The activities of RCCbc’s Education and Training sector are overseen by Dr. Robert Woollard and involve supporting the work of education-focused groups – such as UBC Rural Continuing Professional Development (UBC RCPD) and the Rural Education Action Plan (REAP) – as well as supporting projects and conversations that engage medical school applicants, undergraduates and postgraduates who may be interested in rural practice. Dr. Woollard also supports the Rural Doctors’ UBC Chair in Rural Health by participating on the Dean’s Advisory Committee on Rural Health which supports the work of the Rural Chair.
During 2019-20, the Education and Training sector supported the work of Dr. James Card in strengthening supports and connections for UBC family medicine residents and medical students in an academic environment that focuses more on site-based interactions (Rural Medical Interest Group report, below). The Education and Training Sector also supported UBC Rural CPD’s expansion of resources to support Indigenous healthcare provision as well as clinical coaching for rural maternity providers, in association with RCCbc’s Rural Obstetrics and Maternity Sustainability Program (ROAM-SP). Dr. Woollard has also worked with REAP and Dr. John Pawlovich to support both service and teaching within the rapidly expanding virtual care network in BC. Dr. Woollard also engaged RCCbc’s Rural Site Visits Project to enhance two way understanding of educational support and students as agents for change for more effective education and sustainable service at the community level.
Near the end of the 2019-20 fiscal year, the Covid-19 pandemic necessitated that Dr. Woollard – along with key UBC stakeholders – address the shift to medical teaching in a virtual environments. These conversations are ongoing in 2020, and include considerations such as the potential impact of the pandemic on changes in admissions procedures that may adversely affect entry of rural-interested and rural-experienced students, as well as the impact of expanding virtual networks in influencing educational needs and learning possibilities in new environments.
Dr. Woollard has additionally brought the Education and Training lens/voice to several tables within RCCbc, including the planning working group for the Rural Health Services Research Network of BC’s (RHSRNbc) symposium (now cancelled due to the pandemic) to address climate and/or environmental impacts on rural heathcare in BC, as well as the Truth and Reconciliation Commission’s Calls to Action group to develop a conceptual lens and evaluation matrix to address and action the TRC Calls to Action. Dr. Woollard has also shared learnings from the many international rural health education tables that he is a member of, allowing RCCbc to place its work and innovation within a larger global context.
The response of RCCbc to the many and complex issues relevant to rural health is predicated on two major ideas: reflective practice, and RCCbc as a learning organization. Both of these approaches have a key element of education and the Education and Training sector attempts to provide its perspective and skills where needed.
The BC Rural Health Conference (RHC) team of Dr. Brenda Huff, Elisa Chow, and Michelle Baysan hosted the largest iteration of the conference in Nanaimo during 2019-20. More than 400 participants, speakers, exhibitors, and staff gathered in the Hub City to learn, network, relax with families, and acquire or practice new hands-on skills.
In addition to scheduling CME/CPD learning sessions, the BC Rural Health Conference regularly offers space for other activities such as open meetings, and networking, allowing delegates and other rural healthcare organizations (e.g., RCCbc’s Rural Obstetrics and Maternity Sustainability Program (ROAM-SP) or the BC Emergency Medicine Network) to host conversations about rural health policy, recruitment and retention, provider resiliency, and medical training. These events allow for face-to-face engagement with frontline rural healthcare providers, which provides rich content and lays the foundation for building stronger connections and relationships. The 2019 event offered rural healthcare providers an opportunity to attend workshops ahead of the conference focused on rural locuming, multi-modal chronic pain management, and rural transport, all of which added to broader conversations about healthcare service delivery in rural BC, in addition to disseminating information and building skills and networks.
Over the past several years, the BC Rural Health Conference has mindfully incorporated provider wellness, cultural safety, and environmental sustainability into the event. In addition to providing complimentary mini-massage/yoga/movement breaks, local organized activities (e.g., walking tours) were offered to allow delegates and their families to practice self-care during the conference. As part of its ongoing commitment to improving cultural safety at RHC, RCCbc continues to invite local Indigenous Elders to attend the conference, and works with local community members to host a traditional welcome for delegates. Additionally, the RHC planning team develops new offerings to foster informal learning and relationship building at the conference. During the the 2019 conference, a new networking event – rMEET – paired rural residents and/or new–to–practice rural physicians with an experienced rural doctor for open conversation. The event was well-received by participants and will be offered at future RCCbc health conferences.
Shortly after the conclusion of the 2019 BC Rural Health Conference, the BC Rural Health Conference planning team moved quickly to organize RCCbc’s 2020 event in Penticton, BC. Although the conference was initially scheduled to take place May 29-31, the COVID19 pandemic resulted in an order from the Provincial Health Officer to restrict gatherings to less than 50 people, which necessitated cancellation of this event in March 2020.
Overall, the BC Rural Health Conference is becoming a better known and sought out event, due to consistent branding, high quality rural CME/CPD, and family inclusivity. (We are still one of the few Canadian conferences offering complimentary childcare during conference hours, which allows parents with young children to participate.) The BC Rural Health Conferences planning team will continue to build this brand, looking at how we might collaborate/incorporate conference branding and/or learning activities into the Society of Rural Physicians of Canada’s Remote and Medical Course when it is hosted in British Columbia in the coming years.
Dr. Kevin McMeel and the team supporting the Nanaimo Emergency Education Program (NEEP) completed cohorts 5 and 6 of this popular emergency medicine training fellowship and completed the application and selection process for cohort 7. They also supported providers in the launch of a northern satellite version of the program: Northern Emergency Education Program (NoEEP), operating out of Prince George. Dr. McMeel and his team mentored the Prince George team through the application and selection processes for the first NoEEP cohort, which is scheduled to take place Fall 2020 but is subject to change due to the Covid-19 pandemic.
Over the past year, the NEEP program solidified its relationships with UBC Department of Family Practice’s Enhanced Skills program and the Ministry of Health. All three groups are partnering to follow the development of the NoEEP program as part of the expansion of the CCFP (EM) Enhanced Skills training stream into Prince George. It is hoped that both programs will encourage training and retention of EM trained family physicians outside the Lower Mainland.
An accreditation lead for the CFPC commented to Dr. McMeel that the NEEP/NoEEP programs both feature many leading rural innovations, including a collaborative approach that aligns program development and expansion with recognized societal needs, and an active intention to expose medical residents to family medicine and emergency medicine in smaller communities including remote Indigenous settings. The lead felt NEEP/NoEEP was a “model approach to [embedding] social accountability [into medical EM training].”
For many years, Dr. Dan Horvat has explored how to promote best practices and innovations practiced in rural settings in BC and other jurisdictions, and how to best disseminate that information throughout the province. He’s engaged in ongoing conversations with many BC healthcare stakeholders to discuss how learning organizations can develop in support of the development of a learning healthcare system that continuously improves healthcare service delivery using a triple aim lens.
In August 2019, Dr. Horvat organized and attended – along with 19 other BC participants – a BC specific Nuka Symposium at Southcentral Foundation, to learn more about how this internationally recognized, Native American healthcare organization excels at:
After his return to BC, Dr. Horvat wrote a summary document of the learnings gleaned from the Nuka Symposium, incorporating information from slides from the event as well as soliciting feedback from other BC participants. He submitted the document to the Joint Collaborative Committees’ (JCC) Scholarship committee and has been invited to submit a document outlining how the learnings can be applied within BC to the General Practitioners Services Committee (GPSC). He has also been involved in many discussions regarding how BC might apply the learnings of the Southcentral Foundation to its primary care/team-based care involved input from physician leaders as well as leaders from RCCbc, Divisions of Family Practice, health authorities, UBC Faculty of Medicine, BC Medical Quality Improvement, GPSC, the Joint Standing Committee on Rural Issues (JSC), the Specialists Services Committee (SSC), the Shared Care Committee (SCC), and the Ministry of Health.
Dr. Horvat has further shared the learnings from the Nuka Symposium and generated such discussion via a GPSC-sponsored webinar. He proposed an approach to share learnings of best practices within and from outside of BC which can accelerate implementation of best practices regarding team-based care and organizational excellence in our province. He has also had discussions with RCCbc, JSC, and JCC leadership regarding the creation of a Community of Practice focusing on health system improvement to assist with better aligning the many improvement activities occurring in the province to achieve a shared vision informed by best practices and which assists with the development of a learning healthcare system in BC.
In other work, Dr. Horvat continues to represent RCCbc in the Practice Improvement Hub, a collaboration between RCCbc, UBC CPD, BC College of Family Physicians, College of Physicians and Surgeons of BC, Health Data Coalition, Practice Support Program, UBC Department of Family Practice, UBC Health, and others which works to align efforts to support practice improvement across organizations. He is currently the co-chair of the Practice Improvement Hub Forum and leadership group, and also serves as Chair of the Learning Organization Working Group for the Practice Improvement Hub Forum.
The 2019-20 fiscal year saw the planning, launch, and rapid uptake of the new Rural Continuing Medical Education (RCME) Community Program. This program – funded by the Joint Standing Committee on Rural Issues (JSC) — provides funds to rural generalist physicians, specialists, and interprofessional teams living and practicing in BC’s rural communities to engage in collective learning activities.
The RCME Community program, led by Dr. Ian Schokking and Provincial Manager Heather Gummow, launched in Spring/Summer 2019, with an initial focus on supporting communities in transitioning to the new program. To enable this work, RCME Liaisons were hired by RCCbc and the regional health authority to support physicians and their communities through the process. Each community or collection of communities (“multi-communities”) was encouraged to strike a committee or collaborate with structures already in place to develop a plan to spend the RCME community funds. Creating these structures has allowed RCCbc, the regional health authorities, and the rural communities to build and/or strengthen their relationships, which has improved opportunities and appetite for collaboration in areas beyond medical education, and has also helped build community locally and regionally.
Through the hard work of Heather and the four RCME Liaisons – Nicole Hochleitner-Wain (Interior region), Eva Jackson (Vancouver Coastal region), Antoinette Picone (Island region), and Danielle Richey (Northern region) – to develop infrastructure for the local community committees, 55 of 99 eligible RSA communities for this program were transitioned within the first six months of the program launch date. Although the time demands of addressing the Covid-19 response may reduce physician capacity to move this work forward as quickly as before, the RCME Community Program leads anticipate that all eligible communities will be transitioned over the next year.
Through the work of the RCME Community Program, networks of support for CME administration have formed throughout the province, and are being intentionally brought together into a Community of Practice. This group of 20-25 people meet bi-monthly to connect and share reports on their RCME activities and innovations, and to build local capacity through mentorship and guidance. This collaboration has allowed strong relationships to develop at an administrative level, reinforcing the collaborative work being undertaken by the local rural physician RCME Community Program committees.
One of the innovative components of the RCME Community Program is the flexibility it offers rural communities to access the program as a multi-community ‘pod.’ This option allows physician communities and administrators who self-identify as being similar and/or who already have established relationships built along lines of referral to lay a foundation that sustainably supports CME and potentially other shared resources in the future. These multi-community models vary in their individual structures, often based on the strictures caused by geography and rurality.
Another exciting innovation being offered by the RCME Community Program is an initiative geared towards fostering innovative RCME delivery for specialists, sub-specialists, and providers engaging with Indigenous communities (SPIFI). This funding will enable groups to innovatively organize themselves in ways which best support local and/or regional practice and healthcare needs. SPIFI launched in the Spring of 2020 and uptake for the initiative has been exciting. Two applications have been approved to date, one of which is supporting virtual simulation activities in the community of Golden and the other supporting the intensivists in Prince George to come together to learn about their findings during the pandemic and develop structures and guidelines to support the Northern region. The leads anticipate seeing several more applications for the funding being submitted as this program addresses unmet educational needs for these smaller, distributed specialized groups.
For the past several years, UBC Family Medicine Rural Prince George Training Site Director, Dr. James Card, has engaged undergraduate medical learners and resident trainees on the benefits and joys of rural medical practice. He hosts monthly Rural Medicine Information evening events during the Northern Medical Program’s academic year (and once during the summer) to present information, answer questions, and build relationships. Occasionally, he will invite a rural-curious northern resident to attend the session as well. These events are his primary tool for educating and recruiting the next generation of healthcare providers into rural medicine.
Dr. Card covers a wide range of topics (locuming, compensation models, rural benefits, managing a full-time practice with a young family, etc.), all while getting to know the students and building an ongoing relationship with them. He is coalescing a vast body of information that he has gleaned over the years into one convenient space and it’s having an impact. Students have noted anecdotally that the initiative is useful and that there is good awareness of this resource. Dr. Card would like to see similar Rural Medical Interest Groups be offered to medical learners and trainees at other sites around the province; however, he notes that while these events are not expensive to host, organizing them can be time-intensive, which makes it challenging for rural physicians with a full practice to coordinate on their own time. He has secured ethics approval to collect and analyze some of the data to measure the impact and efficacy of these engagements on rural recruitment and retention, and is looking for support to help him evaluate and complete the analysis.
Dr. Card believes strongly that rural recruitment and retention strategies need to begin earlier than at the completion of residency. He notes that consistently building relationships with Year 1 medical students does (anecdotally) yield results and is interested in building a network of medical students and residents to support rural interest, learning, and recruitment. He is also engaging various Divisions of Family Practice to consider expanding recruitment and retention plans so that there are a variety of short-. medium-, and long-term strategies deployed for best success. At the current time, especially during the Covid-19 pandemic, there is very little capacity to take this on. However, as provincial partners build out stronger treatment and transport infrastructure and create stronger networks and relationships, there may be more appetite and/or capacity to focus on formulating a multi-teired strategy for recruitment.
Parallel to this work Dr. Card along with resident Dr. Kyle Ng, Dr. Carl Whiteside, and RCCbc Communications Manager Sharon Mah started up a BC Rural Resident Network to support and connect rural interested medical students, residents, and new-to-practice rural family physicians throughout the province. While the network has taken a while to find its feet and purpose, Dr. Card believes the network could become a central hub for rural family practice. It could provide information about training, rural practice benefits and compensation, communities, medical education, and more. There are several challenges to overcome – the most important being the rapid turnover of rural residents participating in leadership roles in the Network. Early in 2020, RCCbc, REAP and the BC Rural Residents Network started to explore the idea of hosting an event for rural interested residents in association with the BC Rural Health Conference. However, with the Covid-19 pandemic severely disrupting the studies and exams of both medical students and residents, the future of the BC Rural Residents Network is on pause for now.
This year saw the continuation and growth of a number of Rural CPD programs and projects and the conclusion of others. Our Program is currently leading 11 initiatives and is supported by 13 medical leads and 11 team members. The Medical Advisory Committee and Medical Leads gathered for their annual retreat in May 2019 in Parksville, BC to discuss the application of quality improvement principles to our programs and our operations.
The Rural CPD Program saw transitions in its operational and medical leadership with Dilys Leung resigning in August 2019 and Dr. Nicole Ebert transitioning out of the role of Co-Medical Director at the end of March 2020. Laura Beamish joined as Rural CPD Senior Manager in October 2019 and Dr. Dana Hubler continues as Rural CPD Medical Director.
In the 2019-20 fiscal year, the HOUSE course delivered 12 courses to 184 participants across nine different communities. This brings the total number of courses delivered to 87 and the total number of participants reached to 1055 since the program’s inception in 2015. The program continues to be highly valued by participants for its hands-on format and pool of skilled instructors. Participants reported increased confidence in their POCUS skills after taking the course.
In the 2019-20 fiscal year, five ESCAPE courses were delivered to 68 participants across five different communities including Creston, Salmon Arm, Golden, Powell River and Smithers. Participants report increased confidence in critical care management and value the hands-on instruction from facilitators.
During the 2019-20 fiscal year, 10 Rural Rounds sessions were run from April to March. To respond toidentified learning needs, the series this year featured five presentations from Dr. Omar Ahmad, an urban intensivist who is part of the RCCbc Real Time Virtual Support pathways.
In March 2020, we increased the frequency of the sessions to once per week to address the increased need for rurally specific education about COVID-19. A total of nine (9) sessions were run from March 2020 to June 2020, seven (7) of which were additional Rural COVID-19 Rounds.
RSON Clinical Coaching Pillar
The RSON Clinical Coaching Pillar onboarded three new Northern Health communities this year, including Hazelton, Smithers and Vanderhoof this year. Our team visited all three communities in 2019 to engage with program participants, learn about the communities’ objectives, and provide an overview of the program. Along with increasing community engagement, RSON has improved communication through regular check-in meetings with other pillars and bimonthly coaching pillar working group meetings. The number of coachees and coaches participating in the RSON Clinical Coaching Pillar reached 67 and 70, respectively this year.
We also worked this year to develop new program resources and created a more structured community reporting protocol to successfully onboard new communities. This included developing and updating program resources like the program handbook, online portal, payment protocol, evaluation tools and coach training workbook. Finally, we welcomed new Coach Training facilitators, Executive Coach, Ingrid Price and Nurse, Andrea McKenzie.
Coaching and Mentoring Programs (CAMP)
In fall 2020, CAMP began supporting pairing through a single process for coaching, rather than facilitating matching for coaching pairs through individual streams. During this period, five pairs were matched. Before this change, the Rural Physician Mentoring Program launched its 10th cohort since the program was established in 2014 with a total of 35 pairs completing the program.
After a successful pilot, the FPA Clinical Coaching stream concluded in July 2019. The FPA stream supported coaching activities in 11 communities and 47 coachees. Several of the pilot communities included RSON communities and in some cases the coaching continued after the pilot.
The Peer Emergency stream included three distinct offerings including in-person peer coaching, virtual peer coaching, and coaching for PRA-BC graduates. The in-person format included three communities and seven coachees; the virtual format included seven coachees; and the three PRA-BC graduates received coaching.
Indigenous Patient-Mediated CPD
This was a year of growth and building for the Indigenous Patient Mediated CPD Project, with a number of key deliverables completed.
The Meeting of the Minds event brought together approximately 30 leaders in Indigenous Cultural Safety (ISC) and Humility from across the province to come together in Vancouver. The meeting gathered input from this diverse group of participants to inform the development of an offering that builds on existing work in the province and creates meaningful change at the front line of care.
The environmental scan identifies current evaluation tools and resources used to educate health care practitioners on current Indigenous health inequalities. The findings consist of evaluation and research guidelines from organizations and research projects conducting research alongside Indigenous communities. This environmental scan is consistently refreshed and updated to ensure our working group has the most recent data to inform our work.
We held over 25 meetings with 11 different community and physician groups. With the COVID-19 public health emergency, we were unable to attend three scheduled community engagement visits in Haida Gwaii and Tla’almin Nation. With in-person travel likely to be limited for the foreseeable future, we have refocused our energy on conducting virtual engagement and immediate resources for physicians and providers.
HOUSE Program Evaluation
In 2018, the HOUSE program undertook a comprehensive program evaluation project to explore the impact of the HOUSE EM program on past participants and their communities, while ascertaining the learning needs of rural physicians to sustain and enhance their POCUS skills.
Overall, participants reported positive experiences with HOSUE EM. In particular, participants value the low learner to instructor ratio, hands-on format, tailored content, and the flexible teaching approach. In response to sustaining and enhancing their POCUS skills, participants requested support for tailored refresher courses, mentorship, and support developing communities of practice. Barriers to longitudinal learning include cost of implementation, time, and the need for administrative support.
New to Practice Evaluation Summary
In January 2018, the Rural Coordination Centre of BC (RCCbc) proposed a list of recommendations to the Joint Standing Committee on Rural Issues (JSC) titled “Options to better equip physicians for working in Rural BC,” also referred to as the “setting up for success” initiative. The goal of these recommendations was to better support-new to practice physicians in rural communities and included funding to evaluate PRA-BC and IMG Program participants’ integration to rural practice.
In September 2019, UBC CPD and RCCbc adopted a collaborative and iterative strategy to further build on the “setting up for success” recommendations with the following goals:
2019 Canadian Conference on Medical Education
In April 2019, the Rural Continuous Quality Improvement Needs Assessment abstract was accepted for an oral presentation at the Canadian Conference on Medical Education in Niagara Falls, ON. The findings were presented by Executive Medical Director, Dr. Bob Bluman.
2019 Centre for Health Education Scholarship Celebration of Scholarship
In October 2019, the HOUSE Program Evaluation Project was accepted for an oral presentation at the Centre for Health Education Scholarship Celebration of Scholarship in Vancouver, BC. The project was presented by Research Assistant, Alissa Burrows.
The Rural CPD Program is committed to supporting the learning needs of physicians and other healthcare providers who practice in rural and remote areas of British Columbia. Our program demonstrates that through community-based, interprofessional, collaborative, and practical CPD, we can support rural physicians to deliver safe and effective health care to rural British Columbians.
During the last year, the Rural CPD Program made significant progress toward its stated goals and aims to continue to support rural physicians in BC. The program saw the continuation of highly valued initiatives, the expansion of new initiatives, and the conclusion of others.
The COVID-19 pandemic has provided a catalyst for the rapid expansion and roll out of virtual education opportunities. In partnership with RCCbc, we are exploring how to support education through the newly established Real Time Virtual Support (RTVS) pathways. Directions include accrediting the RTVS calls, faculty development and upskilling for RTVS physicians, and the establishment of a virtual simulation program led by RTVS physicians. Looking forward, we hope to continue to strengthen relationships with our partners, collaborators, and rural physician learners. We will continue to bring an equity lens to all that we do to ensure we are reaching out and supporting those rural providers who need it the most.