Message from the Department Head

Yesterday was a great day for the department.

The University of British Columbia’s Midwifery Program – bolstered by increased funding from the Province of British Columbia – will double in size.

Minister of Advanced Education Naomi Yamamoto and Minister of Health Michael de Jong, surrounded by mothers and children,on May 4 announced the doubling of UBC’s midwifery education program. Starting this fall, first-year spaces in the Midwifery Program will grow from 10 to 20.  UBC will receive $1.914 million in one-time funding, and an increase of $833,920 in ongoing operating funding for the phased expansion.

“UBC’s midwifery education program is part of government’s commitment to educating health professionals in British Columbia,” said Minister of Advanced Education Naomi Yamamoto at an announcement today at UBC’s Vancouver campus. “This funding means more students can pursue their chosen field at UBC, and more midwives will graduate, helping to serve the needs of B.C. families.”

Saras Vedam must take a lot of credit along with all the faculty and staff who have worked so hard over the last 10 years. They demonstrated clearly that this academic program was training midwives to work in BC and meet an increasing demand for midwifery care from mothers to be. That demonstration of success led to the successful negotiation for sustainable funding and expansion. To see the academic performance of the program one just has to look at the Canadian Journal of Midwifery Research and Practice (Winter Spring Issue) to see the many contributions from several faculty. Congratulations to everyone.

Other news is the successful OSCAR electronic medical record meeting being held in Vancouver this weekend. This is more about the added value of the EMR rather than technology. Just glimpsing some of the incredible work done by David Page, John Yap and others is incredibly impressive. If you want an example try this link to David Page’s Chronic Kidney Disease form. You don’t have to have an EMR – just open the page in your browser to see what sort of decision support is available. This meeting really helped us think about how we practice with so many patients with multiple morbidities.

Pie Palooza

Finally many of us are suffering from an over indulgence of pies. After tasting, and scoring, fourteen pies  we were all overcome with great tastes and even more calories. Thank you Shelagh for arranging, Anita, Roy and others for helping run it. A great party.

Martin

A weekend of discussion in Toronto started with guideline creators talking about the need for better tools of integration into practice. This CIHR funded day brought together many guideline authors such as the Canadian Diabetic Association and Canadian Cardiovascular Society. Principles were established some of which were surprising.  For example “There is no need to develop a tool for a poor guideline”. This acknowledges the bias inherent in some guidelines or the reliance on expert advice when evidence from trials is not available. Some of the discussion raised the importance of electronic medical records while recognizing that with the high prevalence of multi morbidity this in itself is not a solution.

At the same time the CCFP had started it’s weekend to determine the strategic direction  of the section of researchers

Key areas are

1. Community Engagement
2. Advocacy and Support
3. Integration
4. External Relationships
5. Capacity Building

The group worked on adding detail to this and a report will be emerging from this workshop. One objective is that there will be a Primary Health Care Institute in CIHR within 5 years. This could transform research funding for primary care researchers, not necessarily more money, but possibly more equity. As we approach the deadline for the largest funding investment in primary care research from CIHR ever there is a feeling that things are changing for the better. Good luck to all the UBC applicants.

Martin

This is an exciting time as we reach the submission date for the CIHR Community Based Primary Health Care Letters of Intent submissions. With 35 going to be shortlisted by CIHR, and over 150 applications expected from across Canada it will be interesting to see what happens over the next few months.

This weekend was the beginning of a large meeting for medical educators in Banff. The news for us is that family practice is not having an easy ride anywhere in the country. As the chairs of departments compared notes it became clear that none of them were relaxed about the future, most were dealing with expansion, and most are worried about their budgets.  Despite that level of anxiety all the departments are proud of the scholarly work seen in practice and especially about the role of the college provincially and nationally in preparing practices to take residents and students. Compared with the situation 20 years ago  potential teaching sites are not only very positive about teaching but they also have the background and understanding of the requirements for training as so many have already been through the CFPC program themselves. This makes the prospect of expansion in BC very much more positive as we consider growing by 50% from the current intake of 124 residents.

Extreme examples of success still are a pleasure to see such as this publication from a BC group : Claire Robinson, Sharlene Kolesar, Mark Boyko, Jonathan Berkowitz, Betty Calam and Marisa Collins , Awareness of do-not-resuscitate orders: What do patients know and want? Can Fam Physician April 2012 58: e229–e233. 

Many Congratulations on a great job in doing the work and getting it published.

Martin Dawes

It is not often an article really makes one think about changing one’s own life. The Lancet this week has an article that started me thinking about aspirin and while I have not yet decided it is reassuring to know that perhaps some of the old drugs are the best drugs (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2811%2961720-0/fulltext?elsca1=ETOC-LANCET&elsca2=email&elsca3=Other). At least we know the side effects of this one in comparison to the new compounds. I will wait for the critical appraisal of this article and the flurry of correspondence that is likely to ensue before making my decision.

The problem of whether or not I should take a drug palls into insignificance when one sees that 1.1 billion Chinese don’t have a family doctor. Those that do may be seeing a very different set of health professionals than you might be thinking of. Perhaps a person who is seeing a minimum of 80 patients a day and sometimes 20 per hour. How can we help this country deal with that problem where most diagnoses are made in hospital, and primary care as you would recognize it hardly exists at all. This was the challenge facing the group of department heads and postgraduate directors from across Canada as they attended a two day summit co-hosted by UBC and the Canadian Embassy in Beijing last week. I was there with a team of five from UBC including Gavin Stuart, our dean, and Kendall Ho who runs our E-Office within the Faculty of Medicine. We have good links with a couple of major universities in Shanghai (Fudan University) and Beijing (Capital University) and also with some health authorities. There was no clear outcome as one might expect but several small steps were taken. In terms of our global strategy China is very much one of our targets for providing support in terms of the development of an infrastructure to start to teach primary care. What we will do on the ground is yet to be determined.

It was interesting to see the response of the Chinese Universities to the Times Higher Education rankings of Universities. UBC has moved from 30th to 22nd (http://www.timeshighereducation.co.uk/world-university-rankings/2011-2012/top-400.html). This enormous leap was mentioned and many more students, both graduate and undergraduate, were expressing interest in coming to visit. That sort of success breeds further success as bright hard working students visit us and work with us. It is a reflection of your academic success that has pushed us up the ratings so thank you to all of you and many congratulations.

Martin

Dee Mangin has kicked off this two day meeting challenging us and inspiring us. In New Zealand divisions have been answering primary care based questions effectively and collaboratively working with the department of general practice. For example demonstrating that with the right resources, family doctors can look after many more patients at home even when patients are quite sick such as those with pneumonia.

A provincial primary care research network is part of the system that will help that happen here and Morgan Price is describing what that might look like. The network will help clinicians interested in answering questions Engage, Develop, and Perform. This week the Canadian Primary Health Care Research Network (CPHCRN) for researchers went live and can followed in Linkedin. This national group indicates the impetus that is happening in primary care research. The number of initiatives locally and nationally is exciting with divisional resources, departmental resources, and provincial and federal research & knowledge translation dollars.

The ERI group of clinical faculty responsible for EBM, Research and Informatics at the residency sites met on Friday with many new members working through common issues. Ideas about creating common core resources for Evidence Based Medicine were discussed. As a large department with 15 sites this is an exciting development in terms of faculty collaborating together to provide our own teaching resources.

We had a visit from the Chinese University of Hong Kong who are very keen to share ideas on undergraduate and postgraduate education as well as research, as they help address the needs of developing primary care in South China. The scale of their population needs is quite incredible when compared to the BC. However some of the solutions are very similar despite this difference in scale. This is only one of many global sites interested in a partnership and we are starting to work on a strategy that will help us respond to these requests.

Martin Dawes

Ever worried about a patient collapsing in your office? At my last practice we had the adrenaline stuck on each door. The first day we did that a patient came in and collapsed. Now we regularly check the expiry date as well! At the practice I worked with in Oxford, UK, the practice nurse had put a steroid injection and the adrenaline in a plastic box with a small IV line, and when you opened the lid there was a little label inside the lid that listed which went in the muscle and which went in the vein and how fast each should be given. “Just in time” information is critical not only in ER, but where people with illnesses tend to come – like your clinic.

One of residents has addressed this problem of what you need in your clinic for emergencies in a video that is part of their R2 project. I thought that if any of you are reading this blog maybe you might help him out by watching the video at www.OfficeEmergencies.ca –  the resident is form Nanaimo and is running this project and I do urge you to go visit this site as the video is very short and very useful. You will learn, very quickly, what you might need in your office and be surprised that most of the equipment will cost only $101  I like the precise estimate – not $100 but $101! – soon to be the cost of a tank of gas in British Columbia the way prices are going.

Resident projects are a feature of this department that is encouraged as part of developing the academic role of the family doctor. The huge variation in ideas and the enthusiasm that residents demonstrate for answering their questions is really evident. Research rounds are held every other Wednesday morning at 8.00am to 9.00 am at the department in Vancouver, and virtually so you can log in. This is a perfect place for residents to present their ideas and have help developing their protocol. It is friendly, supportive and open to all faculty. The residents are starting to use this as a regular sounding board and mentorship setting – maybe you should listen in?

In the rest of the world of family medicine the deadline for the Family Medicine Forum applications was the 24th february but the site is still open if you have a last minute workshop idea.

Martin

An amazing week or two in family practice at UBC. Three TLEF grants that I know about have been granted to Gurdeep Parhar, Christie Newton and Diana Dawes.  Together they have gained nearly $200,000 of funding which is tremendous. At the same time there as been announcement from CIHR for nearly 31 million dollars of funding for primary care research over the next five years (The Transformative Community-based Primary Healthcare Initiative).

There are several groups now developing their letters of intent for this new funding. It is the largest offer of research funding in primary care in Canada and really marks a sea change in the approach of the Federal Government regarding research.

We are anticipating the CARMS match following all the interviews. We are also expecting a report in April about developing a strategic plan for expansion of the postgraduate program. We have been asked to increase both International Medical Graduates and Canadian graduates over the next four years and are approaching potential training sites across the province. The undergraduate curriculum is being renewed with family practice involvement in many of the sub committees.

The first annual Research Skills Workshop is being hosted by the Department of Family Practice Research Office and there are a few places left.

The two-day event will be held at the University Golf Club, 5185 University Boulevard, Vancouver on March 3 and 4, 2012. The event features keynote speakers, Dr. Dee Mangin (New Zealand) and Dr. David Kuhl (UBC, Family Practice) and an interactive primary care network panel discussion. It will be an excellent opportunity to attend research skills building workshops, meet potential collaboratorsand network with colleagues who share your scholarly interests. Immediately after the last workshop on Saturday, March 3^rd, there will be a cocktail and networking reception followed by dinner.

The workshop is free to all members of the UBC Department of Family Practice (faculty, research staff, Clinician Scholars, and residents).
Martin Dawes

The third week in January is always one of the busiest. Everyone is catching up and the flurry of e-mails matches the snow. Despite that we have time to look at space reorganization at the department and are excited by the prospect of  improving the working environment. Those who are likely to move have indicated where their would like to be and it is all looking very achievable.

This is my second vancouver winter and I am still slightly puzzled,as someone who experienced 9 winters in Quebec, how we respond to a slight flurry of snow and a bit of a frost. However I also realize it is not so amusing for many patients and they find it hard to get out to see us in our practices. So how does a patient cancel their appointment. Your MOA might be very busy, assuming that their travel plans were not disrupted, just dealing with twenty five calls to change or cancel an appointment, on top of the already high demand for lab results or other needs. In some countries a lot of patients can get direct access.

This is an example from one site showing the  latest figures for a clinic with  Electronic Access by patients in November 2011.http://gprecordaccess.blogspot.com/

The new year has arrived and has been accompanied by new departmental offspring. Congratulations to Rebecca Goulding, a research coordinator in the department at UBC, who is now sharing her life with Kian Goulding Reynolds, who was born just before midnight on January 2nd, 2012, weighing 3.765kg (8lb 5oz). Mum and baby are both very well and happy!

Cathy Ellis, one of our lead faculty in midwifery, received news that she has been promoted to Senior Instructor. Many congratulations.

Chocolate cake was well employed to welcome Shelagh Levangie who has been appointed Departmental Director of Administration. Many congratulations. At that impromptu meeting there was discussion, prompted by the cake, about how we become more physically active as a department. Look out for notices about walks and other activities as this conversation develops.

Finally if you missed Richard Lehman’s blog in the BMJ this week, you missed his quotation of John Yudkin’s “Ten Commandments of the New Therapeutics”, which should be engraved in every prescriber’s brain.

1. Thou shalt treat according to level of risk rather than level of risk factor
2. Thou shalt exercise caution when adding drugs to existing polypharmacy
3. Thou shalt consider benefits of drugs as proven only by hard endpoint studies
4. Thou shalt not bow down to surrogate endpoints, for these are but graven images
5. Thou shalt not worship Treatment Targets, for these are but the creations of Committees
6. Thou shalt apply a pinch of salt to Relative Risk Reductions, regardless of P values, for the population of their provenance may bear little relationship to thy daily clientele
7. Thou shalt honor the Numbers Needed to Treat, for therein rest the clues to patient-relevant information and to treatment costs.
8. Thou shalt not see detailmen, nor covet an Educational Symposium in a luxury setting
9. Thou shalt share decisions on treatment options with the patient in the light of estimates of the individual’s likely risks and benefits.
10. Honor the elderly patient, for although this is where the greatest levels of risk reside, so do the greatest hazards of many treatments. http://blogs.bmj.com/bmj/2012/01/03/richard-lehmans-journal-review-3-january-2012/

Happy New Year to all

Martin

Christmas day in healthcare is pretty much like any other day of the year. People get sick and professionals take care of them. If you are working over the holiday  then a special thanks to you. It is not easy juggling family and friends and their expectations with the pressure of call and patients. Hopefully you will manage the demands successfully and feel especially virtuous. That feeling of doing something worthwhile is important. When I discuss the career of a family physician with students I talk about the dividend we have as health care professionals in looking after people. For most of us it gives an additional meaning to our lives that is very positive. The same can be said of people who help train health care professionals such as the administrators in Terrace or Nanaimo who schedule undergraduates or residents rotas or the research coordinators helping the residents research projects. The department is made up of many groups of individuals who all contribute to the health of people in BC. Our programs have had, and continue to have, a major positive impact on the people of BC and you should feel justifiably proud of your contributions to that work.

Family practice often may feel like a poorer cousin compared to other health professionals but  that feeling is sometimes shared by other specialties. This week’s Christmas edition of the British Medicial Journal compared the intelligence and grip strength of orthopaedic surgeons and anaesthetists. Orthopaedic surgeons had a statistically significantly greater mean grip strength (47.25 (SD 6.95) kg) than anaesthetists (43.83 (7.57) kg). The mean intelligence test score of orthopaedic surgeons was also statistically significantly greater at 105.19 (10.85) compared with 98.38 (14.45) for anaesthetists. They concluded that orthopaedic surgeons have greater intelligence and grip strength than their male anaesthetic colleagues, who should find new ways to make fun of their orthopaedic friends.

I hope you enjoy your holiday and do not need the attention of either of these groups of respected colleagues if you are out skiing or enjoying other activities.

Martin