Academic culture takes root in Northern Ontario

Left to right are Thunder Bay Health Sciences Foundation board director Clint Harris with orthopedic surgeons Drs. Claude Cullinan, Tracy Wilson, Kurt Droll, David Hoffman, Jubin Payandeh, Peter Clark, and David Puskas, announcing a $2 million donation for a research program aimed at reducing amputation rates in northwestern Ontario.

Left to right are Thunder Bay Health Sciences Foundation board director Clint Harris with orthopedic surgeons Drs. Claude Cullinan, Tracy Wilson, Kurt Droll, David Hoffman, Jubin Payandeh, Peter Clark, and David Puskas, announcing a $2 million donation for a research program aimed at reducing amputation rates in northwestern Ontario.

$7 million a year in research and clinical innovation funding available to Northern Ontario physicians

The great expanse of Northern Ontario and the distances separating physicians in the region from the ivory towers of academia in Toronto and other urban centres used to be obstacles to research and professional development, but that’s not the case today.

The establishment of the Northern Ontario School of Medicine (NOSM), currently celebrating its 10th anniversary, has triggered a flow of research dollars through the Academic Health Sciences Centre Alternate Funding Plan (AFP) and brought together many of the 1,300 clinical faculty members across the region in Local Education Groups.

Traditional medical schools have departments and the faculty is mostly co-located, noted Dorothy Wright, executive director of the Northern Ontario Academic Medicine Association (NOAMA). The reality in Northern Ontario is quite different because NOSM learners spend so much of their time in the field and clinical faculty are spread out across the region in dozens of communities from the Quebec to the Manitoba borders. The challenge NOSM faced was to come up with a way to “build that deeper academic culture that goes beyond clinical teaching” in a distributed model of medical education.

Local Education Groups, of which there are currently 40 across Northern Ontario, were established to “focus on academic and scholarly activities, as well as faculty development,” said Wright. “They’re critical to the sustainability of NOSM and ensuing that our physicians get to take advantage of continuing education and stay abreast of new developments.”

NOAMA has allocated just over $6 million in research and clinical innovation grants to physicians in Northern Ontario since 2010. Of the $6 million, approximately $3 million has been awarded for research and $3 million for clinical innovation projects.

The Ministry of Health and Long-Term Care’s AFP provides an allotment of only $430,000 to NOAMA for innovation initiatives, “but we use some of the other funding we get from the AFP for our own Clinical Innovation Opportunities Fund,” said Wright.

“We get approximately $7 million a year from the AFP and in the earlier years we weren’t spending all of that money. We were building up funds because we knew we had to move forward with the Local Education Groups and wanted to take initiatives that were going to meet our mandate.

“One of our mandates is maintaining access to and improving the quality of health services available to people in Northern Ontario, so the physicians decided we would allocate funding for clinical innovation and any physicians with initiatives they felt were going to improve patient care could apply for these funds.

Improving clinical practice

“The physicians felt there are a lot of ways to improve a process or procedure… to make a difference in day-to-day clinical practice, so we set money aside for that. It provides the opportunity to look at issues that are relevant to what they’re seeing, and to improve health care in Northern Ontario.”

Each application is reviewed by a physician and a NOSM academic faculty member, scored and ranked.

Recipients to date include Dr. Janet McElhaney of the Advanced Medical Research Institute of Canada, the research arm of Sudbury’s Health Sciences North, who received just under $100,000 to research biomarkers and therapeutics to improve outcomes of influenza in the elderly.

“Normally, we limit amounts to $50,000 unless the project is deemed to have a significant impact on patient care in Northern Ontario , and we certainly felt given our aging population that Dr. McElhaney’s project fit that category.

Other recipients include Dr. Margaret Sweet of Thunder Bay, who developed an evidence-based toolkit for triaging TIA and non-disabling stroke, Dr. Lisa Habermehl of Kenora for a project on optimizing electronic medical record data entry and Dr. David Clarke of Parry Sound, for the development of a tool to assess patient-centred care in telemedicine encounters. A complete list of Clinical Innovation Opportunities Fund projects is available on NOAMA’s website.

Between 2013 and 2015, NOAMA received 133 applications for clinical innovation funding of which 66 were successful. Over the five-year period from 2010, 106 applications were received for AFP research funding, of which 46 were approved.

A significant amount of money over and above the $6 million goes directly to the Local Education Groups, said Wright.

“We’re continuing to support individual physicians but we’re also providing funds to groups of physicians, and it’s the groups that decide how they are going to use the funds.”

Last year, NOAMA allocated just under $5 million to Local Education Groups, which also receive clinical teaching payments directly from NOSM.

“They undertake various initiatives to support their members, including clinical innovation and research grants,” said Wright. “Sault Ste. Marie has a huge group with a program that works that way. The Sudbury anesthesia group also gives out grants, as does the Thunder Bay psychiatry group. Some give partial funding for physicians looking to apply for funding from NOAMA or the Canadian Institutes of Health Research.”

In some cases, Local Education Groups have hired research assistants to pull together information on funding opportunities and process applications.

The Thunder Bay orthopedics group, for example, has committed to spending $2.1 million on research to reduce the incidence of diabetes-related amputations in northwestern Ontario. Alarmed by the high rate of amputations in the region, the orthopedic surgeons hope to develop a multidisciplinary model to improve wound care management and access to care.

Local education groups

In addition to providing a framework for academic and scholarly pursuits, Local Education Groups are great for new physicians, said Wright.

“They are important for a number of reasons. If you’re a new physician coming into Northern Ontario, you have colleagues in the Local Education Group who can support you, not only in your academic endeavours, but also for all the other support and mentoring you need.”

To be eligible for AFP funding through NOAMA, physicians are required to have an appointment as NOSM faculty, which opens doors to many other opportunities for teaching and networking. For example, the medical school stages an annual Northern Constellations faculty development conference in March and a Northern Health Research Conference in June allowing physicians to connect with colleagues across the region.

Practising medicine in Northern Ontario is a far cry from what it used to be. With NOSM, NOAMA and Local Education Groups nurturing a culture of learning and research, physicians have every opportunity to stay sharp and connected to the wider world.

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