Last year, the average admission GPA of students in the University of Toronto Faculty of Medicine was 3.94. Two-hundred and fifty-nine students enrolled in the first-year MD program.
There are nine teaching hospitals that are fully affiliated with the university, five of which are within one kilometre of the Faculty of Medicine, which is also the largest medical school in Canada.
All of this can paint an intimidating picture for prospective medical students, a sentiment that Ali Damji, a second-year student at the medical school and vice-president, external affairs of the Medical Society, says is very common.
“It seems very overwhelming when you encounter U of T and you see how vast its networks are,” says Damji.
Yet the “vast networks” Damji describes may be the most distinctive aspect of medical education in Toronto, while also having a profound impact on patient care and research advancements.
To Damji, it is a major incentive to attend U of T medical school in the first place. “I think it’s an enormous strength of the program,” he says.
An integrated system
The Medical Sciences Building on the southeast side of King’s College Circle is just the tip of the iceberg in the University of Toronto’s health web. The university is an integral member in a network of institutions called Toronto Academic Health Sciences Network (TAHSN), which includes all of the university’s affiliated hospitals as full members, in addition to four associate level institutions.
According to TAHSN’s website, members of the network participate in healthcare and biomedical research and teach undergraduate and post-graduate medical and healthcare professional students.
While the network may seem straightforward, the dynamic relationships between U of T and the academic hospitals represented by TAHSN are unique.
Dr. Brian Hodges, vice-president of education at the University Health Network (UHN), works at the intersection of the hospital and the university. He describes TAHSN as a consortium of independent institutions that are highly supportive of one another and share a common goal.
“It’s a bit like a federation that brings together successful but fairly independent provinces that share ideas and work together,” says Hodges. “It’s inclusive — we make an effort to bring everyone to the table.”
One result of this collaborative system is Hodges’ position itself, which he describes as a Toronto invention that is, in many ways, unique to this city.
In other jurisdictions such as the US, Hodges expects that his responsibilities are most likely managed on the university side in a dean’s role.
“The difference in Toronto is that the hospitals have chosen to really strongly support [the role] so it’s created as a [vice-president] on the hospitals side instead of a decanal role on the universities side,” says Hodges.
Education based on integration
Prior to attending medical school, Damji had completed two internships at Toronto General Hospital. Here, he observed the inner workings of a “world-class” hospital and was motivated to attend U of T to have the opportunity to work in the same setting.
Damji explains that all medical students are sorted into one of four academies, each consisting of some of U of T’s teaching hospitals. Most of the in-hospital teaching that the medical students complete is within their own academy.
The academy placements are most pertinent in third and fourth years, the so-called “clerkship” years, in which medical students work alongside physicians in a hospital setting as part of a care team.
Damji says that one of the challenges of such an extensive network is that it can sometimes be difficult for students to transfer between hospitals as part of their experience, especially if they hope to learn in a hospital outside of their academy. “If I wanted to shadow at St. Mike’s, there is some additional paperwork that I would have to do,” he says.
However, Damji maintains that there is ample support staff to help with these challenges, including a student liaison at every hospital.
Hodges says that reducing these sorts of barriers is an ongoing priority for him at the UHN, which represents multiple sites on its own, including the Princess Margaret and Toronto General Hospitals. “We are working hard to integrate that so that when somebody registers, it’s good across all the sites,” Hodges says.
Another aspect of medical education at U of T is the opportunity for students to learn first-hand from physicians. Damji says that physician lecturers are common in second year. “Now that we’ve learned the basic science, they are now trying to teach us the clinical medicine,” he says. “I think they bring a valuable perspective.”
Trevor Young, the dean of the Faculty of Medicine and vice-provost, relations with healthcare institutions, explains that physicians at any of U of T’s teaching hospitals also take on a university appointment. Each physician has a practice plan, which determines what proportion of their time is spent teaching or conducting research.
Cross-appointed teaching has some disadvantages. Damji notes that physician lecturers are “pulled from both sides” and are consequently harder to get into contact with to discuss content.
Overall though, Damji says that the level of support for medical students is high. “We do have access to course directors, tutors and academic counselors to help us,” he says.
Healthcare Model
Young is acutely aware of the learning advantages available to students because of the integrated TAHSN network. “[W]e are uniquely positioned in Canada — and maybe even the world — in terms of the resources and partners that are available to us. And, in turn, our partners have us — the largest medical school in the country and one of the top medical schools in the world — right outside their doorstep,” Young says.
To Hodges, this advantage extends beyond face value. He describes Toronto’s health system as a way of fusing education and research with practice.
Hodges says that, on one side, it is advantageous to try innovative practices as soon as possible, and on the other, to generate data from hospitals that can be fed back into research and education methods.
“We have a lot of information that we generate according to how people are doing, what they’re learning, what their quality of care is, and we can feed that back into the education system. So having the two working closer together I think is a big advantage for everybody,” he says.
Hodges recently discovered that other jurisdictions are replicating aspects of this model. The Ottawa Hospital recently hired its own vice-president of education, a graduate from the Toronto system named Dr. Viren Naik.
Ultimately, Hodges says, cross-institutional networks benefit patients and families.
Hodges cites alliances that have come to fruition because of the Toronto system, including the Medical Psychiatry Alliance and the Toronto Dementia Research Alliance.
The strong institutional relationships realized through TAHSN give Hodges reason to rethink education as a collective responsibility. “I’m most proud of the fact the hospitals are starting to see themselves as educational institutions that have responsibility for the best training of everyone who’s inside the walls,” he says.
