Remapping Medical Education
The challenge of building North America’s first fully distributed and expanded MD program
At 944,735 square kilometers, B.C. is the fifth largest land area in Canada, and its geographic diversity is legendary: an abundance of islands running north along the mountainous coastline, the dense, diverse urban centres flanked by farmlands in the lower mainland, the lakes and deserts lining the south eastern border, and the resource-rich forests of the north.
The challenge to create a program at such geographically distinct sites — Prince George, Victoria, Vancouver, and Kelowna (developed a few years later) — all sharing the same curriculum in real-time, in only a few short years, seemed as difficult a journey as traversing B.C.’s remarkable terrain on a pogo stick. The distances between the sites were not only significant, but within each region, such as Vancouver Island, or Northern B.C., community learning opportunities might be scattered hours away from the base.
And though there had been tremendous work at the executive tables to gain government support and define what the partnership between universities would look like, the details and resources needed to actually build and deliver the program had yet to be determined.
The task of translating the big vision into a real flesh and blood program fell to Dr. Joanna Bates, the senior associate dean of the MD program at the time. Bates, along with a constellation of talented individuals from varied backgrounds, including curriculum experts, architects, technologists, community leaders, dove headfirst into the abyss.
But whether or not they could translate the vision into a reality in time was met with sharp skepticism.
Putting a plan in place
“We had a mandate, a timeline, and a deliverable, but absolutely no plan!,” says Joanna Bates.
While core elements of the curriculum would stay the same, nearly every other corner, nook and cranny of the medical education system — from admissions and student recruitment, to training faculty members to give a video conferenced lecture — would need to be rethought. With opening day scheduled just a few years away — the clock was ticking.
Adding to the logistical obstacles of delivering and implementing such an expansion, the transformation also required a monumental culture shift.
Vancouver had been the seat of medical education in the province since UBC first launched the MD program in 1950. Over the years, the program and the health care system had flourished, with large teaching hospitals, like Vancouver General and St. Paul’s, stocked with large teams of medical specialists who looked after serious and complex cases. UBC’s program was long-established, had a history and many didn’t think there was reason to change.
As it would turn out, Vancouver’s culture wasn’t the only one resistant to change.
While not as severe as the problems in the north, Vancouver Island’s aging population, and physician shortages in rural and remote island communities were palpable. Yet, Island physicians were initially reluctant to accept the idea that distributed medical education could help address those issues. Some doubted the sincerity of the partnership with UBC and many feared that adding teaching to their already busy workload would slow down care, resulting in seeing fewer patients.
Dr. Steve Martin, a family physician and the current director of clinical skills with the Island Medical Program (IMP), had a different view. As the interim course director for Family Practice Continuum and Clinical Skills at the time, Martin was tasked with not only securing family practice office space for medical students to complete their placements, but recruiting clinical teachers — a significant challenge, but one which Martin met with passion, and a bit of creativity. It wasn’t long before the community on the Island came on board.
“Learning how to give input into building a medical program, at the same time as trying to get your medical education – that was unique,” says Jeff Ricketson, a former student of the Island Medical Program. “We were all figuring it out – how to communicate and how to do a lecture and how to do small groups via a satellite. And working through that was also really exciting, really rewarding as well.”
But, as plans got underway, it became clear that another challenge was just around the corner: new groundbreaking technology-enabled learning platforms would need to be developed to support simultaneous, real-time interactive learning. The reasons were both practical and conceptual.