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Background & Reflections

Background »

Sunnybrook is proud of its role as an academic health sciences centre, with education being seen as foundational to its current and ongoing success. Strategically, education is woven into all four directions outlined in Sunnybrook’s 2018-2021 strategic plan, Inventing the future of health care for Ontario and beyond.

Our role as the Education Program is to support the development of competent, capable, confident individuals and teams who are willing and able to apply their skills, talents and experience to take care of patients and families when it matters most. This includes the education of health professional students, residents, fellows, international observers, interprofessional staff, as well as the functioning of the Canadian Sunnybrook Simulation Centre, the Educational Research Unit and Library Services. In addition, working with partners and collaborators within Sunnybrook and beyond, we support the development of an engaged and health literate patient population within a vibrant, quality focused, learning culture.

The delivery of the Education Program is enabled with the support of the Sunnybrook Education Advisory Council (SEAC), a standing committee consisting of an interprofessional team of educators and leaders who provide advice to senior leadership with direct responsibility for education across Sunnybrook. In addition, the Council is responsible for the planning and implementation of a number of key education activities and awards.

Education Strategic Plan 2017-2020 »

The 2017-2020 Education Strategic Plan built on the 2012 Strategic Plan that was subsequently refreshed in 2014. An extensive data gathering and consultation process designed to explore ways to build on existing strengths, overcome internal silos, enhance communication and engage inquiry and scholarship led to the identification of four priorities: Patient as Educator, Team-Based Learning, Learner Experience and Culture, and Education Research and Scholarship. These four strategic priorities, defined in terms of goals, activities and measures, provided us with overall focus and direction, leading to the achievement of a number of important milestones and the delivery overall of a high-quality innovative set of education initiatives.

Current Situation Assessment – Internal »

On an annual basis, Sunnybrook hosts more than 5,000 learners from 45 health professions and 95 countries. Our excellence in such areas as simulation, technologyenabled learning, and innovation in delivering a robust learner experience is widely acknowledged. The process of engaging patients and families on the learning journey is well-regarded and learners evaluate the training received at Sunnybrook very highly. We have captured some of the highlights from the last three years:

  1. Patient as Educator »

    Our commitment to engaging patients, their families and caregivers ("patients") in the critical work of educating learners and staff, inspiring hope for other patients, and enhancing the humanism of physicians, health-care professionals and staff alike, has led to the creation of a number of innovative interventions.

    The Out of Darkness film series was developed to enhance the compassion of learners towards mental health. Engaging bipolar patient volunteers, we have used these short films as a teaching tool with medical students. The series has been adopted by the Faculty of Medicine at the University of Toronto as part of their undergraduate resilience curriculum and has also been offered to other faculties, such as Social Work and Psychology at the University of Toronto Scarborough campus.

    Working with three palliative care physicians at Sunnybrook with the intent of evoking deeper understanding among health-care professionals, we explored the provision of palliative care through a series of interviews with patients and experienced physicians. Funding through a SEAC grant enabled the creation of About Empathy, a series of well-received podcasts based on the principles of narrative medicine.

    The success of a pilot study conducted in 2019 that engaged patients in evaluating the communication skills and professionalism of pre-licensure students has paved the way for the expansion of this innovative practice more broadly across Sunnybrook. Patients reported finding value in their engagement while students both enjoyed the process and found the patient feedback relevant.
  2. Team-Based Learning »

    Sunnybrook’s strategic focus on high performing teams gave impetus to our development of a competency-based interprofessional team assessment tool designed as an efficient mechanism to take the pulse of teams leading to the identification of development opportunities. We are currently the leader in terms of the number of assessments completed combined with the documentation of tailored learning plans. With 75 teams having completed the assessment, communication and role clarification are identified as relative strengths with interprofessional conflict resolution and the need for team reflection being identified consistently as important gaps to be addressed. This, in turn, has enabled us to develop targeted courses and interventions. Preliminary data suggests that this focused assessment-based learning approach is having a positive impact on how our patients and students perceive their experience at Sunnybrook.

    Historically, simulation has been used predominantly for orientation and static skill training e.g., surgical skills purposes. However, because of our expertise in developing team communication and crisis management skills, our simulation activities now include such areas as quality improvement, emergency preparedness, and risk mitigation. We work with teams, practising choreography so that they are ready for stressful highrisk situations, including trauma, Code Blue and Code White emergencies, where the implications of error can be significant. Our introduction of objective tools that incorporate interprofessional team competencies to assess team performance against objectives provides structure and focus to the post-simulation debrief, enabling quicker adoption of new behaviours and practices. More recently, we have been running simulations to upscale the training of nurses redeployed to COVID units. These nurses are from other care areas and need to blend into a situation that is above their normal level of experience. We have also trained University of Toronto residents for redeployment in order to mitigate their stress and their risk of infection.
  3. Learner Experience & Culture »

    Focused on providing learners with the best possible experience, we have placed special emphasis on enhancing the skills and engagement of Sunnybrook’s teachers and preceptors. Regardless of profession, what we learned by surveying this group, is that they enjoy teaching and are rewarded intrinsically in seeing individual learner growth and development. Notwithstanding this finding, we have also introduced more explicit ways of “appreciating” them such as with thank you notes and snacks. Survey findings also identified the need for faculty development support, leading to the design of specific Teacher Master Classes and the introduction of shared interprofessional best practices. Further analysis of the initial survey data is expected to provide ground-breaking insights into the similarities and differences of teacher experience across multiple professions.

    Our concern with physician and learner burnout and wellness led to a survey being conducted of Sunnybrook fellows and residents in fall 2018. Results indicated that the preferred support option was anonymous self-referral. This led to the implementation of a unique option within the TAHSN system: an innovative and seamless hotline that residents and clinical fellows in distress can use to access mental health assistance at Sunnybrook. We have also enhanced our website so that all learners in distress can report concerns and receive support.
  4. Education Research & Scholarship »

    Understanding the importance of developing both capacity and capability in these important disciplines led us to design and implement a number of new and innovative initiatives under the leadership of Sunnybrook Education Research Unit (ERU) working closely with Sunnybrook’s Practice-Based Research and Innovation (PBRI) Team. In addition to the well-attended and highly-rated quarterly Education Research Rounds (each targeted to exploring a specific strategic direction), research intensive workshops have also been introduced. The inaugural workshop covered the foundational principles associated with conducting education research. The one scheduled for early 2020 was to have provided four intensive hours on research methodology for education research. We were forced to cancel the event as part of the COVID-19 pandemic closure but not before high levels of interest were expressed.

    New education awards have recognized the growing expertise within Sunnybrook. With the introduction of the Innovative Curriculum Award, on an annual basis, we honour an educator or team of educators making new, innovative and creative contributions to teaching and learning for students, staff, clinicians, patients and the community. Dr Natalie Coburn, a general surgeon in the Odette Cancer Centre is a shining example of this innovative quality. Seeing a gap in surgical ability to treat gastric cancer, she developed the first surgical course in Canada on lifesaving D2 Lymph Node Dissection Surgery.

    A generous $5 million gift from the Sunnybrook Academic Clinicians Management Services has enabled us to expand both capacity and capability of education research through the establishment of an education research scientist professorship. The selected academic will develop an independent program of research in an area related to one of our education priorities. Recruitment commenced in late 2019 and start date occurred in late April 2020.

Snapshot of Current State (2017-2020) »

Patient as Educator 

  • Number of patient educators across all programs: 470
  • Number of patients and learners reached by patient educators: 17,106

Team-Based Learning

  • Number of teams actively engaged in team development to enhance team performance towards a shared purpose, improvement objectives, and the evaluation of results (2019/2020): 65
  • Team members endorse that they are able to bring up problems and tough issues (2019-2020): 40 per cent
  • Teams agree or strongly agree that 'time' is dedicated for ongoing team reflection (2019-2020): 38 per cent

Learner Experience & Culture

  • Number of students/trainees seeking mental health support from confidential Sunnybrook crisis line (in the last academic year): 15
  • Number of teachers attending Sunnybrook Master Class (2018-2019): 123
  • Number of different professions participating in Master Classes (2018-2019): 21

Education Research & Scholarship 

  • Number of researchers: 26
  • Number of teams receiving research grants: 29
  • Number of education research presentations at Sunnybrook Education Conference: 83

Nursing Education

  • Number of critical care nurses that were trained through the new Michener curriculum: 35

Library Services

  • Number of cumulative hits to the Trauma Information Portal: 6,110
  • Number of cumulative hits to the Cancer Information Portal: 8,447

Other

  • Number of attendees at the annual Sunnybrook Education Conference: 769
  • Number of nominees for the Sunnybrook Education Awards: 137
  • Number of attendees at the annual Interprofessional Collaboration Showcase: 567

Current Situation Assessment – External »

From an external standpoint, there are a number of forces and trends that are shaping the delivery of health care and of the education for all who work in the healthcare sector. While these are not unique to Sunnybrook, we do need to take them into consideration in both identifying our strategic direction as well as building action plans.

Most evident at the time of writing the plan is the impact of COVID-19, which has served to heighten the significance of such factors as the adoption of new technologies for both the delivery of health care and education, the value placed on innovation, requirements for interprofessional, interorganizational and cross sector collaboration, the use of evidence in making decisions, and the ubiquitous availability of both accurate and fake news in shaping consumer and patient understanding of the situation and compliance with directives. And all of these changes have emerged against a backdrop of increased costs and a ballooning deficit.

Other ongoing trends of note include the drive to personalized medicine, patient engagement, integrated care, quality, safety and continuous improvement, the priority placed on serving and educating Black, Indigenous and other communities of colour, as well as the continuing recognition of the need to serve an aging and vulnerable population, address growing mental health issues (including among health-care providers), and deliver care that is accountable to the needs of our local population.

Informing the design and delivery of effective education interventions is an increasingly sophisticated understanding of adult learning, competency-based education, new teaching modalities and technological enablers, many of which are causing conventional teaching approaches to be questioned. In addition, new learning preferences of those entering the workforce and the focus on learner wellness and psychological safety compel us to adopt new and different approaches.

Conclusions »

In looking forward, we are faced with an unprecedented level of uncertainty. So much is unknown about the course of the COVID-19 pandemic even as some of the societal, individual, and economic costs are becoming more visible. The good news is that much has been achieved and there are significant foundational pieces in place of which Sunnybrook Education can build. We will need to be both vigilant and nimble moving forward as there are factors in the external and internal environment that present both challenges and opportunities.

The current four strategic priority areas will continue to be important, with the significance of ongoing/ life-long learning being highlighted as a future area of focus given the ongoing pace of change. Thus, the task over the next three years is to deepen the education footprint at Sunnybrook, expand the profile of education research, and address the need for additional physical infrastructure. At the same time, we will need to enhance our ability to measure the success of our work and the contribution we make on an ongoing basis to the growth and well-being of learners, staff, and health providers in addition to the experience and health outcomes of patients.

Developing the Plan

Different phases of development for Sunnybrook's education strategic plan.

View plain-text version of infographic

Phase 1: Summer 2019
Identify priority and co-leads.
Contract consultant support.
Hold kick-off meeting with priority leads

Phase 2: September – December
Gather data
Workshop 1
Workshop 2
Review findings with SEAC
Hold stakeholder retreat

Phase 3: January – February 2020
Finalize key messages from retreat with SEAC
Test draft plan with senior system leaders

Phase 4: March
Review consultation input with SEAC
Finalize the plan (by April 1): Goals, objectives and key results