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Faculty of Medicine University of Toronto

Academic Plan 2004 -2010

International Leadership in Health Research and Education

June, 2004

APPENDIX 2

Faculty of Medicine Academic Plan 2004 – 2010

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Faculty of Medicine Academic Plan 2004-2010

Table of Contents

Executive Summary................................................................................................ i 1. Introduction ................................................................................................... 8 2. Faculty of Medicine Overall Profile............................................................ 11 3. Faculty Achievements 2000-2004 .............................................................. 16 4. Looking Ahead – The Changing Landscape............................................. 20 5. Faculty of Medicine Goals and Objectives 2004-2010 ............................. 23 6. Academic Incentive Fund Requests.......................................................... 27 7. Faculty of Medicine Research Enterprise ................................................. 42 8. Teaching Programs..................................................................................... 52 8.1 Undergraduate Medical Education ................................................... 52 8.2 Postgraduate Medical Education...................................................... 57 8.3 Graduate Programs............................................................................ 65 8.4 Arts & Science Education.................................................................. 70 8.5 Medical Radiation Sciences .............................................................. 73 8.6 Inter-Professional (Health) Education .............................................. 75 9. Continuing Education................................................................................. 76 10. Academic Faculty........................................................................................ 81 11. Students....................................................................................................... 85 12. Strengthening our relationships................................................................ 87 13. Governance ................................................................................................. 89 14. Development and Advancement................................................................ 90 15. Infrastructure............................................................................................... 92 15.1 Space................................................................................................... 92 15.2 Computing Support Division............................................................. 94 15.3 Human Resources.............................................................................. 95 15.4 MedStore ............................................................................................. 95 15.5 Occupational Health & Safety and Security..................................... 96 16. Organizational Changes ............................................................................. 96 17. Budget Issues ............................................................................................. 98 18. Concluding Notes...................................................................................... 100

Appendices:

I. Dean’s Group II. Faculty of Medicine Goals 2004 – 2010

III. Strengths, Weaknesses, Opportunities and Challenges IV. Research Tables V. Faculty Academic Staff Count

VI. Faculty of Medicine and Affiliated Hospitals Endowed Chairs VII. Faculty of Medicine Organizational Chart

VIII. Budget Tables IX. Sector Plans X. Departmental Profiles

XI. Department and Centre/ Unit Academic Plans


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Executive Summary In June 2000, the Faculty of Medicine identified its priority directions and goals in its Strategic Directions and Academic Plan. The Faculty has achieved virtually all of its targets from the first strategic plan on or ahead of schedule. We benefited meaningfully from the APF initiatives that were launched in the last cycle. In this planning cycle we not only present new initiatives that must be driven forward but also indicate a pressing need to consolidate and stabilize the gains made in the last planning cycle. Our Academic Incentive Fund proposals and our set of plans and strategies reflect this theme of continuity of excellence and stabilization, along with innovation and further forward movement. The Faculty is very proud of the many significant achievements made through the collective efforts of our faculty, staff, students, and institutional partners since initiating the ‘Raising Our Sights’ plan more than four years ago. A few examples of these achievements:

• very positive accreditation results for four major professional groupings • highly favourable OCGS and external departmental reviews • 66% growth in research funding to over $350 m in 2002/03 • new interdisciplinary research centres and collaborative institutes launched • research policies harmonized across the Toronto Academic Health Science community • many new endowed chairs and professorships • enrolment increases across most programs • new professional masters level programs • 14 CIHR Training Grant programs • new collaborative graduate programs • Hospital University Education Committee launched • Centre for Faculty Development created • Dean’s Fund for Excellence in Education seeded 41 projects • New educational awards and annual Educational Achievement Day introduced • New clinical faculty policies approved by Governing Council • State-of-the-art facilities at 500 University for the Rehabilitation Sector • CCBR construction underway on target and on budget • Newly renovated space in MSB, Best Institute and Fitzgerald • Web-based registration and evaluations systems developed for PGE and UME databases

Our future directions will be shaped by, inter alia:

Φ Major advances in biomedical science with spectacular convergence of multiple disciplines Φ Very rapid cycling of discoveries from bench to bedside Φ The growth of international research collaborations Φ Dramatic evidence of the importance of renewing domestic public health systems Φ The moral and academic imperatives of global health outreach Φ Societal emphasis on governance, accountability and performance measurement Φ Rising sensitivity about patient safety and effective use of healthcare resources Φ Concern to understand and exploit the advantages of inter-professional education Φ Demands for rehabilitation to meet the functional expectations of aging ‘Boomers’ Φ Changes in the modes of payment to academic physicians Φ Greater functional integration with and among our teaching hospital partners Φ The need for stronger academic partnerships with community-based providers Φ Renewal and reform of primary care


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Φ Changing dynamics of knowledge translation, with emphasis on life-long learning for students, staff, and faculty alike Φ More use of electronic tools and simulation in education and assessment.

The Faculty is well poised for continued leadership in charting and understanding the new intellectual landscapes and in adapting our academic practices and programs effectively. The following 12 objectives will take the Faculty through its next stage of development. Objectives for 2004 - 2010

1. Advance our scientific and professional training platform for the 21st century

The Faculty will: a) strategically leverage newly created programs such as proteomics and bioinformatics, the Program in Bioethics, and new collaborative programs; b) capitalize on national attention and capacity-building needs of areas such as Public Health and bioinformatics and our expanding role in global health; and c) exploit emerging competencies in knowledge translation, innovative simulation tools, and inter-professional education, to name a few. We shall prioritize the programs that will best prepare future leaders in research and education, consistent with the Faculty’s vision statement.

2. Complete the redevelopment of space for three campus-based sectors

The current capital projects at CCBR and 500 University require funding to reduce debt and/or help manage new operating costs. The new project at 155 College Street will address much-needed space for the Community Health sector and Family and Community Medicine; again, however, there are capital costs and operating costs to be supported. As a consequence of the spring 2005 movement of faculty and staff from the MSB to the CCBR, there will be an opportunity to redesign and rejuvenate the space of the MSB.

3. Create collaborative and common science platforms across the Toronto academic health sciences enterprise The Toronto Academic Health Sciences enterprise includes a massive array of overlapping research activity across the campus and in nine fully-affiliated hospitals and their research institutes. This research powerhouse could achieve even greater impact if we had more sharing of infrastructure, info-structure, and support services, along with agreement on several distinct science platforms that could cut across the campus and multiple institutions. The Faculty’s leadership team places a high priority on more joint planning with our hospital partners for research platforms and infra-structure in the years ahead.

4. Significantly augment student aid for professional students and stabilize and

enhance graduate student funding The Faculty must continue to ensure that access to professional programs, e.g. MD and professional masters programs, is not impeded by high tuitions. Nor should career choices be skewed by large debt loads. We shall implement new processes to increase MD student access to the aid dollars generated by hold-backs on their tuition fees and enhance financial counseling for all students. Improved funding to graduate students is required to ensure competitiveness with stipends offered by other universities. Student aid will also be enhanced for professional masters programs and for emerging needs in programs such as medical radiation sciences.

5. Support the integration of clinical faculty into more joint enterprises across sites

The clinical Deans and clinical Department Chairs have pressed strongly for more consistency and integration of practice plans across sites. As the Ministry of Health moves from Phase I AFP


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funding to a more comprehensive set of financial arrangements, it is crucial that the Faculty work actively with clinical chiefs, AFP leaders, and hospital executives to create more horizontal governance structures. These structures may offer economies of scope and scale in managing clinical revenues, should facilitate inter-site movement of physicians as clinical rationalization continues, and will help align University and hospital objectives. As part of the evolution of the Toronto Academic Health Science Network, clinical Department Chairs must be closely involved in the rationalization of clinical services across the fully-affiliated teaching hospitals and the partly-affiliated hospital sites.

6. Implement University policies and procedures for clinical faculty and extend these

policies in some form to all status-only faculty Important steps were taken at Academic Board and Governing Council in the Spring of 2004 to address and definitively resolve the ambiguous status of clinical faculty. The Faculty’s leadership team views it as a very high priority to implement these policies. Along with moving the clinical faculty policies forward in 2004-05, the Faculty will address the academic status of other full-time and part-time non-tenure-stream faculty (e.g. scientists, other professionals).

7. Better integrate the community affiliated teaching hospitals and other community-

based teaching and practice sites into the education and research enterprise The 2004 Report of the Task Force on Partially Affiliated Hospitals and Related Health Care Organizations made a number of recommendations to strengthen the relationship between the Faculty and the community affiliated teaching organizations to achieve significantly greater participation and contribution to the shared missions of teaching and research. Over the next 2-3 years, the Faculty must operationalize these recommendations.

8. Realign the governance and organization of extra-departmental centres, academic

units and collaborative programs within the overall organizational structure of the Faculty Over the past five years, the Faculty has re-engaged Department Chairs in the governance of non-departmental entities, while reducing direct reporting to the Dean’s Office. We have also supported the alignment of centres with the interests of specific hospital partner. Nonetheless, the integration and accountabilities of various centres, institutes, units, and collaborative programs within the Faculty organization requires attention in this planning cycle.

9. Rationalize the budgetary model between the University and Faculty of Medicine to

ensure better alignment between revenue and responsibilities The Faculty’s base budget has risen little even as the University’s overall budget has grown dramatically. The failure of our budget to keep pace with divisional revenues must be addressed through the adoption of transparent new budget models that align revenues and costs/responsibilities more fairly. The Budget Task Force chaired by Vice Provost Safwat Zaky offers a welcome opportunity for progress along these lines. Implementation of any new model, however, will be a major challenge in the next planning cycle.

10. Enhance information technology and communications capability of the Faculty

Enhancements to information technology are a critical component of the next planning cycle. The Faculty exists on more than 30 separate institutional sites. We have not fully capitalized on advances in information technology to create a more cohesive academic enterprise. As our hospital partners move towards recruitment of an in-common Chief Information Officer and rationalize their info-structure, we must seize the opportunity to implement new information tools


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such as common credentialing and web-based CV systems, videoconferencing capacity, and appropriate bandwidth for data-intensive research applications to be managed across multiple sites.

11. Develop benchmarking and performance measurement capability across the Faculty The University of Toronto is committed to firm evidence on performance and, where possible, understanding how our performance compares with that of peer institutions. The self-study by various Departments and non-departmental units has demonstrated how difficult it is to acquire consistent and comparative data that reflect meaningful dimensions of performance. The Faculty is committed to pursuing a comprehensive and rigorous approach to benchmarking and performance measurement during this planning cycle.

12. Develop a new Internal Budgetary Model.

As the University’s budgetary model evolves, so must the Faculty’s internal budgetary framework. We believe that Departments, Units, Centres, and Programs can strike an effective balance between revenue opportunities from government and non-governmental sources, the University’s broad mission, the Faculty’s own goals and objectives, and the specific goals and objectives of the relevant organizational unit. To this end, we anticipate re-developing our internal budgetary model to align it with any new University-Faculty models, providing incentives for units to capitalize on revenue opportunities.

Key Priorities and Strategies of our Programs Beyond the objectives articulated for the Faculty as a whole, the various programs have identified a number of priority strategies that will focus their attention in the next few years. Several will be sponsored through the Academic Incentive Fund process and these are noted. Research The Faculty has enjoyed more than 66% growth in its total research funding over the last few years. We have taken major steps forward to harmonize research policies between the campus and our teaching hospital partners, and initiated structures and processes to improve research planning across institutions. New virtual structures such as the McLaughlin Centre for Molecular Medicine and the Toronto Centre for Modeling Human Disease have created innovative platforms for collaboration. Faculty appointments and a commitment to graduate and postdoctoral education help to glue together this massive and geographically-distributed research enterprise. Priority Strategies include:

• Renewing research infrastructure space and equipment with priority to design and reorganization of MSB research space following opening of CCBR (an AIF request)

• Improving supports to post-doctoral fellows through enhanced communications, developmental workshops and networking support (an AIF request)

• Supporting faculty grant applications to non-Canadian sources such as NIH (an AIF request)

• Facilitating international research partnerships, as in the Structure Genomics Consortium • Increasing the Faculty share of indirect costs


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Undergraduate Medical Education (UME) The Undergraduate Medical Program recently completed a successful accreditation process with very positive feedback. The priority strategies for the next few years include:

• Planning for potential enrolment expansion through the creation of one or two generalist academies, one to be headquartered at the Sunnybrook and Women’s campus with a major node at UT Mississauga. The new academies would focus on generalism with greater community orientation and involve a network of community-based academic affiliate hospitals as well as affiliated practices.

• Addressing the declining interest in and residency selection of Family and Community Medicine; considering the introduction of primary care in the earliest years of the program

• Creating an Inter-professional Simulation Centre for Clinical Skills Teaching, Testing and Research to support clinical skill teaching in an environment that is not highly-specialized as the major teaching hospitals

Postgraduate Medical Education The Postgraduate Medical Education program is seeing expansion of the program with allocation of additional slots over and above our undergraduate medical program enrolment. Increases in enrolment are also occurring in the International Medical Graduate program. Priority strategies focus on:

• Developing strategies to address capacity issues regarding teaching faculty and training sites to accommodate the increased numbers of residents

• Ensuring that the larger programs and those with a high applicant rate receive additional positions, as possible within the government allocation

• Lobbying government for faculty/infrastructure funding for new CARMS, Re-Entry and Repatriation positions.

• Reviewing fees for sponsored trainees commensurate with the Ministry funding attached to residents in expanded government programs

Graduate Programs The key advances in graduate studies continue to rest on the development of new degree and collaborative programs. Importantly, new funding opportunities have supported these initiatives. The alignment of new revenue for support of academic infrastructure and student funding will continue to dominate the goals for academic advancement in the next 5 years. Priority strategies include:

• Developing new models of clinical teaching in the Rehabilitation disciplines • Creating new revenue models for ClinEpi graduate program to enable enrolment

expansion • Leading reform for more equitable funding (based on cost-of-living) for graduate

students by CIHR and other granting agencies • Establishing agreements with international institutions for shared financial support of

students • Improving the processing of international applicants and enhancing financial support • Introducing a web-based management system for tracking student financial information


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Arts & Science Education Two significant advances have contributed to more effective planning and implementation of curriculum innovation: a Life Sciences Curriculum Planning Committee to oversee all aspects of curriculum, and an agreement for sharing new revenue generated by undergraduate enrolment expansion. Priority strategies include:

• Contributing to the oversight of the new Human Biology Specialist Program • Establishing more effective governance and infrastructure for the Joint Program in

Human Biology Medical Radiation Sciences The second entry BSc degree program in Medical Radiation Sciences is a joint program with The Michener Institute. Key priority strategies include:

• Ensuring health human resource planning to assess enrolment quotas in the context of the job market

• Establishing joint fund-raising for student bursary and merit awards • Creating new Masters’ streams for radiation physics and radiation sciences research.

Continuing Education The four major programs of Continuing Education are: continuing health professional education, faculty development, public education and knowledge translation. Significant development has occurred with the creation of the Centre for Faculty Development at St. Michael’s Hospital, in public education with the Mini-Med School and in the area of knowledge translation. Priority strategies include:

• Creating new offerings in faculty development at certificate, diploma or master’s level • Establishing a Centre for Knowledge Translation in partnership with Sunnybrook and

Women’s (AIF request) • Expansion and study of our efforts in public education

Faculty of Medicine Budget The 2004-05 base budget is $61.2 m with $1.2 m in budget cuts. The cuts are being addressed by a variety of strategies including reduction of academic and administrative staff, reduction of non-salary budgets and replacing operating budget with increased income. The Faculty’s leadership team is aware of practical constraints on the implementation of any new budgetary model by the Central Administration. The serious cuts that have already been projected would be deepened for some divisions if revenues were reallocated in line with a bottom-line budgetary strategy. In this circumstance, one logical mechanism for beginning to implement a new revenue-based budgetary model is the Academic Incentives Fund. We have accordingly put forward an unapologetically ambitious menu of capital and operating requests for the AIF, and have queued up numerous other requests for 2005 and 2006. At the same time, recognizing the importance of protecting flexibility in the AIF for both other divisions and future years, we have deliberately positioned most of our requests as one-time-only recurring across multiple years, thereby conserving base budget in the AIF, and facilitating the accumulation of one-time-only spending capacity in the AIF over the planning cycle.


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Requests to Academic Incentives Fund (AIF) The Faculty reviewed 55 proposals for AIF funding to prioritize the following 22 proposals that will be prepared in detail for a Fall 2004 submission. Collectively they provide enormous capability to strengthen emerging Faculty programs, foster innovative teaching approaches, and address critical infrastructure needs for advancing many initiatives. The proposals that will be coming forward will request operating and/or capital funds for: Advancing the CCBR Centre for International Health HIV/AIDS Initiative for Africa Knowledge Translation Research and Development Expanded Surgical Skills Centre Centre for Faculty Development Centre for Effective Practice Master of Public Health Sciences Program Dissection Based Labs Institute of Medical Science Research Training for Medical Students Radiation Oncology Student support

Institute for Drug Research Pre-grant Award Office Support Cardiovascular Sciences Collaborative Program Postdoctoral Fellow Support Program Faculty Benchmarking 500 University Ave and 155 College Street MSB Preliminary Design and Costing Department of Ophthalmology and Vision Sciences Planning Support Web-based Student Financial Data System Faculty Communications: Videoconferencing

All these requests will be reviewed again internally by the Faculty to ensure that they conform with agreed revisions arising from our adjudication process and that they are appropriately positioned and formatted for assessment by the Provost’s group. The total coming forward for the Fall of 2004 will be approximately $1.1 million in base funding requests, most of which would be operationalized over one to three years, and about $21.5 million in one-time-only funding, spread across the entire planning cycle.


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1 Introduction Founded in 1843 as a school of medicine, the Faculty of Medicine at the University of Toronto is Canada’s preeminent health science faculty and one of the leading Faculties of Medicine in the world. In addition to undergraduate, postgraduate and graduate programs in medicine and medical sciences, the Faculty of Medicine offers programs in Physical Therapy, Occupational Therapy, Biomedical Communications, Community and Public Health, and Speech-Language Pathology, at a variety of academic levels. The Faculty of Medicine also engages heavily in undergraduate teaching of biomedical science in a range of programs in the Faculty of Arts and Science. Over 5,000 faculty members span the University campus and the nine fully affiliated teaching hospitals, Toronto Public Health and many community affiliated hospitals and health care organizations. The Faculty’s education and research programs serve more than 6,000 trainees including undergraduate and graduate programs, postgraduate clinical training and post doctoral fellowships. In student numbers and budget, the Faculty is the second largest division of the University, following Arts and Science. In its research funding and productivity, international profile, and complexity of partnerships and administrative challenges, it arguably occupies a unique place among the University’s divisions. The Faculty undertook an extensive strategic planning exercise in 1999-2000, following the appointment of Dr. David Naylor in August 1999 to the position of Dean of the Faculty. The Strategic Directions and Academic Plan, 2000 was comprehensive and inclusive of all areas of the Faculty. It has provided a framework and guide for the Faculty’s priorities and resources since 2000 and continues in most areas to reflect the overall strategic directions of the Faculty. The Strategic Directions and Academic Plan, 2000 identified the following strategic priorities: • Strengthening our faculty through recruitment of leading scholars, enrichment of start-up

funding and work environments, streamlining and reform of appointments, and enhancing faculty development

• Enriching the student experience through enhancing funding support, counseling services and mentorship, and improving instructional media and technology

• Strengthening our academic programs though attracting a high number of Canada Research Chairs, promotion and support of collaborative and inter-disciplinary programs, realigning teaching in Arts and Science undergraduate programs, promoting knowledge translation, and jointly working with affiliated hospitals and research institutes to harmonize research policies and plan new research initiatives.

• Enhancing our relationships and extending our reach by working locally, provincially, nationally and internationally, and strengthening our partnerships with the affiliated hospitals to optimize the research and teaching missions of the Toronto Academic Health Science enterprise.

• Strengthening our infrastructure and resource base through growing our development strategies, addressing short-term and long-term space planning, maximizing our limited administrative resources, and investing in information technology.

The Plan proposed 11 new initiatives for the Academic Priorities Fund (APF), which collectively were seen to strengthen the foundation on which the Faculty could grow its academic programs and build the infrastructure capacity to equip the Faculty to address new challenges and opportunities. All were supported fully after review by the Provost’s office. As of 2004, strategic investments have been made in all 11 initiatives, contributing significantly to the Faculty’s advancement: • investments in academic personnel for a new Centre for Cellular and Biomolecular Research, • expansion of the Surgical Skills Centre, • stable funding for the Joint Centre for Bioethics, • a Centre for International Health,


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The Faculty of Medicine has achieved virtually all of its targets from the first strategic plan on or ahead of schedule. We benefited meaningfully from the APF initiatives that were launched in the last cycle. In this planning cycle we not only present new initiatives that must be driven forward but also indicate a pressing need to consolidate and stabilize the rapid and major gains made in the last planning cycle. Our Academic Incentive Fund proposals and our set of plans and strategies reflect this theme of continuity of excellence and stabilization, along with innovation and further forward movement.

• a Clinical Evaluation Program, • a Knowledge Translation Program to strengthen the academic framework for Continuing

Education, • enhanced educational computing capacity and an electronic classroom, • a molecular and physiological neuroscience network, • an Institute for Drug Research, strengthening and uniting pharmacology in Medicine and

Pharmacy, • an investment in administrative restructuring in the Dean’s Offices; and, • administrative and teaching support for the Rehabilitation Sector.

Stepping Up Framework for Academic Planning In December 2003, the University of Toronto released the Stepping Up Framework for Academic Planning: 2004 – 2010, a framework to guide the academic planning for all divisions and departments of the University. The major thrusts of Stepping Up are:

• Good teaching and enhancing the student experience • Vision, innovation, stretch into the future • Interdisciplinary research and teaching • “Extending our reach”, proactive international recruitment and outreach with local, national

and international partners • Systematic attention to all aspects of equity and diversity • International benchmarking, performance measurement and evaluation.

The Stepping Up goals and strategic priorities can be mapped readily to the Faculty of Medicine’s five strategic priorities and corresponding goals as outlined in the Faculty’s June 2000 academic plan. Given the close alignment of our established strategic directions with the new Stepping Up framework, the current round of academic planning has provided a welcome opportunity for a “mid-course review”, in which the Faculty reviews progress against the 2000 goals and looks ahead to determine what revisions should be made to our strategic agenda. Academic Planning Process The Faculty of Medicine Academic Planning process was formally initiated in January 2004. The key themes and priorities of Stepping Up framework were systematically mapped to the priorities and goals Faculty of Medicine Strategic Directions and Academic Plan 2000, and key implications for the Faculty of Medicine planning identified.


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The Faculty’s mission, vision and values were reviewed by the leadership team, including the All Chairs Committee, and confirmed as set out in the 2000 Plan. Departments and Centres next completed a self study, assessing progress against their 2000 goals and identifying revised and new goals for the planning cycle of 2004-2010. Departments and Centres engaged faculty, students and external partners in the development of their plans. Departmental plans are included in Appendix XI. The recent accreditation review of the Undergraduate Medical Education program by the Liaison Committee on Medical Education (LCME - accredits medical education programs leading to the M.D. degree in the United States) and the Committee on Accreditation of Canadian Medical Schools (CACMS), included extensive student and Faculty self-study reports (available on Faculty website), which were referenced in preparing this Academic Plan. Each of the four sectors of the Faculty (Basic Sciences, Clinical Sciences, Rehabilitation Sciences and Community Health) also developed a sector-wide plan, including sector priorities and inter-sectoral opportunities. A number of cross-sector priorities evolved to form the Faculty core objectives for 2004 – 2010. The Sector Plans are included in Appendix IX. Each of the program areas, led by the Vice and Associate Deans, also submitted plans that included a review against 2000 goals, and revised or new goals for 2004 – 2010. The Dean provided individual feedback in writing to all Vice/Associate Deans, Departments, Centres and Units on their draft academic plans. Consultation sessions or focus groups were held with targeted groups (junior faculty, holding an appointment held for three years or less, professional masters students, medical radiation science students, MSc/PhD students, and post-doctoral fellows) to gather additional perspectives and input into the planning process. Undergraduate medical students had provided considerable input to the Faculty through the accreditation process. Postgraduate medical trainees also provide input through Royal College accreditations and internal review processes for their respective Postgraduate Medical Education Program(PGME) programs. All Departments and Centres were invited to submit preliminary proposals for the Academic Incentives Fund (AIF). A total of 55 requests for AIF submission were received, totalling over $6M in base funding and in excess of $30M one-time-only costs. The decanal team (Appendix 1) undertook a lengthy review to prioritize those proposals that could be supported for Fall 2004 submission to the Provost and identify the proposals that required additional development for potential submission in future years. Expected revisions were outlined in writing for all prioritized plans. A description of the proposals that are targeted for Fall 2004 submission is included in Section 6. Penultimate review and preparation of the Academic Plan was guided by the group of deans (Appendix I); the Dean did final edits.


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2 Faculty of Medicine Overall Profile The scope and depth of the Faculty of Medicine can be best illustrated by its programs, departments and academic units.

Programs

Research Undergraduate Medical Education Program Undergraduate Program in Medical Radiation Sciences Undergraduate Teaching in Faculty of Arts and Science – Life Sciences Programs

Postgraduate Medical Education - 68 postgraduate medical training programs - Ontario International Medical Graduate Program Graduate Education Programs Basic Sciences

Rehabilitation Sciences Community Health Clinician Scientist MD/ PhD program

Continuing Education Knowledge Translation Program Public Education Faculty Development Continuing Professional Development Ian Anderson Program in End-of-Life Care

Departments

Basic Sciences BBDMR Biochemistry Biomaterials & Biomedical Engineering (Institute of) Medical Biophysics Medical Genetics & Microbiology Medical Science (Institute of) Nutritional Sciences Pharmacology Physiology

Clinical Sciences Anesthesia Family & Community Medicine Immunology Laboratory Medicine & Pathobiology Medical Imaging Medicine Obstetrics & Gynaecology Ophthalmology & Vision Sciences Otolaryngology Paediatrics Psychiatry Radiation Oncology Surgery

Community Health Health Policy, Management & Evaluation Public Health Sciences Rehabilitation Sciences Occupational Therapy Physical Therapy Rehabilitation Sciences* Speech-Language Pathology

Academic Units

Anatomy (Division of) Banting & Best Diabetes Centre Bioethics, Joint Centre for Biomedical Communications (Division of) Bloorview Epilepsy Research Program Cardiovascular Collaborative Program Cellular and Biomolecular Research (Centre for) Clinical Science (Division of) Critical Care (interdepartmental Unit in) Drug Safety Research Group Faculty Development (Centre for) Gage Occupational & Environmental Health Unit Health Promotion (Centre for) Heart & Stroke / Richard Lewar Centre of Excellence for

Cardiovascular Research

History of Medicine International Health (Centre for) Multi-Organ Transplant Program Positron Emission Tomography (PET) Centre Proteomics & Bioinformatics (Program in) Research in Educaton (Centre for) Research in Neurodegenerative Diseases (Centre for) Research in Women’s Health (Centre for) R. Samuel McLaughlin Centre for Molecular Medicine Sleep Medicine & Circadian Biology (Centre for) Structural Genomics Consortium

* Conjoint graduate department for Occupational and Physical Therapy


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Clinical faculty have lived in a policy limbo for 28 years. Important steps were taken at Academic Board and Governing Council in the Spring of 2004 to address and definitively resolve their status. The Faculty views it as a very high priority to implement these policies. Along with moving the clinical faculty policies forward in 2004-05, the Faculty has placed a high priority on addressing the situation for other full-time and part-time status-only faculty (e.g. scientists, other professionals).

Vision, Mission and Values The Faculty revised its vision, mission and values in the development of its 2000 Academic Plan. As noted, these were reconfirmed during the 2004 planning process.

Vision International leadership in health research and education Mission We prepare future health leaders, contribute to our communities, and improve the health of individuals and populations, through the discovery, application and communication of knowledge. Values • Integrity in all of our endeavours. • Commitment to innovation and excellence. • Life-long learning and critical inquiry. • Diversity and social justice. • Partnership with our academic health science centres. • Multi-professional, interdisciplinary and community collaboration. • A supportive and collegial environment. • Accountability to our community of scholars and to the public. • Responsiveness to our local, national and international communities.

The Faculty of Medicine reaches across many sites. It is the nucleus of the Toronto academic health science complex, which includes the University campus and the nine fully affiliated teaching hospitals. The Faculty has linkages to eleven community affiliated hospitals, Toronto Public Health, community-based clinics and practices, and numerous community agencies. The Faculty’s education and research enterprise extends across the full academic health science complex. Cohesion, cooperation and harmonization of purpose across the large enterprise are facilitated by two key multi-institutional committees – TAHSC (the Toronto Academic Health Science Council) and HUEC (the Hospital University Education Committee). The faculty members represent one of the largest pools of intellectual and academic talent in North America. Over 5,000 academic faculty span the University campus and affiliated hospitals, and community agencies. Approximately 1,900 are engaged full-time in academic activities (designated faculty full-time), including 212 tenured/ tenure stream appointments. The number of faculty full-time at the professor rank has increased 17% from 465 in 2000 to 543 in 2003. Over 3,000 faculty contribute in a part-time capacity to the academic enterprise. Of the faculty, only a small number of the non-tenured faculty members are paid entirely by the University. While many faculty appointees receive some stipendiary income from the University, the majority are remunerated primarily through the affiliated hospitals, clinical practice plans, community agencies, or career awards.


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Faculty Facts 2004 Number of Departments (Cognate)

Basic Sciences 8 Clinical Sciences 12 Community Health 2 Rehabilitation Sciences 3 Centres, Divisions, Units 24

Fully Affiliated Teaching Hospitals

Baycrest Centre for Geriatric Care Bloorview McMillan Centre Centre for Addiction and Mental Health Hospital for Sick Children Mount Sinai Hospital St. Michael’s Hospital Sunnybrook and Women’s College Health

Sciences Centre Toronto Rehabilitation Institute University Health Network

Faculty (02-03) Total Academic Faculty 5,016 Faculty Full Time 1,964 Tenure/ Tenure Stream 210 % Female 38

Students (03/04) Medical Students 766 Medical Radiation Sciences 360 Postgrad Clinical Trainees 1338 Postgrad Clinical Visa Trainees 615 Masters - MSc 764

- Professional Masters 525 PhD 819 Continuing Education Registrants 20,000

The Faculty offers an extensive range of educational programs within its undergraduate, graduate, postgraduate clinical training, and continuing education mandate. These educational programs undergo continual development and improvement, examples of which include: • Designation of curriculum themes to weave through all courses in the 4-year undergraduate

medical curriculum, including molecular medicine, pharmacology, bioethics, professionalism, history of medicine and medical jurisprudence

• Transition of programs in occupational therapy and physical therapy from undergraduate to graduate level programs

• Introduction of new collaborative graduate programs, including Proteomics and bioinformatics, Molecular Medicine, Health Care, Technology and Place, and Biomolecular Structure

• Launching of an inter-professional education module through the Centre for Study of Pain

• Expansion of faculty development programs through the new Centre for Faculty Development

The four-year Undergraduate Medical Education program, presently the largest in Canada, attracts a stable pool of some 2,000 applicants. Of those, 198 are admitted annually. The first year class size increased from 177 to 198 over the two years 1999-2000 and 2000-01. The Ontario Government may seek significant enrolment increases in the near future and the Faculty has begun planning for this possibility. The Undergraduate Medical Education program underwent a very positive accreditation in May 2004. The review team was complimentary about many aspects of the MD program and indicated that they did not anticipate returning in less than 8 years, i.e. that full accreditation would be forthcoming. The Postgraduate Medical Education program, in 2003-04, had 1,953 postgraduate trainees across 68 programs, including 1,238 residents and 719 fellows. 615 of the total were international graduates. Moderate increases in medical trainee enrolment, both Canadian trainees and international trainees are expected for the next several years. Graduate programs, including doctoral stream and professional or course masters degrees, are offered across all four sectors in the Faculty: Basic Sciences, Clinical, Community Health and Rehabilitation Sciences. The Rehabilitation Sector initiated new professional masters programs in Occupational Therapy and Physical Therapy in 2001-02. Overall, there has been moderate but steady growth in graduate enrolment, reaching a total of 2,108 graduate students in 2003-04.


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Faculty Facts 2004 Graduate Degrees Awarded 2003

MHSc 110 MSc 187 MSOT 18 MScB 7 PhD 136

Research 2002-03 Total Research Funding $ 386.1 M

Campus-Based $80.2 M Hospital Research Institutes $305.9 M Total Number of Awards 6,138 (incl research grants, contracts, and personnel

awards) Number of Operating Grants 2,794 Number of Personnel Awards 3,096 Number of post-doctoral fellows 1,287

Endowed Chairs

University –based 47 Hospital – Based 89

Total Administrative Staff 649 (03/04) Total Net Operating Budget $60.0 m 2003/04

The Faculty has a long tradition of innovation in its graduate programs. U of T was the first in Canada to introduce MD/PhD, Surgical Scientist and Clinician Scientist programs. Our Master’s Degree program in Family and Community Medicine trains leaders in primary care and is the only one of its kind in Canada. Specialized graduate programs in Public Health Sciences and Health Policy, Management and Evaluation focus on several broad themes that are critical to Canada’s future: urban health, international health, safety in patient care, healthcare leadership and management, and clinical evaluative sciences. A BSc degree program in Medical Radiation Sciences is offered jointly with The Michener Institute of Allied Health Sciences. A total of 360 students in 2003-04 were enrolled in one of the three streams, Radiation Therapy, Radiological Technology and Nuclear Medicine Technology. The Faculty is recognized internationally for its research excellence and is among the top schools in North America in attracting research funding. Faculty appointees oversee more than $350 million per annum in external research funding; and have captured between 20% and 25% of the national total of Canadian Institutes of Health (CIHR) operating grants in the last five years. Over the four years ending in 2002/03 research funding has grown 66%, representing an annual increase of more than 16%. The research activity spans across the campus and affiliated hospitals, many with large research institutes. About 70% of all research funding held by faculty with academic appointments at the University of Toronto is attributable to Medicine appointees. In turn, about two-thirds of the external research funding attributable to the Faculty of Medicine is held by investigators based in the affiliated teaching hospitals. The large and growing number of post-doctoral fellows and clinical research fellows is a tribute to the strength of the Faculty’s academic enterprise. Post-doctoral fellows have grown in number by 17% over the past four years to a total of over 1200 in 2002-03. The Faculty’s extensive research endeavours support five major platforms of inquiry:

• Molecular Health and Applied Genomics • Models and Mechanisms of Human Disease • Improvement in Health and Function • Health Information Technology and Knowledge Transfer • Comprehensive Program in Imaging

Since 2001, the five research platforms have formed the basis for nine successful Canada Foundation of Innovation proposals from the campus and teaching hospitals. The Faculty’s scholarship and academic activity is further reflected in the following indicators for 2002/03:

• 7,112 indexed publications in peer-reviewed journals • 1,252 books / book chapters published • 1,100 faculty were members of national study sections or committees


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In early 2004 the University of Toronto announced it had reached the goal of $1 billion, one year ahead of schedule and The Campaign, the largest university fundraising effort in Canadian history was declared completed. The Faculty of Medicine raised $230 million, more money than any other university division.

• 449 faculty were journal editors, co-editors, or members of journal editorial boards. • 4,587 separate extramural grants were held by faculty members

The research enterprise benefits from significant campus-hospital collaboration and harmony of research policies. New virtual structures such as the McLaughlin Centre for Molecular Medicine and the Toronto Centre for Modeling Human Disease have created innovative platforms for collaboration. The campus-based component of the Faculty currently occupies 11 buildings. New space includes: 500 University Avenue, now the home of the Rehabilitation sector; the former Board of Education building (155 College), recently purchased to be the future home of the Departments of Public Health Science, Health Policy and Management Evaluation and Family and Community Medicine, as well as the Faculty of Nursing; and the CCBR (Centre for Cellular and Biomolecular Research) a $100M project to be completed in the spring of 2005, adding 10,000 nasms to the Faculty space inventory. Renovation projects have been completed in the Medical Sciences Building, the Best Institute, and the Fitzgerald Building, and are underway in the Banting Institute. The Faculty continues to benefit from philanthropic support. There are 47 University-based endowed chairs and 89 hospital-based endowed chairs currently in place, and the number grows every month. The McLaughlin Foundation has provided $50 million to launch the R. Samuel McLaughlin Centre for Molecular Medicine. Moreover, the Faculty has received generous support from benefactors to establish various professorships, graduate student awards, research trust funds, and a range of scholarships for students in professional programs. The new UToronto Medicine magazine, launched in 2003, provides an important vehicle for communications both internally and to the broader stakeholder community. The governance of the Faculty of Medicine, with respect to all academic matters, resides with the Faculty Council under the authority of the Governing Council of the University. The Constitution and By-Laws of the Faculty were revised by Faculty Council in January 2004. The Dean is ultimately responsible for the administration and management of the Faculty and its budget, with appropriate authority delegated to the Vice-Dean, Research, the four Associate Deans with educational portfolios, and the Associate Dean, Clinical Affairs. The Council of Education Deans, formed in early 2000, includes the four Associate Deans who have responsibility for education programs; it provides advice to the Dean in all matters relating to education and plays a major role in ensuring inter-portfolio synergy to support the Faculty’s educational mission and goals. The relationship of the Faculty with the teaching hospitals is truly outstanding, and it continues to evolve in highly positive directions. Two key multi-institutional committees have senior membership from the Faculty and the hospitals. Formerly and still widely-known as TAHSC, the Toronto Academic Health Science Council draws together chief executives from the fully-affiliated hospitals and members of the senior leadership team of the University/Faculty of Medicine. Recently, TAHSC has agreed to evolve into a more formalized network structure, with integration of various functions, as will be outlined below. Its new acronym will be TAHSN, with Network replacing Council. The second key committee is HUEC, the Hospital University Education Committee. TAHSN and HUEC facilitate cohesion, cooperation and harmonization of purpose. Despite recurrent budget cuts and reductions in the University pay-out on endowments, the Faculty has maintained a solid financial record and has the largest carry-forward of any University division.


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The Faculty is fully prepared to serve as a beta test site for aspects of the new budgetary dispensation. We are skeptical about models that impose onerous transaction costs on all parties, but believe that enhanced fairness and meaningful savings may be achievable through a devolved budgetary model that shares both revenues and costs on a fuller and more transparent basis between divisions and the Central Administration.

Nonetheless, budgetary pressures are mounting. The Faculty is therefore examining strategies such as running temporary negative appropriations against its continuously-mounting carry-forward as a way of cushioning the pace, depth, and impact of budget cuts. Furthermore, growth in the Faculty’s budget has not kept pace with growth in the overall University budget. At the same time, Medicine has seen definite growth in the numbers of students enrolled and full-course equivalents taught by its appointees, substantial growth in the numbers of faculty, and dramatic increases in research funding. The net base operating budget for 2003-04 was $60.0 million, after eliminating new transfers earmarked for student aid and graduate stipends. One of biggest challenges for the Faculty over the next several years relates to the need for improved budgetary models externally and internally. The Faculty has strongly supported the University’s gradual move toward more decentralized and transparent budgetary strategies. We accept that Faculties currently enjoying more advantageous financial circumstances should contribute to the support of other divisions that are deemed essential to our mission as a public university. However, the Faculty’s leadership team is very concerned about two aspects of the current budget model. The first is the implicit assumption of indefinite and non-transparent entitlement to subsidy on the part of those academic divisions of the University that are not self-sufficient. The second is the level of “taxation” in current revenue-sharing arrangements. As one example, it is increasingly difficult for us to justify to our MD students why the University centrally retains 25% of the $21,000 in new BIU revenue for new students, or 25% of the $18,000 MD tuition after the 30% holdback for student aid. The marginal costs to the Central Administration from enrolment growth in the MD program have been minimal. Indeed, if central costs for students had risen in lockstep with the hectic tuition increases that MD students have faced, then the entire University would long since have slid into receivership. Similarly, we have trouble understanding the downloading of operating costs of new space to divisions even as the Central Administration taxes tuitions and BIU revenue, and withholds 75% of federal research overhead revenue. We believe that a more agile and open budget model will help the University to adapt to the current constrained funding climate. And we also accept that any changes in the external model must be mirrored by re-alignment of incentives and costs inside the division.

3 Faculty Achievements 2000 – 2004 The Faculty of Medicine’s Strategic Directions and Academic Plan, 2000 created a new vision and charted an ambitious path to strengthen our position as one of the leading health education and research groupings in the world. In only a few years, the Faculty has realized tremendous gains in many areas, setting a strong foundation for continued advancement. Fostered creativity and collaboration in our research enterprise

66 % growth in research funding over 4 years ending 2002-03 New or expanded Research Centres:

o Centre for Cellular and Biomolecular Research launched o Structural Genomics Consortium launched in partnership

with Oxford University o Toronto Centre for Comparative Models of Human Disease


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established o Wilson Centre for Research in Education expanded o R. Samuel McLaughlin Centre for Molecular Medicine

launched and extended to additional hospitals o University of Toronto Centre for the Study of Pain

successfully launched o 2 CIHR Institute offices established in the Faculty of

Medicine, with professors of the Faculty of Medicine as Institute directors

New collaborative institutes/centres established: o Institute for Drug Research o Centre for International Health o International Centre for Disability and Rehabilitation o Centre for Global e-Health Innovation o The Heart and Stroke/Richard Lewar Centre of Excellence

for Cardiovascular Research Centre for Research in Women’s Health formally structured as

an extra-departmental unit Initiated the Knowledge Translation Program Harmonized research policies across the Toronto Academic

Health Science community 90 Canada Research Chairs; many new endowed chairs and

professorships to attract and retain leading scientists;

Strategically expanded and enhanced our educational programs

Enrolment increase and curricular enhancements in Undergraduate Medical Education

New professional masters programs in OT and PT and enrolment growth in Speech-Language Pathology PhD program

New PhD program in Clinical Epidemiology Professional MHSc in Bioethics IMS launched U of T/Sheridan College Combined Program in 3-

D Biomedical Animation Interdepartmental Unit in Critical Care established under the

auspices of the Departments of Surgery, Medicine, Paediatrics, and Anaesthesia

Planning underway for new programs Masters of Public Health Science, Masters of Health Professions Education (jointly with OISE/UT)

14 CIHR Training Grant Programs Leveraged new thematic science to create new collaborative and interdisciplinary programs

New collaborative graduate programs successfully established: o Proteomics and bioinformatics o Molecular Medicine o Health Care, Technology and Place o Biomolecular Structure o Health Services and Policy Research (in development)

Introduced inter-professional education module through the Centre for Study of Pain

Multidisciplinary Pelvic Health Centre established between Urology, Surgery, Psychiatry, Pathology, Obstetrics & Gynecology and Pain


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Strengthened our partnerships with affiliated hospitals

Toronto Academic Health Sciences Council (TAHSC) evolved into the Toronto Academic Health Science Network (TAHSN) with formalization of joint planning for clinical programs, integration of back office functions in the works, and agreement on the creation of an academic oversight council.

Established the Hospital University Education Committee (HUEC) and HUEC – Rehabilitation subcommittee to jointly address improvements in clinical training and education

Established TAHSC Research Committee with representatives of University and Hospital Research Institutes

Growing numbers of campus-hospital collaborative CFI awards Outlined new strategies to strengthen relationships with the

Community Affiliated Teaching Hospitals and other community –based education partner organizations

Launched new initiatives to champion and support our faculty

Established a Centre for Faculty Development as a partnership with St. Michael’s Hospital

New Dean’s Fund for Excellence in Education has awarded funds of $597,031 to 41 projects over 3 years 2001/02 to 2003/04, seeding innovation in all aspects of clinical education.

Facilitated Phase I AFP funding of $33 million for clinical education

Held the first and second Annual Educational Achievement Day and created new faculty awards to recognize outstanding contributions to education

Moved forward new typology and dispensation for Clinical Faculty

Initiated new faculty orientation sessions and grant writing workshops

Created new Associate Dean, Clinical Affairs position to work with clinical faculty and teaching hospitals on issues such as AFPs and licensure/certification challenges

Strengthened staff support and infrastructure renewal

Administrative Staff Modest overall increase in administrative staff with expansion of

programs as per the agreed Strategic Directions of the Faculty in 2000

Consolidation and streamlining of business support functions across a number of departments

Established central Business Officer to support departmental business units

Facilities / Space

New state-of-the-art facilities – 500 University Ave as the Rehabilitation Sciences headquarters (Centre for Function and Well-Being)

CCBR under construction on time and on budget Newly-renovated space in the Medical Sciences Building for the

Office of Student Affairs, Research Office and the Stone Lobby Centre for Research in Neurodegenerative Diseases renovated 155 College Street secured as future space for HPME, PHS,


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DFCM and Faculty of Nursing Major renovations completed for Best Institute and underway

for Banting Institute Collaboration with UHN and MSH on new office space for

academic departments (Medicine, Otolaryngology, OVS) Renovations completed in the Fitzgerald Building for the Heart

and Stroke Richard Lewar Centre Other

Web-based Registration and Evaluation systems implemented for PGME with access by trainees, departments, hospitals and licensing bodies

Novel UME Database (MedSIS) implemented to manage admissions, general administration and student, faculty and course evaluation

Upgrading of educational computing New websites for FOM Research Office and for Graduate

Studies Office Medstore opened with streamlined processes to acquire selected

laboratory inventory items for researchers; now yields a small operating surplus instead of major annual losses

Development/ Advancement

Faculty receives more than $230 million of the $1 billion accrued during U of T’s Campaign

New Faculty magazine UToronto Medicine introduced; MAA Matters overhauled in partnership with the Medical Alumni Association; other communication vehicles enhanced.

Achievement of excellence recognized

Several members of faculty named to Canada’s Top 40 under 40; faculty members win the Killam Prize, two of six Steacie Fellowships, and a variety of other prestigious national and international awards

20 members of the Faculty have received Order of Canada appointments since January 2000

Three Canadian Medical Hall of Fame inductees and two posthumous inductees

Seven Faculty members with primary appointments and two with cross-appointments recently named as University Professors, U of T’s highest internal honour to recognize “unusual scholarly achievement and pre-eminence in a particular field of knowledge”.

The Faculty of Medicine can be proud of the many successes of the past four or so years since completing our 2000 planning process. We have built a solid foundation to move forward into the next planning cycle, advancing the themes of excellence, stabilization and innovation.


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4 Looking Ahead – The Changing Landscape “Our three greatest challenges in the next years arguably lie in the changing intellectual landscape, in our development of academic practices and academic support that enable us to emerge as intellectual leaders in that landscape, and in our reconfiguration of our internal and external relations in response to the intellectual landscape.”1 The intellectual landscape in human health and disease has been changing dramatically. The biological, clinical, natural, information, and social sciences are all converging around the challenges and opportunities presented by human health and the eradication of disease. Over the next several years, our directions will be shaped by: Advancing Biomedical Science and Health Research The sequencing of the human genome has opened up new avenues of fundamental and applied bioscientific research. Functional genomics and the study of proteins encoded by genes, or proteomics, have together catalyzed the convergence of many disciplines around human and non-human biological investigation. Nano-scale biotechnologies and tissue engineering techniques have added further momentum to the scientific enterprise. It is now commonplace for computer scientists, chemists, engineers, botanists and zoologists, and biomedical scientists to collaborate in a wide variety of projects. New imaging modalities are allowing more precise and less invasive methods of assessing disease states and such natural processes as aging. The management of chronic illness will be transformed by advances in regenerative medicine, tissue engineering, and rehabilitation sciences. Fortunately, funding for medical research has significantly increased of the past four years. The Faculty has benefited from the continuation of national and provincial infrastructure programs (CFI and OIT), the inception of the CRC program, the emergence of Genome Canada and its provincial counterpart (OGI), and other new provincial funding programs (ORDCF and PREA). Funding for indirect costs of research has been introduced at the national level in association with federal grants, albeit in a program that is profoundly disadvantageous to the University of Toronto as compared to sister institutions that have smaller funding envelopes. Furthermore, the province also provides overhead on its research funds through the Research Performance Fund. A Rapidly Shrinking Planet International research collaborations, with electronic or long-distance communication and virtual research groups, are flourishing in many areas. Escalating global travel and the worldwide movement of goods and services have increased the opportunities for rapid spread of diseases as evidenced by infectious threats such as SARS and West Nile. Over 30 new infectious diseases have emerged in the last two decades, most from animal sources because of human encroachment on natural habitats and/or consumption of wild animals as exotic foodstuffs. The field of international health or global health outreach has become increasingly important, both as a moral imperative given our relatively privileged circumstances, and as a remarkable learning opportunity for students and faculty alike. It has been argued that investments in global outreach can help build capacity to stop or at least detect the next emerging infectious disease before it spreads around the planet. Some contend that building up the public health and healthcare systems of

1 Stepping Up. A Framework for Academic Planning at the University of Toronto: 2004-2010.


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developing nations is also a way to enhance global security by promoting social stability in those nations, while others have suggested that a coordinated global public health system can help combat bioterrorism at home and abroad. Society’s Changing Needs Significant public health events, including SARS, West Nile virus and contaminated water in Walkerton, Ontario, have led to the call for renewal of Public Health in Canada and across provincial and municipal jurisdictions2. There is a growing emphasis on governance, accountability and performance measurement across all our health systems, as well as education and research enterprises. Raised sensitivity to quality and patient safety, is spurring significant multi-disciplinary approaches to address patient safety. The very high functional performance expectations of the aging baby boomers, the rising prevalence of chronic diseases as a result of the success of biomedicine (people living longer sicker, and therefore needing and expecting more rehabilitation), and of course the impact of demographic shifts with an aging population have caused an explosion of interest in rehabilitation. We anticipate not only an increased demand for rehabilitation services, but also positive convergence around rehabilitation themes as discoveries in neuroscience, tissue engineering, and nano-biotechnology all lead to new rehabilitation modalities.

Changing Dynamics for Knowledge and Education Knowledge translation has joined the creation of new knowledge through discovery as a major focus in the Faculty. This reflects a shift from a narrow focus on undergraduate, graduate or postgraduate teaching, to a broader social focus on life-long learning opportunities. As well, new technologies have opened up new approaches to education and learning. We are seeing more experimentation with web-based curriculum supports, more sophisticated use of audiovisual technology, and a massive growth in simulation technology. With technology advancing, the organizational complexities in health care have never been more apparent. The continuing emphasis on community- and home-based services, concerns about the costs of tertiary care, shortfalls in the supply of health professionals in various disciplines, and renewed emphasis on teamwork in primary and hospital care settings, have all galvanized the Faculty to examine new teaching sites, new training models, and new inter-professional educational initiatives. Adapting to the Changing Landscape The Faculty of Medicine has continually evolved its research directions and educational programs in ways that are highly sensitive and responsive to the landscape around it. The following illustrates only a few such initiatives. New groundbreaking initiatives, such as the Centre for Cellular and Biomolecular Research, will support scientists exploring the functional expression of genes at the cellular, organ system and whole animal levels, creating new knowledge that will revolutionize medical science. The Toronto Centre for Comparative Models of Human Disease at Mount Sinai Hospital will create and image thousands

2 Learning from SARS: Renewal of Public Health in Canada, A Report of the National Advisory Committee on SARS and Public Health, Health Canada, October 2003.


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of genetically engineered mouse phenotypes. It is simply unique on the planet at the present time, and represents a remarkable convergence of the world-leading capabilities that our faculty members bring to murine genetic engineering and sophisticated bio-imaging technology. The Structural Genomics Consortium is the analogue of the Human Genome Project, but for proteins, not genes. The SGC will characterize the structure of hundreds of proteins involved in human disease. Nearby, the Medical and Related Sciences (MaRS) project will support technology transfer and biotech incubation. Discussions are actively underway about strengthening the technology transfer activities on a conjoint basis across the hospitals and the Faculty. Moreover, the Faculty of Medicine and University Research Office joined forces years ago with several teaching hospitals (Mount Sinai, St. Michael’s, Sunnybrook and Women's College, The Hospital for Sick Children and the University Health Network) to launch the Toronto Biotechnology Incubator. This concept has since grown to include the Centre for Addiction and Mental Health, the City of Toronto, and the federal and provincial governments as partners in a comprehensive Toronto Biotechnology Commercialization Centre within the MaRS complex. The MaRS initiative more generally will help research in the Faculty move through the cycle from basic science to health-enhancing and wealth-creating products. The teaching hospitals have always been hotbeds of transdisciplinary research. Researchers in the hospital institutes are organized in clusters around issues or themes, without regard for traditional academic departmental affiliations or disciplinary boundaries. Space does not permit even a minimal list of the activities underway at Toronto’s great teaching hospitals; but a few examples may illustrate how appointees in the Faculty based at these partner institutions are responding to changes in the intellectual landscape. Recently, Prof. Peter Hyslop, the director of the Tanz Centre for the Study of Neurodegenerative Diseases on campus, has assumed the directorship of research at the Toronto Western Research Institute of the University Health Network. This has created an important bridge between a major campus centre and a renowned hospital-based research initiative. The research institutes in the UHN family have drawn massive support from the Canada Foundation for Innovation for initiatives ranging from immune tolerance in transplantation to e-health innovation, and from genomic instability in relation to cancer cell survival to cutting-edge technology platforms for targeted radiation therapy. St. Michael’s Hospital is moving forward with an ambitious plan to develop the Keenan Research Institute, a multi-storey research tower that will be the home for bench and translational researchers based at SMH. SMH continues to draw international attention for its cutting-edge work in areas as diverse as Inner City Health, gene therapy of cardiovascular diseases, novel forms of assisted ventilation for critically ill patients, and HIV/AIDS control in India and Africa. The Toronto General site of UHN will soon open a massive new research tower. Three floors will be occupied by researchers from the Hospital for Sick Children, pending the redevelopment of their own research space. Sick Kids, meanwhile, retains an enviable reputation as one of the top three children’s hospitals in the world, bolstered in large measure by the spectacular performance of the HSC Research Institute. Mount Sinai’s novel ‘mouse hospital’ has already been described. Researchers on the clinical staff of MSH and in the Samuel Lunenfeld Research Institute remain among the most heavily cited scientists in the city and the country, in areas ranging from health services research and genetic epidemiology to cell signaling systems. In October 2000 the Toronto Rehabilitation Institute announced a new $24 million commitment to develop rehabilitation research as a provincial resource, and has since gone on to develop a successful CFI application in collaboration with the Rehabilitation Sector of the Faculty of Medicine. Researchers at Sunnybrook&Women’s continue to lead the world in various areas of cell biology and imaging, and a major CFI grant was awarded in 2000 to the hospital for construction of a new data warehouse for its renowned Institute for Clinical Evaluative Sciences. The Centre for Addiction and Mental Health, a WHO Collaborating Centres, does research ranging from molecular and genetic aspects of major psychoses to sociocultural dimensions of mental


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illness, and from clinical trials of psychopharmaceuticals to mental health services research. Baycrest’s Rotman Research Institute recently underwent an external review by a distinguished international panel that placed it among the top handful of centres of neurocognitive research in the world. Bloorview MacMillan Children’s Centre has just opened its own Bloorview Research Institute, an exciting enterprise catalyzed by a $25M endowment from the Bloorview Children’s Hospital Foundation. The Bloorview Research Institute will focus on helping children with disabilities achieve their maximum potential. It offers tremendous synergy with the rehabilitation sciences sector and biomedical engineering. New trans-disciplinary collaborative graduate level programs have been introduced to align with emerging research foci, such as Proteomics and Bioinformatics, Molecular Medicine, Health Care, Technology and Place and Biomolecular Structure. New undergraduate programs are being implemented as well, e.g., Specialist Program in Bioinformatics and Computational Biology. All these programs involve professors from the campus and the hospital research institutes; indeed, our various educational programs seamlessly link colleagues at more than twenty different sites across Toronto. The Faculty has become increasingly active in the global health sphere with the Centre for International Health and a variety of sister centres at hospitals (the Centre for Global Health and Development at St. Michael’s Hospital, the Peter and Isabel Silverman Centre International Health at Mount Sinai Hospital). The Surgical Skills Centre is already established as an international leader in surgical education, but further investment is needed to consolidate its gains. The SSC has always been a multidisciplinary unit, with a focus on student and resident teaching across a multitude of departments and programs. It is a test-bed for simulation technology, and has made major strides in developing novel ways of assessing and enhancing surgical competence. More and more of its initiatives are aimed at the training and continuing professional development of specialists, as well as better understanding what models of training best enhance the safe diffusion of new surgical techniques. In sum, the Faculty of Medicine is superbly positioned for continued leadership in charting and understanding the new intellectual landscapes of biomedicine and health. We are helping to shape these landscapes in our own right through discoveries and innovations in education, assessment, and knowledge translation. And we are fully confident that the Faculty will continue to adapt its academic practices and programs effectively to strengthen our leadership role for the remainder of this first decade in the new millennium.

5 Faculty of Medicine Goals and Objectives 2004 – 2010 The Faculty of Medicine Goals of the 2000 Academic Plan were intended to guide the Faculty in the long-term. These goals align well with the Stepping Up priorities and remain relevant for the next planning cycle. (see Appendix II for full list of goals). The goals emphasize:

• Preparing academic leaders

• Developing or sustaining programs that build on the research-intensive focus of the Faculty


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• Recruiting the most promising students and trainees, with funding at a level that is competitive with peer institutions.

• Ensuring a supportive environment, with counseling services (career, financial and

personal) and mentorship for all students, trainees and PDFs

• Keeping pace with instructional technology and communications technology

• Supporting our faculty colleagues in efforts to attract research funding and to produce significant research.

• Partnering with the fully-affiliated teaching hospitals and their research institutes

• Promoting multi-, inter- and trans- disciplinary education and research

• Recruiting leading scholars from Canada and around the world to our faculty

• Building strong relationships with organizations on campus, locally, provincially, nationally and internationally, public and private

• Attracting philanthropic funding through a comprehensive development strategy

• Ensuring ongoing enhancement of the space and infrastructure for the Faculty on campus The following 12 objectives will focus the Faculty’s efforts over the next five years. These objectives have been shaped by the changing landscape (described earlier), our Strengths, Weaknesses, Opportunities and Threats analysis (Appendix III), and by the Faculty-wide priorities identified through inter-sectoral discussions. These objectives should take the Faculty through its next stage of development. Our focus will be on formalizing new initiatives, strengthening our partnerships (including more outreach to community hospital partners), streamlining and consolidating rapidly-growing programs and units, pressing forward on infrastructure improvements, and benchmarking our educational and research performance in a more systematic way.

Objectives for 2004 - 2010

1. Advance our scientific and professional training platform for the 21st century

Securing our future as an international leader in education compels our Faculty to: a) strategically leverage newly created programs such as proteomics and bioinformatics, the Program in Bioethics, and new collaborative programs; b) capitalize on national attention and capacity-building needs of areas such as Public Health and bioinformatics and our expanding role in global health; and c) exploit emerging competencies in knowledge translation, innovative simulation tools, and inter-professional education, to name a few. We need to prioritize and focus on the programs that will best prepare future leaders in research and education, consistent with the Faculty’s vision statement.


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2. Complete the redevelopment of space for three campus-based sectors3

The current capital projects at CCBR and 500 University require funding to reduce debt and/or help manage new operating costs. The new project at 155 College Street will address much-needed space for the Community Health sector and Family and Community Medicine; again, however, there are capital costs and operating costs to be supported. As a consequence of the spring 2005 movement of faculty and staff from the MSB to the CCBR, there will be an opportunity to redesign and rejuvenate the space of the MSB. We anticipate some regrouping of faculty around new research nodes and a general renewal of the research infrastructure in the MSB to complement the thematic research approach and quality of space of the CCBR. We believe that some comparability of research space and infrastructure across the campus component of the Basic Sciences sector (i.e. the Best Institute, CCBR, and the MSB) is important for reasons of morale, recruitment, retention, and productivity.

3. Create collaborative and common science platforms across the Toronto academic health sciences enterprise The Toronto Academic Health Sciences enterprise includes a massive array of overlapping research activity across the campus and in nine fully-affiliated hospitals and their research institutes. This research powerhouse could achieve even greater impact if we had more sharing of infrastructure, info-structure, and support services, along with agreement on several distinct science platforms that could cut across the campus and multiple institutions. Just as TAHSN is establishing clinical centres of excellence to permit the rationalization of clinical services across sites, so also must we seek to rationalize research activities across the academic health science complex. The Faculty’s leadership team will place a high priority on more joint planning of research platforms and infra-structure in the years ahead.

4. Significantly augment student aid for professional students and stabilize and

enhance graduate student funding The Faculty must continue to ensure that medical student tuition fee dollars flow back to the Faculty for medical student education and financial aid plans. Following a review of student aid programs, new processes are to be implemented that will reorganize and increase MD student access to the aid dollars generated by hold-backs on their tuition fees. As for graduate students, their funding is not uniform across the Faculty and does not take into account the high cost-of-living in Toronto. Improved funding to graduate students is required to ensure competitiveness with stipends offered by other universities. Student aid must also be enhanced for professional masters programs and for emerging needs in programs such as medical radiation sciences4.

5. Support the integration of clinical faculty into more joint enterprises across sites

The clinical Deans and clinical Department Chairs have pressed strongly for more consistency and integration of practice plans across sites. As the Ministry of Health moves from Phase I AFP funding to a more comprehensive set of financial arrangements, it is crucial that the Faculty work actively with clinical chiefs, AFP leaders, and hospital executives to create more horizontal governance structures. These structures may offer economies of scope and scale in managing clinical revenues, should facilitate inter-site movement of physicians as clinical rationalization continues, and will help align University and hospital objectives. One advantage of a University of Toronto medical staff organization is the creation of a clearinghouse for pensions, benefits, and

3 See AIF Requests – Section 6. 4 See AIF Rquests – Section 6.


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financial advice. Last, as part of the evolution of TAHSN, we need to carry on with the close involvement of clinical Department Chairs in the rationalization of clinical services across the fully-affiliated teaching hospitals and the partly-affiliated hospital sites.

6. Implement University policies and procedures for clinical faculty and extend these

policies in some form to all status-only faculty The 2002 Task Force on Clinical Faculty recommended a number of policy changes for clinical faculty. Important steps were taken at Academic Board and Governing Council in the Spring of 2004 to address and definitively resolve the status of clinical faculty. The Faculty’s leadership team views it as a very high priority to implement these policies. Along with moving the clinical faculty policies forward in 2004-05, the Faculty has placed a high priority on addressing the situation for other full-time and part-time status-only faculty (e.g. scientists, other professionals). We envisage some parallels to the mechanisms set up for clinical faculty under the proposed policies, although there must be due respect for the employment status of these individuals.

7. Better integrate the community affiliated teaching hospitals and other community-

based teaching and practice sites into the education and research enterprise The 2004 Report of the Task Force on Partially Affiliated Hospitals and Related Health Care Organizations made a number of recommendations to strengthen the relationship between the Faculty and the community affiliated teaching organizations to achieve significantly greater participation and contribution to the shared missions of teaching and research. Over the next 2-3 years, the Faculty must operationalize these recommendations; the development of ‘Local Health Networks’ (regional coordinating structures involving hospitals of all types and community service agencies) by the Ministry of Health and Long-term Care may facilitate the process of partnership-building.

8. Realign the governance and organization of extra-departmental centres, academic

units and collaborative programs within the overall organizational structure of the Faculty Over the past five years, the Faculty has aimed to re-engage Department Chairs in the governance of non-departmental entities, while reducing direct reporting to the Dean’s Office. We have supported the alignment of specific centres with the interests of specific hospital partners, and not formalized Extra-Departmental Units until and unless a clear case for multi-departmental or multi-divisional research and teaching activity has been made. Nonetheless, the integration and accountabilities of various centres, institutes, units, and collaborative programs within the Faculty organization requires attention in this planning cycle.

9. Rationalize the budgetary model between the University and Faculty of Medicine to

ensure better alignment between revenue and responsibilities As noted, the Faculty’s base budget has risen little even as the University’s overall budget has grown dramatically. The failure of our budget to keep pace with divisional revenues must be addressed through the adoption of transparent new budget models that align revenues and costs/responsibilities more fairly. The Budget Task Force chaired by Vice Provost Safwat Zaky offers a welcome opportunity for progress along these lines. Implementation of any new model, however, will be a major challenge in the next planning cycle.


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10. Enhance information technology and communications capability of the Faculty5

Enhancements to information technology are a critical component of the next planning cycle. The Faculty exists on more than 30 separate institutional sites. We have not fully capitalized on advances in information technology to create a more cohesive academic enterprise. A Faculty-TAHSN Task Force chaired by Prof. William Sibbald is currently examining a common CV and credentialing system for clinical faculty. Furthermore, the Toronto Academic Health Sciences Network is recruiting an in-common Chief Information Officer for all nine fully-affiliated teaching hospitals. In the first AIF round, we seek support for planning and limited implementation of videoconferencing and information management capacity. Thereafter, in partnership with TAHSN, we shall move towards a comprehensive solution to strengthen our academic info-structure.

11. Develop benchmarking and performance measurement capability across the Faculty6 The University of Toronto is committed to firm evidence on performance and, where possible, understanding how our performance compares with that of peer institutions. Indeed, this has been identified as a priority in the Stepping Up framework. The self-study by various Departments and non-departmental units has demonstrated how difficult it is to acquire consistent and comparative data that reflect meaningful dimensions of performance. Data from the office of the Vice President – Research have been illuminating, but are at a high level of generality. The Faculty is committed to pursuing a comprehensive and rigorous approach to benchmarking and performance measurement during this planning cycle.

12. Develop a new Internal Budgetary Model.

As the University’s budgetary model evolves, so must the Faculty’s internal budgetary framework. We believe that Departments, Units, Centres, and Programs should seek to enhance their revenues through initiatives consistent with academic objectives, striking a balance between revenue opportunities from government and non-governmental sources, the University’s broad mission, the Faculty’s own goals and objectives, and the specific goals and objectives of the relevant organizational unit. To this end, we anticipate developing an internal budgetary model that allows major flow-through of revenues to the originating units, with retention of some divisional seed funding so that other units can capitalize on available opportunities.

These priority objectives will guide the Faculty’s energy and attention over the next planning cycle. Some will require persistent effort over several years to attain, building on the current strong foundation of achievements over the past several years.

6 Academic Incentive Fund Requests The Faculty of Medicine will bring forward a number of important capital and operating requests for the AIF for Fall 2004, and is developing a queue of other requests for 2005 and 2006.

5 See AIF Requests – Section 6. 6 See AIF Requests – Section 6.


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The following 22 AIF requests have been selected from an impressive response to a call for letters of intent in May 2004 and subsequent review by the Education and Research Deans in June 2004. The total call yielded 55 submissions, for a total of $6 million in base and $30 million in OTO funding. This stands against the 6 year cumulative availability of up to $30 million in base funding through the AIF, or up to $105 million in OTO in the absence of recurring base draws on the AIF. Some submissions were set aside as appropriate for other sources of funding. Many were deferred for further development and review on a ‘no-promises’ basis. Some were given a strong signal that they could be prioritized in an ensuing round of submissions if they were developed appropriately. Others were invited forward with specified revisions, including some bundling of multiple submissions. For those invited forward, we suggested major budgetary reductions and deferrals past 2005 as well as shifts to OTO from base funding to converse AIF spending room. We supported single-department proposals only if the pay-offs were particularly clear or the capacity-building implications were self-evident. We specified in all instances that divisional sponsorship was contingent on further review of the proposals in the early fall; thus, it is possible that some of the anticipated proposals may be turned back for revision and not be submitted in the fall of 2004. In determining which proposals should go forward to the Provost, we considered the Provost’s criteria:

• Enhancing the student experience at the University • Enhancing the interdisciplinary, interdepartmental, interdivisional and cross campus

collaboration • Bringing together undergraduate and graduate opportunities with research opportunities • Connecting the university in the broader community in terms of public policy and outreach • Improving equity and diversity • Improving efficiency by generating new revenues or reducing program delivery costs

Individually and collectively the following submissions meet the above criteria and are also expected to advance the vision, goals and objectives of the Faculty of Medicine. The proposals are diverse and innovative. Some represent seed funding for new initiatives while others seek base funding and/or OTO funding to stabilize and further develop initiatives that may have been funded through previous APF opportunities. Others again aim to reduce indebtedness related to capital redevelopment. While most of the proposals have multiple objectives, we have grouped them in the following categories:

A. Advancing innovative scientific research and educational platforms B. Enhancing teaching effectiveness and program development C. Initiatives to support students D. Capital developments and operating infrastructure E. Information systems and communications

A. Advancing innovative scientific research and educational platforms Advancing the Centre for Cellular and Biomolecular Research AIF funding will be requested to support base and OTO funding for the new Centre for Cellular and Biomolecular Research. This request builds on the 2000 APF request for funding for two key leadership positions for the Centre. The inaugural director of the Centre, Professor Brenda Andrews has been appointed and assumes the position July 1, 2004. Although the physical structure will not open until summer of 2005, some recruitment should ideally begin now in anticipation of deferred arrivals of new faculty.


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The CCBR has as its fundamental mandate the enhancement of interdisciplinary, interdepartmental and interdivisional interactions, creating a research environment that encourages the integration of biology, computer science, mathematics, engineering and chemistry and that spans leading areas of biomedical research that have now been redefined as three broad platforms: Integrative Biology; Bioengineering & Functional Imaging; and Models of Disease. The CCBR has served as a magnet for attracting new funds to the University through the CFI, OIT and private donations. It represents a tremendous opportunity to generate new revenues and to enhance program delivery across many departments at the University. AIF base funding is requested to support faculty recruitment, ensuring highly competitive packages to recruit the very best. This proposal builds on current commitments to the Director of the CCBR to allow recruitment of new faculty and to help establish CCBR-associated research and teaching programs. Several new positions have been created to allow targeted recruitment of new faculty in areas of strategic importance for the success of the CCBR. Given the very high salaries commanded by bioinformaticians in the academic market today, we propose to augment the remaining allocation for recruitment through the APF-funded Proteomics & Bioinformatics program, which will now be run by the CCBR Director. A pool of OTO funds to help assemble competitive start-up packages is also requested. The AIF request will be for $175,000 in base funding to augment salaries for five scientists and OTO funding of $100,000 per annum for five years to assist with start-up packages for new researchers. The base funding would be drawn over approximately 3 years as recruitment proceeds. The OTO funding, as noted, is spread over 5 years. Centre for International Health HIV/AIDS Initiative for Africa A request for OTO funds will be made to support U of T’s Centre for International Health HIV/AIDS Initiative, a collaboration of the University’s leadership in research, education and service with African and other partners to address and control the HIV/AIDS epidemic. The initiative was conceived in June 2002 and was launched in October 2003. The intent is to unite the Faculty of Medicine with many other disciplines at the U of T and its global health leadership in a collaborative strategy against the HIV/AIDS pandemic. The goal of the initiative is to develop and sustain innovative health care strategies that will impact public health care systems, community hospitals and centres, communities, families and persons living with HIV/AIDS. The U of T is uniquely positioned to develop intervention research and in so doing contribute to methodical and sustainable improvements in health care provision. This proposal provides a critical opportunity for the University of Toronto to establish a base for health research and education in Africa. The University of Manitoba has long enjoyed a competitive advantage because of its operations headquartered from Nairobi, Kenya (see, for example, J. Beatty, IDRC Rep. 1994 Oct;22(3):24-5). To continue to be competitive in global HIV/AIDs research and education across Africa, and to help stem a health crisis of disastrous proportions, we believe that U of T must move quickly on this initiative. OTO funds of $300,000 will be requested to support the start-up of several research initiatives in these areas. Additional funding support will be sought from Health Canada, CIDA, CIHR, IDRC, Global Fund, Bill and Melinda Gates Foundation, World Bank and private and corporate donors.


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Knowledge Translation Research and Development A request for base and OTO funding will come forward for the Knowledge Translation Program, building on the tremendous start of the program with the APF that was awarded in 2000. This proposal will ‘grow’ the platform for KT research and development at the University of Toronto - building on its strengths in continuing education, health services research and KT. Our aim is for U of T to be the internationally-acknowledged leader in KT research, training and transformative practice. The proposal will focus in four areas: • Clinician-investigators at the Sunnybrook and Women’s College Health Sciences Center to act as

a catalyst for the development of a hospital-based Center for Knowledge Translation, and to extend grant-capture in KT at the hospital level. These individuals will acquire access to hospital databases, link to peripheral hospitals, and develop hospital-wide awareness of KT activities. There will be major leverage through SWCHSC corporately and from clinical practice plans.

• A centrally appointed staff position, to coordinate research and development information flow to all investigators, create research and teaching tools in KT and CE (e.g., in information and communication technology, grant-writing and other developmental purposes), coordinate the development and deployment of graduate studies and other activities in KT, and act as an information broker between and among departments and KT units.

• A patient and public education coordinator to facilitate the translation of research findings and clinical evidence based knowledge into public and patient education. This role will be promotional and development in part - linking with potential partners, funders; extending and increasing reach and developing new delivery methods. This will build on existing activities such as our very successful ‘Mini-Med School’.

We will be seeking $100,000 in base funding for investigator and staff support for the above initiatives as well as OTO funding for two years at $120,000 per annum to stabilize the public education and Faculty KT role, until the latter become self-supporting. B. Enhancing teaching effectiveness and program advancement Expanded Surgical Skills Centre This proposal will seek AIF base funding for professional and support personnel and OTO funding for space redevelopment. The University of Toronto Surgical Skills Centre (SSC) opened in September 1998 and is an internationally recognized leader in the area of technical skills training and assessment. Since its inception, the growth of training through the SSC at all levels of the medical education continuum has been exponential, with programs aimed at undergraduate medical students, postgraduate trainees from the Departments of Surgery, Otolaryngology, Obstetrics and the surgical disciplines as well as ICU, Obstetrics and Gynecology and Otolaryngology. The SSC intends to build on the natural synergies and strengths of the “surgical sector” of the Faculty of Medicine. It will aim to enhance the training and continuing professional development of specialists, as well as deepen our understanding of the models of training that can best enhance safe diffusion of new technologies. To address the issue of enhancing “ex-vivo training” this effort will build on the already existing resources of the SSC and the anesthesia simulators based at U of T. It will be synergistic with at least three other centres of the Faculty, i.e. The Wilson Centre in Research and Education, the Centre for Faculty Development, and the Office of Continuing Education.


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Expansion of the SSC will also be dove-tailed with a wider-ranging initiative for a multi-site Simulation Centre for which planning is currently underway for a 2005 submission.7 The AIF request will be for $100,000 base funding and $500,000 OTO funding to support space redevelopment. The Centre has already secured an additional 4,000 square feet of space at Mount Sinai Hospital, and the hospital is prepared to contribute matching funds to capital redevelopment. Furthermore, the SSC and MSH are successfully pursuing industry partners to support equipment and construction costs. Centre for Faculty Development A request for base funding and OTO funds will come forward to support the enhancement of the Centre for Faculty Development (CFD) in the Faculty of Medicine. The CFD was initiated in October 2002 as a joint venture co-funded by the Faculty of Medicine and St. Michael’s Hospital. Its overarching goal is to assist faculty to achieve their full academic potential, particularly as regards their work as educators and professional role models. As such, the Centre seeks to enhance the recruitment, well-being and retention of our faculty. Key programmatic themes include instructional development, career development, enhancement of inter-professionalism and professionalism, and medical and education leadership. The Centre is well positioned to advance the Stepping Up goals of excellence in teaching, renewed academic leadership, interdisciplinary research and training, national and international reach, benchmarking and innovation. It is also consistent with the Faculty’s strategy of building joint centres with the teaching hospitals, such as the Wilson Centre for Education in Research at UHN, the Centre for Women’s Health Research at Sunnybrook and Women’s College Health Sciences Centre, the Surgical Skills Centre at Mount Sinai, and the Joint Centre for Bioethics involving all TAHSN institutions. The CFD has been supported to date by in kind investments of space from St. Michael’s Hospital and operating funds from SMH and the Dean’s Office. We seeded the initiative while jointly evaluating its effectiveness and usefulness to the Faculty. Based on our exceptionally positive experience to date, the Faculty is ready to lock in the investment and will bring forward an AIF request of $100,000 in OTO funding for business planning and infrastructure and base funding request of $125,000 per annum to support the ongoing operations of the Centre, starting in the academic year 2005-2006. The latter will facilitate continuation of innovative faculty development initiatives such as the successful Teaching Scholars and Master Teacher Programs that have been introduced in partnership with departments in the Faculty. The Centre’s director, Prof. Ivan Silver, is also reaching out to other health science faculties to develop synergistic relationships, particularly in the area of inter-professional education. Centre for Effective Practice The Department of Family and Community Medicine proposes the establishment of a Centre for Effective Practice (CEP) that would be housed within the Department’s new office space at 263 McCaul Street. There is strong government interest in renewal of primary care, and an obvious societal need to ensure that new evidence is translated effectively into the practices of family physicians. The Centre will accordingly capitalize on the Department’s current strengths in ‘best practice research and translation’, and thereby provide an opportunity for branding the DFCM to 7 See description in next section under Potential Future Proposals for Academic Incentive Funding.


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enhance both internal and external recognition. The concept is that the Centre will help to link DFCM with a number of centres and programs across the Faculty, in particular the Wilson Centre for Research and Education, the Knowledge Translation program, departments in the Community Health sector, and the nurse-practitioner program in the Faculty of Nursing. The forthcoming AIF request will be for $250,000 over 3 years as one-time only funding. Master of Public Health Sciences Program A request for OTO funds will be advanced to support the development and implementation of a new Master of Public Health Sciences Program. Currently, Public Health Sciences (PHS) provides Master’s level training in 6 fields: Biostatistics, Community Health & Epidemiology, Health Promotion, Community Nutrition, Occupational & Environmental Health, and Family & Community Medicine. There is a strong provincial and national focus on public health at present. A new program with several new fields will be developed, in collaboration with the Faculty of Nursing, multiple clinical and basic science departments in the Faculty of Medicine, and the Centre for International Health. These new fields will include: Public Health Nursing, Infection Control, and Global/International Health. A special self-funding field will also be developed in Wound Prevention and Care, given existing strengths and a demonstrated ‘market’. The Department is proposing to rename the entire Master’s degree program to Master of Public Health Sciences (MPHSc) to consolidate Master’s-level training in public health. (The Dean’s Office understands that this may be revised to MPH given concern in Simcoe Hall about the proliferation of atypical degree monikers.) Application will be made through U of T governance and the Ministry of Colleges and Universities for the new degree with new BIU funding. The forthcoming AIF request will be for OTO of $200,000 over two years for initial program development and implementation support. In addition to curriculum development it is anticipated that this project will require improvement of current technological infrastructure and senior administrative support. We anticipate that this degree can become a revenue source while meeting a major social need. Dissection Based Labs with Dentistry As departments in the Faculty of Medicine have tried to rationalize their expenditures and meet budget cuts, inter-divisional teaching has become a concern. Large-scale teaching in Arts and Science has grown, but smaller inter-professional teaching commitments are being critically re-assessed. One such commitment that has been given priority is Anatomy education for students in the Faculty of Dentistry. A request for base funding of $45,000 will be put forward to support the continued provision of Anatomy laboratory education to students in the Faculty of Dentistry. Funds are required for teaching assistant salaries and for costs associated with the willed body program as well as the preparation of cadavers. Stabilizing interdivisional teaching is important if the University family is to remain cohesive in these difficult budgetary times. This is a relatively small investment to sustain highly valued interdivisional teaching between the Faculty of Medicine and the Faculty of Dentistry.


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Institute of Medical Science The Institute of Medical Science is one of the University’s under-appreciated educational gems. IMS is a unique enterprise that serves as the umbrella graduate department for clinical departments in the Faculty of Medicine. It is also a major catalyst for translational research, drawing together basic and clinical scientists to supervise students with both clinical and non-clinical backgrounds who wish to undertake thesis work that addresses concrete problems in human health and disease. IMS has grown dramatically and its operating budget has not kept pace. An increase in graduate course offerings requires funds for teaching assistantships, plus an operating base budget increase, as follows: 1. Teaching Assistant for “Introduction to Biostatistics and Clinical Epidemiology”. This IMS

graduate course is heavily subscribed by IMS students, and by other Faculty of Medicine graduate units, especially Rehabilitation Sciences where it serves as a biostatistics degree requirement for the MSc research degree.

2. Teaching Assistant for MSC1040H “Physiologic Basis of Disease. This course attracts over 40 students per year from various graduate units.

3. Operating base to address the continued increase in size and complexity provide an unremitting need for increased administrative and academic services.

The AIF request is modest. It will include an increase of base funding of $20,000 per year and an OTO request for one year of $6,000. C. Initiatives for Student Support Summer Research Training for Medical Students A request for base funding will be put forward for the support of summer research programs for medical students. This program will offer MD students a concentrated exposure to research opportunities under the supervision of Faculty of Medicine graduate faculty in the summer between first and second year. Students will also be able to extend their activities into the school year through elective choices. Investing in future clinician-scientist trainees will enhance the quality of students attracted to U of T and is fully aligned with our vision and mission as a medical school. It will improve students’ understanding of career opportunities in medical research, and will strengthen the research culture of the medical school. In the light of past concerns about re-allocation of student aid monies gained from MD tuition holdbacks, this initiative also represents a chance for the University to support MD students in a constructive and novel program. At this time, it is unclear what the uptake will be for this program. At $6,000 per student per summer, we suggest that the program should start with an investment of $60,000 for the summer of 2005 (i.e. supporting 10 students, chosen competitively). The goal will be to assess demand and qualifications, with the potential to build the program to a maximum of 30 medical students per year ($180,000 per year). The request at present is for $60,000 in base funding, with additional funding on an OTO basis downstream. Radiation Oncology Student support This proposal will request one time only funding to establish financial aid to facilitate recruitment of top caliber graduate students to two new programs in Radiation Oncology.


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The Medical Radiation Science Program is the second largest undergraduate professional program in the Faculty of Medicine. As anticipated when the Program was launched, there is interest in and potential for developing a professional Masters in Radiation Therapy as well as an MSc-PhD stream in Radiation Physics. Student debt-load is significant, and appears likely to stand as an obstacle to recruitment into these streams unless some earmarked student aid and graduate stipendiary support can be put in play. We anticipate benefits will include improving the quality of students, enhancing the student experience, increasing the number of students pursuing graduate research training, and improving equity and diversity. This AIF request will be for OTO funding of $75,000 per annum for two years for student aid to help develop and attract interest in the two new graduate streams in Radiation Oncology. We expect to return for additional earmarked funding and/or integration of this funding stream into the broader arrangements for graduate funding once we assess the uptake of the program. D. Capital Developments and Operating Infra-structure i. Operating Infrastructure Institute for Drug Research A request will be coming forward for administrative support for the new Institute for Drug Research (IDR). The Institute was founded in 2002 as a partnership between the Faculty of Medicine (Department of Pharmacology) and the Leslie Dan Faculty of Pharmacy to create an internationally recognized vehicle for interdisciplinary research, education, innovation and communication related to the discovery, development, actions and uses of drugs. The first phase of the IDR involved the provision of APF funding for the recruitment of a Director (Prof. Denis Grant) and several new faculty members into the Department of Pharmacology. The Faculty of Pharmacy committed positions from its complement expansion to match Medicine’s recruitment into the Pharmacology arm of IDR. This first goal is now 80% complete, and will be finished within the next 12 months. The current AIF request seeks both base and OTO funding to support and develop the next phase of development of the IDR. This phase includes implementing administrative and infrastructural support structures to enable specific research foci, educational and training functions, project coordination activities, and marketing and commercialization efforts in drug discovery and development both within the entire University of Toronto community and with industrial collaborators and sponsors. The request will include base funding of $73,000 for an Administrative Officer and OTO funds of $45,000 for four years for an administrative assistant. Pre-grant Award Office Support This proposal will request OTO funds to develop a pre-grant award office designed specifically to support the submission of grants to the National Institutes of Health (NIH). Investigators at the U of T Faculty of Medicine are world leaders in their field and would successfully compete for NIH funds but often do not know that they would be eligible or are unfamiliar with the logistics of submissions to NIH competitions. Recent success in obtaining NIH grants has spurred the interest of many clinical investigators in the Faculty in requesting assistance in applying for these grants.


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It is proposed that a grants officer be hired and trained to support investigators with submissions to the NIH. Over time, this individual may become adept at helping our faculty pursue other international funding opportunities. The office will identify grant opportunities, instruct investigators about the structure and process of submission, and provide the pre-award budget preparation in keeping with the NIH standards and rules. Based out of the Department of Medicine offices, the officer will work with all clinical departments. If the initiative is successful, we may recruit parallel personnel for the Office of the Vice Dean, Research to serve the other three sectors of the Faculty. OTO funds of $78,000 plus benefits for a grants officer for three years will be requested. After start up costs, the office will be supported by the participating clinical Departments using the service and indirect costs derived from grants. Hence, the program will be self supporting. Cardiovascular Sciences Collaborative Program A request will be forthcoming for base funding for an administrative position to advance a national Cardiovasular Sciences Collaborative Program (CSCP). The University of Toronto CSCP builds on the strengths of the participating multidisciplinary academic units, and other agencies, to enhance the visibility of cardiovascular studies and to facilitate collaborative, trans-disciplinary training and research. This program recently received a Northrop Frye Award in recognition of its excellence. The national CSCP program will build on the proven success of the U of T CSCP program while also stabilizing the CSCP locally. It will promote cross-fertilization of expertise, and enhance the learning and teaching environments across all the pillars of the CIHR in cardiovascular sciences across key Canadian institutions. Through an already established fundraising committee, partnerships with national agencies (eg. HSF, CIHR) and industry will be struck to ensure self-funding when this AIF ends. To date, the local CSCP has been totally self-funded through the persistence and networking strength of its Program Director. Under the guidance of the Executive Program Committee, a full-time administrator is critical to coordinate, launch, and oversee the National CSCP operation, including e-based educational activities. Base funding will be requested for approximately $71,000 per annum. Postdoctoral Fellow Support Program Base funding will be requested to provide enhanced support to the postdoctoral fellowship program. Currently, there are 1,287 postdoctoral fellows linked to Faculty of Medicine, both campus-based and hospital-based. Administrative support is required to assist with recruiting and registering Faculty of Medicine postdoctoral fellows, to familiarize fellows with relevant policies and procedures, to ensure that they are aware of career opportunities, and to establish links to other institutions for exchange and placement. Base funding of $100,000 will be requested. Faculty Benchmarking Officer As noted earlier, the Faculty is committed to systematic performance measurement and benchmarking. We have been frustrated by the range of measures and comparative data available thus far. Many Departments asked for support to do more comprehensive benchmarking in future. And in a Faculty-wide priority setting exercise, all sectors rated the need for enhanced capability in benchmarking and performance measurement as a top priority. This is consistent with the Stepping Up goals that strongly encourage greater emphasis on evidence, evaluation and benchmarking.


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The highly collaborative nature of the Faculty’s research enterprise, with multiple investigators and sites simultaneously engaged in programs and projects, has posed special challenges in benchmarking. Educational performance measurement is still embryonic. As research transfer and translation activities take on increased importance, the impact of time spent by faculty in these activities will need to be measured. A proposal for base funding will be advanced to develop Faculty-wide and department-specific performance measures. We propose to hire an individual who will support the FOM in the development of appropriate indicators. This person would work with a group of faculty in the Department of Health Policy, Management and Evaluation who are members of the Hospital Report Collaborative and have developed expertise in the theory and the processes of development and selection of appropriate indicators for measurement. The base funding request for salary support will be for $80,000 per annum plus benefits. D.ii. Capital Development 500 University Ave OTO capital funding will be requested to reduce the debt associated with 500 University Avenue, the Rehabilitation Sciences Building. This debt will otherwise seriously impede the opportunity for the sector to take full advantage of the opportunities open to it. To service the existing ‘mortgage’ arising from Phase I of the renovations at 500 University Avenue, the sector would have to cut back on faculty recruitment, increase the teaching loads of existing staff with adverse consequences for the growth of its research streams, and forego opportunities for joint initiatives with its teaching hospital partners, such as the Toronto Rehabilitation Institute and the Bloorview MacMillan’s Children’s Centre. Accordingly, $9 million will be sought over 6 years to reduce the size of the notional indebtedness of the Sector, and to allow the sector to self-fund new and innovative initiatives. Further OTO funds of $120,000 per annum for two years will be requested to support fundraising and generating philanthropic support for retirement of the remaining debt, phase II renovations that are critical to planned growth, and support for Rehabilitation Sector priorities. The sector understands that no further funds from the AIF or from the Dean’s Office will be provided to it over this planning cycle. 155 College Street OTO funding will be requested to support the capital project providing new space to accommodate Health Policy Management and Evaluation (HPME) and Public Health Science (PHS) within the recently acquired building at 155 College Street. PHS and HPME are collaborating with Department of Family and Community Medicine and the Faculty of Nursing to create the Centre for Health Improvement and System Performance in this new facility. The new facility will provide vastly improved office, research, laboratory, classroom and student workspace, which will foster a greatly enhanced, cohesive intellectual community and encourage intellectual synergies which will significantly impact graduate and research programs. The proposed renovations to the building consist of necessary modernizing and/or replacing items such as elevators, fire alarm and sprinkler systems, HVAC, lighting and water systems; floor


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coverings, computer and telephone wiring. The renovations are described in detail in “Project Committee Report for CHISP at 155 College Street”. The estimated total costs for the renovation and relocation for HPME and PHS are $3.9 and $7.2 million, respectively. University-wide experience has shown that it is difficult to raise funds for renovations of existing office space. Some projects have been successful when they are in historically-resonant or architecturally-interesting space (e.g. Social Work or the Munk Centre). But neither 500 University Avenue nor 155 College Street are likely to draw major naming gifts in the near future. The Departments have $2 million in funding set aside from the Dean’s Office, and will be seeking OTO funding to retire the notional ‘mortgage’ associated with their new space. Base funding will also be requested to address the increased operating costs of the new home. It is assumed that the departments will be covering the difference of their present operating costs and their future/projected operating costs. Based on that assumption, it is estimated that the incremental operating costs for both HPME and PHS equals $250,000 per annum. This figure is based on an estimated cost per NASM for 155 College Street of $126.59 ($1,087,950/8594 NASM’s), estimates of operating costs for the McMurrich Building, and the assumption that the cost per NASM for present and future comparisons remains constant. This base request represents 50% of the estimated annual operating cost ($125,000) and the remaining 50% is to be covered by both departments through revenue generating sources. Medical Sciences Building Preliminary Design and Costing OTO funding will be requested to support preliminary design and costing work for renovations to the Medical Sciences Building (MSB). As a consequence of the spring 2005 relocation of faculty and staff from the MSB, Best, and FitzGerald buildings to the CCBR, there will be many opportunities for much needed renovations of the vacated space. As noted above, we anticipate that faculty in the MSB may propose new arrangements around emerging research nodes that complement the activity of the CCBR. The MSB space will likely require significant upgrades and redesign to accommodate the changing thrusts in basic science research. One time only funds of $100,000 will be sought for planning for redevelopment of this space. Research Enterprise for Department of Opthalmology and Vision Sciences OTO funding will be sought to support planning by the Department of Ophthalmology and Vision Sciences that is currently housed at 1 Spadina Crescent. The Faculty of Arts and Sciences has been looking at taking over this space and is fundraising to renovate the premises. The Department of Ophthalmology and Vision Sciences has been guaranteed that funds would be available from the University to support its move to equivalent research space on a new site. A complicating factor is the co-location of the provincial Eye Bank with the DOVS research space. The Department accordingly needs to explore the re-location of the Eye Bank to a clinical site, re-negotiate the finances associated with the operation of the Eye Bank, determine potential sites for re-location of its existing research operation, and build the business case for developing those sites. One time only funds of $100,000 will be sought for planning support to accelerate the move to an appropriate new location.


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E. Information Systems and Communications Web-based Student Financial Data System OTO funding will be requested for the development, and base funding for the on-going maintenance of, a Web-based student financial data management system interfaced with ROSI . This system will serve the financial tracking and service needs for undergraduate and graduate students. The purpose of this Web-based data management system is to prospectively track all student funding including bursaries, OSAP/UTAPs, awards and graduate student stipend payments in the Faculty of Medicine. It will enable the Faculty of Medicine to track directly, for the first time, all student funding, and eliminate errors and delays in payment of awards and bursaries. This project is an extension of the undergraduate MedSIS Web-based data system currently being developed. Therefore, the cost for software creation for the financial module for undergraduate medicine, medical radiation sciences and professional masters' students is greatly reduced. The majority of the cost (75%) is for the design of the customized financial model for the graduate departments. No new hardware or server space is required for this development or application of the financial web-based data management system. The forthcoming AIF request will be for $15,000 base funding to support ongoing maintenance of the system and $158,648 OTO funding for development and implementation cost of the web-based software. Faculty Communications: Videoconferencing and Web Casting OTO and base funding will be requested to support the enhancement of the Faculty of Medicine’s communication capabilities, specifically in video-conferencing and web casting. The Faculty is widely dispersed on many sites across campus and the affiliated teaching and community hospitals. The Faculty will need to make investments in info-structure on campus and with its partner teaching hospitals to enhance connectivity with the latter. There is obvious potential for collaboration with teaching hospitals. For example, the Department of Radiation Oncology wishes to link radiation oncology between two sites, Princess Margaret and Sunnybrook and Women’s College Health Sciences Centre. Other clinical Departments will similarly be able to work with hospital hosts to move this agenda forward, and the Faculty in general has a major chance to make progress during this planning cycle through the rationalization of TAHSN info-structure. The Faculty will look to leveraging the existing info-structure such as Network North as well as collaborating with other partners who are eager for linkages between hospitals and university departments. This proposal will be for $80,000 base funding for ongoing salary support and $100,000 OTO funding to help to deploy information technology such as videoconferencing on campus with connectivity to the hospitals. Potential Future Proposals for Academic Incentive Funding Of the many proposals arising from across the Faculty of Medicine for AIF funding, a number were assessed as meriting consideration for possible submission in a future competition. The following are illustrative of the exciting themes that may be developed for future sponsorship.


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Interprofessional Simulation Centre for Clinical Skills Teaching, Testing and Research This proposal calls for the creation of a state-of the art Interprofessional Simulation Centre for Clinical Skills Teaching, Testing and Research. The Centre would be an important resource for all health professionals at U of T and would create an outstanding platform for interprofessional learning and research. The need for such a facility has been articulated as a very high priority by various clinical departments and education centres at U of T.8 The new Centre would address the need for performance-based skills teaching and examination. It would provide space for the Standardized Patient Program that already delivers a significant proportion of clinical teaching across the health professional facilities, thereby reducing space pressures in the Wilson Centre for Research in Education. The new Centre could contribute materially to the Faculty’s international reputation for educational ‘R&D’. Active discussions about this Centre are currently underway with the Michener Institute, the Ministry of Health and Long term Care, and the Ontario International Medical Graduate Program, as well as other health science faculties. Given the growing demand for simulation and standardization in clinical teaching and testing, the Centre is envisioned both as self-supporting and as a future source of revenue. As noted above, collaborative planning is expected with the Surgical Skills Centre which anticipates a major expansion of space and educational offerings as well as other educational centres including the Centre for Faculty Development and the Wilson Centre in Research in Education. Developmental Origins of Health and Disease Research Centre Colleagues in several Departments and hospitals are working up a proposal for a university-wide initiative to define the mechanisms underlying the developmental origins of health and disease (DOHaD). The longer-term goal is to develop intervention strategies that will positively impact on the health of women and their infants and establish positive life-long trajectories anchored in healthy child development. Individual faculty members within the university are recognized as world leaders in research related to DOHaD. However, given the scope of this research area these individuals are spread across faculties, sectors, and hospitals and have not as yet coalesced as a group to design this broadly collaborative initiative. A tremendous opportunity exists here to build a truly world class research effort across the university, involving partners such as CIHR and the Canadian Institute for Advanced Research. Institute of Brain Studies A proposed Institute of Brain Studies would provide a clearing house for the neurosciences community in Toronto. The field of neuroscience has been a recurrent source of frustration for the University, with various task force and committee reports gathering dust on bookshelves, and continued divergent growth and development across all three campuses and several hospitals. The Fundamental Neuroscience Network was funded as an APF program in the last planning cycle, and has successfully linked researchers with a molecular and cellular focus. It could be a potential component of the proposed Institute. Discussions are underway with U of T Scarborough and the Faculty of Arts and Science as well as multiple hospital partners. However, a vast amount of additional effort is needed to sort out the configuration(s) for a neuroscience umbrella for the U of T family. It is possible that several inter-related institutes and centres may be the best way forward. Cellular Microbiology and the Immunopathogenesis of Infectious Disease

8 At an exploratory meeting, potential partners from the Michener Institute, the Faculties of Nursing and Pharmacy, UME Medicine, multiple clinical departments, SSC and the Wilson Centre all agreed on the critical need for development of simulation capacity for professional learning and research.


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Planning has been initiated for a Centre of Research Excellence in Cellular Microbiology and the Immunopathogenesis of Infectious Disease. It will bring together the numerous groups within the Faculty currently working on aspects of immunity to infections. Targeted recruitment to bridge disciplines and nucleate an integrated research cluster would coalesce world-class expertise in microbiology, microbial pathogenesis and immunity to infection. The opening of CCBR provides an ideal opportunity to reorganize space in the MSB for a nucleus for this cross-disciplinary research enterprise. Linkages to the clinical sphere are critical if this initiative is to be credible, integrative, and dynamic. Functional Molecular Imaging A proposal is in development to allow U of T to strengthen areas of structural and cell biology and to assume a leading position in Functional Molecular Imaging. The focus would be on recruiting researchers doing innovative biomedical research using cryoelectron microscopy, solid state NMR, fluorescence molecular imaging or nanotechnologies applied to integrated cell systems and isolated components such as molecular machines. This would be developed between the campus and the Ontario Cancer Institute. The Faculty will be considering proposals ranging from an income-contingent loan scheme for professional students to enhanced support for teaching medical humanities, and anticipates growing liaison with other divisions of the University as their strategic plans become available for cross-discussion in the months ahead. Faculty of Medicine’s AIF requests in context The Provost’s Academic Incentive Fund provides an excellent opportunity to seed new initiatives, to stabilize young and evolving programs and to invigorate mature programs through investments in capital and infrastructure. The Faculty of Medicine is taking a strategic approach to its request to the AIF, balancing all three imperatives with a view to stabilization as well as innovation, eliminating or reducing recently-incurred debts, and supporting initiatives that have clear benefit to multiple departments and disciplines across and outside our division. Wherever possible we have sought one time only funds so as to conserve base funding for the remainder of the AIF process, allowing the accumulation of one-time-only spending capacity in the AIF. We have paid close attention to aligning AIF requests with our past and current goals as well as the goals and criteria articulated by the Provost’s Office in Stepping Up and in the creation of this fund. The following provides an estimate of the total base funding and one time only funding requests that we will be seeking in the Fall 2004 call for AIF proposals.


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Summary of Proposed AIF Requests for Fall 2004 Title Base Request Total OTO Advancing the Centre for Cellular and Biomolecular Research

$ 175,000 $ 500,000

Centre for International Health HIV/AIDS Initiative

$ 300,000

Knowledge Translation Research and Development

$ 100,000 $ 240,000

Expanded Surgical Skills Centre

$ 100,000 $ 500,000

Centre for Faculty Development

$ 125,000 $ 100,000

Centre for Effective Practice

$ 250,000

Master of Public Health Sciences Program

$ 200,000

Dissection Based Labs

$ 45,000

Institute of Medical Science

$ 14,000 $ 6,000

Research Training for Medical Students

$ 60,000

Radiation Oncology Student Support

$ 150,000

Institute for Drug Research

$ 73,000 $ 180,000

Pre-grant Award Office Support

$ 234,000

Cardiovascular Sciences Collaborative Program

$ 71,000

Postdoctoral Fellow Support

$ 100,000

Faculty Benchmarking

$ 80,000

Rehab Sector 500 University Ave.

$ 9,240,000

Community Health 155 College

$ 125,000 $ 9,000,000

MSB Preliminary Design and Costing

$ 100,000

Department of Ophthalmology and Vision Sciences Planning Support

$ 100,000

Web-based Student Financial Data System

$ 15,000 $ 158,648

Faculty Communications

$ 80,000 $ 100,000

TOTAL

$1,163,000

$21,358,648


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Research Indicators: 1998/99 and 2002/03 1998/99 2002/03 %

change (4 years)

Total Research Funding $233M $386M 66 Primary Appointees (PA) 4,323 4,589 6 PA w Research Funds 1,025 1,186 16 # Research Grants 2,726 3,005 10 Number of operating grants

2,643 2,794 6

Value of operating grants $192M $267M 39 Research Personnel Awards

1,825 3,096 70

Career Awards 136 232 71 Postdoctoral Fellows 1,104 1,287 17 Graduate Students 1,493 2,295 54 Campus Space 28,171 29,979 6 Hospital Space 89,346

nasm 128,151

nasm 43

7 Faculty of Medicine Research Enterprise The Faculty of Medicine Strategic Directions and Academic Plan, 2000 introduced the Faculty’s Research enterprise as follows: “The University of Toronto’s vision is to be among the world’s leading research intensive universities. The Faculty of Medicine has already achieved that position in the realm of health science faculties. Together with the affiliated hospitals, and after adjustments for Canadian funding policies, its research enterprise measured by competitive research funding ranks among the top four, after Harvard, UCSF, and UCLA, and similar to Johns Hopkins. Its research income, accounting for more than 20 percent of the national total received by the 16 faculties of medicine in Canada, is by far the largest in the country. In 1998-99 its total research funding was approximately $ 233 million from external sources, compared to approximately $ 120 million ten years ago”. Four years later, all of the above statements remain true9, except that the research funding for 2002/03 was $386 million, representing an annual increase of more than 16%, far in excess of the rate of inflation (2.5%/yr). This substantial increase in research funding is the direct result of innovative federal and provincial research funding programs that have transformed the research enterprise at the University of Toronto as well as increased recruitment of excellent scientists. The increases in total research funding are due mainly to increases in the size of operating grants and substantial increases in graduate students (54%) and PDFs (17%). Neither the number of primary appointees or grants held increased significantly, meaning that the average amount of research funding per lab has increased dramatically. See Appendix III for Research Data by Department. The Guiding Principles of Research Planning in the Faculty (updated from the 2000 planning document) During the past decade, the Faculty has identified and developed thematic programs crossing disciplinary boundaries. Excellence is the overriding consideration. The development of our inter- and multidisciplinary research programs has also been grounded on the following criteria which were established in 1992:

9 The top four US Medical Schools in terms of NIH research funding for, 03/04 are Harvard $977M, Washington U (St. Louis) $489M, U of Pennsylvania $462M and Johns Hopkins $411M (source U.S. News and World Reports http://www.usnews.com/). We have made no attempt to allow for indirect costs, exchange etc.


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• Our research plans should be consistent with major opportunities and challenges in health science research, and should focus on initiatives with the potential to attain international competitiveness.

• Our research activities will be multidisciplinary in perspective, and as much as possible encompass the disciplines, the interests, and the objectives of the multiple-sector nature of the Faculty in research and education.

• Our research activities, initiated and led by faculty members with acknowledged scientific

credentials, should be based on relevant research strength and foster future capacity. • Our research plans should have the potential to attract external resources, particularly to facilitate

the recruitment of new faculty. Over the years, these criteria have usefully served the research enterprise of Faculty as exemplified by research programs in fields as diverse as such as molecular medicine, health services research, cell biology, medical imaging, cardiovascular physiology, neurodegenerative disease, and proteomics and bioinformatics. Five Research Platforms In 1997, in response to the funding opportunity presented by the establishment of the Canada Foundation for Innovation (CFI), the Faculty consulted with Chairs of departments, who in turn consulted widely with their campus-based and hospital-based faculty members to identify five research platforms. The five research platforms were: 1). Proteomics and Bioinformatics, 2). Models and Mechanisms of Human Disease, 3). Promotion, Preservation, Restoration, and Adaptation of Function and Behaviour, 4). Information Systems in Health Care Research, and 5). Comprehensive Program in Imaging. Since 2001, the five research platforms formed the basis for a large number of successful CFI institutional project awards. A partial list of recent successful applications follows; a full list of funded CFI applications since 1999 can be found in the Appendices. 1. Genetic Arrays: mapping cellular networks and

pathways(2002) Faculty of Medicine

2. HIV/AIDS and TB Research Facility (2002) Faculty of Medicine 3. Innovative Rehabilitation for People in Challenging

Environments (2004) Toronto Rehabilitation Institute

4. Spatio-Temporal Targeting and Amplification of Radiation Response Innovation Centre (2004)

University Health Network

5. A Program in Integrated Systems Biology (2004) Mount Sinai Hospital 6. Integrative Genomics for Health Research (2004) Hospital for Sick Children 7. Research Program in Immune Tolerance in

Transplantation (2004) University Health Network

8. Genomic Instability and Cancer Cell Survival (2004) University Health Network 9. Structural Genomics Consortium (2004) Faculty of Medicine


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Together with matched funding from the Ontario Innovation Trust, the total funding received from the two levels of government was more than $100 million during the last planning cycle. Most of the initiatives involved multi-institutional partnerships. A particularly striking example of such partnerships is the Toronto Centre for Comparative Models of Human Disease, a partnership of the Mount Sinai Hospital, The Hospital for Sick Children, The University Health Network and St. Michael's Hospital. Two separate CFI applications have been brought into play to support this novel enterprise where transgenic mice will be studied for phenotypic changes detected by advanced imaging methods. The five original research platforms have since evolved into the following corresponding five platforms:

Five Research Platforms

1. Molecular Health and Applied Genomics This platform recognizes the emerging need to derive as much information about the function of as many genes as possible and as rapidly as possible. It will also focus on questions of protein-protein interaction, protein sub-cellular localization, protein function and the analysis of protein complexes. It encompasses the deciphering of the rules of protein folding and domain assembly, and ultimately the reconstruction of entire cellular pathways and networks. Included on the ‘applied’ end of this platform are investigations into the role of genes with other factors (environmental, behavioural, nutritional, psychosocial) in human health and disease, and the ethical and social issues derived from analysis of genes and their products. 2. Models and Mechanisms of Human Disease This platform recognizes the advance in the development of in vivo animal and in vitro models that are required in an integrative approach in the study of human diseases: the development of the disease phenotypes, their prevention, and their treatment. It envisages the development and the use of animal models as transgenics and knockouts, and other models, such as isolated cells, tissue culture, and computer modelling, that are appropriate for the study of gene functions in health and disease in an integrative approach.

3. Improvement of Health and Function This platform brings together basic and applied research from all sectors.Its primary focus is on improvement, including development and testing of new modalities of diagnosis and management of disease, approaches to promote maximum function among those who develop disease and disability, strategies for sustaining and transforming the health system, and strategies to promote health and wellness for large populations. 4. Health Information Technology and

Knowledge Transfer This platform acknowledges the shaping force of health information technology on fundamental and applied research, as well as delivery of clinical care. It reflects the Faculty's commitment to developing, refining, and applying a range of information technologies, so as to generate and disseminate knowledge. This platform includes novel technologies and methodologies that integrate and support activities on all other platforms. 5. Comprehensive Program in Imaging This platform encompasses innovative approaches to visualize molecules, cells, tissues, organs and whole body, with emphasis on relating and interpreting images obtained in the context of biological and physical function in normal and disease conditions. In addition to the application and use of current state-of-the-art technologies in imaging, the platform includes the development of advanced imaging technology.

The Faculty’s five research platforms will almost certainly evolve over time toward a clearer alignment with the four “themes” of CIHR. At present, however, we believe that these five platforms not only encompass all four CIHR themes, but promote integration across the themes while highlighting the technologies that may play a shaping role in the health research enterprise. The platforms are mutually reinforcing. For example, a major study of gene-environment-nutritional


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interactions in human health might be built on platforms 1 (Molecular Health and Applied Genomics) and 3 (Improvement of Health and Function), and be supported by platform 4 (Health Information Technology and Knowledge Transfer). We similarly expect considerable “cross-walk” between platforms 2 (Models and Mechanisms of Human Disease) and 5 (Comprehensive Program in Imaging), as imaging modalities are used to strengthen our understanding of models and mechanisms of human disease. Indeed, the Faculty’s research plans presuppose and encourage collaboration among scientists whose activities are based primarily on different platforms, with a view to both “horizontal” and “vertical” integration of our research enterprise.

The Past and the Future

The 5 research platforms have formed the foundation for many major initiatives in the Faculty. These include: CCBR As described above, the Centre for Cellular and Biomolecular Research (CCBR) is a multi-Faculty, multi- and interdisciplinary research unit. Creation of CCBR was and is the top priority research initiative, not only of the Faculty but also of the University. With researchers from the biological sciences side by side with researchers from other disciplines such as computer science, engineering, mathematics, and chemistry, CCBR represents a new approach to biomedicine. By placing a selected group of faculty members from different academic departments for a fixed but renewable period of time in a totally research-oriented environment not unlike that of a Howard Hughes Medical Research Institute, CCBR will create a paradigm for research that truly transcends departmental structures. And by virtue of the interaction and collaboration between researchers located in the building and those in the participating departments and affiliated research institutes, CCBR will be larger than the physical structure on campus. The building is almost complete and the inaugural director, Brenda Andrews has been appointed effective July 1/04 McLaughlin Centre for Molecular Medicine The creation of CCBR represents the “basic” end of a continuum of health research. In the middle of the continuum, with a “translational” focus on moving from genes and proteins to patient care, is the McLaughlin Centre for Molecular Medicine. This $200M initiative is a partnership of the University of Toronto and four fully affiliated hospitals (Hospital for Sick Children, Mount Sinai Hospital, Sunnybrook and Women’s and University Health Network). Two other hospitals have since joined the Centre --- St Michael’s Hospital and the Centre for Addiction and Mental Health. The director (Prof. Keith Stewart) and the platform leaders (Prof. Steven Scherer - Computational Genomics, Prof. Kevin Kain - Global Health, Prof. Duncan Stewart – Regenerative Medicine, Prof. Kathy Siminovitch - Molecular Therapeutics), and Prof. Mel Silverman – Education) have been appointed. Funding for this centre is from the partners, the McLaughlin Foundation and the OIT. Centre for Function and Well-Being The rehabilitation sciences sector has recently created the Centre for Function and Well-Being (CFWB) which encompasses the more applied end of the research continuum. CFWB meets the “dry” research space requirements of this sector and will be strengthened by a partnership with the Toronto Rehabilitation Institute which, in partnership with the Rehabilitation Sector, recently received a major CFI grant for assistive devices. Structural Genomics Consortium


46

This joint $100M project between Canada and Britain to solve the structure of 350 medically relevant human proteins was launched last year. The project, lead by Prof. Aled Edwards, will involve the renovation of 35,000 square feet of laboratory space in the faculty and the recruitment of 10 scientists and many support staff. This project is funded by grants from CIHR, Genome Canada, CFI, OIT and ORDCF Hospital Research Investments The affiliated teaching hospitals and their research institutes have invested significantly in research endeavours. Their research funding represents over 65% of the total Faculty research funding of $350 million in 2002-03. When one adds in the extraordinary level of internal support provided to research by the various hospital foundations, the total research funding in the hospitals rises by well over $100 million per annum beyond its ‘official level’ based on external sources. The following summarizes some of the major research initiatives of the teaching hospitals, particularly those supported by the Canada Foundation for Innovation. Most of these were developed in partnership with multiple institutions, often including the campus component of our collective research enterprise, and all involve scientists with primary academic appointments in Medicine. Centre for Addiction and Mental Health

Installation of the world's highest resolution pet camera for clinical studies and a new confocal scanning microscope Krembil Family Epigenetics Research Laboratory

Mount Sinai Hospital Genes, Proteins and People: Canada's First Initiative in Clinical Genomics (Genetic Profiling, Transcription Profiling and Proteomics) Toronto Centre for Comparative Models of Human Disease BIRD-Infrastructure for Biochips and Biorobotics, Imaging and Patient Sample Repository and Database

St. Michael’s Hospital CCURE: Critical Care Unit for Research Excellence Cardiovascular Gene Therapy Initiative

Hospital for Sick Children

Mouse Imaging Centre for Canada Canadian Centre for Applied Cancer Genetics Signaling and Degradation Network of Toronto, SIDNET Integrative Genomics for Health Research

Sunnybrook and Women’s

The Toronto Angiogenesis Research Centre Developing a World Class Data Warehouse for Health Services Research and Building Capabilities for Research, Training and Translating Evidence into Action Sunnybrook and Women's College Comprehensive, Multidisciplinary Breast Cancer Research Centre Imaging Research Centre for Cardiac Intervention

Toronto Rehabilitation Institute

Innovative Rehabilitation for People in Challenging Environments Centre for Global eHealth Innovation


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New Research Funding Opportunities

Canadian Foundation for Innovation (CFI) – provides infrastructure support Ontario Innovation Trust (OIT)

- provides infrastructure support Ontario Research Development Challenge Fund (ORDCF) – provides operating support Canada Research Chairs program (CRC) - a blend of personnel and operating support for faculty retention and recruitment Canadian Institutes for Health Research (CIHR) Premier Research Excellence Award (PREA) – provides graduate student and postgraduate stipends

University Health Network

Spatio-Temporal Targeting and Amplification of Radiation Response (STTARR) Innovation Centre Research Program in Immune Tolerance in Transplantation (RITT) Advanced Medical Discovery Institute: Genomic Instability and Cancer Cell Survival Genes, Proteins and People: Canada's First Initiative in Clinical Genomics (Genetic Profiling, Transcription Profiling and Proteomics)

Other initiatives The Faculty will continue to encourage the development of research programs that meet our established principles and mesh with the 5 research platforms. As noted earlier, one research theme that is being further developed in the Faculty is neuroscience. The APF on the neurosciences network in 2000 focused on the molecular and cellular aspects of neuroscience. We are working towards a major AIF request with multiple divisions and campuses to ensure that we build successfully from the molecular and cellular network funded in 2000. There will be other research initiatives that may be more narrowly focused than those mentioned above. Some could well fit within existing programs. Some would be better suited as group proposals for external funding. We expect several initiatives to arise as a consequence of the “freed up” space in the MSB as the CCBR begins operations. Opportunities and Constraints The landscape of government funding of research continues to change for the better. It began in 1997 with the creation of the Canada Foundation for Innovation (CFI). At the provincial level, the Ontario Innovation Trust (OIT) established by the government of Ontario plays a crucial role in optimizing the competitiveness of the universities and affiliated hospitals in the province by matching the CFI awards. As mentioned above, the Faculty of Medicine has had great success in taking advantage of this new resource to create much-needed infrastructure to support its research platforms. The matching of the R. Samuel McLaughlin Foundation funds by OIT indicates how critical this funding source has been to the Faculty and University. CFI and OIT are therefore the major source of funding for new infrastructure. Our faculty must continue to take the maximal advantage of this funding source.

The establishment of the Ontario Research Development Challenge Fund (ORDCF) by the Province of Ontario to provide operating funds complements CFI and OIT, which fund only infrastructure cost. The constraint is its requirement for one-third industrial matching funds. Nonetheless, in its short span of operation, it has demonstrated a degree of flexibility to accommodate the needs of the research community in the province, and has had a very positive impact on the evolution of health


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CIHR has greatly improved the health research-funding environment in Canada. It has opened up new funding opportunities for researchers who are not in the biomedical areas. Recent declines in the rate of increase of CIHR funding and the expansion of new institute sponsored programs have caused what we hope are temporary retrenchments. Most notably, the termination of all of the career awards beyond the new investigator will cause hardships for all institutions.

research in Toronto. A particularly important provincial initiative is the Ontario Genomics Institute. Supported by the Ministry of Economic Development and Trade, OGI has committed more than $250 million to enhance genomics and proteomics research in Ontario since its inception. Much of the funding has come for group proposals originating from the Toronto academic health science complex. Direct support of investigators has also changed for the better. At the provincial level, the Ontario Premier’s Research Excellence Award (PREA) funds graduate student and postdoctoral stipends. At the federal level, the New Opportunity Awards from CFI provide infrastructure support to attract new faculty back to Canada. As well the recently instituted IOF (Infrastructure Operating Funds) award associated with the New Opportunity awards has helped make the most of the new infrastructure. The newly established federal Canada Research Chairs program is closely linked to CFI and deserves particular consideration. A total of 1880 Chairs will be awarded over a 5-year period. They are allocated to the three general areas of research: the health sciences, the humanities and social sciences, and the natural and engineering sciences, based on the budget of the three federal granting Councils: CIHR, SSHRC and NSERC. Each university will receive its allocation based on its research funding (3-year rolling average) from each of the three Councils. Each Chair is awarded through a peer-review process. The University of Toronto has been allocated a total of 251 slots. Of this total, 132 are based on research funding received from CIHR. Based on its shares of funding from all three Councils, the Faculty of Medicine expects an allocation of about 130 slots for which to compete. The Chairs are divided equally into Tier 1 (senior) and Tier 2 (junior) categories. The program expects the University to take into consideration the contribution of its affiliated hospitals. In our case, this is significant. The program directs each University to show how its Chairs fit with an institutional research plan. It is important that the Chairs be chosen through joint planning and partnership with the affiliated hospitals. Clustering of the Chairs around multi-institutional and multi-departmental programs is mandatory. As we enter the 5th year of this five year program more than 90 of the 130 Chairs have been awarded in the Faculty. As well 3 additional Tier 1 chairs, received as a result of a reconsideration of the number of chairs that should have been allocated to UofT, were allocated to the Faculty for innovative programs (so called Blue Sky Chairs). The Tier I awards through the McLaughlin Centre (2) and the Centre for Research in Women’s Health (1) can split into two Tier II Chairs for each Tier 1 Chair. In 2000, the transformation of MRC into the Canadian Institutes of Health Research (CIHR) occurred, creating a funding structure that spans the full spectrum of health research, from basic biomedical to population health. CIHR has continued the tradition of MRC to support investigator initiated and peer-reviewed research projects. It encourages research that crosses disciplinary boundaries and currently has an annual budget of almost $ 700 million, almost tripling that of the MRC. Indirect Costs In 2003 the Government of Canada through Industry Canada initiated a program to provide indirect costs for research funding from CIHR, NSERC and SSHRC, which recently has been established as an ongoing program. In 2003 the amount awarded was 20% of the 3 year average of tricouncil funding (total about $14M). Internally 75% of the overhead funding is kept centrally and 25% is given to the division. This program has the potential to provide much needed support for research at the divisional level to cover overhead costs and to expand infrastructure.


49

The Faculty has assumed new overhead costs to help manage a variety of research enterprises on and off campus, e.g. postdoctoral fellows, new space in the CCBR, and coordination of multi-institutional research programs. As part of any new budgetary dispensation, the Faculty believes a much higher proportion of the overhead monies from the Federal granting councils should be devolved to divisions, ideally along with responsibility for maintaining research space. Such a dispensation would enable the Faculty of Medicine to make choices about the use of space on and off campus in a more agile and cost-efficient manner. It would also allow us to sustain and expand the infrastructure needed to better unify our complex multi-institutional research enterprise.

The University also receives indirect costs related to provincial research funding from the so-called Research Performance Fund. Funds flow through to the hospitals fully, but all campus-based research overhead funding falls 100% to the bottom line. This situation is prejudicial to the interests to the Faculty of Medicine as we account for a substantial proportion of the University’s total provincial funding on campus. CFI, OIT, ORDCF, PREA, OGI/Genome Canada, Canada Research Chairs, and CIHR present a rich menu of research funds. However, except for CIHR and the Canada Research Chairs, most programs require matching funds from either institutional or non-government sources. The Faculty is often constrained by a lack of resources to provide matching or start-up funds for new faculty. The Faculty continues to pursue several avenues in garnering matching funds. Possible sources include University support, philanthropic support, and partnership with industry and non-government funding agencies. Space In 2000 Cecil Yip, former Vice Dean, Research correctly stated that “The lack of physical space prevents us from realizing our full potential to take advantage of the funds available. Like the rest of the University, the Faculty on campus is faced with a physical infrastructure that is deteriorating and not designed for today’s science.” As the result of three initiatives the situation will dramatically change by next year. 500 University Avenue (the Centre for Function and Well-Being) is the new home for the Rehab sector (OT, PT and SLP). The CCBR will be ready for occupancy in the spring of 05 and will have 100,000 square feet of lab space. As well, the newly purchased former Board of Education building will, after renovation, become the home of Family and Community Medicine, Health, Policy, Management and Evaluation and Public Health Sciences. These new buildings will permit renovation of research/administration space in the Best, MSB, FitzGerald and McMurrich buildings. The acquisition of new space means that rational space management is imperative as our research efforts expand to occupy the space. More than ever we need an efficient way of tracking and allocating space on the basis of need and research funding. Progress with 2000 Planning Priority Goals and Actions:

1. Identify research clusters for the allocation of the Canada Research Chairs. Done very successfully – essentially 100% success rate for CRC chairs

2. Resolve the immediate (next one to two years) wet laboratory space need and dry

research space needs. Done – mainly by diplomacy and good will.

3. Increase the internal funding resources for start-up, and meet matching requirements

of external agencies (including the match for Canada Research Chairs). Achieved by initiation of new arrangements for CFI New Opportunity awards, matching OIT funds, and use of vendor deep discounts as a matching tool.


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4. Encourage and assist Principal Investigators in all sectors to access health research funding from the Canadian Institutes of Health Research (CIHR), through the submission of research proposals that are cognizant of the broad health research scope and the interdisciplinary approach embraced by CIHR. CIHR funding for departments which did not previously receive CIHR funding has increased substantially.

2004 Planning Cycle Priorities: Scientists/Research Environment

1. Improve campus-based research infrastructure space and equipment With the exception of the CCBR, most of the campus Faculty of Medicine research space is more than 30 years old and needs renewal, particularly in the MSB. However, there has been some renovation in the FitzGerald Building, the Best Institute and a new level 3 facility in the MSB. Renovations to the Banting Institute are currently underway.

2. Space Database There is a great need to more effectively manage space

in the Faculty and to inventory space that might be shared with our hospital partners. A space database is required to link information about research activities and personnel.

3. Postdoctoral Fellows Improved support mechanisms for Faculty post-

doctoral fellows are required. This would include career development and teaching activities. See AIF request.

4. New/Junior Faculty Orientation and Development The new faculty

orientation sessions initiated last year were favourably received. They will be expanded to include topics such as grant writing, lab management and career development.

5. Non-Canadian sources of research funding The Faculty will be

pursuing an AIF request for an NIH grants officer to be hired for the clinical sector under the primary auspices of Medicine and Surgery.

6. Improve and expand research support units The Faculty sponsors

and manages several research support units – these include the MSB Level III containment facility, the Proteomic and Mass Spectroscopy Centre (PMSC), the Division of Comparative Medicine (DCM), Microscopy Imaging Lab (MIL) and the Transgenic Mouse service (TGM). Several of these units could be expanded to offer more services to our researchers on a cost recovery basis. Increased utilization would fund new equipment and wider variety of services.

Research Initiatives

There are many opportunities for initiating new research initiatives in the Faculty.

1. The promotion and support of joint campus – hospital research initiatives. Examples include the Blue Sky CRCs, shared infrastructure and core facilities, joint programs and the Cancer Research Institute of


51

Ontario. The Faculty also needs to take more of a role in facilitating cross-talk among hospital research institutes; TAHSN’s current focus on clinical centres of excellence should be extended to research centres of excellence, with similar rationalization of the research enterprise.

2. Expand interdisciplinary research beyond the Faculty of Medicine

to include departments in other divisions such as Arts and Science. This is happening now as Computer Science, Mathematics, Chemistry and Botany wish to join one or other of the CCBR platforms (bioinformatics and functional genomics). Another key priority is the Neurosciences Institute or Centre mentioned earlier.

3. Attract national research initiatives to Toronto. An example is the

concept of a Toronto NRC Institute. The exceptionally rich biomedical environment in the Faculty of Medicine is a natural for a partnership with the technical strengths of the National Research Council. Talks are underway to explore a joint partnership between the NRC, the Faculty of Medicine at the University of Toronto and Battelle Memorial Corporation, a US leader in laboratory management and commercialization.

4. Encourage and establish international research partnerships.

5. EDU management and development. Many of the EDUs on campus

and in the Faculty might benefit from review and re-development. We plan to review Faculty of Medicine EDUs with a view to rationalizing the governance of these bodies and earmarking support for units, centres, and institutes with the greatest potential.

Research Funding

While the level of research funding has never been higher, areas for improvement continue to exist. These include:

1. Increasing the Faculty share of indirect costs from the current 25%. As noted earlier, we would really like to see most of the funds to offset indirect costs, especially if we are to take on the costs of maintaining buildings and research space through some sort of bottom line budgeting process.

2. Advancement and fundraising should be actively supported by the

research office

3. Targeted provincial and national lobbying efforts should be made in support of research (e.g. increased levels of indirect costs, more funding for CIHR and for the creation of a provincial research funding body). An agreement has been struck with the hospitals to support the recruitment of a lobbyist for a three year period.


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Our MD degree program seeks to prepare competent and compassionate professionals who have a broad appreciation of:

the scientific foundations of bioscience, the underpinnings of evidence-based

practice and community health, the requisite knowledge base and clinical

skills to be effective junior clinicians, a deep understanding of the nature of

medical professionalism, and a clear appreciation of the overall

context in which health services are delivered today.

8 Teaching Programs

8.1 Undergraduate Medical Education The four-year undergraduate medical program at the University of Toronto, presently the largest in Canada, attracts a stable pool of some 2,000 high-caliber applicants. We admit, 198 applicants annually based on assessment of both academic and personal attributes. The enrolment increased from 177 to 198 annually in 2001-02. Unless deterred by personal health or family circumstance, virtually all students who are admitted graduate with the MD degree, and match successfully to Postgraduate (Residency) positions across Canada, some 60% remaining in one of Toronto’s 68 postgraduate training programs. In its first two years (Preclerkship), the UME program emphasizes acquisition of the knowledge, skills and attitudes fundamental to the practice of medicine. It also provides an understanding of the broad determinants of health, and an introduction both to clinical methods and to the community as a context for clinical practice. Clinical Clerkship comprises third and fourth year. A 1-month transitional period begins third year, after which students start a 78-week period of rotating placements. During the clerkship period, eighteen weeks are allotted to electives, which students choose from a web-based catalogue of available clinical and research experiences. Various themes (e.g., molecular medicine, pharmacology, bioethics, and professionalism) are emphasized “across courses” throughout the entire 4-year program. Continuing challenges relate to financing a resource-intensive curriculum in times of progressive fiscal restraint, the prospect of a further enrolment increase (perhaps substantial), student pressure to move to a pass/fail grading system, escalating concern with the constraints of early career choice, and the challenges of mounting student debt. Notwithstanding these challenges, the MD program continues to evolve in positive directions. On one level, the MD program is an integral part of our Faculty-wide focus on preparing tomorrow's medical leaders. But the nature of a first professional degree is it that serves only to start learners down a career path, not to determine what that path will be. We have been able to capitalize on a very large collegium of wonderful teachers and scholars and an exceedingly rich clinical environment. We see all our MD students as future colleagues and standard-bearers for the Faculty, and we are gratified that so many of our graduates continue to thrive in diverse fields of medical endeavour. Since the Faculty of Medicine’s last Strategic Planning initiative in 2000, the Undergraduate Medical Education (UME) Program has prepared for and recently undergone (May 16-19, 2004) external accreditation by a combined national and international accrediting authority -- the CACMS


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(Committee on Accreditation of Canadian Medical Schools http://www.acmc.ca/comitt_acred.htm) and the LCME (Liaison Committee on Medial Education http://www.lcme.org). We await the formal report from the review team. The team’s report in turn must be reviewed by the Liaison Committee on Medical Education of the AAMC and the Committee on Accreditation of Canadian Medical Schools of the ACMC before a final decision is rendered. However, only a handful of areas of non-compliance or partial compliance with the accreditation standards were reported to us out of 125 separate standards. The review team was complimentary about many aspects of the MD program and indicated that they did not anticipate returning in less than 8 years, i.e. that full accreditation would be forthcoming.

Preparation for this event, which occurs every 7 years, took place over the last 18 months, and occasioned the collection a broad range of data as required by the accreditation standards. These standards may be viewed at http://www.lcme.org/overview.htm. An extensive “self study” was conducted across all elements of the Faculty which impinge on or support the undergraduate medical program. This was conducted by six domain-specific task forces, the chairs of which, under the direction of the Senior Academic Coordinator for Accreditation, formed an executive committee responsible to the whole initiative. The medical study body, as required, also set up a student task force and conducted its own self study, the results of which have been submitted directly to the accrediting bodies. The aggregate information collected, analyzed, and submitted for this purpose exceeds 2,000 pages. The results of both the student and the Faculty self study may be reviewed at http://bul.med.utoronto.ca/accreditation/index2.html .

Against this backdrop, the undergraduate medical program’s response to Stepping Up will comprise a review of progress made in achieving the program’s strategic objectives articulated in 2000, including a review of current and future initiatives in support of its current strategic plan. Progress since the Faculty’s Academic and Strategic Plan 2000 In 2000, through the Faculty’s strategic planning process, the UME Program determined a number of specific priority goals and actions in order to achieve its educational objectives. Progress in implementing/achieving these, and strategic modifications which have occurred since 2000, are articulated below: 1. Doctor of Medicine Curriculum Enhancement Objectives of the Doctor of Medicine program have been revised to emphasize the competencies known, collectively, as the Canadian Medical Education Directions for Specialists (CanMEDS) as these are equally applicable for primary care and specialist practice. We have also maintained our focus on the preparation of competent and caring physicians who are “undifferentiated”, i.e. ready for entry into any residency training program.

These revised objectives have been mapped to each UME course, thereby ensuring that the program, as a whole, is focused on achieving these outcomes

Several “curriculum themes” have been elaborated which integrate and reinforce at the course level, across the 4-year program, material considered to be essential to achieve its objectives – without radical redefinition of established well-functioning courses. Themes (with supporting Theme Directors) now exist in molecular medicine, pharmacology, bioethics, professionalism, history of medicine, and medical jurisprudence.

The MD/PhD Program remains an important educational opportunity for a subset of our students. We are examining the feasibility of implementing a similar master’s level program


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in priority areas.

2. Resources and support for teaching

Three years ago, UME undertook a thorough analysis of the distribution of teaching loads within the MD Program. With the approval of clinical department Chairs, we implemented a new model for distribution of load according to pedagogical relevance and departmental resources. The Committee of All Chairs approved this new methodology, and now Academy Directors receive departmental teaching support according to an agreed-upon and highly-functional mechanism.

UME Faculty Development Committee, in collaboration with the new Centre for Faculty Development http://www.cfd.med.utoronto.ca/, affords new tutors and teachers training appropriate to their teaching roles.

Stipendiary support for academic administrators has increased substantially in the last several years, and is now eroding UME endowments. Discussions are therefore underway to transfer enrolment growth funds in support of these important functions.

Preliminary planning is underway to meet the provincial government’s commitment of 100 to 150 new undergraduate MD slots. Initial discussions have begun with Sunnybrook and Women’s College Health Sciences Centre and the University of Toronto at Mississauga as potential sites for a new model of distributed education with a strong generalist focus. The government has yet to announce its timeline for expansion.

3. Resource and infrastructure enhancements

We have managed an enrolment increase from 177 to 198. More base transfers from the MD enrolment growth fund will be needed to complete the stabilization of the UME administrative and pedagogic team. OTO capital funding associated with enrolment growth has usefully supported renovations for the Office of Student Affairs and the adjacent lobby (The Stone Lobby). We have implemented a new UME Database (MedSIS), drawing on ROSI for core registration data. MedSIS is designed to manage admissions, general UME administration, and student, faculty, and course evaluation. Management of student financial services will lead to functional interaction with the university’s AMS (SAP-based) administrative systems.

We are currently in the process of relocating the Faculty Registrar’s Office and implementing a new Student Financial Services unit within that office.

The UME portfolio has been consolidated under one Associate Dean. Director portfolios have been created for Admissions/Awards, Student Affairs, and Curriculum.

A rational base budget has been formulated which incorporates the “real” costs of running the medical school. Three primary sources of revenue exist. The base budget of the UME Program supports core administrative activity in the MSB, and, to a limited degree, academic administration at the Academies. The teaching hospitals bear the larger component for Academy support (capital and operating), and a huge, and sometimes under-recognized contribution is made by the volunteer contributions of clinicians’ time (effectively a subsidy to the UME Program by the Practice Plans in which these Physicians’ clinical earnings are vested).

The Dean has decided against early expansion of the MD/PhD program. We have made progress towards full student funding over the normal 8-year course of the MD/PhD program.


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4. Curricular content strengthened

As noted above, cross-cutting themes are now well established for molecular medicine, pharmacology, bioethics, professionalism, history of medicine, and medical jurisprudence. They are seen to have a positive impact by both faculty and students.

5. Program evaluation process revamped

A thorough revamping of our program evaluation processes was completed through the Undergraduate Medical Education Program Evaluation Committee. We have applied a formal evaluation framework with accompanying performance target(s) and performance indicator(s) for each objective.

6. Enhanced computing support

The UME Program and all its courses have significant web presence. The underlying rubric is to provide “added pedagogical value”, and not simply “page turning” of abundant text. The UME Program supports a full-time web-designer/developer in addition to the substantial resources available to it through the Division of Educational Computing (DEC). UME offers extensive audiovisual material in support of the teaching of clinical methods. Courses regularly provide materials in support of their syllabi and case-based learning through electronic media.

The Division of Educational Computing has recently replaced 96 of its 130 desk-top computers, and a UME server has been put in place to manage curriculum resources, and the synchronization of PDA-based logging of case contact and procedures in the clinical environment. With the completion of the 2nd phase of the UME database system (MedSIS), all student, faculty, and course evaluation will be conducted on the web, supported by its own secure servers. This is expected to provide enormous advantages in tracking and analyzing all forms of performance.

With matching funds from the Provost’s Information Technology Course Development Fund, many Course Directors and course faculty have migrated course components, and rendered their teaching considerably more interactive.

We are experimenting with various means of affording administrative and secretarial support staff with a means of deploying and updating educational materials, and presently we are comparing the functionality and ease of use of the new Content Management System and that of CourseView, the latter developed by the University’s Resource Centre for Academic Technology (RCAT).

Present concerns and future strategies Potential Enrolment Expansion Thus far, we have no indication that the Government will ask us to proceed with the 100 new MD program slots that were discussed in the Liberal electoral platform. Were they to do so, we do not believe that the growth can be accommodated in the current Academy structure. Even 20-30 additional students is pushing things given the case mix in the adult general hospitals and at HSC.


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We believe the best way forward is to create a one or two new generalist academies, each able to accommodate about 54 students. The idea is that there would be more of a generalist and community focus to the new academies. One of these academies could be alongside or as a subdivision of the current Peters-Boyd Academy, but with a distributed or networked structure unlike Peters-Boyd which is focused on SWCHSC. Most of the courses would be shared with the regular stream, but we would try to offer more of the clinical experience outside of the traditional fully-affiliated teaching hospitals, instead aiming for exposure to community teaching hospitals (partial affiliates) or community clinics. The strategy also involves building a node or hub at UT Mississauga, and creating a closer partnership with the west-end GTA-905 hospitals. On a contingent basis, we are proceeding to develop detailed plans for these Generalist Academies in the next year. Declining Interest in Family and Community Medicine University of Toronto students continue to do well in their residency matches through the Canadian Residency Matching Service (CaRMS), but as is true in other medical schools, a diminishing number of our graduates choose Family and Community Medicine as their first choice. Against a backdrop of a progressive shortage of physicians, especially in remote, rural, and under-serviced areas, and considering governments’ preferred ratio of 60% specialist to 40% family physicians, it is a source of some concern that our students choose FCM only some 25% of the time. This is not reflective of the strength of FCM training in Toronto, as the Toronto program (the largest in Canada) fills easily during the match’s first iteration. Rather, it is presumably associated with a “retreat from generalism” that began decades ago in medicine as a profession and continues as a secular trend today. The movement appears to be away from not only Family and Community Medicine, but also generalist components of some specialties (e.g. Psychiatry, Internal Medicine, Surgery, Obstetrics/ Gynaecology, and Paediatrics). Given the research intensive nature of the Faculty, it is perhaps understandable that somewhat fewer of our graduates will become small-town or rural family physicians. But the Faculty prides itself on a leadership role nationally in primary care research and education through its very strong DFCM. We shall take steps in the next planning cycle to strengthen the profile of Family and Community Medicine and primary care more broadly in the MD curriculum. A related option is to provide longitudinal and regular exposure of our students in more-generalists educational environments throughout their four years. Clinical skills teaching in highly specialized environments The teaching of relevant clinical skills (interviewing, clinical examination, basic procedural skills) may become compromised in the highly-specialized environments of our major teaching hospitals (most of which are tertiary and quaternary centres). Compounding this challenge is the reduction of average hospital stays, with earlier discharges to home or other settings. To adapt to this phenomenon, we are examining other environments in which to teach these early clinical skills. One approach that would simultaneously enhance inter-professional education is the use of simulated environments. Members of the Faculty of Medicine, and colleagues from the Faculties of Nursing and Pharmacy, have responded to Provincial Government requests for proposals under “primary health care reform” with the submission of a proposal to combine forces in the creation of a multi-professional simulated teaching-practice environment in which physicians-, nurses-, and pharmacists-in-training, may learn together at “point-of-delivery”. As noted above, the Faculty will also be moving forward to develop an AIF request for the creation of a state-of-the-art Interprofessional Simulation Centre for Clinical Skills Teaching, Testing and Research. Such as Centre would be a resource for all health professionals at the University of Toronto and would create an outstanding platform for discipline-specific and inter-professional learning and research.


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Meanwhile, the UME Program is working energetically to secure space in which clinical skills assessment may be undertaken. The Standardized Patient Program at the Wilson Centre (for Research in Education) provides support for this function at present; but it has seriously outgrown its quarters. Again, several Faculties and National professional bodies have expressed significant interest in the creation of dedicated space to house the Standardized Patient Program and any related Objective Structured Clinical Examination (OSCE) facilities. We continue to believe that this initiative would be well-situated in 256 McCaul Street now that Family Medicine has vacated the premises. On the matter of MD student aid, we continue to fund-raise actively for endowments that will help worthy and needy MD students. The Medical Alumni Association and the Ontario Medical Association have both contributed very usefully to this cause. A major step forward has been taken recently with the agreement by the Central Administration to allocate fiscal resources and responsibility for management of MD Student Financial Services to the Faculty of Medicine. Using the full 30% holdback on increased tuitions since fees deregulation, we should be in a much better position to preserve accessibility to the MD program and to mitigate any effects of debtloads on postgraduate career choices of MD students.

8.2 Postgraduate Medical Education Program Background The University of Toronto Faculty of Medicine offers 68 postgraduate (post-MD) training programs accredited by the Royal College of Physicians and Surgeons of Canada (RCPSC). The Family Medicine program, accredited by the College of Family Physicians of Canada (CFPC), offers a two-year program as well as additional one-year certified programs in Emergency Medicine and Care of the Elderly. Teaching facilities for the programs are spread across 9 fully affiliated, 11 partially-affiliated hospitals, and multiple off-campus teaching sites. Apart from clinical training, the Faculty offers an academic training stream in the form of the Clinician Scientist programs. Residents enroll in the School of Graduate Studies to undertake an M.Sc., Masters of Health Science, or Ph.D. degree program in various specialties. Trainees also pursue medical education graduate degrees through OISE/UT. In 1996, the Faculty launched the first Royal College Clinician-Investigator Program in Canada. As MD Scientist trainees must “step out” of clinical work to engage in full-time graduate research and course work, they are supported by their clinical departments with top-ups from the discretionary funds of the Postgraduate Office. Despite this financial obstacle, enrolment in this academic stream reached 41 in 2003-04. According to the national Canadian Post MD Education Registry (CAPER), Toronto has the largest postgraduate medical education program of the 16 Canadian medical schools, accommodating over 20% of Canada’s postgraduate trainees, and approximately half of the total Ontario postgraduate training complement. In 2003/04, there were 1,952 postgraduate trainees. About 66% of the non-visa trainees had MDs from Ontario, and 21.6% had MDs from other Canadian schools. This preference for Ontario grads (with a high proportion from the University of Toronto) is a reflection of the Canadian Residency Matching Service (CaRMS) match results at Toronto PGME for the past five years.


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TORONTO 2003-04 PGME REGISTRATION BY DEPT, TRAINING LEVEL, LEGAL STATUS, April 2004

Residents Fellows TOTAL

DEPARTMENT CDN/

PR Visa CDN/

PR Visa CDN/

PR Visa GRAND TOTAL

Anaesthesia 70 3 14 45 84 48 132 Community Med 18 0 0 0 18 0 18 Critical Care 11 0 3 8 14 8 22 Diag Radiology 52 2 16 38 68 40 108 Family Medicine 162 20 7 3 169 23 192 Lab Medicine 24 12 5 6 29 18 47 Medical Genetics 5 2 0 4 5 6 11 Medicine 290 46 65 75 355 121 476 Obstetrics & Gyn 37 3 18 11 55 14 69 Ophthalmology 21 1 4 17 25 18 43 Otolaryngology 20 2 6 8 26 10 36 Paediatrics 77 12 33 107 110 119 229 Paeds Critical Care 2 0 0 12 2 12 14 Palliative Care 1 0 2 0 3 0 3 Psychiatry 119 5 21 6 140 11 151 Radiation Oncology 17 3 4 19 21 22 43 Surgery 167 29 47 115 214 144 358 TOTAL 1093 140 245 474 1338 614 1952

Report on 2000 Plan and Goals for 2000-2010 Academic Plan The following is a progress report on the PGME sector’s achievement of its objectives from the Faculty’s 2000 Plan, and an outline of the Goals and Strategies for the 2000-2010 planning cycle. The goals focus on 7 key areas: 1. Increase in Ontario Ministry of Health funded residency programs 2. International Medical Graduate Training (sponsored trainees) 3. Clinician Scientist Graduate Scholarship Program 4. Central Support for Faculty/Resident Educational Programs 5. Internal Program Reviews and Accreditation 6. Information Technology 7. Postgraduate Dean’s Liaison with Hospitals, Government, and other training partners 1. Ministry Funded Training In 1999-2000, the Total FTE of ALL MOH-funded medical residency positions was 971 (CARMs entry, OIMG program, and the Re-entry and Repatriation programs). No increase was projected for the CARMs entry positions, but an overall 5% increase (approx. 50 positions) was projected due to


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MOH Prog 99/00 03-04 Regular 909 890 Re-entry/Repat 15 28 (+87%) Old OIMG Prog 49 52 (+6%) New IMG Prog 0 6 TOTAL 971 976

expansion of positions in the OIMG, Re-entry, and Repatriation programs. Residency positions for Canadian Citizens/PR are funded and allocated to each school by the Ministry of Health. CMG-CARMS entry: The expansion in UG medical school enrolment began in 1999. As the Ministry had not decided on the allocation of the subsequent increased CARMS residency intake positions by school, this projection was not included in the Faculty’s 2000 Academic Plan. IMG programs: The OIMG provincial program expanded from 24 to 50 positions over the period, but Toronto’s proportion did not increase as projected due to MOH allocation to other schools (rural and FM focus). The other IMG programs (Specialty Assessment Program, Direct Entry, and the Advanced and PGY+ programs) have been slow to develop, with most candidates accepted within the last 18 months. Re-entry & Re-patriation: Toronto has traditionally accepted the largest percentage of Ontario’s Re-entry and Repatriation program candidates, with 22 of the 49 Re-Entry candidates, and 6 of 14 Repatriation trainees supported by the Ministry in 2003-04. 2004 -10 Goal: Increase Medical Trainee Enrolment – Ontario Government Funded Residency positions for Canadian Citizens/PR are funded and allocated to each school by the Ontario Ministry of Health. CARMS: Toronto was allocated 46 CARMS intake residency positions for 2004 to 2006 (2004 – 13; 2005 – 14; 2006 – 19). This will result in an overall increase of 165 to 248 residency positions from the 2003-04 base, depending on the Family Med/Specialty ratio as directed by the govt. Re-entry & Re-Patriation: Current enrolment in these programs is 28 and is expected to increase to 36 (~20%) by 2010. IMG programs: The Ministry’s new OIMG programs will expand to offer 175 positions annually (entry level and PGY+) across the 5 Ontario medical schools. Toronto’s enrolment in these programs is currently 58 and is expected to increase to 70 (~20%) by 2010. Through the Postgraduate Office, the Ministry will provide $20,000/year to departments accepting selected IMGs. In addition, MOHLTC funding to the Faculty will increase (T&R/GFT Professor funding) as will base enrolment funding to the University from the Ministry of Training, Colleges and Universities. Strategies

1. As much as possible within the government allocation, ensure that the larger programs and those with a high applicant rate receive additional positions.

2. Work with COFM to pressure government for faculty/infrastructure

funding for new CARMS, Re-Entry and Re-Patriation positions. 3. Help to develop strategies to address capacity issues regarding teaching


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faculty and training sites to accommodate the increased numbers of residents

4. Develop strategies to enhance current programs and develop new

initiatives in postgraduate medicine using a portion of the new income generated by the government’s new IMG programs

2. International Medical Graduate Training 2000 Objective: Develop targeted promotional materials to attract international medical graduates and foreign sponsors. Target 15% increase over next 5 years. Achieved: 83% increase in sponsored residents and fellows 67% increase in non-sponsored visa fellows 99/00 03-04 Visa Sponsored Residents + Clinical Fellows 94 172 Other Visa International Fellows 265 443 2004 – 10 Goal: Maintain Medical Trainee Enrolment – Foreign Funded The number of foreign-sponsored IMGs has continued to rise over the past 5 years, providing a steady revenue source for the Faculty and contributing to the intellectual and cultural diversity of the university. With additional funds now being provided by the Ministry of Health for Canadian citizen IMGs, the PGME Office must ensure that remuneration from both trainee sources is comparable. Strategies 1. Review the level of supervision/assessment fees for sponsored trainees to

ensure they are commensurate with Ministry funding of T&R and teaching support attached to residents in expanded government programs

2. Continue to accommodate international residents and fellows to ensure diversity in U of T postgraduate medical training

3. Clinician Scientist Graduate Scholarship Program 2000 Objective: Work with clinical departments to financially support residents during graduate degree component of specialty training Achieved: Clinician Scientist Graduate Scholarship Program: PGME continues to provide financial assistance to residents pursuing a Master’s or PhD degree in the Clinician Investigator Program. $200,000 is distributed among eligible candidates in all departments. The departments have been more effective at supporting these trainees from internal sources, and the number of funding requests has fallen (1999 - 35; 2003 - 21) even as enrolment in the program has risen.


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2004 – 10 Goal: Promotion of Clinician Scientist Graduate Scholarship Program The PGME Office Clinician Scientist Graduate Scholarship Program provides funding to departments who have residents pursuing their Masters and Ph.Ds in the Clinician Investigator Program. Funds are generated by PGME from international medical graduate programs. The level of funding is half of the difference between the resident’s research grant support and the equivalent resident’s salary and benefits total. The maximum amount of annual funding currently allocated for this program is $200,000. PGME wants to continue its support of excellent masters and post-doctoral fellows to ensure an environment that stimulates intellectual growth and research achievement. However, the number of trainees requiring assistance has decreased over the last 4 years. We expect that once awareness of the funding program is enhanced, there will be more applications. Strategies 1. Examine reasons for decreased applications to the Clinician

Scientist Graduate Scholarship Program 2. Re-examine the eligibility criteria of the Clinician Scientist

Graduate Scholarship Program with a view to continuing to support worthy candidates in their graduate degree pursuits.

3. Promote/increase awareness of the scholarship program to all departments and programs

4. Support for Faculty/Resident Educational Programs 2000 Objective: Develop range of workshops and mechanisms to enhance faculty Achieved Seminars/Workshops - Faculty Development: (a) Workshop for faculty on communication skills (b) RCPSC workshop for new Program Directors (c) Educational items at Program Directors meeting such as mentoring, teaching CANMEDS roles,

harassment-free teaching environment (d) internal review workshops to teach faculty to write internal review reports and participate in

Internal Reviews (e) Harassment and Intimidation seminar for specific departments (f) Education Sub-Committee publication of articles on resident evaluation (g) New Postgraduate Faculty Teaching Award instituted in June 2003. Seminars/Workshops – Residents: Organized MD Financial Management Seminars for PGY1s and Senior Residents; publicized PAIRO half-day back for Wellness Seminars; support for Teaching Residents to Teach workshops. 2004-10 Goal: Provide Faculty and Resident Workshops The PGME Office supports the continuous quality improvement of faculty and students.


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Strategies 1. Work with PG Education Consultant to develop topical

educational issues for monthly Program Director meetings 2. Develop relationship with Centre for Research in Education

(UHN) and Centre for Faculty Development (SMH) on issues specific to Postgraduate Medical Education

3. Continue to work with MD Management to offer financial

management workshops; 4. In conjunction with the Centre for Bioethics, support a

coordinator for Postgraduate Bioethics to develop a Postgraduate Bioethics website and continue faculty development among program directors and selected teachers within programs.

5. Internal Reviews and Accreditation 2000 Objective: Prepare for April 2001 RCPSC on-site survey Completed: Excellent results in RCPSC and CFPC Accreditation Survey in April 2001: Of 64 Specialty Programs: 54 Full Approval 4 Inactive (not reviewed) 4 Provisional Approval with Internal Review 2 Provisional Approval With External Review All 3 Family Medicine Programs received Full Approval from CFPC These nation-leading postgraduate accreditation results validated the hard work of the Internal Review Committee which met for 2 ½ years prior to the external survey. 2004 – 10 Goal: Coordinate Internal Review of Programs and 2007 Accreditation Preparation Each postgraduate training program must undergo an internal review to prepare for the 2007 Accreditation. This process will involve over 120 faculty members and 60 resident reps in surveying, report writing, and reviewing reports. The Internal Review Committee, composed of 10 faculty members, a resident representative, and the PG dean, will meet monthly for approximately 2 years prior to the RCPSC/CFPC Accreditation. The IRC members review 4 reports per meeting and provide the Program Director with feedback/recommendations for improvement in addition to those in the Internal Review report. If many weaknesses are identified, a second review may be recommended.


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In non-Accreditation years, the Internal Review Committee work carries on to follow-up on provisional and new programs. Strategies 1. IRC will coordinate workshops for faculty to write reports and how

to conduct internal review.

2. Recruit more members to the IRC

3. For Accreditation 2007, maintain or surpass the 90% Full Approval rate achieved in 2001 (54 of 60 active programs) .

6. Information Technology 2000 Objective: Work with University and Faculty to develop website and “virtual” IT campus Ongoing

• Web-based registration system implemented in 2001 allowing trainees to register on the web • access made available to departments, hospitals and licensing bodies; • Web Evaluation system implemented in 2003

2004 -10 Goal: Increased IT and website development The PGME Office introduced an on-line, web-based registration system in 2001, which can be accessed by all departments and hospitals. It expanded in 2003 to include an on-line evaluation system where residents were assigned evaluations of rotations and teachers to complete. Teachers were assigned the evaluations of residents. Some PGME policies and program contact information are currently on the faculty website. With the re-development of the site and access system, PGME will be able to place all information and access on the website. Strategies 1. Further development of the reporting functions of the Web-

based evaluation system

2. Complete training of staff and faculty on Web-based evaluation system, including report functions

3. Work with hospitals and academic departments on more

efficient ways to transfer/access required data

4. Work with appropriate staff on revisions to PG webpages within new co-ordinated Faculty website

5. PGME Office to increase coordination among hospitals

departments and licensing bodies regarding trainee compliance with regulations and risk management policies of hospitals, licensing bodies and residents’ union regarding


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malpractice insurance, immunization, and health care coverage

7. Postgraduate Dean liaison with Hospitals, Government, and Licensing Authorities 2000 Objective: Participate and lead initiatives to ensure that unique needs of U of T are known to academic, licensing, and government bodies Achieved

Postgraduate Dean’s roles: • Chair of HUEC • Consultant to the Ministry’s IMG program expansion initiative • Advisor to OIMG clearinghouse • COFM representative on CPSO Education Committee • Services on MOH Re-Entry Working Group and other ad hoc committees • ACMC Postgraduate Deans Committee • Member PGE + PGM Committees at COFM table

2004 – 10 Goal: Ensure unique needs of U of T PGME are known to academic, licensing, and governing bodies As an institution with the largest number of postgraduate medical trainees in Canada, Toronto PGME has a unique role to play locally with its affiliated hospitals, and in provincial and national medical education forums. U of T currently has the largest number of resident and fellow IMGs and will likely be the largest recipient of IMGs from the Ministry’s new training programs. Strategies 1. Continue to participate at provincial and national forums to advocate U of

T’s mission to be one of the world’s best public teaching and research universities

2. Strengthen coordination/communication among hospitals via HUEC (fully affiliated) and annual meetings with partial affiliates

3. Continue to work with CPSO, CMPA and other agencies on more efficient methods of data transfer/information-sharing

4. Continue to interact with MOHLTC re IMG evaluation and training initiatives

5. Continue involvement at PGE/PGM COFM and ACMC Postgrad Deans’

Committee


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Graduate Enrolment: Full-time Graduate Students 1999/2000 2000/01 2001/02 2002/03 2003/04 PhD 737 737 783 782 819 MSc 678 678 719 716 764 Prof Masters 253 348 364 481 525 Total 1668 1763 1866 1979 2108

8.3 Graduate Programs Graduate studies in the Faculty of Medicine represent a broad spectrum of academic training in biomedical research and health professions. Our graduate programs exemplify integration of research and education at the highest level of scholarship. Therefore, it is crucial that we strengthen the links between graduate studies and the major research programs throughout the Faculty, including those within the affiliated hospital research institutes. The platform to establish international leadership in graduate studies is in place. To create nationally and internationally competitive doctoral and professional graduate programs, the Faculty of Medicine must provide multi-year, full funding packages for student recruitment (including tuition and cost of living), improve its infrastructure (for professional programs), and market its programs more effectively. The Graduate Units in the Faculty of Medicine are divided among 4 sectors including: Basic Medical Sciences (Biochemistry, Immunology, Medical Genetics and Microbiology, Nutritional Sciences, Pharmacology, Physiology); Rehabilitation (Rehabilitation Sciences, Speech-Language Pathology); Community Health (Community Health, Health Administration); and Clinical (Institute of Medical Science, Laboratory Medicine and Pathobiology). The graduate units in all sectors have a doctoral stream (MSc/PhD research thesis programs) and professional or course masters degrees (Biomedical Communications, Bioethics, Community Health, Health Administration, Speech-Language Pathology, Physical Therapy, Occupational Therapy, Genetic Counseling, Family and Community Medicine, Nutritional Science). As well, the Faculty participates in Collaborative Programs, including: Proteomics and Bioinformatics, Molecular Medicine, Biomolecular Structure, Developmental Biology, Bioethics, Cardiovascular Sciences, Health and the Environment, Biomedical Engineering and Toxicology. Overall, there has been moderate but steady growth in graduate enrolment. Academic Advancement 2000 to 2004 The key advances in graduate studies in the Faculty of Medicine have been in the realm of new degree and collaborative programs. Existing programs have also shown steady growth and positive development. The alignment of new revenue for support of academic infrastructure and student funding will remain a major focus for the next 5 years. At the Faculty level, the centralization of administrative support envisioned in "Raising Our Sights" has not been realized completely, and attention to this issue is required for the new planning cycle. Rehabilitation Sector The major development in the Rehabilitation Sector was the initiation of the new professional masters programs in Occupational Therapy (OT) and Physical Therapy (PT) and the expansion of enrolment in the professional masters in Speech-Language Pathology (SLP). Enrolment expansion will reach a steady state at 400 students in 2006-07. The Departments of OT, PT, SLP and the Graduate Department of Rehabilitation Sciences (GDRS) are now housed at 500 University Avenue. The new


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headquarters for the Rehabilitation Sector has offered a dramatic enhancement of the student experience for both the professional and doctoral program students in these disciplines. GDRS will launch a new PhD program in September 2005. An important goal for the Rehabilitation Sector is to strengthen partnerships with the fully affiliated hospitals and research institutes so as to enhance collaborative research and doctoral education. The recent success of the Toronto Rehabilitation Institute/University of Toronto (UT) partnership in obtaining CFI funds to support innovative research infrastructure will create new opportunities for research and doctoral graduate studies. Partnerships with the affiliated hospitals already provide significant funding for rehabilitation sciences doctoral students. Furthermore, the field of rehabilitation sciences is in great need of new research faculty across Canada, thus there will be great demand for well-prepared PhD graduates and postdoctoral trainees. The joint resources of UT and its affiliated hospitals and research institutes accordingly have great potential for national and international leadership in research and education. Following the initiation of the Hospital University Education Committee (HUEC) in 2001, the Rehabilitation Sector established the HUEC-Rehab (R) consisting of the Chairs of the Rehabilitation Sciences Departments, their professional education coordinators, and the senior management leaders with oversight of rehabilitation from the 9 affiliated teaching hospitals. Among the goals of this committee is enhancing communication and working relationships among the Rehabilitation Departments and the affiliated hospitals. The Task Force on Rehabilitation Teaching in the Affiliated Hospitals was struck to identify the current contribution to rehabilitation teaching by the staff at each hospital and to recommend next steps focused on more closely aligning clinical teaching curriculum needs with existing resource. A fundamental issue is the status of clinical teachers in rehabilitation within the affiliated teaching hospitals. The job descriptions and performance evaluations of some clinical teachers do not include academic activities. This contrasts with MD-stream educators whose contributions are financed by practice plans. HUEC-R is therefore engaged in ongoing work to enhance clinical teaching, secure faculty appointments and set out academic career tracks for clinical teachers in the Rehabilitation Sector. A longer-term goal for the Rehabilitation Sector is the extension of this process to the partially affiliated hospitals and community teaching sites. A major concern for the professional programs is the increasing difficulty in negotiating clinical placement sites, be it in hospitals or the community. This is a problem for rehabilitation programs across Canada. One potential solution for the University of Toronto is the establishment of new clinical teaching units that encompass multiple health professional disciplines. These new multi-purpose CTUs could be staffed by clinical faculty from a range of professions with strong academic credentials, and would provide unique resources for both uni-disciplinary and inter-professional teaching and learning. Exploring the feasibility of such CTUs is a priority for the Faculty in this planning cycle. Strategy The Rehabilitation Sector professional programs will collaborate with the

affiliated teaching hospitals and professional associations to develop new models of clinical teaching. They will participate actively in the move to establish multi-professional CTUs on a pilot basis.

Community Health Sector The Department of Health Policy Management and Evaluation (HPME) was awarded an APF allocation from "Raising Our Sights" for its Clinical Epidemiology and Health Care Research


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Program. This Program had transferred over to HPME from Public Health Sciences, and has been very successful in its new departmental home. Revisions to the Clinical Epidemiology (ClinEpi) program have included deletion of the diploma (non-graduate) stream, establishment of a course-based MSc, and initiation of a PhD program. The ClinEpi program receives highly-qualified health professional applicants, including international graduates, in numbers far exceeding the positions available. The barrier to expanding enrolment is the current inability to mount a sufficient number of courses of appropriate size (20 students or less). Expansion of the ClinEpi enrolment with highly-qualified health professional students would enable this program to develop a larger national and international profile in keeping with the vision of the Faculty and HPME. Increased revenue from the program (requiring a new graduate revenue model) would also enable HPME to support partial FTEs in the Clinical Departments and thereby expand teaching supports for the ClinEpi program in a virtuous cycle. Strategy: The Associate Dean, Program Director, and Department Chair will explore

alternative revenue models, e.g, self-funding program with a modest tuition increase, for the ClinEpi graduate program so as to enable expansion of enrolment within the next 3 years.

The Department of Public Health Science has completed a major strategic planning exercise and is in the process of developing a new course Masters program. As noted above, the MHSc programs will be revised to a Masters of Public Health Science (MPHSc) with the introduction of new fields of study in public health nursing, infection control, global/international health, and wound prevention and care. As well, negotiations are under way to establish a new Masters of Health Professions Education jointly with OISE/UT to replace the current MEd (Option II for Health Professionals). New revenue (full BIU funding + tuition) will be sought for all of the new regulated professional masters’ programs. Strategy: The Dean in collaboration with the Vice President, Government Relations, will

seek provincial support for the new Masters’ programming in public health. The new Collaborative Program in Health Care, Technology and Place, directed by Peter Coyte, began with funding from a CIHR training grant and has also received funding from The Change Foundation. This trans-disciplinary collaborative graduate program spans HPME, PHS, Nursing, Social Work and English; and the advisory committee includes representatives from the senior management of the affiliated hospitals, community agencies, the MOHLTC and the Faculty of Medicine. This program is an exemplar of the integration of research, doctoral education, and health policy. It highlights the potential for non-governmental funding of innovative graduate studies. Basic Science Sector The Basic Science Sector Departments continue to modestly expand doctoral graduate program enrolment through enhanced efforts in marketing. Although doctoral students in most of these departments receive stipends above the minimum level required at UT, it is not evident that these stipends are nationally competitive after taking into account the high cost of living in Toronto. Strategy: The Associate Dean and relevant Graduate Chairs will press for more equitable

funding of graduate students by CIHR and other granting agencies, taking into


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account cost-of-living disparities in Canadian cities, with a view to enhancing the national and international competitiveness of our doctoral research programs.

The Faculty of Medicine and affiliated hospital research institutes have been very successful in obtaining CIHR training grants for support of graduate and postdoctoral study in trans-disciplinary research programs involving multiple departments, institutions and often extending across Canada. Most of the CIHR training grants were used to obtain matched funding from charitable organizations, industry and local sources to support innovative research training. Clinical Sector Research career development for postgraduate MD trainees with enrolment in full-time graduate studies continues to evolve positively. The Department of Ophthalmology and Vision Sciences benefits from the endowed funds available to trainees through the Vision Science Research Program, headquartered at the Toronto Western Research Institute. There is strong support for existing Clinician-Scientist programs in the Departments of Surgery, Medicine and Pediatrics. The Department of Psychiatry has launched a similar fully-funded program in 2003-04. New CIHR training grants in these clinical fields have broadened the scope of graduate training to include the full range of disciplines and more trans-disciplinary approaches. Toronto is clearly the national leader in MD-scientist training as evidenced by the number of postgraduate MD trainees engaged in graduate studies and the high number of external postdoctoral fellowship awards received annually. In this planning cycle, the Clinical Sector must determine the next steps for its member Departments in graduate training of clinician-scientists. Options include expansion of existing programs to encompass larger numbers of trainees or greater participation by other Departments (e.g. Anesthesia, Otolaryngology, Obstetrics and Gynecology), rationalization of offerings in clinical evaluation (currently provided by both IMS and the ClinEpi program), strengthening new programs in Molecular Medicine, and creation of national networks for research training, e.g., as has occurred with the national CIHR training program in Pediatrics. International MDs could be attracted to graduate studies in the Faculty of Medicine with the right set of incentives; currently, most international physicians enroll in non-degree clinical fellowship programs. Challenges and Opportunities Doctoral (MSc/PhD) Programs Although all of the doctoral programs in the Faculty of Medicine have achieved full funding according to the UT policy, the stipend level across departments is not uniform. For example, a difference of up to $8,000 exists across graduate departments within the Basic Science Sector. Taking into account the high cost-of-living in Toronto, even the top-level funding for doctoral students ($26,500 in Medical Biophysics) is not competitive with the stipends provided by some universities, e.g., University of Western Ontario. Strategy: The Faculty will work towards a goal of full funding of all doctoral students to a

minimum of the CIHR doctoral studentship level ($20,000 in 2003-04) within the next 2 years.


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MD/PhD Program As recognized in the self-study for undergraduate medical education accreditation (May 2004), the MD/PhD program identified two fundamental changes that are necessary to ensure excellence and national leadership of this program. First, before the MD/PhD program can grow (as recommended in "Raising Our Sights"), it is necessary to achieve full funding (including tuition) for all MD/PhD students in at least 7 out of 8 years of this program. The Director of the MD/PhD Program, Dr. Mel Silverman, continues to seek new funding from multiple sources including the CIHR, the McLaughlin Fund and advancement. Second, the need for improved integration into the MD program of returning PhD students is recognized and now being addressed. Professional Masters' Programs The rapid expansion of the professional Masters' programs in the Rehabilitation Sector has created new administrative challenges for the efficient management of these complex academic programs. Currently, information gathering and utilization requires a number of shadow systems and also direct entry of data into ROSI. The downloading and reporting capability of ROSI has not been easily adapted to the needs of these professional programs. In particular, the tracking of student awards and bursaries has been particularly difficult. Hence, OT, PT and SLP would benefit significantly from the availability of a web-based data management system that would enable tracking of student finances and academic progress (see Administrative Infrastructure). Currently, the financial services and support for professional masters students in the Faculty of Medicine have improved following enhanced communication with SGS. At this time, the student aid funds generated by professional masters programs in the Faculty of Medicine are entirely used for support of these students through UTAPs, high needs' bursaries and the new annual bursary fund provided to our programs from Admissions and Awards. However, as enrolment reaches steady state in 2006-07, it is essential that the professional masters' students in the Faculty of Medicine are able to access the full amount of student aid funds that are generated by their tuition. Further, these students may benefit from local access to financial services, including counseling in the new Faculty of Medicine Financial Student Services that will commence in 2004-05. International Students The graduate doctoral programs in the Faculty of Medicine enroll very few international students. The first barrier is lack of sufficient scholarship or bursary funding to fully support highly competitive doctoral students. The increases in tuition fees for international students at U of T will presumably reinforce this barrier. CIHR training grants do not limit funding to domestic students, hence the existing (and future) CIHR training grants could contribute to recruitment of some international graduate students. Another barrier is the inability of graduate departments to quickly and accurately assess international academic credentials (outside of the USA). A third barrier is the lack of strategic partnerships with international research institutions willing to collaborate and provide at least partial funding for their students to engage in graduate studies in our Faculty. International-oriented agencies such as the Fogarty Foundation may provide some support of international graduate studies in the Faculty of Medicine. Strategies: 1) The Associate Dean will assist Graduate Departments in establishing

agreements with international institutions for shared financial support of students who are eligible for entry into full time doctoral graduate programs.


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2) The Associate Dean will work with SGS and the University Office of Admissions and Awards to develop mechanisms that can assist graduate departments in the evaluation of the academic records of international applicants.

3) The Faculty will seek to enhance support for international graduate students in doctoral programs through a combination of fund raising, and application to external agencies.

Administrative Infrastructure Most Graduate Departments in the Faculty of Medicine have experienced annual operating budget cuts while graduate enrolment and complexity of management has increased from 2000 to 2004. Currently, the administration of graduate programs requires ROSI and paper-based tracking of student admissions, enrolment, funding, academic record and thesis defence planning. The time-consuming preparation for the Ontario Council of Graduate Studies review process (every 7 years) has been mitigated somewhat through enhanced electronic reporting by SGS, although this process continues to require months of administrative time and is duplicated during the internal 5 year departmental review at the end of each Chair's term. Every Graduate Department uses a shadow system to assemble information that is either not available in, or not easily reported from, ROSI. The annual review necessary for benchmarking and auditing could be streamlined with standardized electronic web-based data management. There is enthusiastic support for a web-based data management solution with a view to elimination of multiple shadow systems and paper tracking of information. An assessment is underway of the adaptability of the current MedSIS Oracle-based web-management system that interfaces with ROSI for the undergraduate medical education program. Such a system would track all intended and actual payments of graduate student awards, stipends and bursaries and significantly reduce the current administrative workload now undertaken in the Graduate Departments. Strategy: The Faculty will establish a web-based management program that interfaces with

ROSI for the purpose of tracking student financial information (see AIF request).

8.4 Arts & Science Education Curriculum Innovation The Basic Medical Sciences Departments contribute significantly to Arts&Science teaching in the life science fields of anatomy, biochemistry, immunology, laboratory medicine and pathobiology, medical genetics, microbiology, nutritional science, pharmacology, physiology and toxicology. The following section describes innovations in curriculum planning and implementation between the two Faculties. Life Science Curriculum Planning Committee In 2000-01, the decanal leadership in the Faculties of Arts&Science and Medicine recognized the need to improve planning and implementation of Arts&Science curriculum between the two


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Faculties. Barriers to joint planning were identified through a Task Force review by the Deans and Life Science Chairs. Adoption of two of the recommendations from this Task Force has greatly improved this programming. The first recommendation was the striking of the Life Science Curriculum Planning Committee composed of the Life Science Departmental Chairs, Director of Human Biology (Arts&Science) and the Director of the Division of Teaching Labs (Medicine) as well as the Chairs of Physics, Chemistry and Mathematics. This Committee is responsible for joint planning of all aspects of the life science curriculum including content development, delivery and administration. The second recommendation was the establishment of an agreement between the Deans of Arts&Science and Medicine for sharing of new revenue generated by undergraduate enrolment expansion in the Life Science Departments. This initial 3 year agreement deals only with the growth beyond the basal enrolment in 1999-2000 and is focused on non-specialist teaching. It is meant to provide an incentive for the Faculty of Medicine to examine its contributions to Arts&Science teaching, including the teaching loads, to optimize teaching time, and to engage in curriculum innovation without reducing current overall teaching commitments. Human Biology Specialist Program The Human Biology Specialist Program was launched in September 2002 with the phasing out of the previous Human Biology Major. To date, the Human Biology Program has received a modest budget from the Dean of Arst&Science in support of the Director, a full time Senior Tutor (Ron Wilson) and teaching assistants. Human Biology Specialist program courses have been established and the first cohort of students will graduate in June 2004. Generally, the Program has received good evaluations by the students. All teaching contributions by the Faculty of Medicine to new courses in the Human Biology Specialist program are included in the calculation of enrolment expansion revenue sharing agreement. Strategies: 1) The Faculty of Medicine will contribute to the oversight of the Human Biology

Specialist Program through recruitment of an Associate Director who will be a tenure-stream faculty member in Medicine, reporting to the Director of Human Biology.

2) The Associate Dean will work with the Deans to initiate a review of the governance and funding for the Joint Program in Human Biology between the Faculties of Arts&Science and Medicine, with a view to identifying a more stable organization and infrastructure for this program.

New Major Programs in Basic Medical Sciences Since 2000, Physiology has been the only Department in the Faculty of Medicine offering a major program. This is a popular program that achieves full enrolment up to the quota set by the Department based on its infrastructure resource limitations. In 2004-05, the Department of Nutritional Science will phase out its specialist program and offer only a major program. In September 2005, the Departments of Pharmacology, Biochemistry and Immunology will launch new major programs. It is predicted that offering these new majors in basic medical sciences will expand


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the number and breadth of courses for life science students. The Department of Biochemistry is planning a new interdepartmental specialist program in Bioinformatics and Computational Biology. These new programs will also provide an avenue for modest expansion of enrolment and teaching loads in the Faculty of Medicine. Challenges and Opportunities Considerable work has been undertaken to address a revenue sharing model for enrolment growth. The Deans of the Faculties of Medicine and Arts&Science have established a 3 year agreement that enables enrolment growth revenue sharing with Medicine aligned with expansion of teaching by the Basic Medical Science Departments in life science courses. The revenue sharing model is being rolled out progressively over the 3 years such that the full sharing of revenue will occur in 2004-05. The model takes into account the administrative and registrarial contributions of Arts&Science to this teaching, and is considered an equitable distribution to the Faculty of Medicine for its increased contribution to non-specialist program life science teaching. The generation of revenue requires the Basic Medical Science Departments to sustain a baseline level of enrolment in their non-specialist life science courses established in 2001-02. These new funds will be utilized by the Basic Medical Science Departments to support enrolment growth in existing courses and to help establish new courses for life science students. What is still needed is a budgetary model that will provide appropriate credit to the Faculty for the massive number of FCEs that our Basic Science Sector commits to Arts&Science teaching, while making some allowance for the administrative expenses and other overheads borne by Arts&Science. The Task Force chaired by Vice Provost Safwat Zaky has been considering ways of crediting divisions for their inter-divisional teaching contributions. Implementing such a credit system is seen by Medicine as essential in any new budgetary dispensation. With respect to teaching by Faculty of Medicine in other Health Science Faculties, we are establishing agreements with the relevant Deans to sustain support for core teaching, e.g., anatomy, physiology. It is recognized that continued budget cuts have eroded the operating funds in the Faculty of Medicine required to sustain these courses. Therefore, the Faculty of Medicine in partnership with the other Health Faculties will seek to establish agreements for joint funding of this teaching provided by Medicine, e.g., as with the AIF from the Faculties of Medicine and Dentistry to support anatomy teaching in dentistry. Importantly, these partnerships are facilitating curriculum evaluation and renewal, leading to more cost-effective and innovative methods of delivering the relevant course material. A critical ongoing challenge for the Faculty of Medicine is achieving an equitable balance in undergraduate teaching loads among the Basic Medical Science Departments while sustaining a reasonable contribution to life science teaching at the University of Toronto commensurate with available resource and academic goals. The number of full course equivalents (FCE) in Arts&Science provided by the Faculty of Medicine has increased considerably from 2000 to 2004, particularly with the introduction of additional second year courses in 2001. The Department of Laboratory Medicine and Pathobiology initiated a new undergraduate specialist program in 2001. The Faculty of Medicine also contributes to teaching in the summer term, e.g., Department s of Biochemistry and Physiology. Some year 4 courses in a number of Basic Medical Science Departments have capacity for increased enrolment. Curriculum innovation in the Life Sciences is both a challenge and opportunity on the St. George campus. A major goal of the basic medical science specialist programs is to encourage entry into


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graduate studies. The inter-disciplinary linkages in graduate studies in both Medicine and Arts&Science occur in collaborative programs, e.g., Developmental Biology, Proteomics and Bioinformatics, Cardiovascular Sciences. The Life Sciences Departments that already collaborate in providing courses, research seminars and graduate student supervision across disciplines are in an ideal position to provide new inter-disciplinary teaching and learning opportunities at the undergraduate level. Further, alignment of specific majors outside of Life Sciences, e.g., Biochemistry and Computer Science, may be ideally suited for preparation of students for existing graduate collaborative programs. The increased complexity of course offerings in life sciences requires a new approach to advising students about their options, particularly the organization of courses in life science double majors. This type of administrative assistance is beyond the scope of the undergraduate coordinators and their administrative staff. Strategies: The Associate Dean will continue to work closely with the Faculty of

Arts&Science to optimize the utilization of current resources to accommodate the sustained increased enrolment in the Life Sciences over the next 5 years.

Basic Medical Science Departments will explore inter-disciplinary teaching and

learning opportunities that align undergraduate programs with existing graduate collaborative programs.

The Faculties of Medicine and Arts& Science will share a new Life Science Associate Registrar whose role will be liaison between student services and the academic programs, with a view to enhanced communication and counseling about course selection and scheduling.

8.5 Medical Radiation Sciences Curriculum Innovation in a New Regulated Program The second entry BSc degree program in Medical Radiation Sciences, offered as a joint diploma program with The Michener Institute of Allied Health Sciences, commenced as a self-funded program in 1999. The three streams include Radiation Therapy, Radiological Technology and Nuclear Medicine Technology. The opportunity to obtain full BIU funding arose through the "Enrolment Growth Fund" of the Ministry of Training, Colleges and Universities. This led to the initiation of a new 3 year regulated program commencing in September 2002, with a target enrolment of a total of 390 students in steady state by 2005-06. The Department of Radiation Oncology (DRO) assumed primary responsibility for the new program in the Faculty of Medicine. DRO and the Michener Institute create a revised curriculum for the regulated program with enhanced self-directed learning, improved evaluation and remediation practices, and novel opportunities for specialized skill development prior to graduation.


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Challenges and Opportunities Attract Highly Qualified Students Since our Medical Radiation Sciences program was the first in Canada to offer a BSc degree, it is essential that our graduates will be viewed as highly qualified and very competitive in the job market. The guarantee of employment immediately following graduation is the most important marketing tool to attract highly qualified applicants. Hence, this program will be carefully tracking graduates and their employment status. The stakeholders in the market for Medical Radiation Sciences include the hospital sector, the MOHLTC, and the relevant professional associations. These stakeholders must work together to delineate and predict the health human resource needs for these professions. The original enrolment plan was to continually reduce the intake of students into radiation therapy (from 75 to 50), while increasing the numbers in the other two streams. This plan was based on the immediate shortage of radiation therapists in Ontario (and across Canada) and the perception that there would be increased demand for technologists in the other two streams from 2005 to 2010. However, the accuracy of these projections is uncertain. The program already attracts funded out-of-province and international students along with highly-qualified applicants from Ontario. The aim of this program is to attract at least 4 eligible applicants (currently the ratio is 2:1) for every student enrolled. The Medical Radiation Sciences academic leadership continually strives to enhance curriculum content and teaching through iterative program evaluation, benchmarking and faculty development. Inter-professional education is a new focus and both faculty and student representatives participate in the Inter-Professional (Health) Education Curriculum Committee (all health professions at the University of Toronto). The students in Medical Radiation Sciences have financial needs similar to other second entry or graduate health professional students, as confirmed by their rate of utilization of OSAP and UTAPs. The major bursary support for these students is from the UofT student aid pool. Accordingly, this program has almost no institutional bursary funding. Improved student funding will be important for ongoing recruitment of highly qualified students to this program. Strategies: The Faculty of Medicine and The Michener Institute should proactively engage

stakeholders interested in the supply of Medical Radiation Science professionals, with a view to assessing enrolment quotas that will reflect job availability in Ontario and beyond.

The Faculty of Medicine and The Michener Institute should establish joint fund-

raising for student bursary and merit awards for Medical Radiation Sciences over the next 5 years.

Academic Faculty Development in Medical Radiation Sciences The development of faculty careers in both teaching and research in Medical Radiation Sciences is now an important focus in the Department of Radiation Oncology and the Faculty of Medicine. Linkages are being developed with the Faculty of Medicine/SMH Centre for Faculty Development and the Wilson Centre for Research in Health Education. A positive by-product of this new stream is


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that it has motivated more clinical faculty in Medical Radiation Sciences to engage in faculty development aimed at pedagogic enhancement. The new Masters in Radiation Therapy will be aimed at academic advancement of therapists (see AIF request).

8.6 Inter-Professional (Health) Education Inter-Professional (Health) Education Curriculum Planning Committee The Council of Health Science and Social Work Deans (CHSSWD) have charged the Inter-Professional Education Curriculum Planning Committee with the task of facilitating the development of innovative initiatives among the Health Faculties in inter-professional education (IPE). The Centre for Study of Pain launched a modular one week course in the study of pain for most of the health professions at UofT over the last 3 years. Based on this model, the Committee plans to organize more IPE modules in inter-disciplinary fields of study such as patient safety, bioethics and public health, as well as begin planning for multi-professional Clinical Teaching Units on a pilot basis in the University-affiliated hospitals. Evaluation of the strengths and weaknesses of IPE initiatives will be essential as the health faculties move forward. Challenges and Opportunities Although IPE has garnered political support at the federal level, the hard evidence in support of pre-clinical IPE is extremely thin, and there is only slightly more evidence to support clinical IPE prior to conferral of the first professional degree. Nonetheless, it seems only logical that today's health professional students who learn together should practice more effectively in client-centred health care teams. There is also a large volume of evidence in support of collaborative education and shared-care initiatives once professionals are established in the clinical workplace. Thus, the challenge is to determine whether and how IPE can be effective at various points in the clinical training of the diverse group of health professionals who receive their degrees from UofT. The implementation of IPE in each health professional program will require expert leadership and dedicated time from a team of faculty members. The Centre for Faculty Development, under the direction of Dr. Ivan Silver, has identified IPE as a major priority. IPE Projects and Research For reasons given, IPE research is required to provide critical evaluation and assessment of impact at the undergraduate, clinical and post-graduate levels. The Wilson Centre for Research in Education has considerable interest in IPE topics and is in a position to provide both consultation and collaboration with educators who wish to pursue research in IPE. The IPE community among the health science faculties should be prepared to respond to new funding opportunities by establishing collaborative initiatives that include partnership with the affiliated hospitals. Existing expertise in specific fields such as patient safety, international/global health and bioethics offers an important framework for IPE project development.


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Four Major Programs (Pillars) of Continuing Education

Continuing health professional education Faculty Development Public Education Knowledge Translation

9 Continuing Education The Continuing Education leadership team in the Faculty held two mini-retreats in 2004 at which future directions for the field were discussed. Participants included core researchers from the Knowledge Translation Program (KTP) established through an APF allocation in the last planning cycle, and members of the Faculty Council Continuing Education Committee (FCCEC). Following these mini-retreats, the Associate Dean consulted other colleagues in the Faculty and external stakeholders as documented below, in the preparation of this plan. We have projected strategic directions against the four major programs (borrowing a phrase from the creation of CIHR, the ‘pillars’) of continuing education - namely, continuing health professional education, faculty development, public education, and knowledge translation. We acknowledge that this strategic planning process crosses beyond traditional boundaries of ‘CE’, in at least two areas: viz. the creation of a truly interdisciplinary knowledge translation program involves aspects of health services research and policy; and the creation of a knowledge broker in health professions education or the development of knowledge management strategies requires active engagement with undergraduate, postgraduate and graduate education. Major Themes Across the Continuing Education Pillars Several major themes are identified in “Stepping Up”: excellence in teaching, renewed academic leadership, interdisciplinary research and training, “extending our reach”, benchmarking, and vision/innovation. Excellence in teaching In building on and expanding the teaching excellence of the Faculty of Medicine in continuing education, we will undertake the following activities: • Enlarge our capacity to reward teaching excellence by a revitalized awards committee in

continuing health professional education, • Develop and expand new awards for participation in and delivery of continuing education across

the Faculty, led in part by the Centre for Faculty Development and the education deans of the Faculty,

• Build on and expand current resources and activities in knowledge management (in undergraduate and postgraduate programs) and at the graduate level in knowledge transfer and knowledge translation. Where practical, we will promote modular courses to permit flexibility in participation.

Further, we anticipate that increasing our excellence in teaching across all sectors will also improve our capacity in public education. Renewed academic leadership To develop new leadership in the broad area of continuing education, we anticipate using the operational successor(s) to the FCCEC (tentatively called the Continuing Education Advisory Committee), and whatever sub-committees this process creates. This process will involve leadership


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training and/or faculty development of these leaders, possibly in concert with programs developed by the Department of Health Policy, Management and Evaluation, and/or by sending educational leaders to external programs such as the Harvard Educational Leadership course. We also anticipate using committee meetings as a forum for professional development, e.g. by inviting speakers in a variety of relevant topic areas to address the regular meetings of committees. Finally, we anticipate being able to select, through departments and centrally, both junior and senior faculty members as leaders in continuing education, thereby ensuring the future of this portfolio in the Faculty. Interdisciplinary research and teaching The provostial planning framework strongly encourages inter-professional education and inter-disciplinarity. While the FCCEC comprises representation from virtually all clinical (and many other) departments, the creation of interdisciplinary educational activities itself is frequently less than optimal because of funding models, intra-departmental planning and logistics, and the realities of disciplinary expertise and interests. We anticipate, however, an increase in the offerings of inter-professional CE by encouraging its development at the Faculty level during the next planning cycle. Critical evaluation of the uptake and impact of these offerings will be undertaken. Further, in faculty development, the Centre (led by Prof. Ivan Silver) will increase its collaborative relationships with the Wilson Centre for Research and Education, the Knowledge Translation Program, and other partners as appropriate. In public education, an area which is already highly inter-professional (given the need to respond to public demand for disease-based education), we will continue to add to the mix of teachers and learning experience with a strong cross-disciplinary focus. In addition, the KTP - already highly interdisciplinary in nature and structure - will acquire expertise in biostatistics, informatics, public health sciences and other areas. This activity will occur within the already-funded APF framework over the next four years of KTP activity. Finally, there are concrete ways in which the Academic Incentives Fund allows the Continuing Education portfolio to broaden its inter-disciplinarity in the field of ‘knowledge translation’. The Faculty will go forward in the fall with a proposal for AIF support for a Centre for Knowledge Translation, in partnership with Sunnybrook and Women’s College Health Sciences Centre (see AIF requests). In this way we will bridge the academic and service aspects of the collegium, train graduate students in practical aspects of professional performance change, and further develop the conceptual framework for knowledge translation. Recognizing the specialized needs of learners within the Faculty and beyond, and the existing strengths in knowledge translation in the cognitive realm, we will also explore further KT linkages oriented to technical skill development by partnering with the surgical departments (Surgery, Ophthalmology, Otolaryngology, Obstetrics and Gynecology) and with Anesthesia. We also intend to forge stronger linkages with colleagues in the rehabilitation specialties to enlarge their interdisciplinary capacity and to promote and study the effect of knowledge translation interventions in these disciplines. Last, we shall forge stronger links with the Centre for Research in Education, the Centre for Faculty Development, the Centre for Global e-Health Innovation and other relevant centres and units in the Faculty. Extending our reach – expanding our local, national and international targets More than any other dimension in this plan, the consideration of ‘extending our reach’ necessitates a conversation about our stakeholders and partners in the CE process. Under the rubric of internationalizing our efforts, we point to the efforts and directions in international continuing education led by Prof. Arnold Noyek and CISEPO. CISEPO has brought a sizeable increase in outreach activities, focused particularly on the Middle East where the objectives go beyond traditional continuing professional development or education, and include relationship– (and even peace–) building. We recognize other initiatives in international health, education and


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Mini Med School a great success Prompted by requests for public educational events and by the example of several American 'Mini Med Schools', the Faculty of Medicine offered the first in a series of these highly popular public lectures in 2002. Over a thousand individuals registered for a six-part series in the fall of that year, and a follow up in the spring of 2003. These two-part series have continued to be offered twice yearly, and continue to be well attended. 'Electives' (one day events in specialized topic areas) have also been offered.

development as well: among them CE activities in Latin America on the part of members of the Department of Family and Community Medicine and the Centre for International Health. We intend to expand this activity to other areas in this planning cycle, and to study the outcomes closely. Locally, our ‘internationalism’ also extends within Canada, where we have started (and will build on and study) a program to prepare international medical graduates for further training in medicine in Ontario. This is an example of ‘cross-pillar’ collaboration in which we blend the best of public and continuing professional education. In CPD, we will also extend our reach by pursuing more active linkages with NorthNet, a distance education and telemedicine network, and other distance education vehicles both within the University and without. This process will permit us not only to extend our reach by web-casts and videoconferencing, but also to study the phenomenon of consultation and distance education. Further, we will build on relationships with the OMA and the Ministry of Health and our role with the Guidelines Advisory Committee of Ontario to study differing modalities for dissemination and local adoption of best-evidence guidelines. In the realm of best practices and guideline adoption, the stakeholders and partners are numerous: e.g. the College of Physicians and Surgeons of Ontario, College of Family Physicians of Ontario, Ontario Hospital Association, and ICES, among others. With regards to faculty development, we see significant potential in programs to enhance teaching and evaluation skills as the Faculty plans for increased educational activities in the partially affiliated teaching hospitals and in community sites. Where possible, we also envisage individuals from non-University of Toronto-affiliated Faculties of Medicine and health sciences participating in faculty development on a cost-recovery basis. Finally, under public education, we see growth beyond our successful “Mini-Med School” into electives offered by selected departments (for example, pediatrics). We also anticipate extending our reach by developing other communication tools, such as web-based or printed newsletters. Benchmarking against international standards We plan to make a more concerted effort to track and report usual benchmarks (for example, numbers of courses, registrants, grants, publications, citations) for continuing education and to disseminate these as widely as possible. In addition, and wherever possible, we intend to identify and track health outcomes or proxy markers, which would enable us to indicate if we do in fact have an impact on the health system and its outcomes. This latter set of markers may best be tracked though our close association with the Guidelines Advisory Committee of Ontario, in which ICES is empowered/funded to determine outcomes to specific educational interventions. Vision and innovation There are several elements to our undertaking of broader vision and innovative strategies to achieve this broader vision. These elements include the following: • The increased incorporation of information and communication technologies (ICT): We intend to

employ, with others, and to study the uptake and effect of ICT across all pillars of continuing


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education, from faculty development to public education and knowledge translation, and from early conceptualization to development to evaluation of outcomes;

• Trans-disciplinarity: We intend that the outcomes of each of the four pillars of continuing

education should be mutually developed and informed, so that advances in one area (faculty development, for example) will positively affect our teaching in the other areas. Further, as the field grows, we anticipate creating new understandings of the effective transfer of knowledge into practice – for teachers, clinicians, researchers and public members.

• Enhanced collaborations: We intend first of all, that all of the activities under the umbrella of

continuing education be mutually supportive. This would include, for example, collaborations being developed among academic partners within the Faculty of Medicine, such as the Centre for Faculty Development, the Centre for Global E-Health Innovation, the KTP, the Centre for Research in Education, in order to expand the theoretical base of knowledge translation, continuing professional/faculty development and public education. Secondly, we anticipate furthering mutually supportive collaborations within and across the University community by exploring partnerships with Bell University Laboratories and the Knowledge Management and Design Institute, among others. Third, collaboration will also feature efforts at the hospital level, focusing on the service end of the continuum, and, in conjunction with partners such as the Guidelines Advisory Committee, efforts on a province-wide level. Fourth and finally, we will explore and expand our international relationships, as outlined earlier in this section.

• Funding/Support: We recognize that CE will be largely funded by external sources, course-based

revenues, and partnerships. This is already the case. Thus, we shall search actively for partnerships and funding with such agencies as Bell University Labs and CIHR, and expand on our success with sources such as the Primary Health Care Transition Fund, among others. Further, we will active in pursuing financial opportunities that might arise from enrolment expansion in any and all health professional programs where we may contribute usefully to teaching and faculty development.

Underwriting each step of this strategic planning process has been one question, raised by members of the FCCEC: ‘What is special about CE at the University of Toronto?’ We believe the following descriptors capture our unique position: • Scholarship & Research - the scholarly and evaluative nature of our program planning and

delivery, linking it to outcomes where possible and a clear understanding of process when not. This academic focus is best expressed through the activities and directions of the KTP (www.ktp.utoronto.ca).

• Innovation and Integration – the development and testing of innovative educational and other interventions, with close anchoring of these, where possible, out to the health care environment and back to the relevant professional programs.

• Global Understanding & Reach – CE at U of T has a substantial international profile and we are growing our international outreach in this planning cycle.

CONTINUING EDUCATION – KEY STRATEGIES The following are the strategies which we shall undertake to create the future vision for continuing education in the Faculty of Medicine articulated above. Pursuit of these strategies should enable the Faculty – already an acknowledged leader in the field – to become the international centre of excellence in continuing education and knowledge translation.


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We suggest that these initiatives have been driven by the University imperative to expand our reach into the community (both public and health professional), improve interdisciplinary activities and education, train and provide environments for graduate students in continuing education and knowledge translation, and – possibly – expand our ability to generate revenue within departments and sectors. While we believe that each of these is achievable within our current funding structure, we look to the Academic Initiatives Fund support for Item 4.

1. The creation of a Faculty (Associate Dean’s) Advisory Committee in continuing education. This committee would be advisory to the associate dean of continuing education, will include representation from the four areas represented by continuing education. Further, we anticipate that consideration of forming a policy-oriented body representing continuing education will occur at Faculty Council.

2. The creation of one or more new offerings in faculty development at certificate,

diploma or master’s level in continuing health professional education and knowledge translation, under the rubric of the Master’s of Health Professional Education program; and the possible expansion of the Fear Fellowship in Continuing Education. The former offerings are outlined elsewhere in this document under Graduate Studies.

3. The addition to the Knowledge Translation Program of two new (already-funded

from the last APF) researchers, including one with skills in biostatistics and trial design, and one other with skills in informatics, public health sciences, and other areas yet to be determined.

4. The creation of a Centre for Knowledge Translation in partnership with Sunnybrook

and Women’s College Health Sciences Centre, with AIF support. Funding support will be directed to ongoing academic positions, enabling trans-disciplinary “knowledge building” (and thus building our faculty capacity in this area). These individuals will acquire access to hospital databases, link to peripheral hospitals, and develop hospital-wide awareness of KT activities. We are also seeking two short-term (two year) staff-level positions as follows:

5. A KT project coordinator and research associate. This individual will act to coordinate research and development information flow to the four academic positions (as well as across the Faculty), create the necessary tools in KT and CE (e.g., in information and communication technology, grant-writing and other developmental purposes), coordinate the development and deployment of graduate studies and other activities in KT, act as an information broker between and among departments and KT units, among other tasks.

6. A public education coordinator: We need one individual who will facilitate the translation of research findings and new knowledge into pubic and patient education. This role will be partly promotional, involving linkages with potential partners and funders, outreach to professional and alumni associations, and creation of new delivery methods (newsletters, web sources).

7. The elaboration of efforts in international education: in this arena, we intend to a)

expand the regions served by our efforts, focusing on lessons learned in our current


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activities, b) continue to develop and test models of delivery (e.g., using ICT and on-site activities, knowledge and capacity-building), and c) develop and measure meaningful outcomes of our work. Among the lessons of SARS for the CE portfolio was the importance of developing virtual tools for continuing professional development. These tools can extend our reach provincially, nationally, and internationally.

8. The expansion and study of our efforts in public education, including the

exploration of new vehicles for this effort.

9. The increased use and evaluation of information and communication technologies across all continuing education sectors/pillars.

10 Academic Faculty The Faculty of Medicine comprises 5,016 academic faculty spanning the University campus and affiliated teaching hospitals and agencies. As noted earlier, these faculty members represent a massive pool of intellectual and academic talent in North America. A total of 1,964 are engaged full-time in academic activity and designated “faculty full-time”, while the remainder are involved in academic activities in a part-time capacity. Among the full-time faculty, 212 are tenured or in the tenure stream (up minimally from 206 in 2000). The variation in compensation arrangements and the extent of work by faculty with limited University salary support was noted above. University-based or -compensated faculty remain important to the leadership and growth of the academic enterprise. They provide both the glue and the leverage to engage and coordinate the participation of a large and diverse group of faculty based in more than 30 different sites, and provide administrative oversight to the academic enterprise. Put simply, the University cannot shortchange the core budget of the Faculty of Medicine on the false assumption that support for academic functions can be offloaded onto hospitals and practice plans. As but one example of the precariousness of the Faculty’s financial situation, CIHR recently cancelled its career awards beyond the level of new investigators. This could amount to a $1 million budget cut for the Faculty of Medicine, as academic Departments, particularly in the clinical sector, come forward to underwrite the salary support that colleagues will be losing over the next 5 years. Academic Staff (May 2003) 10

Rank Faculty Full-time

Other Faculty

Total %change from 2000

Professor Associate Professor Assistant Professor Other Ranks (Lecturers, Instructors, Tutors)

543 508 789 124

133 199 896

1,824

676 707

1,685 1,948

11% 0.7%

5% 4%

Total 1,964 3,052 5,016 5% 10 See Appendix IV for Faculty Staff Count by Department.


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Recruitment For the period 2004 – 2010, relatively few faculty members from the tenure stream are retiring; some will be replaced, but many retirements will be used to cover departmental budget cuts. We therefore anticipate only limited growth in the faculty complement within the tenure stream. This growth will occur from APF positions funded but still unfilled from the last planning cycle; positions requested through the AIF in this planning cycle; endowed funds (chairs and professorships); Canada Research Chairs; and enrolment expansion in the rehabilitation sector, with concomitant growth in BIU and tuition revenues. Recruitment strategies have increasingly emphasized the importance of diversity, and there has been moderate success in recruiting women and members of under-represented groups to faculty positions. Indeed, in some clinical Departments, women dominate recent recruitment to such an extent that pro-active recruitment targeting men has been considered. Furthermore, in many disciplines, the pool of candidates for academic positions itself contains increasing numbers of women and members of ethno-cultural minorities. The Decanal Gender Issues Committee has been asked to review the gender distribution within the faculty. The percentage of female faculty in the Basic Sciences Departments ranges from 6 to 43% while in the Clinical Departments the percentage of female faculty ranges from 9 to 46%. The overall averages largely reflect the demographics of the relevant human resource pools. Nonetheless, ongoing efforts must be made to develop an environment that ensures the appropriate recruitment and retention of qualified female faculty across the departments. For tenure-stream recruits, the Faculty has designated the Decanal Assessor as equity and diversity champion. The Assessor must be appointed by the Dean, and is a senior faculty member from outside the cognate department that is in recruitment mode. The faculty member is provided with a comprehensive dossier on pro-active recruitment and University equity and diversity policies, and specifically mandated to ensure that the search committee seeks out candidates from the under-represented gender and from minority groups. The Faculty enjoys considerable success in attracting the interest of elite candidates. The prime attraction to Toronto is the scope and depth of the research and academic programs. Recruitment challenges include access to sufficient resources for start-up support, access to appropriate physical space for new recruits, and the cost of housing. The availability of the menu of tax-reduced housing loans provided by the University has been helpful in the latter respect. The clinical Departments all make efforts to balance recruitment of clinician-scientists, part-time clinical investigators, clinical educators, and front-line clinical teachers. In some cases hospitals and clinical Departments are recruiting basic scientists into clinical departments and linking them with clinical leaders to enhance translational research. In other instances, service demands in the hospital setting are driving the recruitment and selection of clinician-teachers over research-focused candidates. There are a number of opportunities for the University and the affiliated teaching hospitals to collaborate with respect to recruitment of outstanding scholars to academic positions. In particular, several areas offer ongoing challenges in recruitment: • In the Rehabilitation disciplines (Physical Therapy, Speech-Language Pathology and

Occupational Therapy), there is a shortage of academically-qualified personnel, particularly those with strong research records;

• In some of the clinical departments (e.g., Anesthesia, Radiation Oncology, Medical Imaging, Laboratory Medicine/Pathology), there are shortages of specialists and sub-specialists.


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International recruitment is made difficult by regulatory and immigration restrictions and barriers, although matters have steadily eased with both the CPSO and the Royal College over the last five years.

To deal with these recruitment challenges and clinical service needs, discussions and planning are underway with the Ministry of Health and The Michener Institute to initiate programs for training "Physician Assistants". The starting point will be “Anesthesia Assistants” who will be recruited from the current pool of respiratory technologists. We will explore other fields of practice during this planning cycle. The initiation of comprehensive Alternative Funding Plans should facilitate the deployment of non-physician personnel to cover clinical service needs, be they physician assistants or nurse-practitioners. Clinical Faculty In total, there are 1,655 full-time and 2,122 other faculty members in the clinical departments, making up 75% of the total faculty count. While most full-timers are situated in the nine fully-affiliated teaching hospitals, some departments, such as Family and Community Medicine, have significant numbers of full-time members in partially-affiliated sites, or community clinics. The excellence of the clinical faculty and its breadth and depth are heralded by numerous prestigious national and international awards, the level of grant funding, and their massive numbers of publications in high-impact journals. While there are occasional stresses from shortfalls of qualified academic specialists, the ability to recruit superb clinical faculty to Toronto remains a major comparative advantage for our program. Sources of funding for clinical faculty include University funds, hospital and hospital-based research institute support, external salary awards (such as the now-lapsing CIHR career awards program) and practice plan revenues. However, over the past 10 years clinical departments have seen the University contribution reduced by at least two percent per year without accounting for inflation. These reductions have caused considerable difficulty in maintaining adequate administrative support and in recruiting new faculty. In 2001 the Faculty’s Task Force on Recruitment of Clinical Teachers in Medicine provided its report on the various barriers to recruitment and retention. The Task Force identified that the fundamental barrier to recruiting and assigning teachers in the professional medical education programs was that the clinical faculty felt undervalued. The steps taken, flowing from the Task Force, include: the creation of HUEC, rationalization of teaching loads across departments, streamlined and collaborative methods of recruiting UME teachers, increases in the number of teaching awards and events recognizing teaching as a priority, and clearer promotion criteria related to pedagogy. A faculty survey completed in December 2003 as part of the Faculty Self-Study for UME accreditation, provided very positive results, for example, 94% of faculty agreed (or strongly agreed) with the statement: "My teaching activities are a source of fulfilment and personal satisfaction." A significant enhancement to the remuneration of clinical faculty came from Phase I of the Ministry of Health (MOHLTC) Alternative Funding Plan for Academic Health Science Centres (AHSCs). The intent of the AFP is to develop non-fee-for-service funding envelopes for medical staff for clinical service, education, research and associated administration. Phase I brought over $30 million per annum in remuneration earmarked in support of the clinical teaching time of our faculty, a sum greater than the entire University budgets of all clinical departments combined. Phase I of the Ontario academic AFP project should therefore have a strongly stabilizing effect on our clinical collegium, but a new challenge has arisen from uncertainty about whether Phase I funding will be


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renewed if negotiations between the OMA and MOHLTC fail as regards completion of the AFP process. The worst case scenario would be failure of the AFP negotiations and withdrawal of Phase I support; this would cause immediate income reductions, and could lead many clinical teachers to refuse participation in what are otherwise unremunerated undergraduate teaching responsibilities. One of the significant accomplishments since the 2000 Academic Plan has been the work of the Task Force on Clinical Faculty. The Task Force developed recommendations for policies to govern the appointment of clinical faculty at the University of Toronto. These policies define clinical faculty, and provide mechanisms for their appointment, resolution of disputes, and protection of academic freedom in the hospital setting. They also protect against termination of academic appointments except for cause. The policies have been endorsed by the elected Medical Staff Associations (MSAs), Chief Executive Officers and Chairs of Medical Advisory Committees for all nine fully affiliated teaching hospitals and the clinical leadership of the Faculty of Medicine. They also received overwhelming majority support in a direct survey of clinical faculty organized by the OMA at the request of the MSA executives. The framework for clinical faculty appointments has the following elements:

• Appointments should be based on job descriptions not pay sources • Appointment category should fairly reflect academic role • Major academic participation is generally not possible without membership in a practice

plan and an appointment in variously, a fully-affiliated teaching hospital, an affiliated service in a partly-affiliated hospital, or a formally-affiliated teaching practice in the community.

• All full-time faculty members are expected to participate in practice plans which are governed by core operating principles to be embedded in hospital-University affiliation agreements.

A Clinical Relations Committee of the Faculty will be created as a mechanism to monitor and review the implementation of policies for clinical faculty. It will include:

• The Presidents of the Medical Staff Associations of all fully-affiliated teaching hospitals (or their delegates)

• The Chairs of the Medical Advisory Committees of all fully-affiliated teaching hospitals (or their delegates)

• Clinical department chairs, appointed by the Dean • Provost or delegate (from the University) • The CEO's or their delegates from the fully-affiliated teaching hospitals

The Clinical Relations Committee will therefore be the conduit through which any revisions to these policies must pass before moving on to Faculty governance. The Clinical Faculty policies have been approved in principle by Academic Board and Governing Council in June 2004. Much needs to be done over the next three months to finalize the policies and see them through governance. The Clinical Relations Committee will be convened to develop the detailed manual of policies which will be circulated for comment and approval. The policies will return to Academic Board and Governing Council in the fall of 2004.


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Faculty Development No summary of the status of faculty members would be complete without revisiting the Centre for Faculty Development at St. Michael's Hospital. As noted earlier, the founding Director, Prof. Ivan Silver of the Department of Psychiatry, was appointed in March 2003, and a growing team of collaborators has been assembled into multiple working groups. Projects and development for 2003/2004 academic year include: a faculty-wide needs assessment; a series of nine 2003/2004 instructional development workshops; an instructional development certificate program; a Teaching and Learning journal club; a Teaching Innovations Laboratory wherein creative clinical teachers can share, discuss, and stimulate innovation in teaching; a Faculty-wide "new faculty" orientation program; a teaching consultation service; and a faculty development resource library and website.

11 Students Undergraduate Medical Students The Undergraduate Medical Education Program recently completed its accreditation process from the CACMS/LCME in May 2004. The Student Self Study pointed out the following concerns: • The Self-Study Task Force found that although extensive career counseling is available, typically

only those students who are self-motivated seek it. Reticent students may not avail themselves of mentorship opportunities. The Faculty is considering appointment of a career counselor to meet at least annually with every student. This counselor would work closely with other members of the Office of Student Affairs (OSA) staff, particularly a psycho-educational consultant, to ensure that students make the best personal career choices. The career counselor could also assist with the residency matching processes.

• Financial counseling is provided by the Financial Counselor in the Office of Admissions and

Awards. Students who have exhausted their financial options are counseled by OSA, and in serious cases, applications are made on behalf of the students for UofT high-need bursaries. The financial aid available through the Faculty itself has steadily increased, but remains inadequate relative to rapidly increasing debt loads. The majority of funding (OSAP, Faculty of Medicine) is in the form of loans, contributing to rising student debt loads.

The Faculty was concerned about the increasing amount of "needed assistance not funded". An internal review of student aid programs was undertaken, and as noted above, the Faculty of Medicine has since secured additional resources from the University with which to enhance medical student financial aid. Using data already collected from students applying for OSAP, UTAPs, and Faculty bursaries, those students with unfunded need, as defined by UTAPS criteria, will be eligible for additional bursary funding. The Self-Study Task Force recommended the hiring of an additional financial consultant who would coordinate all MD financial counseling. This individual would provide direction on debt management, and actively pursue partnerships for student support. The UME leadership team agrees, and this hiring process will get underway shortly. The Self-Study Task Force also recommended that consideration be given to the appointment of a social worker and psychology consultant to work with OSA staff. These professionals would facilitate


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early student access to appropriate expertise. Job descriptions and budget are being developed at present for these positions. Whether we hire for one or both positions is still unclear. Further, the University health/dental plans will be reviewed to identify gaps in provision of care for students and their offspring. Graduate Students The perspectives of graduate students have been drawn from Ontario Council on Graduate Studies reviews of graduate programs (which include assessment and reporting of student issues), and from focus groups and consultation sessions with graduate students. Key issues for graduate students include: • Inadequate levels of financial support (stipends in particular are not always competitive with

those stipends provided by other Universities) • Access to counseling beyond the level of research supervisor (this may need to be organized by

site given that two-thirds of graduate students are based in teaching hospitals) • Access to teaching and research assistant opportunities in selected areas Professional Masters students As part of the academic planning for the Faculty, consultation sessions were held with professional masters students. Participation in the sessions was small. However, we obtained the following comments: • All candidates confirmed the quality of their programs and their perception that they were in

nationally competitive programs. • The small size of the programs leads to good access to faculty. • The programs are seen as practical, with strong connections to community practitioners. • The students did question Stepping Up’s strong focus on research and wondered about the depth

of the University’s commitment to professional graduate programs. A Task Force to Examine the Needs of Professional Graduate Students in the Faculty of Medicine reported to the Dean in May 2002. The Task Force surveyed professional masters students in the Faculty and discovered that at least 50% entered their graduate programs with a significant debt accumulation due mainly to education expenses. At the time of completion of their Masters' degree programs, these individuals have a total debt load averaging from $30,000 to $40,000. The Faculty of Medicine obtained a pool of funds for Professional Master's bursaries in negotiations with the Provost in April 2001. These funds do assist materially in the financial support of professional masters students. Nevertheless, the current contribution to the student aid pool of funds by the professional masters students is more than the total amount of aid they currently obtain from the sum of the high needs' bursaries from SGS, UTAPs and the Faculty of Medicine bursary fund. Just as with MD students, there appears to be a need for repatriation of the funding envelope for the professional masters stream. The Faculty of Medicine is therefore committed to re-surveying the financial needs of professional masters students and providing better support for assessment and distribution of bursary funds. We believe the total contribution to student aid made by our professional masters students should be returned to them.


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Medical Radiation Science As noted earlier, Medical Radiation Science students are also facing significant debt loads owing to fairly high tuitions for their programs. A consultation session with Medical Radiation Science students identified the following needs: • A comprehensive orientation to new students about the relationship of the program with U of T

and where they can access services and information; greater clarity about the respective roles of Michener and UofT

• Identification of key contacts for students, including the leadership for the program, and development of better mechanisms for student and alumni input about the program

• Student guidebook to help students navigate both Michener and UofT • Reduction in the amount of duplicate documentation required by the two partner institutions • Improved communications overall. Post-doctoral Fellows The perspectives of post-doctoral fellows were drawn from a consultation session held in early May, as well as informal input through the Office of the Vice Dean, Research. Over 1,200 post-doctoral fellows are dispersed across the academic health science enterprise. For the post-doctoral fellows on campus, a new letter of engagement and minimum stipend requirements were instituted in 2002. Suggestions arising from the post-doctoral fellows included: • Improved connectivity and communications through an identified departmental point person (e.g.,

graduate administrative coordinator) • More opportunities for post-docs to give guest seminars, as well as serve as TAs to develop and

showcase teaching skills • Consider post-doc networking opportunities that allow post-docs to meet each other and attend

targeted seminars/ workshops on topics such as grant writing, career development planning, job searching, etc.

• Improved communications (e-mail and web-based) to post-docs about seminars, lecture, events, and Faculty news

• Enhancement of salaries and benefits, as both are a continued source of concern for a majority of post-doctoral fellows.

An AIF request will be forthcoming to help improve administrative support for post-doctoral fellows through the Office of the Vice Dean.

12 Strengthening our relationships One of the key strengths and distinguishing features of the University of Toronto Faculty of Medicine is its relationship with nine TAHSN teaching hospitals and their respective research institutes. As noted earlier, the Toronto Academic Health Sciences Council (TAHSC) has evolved into TAHSN with formalization of joint planning for clinical programs, integration of back office functions underway, and agreement on the creation of an academic oversight council. The Faculty and teaching hospitals continually seek out opportunities to better integrate the campus-based and hospital-based faculty and academic activities. Nonetheless, more joint planning is possible, particularly in the research realm.


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The University Health Network recently opened The Paul B. Helliwell Centre for Medical Education at the Toronto General Hospital site, a new home for the Wightman-Berris Academy. With innovative technology and design, the centre is expected to set new global standards of excellence in health professions education. In 15,000 square feet of space, it provides the latest technology in education, including wireless technology and superb audiovisual capability to provide a teaching setting as close to the “real world” as possible.

In 2001, the Faculty created the Hospital University Education Committee (HUEC). Advisory to the Dean and chaired by the Associate Dean, Postgraduate Medical Education, HUEC’s membership consists of key educational leaders from the campus and hospitals – hospital Vice Presidents Education, all Associate Deans, and selected clinical chairs. HUEC played a key role during the SARS outbreak last spring. It has also produced an influential report on the distribution of the costs of undergraduate and postgraduate medical education within the Faculty of Medicine and its teaching hospitals, implemented an educational ethics policy, and developed a Faculty teaching award program. HUEC will continue to address issues as they are brought forward by the Dean and other educational stakeholders. Issues to be addressed by the HUEC in the foreseeable future include: managing enrolment enhancement, implications for education of hospital shifts in core services and caseloads, and disaster planning. Research is also viewed as a collaborative enterprise. The Hospital-University Research Coordinating Committee is chaired by the Vice Dean - Research in Medicine, and includes all the VPs - Research of the fully affiliated teaching hospitals as members. The Dean of Medicine in his capacity as Vice Provost chairs the same group reconstituted as the Research Committee of TAHSN to deal with policy issues that go beyond the Faculty of Medicine. As well, the partners have formally agreed to work together synergistically in a number of ways. In 1999-2000, the University and hospitals embarked on a major process of research policy upgrading and harmonization across the campus and hospitals, led by the Vice Provost/Dean. This has been a highly successful process that has placed Toronto at the national forefront in all areas of research policy. In 2002, the University and hospitals also arrived at an omnibus agreement on sharing research revenues as well as joint planning for infrastructure. The hospitals have invested very significantly in research and educational endeavours that are complementary to the broad strategic priorities of the Faculty. The three hospital-based Academies for UME are sterling examples of the support that the teaching hospitals give to the Faculty’s educational enterprise. As other examples of partnership, one can point to, variously, the Wilson Centre for Research in Education at UHN, the Centre for Faculty Development at St. Michael’s, the proposed new Centre for Knowledge Translation at Sunnybrook & Women’s, the Centre for Research in Women’s Health at Sunnybrook & Women’s, and the Surgical Skills Centre at Mount Sinai. This inter-leaving of clinical, educational and research activities between the major teaching hospitals and the Faculty remains a core attribute and signal strength for both sides of the partnership. We earlier reported that in 2004, the Faculty’s Task Force on Partially Affiliated Hospitals and Related Health Care Organizations described and characterized the community affiliated settings for education. It profiled the educational and research activity in various of the partially-affiliated hospitals, and outlined issues relating to research policy, faculty appointments, and future capacity. In fact, there are over 400 organizations and practice settings that could be considered members of the broad group of community affiliated teaching institutions. They already contribute meaningfully to the education of undergraduates, graduates, and postgraduates. The relationships with the Faculty and/or University


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are recognized through affiliation agreements, placement agreements, and sometimes informal documentation. The Task Force made a number of recommendations to strengthen relationships between the Faculty and this community-affiliated network of teaching settings. Among the recommendations were: establishment of a Council of Community Affiliated Organizations, adoption of the template affiliation agreement and placement or practice setting agreements, determining the process by which an organization may seek community affiliation status, clarifying faculty appointments, delineating the responsibilities of community affiliates, and harmonizing teaching and research policies.

13 Governance The governance of the Faculty of Medicine, with respect to all academic matters, is vested in Faculty Council under the authority of the Governing Council of the University of Toronto. The Constitution and By-Laws of the Faculty are reviewed at 10-year intervals. One such review has been recently completed, and revisions to the Constitution and By-Laws were approved by Council in January 2004. Faculty Council has representatives from the undergraduate, graduate and postgraduate student bodies, elected faculty members, Chairs, Deans, and elected members of the administrative staff. Council meets up to six times per year. Its Education and Research Committees play a key role in detailed examination of relevant issues. Consistent with the separation of governance from administration, any member of Faculty Council other than one of the Deans can chair the Council and its Committees. Thus, representatives can bring policy matters directly to Council for debate and approval from the faculty at large, not only through senior administrative officers. The membership of Council, and the type and number of Standing Committees, are defined by the Faculty's Constitution and By-Laws. The Faculty Council approves all policies that are elaborations of University policy, or policies where the Faculty has authority distinct from the University. Faculty Council is also required to approve significant educational program changes. The Faculty Council submits for approval to the Academic Board of Governing Council proposals for: the creation and termination of academic units (departments, centres, programs); the creation and termination of degree, diploma and certificate programs; major changes to the content and/or requirements of existing academic programs; changes to grading practices; and new policies and changes to existing policies concerning academic services, research, admissions, and awards. Budgetary allocations must be approved by the University's Planning and Budget Committee, and thereafter by Governing Council. The Dean is ultimately responsible for the administration and management of the Faculty and its budget, with appropriate authority delegated to the Vice-Dean, Research, the four Associate Deans, Education, and the Associate Dean, Clinical Affairs. The Dean consults widely and frequently with department chairs and other stakeholders. Chairs manage their own budgets with 100% retention of departmental carry-forwards and debts.11 The Council of Education Deans, formed in early 2000, was described earlier. It includes the four Associate Deans, with responsibility of education programs. The Associate Deans co-ordinate their responsibilities and manage other Faculty-wide educational initiatives through the Council. The Council operates through the authority of, and reports to, the Dean of Medicine. It is responsible for: advising the Dean in all matters relating to education and implementing educational initiatives; recommending policies, guidelines and procedures for educational initiatives, including new programs, activities and events; and providing guidance and oversight for education awards. 11 See Appendix VII for Faculty of Medicine Organizational Chart


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As noted, while the Faculty and teaching hospitals are separately governed, the relationship of the University and Faculty with the teaching hospitals includes interactions at the governance level. For example, Joseph Mapa, the current Chief Executive of Mount Sinai Hospital and Jack Petch, the immediate past chair of the Board of St. Michael’s Hospital, are both members of the Governing Council of UofT. University appointees or nominees sit on the boards of all nine teaching hospitals. The Dean of Medicine/Vice Provost for Relations with Health Care Institutions alone sits on the boards of five institutions (MSH, SMH, UHN, TRI, and SWCHSC) and has delegated his seat on the CAMH board to the Chair of Psychiatry. Two Associate Deans sit on the Bloorview MacMillan Children’s Centre Board. The Chair of HPME is an active member of the TRI board. In short, close relations are sustained at a governance level through interlocking appointments and through the new TAHSN structures that provide for regular meetings of Board Chairs, CEOs, and University leaders.

14 Development and Advancement The Office of Advancement works collaboratively with the Dean of Medicine, faculty, alumni and others to build the Faculty’s academic capacity. Working from a list of priority projects as established by the Dean and approved by the Provost, the Advancement Office concentrates efforts in the following four areas: • Building endowments for student aid; • Building endowed faculty support through chairs and professorships; • Enabling research through funding from individual donors and corporate benefactors; • Raising funds in support of capital expansion. Progress Against Goals Since 1997, the Faculty of Medicine, like all divisions at the University of Toronto, has been an active participant in The Campaign. Earlier this year, the University of Toronto announced it had reached the goal of $1 billion a year ahead of schedule and The Campaign for the University of Toronto, the largest university fundraising effort in Canadian history was declared complete as of December 2003. The Faculty of Medicine played a very important role in this success, contributing more than $230 million to the total. Many of the projects completed over the course of The Campaign have had a transformative impact on the Faculty: • 31 chairs and professorships were created in the Faculty of Medicine over the course of The

Campaign, bringing the total to 47 (see Appendix VI.1 for a listing of Faculty chairs); • 85 new chairs were created in our teaching hospitals bringing the total to 89. The number

continues to growth monthly. See Appendix VI.2. These important endowments ensure that we are able to attract and retain some of the most brilliant and creative scientists in the world.

• More than $43 million was raised for student financial support, to ensure that, in the face of tuition increases, our programs continue to be as accessible as possible to all outstanding students

• More than $100 million was raised to augment and enhance all sectors of the Faculty’s world-renowned research enterprise

• The McLaughlin Centre for Molecular Medicine was launched with a gift of $50 million from the McLaughlin Foundation and matching gifts from the Ontario Innovation Trust fund and a consortium of research partners


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• A lead gift of $13 million has been secured from Mr Terrence Donnelly for the Donnelly Centre for Cellular and Biomolecular Research. The CCBR will house teams of world-class scientists exploring the newest frontiers of fundamental medical research

• The Centre for Research on Neurodegenerative Diseases has secured well over $10 million in gifts and continues to make significant advances in our understanding of diseases neurodegenerative diseases;

• The Heart & Stroke/Richard Lewar Centre of Excellence draws together a multi-million dollar gift from the late Stephen Lewar and a matching grant from the Heart and Stroke Foundation of Ontario. It has united basic and clinical researchers to address key challenges in cardiovascular disease.

The Faculty of Medicine, with its $230 million contribution to The Campaign, raised more money than any other university division and had substantially the highest return on investment when measured in terms of dollars invested in the operations of its Office of Advancement. Future Plans Although the $230 million raised during The Campaign represents a significant amount of money, our funding needs continue to grow rapidly. • Our campus capital projects – the CCBR, the CRND and the renovated Centre for Function and

Well-Being at 500 University Avenue are not yet fully funded. • An important renovation project at 155 College Street that that will provide much-needed space

for our Departments of Family and Community Medicine, Public Health Sciences, and Health Policy, Management and Evaluation is just underway and requires significant funding.

• Our endowment holdings in support of students, among the brightest and most motivated in the country, are not sufficient to meet the needs of our students. The MD program and our professional Masters programs are just two of the areas in tremendous need of additional funding.

Over the last two years a concerted effort has been made to improve communications both internally and to the broader stakeholder community. Our Faculty tabloid/magazine UToronto Medicine took shape in early 2003 and has met with positive comments from all constituencies. The publication gives Advancement the opportunity to cultivate and recognize donors, profile our projects and our people and it gives the Dean an opportunity to highlight issues of concern and interest to the broader community. Our plan is to continue with three issues of UToronto Medicine annually. In addition, the Office of Advancement continues to provide an important communications resource to various departments and divisions in the Faculty. Although our fund raising efforts are focused on the Dean’s priorities, fund raising advice and assistance is provided to many Departments over the course of a year. In early 2003 the Chair of the Department of Surgery discussed the potential of hiring a development officer to work only on Department of Surgery fund-raising initiatives. In May 2003 a development officer was hired and took on all existing projects related to the Department of Surgery. An initial needs assessment was conducted with the Chair and all divisional chairs and a list of priority projects for the Department was developed. The position was evaluated after one year and was seen to be successful in terms of both the qualitative and quantitative goals established. Several other departments have now discussed a departmentally focused development officer. We anticipate hiring two or three additional development officers over the course of the next year. Although departmentally focused development officers are not the answer for every department in terms developing alternate streams of revenue, for some, the investment in a development officer can be a very effective strategy.


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An emphasis on high quality stewardship will continue to be a focus of the Office of Advancement. Over the course of the last two years significant investment has been made in both financial reporting back to donors through the Donor Financial Report and through progress reports from holders of endowed chairs and professorships, letters from student award recipients and reports from leaders of research centres and programs receiving $100,000 or more in financial support from private donors. The results of this effort have had significant impact in engendering both goodwill and new gifts for the Faculty. There are many opportunities to garner broad support for the Faculty of Medicine’s ambitions. One recurrent question for the Office of Advancement is whether more in the way of joint fund-raising initiatives can be launched with our teaching hospital partners. Currently, incentives are aligned in a more competitive than collaborative direction, yet it seems intuitively appealing to develop elements of an ‘in-common campaign’ to support health research or health professional education across multiple hospital sites and the Faculty. Exploring this option will be one of the strategic issues for the Office of Advancement in the next planning cycle, as it continues to collaborate with and support all departments and units within the Faculty of Medicine.

15 Infrastructure

15.1 Campus Space While the Faculty’s administrative team has perforce been primarily concerned with campus-based space, we should be moving towards a more collaborative and coordinated approach to space planning with our hospital partners. Both the University and the hospitals invest considerably in research space and there may be significant opportunities to leverage limited resources through complementary facility planning and shared infrastructure, info-structure and support services. The campus-based component of the Faculty currently occupies 11 buildings located north of Dundas Street, between Elizabeth Street on the east and Spadina Avenue on the west. The current buildings are the Banting, Best, FitzGerald, McMurrich, MSB, 500 University, 256 McCaul, 88 College, 92 College, 223 College and 1 Spadina Crescent. Buildings under construction/renovation are the CCBR and 155 College (both expected to be ready in spring 05). The serious shortage of space that has plagued the Faculty for more than 15 years will be resolved over the coming year. This is the result of eight significant developments.

1. 500 University Avenue (now named the Centre for Function and Well Being) was purchased in 2000 and subsequently renovated and is now the home of the Rehabilitation Science Departments (Occupational Therapy, Physical Therapy, Speech Language Pathology and the graduate program in Rehab Sciences) as well as the administrative home of our Postgraduate and Continuing Education Programs. In all 2,000 nasms of space were acquired. 256 McCaul, the former home of the Rehabilitation Departments became the temporary home of the Department of Family and Community Medicine.

2. The former Board of Education building (155 College) has recently been purchased (along with the old Administration building). Following renovations (about $15M) planned for late 2004 this will be the future home of the Departments of Public Health Science, and Health Policy and Management Evaluation, and the Faculty of Nursing. This building will become the Centre for


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Health Improvement and System Performance. The total space will be about 4,000 nasms. Family and Community Medicine has recently moved into newly renovated space in the administration building on the 155 College site.

3. The Donnelly CCBR, a $100M project, will be completed in the spring of 2005. This research building will add 10,000 nasms to the Faculty space inventory. There will be 10 laboratory floors and it will provide space for 40-50 principal investigators and a staff complement of 500.

4. The Best Institute has been extensively renovated (> $4M) to provide staging research space for investigators who will ultimately be located in the CCBR, and to ensure that the building remains useful for laboratory research over the next 20-30 years. About 1,000 nasms were renovated. We expect the Best Institute to be decommissioned and demolished sometime after 2025.

5. As noted above, a recent initiative involving the Wellcome Trust and Canadian granting agencies

has led to the creation of the Structural Genomics Consortium. The $60M Canadian component of the project will be headquartered in the Banting Institute where renovations are in progress on the sub-basement, basement, third and fifth floors to provide 1,500 nasms of laboratory space. We have tried to keep the cost of these renovations to a minimum, given the fact that the Banting Institute is already at the end of its useful life-expectancy as a building.

6. The MSB has also had extensive renovations ($1.5M) that have resulted in the creation of new

office and multi-use space. Almost 500 nasms of space have been renovated to create a new Research Office as well as a number of new or renovated offices in support of medical teaching and faculty administration.

7. The move of the Research Office from the FitzGerald building has provided expansion space for

the Departments of Medical Imaging, Anesthesia and Radiation Oncology. About 150 nasms of renovated space were made available. When the Departments of Public Health Sciences and HPME move into 155 College, expansion space will also become available in both the FitzGerald and McMurrich buildings.

8. The Institute for Drug Research will be located in MSB where Pharmacology is now located and

in the new Pharmacy building which is under construction. 9. A level 3 facility (200 nasms) has been created on the fourth floor of the MSB for studies on

AIDS and other viruses. Funding for this facility was from a $1.5M CFI grant to Dr. Jun Liu. 10. The Richard Lewar Heart and Stroke Centre was created in 2000 by a $10M donation from the

Lewar family with matching funds from the Heart and Stroke Foundation. The laboratories for the centre were created by renovation of 500 nasms of the FitzGerald Building basement.

There remain serious shortages of research space at all of our fully affiliated hospitals. Major building programs are ongoing or planned at all the hospital sites. The recent construction at MaRS will house research activities from the University Health Network and the Hospital for Sick Children. Mount Sinai, St Michael’s and Sunnybrook& omen's all have major space expansion plans. For the future, the challenge will be to effectively manage existing and new space in the Faculty. As noted, planning for space must move to a more collaborative and coordinated approach with our teaching hospital partners. A key element of the space equation will be obtaining the funds needed to service the space utilized. This will require a careful budgeting exercise and the initiation of new


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budgetary arrangements with the Central Administration so that costs are covered by the revenues the Faculty generates as a result of its teaching and research activities. As a consequence of the spring 2005 movement of faculty/staff from the MSB, Best, FitzGerald and McMurrich buildings to the CCBR and 155 College, there will be many opportunities for much needed renovations of the vacated space. A Faculty space committee will be struck to develop a long range plan for these buildings. Consultants will be engaged to assist in the planning process (see AIF request). It is our goal to upgrade existing space wherever possible to meet the standards of the new CCBR space. We believe that the new space will act as a catalyst for the enhancement of the research activity in the old space by permitting regrouping as appropriate and renewal of basic research infrastructure such as glass washing and autoclaves etc.

15.2 Computing Support Division The primary mandate of the Computing Support Division (CSD) is to develop and maintain the network infrastructure throughout the Faculty of Medicine and to enable the electronic connectivity of all members of the Faculty to the Internet. The division also provides user support for various operating systems, data backup and recovery, hardware and software upgrades, emergency repairs, anti-virus protection, server support for systems including Exchange and SQL servers, and consulting advice on various aspects of computing. CSD provides computing support for members of the Faculty located across 10 buildings on the University campus as well as to some members located in the fully-affiliated hospitals. An ongoing aspect of network maintenance is the upgrading and installation of Ethernet switches and UTP cabling to support higher speed (100MHz) connectivity. The staff of CSD (3 FTE) have worked with various departments and units to upgrade their wiring and connective devices so that all offices and labs across the Faculty are connected via the most effective yet economical means to the backbone. The Faculty’s infrastructure is such that the higher speed of connectivity is now available to most departments upon request. Some of the newest installations are configured to support even faster backbone speeds of 1000Mhz. CSD provides connectivity for Faculty members in the hospitals through liaison with hospital, UTCNS and Bell IT staff and by deploying either fibre or copper connectivity directly to the UofT backbone (University Avenue hospitals) or high-speed ISDN lines for offices at the FitzGerald (St Michael’s Hospital) and Peters-Boyd (SWCHSC) Academies. The staff of CSD also assists administrative, research and teaching staff members by providing core IT services such as data recovery, the emergency repair of computing equipment, assistance in setting up and maintaining access to the University’s Administrative Management Systems (AMS) and ROSI, and consultation and advice. An additional important aspect of the services provided by CSD includes the test scoring and course evaluation service using optical mark-sense cards and proprietary performance evaluation software. The mandate of the CSD group will continue to be reviewed and long term plans for faculty IT support developed.


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15.3 Human Resources The Faculty of Medicine Human Resources Office provides a full range of services to management and staff. The demands resulting from some 5000 Faculty members and 700 administrative and technical staff are substantial and growing. For example, increased demand for services have resulted from the Faculty’s success in attracting grants and contracts (such as the Structural Genomics Consortium), changes to the practices and policies for clinical faculty members, and new compensation programs for unionized and professional/managerial staff. Also, the enormous increase in the recruitment of foreign physicians within the Toronto Academic Health Science complex has resulted in an increased demand for services. The office is sometimes constrained in providing optimal service levels due to limitations on the resources of Central HR and AMS. The ongoing staff complement is 6, with a 7th staff member on a two year contract funded by overhead from SGC. The staff remains fully utilized due to the high volume and variety of services required. This office offers valuable leadership to Academic Administrators and Professional Managers and Business Officers to facilitate HR management within the Faculty.

15.4 MedStore With the closure of the Materials Distribution Centre (MDC) on April 30, 2000 (owing to its serious negative financial situation), faculty members made it clear that they still wished to have the convenience of a research supplies store available to them. Thus, on May 1, 2000 MedStore was opened. While MDC was a full-service store and procurement operation, MedStore is a much more limited operation. The inventory was reduced to a few hundred of the most sought after items. The method of payment was only by institutional credit card i.e. no cash sales, no accounts, no invoicing. After three years, this new model of operating has proven successful. The number of vendors has decreased to 6 but because of the advent of web-based sales technology and “virtual inventories”, in addition to the over-the counter sales, MedStore also does a flourishing web-based sales business. Sales are annually around $2.5M with expenses at about $2.45M. The manager and his staff of 5 employees are to be congratulated for making this operation so successful and for meeting the needs of the researchers of the Faculty of Medicine. In the fourth year of operation the business has embarked on product and customer base expansion. Retail transactions (credit card only) can now be processed for students and staff. Considerable resources were allocated to the development and implementation of “virtual inventory”. Electronic links were created between the MedStore website and the vendors order entry system allowing the store to sell and deliver products that are not physically in stock. As a result of increased efficiencies and the implementation of activity-based costing, the store experienced a modest profit. This will be set-off against carried indebtedness from MDC and also used for infrastructure reinvestment in the coming year. The full scope of reinvestment requirements will be reviewed and an implementation plan developed.


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15.5 Occupational Health & Safety and Security The Occupational Health and Safety and Security Office (1.5 FTE) has the mandate of ensuring Faculty compliance with the Ontario Occupational Health and Safety Act, and providing a safe and secure environment for staff and students. The office provides consultative and expert advice on both technical issues and legislative requirements and acts as a referral service in all areas of safety and security. Specifically in the area of Occupational Health & Safety, the office provides clarification and advice on Ontario Occupational Health and Safety legislation and provides administrative support for all Faculty Safety Committees (currently four with three additional to be established). Advice is provided on protocols and procedures for handling chemicals and other workplace health and safety issues. Instructional safety seminars are organized for new employees and students working in laboratories. Staff and student accidents are investigated to proactively eliminate hazards. The office also evaluates and implements accessibility and safety strategies for staff and students with disabilities. Construction plans for new projects are reviewed from both a safety and security perspective. With respect to security issues, the office assesses and monitors security risks and implements response protocols. A large building access control system is maintained which includes controlling perimeter access and access to restrictive areas. Specific activities include the creation and maintenance of faculty duress alarm systems and the protection of the faculty fixed assets through advice and security recommendations. Plans are currently under discussion for the expansion of access control systems and integration of alarm systems. The office also acts as the liaison with University of Toronto Police.

16 Organizational Changes A number of organizational changes have evolved since the Academic Plan of 200012. A major review of the Dean’s office and the UME sector in the Dean’s office was undertaken in 2000, followed by re-organization in 2001. The Review Committee identified the strengths and challenges in each area of responsibility through wide consultation with students, faculty, and administrative and academic staff. Their recommendations focused on a significant re-organization that clearly delineated registrar, counseling and academic duties. The governance of all academic elements of the Undergraduate Medicine Program, including admissions and awards, student services and counseling, was placed under the authority of the Associate Dean - Undergraduate Medical Education. The formation of a registrar service was implemented to allow horizontal integration of the administrative functions of many academic programs in the Faculty of Medicine - such as, awards, student informatics and counseling, to improve efficiency of delivery, and to benefit students.

12 See Appendix VII for Faculty of Medicine Organizational Chart


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The Office of Admissions & Awards previously had responsibility for Student Affairs, Admissions & Awards, and Registrar functions. These three responsibilities have been separated from one another. • Student Affairs: Reporting jointly to the Associate Dean, UME, and the Associate Dean Inter-

Faculty and Graduate Affairs, the Student Affairs portfolio has now been separated administratively and fiscally from Admissions and Awards. New (and expanded) space has been allocated to this portfolio. Office space also has been included for additional staff, expected to include a Psycho-Educational Consultant, and a Counselor with a Social Work or Clinical Psychology background.

• Admissions & Awards: Reporting to the Associate Dean, UME, the Admissions & Awards

portfolio is now separate administratively and fiscally. • Registrar: Reporting jointly to the Associate Dean, UME, and the Associate Dean Inter-Faculty

and Graduate Affairs, the position of Faculty Registrar is now a separate entity. Other changes include: Associate Dean, Clinical Affairs: This is a new portfolio, vital in the light of growth of Alternative Funding Plans; continued interaction with a variety of regulatory bodies and the Ministry of Health and Long-Term Care (MOHLTC) on health human resources and licensing/certification; and, the need to review and implement the anticipated new clinical faculty policy. Prof John Wedge was appointed as Associate Dean, Clinical Affairs in 2003. Assistant Dean & Counsel: This new part-time position was created in 2001 to assist with legal and regulatory issues. Currently held by Kathy MacDonald, LLB, this portfolio has been a valuable addition to the Faculty’s administrative complement. Judicial Affairs Advisor: This position was created to play a policy advisory role. Currently held by Prof. Lorraine Ferris of the Department of Public Health Sciences, the JAA has been involved in drafting new guidelines for defining and addressing research misconduct, revising the Faculty’s policy on finder’s fees in clinical research, and developing the new clinical faculty policy manual. Starting January 1 2005, this position will be titled Academic Advisor on Judicial Affairs and Policy. Prof. Ferris will helping to investigate research misconduct issues and guide Chairs, Deans, and others in dealing with the new clinical faculty policies which we anticipate will be implemented by then. Additional administrative staff has been added to the offices of several of the Deans to assist with the ever increasing workload. As per the Administrative Restructuring APF funded through the “Raising Our Sights” cycle, a business systems expert has been added to assist Departmental business officers in working with the University's administrative management systems, and to support Departments in the absence of their business officers. An additional human resources professional has been added in the Faculty Human Resource Office, and another accountant has been added to the Faculty Comptroller's Office.


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17 Budget Issues Overview of Funding Sources The funding of the Faculty of Medicine is far more complex than that of other University Faculties. The “campus” for the Faculty of Medicine includes not only the academic area of the University but also the teaching hospitals and a wide variety of community clinics and agencies. Just as the health professional students move between the university campus and health care settings, so also do the funds that support academic activity move between the university and health care institutions. The funding of most of the Departments of the Faculty of Medicine at the UofT include financial arrangements with external organizations. Those arrangements are most diverse for clinical departments and include the following: (a) the U of T Operating Fund (includes net operating support, divisional income, salary recoveries and the MOH Teaching &Research (T&R) budget – although not all clinical departments receive T&R funds) (b) research grants (particularly personnel awards) (c) support from fully-affiliated hospitals and their research institutes (d) clinical earnings through physician practice plans (e) interest income from endowed trust funds To obtain a perspective on these sources of funds, please see Appendix VIII.1 which shows Sources of Funds by Department for the Operating Fund ($112.1M), Restricted Funds (Expendable $82.5M and Endowed $277.4M) as well as University ($127.5M) and Hospital Administered Research Grants ($258.5M). Using the latest figures, we can calculate that University-administered research grant funding has increased by $57.2M since 1999/2000 (81%) while hospital-administered research grant funding has increased by 60% ($96M). Funds referred to in (c) and (d) above do not “flow through” the University and are thus “off-budget”. In the past several years, all of these sources have been under significant financial pressure; however, only the Operating Fund will be discussed in the remainder of this report. University Operating Budget These funds are provided by the University to support the Faculty’s teaching and research programs. In 2004/05 this net operating support amounted to $67.6M. The relevant base excluding Graduate Scholarship/Fellowship is $61.2M. Divisional Income This includes revenue from services and externally (mainly Ministry of Health) funded program operating grants. This source has also been subject to budget cuts. Ministry of Health T&R salary funding This provides salary support for physicians engaged in clinical teaching and in 2004/05 it will make up 11% of the Faculty’s operating budget. It is anticipated that the level of T & R funding will remain relatively stable as it has for the past five years. However, there is a threat to T&R funding from AFP negotiations, as the MOHLTC has at times proposed to roll T&R funding into the AFP envelope.


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Budget Cuts From 2004/05 through 2009/10 there will be two kinds of budget cuts, “base” and “one-time-only” (OTO). Both base and OTO cuts are determined as a percentage of the relevant base budget of the Faculty. In simple terms, the relevant base is Faculty’s prior year net base budget adjusted for prior year salary and benefit increases, after reversal of the prior year’s research overhead. The annual base budget cuts assigned by the University over this period range from 2 to 5% totaling 16% and the OTO cut is 6.7% phased over the latter part of this period. The 2004/05 relevant base budget is $61.2M giving rise to base cuts of $1.2M (Appendix VIII.2). Distribution of Budget Cuts For 2001 through 2004, following discussions between the Dean and Departmental Chairs, base budget and OTO reductions were applied on a uniform basis. This same approach has been used for the upcoming planning period. The position taken by the Faculty is that revenues flow to Departments proportional to their generation, thus the strategy is to level out disincentives across the Faculty (i.e. uniform cuts) while allowing the incentives to be aligned with revenue on a Departmental basis. For the period 2004 through 2010, a variety of strategies are being employed by Departments to cope with these base budget reductions consistent with each Department’s goals and objectives. The Vice Dean has obtained and reviewed budgetary projections from each Department to ensure that proposed methods of meeting the cuts do not damage the academic mission of the Faculty. As noted earlier, the Faculty has not ruled out running a negative appropriation against its growing carry-forward as a way of softening the pace and depth of the budget reductions. Divisional strategies will be materially altered depending on the outcome of the Budget Task Force chaired by Vice Provost Safwat Zaky.


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18 Concluding Notes The Faculty’s Strategic Directions and Academic Plan of June 2000 set an ambitious course with a view to achieving our vision of international leadership in health research and education. In the past four years we have met virtually all of the targets articulated in our 2000 strategic plan either on or ahead of schedule. We have benefited meaningfully from the APF initiatives that were launched in the last academic planning cycle. For 2004 – 2010 we continue to present new initiatives that must be driven forward but have also indicated a pressing need to consolidate and stabilize the gains made in the last planning cycle. Our AIF proposals and our set of plans and strategies reflect this theme of continuity of excellence and stabilization, along with innovation and further forward movement. The Faculty’s teaching and education enterprise remains a great strength. One program after another has achieved stellar accreditation results or glowing external reviews. We have generated a number of cutting-edge programs and teaching approaches. Actual or anticipated initiatives in collaborative and interdisciplinary education, joint degree programs, inter-professional education pilots, expanding simulation strategies and innovative clinical teaching models all reflect the remarkable appetite of the Faculty for pedagogical innovation. Moreover, the groundwork has been laid for new thrusts in areas such as international health, bioethics, research in education, faculty development, and knowledge translation. Continued efforts in these areas over the next several years will strengthen and stabilize the early investments. The Faculty’s research enterprise is at a tremendously exciting stage with the development of the Donnelly Centre for Cellular and Biomolecular Research, the growing collaboration across the campus and teaching hospitals, and the emergence of new virtual structures such as the McLaughlin Centre for Molecular Medicine and the Toronto Centre for Modeling Human Disease. Research funding from both national and provincial sources continues to offer many opportunities across all sectors. The Faculty has gained tremendously with its renewal of space and capital. The CCBR, Rehabilitation Sciences Building, 155 College Street, and renovated space in the MSB, Best Institute, and other facilities have addressed significant space problems and laid a solid foundation for the future. However, retiring some of the debt associated with capital redevelopment is critical for the Faculty to reap the full benefits of these new facilities. Our energies over the next five years will therefore focus on completing the planned redevelopment of our facilities, materially enhancing the level of student aid, implementing the new clinical faculty policies and achieving more horizontal integration of this important group of colleagues, augmentation of joint research planning with the teaching hospitals, reviewing and renewing policies for other non-tenured faculty, further integrating the community affiliated hospitals and teaching sites, rationalizing the budgetary model, enhancing information technology and communications capability, realigning governance and organization of extra-departmental units, and developing benchmarking capability. With the Provost’s support of our AIF requests, continued collaboration with our institutional, community, and government partners as well as other divisions of the University, and the extraordinary creativity and vigor of our faculty members, we foresee a bright future of continued leadership and achievement for the UofT Faculty of Medicine.

Faculty of Medicine Academic Plan

2004 – 2010

Appendices

Appendix I Dean’s Group Appendix II Faculty of Medicine Goals 2004 - 2010 Appendix III Strengths, Weaknesses, Opportunities and Challenges Appendix IV Research Data Appendix V Faculty Academic Staff Count Appendix VI Faculty of Medicine and Affiliated Hospitals Endowed Chairs Appendix VII Faculty of Medicine Organizational Chart Appendix VIII Budget Tables Appendix IX Sector Plans – Basic Sciences, Clinical, Community Health

and Rehabilitation Sciences Appendix X Departmental Profiles

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