The Journal of the Canadian Rheumatology Association
Volume 17, Number 1 • Spring 2007
FOCUS ON
Career Choices
EDITORIAL
Ice
TOPICAL MEDICAL ISSUES
Rheumatology Residents’ Weekend in Montreal
Is Educational Culture Linked to Resident Sub-specialty Choice?
NORTHERN (HIGH)LIGHTS
2007 CRA Award Recipients: Dr. Arthur Bookman, Dr. Henri Ménard
and Dr. Carol Hitchon
JOINT COMMUNIQUÉ
- Academic Job Postings
- Campus News • Dalhousie University
• University of Western Ontario
• University of British Columbia
JOINT COUNT
“Career Choices” Survey
IN MEMORIAM
John T. Sibley
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CRA EDITORIAL BOARD
Mission Statement
The mission of the CRAJ is to encourage discourse among the Canadian Rheumatology community for the
exchange of opinions and information.
EDITOR-IN-CHIEF Dr. Glen Thomson, Dr. Ken Blocka, Dr. Michel Gagné, Dr. James Henderson,
Dr. Joanne Homik, Dr. Sindhu R. Johnson, Dr. Majed Khraishi, Dr. Gunnar Kraag, Dr. Diane Lacaille,
Dr. Ronald M. Laxer, Dr. Barbara A. E. Walz LeBlanc, Dr. Janet Markland, Dr. Eric Rich, Dr. John Thomson,
Dr. Michel Zummer.
The editorial board has complete independence in reviewing the articles appearing in this publication and is
responsible for their accuracy. The advertisers exert no influence on the selection or the content of material
published.
PUBLISHING STAFF
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Executive Editor
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Managing Editor
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Production Manager
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Editor-proofreader, French
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Publisher
Copyright© 2007 STA HealthCare Communications Inc. All rights reserved. THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION is published by STA Communications Inc.
in Pointe Claire, Quebec. None of the contents of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, mechanical,
photocopying, recording or otherwise) without the prior written permission of the publisher. Published every three months. Publication Mail Registration No. 40063348. Postage paid at
Saint-Laurent, Quebec. Date of Publication: April 2007. THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION selects authors who are knowledgeable in their fields.
THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION does not guarantee the expertise of any author in a particular field, nor is it responsible for any statements by such authors.
The opinions expressed herein are those of the authors and do not necessarily reflect the views of STA Communications or the Canadian Rheumatology Association. Physicians should take
into account the patient’s individual condition and consult officially approved product monographs before making any diagnosis or treatment, or following any procedure based on
suggestions made in this document. Please address requests for subscriptions and correspondence to: THE JOURNAL OF THE CANADIAN RHEUMATOLOGY ASSOCIATION,
955 Boul. St. Jean, Suite 306, Pointe-Claire, Quebec, H9R 5K3.
EDITORIAL
Ice
By Glen Thomson, MD, FRCPC
I
ce is a quintessentially Canadian substance, ubiquitous
to any Canadian who has seen the south side of 0°C.
Humble and utilitarian, it provides the surface for our
national game and plays a supporting role in most of our
favourite beverages. Despite attempts to tame this substance with sand and salt, ice remains the nemesis of
those of us left behind in the Great White North who dare
venture onto winter sidewalks and roads. It is the reason
for the vast migration of snow birds every autumn.
Yet in the Shangri-La atmosphere of Lake Louise, even
this solid water can be transformed into shapes of the
most exquisite beauty. There is something metamorphic
about the idyllic setting for our most recent CRA annual
meeting. This is demonstrated in part by the photo contest winners featured in this issue. Somehow, the humble
and utilitarian delivery of rheumatologic services in
Canada, are transformed by the promise from industry of
amazing novel therapies. Our national opinion leaders
reset the bar of practice with data and exhortations not to
under treat our patients. Our national organization, having grown from the status of vassal to the Royal College,
can now dream of publishing an international journal.
It is the departure from Shangri-La that is the tough
part—back to the world where ice is the “orthopedic
make-work project.” However, seeing what beauty can be
released from a block of ice makes me optimistic that
some of what we talked about at Lake Louise may also be
possible. The CRA and its secretary-treasurer Dr. Jamie
Henderson are doing extreme due diligence into the possible involvement of our organization with the venerable
Journal of Rheumatology. Canadian rheumatologists may
not have ready access to ankle replacement surgery and
vertebroplasty, but we now have the knowledge to debate
access with the gatekeepers of health care. Most of us do
not have the teams of nurses, physiotherapists, pharmacists,
social workers etc., as do our national opinion leaders, but
Line Dancing at Louise—another way to "break the ice."
we are more resolved to do a better job with our available
resources. We are inspired to carry on the good fight by
our deserving national awardees whose interviews are featured in this issue.
This issue is about careers and choices. Our trainees
speak out at their national retreat. We also feature the
article about the culture of residency and how this
influences our trainees. I am proud to have been part
(long ago) of the training of Dr. Anne Minenko, who was
awarded the prestigious ACR Clinical Educator Award in
Washington in November. Clearly, Manitoba’s loss was
Minnesota's gain.
The CRA lost one of its best this past winter. I will
always remember John Sibley as the nice guy that I met in
Cincinnati in the 80s willing to take a green trainee
under his wing to demystify the three ring circus that was
the ACR. Saskatchewan and Canada salute his life of service and accomplishment.
Dr. Thomson is the Editor-in-Chief of the Journal of the
Canadian Rheumatology Association.
CRAJ 2007 • Volume 17, Number 1
3
TOPICAL MEDICAL ISSUES
Rheumatology Residents’ Weekend
in Montreal
By Heather McDonald-Blumer, MD, FRCPC
D
uring the last weekend of January, a “first” took
place in the Canadian rheumatology community.
Thanks to an educational grant provided to the
Canadian Council of Academic Rheumatologists
(CCAR) by Schering-Plough inc., the inaugural
National Rheumatology Residents’ Weekend was held
in Montreal. The planning and implementation committee included Dr. Ciaran Duffy (Pediatric rheumatology, McGill University), Dr. Eric Rich (Adult rheumatology, Université de Montréal), Dr. Nader Khalidi (Adult
rheumatology, McMaster University) and was chaired
by Dr. Heather McDonald-Blumer (Adult rheumatology,
University of Toronto).
The weekend brought together pediatric and adult
rheumatology residents from across the country along
with Program Directors and Arthritis Centre Directors
from the active rheumatology training centres across
the country. In total, there were 42 trainees, 14
Program Directors and 8 Arthritis Center Directors.
The weekend was designed to provide a forum where
everyone could get to know each other better but at the
same time learn some rheumatology. The content was
chosen from interest areas identified by the residents
within the framework of the CanMEDS competencies,
as outlined by the Royal College of Physicians and
Surgeons.
On Friday evening, everyone assembled for dinner.
Dr. Hani El-Gabalawy was our introductory speaker and
his address provided the residents with a glimpse into
the world of research. The key message appeared to be
“if at first you don't succeed, try, try again.” Dr. Janet
Pope provided perspective on the role of the Canadian
Rheumatology Association. Dr. Bookman, who was supposed to address the residents on Friday evening, sat on
4
CRAJ 2007 • Volume 17, Number 1
the tarmac in Toronto courtesy of Air Canada and
inclement weather.
On Saturday morning, Dr. Claire Bombardier (Chair
of CCAR) and Mr. John Fleming (CEO of The Arthritis
Society) offered words of welcome and provided some
perspective on how these national organizations interface with Canadian rheumatologists. The remainder of
the morning was dedicated to improving our understanding of lupus. Dr. Tamara Grodzicky blew people
away with her “Pathogenesis of SLE” lecture which was
then followed by Dr. Joyce Rauch eloquently discussing
the “Laboratory Aspects of Antiphospholipid
Syndrome” (APS). Rounding out the clinical side, Dr.
Carl Laskin reviewed the “Clinical Aspects of APS” in his
usual mix of wit and wisdom and Dr. Earl Silverman provided insights into the world of “Neonatal Lupus,” making it relevant for both pediatric- and adult-rheumatology listeners. All of the lectures were erudite and wonderfully relevant. Collectively, they provided a balance
between basic and clinical science. As Canadian
rheumatologists, it was wonderful to see the expertise
of our own colleagues showcased so beautifully.
After a quick lunch break, Saturday afternoon had
two main presentations—one on communication and
the other on practice management. Our guest presenter, Myra Plotnick, captivated the entire group with her
multimedia presentation on “Risk Communication”—
the art and science of communicating effectively in situations that are of high concern or sensitive in nature.
By the end of her session, many of us were certainly
able to identify the mistakes that we make in our dayto-day communication with patients (and will hopefully improve upon these in the future.) Dr. Gary Morris,
from Calgary, rounded out the afternoon with a step-
by-step review of the most critical issues to consider
when setting up a rheumatology practice. Although
aimed primarily at the residents, Dr. Morris had some
wonderful pointers for everyone in the audience and
his laminated card with key diagnostic codes is sitting
on my desk and has been a useful teaching tool ever
since.
In addition to the very content-based sessions on
Saturday, Dr. Arthur Bookman (who finally made it to
Montréal late Friday night) and Dr. Ronald Laxer provided a wonderful review of how adult (AB) and pediatric (RL) rheumatology have developed in Canada and
how Canadians have made such amazing contributions
to these disciplines over time.
The National Rheumatology Residents Weekend continued on Sunday morning with a national objective
structured clinical examination (OSCE). Dr. Eric Rich
had prepared a multi-station OSCE for the adult residents and Dr. Ciaran Duffy had done similarly for the
pediatric trainees. Although heading off en masse to
several of the Montréal hospitals for the OSCE felt a bit
like heading to summer camp, the residents all commented on the stressfulness of the situation but felt
that the OSCE served them well by showing what they
did and didn't know. On this note, the first-ever
National Rheumatology Residents Weekend concluded.
Overall, this first-ever National Rheumatology
Residents Weekend was a wonderful event. It had a great
“feel” to it. It is my opinion that it helped foster a
greater sense of community amongst all of the participants and at the same time, provided some valuable academic content.
On a personal note, I extend my most sincere thanks to
the members of the planning committee—Dr. Khalidi,
Overall, this first-ever National
Rheumatology Residents Weekend was
a wonderful event. It had a great “feel”
to it. It is my opinion that it helped
foster a greater sense of community
amongst all of the participants and at
the same time, provided some valuable
academic content.
Dr. Duffy and Dr. Rich for their wonderful contributions
and there unending support. Additionally, I must again
recognize the generosity of Schering Plough inc. for the
educational grant which made this possible. My deepest
gratitude goes to Dr. Douglas Smith, the past chair
CCAR and Dr. Claire Bombardier, the current chair for
allowing me the opportunity to be involved in this project and for their wise counsel over the past 10 months.
Finally, thanks to all of the participants—you made it all
worthwhile.
Heather McDonald-Blumer, MD, FRCPC
Chair, Working Group
National Rheumatology Residents’ Weekend
CRAJ 2007 • Volume 17, Number 1
5
TOPICAL MEDICAL ISSUES
We asked Residents about their own career choices within Rheumatology...
“I think my favorite part about Rheumatology is that you
don’t always have the right answer right in front of you. You
really have to work to figure it out.”— Sabrina Fallavollita
“I wonder sometimes what kind of life a researcher has, the
quality of life he or she has and the years of study someone
has to have to become a principle investigator...For me if I
was going to be a researcher I would want to be a good one
and I am not ready to spend more years studying and
training and publishing... In the next few years, if everything goes well, I will be working in
community practice, in a hospital, in a position that will allow me to have a family.”—Judith Trudeau
“I think a Rheumatology job bank would be very useful... I think knowing what positions are available along with the details is
very important: knowing whether its in an access centre, being frank about salary, how your
time is divided, how much time would be devoted to research
and teaching. You would need to know all that information to
know if that job would be a good fit.”—Linda Hiraki
“Most rheumatologists I’ve encountered are very well-balanced.
Alot of them are young women and I think its still an effort to be
a woman and an academic, a researcher and a wife and a
mother. But I have alot of good role models that are
Rheumatologists who have been able to balance all of that.”
—Bindee Kuriya
‘I came from Germany to complete my Rheumatology
Fellowship and do research in Canada.”—Heinrike Schmeling
“I didn’t choose Rheumatology as a specialty for one specific
reason. There were multiple reasons. I have alot of family
members in Rheumatology... growing up I spent alot of time with Rheumatologists”
— Jonathan Stein
“I would like to stay central
in Montreal or Quebec to
work. When I was
completing my general
rotation in Internal
Medicine I did work in rural
6
CRAJ 2007 • Volume 17, Number 1
areas which I liked but I would stay in Montreal or Quebec
with my husband.”
—Judith Trudeau
“I think it’s different for Pediatric Rheumatologists. If you
want Pediatrics to be the focus of your specialty you can’t go
rural because you need to find enough children with your
diseases. I think if you want to solely do Pediatric
Rheumatology you can’t have a private practice for the same
reason, you have to be in an access centre. Really I think if
you are trying to be a Pediatric Rheumatologist you have to gain access to your patients.
The question of how much time we divide between teaching or clincial work or research
work, that’s the part we have flexibility with.”
—Linda Hiraki
“I think there are alot of opportunities in Canada for
Rheumatologists. I don’t think we will ever be
out of work, there’s always new trials and
development... ideally in the next few years I
would like to plan a practice so that I could work
within a community and help alot of patients
who may not be able to reach an academic centre
but at the same time I would love to teach.”
—Bindee Kuriya
“I’m from Ottawa and there’s a real focus on research for sure and not enough emphasis on
community work, its just not a priority in the Toronto Program. We don’t have mandatory
community experience... I’m definitely leaning towards community work now and in the next few years I hope to work in
community practice in the greater Toronto area. After that I’m not sure...”
—Angela Montgomery
CRAJ 2007 • Volume 17, Number 1
7
TOPICAL MEDICAL ISSUES
Is Educational Culture
Linked to Resident
Sub-specialty Choice?
By Anne Minenko, MD, FRCPC, CCD
Dr. Minenko graduated from the University of Manitoba Medical School in
1987. She completed both her Internal Medicine residency and fellowship in
Rheumatology also at the University of Manitoba, in 1991 and 1993,
respectively. In 2000, she moved from Winnipeg, Manitoba where for seven
years she practiced rheumatology in the community, to join the University of
Minnesota, and establish herself as the Division of Rheumatic and
Autoimmune Diseases’ Education Leader. In 2003, she was awarded a 3
year Clinician Scholar Educator (CSE) Award by the American College of
Rheumatology–Research and Education Foundation (ACR-REF) to study
whether educational culture might be linked to resident sub-specialty choice.
The following article is a brief summary of the Project and findings to date.
She acknowledges Dr. Kim Cameron, Professor of Higher Education;
Organizational Behavior and Human Resource Management, School of
Business, University of Michigan, for granting permission to use the
Organizational Culture Assessment Instrument©. She also acknowledges the ACR-REF, for bestowing this award upon her and in
funding the Project, for their recognition of the importance of culture to organizational success. Even after relocating from Winnipeg
to the tropics of Minnesota, she and her husband continue to enjoy winter sports.
Background
According to the ACR-REF, “arthritis, rheumatic and musculoskeletal diseases…strike one in every three American
adults…and will continue to increase as our population
ages.”1 Disturbingly, as the need for rheumatologists to
care for these patients is projected to escalate, “by 2015
the number of rheumatology retirees is expected to surpass the number entering the field.” Of further concern,
between the years 1996 and 2003, only 1 resident from
among the University of Minnesota (UMN) Internal
Medicine residents pursued Rheumatology, having been
accepted to the University of Washington Fellowship
Program in 1996. In contrast, in the same six year period,
other subspecialties (Infectious Diseases—7 residents,
Cardiology—22 residents) were more successful in
recruiting from the local resident pool.2 The introduction
of upgrades, highly rated by house-staff, to the UMN
Rheumatology Elective after the year 2000, such as
space for conferences and study, a personal face-to-face
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CRAJ 2007 • Volume 17, Number 1
orientation to the Elective, a CD-ROM of tutorials and
learning exercises, a MSK exam workshop using “patients”
from the UMN Standardized Patient Program, and an
Injection workshop using limb models equipped with
indicator lights or replenishable knee “effusion,” did not
seem to increase resident interest in Rheumatology as a
sub-specialty. This Programs’ education outcome data such
as improvement in learner post-Elective confidence levels in
procedure skills, MSK exam skills and Multiple Choice test
scores over Pre-Elective baseline measures even indicated
that educational goals were being achieved. But is the UMN
Program truly successful if local house-staff choose other
areas over Rheumatology as their sub-specialty?
The Importance of Culture
Reading the book “Diagnosing and Changing
Organization Culture Based on the Competing Values
Framework”3 by Drs. Kim Cameron (Professor of Higher
Education; Organizational Behavior and Human
Figure 1.
Question #1:
Dominant Characteristics
Now
Preferred
100
100
A The organization is a very
personal place. It is like an
extended family. People seem
to share a lot of themselves.
B The organization is a very
dynamic and entrepreneurial
place. People are willing to stick
their necks out and take risks.
C The organization is very results
oriented. A major concern is
with getting the job done.
People are very competitive and
achievement oriented.
D The organization is a very
controlled and structured place.
Formal procedures generally
govern what people do.
Total
Resource Management) and Robert Quinn, both presently
of the School of Business at the University of Michigan, was
enlightening. The authors reassure that the UMN
Rheumatology Program is not alone in its failure to implement organizational improvements, quoting a 75% failure
rate. They explain that without considering culture, implementation of new procedures, better processes, and curricular revisions, are simply superficial and short term as an
organization’s values are allowed to remain the same. To
rephrase, if one wishes to implement enduring organizational improvements, then culture change is needed.
Diagnosing Culture using the OCAI©
But determining what the culture is presents as a challenge
because “culture” is not synonymous with “climate” or “ethnicity”, as culture is occult, recognized by symbols, slogans
and leadership behaviors. So, Dr. Cameron developed and
validated the Organizational Culture Assessment
Instrument© (OCAI©) in his research of culture of over
300 institutions of higher education.4 The OCAI© is a reliable,5 quantitative instrument used to diagnose culture
type and to measure culture strength. It takes 5 minutes to
complete only 6 questions, each question corresponding to
one of six key attributes of organizational culture:
Dominant characteristics, Criteria for success,
Organizational glue, Strategic emphases, Employee management, and Leadership style. Respondents divide 100
points among 4 alternatives labeled A–D, each alternative
corresponding to a culture type. (See Figure 1, Question
#1. Dominant Characteristics) More points are to be
assigned to the alternative that most closely currently
resembles the organization level that is the target of change
(i.e., the Rheumatology Program). The exercise is repeated
under the PREFERRED column, imagining the organization as highly successful (i.e., Rheumatology as the sub-specialty of choice of UMN residents). The numeric answers to
the OCAI© are then plotted on a type of radar graph, the
Competing Values Framework, which arranges four core values into competing diagonal quadrants: Clan values compete with Market values, Adhocracy with Hierarchy. (See
Figures 2 and 3 Student and Faculty Responses to Question
#1 addressing the attribute of Dominant characteristics)
to view the quadrant arrangement.
A determination of culture type, culture strength, alignment among attributes and mismatch between current
and desired cultures can then be made. The higher the
point on the scale, the stronger the culture in that quad-
Of further concern, between the years
1996 and 2003, only 1 resident from
among the University of Minnesota
(UMN) Internal Medicine residents
pursued Rheumatology, having been
accepted to the University of Washington
Fellowship Program in 1996.
rant. A discrepancy in excess of 10 points between the
current and preferred plots identifies attributes in need
of culture change. Drs. Cameron and Quinn reference an
extensive list of their own and other’s scholarly work,
including studies of organizations in the health care
industry and institutions of higher education, in support
of the facts that organizations with strong cultures are
more effective than those with weaker ones, organizations
with culture congruency among attributes and between
current and preferred cultures are more effective than
those with incongruencies and, that culture type is the
most powerful predictor of an organization’s success.3
CRAJ 2007 • Volume 17, Number 1
9
TOPICAL MEDICAL ISSUES
The CSE Project
With this new appreciation for culture, the following
hypothesis was formulated: in spite of upgrades to the
Rheumatology Program at UMN, local residents are disinterested in Rheumatology as a career sub-specialty because
...organizations with strong cultures are
more effective than those with weaker
ones, organizations with culture
congruency among attributes and
between current and preferred cultures
are more effective than those with
incongruencies and, that culture type is
the most powerful predictor of an
organization’s success.3
the existing (undesired) culture is overly oriented towards
efficiency, structure and achievement of measurable
results. For Rheumatology to become the sub-specialty of
choice to UMN residents, culturally, the Program might
need to become more oriented towards personal development, mentorship, and participation. This CSE Project
proposed to perform a “culture needs assessment” and to
determine the current and desired cultures of the
Rheumatology Program at the University of Minnesota.
Between March 2004 and June 2006, the OCAI© was
completed by 12 of 19 medical students at the end of
their 3 week UMN Rheumatology Elective, 6/18 Internal
Medicine residents at the end of their 4 week
Rheumatology rotation and 4/5 UMN Rheumatology
Clinical Faculty once in 2006. Of the 18 residents who
rotated through Rheumatology, 2/3 either didn’t complete the OCAI© or their 4 week rotation was abbreviated by vacation or the need to involuntarily fill inpatient
service vacancies. One of the six residents who completed
the full 4 week rotation went on to pursue Rheumatology.
Results to date
First the responses by house-staff and faculty to each of
the 6 attribute questions were reviewed. Figures 2 and 3,
respectively, represent the student and faculty responses
to e.g. Question #1 assessing the attribute of Dominant
characteristics. Each 4 point plot represents a single
respondent’s answers. Presently, for this attribute, students
perceive an orientation towards Hierarchy and secondarily, Market, but they prefer Clan and secondarily, Adhocracy.
In contrast, for this attribute, Faculty presently see a strong
orientation towards Market, but they prefer a strong
Adhocracy and secondary Clan and Market balance.
Figure 2 . Organizational Culture Attribute of Dominant Characteristics
Student responses (n = 12)
Clan
Hierarchy
Adhocracy
Hierarchy: emphasis on structure and efficiency
Adhocracy: emphasis on creativity and innovation
Clan: emphasis on mentorship and teamwork
Market
10
CRAJ 2007 • Volume 17, Number 1
Market: emphasis on competition and productivity
Figure 3 . Organization Culture Attribute of Dominant Characteristics
Faculty responses (n = 4)
Clan
Hierarchy
Adhocracy
Hierarchy: emphasis on structure and efficiency
Adhocracy: emphasis on creativity and innovation
Clan: emphasis on mentorship and teamwork
Market
Market: emphasis on competition and productivity
Figure 4 . Determination of Alignment Among Attributes
OCAI© plot for residents (n = 6)
Clan
Hierarchy
Adhocracy
Market
Next, the collective responses by house-staff and faculty to all 6 questions were superimposed to look for
alignment among the key culture attributes. Figures 4
and 5 represent the resident and faculty responses,
respectively. Each 4 point plot represents a single
attribute. According to the residents, presently there is
neither congruency among the attribute culture profiles, nor between the current and preferred responses.
For example, they perceive Leadership style to be
strongly oriented towards Clan, but Organizational glue
towards Hierarchy. However, uniformly among the key
attributes, residents have a preference for a strong Clan
culture and secondary Adhocracy, with some variation
in strength, depending on the attribute. Like the residents, according to the collective faculty responses,
presently there is neither congruency among the attrib-
CRAJ 2007 • Volume 17, Number 1
11
TOPICAL MEDICAL ISSUES
Figure 5 . Determination of Alignment Among Attributes
OCAI© plot for residents (n = 6)
Clan
Hierarchy
Adhocracy
Market
ute culture profiles, nor between the current and preferred responses. For example, Faculty perceive Dominant
characteristics to be strongly oriented towards Market,
Leadership style, Organizational glue towards Hierarchy, but
Employee management balanced between Clan and
Adhocracy. Once again, for Faculty, there is alignment
For Rheumatology to become the
sub-specialty of choice to UMN
residents, culturally, the Program might
need to become more oriented towards
personal development, mentorship and
participation.
among attributes’ preferred culture profiles. However, unlike
house-staff, Faculty prefer a strong culture balanced among
Adhocracy, Clan and Market.
Figure 6 plots the calculated dominant culture types
from the responses of the one resident who chose
Rheumatology as a sub-specialty. Important to the deter-
12
CRAJ 2007 • Volume 17, Number 1
mination of organizational effectiveness, there is a clear
match between the current and preferred culture profiles,
specifically a strong Clan, moderate secondary Hierarchy
and weaker Market, Adhocracy. Upon closer examination,
(plot not shown) and unique to this resident, the existing
and preferred profiles match exactly for 4 of the 6 attributes, the highest degree of attribute congruency of all the
respondents.
Development of a Plan
To date, house-staff and Rheumatology Faculty responses to the “culture needs assessment” of this specific US
Program suggest that fellows are more likely to be
recruited from the local resident pool if the Program was
to develop a strong CLAN, and secondary ADHOCRACY
cultures for all 6 key attributes. Therefore, along with
programmatic improvements, the UMN Rheumatology
Faculty should give priority and focused attention to
developing their Clan and Adhocracy managerial competencies. Examples of Clan quadrant skills include
clearly stating expectations for performance, turning
students into teachers, and ensuring learner tasks have
variety, identity, significance, autonomy and feedback.
Examples of Adhocracy quadrant skills include celebrating trial and error learning, showing off underdeveloped, experimental ideas, measuring improvement not
Figure 6 . Determination of Dominant Culture Type
OCAI© plot for resident AD
Clan
Hierarchy
Adhocracy
Market
just goal accomplishment, posting of results so that
(even small) successes are visible, and frequently communicating the vision of the future aloud, in written
form and in their behaviors.
According to Cameron’s and Quinn’s book, in preparing for this educational culture reorientation, the UMN
Rheumatology Faculty “should hold a discussion regarding the culture that should characterize the Program in
the future and reach a consensus.” At the present time,
Faculty are examining the expectation systems that are
driving their behaviors that are perceived to be of the
(undesirable) Market and Hierarchy and are looking for
ways to alter the incentives.3
According to the responses of the one resident who pursued Rheumatology, it might be possible to identify UMN
specific house-staff, who will enter a Rheumatology
Fellowship by the matching of their currently perceived culture profiles of the UMN Rheumatology Program with preferred culture profile, congruency among the 6 key attributes, and/or by his/her preference towards Clan and secondarily Hierarchy. To determine if these identifiers and
pro-recruitment culture profiles are applicable to other subspecialty Programs or to other institutions, plans are also
underway to expand the distribution of the OCAI© among
UMN residents rotating through other sub-specialty
Electives and to other Rheumatology Programs in this city.
1. ACR Research and Education Foundation. Available at: www.rheumatology.org/ref/
accessed November 2006.
2. University of Minnesota Internal Medicine Residency Graduate Tracking Data.
3. Cameron, Kim S. and Quinn, Robert E. Diagnosing and Changing Organization Culture
Based on the Competing Values Framework. Reading, MA: Addison–Wesley Publishing
Company, Inc., 1999.
4. Cameron, Kim S., Freeman, Sarah J. Cultural congruence, strength, and type:
Relationships to effectiveness. Research in Organizational Change and Development
1991; 5:57-73.
5. Yeung, Arthur, et al. Organizational culture and human resources practices: An
empirical assessment. Research in Organizational Change and Development 1991; 5:
59-81.
CRAJ 2007 • Volume 17, Number 1
13
NORTHERN HIGHLIGHTS
CRA Distinguished Rheumatologist 2007
Arthur A. M. Bookman, MD, FRCPC
D
r. Bookman’s first exposure to rheumatology
began in 1966 at the University of Western
Ontario, when in his third year of medical school,
he was introduced to “the most hopeless looking disease”—scleroderma. He would see his next rheumatology case, florid systemic lupus erythematosus, as a firstyear medical resident with Dr. Jack Reynolds at the
Toronto Western Hospital. When he took some serum over
to Dr. Murray Urowitz at the Wellesley Hospital to perform an assay for free DNA and anti-DNA antibodies, the
specialty suddenly seemed like “living immunology.” He
applied to rheumatology in Toronto and was accepted. A
whole crew of recruits had been attracted into rheumatology at that time: Dr. Frank Lipson, Dr. Lynn Russell,
Dr. Lorraine Flatt, Dr. Sid Gershon, Dr. Barry Koehler and
Dr. Arthur Weinstein. Dr. Bookman, along with Dr. Lucien
Latulippe, were the only recruits the year after they all
graduated and virtually ran the 40-bed ward for a year
(along with a core housestaff). “I saw and did everything.
Dr. Metro Ogryzlo, Dr. Duncan Gordon, Dr. Hugh Smythe
and Dr. Urowitz were my mentors” he remembers.
Dr. Bookman is now Associate Professor of Medicine at
the University of Toronto and a Clinical Teacher at the
Toronto Western Hospital—University Health Network.
He says “the affiliation with young trainees in rheumatology has been the most satisfying aspect of my career.” He
also has a special interest in Sjogren’s Syndrome. He
founded the Multidisciplinary Sjogren’s Clinic at Toronto
Western over 12 years ago, and proudly continues to head
it. Dr. Bookman has been an advisor to the Federal Health
Protection Branch on medication for arthritis and an
advisor to The Arthritis Society (TAS) in a variety of different roles for over twenty-five years, currently acting as
Chair of the Medical Advisory Committee.
From 2002-2004 he took important steps as President
of the Canadian Rheumatology Association (CRA) when
he forged a liaison with pediatric rheumatology, which
finally ended in an amalgamation of the CPRA last year
with the CRA. He also invited the Arthritis Health
Professionals Association to hold their Annual Meeting
concurrently with the CRA, and began dialogues regarding cooperative efforts. Finally he started the first
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CRAJ 2007 • Volume 17, Number 1
“Access to Care” Committee at the CRA, which, headed by
Dr. Dianne Mosher, has had considerable achievement.
“Nothing in my career in rheumatology has happened
with a flourish. Every achievement has been accumulated
with little steps,” notes Dr. Bookman. While patient care
and teaching have been his favourite professional passions,
he also admits that he has enjoyed returning to the basics
these past couple of years. The last few years have rewarded
him with grandchildren, his “three sparkling jewels.” “And I
fully expect more” he adds. “I want them all with me in the
summers by the lake. Nothing is better than that.”
Congratulations on your 2007 CRA Distinguished
Rheumatologist Award. How would you describe your
past and your path to the present point of your
career?
My undergraduate training was at the University of
Western Ontario. I was a third year medical student when
I first was exposed to rheumatology. I had a clinic with
Manfred Harth at the Westminster Hospital. He showed
me a case of Scleroderma. I thought that it was the most
hopeless looking disease, and wondered what Dr. Harth
could ever offer a person like that. I did my post-medical
school training in Toronto. I didn’t see another rheumatology case until I started to work with Jack Reynolds at
the Toronto Western Hospital, as a first year medical resident. He had a lady who was suffering with florid systemic lupus erythematosus. I took some serum over to Dr.
Urowitz at the Wellesley Hospital so that they could perform an assay for free DNA and anti-DNA antibodies.
Suddenly the specialty seemed like living immunology,
and I saw a whole new perspective. I applied to rheumatology in Toronto and was accepted.
Murray had attracted a whole crew of recruits into
rheumatology at that time: Frank Lipson, Lynn Russell,
Lorraine Flatt, Sid Gershon, Barry Koehler and Arthur
Weinstein. I was the only recruit the year after they all
graduated, along with Lucien LaTulippe. I virtually ran the
40-bed ward on my own for a year (along with core housestaff). I saw and did everything. Metro Ogryzlo, Duncan
Gordon, Hugh Smythe and Murray were my mentors. The
physiotherapists from the Canadian Arthritis and
Rheumatism Society would round with us, along with
social workers, physios,and occupational therapists.
Charles Godfrey was the Physiatrist at the hospital, and
Waldemar Pruzansky was the immunologist. After a third
year of internal medicine, I returned to complete a second year of rheumatology at Wellesley. I was the Chief
Rheumatology Resident, with Isaac Dwosh, Howard Stein,
Ed Keystone,Peter Lee and Dafna Gladman.
I went on staff at the Toronto General Hospital, part
time, and entered private practice at St. Clair and Yonge
Street in Toronto. Two years later, my office burned down,
and my practice evaporated. Dr. Phillip Rosen, an eminent
rheumatologist in Toronto died in 1979, and I took over
his practice, but remained tied to the Toronto General,
where I eventually was asked to become the Division Chief
of a “Tri-Hospital” rheumatology unit (Mount Sinai,
Toronto General, Women’s College). With the merger with
Toronto Western in 1990, I moved there, and the rest is
history.
What have been the major influences in your success
as a Rheumatologist?
Of course one’s colleagues influence one greatly. I spent
15 years at the Toronto General with Dr. Dale McCarthy
and Dr. Carl Laskin. I learned the importance of maintaining a broad knowledge base. Often I found that I was
the specialist who pulled complicated cases together.
Furthermore, medical problems such as sickle cell anemia, HIV and amyloidosis would present with MSK manifestations, and I would be called to see them. I learned
that in a general hospital, your colleagues were looking
for reassurance, and appreciated a clear perspective on
complicated medical problems whenever possible.
I have felt a special affinity for TAS from the beginning
of my training, and have worked with them since 1980,
always on a voluntary basis. When I saw the political drift
of our specialty in the mid-nineties, I became impassioned about the importance of being recognized as a
specialty comprised of THE experts on arthritis. I started
to get involved. I became Chair of the Health
Professional Advisory Committee of TAS in Ontario. I
worked with Dr. Rob Inman, Dr. Jody Lewtas and Dr. Carter
Thorne, and they really got me going! We started to draw
attention to the drift of TAS away from Rheumatology and
inequities between the divisions.
When Dr. Barry Koehler asked me to become the Editor
of the CRAJ, I saw an opportunity to have a national voice,
and I took note of the growing strength of the CRA. I
Dr. Bookman receiving his Distinguished Rheumatologist Award at this year’s
CRA Annual Dinner in Lake Louise, Alberta.
arranged the design of the CRA logo that we still use
today. I felt strongly that we needed to be noticed, and
when then CRA President Dr. Glen Thomson decided to
establish a public relations arm, I was the one that hired
I was the only recruit the year after they
all graduated, along with Lucien
LaTulippe. I virtually ran the 40-bed ward
on my own for a year (along with core
housestaff). I saw and did everything.
Metro Ogryzlo, Duncan Gordon, Hugh
Smythe and Murray were my mentors.
Cohn & Wolfe to become the publicists for the CRA, and
eventually for TAS as well.
I felt very strongly that there should be a Medical
Advisory Board at the national level of TAS, and along with
Dr. Dianne Mosher and Dr. Gunnar Kraag, we told the
CRAJ 2007 • Volume 17, Number 1
15
NORTHERN HIGHLIGHTS
board of TAS, in no uncertain terms, how we felt. A Medical
Advisory Committee was ultimately established, and it has
been hard work finding a direction and voice for this
group. I have felt all along that a medical person had to be
on paid staff, and recently, Mr. John Fleming, TAS CEO has
given an interim position to Dr. David Hawkins as Vice
President, Medical Affairs. I think that ultimately, this is
the rheumatology influence that TAS requires.
What have been your proudest achievements and
highlights?
Nothing in my career in rheumatology has happened with
a flourish. Every achievement has been accumulated with
little steps.
I was proud to be the President of the Canadian
Rheumatology Association. I thought that I took some
important steps during my two years. I forged a liaison
with Pediatric Rheumatology, that finally ended in an
amalgamation of the CPRA last year with the CRA. I invited the National Arthritis Health Professionals Association
Nothing in my career in rheumatology
has happened with a flourish. Every
achievement has been accumulated with
little steps.
to hold their Annual Meeting concurrent with ours, and
began dialogues regarding cooperative efforts. I started
the first “Access to Care” Committee at the CRA, a committee that Dianne Mosher headed with considerable
achievement. I initiated the first steps towards our combined conference in Mexico last year, and Michel Zummer
can take credit for the ultimate achievement. I clarified
and matured the rules of operation of the CRA.
Aside from political activities, I started the
Multidisciplinary Sjogren’s Clinic at Toronto Western
over 12 years ago, and have been proud to keep this
going as the Coordinator. It has grown, and this year a
National Support Group for Sjogren’s Disease, “The
Sjogren’s Society of Canada” will be inaugurated under
a patient, Lee Duran.
I have been proud to be awarded for my teaching. The
affiliation with young trainees in Rheumatology has
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CRAJ 2007 • Volume 17, Number 1
been the most satisfying aspect of my career. I continue
to teach and lecture. It is nice to know that my clinical
experience has value.
Currently I am Chair of the Medical Advisory Board of
the Arthritis Society. I see many roles for rheumatologists
to work with TAS, and I think that this jewel of an organization has been neglected by us to our own detriment. We
grew to our current state of independence initially in
conjunction with TAS. They still raise five million dollars
for arthritis research and manpower annually, and can
benefit greatly from our support. Rheumatology in
Canada is nothing without a research and education program, and TAS remains the underpinning for these industries for arthritis.
What things do you miss and not miss about being
President of the CRA?
You know, I think most of us work so hard because we want
to make a difference, and we usually do, but the difference
is accumulative, and sometimes we hardly notice that we are
achieving anything. Being the President of the CRA was one
of those key moments when what you initiated actually
made a noticeable difference, and you could palpate the
impact that you were having. That doesn’t happen often in
life, so this was a highlight. But we only have a certain
amount of fresh viewpoint and fresh ideas within us, and so
I think that it is good that we change the Presidency of the
CRA every two years. It would be nice to do it again I guess,
but it takes a lot of energy, and a very understanding family.
What should the CRA be doing in 10 years?
The CRA must continue to lead, it cannot drift. I think that
it is important for the organization to remain representative
of community and academic rheumatology. At this point I
can see many opportunities for exciting new initiatives.
First, I think that the CRA should take the lead in
coordinating the manpower strategies that exist all over
the country in a continuum from studentships to residency programs. The CRA has the resources and the
expertise to pull together the educators, the program
directors and the student preceptors, to create a
roadmap for efficient manpower recruitment. There has
been one meeting funded by TAS. That has to grow, and
I think CRA should take the lead.
I think that the CRA should be taking a lead in
fundraising for manpower and education programs, and
I think that they should use TAS as a partnership-repository for funds raised for these initiatives. My perception
is that the CRA has more influence with industry than
TAS will ever have.
We also need to be cognizant of the growing regional
rheumatology meetings, French and English, and we need
to make these part of the CRA, advertise them, highlight
them, support them and coordinate them. Regional meetings are growing in importance. They are fostered by
pharmaceutical funding, and the necessities of regional
politics. To be strong, the CRA must remain relevant, and
to be relevant, we must organize our relationship with
these regional societies.
What is your role as the Chair of the Medical
Advisory Committee of The Arthritis Society? How are
the priorities and goals of Canadian Rheumatologists
similar and different from those of The Arthritis
Society?
I think that my main aim has just been to get this going.
TAS needs medical advisory. It needs to know what the
relevant medical issues are, and how to set direction. Of
course, the CEO of TAS takes advice from many arenas,
not least of which are the lay people that work in the
divisions and on the boards. Whereas TAS started off in
a partnership with rheumatology, raising funds for
rheumatology research as a primary goal, it has diverted, especially at a divisional level, into programs and
advocacy. Peer review research has always been a
National function, but the divisions raise the money,
and have had a lot to say about how much gets into
National coffers. These tensions are being addressed by
the administration of the Society, and hopefully with
funds raised, research will thrive.
CRA has grown to meet the void left as TAS changed
its focus away from rheumatologists, and more towards
its clients. CRA is our professional body, and serves us
alone. But in doing so, I do not see why we cannot support the manpower funding of TAS, help it grow, and
augment it. It is essential that we remain engaged with
TAS. They do have respect for our specialty, they still
want to work with us and support us. There have been
some political obstacles, but I think that we are starting to engage in mutual projects, such as the recent
revision of their booklet on medication.
What are your next personal and professional goals?
I have enjoyed returning to basics this past couple of
years. Patient care and teaching are my favourite professional passions. I have my eye on some special avenues,
and time will tell which one I will pursue. The last few
years have rewarded me with three sparkling jewels: my
grandchildren. And I fully expect more. I want them all
with me in the summers by the lake. Nothing is better than
that.
What message would you like to leave with your
colleagues in Canadian Rheumatology?
There is going to be a fundamental change in rheumatology within the next five to ten years. The current heady
days of biologics trials in Rheumatoid Arthritis and other
forms of inflammatory arthritis are going to peter out. I
think that that is fairly predictable.
I suspect that there is going to be a revolution with
the trial and marketing of DMARDs for osteoarthritis.
The first of these DMARDs are already coming to trial,
and if and when they are marketed, we will have the first
real medical foothold into controlling osteoarthritis
progression. Once that happens, we are going to need
skills that we currently do not hold. As we medically
treat more patients with osteoarthritis, rheumatology, at
least in some hands, is going to have to become procedural. This will become a very popular specialty. We may
find utility for the first time in using office arthroscopy
and office ultrasound for diagnosis and treatment of
The CRA must continue to lead, it cannot
drift. I think that it is important for the
organization to remain representative of
community and academic rheumatology.
degenerative joint disease. We will have new markers for
monitoring disease progression, and we will be treating
degenerative arthritis in younger patients. This is my
prediction, and our young teachers will need to acquire
these skills as they come on staff, so that they can disseminate them.
I thank the CRA and my colleagues for honouring me
with this award. I know that it conveys a certain special
regard by ones colleagues. There is nothing in a career
more wonderful than that. I also know that I am in good
company with the receipt of this award, and I plan to
hang it where I can look at it often.
CRAJ 2007 • Volume 17, Number 1
17
NORTHERN HIGHLIGHTS
CRA Distinguished Investigator 2007
Henri Ménard, MD, CSPQ
D
r. Ménard has always enjoyed reading, studying,
exploring, learning and applying new knowledge. His
parents raised their 5 children to follow the French
adage “Qui s’instruit, s’enrichit.” After graduating with a
Bachelor degree in Arts, Sciences and Philosophy from the
Séminaire de Valleyfield, and a MD degree from the Université
de Montréal, Dr. Ménard soon realized that the textbook of
medicine was, “often, a limited and, sometimes, misleading
source of knowledge.” That is why in the early 1970s he
became interested in “that new specialty, rheumatology, where
the body of knowledge was just being put together.”
His training began at the University of Texas (Dallas)
where he focused on clinical and molecular rheumatology
allowing him to later make original observations both as a
clinician and a scientist. He approached each patient by
following scientific leads underlying signs and symptoms.
He also thanks Dr. Morton Kapusta and Dr. Morris Ziff for
being great influences and for providing him with the
best mentorship and advice.
After completing three years of clinical research fellowship in Dallas and Paris, he established the Autoimmune
Laboratory at the Centre Hospitalier Universitaire de
Sherbrooke to develop and validate autoantibody tests that
would help him and his colleagues’ clinical practice. “The
intellectual challenge of the to-and-fro between lab and
clinic is what stimulated me then and now,” he says. In
fact, from 1973 to 2000, while continuing his original
clinical research, Dr. Ménard worked at the Université de
Sherbrooke as Professor of Medicine, Director of
Rheumatology and Program Director for Undergraduate
and Postgraduate Rheumatology. He left the university
having recruited the three clinical rheumatologists-scientists working there: Drs. Boire, Fernandes and Liang and
having also participated in the training of many residents,
graduate students and post-doctoral fellows now enjoying
academic or industrial careers in Canada, the USA, and
abroad.
Dr. Ménard is currently working at Mcgill University as
Professor of Medicine, Director of Rheumatology at the
Health Center, Director of the McGill Arthritis Centre,
and co-leader of the MSK Research Axis at the MUHC
Research Institute. He is also a senior physician at the
Royal Victoria Hospital, the Montreal General Hospital
and the Montreal Shriners’ Hospital.
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CRAJ 2007 • Volume 17, Number 1
Dr. Ménard has enjoyed a longstanding career in
rheumatology and has always relied on the same inquisitive
and creative approach whether he was in the clinic or in
the laboratory. His expertise has made him a popular guest
lecturer and visiting professor, an invaluable consultant for
governments, laboratories and private companies, and a
prolific researcher with over 200 published papers.
Throughout all his endeavors, he applied a systematic
Cartesian approach, incorporating the Claude Bernard scientific method and remembering the virtue of tolerance in
dealing with all human affairs and behavior. “Those were
the best ways of dealing with everything, including familial
and professional life as well as research and, clinical and
administrative management problems. Bottom line, there is
still very much to learn in rheumatology for a receptive, disciplined and dedicated mind,” says Dr. Ménard.
What have been the turning points and influences in
your past which have led you to this point in your
career?
My parents valued higher education and raised their 5
children with the slogan “Qui s’instruit, s’enrichit”. They
took it globally: materially and intellectually. I have always
liked to read, study, explore, learn and apply new knowledge. For example, in college, I was trying to apply the laws
of physics to hockey as I do now for golf. I still fail most of
the time as “too many controls ruin a good experiment” (M
Ziff). I always thought that Rocket Richard or Guy Lafleur
who both had problems putting a sentence together, had
to be geniuses in their field of endeavor. All I had to do
was to find my field and work hard at it and “become a student of the game” to improve it.
It soon became clear to me in the early 1970’s that textbook medicine was a very limited and sometimes misleading source of knowledge. I liked hematology (blood banking serology) and neurology (superb clinical-pathological
correlation without MRI or CT). There was that new specialty: rheumatology where the body of knowledge was
just being put together. Fibromyalgia in those days was
known as polymyalgia with a normal sed rate, high dose
ASA was the treatment for RA and there was only one kind
of lymphocyte. That was simple enough. To participate in
this lifetime adventure I decided to listen to the scientific leads given by the sign and symptoms of patients. I fig-
ured it would allow me to explore new ideas. Morton
Kapusta and Morris Ziff had a great influence and provided the best mentorship.
When I came back from three years of clinical research
fellowship in Dallas and Paris, I did what is now known as
knowledge translation. I established an autoimmune laboratory in Sherbrooke to develop and validate autoantibody tests that would help me and my colleagues in our
practice. I thus supported the hospital with funds from
my research grants. The intellectual challenge of the toand-fro between lab and clinic is what stimulated me then
and now. Basic science graduate students, clinical science trainees, patients and our respective families were
great teachers. They kept me young at heart and on top
of things. I developed a systematic Cartesian approach,
incorporated the Claude Bernard scientific method and
applied the virtue of tolerance to all human affairs and
behaviour. Those were the best ways of dealing with everything: familial and professional life as well as research and,
clinical and administrative management problems. Bottom
line: there is still very much to learn in rheumatology for a
receptive, disciplined and dedicated mind.
What professional accomplishments make you most
proud?
1. The description of the Ménard’s sign with a medical
student. I teach it everyday to this day.
2. The identification of Charcot-Leyden crystals in synovial fluid and the description of the corresponding
new disease with a resident, the young J Brown, now
Director of Rheumatology at Laval University.
3. The international impact and ramification of my pioneering work on the Sa immune system. That was developed mainly over the past 15 years with G Boire and
the Sherbrooke group, with J Lopez-Longo now in
Madrid and with N Després, now in R&D with the
Bayer Corporation in the USA.
4. The still not-widely-known generic RIA to detect autoantibodies to each (and all) known serine proteinases.
Still to this day, it is the best diagnostic and monitoring
test for anti-PR3 and, as a bonus for anti-elastase which
is associated with drug-induced vasculitides. The test
was put together with the help of Drs. F LucenaFernandes and ZJ Zhou, both Ogryzlo fellows from Brazil
and China, respectively.
5. My unique participation in building the Rheumatology
Division at the Université de Sherbrooke and in rebuilding the Rheumatology Division at McGill University.
Both are internationally recognized academic Centers
Dr. Ménard (right) receiving his Distinguished Investigator Award at this year’s
CRA Annual Dinner in Lake Louise, Alberta.
focusing on the rheumatic patient with one cohesive
vision: excellence whether in research, teaching,
patient care and service to the community.
What are the three or four areas of rheumatoid
arthritis research that have the potential to have the
greatest impact on the disease over the next decade?
1. We will refine the HLA association by also looking at
protective alleles.
2. We will validate better biomarkers like the anti-Sa
autoantibodies. The anti-CCP tests as we know them
are transition tests.
3. We will incorporate ultra-sound MSK imaging in the
formal teaching program of rheumatologists to be used
daily in the clinic and be justly remunerated for it.
4. We will study more environmental triggers like oral
health.
5. We should look, independently from the big pharmas,
at the proper use of old and new therapeutic modalities. The marketing pressure on the rheumatologists is
very high almost conflicting with innovative clinical
science.
6. We should look at access to care with creativity using
as a model, RA interventions in early arthritis in captive populations (to restrict the gene pool and the
environmental variables). Looking first as we are
doing now at multiethnic and multicultural RA populations may be jumping the gun.
CRAJ 2007 • Volume 17, Number 1
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NORTHERN HIGHLIGHTS
What will be the sources of research funds for the
next-generation of Canadian Rheumatology
researchers? Do you think that government agencies
will play a bigger or smaller role in basic research
over the next decade?
I don’t know. It could take different forms. That is a very
complex and political question. Too complex an issue to
answer in only a few sentences!
Dr. Ménard in a nutshell...
How do you balance the demands of administration
and clinical practice with your research interests and
with the rest of your life?
It is difficult at times and this is causing the disappearance of the wet-lab clinician scientist. It seems
inevitable. Young rheumatologists now favour less
labour intensive and less challenging epidemiological
dry-lab research. Clinical research has evolved to consist
essentially into doing drug trials. To compensate the
disappearance of the classical clinician scientist, I have
tried to recruit to McGill teams of MD scientist and PhD
scientist so that they can work together on the same
topics.
What is your idea of adventure?
With my wife, we trekked the Inca Trail on the Altiplano
from La Paz to Cuzco and later went deep into Papua-New
Guinea at a time when the locals had never seen a Coke
bottle.
What attributes are required for a young
Rheumatologist interested in research to become a
successful researcher?
Get a local mentor to guide your reflection, early on,
in your career decisions. Get good training in a good
place: 2-3 years post-core training in rheumatology.
Practice your creativity and critique by challenging
the textbook, the journals and your mentors. Cultivate
intellectual honesty and be thorough. Listen to
patients with a scientific and a humanistic approach:
that is not mutually exclusive. Practice debunking the
pseudo-science too often polluting the meetings and
journals and sometimes even finding its way into the
textbook. That pseudo-science provides an unlimited
source of research topics either to clarify issues or
destroy myths.
What is your advice to them?
Get a good life companion, get good training, build
your CV early with publications-presentations, read a
lot, test your ideas with peers and mentors, persevere
and finally, work hard. Never forget to get a life that will
include if possible, children and eventually grand-children. Family is the secret to keep it all together.
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CRAJ 2007 • Volume 17, Number 1
Describe yourself in three words?
I am creative, persevering and hard working.
If you hadn't become a doctor, what would you like to
have been?
A journalist or a novelist.
What is your favourite medical aphorism?
Remember this, it is a dragon: you see one, you see them all!
What was the first record/CD you ever bought? Sonatas
for flute and harpsichord by JS Bach played by JP Rampal.
What book/movie character would you most like to be
stuck on a Desert island with?
I would bring the books of the Series: "Chicken Soup for
the Soul". I recently appreciated "Chicken Soup for the
Golfer's Soul".
What is the best piece of advice you've ever been given?
As a manager, try to be like God: present everywhere, visible nowhere.
What vice do you have that you hide from patients?
That I am so ignorant.
What is your biggest extravagance?
Cycling around the Cabot Trail without prior training.
What personality trait has got you into the most trouble?
I have never been in a lot of trouble. Low profile, I am
quite cool unless physically threatened or intellectually
challenged by incompetence.
Do you have a nickname?
No I project too serious an image
Have you tried any alternative therapies? Did they work?
Yes, on both counts. They do because success is "in
the eye of the beholder". The problem is just that we
don't quite know the proper indication for most of
them.
What is your biggest frustration as an MD?
The Canadian Health Act has progressed from being
THE solution to being THE problem. It needs some
creative rethinking outside the various political
agendas.
What talent do you envy in others?
I am quite good with the Written word and I wish I
would be as good with the Spoken word i.e. be honest,
witty and fluid without becoming improper.
When were you the happiest?
When my daughters got married and I discovered that I
now had two marvellous sons that gave us two
marvellous grand-children (and counting).
When were you saddest?
When my parents died at 6 months interval. I was 50. I
then became an orphan.
What's your idea of a perfect vacation?
Find a nice place and enjoy it with friends and family.
No « unannounced » visitors as "L'enfer, c'est les autres"
(JP Sartre).
What is your least favourite medical procedure that
you regularly perform?
H&E on somebody with a chronic problem that I know
from the onset, I cannot help.
What is your favourite medical procedure that you
regularly perform?
H&E on somebody with a chronic problem that I know
from the onset, I will restore his life.
What is your favourite meal?
I like sophisticated food but I also eat junk with
pleasure. The recent good meals I had were at "Le
Bouchon De Liège" and Europea. The former is
Montreal's best kept secret. The chef is creative: he
knows the classical food and wine harmonies and yet,
he surprises you at every service.
What do you know now that you wished you'd known
10 years ago?
That I had a slow growing but resectable meningioma
that was responsible for an annoying "positional
vertigo." Now that it has been removed, I know, it was
slowing me down in term of creativity and productivity.
What famous person do people compare you to?
Tony Russel once told me I looked like Peter Sellers but
was definitively not as funny.
Have you had a "15 minutes of fame" moment and how
did it come about?
I had 20 seconds of fame. I was featured on CTV
National News when its crew came filming while I was
doing voluntary work at the Canadian Red Cross on
Nuns' Island in Montreal. They taped me answering the
phone "in English" during the recent Tsunami fundraiser
on New Year's eve. All the other volunteers were
speaking "in French."
What is the best piece of advice you have received,
and from whom?
From my wife: "Be a facilitator and an agent of change
instead of an agent of inertia". No, it had nothing to do
with sex!
What do you think is the most exciting field of
science at the moment?
Our extraordinary capacity to define the essence of
human biodiversity through genomics and the use of
longitudinal large biobanks to assess the contribution of
the environment to the phenotypic expression of disease.
What is the least enjoyable job you've ever had?
I have always loved every single job I had except the first
one. I was 15 and employed during the summer at a Green
Giant Plant in Ste-Martine in rural Quebec. I rode my
father’s bike for the 4 miles from home to the Cannery at 6
am and back at 6 pm. While there, I had to stand by a
machine and was responsible for putting a salt pellet in
every one of the zillions of aluminium can that passed in
front of me, every day, all day. I had to put the salt pellet
after the can was filled with peas, beans or corn but before
the cover fell on it and the machine sealed it. The deafening noise, the automatism and the boredom were incredibly "chaplinesque" as in "Modern Times".
CRAJ 2007 • Volume 17, Number 1
21
NORTHERN HIGHLIGHTS
CRA Young Investigator 2007
Carol Hitchon, BSc, MSc, MD, FRCPC
r. Carol Hitchon has always excelled academically and within her research efforts having
received numerous awards and scholarships
throughout her career from her pre-medical education
at the University of Calgary in 1988 to her most recent
research award grant from the Manitoba Health
Research Council.
Dr. Hitchon pursued her medical degree and passion
for research at the University of Alberta within the
Honours in Research Program and graduated in 1992.
She continued on to complete her residency in Internal
Medicine and Research Fellowship at the University of
Manitoba where she focused her research on alternative
therapy use in rheumatoid arthritis, anti-oxidants in
rheumatoid arthritis, psoriatic arthritis and SLE in the
Canadian aboriginal population.
Since 2001, she is an Assistant Professor in the
Section of Rheumatology at the University of Manitoba
and is on staff at the Health Sciences Centre and St.
Boniface Hospital in Winnipeg, Manitoba. She is also
establishing herself as a reputable presenter and guest
lecturer as well as published expert.
She is currently interested in identifying predictors of
treatment response and outcome in rheumatologic conditions, focusing on early inflammatory arthritis. This
project involves analysing biomarkers, correlating them
with spectroscopy imaging and clinical features, and
seeing whether these help predict clinical outcome. Dr.
Hitchon hopes this will lead to a better understanding of
the early pathogenic events in synovitis. Her next
research questions will likely develop from what happens
from her current studies.
D
Congratulations on your Canadian Rheumatology
Association Young Investigator Award for 2007.
Would you describe your current research and the
next research questions that you hope to answer?
Thank you. My interests are in identifying predictors of
22
CRAJ 2007 • Volume 17, Number 1
Dr. Hitchon receiving her Young Investigator Award at this year’s CRA Annual
Dinner in Lake Louise, Alberta.
treatment response and outcome in rheumatologic
conditions, and I am currently focusing on early inflammatory arthritis. The project involves analysing biomarkers, correlating them with spectroscopy imaging
and clinical features, and seeing whether these help
predict clinical outcome. Hopefully this will lead to a
better understanding of the early pathogenic events in
synovitis. The next research questions will likely develop from what happens with the current studies.
Do think it is helpful for the CRA to recognize
young Canadian researchers with this award?
Should there be more recognition and
encouragement given to researchers in their early
careers?
Yes! I am quite honoured to receive this award and owe a
lot of the success I have had to my mentors, in particular
Dr. El-Gabalawy. The CRA’s recognition of those who have
made contributions to research either while training or
early in their careers is important. Hopefully it will
increase awareness of rheumatology research in Canada
and will encourage trainees to consider academic
rheumatology and research.
Is Canadian research well enough funded for to
attract more young investigators?
No. Research funding is becoming increasing limited
and competing for national funding is challenging for
investigators who do not have an extensive publication
record. There are some competitions that prioritize
funding for junior applicants and this certainly helps.
However, more funding is definitely needed.
What are your goals for 10 years from now?
To continue both clinical care and research in rheumatology and to still enjoy it. I hope the early arthritis
cohort will have matured and with multi-center initiatives
be productive in answering some interesting clinical
questions. Improved access to the clinic will be hopefully
result in patients being seen and treated early with individualized and targeted therapy, perhaps to the point
where persistent synovitis and erosive damage are prevented and sustained remission of treatment is feasible.
What advice do you give your residents about a
career in rheumatology and research?
Rheumatology is an exciting field with many opportunities for clinical and basic science research. Residents can
take advantage of these opportunities by participating in
research projects and attending workshops and conferences like the CRA annual meeting where you can meet
other clinicians and researchers. Mentorship is invaluable. Mentors can help you develop skills needed for
Research funding is becoming increasing
limited and competing for national
funding is challenging for investigators who do not have an extensive
publication record. There are some
competitions that prioritize funding for
junior applicants and this certainly helps.
However, more funding is definitely
needed.
independent research, provide feedback on your ideas
and help with pursuing collaborations needed for successful research programs. I have been very fortunate to
have the mentorship of several academic rheumatologists, in particular Drs. El-Gabalawy and Peschken.
Most important, the research experience while challenging at times is fun and very rewarding!
CRAJ 2007 • Volume 17, Number 1
23
CRAJ PHOTO CONTEST
Photo Contest Winners from the
62nd Annual Meeting in Lake Louise
BEST CANDID: THE STARVING RHEUMATOLOGIST
This photo was taken by Dr. Michel Zummer
BEST SCENIC: PARADISE AT LAKE LOUISE
This photo was taken by Dr. Karen Duffy
24
CRAJ 2007 • Volume 17, Number 1
The Runners-up
Candid
First runner-up: Dr. Michel Zummer
Rheumatologists “R” Us!
Scenic
First runner-up: Dr. Abdullatif Al-Arjaf
Victoria Glacier at Château Lake Louise
Second runner-up: Dr. Robert Ferrari
Fear not Princess, a gaggle of rheumatologists has
arrived. Perhaps they have seen this syndrome of
wrist flexion contracture associated with lumbar
hyperextension!
Second runner-up: Dr. Alf Cividino
The new scientific program will include
compulsory skiing
Third runner-up: Dr. Abdullatif Al-Arjaf
Rock “n” Roll Rheumatology!
Third runner-up: Dr. Christopher Penney
It’s a long way to the Château!
CRAJ 2007 • Volume 17, Number 1
25
LAKE LOUISE SNAPSHOTS
26
CRAJ 2007 • Volume 17, Number 1
CRAJ 2007 • Volume 17, Number 1
27
LAKE LOUISE SNAPSHOTS
Our next president in the buff!
Claire and current boyfriends.
If they don’t get better outfits, they won’t last long...
I’ve had all these beers and these guys still don’t look any good.
It has never been about the science for Dennis.
Il est un Bonhomme!
Meetings over! We survived, still have our jobs
and we even slipped the budget past them.
28
CRAJ 2007 • Volume 17, Number 1
Cowgirls and Cowboys at work and lookin’ good. Who says
Rheumatologists don’t have rhythm?
JOINT COMMUNIQUÉ
Academic Job Postings
By John G. Hanly, MD, FRCPC
T
he Canadian Council of Academic Rheumatologists
(CCAR) has maintained a national database of physician resources in Canadian Academic Rheumatology
units since 1998. Information is recorded on an annual
basis and includes descriptions of current faculty, rheumatology trainees and vacant staff positions within the individual academic units. Since the inception of the database
the number of unfilled positions has varied from a low of 21
to a high of 29, located in 11 to 13 academic centers in any
given year. The information below summarizes the number,
type and location of vacant academic rheumatology positions in July 2006. There are a total of 29 positions in 12
centres across Canada. All of the positions are full time and
include a variable mix of clinical, teaching, research and
administrative responsibilities. This information, and that
from previous years, reflects the significant physician
resource needs of Canadian academic rheumatology centres. No details are provided on the mechanisms for funding of these positions as this varies widely from centre to
centre and is not captured within the current database.
John G. Hanly, MD, FRCPC
Division of Rheumatology,
Queen Elizabeth II Health Sciences Centre and
Dalhousie University,
Halifax, Nova Scotia, Canada
Vacant Academic Rheumatology Positions
University of Calgary
Adult
Adult
University of Saskatchewan
Adult
University of Manitoba
Adult
University of Western Ontario
Adult
McMaster University
Adult
University of Toronto
Queen’s University
Adult
University of Ottawa
Pediatric
McGill University
Adult
University of Montreal
Adult
Adult
Sherbrooke University
Adult
Laval University
Adult
Memorial University
0
1
2
3
4
5
Number of jobs
Source: The Canadian Council of Academic Rheumatologists (CCAR), July 2006
CRAJ 2007 • Volume 17, Number 1
29
CAMPUS NEWS
News from the East
By Evelyn Sutton, MD, FRCPC
ot the “far east”—you have to go to Newfoundland
for that. When I was living in Winnipeg, the “east”
was considered Toronto. If one was going as far as
Quebec, that was “way east” and if one was going to the
Maritimes, well, one just didn’t, so it was never mentioned,
except in reference to transfer payments for those poor
people living in that region of economic disparity. When we
moved “East,” we discovered that the term “western,” when
applied to beef, meant it came from Ontario, but otherwise
it meant a fried egg sandwich with ham and onions. The
real west (Manitoba and beyond), was rarely mentioned,
until Alberta got richer than Ontario, and more people
from the Maritimes moved to Calgary than Toronto, and
well, you know the rest.
What has all that got to do with this column? Well nothing really, so now I will get down to brass tacks (now there
is an expression I have not heard used in everyday language since I was a child. Wonder where it came from?)
and news from Dalhousie University and the Arthritis
Center of Nova Scotia! I am happy to report that life in
the Maritimes is great, and academic life at Dalhousie is
thriving. Our squabbles with the government have abated
for a time, and after a year on an extended AFP, we have
just signed a deal with the government that should bring
some stability in the Department and our Division for the
next few years. In 2006, two new faculty members came on
board (nautical terms are appropriate for a university in a
port city—did you know that Halifax has one of the deepest natural harbors in the world?): Trudy Taylor, a
Dalhousie medical school grad who studied Internal
Medicine at Memorial University and Rheumatology with
us, joined the Division in a fulltime university based position, and a few months prior, Dr. Jill Wong returned to
Dalhousie after completing her training with Dr. John
Esdaile’s crowd at the University of British Columbia and
accepted a community-based appointment with us. Both
young women have already developed reputations as fantastic teachers and superb clinicians, and with their
appointments, our ranks have swelled (note another nautical term) to four university-based and 3 communitybased rheumatologists. Add Dr. Siraj Ahmad in a postretirement position (he has hung up his clinical hat but
continues to teach) and we still have fewer people than in
N
31
CRAJ 2007 • Volume 17, Number 1
Left to right: Caprice Stone (Team Lead Secretary), Dr. Souad Shatshat,
Dr. Jill Wong, Michelle Baker (Manager), Dr. Dianne Mosher, Dr. Evelyn Sutton,
Dr. Volodko Bakowsky, Dr. Trudy Taylor and Dr. John Hanly.
Dr. Janet Pope’s immediate family, but we are growing!
By now most of you know that in 2005 Dr. John Hanly
stepped down as Division Head after 11 years of exemplary leadership and I, with great trepidation, took over the
helm. Before he had a chance to get used to less responsibility, let alone say “no,” I quickly appointed him
Director of Research and as Director of CME. Fifteen
months later, no surprise, he is excelling in both roles. In
the Fall, the division’s CME event for family physicians was
a critical and financial success. As our Director of
Research, Dr. Hanly leads a Canadian Institutes of Health
Research (CIHR)-funded international lupus cohort
study on neuropsychiatric disease, maintains a Dalhousie
lupus cohort, runs clinical trials in RA and is leading our
group in targeting specific clinical research projects.
Setting the course as Program Director (PD) for our
rheumatology training program is Dr. Volodko Bakowsky,
another CFA (“come from away”); originally from Thunder
Bay and a Queen’s University MD graduate, Dr. Bakowsky
set anchor in Halifax to complete his studies in Internal
Medicine and Rheumatology. In his first year as PD, he
groomed the Rheumatology training program to one of
excellence—not just my words, but those of the Royal
College reviewer! Dr. Emily Shaw is our current trainee,
and we are encouraging her to emulate Dr. Bakowsky in all
things academic, but to take her own counsel with respect
to his preferred mode of transportation—cycling yearround might be reasonable in Victoria, but in Halifax?
Rounding out our university crew are Dr. Souad
Shatshat and Dr. Dianne Mosher, community-based but
academically-active and vital members of our teaching
and clinical programs. Both accept trainees in their
respective offices for community-based experience, as do
our colleagues in New Brunswick—Dr. Jamie Henderson
in Fredericton and Dr. Peter Docherty in Moncton and Dr.
Eric Grant and Dr. Ewa Sadowska in Saint John. These
rotations win rave reviews by the trainees, and we are all
enriched by their contributions. Dr. Sylvie Ouellette in
Dartmouth and Dr. Diane Wilson in Lunenburg have also
offered placements, so if there are any trainees in other
centres looking for community-based experience in the
most beautiful area of the country (i.e., the Maritimes),
come aboard!
On a separate ship but part of the same convoy are our
pediatric colleagues at the IWK Health Center, located
across the street from the Arthritis Center. Dr. Bianca
Lang, Dr. Suzanne Ramsey and Dr. Adam Huber are well
known in the Canadian pediatric community and our
journal clubs and selected rounds throughout the year
are enriched by their attendance. Their clinical activities
include outreach clinics in Fredericton, Saint John and
Charlottetown, 3 to 4 times per year, transition clinics
(with Mr. Dianne Mosher) for their adolescent and young
adult patients in addition to their inpatient and outpatient responsibilities in Halifax. This energetic trio is
involved in multi-center collaborative projects including:
Research on Arthritis in Canadian Children Initiative
(REACCH), a study of outcomes in children with newly
diagnosed juvenile idiopathic arthritis, Study on
Osteoarthritis Progression Prevention (STOPP), a CIHRfunded study of bone health in children receiving
steroids and the 1,000 Faces of Pediatric Lupus study. In
addition to their academic and clinical commitments, all
three are busy raising young families—and I mean young,
ranging in age from 13 months to 8 years.
With such great people around, my job has been easy.
They have allowed me, along with colleagues in respirology, cardiology, nursing and pharmacy, to chart a course
for patients with pulmonary artery hypertension. Since
April of 2006 we have run a pulmonary arterial hypertension (PAH) clinic based out of the Arthritis Center.
Appropriate patients are registered in Dr. Murray Baron’s
national Scleroderma Family Registry, as are all my scleroderma patients. Starting in February, I will be trialing a
new model of care in the outpatient clinics, utilizing a
physiotherapist as a physician extender (I can hear Dr.
Carter Thorne yelling “that is not new!” But hey, I am
dealing with hospital administrators here who think it is).
So, in closing, I would like to extend a warm invitation
to any and all of you to visit us here in the east (west for
the Newfoundlanders). I maintain that Halifax is the best
kept secret in the country, and I cannot imagine wanting
to live elsewhere. I am extremely grateful to be part of a
fantastic crew–both locally as part of Dalhousie
University and nationally as part of the CRA. I am attaching a picture taken at last year’s rheumatology retreat,
held in a private home called Whalesback, on Ferguson
Cove, 15 minutes from the hospital.
Best wishes,
Evelyn Sutton, MD, FRCPC
Professor of Medicine
Rheumatology Division Head
Dalhousie University
Director Arthritis Center of Nova Scotia
Director Nova Scotia Pulmonary Artery Hypertension
Program
CRAJ 2007 • Volume 17, Number 1
32
CAMPUS NEWS
Young Blood at Western
By Janet Pope, MD, FRCPC
D
r. Andy Thompson is completing his Master of
Education degree and is on staff at the University
of Western Ontario (UWO). He continues to work
on “Thompson’s Rheumatology Pocket Reference,” his
website, the CRA drug information sheets and is webmaster of the CRA website. Dr. Thompson is also interested in an educational tool which will work as a referral
form to help with the information necessary to prioritize
referrals. Dr. Gina Rohekar is junior faculty and is working on her Master’s degree in Epidemiology. We are also
lucky to have Dr. Rohekar’s identical twin, Dr. Sherry
Rohekar, who is also nearly done the course work for her
Master’s degree and is interested in seronegative arthritis. Our senior rheumatology residents have made ongoing progress. Dr. Khulood Mohammed will be returning
to Kuwait and we wish her well—she is an excellent
trainee. We have Dr. Suzanne Leaf who is back from her
maternity leave (now a boy and a girl at home) and is considering sticking around at UWO, pursuing an academic
career in education. We have hired a nurse practitioner to
help in seeing the follow-up patients and is currently in
training. He has years of experience as a nurse practitioner in orthopedics, so his MSK exam skills are already
33
CRAJ 2007 • Volume 17, Number 1
Left to right is Suzanne Leaf (Rheumatology Resident), Bob Harris (Nurse
Practitioner), Khulood Mohammed (Rheumatology Fellow from Kuwait) and
Andy Thompson (Junior Faculty).
fine tuned. We are in a position to still grow and are looking at recruits such as clinician scientists, basic
researchers and a division head. If interested, contact
me: [email protected]
The University of British Columbia
By Barry Koehler, MD, FRCPC
T
he loss of Dr. Howard Stein this past fall has been
felt across the country by his colleagues and many
friends. Howard was always “the wise man” for many
of us, able to sort through all the information and arrive
at a sensible, workable conclusion. Even though he had to
give up his clinical practice because of his illness, he
remained involved with regular teaching of fellows and
residents, as well as participating on advisory boards. I
keep expecting to see Howie strolling across the parking
lot to attend rounds, or waiting at the first tee of the golf
course. His contributions were many over the years.
Dr. John Esdaile is paddling the waters off the coast of
Brisbane while working on a well-deserved sabbatical and
no doubt leading Dr. Nicholas Bellamy astray. Never one
to let there be a moment of idleness, he is completing his
tenure as Head of our Division and has recently accepted
the position as Scientific Director for the Canadian
Arthritis Network.
Dr. Jolanda Cibere’s work in the identification of early
osteoarthritis will prove to be an exciting preliminary to
the development of disease-modifying drugs for
osteoarthritis. She is a collaborator in the Centre for Hip
Health, which uses a multidisciplinary approach to investigating early osteoarthritis of the hip.
The research of Dr. Diane Lacaille in the area of work
disability (“Making It Work”) will have practical consequences in keeping folks with arthritis in the work force.
Her grant application for outcomes of treatment in
rheumatoid arthritis received the Quality of Life Award
from the Canadian Institutes of Health Research (CIHR)
as the best study proposal in its category.
Dr. Hyon Choi, the Mary Pack-Arthritis Society Chair in
Rheumatology Research, has been collecting fascinating
data on our old friend, gout, which may make all of us
reconsider our dietary intake of protein and our consumption of certain types of alcohol.
Dr. Ian Tsang has established close working relationships with some of the traditional Chinese medical colleges in China. This has led to educational and
research-based collaborations with more exciting developments in prospect. The CRA can take full credit for this,
since Dr. Tsang dates all of this from his participation in
one of our “Great Debates” on the topic of alternative treatments. (You will all recall Dr. Liam Martin’s voodoo doll).
Our training programme continues to attract fellows
and residents. There are presently two first- and two second-year fellows, as well as a regular rotation of general
internal medicine residents. All of our fellows attended
the Canadian Council of Academic Rheumatologists
(CCAR) weekend retreat in Montreal in January and gave
it a glowing review.
The vicissitudes of on-call reimbursement, lucidly outlined in Dr. Ken Blocka’s past article (CRAJ, Fall 2006),
have not been resolved. The funding of biologics, both
new ones for rheumatoid arthritis and those for other
inflammatory arthritides, remains a major impediment to
patient care.
Ah well, but we still have the mountains and the ocean!
And we don’t have snow—at least, not very often.
Barry Koehler, MD, FRCPC
Clinical Professor Emeritus and Acting Head,
Division of Rheumatology, Department of Medicine,
University of British Columbia
CRAJ 2007 • Volume 17, Number 1
34
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JOINT COUNT
Career Choices
By Glen Thomson, MD, FRCPC
I
s it “nature or nurture” that determines one’s choice of medical subspecialty? Were our experiences in training formative to determine our future career paths? The answers to this issue’s Joint Count survey would suggest that the
“nurturing” of general medical residents does influence future career decisions. There is reasonable exposure to academic and hospital role models but less so to independent and community-based Rheumatologists. This may be why half
the respondents would be willing to explore different ways or places to practice rheumatology.
1) Your first rheumatology rotation was a major and positive
influence for you to choose this subspecialty
as your career
3) In your rheumatology training, you had enough exposure to
urban independent practice or remote under-serviced regions
to make your decision about future practice in community
rheumatology
46.8
n = 141
Response percent
Response percent
n = 140
29.1
13.5
3.5
7.1
32.9
25.0
20.0
17.9
4.3
Strongly
disagree
Disagree
Neutral
Agree
Strongly
agree
Strongly
disagree
Source: Survey Monkey “Career Choices”, March 2007
Disagree
Neutral
Agree
Strongly
agree
Source: Survey Monkey “Career Choices”, March 2007
2) During your training, you had enough exposure to research and
academic medicine to make your decision about future practice in
academic or research Rheumatology
4) If given the opportunity, you would like to spend a period of time
away from your current practice to explore other types or settings of
rheumatology practice.
n = 141
n = 141
37.6
29.1
16.3
10.6
5.0
Strongly
disagree
Disagree
Neutral
Source: Survey Monkey “Career Choices”, March 2007
Agree
Strongly
agree
Response percent
Response percent
39.0
19.9
18.4
12.1
Strongly
disagree
12.1
Disagree
Neutral
Agree
Strongly
agree
Source: Survey Monkey “Career Choices”, March 2007
Thanks to all those who participated and congratulations to Dr. Jody L. Lewtas from Markham, Ontario who
won the draw for a CRA Mountain Backpack!
CRAJ 2007 • Volume 17, Number 1
35
IN MEMORIAM
John T. Sibley, MD
(1951-2007)
“A beautiful life came to an end”—
Dr. John Sibley passed away in the
early morning of January 16th, 2007
at Royal University Hospital, as a
result of complications from brain
cancer. He will be dearly missed by
his wife Anne Zielenin, his daughter
Kalle and son-in-law Brendan, his
sons, David, Kevin, and Brian Sibley,
his stepchildren, Jolyne and Adam
McKee, his sister Anne (Ron) Luxon,
his niece Sarah, his nephew Jamie,
his stepmother Jean Sibley and
mother-in-law Jenny Zielenin, and
by many Canadian rheumatologists.
Dr. Sibley was predeceased by his
mother, Margaret, in 1970 and father, Norman, in 1995.
Dr. Sibley was born in Dundas, Ontario and several
times mentioned he grew up just down the street from the
Osler household (whom he later found out was the
“Father of Internal Medicine”). He loved mathematics and
achieved his Bachelor’s of Mathematics degree at the
University of Waterloo. He always liked to challenge others
with his love of statistics and especially his own children
when they went on long car trips. After obtaining his MD
at the University of Waterloo and specializing in Internal
Medicine, he came west to the Prairies. Here he completed
his Certificate of Special Competence in Rheumatology
under the direction of Dr. E DeCoteau. He continued to
stay on doing research and teaching, eventually becoming
Director of Student Affairs, then Director of Admission.
36
CRAJ 2007 • Volume 17, Number 1
Dr. Sibley was recognized by his
medical students, receiving a
University of Saskatchewan Award
for Teaching Excellence. He became
Head of the Department of
Rheumatology in 1999, succeeding
Dr. Ken L. Blocka.
Throughout Dr. Sibley’s career,
his passion for research was evident by the number of papers he
published in journals, and his contributions to chapters in medical
textbooks. His oratory abilities were
evident to all as he was invited to
speak throughout the province on
many topics. He also embarked on
a joint venture that resulted in the creation of the S.T.A.R.
Rehab clinic. John was a loving husband, an incredibly
great father, a good brother, an exceptional doctor, a
patient teacher and a good friend. He had a zest for life
that was indescribable—loving tennis, music, dancing,
traveling, languages, good wine, and friends of all walks of
life.
The John T. Sibley Scholarship Fund has been established in the Department of Rheumatology at University
of Saskatchewan in his honor. He will be greatly missed.
Janet Markland, MD, FRCPC