School programs

Hospital crisis endangers U of M medical school programs



Manitoba’s hospital system is so overstretched that a national regulatory body has threatened to suspend some training because doctors are too busy to safely teach residents, the Free press has learned.

No one expects the University of Manitoba to lose its reputation for training doctors, but hospital doctors say the regulatory warnings are a sign of a system in crisis.

“Three programs are on notice of intent to withdraw,” read an internal email that medical dean Dr. Brian Postl sent to faculty in March, explaining that the team review board was concerned about whether “residents are properly supervised” and “resident education takes place in a safe learning environment.”


DOCTORS MANITOBA

Medical dean Dr Brian Postl told the Free Press that the pandemic has strained the healthcare system, which was already under pressure due to government austerity.” width=”2048″ height=”1365 ” srcset=”https://media.winnipegfreepress.com/images/400*400/NEP365819_web_Postl-Brian.jpg 400w,https://media.winnipegfreepress.com/images/600*600/NEP365819_web_Postl-Brian.jpg 600w, https://media.winnipegfreepress.com/images/700*700/NEP365819_web_Postl-Brian.jpg 700w,https://media.winnipegfreepress.com/images/800*800/NEP365819_web_Postl-Brian.jpg 800w,https:// media.winnipegfreepress.com/images/900*900/NEP365819_web_Postl-Brian.jpg 900w,https://media.winnipegfreepress.com/images/1000*1000/NEP365819_web_Postl-Brian.jpg 1000w”/>

MANITOBA PHYSICIANS

Medical dean Dr Brian Postl told the Free Press that the pandemic has put a strain on the healthcare system, which was already under pressure due to government austerity.

On behalf of the Royal College of Physicians and Surgeons, regulators assessed 46 U of M programs last month, asking medical residents and the doctors who supervise them about the quality of education.

Three of the 46 programs were flagged as insufficient: neurology, basic internal medicine, and obstetrics and gynecology.

Postl told the Free press the pandemic has strained a system that was already under pressure from government austerity.

“It would be dishonest to think they weren’t related,” he said.

“COVID arrived in a system that was unprepared for it, and was already remarkably stretched (and) living with austerity budgets for several years.

“And superimposed on that was a significant restructuring that changed the way things worked.”

“Moral is very low among teachers; they were overwhelmed and overworked. Residents provide services (to hospitals) but they were used to over-indulging patients, which likely affected the ability to deliver an educational program. – Unidentified doctor

Some physicians working in Winnipeg hospitals agreed, acknowledging that the system does not provide optimal patient care, let alone provide an environment where trainees can reflect and seek assessment.

“There are so many patients to care for that residents and staff are overwhelmed,” said a longtime doctor not cleared to speak to media.

“Thus, education occupies a smaller part of the pie chart of time, energy and attention than the patient care department.”

Another physician in a supervisory position offered a similar assessment:

“Moral is very low among the faculty; they were overwhelmed and overworked. an educational program.




<p>MIKAELA MACKENZIE / FREE PRESS KITS</p>
<p> In a statement, Shared Health acknowledged that the problems are not solely caused by COVID-19, but stressed that the reviews do not mean patients are receiving substandard care.” width=”2048″ height=” 1365″ srcset=”https://media.winnipegfreepress.com/images/400*400/NEP365819_web_201208_HSC_00110.jpg 400w,https://media.winnipegfreepress.com/images/600*600/NEP365819_web_201208_HSC_00110.jpg 600w,https:/ /media.winnipegfreepress.com/images/700*700/NEP365819_web_201208_HSC_00110.jpg 700w,https://media.winnipegfreepress.com/images/800*800/NEP365819_web_201208_HSC_00110.jpg 800w,https://media.winnipegfreepress.com/images /900*900/NEP365819_web_201208_HSC_00110.jpg 900w,https://media.winnipegfreepress.com/images/1000*1000/NEP365819_web_201208_HSC_00110.jpg 1000w”/>				</a>																
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<p>MIKAELA MACKENZIE / FREE PRESS KITS</p>
<p>In a statement, Shared Health acknowledged that the problems are not solely caused by COVID-19, but stressed that the reviews do not mean patients receive substandard care.</figcaption></figure>
<p>In some cases, limited nursing resources have been shifted to COVID-19 wards, which has added hands-on patient care to physicians’ responsibilities and left far less time to assess their residents.			</p>
<p>Some specialists ended up screening ER patients, a duty residents normally take on, but many were too busy in the wards.			</p>
<p>Experts were particularly concerned that basic internal medicine was among the three programs reported, as physicians must complete this residency before moving on to more specialized branches of internal medicine, such as nephrology, rheumatology or cardiology.			</p>
<p>Postl said his neurology program is hampered by the shortage of neurologists in Manitoba, which makes it difficult to train more.  The few people working in the field have large patient loads and a new stroke program is not yet fully staffed.			</p>
<p>It’s not uncommon for a neurologist to be on call in town to treat all stroke patients, doctors say.			</p>
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“COVID arrived in a system that was unprepared for it, and was already remarkably stretched (and) living with austerity budgets for several years.” – Dr. Brian Postl

Midwifery has also faced staffing shortages, Postl said, which “probably put stress on the relationship in that teaching environment.” He noted that residents training to become family physicians often have a short obstetrics module, which means they need access to supervisors during this short period in order to acquire the skills required to graduate.

The Professional Association of Residents and Trainees of Manitoba said it would not comment on Postl’s interim assessment until the final report is filed.

“Resident physicians work incredibly hard to provide frontline medical care to Manitobans around the clock in every corner of the province, while completing their advanced clinical training,” association director Dr. Josh wrote. Aquinas.

He called for “a safe, respectful and inclusive working and learning environment”.

It is rare for a medical school to have three programs challenged in a single review. Shared Heath said Wednesday that in the university’s last review in 2014, general surgery and urology were flagged; both returned to the norm.

“In the long run, it can be a very useful punch, that things aren’t where they should be.” – Dr. Brian Postl

The designation literally means that the university risks losing its accreditation to teach certain areas, in which case students would be transferred to teaching hospitals in other provinces. Typically, the threat of a devastating pullback results in a rapid course correction.

“In the long run, it can be a very useful punch, that things aren’t where they should be,” Postl said.

University officials are currently in discussions with the province about new funding to bring the three programs back to full accreditation.

In a statement, Shared Health acknowledged that the problems are not solely caused by COVID-19, but stressed that the reviews do not mean patients receive substandard care.

“These identified areas of improvement do not reflect patient care levels or patient safety and Manitobans need to be assured that our health care system and the dedicated members of our medical teams continue to provide excellent care,” says the press release.

“Accreditation exams are an important component of our collective efforts to maintain a high quality of care, ensuring that medical residents receive appropriate training.”

The agency has listed positions in the three areas where it has started recruiting or will post positions soon.


MIKAELA MACKENZIE / DOSSIERS DE PRESSE GRATUITS</p>
<p>"In Manitoba, we cannot afford to lose a single doctor, in any of these areas," said NDP Health Critic Uzoma Asagwara. “width=”1024″ height=”683” srcset=”https://media.winnipegfreepress.com/images/400*400/Uzoma+Asagwara3. JPG 400w,https://media.winnipegfreepress.com/images/600*600/Uzoma+Asagwara3.JPG 600w,https://media.winnipegfreepress.com/images/700*700/Uzoma+Asagwara3.JPG 700w,https ://media.winnipegfreepress.com/images/800*800/Uzoma+Asagwara3.JPG 800w,https://media.winnipegfreepress.com/images/900*900/Uzoma+Asagwara3.JPG 900w,https://media .winnipegfreepress.com/images/1000*1000/Uzoma+Asagwara3.JPG 1000w”/>				</a>																
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<p>MIKAELA MACKENZIE / FREE PRESS KITS</p>
<p>“In Manitoba, we cannot afford to lose a single doctor, in any of these areas,” said NDP Health Critic Uzoma Asagwara.</figcaption></figure>
<p>But the NDP said the Conservative government was reacting too late.			</p>
<p>“The decision-making of this government…has contributed to our health care system being in such a state of distress and crisis that the medical expertise we badly need to retain here in Manitoba could be forced into a position where she has to go,” said health critic Uzoma Asagwara.			</p>
<p>The MP was concerned that the warnings would make Manitoba unattractive to medical students.			</p>
<p>“In Manitoba, we can’t afford to lose a single doctor, in any of these areas,” Asagwara said.			</p>
<p>U de M’s medical school is known for having fewer resources than other Canadian universities, but a broader experience that exposes students to more complex cases.			</p>
<p>The catch is that staff and physicians don’t have time to regroup, reflect on what went well and how residents can improve the care they provide.			</p>
<p>“Our specialists are incredibly good. But what they have to endure – both staff and residents – is not fair,” said a doctor.			</p>
<p>dylan.robertson@freepress.mb.ca			</p>
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Dylan Robertson

Dylan Robertson
Head of the Parliamentary Office

In Ottawa, Dylan likes to snoop around access to information requests and ask politicians, “What about Manitoba?