Annual Report Department of Medicine 2009-2010€¦ · Gastroenterology and Hepatology, General...

Annual Report

Department of Medicine

2009-2010

Submitted by Dr. David Eidelman

Compiled by Ms. Josée Cloutier

Department of Medicine Annual Report, 2009-2010

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Index

I. Overview of the Department ................................................................................................3

II. Organization of the Department ..........................................................................................4

III. Departmental Highlights ....................................................................................................5

IV. Divisional Highlights ..........................................................................................................7

V. Successes ....................................................................................................................... 18

VI. Postgraduate Training .................................................................................................... 19

VII. Undergraduate Education ............................................................................................. 20

VIII. Division of Experimental Medicine ............................................................................... 26

Appendix IV: Publications .................................................................................................... 34


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I. Overview of the Department

It is the mission of the Department of Medicine to be the leading department in its field in Canada

and a leader internationally. While our department enjoys the enormous advantage of its historic

roots and longstanding tradition of excellence, we struggle with the resource constraints that

characterize all Quebec based institutions. Nevertheless, we are in the middle of a major renewal

of our faculty and remain optimistic about our prospects to lead in the future.

The Department of Medicine is the largest department in the Faculty of Medicine, with 460 full

time faculty members as of this writing (February 2011) who are engaged full time in its research,

educational, administrative and clinical activities. The size of the Department reflects its broad

scope and major role in each of three major domains: research, teaching and clinical care.

Our faculty members fall into three categories. With regard to tenure-track and tenured faculty,

we currently have 103 PhD scientists who are full members of the Department. In addition, 82

physicians hold tenure track appointments and are classified as GFT-U by the Faculty of

Medicine in recognition of their dual role as full time members of the hospital staff as well as

academics with McGill salaries. The number of GFT-U physicians is in decline and the current

cohort is aging rapidly. Because of limits on the number of tenure-track positions available to the

Department and because of a world-wide phenomenon of declining interest in clinician-scientist

careers, it is becoming increasingly difficult to replace retiring faculty members. This poses a

strategic threat to the department‟s academic performance over the long term.

The largest component of our full time staff is represented by 278 individuals who had been

previously classified as GFT-H. Toward the end of the evaluation period, the University Senate

accepted a series of changes in classification of faculty members and these individuals were

recognized for the first time in our history as “full-time” members of the University Faculty. They

are now classified as Contract Academic Staff (CAS) with the ranks of Lecturer (Clinical),


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Assistant Professor (Clinical), Associate Professor (Clinical) and Professor (Clinical). This

change is far more than cosmetic. With the establishment of the CAS classification, the stage is

set to normalize the role of these individuals who are key to our educational and research

missions. This will help to cement stronger links between our Faculty members and their

University.

As in other medical schools, the Department of Medicine is active in the core activities of our

Faculty including teaching at the undergraduate, graduate and postgraduate medical levels. The

Department provides clinical care and clinical teaching in internal medicine and its associated

disciplines at the MUHC, the JGH and St. Mary‟s Hospital as well as at community hospitals

across the McGill RUIS. The Department runs one of McGill‟s larger graduate programs in the

Division of Experimental Medicine (in partnership with Pediatrics, Oncology and most recently

Family Medicine) and is a major contributor to the programs of the Department of Epidemiology,

Biostatistics and Occupational Health through a series of ongoing collaborations.

Members of the Department serve as administrative leaders of the Faculty, of the Research

Institute of the MUHC (RI MUHC) and are prominent in other important academic units including

the Lady Davis Institute (LDI). Most importantly, the Department of Medicine is very prominent in

the leading research programs of both the RI MUHC and the LDI, including those directed at

cardiovascular disease, respiratory disease, disorders of infection and immunity, endocrine and

metabolic diseases as well as cancer. In particular, the Department continues to play a leading

role in planning for the redevelopment of the RI MUHC at the Glen Yards and at the Montreal

General Hospital.

II. Organization of the Department

The Department includes 13 divisions reflecting the breadth and scope of internal medicine:

Allergy and Immunology, Cardiology, Dermatology, Endocrinology and Metabolism,


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Gastroenterology and Hepatology, General Internal Medicine, Geriatrics, Hematology, Infectious

Disease, Nephrology, Respiratory Medicine and Rheumatology. Medical Biochemistry, while not

currently listed as a full division, remains under the academic supervision of the Department of

Medicine. Two other divisions, Medical Oncology and Palliative Care, have their home in the

Department of Oncology with cross-appointments to Medicine. Their activities are encompassed

by the Oncology Annual Report.

In addition to joint activities with Oncology, the Department of Medicine has partnerships with

other groups including the MGH Division of Neurology (with Neurology and Neurosurgery), the

McGill AIDS Centre (with Microbiology and Immunology), the McGill Bone Centre (with Dentistry)

and the McGill Nutrition and Food Science Centre (Agriculture and Environmental Sciences).

The Department boasts several leading units of importance to the McGill community including the

Meakins-Christie Laboratories and the McGill Centre for Tropical Medicine.

These divisions report to the Chair via the Executive Committee of the Department of Medicine.

Presided by the Chair, the Executive Committee includes Dr. Michael Bonnycastle (Physician-in-

Chief, St. Mary‟s Hospital), Dr. James Martin (Vice-Chair, Faculty Affairs), Dr. Ernesto Schiffrin

(Vice-Chair, Research and Physician-in-Chief, Jewish General Hospital) and Dr. Linda Snell

(Vice-Chair, Education). In addition to proposing departmental policies, this committee oversees

recruitment and attempts to ensure proper coordination of programming among the different

elements of the Department. This is particularly important for our educational mission, which is

organized on a departmental rather than a hospital basis.

III. Departmental Highlights

This last 19 months saw the reappointment of the Dr. David Eidelman as Chair and as Physician-

in-Chief of the McGill University Health Centre. In addition, Dr. Ernesto Schiffrin was reappointed


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as Physician-in-Chief of the Jewish General Hospital. Although the leadership has remained

stable, the department continues to evolve in important ways.

Arguably the most important changes relate to the way in which clinical care is being delivered to

inpatients and therefore, the way in which we are training residents in the Department. Following

successful preliminary experiments at the MUHC, the entire Department has moved to smaller

clinical teaching units (CTUs), similar in size to those in sister universities. Although this has put

pressure on our hospitals to find ways to care for those patients no longer admitted on the CTUs,

it has greatly improved the learning environment. Another major change has been to eliminate 24

hour call on CTUs, adopting a “night float” system which is similar to that employed in other

departments including Pediatrics as well as in many institutions in the US. Rather than asking

residents to remain overnight, a second team takes responsibility for evenings and nights over a

two week period. This night float team covers all of the medical services in the hospital at night,

ensuring that the daytime team is present and fully functional throughout the week. In parallel, we

have stopped asking medical students to stay overnight. McGill is the first Department of

Medicine in Canada to adopt this type of night float system on a wide basis and our training

program director, Dr. Thomas Maniatis has been consulted by leading programs across the

country for advice on how this can be adopted elsewhere. From both learning and clinical points

of view, this new system has led to major improvements. Residents and students report much

improved working conditions, find that they learn better and are able to handle a much higher rate

of throughput. Indeed, because residents are no longer “post-call”, the number of patients

admitted per active bed has increased substantially. Residents and students are getting better

exposure to cases and patients are getting more rapid access to care.

From a research perspective, the Department continues to perform well but faces two major

challenges. Firstly, from a recruitment perspective the Department finds itself with limited access

to tenure slots, in part because of robust hiring in the last few years. Nevertheless, research

success is critically dependent on the ability to recruit new active researchers and ways will need


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to be found to continue to do so. In this regard, we hope to be able to take advantage of

Quebec‟s new remunération recherche system, which allows young clinician scientists who win

peer-review salary awards from the FRSQ or from CIHR to apply for research funding from the

Health Ministry. This remarkable program may allow Quebec universities to compete

successfully for clinician scientists against other provinces, which offer very substantial salaries

and protected time to new recruits.

The other major challenge to our research performance relates to the falling success rate in the

open competition of the CIHR. Although this is not unique to our Department, given our research

intensive nature, it has a profound effect on our operations. Total research funding for the

Department in 2009-2010 was $66.1 million, of which $50.8 million was peer reviewed funding

recognized by the FRSQ (including grants, fellowships, bursaries and salary awards). This is a

substantial decline from previous years, largely due to the transfer a large number of grants from

the Department to the Goodman Cancer Centre, as the Molecular Oncology Group was

consolidated there. The remaining funding is administered by the RI MUHC and the Lady Davis

Institute and constitutes a baseline for future comparisons. The falling research funding is of

great concern to the department, which will work with the hospital research centres to seek new

opportunities for large scale grant funding.

Notwithstanding funding difficulties, the Department remains prolific. No less than 269 of our

members published in peer reviewed journals in 2009 for a total of 1028 papers. There has been

little change in this since 2006.

IV. Divisional Highlights

Allergy and Immunology

The Division is increasingly integrated across our teaching hospitals. This has led to the

development of standardized protocols for allergy testing and to successfully meeting the


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challenge of the H1N1 pandemic, providing specific expertise in handling the vaccination of egg

allergic individuals. The Division welcomed Dr. Emil Nashi, who recently completed his PhD at

Columbia, as a new recruit. Dr. Phil Gold was inducted into the Canadian Medical Hall of Fame.

Medical Biochemistry

This discipline continues to be organized differently at each hospital, in part related to the failure

of the MUHC to develop a laboratory medicine program. Nevertheless, two new recruits were

welcomed into the Division. Dr. Fabienne Parente, who will be based at the Montreal Children‟s,

has specific expertise in the development and application of advanced genetic testing methods.

Dr. Alexis Baas has a background in lipidology and will be pursuing further training in this area

over the next year.

Cardiology

Dr. Jacques Genest reached the end of his second term as McGill Director of Cardiology, having

achieved enormous progress in leading the renewal of this important division over the course of a

decade. Dr. Genest has accepted a position in the management team of the RI MUHC, where he

will direct the Centre for Innovative Medicine, a key component of the redeveloped MUHC

Research Institute at the Glen. An international search is underway to identify Dr. Genest‟s

successor. Dr. Nadia Giannetti has accepted to be interim director of Cardiology at the MUHC.

Dr. John Burgess will be interim McGill Director of Cardiology.

Dr. Luc Bilodeau, an exciting and innovative interventional cardiologist, joined the Division as an

Associate Professor and as Director of the Catheterization Lab at the MUHC. Dr. Sonny

Dandona, another interventional cardiologist, joined the MUHC after completing a fellowship at

the Ottawa Heart Institute. Dr. George Thanassoulis, a McGill trained clinical epidemiologist, was

recruited as an Assistant Professor and clinician scientist to the MUHC after completing a

fellowship at the National Heart Lung and Blood Institute Framingham Heart Study. Dr. Allan


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Sniderman was made a Fellow of the Royal Society and Dr. Vidal Essebag received a CIHR

Clinician-Scientist Phase 2 award.

Under the joint leadership of Dr. Regina Husa and Dr. Mathieu Walker, the cardiology training

program continues to thrive with large numbers of postgraduate trainees. In addition, the Division

has been able to welcome clinical fellows from other centers undertaking training after their

residencies in echocardiography, interventional cardiology, advanced heart failure,

electrophysiology, congenital heart disease and preventive cardiology/lipidology.

Critical Care

The Division of Critical Care continues to be focused on fulfilling its clinical mandate. The

demand for critical care resources is ever increasing at each of the JGH, MGH and RVH.

Nevertheless, the Division continues to be very active in teaching at the residency level.

Members of the Division remain very successful in research including Dr. Maya Saleh who was

awarded a prestigious Canadian Society for Immunology New Investigator Award in 2010. Dr.

Arnold Kristof successfully renewed his Canada Research Chair in Pulmonary Critical Care.

Dermatology

The Division of Dermatology is undergoing major renewal. Dr. Denis Sasseville has announced

his imminent departure as Director of the Division and a search is underway for a successor. A

major challenge to the Division is space, which is very limited at each of the major teaching

institutions. Moreover, in the MUHC‟s strategic planning exercise (CAPS), dermatology was

deemed as “low performer”. This has had the effect of forcing the division to reexamine its role in

the MUHC and at McGill. The division has asked that a plan to focus Dermatology‟s activities on

a single site (the Montreal General Hospital), which was previously proposed in 2003, be

reactivated. It is hoped that this will help to create a critical mass of faculty members and make

the best possible use of resources. In addition, under the leadership of Dr. Linda Moreau, the

training program has been rejuvenated and is much more firmly established than in recent years.


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Reflecting the strength of the division‟s training program, Dr. Denis Sasseville was named the

winner of the Canadian Dermatology Society‟s Teacher of the Year Award for 2010.

Dr. Audrey Lovett was successfully recruited to the Montreal Children‟s and Royal Victoria

Hospitals. Dr. Roy Forsey retired after a remarkable 60 years of dedicated service at the

Montreal General Hospital in late 2009. Dr. David Gratton also left the division in 2010.

Endocrinology and Metabolism

The Division of Endocrinology and Metabolism continues its long tradition of leadership in

research and clinical care. Among many achievements was the awarding of no less than $7.1

million for research infrastructure in the CFI 6 competition. The Division has also established the

largest insulin pump treatment program in Quebec, providing training in this emerging field not

only for McGill but also for the Université de Sherbrooke.

The Division welcomed Dr. Nadia Sabbah, an expert in ultrasound guided diagnosis of thyroid

disorders. Dr. Sabbah will provide a much needed boost to the training program. In addition, Dr.

Wen Hu was recruited as a new faculty member with a research interest in the way in which the

central nervous system control of appetite contributes to obesity. In regard to departures, Dr.

Fernando Congote retired after a distinguished career as an investigator.

Despite many successes, the Division suffered a severe blow in the last 19 months with the loss

of Dr. Patrick Doran, Director of the Endocrinology training program, whose sudden and tragic

death deprived the Department of one of its best teachers.

A key challenge for this Division relates to the coming redevelopment of the MUHC, the locus of

most of the Division‟s research programs. At this writing, the plan for the eventual location of the

Division and its laboratories still remains unclear as it was in the last annual report. Although


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space at the JGH has been renewed, the long-term outcome of the MUHC component is

unknown.

Gastroenterology

Dr. Alain Bitton was appointed director of the Division, succeeding Dr. Alan Barkun. Widely

admired among his peers as a leader in the field of inflammatory bowel disease, Dr. Bitton brings

strengths in administration, teaching and clinical research to his position. In the short time since

he has been leader, the Division has been able to develop a new endoscopy centre at the

Montreal General site, create and implement a McGill combined Adult and Pediatric inflammatory

bowel disease database, and inaugurate a new quality assurance pilot project at the MUHC.

The Division is very clinically active, providing no less than 54,000 endoscopic procedures per

year across the McGill teaching hospital network. While this puts enormous pressure on faculty

members to address clinical demand, it also provides a strong base for clinical training of

residents and fellows. The Division has one of the busiest training programs for advanced

endoscopic techniques in Canada. Although the newly renovated space at the MGH has helped

to accommodate these volumes, the spaces at the RVH and JGH are inadequate. In addition,

the Division faces growing demand for other specialized services including the hepatology and

liver transplant program (based at the RVH) and the esophageal program (in collaboration with

surgery) at the MGH.

Geriatrics

The Division continues to be highly active in education, as Geriatrics has become a standard

rotation for all medical students. Similarly, the Division is responsible for supervising internal

medicine and other residents who undertake rotations in Geriatrics. Although the educational

experiences continue to be excellent, a key challenge is that the number of geriatricians is

insufficient to meet the demand. This shortage affects both clinical activity and teaching and is

expected to lead to changes in the models used for geriatric care at McGill in the future. In


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particular, it will be necessary to move away from an inpatient model to one built around

community resources.

The past year saw the recruitment of Dr. Melanie Mondou to the Division, based at the MGH site.

Dr. Mondou will focus her academic work on medical education and is expected to complete a

MEd in the coming year. Dr. Catherine Brodeur joined the Division brining expertise in cognitive

disorders. Although based at the MUHC, Dr. Brodeur will participate in memory clinics at both the

JGH and the Douglas. Among numerous distinctions, the appointment of Dr. Nadine Larente as

Chair of the Royal College examination committee in Geriatrics is particularly noteworthy. An

important initiative by the Division of Geriatrics is the development of a program of an Age

Friendly Hospital Environment as part of the MUHC redevelopment project. Another original

initiative is the McGill Geriatric Oncology Interest Group, based at the JGH in collaboration with

Oncology.

Hematology

The Division continues to be successful in its major clinical and educational activities including

the stem cell transplant program (RVH, JGH), the sickle cell anemia program (RVH) as well as

programs in leukemia, lymphoma and myeloma across sites.

A major loss for the Division was the departure of Dr. Jacques Galipeau, who moved to Emory for

family reasons. In addition, Dr. Gwen Spurll is on progressive retirement because of health

problems, creating a major gap in laboratory supervision, particularly in relation to transplant lab

services. A major goal for the division over the coming months will be to address these strategic

losses.

Other members of the Division continued to be successful in their research. In particular, recent

recruit Dr. Sarit Assouline was successful in obtaining a FRSQ Chercheur-boursier clinicien

award to support her clinical research program in malignant hematology. Dr. Chantal Seguin


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received substantial operating funds from the Leukemia and Lymphoma Societies of the United

States to support her pioneering work on avascular necrosis of bone. Dr. Jean-Pierre Routy

continues his leading work in the field of immunodeficiency and the development of innovative

vaccines for HIV. Other recent recruits to the Division have also been productive. Dr. Michael

Sebag has developed a strong program in multiple myeloma research and Dr. John Storring has

developed an active clinical research program in myelodysplasia and acute leukemia.

Clinically, Dr. Patricia Pelletier has begun to take on a leading role in transfusion medicine at the

MUHC, providing a service for the entire McGill network. On the educational front, the Division

has maintained a successful training program that continues to produce excellent hematologists,

many of whom have been recruited to academic positions at McGill and other universities.

Infectious Diseases

The Division continues to be a leading clinical, research and teaching program across the McGill

hospitals. Among the highlights of the last 19 months has been an external review of MUHC HIV

services which recommended their consolidation. This was formally approved in late 2010, with

the expected announcement of a single leader in early 2011. As recommended by the external

review, HIV services will evolve into a Chronic Viral Diseases Clinic based at the Montreal Chest

Institute under Infectious Diseases and a Primary Immunodeficiency Program, based at the

Montreal General site under Allergy and Clinical Immunology.

Given the importance of infectious diseases in the modern hospital environment, the Division has

been very active in responding to emerging needs. At all sites, the H1N1 pandemic presented

enormous challenges, including the development of novel rapid diagnosis methods and

innovative educational materials. A new antibiotic stewardship program is being established at

the MUHC and the JGH is working on a “Multicultural Communication” project to address the

needs of the culturally diverse population cared for there.


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New recruits to the Division include Dr. Mathew Oughton, based at the JGH, who is working on

the molecular analysis of Clostridium difficile and its application to reverse vaccinology. Dr.

Donald Vinh was recruited from the National Institutes of Health to join the primary

immunodeficiency program led by Dr. Chris Tsoukas.

General Internal Medicine

The Division continues its tradition of playing a leading role in clinical care, education, research

and administration within the Department. In particular, the Division‟s clinical and educational

activities continue to do very well. The training program for General Internal Medicine, led by Dr.

Vicky Tagalakis attracts numerous excellent trainees. The Division continues to help lead the

effort in medical education research at McGill, particularly through the active participation of Drs.

Peter McLeod, Linda Snell and Jeff Wiseman in the McGill Centre for Medical Education. The

Division also continues to excel in research with many of the department„s most productive

clinical scientists including Dr. Susan Kahn, Dr. Ernesto Schiffrin and Dr. Louise Pilote. Dr. Stella

Daskalopoulou received the New Investigator Award from the Canadian Society for Internal

Medicine and Dr. Ernesto Schiffrin received the Bjorn Folkow Award of the European Society of

Hypertension.

Many were honored for their educational contributions. Among those honored, both Drs. Patricia

Zanelli and Dr. Jeff Wiseman were named to the Faculty Honor List for Educational Excellence.

Dr. Tom Maniatis received the CAME Certificate of Merit from the Canadian Association for

Medical Education. Dr. Linda Snell received the Association of Faculties of Medicine of Canada

Award for her exemplary contributions to faculty development. Dr. Laurence Green received the

Osler Award, presented at Convocation, as the best teacher in the medical school as chosen by

the graduating MD,CM class.


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Meakins-Christie Laboratories

The Labs continue to be very successful despite a challenging grant environment. Two new

recruits arrived, Dr. Carolyn Baglole and Dr. Maziar Divangahi. Both have already established

independent research programs. A number of international symposia were held under the

auspices of the Meakins-Christie Labs and a distinguished alumna, Prof. Marina Saetta of the

University of Padua, was appointed an Associate Member of the Laboratories. As a measure of

the international reach of the Labs, this year saw alumni of the Meakins-Christie Labs serving as

presidents of both major international respiratory medicine societies, the American Thoracic

Society and the European Respiratory Society.

Nephrology

The Division has continued its tradition of excellence in teaching and clinical care. The Division is

highly active in undergraduate and medical physiology teaching, as well as in all aspects of

residency training.

After an extensive search, Dr. Istvan Mucsi has been recruited as an Associate Professor to

assist with the kidney transplant service. Originally from Hungary, Dr. Mucsi was formerly on the

faculty of Semmelweis University. Another recent recruit is Dr. Ahsan Alam, who returns from

advanced training in clinical nephrology research at Tufts.

The future of hemodialysis continues to be a major strategic challenge. The redevelopment plan

for the MUHC proposes a major decrease in the number of dialysis chairs without a clear plan as

to where patients will be accommodated. Attempts to move some dialysis to community-based

centers have so far been unsuccessful.

Respiratory Medicine

During the past 19 months, Dr. Richard Menzies was reappointed as Director of the Division after

a formal external review. That review confirmed that the Division is among the best in Canada,


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highlighting its leadership in research and the high quality of the respiratory medicine training

program. The strength of the Division at the MUHC was further confirmed by a very high rating

from the strategic planning process (CAPS), where the Division finished with top marks in almost

every category.

In addition to continuing excellence in the traditional areas of strength such as tuberculosis,

chronic obstructive lung disease and asthma, the Division has undertaken to improve the quality

of care related to lung cancer, particularly at the MUHC where this has not been a priority in the

past. A novel rapid access clinic has been established at the Montreal Chest, supported by the

Lung Cancer Navigation Centre, with the aim of improving access to care. Dr. Anne Gonzalez

has been spearheading a new program in interventional bronchoscopy and has taken the

leadership in assuring that clinicians in the division are up to date in the use of modern imaging

techniques.

Rheumatology

The Division of Rheumatology continues to thrive across sites in each of the domains of clinical

care, education and research. Among the highlights of the past year were the establishment of

the Canadian Consortium of Rheumatology Research Cohorts by Dr. Murray Baron, the

appointment of Dr. Henri Ménard to the International Expert Committee charged by the American

College of Rheumatology/European League Against Rheumatism for the establishment of

diagnostic criteria for rheumatoid arthritis and the development of new premises for rheumatology

at the JGH. Dr. Sasha Bernatsky received the Young Investigator Award of the Canadian

Rheumatology Association.

Several new faculty members were recruited including Dr. Sabrina Fallavolita, who joined the

JGH as a clinician teacher; Dr. Geneviève Gyger who is a research fellow at the JGH and will

soon join the faculty as a member of the McGill Scleroderma program and Dr. Ines Colmegna

who joined the MUHC as a clinician scientist after completing training in Argentina at Louisiana


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State University and Emory. Dr. Colmegna was successful in obtaining a Chercheur-boursier

clinicien award from the FRSQ and will be focusing on translational research in rheumatoid

arthritis.


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V. Successes

Salary Awards – awarded Spring 2010

CIHR Clinician Scientist Phase II

Dr. Vidal Essebag CIHR New Investigator

Dr. Nitika Pai

Dr. David Stellwagen CIHR Institute of Genetics Maud Menten Principal Investigator Award

Dr. Maya Saleh CIHR Institute of Genetics Clinical Investigatorship Award (renewal)

Dr. Brent Richards

FRSQ Chercheurs Nationaux

Dr. Marcel Behr FRSQ Chercheur Boursier – Junior 2

Dr. Sasha Bernatsky

Dr. Momar Ndao

Dr. Peter Siegel

Dr. Maia Kokoeva

Dr. Christian Rocheleau

FRSQ Chercheur Boursier Clinicien – Junior 2

Dr. Ronald Postuma FRSQ Chercheur Boursier Clinicien – Junior 1

Dr. Sarit Assouline

Dr. Ines Colmegna

Dr. Vidal Essebag


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VI. Postgraduate Training

By Dr. Thomas Maniatis

The core training program is led by Dr. Thomas Maniatis, assisted by Dr. Patrizia Zanelli at the

MGH and Dr. Michelle Elizov at the JGH.

The McGill Internal Medicine Residency Training Program has undergone an Internal Review in

early 2010, which solicited detailed feedback from Residents across all sites. This report

identified a number of areas that the Training Program had already been working on, and

continued to do so throughout the remainder of 2010. Specific changes that were implemented

this year include a complete transition to a Program-wide Academic Half-Day, which is

teleconferenced across all sites to minimize the impact of travel time on Residents and clinical

services. Another major change was to transition all 3 core teaching sites to a "night float" system

for overnight coverage in medicine. This involved significant efforts across all 3 teaching hospitals

to ensure a safe and effective transition. Given the importance and magnitude of this change, it

attracted local, provincial, and national media attention. Feedback has been very positive from

both Faculty and Residents. The Training Program also implemented a ratio of patients : resident

that has been identified as ideal from a service : education perspective, and informed all core

teaching sites of this standard. Ongoing changes continue to occur at various teaching sites

based on continued feedback throughout the year.

The Training Program continues to expand its use of Simulation-based training. In addition to

previous initiatives, the Training Program has developed and added simulation-based training in

advocacy, crisis-resource management, and expanded the annual OSCE to R1s. This has

required an ongoing and significant commitment from Faculty across all teaching sites to help

supervise these sessions at the Simulation Centre. Feedback from these sessions has been

overwhelmingly positive from Faculty and Residents.


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During the CaRMS match for positions starting July 1, 2010, the Training Program attracted

trainees from all across Canada and outside of North America as well. All of the allotted entry-

level positions for Internal Medicine at McGill were filled following the second iteration of CaRMS.

VII. Undergraduate Education

By Dr. Jeff Wiseman

The Department is heavily engaged in the teaching and training of medical students. Dr. Jeff

Wiseman is responsible for the coordination and leadership of undergraduate education within

the Department.

Internal Medicine Clerkship

Over the last year there have been a lot of changes in response to our Accreditors‟ demand to

establish, standardize, track and react to new McGill-wide clerkship indicators. We have created

or updated all of the common McGill/MUHC-wide items below.

McGill Policies for Internal Medicine clerkships

Workload: 24 hour overnight call was abolished for Medicine Clerks as of this academic

year starting in August 2010, and the number of hours and weekends that students can

work have been defined and brought in line with residents‟ work hour changes.

Mistreatment: This was made coherent with the McGill University and the new Faculty of

Medicine definitions of student mistreatment and widely publicized.

Minimal clinical exposures: This year we eliminated certain clinical exposures that

students get during other parts of the clerkship.

Core seminars: These interactive seminars have common topics and standardized

learning objectives to be given to all clinical clerks in internal medicine at all training sites.


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Clerkship clinical rotations: All internal medicine clerks across all sites get 4 weeks on a

GIM inpatient ward, 2 weeks on a medicine sub-specialty ward and 2 weeks in an

Emergency GIM Consultation setting.

Summarizing evaluation comments from multiple observers: These are guidelines that all

internal medicine clerkship site directors use to create a fair and representative summary

of evaluation comments and marks from multiple observers.

McGill standardized job descriptions for clerkship administrators

Overall clerkship Director and Secretary

Site Clerkship Director and Secretary

Changes in UGME Internal Medicine Committee Membership

We have welcomed Dr. Peter Ghali as RVH Site Clerkship Director since September

2010, replacing Dr. Jeff Wiseman. Dr. Wiseman remains on as overall Internal Medicine

Clerkship Director.

Dr. Devi Banerjee has informed me that she has agreed to take on the MGH Site

Clerkship Director job from Dr. Suzanne Morin in July 2011. Dr. Morin has decided to

devote all of her time to research and clinical work and we will miss her.

McGill common clerkship orientation materials for clerks, residents and attending physicians:

Plasticized cards summarizing new clerkship policies.

A new McGill/MUHC common Internal Medicine clerkship orientation package.

A new McGill/MUHC common Internal Medicine clerkship website:

https://www.mcgill.ca/deptmedicine/education/undergraduate-education

https://www.mcgill.ca/deptmedicine/education/undergraduate-education


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Clerkship Quality Indicators

We now track and react to clerkship quality indicators in one45, the McGill Rotation Evaluation

System. A detailed report of these indicators is available upon request. Below is a summary of

the last 6 months:

Over the last 6 months:

100% of clerks have seen their minimal clinical exposures.

95% of clerks received documented feedback.

95% of clerks attended their core seminars

An average of 6.3% of the clerks reported Mistreatment and 13.6% reported Workload

violations.

The Gatineau Integrated Clerkship

This longitudinal clerkship started in August 2010 with 9 student volunteers who do their entire

clerkship in the Gatineau in French. This is described in the following link:

http://www.medicine.mcgill.ca/ugme/curriculum/PDF/D%C3%A9pliant_Externat_int%C3%A9gr%

C3%A9_VFsept2010.pdf

The Gatineau offers the same Core Lectures and Minimal Clinical Exposures and uses the same

learning objectives and evaluation system as the clerkship at the MUHC. The main differences

are that:

Clerks do both their surgery and internal medicine clerkships simultaneously spread out

over a 16 week block rather than doing only surgery or only medicine in 2 separate 8

week blocks.

The language of the clerkship is French.

The setting of the clerkship is small community/semi-rural.

Exposure to emergency room work, family medicine clinics and ward work continues

throughout the entire year.

http://www.medicine.mcgill.ca/ugme/curriculum/PDF/D%C3%A9pliant_Externat_int%C3%A9gr%C3%A9_VFsept2010.pdfhttp://www.medicine.mcgill.ca/ugme/curriculum/PDF/D%C3%A9pliant_Externat_int%C3%A9gr%C3%A9_VFsept2010.pdf


23

Students‟ reactions to this clerkship experience are mixed. Some students feel that the internal

medicine components of the clerkship are not as busy and rigorous as the internal medicine

clerkship experience of their classmates at the MUHC while others feel that it has been a superb

learning experience.

Dr. Wiseman will visit the Gatineau to meet the Directors and clerks tentatively for April 1, 2011.

For the coming year it will be important to arrange for an interactive videoconferencing

mechanism so that the Gatineau Internal Medicine Clerkship Director can participate online in all

of our monthly UGME Internal Medicine Committee meetings.

Introduction to Internal Medicine

This pre-clerkship course remains essentially unchanged from the previous year. It is still a

challenge to recruit tutors for these groups who are able and willing to spend the considerable

amount of time necessary to teach them. A slow but steady trickle of new young attending

physicians at the MUHC has greatly helped. Most of the tutors who teach in this course, however,

are seasoned clinicians who are or will soon be of retirement age. There has been a significant

drop off in seasoned teachers who can give students their clinical reasoning and other seminars.

This problem could be readily addressed by developing an online videoconferencing/chat system

across all of McGill‟s clerkship sites. This way a gifted teacher at one site could have his/her

session made available across all sites simultaneously.

Professional Skills

For the last 2 years this physical exam course, run by Dr. David Shannon, now features an OSCE

using standardized patients at the Simulation Center. The course remains highly rated by the

students.


24

Future Challenges and Opportunities

The following areas are critical to future medical student clinical education in internal medicine

(and in other specialties of medicine as well) at McGill. Each of the components described below

depend upon and interact with each other:

Education as a Profession at McGill

The tasks of teaching, mentoring and supervising medical students have become more complex

and compete with increasing clinical, administrative and research demands on Faculty members‟

time. For many of our faculty members, education is not a priority (or they are unable to make it a

priority) and not seen as a profession and a career path in its own right, with equal weight as the

career paths of research and administration. The solution to this problem is to define, defend,

fund and enforce clinical teaching of medical students as a career path as desirable and valued

as those of research and clinical care.

Faculty Development

The majority of Faculty who teach medical students has no formal training as educators. There is

no standardized cyclic teaching skills program at McGill for Faculty. There are several very

successful exemplars of such programs (at Stanford and University of Toronto among many) and

this is an important growth area for McGill.

Distributed learning

Running a clerkship dispersed across multiple sites has been extremely challenging. The opening

of the new Glen Site, further development of our Reseau and movements of health care

professionals and learners between all of these and other sites even in the same day will magnify

further the difficulties we will face in communicating with and learning from each other.

There are many exemplars of highly interactive hybrid online teaching programs in other

disciplines (Management & Education, to name but a few). The IT resources and administrative

support available to McGill Medical educators is poorly developed and organized for day-to-day


25

learning activities. Most clinician-educators do not know how to run interactive hybrid online

sessions. Videoconferencing sessions are frequently hijacked by technological problems that

could have been prevented by a dedicated IT team.

Distributed learning via a hybrid of real and virtual learning communities is a critical education

wave of the future and a critically important area for the MUHC and McGill to develop. See the

following description of the Northern Ontario Medical School‟s virtual Learning Environment:

http://www.nosm.ca/about_us/general_image.aspx?id=104

Of course there are difficulties with starting and running such a program – but can we at McGill

afford to wait much longer before developing our own? Many McGill Faculties other than

Medicine have considerable expertise in creating these environments:

http://www.mcgill.ca/atlas-lab/

Our own Dean is well known for his work and interest in the use of Information Technology in

medical education.

We need a McGill Medical Virtual Learning Environment Team that combines the expertise of

clinician-educators, educational scholars, Information Technologists, and MUHC/McGill financial

administrators to make this possible. Members of this team should visit and appraise other

exemplars of VLE‟s and bring back what they have learned to help inform the activities of this

team.

Educational Scholarship as a Profession at McGill

Education is a “basic science” of medicine for which the “laboratory” is invisible – it is embedded

in our minds and social interactions in complex, messy, fast-changing clinical environments away

from the McIntyre and other research buildings.

How doctors think and learn, what motivates them, how do doctors‟ emotions impact on their

practice, how they keep their skills up to date, how they teach patients and how doctors are

http://www.nosm.ca/about_us/general_image.aspx?id=104http://www.mcgill.ca/atlas-lab/


26

evaluated and how can all of this be done online are critical research questions to be addressed

in the future.

At McGill, harried clinician-educational administrators often do the design and evaluation of new

learning activities as piecemeal homegrown garage projects. They may or may not be able to find

experienced educational research mentors to help them.

Every MUHC clinical site or conglomeration of sites ought to have a designated Educational

Scholar, someone with an advanced degree in Education or Medical Education whose role would

be to function as a resource person to advise and support clinicians, Program Directors and

administrators in the design, implementation and publication of the MUHC‟s natural learning

experiments.

VIII. Division of Experimental Medicine

by Dr. Hugh Bennett

The Division of Experimental Medicine, providing Graduate Studies in the Department of

Medicine, is completing its seventh year under the directorship of Dr. Hugh Bennett, with

headquarters at Lady Meredith House.

Present State of the Division

(i) Experimental Medicine Graduate Student Society (EMGSS): The year was a productive one,

with continuing leadership and activity from EMGSS whose stated purpose is “to promote and

defend the rights, welfare and interests of the more than 200 graduate students in Experimental

Medicine and to enhance the educational, social and cultural atmosphere in which they evolve”.

The 2009-2010 EMGSS Council was thus composed of 10 dedicated and enthusiastic graduate

students whose goals were (a) to provide support to the graduate student body, (b) to speak for


27

their constituents to the faculty and to the larger McGill community, and, most importantly, (c) to

encourage students to get to know one another.

One of the most significant achievements of the EMGSS in the past year was the organization of

the landmark “10th Annual McGill Biomedical Graduate Conference” (AMBGC) at McGill. The

symposium offers graduate students, as well as outstanding undergraduate students, engaged in

biomedical research the opportunity to present and discuss their work in an encouraging and

stimulating environment. A major focus of this year‟s conference was to bring together students

from all four Montréal-based research universities: Université de Montréal, Université du Québec

à Montréal, Concordia University and McGill University. While being open to all biomedical fields,

this year‟s symposium focused on “Advances in Basic Cancer Research.” Approximately 250

people attended this year‟s conference, representing undergraduate and graduate students from

the Montréal area, post-doctoral fellows, and university faculty and community members. There

were 8 oral presentations and 102 poster presentations from students engaged in biomedical

research in Montreal. Dr. Javier Espinosa, Director and Principal Investigator, Terry Fox

Laboratory and British Columbia Cancer Agency, was the keynote speaker at this conference.

For the first time, the EMGSS was awarded a CIHR, “Meetings, Planning and Dissemination

Grant.” The funds provided by this grant, in combination with funding received from McGill

associations and private corporations, were used to ensure the continued success of this event.

In addition to the AMBGC, the EMGSS hosted several other social events, including the first

ever, “Social Soccer Tournament,” which saw 50 participants, both students and faculty, come

and battle it out for first place on the field outside of Thomson House in September. Continuing

with the active theme established by this event, the EMGSS also offered a free yoga class and

swing dance lessons, which involved the participation of all the graduate departments within the


28

Faculty of Medicine. A detailed summary report of the EMGSS‟ activities is available upon

request.

(ii) Let‟s Talk Science (LTS) Program: The LTS program, brought to McGill on the initiative of

the EMGSS in 1998 has continued to be very successful. The McGill chapter of the LTS has its

own web site ( (http://www.medicine.mcgill.ca/EXPMED/LTSM/ ) which continues to be

maintained by one of the program co-coordinators.

The LTS program, aimed at demystifying science and promoting it as an enjoyable career for

elementary and high school students has grown further in the past year. A detailed summary of

the activities is available upon request.

Graduate Students

(i) Numbers: There were 227 students registered in Experimental Medicine as of the Fall 2010

semester. Of these, one hundred and thirteen were newly admitted to our programs, in the

following proportions (42 Ph.D., 57 M.Sc., and 14 Diploma in Clinical Research).

Sixty-four students graduated from our programs in the 2010 calendar year, in the following

proportions (15 Ph.D., 39 M.Sc., (including Bioethics Option) and 10 Diploma). With an

anticipated enrollment of more than 100 students in the upcoming calendar year, our numbers

are expected to increase. Although the push at the University has been to increase enrolment by

25%, we have found this difficult to achieve in that we continuously strive to accept only those

students with a higher than average academic record and have refused to lower our admission

standards in order to simply meet recruitment targets.

(ii) Years in the program: The average number of years in the program has increased to slightly

above the 6 year mark for Ph.D.‟s; this, however, is due to a few students who exceed time

http://www.medicine.mcgill.ca/EXPMED/LTSM/


29

limitation and thus skewed the numbers. The average number remains steady around the 2-1/2

year mark for M.Sc.‟s and has decreased to the 1 year mark for Diploma students. The Director

continues to work towards assuring the timely submission of theses of those students in thesis

programs. The Division is hoping to make greater inroads into reducing the time to graduate in

order to fall in line with the new Graduate Faculty guidelines on time limitations. To this end, a

new initiative will be put in place in the upcoming academic year, whereby expectations regarding

time to completion will be transmitted to both students and supervisors and a channel of

discussion as to what can be done to improve this will be implemented.

0

1

2

3

4

5

6

7

Years to

Complete

2001/2002 2003/04 2005/06 2007/09 2009/10

Academic Year

Diploma

M.Sc.

Ph.D.

(iii) Graduate student funding: A summary of graduate student funding for 2010 is shown below.

With the continued high enrollment and despite the diminishing of funds available, 63 of our

students remain supported by external peer-reviewed funding. Internal funding, however,

remained very high due to the Principal‟s, Provost‟s and GREAT Fellowships implemented by

McGill. Despite these, however, internal funding decreased from the last academic year as fewer

monies were generated from awards from departments, institutes and hospitals where our

students are housed. The Division was allotted an all-time record amount of almost $320,000 in

Graduate Fellowships monies, which monies were distributed as awards for excellence to

returning students, recruitment fellowships to new students and travel awards to allow students to


30

attend and present at international conferences. A total of $1,821,077 was raised by our

graduate students from both internal and external sources.

Funding From External Peer-Reviewed Studentships and Fellowships

Source of Funding Number of Awards

Total Value $

1. CIHR Studentships 6 112,700

2. CIHR Doctoral Awards 12 352,000

3. CIHR Strategic Training Award 1 12,000

4. CIHR M.D./Ph.D. Studentships 2 42,000

6. MCETC/FRSQ/CIHR Strategic Training Program 1 25,000

7. NSERC Scholarships 2 35,700

8. FRSQ Assistantships 1 6,000

9. FRSQ Studentships 14 259,000

10. FRSQ Fellowship for Medical Residents 2 76,666

11. Ministry of Health Scholarship 1 1,000

12. Jackie Robinson Post-Graduate Scholarship 1 500

13. Multiple Sclerosis Studentship 2 34,000

14. Centre for Asthma in the Workplace Award 1 20,000

15. IRCM Studentship 4 47,000

16. Canadian Diabetes Association Studentship 1 17,850

17. Cole Foundation Studentship 2 44,000

18. NCIC Studentship 1 22,000

19. NCI Fellowship 1 22,500

20. Foundation for Fighting Blindness Studentship 1 20,000

21. Astra Zeneca Award 1 21,000

Neurodyn Inc. Award 1 5,950

22. Belgian Government Award 1 9,000

23. Egyptian Government Award 1 26,000

24. Senocyt 1 9,335

25. Saudi Ministry of Higher Education 1 6,000

26. Greek Government Gellowship 1 7,667

TOTAL: 63 $ 1,234,868


31

Funding from McGill Graduate and Medical Faculties, and Hospital Research Institutes

Source of Funding Number of Awards

Total Value $

1. Tomlinson Fellowships 1 25,000

2. McGill Graduate Faculty Fellowship 3 20,167

3. Max Stern Recruitment Fellowships 1 10,000

4. Department of Medicine Fellowship 1 48,000

5. Department of Medicine Awards 1 8,750

2. MUHC Awards 9 79,925

5. Faculty of Medicine Internal Award 5 41,517

6. McGill Integrated Cancer Research Fellowship 4 24,000

7. Principal‟s Graduate Fellowships 34 85,000

8. Provost‟s Graduate Fellowships 75 218,350

9. GREAT Travel Awards 16 16,000

11. Gerald B. Price Memorial Travel Awards 2 2,000

12. Experimental Medicine Travel Awards 7 7,500

TOTAL 159 586,209

(iv) Honours: The outstanding caliber of our students continues to be recognized by both McGill

and the Canadian scientific community. Notably, Mr. Craig Park has been invited to serve as a

representative to the Canadian Student Health Research Forum in Winnipeg. Two other

students, Ms. Maria Ait Tihyaty and Ms. Erin Lafferty, have also been invited to attend the Forum.

Two of our students, Mr. Sebastien Langlois and Mr. Matthew Parsons, were successful in

securing a highly prestigious Vanier Scholarship valued at $50,000/year, of which only 7 were

awarded in the biomedical sciences at McGill. Moreover, several of our students were placed on

the Dean‟s Honors List upon graduation and have been put forward for various dissertation

awards.

Staff Membership

The Division‟s membership decreased slightly over the past year. The Division presently has

241 members (65 Full, 43 Associate and 27 Assistant Professors in Medicine together with 52


32

Associate Members from other departments at McGill, 38 Associate Members from Université de

Montréal and 2 Associate Member from Institut Armand Frappier, 10 Adjuncts, as well as 4

Emeritus Professors). Of these, 111 are currently active supervisors of graduate students

registered in the Division.

Program and Other Developments

The World Wide Web page (www.medicine.mcgill.ca/expmed) continues to be an excellent

promotional/educational/research resource tool. It has been updated to include more resources

for applicants and students alike in that both an Applicant Handbook, a Student Handbook, and a

first draft of a Supervisor`s handbook have been added.

The Division remains open to the development of both new programs and new courses and the

implementation of new collaborations. Specifically, the new M.Sc. with a specialization in Family

Medicine was offered for the first time during this academic year. Seven (7) students were

admitted to the program in 2010 and are expected to graduate within the 2 years allotted for

completion of a M.Sc. in this field. However, until students graduate, no more will be accepted in

the coming year, as there are issues with funding of students in this program.

Several new courses have been proposed in order to round out our course offerings. These

include a course entitled “Recent Advances in Virology and Antiviral Therapeutics” and another

on “Cellular Methods in Medical Research”. These courses have been approved at the Faculty

level and are now ready to be brought before SCTP for final approval.

Lastly, in an effort to improve its capacity to deliver outstanding administrative support, the

Division has undertaken various new initiatives. The most important of these is a new

collaborative project with Mr. David Syncox of McGill, whereby supervisor and student

presentations will be developed. We hope to organize meetings in all of the institutes which

http://www.medicine.mcgill.ca/expmed


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house our students and supervisors and to present to all concerned parties our expectations

regarding the training of graduate students, the timelines which are expected to be followed and

the roles, responsibilities, rights and obligations of all parties concerned. Also, the new method

of tracking student progress has been fully implemented and is now working effectively.

An electronic PDF version of this report is available at the following website link:

https://www.mcgill.ca/deptmedicine/about-us/annual-reports/archives

https://www.mcgill.ca/deptmedicine/about-us/annual-reports/archives


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Appendix IV: Publications

The 2009 (calendar year) MUHC Publications and the JGH Publications can be found at the

following website link:

https://www.mcgill.ca/deptmedicine/research/publications

Publications for 2010 (calendar year) will be available on-line at the same website link during the

summer of 2011.
https://www.mcgill.ca/deptmedicine/research/publications

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