An agreement facilitated by the University of Saskatchewan’s new president has eased tensions between the university’s administration and its college of medicine, giving the two sides some much needed breathing room to come up with an alternate proposal for the college’s restructuring.
Brett Fairbairn, U of S provost and vice-president, academic, said the agreement that was brokered by President Ilene Busch-Vishniac in mid-September was almost universally well received. “I think we’ve turned down the heat in the debate which really was very agitated,” he said. “Of course there is hard work ahead.”
Tensions had been building at the university since May when the administration unveiled a plan to redesign the medical school. The proposal would have realigned the teaching, research and clinical duties that faculty members perform, a move designed to boost the college’s flagging research output and to address some accreditation issues. But the plan was widely opposed by the college’s faculty and students, who fought to have it withdrawn.
Dr. Busch-Vishniac, who assumed office in July, convened a meeting of the provost’s office, the acting dean of medicine, the college’s faculty council, and members of the university council. The pact they struck gives the college’s faculty members and students greater say in its overhaul. The administration agreed to withdraw the original restructuring concept, provided that the college of medicine, working through a dean’s advisory committee, comes up with an alternate plan by December. The 16-member advisory committee consists of department heads, faculty members, students, residents, alumni, university officials, associate deans, representatives of regional health authorities and provincial government officials.
The plan must address the accreditation concerns within one year and come up with a proposal to rebalance faculty members’ teaching, research and clinical responsibilities within five years without additional funding from the university. “There’s no preconception about the precise solution, but what is essential is that we see our medical school performing in academic matters, in teaching and in research at a level that’s accepted,” Dr. Fairbairn said.
If the advisory committee can’t come up with an alternate proposal by the December deadline, administrators will resubmit the original restructuring plan to the university council for approval. The university has a tricameral governance structure: a board of governors; a senate, comprised of community representatives; and a university council, which consists primarily of faculty members.
The most pressing issue the advisory committee must address is accreditation. The college received a “warning of probation” from two undergraduate accreditation agencies, the Committee on Accreditation of Canadian Medical Schools and the Liaison Committee on Medical Education, a U.S. body, following a routine site visit in 2011.
The accreditors concluded that the medical school dean has insufficient authority to assign teaching duties to full-time university faculty members. They wanted the chain of authority within the college tightened. Responsibility for assigning teaching load currently rests mainly with department heads. One consequence is that interdisciplinary courses sometimes went ignored. In other instances, undergraduate students had turned up at hospitals for clinical instruction when not enough instructors were there to teach them. The next site visit by the accrediting agencies is scheduled for April 2013.
This is the second time the college has been dogged by accreditation issues. It was placed on probation a decade ago over concerns about insufficient funding, faculty size, its library and other resources. Over the intervening years the medical school has received targeted funding from the province to fix the problem, including $170 million for an addition to its health sciences building that recently opened. Only two of Canada’s 17 medical schools have been placed on probation in recent times: U of S in 2002 and Dalhousie University in 2009. Dalhousie’s probation was lifted in 2011.
Cy Frank, professor of orthopaedic surgery at the University of Calgary, said while it’s uncommon for medical schools to be threatened with probation, all schools are constantly at work on improving accreditation requirements. “I think every medical school has some issues that are identified by the accrediting body on a regular cycle,” said Dr. Frank who has been involved in the accreditation process at U of Calgary. Those that fail to fix the problems within the set time can be placed on probation or even shut down.
At U of S, the accreditation concerns triggered the restructuring process but the initial plan proposed by the provost’s office also sought to fix other longstanding problems, namely, ways to increase research productivity. In a post on the university’s website, Dr. Fairbairn noted that most Canadian medical schools generally account for between 20 and 30 percent of the university budget and generate between 40 and 50 percent of research revenues. The U of S medical school accounts for 24 percent of the university’s budget and generates only eight percent of research revenues, “by far the lowest in the country,” he noted. The medical school’s granting-council success rate is also near the bottom. And its students have performed below the median on national exams for seven years.
Part of the reason for this, Dr. Fairbairn said, is because too many faculty members, though hardworking, spend too much time on clinical duties and not enough on research and teaching. Of the college’s 185 faculty members, 107 are “clinical teachers” who have minimal research responsibilities. The university shouldn’t be paying full university salaries to those whose time is spent primarily on clinical service, he said.
“We know that at great medical schools all three of those things go together,” he said. “But if there’s kind of three cylinders, we have a college that’s only firing on one.”
The med school also lacks a culture that supports research, he said. Last year the university tried to hire two clinical research chairs, one in multiple sclerosis and another in Aboriginal health. The successful candidates turned down the offers because they would have been required to do the same amount of clinical service as other less research-intensive professors, Dr. Fairbairn said. The situation has developed over decades and won’t be easily corrected with minor tweaks, he added. “It will require a major effort.”
The restructuring plan proposed by the provost’s office called for the creation of three divisions within the medical school. It would have transferred more of the teaching load to part-time community based physicians who would report to regional and provincial health authorities. They would have been part of the new division of medical education. Full-time faculty members whose primary focus is research would report to the university and fall under the division of clinical research. A third division would include biomedical and population scientists.
The plan was widely opposed by faculty because they feared they would lose their tenured academic positions and they resisted having a solution imposed on the college, said Thomas Wilson, professor in the department of medicine.. “The process we felt was rushed and given a somewhat false sense of urgency,” he said. “It was top-down with little or no consultation with faculty and students and staff.” Dr. Wilson chairs the college’s faculty council but said he was speaking on his own behalf and not on behalf of the council.
Dr. Wilson said specialists in the province face a lot of pressure to do clinical work because there are so few of them. “We can’t just abandon patients,” he said. “It’s not as if we have a huge number of non-academic physicians to take up the slack.” Rebalancing professors’ duties can be achieved over time as the province trains more physicians, he suggested.
Dr. Fairbairn said while there is no set time limit for fix the imbalance, as there is for the accreditation process, the situation “is not less urgent.” U of S joined the U15 group of research-intensive universities two years ago and research remains one of its top institutional priorities. “In that context,” he said, “a medical school that is performing at the very bottom in research was a trend heading in the wrong direction.”