SELF-STUDY REPORT External Review 2013–2018 Volume 1: Sections 1 to 9 SELF-STUDY REPORT External Review 2013–2018 Volume 1: Sections 1 to 9 2 | University of Toronto, Department of Medicine | External Review 2013–2018 | Self-Study Report University of Toronto, Department of Medicine | External Review 2013–2018 | Self-Study Report | 3 Glossary of Abbreviations AACU Acute Ambulatory COPD chronic obstructive GEMINI General Medicine Care Unit pulmonary disease Inpatient Initiative AFP Alternate Funding CPA creative professional GI Gastroenterology Plan activities GIM General Internal APD academic position CPD Continuing Medicine description Professional HSF Heart and Stroke Development BBDC Banting and Best Foundation Diabetes Centre CP&T Clinical HSRLCE Heart and Stroke/ Pharmacology and BMJ BMJ (formerly British Richard Lewar Tox icolog y Medical Journal) Centre of Excellence C-QuIPS Centre for Quality CaRMS Canadian Resident ICES Institute for Clinical Improvement and Matching Service and Evaluative Patient Safety Sciences CBD Competence by CREMS Comprehensive Design ICU Intensive Care Unit Research Experience CBME competency-based for Medical Students ID Infectious Diseases medical education CREOD Centre of Research IDCCM Interdepartmental CCO Cancer Care Ontario Expertise in Division of Critical Occupational Disease Care Medicine CDA Diabetes Canada (formerly Canadian CSTP Clinician Scientist JAMA Journal of the Diabetes Association) Training Program American Medical Association CFAR Continuing Faculty CTU Clinical Teaching Appointment Review Unit JDRF formerly Junior Diabetes Research CGS Canadian Geriatrics CWC Choosing Wisely Foundation Society Canada KT knowledge CIA Clinical Immunology DDD Departmental translation and Allergy Division Director MAM Mississauga Academy CIHI Canadian Institute of DFCM Department of Medicine Health Information of Family and Community MD Medical Doctor CIHR Canadian Institutes of Medicine Health Research MED Membership, Equity DoM Department of and Diversity CISEPO Canada International Medicine Scientific Exchange MERS Medical Education Program EM Emergency Medicine Research & Scholarship CME continuing medical EPA entrustable education professional activities MOHLTC Ministry of Health and Long-Term Care FoM Faculty of Medicine (in Ontario) 4 | University of Toronto, Department of Medicine | External Review 2013–2018 | Self-Study Report MOTP Medical Oncology RCPSC Royal College UME Undergraduate Training Program of Physicians and Medical Education Surgeons of Canada MSc Master of Science U of T University of Toronto RPC Residency Program MScCH Master of Science in VC Vice Chair Committee Community Health WCH Women’s College SCOPE Seamless Care MSB Medical Sciences Hospital Optimizing the Building (at U of T) Patient Experience WCRI Women’s College MSH Mount Sinai Hospital Research Institute SHS Sinai Health System NIH National Institutes of WIHV WCH Institute for SMH St. Michael’s Hosptial Health Health Systems SMPA St. Michael’s Solutions and Virtual OSCE objective structured Hospital Physicians Care clinical examination Association OTN Ontario SPOR Strategy for Patient- Telemedicine Oriented Research Network TAAAC Toronto Addis PARO Professional Ababa Academic Association of Collaboration Residents of Ontario TAHSN Toronto Academic PBL problem-based Health Science learning Network PCC person-centred care TARRN Toronto Antibiotic PD Program Director Resistance Research Network PGME Postgraduate Medical Education TES teaching effectiveness scores PGY postgraduate year TGH Toronto General PhD Doctor of Philosophy Hospital PHO Public Health TRI Toronto Ontario Rehabilitation PI Principal Investigator Institute PIC Physician-in-Chief TWH Toronto Western Hospital PMCC Princess Margaret Cancer Centre UGME Undergraduate Medical Education PM&R Physical Medicine and Rehabilitation UHN University Health Network University of Toronto, Department of Medicine | External Review 2013–2018 | Self-Study Report | 5 TABLE OF CONTENTS SECTION 1 SECTION 2 SECTION 3 Executive Introduction Chair’s Summary Statement 8 12 26 SECTION 4 SECTION 5 SECTION 6 People Education Research & Scholarship 42 46 66 SECTION 7 SECTION 8 SECTION 9 Quality & Faculty Hospital Innovation (QI) (Mentorship, Reports Equity & Diversity) 78 88 98 SECTION 1: EXECUTIVE SUMMARY 1. Executive1. Summary The Department of Medicine (DoM) at the University of Toronto is one of the oldest and largest in North America, dating back to the founding of the School of Medicine in 1843. A historic milestone in the Department’s history was the establishment of the Sir John and Lady Eaton endowment in 1919. The endowment subsequently led to the appointment of the first full-time Chair of Medicine in what was then the British Empire, and the Chair of the Department has held the Sir John and Lady Eaton Chair in Medicine title since that time. What is special about this endowment is that it was established to protect physicians’ time for research and teaching; in effect, these funds ($375 thousand in 1919, approximately equivalent to $5.4 million in 2018) laid the foundation for the principle of pooling clinical income to support academic activities through departmental practice plans. In 2019, we will celebrate this important milestone. Our mission is to prepare future physician leaders, contribute to our communities and improve the health and health-care experiences of individuals and populations through the discovery, application, translation and communication of knowledge. Our vision is to meaningfully impact health through international leadership in education, research and the translation of new knowledge into better care and health outcomes. In 2015, the Department identified the following eight strategic priorities toward achieving this vision: https://www.deptmedicine.utoronto.ca/values- guiding-principles 1. Ensure the perspectives and experiences of our patients and their families guide our work. 2. Promote equity, diversity and professionalism. 3. Be socially accountable and steward health-care resources. 4. Align future physician training to meet future population needs. 5. Promote the generation and translation of new knowledge with the potential to impact patient care and outcomes. 6. Recognize and value the contributions of all (diverse teams, teachers and researchers, etc.). 7. Enhance mentorship across the academic lifespan. 8. Raise funds to meet our goals. University of Toronto, Department of Medicine | External Review 2013–2018 | Self-Study Report | 9 On January 30, 2018, the Department leadership The Chair works closely with the fully affiliated hospital reaffirmed its commitment to these priorities. Progress Physicians-in-Chief (PICs) and Chief of Emergency and growth of these strategic priorities is outlined in Medicine, who report both to the Chair and to their this report. respective hospital CEOs, and with the departmental division directors (DDDs). Hospital division heads Today the Department has 1,4741 faculty members, of similarly have dual reporting responsibilities to their whom 789 are full-time (including 15 PhD scientists) PIC and DDD. and 652 part-time or adjunct; the Department comprises approximately 27 per cent of the Faculty of Medicine's The Department’s faculty is not only large, but also full-time faculty members. deeply committed to academic endeavours. The Department provides an extremely rich environment Of the full-time faculty members, 15 are research in which to teach and conduct scholarly work and is scientists, 197 are clinician scientists, 178 are clinician particularly research intensive. Our research spans the investigators, 45 are clinicians in quality and innovation, full spectrum: fundamental science; clinical translational 57 are clinician educators, 286 are clinician teachers research; clinical trials; clinical epidemiology and health- and 26 are clinician administrators. Faculty members services research; global health; and scholarship in quality are distributed primarily in six major hospitals and improvement, innovation and education. Research is health systems: (i) St. Michael’s Hospital, which now conducted on campus, in the hospital-affiliated research incorporates St. Joseph’s Health Centre and Providence institutes in the hospitals themselves. In 2017 (the most Healthcare; (ii) University Health Network (UHN), recent year for which data are available), Department which includes Princess Margaret Cancer Centre, research funding totalled $185.448 million, an increase Toronto General Hospital, Toronto Western Hospital, from $160.613 million five years ago. These are primarily and Toronto Rehabilitation Institute; (iii) Sinai Health operating funds since the Canadian Institutes of Health System, which includes Mount Sinai Hospital and Research does not allow funding of scientists’ salaries. In Bridgepoint Active Healthcare; (iv) Sunnybrook Health the last five years, the DoM has generated 23,607 peer- Sciences Centre, which includes St. John’s Rehabilitation reviewed publications (articles, editorials, proceeding Hospital; (v) Women’s College Hospital, a fully papers and reviews) and 245,770 citations (see appendix). ambulatory hospital; and (vi) Baycrest, a geriatric hospital. All hospital sites used by the Department of Medicine are Merit Review of Clinician Scientists full affiliates or community affiliates of the University The impact of our research is broad. It includes: basic of Toronto https://medicine.utoronto.ca/about-faculty- discoveries; patents for novel devices and methodologies;