CTLC Retreat 16 April 2015 School of Epidemiology

CTLC Retreat, 16 April 2015 School of Epidemiology, Public Health and Preventive Medicine

Rationale v Name § International increased use of the term “public health” since the late 1980 § “Public Health and Preventive Medicine” replaced “Community Medicine” as specialty identified by Royal College of Physicians and Surgeons of Canada in 2011 § Recognition that health research ongoing in multiple faculties SEPHPM, CTLC Retreat

Rationale v Status § Academic and professional training o UGME, PGME, MSc & Ph. D in Epidemiology, Graduate Certificate in Population Health Risk Assessment and Management o Ph. D in Population Health § Relationships with hospital research institutes and federal, provincial and municipal agencies § Diverse portfolio of research SEPHPM, CTLC Retreat

Education • • UGME – SIM – Community Service Learning – Inter-professional education PGME – PHPM Residency program Graduate – MSc in Epidemiology, 2 streams – Ph. D in Epidemiology – Options for enhanced training in • Biostatistics in applied health research • Health economics • Global health • Knowledge Translation – MPH (LOI approved) Summer School in Epidemiology & Biostatistics SEPHPM, CTLC Retreat

Overarching Model Guiding The Work Of The School

Overarching Model Guiding The Work Of The School - Translational research gaps

Translation gaps and associated research methodologies

Research development Practice-changing Policy-changing Clusters (but not silos): • Chronic disease • Communicable disease • Mental health • Nutrition, • Biostatistics • Clinical epidemiology • Global health • Health economics • Knowledge translation • Public health genomics • Rational therapeutics and medication policy • Risk assessment and management

Network Integration • • Developing core disciplines and methodological perspectives Developing core infrastructures – – – – – Space IT Research administration Research ethics Methods centre and methods development Large administrrative database centre Biobanking Assessment factilities GMP etc

In 5 -10 years… • improved collaboration and cooperation between u. Ottawa and partners • stronger more interdisciplinary training programs • more applied impactful health research • internationally recognized methodological breakthroughs • better health outcomes for the region, Ontario, Canada and beyond

HR Plans and Partnerships Opportunity for partnership with ECM? Anesthesiology 1 Ph. D. tenure-track Health Systems Research Health Economics or Analytical epidemiology? Is there a potential link with CHEO-Peds Epidemiology (Child Health Services Research) CHEO and Pediatrics Epidemiology (Epidemiology and Health Service Delivery of 1 Ph. D. tenure-track Childhood Mental Health Dis. ) 1 Ph. D. tenure-track Epidemiology (Child Health Services Research) Family Medicine [link between either position and UOHI? ] 1 Ph. D. tenure-track Is there a potential link with IMHR Mental Health Epidemiology (share w ECM and Psy) Analytical Epidemiology/Biostatistics s there a potential link with Anesthesiology Health Systems Research? Analytical Epidemiology/Biostatistics Epidemiologist (Clinical Trials) 1 Ph. D. tenure-track Primary Health Care Epidemiologist/Population Health Scientist Epidemiology and Pharmacy (Medication appropriateness in 1 Ph. D. tenure-track Primary Care) Analytical Epidemiology/Biostatistics Public Health Analytical Epidemiology/Biostatistics

HR Plans and Partnerships Opportunity for partnership with ECM? IMHR OHRI OPHTH. Psychiatry 1 Ph. D. tenure-track 1 Ph. D tenure-track Mental Health Epidemiology (share w ECM and Psy) Analytical Epidemiology/Biostatistics Is there a potential link with CHEO-Peds Epidemiology (Epidemiology and Health Service Delivery of Childhood Mental Health Dis. ) Mental Health Economics (share w ECM and Psy) Health Economics Practice Changing Res (Knowledge Syn. , Methodology, Stats, Knowledge Transl. , etc) Biostatistics/Analytical Epidemiology Vision Analytical Epidemiology/Biostatistics Health Service Research - Mental Health Epidemiology and Health Economics Suicide Research Analytical Epidemiology/Biostatistics [link with IMHR already identified]

HR Plans and Partnerships Opportunity for partnership with ECM? UOHI [link betewenn either position and Family Medicine? ] 1 Ph. D tenure-track Qualitative / Outcomes Research Methods (2014) Public health/mixed methods Public health 1 Ph. D tenure-track Outcomes Research (2015)

Public Health & Preventive Medicine Resident Training Program Potential collaboration with Family Medicine

PHPM Residency Training Program: Family Medicine Stream PGY 2 Family Medicine PGY 3 Master’s Program PGY 4 Junior Rotations PGY 5 Senior Rotations PGY 1: Basic Clinical Training 15

PHPM Residency Training Program: Basic Clinical Training Stream Option: Early Exam PGY 2 Master’s Program PGY 3 Junior Rotations PGY 4 Junior/Senior Rotations PGY 5 Senior Rotations PGY 1: Basic Clinical Training 16

Collaboration • Is there a problem? • What is the problem? • Is it our problem? 17

Is there a problem? • FM stream residents want the PHPM program to facilitate maintenance of FM competencies • FM PD wants FM trainees to retain their FM competencies 18

What is the Problem? • Evidence-based finding that if clinical practice is not reinforced in the 2 -3 years immediately post training, skills decline precipitously. 19

Is it our problem? • Policy for Canadian Residency Matching Service (Ca. RMS) is to select residents through Family Medicine • Our policy decision causes FM to invest in the cost & supervision of PHPM Residents for 2 years 20

Program Drivers for change • Residents who enter PH through FM are concerned that they will loose their clinical practice skills. • While PH residents are in FM, they are isolated from PH practice • Family medicine wants more support/training and knowledge exchange with PHPM 21

Program Drivers for change • RC and Ontario projections for jobs suggest an excess of PHPM graduates* • About 20% of PHPM graduates continue to practice clinical medicine** • PH Units foster relationships with FPs in their community – Pandemic planning – Hospital identified or hospital setting outbreaks – CD management • Emergence of Primary Care Centres for delivery of population level health interventions 22

What is happening in other programs? • Scan of PDs across Canada found that each program has its own approach to continuing education in clinical medicine: – active discouragement – residents are permitted under their contract to work outside of residency training as long as doing so does not impede their training – program embeds clinical training throughout PHPM years 23

Opportunities for PHPM Residents • PH residents would benefit from – Participation in research funded by FM – Teaching FM residents about PH – Retaining their connection with clinical medicine – Field application of knowledge/skills – Acting as consultants for PH research project 24

Emerging professional practice area for PHPM residents? • “CHCs stood out in their care of disadvantaged and sicker populations and had substantially lower ED visit rates than expected” (ICES comparison of primary care models) • Growth of importance of Primary Care as an opportunity for delivery of population level health interventions creates attractive practice setting for PH physicians & ‘market’ for physicians skilled in – Program design, implementation & management e. g. screening incentives – Evaluation e. g. benchmarking, Primary Care Performance Measurement – Performance management e. g. population health assessment, provincial quality improvement initiatives – Equity & population health delivery e. g. services for health promotion and disease prevention, Family Practice models such as FHOs, Rural. Northern Physician Group agreements – Management & leadership e. g. Cross-disciplinary teams, relationship with PHU 25

Considerations 1 of 2 • Cost – Supervision at FM; overhead & infrastructure costs for PHPM resident • PHPM needs to articulate training goals – What is the purpose of extension of FP training into R 3 -R 5 – What is “PH oriented” clinical training? Should there be a specific project? – How does it map onto RC Objectives of Training • Timing – ½ day per week? 2 days per month? 1 week every 2 blocks? • Eligibility Criteria – PHPM resident must be able to articulate their goal and explain how it can be achieved through FM stream – Pre- or post-Masters? 26

Considerations 2 of 2 • Settings – Which sites are acceptable? Academic family practice setting, community health centre, special populations settings – Resident’s choice of settings or prescribed by program? • Programming? – Spend 3 remaining years in one setting? Or move between settings? • Assessment – How will we jointly assess residents? • Supervision while at FM site as PHPM resident • Evaluation 27

← Public Health & Preventive Medicine↔ Family Medicine → WHAT NEXT? 28

Residency Training Subcommittee • Strike a subcommittee to develop a proposal for the review of RTC • Describe a PHPM curriculum for a longitudinal placement with FM (~0. 5 days per week) post. BCT or post-FM training • Proposal will not compromise the capacity of u. Ottawa program to produce highly skilled PH physicians 29

Subcommittee members • • 1 Resident from each of General & FM stream FM PD PHPM PD 1 FP practitioner 1 PHPM practitioner Program Managers (2) PGME office (TBD) 30

Vision and Mission • Vision: To improve patient and population health outcomes in the Champlain LHIN, Ontario, Canada and globally through research on the determinants of health and disease etiology and the development, implementation and evaluation of practices, programs and policies that will optimize health (and social) services. • Mission: The School will contribute to health promotion and disease prevention and control by research, engagement and building capacity, through training in epidemiology, public health and related disciplines, designed to advance research on the determinants of health and disease etiology and to develop, implement and evaluate practices, programs and policies that will optimize health (and social) services, and thereby improve patient and population health outcomes.