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Chair's Column:
Surgery Without Borders

Integrated Medical Education at UofT

James Rutka
James Rutka

I am honored to have taken over the responsibility of Chair of the Department of Surgery this year. I want to take a moment to again thank David Latter who served most capably as interim chair from May 1st, 2010 March 31st, 2011. Under David's leadership, our Department not only grew in size, but thrived in terms of all metrics applied to academic units such as ours. Interestingly, one of the most significant changes in medical education at the University of Toronto which arose during David's tenure and with which I needed to be brought up to speed quickly was Integrated Medical Education (IME).

By now, most of you have heard the term IME as a new initiative in the Faculty of Medicine at the University of Toronto. IME refers to the coordination of a sustainable framework for MD learners and residents into the expanding repertoire of University of Toronto community affiliate hospitals. The overarching goal of IME is to provide new professional standards for accreditation, education, and clinical care in urban, suburban and community settings. For many years, our medical students and residents have benefited from surgical rotations and experience in these community affiliate hospitals. IME is the initiative that will formalize the relationship between our learners and educators at these sites.

Over the past year, the Department Appointments Committee (DAC) has vetted dozens of applications for appointments in the Department of Surgery. The vast majority of these have been in the Adjunct Lecturer Surgeon-Teacher category. Some of the community affiliate hospitals where these appointments have been granted include: Humber River Regional Hospital, the Royal Victoria Hospital in Barrie, The Scarborough Hospital, Southlake Regional Health Centre, and Credit Valley Hospital. The application process for appointments in the Department of Surgery for surgeons at the community affiliate hospitals is rigorous and includes a letter of interest from the candidate, a letter of support from the Surgeon-in-Chief at the hospital, submission of a current CV, demonstration of good standing in the College of Physicians and Surgeons of Ontario, and an interview with the Chair of DAC, Avery Nathens.

I personally have enjoyed speaking to many of the Department of Surgery applicants from the IME initiative. I have been very impressed with the established case volumes, mix, and expertise that exists in our community affiliate hospitals in areas such as bariatric surgery, minimally invasive surgery, thoracic surgery, plastics and reconstructive surgery to name just a few. As many of our

residents will opt for surgical elective rotations in any one of a number of our community affiliate hospitals, I am pleased to report that these experiences continue to be highly sought after and regarded, thanks to the outstanding surgical teaching they receive on site. In addition, many of our resident and fellow graduates will be looking towards the community affiliate hospitals for employment opportunities upon completion of their training in surgery. Of course, our graduates will be keen to keep an affiliation with the University of Toronto through this IME initiative in the future.

In case some of you did not know, a new Academy of Medicine will be opening this fall where our MD learners will be receiving their education The Mississauga Academy of Medicine (MAM). MAM is a new partnership between the University of Toronto and Trillium Health Centre and Credit Valley Hospital. A key faculty member at MAM for Surgery is Dr Norman Hill, who is the Vice President of Medical and Academic Affairs at Trillium. Norm is a FRCSC-trained General Surgeon with a certificate in Health Administration from the University of Toronto. We will be working closely with Norm as we initiate the educational programs in Surgery for medical students, residents and fellows.

It is timely for the Department of Surgery to be actively involved in the IME process. In fact, one can argue that perhaps this is long overdue. I know of many Departments of Surgery in countries around the world where formal linkages with their community affiliate hospitals has been practiced for decades. This is particularly true in Japan where the Department of Surgery at a given University may have an affiliation with 30 or more hospitals across a broad, bordering region. This relationship leads to outstanding opportunities for crosspollination with respect to surgical techniques, collaborations in education, advancement of research trials, and publications in high impact peer reviewed journals. I envision the possibility of expanding our reach with best practices and quality performance in surgery for various procedures across all divisions in our fully affiliated and community affiliate hospitals. The power of such collaborative research would be enormous.

In closing, I welcome our newly appointed faculty members from the IME initiative. For those of you who wish to know more about IME at the University of Toronto, you can visit the Faculty of Medicine website at: http://www.facmed.utoronto.ca/programs/ Integrated_Medical_Education.htm

James T Rutka, MD PhD, FRCSC
RS McLaughlin Chair
Department of Surgery

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