One of the many things the pandemic has shone a light on in the past year, is the ways in which a variety of systems intersect and influence health – from politics, to economics and business, to social justice and the environment.

“Health and health care is complex, and we know that some of the greatest innovation, brightest ideas and most prolific out-of-the-box thinking comes from professionals who have a broad perspective of the world and draw on concepts from outside their specific area of expertise,” said Dr. John Yoo, Dean of Schulich Medicine & Dentistry.

That’s why it is important to provide support for these learning experiences, which promote critical inquiry and invigorate a passion for life-long learning, Yoo says.

The idea for MD+ was sparked by conversations with students, who shared with Yoo that they were looking for opportunities to continue with their pre-medicine interests, explore leadership skills, or seek new opportunities to broaden knowledge and expand their career abilities.

Taking these paths during residency can be challenging. With that in mind, the School sought out ways to allow these learning opportunities to occur during a student’s medical school training by providing the time and financial and academic support for those who are inclined to follow this path.

The track is unique among medical schools in the country and provides students the opportunity to take a highly individualized approach to their education. The School continues to explore programs across the University that students can take advantage of, including Canada’s only Professional Master’s degree in Interdisciplinary Space Studies and the world-leading Ivey Business School.

Shaily Brahmbhatt, Medicine Class of 2023, is the School’s first student to take advantage of the unique opportunity that MD+ offers. Beginning in fall 2021, Brahmbhatt will begin her Master of Public Health, taking a one-year leave of absence from her medical school studies.

“This track will continue to open doors for medical education in the future and I look forward to seeing how students will use this opportunity to grow as leaders in health care,” Yoo said.

Developed by Shawn Li, PhD, Canada Research Chair in Proteomics and Functional Genomics, in collaboration with researchers at Schulich Medicine & Dentistry and the University of Toronto, the test uses serum or plasma samples to detect antibodies, whether from previous infection or from vaccination.

According to Health Canada, 70 per cent of Canadians will need to show immunity to safeguard against further pandemic-level spread of the COVID-19 virus.

“As vaccinations are carried out on large scales, a highly sensitive and specific antibody test will be invaluable to inform public health decisions, both for directing resource allocation and determining response to vaccination,” explained Li.

Test samples can be processed in a lab or at a patient’s bedside, and although it can’t be used to diagnose someone newly infected, the test is sensitive enough to measure antibodies days after a person contracts the disease.

The research was recently published in Cell Reports Methods. WORLDiscoveries, Western’s technology transfer office, has also applied for a US Provisional Patent around the technology and is actively searching for commercialization partners to license and manufacture the test and make it commercially available to health care providers in Canada and abroad.

The research team is now partnering with London Health Sciences Centre’s vaccination program to complete a larger scale validation of the test, with about 1,000 patients currently enrolled. As part of this work, Li is also investigating antibody responses in cancer patients, whose compromised immune systems may impact their response to the COVID-19 vaccine.

“We started this project wanting to be part of the solution to the pandemic, and to meet the pressing need for a quick, simple and reliable antibody test,” said Li. “As a researcher, this problem-solving approach is really what drives innovation.”

The first, supported by a $1.44 million grant from the COVID-19 Immunity Task Force, examines the impact of COVID-19 on Canadian dental schools. Pani and his network collect data from each school’s students, faculty and staff on virus prevention protocols, infection rates and occupation-related infection factors, which will eventually help inform existing data on COVID-19 in university, dental and public health communities.

“What we really hope to get is the human perspective to some great biological research that is already happening,” he said. “Schulich Dentistry has an especially important role to play in not just being a place where data is collected, but where it is contextualized. We see patients across the region, in small rural centres as well as urban ones, and this gives us diverse social perspectives for this type of research.”

Pani and his collaborators are also developing a national oral health survey to address the knowledge gaps related to oral care access and associations with general health. The last national oral health survey of this kind was conducted more than a decade ago. Thanks to $3.3 million in funding from the Canadian Institutes of Health Research, they will design an oral health component for Statistics Canada’s existing Canadian Health Measures Survey (CHMS) platform. As the largest health survey in the country, the CHMS takes a wide range of self-reported anthropological and biological data from a representative sample of Canadians, which will provide rich context for the oral health data collected.

A partnership of this magnitude could not have been possible without adequate funding from national agencies, Pani emphasizes. Through collaboration, the broad scope and impact of these research projects will influence dental research across Canada, rather than the local or regional results each collaborator could achieve individually.

“It allows us to present a much stronger proposal to funding agencies, because we are a single network that can capture the whole Canadian picture,” he said. “I really believe we need collaboration. Not because we are weak alone, but because our impact can be stronger.”

Safe, equitable, sustainable, patient-centred, and effective care became the mantra of the group as they planned and launched the Clinic.

As patients are discharged, a pulse oximeter is delivered to their home with simple instructions for use. Arrangements are made with pharmacies to deliver medication and a contact schedule for the physician and patient is established. Patients are also given an easy pathway back to inpatient care if needed to avoid returning to the emergency room. Patients only needed a phone to participate in the clinic and receive ongoing care.

A year into the pandemic, the Clinic has supported more than 1,300 patients. Some require care for several months, while others are referred to other specialized care physicians and therapists who have become a critical part of the Clinic.

“This has been one of the most gratifying experiences any of us has had,” said Spicer. “As we do our follow-up appointments, patients continue to express how grateful they are and share their relief that they have a life line to call, when at home.”

As the pandemic has changed, so too have symptoms, patients needs and the demands on hospital care. The Clinic responded.

Through research and analysis conducted by Schulich Medicine & Dentistry’s new Centre for Quality, Innovation and Safety (CQuInS), the Clinic’s physician leads have access to quantifiable and qualitative data to respond to patient needs and make change.

During the initial data collection, results showed 46 per cent of patients experienced symptoms of stress and anxiety prior to their referral to the Clinic. Of that group, 100 per cent indicated the Clinic and the support they received alleviated their concerns.

By tracking clinical outcomes and demographic data, as well as conducting patient experience surveys, the physicians know they are making an impact on hospital utilization, resource management and patient experience. The final piece they have analyzed is the cost of running a virtual clinic, and after completing a small study, they know that there is a cost avoidance of running a clinic like this.

“Monitoring the patient experience and keeping track of quality and patient safety metrics continues to guide us,” said Spicer. “The Centre is providing us with the ongoing information we need and the acute data collection that drives our decision making.”

Dr. James Calvin, Chair/Chief, Department of Medicine, says that supporting the Clinic through research and analysis is the mission of CQuInS.

“Excellence in clinical care is mission one,” he said. “It’s only when we look at data, have targets and develop plans to reach those targets as we are doing through the Centre that we can perform at a high level.”

Currently, the Clinic is adapting to the health care needs and demands of the third wave of the pandemic. With increased admissions of COVID-19 patients, individuals are being discharged in a safe manner while on oxygen. The LUC3 team monitors high-risk patients through their return home, calling daily to ensure that their needs are met and they can fully recover without the risk of being readmitted to hospital.

LUC3 Team

Megan Devlin, Marko Mrkobrada, Michael Nicholson, Erin Spicer, Kaylee Moore, Inderdeep Dhaliwal, Jackie Ernst, Kathy Myers, Rasha Abdul-Karim, Jeff Yu, Emily Jones, Natasha McIntyre, Stephanie Hansor, Melissa Stephen, Brenda Giasson, Chrissy Kienapple, Chelsea Norris, Natasha Woodcock, Anissa Robinson, Taniesha Robart, Fatima Fadel, Andrea Dafel, Danny Kwon, Jennifer D’Cruz, Zoe Lau, Tim Varghese, Hasan Baassiri

To encourage the success of applicants who are underrepresented in medicine, as well as identify and address potential barriers to their success, the School has created the ACCESS pathway. This application process allows students to submit additional information for consideration about potential socio-cultural, financial or disability-related adversities they have faced.

An autobiographical sketch which allows applicants to highlight non-academic achievements, was included in the application process to a achieve a comprehensive and informed portrayal of each candidate.

“While a physician needs to be strong academically, there are other qualities of an excellent physician that we focus on, like collaboration and leadership, social accountability and responsibility,” said Dr. Tisha Joy, former Associate Dean, Admissions. “And diversity is intimately intertwined in each of these values. Diversity fosters mutual respect, empathetic collaboration, encourages social accountability and nurtures innovative problem solving.”

In addition to enhancing the breadth of applicant information collected and considered, the School also introduced systems to help mitigate biases in the application review process. In addition to recruiting admissions committee members from diverse backgrounds and providing implicit bias training for all interviewers and file reviewers, applicants’ files were also anonymized. A post-file review and post-interview statistical analysis was also implemented to ensure fairness and standardization within the MD admissions process.

“We hope these changes will achieve, for applicants, a sense that they were viewed holistically and fairly,” Joy said. “For the School, these changes hope to support an inclusive environment for all, and achieve the attraction of a strong cohort of qualified students who, because of their diverse perspectives, would engage in respectful collaboration, mutual learning and empathy, that will ultimately better serve the diverse Canadian population.”

They wanted women to feel culturally safe and have access to resources.

They also wanted to reimagine medical education and identify ways in which medical learners could engage with communities of colour more meaningfully, at an earlier stage in their training.

The students contacted the experts and began their research.

Danielle Alcock, PhD, Schulich Medicine & Dentistry’s former Indigenous Lead, was their first call. Alcock was extremely supportive of the group, helping them understand the inequities related to Indigenous women, mentoring them and opening important doors to health leaders.

During the meetings, the students learned about how they could frame their initiative to address the need for culturally-safe and accessible care. They also realized the value of their own voices and experiences as women of colour.

Two months later, they launched The BIPOC Women’s Health Network – a national, student-led organization that now has representation from 12 Canadian medical schools in six provinces across the country.

They set out to achieve an equitable health care landscape.

Long term, the students would like to create sustainable and meaningful change through partnerships, responsive programming and integration with medical school curriculum.

Firmly focused on being advocates today and into their future medical careers, and living the School’s value of social responsibility, the three future physicians have found the work they have dedicated to the Network to be enlightening and rewarding.

For them, social accountability means partnering with and learning from the communities they are living in and working with. Importantly it also means unlearning.

The experience of establishing the Network has complemented their medical school studies. They all agree that their most important learning is that advocacy isn’t just a CanMEDs competency.

“Anyone in society can stand up for justice,” Sivajohan said. “But it must happen in partnership with the community and with people who have lived experience.”