December 1, 2016
GROWTH AND CHANGE: As change is inevitable, it is how we adapt to change that shapes what we become.
Two events over the past few months demonstrate the exciting ways in which critical care continues to grow as a specialty. The Intensivist leaders with our country are taking us in exciting new directions. The first is the creation of the 3 rd and 4th academic Departments of Critical Care in Canada. Following on the footsteps of the University of Calgary and Dalhousie University , are Queens University and now the University of Alberta . The intensivists in these departments are to be congratulated for their vision and perseverance. Our multidisciplinary specialty should evolve to educate physicians, as well as other members of the team, and solidify research of critical care under a single group. The lead taken by this group of intensivists will hopefully be possible in other academic centres; interested members to seek out the Chairs (Chip Doig – Calgary, Ward Patrick – Dalhousie, or Dave Zygun – Alberta, Dan Howes - Queens) for advice and insight.
The second change is the move to competency-based medical education for Critical Care Medicine
led by Dr. Ron Gottesman, chair of the specialty committee and Dr. Farhan Bhrani, Associate Director of Assessment at the Royal College
(and lucky for us also a pediatric intensivist). Thirty intensivists including members of the Critical Care Specialty Committee, the program
directors, and Elaine Gilfoyle and myself as the exam board vice-chair and chair met for 3 days at the end of June in Ottawa. We reviewed
the reasons why the Royal College is embarking on this “Big C” change in training. During that first meeting we laid the framework for
what will become the entrusted professional acts (EPAs) of our profession and a preliminary framework at each stage of training. Over the
next 2 years this group will meet regularly to solidify those EPAs, link them to milestones, set an assessment framework and by 2018 be
ready to implement. Change at this rate requires engagement of the entire critical care community. The CBD leadership (Drs Gottesman, Bhrani,
John Drover, Jason Lord, Gilfoyle and myself) will be presenting documents beginning after our January meeting. Please share with your
colleagues, add to the discussion and give us feedback.
This year has seen several areas of growth for the society. With a formal memorandum of understanding between the CCCS and the Critical Care
Canada Forum, CCCF has become the official meeting of the society. We are grateful that our colleagues Brian Kavanagh and Niall Ferguson
see the value of this agreement. While we have held our annual face to face board meeting and Annual General Meeting at CCCF for years
we only had input into the poster presentations and the residents education day. This new agreement sees a greater collaboration in the
scientific programming as well as formal agreements to support the research awards that honour our past presidents (the Garner King Award
for the best Scientific presentation and the Alan Spanier Award for the Educational presentation). In addition, this year Claudia dos Santos,
a member of the Scientific Committee, organized a very successful session on behalf of the society with the CIHR and the Institute for
Cardiac and Respiratory Health (ICRH), attended by some senior scientists as well as trainees interested in an academic career. We also
saw an enthusiastic debate about critical care education.
This year has also seen growth and progress within the CCCS Board. The next few paragraphs will highlight the varied activities.
With the restructuring of the CCCS board we added a Clinical Director. Dominique Piquette, with her PhD in Medical Education has taken on the
task of developing a continuing education program for the members. For World Sepsis Day (Sept 13) Dominique and her clinical committee
organized a 1 ½ hour accredited educational webinar that included presentations from 4 of Canada’s world-leading sepsis researchers as
well as the story of an ICU nurse who is a sepsis survivor. The transcript of this event should be available for independent learning on
the website with the ability to earn some MOCOMP points. Stay tuned to the website for additional learning opportunities. This is also
a great opportunity to distribute your knowledge translation plan for those research projects.
The Knowledge Translation committee, led by Francois Lamontagne, has had a very busy year. Francois has been working to standardize both the
guideline development and review process to align with evidence-based transparent practice. If you are working on a practice guideline
that you believe should have the CCCS stamp of approval then please contact Francois early in the process. His committee will often be
able to assist with methodological support or give your documents a rigorous appraisal.
The Education committee led by Mithu Sen, held a very successful Critical Care Review Course in June. The review course is not only open to
all critical care trainees but is also attended by practicing physicians who want a concentrated updated. A precourse on mechanical ventilation
was extremely popular and will be repeated this coming spring. Dr. Sen also worked with Dr. Damon Scales on the Resident’s Day at CCCF.
If you are interested in critical care education for our trainees join Mithu’s committee.
The Liaison committee, led by Stephen Beed, had the challenging task of connecting different groups with relationships to critical care, notably
the donation arm of Canadian Blood Services, CanCARE (the cardiac surgery group) and the Neuro critical care society as well as other societies
such as Palliative Care. We would like to thank Stephen for his leadership of this diverse group and welcome Vinay Dinghra to the Board
as the new director of this committee. Vinay’s next task will be to convene a committee that includes representatives from provincial critical/intensive
care societies to assure we understand regional issues.
Along those lines, James Downar as the director of the Ethics Committee continues to work towards an improved end of life policy from the College of Physicians and Surgeons of Ontario. We are concerned that the language around mandatory CPR even when non-beneficial is still problematic. Over this past year we sent a letter to the CMAJ expressing our concerns. The Ethics Committee has also published the guidelines on withdrawal of life-sustaining measures in ICM ( Intensive Care Med (2016) 42:1003–1017). James and Bojan Paunovic, our society Secretary, also have a position statement ready to publish.
Finally members of our society were invited to the Canadian Geriatric Society annual
meeting in Vancouver in January. Karen Burns, Scientific Director, along with Peter Dodek, Sean Bagshaw and Rakesh Arora presented.
In the New Year you will see a survey coming by email and/or paper. In 2015 Critical Care Medicine underwent a major review of our discipline
at the request of the Committee on Specialties at the RCSPC. While the college is pleased with our training programs and growth as a subspecialty,
they are concerned about whether our graduates will have jobs. This survey, seeks to understand current intensivist human resources and
predict our future needs. Claudio Martin (past president), and our scientific director, Karen Burns, (an expert in survey development)
spent the past months working on 2 documents. Our thanks to the colleagues across Canada who helped pilot the questions. The first survey
will be for all practicing intensivists and will ask questions about where you work and your career progress and plans. A second survey
will be sent to the medical leads/directors of each ICU in Canada to learn about the variations in organizational structure across the
country. Please take the time to complete a survey when it arrives from the society or the Royal College. The data we gather will inform
all our practice.
In the New Year we should be able to announce the final journal arrangements. We voted in October to increase the dues for full members to
support our members who will be working on the editorial board. We are also making some changes to the society bylaws around equity. This
will require a vote of the membership on line.
We have also taken leadership in sepsis advocacy.Canada has agreed to co-sponsor Germany’s proposal for an agenda item on sepsis at the 70
th World Health Assembly, which will first be discussed at the 140th Executive Board of the World Health Organization, in January 2017. Thanks to Dr. Tex Kissoon for his leadership nationally and internationally
to improve the timely recognition and treatment of sepsis.
In closing, critical care medicine as a specialty has grown significantly in the past decade. We continue to see how the evolving changes in
Canada impacts the how we care for the critically ill within our intensive care units and outside on the wards. As we adapt to these changes,
let us think about the skills we bring and what we will need to acquire in this changing environment.
As always please contact any member of the executive or board if you have issues or ideas to improve the society or you would like to join