Guest editorial: Improving health: Expanded and distributed medical education in British Columbia

In order to achieve the goals for healthy living and a quality health system articulated by the government of British Columbia, a sustainable health human resource base is critical. 

The Conversation on Health has already shown that British Co­lumbians want appropriate access to physicians, and that they want to see a patient-centred model of interprofessional education and collaborative practice to ensure that health care providers are available throughout the province. 

As well as ensuring adequate numbers of nurses, midwives, pharmacists, physical therapists, occupational therapists, audiologists, and others, BC needs to educate and train more physicians—a challenge now being addressed by the University of British Columbia’s Faculty of Medicine.

In May 2008, the first class of medical students from the expanded and distributed MD undergraduate program graduated, thus marking a milestone in the history of health care in BC. For people in underserved areas of the province, the reasons for such an expansion are well understood. 

The story of expansion really began in a packed hockey arena in Prince George in 2000, when nearly 7000 people gathered to protest a critical lack of rural health care. That gathering eventually led to an extremely complicated and extensive plan involving three universities, six health authorities, the government of BC, and health professionals in all fields, disciplines, and regions of the pro­vince. 

Agreements were signed, partnerships were formed, new facilities with state-of-the-art technology were constructed at three university campuses, many new faculty members were hired, administration and support systems were developed, and, most importantly, 72 students were added to the incoming class in 2004. 

As you can imagine, this was neither a simple task nor a project that could rely on pre-existing templates—in fact, many innovations in teaching, technology, and planning were necessary to transform an idea into a reality and create an integrated province-wide Faculty of Medicine. 

For many years, UBC’s Faculty of Medicine has supported clinical learning opportunities across BC. By 2000, more than 100 affiliation agreements were in place between UBC and hospitals/clinics in rural and remote locations and in Victoria, Kelowna, and Kamloops. The benefit to learners of working in rural and remote settings is widely acknowledged and has been implemented across Canada. Today, UBC remains at the forefront of distributed medical education, and is highly acclaimed for its innovative programs.

The articles in this theme issue depict aspects of the expansion and describe physician education from the undergraduate and postgraduate levels to the continuing professional development level. 

After Joanna Bates provides an overview of the medical school expansion, David Snadden and Oscar Casiro discuss the maldistribution of physicians across the province that led to the need for expansion. 

Students in the first class to graduate from the distributed education program then provide firsthand accounts of un­dergraduate life on Vancouver Island, in the north, and in the Vancouver Fraser region. 

UBC’s medical school now admits 256 students each year, one of the highest admission rates in North America. Cliff Fabian describes the challenges applicants face when applying to a medical program, and how comprehensive and complex processes are now used to select the best individuals for these coveted positions. 

He describes how innovative strategies help us achieve our commitment to increasing the number of Aboriginal physicians in the province and increasing the number of physicians willing and able to practise in rural, remote, and northern areas.

While numerous advances have enabled UBC to extend medical education across the province, few are as fundamental and full of exciting possibilities as technology. The delivery of education in our distributed model relies on the kinds of innovative approaches to online learning des­cribed by Wayne Vogl and William Ovalle in their article about multisite teaching of anatomy. 

The success of technology-enabled learning is also discussed in Chris Lovato and Caroline Murphy’s article about their evaluation study, which assessed the effectiveness of new teaching methods by meticulously tracking and comparing students to ensure that learning objectives were met at all sites.

Not only undergraduates have benefited from expansion. Residency programs have expanded, as described in an article by Eric Webber, Kam Rungta, and Kris Sivertz. And an article by Mark Dickeson shows how postgraduate distributed learning has helped residents travel the province in search of rural experiences.

With the influx of undergraduate and postgraduate students comes the need for more teachers, particularly at regional campuses. The delivery of clinical education relies on practising physicians who can combine teaching with patient care. Bob Armstrong argues for more departmental involvement, both educationally and clinically, in delivering medical education around the province. 

In a sidebar to this article, Katherine Paton describes both the development of an enormous clinical faculty and the critical role these instructors play in the new distributed model of medical education.

Finally, many of the advances in web-based delivery used in the undergraduate and residency programs are being used now by the Division of Continuing Professional Development and Knowledge Translation, as describ­ed in an article by Kendall Ho, Luke Ferdinands, Sandra Jarvis-Selinger, Robert Bluman, and David Hardwick.

Thus, from the undergraduate and postgraduate levels to the professional development level, the Faculty of Medicine is engaged in a continuum of medical education that is supported by an incredible constellation of health professionals, students, provincial government officials, university partners, and health authorities. 

With this collaborative and integrated BC-wide medical education system, we can look forward to improving the health of individuals and communities in this great province. 

—Gavin C.E. Stuart, MD, FRCSC
Dean, Faculty of Medicine, University of British Columbia

Acknowledgments
Special thanks to the UBC editorial team of Dr David Snadden, Ms Ali Liversage, and Mr Daniel Presnell for their invaluable assistance with these articles.