Past department head monthly addresses

I am sure I am not alone when I say that sometimes I think “What am I doing? Why did I choose Family Medicine?“ Our world as family physicians and teachers is sometimes stressful. Clearly defining ourselves in times of crisis is an important first step before rolling up our sleeves and finding solutions. 

At times like this, it is important to balance the past, present, and future. DFM’s annual David Gass Memorial Walk on this past Friday, is an example of how we honour our past leaders, enjoy the present, and hope to inspire our future family physicians. Cathy Cervin spoke of David’s love of three things – Family, Walking, and Family Medicine. As we walked together through Point Pleasant Park on a glorious sunny fall afternoon I was reminded of the symbiotic relationship of physical and emotional health and how family medicine is the one discipline in medicine that transcends the artificial mind-body divide in the therapeutic patient-physician relationship.

Ian McWhinney, another great father of family medicine in Canada, speaks in his article “The Importance of being different"¹ of the great power of this unique feature. “Clinicians in other fields form relationships with patients, but in general practice, the relationship is usually prior to content. We know people before we know what their illness will be"¹. There is good evidence to support the therapeutic benefits of this relationship².

As family physicians, we can play a significant role in restructuring our healthcare system to value the primary care of our patients and value the skills we bring as managers of complexity. Ian McWhinney describes how family physicians think: “to think organisimically, is to “think complexity” and to accept uncertainty. Of all the clinical disciplines, general practice operates at the highest level of complexity"¹. This is certainly a complex skill in itself, one which we must celebrate and promote in order for it to be valued.

As we all look for solutions to the present crisis in primary care, and the importance of promoting the value of family medicine’s role in this process, I am also reminded of another great physician – Dr David Sackett – the father of evidence-based medicine in Canada. He challenged what he called the “we’ve always done it that way” mentality and by doing so changed the way medicine is practiced today.  

Our profession is complex, so creating the evidence to support our methods is a unique skill in itself, but we can find inspiration in David Sackett’s approach of questioning the status quo at the start. 

This week some of you will be heading to FMF, the first in-person FMF since 2019. I hope you all enjoy the experience and are inspired by being amongst friends and colleagues from across the country. FMF is a great place to celebrate family medicine and you as family physicians – unique special characters in a sometimes unrelenting healthcare system. 

Here’s to you, thank you to each one of you for all that you do.
 
References:

1. McWhinney IR. The importance of being different. Br J Gen Pract. 1996;46(408):433–6
2. Stewart M.  Effective Physician-Patient Communication and Health Outcomes:  A Review. CMAJ, 1995;152(9): 1423-1433

“Happy holidays and Seasons greetings to all! While the term “holidays” is sometimes a misnomer with everyone busier than ever at the end of a calendar year, I do hope you take some time away from work to enjoy family and friends this year. With so much on the go, including increasing residency seats, getting our heads around the outcomes of training project, and new initiatives supporting the implementation of the patient medical home model, this is a time to step back and celebrate all that we have achieved, amidst all the challenges that we face. Thank you to all our physicians and staff for your endless work and commitment to the Department of Family Medicine, our learners, and patients and your respective communities.
 
This commitment and the amazing work that is occurring was particularly obvious to me during our annual site visits, which wrapped up recently. Thank you to all those who welcomed us from the program level of DFM and some members of the faculty of medicine in your communities. As always, it was wonderful to connect with you, our learners, and other stakeholders and community members. I deeply value the time I spend across the Maritimes; each time I meet new members and visit new teaching sites and communities, I am better able to understand the unique strength of our distribution and diversity and in doing so, find ways to make sure that benefits us all.
 
I am going to use the newsletter as an opportunity to share recent publications from DFM and hope that you enjoy this recent one led by our very own Dr. Ruth Lavergne, which provides valuable information as we consider what is that we need to support a stronger primary care base for our health care systems. 
 
With flu, COVID, and other viral illnesses still on the rise, please take this as a gentle reminder to get your flu shot and COVID boosters if you are able. Getting your flu shot is a great way to support our physicians and learners and ease the burden on our healthcare system. 
 
As we move into 2023, we hope you continue to enjoy the newsletter, which we are going to transition to bi-monthly (every second month, with my next newsletter released in February.) publications to ensure you receive consistent, relevant, and timely information.
 
Once again, happy holidays to all!
Dr. Kath Stringer, department head

Welcome back to the new academic year everyone, I do hope you all had some much needed time over the summer holidays to focus on yourselves, friends and family.  

This fall, DFM will continue to focus on educating learners and training residents who are capable, confident, and adaptable to provide care in a team-based environment. We are all aware however of the pressures everyone involved in medical education, the health care system and particularly primary care are experiencing at this time. Our response in family medicine education will be to think about innovative and supportive ways to maximize educational capacity in family medicine to assist in meeting the demands of primary care in the Maritimes.
 
The CFPC’s Outcomes of Training Project has highlighted the importance of a combination of health system and educational reform in meeting the needs of modern residents’ transition to practice. The implementation of the recommendation for a three-year residency program is planned for 2027—with local leadership working on its early development stages. Alongside this change, FM across the Maritimes will continue to see a much-needed shift towards team-based care. We have begun to see this in PEI, for example, where patient medical homes have been formed at five Island primary care locations, beginning their shift in primary health care from solo family practices to collaborative health care.

In Halifax our Proof of Concept project is continuing to advance, and onboarding of new patients has begun. Work is focussing on team support of the patient onboarding process and developing clinical pathways that ensure all team members are working to full scope of practice, as well as the clarification of roles and responsibilities, and associated training and orientation tools.

This project is set to extend to others areas of Nova Scotia in the near future. Changes to our family medicine curriculum that align with the very much needed system reform will be two key factors in addressing the Maritime region’s primary care needs.
 
Our leadership in undergrad, postgrad, research, and faculty development are all working hard as we all consider the need to maximize our educational capacity and our influence on health system planning; please see their updates below and a list of upcoming events and important dates this fall.  I look forward to meeting with as many of you as possible during some of these events such as the FMREW, Faculty Development Weekend and the site visits. If any faculty are considering attending FMF in person in Toronto this year, please let me know (dfmadmin@dal.ca) as we would like to organize a Dal gathering and planning for that will depend on the numbers of folks interested in attending a social gathering.
 
Finally, I am pleased to share that Dr. Sarah Cook has been appointed as Chief, IWK Department of Family Medicine – Maternal Newborn Care,  this is a shared position with the DFM based in Nova Scotia. In the coming months, Dr. Cooke will become a clinical faculty member at the DFM Halifax Site, the newly opened Wije’winen Health Centre, and begin her involvement in teaching the Family Medicine undergraduate and postgraduate curricula.”

Dr. Kath Stringer, department head

Happy Summer everyone! As many of us utilize the summer months to take some much-needed time off, I wanted to send one final update before the beginning of the academic year.

Most recently, I wanted to share our excitement for the opening of the Wije’winen Health Centre. Under the direction of Dalhousie’s Dr. Brent Young, the center will address the growing urban Indigenous population’s escalating and complex health needs.

Amidst an acute access shortage, Wije'winen Health Centre is a strong example of the importance of empowering communities to lead and serve their members. An Indigenous-led health centre will ensure that essential services are culturally relevant and eliminate barriers for urban Indigenous people to access much needed mental, physical and spiritual health services.

The Dalhousie Department of Family Medicine is committed to strengthening our ties with Indigenous communities and learning how to support education regarding the health and social issues facing Indigenous peoples. This clinic will provide a wonderful opportunity for us to learn together. We were delighted to be involved, thank you to the Mi’kmaw Native Friendship Centre (MNFC) for inviting us to be a part of this journey.

My next newsletter will be released in September, in the meantime, I hope everyone enjoys the beauty and peace that can be found across the Maritimes during the summer months.

Dr. Kath Stringer, department head

Spring is finally here in all its colorful splendor. With spring comes the invitation to look ahead as we transition to warmer (and hopefully more relaxing) times over the summer.

This month, I want to focus on an important longer-term transition occurring in Family Medicine, namely the recommendations of the Outcomes of Training project. The full document “Preparing our Future Family Physicians – an educational prescription for strengthening health care in changing times" can be accessed here.

As many of you know, this project is a critical reflection on the training of family physicians in dynamically changing times. It covers where family physicians are practicing, graduate preparedness, the Family Medicine Professional Profile, and the training needed for residents to be competent and confident to begin a comprehensive family practice.

What has emerged is an understanding that preparedness for practice is not solely based on competence. Constructs such as capability, confidence, and adaptability are also important to resident preparedness. Changes to our curriculum are therefore going to need to address and reflect these constructs. As our outgoing CEO Francine Lemire stated, “the status quo is no longer an option for us.“ With the shortest FM residency program globally, it is not surprising that two years is not long enough.

Our Dalhousie Family Medicine education leaders are beginning to look ahead to a three-year residency program starting in 2027 focusing on designing a new transition to practice. The new curriculum will aim to transition residents more effectively, guided by data collected on the challenges identified by new graduates in their first year of practice. Our goal is to have happier, more confident, capable, and adaptable graduates ready to tackle the everyday challenges of primary care–and, in doing so, improve patient access to comprehensive care close to home.

Changing Family Medicine residency to a three-year program will not solve all our primary care problems. The takeaways from the Outcomes of Training project link education reform to health system reform to improved access. With our various leadership roles in family medicine in the Maritimes and nationally, this will require that all of us come together to ensure we do just that – change both together to improve patient care.

I look forward to working with many of you on this over the next eight years and invite any comments, questions, or suggestions as it rolls out.

Dr. Kath Stringer, department head

Happy April, I hope everyone had a wonderful long weekend. I recently had the opportunity to join Dr. Anderson and members of the DFM and Faculty of Medicine on the Dean’s tour of the distributed education sites in mainland Nova Scotia. Along the way, it was a pleasure to meet and speak with so many of you in person.

The trip was an opportunity for the Dean, myself and others to connect with everyone who plays an essential role in delivering medical education in mainland Nova Scotia. The goal of the tour was to gain an understanding of your unique perspectives and learn how the Faculty of Medicine and DFM can better support your sites.

Listening to what is and is not working well at your sites will better equip us to apply best practices and to represent you and advocate on your behalf. It was also excellent for the Faculty of Medicine, and Postgraduate and Undergraduate medical education to get a sense of the state of your sites as well as the unique needs and opportunities within your communities. Thank you for sharing your problems, challenges, and amazing successes. It was a privilege to see how so many of you collaboratively work together to find solutions and advance family medicine and medical education. I look forward to visiting Cape Breton, NB and PEI in the Fall. In my last newsletter, I spoke about upcoming changes at the HFX site of the DFM. Nova Scotia Health (NSH) and Dalhousie Department of Family Medicine (DDFM) have officially partnered on a Proof of Concept project for the two Dalhousie Central Zone Primary Health clinics. The proof of concept is ambitious in scope, with quick timelines for the development of applying new and innovative approaches to promote patient attachment.

The project aims to enhance support to the primary care teams at the Halifax Mumford and Spryfield clinics to attach an additional 3500 patients to the clinic by fall 2022. It will also create supportive primary care incubator clinics that provide wrap-around services and support to care teams to improve access and efficiency.

The new structure will engage and support medical learners in making connections with other health care providers and enhancing their educational experience with a focus on improving the patient experience. We are confident that with a strong partnership and collaboration with NSH, we can make improvements for providers, learners, and patients to primary care access at these two DFM clinics. This process is certainly not limited to the central zone or Nova Scotia, as we hopefully show success in this innovation, the plan is to expand this work provincially in Nova Scotia and share evaluation data across the Maritimes to promote further development of well functioning efficient patient medical homes and an integration of clinical care and education.

Thank you to all of those members of the DFM who have engaged in this innovation thus far, significant changes are not without their challenges and your continued engagement is very much valued and key to the Department-wide success of this project.

The project aims to enhance support to the primary care teams at the Halifax Mumford and Spryfield clinics to attach an additional 3500 patients to the clinic by fall 2022. It will also create supportive primary care incubator clinics that provide wrap-around services and support to care teams to improve access and efficiency.

The new structure will engage and support medical learners in making connections with other health care providers and enhancing their educational experience with a focus on improving the patient experience. We are confident that with a strong partnership and collaboration with NSH, we can make improvements for providers, learners, and patients to primary care access at these two DFM clinics. This process is certainly not limited to the central zone or Nova Scotia, as we hopefully show success in this innovation, the plan is to expand this work provincially in Nova Scotia and share evaluation data across the Maritimes to promote further development of well functioning efficient patient medical homes and integration of clinical care and education.

Thank you to all of those members of the DFM who have engaged in this innovation thus far, significant changes are not without their challenges and your continued engagement is very much valued and key to the Department-wide success of this project.

Dr. Kath Stringer, department head

DFM has kept busy with exciting discussions with the Nova Scotia Department of Health and Wellness and Nova Scotia Heath around collaborative and innovative solutions to address the patient unattachment crisis. We will provide more updates as they develop.

We are also excited to be participating in the upcoming PEI Medical education strategic planning session in March.

DFM in Halifax continues to work with the Friendship Center to support the planning and construction of the Urban Indigenous Health and Wellness Centre. The goal of the project is to work with the urban Indigenous population and the Friendship Centre to try to meet some of their primary healthcare needs. The project is now entering the construction phase to open its doors in the Spring.

Finally, please join me in welcoming Dr. Brent Young and Dr. Elaine Davies, who have recently joined DFM as faculty.

I am sure we are all looking forward to the warmer months to come, yet I hope you can also find time to enjoy the winter snow.

Dr. Kath Stringer, department head

As the calendar year draws to a close and we look back at the last 12 and even 20 months, let's remember how much we've accomplished in this extraordinary time, individually and collectively. I’m delighted to be sending seasons greetings; your collective effort, resilience, and commitment to the Department of Family Medicine in the past year continue to inspire curiosity, innovation, and compassion in learning, teaching, and research. Everyone has consistently gone above and beyond, THANK YOU. I am particularly struck by the ways our educational community continues to uphold one another and remain connected virtually and through other means across the Maritimes.

Over the holidays, I hope you can find time for friends, family and loved ones and participate in activities that bring you meaning. Let's continue to support each other, and take advantage of the holiday season to connect and recharge. This month concludes our collective exploration of the seven sacred teachings of Indigenous peoples inspired by the talk I attended earlier in the year by Dr. Nel Wieman. So far, we have explored Truth, Respect, Courage, Honesty, Humility, and Wisdom. The final of the Seven Sacred Teachings is Love. “ Love is forever, unconditional. Love instills peace. Love heals. People who have been hurt or injured need love the most.” As physicians, healing and hence this teaching, is so important in everything that we do. My hope for you this holiday season is that you may experience both the giving and receiving of this love.

As we look to the year ahead with renewed purpose we continue to collaborate with our various partners in finding new ways to improve.

Dr. Kath Stringer, department head

November marks seven months since I began my monthly newsletters to you. Now, seven months into our communications, we focus on the sixth of the seven sacred Indigenous teachings—honesty. In reading more about the seven sacred teachings, ‘honesty’ refers primarily to being honest with oneself. If we are not able to be honest with ourselves, then we cannot move forward.

The notion of honesty connects well to our focus on inclusion, equity, diversity, and antiracism. We need to be honest with ourselves in recognizing and admitting our biases and privileges and how those unintentionally influence our actions. Truth is the first step in the process of truth and reconciliation. Being honest with ourselves and others requires that we, as the Department of Family Medicine, provide a secure, supportive, and non-judgemental space in which to do so.

Building a culture that values honesty means we expect and support personal and group commitment to self-reflection. With your commitment, the DFM has begun this journey, and I am excited to see the results of this process influencing how we set and meet our strategic priorities of research, education, serving our communities, and engagement and partnerships

Dr. Kath Stringer, department head

Hello October, despite recently wanting to slow the passing of weeks, time flows on.
 
Last month, the DFM observed the first National Day for Truth and Reconciliation. September 30 was a day to honour the lost children and Survivors of residential schools, their families, and communities. The Department of Family Medicine’s observance of the day aligns with our commitment to being a catalyst for change in our communities and to fostering an inclusive and welcoming place to learn. Each month we continue to select and discuss one of the seven sacred teachings of Indigenous Peoples based on the talk I attended earlier in the year by Dr. Nel Wieman—this month, the focus is the teaching of ‘humility’. 
 
Practicing humility requires us to own up to our shortcomings and learn from our past mistakes. This learning theme can be applied to our approach to Truth and Reconciliation. Public commemoration of the tragic and painful history and ongoing impacts of residential schools is vital for the reconciliation process. By acknowledging and reflecting on the past, we are better equipped to build a future together that is more tolerant and inclusive, and reflective of our communities.  
 
Humility is a key step to moving forward. It does not assign blame but allows reconciliation to occur. As family physicians, we are in positions of great power, and we must practice humility to serve our patients best. Humility in a health system does not equal weakness but rather allows one to represent the voice of one’s patients in a powerful way to effect change. The DFM is also continually committed to educating medical students and residents about the health and social issues facing Indigenous Peoples to help them attain competencies to provide culturally safe care now and into the future.

Dr. Kath Stringer, department head

As we continue with our theme of the seven sacred teachings of Indigenous peoples, I thought I would focus on respect for the month of September. 

"Respect is the gift from the Buffalo. In all life, respect is the first and foremost. Respect oneself and respect will be bestowed (i.e. treat your body with respect and it will look after itself; treat it with poison and it will destroy itself)" https://www.southernnetwork.org/site/seven-teachings.

In times of healthcare crises, as we have experienced over the past 18 months, which require us to overextend ourselves, we sometimes forget to respect ourselves. As we come out of the summer vacation period, I do hope you have all had a chance to respect yourselves by focussing on what makes you well, including perhaps travelling, even if locally, and reconnecting with family and friends in the more tangible ways that we were once used to. 

Many of us have had the pleasure of connecting with our new residents over the summer and it has been wonderful to do so in person and connect on a more personal level as they share their recent new experiences as residents, past experiences as medical students and hopes for the future.

As we consider respect, in the July edition of Canadian Family Physician, Jennifer Leason, author of the Third Rail article on forced and coerced sterilization of Indigenous women stated,
“as family physicians, there are 2 calls for action: one is to create culturally safe and appropriate sexual and reproductive health care supports and services. Another is to address Indigenous-specific racism and discrimination in health care through ongoing reconciliation efforts and activities and by respecting the rights of Indigenous peoples.”

As family physicians and particularly as family physician educators and role models, let us continue to respect all our patients, but especially those who have traditionally not received the appropriate supports and services as we advocate to decrease the discrepancies so evident in our present health care system. 

Dr. Kath Stringer, department head

Happy August, as we look towards the beginning of the undergraduate academic year, it is a reminder that we all share the vision and purpose of teaching the next generation of family physicians. This month, I thought we might explore 'wisdom' as a form of wellness and how it can be applied to our life and work. 

This quote is taken from a book entitled “Our Stories: First Peoples in Canada” describing the various aspects of the seven sacred stories: 

The teaching of wisdom is taught to us by the beaver. Beavers use their teeth to cut trees and build dams; in doing this they have a positive impact on their community (the nature around them), their family (who live in the dam), and themselves (by finding purpose and health in doing what they are meant to do). The beaver reminds us that we all have gifts and a purpose in this world. It is through the love of knowledge that we find wisdom.

Each one of us can take something from the beaver. As family physicians, and those involved in producing future family physicians, we are all role models and mentors, and as such have an amazing opportunity to have an impact on our community, our families, and most importantly as we consider our own wellbeing, a positive impact on ourselves. Take some time this August to consider your strengths and how they can be applied to affect positive change.  

https://ecampusontario.pressbooks.pub/indigstudies/chapter/seven-grandfather-teachings/

Dr. Kath Stringer, department head

Hello everyone, it is officially summer in the Maritimes! I hope you all had a restful and reflective long weekend.

Last month, I challenged you all to the “Hug a Tree” challenge coined by Dr. Nel Wieman, who spoke at the CFPC leadership forum last month about Indigenous forms of wellness. To add a Maritime spin on the “Hug A tree” challenge I asked that you get outside and submit a photo of the nature that is close or important to you—and boy did you deliver! As the weather warms up and many of us are spending more time outside and taking some much-deserved vacation, it brings me great joy to see so many of you out reconnecting with nature. Check them out below!

As we head into the heat of the summer, I encourage you all to continue to prioritize your wellness. Especially as we continue to grapple with the ongoing discoveries of the unmarked mass graves of Indigenous children across Canada. Let us reflect on how these atrocities afflicted against Indigenous peoples affect the health and wellness of the populations we serve and listen to, honour, support and respect Indigenous peoples in our communities—now and every day moving forward.

The seven sacred teachings of the Indigenous peoples, as Dr. Nel Wieman defined them are “truth, love, respect, courage, honesty, humility and wisdom.” We can use each of these as tools to use in our own journeys to encourage wellbeing. This month, let us focus on “courage” - as it pertains to family medicine let us consider “clinical courage”.

John Wotton, a past president of the SRPC defined clinical courage as the “inner debate that we must have with ourselves, in that space where the needs of our patients and the extent of our training and experience intersect.” COVID has certainly forced us all to adapt with clinical courage. Applying clinical courage is by its very nature, a stressful experience requiring deliberate personal thought and action, even when supported by colleagues or mentors. It requires us to be strong enough to act and humble enough to reflect and learn from our experiences in order to improve patient care.

I encourage you all to share your experiences of clinical courage with your colleagues as in so doing we support each other and multiply our learning and the benefit to our patients and ourselves.

Dr. Kath Stringer, department head

Despite having prepared a message for your all last week, after attending the CFPC leadership forum this past weekend and listening to Dr. Nel Wieman, speak on Indigenous perspectives on wellness, I feel compelled to do my best to pass on a few of her inspiring messages.

Her talk took us through the seven sacred teachings of the Indigenous people:
“Truth, love, respect, courage, honesty, humility and wisdom” as tools to use in each of our own individual journeys to encourage physician wellbeing. Today and in the coming months, I will be addressing these seven different teachings and invite you all to reflect on them with each other.

When speaking of truth, one thing that I heard her say was “I am who I am”. I encourage you all to celebrate your uniqueness, get to know yourselves and in doing so move towards understanding what supports you can benefit from and what strengths you can share with others.

A message shared from an Elder “the longest journey is from one’s head to one’s heart”. Let us try to be true to ourselves by admitting that our emotions affect our thoughts and actions, hence the need to attend to them.

Managing work and personal life throughout the ongoing pandemic can feel overwhelming. Whether you are living alone and feeling isolated, working on the front lines, or working from home while trying to manage your children’s homeschooling, we empathize with you—the last mile is always the most challenging.

Let’s continue to stay connected, check-in and share hope with each other. If you are a primary preceptor, for example, check in with your resident to see how they are doing. Our new DFM Faculty Development TimedRight group is a lovely new way to connect—read more about this below.

If you can, take a moment today to tell yourself that you are doing more than enough—even if it might not feel like it sometimes. Every day I see family physicians and administrators going above and beyond for patients, learners and communities and despite everything, training and graduating excellent new family physicians for the Maritimes.

In parting, I would like to share a challenge. Dr. Wieman spoke of the importance of a connection with nature as part of our wellness. An Elder encouraged her to regularly hug one of the towering old spruce trees in a nearby forest in BC as part of this. She admitted to not really being a “hug a tree” person but has started touching the trees and feeling the benefits of this tangible connection with nature. At the meeting a – “hug a tree challenge” was launched – so let us launch it here in the DFM with a Maritime twist! This month I encourage you all, as the hope of summer fills our sails, to send in your pictures of beautiful nature scenes, green/blue whatever they are, let us connect by seeing each other enjoying the outdoors and in doing so help us all to be well!

Dr. Kath Stringer, department head

Tomorrow, May 1, 2021, marks one year since I stepped into the role of Department Head with the Dalhousie Department of Family Medicine.

Over the past year, I have had the pleasure of meeting and working with so many of you across the Maritimes, albeit a mix of in-person and Zoom connections. Together, we are working towards the shared goal of advancing family medicine through education, research, and comprehensive clinical care to meet the needs of our communities.

May 1 is also National Doctors' day—a day to celebrate physicians' skills, knowledge and dedication to patient care. Every day, physicians go above and beyond to care for their patients and build a stronger health care system. I want to personally express my gratitude and appreciation for your continued passion, expertise and diverse and immeasurable contributions throughout the pandemic. 

As we continue to build on our broad range of strengths and capitalize on opportunities, I want to reflect on where we have been and where we are going in the years to come. Watch my full (4 min.) address below.

Watch video

Dr. Kath Stringer, department head