‘In Dialogue’ Episode 2: Dr. Janet van Vlymen | Dialogue - CPSO's Publication for Ontario Doctors

‘In Dialogue’ Episode 2: Dr. Janet van Vlymen

2022 CPSO Council President Dr. Janet van Vlymen talks about her road to leadership and goals for her one-year term, the importance of quality improvement, ongoing efforts to ease physician ...

April 2022

Reading Time 104 min.

In episode two of “In Dialogue,” CPSO’s Senior Communications Advisor Joshua McLarnon speaks to anesthesiologist and 2022 CPSO Council President Dr. Janet van Vlymen about her road to leadership and goals for her one-year term, the importance of quality improvement, ongoing efforts to ease physician burnout, and the College’s role in medical education.

https://soundcloud.com/cpso_ca/ep2-vanvlymen

Dr. van Vlymen is an Associate Professor and previous Deputy Head of the Department of Anesthesiology and Perioperative Medicine at Queen’s University, and has been their academic representative on CPSO Council since 2016. She’s also served as chair on the College’s Quality Assurance and Education Advisory committees. At the Kingston Health Science Centre (KHSC), her clinical interests include preoperative assessment, ambulatory anesthesia and perioperative medicine, and she is currently the Program Medical Director for the Perioperative Services program. 

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Interview with Dr. Janet van Vlymen

Introduction:
CPSO presents "In Dialogue", a podcast series where we speak to health system experts on issues related to medical regulation, the delivery of quality care, physician wellness, and initiatives to address bias and discrimination in health care

Joshua McLarnon, Senior Communications Advisor (JM):
Thank you for joining us "In Dialogue". My name is Joshua McLarnon, and I will be your host today as we are joined by CPSO President, Janet Van Vlymen. Janet, thank you for joining us.

Dr. Janet van Vlymen, Anesthesiologist and 2022 CPSO Council President (JVV):
Well, thank you so much for inviting me to be part of this new initiative. I think it's really exciting that the CPSO is branching out into new forms of communication, and I've really enjoyed the podcast so far.

JM: You know, Janet. I was hoping you'd be able to introduce yourself to our listeners, and maybe share what's brought you to your current position.

JVV: Yeah, well, you know, I'm very lucky to have a very interesting and varied career in medicine. I'm an anesthesiologist, I work at Kingston Health Sciences Centre, and I've been on staff there since 1998, and I've been involved in a variety of healthcare leadership roles within the organization. I was Medical Director of Pre-Surgical Screening. I have become the Program Medical Director for Perioperative Services and was the Deputy Head of our department. So, I've had a lot of leadership experiences that have helped to bring me eventually to this role at the CPSO.

JM: And, you know, while we're on your experience in medicine, I did want to start this interview out on a positive note. In your career, what have been some of the things that have really sparked joy in your practice and your teaching?

JVV: Yeah, that's a great question. So, it's interesting, I was an anesthesiologist. It's not a profession that people often, you know, think about or aspire to. Very few medical students start medical school thinking I want to be an anesthesiologist. But you know, it's a really great career that people sort of, find their way to, and so one of the really exciting things that I've been able to be involved with is a mentorship program at Queen's [University] that involves undergraduate medical students. And so, I've been a mentor along with my husband, with a group for — since 2002, and this includes medical students throughout the various stages of their training. And so, it's really been a great honour to meet these exciting young people at the early stages of their career, where they're really, just sort of, open to all kinds of opportunities. And so, we have a program here that offers observerships, where students come in and basically follow around a doctor for a day or a part of a day, or an on-call shift, just to kind of get an idea of what types of careers there are in medicine, because there's lots of them that they may not have ever considered. And so, anesthesia is very, very much one of the ones that they may not have considered before, and so, there have been so many of the students that have been part of our mentorship group that I'm very proud to say have gone on to become anesthesiologists. And I tease them when they first get started in first-year, saying, "Well, decide amongst yourselves, because one of you will be an anesthesiologist." And I think, every year we've had at least one, so that's, that's been a really great honour.

And because I've been at this for so long, I've been able to see these students go through their residency training and become staff, and been able to work with them as colleagues afterwards. So, that's been certainly a true, true joy. I think one of the other pieces for me that is really lovely is that we work in teams in anesthesia. So, we work in an operating environment — high stress, high risk, but very high-functioning team. So, we have surgeons, nurses, residents, anesthesia assistants, and other health care providers, and we really all are working together for the betterment of a patient. And so, you know, it can sometimes be really hard, really difficult situations, very sick patients, but it can be very joyful too, and so, that part for me has been a really invigorating part of the practice for me. And I always sort of say to people — you know, they think anesthesiologists really don't have any patient contact and don't really need to have good interpersonal skills, and I sort of say the opposite: you meet a patient, maybe five or 10 minutes before this big surgical procedure, and you need to build trust and gain confidence. And this is a very stressful time for patients. They arrive, you know, they're often maybe by themselves by that point. They may have one family member with them, but they're scared. And so, just that short period of time being able to reassure a patient, explain what's going to happen to them, and to really reassure them that the team is there to care for them. That part is really, really lovely.

JM: So, you've spent a majority of your time as a physician practicing in Kingston, which has a fairly large seniors' population. Has serving a community that skews older and its demographics shaped the way you teach or the way you think about work?

JVV: We sort of get known for our students, particularly around St. Patrick's Day when we're [recording] this podcast, but we do have a large seniors' population. And, not surprisingly, people choose to live in Kingston, because it's a beautiful historic city. It's a relatively small size, but it's easy to get to bigger cities. We have the waterfront, which is lovely, and great restaurants. So, all those things are really great, but I think the big draw for them is that they have access to an academic, tertiary healthcare centre. So, that's a big draw, and we all know that as we get older, we're likely to require the services of healthcare providers, so having a medical school and a tertiary care centre right at your disposal is a big draw.

So, we do see a lot of seniors. So, we know that as we age, we're going to be needing lots of things — surgical procedures, in particular, cardiac disease, cancer operations, joint replacements, cataract surgery, just to name a few, and accessing that care in a timely way can be a big challenge, particularly as a result of the pandemic and the backlogs that have come. So, the planning for these procedures can be really difficult. So, of course, there's the patient themselves, where we need to make those plans, but they often need the support of their family members or friends, and so, trying to arrange for the support — you may have family flying in from another city, taking time off work to be there to support their loved one — and you know, if procedures get delayed or cancelled, there's a whole ripple effect. It doesn't just affect the patient, but it has a whole sort of domino effect on all of the other people that have been there to support that patient. So, it's really, really challenging if you have someone that's gone to all of these extraordinary measures to have a procedure, and then to have it postponed, which can — unfortunately can happen for a variety of reasons, whether it's a lack of resources, like hospital beds, or an emergency procedure that needs to bump a scheduled case. So, that's very disheartening for people and I recognize how difficult it is, and that's always a really hard conversation when you have to have it. I think the other thing we're seeing with seniors is, you know, a lot of people are really just sort of hanging on living on their own, and they don't always have all the supports they need, and something like an illness or an injury can be the thing that tips them over the edge. So, they've been able to manage at home without supports, and now all of a sudden, as a result of a hip fracture, or pneumonia or something that deconditions them, they now need supports in their home, and so that can really be a problem — it's delaying discharge because of a lack of homecare supports, or if their condition has deteriorated such that they need long term care facilities. And so, as a health care system, we really need to really be continuing to focus our energies and attention and resources on improving our access to home care, long-term care, or rehabilitation services, and as our population continues to age, these needs are just going to increase.

JM: So, I wanted to shift gears a bit and look at your relationship with the CPSO, and we were wondering why you initially chose to get involved with the organization.

JVV: So, I actually first did work at CPSO quite a long time ago. Probably about 15 years ago, I was invited to be part of a working group that was looking at standards for independent health facilities, and this was really my first experience of doing any kind of work. And I really found it fascinating and incredibly meaningful to sort of work at a higher level beyond an immediate patient or even at my hospital level, to have an influence on improving the quality of patient care at the provincial level. So, I really enjoyed that work, and then I was invited to be a medical investigator for some quite complex cases at ICRC [Inquiries, Complaints and Reports Committee]. And so again, this sort of sparked my interest in ensuring high-quality care for patients, and I really enjoyed the work. I had sort of a vague idea of what Council was, you know, I would say I had quite a good orientation, but the orientation process is improved even more so now, so that people joining — even before they become — have a much more deep understanding of the work of the College and the opportunities there.

So, I started off on Council and I was asked to be part of the Quality Assurance Committee, so that really fit nicely with the kind of work that I had been doing at the hospital and the areas that are of interest for me. So, I really enjoyed the work at QAC and also the Education Advisory Group, which involves all of the academic reps from the various medical schools. So, I kind of got involved in that and again, just you know, one thing leads to another — I really enjoyed it and I was encouraged to sort of move along and apply to be on the Executive [Team], and so here I am today. So, yeah. So, I actually had a little tap on the shoulder from a previous CPSO President, Dr. Dale Mercer, who had been the President of the CPSO, and he was the one who had first invited me to join the working group, and he was very, very much encouraging me to join Council. So, when there was an opportunity for the academic representative at Queen's [University], I was fortunate to be appointed into that role, and that was in December of 2015. So, that was my initial first work at Council, and I have to say, I didn't quite appreciate really what the role would involve.

JM: So, I think this is going to be a question that you are uniquely suited to be answering, but what do you think the role of a medical regulator is in medical education?

JVV: That's a great question. So, you know, first of all, I would start with the undergraduate medical students, as they're not members of the CPSO, unlike the postgraduate trainees who all have an educational license. So, of course, one of the important roles as regulators is to ensure that there's appropriate credentials for educational licenses for trainees, so your first license will be an educational license, and they'll review all of your training at medical school in order to grant that license. So, of course, that's an important role as a regulator. But I think there's an expanding role right now. So, I would say the CPSO right now has more involvement with undergraduate students than it has ever had. So right now, we do presentations at all of the medical schools on a variety of topics that will be of interest to the students, as well as throughout their careers — things on medical professionalism, relevant policies, and that type of thing. We also now have a link, so Dialogue is being provided to the medical students. So, at an early stage of their training, they're starting to see the work of the College and the regulators, and that it's not just a place where you send your money for your license and worry about getting a phone call that you did something wrong. It really looks at a variety of ongoing educational topics and areas of interest that will be with them throughout their career. So, I think it's great that we have those connections that are evolving with the medical student.

And also the messages from the Registrar, which the students didn't used to receive, are now going to the Deans. The Deans are then forwarding them along. So, they're getting their first steps, their baby steps into getting a look into the work of the College. So, I think that's been a really great step forward. Then with the postgrad trainees, I've personally been involved in a variety of presentations, where we look at topics that may be of particular interest to postgrad trainees. It includes some of our policies, so they have a big interest in our current policy on social media. And so, I've done a number of presentations on that, as well as, again, professionalism, and a variety of the policies that are important. The postgrad trainees now are, again, better prepared to start their careers than ever.

So, they — when they get their first license, they embark upon a series of modules, which is called the New Member Orientation, and this has been, I think, a fantastic new initiative at the College, which ensures that everyone when they first get started understands the expectations of the regulator. So, these are around professionalism, boundaries, medical records. All of these types of very important things that we sort of hope that people have learned and know as they finish medical school. But it's really important to start off on the right foot to say, these are the expectations so it doesn't come as a surprise 10 years into their career that perhaps they were not doing things as expected. So, I think that's a — that's been a wonderful way to start off your career with a good understanding of the expectations.

Also, CPSO has a policy on Professional Responsibilities in Medical Education. This was actually a policy that was just revised and released last year [2021] with lots of input from all of the various stakeholders. And so, I think this is really good because it very clearly outlines the requirements both for the supervisors, as well as the trainees, on what's expected in terms of supervision and documentation, consent, boundaries. So, this has been a really great revision to two existing policies and they've come together. So, I think from all of that, you can say that there's a very big role for the regulator in medical education.

JM: So, you know, in the recent past the CPSO has made a fairly strong commitment to equity, diversity and inclusion [EDI], particularly, you know, in our role in the healthcare space, and I'm wondering as president, how you feel it's important that we continue this work.

JVV: I have to say it's been so exciting to see the incredible focus on EDI over the past few years of the College. It really has come to the forefront, and we're very fortunate to have our EDI lead as one of our medical advisors, Dr. Saroo Sharda, who's also an anesthesiologist and very much a leader in this space in EDI and medicine. So, I think Saroo has been a wonderful addition to the College and has really been a key player in moving these initiatives forward. I think that the first focus is really around education. So, you know, we have had a variety of educational sessions that have occurred for the staff at the College, Council members, as well as Committee Members, to really highlight a variety of areas of concern and to — I know it's been incredibly enlightening for me.

As well as the Dialogue magazine, which has had, you know, focused articles on a variety of racism issues, weight bias, ableism, gender bias, care of trans patients. So, really these broad areas of medicine that we haven't often talked about in the past. So, I think that's educating not just the members at the CPSO, but the membership in general, and those articles have had tremendous positive feedback from patients as well as people who work in the field. So, I think it's really become front and centre — the EDI work has really become front and centre, and we really don't want to have it as a checkbox, like we've now done anti-Indigenous racism, so now we don't need to think about that anymore. We really want it to weave its way through the work of the College, and it really needs to be front and centre on things like the composition of our panels, the appointments of Committee Members, the policy development work that we're doing. And all of this work is really happening with that EDI lens, and the idea behind it is it's not something that we sort of do once, and then put in our back pocket. It really is in the forefront.

JM: So, speaking of important initiatives, and really strong segues, I know that one of the key things you want to deliver as President is improving physician burnout and improving physician wellness. And we know that some physicians are worried that there will be regulatory repercussions if it's found out that they are seeking help for mental health. What would your response be to those concerns?

JVV: A concern of mine for quite some time and an initiative that I'm very passionate about. So, you know, I see that starting even as a medical student. So, I see the medical students who worry about stepping away for a period of time and getting the help that they may need, for fear that that will show up in their records and may actually limit or delay or prevent them even from being licensed as a physician. And so, that's just heartbreaking to me, actually, to think that someone would ignore their personal health for that kind of fear. So, I think the first thing is we're trying to help with the messaging, to really have the supportive messaging for both trainees, as well as some practicing physicians, that that's not — The College's role, our mandate, is to ensure public safety, but we know that if a physician isn't well, they can't provide safe care. So, we really need to start with a healthy physician workforce.

And so, there may often need to be a need to step away for a period of time — it could be a short time, a few days, a few weeks, or could be a considerably longer period of time — but whatever that time is, it's necessary. And there's a variety of ways that may come to pass. You may be working with your own family doctor, a specialist, or you may be working with the Physician Health Program through the OMA, which is a fantastic program that the CPSO is very supportive of and really works at an arm's length from. So, you know, our goal is to ensure that you're getting the help that you need, but not get in the way of that. So, I would say that the CPSO is very supportive of both physicians and trainees seeking that help, and to not have this be an impediment to licensure, and we really want to help the physician workforce.

JM: And you know, the pandemic certainly affected physicians and contributed to a bit more of a widespread burnout. What's your personal experience been practicing over these past two years, and maybe some of the measures you've taken to stay well and keep wellness at the forefront of your mind as a physician?

JVV: Yeah, well, we know that physician burnout was a problem before the pandemic, but you know, the stress that's come from the increased workload, long hours, working in full PPE, as well as the worry for your own personal health as well as that of your family, has really highlighted the problem. So, I think that burnout and exhaustion and health care providers leaving the profession is a critical issue that we need to address.

So, I'd say for me, personally, it's been a very challenging couple of years. Just before the pandemic, I was actually involved in a very serious car accident. So, I was crossing an intersection as a pedestrian in Toronto, and I was hit by a speeding car that ran a red light, and I actually sustained multiple injuries: I had broken ribs, pelvis, leg, and I was facing a very long recovery from that. So, that was sort of how I was — I started into the pandemic phase. I was just getting ready to sort of return to work in a sort of a modified fashion, and just as I was getting ready to start, COVID hit, and, you know, I was, I'm the Medical Director of Perioperative Services at the hospital. So, I was working very long hours in that role trying to create policies and processes and ever-changing our schedules as a result of the various directives. And also dealing with an extraordinarily group of healthcare providers who were facing an unprecedented thing with this pandemic, and lot of uncertainty — and you know, as a group of providers, uncertainty is probably one of the most stressful things that we can face.

So, I was sort of facing my own personal physical recovery, as well as this work with a pandemic, and then I was returning to my work as an anesthesiologist, which, of course, also involves sort of personal risk in that type of care in the operating room and intubation. So, there was a lot of things, and I was also getting busier at the College. So, I was, you know, I would say, getting pretty stretched. So personally, I think, I'm very, very lucky to have a lot of supports, and I have a very supportive husband and children, and I have great friends, both within medicine and outside of medicine. And so, when I get stressed, I really do rely on those sorts of support systems. We're also very lucky we have a cottage very close by, so we were able to sort of escape when we had free time, and really embrace the outdoors, and it helps to sort of make you feel like life was more normal. You know, you could go for a long walk or work in the garden, and it made life feel normal. So, those were very rejuvenating, for me personally. And I think some of the things that we all know are important for our overall health, I really tried to kind of bring to the forefront, so exercise and mindfulness as well as the physical therapy I was continuing to do as a result of my accident.

But we know that from, the research in this area, all of these efforts, this work on yourself personally with all of these important things — it doesn't actually fix the problem of burnout. You know, we really need to look at things from an organizational level and the drivers of burnout, you know, probably only 20 percent of them are really things you can personally impact yourself. So, in my role as a leader within the hospital, I also tried to look at the kinds of things as an organization that we could do at the hospital level, to try to support our staff through these times. And there's not a lot of easy answers, but it's our peril to actually ignore them and think we can't do anything. And I think even small steps sometimes can really make a big difference.

JM: Yeah, so between some of the things that you were just sharing, and what we'd actually heard from Dr. Jillian Horton, you know, most of the contributors to burnout are systemic — systemic issues within the healthcare system, that we, as the regulator, do not necessarily have direct control over. So, I'm wondering what we can do as the CPSO to start easing the burden on physicians and making burnout slightly less.

JVV: We were very lucky to have Jillian Horton as a guest speaker at our recent Council meeting, and, you know, I could listen to her all day, I think, and I've really enjoyed her books and her other correspondence. So, I think she was really — had a really great approach to look at things from a data-driven level. So, I think there's — it's easy enough to say we're having a yoga program and a night mindfulness program, and we're all going to go away and be well, and we know that's just not the case. So, as I said, from an organizational level, there's work that needs to be done to support physicians for things like their stresses with EMRs that are clunky and awkward and take a lot of time, hostile leadership engagement and administrative support, and those sorts of things. But as a regulator, we often also don't really think that we have a role to play in this. And I would say that we actually do and it may not be directly affecting those sorts of things like how your EMR works, but we can also be not a contributor to stressors. So, I think that's really one of the ways that we have really tried to have a focus.

So, traditionally, I think, a lot of physicians would think that the CPSO is an organization to be feared, and we're really working hard to change that message that, you know, our mandate is to provide good care for patients, and that's what physicians want as well. So, we're actually aligned and we're on the same page. And so, there's some really tangible things that have happened at the College over the last couple of years that I'm really, really proud about. And I would say that the first thing that kind of overrides all of the work that we're doing right now is Right-Touch Regulation, and that really is where we're applying the right amount of regulation to the circumstance. So, essentially, the right hammer for the right nail, and not being too overly overbearing with sort of small issues.

And I think one great example of that is the Alternative Dispute Resolution Process. So, low-risk complaints that come in from a variety of sources can't be resolved very quickly. So, sometimes these are communication problems or misunderstandings, and all it really takes is someone in the middle, a mediator, who can reach out to both sides and help them to have a better understanding. And so, you can take something that would have previously gone through the formal complaints process and may take even upwards of a year to resolve with that stress hanging over your head for that whole period of time. And now, you know, people who call with a concern, their phone call is answered within one to two days. The connections are being made immediately. Sometimes, these concerns can be resolved with ADR within less than a month. And so, now this thing that used to hang over your head for a year is something that you can resolve, you feel like the College has been a support for you rather than something that is to be feared. So, I think Alternative Dispute Resolution has been a big source of improvement, anything is really in how the profession is being communicated to by the CPSO.

So, there's been a variety of messaging, particularly through the pandemic, from the Registrar, providing notes of support, as well as encouragement, and as well as direction. So, I know a lot of physicians who were faced with patients wanting mask exemptions or vaccine exemptions, and were really being pressured and felt the stress from their patients asking them for these things — and to have something from your regulator very clearly stating that this is the expectation — it was a tremendous relief for a lot of physicians to say, you know, "I can't do it, my regulator has told me I can't. It has to meet these certain criteria." So, I think that kind of messaging that's coming from the Registrar's really been very well received.

Also, just the general way that the physicians are being communicated to so, you know, you used to get a piece of paper in the mail stamped "Private and Confidential," and your heart would race or even an email that might come. So, I think that people are getting used to seeing emails coming from the College, we're asking for your opinion about our policies, we're communicating with you about your Annual Renewal online. You know, we're engaging with the profession, we're sending our eDialogue. So, there's ongoing communication that's occurring between the College and physicians, and we want to encourage that. We want that to be a two-way dialogue, and so that there isn't a fear of when you get an unexpected note in whatever format from the College. And then, now with our new Quality Improvement initiative, there will be ongoing intersections between physicians and the College. There'll be an expectation that all physicians in Ontario participate in a Quality Improvement project every five years. So, it's not going to be this, just send in your annual dues once a year, and that's your only intersection with them. They'll be ongoing, kind of back and forth, so, I think that communication piece is really key as well.

JM: So, I actually do want to jump in on that Quality Improvement piece. I know the College has modernized and changed a number of pieces with respect to the QA and QI with a specific focus on reducing some of the administrative burden that physicians face, as well as starting to foster more of a culture of lifelong learning and quality improvement, and you've led some Quality Improvement work in your hospital department. Can you tell us a little bit about that work and why you feel it's so important?

JVV: Yeah, for sure. So, you know, I think as physicians, we always want to be providing high-quality patient care, and none of us go into the profession with a goal of not providing high-quality patient care, but sometimes we're not really aware of what the concerns may be. You know, if we don't actually stop and pause and take a look objectively at what's happening, there may be things that are happening that we don't even realize. I know for me, as an anesthesiologist, many of my interactions with patients may occur on a single period of time, and I may not ever have another meeting with that patient ever again, and quite likely may not. So, if I don't have a process in place to look for and sort of systematically follow up on issues that occur, we may not even realize that we're not providing the care we think we are.

So, things like postoperative nausea and vomiting — so, if someone looks great in the recovery room and we send them home after a day surgery case, and they get home and spend the next 24 hours vomiting, I think I've done a great job. But if I don't have any ability to feedback and connect with that patient, I'm not going to know about that. So, our day surgery patients are contacted by nurses the following day, and we have a series of questions that we asked them about things like pain and nausea and those sorts of symptoms. So that we can really look for systematic problems and identify high-risk patients, and change our processes. So, really, that QI piece, that Quality Improvement is taking a process that may be pretty good and trying to make it better. So, it's really not — you know, it's not trying to meet just a standard, but it's trying to always improve beyond to have the very best quality care that we can have.

So, those are some of the kinds of things that we've done as an organization and can continue to do at looking at morbidity and mortality, and other forms of postoperative concerns and complications, and then modifying either our policies or our processes to really try to prevent medical error or medical complications. So, I think that's embedded within our organization, and I think there's a lot of physicians who are doing quality work, QI work, and they don't even kind of realize that they're doing QI work. So, because it hasn't been it — it may not be labeled that way as QI, but they may be taking these sort of reflective opportunities to improve care.

JM: And you'd mentioned our QI Program runs on a five-year cycle, and we've certainly seen some physicians experience a bit of anxiety when they're selected. Is there anything you'd say to physicians about our program that might comfort them and make them more excited to engage in some of the self-reflective and quality improvement activities, you know, that we feel can be — you know, contribute to a better practice?

JVV: Yeah, no, for sure. I think a lot of our medical students and trainees are coming out of school with this type of education that's already happened. So, they're used to it — the QI — the idea of a QI, the idea of a SMART goal, they understand that they're encouraged, right from a very early stage, to have these sort of self-reflections and journals and things. So, and, you know, their training is very much in line with that, but some of the older physicians may not have trained in a time when QI was even something that they had even ever heard of, so — and they may be a little bit lost, particularly, if they're working in a solo practice on where you start. So, I think that the key piece is there's lots of supports out there.

So, first of all, there's coaches that work within the QI Program — the QI Coaches that will work with individual physicians or groups to help them to set up their goals and to have their Quality Improvement project kind of meet the standards that the College expects. And it's also kind of exciting to see some of the other supports that are out there. So, for instance, the Ottawa University has started a CPD program for — that's available for physicians to help them in setting up their QI project, and as well the CPSO was putting on a new webinar series, which again, helps us sort of demystify and explain what the process would look like, sort of in a more practical sense. And also, the OMA is developing tools — so, there's a variety of tools that will help physicians to have that data-driven aspect to their QI project. So, I think there's lots of resources out there, and I think that the more people who may have concerns engage within some of these opportunities to have assistance with their program, I think they'll find — which we've seen as the really positive feedback.

So, at the end of it, although it might have been a little bit stressful going into it, by the time you come out the other end, you realize, actually, wow, that was actually pretty interesting and informative, and will actually help my practice and help my patients. So, I think that the feedback we've had is, you know, even people who had concerns are finding it to be a useful tool. And also, far, far less stressful than the previous process, which was random peer assessments where you might have someone descend upon your practice for the day and read through your charts, and that was a very anxiety-provoking experience for many physicians. So, I think that most of the feedback we've had from people is, although they might be a little bit worried about starting into these QI projects, that in the end it's actually been a very interesting and much less stressful experience.

JM: So, I'm going to pull it back about 50,000 feet here for our last question, and as President, just wondering, you know, what's your message to medical students and physicians in Ontario?

JVV: My main message, my hope, as we move forward is that the trainees and the physicians within Ontario will see CPSO as an ally, and as an organization that is there to help support them. Changing that sort of lens that it's something to be feared is really probably, you know, my biggest goal. I don't know if I'll be able to accomplish it in the year, but, you know, I think there's been lots of work that's sort of set the stage for that, in the few years leading up to my presidency, and I know, there'll be ongoing work when my year is finished. But that's really my hope, as we move forward.

And then my other message would be to encourage people who have those same goals of providing great care to consider being involved in College work. It's really very enlightening and rewarding experience. It's so nice to work with a group of varied physicians — different specialties, as well as the fantastic staff that we have at the College. We have amazing groups of Communications people, Policy Analysts, Lawyers, and so it's, it's just so refreshing to have that, you know, just a different way of thinking about things, and that and I would say after my years working at the hospital and various levels of hospital leadership, to try to look at things from a little bit, as you say, 50,000 feet — try to step back and look at how we can have an impact at a provincial level — has really been a great joy for me.

JM: Very well said, Dr. van Vlymen. Thank you so much for joining us today.

JVV: Thank you for having me.

Closing: Thank you for joining us. Please visit www.CPSODialogue.ca for more in-depth discussions about health care.