Message from the Department Head

Dear All

It has been a busy, if not hectic,  year and hence blogs have dropped off the completed section of the todo lists – my New Year resolution is to improve communictaion and I will write the blog more frequently!

I hope this message finds you all on the eve of what will be a restful and restorative holiday break.  This year has been packed with activity and accomplishments…I am just picking on a few as examples

• Postgraduate accreditation was a major piece of work and I am incredibly grateful to everyone who made this such a successful visit. There is work to be done but there were no surprises! The opportunity to visit so many of the teaching sites and see the residents and faculty was a highlight of the year for me.
• We welcome two new faculty – Joanie Sims Gould and Michelle Butler
• Michelle will be arriving in the new year to take up the position of Director of the Midwifery Program, while Joanie will be working at Hip Health.
• We welcomed the move Centre of Rural Health Research to our David Strangway Offices
• Oak Street Clinic moved to became the Broadway Family Practice Clinic and has so much more space to accommodate the 9 or so residents.
• The number of our clinical faculty has grown to over 1800
• The undergraduate program is changing with the third year rotation to happen over the whole year rather then just in the summer.
• Christie Newton, Maureen Ashe, Michael Koehle were promoted to Associate Professor
• Rob Lloyd-Smith was inducted to UBC Sports Hall of Fame; and Jack Taunton inducted to the BC Sports Hall of Fame

The list of activities and accomplishments is way too long for a blog and this really just demonstrates the amount and the quality of the work being undertaken.

Thank you for all your contributions, commitment and continued collaboration.

Best wishes to you and your family over the holiday. Meanwhile I shall share the winter weather with our family.

The dog seems to be the most happy with the recent snowfall.

Sincerely

Martin

Dr. Michelle Butler hired as new Director, UBC Midwifery Program

I am delighted to announce that Dr. Michelle Butler has been hired as the new Director of the UBC Midwifery Program.

Dr. Michelle Butler is an experienced midwife, teacher, researcher, and university administrator.  She qualified as a Registered Nurse and Midwife before pursuing a BSc in Health Sciences and a MSc in Health Studies. In 2001, she completed her PhD from the University of Nottingham and joined the University College Dublin.  Dr. Butler has served as Dean and Head of the School of Nursing, Midwifery and Health Systems and is currently the Subject Head of Midwifery at University College Dublin and Clinical/Academic Research Liaison with the National Maternity Hospital.  An active researcher she has had multiple grants and published widely in the areas of midwifery competence and learning, woman-centered care, health care outcomes, and health service policy and planning.  A highly regarded teacher, Dr. Butler lectures on advanced research methods, midwifery research and health policy and planning.

The Department of Family Practice and the Midwifery Program are very pleased to welcome someone of Dr. Butler’s stature and reputation to the Department.  We look forward to working with her and warmly welcome her to our Department and University.

Dr. Martin Dawes, Head, UBC Department of Family Practice

Kim Campbell, Interim Director, UBC Midwifery Program

The  job of a department head is not always easy. However the challenges are offset by the positive aspects. This week had two very positive experiences. I visited Prince George with Willa Henry to talk about the accreditation visit coming up in November. We spent the day meeting with residents and faculty. It is good to hear from both teachers and learners that the program works and works well. Of course there are opportunities to improve and we will work on those, but the overall picture of an active, interesting site that is proud of its accomplishments was a really positive experience.

On returning to Vancouver the next job was to celebrate the success of one of our clinical faculty in becoming Professor. UBC takes promotion very seriously and the faculty of medicine recognizes its new professors in a gowning ceremony where new professors are introduced to the audience by the department head and welcomed personally by the dean. This year we were very proud to promote Fraser Black.

Dr. Black (MD, CCFP, FCFP) is an outstanding Palliative Care Physician in Victoria, well known in the UBC academic community. Dr. Black has contributed greatly to the success of the UBC Department of Family Practice Postgraduate Residency Training Program in Victoria as a clinician, mentor, researcher and Program Administrator. He is Associate Director of the Palliative Access Program (PAX) of the International Network for Cancer Treatment and Research (INCTR) and has worked on palliative care initiatives in many countries, including Nepal, India, Tanzania and Brazil. Dr. Black has practiced palliative care over the last 14 years, providing care to both adults and children. He is currently the Medical Director of Victoria Hospice in Victoria, as well as a Consultant with the BC Cancer Agency.  He is an International Associate Faculty Affiliate with the Institute of Palliative Medicine at San Diego Hospice.

Many congratulations Fraser.

Martin

Congratulations to everyone involved in the residency matching process

UBC’s expanded Family Medicine program filled 107 of 108 positions, the largest ever in BC.  All 32 seats for International Medical Graduates were also filled.

Well done everyone

Martin

It has been a good two weeks. We have had two good candidates for the head of the division of midwifery visit, Melissa Cheyney last week from Oregon, and Julie Wray from the UK this week. Both gave public presentations, had a whirlwind tour and met many faculty, students and provincial leaders. I am grateful to all of you who gave time for these meetings andhave, and are still, providing useful feedback to the search committee. I will  keep you posted as the recruitment process develops.

Postgraduate had the CARMS interviews last week, over 600 students being interviewed,  and we are very grateful to all who are helping with that process.

This week we sent out the Cancer Benchmarking survey. For those who may have missed the link to the online survey is here and we would like as many of you as possible to complete this.

I try to avoid asking you to do extra but in this case I felt it was important to ask for your help. I was asked by the BC Cancer Agency to have the department assist in the setting up of this project and as the results will help determine primary care cancer service provision in BC.  We are working with two other groups, The BC College of Family Physicians and the Family Practice Oncology Network . To take part in this study please click on the following link . You will also have a chance to win one of three iPads by completing this survey. This survey is conducted in cooperation with the International Cancer Benchmarking Partnership (ICBP) that includes partners from other provinces in Canada as well as other countries including the United Kingdom, Denmark, Australia, Sweden and Ireland. This will apply the expertise on international experts on these issues, and also permit an international analysis and cross-jurisdiction comparisons of the results. The lead for this work in the department is a post doctoral fellow; Dr Jin Mou. (jin.mou@familymed.ubc.ca) who will be happy to answer any questions.

DATA: On the subject of data there has been a push to get more data available from trials that are not published. An example is Tamiflu where more than 100 trials have been undertaken and yet many remain unavailable . If it was just one drug that was in the headlines that might be ignored but this is a problem affecting multiple drug trials. It makes no sense that research on the effectiveness for a therapy should ever be withheld from clinicians and yet that is the case. The commitment to register a trial has not had the desired effect and we now need to make sure that all trial data is available. For more information on this and a petition go to All Trials

In the meantime have a great family weekend (for those in BC).

Martin

David Kuhl has been awarded the Queen Elizabeth II Diamond Jubilee Medal.

He was nominated for his work in co-founding the Veteran’s Transition Program (VTP).

This is a truly remarkable acknowledgement of the work David has done for veterans and as a department we should feel very proud of his commitment and scholarship that led to the development and success of the program.

David is the Director of the Centre for Practitioner Renewal and  Professor for the Department of Family Practice, Faculty of Medicine at the University of British Columbia. Previously, he was the physician leader for palliative care at Providence Health Care for many years. As the Director of CPR, he is working to combine his interests in medicine and psychology to develop a program of service, education and research to sustain health care providers in the workplace.

Could this be another effective way to change doctors’ behaviour? Not really, says a linked editorial (doi:10.1001/jamainternmed.2013.1984). Healthy people with uncomplicated bronchitis should never be given antibiotics. We have known this for 40 years and should be aiming for prescribing rates below 10%.

Efforts to change have been well made and well evaluated. We know what works, but nothing seems to work well enough. Traditional medical interventions have failed, and it may be time to look further afield to business leaders, behavioural economists, and psychologists for inspiration. We might also be clearer with patients about just what they can expect from antibiotics—a few will recover slightly faster, between 5% and 25% will have an adverse reaction, and at least one in every 1000 will present to an emergency department with a serious drug related event.

This year will be challenging for the department. We have accreditation, a new post graduate curriculum, expansion and the development of new postgraduate training sites and that is just post graduate. In undergraduate the renewed curriculum development continues and the role for family practice is going to be significant. In faculty development the activity continues apace with one of the largest events being Family Medicine Forum which is this November in Vancouver. Amongst other research activities we await the first community based primary health care team grants from CIHR that will be announced in April. So it will be an exciting twelve months.

To address some of the expansion issues we have been working closely with the faculty of medicine to restructure the payment system for clinical faculty. We have a temporary fix in place and will now be putting into place a new finance process run from the department as the long term solution. The training to implement this will take six months but at the end of that period faculty should see a much improved payment process. To enable this we have undertaken several structural changes in the department to create space for groups of administrative staff to work more closely. We are continuing changes and in six weeks will see three new offices being constructed. I am grateful to the patient of staff and faculty living through these departmental disruptions!

Outside of the department we are seeing some interesting developments. A world wide call for open access to clinical trial data is starting to really gather momentum. With many of Tamiflu’s trials results still not revealed the pressure is on various governments to reassess recommendation for its use (http://www.bmj.com/tamiflu). This might be very appropriate as we face such a demand and yet we don’t have access to the evidence. At this stage you might expect to see a Cochrane review . Roche have now promised to release their data to the Cochrane trialists (November 2012). There are other examples of this but as the flu epidemic hits it is really quite worrying that eight of the ten randomised controlled trials using Tamiflu have not yet been published or their data released.

So what should we do in response to patients with symptoms. The real question is what source of evidence do you use. I usually check Dynamed on my cell phone. In head to head comparisons it came off better than UptoDate for timeliness but did not have so much breadth of coverage (Prorok et al The quality, breadth, and timeliness of content updating vary substantially for 10 online medical texts: an analytic survey, Journal of Clinical Epidemiology, Volume 65, Issue 12, December 2012). In the end one source of evidence is rarely enough and I suggest having two or three you become familiar with. Rx files is another of my regular sources as it has the advantage of showing some information on cost.

Whatever the source of information you use I hope the flu epidemic is mangeable in your clinical setting. In the end Semmelweiss’s advice on hand washing is never wrong!

Bounding enthusiasm

The North American Primary Care research meeting was again full of research that changes practice. Whether it was identifying the mean duration of cough, or the effectiveness of antiviral agents for flu like illnesses, the amount of clinically relevant information out of the 550 presentations was quite staggering. Just becoming aware of all this new clinical knowledge is a challenge all of us face. This is the time of year when there is just a little more time to try and read through that article I said I would read. I use a program called “Papers” to keep these but there are currently over 50 in my “to read” folder. Ah well – I will just have to pick the one’s that relate to patients seen in the last week or so.

To all those of you working over the holidays a big thank you. Emergency rooms, on call rotas for the office, deliveries, and acute hospital care all need us to give up family time. At this time of year the enthusiasm for undertaking such an incredibly important and worthwhile job sometimes may not seem enough when balanced against demands of family and friends. It always was a tension – I can just imagine Hypocrates coming back home from a house call on Cos to a dried up dinner of humus, soggy tomatoes in olive oil, and burnt lamb. His two sons would already be asleep and he had yet again missed reading them the next chapter in their favorite story of the Battle of Troy.

For over two thousand years we have been working on various types of rotas, group practices, out of hours co-operatives, urgent care centres. There is no simple solution to the call of the mother of a child with fever and cough. Maybe tele-health will mean we don’t have to leave our house in the future but for now health professionals around the world shrug their shoulders and just get on with it. There is a pride of being part of an organisation designed to look after others and there is certainly appreciation from society of all that you do especially over any holiday season.

I hope that you all have at least some time to relax, see some sunshine, have time with family and friends, and know that the work you do is appreciated by many.

Martin

Yesterday the sunshine was here and yet our department boardroom was full of people who had still found the enthusiasm and keenness to attend a workshop. This was designed to give people hands on experience of designing a randomised controlled trial for family practice. It started with Raina Elley (Peter Wall Institute Visiting fellow) giving us the methods of design, methods to avoid bias, and the steps to actually do this for real in an excellent presentation answering plenty of questions as she went along. Then we were split into three groups and over the next hour or so developed a trial. We all competed for the best acronym, produce a rationale for a trial, developed the aims and wrote a study question. We develooped the design, described the particiapnts, the intervention and the control. We had plenty of discussion over outcome measures, agreed the duration of the study, and looked at the the methods of randomisation, allocation, concealment and blinding. Finally we addressed the strengths and weaknesses of our design. In the workshops were those who had undertaken RCT’s, people thinking of doing them, and people starting with a question. By 12.30  the three groups had each given a five minute presentation. It was a remarkable workshop revealing Raina’s strengths as a teacher, facilitator and trialist. She is heading off to the North American Primary Care Research Workshop where she will give the workshop again, helped this time by our previous research director, now chair of research at University of Montreal, Janusz Kaczorowski. If you are in New Orleans on Saturday for NAPCRG then I recommend  making time for this workshop if you can.

Raina is returning to New Zealand after three months in the department. During that time she has applied for and gained ethics for a study to test a New Zealand tool called CHAT, identified the two practices, recruited the patients and delivered the tool.  The Case-finding Health Assessment Tool (CHAT), a short self-administered tool for life-style and mental health assessment of adult (19 years and over) patients in Family Practice, has been developed by a multi-disciplinary team (including the fields of Family Practice, nursing and psychology) from the University of Auckland in New Zealand, led by Prof Goodyear-Smith. The tool assesses for risky behaviours (smoking, drinking, other drug use, gambling, abuse, physical inactivity) and mental health issues (depression, anxiety, anger control) in Family Practice. For each item patients are asked whether this is something with which they would like help, either during this consultation or at a later date. From the two practice 171 patients completed the tool and the responses are now being evaluated. This demonstrates what can be done but especially reflects Raina’s enthusiasm for answering primary care questions that are highly relevant to the health professionals and patients.

During her stay she has helped many faculty with research protocol design, worked on collaborative projects, and given several teaching sessions including this workshop. We owe a debt of gratitude to the Peter Wall Institute for supporting her fellowship and to Raina for everything she has helped with over the last three months.

Martin