the clinical presentations. 2. Quantitative criteria for the number of exposures for each clinical presentation. 3. Specifications related to the Encounter setting. 4. Definitions for each Role that is expected of the student learner. 5. Alternate case identification that may include paper, computer or simulated learning cases. 6. Complete review of all specified procedures in each Clerkship rotation. 7. Development of Level of Competence criteria with grading of the expected level of performance, established according to the Association of Faculties of Medicine of Canada (AFMC) Procedural Skills Working group definitions. 8. Preceptor identification requirements for each essential clinical presentation and procedure specified. 9. Development of online electronic forms to facilitate logging of all essential clinical presentations and procedures.

Mechanisms to improve and facilitate the local and central tracking of ECP include the MITER (Mid-In- Training Evaluation Report), which includes a check box to verify progress with completion of the ECP and to identify areas that may require further intervention and the FITER (Final-In-Training Evaluation Report), which also includes a check box for verification of completion of all ECP. Learning gap identification with a further action plan has to be specified by the Clerkship Director or designate completing the FITER. A central oversight policy for ECP monitoring has been developed which includes ECP gap reports and documentation of completion of assigned remediation.

All ECP documents are completed electronically by the students. Clerkship directors review ECP at the mid- point of rotations and prior to completion of FITER. Central reporting and management of ECP learning experience is governed by the Clerkship Curriculum Committee, and Curriculum Executive Committee.

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ECP gap reports are generated by OPAL at the end of each rotation and the first set of these was provided to clerkship program directors for Period 2, November/December 2010. By way of example, for the Family Medicine (FM) rotation, 46 gaps out of 630 ECP encounters were recorded for 15 students. Five of these gaps were encountered in 4 students and the remaining 41were in 3 students. The clerkship director was informed of these deficiencies and the FITERs were returned for remediation. The OPAL ECP gap resource list in FM allows the student with the occasional deficiency easy electronic access for remediation. Other previously described remediation methods are also utilized when required. Data is being collected for all clerkship rotations.

B. Structure of the Educational Program

4. Delineate the mechanisms ensuring that the educational program provides a general professional education that prepares students for all career options in medicine. Cite relevant outcomes indicating success in that preparation.

PreClerkship academic content is delivered in six Blocks. The first two Blocks are foundational for understanding disease states, determinants of health and the fundamentals of critical appraisal of scientific data with statistical analysis, in courses Structure and Function and Population Health and Medicine in Block 1. Block 2 emphasizes the life cycle from pediatrics to geriatrics and mental health. Blocks 3 to 6 are system Blocks with integrated disciplines of anatomy, biochemistry, genetics, physiology, microbiology, immunology, pharmacology and therapeutics, immunology and preventative medicine. Interwoven through the first two years of the curriculum are four fundamental courses that prepare the students for the clinical training. These courses include Clinical Skills development, Problems-Solving in small group sessions, Medical Ethics and Humanities and Laboratory Medicine. The curriculum covers all aspects of health care across the spectrum of all age groups, and includes a strong focus on preventative medicine issues of local, national and global importance. Survival Tactics is offered as a voluntary course across all four years to assist students with challenging aspects of medicine and decision making.

Students are exposed to laboratory and other practical learning environments in order to make observations of biomedical phenomena and to collect, analyze and interpret scientific data. The curriculum combines various learning formats that include lectures, hands-on clinical and laboratory teaching, tutorials, small group problem solving sessions and self-directed study.

The Clerkship includes mandatory rotations through all core clinical specialties: family medicine, emergency, obstetrics and gynecology, pediatrics, internal medicine, surgery, psychiatry, and a multiple specialty rotation. Within surgery and internal medicine there are also options for subspecialty rotations. Recognizing that patient exposures and encounters will vary from service to service many clerkship rotations have complementary didactic components to ensure that all students receive the requisite core body of knowledge to meet the objectives of the clerkship curriculum. In addition to MITER and FITER evaluations, five mandatory Clerkship rotations are summatively evaluated by the end-of-rotation NBME.

Outcome data in the form of survey study has recently been gathered from graduates to critically assess the effectiveness of the UGME program. Survey data was obtained from 103 (19.8%) of 520 graduates from the year 2004-2009. In response to the question „How well did UGME meet their needs in their ability to function effectively as a resident overall?‟ 85% of respondents indicated „well‟ or “very well” to the question. Furthermore 74% of respondents reported that UGME struck the right balance between clinical care and the domains of Research and Scholarship, Communication, Ethics, Professionalism and Social Accountability. In the recent CGQ 2010, 95% of students indicated they felt confident in having acquired the clinical skills to begin a residency program. The Faculty is committed to ongoing efforts to survey graduates to determine the effectiveness of the educational program. This information will be used for future curriculum planning and development.

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5. Evaluate the adequacy of instructional opportunities for students to engage in active learning and independent study. How well does the program prepare students to engage in self-assessment of their learning needs and to develop other skills to support habits of lifelong learning?

Significant efforts have been made to restructure rotations, revise content and delivery and to explore methods to maximize student self-learning opportunities. Self-directed learning skills are promoted as well the concepts of self-reflection and self-evaluation that are important for ongoing professional development. The students have an early exposure to this through the PreClerkship Problem Solving (PR) course. Students engage in active self-directed learning under the guidance of a preceptor in both the first and second years of medical school. The PR courses help students to develop a systematic approach to solving real-life medical problems, engage in teamwork and foster good communication skills. The PR course curriculum has been revised in the last year. This included a complete review and renewal of all cases and examinations. Students have the opportunity to participate in voluntary extra-curricular activities some of which are supported by the Medical Humanities program. Two activities that foster the exploration of personal beliefs, thoughts and biases include the Book Club and Medical Student Art Show. The meaning of health care and medicine is explored to further enhance reflection and promote creative thinking skills.

Students all complete a Community Health Sciences scholarly project which is a mentored self-directed, self- learning opportunity. The scholarly experience is crucial to help build on the scientific and scholarly foundations developed in the pre-clinical years. In Clerkship, students are also given the opportunity to research and present a topic to their peers and mentors. This is then openly critiqued for the benefit of the students‟ own assessment of their self-learning capabilities.

6. Evaluate the adequacy of the system for ensuring consistency of educational quality and of student evaluation when students learn at alternative sites within a course or clerkship.

The Clerkship directors of each program are responsible for orientating faculty at all sites to the goals and objectives of the educational program. Individual clerkship directors remain fully in charge of the students‟ global evaluation while they are at alternative sites. UGME evaluation is consistent across all sites and is monitored by the Committee on Evaluation, Clinical. All Clerkship Directors are members of this Committee.

Newly developed reporting features within OPAL will allow comparisons of Essential Clinical Presentations (ECP) amongst all educational sites, and an ECP gap report has been created to optimize assessment of the comparability of learning experiences. Formal affiliation agreements have been struck with each clinical teaching site to outline shared responsibilities and expectations of site support to the learner.

7. Comment on how well all content areas required for accreditation are addressed in the curriculum. How confident is the educational program leadership that these topics are appropriately addressed?

Reporting strategies to show gaps and redundancies were built into OPAL to verify that all required content areas are addressed in the curriculum. Generated reports to date indicate that the vast majority of key areas are addressed within the curriculum. The current search strategies within OPAL coupled with the completed curriculum map will facilitate more in depth review of all curricular components.

During the self study, feedback from department heads showed that coverage of the newer standard area of translational research was not formally addressed in the curriculum, although students could encounter many examples of “bench to bedside” applications at clinical sites (see response to ED-17A). This finding was validated through an OPAL search of keyword “translational” research which generated no results. Through the

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 leadership of the Department Head, Community Health Sciences and her working group, the curriculum was changed for the incoming class of 2014 so students are trained in the basic sciences of clinical, epidemiological and translational research and evidence-based medicine in the Medicine I, Block I during the Population Health and Medicine course. This is reinforced in Medicine I, Block II during Problem Solving, while in Clerkship, the concepts of translational research are presented in Introduction to Clerkship.

The clinical teaching sites in support of the Clerkship rotations provide a broad and diverse clinical exposure to many disease states. Students attend academic days and educational rounds during their Clerkship rotations and are encouraged to pursue self-directed learning strategies to optimize clinical learning opportunities and cases. There are sufficient opportunities for students to maximize both their essential clinical presentation exposures and procedural experiences.

Expanding learning opportunities within a distributed medical education platform will be implemented by the Department of Family Medicine in the new academic year. Increasing class size coupled with the challenges posed by the addition of multiple new learners into the clinical environments will have to be monitored very closely.

8. Assess the balance between inpatient and ambulatory teaching and the appropriateness of the teaching sites used for required clinical experiences.

The clinical rotations utilize a balanced mix of inpatient and outpatient learning settings within tertiary, community and rural settings based on summative data provided by all Clerkship Programs. The Family Medicine clerkship utilizes 29 sites across multiple communities with a predominant emphasis on out-patient learning experiences. All sites are carefully assessed for teaching suitability prior to the implementation of teaching programs by the Clerkship Directors. Close collaboration with Regional Health Authorities in addition to affiliation agreements have facilitated site expansion particularly in the Department of Family Medicine. The Faculty closely monitors each site and has confidence in the appropriateness of all clinical teaching sites.

C. Teaching and Evaluation

9. Comment on the adequacy of the supervision of medical students during required clinical experiences. Discuss the effectiveness of efforts to ensure that all individuals who participate in teaching, including resident physicians, graduate students, and volunteer faculty members, are prepared for their teaching responsibilities.

Overall, supervision is adequate and students are always under the direct supervision of either a resident and attending physician or attending physician alone. As the junior members of the healthcare team, their findings, investigations and treatment plans are all reviewed and verified in the context of the healthcare team. The supervision of students during some required clinical experiences can be improved upon based on the data from the CGQ 2010 and student accreditation survey. The responsible departments have been informed and action is being taken to address any deficiencies.

The preparation of teachers that may include residents, graduate students and post-doctoral fellows has been an area of concern in the past. Recognized deficiencies included a lack of knowledge regarding objectives related to learning sessions and minimal preparation for the role as teacher. All teachers, including residents, graduate students and postgraduate fellows are orientated to learning objectives using several strategies, and their preparation for teaching has been predominantly the utilization of the Teaching Improvement Project System (TIPS) course. Attendance at these sessions has been good in the last few years. Key developments to enhance the preparation for teaching and to demonstrate the Faculty‟s commitment to the process include:

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1. A formal policy on Resident, Graduate Student and Post-Graduate Fellow Teaching and Evaluation of Medical Students was developed and approved by the Faculty Executive Council. Key areas addressed in this policy include: Orientation of resident, graduate student and/or post-graduate fellow teachers. Training for resident, graduate student and/or post-graduate fellow teachers. Evaluation of resident, graduate student and/or post-graduate fellow teachers. Assignment of responsibility for the implementation of policy will be with the Associate Dean PGME, Associate Dean, UGME and the Assistant Dean of Graduate Studies.

2. The creation of a Teaching Development Program (TDP) to prepare all teachers for their role in the medical school. A Faculty Lead for the program was appointed and session attendance is monitored. The first year residents are all going through the mandatory first year of a three year module. The developed evaluation and feedback reporting mechanisms will further enhance teaching within the UGME program.

10. Evaluate the adequacy of the methods used to evaluate student attainment of the objectives of the educational program. How appropriate is the mix of testing and evaluation methods? Describe the frequency with which students receive formative assessment in addition to summative evaluations? Discuss the timeliness of performance feedback to students in the preclinical and clinical years.

The evaluation of students in both PreClerkship and Clerkship is effective, and based upon an extensive framework of evaluations (summative and formative). The evaluation formats include multiple choice, short answer, narrative evaluations, OSCE, practical lab and problem solving exams. The Director of Student Evaluation (appointed in 2006) chairs a reconstituted Student Assessment and Progress committee. The responsibilities of the committee include overseeing all aspects of student evaluation, including the setting and enforcement of evaluation policies, recommending improvements in continuity of student monitoring and remediation, and reporting on student performance.

The formative assessment of students has been added within various courses in PreClerkship including instructional tests, self-assessments, narrative student self-evaluation (qualitative), practice questions, reflective writing and learning portfolios. Summative assessment in PreClerkship consists first of the end-of block examinations (Blocks I, II, and III in Medicine I, Blocks IV, V, and VI in Medicine II), which are aligned with course objectives. These consist of a “cognitive” multiple choice component worth 50% of the final block mark, a short answer “problem solving” component worth 25% of the final block mark, and a multiple choice “lab practical” component, worth 25% of the mark. There is also a summative OSCE-type examination administered at the end of Medicine II, which assesses clinical skills. There have been issues in the past year related to the timing of release of PreClerkship grades but a new administrator in Evaluations has been hired in 2010 and since then end-of-block student evaluations and grades have been distributed no later than three weeks from the end of scheduled exams.

Formative assessment within the Clerkship is accomplished in all rotations of four weeks duration or longer by completion of the MITER, which includes checking the status of ECP completion. Any indications of concern for the student‟s progress will result in a face to face meeting with the responsible preceptor/director. There are several methods of summative assessment in Clerkship. First, a new FITER form has been recently developed, which more precisely evaluates Clerkship objectives, and which uses semantic anchors in order to enhance the richness and validity of the assessment. Written comments regarding student performance are also articulated on the FITERs. Second, a Clinical Comprehensive Examination (CCE) is an OSCE-type examination that is administered approximately two thirds of the way through clerkship, which summatively evaluates clinical skills.

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11. Describe the system for ensuring that students have acquired the core clinical skills specified in the school’s educational program objectives. Evaluate the frequency with which students are observed and receive feedback on their clinical skills. Are there any limitations in the school’s ability to ensure that the clinical skills of all students are appropriately assessed?

The Clinical Skills course is a longitudinal course that spans the first two years of medical school. The Standardized Patient Program and the state of the art Clinical Learning and Simulation Facility (CLSF) represent significant investments in foundational clinical skills education for the students. Formative assessment is provided via the Mini-OSCE, at the end of the first year of medical school. The CLSF is used for the clinical skills assessment. Video and audio tape technology are used to record student examinations, with immediate feedback provided by the preceptors. The recordings enhance the learning experience and provide a mechanism for feedback. Secondly, a Clinical Comprehensive Examination (CCE), an OSCE-type examination that is administered approximately two thirds of the way through clerkship, provides a summative evaluation of clinical skills.

Our CLSF is well-resourced to address most areas of clinical skills simulation-based training with the exception of some more invasive procedural skills. A proposal was approved in December 2010 at Dean‟s Council to renovate Lecture Theatre D to develop a clinical skills lab and Dean Postl has indicated a commitment toward this initiative for 3,000sq ft at $1 million. This further development will allow for a comprehensive approach to simulation-based training.

D. Curriculum Management

12. Assess the adequacy of the system for managing the curriculum and ensuring that it is coherent and coordinated. Do the curriculum as a whole and its component parts undergo regular, systematic review? Describe the procedures in place to identify and rectify any problems in the curriculum as a whole and in individual courses and clerkships? Evaluate the effectiveness of the procedures, and provide specific illustrative examples. Provide evidence that the school monitors the content covered in the curriculum to ensure that all desired content is covered and gaps or unwanted redundancies do not occur.

The Curriculum, under the previous Governance Structure in place for the 2009-2010 academic year, was managed centrally by the Undergraduate Medical Curriculum Committee (UGMCC) which met monthly to discuss and review curriculum issues, receive reports from coordinators, committee chairs and students. Under the previous governance structure the Cognitive Coordinators I and II, Program Coordinators and Clerkship Directors worked with course directors, clerkship directors, faculty and students to review the different components of the educational program. They worked with the Associate Dean, UGME, the Undergraduate Medical Curriculum Committee (UGMCC), PreClerkship, PreClerkship Advisory and Clerkship Curriculum committees. Subcommittees worked with Course Directors to ensure the course content was current and relevant.

The subcommittees played an important role in planning their respective component of the curriculum. The Pre- Clerkship Curriculum Committee (PCC) brought together the course directors, program coordinators, administrative assistants, library representatives, information technology representatives, bookstore representatives and Committee chairs involved in managing and delivering the curriculum. The PCC responded to issues raised by the Course Directors, Faculty and students, responded to CES reports, developed proposals for curriculum development, program delivery and resources and submitted recommendations to UGMCC. The PreClerkship committee met quarterly. The PreClerkship Advisory Committee (PAC) met monthly. It advised the Associate Dean, UGME. This committee formed the nucleus of the PreClerkship management, and ensured that curriculum planning was appropriate and ongoing. The Clerkship Curriculum committee met monthly to

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 review planning, management and evaluation of the clinical rotations. Curriculum Evaluation Seminars (CES) were held at the end of each block. They provided a forum for student opinion on the medical curriculum and opportunities to discuss potential improvements to the delivery of academic content. The CES reports were held annually for the Clerkship rotations. There was no formal faculty-led evaluation to supplement and validate the information collected in the CES reports.

The management of the curriculum was identified as an area of concern following the last accreditation cycle and an external review of the curriculum in 2008. The development of a curriculum management system to support effective curriculum planning, scheduling, monitoring and review was deemed fundamental to address several of the concerns that were raised. The Faculty has developed an online electronic curriculum management system, the Online Portal for Advanced Learning (OPAL) that has been phased in sequentially over the last eighteen months. The features of OPAL include but are not limited to:

1. Curriculum hosting and scheduling features. 2. Curriculum course and session content and resource uploading for every session. This includes web- based links and live recordings of sessions. 3. Placeholders for course and session objectives. 4. Placeholders for completion of ED standards 10, 11 and 13. 5. Reporting and searching features for review of content. 6. Evaluation forms creation and distribution. 7. Online hosting of ECP forms. 8. Examination information technology infrastructure and PGME scheduling features.

Faculty-wide orientation and learning sessions to OPAL have been implemented and continue to support the management of the curriculum management system. The implementation of OPAL has been challenging and will continue to evolve as the demands for reporting and evaluation features increase to facilitate curriculum management. A Curriculum Mapping Project has been implemented to facilitate mapping of objectives, content and evaluation across the entire curriculum. The new UGME learning objectives have been mapped to the course and clerkship objectives. Mapping of individual session objectives and the evaluation blueprint linking objectives to examination questions are the next scheduled phases of the project. The expected completion date for the remainder of the project is December 2011. The ability to perform a comprehensive review of the curriculum, identify gaps in content and link outcome measures to global program, course and session objectives is fundamental to curriculum management.

The UGME curriculum has not been reviewed by the curriculum governance structures and Faculty as a whole since 2001/2002. Parts of the curriculum have been subject to internal review (Problem Solving course, Blood and Lymph course, Reproduction). In response to Curriculum Evaluation Seminar (CES) reports and the student accreditation surveys, several PreClerkship courses and Clerkship rotations have undergone extensive internal review. These include the Musculoskeletal course, Population Health and Medicine course, Anatomy Teaching, Introduction to Clerkship course, Pediatric Clerkship rotation, Obstetrics and Gynecology Clerkship rotation, and Community Health Sciences Clerkship rotation.

The effectiveness of changes implemented will be monitored by the PreClerkship and Clerkship Curriculum Committees, Curriculum Executive Committee and the UGME Management Committee which form part of the new UGME governance structure. This new governance structure within UGME was established to provide improved central oversight of the curriculum and to develop mechanisms and processes to facilitate ongoing Faculty led review of the curriculum across the continuum of undergraduate education.

A summary of the changes adopted after a review of the governance structure include the following:

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1. The Faculty Undergraduate Medical Curriculum Committee was replaced by the UGME Management Committee chaired by the Associate Dean of UGME. 2. A new Director of Curriculum position was created reporting directly to the UGME Management Committee and the Associate Dean, UGME. 3. A new Curriculum Executive Committee chaired by the Director of Curriculum. 4. The Year I and Year II coordinators were replaced by a single Pre-Clerkship Director who would be responsible for both the first and second year Pre-Clerkship academic program. 5. The Pre-Clerkship Committee meets on a monthly basis as opposed to the quarterly meetings under the old governance structure. 6. The new governance structure was approved by the Faculty Executive Council in June of 2010 and has been in place since the fall of the 2010 – 2011 academic year. A revitalized governance structure is part of the Faculty‟s commitment to accountability for the overall design, implementation, management and evaluation of the curriculum in UGME. 7. A Director of Curriculum Renewal was appointed in 2010 to undertake a curriculum renewal process with broad stakeholder involvement. 8. A Curriculum Renewal Working Group has been established and a formal Faculty wide survey has been completed. The timeline for implementation of the new academic curriculum is 2013. 9. Course Directors will also be providing feedback to Deans Council, Department Heads and FEC on a twice yearly basis to ensure communication and remediation where necessary.

13. Does the chief academic officer have sufficient resources and authority to assure that the educational program can achieve institutional goals and learning objectives?

The provincial funding of the Faculty has increased proportionally to the number of students based on an activity costing model. Basic science and clinical departments have also received direct funding from increased enrolment to hire academics in their departments to support the mission of education and research. The Faculty of Medicine has allocated a specific operating budget to support the Undergraduate Medical Education office. This budget was created historically and adjusted salary expenses based upon the recommendations of an external review of the office. The Faculty works annually with each unit to review the financial status of the area and to review the previous year‟s fiscal budget. The Dean of the Faculty then reviews and ranks all the requests. For increased enrollment funds, the priority has been to emphasize hiring more academic positions and limit the support staff requests to key accreditation support positions. The Dean has focused on the administrative staff structure in the central UGME office and supported a number of additional hires to key positions in the 2009/10 year.

14. Assess the effectiveness of curriculum planning in the medical education program. Describe efforts to ensure that there is appropriate participation in planning and that resources needed to implement the plans will be available.

The foundations of the present comprehensive curriculum planning initiative were initiated by Dean Sandham and have been effected by the efforts of Dean Postl and the Associate Dean, UGME. Curriculum governance was initially significantly amended to reflect centralized oversight in all areas of curriculum content, evaluation and reporting. Global educational objectives were adopted reflecting the CanMED competencies. A comprehensive mapping of the entire curriculum is underway and will be completed by December 2011. All course and session objectives are in the process of being linked to the global objectives and examination content will also reflect the objectives.

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The Associate Dean, Undergraduate Medical Education provides leadership and coordination to the Undergraduate Program to ensure that the mission and goals of the Faculty are achieved. This includes budget oversight, curriculum design and delivery, coordination of all teaching activities and the evaluation of students and programs. The mandate of the curriculum renewal process is for broad faculty, students and stakeholder consultation. The faculty and infrastructure resources needed to support the new curriculum will be subject to careful financial and budgetary analysis, but Dean Postl has made curriculum renewal a high priority and declared that we will have a new curriculum in place by 2013. In addition consideration will be given to the impact of potential future increases in student enrollment.

15. How does the curriculum committee assure that students have sufficient time for learning? Evaluate the educational workload and the balance between education and service in the clinical years. Assess the effectiveness of the mechanisms used to monitor student duty hours. Do students receive sufficient formal teaching during their clinical clerkships?

The curriculum governance committee structure is responsible for ensuring that students have sufficient time for learning in both the PreClerkship and Clerkship years. A review of our current data shows that students in Clerkship receive on average a median of 6 hours of formal instruction per week across the continuum of Clerkship training. Extensive formal teaching is also provided in the Introduction to Clerkship course which prepares the students for the Clerkship program. The student‟s duty hours must be in compliance with the contractual limits of the Professional Association of Residents and Interns of Manitoba (PARIM). Monitoring of duty hours and the reporting mechanisms for violations of established duty hours policies, have been extensively reviewed at the Clerkship Curriculum Committee with policy updates in 2010 / 2011.

16. For schools that operate geographically, separate campuses evaluate the effectiveness of mechanisms to assure that educational quality and student services are consistent across sites. In order to assess the comparability of the evaluation system, review the patterns of grades given at the geographically separated campuses.

Notwithstanding the information in the ED database re: this issue, we do not at this time have a geographically separate campus. There is one medical school on the Bannatyne campus, with many affiliated sites. We are in compliance with the LCME standards 2008 against which we are being surveyed, but recognize that the new 2010 standards require completion of ED-39 to ED-44 for instructional sites, and therefore provided the information in the database in relation to our affiliated teaching sites.

E. Evaluation of Program Effectiveness

17. Describe the evidence indicating that institutional objectives are being achieved by enrolled students.

The Faculty has internal and external measures of student performance to demonstrate achievement of objectives, i.e. preparing students for successful transition to residency. Internal clinical and cognitive examinations (end-of-Block examinations, OSCE examinations) and external examinations (NBME, MCCQE I), and CaRMS results evaluate the students‟ success in completion of the educational program.

The Committee on Evaluation (Clinical) reviews NBME examinations on a monthly basis. The proportion of students who pass or fail each discipline is reported. On average, the Associate Dean, UGME reports that there are about 20 failures/year (i.e. 5 exams taken by 110 students), some of which are repeat failures. The student accreditation survey reported a somewhat higher failure rate (i.e. one quarter to one third fail at least one exam). The pass rate overall is over 90%. Percentile scores are used to compare student performance from other

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Canadian and American, Faculties of Medicine educational programs. The results also provide an opportunity to reflect and validate the Clerkship curricula. The results of the MCCQE Part I have hovered near the median national average for the past three years with a pass rate of approximately 98%.

The 2010 CaRMS match was very successful with only two students unmatched in the first iterations and 89% of students being matched to one of their top three choices (above the national mean of 85%). In the CGQ 2010, 94.6% of 91 students agreed or strongly agreed that they have acquired the skills required to begin a residency program.

18. Discuss how information about enrolled students and graduates is used to evaluate and improve the medical education program.

The Faculty utilizes a variety of methods of evaluation and feedback to monitor and improve the medical education program. These methods include evaluation of PreClerkship and Clerkship student academic performance on examinations by the Committees on Evaluation, Years I and II.

Student feedback through a global evaluation system in OPAL has improved timely review of both PreClerkship and Clerkship programs e.g. Introduction to Clerkship course was fully reviewed and revised for the 2010/2011 academic year.

The Faculty initiated tracking of long-term outcomes for the class of 1998 to 2009 (N=943). The outcomes of interest included graduation rates, postgraduate (residency) training program choices, success at matching to chosen residency programs, proportion matched to first choice program, geographic location of postgraduate training, specialty fields of postgraduate training, rate of changes in chosen specialty fields, rate of sub- specialization in chosen fields, time-to-practice, and location of practice. While the response rates to this initial survey were a bit low, this promises to be an invaluable tool for continuing feedback from our graduates.

Data analysis of the Canadian residency match results for the last five years reveals that over 90% of Manitoba graduates match to either a first choice program rank list or a lower choice rank list with the exception of a single year in 2008.

Educational Program Strengths

1. Commitment of the Faculty and administrative staff to providing a high quality UGME program within diverse learning environments.

2. Overall satisfaction of students with the quality of the medical education they have received and confidence in acquired clinical skills required for commencing postgraduate residency training.

3. Student success in matching to postgraduate residency programs in Canada.

4. The Curriculum Management System (OPAL) and the state of the art Clinical and Learning Simulation Facility.

Educational Program Challenges

1. Demonstration of effective UGME program governance in order to facilitate the management of all components of the curriculum. Responding to students‟ longstanding curricular concerns has sometimes

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taken too long. Establishment of a governance model along with supporting policies and procedures has improved the response to issues from poor presentations and lack of course organization to insufficient course leadership. The Dean has also resolved that we will be proactive in this, to good effect thus far. An example of this is the MS course, a longstanding concern, which was addressed by changing the Course Director and providing him with a strong mandate to address and resolve deficiencies which he has done.

2. Optimizing OPAL infrastructure to support curriculum maps, reporting and evaluation features.

3. Managing the increased enrollment in the medical school, especially as regards clinical teaching.

4. Maximizing resident physician participation in the Teaching Development Program and ensuring that all PGME programs have oriented their residents to the UGME objectives.

III. MEDICAL STUDENTS

A. Admissions

1. Critically review the process of recruitment and selection of medical students, and evaluate the results of that process. Is the size of the applicant pool appropriate for the established class size, both in terms of number and quality? How are the medical education program’s selection criteria validated in the context of its mission and other mandates?

The Faculty introduced substantial changes to the admissions policies and processes in 2008 pursuant to a process of an internal and external review, the latter occurring in October 2007. Broad consultations across the province were undertaken with recommendations approved in 2008.

The admissions process at the University of Manitoba is overseen by the Admissions Committee chaired by the Associate Dean, Students. This is a new position that was created by the amalgamation of Student Affairs and Admissions. This provides a vehicle for better coordination between intake of medical students and student support services. Approximately 850 – 1000 students apply annually, suggesting an adequate size of the applicant pool. Of these, 350 are offered an interview. Comparators of the applicant pool with other Canadian schools on items such as Medical College Admission Test (MCAT) scores and MCAT sub scores indicate this is a comparable applicant pool.

Manitoba‟s selection criteria are congruent with other Canadian medical schools and include Adjusted Grade Point Average (AGPA), MCAT scores and Multiple Mini Interview (MMI) score. The MMI was introduced three years ago as a validated approach to assessment of non-cognitive attributes. It is used across Western Canada. When the MMI was introduced, the selection criteria were altered to provide greater weighting on the interview component of the application in order to achieve a greater balance of cognitive and non-cognitive attributes in keeping with our mission to produce competent and caring clinicians.

It is also within the mandate of Admissions to attract students from rural Manitoba and students of Aboriginal heritage. Students of Aboriginal descent can apply through the regular stream or through an Aboriginal application stream. In the “Aboriginal” application stream, students undergo a panel interview rather than MMI interview, their composite score places greater weight on the interview, references and autobiography and less on the AGPA and MCAT.

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The Central Admissions Committee introduced a “rurality index” into the admissions weighting. The Admissions Committee evaluates rural attributes in the following three domains: rural “roots”; rural work experience; rural volunteer or leadership experience. The coefficient assigned to rural attributes results in a weighting factor of no greater than 13%.

2. Evaluate the number of students of all types (medical students, residents, visiting medical students, graduate students in basic sciences, etc.) in relation to the constellation of resources available for teaching (number faculty members, space, clinical facilities, patients, educational resources, student services, etc.).

These past four years has seen an incredible growth in the number of clinical learners in our teaching facilities. Expansion of the medical school class size from 87 acceptances in 2004/05 to 110 in 2008/09 is a significant factor and this will carry over the years. The class of 2012 represents the first class of the full class size of 110. They are now entering their clerkship stream and will enter postgraduate training in summer of 2012. In addition, Manitoba introduced a two-year; Masters level Physician Assistant Education Program (PAEP). This has added 12 learners annually to the clinical setting. The clinical aspect of this program started in September 2009. Finally, Manitoba has introduced a structured program for assessing and training international medical graduates (IMGs). IMGs whose credentials are deemed to be acceptable for direct entry into clinical practice are, depending on their background, requested to do three month evaluation within the teaching hospital setting, or alternatively, undergo a one year evaluation training program. This program enrolls 40 trainees annually.

In the setting of clinical teaching, this significant increase in clinical learners has raised concerns regarding capacity. In particular, pediatrics and obstetrics and gynecology, are identifying difficulty accommodating the number of learners requiring supervision. A number of new clinical environments, in particular in community settings, have now become engaged in the clinical education process to help us build our clinical capacity. In particular, the Grace and Victoria Hospitals, both small tertiary care community hospitals, now have internal medicine clinical teaching units. This has been viewed as a very positive asset to the spectrum of patient mix to which internal medicine trainees are exposed. Seven Oaks General Hospital, also a community hospital, has become very actively engaged in teaching in the emergency department. Their emergency department was renovated and through the renovation process, they have purposely built in education space as well as space for clinical simulation. Seven Oaks also plans to incorporate a dialysis teaching unit over the next one to two years.

The Faculty is assessing a broader distributed approach to medical education. There are many rural and northern communities in Manitoba that have the potential to provide excellent teaching experiences to a variety of learners and that resource has been underutilized.

With respect to student services, there has been a recent substantial increase in students at the Bannatyne campus, with the enlargement of medical school enrolment and the addition of the Faculty of Pharmacy on campus. A number of student services that are routinely available at Fort Garry campus are not available at Bannatyne. Specifically, Financial Aid and Awards do not have a presence at this campus and each faculty must provide their own if they wish their students to have these services onsite. Equity Services and Student Health Services do not have an established presence on Bannatyne. Effective September 2010, Learning Assistance Centre and Student Advocacy began offering services at Bannatyne one day a week. Student counseling has a well established presence at Bannatyne and through the Faculty of Medicine there is also a Faculty Counseling service accessible to students, resident and graduate students. This has been substantially expanded in the last year. The Faculty of Medicine has made a commitment to student services, to provide expanded space, and has allocated 2,000 square feet of space on the second floor of the “T” Building so that Student Counseling, Disability Services, Learning Assistance and Student Advocacy can be co-located. Dr. Lynn Smith, Director of Student Affairs, chairs a committee of the faculties at Bannatyne Campus to look specifically at gaps in student services and how to prioritize supports to Bannatyne campus.

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3. Describe the school’s successes in broadening diversity among medical school applicants. How well are the school’s programs to enhance the diversity of the medical school applicant pool functioning? Manitoba targets three groups specifically in addition to ensuring our application policies and procedures are non discriminatory for students of all races, disabilities, economic background and sexual preference.

Manitoba has a strong tradition of engaging students in rural communities in partnership with initiatives including the Medical Hall of Fame Discovery Days, the Office of Rural and Northern Health, and activities of the medical students‟ rural interest group. The rurality index during the evaluation of application process recognizes our dedication to increase the representation of students with connections to rural communities. At the time of the 2004 survey 24% of students were graduates of rural Manitoba high schools; for the cohort admitted in 2010, 49% had defined connections to rural communities.

The University of Manitoba has a well established commitment to trying to ensure that students of Aboriginal heritage succeed in post secondary education. Within the University, there is a strong Aboriginal support program for students who identify as First Nations, Métis, and Inuit. The Access Programs of Extended Education are located at Aboriginal House on the Fort Garry Campus; the Health Careers Access Program (HCAP) is specifically for students entering health professions. Bannatyne Campus hosts the Centre for Aboriginal Health Education (CAHE) which provides a broad array of supports for all students at Bannatyne Campus. The Faculty of Medicine‟s admission policies continue to support an Aboriginal stream within the application processes. Dean Postl, in recognition of the importance of engaging the Aboriginal First Nations, Inuit and Métis communities, and recognizing their integral role in our Faculty, has newly created a position of Associate Dean, First Nations, Inuit and Métis Health. For the incoming class of 2014, eight of the 110 students self-declared their Aboriginal heritage = 7.3% of first year students; 24 of 427 total undergraduate medical school enrolment = 5.6% of all Faculty of Medicine undergraduate students. This represents a slight increase over the previous years with a goal of moving closer to the representation within the province i.e. the 2001 census showed Manitoba had 150,040 Aboriginal people. This represented 13.6 per cent of Manitoba's total population. In Winnipeg, Aboriginal people represented 8.5 per cent of the total 2001 population.

Manitoba has also had a long standing commitment to ensuring that a proportion of students in our medical school come from out of province. We believe it is important to ensure there is a mix of ideas, philosophies and backgrounds. Ten percent of positions are reserved for out province students, and there are a substantial number of high caliber applicants for these positions.

Manitoba is supportive of students with disabilities into our program. We have recently introduced a technical standards policy for admission, progress and graduation; there is a companion policy for accommodation of students with disabilities. A member of the class of 2013 is deaf and requires sign language interpreters for communication. The Faculty of Medicine worked closely with Disability Services in the year prior to her admission to develop an appropriate plan and resources to support her success in the Program.

4. Evaluate whether the acceptance of transfer students, or visiting students in the school’s affiliated teaching hospitals, affects the educational program of regular students (i.e., in the context of competition with the school's own students for available resources, patients, educational venues, etc.).

Acceptance of transfer students has had minimal impact on the educational program. The frequency of accepting transfer students is low. The impact of the transfer student on total class size and educational resources is taken into account in the decision making re: acceptance. Recently, the volume of visiting student requests, in the setting of increasing medical school class size and introduction of the Physician Assistant learners, has become challenging. Manitoba has been able to accommodate the majority of visiting student

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 requests; however, from May to October 2010, the Faculty has had to put a moratorium on granting new visiting student requests. This illustrates that the needs of Manitoba‟s medical students are carefully considered.

B. Student Services

5. Comment on the levels of student attrition and academic difficulty in relation to the medical education program’s admission requirements, academic counseling efforts, and remediation programs. How effective is the program’s system for early identification of students in academic difficulty? Describe the counseling and remediation systems that are in place, and evaluate their effectiveness.

University of Manitoba has developed a system to identify and define students in academic difficulty and to have defined students as being on “monitored” or “probationary” status. Monitored status is for students who have had borderline performance on a major Block exam in Med I or II or had borderline performance on a Clerkship FITER or single failure of NBME exam. Probation status is reserved for students who have failed a Block exam, failed an FITER or failed two or more NBME exams. Using this designation, the students are regularly reviewed at the Faculty‟s Progress Committee. For students in academic difficulty, counseling on personal and academic issues is coordinated through the Student Affairs and the Director of Remediation. There are strong counseling supports available at Bannatyne Campus. The Self Study has identified that there had been communication issues between Evaluations and the Office of Student Affairs, but this has improved over the past 12 months with the implementation of new policies and processes. The overall success rate in the remediation program as well as overall success at the medical school is high with a 99% overall pass rate. In the 2009-10 year, there has been a notable increase in exam failure rate for the class of 2012, but that this has only been observed in one academic year, it is premature to draw any long term conclusions.

The Self Study report has identified that improvement is needed in supporting the students who self-identify with academic difficulty but do not meet the criteria for monitored or probationary status. There have been recent enhancements to the information available on the Continuing Professional Development and Student Affairs websites, and an introduction of new workshops in exam taking and time management. The Learning Assistance Centre has a presence at Bannatyne campus one day per week which started in the fall 2010, as well as a new provision of personal tutoring which started January 2011, which are all positive steps.

6. In the context of data from the Student Self-study and the most recent AAMC Medical School Graduation Questionnaire, evaluate the effectiveness of the systems in place for career counseling, residency preparation, and the selection of elective courses.

The student independent accreditation survey, as well as data from the Canadian Graduate Questionnaire, identify that students have concerns with respect to the career counseling program in place. The Faculty has shared that concern and the database identifies a range of initiatives put in place over the past 12 months, as well as initiatives planned over the next two to three years. Manitoba has adopted the AAMC Careers in Medicine Framework as the basis of their career counseling program and using that framework, has developed a range of activities that match the developmental stage of each medical school year.

A new fund, the Oatway Fund, became available in 2009 through the Manitoba Medical Service Foundation, to fund career planning initiatives and is being used to fund Careers in Medicine training for faculty advisors, a recent expansion of the careers website, as well as student-led initiatives. Restructuring of the office of Student Affairs has created a new Senior Advisor position with responsibility for academic and career counseling.

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Faculty advisors were offered to will assist Med IV students to prepare for the CaRMS process prior to the November 2010 submission date including review of their MSPR (Dean‟s letter), CV, reference letter, personal cover letter and interview skills and 54 students took advantage of this service.

A goal for the career counseling program is to involve the current Faculty Mentorship Program over time, so that mentors can take on a more active role in career counseling. An ongoing challenge for the program is the scheduling of career planning sessions, so as to imbed them more fully in the curriculum.

It will take several years for the effectiveness of the many new initiatives that have been put in place to be fully realized and evaluated. Preliminary success was demonstrated in 2010, when the University of Manitoba students were second in the country for the percent of students who obtained their first choice in the CaRMS match. This was a substantial improvement to 2009 when they were second lowest in the country.

With respect to elective courses, there is both lecture and web-based information available for students. This is a challenging task for students and is a source of stress for them. The Faculty has developed new workshops in the fall 2010 with the hopes of alleviating some of the anxiety expressed by students.

7. Evaluate the level of tuition and fees in relation to the size of graduates’ accumulated debt, and to the level of financial aid needed and available. Describe the efforts in place minimize student indebtedness. Comment on the effectiveness of these efforts? Comment on the adequacy and availability of financial education and debt counseling programs.

Tuition for the medical student class of 2014 was approximately $7,600 ($10,000 including textbooks and resources), the sixth lowest of the 17 schools in Canada behind Memorial and Quebec medical schools. The Canadian Graduate Student Questionnaire of 2010 showed that Manitoba student indebtedness has remained consistently lower than that reported by other schools, for each year reported since 2006. There are substantial tuition rebate tax credits as well as provincial grants available to students who stay in Manitoba for post graduate training and/or practice or return to Manitoba to practice. Only 30% of the medical student population applies for bursaries and grants offered by the Faculty of Medicine. For those students eligible for a bursary, they vary in amount from $400 to $1,000. On an annual basis the Faculty of Medicine spends $632,000 on bursaries and scholarships for medical and graduate students. These amounts are relatively low, given the overall cost of education. External Relations has prioritized bursary funds in its fundraising efforts.

The financial education and debt counseling programs of Manitoba are comparable to those in other medical schools in Canada.

8. Evaluate the adequacy and availability of student support in the following areas:

8.1 Personal counseling and mental health services, including their confidentiality and accessibility: On site at Bannatyne campus, students have access to the Student Affairs, student counseling services and faculty counseling services. Waiting times range from less than five days to meet with the Student Affairs, to two to four weeks for meeting with the counseling services and students can be accommodated more urgently if requested by Student Affairs. All three services operate at arm‟s length from Undergraduate Medicine. All three services have their own confidentiality processes in place and records are not accessible by Undergraduate Medicine.

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8.2 Preventive and therapeutic health services, including immunizations and health and disability insurance: Manitoba has a well coordinated system for monitoring immunization status and providing immunizations as needed. Medical students have universal coverage for health services through the Province of Manitoba. Doctors Manitoba (formerly the Manitoba Medical Association) has a unique disability insurance program for medical students. This is a voluntary insurance package, but all students are strongly encouraged to enroll in the Doctors Manitoba Program.

Access to health services at Bannatyne Campus itself is an ongoing concern for the medical students. 69% of students have an established primary care physician. There are policies in place in Clerkship and which allow students to be excused from class or clinical service to attend an appointment with their primary care physician. However, students are still unable to access a physician for episodic care at Bannatyne campus as this is a service that is situated at the Fort Garry campus. University Health Services is working closely with the Faculty of Medicine to try and put in place such a service, over the next few years.

Establishing ongoing primary care for those students who are entering school without an established primary care physician has also been an area of ongoing concern. Starting February 2011, the Health Sciences Centre Northern Connections Medical Centre will be accepting these students for ongoing primary care. The Centre is located geographically close to the Bannatyne campus and students will be accepted as patients of that clinic for the time they hold student status. This will be a significant asset to the Bannatyne medical student population.

8.3 Education of students about bodily fluid exposure, needle stick policies, and other infectious and environmental hazards associated with learning in a patient care setting: Education regarding infection control and precautions is taught both in the early Med I program as well as the Introduction to Clerkship (ITC). Students are educated to the same level of precautions as all WRHA employees. For the 2010-11 academic years, UGME has introduced a number of initiatives to ensure that students are aware of both the University as well as clinical teaching site processes they must follow e.g. a wallet sized, laminated card has been provided to the students to carry with their identification which outlines the post-exposure procedures Clinical teaching sites are reminded in their affiliation agreement with the University of their obligation at the time of student orientation to the site, to ensure that students are aware of processes unique to their institution that they need to follow in the setting of an exposure or needle stick injury. Following the lessons learned from SARS in 2003 and the H1N1 pandemic of 2009, the Faculty has provided all students with access to N95 standard fit testing soon after the time of registration.

C. The Learning Environment

9. How effective are the medical school and its clinical partners in assuring an appropriate learning environment for medical students? Summarize successes and challenges in supporting positive and mitigating negative influences on students’ acquisition of defined professional attributes.

The development of the position of an Associate Dean, Professionalism and the hiring of Dr. Samia Barakat into that position, has been a catalyst for creating a positive culture regarding professionalism in the Faculty of Medicine. Under her leadership, there is a now a Professionalism Charter and guidelines for Teacher-Learner Conduct for the Faculty. There is ongoing work regarding attendance, professional attire, and student conduct in online settings/social networking.

The Human Values curriculum sets a strong foundation for students to reflect on their role as physician, both as a healer and a member of society. Over the course of the next academic year, the Faculty will be putting into place a professional unsuitability committee chaired by the Associate Dean, Professionalism. This will

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 formalize a process for examining conduct that may determine that the student does not meet the standards of the profession, and therefore the Faculty, from admission application through to clerkship. This will include putting into place a professional unsuitability bylaw, consistent with the approach in place at the Faculties of Law, Education and Nursing at the University of Manitoba.

A new challenge being faced by the Faculty is the use of electronic media, including text messaging by students. This will require ongoing evolution of Faculty policies as social media and social networks also evolve and change.

An ongoing challenge, as well, within the clinical context, is a discounting of the value of primary care within the setting of a tertiary care hospital. It is the mandate of the incoming Dean of Medicine to openly address this aspect of the “hidden curriculum”.

10. Comment on the effectiveness of school policies for addressing allegations of student mistreatment, and for educating the academic community about acceptable standards of conduct in the teacher-learner relationship.

The University of Manitoba has a Respectful Work and Learning Environment policy for issues of student mistreatment for all faculties. Until fall 2010, there were gaps in ensuring that all students were aware of this policy, and in clearly identifying on websites and in print literature the appropriate steps for students to follow in cases where there are concerns.

In the clinical setting, the WRHA and its sites have Respectful Workplace policies, which govern all staff, including medical staff. The WRHA has reinforced its expectations regarding respectful workplace with a respectful workplace campaign, including posters in its facilities and information posted on the WRHA website.

In fall 2010, the Student Affairs website added information about intimidation and harassment in its “Wellness” content, including appropriate steps to take. The Respectful Work and Learning Environment policy is easily accessible from the Student Affairs website.

The Associate Dean, Professionalism and the Associate Dean, Students are initiating a new teaching session during the Introduction to Clerkship (ITC) curriculum on issues of boundaries and harassment. As well, Professionalism and Student Affairs are collaborating to work with Family Medicine and Rural Week Coordinators to look at educating community based preceptors on issues of boundaries and standards of conduct in the teacher-learner relationship. A drop box was installed in January 2011 outside the student lockers inviting comments, signed or unsigned, to be dealt with in confidence by the Associate Dean, Professionalism, along with contact information.

The issue of mistreatment was identified by students. In a meeting with Department Heads, the Associate Dean, Students and Associate Dean, Professionalism outlined action they have taken to address concerns brought to their attention. The Dean along with Associate Deans of UGME, PGME, Students and Professionalism, is hosting meetings in February 2011 with the Chief Medical Officers of the WRHA clinical teaching sites and with faculty of clinical departments to improve this situation. These meetings will also include representatives of the Professional Associate of Residents and Interns of Manitoba (PARIM) and the Manitoba Medical Students Association (MMSA). The Dean has met with the WRHA to discuss this matter, and he is meeting with provincial nursing leadership in relation to mistreatment on clinical units.

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The Faculty is working to improve the situation with a multipronged effort that includes education of all staff, students and faculty. In early February students will be receiving a wallet size resource card specific to the topic of harassment and professionalism to direct them to available resources in the Faculty and at the University.

11. Evaluate the familiarity of students and course and clerkship directors with the school’s standards and policies for student advancement, graduation, disciplinary action, appeal, and dismissal. Review the adequacy of systems for providing students with access to their records and assuring the confidentiality of student records.

School standards for student advancement, graduation and appeal are well documented and laid out in the General University Calendar. Faculty Committees of Evaluation exist at the Med I, Med II and Clerkship level. Relevant course directors are represented on each of these committees, as well as student representatives. These committees review examination results and forward recommendations for student advancement to the Progress Committee. Through this structure, the students and course directors gain familiarity with policies for student advancement, graduation and appeal.

Familiarity with standards for disciplinary action and dismissal are not well laid out in the Calendar. The Student Discipline By-law covers most of what is required regarding student discipline, however, students and faculty are not well versed in its existence or content. The inclusion of materials on discipline and dismissal is planned for the UGME website, and a link to the University Student Discipline By-law has been added on the UGME website for current students. As well, an information package for faculty is planned which will be beneficial. Establishment of a professional unsuitability committee will also create an enhanced awareness of codes of conduct, process for disciplinary action and standards for dismissal.

Student records are maintained in a confidential manner and students do have access to their student record. A Student Record policy formalizing the processes of creation, storage and management of the student record, including student access, has been implemented effective September 1, 2010. The policy is included on the Undergraduate Medicine website Policies and Procedures.

12. Assess the adequacy and quality of student study space, lounge and relaxation areas, and personal storage facilities. Do available resources for study contribute to an environment conducive to learning?

For students in Clerkship years who spend the majority of their time at Bannatyne campus, the study space, lounge, and personal facilities are very good. There is wireless computer access throughout the facility allowing students to choose a study environment that meets their needs, be that the Brodie Atrium, or selective access to tutorial rooms after hours.

In the MMSA Accreditation Survey, the students indicated a need for more individual study space, and especially group work areas. This concern is partially related to the move of the Faculty of Pharmacy to the Bannatyne campus, but as well, the Library has become a desired place to study by students from the main Fort Garry campus who live in the area and by students from the University of Winnipeg as well as the general public. Following the Interim MMSA Accreditation report in November 2009, process changes were made in the Dean‟s office, facilitated by UGME, to allow study rooms to be booked and held under the MMSA for medical students‟ use when not needed for meetings or teaching. Renovations to the NJM Library, fully described in ER-11 and ER-12, have added needed study spaces. Improvements are underway in the provision of student personal storage facilities in some of the clinical sites. The adjacent Health Sciences Centre does not have dedicated student space, but as there is tunnel and walkway access to the medical school, students are able

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 to use their personal school lockers. Community teaching hospitals such as Grace, Victoria and Seven Oaks Hospital have gone to great lengths to provide space and storage for students as well as access to internet and resources. There were some challenges to meet needs identified by the medical students at the second tertiary site; St. Boniface Hospital. These have been addressed appropriately and are now in full compliance.

Medical Students Strengths

1. The admissions process is a transparent one with special streams to support the Faculty‟s priorities for diversity.

2. Good working relationship exists between the Associate Dean, Students and the students.

3. The commitment of the Manitoba Medical Student Association to the Faculty is exemplary.

4. The Faculty and University are well resourced to support our Aboriginal students.

Medical Students Challenges

1. Communication with students was identified as needing work by the students in a variety of venues including communication with UGME office, communication around policies and procedures. A multi- faceted communication plan that has been developed by the Director of Communications and Marketing. From the Dean‟s Office, “breakfast with the dean” was initiated for all Med I and Med II students, and lunches with the Associate Dean, UGME are continuing. The Dean has also initiated Town Hall Meetings with the students, begun a Dean‟s Blog and accreditation newsletter.

2. Increasing Bannatyne student access to acute, episodic health care is a continuing challenge.

3. Professionalism issues including student attendance, professional conduct, social networking, and harassment are challenging matters that are being addressed in an ongoing fashion. The issue of mistreatment will require ongoing vigilance and work towards a safe environment for all learners

4. The longstanding challenge to meet career, personal and financial counseling needs of the students is being addressed. The Dean has committed to enhance Student Services with additional space, renovations at the Bannatyne campus.

IV. FACULTY

A. Number, Qualifications, and Functions

1. Is the current size and mix of faculty appropriate for the attainment of the medical school’s mission and goals?

The Faculty of Medicine has an adequate number of full time and part time faculty members to meet the commitment to medical student education. Medical school enrollment has been increasing, but there has been an investment from the Council on Post Secondary Education (COPSE) and Manitoba Health to fund this increased enrollment. The Faculty of Medicine has allocated the majority of this new funding to the various departments to enable recruitment of new faculty members ("Managing Growth" Funds). Full time and part time faculty numbers have all been increasing over this period of increasing enrollment. Due to significant variation in the

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 type and extent of teaching being done in the various clinical and basic science departments, there have been a range of different strategies for sustaining medical student education capacity.

The Faculty of Medicine has maintained a strong focus on and commitment to medical student education despite the reality of competing productivity requirements in research and clinical service. The Faculty has taken active measures to address these issues and demands in both clinical and basic science departments. In clinical departments, the most significant initiative in this regard is the creation of the Joint Operating Division (JOD) of the University of Manitoba and the Winnipeg Regional Health Authority. The JOD, in negotiations with Doctors Manitoba, has developed a proposed new contractual model for academic physicians. Following further consultation with stakeholders, subject to endorsement by the academic physicians, The JOD will be deploying a new contract model for academic physicians in the upcoming year. This contract for academic physicians will enhance the clarity of communication of expectations for educational contributions and also specify realistic time-based deliverables in other domains (research, clinical service, administration). This will help to ensure that productivity requirements in research and clinical service do not interfere with commitments to medical student education. In basic science departments, one significant initiative is the Central University– wide Optimizing Academic Resources (OARs) Project, which will seek efficiencies in the teaching of courses across basic science areas and student groups.

Although the Faculty has used part time and volunteer faculty (including graduate students) to deliver some of the medical student teaching, this has not generally been deployed as a strategy to offset deficiencies in the number of full-time faculty. Graduate students in particular directly benefit from the opportunity to engage in formal educational activities as they prepare for their future academic careers.

2. Describe and evaluate the availability of opportunities for both new and experienced faculty members (fulltime, part-time, and volunteer) to improve their skills in teaching and evaluation. Is institutional or departmental-level assistance, such as training sessions from education specialists, readily available? What is the level of faculty participation in such programs?

There are a variety of resources available in the Faculty of Medicine to support the development or remediation of teaching skills. These resources include programs through the central university and workshops through the Faculty of Medicine. In some instances individual departments have supplementary mechanisms for teaching remediation.

Central U of M, University Teaching Services (UTS) offers Faculty workshops and has a website listing extensive resources e.g. “Tips to Improve Academic Teaching. There is a New Faculty Program to develop teaching skills. There is information on ANGEL Learning, the University of Manitoba's Learning Management System which provides web-based teaching and learning tools for the campus. Central U of M Learning and Development Services (LDS) support organizational and personal effectiveness through partnerships, programs, and initiatives in staff and organizational learning and development, noted on their website.

Faculty-wide workshops are offered through Continuing Professional Development, the Office of the Associate Dean, Academic and through the Faculty‟s Department of Medical Education e.g. February to July 2011, course offerings from Medical Education include teaching clinical reasoning; teaching one on one; affective evaluation; working with a problem learner in a clinical program; writing multiple choice questions.

The Faculty of Medicine has provided financial support in aid of faculty participation in education-related events. The Dean‟s Office has actively offered to support Department Heads‟ and Associate Deans‟ attendance at external workshops that will enhance personal skills and build skills and resources for faculty development e.g. Banff Management Centre. All clinical departments and most basic science departments also provide

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 financial support for members to attend meetings and conferences with an educational focus in their professional area. The sources of funding vary by department but include a departmental "tithe," practice plan, professional development allowance, or personal development account.

There has been a fair level of participation in these educational activities (numbers for the faculty-level activities are available in the Faculty Standards database, Appendix FA-11a), though there is currently capacity to train more faculty. Individual departments have also taken the initiative to build faculty skills e.g. several Departments have used their Grand Rounds schedule to address faculty teaching skills and the Department of Psychiatry has hired a Director of Faculty Development and Educational Scholarship who will encourage and support participation of Junior Faculty in existing faculty development opportunities. There is also an opportunity to more formally link individual teaching evaluations with remediation efforts, for example, by linking instructor evaluations in OPAL.

3. Do faculty receive appropriate support and mentorship related to scholarship? Are formal institutional programs available to support faculty research?

Responsibility for fostering faculty research and scholarship is a matrix between the associate deans of academic, research, and medical education. Since 2006, all new faculty members meet with the Office of Academic Affairs (assistant dean- faculty development) to review the function of the dean‟s office, the relationship with central university (Fort Garry Campus), the academic weighting of their faculty position, the value of academic performance reviews, the development and structure of their academic dossier and curriculum vitae, the promotions process and the availability and access to resources such as books, policies, websites, and journal articles on academic career advancement.

Other formal Faculty-wide opportunities include a) workshops on academic advancement coordinated with the promotion/tenure workshops and presented by the chair of the academic promotions committee in February- April annually; b) workshops at Fort Garry for all new faculty organized by the University Teaching Service in July each year; c) access to the academic resource library in the Office of Academic Affairs; d) a formal Faculty of Medicine review process through the Office of the Associate Dean, Research, that requires formal internal reviews of national grant applications by new investigators.

Additional formal longitudinal opportunities for academic career advancement include the Western Canadian CIHR network IMPACT (local coordinator Dr. T. Duhamel, St. Boniface Hospital Research Foundation), Canadian Child Health Clinician Scholars Program (local coordinator Dr. R. Schroth, Manitoba Institute of Child Health). Informal opportunities for career advancement exist in seminars on reviewing for grant panels, manuscripts, and personnel awards.

There currently is not a formal Faculty-wide, or University-wide, process of mentoring junior research faculty, except for faculty members who apply for Canada Research Chairs. Currently, the mentoring of junior faculty members is arranged by specific departments or units.

The Office of the Associate Dean (Research) has initiated some activities designed to enhance collaborations between basic and clinical colleagues, to improve mentoring, and to increase competitiveness at National granting councils. These are:

Formation of an Associate Dean of Research Advisory Group (ADRAG) consisting of the Associate Dean, Research, Assistant Research Deans and Directors, Heads of the eight basic science departments, representation from several clinical departments, and representation from two research institutes, was

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established in the summer of 2009. Meets monthly or semi-monthly to design and implement research enhancing strategies; including: Development of an enhanced internal pre-review process to vet grant applications before submission to CIHR competitions, that incorporates feedback from basic and clinical researchers in a group format; Establishment in September 2010 of an annual Translational Research Symposium, featuring successful basic and clinical researchers who have “bridged the gap” between the two disciplines; Active participation in a research database that promotes keyword searching and interdisciplinary collaborations; a newly-established University "My Research Tools" set up in summer/fall 2009. The hope was that faculty members would participate in populating such a database with their own expertise and use it to search for colleagues with complementary expertise.

Discussions currently working out logistics for implementing a “joint mentorship” process, in which new recruits are matched with both a more senior basic scientist as well as a more senior academic clinician in order for the new recruit to benefit from both perspectives as well as expose the mentors to each other as an additional collaboration-building mechanism.

A variety of additional processes are implemented at the individual department level to foster faculty scholarship. These processes include informal mentorship arrangements, formal mentorship arrangements (often involving the departmental director of research) affiliations of new faculty with established research groups, department head counsel, financial support for research meetings and coursework, and protected time for research (in clinical departments).

B. Personnel Policies

4. Evaluate the systems for the appointment, renewal of appointment, promotion and granting of tenure, and dismissal of faculty members. Are policies clear, widely understood and followed?

Academic appointment, renewal of appointment, promotion, granting of tenure and dismissal of faculty members are governed by University of Manitoba policy. These policies are posted on the Faculty of Medicine website and are specifically referenced in the FA-7 Standards section of the accreditation database. These policies are clear and appear to be widely understood and followed by those who are affected by them.

Academic appointment, renewal of appointment and promotion and tenure are managed under the direction of the Office of Academic Affairs, Faculty of Medicine. For clinical faculty (geographical full-time “GFT” faculty), academic appointment is coordinated with clinical appointments and privileges in the Winnipeg Regional Health Region through a Joint Operating Division (“JOD”) developed to support an integrated approach to recruitment and retention of academic clinicians.

A new contractual model for engagement of academic physicians is currently under development between the JOD and Doctors Manitoba, representing the interests of the GFT‟s. Through the JOD, the recruitment process for engaging academic clinicians is being streamlined. Pending approval of a new contractual model, the systems for engaging the services of academic physicians are still distinct, with faculty being employees of the University of Manitoba for their academic duties and independent contractors for clinical services provided. If the new contractual model is approved, the process of engaging clinical faculty will be further streamlined into an integrated single contract with the University of Manitoba and the Winnipeg Regional Health Authority jointly, including an integrated payment system, with coordination of academic and clinical appointments.

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These changes in the administrative processes to support recruitment address concerns about timeliness in the recruitment process outlined in the 2004 Self-Study Report.

Regarding the promotions process, during the 2004 accreditation process, one of the recommendations by the Self-study Task Force was that the Faculty undertake revisions to the promotions document to specify criteria for teaching performance and clinical and research activity related to promotion and tenure. In response to this recommendation, a committee of senior faculty members reviewed the literature and held focus groups to address these issues. In 2006, the Faculty of Medicine, through the Faculty Executive Council, adopted a new promotions document, including new broad criteria for definition and measurement of scholarship. Promotion is based on academic achievement, as is clearly outlined in the promotions document which is posted on the Faculty of Medicine website. This promotions process has been designed to be robust, transparent and fair. Feedback from senior faculty and the promotions committee has been positive.

All new faculty members meet with the Office of Academic Affairs (Assistant Dean, Faculty Development) to review, amongst other matters, the academic weighting of their faculty position, the value of academic performance reviews, the development and structure of their academic dossier and curriculum vitae, the promotions process and the availability of and access to resources such as books, policies, websites and journal articles on academic career advancement. Faculty development workshops on academic career advancement, promotion and creation of academic dossiers are held at least three times annually by the chair of the faculty promotions committee.

5. Assess the adequacy of institutional and departmental conflict of interest policies relating to faculty members’ performance of their academic responsibilities.

In addition to University-wide policies on conflict of interest which govern all faculty, Faculty-wide policies addressing conflict of interest relating to faculty members‟ performance of their academic responsibilities are comprehensive and are posted on the Faculty of Medicine website.

The Winnipeg Regional Health Authority also has comprehensive conflict of interest policies which address conflict of interest in the clinical and administrative settings within the Winnipeg Health Region. These policies were developed following extensive review of conflict of interest policies in other jurisdictions, and following broad consultation with stakeholders.

Both the Faculty of Medicine and the Winnipeg Regional Health Authority are in the process of widely educating faculty members and staff about their obligations pursuant to these policies. As part of the ongoing implementation of the policies, a joint disclosure statement has been distributed to all clinical faculty members requiring that they disclose any potential, perceived or actual conflicts of interest. These disclosure statements will be received and reviewed by the Joint Operating Division and will be forwarded to the faculty member‟s Department Head for ongoing management in the event that a conflict of interest is disclosed.

As a matter of process, all employment agreements and contracts with faculty members require adherence to the policies of the University of Manitoba. Contracts with clinical faculty also require adherence to the policies of the Winnipeg Regional Health Authority.

6. Describe the extent of feedback provided to faculty members about their academic performance and progress towards promotion and/or retention. Are faculty members regularly informed about their job responsibilities and the expectations that they must meet for promotion and/or retention?

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Feedback regarding job responsibilities and expectations faculty members must meet for promotion and tenure occurs along a continuum, beginning with the recruitment and orientation processes, and continuing at periodic intervals thereafter.

During the recruitment process, both in face to face meetings with the Department Head (or Section Head, in larger Departments) and in the subsequent letter of offer, the faculty member is informed about job responsibilities expected of them. Once the faculty member starts in their position with the Faculty of Medicine, the Office of Academic Affairs (through the Assistant Dean, Faculty Development) meets with each new faculty member individually, to review the function of the Dean‟s Office, the relationship with the University of Manitoba more broadly, the academic weighting of their faculty position, the value of academic performance review, the development and structure of their academic dossier and curriculum vitae, the promotions process and the availability of resources to support academic faculty development.

Subsequent to the recruitment and orientation processes, feedback regarding academic performance is generally provided on an annual basis, during face to face meetings between individual faculty members and their respective Department Heads. Through the Self-Study process, we noted considerable variability in the departmental approaches to performance evaluation and identified a need to adopt a faculty-wide approach to performance review and feedback. A number of departments have very robust evaluation processes. These processes are being studied by the Associate Dean, Academic and he is leading a process to develop and implement a more standardized, Faculty-wide performance review process

On an ongoing basis, should job responsibilities change, communication of such changes occurs between the Department Head (or Section Head) and the faculty member at that time. Similarly, should a performance issue arise; the feedback is provided to the faculty member by the Department or Section Head, or a designate such as a Director of Undergraduate Education or Director of Postgraduate Education if appropriate.

In addition to these avenues for feedback, each department has a Promotions and Tenure Committee, chaired by a faculty member in the department, providing another avenue for feedback regarding promotion and tenure at the level of the peers of the faculty member. These departmental Promotions and Tenure Committees provide formative evaluations for Department members.

7. Discuss the extent to which education is valued in the institution. How are the degree and quality of participation in medical school education factored into decisions about faculty retention and promotion?

Education is highly valued within the Faculty of Medicine. On August 27, 2008, the Dean of Medicine convened a daylong meeting of Department Heads and other partners (WRHA, Manitoba Health) to specifically obtain input on an agreed upon method of managing growth in education programs over the next four years. By way of context, over the preceding decade, the province of Manitoba had witnessed the largest growth (approximately 57%) in medical education in two generations – from approximately 70 students in 1999 to 100 in the fall of 2008. In order to meet the Faculty‟s responsibilities to support this growth in educational programs, the meeting was held to address the following objectives:

1. An allocation of resource for increased education based on data; 2. A rational balance of central supports and departmental supports; 3. A process to review, renew and update the proposed method.

Following this meeting, a process was implemented whereby incremental funds provided by Manitoba Health and the Council on Post-Secondary Education (COPSE) were allocated to Departments with corresponding deliverables to meet the educational needs of all learners, specifically including undergraduate and post-

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CACMS / LCME SELF-STUDY REPORT 2009 – 2011 graduate medical students, physician assistant students, international medical graduates and nurse practitioner students. Throughout this process, the Faculty of Medicine‟s commitment to high quality education was at the forefront of the discussions. The allocation of new funding was specifically dedicated toward faculty recruitment and retention, and capacity to meet the demands associated with increased enrolment.

C. Governance

8. Evaluate the effectiveness of mechanisms for organizational decision-making. Are necessary decisions made in a timely and efficient manner with appropriate input from faculty and other concerned parties? Describe and assess the relative roles of committees of faculty, department heads and medical school administrators in decision-making.

Faculty Executive Council (FEC) is the primary decision-making body for the Faculty of Medicine in relation to academic matters. FEC meets at least quarterly and is comprised of a broad cross section of representatives from across the Faculty of Medicine, the College of Physicians and Surgeons of Manitoba, the Dean of Nursing, and student representatives. The educational policies and procedures including academic standards, curriculum, reviews and courses are determined and approved by Faculty Executive Council (as delegated by Senate and Faculty Council). The Dean (together with the Associate Deans) is responsible to supervise the educational programs and students in accordance to the regulations and rulings of the Faculty Council and the Senate. The Dean of the Faculty of Medicine, with advice from Associate Deans and Department Heads, determines the administrative policies of the Faculty of Medicine. Department Heads hold meetings with members of their respective Departments, and bring the views of their members to discussion at both Department Heads Council and Faculty Executive Council and in their individual meetings with the Dean or Associate Deans.

These decision-making structures, for academic and administrative matters respectively, facilitate decision making in a timely and efficient manner with appropriate input from faculty and other concerned parties.

9. Assess the effectiveness of the methods to be used to communicate with and among the faculty. Do faculty perceive themselves to be well informed about important issues at the institution? Do faculty believe that they have sufficient opportunity to make themselves heard?

The Faculty of Medicine uses a variety of methods to communicate with faculty members. These include the Faculty of Medicine Website, a Faculty magazine, "Manitoba Medicine" and e-mail bulletins ("Medlines"). There are also two email list-serves ("Med-All" and "Med-Academics") that can be used by faculty members to communicate broadly within the medical school. There is an annual Faculty Council Meeting, though attendance at the latter forum is moderate. Much of the communication in the Faculty of Medicine occurs in a hierarchical fashion; information flows from the Dean's Office to department heads at the Faculty Executive Council and the Department Heads Council meetings and the department heads in turn share information with their department members.

There are a variety of mechanisms available for faculty members to make themselves heard in the Faculty of Medicine. Again, much of the communication from faculty members to the Dean's Office is organized hierarchically. Faculty members meet directly with their Department or Section Head, attend staff meetings (including Department Council meetings), and participate on departmental committees. The Department Head in turn communicates to the Dean, Faculty Executive Council, and Department Heads Council. Individual faculty members also have the opportunity to register their opinions or perspectives at a variety of Faculty Committees, Faculty Council meetings, Town Hall meetings, and periodic retreats that are held to focus on specific issues.

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The Dean has enhanced transparency in faculty wide financial reporting by creating quarterly reports, available online to all department heads. In addition there has been an increase in direct communication with faculty in the form of Dean‟s blog, “Postl Notes”, to provide his own regular updates to the Faculty. Anecdotal feedback has been very positive. Since the first blog entry in October 2010, there have been 11 blogs which have been well received by faculty, students and staff.

Faculty Strengths

1. The Faculty of Medicine has a favorable complement of faculty members to students, and increasing faculty numbers in tandem with increasing enrollment.

2. Robust policies for industry relationships and conflicts of interest, and ongoing work to establish monitoring and enforcement mechanisms.

3. The Joint Operating Division of the Faculty of Medicine and the WRHA and the strong working relationship between Faculty of Medicine and WRHA.

Faculty Challenges

1. Faculty Evaluation. The institutional self study process identified variability in the evaluations process from Department to Department. Every Department has instituted an evaluation process, but the content and processes of these evaluations range from fairly basic to very robust. The challenge going forward is to create a more standardized process that will reflect the variety of important educational, scholarly and service roles performed by our faculty members, and accommodate the diversity of Departmental settings. The implementation of a standardized database for this function (STAR system) will facilitate the development of an improved (standardized and more comprehensive) assessment process. The OPAL system is already being used to collect teaching evaluations and there is considerable potential to expand upon this function.

2. Communication between Dean and Faculty. With the members of a large and diverse Faculty, this is an inevitable challenge. As noted, much of the communication within the Faculty occurs on a hierarchical basis from Dean to Department Heads to members. Faculty members receive numerous messages and memoranda from their Faculty, Department, Hospital and Health Region. Communication strategies need to assist members in identifying the most important initiatives and development taking place in their Faculty. Recent Faculty of Medicine developments include a new Dean's Blog ("Postl Notes"), the institution of "town-hall" style meetings with faculty and the Dean's attendance at Department Council Meetings. A recent initiative in December 2010, to increase communication between the faculty and Dean, was the institution of mandatory reporting of Department Council minutes to the Dean to keep him apprised of Departmental issues.

3. Remuneration models for academic work. Funding models vary markedly for clinical faculty from department to department. Within the Faculty, there are examples of equitable and transparent mechanisms for remunerating academic work, while in other departments such models have yet to be developed. We have identified the need for ongoing advocacy to address these discrepancies, and continue to advocate with government to develop a consistent funding model with appropriate remuneration and consistency across departments.

V. EDUCATIONAL RESOURCES

A. Finances

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1. Discuss the stability of and the balance among the various sources of financial support for the medical education program and school (i.e., state and local appropriations, income from patient care, endowments, tuition income, research income, hospital revenues).

The Faculty of Medicine receives financial support from the following five direct areas. Funding from the Ministry of Advanced Education and Literacy (Council of Post Secondary Education (COPSE) is deemed to be fairly stable but not recession proof and is comprised of a central base allocation and tuition. Funding from the Ministry of Health (Manitoba Health, Province of Manitoba) is deemed to be very stable. Research funding from Federal Government (tri-council funding), Industry and other foundations and associations can be categorized as fairly stable. Trust and Endowment funding from external sources are held centrally and the Faculty is able to spend the capital contribution and spending allocation in a trust fund and only the spending allocation in an Endowment fund. The stability of these funds depends upon market trends. The fifth source of revenue is indirect in-kind supports from the Regional Health Authorities and the University Medical Group. The stability of these funds is independent of the individual agreements and has been stable over the last five years.

Discuss the implications of any downward trends in specific revenue sources. The Faculty is not solely dependent on one source of financial support so a downward trend in one specific area would not have significant impact on the faculty. However the faculty is not immune to the effect of the shifts in the global economy and a severe and prolonged downward trend in one source would undoubtedly increase the pressures on the remaining trust and endowment resources.

Describe the financial prospects for the medical school over the next five years?

The Faculty has partnered with and developed strong relationships with Manitoba Health, Health Canada, the Winnipeg Regional Health Authority and its Trust and Endowment donors. We anticipate that these relationships will continue to generate additional revenues for the Faculty.

Are there any departments in financial difficulty? Are there systems/policies in place to address departmental financial difficulties?

Although each department has its own separate budget they all fall under the purview of the Office of the Dean. Under the Director of Operations, the Senior Financial Officers monitor the departmental budgets to ensure that strict financial policies are adhered to. Any departmental budgets that start to slip are flagged and corrective action taken. Such corrective action may include providing additional administrative supports, reallocating available budget from another unit or reassigning operational expenditures to another unit.

2. Comment on the degree to which pressures to generate revenue (from tuition, patient care, or research funding) affect the desired balance of activities of faculty members. What mechanisms are in place to protect the accomplishment of the educational mission?

The Faculty receives little or no revenue from tuition ($3,600 per student) or patient care and is not solely dependent on one source of financial support for the accomplishment of the educational mission. The faculty‟s partnerships with Manitoba Health, Health Canada, the Winnipeg Regional Health Authority and its Trust and Endowment donors ensure that the faculty members can maintain their desired balance of activities.

3. Describe how the school has positioned the clinical enterprise (faculty practice plan/organization and

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The clinical enterprise is closely aligned with the local health environment through the affiliation between the University and the RHAs, supported by the Joint Operating Division and the concurrent appointment of Department Heads and Program Medical Directors, who are also chairs of their respective practice plans. While the practice plans are independent of the Faculty from an accounting perspective, funds derived from the Departmental tithe through the practice plan are used to support the academic mission of the Faculty.

4. Describe how present and future capital needs are being addressed. Is the financial condition of the school such that these needs can be met?

The capital needs are determined by the strategic plan of the Faculty. Under the direction of the Dean, projects are initiated in consultation with the faculty. These needs are then channeled through to a Faculty space committee that determines which spaces will meet the strategic direction as well as which spaces are in need of redevelopment.

The Faculty is responsible for the redevelopment (renovation) of an existing space and/or construction of new space. Certain costs related to the development of a space are provided through a central University fund and the Faculty has representation through the Director of Operations position. The Faculty is not responsible to cover the utilities of the space nor the replacement costs associated with the space as those expenses fall to the University as a whole. Over the last four years 200,000 sq feet of building have been upgraded or renovated. A listing of the renovated/new space can be found in ER-4.

Deferred maintenance such as windows, roofs, etc. is managed by the Director of Central Physical Plant in consultation with each Faculty. The Director of Operations, Faculty of Medicine, meets monthly with the Director of Physical plant and Associate VP Admin to rank deferred capital projects. In 2010/11, a major renewal of windows in the Pathology Building, Basic Medical Science Building second floor ceiling replacement, BMSB Sprinkler system, 4th floor BMSB sheet flooring replacement; multiple air handler enhancements in all buildings as part of the University‟s Evergreen Plan.

B. General Facilities

5. Evaluate the adequacy of the general facilities for teaching, research, and service activities of the medical school. Are the opportunities for educational excellence or educational change (e.g., introduction of small group teaching, opportunities for active learning) or for the attainment of other medical school missions constrained by space concerns? Describe the likelihood that needed space or space upgrading will be available in the near future. Have enrollment increases led to space constraints? If so, how are these constraints currently being addressed?

The Faculty of Medicine has been working since 2007 to improve the adequacy of the general facilities for teaching, research and services of the medical school on the Bannatyne campus. Three main lecture theatres have been upgraded to provide appropriate seating for a class size of 110 as well as an increased reliance on an upgrade on E-services such as high definition, web casting and direct links with health facilities to ensure that the maximum exposure to presentations, research presentations and ground rounds are accomplished.

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In addition the Faculty of Medicine has financially supported the Neil John Maclean Library Services on the Bannatyne campus for a third floor expansion which has significantly increased the number of small group teaching facilities for medicine students.

The summer of 2010 saw the upgrade in all small group teaching sessions, the installation of smart board technology including the library rooms and the ongoing roll out of the OPAL curriculum management system.

The Faculty identified in 2007 the need for comprehensive clinical learning and simulation facility to meet its medical education needs. The clinical learning and simulation facility was opened in the summer of 2008 and has the capacity to meet the increased students in all of the educational programs. In addition to the onsite campus facilities, the faculty is also working with departments to meet the need for clinical teaching units in urban and rural hospitals over the next two years.

Student concerns related to additional study spaces have been addressed through a variety of processes including an increase in the number of rooms open between 4 pm and 11 pm to provide students a variety of options for study space. The student concerns related to clinical teaching site resources have been addressed through a process of site visits by the Dean, Associate Deans of UGME and PGME, student and resident representatives, the Director of Operations and the accreditation team, to WRHA clinical teaching sites to review and provide feedback on the accommodations provided onsite. Deficiencies such as access to study and lounge space, condition of call rooms, site orientation have been resolved and other matters identified such as locker storage and are being worked on. Study space at Bannatyne is a challenge with increased enrolment and the use of the campus as a study space by members of the community and other university students not enrolled at Bannatyne, and will continue to be monitored.

6. Discuss the adequacy of security systems on each campus and at affiliated sites.

Students identified, as a “strength” in their accreditation survey a “feeling of personal safety during business hours at the Bannatyne campus” (82% of respondents). As part of the University of Manitoba´s emergency response and notification plan, telephones were installed in mid-September 2008 in all classrooms. The telephones provide one button access to Security Services in the event of an emergency. The telephones are also equipped with a speaker that will automatically play emergency messages should the need arise. The telephones will also allow for direct one button access to the Audio Visual Trouble Line, however, the telephones are not connected to the outside telephone network and cannot be used for any other incoming or outgoing phone calls.

For the third consecutive year during Med I orientation, Security Services have presented to the medical students regarding security and keeping safe at Bannatyne campus. The Bannatyne Campus Security office is located in S105 Medical Services Building right next door to the Brodie Centre. The office can be reached for emergencies from any phone on the 474 or 789 networks by dialing 555, 9341 or by pressing the campus security button on the pay phones in Brodie Centre and for non-emergencies, call 789-3330. Bannatyne campus has five Emergency Code Blue Telephones connected to Health Sciences Centre Security, located outside on campus. Students are advised of this information during orientation by the Faculty and the MMSA who prepare their own welcome package. Officers have a visible presence around the campus.

All clinical teaching sites have site specific safety processes, and workplace health and safety issues including security and working alone are discussed with learners during their orientation at the site.

C. Clinical Teaching Facilities

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7.0 Analyze the resources for clinical teaching available to the medical education program. For the size of the student body, are there adequate numbers of patients and supervisors available at all sites? Has the school needed to expand its clinical teaching network to address either expanded enrollment or decreased patient volume? Is the patient mix appropriate? Are clinical facilities, equipment, and support services appropriate for exemplary patient care? Discuss the availability, quality, and sufficiency of ambulatory care facilities for teaching.

The Faculty of Medicine, through its affiliated hospitals and institutions, has access to more than adequate numbers of patients to meet the needs of all learners. The Faculty has significantly expanded its clinical teaching network beyond its traditional base (HSC, SBGH and SOGH family practice) to include all the remaining Winnipeg community based hospitals (VGH, CH, and GH). The initial drivers for this were not related to the need for additional patient resources, but rather, the WRHA‟s regionalization of programs as well as changing practice patterns. The net effect of this required change is that more teaching units have become available and they are continuously staffed by highly qualified supervisors for learners.

Rural and northern RHA‟s and their affiliated sites are also now full participants in the educational mission of the Faculty and we are looking to expand and enhance this through the efforts of Dr. Don Klassen, Associate Head, (Distributed Medical Education), Department of Family Medicine. There has been no decrease in patient volume, the full spectrum of patient mix is represented, and in fact the patient resources exceed the educational requirements for the Faculty. The clinical facilities, equipment and support services for exemplary care are second to none. As to ambulatory care facilities, medical services provided in ambulatory care clinics in the hospitals within the WRHA are provided by full time academic staff whose ambulatory practice is entirely based within these institutions. The WRHA has therefore heavily invested in ambulatory care facilities for both specialists and family practitioners. Ambulatory care teaching is embedded in many rotations in clerkship and pre-clerkship.

8. Describe and evaluate the interaction between the administrators of clinical affiliates used for teaching and the medical school administration. Does the level of cooperation result in a smoothly operating and effective clinical education program?

The interaction between the Faculty and administrators of clinical affiliates is prescribed through affiliation agreements, the Faculty of Medicine By-laws and terms of reference of Faculty committees. Planned key joint positions and the Joint Operating Division structure ensure cooperation and communication, at scheduled, regular meetings. This has provided for a high level of cooperation and support to the medical school.

Required interaction between administrators of clinical affiliates and medical school administration are also prescribed through the affiliation agreements which are in place between the University of Manitoba Faculty Of Medicine and the Regional Health Authority (RHA) clinical teaching sites and their associated clinics.

The Faculty of Medicine By-law outlines the membership of Faculty Council which includes “The Chief Medical Officers or their designates of the Health Sciences Centre and St. Boniface General Hospital and such other teaching hospitals as may be designated by the Faculty Council upon the recommendation of the Executive Council.” Committee terms of reference, such as the Admissions Partnership Committee include, in their membership one representative appointed by the President and CEO, WRHA. More recently the JOD Education Advisory Subcommittee has representation form faculty, the WRHA and the CMO‟s of all affiliated hospitals.

The Dean of Medicine is a member of the Board of Directors and on the Planning and Priorities Committee of St. Boniface General Hospital, one of the two tertiary care teaching sites. The Dean meets regularly with the

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Chief Operating Officer and Chief Medical Officer (CMO) of the other tertiary care teaching site, Health Sciences Centre (HSC) which is adjacent to the Bannatyne campus. Discussions include the shared HSC/Faculty responsibilities for space (e.g. teaching, lab, research, administrative), and services (e.g. parking, Security, personal safety). The CMO‟s of the two sites are members of the Faculty Executive Council.

The Dean regularly travels to rural and northern Manitoba and meets with the heads of other regional health authorities and is considered a valued stakeholder by Manitoba Health e.g. the Dean is currently participating in a review of the NorMan Health Region.

The Faculty‟s monthly Department Heads‟ Council, chaired by the Dean, ensures regular meetings with the Deanery and Department Heads. With few exceptions, the clinical department heads are also WRHA Clinical Program Directors responsible for the programs at the clinical teaching sites.

Special meetings as required such as a February 2011 meeting planned with CMOs to discuss the outcome of the Canadian Graduate Student Questionnaire, or site visits initiated in 2009 to the urban clinical teaching sites ensure regular communication and resolution of issues of concern to both parties.

9. Describe and evaluate the level of interaction and cooperation that exists between the staff members of the clinical affiliates used for teaching and medical school faculty members and department heads, related especially to the education of medical students.

Staff members at clinical affiliates are recognized by academic appointment to their appropriate parent department. Through the combined efforts of the departmental undergraduate director and the department head they are initially fully oriented to the objectives of training and their responsibilities as preceptors. They report back to the Faculty department on the progress of the student and are required to comply with the established evaluation processes. Direct communication channels are always open between the Faculty and site if difficulties arise during the course of a rotation.

There is regularly scheduled interaction which is prescribed through committee terms of reference and planned consultative meetings, which helps to enhance cooperation, which is good between staff members of clinical sites and medical school faculty and department heads.

Course and clerkship directors and their undergraduate coordinators have an opportunity to meet as members of the PreClerkship and Clerkship Committees, which is also attended by the Associate Dean, UGME.

In November and December 2010, the Dean initiated meetings with the Course and Clerkship Directors and the Associate Dean, UGME to familiarize himself with their responsibilities and understand their job better. From this came the recognition of the need to hold these meetings regularly for ongoing feedback. As well, it was identified that issues of concern to course and clerkship directors may not be well known to the department heads, and the Dean is working to improve the links between the two groups.

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D. Information Resources and Library Services

10. Evaluate the quantity and quality of the print and non-print holdings of the library as a resource for medical students, graduate students, and faculty members.

The Library currently holds 107,000 print and electronic books and subscribes to 7800 electronic and paper journals in health and medicine. Important online point-of-care and evidence-based resources are available such as UptoDate, Lexi-Comp, FirstConsult, Cochrane Library, and eCPS. The Faculty provides funding for on-site and remote access to UpToDate. A variety of core electronic medical textbooks and video resources are available, for example Access Medicine, MD-Consult, Stat!Ref, ProceduresConsult, Anatomy.TV and Bates. All electronic resources are available on- and off-campus through the Internet using UM ID number and a password. The University of Manitoba Libraries provides free document delivery within three days to all staff and students. Periodic collection assessments are conducted of the print and online collections in support of courses and programs.

11. Comment on the adequacy of information technology resources and services, particularly as they relate to medical student education. Are resources adequate to support the needs of the educational program? Are the information systems of the medical school and major clinical affiliates sufficiently well integrated to assure achievement of medical school missions? Note any problems, and describe any plans in place to address these problems.

The OPAL electronic curriculum management system, implemented in the 2009-2010 academic year, provides an integrated platform for student schedules, a repository for objectives, course content and notes, and for student and course evaluations, and is a direct portal to the library. It is being used for reporting of gaps in essential clinical learning experiences, for curriculum mapping and for people and topic searches. Students‟ satisfaction with OPAL is high (91% of 109 respondents). OPAL was recently chosen as the 2010 Project of the Year by the Project Management Institute of Manitoba.

OPAL hands-on training sessions are provided for instructors, department/section heads, course/ program directors, course coordinators, session leaders, department representatives, and department assistants. Instructors and preceptors are becoming more comfortable with the OPAL tool, but UGME and the OPAL team will need to continue to be vigilant in their monitoring of, and follow up re: the timeliness of uploading of material and the timeliness of MITER and FITER completion, both of which have been identified as issues of concern.

One enabler for the success of the OPAL system would be the presence of wireless internet capability at all major clinical sites, which is currently not the case, and will remain a recommendation for the long term. IT resources have been upgraded on an ongoing basis and are adequate to support local and major clinical affiliate users‟ needs, e.g. upgrade of video link classroom connection to St. Boniface Hospital link room in 2008. Undergraduate teaching theatres upgraded in late 2009 to include videoconferencing capability as well as video recording of lectures for uploading into OPAL.

It is expected that with the completion of the voice and data cable plant upgrade during this fiscal year 2010/2011 at the Bannatyne Campus, the only changes that will be made would be to expand the wireless network, as funding allows. The wired network will not require any further upgrades until it reaches the renewal phase in the evergreening cycle, which is seven years out.

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12. Evaluate the usability and functional convenience of the library and of information resources. Are hours appropriate? Is assistance available? Is study space adequate? Are resources, such as computers and audiovisual equipment, adequate? Can students access information from affiliated hospitals or from home?

Library hours extend to 11 pm most evenings and weekends. Reference assistance (both in person and virtual) is available most days until 9 PM and also on weekends during the day. Study space has been expanded to include 10 small group study rooms for up to 10 students each, and two larger group study rooms for 12 people each. Use of these rooms is restricted to students and faculty of the Bannatyne campus. All rooms include LCD large touch screen computer monitors. There are 138 study seats/carrels and 48 casual seats. The library is equipped with 4 public and 30 computer lab workstations. Wireless connectivity is available throughout the library. All eight WRHA hospital libraries are satellites of the NJMHS Library and report to its Head. Each hospital library has public workstations with access to all of the Library's electronic resources, an onsite collection of materials, and librarians available from 8:30-4:30 weekdays to provide assistance.

All electronic resources are available on- and off-campus through the Internet using UM ID number and a password.

13. Assess the contributions of library and information technology staff to the education of medical students and the professional development of faculty members in the following areas: • Teaching specific skills, such as instruction in computer usage and bibliographic search • Retrieving and managing information • Interaction with the curriculum committee to coordinate various library and information resources with planned curricular design

The Education Services Librarian coordinates bibliographic instruction for Med I, Block I students on basic EBM principles, the use of point-of-care resources, PubMed, SCOPUS, and RefWorks. Instruction is followed with an assignment in PR sessions that focuses on using these resources to answer clinical questions and generate a bibliography using APA style. The assignment is graded by the Block I Coordinator and the Education Services Librarian. Additional evidence-based medicine instruction is incorporated into Clerkship rotations including Family Medicine and Obstetrics and Gynecology.

Faculty members may choose to attend any of the Health Sciences Libraries‟ regularly scheduled seminars and in some instances may be eligible to receive CME credits from either the College of Family Physicians of Canada or the Royal College of Physicians and Surgeons of Canada. The Health Sciences Libraries also provides one-to-one learning opportunities for faculty through its House Calls service.

The Faculty of Medicine and the NJMHSL are developing an innovative program to embed a physician in the Library. A physician was appointed Course Coordinator, Information Literacy and Biomedical Informatics and will work in collaboration with academic librarians at the NJMHSL, the faculty and students of the Undergraduate Medical Education, Postgraduate Medical Education, Continuing Professional Development, and International Medical Graduate programs and members of the Curriculum Renewal Committee. This position has been created to support the development of instructional strategies and resources across the medical curriculum, using current technologies in the areas of information literacy and informatics.

The Head and/or the Education Services Librarian attend PreClerkship, Clerkship, Introduction to Clerkship committees and associated curriculum evaluation seminars. The Head sits on Faculty Council, Faculty Executive and the Curriculum Executive Committee. The Education Services Librarian sits on the OPAL Steering Committee and UGME Curriculum Renewal Committee.

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Educational Resources Strengths

1. The Faculty is financially stable and well resourced. Medicine has been successful in putting forward its priorities to the University Central Administration and has been supported in moving its priorities forward.

2. There are strong resources to move the educational mission of the Faculty forward most notably the new Online Portal for Advanced Learning (OPAL) curriculum management system and the state of the art Clinical Learning and Simulation Facility (CLSF). There is a plan to enhance the clinical skills aspect of the CLSF through an investment of more than $1 million and the redevelopment of another 3000 square feet of space into a clinical skills lab.

3. The Neil John McLean Library has completed extensive renovations with a total of 9160 sq ft of space added to the 300 level of the library. The NJM Library can support clientele from Manitoba Health, all of Manitoba‟s Regional Health Authorities including all sites in the WRHA, with enhanced access for all learners.

4. The Faculty is well positioned for learners at the Bannatyne campus, being connected to the Province‟s largest tertiary teaching hospital and with close proximity (10 minutes) from the second tertiary teaching hospital, St. Boniface General Hospital.

Educational Resources Challenges

1. Managing the ongoing need for study space at Bannatyne campus, as noted by the medical students in their accreditation report is an issue. The Faculty continues to monitor use and provide additional study space through building (e.g. Library renovations and the addition of 12 study rooms) and prioritizing space for medical students.

2. Building strong and mutually beneficial relationships with the historic as well as expanded clinical teaching sites is paramount. Site visits with representatives of UGME, PGME and Dean‟s Office staff will continue to ensure that shared responsibilities to meet student needs are being met and site issues are addressed in a timely manner.

3. Building stability in the UGME Program office staff, noted as a concern by the students, will continue to be a focus, with strong attention to staff communication, processes and evaluation.

4. The success of the Northern and Remote initiative will require ongoing development of Faculty-based on- line resources and community based supports to ensure students and residents have a positive experience and have a successful return of service experience.

5. Bannatyne faculties are working to exploit the opportunities for efficiencies in teaching and utilization of resources and will need to continue to find creative ways of meeting learner needs together.

6. To meet its research mission, the Faculty will need to provide space and resources to continue to attract researchers in a competitive environment

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SELF-STUDY SUMMARY

1. Summarize the medical education program’s strengths and challenges including potential areas of noncompliance with accreditation standards; and areas in transition that may impact future compliance with standards. Analyze changes that have occurred since the last survey visit. Have new strengths or problems emerged? Are changing conditions likely to cause problems in the near future?

Strengths Our faculty - an excellent, large and diverse faculty that is, in the main, actively engaged in the affairs of the Faculty of Medicine. Excellent working relationships with all major stakeholders in the Province - including the Government of Manitoba, the WRHA, the College of Physicians and Surgeons of Manitoba, and all of its affiliated hospitals and institutions. Committed Medical Student Association - has contributed time and energy of its Executive to the ongoing improvement of the Faculty. Fiscally stable environment - the Faculty is privileged that it can operate within a fiscally stable environment Joint Operating Division - allows for a continuum for clinical service and the academic mission of the University for all academic physicians within the context of an Academic Health Services Network. OPAL curriculum management system - our comprehensive system will allow the Faculty to move forward with our curriculum renewal. It allows for all integration of curriculum mapping, learning objectives, learning materials, scheduling, evaluation and feedback for undergraduate and postgraduate students. The Clinical Learning and Simulation Facility - the largest educational infrastructure support project undertaken, this is a 11,000 square foot, multi-disciplinary centre which supports delivery of curriculum and medical education, as is used for examinations, clinical assessments, training sessions, remediation of learners, standardized patient scenarios and continuing professional development.

Challenges The major challenges for the future are: Communication - ensuring timely and effective communication with faculty and students and engagement of faculty in undergraduate education. New curriculum governance model - ensuring adherence to the new curriculum governance model processes, building in meaningful feedback and evaluation iterative loops, ongoing curriculum review and renewal will be major tasks for the Faculty Managing increased enrolment – ensuring maintenance of adequate resources to support all learners Continued development of the Joint Operating Division to bring clinical service and academic responsibilities under one contractual framework for academic physicians and enable the best possible continuum of clinical service, education, and research.

Much work is ongoing in relation to the following areas:

IS-14A. Faculty has responded to the students‟ criticism that service-learning was too student driven and the Faculty has now undertaken a leadership role, enhancing opportunities and formally embedding this in the curriculum.

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ED-24. The Faculty has recognized the need for a common and comprehensive process to prepare residents and graduate students for their role as teachers. To that end the TDP has been developed and implemented. First year residents are completing the first year module.

ED-33. We have a new curriculum management system which we are optimizing to provide better reporting and evaluation. We have a new centralized UMGE governance model in place and documentation of its effectiveness is pending.

FA-10. Faculty evaluation was not historical centralized or standardized and the Associate Dean Academic has been charged with the development and implementation of a central system.

MS-18. The Faculty has made commitments of substantial space and resources to enhance and broaden Student Services at its Bannatyne Campus. This is being done with Student Services at the main Fort Garry Campus.

Changes

The period of 2004 to June 2010, under Dr. J. Dean Sandham, was characterized by a combination of renewal and growth. Subsequently, Dean Brian Postl built on this legacy and has made several strategic and necessary changes advancing implementation of the items central to this accreditation. Changes since 2004 include:

Medical Students Increased enrolment of medical students - In September 2008, the Faculty welcomed its largest class of first year medical students in its history, 110 students, a 60% increase from 2002. Appropriate Faculty infrastructure was upgraded to support these changes with high definition web casting and direct link capabilities with remote health facilities. In 2110 the main Medical Library underwent a major renovation and expansion. PGME residents - have also increased, as increased undergraduate classes move into postgraduate training. Physician Assistant Education Program - the first University-based graduate level PA program in Canada was launched in 2008, with required faculty infrastructure supports provided International Medical Graduate program – continued growth of the program since introduction in 2001, to bring this resource into the equation for the healthcare needs of the Province.

Education UMGE objectives – there has been a revision and linkage of the objectives to CanMEDS competencies. The full curriculum is in the process of being comprehensively mapped to these competencies. This has proven to be a challenging undertaking but much has been achieved to date and we have a timetable in place that will see this process completed in the latter part of 2011. Curriculum renewal - has been launched with a view to having a new curriculum in place by 2013. Distributed teaching sites increase - a two year Northern & Remote Family Medicine Stream Residency Program within Family Medicine was established in April 2008 and expanded in 2010 with the ultimate aim to create more needed physician activity in the North of Manitoba. Distributed Education was officially launched in January 2010 and in January 2011, a new Associate Head (Distributed Medical Education) Department of Family Medicine, was appointed to manage the development of a growing, critical component of medical education, that of community-based preceptors. Diversity and Professionalism - key initiatives in these areas have been undertaken with the appointment of an Associate Dean, Professionalism in 2007, her portfolio extended to include diversity in September 2010, and the development of a foundational document on professionalism for faculty and students and a key policy on Faculty-wide diversity

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Resources Centre for Aboriginal Health Education (CAHE) - Establishment of the in 2006 at the Bannatyne campus to provide supports to promote the success of Aboriginal (First Nations, Métis and Inuit) students in the Health Education Faculties. First Nations, Métis and Inuit Health - In January 2010, the Section of First Nations, Métis and Inuit Health was established in the Department of Community Health Sciences. Subsequently the Faculty‟s commitment to this very important component of our province was cemented by the appointment of an Associate Dean, First Nations, Métis and Inuit Health, Dr. Catherine Cook. Student Affairs - has seen a significant change with the appointment of a new Associate Dean, Students and Senior Advisor in September 2010 and a large space expansion to support student services. George & Fay Yee Centre for Healthcare Innovation (CHI) – created in November 2008. The CHI, a partnership between the University of Manitoba and the Winnipeg Regional Health Authority, serves as a focal point for inter-professional education championing system design, healthcare quality and health informatics through research, pedagogical activities, clinical application, and outreach activities. The Centre for Global Public Health (CGPH) - in the Department of Community Health Sciences in June 2008, was established in collaboration with the Department of Medical Microbiology, to enhance the contribution of the University of Manitoba to the improvement of public health systems, programs and activities in diverse global settings.

Research & Programs Opportunities for medical students to engage in scientific activities – to broad opportunities for students, in 2007 the position of the Director for Advanced Degrees in Medicine was created with a view to grow our pool of clinical scientists by enhancing and coordinating research training of medical students through the B.Sc. (Med) program, and the Faculty-wide MD/PhD program. In 2010 a further new program was introduced which allowed students not in or beyond the B.Sc.Med to work with established researchers in the Faculty for the summer months. Provincial funding - in 2008 the provincial government agreed to increase the funding of the Manitoba Health Research Council (MHRC), the principle health granting agency Council from $2.5 million to $6 million. This will provide researchers with greater opportunity to obtain start-up funds and enhance the success of obtaining support for research trainees. The Dean‟s Strategic Research Fund - implemented in 2006, with a current value of $450,000, the Fund supports the development of a trans-disciplinary, Faculty wide, centrally located research infrastructure at the Bannatyne campus. Professorships and Endowed Chairs – growth over time, to now 15 and 11 of these respectively, with five new in each category since 2008. Regenerative Medicine - A faculty wide consultation on the development of this program was carried out in early 2007 and gained the support of the entire Faculty as well as all the hospital affiliated institutes. Includes six tenure-track positions, three of which are slots for Canada Research Chairs. $500K was provided for site renovation, and $1 million for start-up funds, with the vision that the University of Manitoba will be recognized as one of the top three Canadian regenerative medicine programs in three years. Neurosciences Program –a new priority initiative, the Neuroscience Research Program, is aligned with the national priority, university research focus and has tremendous public impact. The program is currently recruiting five tenure-track faculty positions in the area of neurosciences, mental health and addiction. Housed in the new Kleyson Institute of Advanced Medicine, at Health Sciences Centre, the Neuroscience Research Program will have access to state-of-the-art facilities and expertise.

Faculty Full-time clinical faculty has increased from about 500 in 2005/06 to greater than 600 in 2009/10.

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Joint Operating Division (JOD) - has been established as the model for the Faculty‟s development of an academic health sciences network Medical Education - in December 2010, Dean Postl announced the allocation of $700,000 to recruit a Head for the Department of Medical Education to serve as a resource to the rest of the Faculty and develop a master teacher program to enhance the quality of teaching within the Faculty.

2. Note major recommendations for the future. How can the strengths be maintained and the most pressing problems addressed? Be brief, but specific in describing actions that will need to be (or already have been) taken.

The Self Study process has been very beneficial for the Faculty, strengthening working relationships, internal and external and producing improvements with immediate and future benefit. As the Faculty moves forward the challenges and recommendations have been detailed in their respective sections within this report and the major recommendations include:

1. Institutional Setting 1. Develop the portfolio of the Associate Dean, Professionalism and Diversity to become a strong resource for the Faculty. Implement the diversity policy and build diversity evaluation data for students, staff and faculty to confirm attainment of goals set. 2. Improve coordination and communication to students about volunteer and research opportunities. 3. Continue to build supports for UGME staff to provide a stable complement. Continue to monitor turnover and changes in the Dean‟s office.

2. Educational Standards for MD Degree 1. Monitor the effectiveness of the new curriculum governance model alongside further integration of the OPAL curriculum management system. 2. Complete curriculum mapping and fully link to CanMEDS competencies in all aspects of the curriculum. 3. Monitor the challenges of increased enrollment and build capacity/increase clinical sites within the Program to ensure objectives for clerkship, electives and rotations can be achieved for students in Medicine but also beyond that as they move into residency.

3. Medical Students 1. Enhance student communication and student support services, as these are high priorities for the Faculty. 2. Implement of all the facets of professionalism throughout faculty, staff and the student body and keep current with new challenges posed by the social networks. 3. Work to continue to build an environment that is safe and where harassment and bullying is not tolerated.

4. Faculty Standards 1. Strengthen processes for faculty involvement in the undergraduate curriculum. Build a culture of quality education improvement and accountabilities. 2. Inform and communicate effectively with faculty 3. Strengthen faculty evaluation as a central process and build consistency across the Faculty. This will be facilitated by the new contractual framework of the JOD.

5 Educational Resources 1. Monitor and manage space challenges at the Bannatyne campus. 2. Continue to build relationships with WRHA clinical teaching sites. Build and maintain effective linkages with distributed education sites.

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LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Dr. Brian Postl Dean of Medicine, July 1, 2010 - present Self Study Dr. J. Dean Sandham Dean of Medicine, to June 30, 2010 Task Force Dr. Bruce Martin Associate Dean, Students, and Medical Director, J.A. Hildes Northern Medical Unit, Faculty of Medicine

Dr. Helmut Unruh Faculty Lead, UGME Accreditation, Medicine, June 2010 to present Dr. Diane Biehl Faculty Lead, UGME Accreditation, Medicine, June 2009 – May 2010 Dr. Ira Ripstein Associate Dean, UGME

Dr. José François Associate Dean, Continuing Professional Development

Ms. Carol Anne Northcott Program Manager, UGME, Faculty of Medicine Ms. Ilana Simon Director of Communications & Marketing, Faculty of Medicine Dr. Louise Simard Professor & Department Head, Biochemistry & Genetics Dr. Dan Roberts Professor & Department Head, Internal Medicine Dr. Don Klassen Associate Head, Distributed Education, Dept of Family Medicine & Medical Director, Manitoba Office of Rural and Northern Health Dr. Keevin Bernstein Director, UGME Curriculum Renewal Dr. William Pope Registrar, College of Physicians and Surgeons of Manitoba Dr. David Collins Vice-Provost (Programs) – July 1, 2010 to present Dr. Richard Lobdell Vice-Provost (Programs) – June 2009 – June 30, 2010 Dr. Karen Grant (alternate) Vice-Provost (Academic Affairs) Ms. Michele Mathae- Director, Physician Resource Planning Office, Manitoba Hunter Health & Healthy Living, January 2011 to present Mr. Jerry Ross Executive Director, Workforce Policy & Planning, Manitoba Health & Healthy Living to December 2010 Dr. Chris Christodoulou Director, Undergraduate Curriculum Chair, Educational Program for the MD Degree Standards Subcommittee Undergrad Program Director, Anaesthesia Dr. Cornelia (Kristel) van Co-Chair, Medical Students Standards Subcommittee; Ineveld Advisor, Student Affairs Mr. Keith McConnell Chair, Educational Resources Standard Subcommittee; Director of Operations, Faculty of Medicine Dr. Murray Enns Co-Chairs, Faculty Standards Subcomm. Dept. Head, Ms. Beth Beaupre Psychiatry; Exec. Director, Joint Operating Division

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UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Dr. Brock Wright Chair, Institutional Setting Subcommittee; Associate Dean, Clinical Affairs, Faculty of Medicine, Senior VP Clinical Services & Chief Medical Officer, WRHA Dr. Perry Gray (alternate) Vice President & Chief Medical Officer, Health Sciences Centre (HSC) Ms. Karen Howell Project Manager, UGME Accreditation, Faculty of Medicine (on all committees and working groups) Mr. Pawan Sharma President, Health Sciences Grad Students Association PhD Candidate, Dept of Physiology & National Training Program in Allergy & Asthma Ms. Meaghan Labine President, Health Sciences Grad Students Association – to 2010 PhD Candidate, Dept of Pharmacology and Therapeutics Ms. Jessica Cudmore Manitoba Medical Students‟ Association (MMSA) Senior Stick/Internal 2012 Dr. Kaif Pardhan Manitoba Medical Students‟ Association (MMSA) Senior Stick/Internal 2010 – to June 30, 2010 Ms. Allison Stasiuk MMSA Vice Stick Academic, Class of 2011 Ms. Alli Paige Local Exchange Officer Sr. Manitoba Health Services Students‟ Association (MaHSSA) VP Internal, U of M, Medicine Mr. Mark Lipson Vice Stick Internal/Academic, Class of 2012 Mr. Ray Karasevich Director, Institutional Relations (Non-voting observer) Manitoba Council on Post Secondary Education Dr. Brock Wright (Chair) Associate Dean, Clinical Affairs, Faculty of Medicine, I. and Senior VP Clinical Services & Chief Medical Officer, INSTITUTIONAL WRHA SETTING Subcommittee Dr. Perry Gray (alternate) Vice President & Chief Medical Officer, Health Sciences Centre (HSC) Dr. Heather Dean Assistant Dean, Academic Professor, Department of Pediatrics, Section of Endocrinology and Metabolism Dr. Sharon Macdonald Professor & Department Head, Community Health Sciences Dr. Owen Williams Assistant Professor, Department of Surgery

Dr. Grant Pierce Assistant Dean, Research - to Sept. 2010 Dr. Ed Kroeger Assistant Dean, Graduate Studies Dr. Francis Amara Director, UGME Remediation; Associate Professor, Biochemistry & Med Genetics, Head Start Aboriginal

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UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Biomedical Youth Program

Dr. David Eisenstat Director, Advanced Degrees in Medicine Program

I. Dr. David Collins Vice-Provost (Programs) – July 1, 2010 to present INSTITUTIONAL Dr. Richard Lobdell Vice-Provost (Programs) – June 2009 – June 30, 2010 SETTING Dr. Karen Grant (alternate) Vice-Provost (Academic Affairs) Subcommittee Dr. Thomas Klonisch Professor & Department Head, Human Anatomy & Cell continued Science Dr. Cheryl Rockman- Professor & Department Head, Pediatrics & Child Health Greenberg

Dr. Diane Moddemann Associate Professor, Pediatrics & Child Health (alternate) Ms. Heather Christenson Administrator, UGME Admissions and Enrolment Services Ms. Laura Kryger Administrator, Post Graduate Medical Education Program

Mr. Navdeep Bhullar Medical Student, Class of 2012

Ms. Amber Berscheid Medical Student, Class of 2012

Ms. Tito Daodu Medical Student, Global Health Liaison GHL Junior Representative, Class of 2013 Ms. Robin Carels Support to Subcommittee; WRHA Assistant to Dr. Brock Wright, and Ms. Beth Beaupre Dr. Brock Wright (Chair) Associate Dean, Clinical Affairs, Medicine; Senior VP IA. Diversity Clinical Services & Chief Medical Officer, WRHA Standards Working Group: Dr. Dan Roberts Professor and Department Head, Internal Medicine IS-16 & MS-8 Dr. Barbara Mackalski Assistant Dean, Admissions - to May 2010

Dr. Sharon Macdonald Professor and Department Head, Community Health Sciences Dr. David Collins Vice-Provost (Programs) – July 1, 2010 to present Dr. Richard Lobdell Vice-Provost (Programs) – June 2009 – June 30, 2010 Dr. Karen Grant Vice-Provost (Academic Affairs) (Alternate) Ms. Carol Anne Northcott Program Manager, UGME, Faculty of Medicine

Ms. Beth Beaupre Co-Chair, Faculty Standards Subcommittee; Executive Director, Joint Operating Division Dr. Malathi Raghavan UGME Academic Lead, Evaluation

Ms. Heather Christenson Administrator, Admissions and Enrolment Services

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UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Dr. Janice Dodd Professor & Department Head, Physiology

Mr. Keith McConnell Chair, Educational Resources Standard Subcommittee; Director of Operations, Faculty of Medicine Ms. Louise Giesbrecht Employment Equity Officer, U of M Equity Employment

Dr. Malathi Raghavan UGME Academic Lead, Evaluation

Dr. Catherine Cook Associate Dean, First Nations, Métis and Inuit Health Assistant. Professor, Community Health Sciences Dr. Samia Barakat Associate Dean, Professionalism and Diversity

Ms. Robin Carels Administrative Support to Working Group, WRHA Assistant to Dr. Brock Wright, and Beth Beaupre Dr. Bruce Martin Associate Dean, Students, and Medical Director, J.A. IB: Service Hildes Northern Medical Unit, Faculty of Medicine Learning Working Dr. Brock Wright (Chair) Associate Dean, Clinical Affairs, Medicine; Senior VP Group Clinical Services & Chief Medical Officer, WRHA Standard IS-14A Ms. Sheila Smith Administrator, Student Affairs

Ms. Carol Anne Northcott Program Manager, UGME, Faculty of Medicine

Ms. Tito Daodu Medical Student, Global Health Liaison GHL Junior Representative, Class of 2013 Dr. Michael West Associate Dean, PGME

Ann Marie Aldighieri Administrative Support; Accreditation Assistant

Dr. Chris Christodoulou Director, UGME Curriculum II. ED. (Chair) Undergrad Program Director, Anaesthesia PROGRAM FOR Dr. Bruce Martin Associate Dean, Students, and Medical Director, J.A. MD DEGREE Hildes Northern Medical Unit, Faculty of Medicine Subcommittee Dr. Barry Cohen Director of Evaluation, Assistant Professor, Internal Med; Chair, Progress Committee, Faculty of Medicine

Dr. Ira Ripstein Associate Dean, UGME

Ms. Carol Anne Northcott Program Manager, UGME, Faculty of Medicine

Dr. Mark Torchia Pre-Clerkship Director, Chair, Pre-Clerkship Committee Dr. Eunice Gill Clerkship Director, Chair, Clerkship Committee

Dr. Sora Ludwig Course Director, Med II COG/EM

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UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Dr. Maggie Morris Professor & Department Head, Obstetrics/Gynecology

Ms. Aarti Paul Information Systems Manager, Faculty of Medicine – June 2009 – June 2010 Mr. Ben Goldstein Project Manager, OPAL & Curriculum Mapping

II. Mr. Rick Ikesaka Academic Class Rep 2011 ED. PROGRAM Ms. Veena Agrawal Academic Class Rep 2012 MD DEGREE Subcommittee Mr. Huntae Kim Academic Class Rep 2013 (continued) Dr. Robin Ducas PARIM Representative, Internal Medicine

Mr. Naresh Rehdu Graduate Student Representative

Ms. Tara Petrychko Clerkship Program Administrator

Ms. Pat McCullough Pre-Clerkship Program Administrator – to May 2010

Dr. Malathi Raghavan UGME Academic Lead, Evaluation

Ms. Suzanne Doyle Education Coordinator/GI/HEP/ENDO

Ms. Ingrid Heinrichs Admin Support to Subcommittee Administrative Assistant; Anesthesia and Surgery, University of Manitoba **Ad hoc Members – consult as required Dr. Sat Sharma ** OPAL/CMS - Medical Director, CIS

Dr. Rob Brown ** Medical Director, Clinical Learning & Simulation Facility Dr. Chris Burnett Associate Dean, Distributed Education to Sept. 2010

Dr. Cornelia (Kristel) van Co-Chair, Medical Students Standards Subcommittee; Ineveld ** Advisor, Student Affairs Dr. Chris Christodoulou Director of UGME Curriculum IIA. ED-24 (Chair) Undergrad Program Director, Anaesthesia Working Group Dr. Bruce Martin Associate Dean, Students, and Medical Director, J.A. Hildes Northern Medical Unit, Faculty of Medicine Ms. Carol Anne Northcott Program Manager, UGME, Faculty of Medicine

Dr. José François Associate Dean, Continuing Professional Development;

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UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Dr. Ira Ripstein Associate Dean, UGME

Dr. Michael West Associate Dean, PGME

Ms. Laura Kryger Administrator, Post Graduate Medical Education Program

Ms. Joanne Hamilton Faculty Developer, Department of Medical Education

Dr. Diane Biehl Faculty Lead, UGME Accreditation June 2009 – May 2010 Dr. J. Dean Sandham Dean of Medicine, to June 30, 2010 IIB. (Chair) ED-33/35 Dr. Bruce Martin Associate Dean, Students and Medical Director, J.A. Curriculum Hildes Northern Medical Unit, Faculty of Medicine Governance Working Group: Dr. Diane Biehl (Co-chair) Faculty Lead, UGME Accreditation, Medicine, June 2009 (March –June – May 2010 2010) Dr. Sharon Macdonald Professor & Department Head, Community Health Sciences Dr. Fiona Parkinson Professor & Department Head, (A), Pharmacology & Therapeutics Dr. Thomas Klonisch Professor & Department Head, Human Anatomy & Cell Science Dr. Keevin Bernstein Director, UGME Curriculum Renewal

Dr. Eric Jacobsohn Professor & Department Head, Anaesthesia

Dr. Janice Dodd Professor & Department Head, Physiology

Ms. Carol Anne Northcott Program Manager, UGME, Faculty of Medicine

Ms. Jessica Cudmore Manitoba Medical Students‟ Association (MMSA) Senior Stick/Internal 2012 Dr. Kaif Pardhan Manitoba Medical Students‟ Association (MMSA) Senior Stick/Internal 2010 – to June 30, 2010 Mr. Mark Lipson Vice Stick Internal /Academic, Class of 2012

Dr. Chris Christodoulou Director of UGME Curriculum; Chair, ED Standards IIC. Curriculum SubCommittee; Undergrad Program Director, Mapping Working Anaesthesia Group Dr. Keevin Bernstein Director, UGME Curriculum Renewal

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UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Dr. Eunice Gill Clerkship Program Director, Chair, Clerkship Committee

Dr. Mark Torchia Pre-Clerkship Program Director, Chair, Pre-Clerkship Committee Ms. Alison Pattern Acting Librarian, Neil John Maclean Health Sciences Library Ms. Tania Gottshchalk Associate Librarian, Neil John Maclean Health Sciences Library Dr. Charlotte Rhodes Research Associate and Program Evaluator, Department of Medical Education Ms. Joanne Hamilton Faculty Developer, Department of Medical Education

Ms. Karen Howell Project Manager, UGME Accreditation

Mr. Ben Goldstein Project Manager, OPAL & Curriculum Mapping

Dr. Ira Ripstein Associate Dean, UGME

Green Binder: Ms. Pat McCullough Pre-Clerkship Program Administrator – to May 2010 Required Course & Clerkship Docum‟n Ms. Tara Petrychko Clerkship Program Administrator Coordinated Thru Ed Program For MD Degree Subcommittee Ms. Laura Kryger Administrator, Postgraduate Medical Education Program

Dr. Cornelia (Kristel) Van Senior Advisor, Student Affairs; Postgraduate Education III. MEDICAL Ineveld (Co-Chair) Director, Geriatric Medicine STUDENTS Dr. Bruce Martin Associate Dean Students, & Medical Director, JA Hildes Subcommittee (Co-Chair) Northern Medical Unit Dr. Barbara Mackalski Assistant Dean, Admissions to May 2010

Dr. Marcia Anderson Assistant Professor, Community Health Sciences

Dr. Barry Cohen Director of Evaluation, Assistant Professor, Internal Med; Chair, Progress Committee, Faculty of Medicine Dr. Merrill Pauls Director Medical Ethics & Humanities Associate Professor, Emergency Medicine Dr. Lynn Smith Executive Director, U of M Student Services/Student Affairs Dr. Janice Dodd Professor & Department Head, Physiology

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UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

LCME ACCREDITATION TASK FORCE, SUBCOMMITTEES & WORKING GROUPS 2009 – 2011 COMMITTEE MEMBER POSITION/ DEPARTMENT Dr. Larry Tan Associate Professor and Clerkship Director, Surgery

Ms. Tamara McColl Medical Student, Academic Class Rep 2011 Mr. Mark Lipson Medical Student, Academic Class Rep 2012 Ms. Anne Sutherland Medical Student, Academic Class Rep 2013 Mr. Marcus Hancock Medical Student, Academic Class Rep 2013

Dr. Barbara Triggs-Raine Professor, Biochemistry & Medical Genetics

Ms. Carol Anne Northcott Program Manager, UGME, Faculty of Medicine

Ms. Heather Christenson Administrator, UGME Admissions/Enrolment Faculty of Medicine Ms. Tara Petrychko Clerkship Program Administrator

Dr. Murray Enns Professor and Head, Department of Psychiatry Professor, IV. (Co-chair) Community Health Sciences University of Manitoba FACULTY Medical Director, Mental Health Program, WRHA Subcommittee Ms. Beth Beaupre Executive Director, Joint Medical Staff Division, Faculty (Co-chair) of Medicine & WRHA

Dr. Dan Roberts Professor & Department Head, Internal Medicine

Ms. Joanne Hamilton Faculty Developer, Department of Medical Education

Dr. Joanne Embree Professor & Department Head, Infectious Diseases

Dr. José François Associate Dean, Continuing Professional Development

Ms. Heather Drenker Recruitment Coordinators, Faculty of Medicine Alternates: Ms. Paula Healy/Ms.Tamara Horbatiuk Ms. Lana Rosenfield Medical Student, MMSA Programmer, Class of 2012 Mr. James Bras Medical Student, Class of 2013 Ms. Marli Leibl Medical Student, Class of 2013 Ms. Jessica Cudmore Medical Student, MMSA UMSU Rep, Class of 2012 Mr. Peter Klippenstein Medical Student, Class of 2010

UNIV OF MB.INSTITUTIONAL SELF STUDY REPORT TO LCME 2/11/2011; page 66 of 66

UNIVERSITY OF MANITOBA – FACULTY OF MEDICINE

CACMS / LCME SELF-STUDY REPORT 2009 – 2011

Mr. Keith McConnell Director of Operations, Faculty of Medicine V. (Chair) EDUCATIONAL Mr. Thomas Thompson Senior Financial Officer, Faculty of Medicine RESOURCES Subcommittee Mr. Blair Petriw Senior Financial Officer, Faculty of Medicine Ms. Aarti Paul Information Systems Manager to June 2010 Ms. Ada Ducas Head, Neil John Maclean Health Sciences Library Ms. Carol Cooke & Associate Librarians, Neil John Maclean Health Sciences Mr. Michael Tennenhouse Library (alternate) Ms. Maggie Ford Director, Education Program, Women's Hospital Dr. Perry Gray Vice President & Chief Medical Officer, Health Sciences Centre (HSC) Dr. Brock Wright - Senior VP Clinical Services & Chief Medical Officer, alternate WRHA Dr. Elizabeth Cowden CMO, Grace General Hospital

Dr. Bruce Rowe Executive Director Clinical Programs, CMO, St. Boniface General Hospital Dr. Ricardo Lobato deFaria CMO and Head of Emergency, Seven Oaks Hospital

Dr. Mary-Jane Seager CMO, Victoria Hospital

Ms. Tara Petrychko Clerkship Program Administrator Mr. Konstantin Jilkine Medical Student, Class of 2013 Mr. Llewellyn Surajballi Medical Student, Class of 2012 Mr. Peter Sytnik Medical Student, Class of 2013

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