Managing Growth in Medical Education

Raghavan M, Martin BD, Ripstein I, Sandham JD.

University of Manitoba Faculty of Medicine.

Abstract of article published in the Journal of the International Association of Medical Science Educators in 2010.

In response to concerns about future physician shortage, urgent calls have been issued in the USA and Canada to increase medical student positions by 20-30% from current numbers. Yet very little information has been published on how to successfully plan for and manage medical school expansions.

Between 2000 and 2008, the University of Manitoba gradually managed a 53% expansion in Undergraduate Medical Education (UGME) class-size. The latest installment of UGME expansion occurred in 2008-09, amidst concurrent growth in Postgraduate Medical Education. In the same year, a program to evaluate and educate international medical graduates expanded 58% and, a new Physician Assistant Education Program was implemented. To meet the challenge of maintaining quality education for all learners and to appropriately plan for resource development, a systematic inventory of teaching responsibilities and an analysis of the gap between teaching capacity in 2007-08 and future demands were done. Using a combination of qualitative and quantitative methods, pre-clinical teaching was expressed in instructor-hours while clinical teaching was expressed as learner-weeks in clinical teaching units.

The methodology and the guiding principle that data should be expressed numerically using common units across all departments and programs, aided in unequivocally identifying scarce resources and competing needs. The results, allowing for a Faculty-wide accounting of future commitments, set in motion a teaching-based pro-rating system to allocate funding across departments in a transparent manner. Our methodological approach and experience will be of interest to faculty and administration involved in expansion of health professionals’ education.

Reference: Raghavan M, Martin BD, Ripstein I, Sandham JD. Managing growth in medical education. JIAMSE 2010; 20 (2): 143-152. [Link]

Christian the lion

There is a video gone wild, I mean, viral that depicts the heart-warming scene when Christian the lion reunites after a year-long gap with his human foster parents.

Christian was a lion originally purchased by Australians John Rendall and Anthony "Ace" Bourke from Harrods department store of London in 1969 and ultimately reintroduced to the African wild by conservationist George Adamson. One year after George Adamson released Christian to the wild, his former owners decided to go looking for him to see whether Christian would remember them. Surprisingly, he did, and with him were two lionesses who accepted the men as well. [Wikipedia entry]

It is still mind-boggling to me that people could actually buy a lion cub at Harrods of all places. The scourge of current day pet stores seems mild compared to the department store of the 60s.

Christmas shopping list:

1. Blue-eyed doll for Sara, check.
2. Football for John, check.
3. Tool kit for Adam, check.
4. Baking set for Mary, check.
5. One bonnie lion cub for Noah, check.

More about Harrods' contemporary contribution to the human-animal bond can be found here. I am not sure which is worse: the past or the present.

Fatal dog attacks in Canada

Approximately 15 deaths per year, on average, are attributed to dog-bite injuries in the United States. Victims are usually children. With an average of 1 to 2 deaths per year attributed to fatal attacks by dogs, the pattern in Canada appears to be somewhat similar to that in the United States. However, there are several differences in the epidemiology of dog-bite related deaths between the two countries. Here is the abstract from a study on fatal dog attacks in Canada (Can Vet J 2008;49:373–378) that highlights the differences. [Link]

Dr. Sheela Basrur, voice of reason during Toronto's SARS crisis

Dr. Sheela Basrur, the public health doctor, who appears to have calmed and charmed Canada even while Toronto was reeling under the fearful SARS crisis, passed away on June 2, 2008. She was only 51.

I am touched by how much Dr.Basrur seems to mean to Canada at a national level and to the average Canadian. Having lived in the US, I find it hard to imagine similar levels of warmth, public affection and emotions extended towards a public health professional/doctor over there (think CDC) even if they had worked through something as new and scary as SARS. Several factors have aligned together in her case, of course, but not least of which is the comparative smallness of the Canadian population that seems to tap into a 'close-knit community' feel when needed.

A female co-worker remembers bumping into her one day during the crisis as she emerged from a washroom. The co-worker told Dr. Basrur that she looked great and the doctor responded by saying she felt so tired.
“And I said Sheela, you're great,” said the co-worker. “The whole city loves you and is counting on you. And this morning on the radio I heard the host of the morning show say that he knew it was OK to go out because the little doctor with the glasses said it was.”

[Link]

Toronto Star has a picture gallery and a collection of videos on their site [Link].

I was living in the US during Toronto's SARS crisis, so the first time I heard her voice over the radio was only about a few months ago. She was talking about her cancer and her experience of the health care system as a patient. She was so candid, calm and composed despite probably knowing that the prognosis for her was not good. I felt immense respect and yes, affection, for this stranger whom I have never personally known. You can listen to parts of this interview on the June 2 show of 'As It Happens.' [Link]

As a mother myself, I could not hold back the rush of emotions that swept through my body when I read yesterday that her daughter is only 16 years old.

Of interest to public health and medical students: how her travels to Nepal and India shaped her extraordinary career in public health [Link].

Pets as sentinels

Our cats and dogs, our companion animals, live in our homes, picking up the same chemicals we pick up. If we expect some of those chemicals to affect our health adversely, we can expect to see similar effects in our pets too. Not only that, but as their life spans are shorter (i.e., they age at a faster rate) the endpoints we are concerned with may manifest themselves sooner in our pets than in us.

But first, we need to show that pets actually pick up some chemicals in their systems. Which is what several groups have done in the past. Several more will undoubtedly continue to carry on such work. Read and hear about one such recent effort. [Link]

Dr. Rosling's presentation with Trendalyzer software

Not only do you learn to present data more effectively, but you also get a 20-minute crash-course on the importance of sub-group analysis, changing socio-economic trends around the world, and their influence on the health indicators. [Link]

Found via Dr. Buttery's blog.

Surrogate motherhood

In animal husbandry, surrogate motherhood is not a new concept. Prized foals or heifers with desirable traits and genes are carried to term by "lesser" individuals within the breed or even occasionally, by individuals of related species. The focus is typically on aspects of efficiency--the gestation and delivery by multiple gestational moms during which time the genetic or donor mom is either aging or competing/producing (i.e., doing what a mare or a prized dairy cow is bred to do). We instinctively understand how humans benefit from this scheme. The assumption is that nature is happy with the chosen super(ior) mom. But we don't ever ask what's in it for the surrogate moms.

In humans, it is another story of course, although surrogate motherhood in people is less common. The answers can surprise us. But the development brings with it a whole new set of questions.

Dr. Naina Patel of Anand, Gujarat, alternatively referred to as Dr. Nayana Patel elsewhere, dominates most articles I read (in North America) about surrogate motherhood in India. In these articles she plays twin roles simultaneously--highlighting her role as the Director of the Akanksha Infertility Clinic and voicing her concerns about the lack of regulations by the Indian Medical Council. Clearly there is an unavoidable conflict of interest for her although she is on record claiming ethical and moral thought processes (but some may consider her ethics and morality selective and subjective). For example, as reported in the WebMD article:

But [Dr.Patel] refuses to treat gay couples, revealing her deeply conservative cultural roots. "I get e-mails from gays and lesbians," she says, "some of them very well written — but I don't feel right about helping them."

If empowerment of impoverished Indian women is one major goal of her program, why discriminate against gay couples who have a legal right to become parents in the countries they originate from?


Nowhere in these articles did I find any description or explanation about what happens when the health of the surrogate mother deteriorates on account of the surrogate pregnancy. Perhaps the situation has not come about yet. It is true that the potential surrogate moms are carefully chosen to be at low-risk for most pregnancy-related adverse events and are even more carefully monitored once they become pregnant. But what happens to the family of the surrogate mother in case of medical emergencies or tragic circumstances arising from the invasive procedures and/or pregnancies? This is a question that is also asked by C.P.Puri, Director of National Institute for Research in Reproductive Health [Link here.] With only about 50 surrogate pregnancies reported from India thus far, sorting out the legal and ethical nuances may not yet be a priority for the country; but I cannot help but think that all political hell will break lose if and when there will be one well-publicized adverse (health) incident.

It is interesting to see how the law regarding surrogacy differs in different countries. Canada, U.K. and parts of Australia do not permit commercial, but allow altruistic, surrogacy. In Israel, commercial surrogacy is legalized but altruistic and familial surrogacy is banned based on religious principles. In the United States, a large number of states have banned all forms of surrogacy (Reilly DR, 2007). The nuances in the ethical and legal aspects of caring (by a physician or another health-care worker) for a surrogate mother are well articulated in the following articles. Read here, here and here.