Health Committee on Feb. 5th, 2013

[Dr. Alireza Jalali]

For the podcasts?

[Ben Lobb, Conservative, Huron—Bruce, ON]

What software platform do you use?

[Dr. Alireza Jalali]

All of them are independent. My site is hosted by Yahoo. I do all of it myself. I have a server that I put the podcasts on, and it just generates an RSS feed that goes out. And as I said, for the videos it's YouTube, because it's free.

[Ben Lobb, Conservative, Huron—Bruce, ON]

Basically, it's pretty low cost to provide this. If you go back.... I'm not sure how long you've been a professor—

[Dr. Alireza Jalali]

For 10 years.

[Ben Lobb, Conservative, Huron—Bruce, ON]

If you look back to 10 years ago, obviously a lot of what you just mentioned wasn't available. Just explain to the committee how this has changed the outcomes. We're talking about technology in health care. Using technology, how are we producing better students, better doctors?

Just go into that a little bit.

[Dr. Alireza Jalali]

It links very much to the AFMC changes and the CanMEDS role, the competencies that are out there. Before that—and I'm not talking about just the last 10 years; I will get to that—we had doctors who were experts. They knew everything about medicine, but there wasn't much emphasis on their being health advocates, how to be collaborative, how to be communicators with the patients.

With the arrival of technology about 10 years ago, as I said, I removed all the lectures, so it gives me more options in an anatomy lecture to tell my students how they should communicate with each other. From the first year of medical school it's no longer just about books, it's about how to talk with people. And it's important for a health care professional to know how to talk to patients. These are the changes that are made.

One thing I must say is that I know about this stuff, so it was easy for me to produce my own. But now we have a lab where people can come—clinicians, nurses, kinesiotherapists—to sit and produce these. Many of this generation of professors are not tech-savvy, so we still need to have a central place for people to go to produce this.

Now, for the outcomes, just to tell you for the anatomy, I teach a lot and I'm also unit leader, so I look at the curriculum in different ways. I have been in contact with radiologists.... You need to know why we teach anatomy. I don't want my students to know anatomy just for anatomy. Anatomy is the base of a physical exam. When a doctor is examining you, that's the base of anatomy. To tell me this is an artery on a cadaver is not the point. They're trying to go with a higher level of stuff.

For example, radiologists—

[The Chair, Conservative, Joy Smith]

I'm sorry, Dr. Gold, before the time runs out, I think you want to add to what Dr. Jalali says.

[Irving Gold]

Just very briefly, I wanted to mention—my colleague just reminded me—the Future of Medical Education in Canada project first looked at undergraduate medical education, and then it looked at postgraduate education. We're very much hoping to be positioned to do our third component, which is continuing professional development. One of the things we need to do is bring folks up to date in terms of some of the technological innovations that are going on.

The only other thing I would say is that the AFMC has several projects that are meant to enable these types of innovations.

One of the things Canada does not do well is diffuse its innovations. Something really neat will be happening in Saskatchewan, and they don't even know about it in Manitoba. That's not just in the health care system, it's all over the place. One of the things the federal government could do is try to stimulate some of that sharing of innovation amongst jurisdictions.

[The Chair, Conservative, Joy Smith]

That's exactly what we're trying to do now, Mr. Gold and Dr. Jalali. I have to tell you it's very interesting and very exciting to hear what you're all talking about today.

Now we'll go to Mr. Kellway.

[Matthew Kellway, NDP, Beaches—East York, ON]

Thank you to the witnesses for coming today.

Mr. Gold, I noticed you were thankful and eager to clarify your comments on the planning role for the federal government. I hate to say that your clarification confused me a bit because it seems to me that we talked about a couple of roles that the federal government may take to assist with planning, like the distribution of physicians across the country to make sure the supply is spread out where it needs to be. We talked about the loan forgiveness program as a planning role. I was going to ask you what other things the federal government can do to assist in ensuring that the supply of physicians is the supply we need.

That brings me to the second question. I'm hoping I'm clear enough that you get the connection. The second question is this issue of diversity that you talked about. That's not just about first nations doctors and that cultural competency, but it seems that you have a broader perspective perhaps in competencies that emerge out of a more diverse workforce.

I wonder if you could talk about those two things: again, if you could clarify for me the federal role that you see in planning and what planning maybe means to you; and if you could also specify the value that your organization sees in diversity.

[Irving Gold]

I'll take a stab at clarifying and you can tell me whether I've done a decent job. From my perspective, effective planning needs to be based on data that is as complete as possible. I believe that at the moment there are large gaps in the data that we have at the national level. What the federal government can do is create a mechanism whereby the provinces can truly understand the need and the supply. We'll never answer this question, we'll never be able to align supply and demand unless we understand both.

What the provinces do with that information is within their jurisdiction. We are not asking this entity to tell Manitoba it needs to create more x. What we want, though, is for Manitoba to be able to see not only what its provincial needs are but what the national picture looks like and whether Canada is heading for a surplus of cardiovascular surgeons. Does that mean maybe in Manitoba we should train fewer? Does it mean maybe we should try to recruit some? In other words, look at the national picture because physicians are mobile and provinces could do things to attract or disincent certain sub-specialties. What this centre is about is ensuring that all the jurisdictions can look not only at their own data relating to needs and supply, but the national picture.

[Matthew Kellway, NDP, Beaches—East York, ON]

Can't one imagine a relationship between the federal and provincial governments that is different from the centre just saying—planning—meaning the centre just tells the provinces what to do? Isn't there room for a more collaborative, multi-governance approach to this, a shared role?

[Irving Gold]

Absolutely. This proposal is this proposal. We believe that this proposal in the current environment is achievable, possible, and will contribute to the solution.

[Matthew Kellway, NDP, Beaches—East York, ON]

All right. On the issue of diversity, can you explain why you're talking to us today about the value of diversity?

[Steve Slade]

The recommendation concerning diversity largely comes out of our Future of Medical Education undergraduate review. The data is very clear. We have only seen a greater polarization of medical students with respect to parental income; it is grossly misaligned with the averages for Canadians.

We know as well that representation of black populations within our medical schools or of Filipino populations doesn't fit. There are other areas—southeast Asian populations—that are misaligned. Part of this is about correcting disparities of the past. Really, it's that, writ large. Do rural kids feel as drawn into medical school as urban kids? I come back to Irving's earlier comments about K to 12. A lot of the messaging really has to happen at that age, that a medical career is possible.

So whether you look at it in terms of geographic dimensions.... We really do look at diversity quite broadly. Geography, socio-economic status, ethnic diversity—these are all factors that we've not measured properly, I think, and we've had little in the way of a forum in which to formulate a plan. Not to be too circular in the thinking, by looking at a forum that first focuses on data, let's just get a clear picture of what the challenges are—

[The Chair, Conservative, Joy Smith]

I'm sorry, Mr. Slade, that picture will have to be forthcoming, but your answer is very good.

We'll go to Mr. Brown now, please.

If you want to pick up the same vein, it's up to you, Mr. Brown.

[Patrick Brown, Conservative, Barrie, ON]

I didn't know I was next.

[The Chair, Conservative, Joy Smith]

Would you like me to go, then, to Mr. Wilks, so that you can gather your thoughts?

[Patrick Brown, Conservative, Barrie, ON]

Sure; I'll follow up Mr. Wilks.

[The Chair, Conservative, Joy Smith]

Mr. Wilks.

[David Wilks, Conservative, Kootenay—Columbia, BC]

Thanks, Chair.

I don't have much of a background in the medical field; I am a retired policeman. My only two analogies with the medical profession are that I can drive fast as long as you don't die, and that when someone calls us from the hospital and asks us for help, I just tell the doctor to say, “You're going to have about eight to ten seconds after I apply carotid control”, so that you can get that person to understand that it would be better to cooperate.

I have a couple of questions to Dr. Jalali and then one in general.

First of all, you mentioned self-learning modules, which I see as an advantage in some senses. But being retired from the RCMP, when the force moved down the road to some self-modules, I had mixed feelings about it and I still do. Sometimes you can get to the point where the students start trying to teach themselves.

You can't teach common sense. You either have it or you don't have it. Do you see a point at which there needs to be some intervention? In your classes, when there are self-modules, if you see a student starting to stray, at what point do you feel that you need to intervene and say, “Just a second, that's not what we meant by this” and bring them back?

[Dr. Alireza Jalali]

That's a very good point.

With the self-learning modules, you need to mostly put basic stuff in, stuff that isn't very confusing and that they can get on their own. Then you bring them back—in my case, in the lab, or it may be at the patient's bedside or something—and then, when they're all working together, I usually wait, if someone is making a mistake, for the group to see whether they can correct it. We are all based on problem-based learning, which shows that if someone is in front of the problem, they learn better than if you just give them the answer right away. So we try to go with problem-based learning. We do that also in the small group sessions we have.

But then slowly, if they're really all going to the wrong side, you have to bring them back. You need facilitation.

[David Wilks, Conservative, Kootenay—Columbia, BC]

I have two more questions, so go ahead quickly.

[Irving Gold]

I just want to add that some of the new e-learning tools we're talking about not only present new ways of teaching, but new ways of evaluating. There are some very exciting opportunities, I think, facing medical educators in terms of rethinking the way we assess. There are some really neat things going on. The use of virtual patients and the way the faculty can assess learning progress is pretty exciting.