The departments within the Faculty of Medicine at UBC play a central role in achieving the goals of the expanded medical school, and the goals of the broader health care system. Four strategies are needed for success: make professionalism the tie that binds the Faculty of Medicine and the health authorities; engage clinical and academic de­partments as key drivers of professionalism; ensure knowledge development and continuous learning are recognized as central to professionalism; challenge government to focus on supporting professionalism

Armstrong, Robert

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eCommons@AKUPaediatrics and Child Health, East Africa Medical College, East AfricaJanuary 2008Focus on the profession: academic and clinicaldepartmentsRobert ArmstrongAga Khan University, robert.armstrong@aku.eduFollow this and additional works at: http://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_healthPart of the Pediatrics CommonsRecommended CitationArmstrong, R. (2008). Focus on the profession: academic and clinical departments. BC Medical Journal, 50(7), 390-392.Available at: http://ecommons.aku.edu/eastafrica_fhs_mc_paediatr_child_health/49ABSTRACT: The departments withinthe Faculty of Medicine at UBC playa central role in achieving the goalsof the expanded medical school, andthe goals of the broader health caresystem. Four strategies are neededfor success: make professionalismthe tie that binds the Faculty of Medicine and the health authorities;engage clinical and academic de -partments as key drivers of profes-sionalism; ensure knowledge devel-opment and continuous learning arerecognized as central to profession-alism; challenge government to focuson supporting professionalism.The BC government hasfund ed a provincial med-ical school linked to oneprovincial and five region-al health authorities. Unique in Cana-da, this structure provides an unprece-dented opportunity for improvementin the health and health care of BritishColumbians. Appropriate training of new physi-cians and the support of these physi-cians in clinical practice, academicpursuits, and leadership will definethe degree of success we have in sus-taining and improving on health care.The challenges in medical educationare significant and are related directlyto changes that have occurred in thehealth care system during the last 30years. They are not unique to BC, asdemonstrated by recent calls for broadeducational reform to meet the reali-ties of medical practice today.1,2 In arecent study, the Institute of Medicinenoted that “education will require thegreatest changes in the coming decade”and that education is “one of the pri-mary mechanisms for initiating a cul-tural shift toward an emphasis on theneeds of patients and populations anda focus on improving health, using thebest of science and the best of caring.”3This cultural shift is expressedthrough how we function as a profes-sion. Professions are “complex socialstructures derived from the guild system of specialized competences,intended to organize specialized andcomplex bodies of knowledge in sucha way as to address both individualand societal needs.”4 For physicians this encompasses a moral and ethicalframework and the knowledge, prac-tices, and behaviors that define pro-fessionals and as such the relationshipthey have to their patients, to their col-leagues, and to the broader society. Departments are the structurethrough which professional functionis organized and supported, whetherthat is clinical departments within hos -pitals, academic de partments within theFaculty of Medicine, or departmentsthat bridge the university and clinicalenvironments of the major teachinghospitals. At their core, these depart-ments share common responsibilitiessupporting professionalism: creden-tials, standards of practice, collegialrelations, continuing professional de -velopment, and quality improvement.Focus on the profession:Academic and clinicaldepartmentsA focus on professionalism will help the departments within theFaculty of Medicine and health authorities solve many of the chal -lenges inherent in our groundbreaking medical school expansion.Robert W. Armstrong, MD, PhD, FRCPCDr Armstrong is an associate professor andhead of the Department of Pediatrics in theFaculty of Medicine, UBC. He is also chiefof Pediatric Medicine for BC Children’s Hos-pital, Sunny Hill Health Centre for Children,and BC Women’s Hospital, and  head ofPaediatrics for St. Paul’s Hospital and Providence Health Care.390 BC MEDICAL JOURNAL VOL. 50 NO. 7, SEPTEMBER 2008 zations such as the BCMA and theCollege of Physicians and Surgeonsof BC, and the health authorities needa common vision of professionalismas they support physicians movingalong the continuum from medicaleducation to practice to retirement.There should be agreement that pro-fessionalism is central to the successof the Faculty of Medicine and thehealth care system, and that it is the tiethat binds.Engage clinical andacademic departmentsIn BC we have a large number of clin-ical departments beyond the universi-ty structures. They are involved in theorganization and delivery of servicesto a significant degree. Expansion ofthe medical school has thrust on thema whole new relationship that addscomplexity and has clearly been chal-lenging. Most of the focus in the earlyyears of medical school expansion and distribution has been on trying toaddress the impact of having moretrainees on delivery of clinical ser-vices, issues around the coordinationof academic appointments, challengesaround collaborative recruitment, andthe logistics of housing the education-al enterprise. There have been tensions betweensome of the academic departmentsand the hospital-based clinical depart-ments. This is to be expected given thedifferent mandates, the different gov-ernance structures, and the differentpressures being experienced. The clin-ical departments are challenged by thecomplexity of issues related to patientcare, access to resources such as operating room time, and appropriatecompensation for the teaching theyprovide. At the same time, UBC de -partments have suddenly faced a com-plex set of new challenges—how todeliver and ensure a high-quality cur-riculum using a distributed model.The UBC basic science departmentshave more specific challenges. Whilebasic science is integrated into muchof the curriculum through problem-based learning, a broad range of content and expertise needed by medical students remains outside thecurriculum.Perhaps it is time for departmentleadership across the clinical and aca-demic spectrum to think differentlyabout how they work together. By sup-porting students in medical school andphysicians in practice they can becomethe key drivers of professionalism. Ensure knowledgedevelopment andcontinuous learning Continuous learning is an individualresponsibility, but departments play akey role in creating and supporting theenvironment for continuous learningand quality improvement. It is impor-tant to think about how departmentscan support new knowledge develop-ment and the translation of this knowl-edge into practice. Integrating the med-ical school with the expertise in thecommunity can provide the opportuni-ty to develop innovative learning andcontinuous improvement strategies. Challenge government The BC government has created animportant public policy experiment.To take this experiment further, bothgovernment and health authoritiesneed to move from seeing physiciansas “practising together alone” to see-ing them as leaders and change agentsfor progress. They also need to recog-nize that departments have a centralrole to play. The recent agreementbetween the government and theBCMA is a positive example of mov-ing beyond compensation issues tosupporting physician engagement andleadership in the organization anddelivery of health care. Focus on the profession: Academic and clinical departmentsMedical students do not becomeprofessionals in the classroom. Theybecome professionals through men-tored engagement in all aspects of pro-fessional practice.5 As argued by Sternand Papadakis, “students need to seethat professionalism is articulatedthroughout the system in which theywork and learn… this means provid-ing an environment that is consistent-ly and clearly professional not only inmedical school but throughout theentire system of care.” 6So how effective are departmentsin supporting education and how canwe do an even better job? Four stra te -gies can move us in the right direction:• Make professionalism the tie thatbinds the Faculty of Medicine andthe health authorities.• Engage clinical and academic de -partments as key drivers of profes-sionalism.• Ensure knowledge development andcontinuous learning are recognizedas central to professionalism.• Challenge government to focus onsupporting professionalism. Make professionalism the tie that binds Whether we are educating students ordelivering the best quality of care, themessage from the literature is clear:We need to focus on building and sup-porting professionalism. During thelast 30 years the social contract withphysicians has changed as the healthcare system has changed. Physiciansare no longer “practising togetheralone”; instead they have moved awayfrom “professional values and train-ing based on an individualistic orien-tation” to function as members of“large, complex organizations. Littletraining is given to equip doctors forthis, and the difficulty that many con-sequently experience leads to stressand frustration.”7The Faculty of Medicine, organi-391VOL. 50 NO. 7, SEPTEMBER 2008 BC MEDICAL JOURNALSummaryThe expansion and distribution of theundergraduate and postgraduate medical programs, combined with theregionalization of health care and arenewed focus on the quality and safe-ty of health care, provides an unprece-dented opportunity for improvementand national and international lead -ership. Professionalism is central to this major public policy experiment.While education and clinical andresearch services may be delivered inmultidisciplinary settings, the devel-opment and support of professionalsis achieved through the discipline ofdepartments. We must support andstrengthen departments and encour-age stronger working relationshipsamong them.Competing interestsNone declared.References1. Cox M, Irby DM. A new series on med-ical education [editorial]. N Engl J Med2006;355:1375.2. Cooke M, Irby DM, Sullivan W, et al.American medical education 100 yearsafter the Flexner report. N Engl J Med2006;355:1339-1344.3. Institute of Medicine. Academic HealthCenters: Leading Change in the 21st Cen-tury. Washington, DC: National AcademyPress; 2003:116.4. Barondess JA. Medicine and profession-alism. Arch Intern Med 2003;163:145-149, 2003.5. Swick HM. Viewpoint: Professionalismand humanism beyond the academichealth center. Acad Med 2007;82:1022-1028.6. Stern D, Papadakis M. The developingphysician—Becoming a professional. NEngl J Med 2006;355:1794-1799.7. Edwards N, Kornacki MJ, Silversin J.Unhappy doctors: What are the causesand what can be done? BMJ 2002;324:835-838.Focus on the profession: Academic and clinical departmentsClinical faculty: Growing, changing, and respondingThere is something magical and inspiring about the eagerness of students to learn and their willingness to devote countless hours and much effort tomastering the skills required to be physicians. Students humble us with theirknowledge of current innovations, spur us on with their questions, and chal-lenge us to explain and transmit what it is we do when we practise the sci-ence and the art of medicine.  Understanding these students and what ittakes to transform their newly minted skills and ideas into astute practice isthe fundamental territory of clinical teaching, much of which is provided byclinical faculty.  Since the inception of the Faculty of Medicine at the University of BritishColumbia, there has been a deliberate inclusion of and reliance on clinicalfaculty members to translate and transform classroom learning into medicalpractice at the bedside and in the consultation room. The number of clinicalfaculty is breathtaking: at UBC there are more than 3500 clinical teachers,and at least 3000 of those are physicians. Clinical instructors are governed by an appointment offer/letter that grantsthem independent contractor status; they are not usually employees of theuniversity. Attracting, honoring, rewarding, and retaining the devoted clinicalfaculty members who provide professional academic activities in education,administration, and research in the faculty is a challenge. This challengebecomes difficult to meet when many of the desired “rewards,” such asincreased access to health authority and patient care resources, are notregulated by the Faculty of Medicine, and when personnel shortages, waittimes, and accountability measures have pushed many practitioners to theirlimit. This challenge is not unique to UBC: it is seen across the country anddiscussed at international meetings. However, many new initiatives aimed at recognizing clinical faculty havebeen put in place: examples include the creation of the Office of ClinicalFaculty Affairs; the development of a new contract for clinical faculty withrecognition for teaching at the undergraduate and postgraduate levels; thecreation of a Faculty of Medicine and BCMA venue for discussing generalmatters of joint interest; and the formation of a clinical teaching subcommit-tee.  These initiatives demonstrate some of what is being done to make theintersection of clinical faculty with the faculty easier and more enjoyable.While there are still many hills to climb in this process, substantial strideshave been made—strides that have improved matters for clinical faculty inall spheres of their work, teaching, research, and administration. The nature and pace of the mandated medical program expansion havepresented opportunities and challenges. Its success to date is in large partdue to the growing cohort of clinical faculty members across BC who blendteaching with patient care.  Working with clinical faculty to support eachcomponent will be important to the continued success of this initiative. —Katherine Paton, MD, FRCSCSpecial Advisor to the Dean on Clinical Faculty Affairs, Faculty of Medicine, UBCClinical Professor, Department of Ophthalmology and Visual Sciences, UBC392 BC MEDICAL JOURNAL VOL. 50 NO. 7, SEPTEMBER 2008 

Focus on the profession: academic and clinical departments

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Focus on the profession: academic and clinical departments

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