MCGILL UNIVERSITY DEPARTMENT OF

MEDICINE 2016 ANNUAL REPORT

Dr. James Martin, Chair

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INDEX

EXECUTIVE SUMMARY 2

UNIT STATUS UPDATE 3

SELECTED DIVISIONAL ACTIVITIES AND HIGHLIGHTS 3

CONCLUDING REMARKS 27

APPENDICES 28

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EXECUTIVE SUMMARY The Department of Medicine has experienced significant progress in all areas; teaching, research and community involvement. The clinical faculty has adjusted to new configurations of the hospitals and the researchers at the MUHC have enjoyed the new facilities that are second to none. The epidemiology researchers at the MUHC continued to suffer the separation from the hospital sites throughout the past academic year and were housed in unsuitable locations. This problem is largely solved at the time of writing. The graduate student program in the Division of Experimental Medicine is adding new courses to accommodate to changing needs. Several clinician scientists have secured personal support awards and had their careers launched. Despite the disruptions, publications from the first RI-MUHC authors numbered 1039 (for year 2016, the most recent data available, compared to 1035 in 2015) and from the JGH 354 for 2016. Publications cover a broad range of research interests from basic biomedical science to population health (https://www.mcgill.ca/deptmedicine/research/publications). The research performed was supported by $69,075,745 in funding at the MUHC (this number includes funding received by both full and associate members, the latter group accounting for roughly 26%) and $28,426,745 at the JGH. There have been many members honored in the past year. A complete list of prestigious honours, awards and prizes conferred on members of our Department is available at the following website link: https://www.mcgill.ca/deptmedicine/files/deptmedicine/summary_honoursawardsprizes_2016.pdf There were 268 students registered in Experimental Medicine as of the Fall 2016 semester, a slight but continuous decrease since the peak of 322 reached in 2013 and a decline from last year's figure of 280. These trends will likely continue as the modalities for accessing CIHR funding continue to evolve in a profoundly negative fashion for biomedical research. The MUHC Department invested $244,824 in bridge and extended bridge funding to allow 9 faculty members (7 bridge and 2 extended) to maintain their research programs. This was an increase from $145,000 in the previous year. The distribution of funds received from the Association of Physicians to the Department at the MUHC is shown in appendix 2 (2016 Research Education and Development). The Clinical Research Program at the JGH provided $192,000 to CAS members to liberate time for research. The McGill Department of Medicine across sites provided over $1.9 million in start up to new faculty members as well as salary support, as shown in appendix 3 (Research and Teaching support from Practice Plans). The Department had a 40% success rate in obtaining FRQS awards and procured several other salary awards from national agencies. The Department of Medicine ran a highly successful Research Symposium at the New Residence. The attendance exceeded that of the previous year; up to 107 attendees. The first Clinical Symposium of the Department of Medicine on the topic of "High Value Care" was held in November and was attended by more than 100 people, drawn from all professions. Additionally there are numerous workshops and research symposia organized by the different divisions of the Department of Medicine as well as the Division of Experimental Medicine that provide excellent opportunities for students to present their work. A complete report for the Division of Experimental Medicine is available at the following website link: https://www.mcgill.ca/deptmedicine/files/deptmedicine/experimental_medicine_annual_report_2016.pdf The workshop on “Patient relationships” designed to train faculty members to interact optimally with patients was attended by 80 members of the Department at the MUHC. Members of the Department make many contributions to scholarly communities locally (FRQS), nationally (CIHR, NSERC and many

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foundations) and internationally (NIH, other foreign granting agencies), maintaining the excellent profile of the Medical Faculty and the University abroad. Our challenges are several:

1. The decline in the number of departmental members devoted to basic research and the inability to renew due to lack of tenure-track positions is a continuing concern. Appendix 1 shows the demographics of the McGill Department of Medicine.

2. The numbers of graduate students enrolled are declining; future productivity will diminish and revenues to the University will suffer.

3. Lack of funding by CIHR and other agencies for fundamental research threatens many faculty members but has been palliated by provision of bridge funding by the Department of Medicine at the MUHC and by the MUHC-RI.

4. The Ministry is failing to address the particular needs of university hospitals in the face of major re-organization of the structure of the health care system.

5. We have had many changes in program coordinators due to various reasons, so maintaining stability in these programs has been difficult.

UNIT STATUS UPDATE The executive committee of the Department, comprised of Drs. Ernesto Schiffrin (Physician-in-Chief at the JGH and Associate Chair for Research), Michael Bonnycastle (Physician-in-Chief at St Mary’s) and Joyce Pickering (Executive Associate Physician-in-Chief at the MUHC and Associate Chair for Education) oversees cross-site issues. There is complete integration of the educational mission across sites but research and clinical activity, in general, proceed with a great degree of autonomy at individual sites. Cross-site coordination and cooperation have been encouraged through well-attended bi-annual division directors’ meetings at Holmes Hall and the Annual Department of Medicine Research Symposium. Meetings of the directors of specialty training programs in medicine have been started with a view to sharing best pedagogical practices. The Administrative Excellence Center is doing remarkable work for the Department. SELECTED DIVISIONAL ACTIVITIES AND HIGHLIGHTS ALLERGY AND CLINICAL IMMUNOLOGY Noteworthy events - Dr. Phil Gold received the Order of Montréal, Dr. Emil Nashi the Phil Hill Award from the Department of Medicine and Dr. Danuta Radzioch was part of the team who received the Prix du public - Découverte de l’année 2016, Québec Science. Dr. Erwin Schurr was the co-organizer of an NIH-NAID workshop on “TB resistors” held in Rockville, MD in 2016. Research - Dr. Nicole Bernard was awarded a new CIHR Grant "Investigation of the role of HIV-Envelope specific antibody dependent innate immune cell functionality in HIV control". Dr. Radzioch completed genetic mapping of candidate atopy genes in mice and found that a compound fenretinide corrected defective synthesis of anti-inflammatory ceramides, which is being applied in a Phase II trial (APPLAUD) (for submission to FDA) already approved by Health Canada. She completed a study of phospholipid kinetics in patients with spinal cord injury from MGH and Sacré-Coeur Hospital, funded by the US Department of Defense. Dr. Schurr holds a multi-site grant from the National Institutes of Health USA (NIAID-NIH) to study mechanisms of immune protection from TB among HIV-infected individuals.

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Teaching - The Division members participate in teaching and research trainee supervision; this includes collaborations with the Division of Rheumatology in the Department of Medicine and the Department of OtoRhinoLaryngology. Involvement in the community - At the MUHC, Dr. Schurr organized the 2nd Research Symposium, Infectious Diseases and Immunity in Global Health Program at the RI-MUHC in September 2016. Dr. Ciro Piccirillo launched the MUHC/McGill Centre of Excellence in Translational Immunology (CETI), the first inter-program research initiative at the MUHC/McGill to foster collaborative, multi-disciplinary research and training initiatives in translational immunology. At the JGH, Dr. Peter Small is co-director of National Guidelines for Upper Airway Diseases, sponsored by the Canadian Society of Allergy and Clinical Immunology and the Canadian Otolaryngeal Society and Dr. Fanny Silviu-Dan is chair of the Royal College Committee for Clinical Immunology and Allergy. Clinical innovation - At the MUHC, Dr. Radzioch, in collaboration with investigators from JGH, is preparing for a safety study in cancer using a novel drug delivery vehicle which specifically targets hypoxic regions in the tumors. The hypersensitivity risk assessment of drug allergies and peri-operative anaphylaxis clinic successfully completed its first year. In a second phase, a relational database was created and a graduate student has begun evaluative research within a novel clinical improvement initiative. The Division has established a Drug Allergy Screening Program with a preoperative screening service at the MGH and JGH sites. What we envision as major threats to our academic activities - A major threat is the insufficient core of young investigators within the Division. Other threats include the geographic restructuring of the Division, the restriction of patient numbers, the reduction in support services and the lack of funding for novel clinical activities. CARDIOLOGY Noteworthy events - The past year was a great year for Cardiology at the MUHC. The Division saw a growth in clinical activity, particularly in the technical platforms (Pacemakers, TAVIs, electrophysiology procedures and angioplasties) in keeping with the mandate of offering tertiary and quaternary high level care to our RUIS. A dossier was mounted to justify this growth in volumes and was accepted and funded by the Ministry. The first large-scale gala, the Red Ball, was held in August in honor of our catheterization lab, raising over $800,000. Other fund-raising efforts led to the creation of a multi-million dollar fund for the development of a newly named Cardiovascular Imaging Centre with its own dedicated research Cardiac MRI.

The recruitment of Dr. Stéphane Rinfret, an FRQS clinician scientist, as the new chief of our catheterization lab transformed the MUHC catheterization lab into an academic, major referral centre for high risk and complex coronary interventions. At the present time most of the major programs are being led by clinician scientists (Interventional Cardiology: Dr. Rinfret, Congenital: Dr. Ariane Marelli, Imaging: Dr. Matthias Friedrich, Prevention: Dr. George Thanassoulis, and Electrophysiology: Dr. Vidal Essebag). Thanks to the efforts of Ms. Alyson Turner, Mr. Michel Sergerie, Ms. Andréanne Saucier and Dr. Magdi Sami, this year saw the start of a Cardiovascular Nurse Practitioner Program in Cardiology. Four nurse practitioners allowed the development of new innovative clinics such as a nurse-led atrial fibrillation clinic and a continuity of cardiovascular care clinic.

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At the JGH, Dr. Lawrence Rudski assumed the position of President of the Canadian Society of Echocardiography, the largest affiliate of the Canadian Cardiovascular Society and Dr. Jonathan Afilalo received the Young Investigator Award 2nd Prize, Canadian Cardiovascular Society, Montréal, QC, 2016

Research - Dr. Marelli led a major effort to bring our scientists together under our CHAL (Cardiovascular Health Across the Life-span) Program. The program which now aligns research with clinical programs grew to include new members, millions of dollars in funding and many publications. In the 2016 FRQS competition, Drs. Marelli, Thanassoulis and Essebag were all promoted to Chercheur-boursier clinicien Junior 2. In highly competitive grant applications, Dr. Marelli received a 7-year CIHR Foundation grant ($974,686) and Dr. Thanassoulis received a large NIH operating grant ($2.3 million). There were notable successes in research at the JGH including advances in understanding the impact of frailty in elderly patients undergoing cardiac surgery (Dr. Afilalo), in smoking cessation in patients with acute coronary syndromes (Dr. Mark Eisenberg), in the results of novel treatments in pulmonary hypertension (Dr. David Langleben) and in peripartum cardiomyopathy (Dr. Richard Sheppard). Teaching - At the MUHC, Dr. Jay Brophy was an Osler Fellow. Dr. Adel Schwertani coordinated the Advanced Cardiovascular Physiology course EXMED 506. Dr. Rinfret has started a course dedicated to electrocardiography. The JGH welcomed its first Fellow into a unique program in Canada, combining Echocardiography and Cardiac Magnetic Resonance imaging into a two year complementary and simultaneous training Fellowship. Dr. Eisenberg continued as director of the MD-PhD program at McGill, mentoring 16 students. Dr. Regina Husa began a McGill-wide internal review of over 200 specialty programs as McGill’s Director of Accreditation.

Involvement in the community - The web-site, http://www.cardiomuhc.ca/or http://www.cardiomuhc.ca/fr/ is now fully operational and highlights accomplishments. The educational community event in both French and English provided great visibility for hundreds of members of our community.

Internationally, our globally recognized leaders, Drs. Nicolo Piazza, Marelli, Friedrich, Thanassoulis, Rinfret, Jacques Genest, Allan Sniderman, and Essebag put the McGill name in the spotlight organizing, chairing and directing international conferences and courses in the fields of valvular heart disease, complex coronary disease, congenital heart disease, cardiac imaging, prevention, dyslipidemia and electrophysiology. The catheterization lab was transformed into a site for “live-cases” shown internationally at 2 major large conferences: TVT (trans-valvular therapeutics) and TCT (transcatheter therapeutics) thanks to our international recognition. Other community involvement includes Dr. Brophy on the Board of Directors of INESSS and the Editorial Board, Canadian Journal of Cardiology; and Dr. Marelli President of the Canadian Adult Congenital Heart Network. The JGH members participated in the EMSB-Secondary V HOPS program, welcoming students weekly from numerous schools in Montréal. Under the directorship of Drs. Igal Sebag and Rudski, the JGH hosted the 7th Annual JGH-McGill Imaging Symposium in June, with over 200 participants. Dr. Rudski co-chaired the 18th annual Canadian Echo Weekend (Canadian Society of Echocardiography) in April, with over 600 attendees. Dr. Afilalo co-chaired McGill’s Annual Cardiology Research Day. Dr. David Langleben was a member of the Steering Committee, International PH Science Forum, Berlin, Germany, April 2016.

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Clinical innovation - The following initiatives are in progress at the MUHC: Development of the cardiogenetic clinic for inherited arrhythmia syndromes (Drs. Martin Bernier and Jacqueline Joza); a familial hypercholesterolemia (FH) website for patients, the FH Canadian registry and the development of FH software (Apple and Android) application (Dr. Genest); the Coronary Total Occlusion Fellowship Program in collaboration with JGH; Expertise in complex CPI in patients with a left ventricular support device (Impella) – unique in Canada. The delivery of clinical care at the JGH was transformed, with a move to Pavilion K - the Critical Care Pavilion, and with the merger of the Division of Cardiology with the Division of Cardiac Surgery. Each clinical teaching unit is comprised of both surgical and medical patients, and is staffed by physicians, surgeons and advanced nursing resources. Additional program development included the establishment of a pericardial diseases program directed by Dr. Vartan Mardigyan, and a cardiac palliative care program, directed by Dr. Caroline Michel. What we envision as major threats to academic activities - We lack the ability to recruit due to lack of PEMS and inadequate funding for clinical volumes needed. Academic activities continue to face significant challenges in our current health care delivery model. Rising clinical demands have transformed the focus of health care at academic centers from a balance of clinical activity, teaching and research to a more service-oriented model. CLINICAL EPIDEMIOLOGY Noteworthy events - Dr. Theresa Gyorkos received the 2016 Vic Neufeld Mentorship Award in Global Health Research from the Canadian Coalition for Global Health Research. Dr. Robyn Tamblyn received the National Award for Infoway’s ImagineNation Challenges from Canada Health Infoway. Dr. Louise Pilote was awarded the Women of Distinction award from the Women’s Y Foundation, in recognition of her impact in the field of health research. The Division of Clinical Epidemiology, a recent addition to the JGH Department of Medicine includes two members, Dr. Kristian Filion and Dr. Samy Suissa, the Chief of the Division. Research - At the MUHC, there were publications that received a high level of media attention. For example, Dr. Tamblyn was senior author on a report describing treatment indications for antidepressants prescribed in primary care in Quebec; she was interviewed by CTV news and Radio Canada International; the study was reported in Time magazine, the Huffington Post, the Los Angeles times, and the websites of other national and international news organizations. Dr. Pilote conducted interviews in 2016 discussing her innovative work studying sex and gender differences in cardiovascular disease with the Montreal Gazette, the National Post, Le Devoir and La Presse. Her work was also highlighted by BBC World Service, TVA Nouvelles and CBC Daybreak.

Division members received new research operating grants. Dr. Isabel Fortier received a $1.3 million grant from the CIHR entitled Research Advancement through Cohort Cataloguing and Harmonization (Reach). Related to her pioneering work on data harmonization, she published in the International Journal of Epidemiology guidelines for rigorous retrospective data harmonization. Dr. Pilote successfully secured funding through the Canadian Vascular Network for: bioMarkers linking Obstetric events to Major cardiovascular outcomes and Cognitive Impairment following Pre-Eclampsia: of mice and women. Dr. Paul Brassard received grants from the Réseau FRQS-Sida-Maladies Infectieuses (The Impact of Food Insecurity on CD4 Count and Viral Load among HIV/HCV co-Infected people in Canada) and Diabetes Canada (Type 2 diabetes, its treatment with metformin, and the incidence of viral-induced cancers). Dr. Kaberi Dasgupta received grants from Diabetes Canada (Stigma and Its Impact on Glucose Control

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Among Youth With Diabetes (STIGMA)) and from the Lawson Foundation ( Partnering with the Cree to develop, implement, and evaluate a sustainable diabetes prevention strategy in young families with a gestational diabetes history). Dr. Sara Ahmed received a CIHR grant for the project “Maximizing the effects of self-management interventions on chronic disease outcomes: implementation of a chronic disease patient health portal in primary care”.

At the JGH, Dr. Suissa is the principal investigator of the Canadian Network on Observational Drug Effect Studies (CNODES), and oversees funding of $17.5 million received from CIHR for this network. CNODES assembles the top pharmaco-epidemiologists in the country and uses a collaborative, population-based approach, exploiting existing healthcare databases across the country and using sophisticated, cutting edge and powerful analytical methods to rapidly evaluate the risks and benefits of medications on the health of Canadians. Dr. Suissa’s research specializes in the exploitation of existing computerized health databases to rapidly evaluate drug safety. He has conducted pharmaco-epidemiological studies of several medications used for the treatment of chronic diseases, including asthma and COPD, cardiovascular and rheumatic diseases, and women’s health issues. Dr. Filion was awarded two grants in 2016 by CIHR: Incretin-based drugs and the risk of adverse renal outcomes and the Canadian Network for Observational Drug Effect Studies CNODES (DSEN Collaborating Centre for Observational Studies). He also published in the New England Journal of Medicine as first author.

Teaching - Dr. Mark Goldberg led the development of a new graduate program in environmental and occupational health. The program has been approved by the Ministry of Education and McGill University. Dr. Dasgupta, Director of the MUHC Division, along with colleagues Drs. Gyorkos, Nancy Mayo, and Fortier, is working to create an MSc. Clinical Epidemiology option specifically targeting clinical trainees.

Dr. Suissa leads the Pharmaco-Epidemiology Summer Program in the Department of Epidemiology and Biostatistics which holds 4 courses each summer and in which he teaches the Advanced Pharmacoepidemiology course. Dr. Filion is an instructor in the course entitled “Knowledge Synthesis” and in “Systematic Reviews and Meta-Analyses” and a co-instructor in the course entitled “Intermediate Pharmacoepidemiology”.

Involvement in the community - Dr. Suissa is a member, External Advisory Board, PROTECT-European Medicines Agency, the Drug Safety and Effectiveness Network (DSEN), Interim Science Advisory Committee (ISAC), Canadian Institutes for Health Research. He participates in the Summer Course on Pharmacoepidemiology and Drug Safety, Utrecht, Netherlands and has a Research and training collaboration with Clalit Health in Israel. Dr. Filion is on the 50th Anniversary Program Committee, Society for Epidemiologic Research and serves on several steering committees for major clinical trials.

Dr. Nitika Pai presented her HIV! SMART application at a Results Canada meeting held in Ottawa in May 2016 and was a keynote speaker at a National Institutes of Health meeting held in Washington in May 2016 on HIV self-testing. Dr. Tamblyn was invited speaker at the House of Commons in May 2016 in a discussion on the implementation of a national Pharmacare program. She was also the invited moderator at an international summit hosted by the federal Ministry of Health entitled Reigniting Health Systems, Sparking Population Health Solutions - Research for a Healthier Future. Also in the arena of knowledge translation, Dr. Mayo developed a self-management workbook titled Getting on with Your Life with Multiple Sclerosis (GETONMS).

Division members led important international meetings. Dr. Gyorkos, as Director of the PAHO/WHO Collaborating Centre for Research and Training in Parasite Epidemiology and Control, successfully applied to the Rockefeller Foundation to co-host, with the World Health Organization, an Advisory Meeting on Deworming in Girls and Women of Reproductive Age. In addition, a grant from the Institute

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of International Education was awarded to Dr. Gyorkos to support the travel of participants from developing countries to attend this meeting. Dr. Susan Bartlett co-chaired the NIH-Patient Reported Outcomes Measurement Information System (PROMIS) meeting held in Copenhagen, Denmark. She also co-led the development of OMERACT (Outcome measures in rheumatology) guidelines for rheumatoid arthritis flares. Dr. Dasgupta is a member of the Central Review Committee for Hypertension Canada guidelines.

Drs. Michal Abrahamowicz, Sasha Bernatsky, and Pilote co-lead the CAnadian Network for Advanced Interdisciplinary Methods for comparative effectiveness research (CAN-AIM). Its objective is to respond to key knowledge gaps regarding drug safety and effectiveness by answering queries which arise from Health Canada and other regulatory parties. They have received CIHR funding to study Intravitreal bevacizumab for retinal conditions: real-world safety assessment, Pharmacoepidemiology in multiple sclerosis, Pharmacoepidemiology in Hepatitis C, and Early Arthritis Cohort Drug Safety and Effectiveness.

What we envision as major threats to our academic activities - The MUHC Division of Clinical Epidemiology is working to redefine its role in the context of the Centre for Outcomes Research and Evaluation (CORE), a centre that evolved from the Division of Clinical Epidemiology itself.

CRITICAL CARE Several of the members of the MUHC Department of Critical Care are appointed within the Respiratory Division and their research and teaching is mentioned under this division.

Clinical innovation - The most noteworthy clinical evolution in the department has been the on-going development of an extracorporeal circuit program for patients requiring pulmonary and/or circulatory support.

We have been faced over the past year with an increasing demand from the Emergency Department and from, in particular, the cardiac catheterization lab to treat patients with extracorporeal membrane oxygenation(ECMO) in the context of acute myocardial infarction in the case of the former and in the context of percutaneous cardiac interventions, in the latter. Given that this therapeutic approach is becoming accepted we have embarked on an ambitious program of establishing a very structured approach to the management of these patients.

Under the direction of Dr. Gordon Samoukovic, we are establishing treatment pathways for veno-venous and veno-arterial ECMO by elaborating eligibility criteria, identifying individuals within and without Critical Care with the expertise to establish arterial and venous conduits, introducing a robust nurse –education program in which nurses would be enabled to care for the ECMO and developing both an ECMO team and a code ECMO process. This program will be buttressed by a research curriculum with which the McGill group will be able to add substantively to the published ECMO literature.

Finally, while within the purview of Critical Care, this endeavor will involve a myriad of health professionals, ethicists, and researchers.

DERMATOLOGY Noteworthy events - Dr. Therese El-Helou was voted the McGill Dermatology staff Teacher Award of the Year 2016. Research - The Canadian Dermatology Foundation awarded a grant to Dr. Denis Sasseville for a project entitled “Occupational contact dermatitis in Canadian Aircraft Industry: A 25 year retrospective study”.

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There is an ongoing program of research into the molecular mechanisms underlying cutaneous T cell lymphoma by Dr. Sasseville.

Teaching - The members support teaching at many levels from undergraduate to postgraduate teaching. The dermatology program is fully accredited and supervised by two program directors, Drs. Linda Moreau and Mathieu Powell. Dr. Sasseville is involved in supervising two residents through a Masters Program in the Division of Experimental Medicine, a new program within the MUHC Division of Dermatology. The teaching sites for the program includes the new hospital adult RVH, the MCH, as well as the MUHC hospital MGH and the JGH. The dermatology program has on average 20 full-time dermatology residents who rotate through dermatology clinics on a regular basis. The Division service also participates in teaching basic dermatology to Herzl and CLSC Family Medicine residents as well surgical and technical skills to basic dermatology and provides teaching of surgical, medical and technical skills to medical student electives and visiting physicians/dermatologists.

Involvement in the community – Most of the MUHC teaching staff have significant involvement in community practice to improve accessibility to patient care. There in a Psoriasis "Talk To Patients" 7 to 9:30 PM on Tuesday, yearly, with Drs. Howard Yanofsky and Robin Billick.

Clinical Innovation - The JGH Division of Dermatology has continued to see an increasing number of patients’ visits in consultation - referrals from emergency, oncology, infectious diseases, rheumatology, Herzl family medicine, and CLSC. The MUHC Glen polyclinic area offers access to dermatology consults to add in multidisciplinary care.

What we envision as major threats to academic activities - Cuts in PEMs are making the recruitment of academically oriented physicians within the hospital workforce difficult. The new rules for fellowship and residency positions have created a significant constraint, refusal of applicants based on limited funded positions has discouraged motivated graduates from completing a fellowship and from being recruited to the hospital necessitating those specific services.

ENDOCRINOLOGY AND METABOLISM Noteworthy events - Dr. Natasha Garfield was voted the Best Teacher Award in Endocrinology. Dr. Stéphane Laporte was appointed Director, Réseau québécois de recherche sur les médicaments. Dr. Barry Posner is Associate Director of the Montreal Diabetes Research Center. Dr. Robert Sladek was involved in the preparation of the strategic plan for the Aljouf University Medical College Diabetes Research Centre and is a steering committee member for the international consortia for genetic studies of type 2 diabetes (DIAGRAM), glycemic traits (MAGIC), a working group member of the TOPMED-T2D whole-genomic sequencing study for T2D and cardiometabolic disease and a steering committee member for the FNIH Accelerating Medicine Partnership. Dr. Jean-François Yale is a steering committee of the Exscel Trial, Start Trial and Global principal investigator of Titration trial.

Research - A variety of new grants have been secured; CIHR grant (Drs. Richard Kremer and Maia Kokoeva), Zavalkoff Family Foundation (Dr. Louise Larose), US Department of Defense (Dr. Tommy Nilsson), NSERC Discovery Grant (Dr. Simon Wing).

Teaching - Dr. Juan Andres Rivera has developed a Phantom Neck Simulation for Fine-Needle Aspirations. Dr. David Goltzman is writing a chapter in Up-to-Date on Hypocalcemia. Involvement in the community - Division members gave many invited international lectures, participated in the writing of practice guidelines for diabetes, neuroendocrine tumours and were extensively involved in grant reviews for major funding agencies; CIHR (Drs. Kremer, Goltzman, Geoffrey Hendy, Laporte, Jun-Li Liu, Christian Rocheleau, Sladek), NIH Board of Scientific Counselors (Drs.

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Goltzman and Liu), Netherlands Organization for Scientific Research (Dr. Kokoeva), Diabète Québec (Dr. Larose), FRQS (Drs. Larose, Rocheleau, Sladek, Wing), CFI Leaders (Dr. Larose) and the Canadian Diabetes Association (Dr. Liu). There was also major participation in the organization of symposia/scientific meetings: Vitamin D workshop program (Dr. Kremer), Pan American Health Organization Meeting in Lima (Dr. Sara Meltzer), Canadian Neurometabolic Club (Dr. Kokoeva), 6è Journée Scientifique du RQRM (Dr. Laporte), 7th Proteasome and Autophagy Workshop, France (Dr. Wing), Diabète Québec (Dr. Yale) and Diabète International (Dr. Yale). Division members are on editorial boards of 12 major journals. Clinical innovation - There is a Diabetes Transition Clinic for adolescents to move to adult clinical care (Dr. Garfield); Multidisciplinary Islet Transplantation Clinic: Three islet transplantations have been performed to date (Drs. Meltzer, Steven Paraskevas, Yale); Thyroid Teaching Clinic at the Glen (Dr. Jacques How); Bariatric Multidisciplinary Clinic (Drs. Michael Tsoukas, Wen Hu). What we envision as major threats to academic activities - Lack of renewal of the PhD research stream and decreasing clerical support of the Division. GASTROENTEROLOGY Noteworthy events - Dr. Dean Soulellis was awarded the Teacher of the Year award by the residents. Dr. Elise Vuille-Lessard, internal medicine resident, was awarded the student research prize from the Canadian Association for the Study of the Liver (CASL) and two scholarships (Canadian Association for HIV Research and International AIDS Society). Dr. Thomas Pembroke, a hepatology fellow, was awarded the student prize from the FRQS – Réseau SIDA MI for the best oral presentation. Dr. Kevin Waschke received a Royal College Award - Accredited Provider Innovation Award for work of CAG SEE program (colonoscopy skills improvement course). Dr. Alain Bitton was promoted to Full Professor.

Research - Dr. Alan Barkun received a large grant as PI for Pan-Canadian investigator initiated series of RCTs evaluating colonoscopy preparations. Dr. Giada Sebastiani was nominated as the Canadian representative in an international research initiative SHIVER - Steatohepatitis in HIV Emerging Research Group. Dr. Bitton received a grant as a co-investigator for a Canadian Quality Assurance Project PACE (Promoting Access and Care through Centers of Excellence from Crohn’s Colitis Canada).

Teaching - Dr. Peter Ghali remained undergraduate medical education director for the Department of Medicine. He continued to develop and implement the new Internal Medicine curriculum. He helped introduce the new cardiology simulation program using the simulation manikin HARVEY. Dr. Marc Deschenes contributed to a novel educational initiative with l’Institut national de santé publique du Québec to educate physicians on hepatitis C. Dr. Gad Friedman organized educational seminars for McGill gastroenterology nurses.

The Gastroenterology program received full accreditation during the McGill internal review process.

Involvement in the community - Dr. Kevin Waschke served as the Canadian Association of Gastroenterology VP for educational affairs and was educational lead for the skills enhancement in endoscopy program. Dr. Ernest Seidman was President of the organizing committee and host of the 5th World Congress of Pediatric Gastroenterology, Hepatology and Nutrition, Montréal, Oct. 2016. Dr. Phil Wong was vice-chair of the committee responsible for creating and implementing the Area Focus Competence diploma in hepatology for the Royal College and was also chair of the section of Hepatology, Biliary and Pancreas for the Competency by Design change in educational structure.

The Division was involved in many scholarly activities including (i) steering committees for National Consensus Guidelines in IBD Quality indicators (Dr. Bitton as chair, Dr. Peter Lakatos), H. Pylori (Dr. Carlo

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Fallone), international Clinical Practice Guidelines on the management of patients with non-variceal upper GI bleeding (Dr. Barkun); (ii) organization and contribution to the post-graduate course, scholar’s course and conferences at the Canadian Association of Gastroenterology annual meeting (Dr. Waschke); (iii) organizer (provincial) (Drs. Bitton, Waqqas Afif) and co-organizers (national) for conferences, mentoring in IBD (Dr. Bitton), co-organizer of the Quebec liver fibrosis forum (Dr. Sebastiani), development of the AGEQ post graduate course in hepatology (Dr. Marc Deschenes); (iv) VP secretary of the Canadian Association of Gastroenterology (Dr. Fallone); (v) executive board member of the Canadian Digestive Disease Foundation (Dr. Fallone); (vi) chair of Quebec Colorectal Cancer screening guideline committee (Dr. Barkun); (viii) president of the Quebec Association of Gastroenterology (Dr. Josée Parent).

Dr. Barkun continued his volunteer work teaching gastroenterology and endoscopy in Morocco at the only Annual GI Course for French Magrebian and Subsaharan Africa. Dr. Paul Cleland continues to work in Nunavik 10 weeks a year providing much needed GI care. Clinical innovation - The MUHC IBD center, opened at the MGH in late 2015, offers an innovative, multidisciplinary platform for delivery of care to IBD patients, integrated with clinical research and teaching. Dr. Barkun chaired the Quebec Colorectal Cancer Screening Program multidisciplinary committee, updating clinical guidelines for the province. Dr. Soulellis continues to take the GI lead on the Duodopa PEG/PEJ program in conjunction with the Movement Disorder Clinic for patients with advanced Parkinson’s disease. The Quebec Fibrosis Network, under the leadership of Dr. Sebastiani, and in collaboration with l’Université de Montréal, has continued to provide non-invasive diagnostic tests for individuals at risk of liver disease (HIV infected, IBD). At the JGH a multidisciplinary clinic screens and follows hereditary GI cancer patients long-term, with a genetic counselor and has a unique registry for comprehensive follow-up and for research.

What we envision as major threats to academic activities - (1) Cuts in budget /resources and clerical reorganization have required significant time and energy, compromising research and academic activities. 2) The imposed clinical volume cuts are pressuring divisions to export some of the clinical activities to outside clinics, fragmenting the division. 3) The reduction in PEMS has been a serious threat as fewer physicians are available to provide care for the high volume of in- and out-patients pulling them away from academic activities. 4) Decrease in resident’s spots for the 2018 year will reduce the critical mass needed to have a well-balanced clinical and academic residency program. GENERAL INTERNAL MEDICINE (GIM) Noteworthy events - The Division of General Internal Medicine members play leadership roles at the hospital and university levels including associate deans, undergraduate and postgraduate teaching coordinators, clinical teaching unit directors, physician-in-chief (JGH) and associate physician-in-chief (MUHC). Division members are international leaders in medical education, quality improvement, cardiovascular, hypertension, thrombosis, osteoporosis, and diabetes research. Dr. Louise Pilote stepped down from her role as the McGill University and MUHC Divisions Director and was replaced by Dr. Vicky Tagalakis as McGill Division Director and by Dr. Thomas Maniatis as the MUHC Division Director. Dr. Ernesto Schiffrin was awarded The 2016 Margolese National Heart Disorders for advancing the understanding of high blood pressure’s effects on vasculature. He was one of 3 of Canada’s leading researchers in brain health, heart health and cancer to have been singled out by the University of British Columbia Faculty of Medicine for their accomplishments. Dr. Beth-Ann Cummings

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was appointed Associate Dean, Undergraduate Medical Education in January 2016. Dr. Ning-Zi Sun was appointed Assistant Program Director of the Core Internal Medicine Training Program. Dr. Linda Snell received the Ian Hart Award for Distinguished Contribution to Medical Education, Canadian Association of Medical Education. Dr. Susan Kahn received the Canadian Society of Internal Medicine (CSIM) 2016 David Sackett Award. Dr. Jeff Wiseman received the CSIM 2016 Osler Award and was one of 11 laureates for the McGill Faculty of Medicine Award for Teaching in the Transition to Clinical Practice course in internal medicine. Dr. Cummings was named to the 2016 Faculty Honour List for Education Excellence. Dr. Stella Daskalopoulou received the MUHC Department of Medicine Early Career Staff Research Award. Dr. Blair Schwartz received the JGH Department of Medicine Teacher of the Year Award, voted by residents. Dr. Khue Ly received the MUHC Department of Medicine Physicianship Award, as an exemplary physician. These awards spotlight the achievements and leadership of women and men in many sectors of Montréal, whose paths serve as models for all. Research - Dr. Tagalakis initiated a Canadian multi-center clinical study to address the role of dose reduction of low molecular weight heparin in the long-term treatment of cancer-associated thrombosis. Dr. Daskalopoulou obtained 2 new CIHR grants; Unraveling the mechanism of action of the adiponectin receptor pathways in a humanized in vitro model of carotid plaque instability; Adiponectin receptor pathway as a key player in carotid atherosclerRotic plaque instability. Dr. Suzanne Morin received a large grant for her eHealth innovative project,“Smart soles” in shoes to help patients recover from a broken hip. She was awarded a 2-year grant from the Dairy Farmers of Canada to study the effects of calcium on vascular health in postmenopausal women. Colchicine for prevention of perioperative atrial fibrillation in patients undergoing thoracic surgery (COP-AF) is studied by Dr. Pilote. She was an author of the 2016 Canadian Cardiovascular Society Perioperative Cardiac Assessment Guidelines. Drs. Todd Lee and Emily McDonald were awarded a CIHR grant as co-principal investigators to reduce potentially inappropriate medications amongst the elderly and are co-investigators on a grant from the Canadian Frailty Network. Dr. Steven Grover initiated the McGill Comprehensive Health Improvement Program (CHIP) Healthy Weight Program based on the Diabetes Prevention Program and results of two CIHR funded clinical research trials at CHIP. He received a Rossy Cancer Research Grant to develop an exercise program for survivors of breast cancer. Additional funds were obtained from philanthropy to include men with prostate cancer in the program. He was selected by the Canadian Heart and Stroke Society to develop the web-based lifestyle management platform for a three year national proof of concept study to reduce the risk of CVD among Canadian adults with pre-hypertension. Dr. Snell was an author of a series of articles on competency-based education and that appeared online in 2016. Dr. Wiseman continues his work as co-investigator in the Learning Environments Across Disciplines (LEADS) international partnership grant sponsored by the Canadian Social Sciences and Humanities Research Council. Teaching - The following are extraordinary resident successes in 2016: Dr. Romina Pace received FRQS résident chercheur funding and will investigate shared cardiometabolic risk factors in couples in the Eeyou Istchee region of Quebec. Dr. Isabelle Malhamé was accepted to the Women & Infants Fellowship in Obstetric & Consultative Medicine at Brown University. Dr. Sam Mamane was the first R4 to win the newly established JGH Fellow of the Year Award to recognize excellence in the training and formation of the JGH internal medicine residents. The medical smartphone-based game (Dr. Wiseman), The Deteriorating Patient (DP) App, is now ready to beta test with 3rd and 4th year medical students and PGY1 residents. This app will help medical students practice stabilizing patients suffering from 6 basic common emergencies. It is designed to be

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used as an integral part of the Early Recognition of and Response to Acute Deterioration in hospitalized patients (ERRAD) course to provide learners with deliberate practise with feedback in addition to teaching from live tutors. The HOWARD (Helping Others With Argumentation and Reasoning Dashboard) project is a new software designed to help problem-based teachers supervise multiple student learning groups simultaneously and “diagnose” common student group problems. The Thrombosis Medicine fellowship program based at the JGH is internationally recognized as a leading clinical and research training centre, attracting both local and international trainees. It encompasses a broad range of clinical and research activities that relate to thrombosis. The program is an integral component of the JGH’s Centre of Excellence in Thrombosis and Anticoagulation Care (CETAC). Dr. Sun developed the flipped classroom into the academic ½ day of the core internal medicine residency program to increase interactive learning centered on knowledge application and synthesis. This is an innovative project and GIM is the first postgraduate program to apply it on a large scale in its formal curriculum. Clinical innovation - Dr. Maniatis is spearheading the MUHC Complex Care Centre. The GIM and Complex Care Clinic at the RVH was initiated in November 2015. In addition to coordinating referrals from Family Medicine and subspecialties in the McGill RUIS, the clinic receives patients with complex disorders transitioning from the Children’s hospital, including patients with cystinosis and hereditary hemorrhagic telangiectasia. A similar initiative was started at the MGH in June 2016, and will help to support the development of a GIM-led Medical Day Hospital and Rapid Assessment Unit. Dr. Jed Lipes is the Director of the Diagnostic and Therapeutic Clinic (DTC) at the JGH. The DTC is a rapid access internal medicine clinic with dedicated nursing, procedural capabilities on site, therapy rooms (transfusions, IV medication) and dedicated access to radiology. The DTC is equipped with a procedure room and point-of-care ultrasound and the capacity for a number of diagnostic procedures. Involvement in the community - Division members are active internationally and nationally through their roles at the American Journal of Hypertension (Dr. Schiffrin, Editor-in-Chief), the Canadian Medical Association Journal (Dr. Ken Flegel, Senior Editor, Research), in the Canadian Society of Internal Medicine and the Royal College of Physicians and Surgeons. Dr. Daskalopoulou became chair of the Central Review Committee of the Hypertension Canada Guidelines and Associate Leader of the Cardiovascular Health Across the Lifespan Program, MUHC-RI. Dr. Lee was appointed to the Association of Medicine Microbiology and Infection Disease (AMMI) Canada Clostridium difficile guidelines writing group. Dr. Snell is an advisor for faculty development for the RCPSC Competency Based by Design (CPD) initiative. She collaborated in developing a very successful 4-day McGill international course on Faculty Development. Dr. Emily McDonald is the Quebec lead for the Choosing Wisely Canada and she participated in the organization of the first McGill High Value Healthcare Summit, inviting international guest speakers including Dr. Vikas Saini and Dr. Wendy Levinson. Dr. Pickering is the vice-chair of the executive board of the Medical Council of Canada. The Division provides consultations and clinics in CS Tulattavik, Kuujjuaq and in Chisasibi, working with the Nunavik Regional Health Board to organize Télésanté services in the northern regions and to assist in coordination of specialized care between the MUHC and the northern health centres. Dr. Romina Pace is the first GIM graduate with a position in the Cree Territories. Drs. Patrick Willemot and Pace are working to build a regular GIM consultation service including echocardiography, exercise stress testing, telehealth and e-mail support to Eeyou Istchee.

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The GIM Global Health Haiti Project has grown to two rotations per year. In 2016, Drs. Han Yao and Elise Veuille-Lessard were the first two recipients of the new travel awards from Postgraduate Medical Education and the McGill Global Health Program. They made their first trip to Haiti in November, along with two R5s, Drs. Belinda Go and Isabelle Malhamé, and faculty members Drs. Pilote, McDonald and Veronique Naessens (Division of Hematology). Dr. Pilote and two research colleagues received a Steinberg Grant, McGill Global Health Program, to address two major pregnancy-related non-communicable diseases prevalent in Haiti. The researchers implemented a screening strategy to measure the problem of gestational hypertension/preeclampsia and diabetes among Haitian women. This information will help develop a local treatment strategy and its measured impact on maternal and neonatal health outcomes. What we envision as major threats to academic activities - Bed closures, imbalances in patient mix between sites, and stifling of clinical programs impact on our teaching programs, and patient recruitment into our research programs. Lack of mentoring resources is a challenge to new clinician-researchers. GENERAL INTERNAL MEDICINE RESIDENCY PROGRAM (R4-R5) Noteworthy events - In July 2016, 6 new residents joined the GIM Program, a return to the average cohort entry after the unusually large cohort of 11 incoming in July 2015. The total number of residents in the program is 21 residents for the 2016-2017 academic year. The GIM Program increased career counseling for GIM residents, with multimodal approaches including assessment of all GIM PEMs and rest-of-Canada GIM positions, one-on-one career counselling, and ongoing yearly GIM-specific workshop with presentation from new graduates (academic and community), ASMIQ and FMRQ. In addition CV writing/review and job interview workshops were held in response to resident feedback. There was excellent success in job placement of graduates with variety of jobs spanning the spectrum of roles of GIM in medicine (academia to community, metropolitan to rural, Québec and rest of Canada), sustained throughout many years of high resident numbers. Teaching - A non-invasive cardiology rotation was re-developed to ensure competency of graduates in stress testing, Holter monitor interpretation and 24-hour BP monitoring. In collaboration with the Faculty of Management, a high level communications and inter-professional conflict resolution workshop was held. A regularly scheduled GIM program review of all core rotations and updating of goals and objectives and ITERs to CanMEDS 2015 standards was performed. GERIATRICS Noteworthy events: Dr. Howard Bergman is co-honorary President of the Société francophone d’oncogériatrie and received the Prix reconnaissance de la Société québécoise de gériatrie for his commitment to the development of geriatric medicine in Québec.

Research - The team of investigators under the leadership of Drs. Russ Hepple and José Morais from the MUHC-RI have been extremely active in the area of aging muscle with support from the CIHR. They showed 1) persistence of the reduction in single muscle fiber rate of force development with aging even in world class older masters athletes; 2) that denervation modulates mitochondrial function in skeletal muscle of octogenarians and 3) the impact of aging, physical activity, and pre‐frailty on skeletal muscle phenotype, mitochondrial content, and intramyocellular lipids in men. The team of Dr. Andrea LeBlanc from the LDI-JGH has made important discoveries by showing increased Caspase-6 activity in the human

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anterior olfactory nuclei of the olfactory bulb is associated with cognitive impairment. Dr. Stephanie Chevalier and Morais, using the data from the Quebec Longitudinal Study on Nutrition and Aging (NuAge), have shown that a more even distribution of protein intake in daily meals can slow down the rate of lean mass loss in free-living older adults which should contribute to maintain mobility and functional autonomy with aging. Dr. Lisa Koski and other co-investigators from Neurology are investigating, in collaboration with Dr. Zahra Kazem-Moussavi from the University of Manitoba, the efficacy of high-frequency rTMS treatment for Alzheimer's disease with funds from the Weston Brain Institute. This treatment modality is showing promise to deal with the threat of Alzheimer’s. The team of Dr. Nancy Mayo and Morais have developed a clinical relevant scoring system to measure frailty, called the “Frailty Ladder” with funds from the Canadian Frailty Network that would be sensitive to interventions. They have also tested a technical biofeedback device developed by Professor Robert Kearney PhD from Department of Biomedical Engineering to improve gait in vulnerable populations, including older adults. A YouTube video on this device is available at: https://www.youtube.com/watch?v=GPof-8nbutg. Teaching - Geriatrics is a mandatory rotation during the 4th year of medical clerkship with most of the students (100) rotating through the MUHC and JGH. The Division also assures a rotation at the Gatineau Hospitals as part of the RUIS McGill. This year, we had two residents in the Geriatric Fellowship program and one in the Care of the Elderly Program (Family Medicine stream) and well as many internal medicine and family medicine residents that spend a month rotating in the Division. The student and resident evaluations have been very good to excellent and an increasing number of students having expressed interest in geriatric medicine as a career. These positive evaluations are a testimony to the hard work and dedication of all the teachers in the Division. Dr. Melanie Mondou is the Clerkship Director and Interprofessional Education Course Director in the administration of the MDCM program at McGill.

Involvement in the community - Dr. Howard Chertkow of the JGH is the leader of the Canadian Consortium on Neurodegeneration in Aging (CCNA). The goal of the program is to unite the clinical/research teams on neuro-cognitive disorders across Canada. Dr. Morais participates in the Exercise Nutrition and Life style Team as well as in the Motor and Cognition Team. Drs. Bergman and Isabelle Vedel participate in the Health Care Utilization Team. The McGill Division of Geriatrics held six Grand Rounds during the academic year that were well attended and open to public as well as to physicians of all backgrounds and allied health professionals. Several physicians of the Division act as consultants at Long Term Care Institutions and Rehabilitation Centers of the CSSS Cavendish and de la Montagne. The Division also provides consultation services at Lachine and Lakeshore Hospitals. Physicians of the Division participated in the McGill CME activities 2016: Thursday evening learning series and the Wednesday e-learning series. The Division organized the 13th Annual McGill Interdisciplinary Geriatric Seminar (MIGS) for family physicians and allied health professionals on September 29, 2016: “A Global approach to chronic illness during the time of chance”. It was a great success with nearly 100 participants from the RUIS McGill. Through its Centre d’excellence on Aging and Chronic Disease (CEViMaC) and under the leadership of Dr. Olivier Beauchet, the Division is participating in the implementation of Phase 2 of the Provincial Plan Alzheimer in the RUIS territory and particularly in the CIUSSS du Centre-Ouest-de-l'Île-de-Montréal. Of particular relevance is the clinical initiative of the CEViMAC in creating the Geriatric Inclusive Arts for patients with dementia involving them in painting and in music to assist in communicating verbally or non-verbally or in expressing their emotions. This initiative was highly acclaimed by the press: http://montrealgazette.com/news/local-news/vernissage-at-jewish-general-hospital-to-feature-works-by-geriatric-patients

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Clinical innovation - In the fall 2016, the Division created an academic level Falls and Mobility Clinic based at the MUHC - MGH site. This clinic performs a comprehensive assessment of fall risk and proposes remedial approaches to be completed in majority of the cases at local community resources. The Division is actively participating in each of the main teaching hospital centres of McGill University in the implementation of the Approche adaptée pour la personne agée, a MSSS program enabling hospitals to adequately address the problem of loss of autonomy of elderly inpatients during hospitalization.

What we envision as major threats to academic activities - The reduced number of geriatricians at the MUHC is reaching a critical threshold to be able to maintain the geriatric clerkship program.

HEMATOLOGY Noteworthy events - Dr. Nathalie Johnson was promoted to associate professor with tenure and Dr. Sarit Assouline became an Osler Fellow. At the MUHC, two major grants were awarded to Dr. Chantal Séguin (osteonecrosis), and Dr. Jean-Pierre Routy (HIV), respectively. Dr. Routy was also elected as a member of the CIHR HIV/AIDS Research Advisory Committee. At the JGH, Dr. Arthur Rosenberg retired after a 49 year career including 22 years as Chief. In 1982 he initiated Palliative Care at the JGH and was at the origin of the Molecular Pathology Laboratory. For Dr. Rosenberg, to be a hematologist was not a profession but a vocation and passion. Research - The Division had an excellent record of publication with a number in very prestigious journals. Since 2011, Dr. Johnson has developed the lymphoma axis of the “Banque des cellules leucémiques du Québec” located at the JGH, providing an infrastructure that has stimulated translational and basic lymphoma research in Québec and in Canada, resulting in 7 successful grant applications. Currently there are 27 ongoing clinical trials, 12 at the RVH site including 4 phase 1 studies, and 15 at the JGH site, including 7 phase 1 studies. The main topics are multiple myeloma (8 studies) and AML (6 studies). A stepwise change to Next-Generation-Sequencing (NGS) was successfully initiated in 2016 under the lead of Dr. Yury Monczak. In particular, immunoglobulin heavy chain-variable (IGHV) gene sequencing to detect somatic hypermutation within the IGHV gene region was transferred to the NGS platform. This test is important for prognosis and clinical management of chronic lymphocytic leukemia. NGS will also soon be applied in acute myeloid leukemia (AML) since the validation of the AML panel by this method (NGS) was successfully terminated end of 2016. Teaching - Dr. Chantal Cassis, Program Director of the McGill University Teaching Program and Director of the Hematology Fellow Program accredited by the RCPC in February 2015, has accomplished substantial work to further improve the Hematology Residency program. In preparation for the internal accreditation of April 5th, 2017, novel teaching strategies and enriched rotations have been added. In particular, Dr. Cassis has developed a research mentorship program for residents to increase resident research productivity. Dr. Gizelle Popradi developed a Stem Cell Transplant rotation with focused teaching for fellows including a strong HLA laboratory component and Dr. Geoffery Blake created a structured morphology review for fellows. A Health advocacy course has been introduced. A further innovative teaching approach requires participation in a quality improvement project. An excellent innovation is the monthly McGill Hematology Program Journal “BLOOD DROPS”, where all pertinent information concerning rotations, resident call on holiday periods, courses and seminars is covered. Involvement in the community - Dr. Martin Gyger was the invited speaker for the second Clinical Arthur Rosenberg Lecture at the JGH in June 2016 entitled “Bone marrow transplantation in Québec: past, present and future”. This lecture honours a clinician-scientist, whose accomplishments had and have a substantial impact on patient care and survival. Dr. Routy acted as a co-chair of the 84th Congrès de

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l’Acfas (Association canadienne-française pour l'avancement des sciences) held at UQAM from May 9-13, 2016. Clinical innovation - At the JGH, Dr. Mark Blostein fully computerized the Anticoagulation Clinic. A new nanotechnology approach to identify a prognostic biomarker in Hodgkin’s lymphoma is currently under investigation in the context of a 3D structural research project focusing on the molecular pathogenesis of Hodgkin’s lymphoma. This project occurs in collaboration with the Genomic Center for Cancer Research and Detection (GCCRD) at U of Manitoba in Winnipeg (Dr. Sabine Mai, PhD, Drs. Hans Knecht and Johnson). For cost-saving reasons autologous bone marrow transplants for myeloma are now performed as an out-patient procedure. What we envision as major threats to academic activities - The lack of new job opportunities for talented new hematologists and a substantial increase of administrative load (paper work) to try to get powerful new medications. INFECTIOUS DISEASES Noteworthy events - Dr. Marcel Behr received a CIHR Foundation award and was elected to the Canadian Academy of Health Sciences. Dr. Cedric Yansouni was awarded an FRQS Junior I Chercheur-boursier clinicien career award and received the Dr. Donald A. Henderson Prize for Outstanding Global Health Research from the McGill University Global Health Program. Dr. Don Vinh received the Young Investigator of the Year Award from the Canadian Association of Medical Microbiology and Infectious Diseases. Dr. Martin Olivier received the Robert Arnold Wardle Award from the Canadian Society of Zoology in recognition of outstanding research in the field of Parasitism, Immunity and Environment. Dr. Marina Klein received the Department of Medicine Senior Staff Research Award.

Research - Researchers in the Division continued their track record of success in attracting new peer -reviewed funding including a CIHR Foundation award (Dr. Behr); CIHR operating grants (Drs. Vinh, Lee); a US Department of Defence grant (Dr. Donald Sheppard); operating funding from FRQS (Drs. Yansouni, Giada Sebastiani from the Division of Gastroenterology and Cecilia Costiniuk), the Arostegui JR. Steinberg Fund for Interdisciplinary Global Health Research (Dr. Yansouni) and the NIH (Dr. Klein). Fundamental science investigators continued to shed light on the pathogenesis of mycobacterial (Drs. Behr and Michael Reed), fungal (Dr. Sheppard), parasitic (Dr. Olivier) and viral infections (Dr. Brian Ward). Notable among these was the report of Cryptosporidium hominis as an emerging pathogen in the Arctic, by Dr. Yansouni, and the description of a novel inherited immunodeficiency in the Quebec population conferring susceptibility to CNS fungal infection published by Dr. Vinh. In clinical studies, Dr. Behr reported on the effects of multiple exposures and the risk of progression to active tuberculosis. The infection control group reported on the utility of rapid diagnostics for viral respiratory infections in reducing antibiotic prescriptions (Drs. Charles Frenette and Makeda Semret) and their experiences with implementation of antimicrobial stewardship programs (Dr. Frenette). Drs. Vivian Loo and Yves Longtin highlighted the importance of identifying C. difficile carriage at the time of hospital admission. Pivotal clinical studies from members of the CVIS group reported on bridging clinical trial results to real life therapy for HIV/HCV coinfection (Dr. Klein), the natural history of neurocognitive decline in HIV infection (Dr. Marie-Josée Brouillette, Department of Psychatry); methods to diagnose non-alcoholic fatty liver disease in HIV infection (Dr. Sebastiani and patient engagement in clinical trial design (Dr. Bertrand Lebouché). In collaboration with other Canadian leaders in HIV care, Dr. Joseph Cox coauthored an AMMI-Canada Position statement on early use of antiretroviral therapy in HIV infection.

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In collaboration with Medicago, Dr. Ward has advanced a plant-made influenza vaccine successfully to the End of Phase 2 meeting with the FDA and was approved to enter Phase 3 studies in adults >18 years of age. Dr. Sheppard successfully prosecuted a national patent for the use of recombinant glycoside hydrolase enzymes as antibiofilm therapeutics for fungi and bacteria. Physicians at the Tropical Diseases Centre have initiated the first prospective surveillance project for nosocomial infections in a teaching hospital in Addis Ababa, Ethiopia (Drs. Semret, Yansouni). Teaching - The McGill Summer Institute in Infectious Diseases & Global Health was expanded to include the Integration of a Tropical Medicine Course (Drs. Libman, Yansouni) and Diagnostics for Tropical Diseases (Dr. Yansouni). International teaching activities included the summer course in Molecular Mycology, Woods Hole, Massachusetts (Dr. Sheppard); Gorgas Course in Tropical Medicine, Lima, Peru (Dr. Ward); IDSA/ASTMH Tropical Medicine Update Course and International Short Course in Clinical Tropical Medicine, Vellore, India (Dr. Libman); and the Neurology Clinical Update Course, Port-au-Prince, Haiti (Dr. Anne-Marie Bourgault). During 2016, two PGY6 residents passed their examinations in Medical Microbiology and both are now working as specialists in Quebec. In addition, four PGY5 residents passed their Royal College examinations in Infectious Diseases and continued their training in medical microbiology. The program welcomed one new PGY4 resident into our dual training program and one of our PGY5 residents was accepted by Stanford University for further training in a clinical microbiology fellowship program. During 2016 our 8 residents published nine articles in peer-reviewed journals, one textbook chapter and gave fourteen presentations at national and international conferences. We welcomed our first fellow in Tropical and Parasitic Diseases. Involvement in the community - Members participated as lead authors in national and international clinical care guideline development: ESCMID Guidelines for the management of invasive aspergillosis (Dr. Sheppard) and CATMAT Zika virus guidelines as well as Canadian Guidelines for strongyloidiasis (Dr. Libman). Dr. Ward was appointed to the CIHR Institutional Advisory Board for Prevention and Public Health. Dr. Klein was chair and co-organizer of the 3rd International HIV/Viral Hepatitis Co-Infection Meeting (AIDS 2016 Satellite Meeting) in Durban, South Africa and the 5th Canadian Symposium on HCV in Montréal. Dr. Frenette was appointed the chair of CNISP, the Canadian Nosocomial Infection Surveillance Program. Dr. Yansouni was appointed as a member of the Comité scientifique permanent des analyses de biologie médicale, Institut national d’excellence en santé et en services sociaux (INESSS), Québec. Dr. Vinh served as organizer, moderator and presenter at the meeting of the Association des patients immunodéficients du Québec during World Primary Immunodeficiency Week. Dr. Lebouché is leading Le Projet Engagement Patient, a study designed to increase engagement of persons living with AIDS in the design and conduct of clinical studies Other activities include participation in the Royal College of Physicians (Drs. Gerasimos Zaharatos and Matthew Oughton), Comité des infections nosocomiales du Québec (Dr. Longtin), International Society of Travel Medicine (Dr. Christina Greenaway), Committee to Advise on Tropical Medicine and Travel (Dr. Greenaway), and the Comité du programme provincial de diagnostic de laboratoire de l’infection à VIH (Dr. Zaharatos), Provincial Medical Microbiology Quality Assurance Committe; Association des médecins microbiologistes-infectiologues du Québec (Dr. Yansouni), AMMI Canada Grants and Awards Committee (Dr. Vinh as chair, Dr. Sheppard as vice-chair). Clinical Innovation - Several innovative approaches have led to implementation of improved methods of care. A standardized management scheme for Staphylococcus aureus bacteremia was introduced.

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Infection control initiatives led to an all-time low in our rate of C. difficile below 7/10000 patient days and VRE infection at the RVH site was reduced by 90 %. There was a reduced rate of surgical site infections through a proactive antimicrobial prophylaxis stewardship program and individual reports to all surgeons with significant improvements (no infections in liver transplants in 2016 and only one in kidney transplant). Infection control bundles were introduced to decrease ventilator associated pneumonia in the ICU. What we envision as major threats to academic activities - Increased clinical and administrative workload in the face of manpower restrictions imposed by the PREM system; increased teaching load as a consequence of curriculum reforms and Royal College requirements; reduced levels of administrative support due to budget cuts – workload transferred to faculty. MEAKINS-CHRISTIE LABORATORIES (MCL) Noteworthy events - These laboratories are the major site dedicated to fundamental research in respiratory diseases and to the training of graduating students and postdoctoral fellows. MCL faculty were successful in receiving Chercheur-boursiers and Chercheurs-boursiers cliniciens awards from the FRQS (Dr. Carolyn Baglole - Junior 2, Dr. Sushmita Pamidi - Junior 1, Dr. Jason Shahin - Junior 1, Dr. Ilan Azuelos - Formation pour les médecins residents visant une carrière en recherche). Drs. Baglole and Dao Nguyen were promoted to Associate Professor with tenure at McGill University. Dr. Nguyen received the 2016 Cystic Fibrosis Research Innovation Award (for a junior investigator). Dr. Bruce Mazer was appointed Interim Executive Director and Chief Scientific Officer, RI-MUHC. Dr. Christine McCusker was honoured as the inaugural recipient of the Canadian Society of Allergy and Clinical Immunology’s (CSACI) F. Estelle R. Simons Award for Research. She was also invited to speak during the launch of the MUHC Foundation’s Discovery Club to communicate how researchers at the RI-MUHC are defining the future of research. Research - MCL investigators received five new CIHR Project Scheme grants, one Discovery Award from the Department of Defense (USA), grant support from the Cystic Fibrosis Foundation, an industry-researcher partnership (Engage) grant from NSERC, as well as industry funding from the Boehringer-Ingleheim’s Innovation in Understanding Interstitial Lung Disease (BUILD) program. Over 60 publications were authored by MCL member, including publications in high-impact journals such as Autophagy, J Pathology, Thorax, Am J Respir Crit Care Med, and J Immunology. Dr. Maziar Divangahi, together with an international consortium, published the first Primer on Tuberculosis in Nature Reviews Disease Primers. A study by Dr. Larry Lands reinforced the importance of implementing newborn screening for Cystic Fibrosis in Quebec. The GET-FACTS (Genetics, Environment and Therapies: Food Allergy Clinical Tolerance Studies) study co-led by Dr. Mazer is having great success with helping children with milk allergies build up tolerance to milk protein by introducing the allergen very slowly into the diet. MCL members continue to be invited to present at, chair, and organize scientific sessions at international conferences such as the American Thoracic Society and the European Respiratory Society. Teaching - Dr. Anne-Marie Lauzon continues to be the Director of the Division of Experimental Medicine. MCL trainees were extremely successful in receiving FRQS funding in (2 Masters awards, 2 Doctoral awards, and 2 Postdoctoral awards) as well as CIHR funding (1 CIHR Postdoctoral fellowship and 1 Frederick Banting and Charles Best Canada Graduate Scholarship Doctoral Award). Dr. Benoit Allard (postdoctoral fellow with Dr. James Martin) received a prize for best oral communication during the 2016 Congrès québecois en santé respiratoire. Trainees at the MCL are exposed to a structured training program that includes weekly research seminars with prominent national and international guest

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speakers and weekly work-in-progress presentations. An annual Respiratory Research Day provides a forum for the presentation of clinical, basic, and translational research from all trainees. This year, a formal committee-based training program for postdoctoral fellows was established. A yearly meeting with the postdoctoral fellow, supervisor, and a selected committee ensures that the postdoctoral fellow has all the appropriate scientific support, resources, and mentorship to achieve both their scientific and professional development goals. Yearly workshops organized by the MCL are open to all trainees, staff and faculty to attend. The 18th Annual Meakins-Christie International Workshop on Asthma and Chronic Obstructive Pulmonary Disease, in collaboration with the Strauss Severe Asthma Program, was held in Montréal, QC and hosted national and international experts to discuss and present the latest research on these multifactorial airways diseases. This year, MCL received a CIHR Dissemination Grant to organize the Monocyte/Macrophage Biology Symposium at the RI-MUHC that attracted world class scientists. Involvement in the community - Drs. Russell Hepple, Mazer, and Lands communicated their major scientific discoveries to the public through radio, newspaper, and television interviews. Several investigators continue to be involved in national research networks, including the Allergy, Genes and Environment Network (Dr. Mazer), the Canadian Epigenetics, Environment and Health Research Consortium (Dr. Baglole), and the Canadian Respiratory Research Network (Dr. Martin is co-director). The MCL, in collaboration with the CIHR Institute of Genetics and Cystic Fibrosis Quebec, co-hosted a Café scientifique on rare respiratory diseases. This event was live-streamed and filmed for television (Canal Savoir). A patient participated in the Café and shared their courageous journey as a cystic fibrosis patient. Several RI-MUHC investigators, including Drs. Lands, Simon Rousseau, Jennifer Landry, and Arnold Kristof participated in the Café to discuss with the public the latest research and clinical efforts on rare respiratory diseases. Dr. Martin was a chair for the CIHR Foundation Grants Competition. Clinical innovation - In collaboration with the clinical Respiratory Division, the MCL are in the process of developing a rare respiratory diseases clinic. Funding was received by the clinic to perform an environmental scan that will inform the process of uptake and care of patients with rare respiratory disorders in the MUHC Pediatric to Adult Transition and Orphan Lung (PATROL) disease clinical care and research platform. What we envision as major threats to our academic activities - The current financial and administrative barriers to recruitment of new faculty are the primary threat to our future success. Two faculty members left the MCL in 2016 and only one new clinician-scientist was recruited (Dr. Azuelos). MEDICAL BIOCHEMISTRY Noteworthy events - At the JGH, Dr. Elizabeth MacNamara, Medical Lead of the Patient Order Sets project, has been instrumental in implementing digitalized Patient Order Sets throughout the JGH. They have had a significant decrease in length of stay in surgery, and will be implemented in the Emergency Department and Medicine early in 2017. Patient Order Sets allow access to the accumulated data sets covering a vast array of diseases, illnesses and medical conditions. This data represents best practices from numerous hospitals and other health care institutions that subscribe to the service. The JGH was the first to implement Patient Order Sets in Quebec. Dr. Christoph Borchers has been appointed Head of the Division of Clinical and Research Proteomics at the JGH. The Proteomics Unit has expanded to two post-doctoral fellows, three Ph.D. students and a manager. More state-of-the-art equipment has been acquired for the Proteomics Laboratory, in order to develop advanced technologies that increase the range of high-quality proteomics. Applications have been made for CFI, CIHR and Genome Canada

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funding. Dr. MacNamara is continuing the development of the IBM-Apple Health Care Apps system for the JGH, in collaboration with Dr. Lawrence Rudski (Division of Cardiology), and Nursing.

Research - At the MUHC, Dr. Alexis Baass is working on the development of the Montreal Familial Hypercholesterolemia Score to evaluate cardiovascular risk in individuals with Familial Hypercholesterolemia, the most common monogenic disorder worldwide. At the JGH, Dr. MacNamara is continuing her interest in proteomics research. She has become actively involved in the Genomics Innovation Network (GIN). The goal, or mission, of this network is to create a mechanism for the innovation centres across Canada to work. The Proteomics Unit at the JGH had 14 projects that were either completed or ongoing this past year.

Teaching - Members of the Division provide teaching to medical residents as part of the academic half days.

Involvement in the community - Dr. Richard Kremer organized international conference at the Annual Meeting of the American Society for Bone and Mineral Research in Atlanta, Georgia; Dr. David Blank was a member of the organizing committee for the Canadian Society of Clinical Chemists 2016 Annual Meeting in Edmonton; Dr. Brian Gilfix is President of the Canadian Association of Medical Biochemists; Dr. Julie St-Cyr is a member of the provincial Laboratory Quality Control Committee; Dr. Fabienne Parente is a member of the provincial Comité consultatif sur le dépistage néonatal sanguin et urinaire. The JGH staff is continuing the development and implementation of a laboratory training program for technologists from health centres in Gansu Province, China in a collaboration between the JGH laboratory and the Ministry of Health, Gansu, China. Dr. MacNamara has been appointed as the chair and external examiner for the Medical Biochemistry and Metabolic Medicine Program, Kuwait Institute for Medical Specialization (KIMS).

What we envision as major threats to our academic activities - The imminent creation of a hospital Department of Laboratory Medicine could create a disconnect between the academic linkage of Medical Biochemistry with Medicine (as a subspecialty). Over time this may impact on our training program. NEPHROLOGY Noteworthy events - Dr. Ruth Sapir-Pichhadze was the recipient of a Canadian Society of Nephrology New Investigator award. Dr. Andrey Cybulsky’s Endowed Chair (Catherine McLaughlin Hakim Chair in Medicine) was renewed for a 5-year term. Dr. Sharon Nessim received the Teaching award from the nephrology fellows at McGill. Dr. Mark Lipman received the award for Physician Management from the administration of the JGH.

Research - The group continues to publish in excellent journals on glomerular pathophysiology, including a paper in Nature Medicine. Dr. Tomoko Takano gave an invited lecture at the Societé québecoise de néphrologie annual meeting, Montréal, “Podocytes in FSGS: evolution of podocyte biology” in May 2016. Dr. Cybulsky gave an invited lecture at the American Society of Nephrology Annual Meeting, Chicago, IL, USA. “Unfolded protein response as a therapeutic target in glomerular disease” in November 2016. At the JGH, the Division has continued to expand its research activities with three ongoing local investigator-conceived and implemented studies: Dr. Lipman, in collaboration with Dr. Schiffrin (Division of General Internal Medicine), are working on gene expression profile in small resistance arteries of patients with hypertension with or without nephroangiosclerosis and its relations to small and large artery function and remodeling, while Dr. Lipman is also studying the effect of vitamin D3 supplementation on arterial and bone remodelling in chronic kidney disease patients as well as the

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pharmacodynamic and pharmacokinetic profiles of apixiban in hemodialysis patients.

Teaching - Dr. Tiina Podymow is the course director for Fundamentals of Medicine and Dentistry (Med I). The course, “Physiological Foundations of Kidney and Electrolyte Disorders”, has become part of the new 4th year medical school curriculum in the “Putting It All Together” (PIAT) section.

Involvement in the community - Dr. Marcelo Cantarovich was The Transplantation Society Vice-President 2014-2018, and member of the Scientific Planning Committee, CME liaison and co-chair of the post-graduate course. Dr. Sapir-Pichhadze is a Quebec board member of the Canadian Society of Nephrology. Dr. Takano is the chair of the Canadian Society of Nephrology Scientific Committee and a board member. She is also a Steering Committee member, HORIZONS 2022, Kidney Foundation of Canada. The Division has undertaken to organize the 12th International Podocyte Conference in 2018 in Montréal (Dr. Elena Torban is the committee chair). The JGH Division participated in the Dialysis

Outcomes and Practice Patterns Study Program (Dr. Nessim) and in the Canadian Organ Replacement Register.

Clinical innovation - At the MUHC, Dr. Ahsan Alam has led the establishment of a dedicated clinic for referred patients with adult polycystic kidney disease (ADPKD). This clinic is co-managed with a nurse, and provides diagnosis, assessment, and novel treatments for patients with ADPKD. This also provides a platform for existing (i.e. C-MAJOR Registry) and future (e.g. SPOR ADPKD theme) research. Dr. Ratna Samanta has established a specialty glomerulonephritis clinic. This clinic provides diagnosis, assessments, second opinions, and access to novel treatments for patients with glomerulonephritis. The HLA laboratory at the MUHC received official American Society for Histocompatibility and Immunogenetics accreditation (Dr. Dana Baran). A Hemolytic-Uremic Syndrome registry has been established at the MUHC (Dr. Baran). At the JGH, after over six years of planning and fundraising, the new, modern and enlarged Hemodialysis Unit in the Sandra and Steven Mintz Nephrology Centre opened in September 2016. This new facility merges the two former hemodialysis treatment units in one location.

The Division is participating in a new provincial initiative, «Comité sur la communication avec les donneurs et receveurs de don vivant» (Drs. Shaifali Sandal and Alam). The Division saw the establishment of a kidney disease biorepository at the MUHC (Drs. Sapir-Pichhadze and Takano) and the development of new, more focused Cree Renal Care Committee, which will work on chronic kidney disease programs in our northern satellite areas (Dr. Vasilevsky).

Monthly dialysis Vascular Access Rounds, with participation of nephrologists, vascular access nurse, interventional radiology and Vascular Surgery is a very successful model of collaborative, multi-disciplinary assessment and management of vascular access problems and learning experience for Nephrology and Vascular Surgery fellows (Dr. Vasilevsky).

What we envision as major threats to academic activities - Dwindling and inadequate research operating grant support.

NEUROLOGY

Noteworthy events - In keeping with the Division’s long-standing reputation for teaching excellence, this year two members won McGill-wide recognition: Dr. Lucy Vieira won the TCP (Transition to Clinical Practice) Neurology teaching award, and Dr. Stuart Lubarsky was named the Richard and Sylvia Cruess Faculty Scholar in Medical Education. Dr. Anne-Louise Lafontaine received a Department of Neurology & Neurosurgery Award of Distinction for her work on behalf of the Department.

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Research - Dr. Colin Chalk contributed to the completion of the NIH-funded multicentre international randomized controlled trial of thymectomy in myasthenia gravis, which adds new and important evidence to guide the management of the disease. The importance of the study was emphasized by an accompanying editorial in the New England Journal of Medicine. Dr. Ron Postuma continues his investigations of the non-motor manifestations of Parkinson’s disease. Of particular interest are clinical phenomena which can predict the emergence of Parkinson’s disease years in advance, potentially opening a window for application of ‘neuro-protective’ therapies. Dr. Lafontaine is collaborating with colleagues in the Respiratory Division studying sleep in Parkinson disease. Drs. Vieira, Eric Ehrensperger, and Robert Coté have ongoing involvement in clinical trials of stroke prevention. Dr. Lubarsky and colleagues at the McGill Centre for Medical Education obtained funding from CIHR and other sources for studies of clinical reasoning and diagnostic error. Teaching - A team lead by Dr. Chalk implemented a new formative OSCE (objective structured clinical examination) for McGill medical students at the end of their second year. Concurrently, the team is developing and implementing a series of new ‘progress tests’ during the final two years of the undergraduate curriculum. Dr. Lubarsky’s expertise in script concordance testing was recognized by an invitation to give Medical Grand Rounds at the Uniformed Services University, Bethesda, Maryland. Involvement in the Community - Dr. Chalk is president of the Canadian Neurological Society. Dr. Lafontaine is the chair of the Comprehensive Care Committee and member of the Steering Committee for the 2019 World Parkinson Congress, and Dr. Coté is a member of the Scientific Advisory Committee for the 2018 World Stroke Congress. He is also the spokesperson for the Heart and Stroke Foundation of Canada. Members of the Division are making particular contributions to the care of neurological patients from remote parts of the McGill RUIS. Dr. Lubarsky provides tele-health consultation and follow-up for Inuit patients in Nunavik via the MUHC Tele-Neurology Clinic. Drs. Lubarsky and Lafontaine are making regular visits to see patients in Rouyn-Noranda, substantially reducing wait lists for neurological care in Abitibi. Clinical innovation - At some date in 2017-2018, a new dedicated MUHC stroke unit will be opened at the Montreal Neurological Hospital (MNH), combining beds to be moved from the MGH with MNH beds. Dr. Vieira has been the MGH lead for this project, which involves a number of logistical and culture-of-practice challenges. Dr. Coté is a member of the Stroke Trajectory project, with the mandate to improve quality and continuity of stroke care between the MUHC and McGill RUIS partners. What we envision as major threats to our academic activities - The Division’s academic activities are mainly vulnerable to the competing demands on our members’ time posed by clinical demands, particularly in-patient service time. The upcoming reorganization of MUHC in-patient neurology beds and stroke services on the island of Montréal potentially threaten to increase on-call requirements. Like other clinical services in the MUHC, manpower restrictions imposed by the MSSS also severely limit our means to rationally renew our membership. RESPIRATORY DISEASES Noteworthy events - Dr. Jean Bourbeau received a Certificat de reconnaissance pour dévouement et leadership au comité exécutif de la société canadienne de thoracologie (SCT/Canadian Thoracic Society) 2011-2016. Dr. Faiz Ahmad Khan received a CIHR Project Scheme grant to study the accuracy and cost-effectiveness of computer-aided TB detection programs in a high-TB burden setting. Dr. Benjamin Smith received an NIH R01 operating grant. Drs. Sushmita Pamidi and Jason Shahin received FRQS Chercheur

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-boursier clinicien Junior 1 awards.

Research - The CanCOLD Collaborative Research Group continues to publish exceptionally well and is closely linked to the Canadian Respiratory Research Network. Dr. Salman Qureshi is collaborating with Dr. K Marr, Johns Hopkins Medical Institution on the CINCH substudy: Cryptococcus Infection in Non-immunocompromised hosts. Dr. Pierre Ernst is a co-investigator on the renewal by CIHR of the Canadian Network for Observational Drug Effect Studies (CNODES); 17.5 million over 5 years. Dr. Andrew Hirsch and the JGH Thrombosis group finished analyzing the Multi-Centre CIHR funded ELOPE (Evaluation of Long Term Outcomes of Pulmonary Embolism), resulting in 4 publications and multiple presentations and international meetings.

Teaching - Dr. Stéphane Beaudoin planned and developed the first Quebec-wide bronchoscopy education seminar, which brought together the respirology residents (20 trainees) from all adult respirology training programs in the province for a day-long bronchoscopy education activity. Faculty from 3 universities were welcomed, and competency-based assessments of trainees were fed back to program directors. The Division, with the particular contribution of Dr. Qureshi, was a major contributor to the first-year medical student curriculum, with most members involved in teaching a highly rated module on respiration and respiratory diseases. Dr. Kevin Schwartzman organized the interuniversity course entitled, “Clinical Aspects of Research in Respiratory Diseases,” (EXMD 633) for the FRQS Réseau en santé respiratoire.

Involvement in the community - Dr. Bourbeau was the only Canadian respirologist invited to participate in the writing of COPD care delivery perspective in USA published in Lancet Respir Med. Dr. Qureshi was a member of the ATS Program Committee, and the Early Career Working Group; he was the chair and invited speaker of ATS 2016 scientific symposium: “New insights into the predisposition, pathogenesis, and management of fungal respiratory diseases.” He had the highest evaluation score among an international panel of speakers (4.36/5) at American Thoracic Society’s conference, “Subversion of Host Immunity by Endemic Fungal Pathogens”. In his capacity as programme secretary for the Tuberculosis Section of the International Union against Tuberculosis and Lung Disease, Dr. Schwartzman co-organized the 2016 Union World Conference on Lung Health in Liverpool, England. Dr. Jennifer Landry received an award for "dedication toward cystic fibrosis" from the Cystic Fibrosis Quebec association. Dr. James Martin continued his role as co-director of the Canadian Respiratory Research Network and participated in an ATS workshop on inhalational toxicants. He was also a member of the ATS Nominating Committee. Dr. Deborah Assayag has instituted a multi-disciplinary interstitial lung disease (ILD) conference with the Departments of Radiology and Pathology, and the Divisions of Respiratory Medicine and Rheumatology.

Clinical innovation - Dr. Bourbeau is involved in the Clinical program on early diagnosis and optimization of the management of COPD patients in primary care in the 5 CIUSSS (CLSC, GMF, cliniques réseaux integrées) of the Island of Montréal and a utility registry for surveillance/quality indicators/improving practices. Dr. Beaudoin created and co-chairs the MUHC pleural care committee, an interdisciplinary initiative aiming to improve the quality of pleural care at MUHC. The Committee has updated the nursing care protocol for conventional chest drain; created a nursing care protocol for pigtails, a nursing best practice guide for pleural drain flushing, a nursing care protocol for indwelling pleural catheters (PleurX©). Dr. Beaudoin was the main developer of a pleural care nursing competency survey which has been completed and analyzed. The Department of Medicine awarded the 2016 clinical innovation award to the pleural care team. Dr. Nathalie Saad has successfully started the first Tele-Medicine pulmonary Rehab program in Quebec.

What we envision as major threats to academic activities - Forced reductions in size of respirology subspecialty training program, compromising critical mass of trainees.

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RHEUMATOLOGY Noteworthy events - Dr. John DiBattista was nominated as Scientific Director and chair of the Scientific Advisory Committee of the Arthritis Society of Canada (TAS). Dr. Ines Colmegna was promoted to Associate Professor Department of Medicine. Dr. Marie Hudson was the recipient of the Jeffry Shiroky prize awarded at the Laurentian Conference in Rheumatology held in Mont Tremblant, May 2016. Sabrina Hoa, a post-doctoral fellow under the supervision of Dr. Hudson, was awarded The Arthritis Society’s Post-doctoral fellowship award (2016-18), the CIHR Canada Graduate Scholarship award (2017-2019) and the Drug Safety and Effectiveness Cross-Disciplinary Training (DSECT) Program award (2017-2018). Dr. Laeora Berkson is the inaugural chair of the Program Evaluation and Curriculum Outcome Committee for McGill University's Undergraduate Medical Education Program. Dr. Joyce Rauch’s PhD. student, David Salem, received a FRQS studentship for the years 2016-2018. Dr. Christian Pineau was named President and Scientific Director of the Laurentian Conference of Rheumatology. Dr. Hudson was guest editor (with Dr. Susanna Proudman) on a special issue on connective tissue diseases of Best Practice and Research: Clinical Rheumatology published in February 2016. Research - Dr. Colmegna was awarded an Arthritis Society 2016 Operating Grant on Improving Influenza Immunization Responses in Rheumatoid Arthritis. (Co-PI: Dr. Brian Ward) and she was also awarded a Canadian Initiative for Outcomes in Rheumatology cAre (CIORA) Operating Grant on Strategies to Enhance Influenza/Pneumococcal Coverage Among Rheumatoid Arthritis Patients(Co-PI: Kim Lavoie). Dr. Evelyne Vinet received a Canadian Initiative for Outcomes in Rheumatology cAre (CIORA) grant for focus group study on “Needs and barriers to pregnancy counselling in women with RA”. She held a full-day CIHR funded workshop for 30 international researchers on the planning of an international prospective cohort of SLE pregnancies at the American College of Rheumatology annual meeting. Dr. Sasha Bernatsky obtained funding from the U.S. Department of Defense for her study of “Pollution, Epigenetics and Serologic Markers of Rheumatoid Arthritis”. The Scleroderma research group, led by Dr. Murray Baron, published an important study showing the longitudinal relationship of calcinosis in scleroderma to underlying ischemia and also published the last of a series of articles regarding oral abnormalities in scleroderma. This series will represent the definitive set of articles on this topic. Dr. Alexander Tsoukas co-authored “Axial Spondyloarthritis”, a textbook published by the Oxford University Press. Teaching – Division members teach at all levels from undergraduate to postgraduate. Involvement in the community - Dr. Colmegna organized and led in September 2016 the second Rheumatology Workshop Black Lion Hospital, Addis Ababa University, Ethiopia. Dr. Genevieve Gyger is on a committee of the Scleroderma Clinical Trials Consortium seeking to establish training programs and a certification process for the use of video capillaroscopy in scleroderma. Dr. Colmegna organized and led in September 2016 an Inflammatory Arthritis Annual Educational Meeting for patients, relatives and friend in collaboration with the Constance Lethbridge Rehabilitation Center. Dr. Hudson is medical advisor for Myositis Canada, a national grass-roots advocacy organization and AWISH, a local self-help group for patients with arthritis. Clinical Innovation - Dr. Pineau’s project for the formation of a Center of Excellence for Systemic Autoimmune Diseases and Inflammatory Arthritis was selected by the Department of Medicine for development. Drs. Alexander Tsoukas and Michael Starr started a Spondyloarthropathy Program. Dr. Tsoukas started a Rheumatology Rapid Access Clinic at the MGH. Dr. Vinet started a “Pregnancy and Rheumatology” Program. The rheumatology group at the JGH imitated their own vaccine clinic for rheumatology patients. Dr. Berkson is collaborating with Dr. Vartan Mardigyan (Cardiology) in the

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treatment of patients with refractory pericarditis. Dr. Sabrina Fallavollita is a member of a national organization developing a core clinical dataset for quality care for rheumatoid arthritis. What we envision as major threats to academic activities - The lack of adequate research funding is an increasing problem for all investigators. Academic activities in terms of teaching require adequate time and space to teach in the outpatient setting. Any attempt to remove offices and exam rooms from inside the hospital will seriously affect this. This would also likely affect research as that also depends on seeing patients with adequate time and space to collect data. UNDERGRADUATE MEDICAL EDUCATION The Department members are deeply engaged in the undergraduate medical program.

Clinical Methods II: Review Assess Consolidate (RAC) - The RAC course took place from December 5-13, followed by an OSCE period from December 14-16 with 184 students. The focus of this course is to review of clinical exam skills. Even though it was a challenge to recruit tutors, we managed well in the end. 16 out of the 23 staff members who taught this course are from the Department of Medicine (see our July 2017 newsletter for a listing of members). The course was successful as in previous years.

Transition to Clinical Practice (TCP) - The TCP course took place as usual from January –June 2016. 185 students completed the course. This year, we were partnered with Mindful Medical Practice, Palliative Care, and Medical Ethics and Health Law in the block. We added a Patient Safety session given the growing recognition of the importance of this domain. We made the decision to introduce Harvey for 2017 based on very positive feedback from the 2016 clerkship class. We also applied for and obtained spirometers to assess lung function, which will phase into this course in coming years. The TCP course helps students develop the basics of clinical reasoning, and provides students with fundamental skills to allow success in clerkship. Overall, the strength of the course is its tutors, whose skill, enthusiasm, professionalism, and dedication make a significant impression on the students, as reflected by their reviews and comments. We introduced an OSCE for the TCP course in 2016 and it was well received. The majority of the teaching staff (34 out of 36) is from the Department of Medicine (see our July 2017 newsletter for a listing of members). Clinical Clerkship in Internal Medicine - The number of students taking the course was 190. As with TCP, we are re-evaluating our evaluation process and a major goal for 2016 and 2017 will be to introduce multiple methods of assessment. Harvey was added to the clerkship in July 2016; the sessions have been extremely popular. In fact some students and tutors requested extending Harvey hours or having extra Harvey sessions scheduled, which led to the addition of TCP teaching time. Once again, the need for support for Faculty Development teaching workshops for McGill Attending Physicians remains. Challenges - We need to focus on developing young attending staff to become leaders in undergraduate teaching in the coming years. MCGILL INTERNAL MEDICINE RESIDENCY TRAINING PROGRAM Noteworthy events - The McGill Internal Medicine Residency Program is the largest specialty training program at McGill with over 120 residents in training. This year Dr. Patrizia Zanelli, a leader in residency education at McGill will be completing her last term in the role of MGH site director. She has mentored and inspired over a hundred residents to successful career paths. Dr. Leora Birnbaum is the incoming MGH site director, and along with Drs. Ruxandra Bunea (JGH) and Jennifer Landry (RVH) and our

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program administrators, Maureen Dowd, Sandra Persaud (MGH), Angie Sacratini (JGH) and Carol Seguin (RVH), and all the faculty in the Department of Medicine will continue to innovate and strengthen the Internal Medicine residency program so that we can maintain it as one of the best residency training programs in the country. The Program is in the process of shifting towards a competency-based medical education framework. As part of this educational transformation, the Royal College certification exam will move to the end of the third year of core training starting in 2019. To help prepare our residents for this earlier milestone, Dr. Ning-Zi Sun and the curriculum sub-committee has pushed forward with a flipped classroom approach to academic half-day. This program integrates a pre-recorded video series with live problem-based learning sessions. This year saw one of the best CaRMS match results with all places matched after the first iteration. The new cohort will consist of 17 candidates trained at McGill, 6 from the other universities in Quebec, as well as candidates from the Universities of McMaster, Ottawa, Queen’s, Toronto, Dalhousie and Saskatchewan. Along with 9 residents from the Middle East and other international schools, the future trainees represent one of the most diverse groups we have ever welcomed, and will certainly enhance our training program. Additionally the outgoing residents all matched in their first iteration, pursuing further training in some of the most competitive programs in the country, matching to McGill (17), Université de Montréal (4), Laval, Sherbrooke, Toronto (4), Ottawa (2), Queen’s, Alberta, and British Colombia. We are very proud of their achievements and wish them the best in their ongoing training. Teaching - The Annual Clinical Vignettes Evening was held on March 29 at the McGill Faculty Club. It was a fantastic display of clinical acumen and scholarship. All hospital sites were well represented with excellent presentations by Drs. Mehdi Afshar, Corey Miller, Ketaki Rawal, Jacinthe Boulet, Marina Maskauchan, and Ahmed Al-Turki. This year the Dr. Harold Frank Award for the best clinical vignettes case this year was awarded to Dr. Corey Miller. We also held our 3rd annual Scholarly Activity Poster Day on May 18 at the JGH. All PGY3 residents in the program prepare an abstract and display their posters to showcase a project they worked on over their training. This year Dr. April Rose won for the best poster presentation, with honourable mention to Dr. Douglas Slobod and Dr. James Zhang. We thank all the faculty members for their mentorship and promotion of scholarship to our trainees. Involvement in the community - Residents participated in the program’s Global Health Initiative to Haiti. Directed by Dr. Michelle Elizov, and supported by the Departments of Medicine at the MUHC and JGH, this initiative joins with Partners in Health (PIH) and St. Nicolas Hospital to send a cohort of senior residents and faculty to Haiti to teach and learn from the local physicians and trainees. https://www.mcgill.ca/deptmedicine/files/deptmedicine/im_training_program_annual_report_2016_2017.pdf

CONCLUDING REMARKS

The Department continues to have a substantial output in teaching, research and clinical innovation and is a major influence for the maintenance of academic medicine at the teaching hospitals. Departmental members were successful in obtaining 8 personal support awards. Laboratory facilities at the MUHC are second to none. New clinical facilities and envisaged renovations have and will improve patient experience at our institutions. There are significant challenges that should not be ignored. Renewal of

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faculty is not keeping pace with losses. The judicious hiring of top tier PhD scientists will also be required to maintain the excellence in basic biomedical science for which the Department was so well known. The Department has not benefitted recently from the provision of Canada Research Chairs. Furthermore, the new Faculty rules governing the long term funding of salaries for clinician scientists and PhD scientists place the onus on departmental chairs to broker the deals that are required to ensure the academic renewal of their respective departments. Fortunately the hospital foundations seem open to the idea of fund-raising for professorships to assist with hiring.

All Divisions within the Department identified the following threats: 1. CIHR: The new programs that have been put in place by the CIHR are threatening both young andsenior investigators. This is reflected in declining enrolment of graduate students. The taxation of clinicians at both MUHC and JGH provides more than 3 million dollars for academic enrichment and for administrative stipends and without which we could not function. However the Department is depleting its funds in attempting to provide adequate bridge funding to researchers. 2. The policy of post-award support is inadequate for clinician scientists who are already juggling severalmajor functions in addition to their research portfolios. A major problem in applying for grants is the lack of secretarial help for updating CV, writing and reformatting grant applications that are required several times a year. Increasing reporting requirements from the hospital and university are not accompanied by the necessary administrative support to meet these requirements. 3. Restrictions on hiring and micromanagement by the Ministry of Health have further limitedpossibilities for growth. The Ministry does not calculate FTEs but simply license numbers. There is no opportunity for replacement of senior clinician scientists as their productivity declines. We will need to deal with these challenges effectively but many of the solutions are not within the grasp of departmental chairs.

APPENDICES

The following appendices are also part of this report and have been submitted separately:

Appendix 4: Milestones (new hires, promotions, departures and salary awards)

Appendix 5: Honours, awards and prizes

Appendix 6: Consulting activities table

A copy of this report is available at the following website link:

https://www.mcgill.ca/deptmedicine/about-us/annual-reports

Report compiled by Ms. Josée Cloutier, Human Resources Administrator

APPENDIX 1

DEMOGRAPHICS OF THE MCGILL DEPARTMENT OF MEDICINE

Classification

Total

GFT-U FT FT PT FT PT FT PT Faculty

2011 79 98 277 118 13 9 - - 594

2016 66 92 300 153 12 4 5 0 632

Level of Rank

ASST ASSC PROF FAC LECT

2011 226 179 135 54 594

2016 249 175 125 83 632

Tenure Track Tenure

Cohort

4 Candidates (2 PhD & 2 MD) 2016 Tenure Granted 2016

1 PhD Candidate (Early Tenure) 2018 Tenure Granted 2017

2 Candidates (1 PhD & 1 MD) 2018 Tenure Review 2017

1 PhD Candidate (Early Tenure) 2022 Tenure Review 2017

1 PhD Candidate 2022 Tenure Review 2021

1 MD Candidate in process of switch 2023 Tenure Review 2022

CAS - Clinical CAS - Research CAS - Professional

53%

13%

30%

4%

Appendix 2 2016 Research Education and Development

MUHC

Recruitment and Research Activities

Educational Activities

Stipends & Administrative Activities

Infrastructure

Appendix 3

RESEARCH AND TEACHING SUPPORT FROM PRACTICE PLANS

MUHC JGHResearch:Research Start Up 1,000,093 924,600 Bridge/Extended Bridge Funding 244,824

Teaching:

Educational Stipends 47,000 73,676 Resident Activities 64,069 76,000

Total Support $1,355,986 $1,074,276