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STATE OF THE DIVISION :

DPC Grand Rounds June 14, 2012. STATE OF THE DIVISION : An Update on the past, present & future of the DIVISION OF PALLIATIVE CARE. Jeff Myers MD, CCFP, MSEd W. Gifford-Jones Professorship in Pain and Palliative Care Head and Associate Professor - Division of Palliative Care,

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STATE OF THE DIVISION :

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  1. DPC Grand Rounds June 14, 2012 STATE OF THE DIVISION: An Update on the past, present &future of the DIVISION OF PALLIATIVE CARE Jeff Myers MD, CCFP, MSEd W. Gifford-Jones Professorship in Pain and Palliative Care Head and Associate Professor - Division of Palliative Care, Department of Family and Community Medicine Faculty of Medicine, University of Toronto

  2. DIVISION OF PALLIATIVE CARE Who are we? What does being a DPC Member mean? What do we do? Why do we matter? Where are we going? How will we get there? What can each of us do?

  3. DPC: WHO ARE WE? “The core purpose of the DPC is to create and support a community of learners, teachers, innovators, researchers and practitioners working together to improve the quality of palliative and end of life care for patients and their families.” DPC Strategic Plan, 2009

  4. DPC: WHO ARE WE? The values serving to guide all DPC activities are: Interprofessionalism Community Innovation Advocacy DPC Strategic Plan, 2009

  5. The largest academic palliative care division in Canada!!! DPC: WHO ARE WE?

  6. DPC: WHO ARE WE? 2002: Residency Program 2007: Formal status as an academic Division (Head, Dr. Larry Librach, 2007-11) 2009: Inaugural Strategic Plan: Long Term Vision Every health care professional trained through the U of T will be able to demonstrate basic competencies in the provision of quality palliative and EOL care DPC will be a leader in developing, measuring and teaching advanced competencies in palliative care in Canada

  7. DPC: WHO ARE WE? Long Term Vision A robust and collaborative research program will be credited with discoveries that challenge current best practice in care provision and education and explore innovative interventions that improve the quality of palliative and EOL care Professionals seeking a location for clinical practice, research and/or education in palliative care within an expansive, dynamic environment will choose Toronto and the DFCM’s DPC

  8. DPC: ORG STRUCTURE

  9. DPC: COMMITTEE LEADS CPD Lead: Monica Branigan RPD: Giovanna Sirianni Interim RPD: James Downar Education Co-Leads: Anita Chakraborty & Monica Branigan Research Co-Leads: Amna Husain & Paolo Mazzotta Admin Lead:Heather Huckfield

  10. DPC: PROFESSION / DISCIPLINE LEADS Social Work: Susan Blacker Nursing: Sharon Reynolds Pediatrics: Adam Rapaport

  11. DPC: SITE REPS Baycrest: Daphna Grossman CVH: Manisha Sharma Markham Stouffville: Gina Yip Mt Sinai: Russell Goldman NYGH: Niren Shetty PMH: Julia Ridley Scarborough: Larry Zoberman SickKids: Adam Rapaport

  12. DPC: SITE REPS Southlake: Cindy So St. Joseph’s: Carol Hughes St. Michael’s:IgnazioLaDelfa Sunnybrook: Dori Seccareccia TEGH: Kevin Workentin TGH/TWH: Sharon Reynolds Trillium: Tony Hung

  13. DPC: MEMBERS Membership Assembly Current composition: Over 60 Faculty Members Over 60 Associate Members

  14. DPC: WHAT DOES BEING A MEMBER MEAN? FACULTY MEMBERS Clinicians who have pursued and achieved a U of T faculty appointment Available to all professionals who are members of a U of T affiliated institution and actively involved in palliative care and teaching, education, research, creative professional activity and/or leadership

  15. DPC: WHAT DOES BEING A MEMBER MEAN? ASSOCIATE MEMBERS Clinicians without a formal clinical or faculty appointment with the U of T who have an interest and/or a clinical practice involving palliative care

  16. DPC MEMBERSHIP: WHY? • Participate in DPC related activities, initiatives and committees (eg. PD, teaching/education, research, clinical, operations, administrative, social networking) • Contribute to building a sense of academic community • Be informed about DPC related activities and initiatives • Connect/collaborate with colleagues across the DPC • Cultivate a profession specific community • Gain exposure to and develop skills related to professional and/or academic activities • Collaborate on profession specific projects/initiatives • Opportunities to explore formal and informal mentorship

  17. DIVISION OF PALLIATIVE CARE WHAT DO WE DO?

  18. DPC: WHAT DO WE DO? We Educate 95% of DPC Members are involved in teaching and education activities

  19. DPC: WHAT DO WE DO? Undergraduate Medicine Pre-clerkship: “Pain Week”; MMMD course “Approaching End Of Life”; ASCM Clerkship: Anesthesia, General Surgery, Family Medicine, Transition to Residency, FMLE

  20. DPC: WHAT DO WE DO? Postgraduate Medicine

  21. DPC: WHAT DO WE DO? Postgraduate Medicine: Enhanced Skills • Clinical Palliative Care Enhanced Skills Program St. Joseph’s Health Centre Site 12 graduates since 2005 North York General HospitalSite* • Conjoint Palliative Medicine Residency Program *Recently implemented

  22. CONJOINT RESIDENCY PROGRAM Annual Growth in # of Positions and Applicants

  23. CONJOINT RESIDENCY PROGRAM:GRADUATES

  24. DPC: WHAT DO WE DO? CE & PD

  25. DPC: WHAT DO WE DO? We Educate - Innovations • Centre for IPE - Case Based Session • PGCoreEd • Social Work Interest Group - Susan Blacker • National Learner Assessment Collaborative • CVH/Trillium - collaboration with FHT (LEAP) • Collaboration with Cicely Saunders Institute: Medical Student Exchange Fellowship (Dr. Robert Buckman)

  26. DPC: WHAT DO WE DO? We Discover Over 50 publications in last five years Dr. Amna Husain PI for CIHR Grant: Ranked #1

  27. DPC: WHAT DO WE DO? A few examples…

  28. DPC: WHAT DO WE DO? A few examples…

  29. DPC: WHAT DO WE DO? We Are Acknowledged 2011 Undergraduate New Teacher Award: Dr. Jean Hudson 2010 Helen P. Batty Award: Dr. James Meuser 2010 DFCM Awards of Excellence: Dr. Monica Branigan 2010 PD Program Excellence Award: Dr. Kevin Workentin 2010 PD Program: Dr. Pauline Abrahams 2009 John W. Bradley Educational Admin: Dr. Dori Seccareccia 2009 Postgraduate Education Program: Dr. Leah Steinberg A few examples…

  30. DPC: WHAT DO WE DO? We Are Acknowledged Senior Promotion to the Rank of Associate Professor: 2012: Dr. Albert Kirsen & Dr. Vince Maida 2011: Dr. Monica Branigan, Dr. Amna Husain & Dr. Jeff Myers 2010: Dr. Jamie Meuser A few examples…

  31. DIVISION OF PALLIATIVE CARE WHY DO WE MATTER?

  32. DPC: WHY DO WE MATTER? The MOH says so…

  33. DPC: WHY DO WE MATTER? The care we provide makes a difference…

  34. DPC: WHY DO WE MATTER? We are catching on in other settings…

  35. DPC: WHY DO WE MATTER? Conclusions: “Our prospective study shows that dementia is a terminal illness and furthers our knowledge of the clinical complications characterizing its final stage.” This was the first time this statement was made We are catching on in other settings…

  36. CLINICAL COURSE – DEMENTIALETTER TO THE EDITOR DPC: WHY DO WE MATTER? “Classifying all seniors affected by advanced dementia as terminally ill…can become a gateway to therapeutic neglect." We are catching on in other settings…and familiar challenges lie ahead

  37. DPC: WHY DO WE MATTER? A request was recently made of me to speak to the topic: “How to initiate and have end-of-life discussions in the office for patients with palliative conditions?“

  38. DPC: WHY DO WE MATTER? A request was recently made of me to speak to the topic: “How to initiate and have end-of-life discussions in the office for patients with palliative conditions?“ How might this be more precisely worded?

  39. DPC: WHY DO WE MATTER? A request was recently made of me to speak to the topic: “How to initiate and have goals of care discussions in the office for patients with advanced and/or incurable“

  40. DPC: WHY DO WE MATTER? A request was recently made of me to speak to the topic: “How to initiate and have goals of care discussions in the office for patients with advanced and/or incurable“ Propose this to be a primary solution to effectively addressing the “tsunami of chronic disease”

  41. Actual and Projected Deaths in Ontario: 1996-2036 WE ARE HERE!!!

  42. DIVISION OF PALLIATIVE CARE WHERE ARE WE GOING?

  43. DPC: WHERE ARE WE GOING? SUB-SPECIALTY STATUS • Currently, the RCPSC application process for formal recognition of Palliative Medicine as a Sub-Specialty is in Stage 2 (Consultation Phase) • New two-year medical training program • Routes of entry are IM, Neuro, Anesth for Adults stream and Peds • Uncertain what the current one-year program will evolve in to as per CFPC

  44. DPC: WHERE ARE WE GOING? • If/when a Sub-Specialty is formally created, the route of “practice eligibility” will likely be made available to physicians who have both completed the current one-year program and entered from a RCPSC specialty as well as current RCPSC members who maintain a clinical practice focused in Palliative Medicine • Discussions at the CFPC are currently underway to determine if a certification and/or designation process will be instituted for the one-year program

  45. DPC: WHERE ARE WE GOING? • Based on what is determined, a practice eligible route is likely to be made available to current CFPC members who maintain a clinical practice focused in Palliative Medicine (with or without having completed the one-year training program) • Family physicians who do not hold certification can acquire certification until December 31, 2012 via “Alternate Route to Certification” - see cfpc.ca

  46. DPC: WHERE ARE WE GOING? Curative / Remissive Therapy CG Support & Bereavement Presentation Death Hospice & Palliative Care EOL Care Model of Collaborative or Shared Care

  47. DPC: WHERE ARE WE GOING? Curative / Remissive Therapy CG Support & Bereavement Presentation Death Hospice & Palliative Care EOL Care Model of Collaborative or Shared Care Its time to move beyond this

  48. LEVELS OF PALLIATIVE CARE Complex palliative care-related needs Pt E Basic palliative care-related needs Pt D Pt C Pt B Pt A Illness trajectory EOL • Most will have needs requiring only basic PC skills (Pt A) • Others will occasionally require specialty level PC (Pts B, D) • A small number with highly complex needs will indefinitely require specialty level PC (Pts C, E)

  49. PROVISION OF PALLIATIVE CARE Tertiary Level Secondary Level PC Expertise Primary Level PC Expertise

  50. PROVISION OF PALLIATIVE CARE Tertiary Level Secondary Level PC Expertise Primary Level PC Expertise

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