Message from the Division Director
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Dear Colleagues,
We heard last week that the core internal medicine program accreditation status has been downgraded by the Royal College to “intent to withdraw”. The full report is not yet available, but the issues cited were related to (1) clinical supervision of learners and a perceived lack of support for junior residents on weekends and (2) a suboptimal learning climate where residents feel they cannot raise concerns for fear of repercussions. Please note that this is not the GIM PGY 4/5 subspecialty training program, but rather the core internal medicine program (PGY 1-3), so the accreditation pertains to both GIM and other subspecialities. We anticipate there will be further information and guidance for all divisions across the Department of Medicine.
To the core internal medicine residents: I am saddened that this has been your experience, and recognize that this news about your program can only add to the stress of an already difficult year. Our division (along with the Department of Medicine more generally) takes these concerns very seriously and will work with the program, the site directors and with you to understand the specific issues related to GIM, address these appropriately, and ensure that the program is worthy of full accreditation at the next review.
To the faculty: I know you are disheartened by this outcome that comes despite efforts to teach and protect learners while simultaneously assuming increased clinical and administrative workloads related to COVID. Despite this setback, I have every confidence that we will be able to work with the program and trainees to continue our long tradition of providing an exceptional educational experience and positive learning environment on our CTUs and other GIM services.
To all of us: A reminder (with credit to Barry Goldlist) that the majority of our excellent junior faculty in GIM and the subspecialities are recent graduates of the core medicine training program, and their skill in clinical care and teaching should give us full confidence that the program provides appropriate medical training for practice. The program is fortunate to have outstanding residents and educational leaders who are committed to supporting both learners and faculty. As we work together to optimize the learning environment, rebuild trust, and recuperate from a pandemic year that has been professionally and personally difficult for all of us, let us be kind, assume the best of intentions in others, and reclaim the joy in clinical medicine.
Yours,
Moira
Dr. Moira Kapral, Director, Division of General Internal Medicine, University of Toronto
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Associate Dean, Inclusion & Diversity, Temerty Faculty of Medicine
Dr. Lisa Richardson has been appointed as Associate Dean, Inclusion & Diversity, at the University of Toronto. In this role she will work collaboratively across the Faculty of Medicine to build alliances, develop strategic partnerships, and engage internal and external partners to enhance and promote the diversity of our faculty, learners and staff. Lisa has served as Vice-Chair, Culture and Inclusion for the Department of Medicine as well as Strategic Advisor on Indigenous Health. She also serves as Indigenous Health Strategy Lead for Women’s College Hospital and chairs several national committees to advance Indigenous medical education.
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New Faculty - Dr. Ariel Lefkowitz
Dr. Ariel Lefkowitz has been appointed as a Clinician Teacher and Assistant Professor based at Sunnybrook Health Sciences Centre. His academic interests include ethics, equity, narrative medicine, and the involvement of patients in medical education. He and his wife Sarah have two children, Etai and Roey, who are locked in a pitched battle for cutest child ever. In a former life, he was an actor of the stage and screen, but you’ll never find him on IMDB!
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National Magazine Award Nomination
Dr. Seema Marwaha's CMAJ series, "Patient Portraits", has been nominated for a National Magazine Award in the category of Best Column or Regularly Featured Department.
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Nominations for General Internal Medicine Teaching and Mentorship Awards
Have you worked with an attending physician in General Internal Medicine (GIM) who provided an excellent educational experience or was an excellent mentor? If yes, please consider nominating him/her for a citywide GIM award. One mentorship and two teaching awards (one for an early career faculty member and one for a more senior faculty member) will be awarded this year. You may nominate as many people as you wish, but please use a separate nomination form for each nominee. The nomination process is meant to be easy: just a few words will suffice. Nominators must be trainees. Nomination deadline: June 4, 2021. Please send completed nomination forms to tina.teng@uhn.ca
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GEMINI Post-Doctoral Fellow Posting
GEMINI is seeking a recent PhD graduate with excellent analytical skills to study hospital care, resource use, and clinical outcomes related to COVID-19. Supervised by GEMINI’s Co-Principal Investigators, the successful candidate will provide mentorship to graduate students and assist with preparation of research for publication and dissemination. More details available HERE
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U of T GIM Research Day
This year's GIM Research Day will be held virtually on Friday, May 28th from 12pm to 1:30pm.
Research Day provides a forum to showcase, connect and strengthen research excellence within our vibrant division. All faculty and trainees are welcome to attend to hear short trainee presentations and a keynote speech by Dr. Leora Horwitz.
Dr. Horwitz is Director of the Center for Healthcare Innovation and Delivery Science at NYU Langone Health and was recently named an Emerging Leader by the National Academy of Medicine. Her work focuses on improving the safety and quality of healthcare delivery and transitions in care and she has developed widely used quality measures for the Centers for Medicare & Medicaid Services.
2021 GIM Research Day Agenda
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University of Toronto GIM June Citywide Rounds
Date: June 25, 2021
Time: 12-1 PM
Dr. Bourne Auguste will provide an overview of best practices in the management of hyperkalemia and Dr. Harindra Wijesundera will provide an update on the management of acute coronary syndromes.
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Journal Articles
Divisional members have published the following journal articles since the last issue of the GIM newsletter:
- Le Petit Prince: Lessons From a Beloved Fable for Our Current Time.
Taran S, Detsky AS.
J Hosp Med. 2021 Apr 21. doi: 10.12788/jhm.3640.
PMID: 33929944
- Tool development to improve medication information transfer to patients during transitions of care: A participatory action research and design thinking methodology approach.
Hahn-Goldberg S, Chaput A, Rosenberg-Yunger Z, Lunsky Y, Okrainec K, Guilcher S, Ransom M, McCarthy L.
Res Social Adm Pharm. 2021 Apr 10:S1551-7411(21)00125-X. doi: 10.1016/j.sapharm.2021.04.002.
PMID: 33926826
- Cognitive determinants of community functioning and quality of life in homeless adults with mental illness: 6-year follow-up from the At Home/Chez Soi Study Toronto site.
Gicas KM, Mejia-Lancheros C, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V.
Psychol Med. 2021 Apr 30:1-9. doi: 10.1017/S0033291721001550.
PMID: 33926584
- Hand hygiene sprayed into eye.
Redelmeier DA, Thiruchelvam D.
IDCases. 2021 Mar 27;24:e01092. doi: 10.1016/j.idcr.2021.e01092.
PMID: 33912387
- Bradycardia associated with remdesivir therapy for COVID-19 in a 59-year-old man.
Day LB, Abdel-Qadir H, Fralick M.
CMAJ. 2021 Apr 26;193(17):E612-E615. doi: 10.1503/cmaj.210300.
PMID: 33903133
- Health of people experiencing co-occurring homelessness, imprisonment, substance use, sex work and/or severe mental illness in high-income countries: a systematic review and meta-analysis.
Tweed EJ, Thomson RM, Lewer D, Sumpter C, Kirolos A, Southworth PM, Purba AK, Aldridge RW, Hayward A, Story A, Hwang SW, Katikireddi SV.
J Epidemiol Community Health. 2021 Apr 23:jech-2020-215975. doi: 10.1136/jech-2020-215975.
PMID: 33893182
- Weight-based thyroid dosing vs fixed-dosing during pregnancy for subclinical hypothyroidism: A retrospective cohort study.
Bohlega B, Zahedi A, Tomlinson G, Feig DS.
Clin Endocrinol (Oxf). 2021 Apr 23. doi: 10.1111/cen.14488.
PMID: 33891710
- Striae and an Adrenal Mass.
Yo JH, Gandhi S.
N Engl J Med. 2021 Apr 22;384(16):e57. doi: 10.1056/NEJMicm2024730.
PMID: 33882208
- Testing for non-inferior mortality: a systematic review of non-inferiority margin sizes and trial characteristics.
Pong S, Urner M, Fowler RA, Mitsakakis N, Seto W, Hutchison JS, Science M, Daneman N.
BMJ Open. 2021 Apr 20;11(4):e044480. doi: 10.1136/bmjopen-2020-044480.
PMID: 33879485
- Venlafaxine-induced hypoglycemia.
Kobylianskii J, Wu PE.
CMAJ. 2021 Apr 19;193(16):E568. doi: 10.1503/cmaj.78409.
PMID: 33875464
- Initiation of anticoagulation in atrial fibrillation by primary care physicians: Results of a telephone survey.
Carlin S, Bond A, Gross P, Bell A, Douketis J, Geerts W, Galanaud JP.
Thromb Res. 2021 Apr 15;202:176-181. doi: 10.1016/j.thromres.2021.04.004. .
PMID: 33872825
- Utilization Rates of Pancreatectomy, Radical Prostatectomy, and Nephrectomy in New York, Ontario, and New South Wales, 2011 to 2018.
Pang HYM, Chalmers K, Landon B, Elshaug AG, Matelski J, Ling V, Krzyzanowska MK, Kulkarni G, Erickson BA, Cram P.
JAMA Netw Open. 2021 Apr 1;4(4):e215477. doi: 10.1001/jamanetworkopen.2021.5477.
PMID: 33871618
- Multi-trajectory group profiles of well-being and associated predictors among adults experiencing homelessness and mental illness: findings from the At Home/Chez Soi study, Toronto site.
Mejia-Lancheros C, Lachaud J, Aubry T, Wiens K, O'Campo P, Stergiopoulos V, Hwang SW.
Soc Psychiatry Psychiatr Epidemiol. 2021 Apr 17. doi: 10.1007/s00127-021-02093-x.
PMID: 33866385
- Implementation, spread and impact of the Patient Oriented Discharge Summary (PODS) across Ontario hospitals: a mixed methods evaluation.
Hahn-Goldberg S, Huynh T, Chaput A, Krahn M, Rac V, Tomlinson G, Matelski J, Abrams H, Bell C, Madho C, Ferguson C, Turcotte A, Free C, Hogan S, Nicholas B, Oldershaw B, Okrainec K.
BMC Health Serv Res. 2021 Apr 17;21(1):361. doi: 10.1186/s12913-021-06374-8.
PMID: 33865385
- Association of diabetes with frequency and cost of hospital admissions: a retrospective cohort study.
Choi J, Booth G, Jung HY, Lapointe-Shaw L, Tang T, Kwan JL, Rawal S, Weinerman A, Verma A, Razak F.
CMAJ Open. 2021 Apr 16;9(2):E406-E412. doi: 10.9778/cmajo.20190213.
PMID: 33863799
- Interpretation use for consent to hip fracture surgery in patients with limited English proficiency.
Mong J, Cram P, Syed K, Rawal S.
J Am Geriatr Soc. 2021 Apr 15. doi: 10.1111/jgs.17157.
PMID: 33856689
- Disparities in access to palliative care facilities for patients with and without cancer: A retrospective review.
Lau C, Meaney C, Morgan M, Cook R, Zimmermann C, Wentlandt K.
Palliat Med. 2021 Apr 15:2692163211007387. doi: 10.1177/02692163211007387.
PMID: 33855886
- The association between varying levels of palliative care involvement on costs during terminal hospitalizations in Canada from 2012 to 2015.
Isenberg SR, Meaney C, May P, Tanuseputro P, Quinn K, Qureshi D, Saunders S, Webber C, Seow H, Downar J, Smith TJ, Husain A, Lawlor PG, Fowler R, Lachance J, McGrail K, Hsu AT.
BMC Health Serv Res. 2021 Apr 13;21(1):331. doi: 10.1186/s12913-021-06335-1.
PMID: 33849539
- Prediction of personal protective equipment use in hospitals during COVID-19.
Furman E, Cressman A, Shin S, Kuznetsov A, Razak F, Verma A, Diamant A.
Health Care Manag Sci. 2021 Apr 12:1-15. doi: 10.1007/s10729-021-09561-5.
PMID: 33843005
- Evaluating the conduct and application of health utility studies: a review of critical appraisal tools and reporting checklists.
Zoratti MJ, Pickard AS, Stalmeier PFM, Ollendorf D, Lloyd A, Chan KKW, Husereau D, Brazier JE, Krahn M, Levine M, Thabane L, Xie F; Health Utility Book (HUB) Working Group.
Eur J Health Econ. 2021 Apr 11. doi: 10.1007/s10198-021-01286-0.
PMID: 33839968
- Lessons for hospital care from the first wave of COVID-19 in Ontario, Canada.
Verma AA, Razak F.
Hosp Pract (1995). 2021 Apr 19:1-3. doi: 10.1080/21548331.2021.1915657.
PMID: 33832401
- Reducing unnecessary red blood cell transfusion in hospitalised patients.
Mehta N, Murphy MF, Kaplan L, Levinson W.
BMJ. 2021 Apr 6;373:n830. doi: 10.1136/bmj.n830.
PMID: 33824140
- Redefining Health Care Utilization as a Quality Measure for Goal Concordance at the End of Life.
Nayfeh A, Kamra M, Fowler RA.
JAMA Netw Open. 2021 Apr 1;4(4):e213835. doi: 10.1001/jamanetworkopen.2021.3835.
PMID: 33822075
- Adoption, feasibility and safety of a family medicine-led remote monitoring program for patients with COVID-19: a descriptive study.
Agarwal P, Mukerji G, Laur C, Chandra S, Pimlott N, Heisey R, Stovel R, Goulbourne E, Bhatia RS, Bhattacharyya O, Martin D.
CMAJ Open. 2021 Apr 1;9(2):E324-E330. doi: 10.9778/cmajo.20200174.
PMID: 33795222
- Prevention and Management of Urgent/Emergent Limb Ischemia.
McClure GR, Chan N, Kaplovitch E, Bhagirath V, Anand SS.
Curr Cardiol Rep. 2021 Mar 11;23(5):41. doi: 10.1007/s11886-021-01472-9.
PMID: 33704609
- Mortality Among Parents of Children With Major Congenital Anomalies.
Fuller AE, Horváth-Puhó E, Ray JG, Ehrenstein V, Sørensen HT, Cohen E.
Pediatrics. 2021 May;147(5):e2020028571. doi: 10.1542/peds.2020-028571.
PMID: 33811179
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Trainee Publications
- Bradycardia associated with remdesivir therapy for COVID-19 in a 59-year-old man.
Day LB, Abdel-Qadir H, Fralick M.
CMAJ. 2021 Apr 26;193(17):E612-E615. doi: 10.1503/cmaj.210300.
PMID: 33903133 No abstract available.
- Venlafaxine-induced hypoglycemia.
Kobylianskii J, Wu PE.
CMAJ. 2021 Apr 19;193(16):E568. doi: 10.1503/cmaj.78409.
PMID: 33875464 Free PMC article. No abstract available.
- Utilization Rates of Pancreatectomy, Radical Prostatectomy, and Nephrectomy in New York, Ontario, and New South Wales, 2011 to 2018.
Pang HYM, Chalmers K, Landon B, Elshaug AG, Matelski J, Ling V, Krzyzanowska MK, Kulkarni G, Erickson BA, Cram P.
JAMA Netw Open. 2021 Apr 1;4(4):e215477. doi: 10.1001/jamanetworkopen.2021.5477.
PMID: 33871618
- Prediction of personal protective equipment use in hospitals during COVID-19.
Furman E, Cressman A, Shin S, Kuznetsov A, Razak F, Verma A, Diamant A.
Health Care Manag Sci. 2021 Apr 12:1-15. doi: 10.1007/s10729-021-09561-5.
PMID: 33843005
- Prophylaxis for covid-19: living systematic review and network meta-analysis
Bartoszko JJ, Siemieniuk RAC, Kum E, Qasim A, Zeraatkar D, Ge L, Han MA, Sadeghirad B, Agarwal A, Agoritsas T, Chu DK, Couban R, Darzi AJ, Devji T, Ghadimi M, Honarmand K, Izcovich A, Khamis A, Lamontagne F, Loeb M, Marcucci M, McLeod SL, Motaghi S, Murthy S, Mustafa RA, Neary JD, Pardo-Hernandez H, Rada G, Rochwerg B, Switzer C, Tendal B, Thabane L, Vandvik PO, Vernooij RWM, Viteri-Garcia A, Wang Y, Yao L, Ye Z, Guyatt GH, Brignardello-Petersen R.
BMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n949
- Accuracy of cardiovascular trial outcome ascertainment and treatment effect estimates from routine health data: a systematic review and meta-analysis
Rodrigues C, Odutayo A, Patel S, Agarwal A, da Costa BR, Lin E, Yeh RW, Jüni P, Goodman SG, Farkouh ME, Udell JA.
Circ Cardiovasc Qual Outcomes. 2021. doi: 10.1161/CIRCOUTCOMES.120.007903.
PMID: 33993728
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For future newsletters, please email information on your contributions to tina.teng@uhn.ca.
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