DFCM SELF-STUDY REPORT 2012-2020 DEPARTMENT OF FAMILY AND COMMUNITY MEDICINE VISION Excellence in research, education and innovative clinical prac- tice to advance high quality patient-centred care. MISSION We teach, create and disseminate knowledge in primary care, advancing the discipline of family medicine and improving health for diverse and underserved communities locally and globally. VALUES We are committed to the four principles of family medicine: • The family physician is a skilled physician. • Family medicine is a community-based discipline. • The family physician is a resource to a defined practice population. • The doctor-patient relationship is central to the role of the family physician. We are guided by the following values: • Integrity in all our endeavours. • Commitment to innovation, and academic and clinical ex- cellence. • Lifelong learning and critical inquiry. • Promotion of social justice, equity, diversity and inclusion. • Advocacy for accessible and quality patient care and prac- tice. • Multidisciplinary, interprofessional collaboration and ef- fective partnerships. • Professionalism. • Accountability and transparency within our academic communities and with the public. DFCM Vision, Mission & Values | 2 TABLE OF CONTENTS 1.0 INTRODUCTION 6 1.1 Key Milestones 2012-2020 7 1.2 Strengths & Challenges 7 1.3 Equity, Diversity & Inclusion 9 1.4 Self-Study Participation 9 1.5 Recommendations from 2012 Review 10 1.6 Chair’s Report 25 2.0 PEOPLE 28 3.0 EDUCATION 35 3.1 Undergraduate Program 36 3.2 Postgraduate Program 50 3.3 Academic Fellowship & Graduate Studies Program 62 4.0 LEADERSHIP & FACULTY DEVELOPMENT 66 4.1 Faculty Development 67 5.0 QUALITY & INNOVATION 74 5.1 Who We Are 74 5.2 Vision & Strategic Plan 75 5.3 Key Activities 75 5.4 Funding 78 6.0 GLOBAL HEALTH & SOCIAL ACCOUNTABILITY 79 6.1 History & Context 80 6.2 Leadership 80 6.3 Key Milestones 81 6.4 Educational Offerings 81 6.5 International Partnerships 84 6.6 Global Health Research 85 6.7 Future Directions 85 7.0 ACADEMIC DIVISIONS 87 7.1 Emergency Medicine 87 7.2 Palliative Care 90 8.0 PHYSICIAN ASSISTANT PROFESSIONAL DEGREE PROGRAM 93 8.1 Academic Leadership 93 8.2 Program Overview 94 8.3 Curriculum 94 Table of Contents | 3 8.4 Admissions, Enrolment & Graduates 94 8.5 Future Directions 95 9.0 RESEARCH & SCHOLARSHIP 96 9.1 Research Program 96 9.2 UTOPIAN: The University of Toronto Practice-Based Research Network 103 9.3 Office of Education Scholarship 105 10.0 ORGANIZATION & FINANCIAL STRUCTURE 114 10.1 DFCM Central 114 10.2 DFCM Sites 115 10.3 Governance Committees 117 10.4 Financial Resources 117 10.5 Appropriateness of Resources 118 11.0 RESOURCES & INFRASTRUCTURE 120 12.0 INTERNAL & EXTERNAL RELATIONSHIPS 122 12.1 Internal Relationships 122 12.2 External Relationships 123 12.3 International Relationships 124 12.4 Social Impact 125 13.0 ALUMNI & ADVANCEMENT 126 13.1 Advancement 126 13.2 Alumni 130 14.0 FUTURE DIRECTIONS 131 15.0 FACULTY REPORT 134 16.0 LEARNER REPORT 136 17.0 SITE REPORTS 140 17.1 Markham Stouffville Hospital 141 17.2 Mount Sinai Hospital 147 17.3 North York General Hospital 151 17.4 Royal Victoria Regional Health Centre 156 17.5 Rural Residency Program 160 17.6 Scarborough Health Network 162 17.7 Southlake Regional Health Centre 165 17.8 Sunnybrook Health Sciences Centre 169 17.9 Toronto East Health Network - Michael Garron Hospital 174 17.10 Trillium Health Partners - Credit Valley Hospital 178 Table of Contents | 4 17.11 Trillium Health Partners - Mississauga Hospital 182 17.12 UHN - Toronto Western Hospital 186 17.13 Unity Health Toronto - St. Joseph’s Health Centre 190 17.14 Unity Health Toronto - St. Michael’s Hospital 194 17.15 Women’s College Hospital 202 Table of Contents | 5 The University of Toronto Department of Family and Com- munity Medicine (DFCM) is a large, distributed department that functions with unity, collaboration and responsive- ness as a result of a well-resourced leadership and admin- istrative infrastructure both centrally and at the sites. The central senior-most leadership functions are managed by a team of key leaders to ensure that all programs and ac- tivities are accessible and responsive to learners, faculty, staff and sites. DFCM Central DFCM is focused in five major areas: education, research, quality and innovation, global health and family doctor leadership. With this focus, the Department is divided into nine programs (Undergraduate Education, Postgraduate Education, Academic Fellowship and Graduate Studies, Research, Faculty Development, Quality and Innovation, Global Health and Social Accountability, Office of Educa- tion Scholarship, Physician Assistant) and two divisions (Emergency Medicine and Palliative Care), with an addi- tional four divisions in development (Care of the Elderly, Hospital Medicine, Mental Health and Addiction and Clini- cal Public Health). Our network of committed leadership is dedicated to training and mentoring future leaders and providing op- portunities for advancement within the Department. In our major programs, Vice-Chairs are supported by Pro- gram Directors and Associate Program Directors. This has enabled our programs to expand and thrive. Programs are also guided by various committees that provide oversight, expertise and a forum for collaboration. DFCM Sites Central DFCM programs support teaching and research at 14 core teaching sites, four rural sites and 40 teaching practice sites. Sites are responsible for the day-to-day or- ganization, implementation and supervision of teaching and learning, under the oversight of various leads, the site chief and the executive committee. The leadership structure at each site mirrors the central leadership structure with each site having its own Site Di- rectors, Site Program Administrator, QI lead and Research INTRODUCTION lead. This enables all our sites to provide a strong learning environment for our residents and deliver the core aca- demic program in unique and geographically grounded ways. Meanwhile, DFCM committee and communication 0 structures allow us to work in an environment that fosters collaboration, respect, responsiveness and flexibility. Further details on DFCM structure and governance are in- 1. cluded in Chapter 10. Introduction | 6 KEY MILESTONES 2012-2020 Leadership & Faculty Development • All DFCM education programs have been strengthened by the addition of Associate Program Directors, enabling programs Education to expand and thrive thanks to greater collective expertise and greater depth of • Tremendous growth in the Undergradu- leadership. ate Program, with faculty members pro- • Leadership expansion in the areas of So- viding leadership and teaching family cial Accountability, Indigenous Health, medicine at all levels of the MD Program. and Equity, Diversity and Inclusion. In particular, DFCM faculty played pivot- al roles during the transformation of the Global Health pre-clerkship years, now called the Foun- dations Program (2016/17). • DFCM supported Addis Ababa University • Postgraduate Program recognized nation- to establish Ethiopia’s first training pro- ally and internationally for its excellence. gram in family medicine (2013). Nationally accredited by the College of • DFCM named the first World Health Orga- Family Physicians of Canada (Dec. 2020) nization Collaborating Centre on Family with a provisional result of Full Accredita- Medicine and Primary Care (2018). tion with Action Plan Outcome Report in two years, and the first family medicine residency program in North America to be accredited by the World Organization STRENGTHS & CHALLENGES of Family Doctors (2018). Research & Scholarship DFCM Structure & Leadership • Office of Education Scholarship estab- Despite being large and dispersed, DFCM’s lished (2012). organizational structure allows for efficien- • The University of Toronto Practice-Based cy over geographically distributed sites. This Research Network (UTOPIAN) established is achieved through consistent leadership (2013). structures centrally and at each site, and nu- • Art of the Possible Education Grants in- merous committees that encourage informa- troduced to support DFCM education tion sharing and collaboration towards DF- programs and faculty members, through CM’s mission. seed funding and consultation, to engage in education scholarship innovations and The Department also benefits from strong research (2016). leadership and expertise in our Vice-Chairs, Program Directors and Associate Program Quality & Innovation Directors, and a large and deeply committed • Led the way nationally in the develop- faculty. However, DFCM has experienced nu- ment of a comprehensive, longitudinal merous transitions in the Chair position since quality improvement curriculum that is 2016 (two Chairs, two Interim Chairs). These contextualized for primary care. fluctuations have been challenging for the • The COVID-19 Community of Practice for Vice-Chairs, Program Leads and Site Chiefs. Ontario Family Physicians (co-created by DFCM and the Ontario College of Family Diverse Learning Environment Physicians) has created a space for hun- DFCM’s diverse sites (inner city, rural etc.) and dreds of family physicians across Ontario numerous specialized and vulnerable popu- to come together to learn from each oth- lations ensure a comprehensive learning er during the pandemic (2020). experience and offer opportunities to tailor Introduction | 7 learning based on personal interests. How- In terms of education, DFCM’s Office of Ed- ever, DFCM is aware of the need to strength- ucation Scholarship