York Medical School

[Edict]

Why not open a small medical school at York University, with maybe 80 or so students? If the government doesn't want to find more medical school spots, some spots could be taken away from other universities like McMaster, Toronto etc. The benefits the way I see it: 

 

*Turning community teaching hospitals into teaching hospitals i.e. Humber River and NYGH

*Turning community hospitals into community teaching hospitals i.e. Markham-Stoufville

*New medical school means more residency spots, academic positions etc. 

*North York and York Region are growing rapidly and could use the investment a medical school would bring

*The GTA is one of the few regions in Ontario that are still growing rapidly and a medical school at York University is inevitable, an earlier start would cause little harm and likely more benefit

*Intracity competition for UofT would promote development and innovation and less academic stagnation/bureaucracy i.e. academics could easily switch universities and smaller academic structures tend to work more efficiently than one large bureaucratic one

*Toronto is one of the only cities in the developed world of its size and stature to have only one medical school 

*The medical student-population ratio is one of the lowest in Toronto compared to other Ontario schools and rebalancing student numbers to reflect population numbers would improve any overcrowding of wards etc. 

 

Cons would be:

 

*Cost

*More students training in a suburban setting might mean less inclination to go into rural medicine

[ralk]

Why not? Added complexity without nearly the number of advantages listed.

 

The community hospitals you mention already have U of T affiliation and do host some students and residents on rotations. There are advantages to having true community centres involved in medical education, including some notable advantages for patients. Community centres can be more efficient with fewer residents around. Not all physicians, including those in specialty services, are meant to be researchers or full-time educators yet make excellent clinicians. Residency spots are capped - opening up a new school wouldn't provide more. The GTA may be growing, but is still a major destination for new grads and has comparatively little trouble attracting new practitioners. Despite a lower student-to-population ratio, the large number of residents and fellows means plenty of learners in the GTA, and the GTA still has the highest physician-to-population ratio in Ontario. We really do not need to push more students towards the GTA. If students were being siphoned from the downtown core, that would be one thing, but not from the rest of Ontario.

 

I do think having more community-based medical students can be beneficial. I've seen the benefits for students at smaller, less academic sites like Schulich's Windsor campus, as well as at Mac's Kitchener and Niagara campuses. But that doesn't mean York should be creating a new school from scratch. They don't have the infrastructure or the in-house expertise. They'd need to design a new curriculum, go through the whole expensive accreditation process, hire new administrative staff, set up relations with existing schools (particularly for electives), etc. With NOSM, there was a clear regional need to justify that expense and no existing schools had an obvious connection to that area. In this case, there isn't much of a regional need, and U of T already has established roots in the area. U of T could much more easily create a satellite campus if expansion to the York region is considered worthwhile, taking students from the downtown campus. I disagree that smaller academic structures are inherently more efficient - our most productive universities in Canada are our largest ones. Likewise, competition can be destructive as easily as it can be constructive, particularly in a field like medicine that relies on co-operation to function.

 

Basically, even though I agree with your premise that there would be some advantages to having medical students train full-time in the York region, we don't need to reinvent the wheel here. Satellite campuses have worked well in the past and would be well-suited for this situation. No need for York University to build from the ground up.

[indefatigable]

*Toronto is the only city in the developed world of its size and stature to have only one medical school 

 

Wanted to clarify this point: McMaster is also in the GTHA (Greater Toronto Hamilton Area).

 

In California, Stanford is in Palo Alto which is part of the San Francisco Bay Area, but UCSF is only the medical school in SF.

[Edict]

Why not? Added complexity without nearly the number of advantages listed.

 

The community hospitals you mention already have U of T affiliation and do host some students and residents on rotations. There are advantages to having true community centres involved in medical education, including some notable advantages for patients. Community centres can be more efficient with fewer residents around. Not all physicians, including those in specialty services, are meant to be researchers or full-time educators yet make excellent clinicians. Residency spots are capped - opening up a new school wouldn't provide more. The GTA may be growing, but is still a major destination for new grads and has comparatively little trouble attracting new practitioners. Despite a lower student-to-population ratio, the large number of residents and fellows means plenty of learners in the GTA, and the GTA still has the highest physician-to-population ratio in Ontario. We really do not need to push more students towards the GTA. If students were being siphoned from the downtown core, that would be one thing, but not from the rest of Ontario.

 

I do think having more community-based medical students can be beneficial. I've seen the benefits for students at smaller, less academic sites like Schulich's Windsor campus, as well as at Mac's Kitchener and Niagara campuses. But that doesn't mean York should be creating a new school from scratch. They don't have the infrastructure or the in-house expertise. They'd need to design a new curriculum, go through the whole expensive accreditation process, hire new administrative staff, set up relations with existing schools (particularly for electives), etc. With NOSM, there was a clear regional need to justify that expense and no existing schools had an obvious connection to that area. In this case, there isn't much of a regional need, and U of T already has established roots in the area. U of T could much more easily create a satellite campus if expansion to the York region is considered worthwhile, taking students from the downtown campus. I disagree that smaller academic structures are inherently more efficient - our most productive universities in Canada are our largest ones. Likewise, competition can be destructive as easily as it can be constructive, particularly in a field like medicine that relies on co-operation to function.

 

Basically, even though I agree with your premise that there would be some advantages to having medical students train full-time in the York region, we don't need to reinvent the wheel here. Satellite campuses have worked well in the past and would be well-suited for this situation. No need for York University to build from the ground up.

 

While I agree with some of your points, there have been some serious issues with how universities often run regional campuses that I feel need to be ironed out. The benefit of regional campuses is to establish a presence in more rural areas to encourage students to eventually work in those areas. That I see is the main benefit. A main campus of York or a satellite of Toronto would do the job in either case. In addition, we could also argue that the York Region does not have trouble attracting doctors like some other regional campuses do. 

 

With that being said, we also have to consider the idea of how all medical schools are founded. All medical schools were founded from the ground up and they do require more capital from the outset but I believe the ceiling is endless. I was reading up on the beginning of the medical school at McMaster and it started with a significant amount of effort and lobbying by the president at the time H.G. Thode, and it brought together a group of young "medical revolutionaries" lead by John Evans who built a new school from scratch. In many ways, these were likely mid-career academics who had ideas about medical education but had trouble implementing them in the bureaucracy that they worked in and found an outlet to do so through Mac. While i'm not saying this is exactly what should happen with York or what will happen, it is an interesting thought. 

 

Regional campuses also often have issues running effectively. Sometimes the VC connectivity won't work properly and as a result the regional campus students are left out of the discussion during lectures and the issue has been left lingering by the medical school for years without a proper fix. That I see is often a fundamental issue with the fact that a medical school's academics and bureaucracy center from the main campus and as a result the resources aren't properly directed at the regional campuses and they are left to just "survive". If an issue at a main campus occurs, it is attended to or looked into quickly and despite how medical schools have tried to focus equally on regional campuses, there are many small little things which benefit main campus students that regional campuses don't have access to and often there isn't much that can be done about it or there is something to be done but the school has not done it. 

 

I think in any case, I do have doubts that York would allow UofT to open a regional campus in their area primarily because they are looking to start one in the nearer future. There is definitely tension between York and UofT on this issue. Not really an issue in our hands as students for sure. 

[Edict]

Wanted to clarify this point: McMaster is also in the GTHA (Greater Toronto Hamilton Area).

 

In California, Stanford is in Palo Alto which is part of the San Francisco Bay Area, but UCSF is only the medical school in SF.

 

Great point, I double checked though and the distance from SF to Palo Alto is actually about the distance from Toronto to Mississauga. I think Stanford can pretty much be included as part of SF. Sure the city boundaries are tiny, but in effect SF to Palo Alto is about half the distance of Toronto to Hamilton. 

[hkmedic]

It's been talked about for years. 

 

http://www.theglobeandmail.com/news/toronto/tory-releases-jobs-plan-wants-medical-school-at-york-university/article18564783/

[indefatigable]

Great point, I double checked though and the distance from SF to Palo Alto is actually about the distance from Toronto to Mississauga. I think Stanford can pretty much be included as part of SF. Sure the city boundaries are tiny, but in effect SF to Palo Alto is about half the distance of Toronto to Hamilton.

 

This is more a reflection of urban density: SF has much higher density whereas TO area is also known for "sprawl". Palo Alto is most assuredly not in San Francisco, although they are close as I mentioned.

[ralk]

While I agree with some of your points, there have been some serious issues with how universities often run regional campuses that I feel need to be ironed out. The benefit of regional campuses is to establish a presence in more rural areas to encourage students to eventually work in those areas. That I see is the main benefit. A main campus of York or a satellite of Toronto would do the job in either case. In addition, we could also argue that the York Region does not have trouble attracting doctors like some other regional campuses do. 

 

With that being said, we also have to consider the idea of how all medical schools are founded. All medical schools were founded from the ground up and they do require more capital from the outset but I believe the ceiling is endless. I was reading up on the beginning of the medical school at McMaster and it started with a significant amount of effort and lobbying by the president at the time H.G. Thode, and it brought together a group of young "medical revolutionaries" lead by John Evans who built a new school from scratch. In many ways, these were likely mid-career academics who had ideas about medical education but had trouble implementing them in the bureaucracy that they worked in and found an outlet to do so through Mac. While i'm not saying this is exactly what should happen with York or what will happen, it is an interesting thought. 

 

Regional campuses also often have issues running effectively. Sometimes the VC connectivity won't work properly and as a result the regional campus students are left out of the discussion during lectures and the issue has been left lingering by the medical school for years without a proper fix. That I see is often a fundamental issue with the fact that a medical school's academics and bureaucracy center from the main campus and as a result the resources aren't properly directed at the regional campuses and they are left to just "survive". If an issue at a main campus occurs, it is attended to or looked into quickly and despite how medical schools have tried to focus equally on regional campuses, there are many small little things which benefit main campus students that regional campuses don't have access to and often there isn't much that can be done about it or there is something to be done but the school has not done it. 

 

I think in any case, I do have doubts that York would allow UofT to open a regional campus in their area primarily because they are looking to start one in the nearer future. There is definitely tension between York and UofT on this issue. Not really an issue in our hands as students for sure. 

 

We don't need new medical schools to spur innovation. McMaster is hardly a small or new school anymore, yet continues to be a leader in medical education. Queen's is practically ancient by Canadian medical school standards, yet has been pushing a number of new educational reforms since they revamped their program. Regional campuses aren't devoid of innovation either and what they push forward can influence their main campus partners as well. And when main campuses do develop new programs or structures, it may take time for them to be adopted in the regional campuses, but far less time than it would if they were independent institutions.

 

For example, London has more student-run clubs than our Windsor campus, which is legitimately unfair to the Windsor students. Much of this is due to simply having far more students available to organize and develop these clubs in London - along those lines, U of T medicine has more student groups than Schulich does. However, when there is a clear interest in Windsor, I've been a part of two clubs now that have made a reasonably smooth transition to including the Windsor campus. Likewise, another group I work with saw a drop in interest from Windsor students, with none wanting to participate for a year. Lack of interest is what kills clubs, but we were able to continue on in London and pick things back up with interested Windsor students the next year. None of these would have been possible if Windsor campus wasn't affiliated with Western, but was instead run directly by the University of Windsor. There are definitely some difficulties with regional campuses, but there are advantages to regional campuses as well, and having independent programs doesn't necessarily eliminate those difficulties regional campuses experience.

 

Anyway, the bottom line for me is that we don't need more medical students in general, and we really don't need more in the GTA. Taking students from U of T, to me, is about the only move that would make sense to establishing a medical campus in York. U of T already has a presence in York and while York may not like U of T encroaching on their territory, they're already there.

[Edict]

We don't need new medical schools to spur innovation. McMaster is hardly a small or new school anymore, yet continues to be a leader in medical education. Queen's is practically ancient by Canadian medical school standards, yet has been pushing a number of new educational reforms since they revamped their program. Regional campuses aren't devoid of innovation either and what they push forward can influence their main campus partners as well. And when main campuses do develop new programs or structures, it may take time for them to be adopted in the regional campuses, but far less time than it would if they were independent institutions.

 

For example, London has more student-run clubs than our Windsor campus, which is legitimately unfair to the Windsor students. Much of this is due to simply having far more students available to organize and develop these clubs in London - along those lines, U of T medicine has more student groups than Schulich does. However, when there is a clear interest in Windsor, I've been a part of two clubs now that have made a reasonably smooth transition to including the Windsor campus. Likewise, another group I work with saw a drop in interest from Windsor students, with none wanting to participate for a year. Lack of interest is what kills clubs, but we were able to continue on in London and pick things back up with interested Windsor students the next year. None of these would have been possible if Windsor campus wasn't affiliated with Western, but was instead run directly by the University of Windsor. There are definitely some difficulties with regional campuses, but there are advantages to regional campuses as well, and having independent programs doesn't necessarily eliminate those difficulties regional campuses experience.

 

Anyway, the bottom line for me is that we don't need more medical students in general, and we really don't need more in the GTA. Taking students from U of T, to me, is about the only move that would make sense to establishing a medical campus in York. U of T already has a presence in York and while York may not like U of T encroaching on their territory, they're already there.

 

If the medical school was run by the University of Windsor, there would likely be more students so it would be less likely there would be lack of interest. I think you definitely pointed out an example of a small pro, but there are also cons.  

 

First, regional campuses often do not have the same access to research that main campus students have. They typically have to commute all the way to the main campus to have access to research. Second, some issues at regional campuses have not been fixed for several years, like the lack of consistent access to video conferencing of lectures which should be a reason for unaccreditation. These wouldn't be an issue if the main admin and profs were all at the regional campuses, but unfortunately these campuses are a small pet project and do not get the attention they deserve. 

 

I do agree that taking students from UofT to establish a York school would be appropriate if one were to be established. Although it would be reasonable for it to be a mix of taking students and adding new spots. In effect, a York school due to the large regional population could have more residency spots than medical school spots, thus alleviating the current trend towards a 1:1 ratio of med school to residency spots.  

 

The key thing is regional campuses tend not to have the surrounding infrastructure of a main school. Main schools would have profs, faculty, and sub-specialties which would allow for residency programs that would not normally exist at a regional campus.  

[ralk]

If the medical school was run by the University of Windsor, there would likely be more students so it would be less likely there would be lack of interest. I think you definitely pointed out an example of a small pro, but there are also cons.  

 

First, regional campuses often do not have the same access to research that main campus students have. They typically have to commute all the way to the main campus to have access to research. Second, some issues at regional campuses have not been fixed for several years, like the lack of consistent access to video conferencing of lectures which should be a reason for unaccreditation. These wouldn't be an issue if the main admin and profs were all at the regional campuses, but unfortunately these campuses are a small pet project and do not get the attention they deserve. 

 

I do agree that taking students from UofT to establish a York school would be appropriate if one were to be established. Although it would be reasonable for it to be a mix of taking students and adding new spots. In effect, a York school due to the large regional population could have more residency spots than medical school spots, thus alleviating the current trend towards a 1:1 ratio of med school to residency spots.  

 

The key thing is regional campuses tend not to have the surrounding infrastructure of a main school. Main schools would have profs, faculty, and sub-specialties which would allow for residency programs that would not normally exist at a regional campus.  

 

The main assumption I disagree with here is that if regional campuses were run locally, they'd have the profs, faculty, and sub-specialties they currently don't. When it comes to subspecialists, patient volumes are often the main limiter, not the presence/absence of medical school. For example, I'm on a service now that I know doesn't exist in Kingston, despite it being an academic centre. Kingston's catchment area is simply too small to justify it's existence. Likewise, Windsor's catchment area would be too small to justify this service there, regardless of whether a medical school was set up there. Likewise, U of Windsor doesn't suddenly become a medical research hub just because a medical school exists there, nor does health research require a medical school present to develop - U of Waterloo, for example, is developing some interesting medical research in medical imaging, medical devices, and public health, all without having its own, separate medical school. I'm also aware of many research projects for students in Windsor.

 

I'm not sure how it works at Mac, but with Western, Windsor accesses our recorded lectures the same way London students do. We have the odd video-conferencing hiccup and some lecturers are very bad at talking through VC, though that sometimes disadvantages London as lectures do come from Windsor as well. When I took in some lectures in Windsor, I didn't find it to be an issue at all. I'm certainly not denying that there are some issues at the Windsor campus, some of which have gone on for longer than they should, but that's true for the London campus as well. And there are advantages for Windsor students that Londoners don't enjoy, particularly the low learner-to-staff ratio - an advantage that might disappear if, as you suggest, an independent campus ended up with more students overall.

 

Again, we don't need more medical students, or more residents at this stage. We're overloaded on both at the moment and the government is actively cutting down on the latter. I'm in favour of improving the geographic distribution of students/residents by shifting capacity to lower-leveraged learning environments, but an overall increase in the physician pipeline - especially as the government is clamping down on both physician costs and medical education costs - neither makes sense to me, nor is it feasible in the current political climate.

[rogerroger]

The last thing this country needs is another medical school.

 

There is no money left. People don't get that. Your Ontario government has wasted it all. All that is left is health care cuts and the removal of more residency positions. The last thing needed is more medical students.

 

You won't see a medical school at York for the next ten - twenty years minimum and probably never.