MCGILL UNIVERSITY DEPARTMENT OF

MEDICINE 2017 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 26

APPENDICES 27

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EXECUTIVE SUMMARY The Department of Medicine has seen a significant recruitment of clinicians and clinician scientists in the past 12 months. Clinical researchers at the MUHC engaged in the health outcomes and evaluative research have been placed in a dedicated facility (5252 de Maisonneuve Ouest), greatly facilitating their work. The graduate student program in the Division of Experimental Medicine is adding new courses to accommodate changing needs. The Department has had record success in achieving a 76% success rate in the latest FRQS competition, securing awards in all categories from Junior I to Senior. Our principal metric of research success, namely publications, obtained from data at the RI-MUHC numbered 1036 (for year 2016, the most recent data available, compared to 1039 in 2015) and from the JGH 394 for 2017. The research performed was supported by $73,072,563 in funding at the MUHC (includes funding received by both full and associate members, the latter group accounting for roughly 25%) and $21,379,346 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_2017.pdf There were 280 students registered in Experimental Medicine as of the Fall 2017 semester, a value that has declined somewhat since the peak of 322 reached in 2013, reflecting the harsh funding environment. To palliate this, the Department of Medicine at the MUHC is offering 10 awards of $10,000 each to investigators to support the operating costs involved in supervision, to encourage increased engagement. The MUHC Department invested $275,000 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 of $30,000 from the previous year. The distribution of funds received from the Association of Physicians to the Department at the MUHC is shown in appendix 1 (2017 Research Education and Development). The Clinical Research Program at the JGH provided $208,000 to CAS members to liberate time for research. Through taxation of physicians earnings, the McGill Department of Medicine across sites provided close to $1.8 million in start up to new faculty members as well as salary support, as shown in appendix 2 (Research and Teaching support from Practice Plans). The Department of Medicine ran another highly successful Annual Research Symposium at the New Residence Hall. The attendance exceeded that of the previous year; up to 107 attendees. The second 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_2017.pdf The workshop on “Patient Relationships” designed to train faculty members to interact optimally with patients was again held and currently over 140 members of the Department at the MUHC have attended. Members of the Department make many contributions to scholarly communities locally (FRQS), nationally (CIHR, NSERC and many 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. There is a lack of a career plan to recruit PhD scientists. The requirement for partnerships to fund

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tenure-track salaries is challenging. 2. 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.

3. The Ministry has created a new organizational structure for hospitals that is collapsing 21 departments into 10. This re-organization is creating major misalignment of university departments and hospital departments.

4. Some postgraduate clinical training programs are experiencing difficulties.

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 there has been little progress in enhancing collaborative research activities. 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 continues to provide impeccable support for the mission of the Department. SELECTED DIVISIONAL ACTIVITIES AND HIGHLIGHTS ALLERGY AND CLINICAL IMMUNOLOGY Noteworthy events - Dr. Phil Gold received the Einstein Legacy Award and we saw the inauguration of the Phil Gold Distinguished Lecture. Dr. Genevieve Genest received an FRQS Doctoral Training Award (2018-2022) as well as the Garbarino Girard Award, the Anna Maria Solinas Award and the Dr. Phil Gold Award of Distinction. Dr. Natacha Tardio was honoured with the Distinguished Clinical Immunologist Award and Dr. Ciro Piccirillo the Anna Maria Solinas Laroche Career Award in Immunology. Research - Dr. Nicole Bernard is studying innate immunity and HIV with two ongoing CIHR grants. Dr. Genest initiated research to investigate how immune intervention allows successful reproduction in women experiencing recurring abortions. Drs. Joseph Shuster and Chris Tsoukas completed a study of pre-op evaluation of patients with β-lactam allergy. Dr. Danuta Radzioch demonstrated in vivo efficacy of a novel drug delivery vehicle (magnetic bacteria) and obtained a patent on work on fatty acids and sphingolipids (New Patent No. 62/658,001 filed). She was the recipient of the November Translation Acceleration Award TAG2017 for $1,495,000 from Prostate Canada. Dr. Erwin Schurr discovered a significant overlap in the genetic control between leprosy and the phenotypes of Parkinson’s and Crohn’s disease, and dissected the genetic control of human response to M. leprae. Teaching - Drs. Tardio and Tsoukas created a Career Planning and Professional Skills Development curriculum for trainees with a predominant focus on the teaching of the non-medical CanMEDs roles. Involvement in the community - Dr. Bernard became the Adjunct Director of the FRQS funded AIDS and Infectious Diseases Network Executive Committee. Dr. Schurr co-organized two workshops for the NIH

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and served on a CIHR panel and also directed the Infectious Diseases and Immunology program at the RI-MUHC. At the JGH, Dr. Peter Small is Co-Director of the National Guidelines for Upper Airway Diseases, sponsored by the Canadian Society of Allergy and Clinical Immunology and the Canadian Otolaryngeal Society. Dr. Fanny Silviu-Dan is chair of the Royal College Committee for Clinical Immunology and Allergy. Clinical innovation - Dr. Genest inaugurated a reproductive immunology clinic. Drs. Shuster and Tsoukas had success with the pre-op evaluation program of patients with β-lactam allergy, with attendant significant cost savings. Dr. Radzioch submitted a Canadian and European patent applications (US Patent 780/16089.3: on Solid oral formulation of fenretinide). 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 clinical activities.

CARDIOLOGY Noteworthy events - At the MUHC, the recruitment of Dr. Marco Spaziano and Dr. Jacqueline Joza saw the arrival of new academic members to the Catheterization Lab and Electrophysiology teams. Dr. Spaziano will work closely with Drs. Giuseppe Martucci and Nicolo Piazza to oversee quality and cost-effectiveness of structural and valvular interventional procedures. Dr. Joza will lead a genetic arrhythmia group closely linked with genetic experts, Dr. George Thanassoulis and Dr. James Engert. Drs. Thanassoulis, Ariane Marelli, Matthias Friedrich, Vidal Essebag and Adel Schwertani obtained peer reviewed grants. In the FRQS competition, Dr. Essebag was promoted to chercheur-clinicien senior. Internationally Drs. Piazza, Marelli, Friedrich, Thanassoulis, Normand Rinfret, Jacques Genest, Allan Sniderman, and Essebag put the McGill name in the spotlight again, 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 JGH Division of Cardiology underwent a transformational change, becoming the Azrieli Heart Center, following the largest donation given to the JGH by a single donor. This gift allowed us to continue in our mission to transform cardiovascular care delivery through a patient-centered and intergrated care delivery model. In addition, funds have been allocated to endowed fellowships, integration with the community, research and IT advances. Dr. Michael Goldfarb was recruited after completing a Fellowship in Cardiac Intensive Care and will be leading our Quality and Outcomes program. Dr. Ali Omar Abualsaud, trained in structural cardiology and congenital heart diseases was recruited to serve as a liaison with the MUHC in these fields. Dr. Jonathan Afilalo and Dr. Mark Eisenberg received CIHR funding. Dr. Regina Husa was promoted to Assistant Dean - Accreditation and Dr. Judith Therrien was promoted to Full Professor.

Research - At the JGH, Dr. Lorraine Chalifour continued her work linking Bisphenol A with an inability to respond to cardiac stressors in animal studies as well as exploratory work in humans, documenting its presence in medical supplies and equipment. Dr. David Langleben expanded his work on capillary recruitment in pulmonary arterial hypertension, with his international collaborators. His landmark studies have helped clarify the basis for the evolution of disease. Dr. Afilalo worked on his novel Lamin protein assay and its relationship with frailty and, with Dr. Goldfarb, has studied the financial impact of frailty. Dr. Eisenberg continued his epidemiologic studies on smoking cessation strategies on cardiac

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patients and Dr. Goldfarb initiated a number of local and Canadian studies looking at quality metrics in the cardiac intensive care unit. At the MUHC, many successes were achieved, notably CIHR and Heart and Stroke Foundation new grants (Drs. Thanassoulis, Marelli, Friedrich and Essebag); Patent: Identification of Desmocollin 1 as a novel apoA-I binding protein in atherosclerosis (Dr. Genest); $2 million for Cardiac Signatures Project- Courtois Foundation (Dr. Friedrich, Nadia Giannetti and Thanassoulis); $600,000 for the Cardiac prevention program from the Valeria and Michael Rosenbloom Foundation (Drs. Thanassoulis and Sniderman); $120,000 from the MGH Foundation for the Home Monitoring Program for Heart Failure (Dr. Giannetti); and $1 million from the Ingram Family Foundation for the Family Heart Centre (Drs. Thanassoulis and Jacqueline Joza). Teaching - Dr. Afilalo established the first recognized Fellowship in Geriatric Cardiology and welcomed a first trainee. Drs. Igal Sebag and Afilalo developed the first Canadian Fellowship program with simultaneous multimodality training in Echocardiography and Cardiac MRI. At the MUHC a new resident educational center with dedicated space for cardiology trainees was created. On academic half days, the Division started a new Landmark Trial series for the R5s and R6s to review major studies (both historic and contemporary) over the summer while the R4s undergo a boot camp that is the curriculum for Transition to Discipline. To improve performance in exams and to better track progress, the Division has increased the number of OSCEs and practice STACERS that the R5s and R6s have, and plan to introduce these to the R4s next year as well. The Division incorporated SIM Centre sessions for residents to work on certain CanMeds roles. A Quality Improvement curriculum has been introduced into the Academic Half Day and will engage the residents to develop QI projects. A curriculum on Fatigue Risk Management to facilitate discussion and reflection on how to prevent burnout has been started. A research “speed-dating” event was well-received and will be repeated in the Fall 2018. Similar events are planned for residents to explore sub-specialties and career tracks. Residents continue to have great success in publishing original research and case reports and presenting at conferences. Manuscripts are under preparation for the CJC Trainee Program Initiative, which in the past McGill has not participated in.

Involvement in the community - Dr. Friedrich is President of the Society for Cardiovascular Magnetic Resonance. Dr. Marelli is President of the Canadian Adult Congenital Heart Disease Society. Dr. Rudski is the President of the Canadian Society of Echocardiography and the Quebec Governor of the American College of Cardiology. Drs. Lawrence Rudski, Afilalo, Sebag, Eisenberg and David Langleben were active organizing, chairing and directing major local, national and international conferences and courses in the fields of cardiovascular imaging, pulmonary hypertension, cardiovascular trials and epidemiology, as well as frailty.

Clinical Innovation - At the JGH, the Divisions of Cardiology and Cardiac Surgery underwent a transformational change through the creation of the Azrieli Heart Center. At the MUHC, a new Mitral Clip Program to treat patients with mitral regurgitation was developed (Drs. Piazza, Martucci, Spaziano). We saw the implantation of a novel leadless pacemaker for patients who are not candidates for transvenous pacemakers (Dr. Essebag). A new academic centre, the MUHC Center for Preventive Cardiology (Drs. Thanassoulis and Sniderman), was set up to evaluate high risk individuals for heart disease with an emphasis on genetics and novel biomarkers. What we envision as major threats to academic activities - Lack of administrative support, inability to hire cardiologists due to lack of PEMs and lack of funding for innovative programs.

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CLINICAL EPIDEMIOLOGY The Division of Clinical Epidemiology leads health outcomes, epidemiological, and clinical research within the Department of Medicine and trains students and junior scientists in this important domain. The majority of members moved to new offices at the Centre for Outcomes Research and Evaluation (CORE) at 5252 de Maisonneuve and the remainder will be moving to the CORE MGH site in 2019. Noteworthy events - The importance of Dr. Nitika Pai‘s HIV Smart! Evidence-based app- bringing HIV testing and care to the most underserved- was highlighted by MacLean’s magazine as one of the innovations that landed McGill University as the top medical/doctoral university in Canada. Dr. Pai was also named by The Economist as one of the top 30 Change Makers in the field of Hepatitis C. Dr. Nancy Mayo was awarded the President’s Award by the International Society of Quality of Life, for her research and training contributions and for her role as Editor of the Dictionary of Quality of Life and Health Outcomes Assessment. She also received the David Hawkins Health Science Award from Memorial University. Dr. Robyn Tamblyn was selected as a Justice Emmett Hall laureate for her work on relationships between health professional training, licensure and practice, computerized interventions to improve drug safety, and e-health technologies to improve integrated care for chronic disease. She was also selected to the Peggy Leatt Knowledge and Impact Award from the University of Toronto for achievements in developing transformative evidence on ways and means to improve healthcare and health systems. Research - Dr. Kaberi Dasgupta’s SMARTER trial, demonstrating that a physician-delivered step count prescription and management strategy can improve glycemic control in type 2 diabetes, was cited by the 2017 Roadmap for Innovation - American College of Cardiology Health Policy Statement on Healthcare Transformation in the Era of Digital Health, Big Data, and Precision Health. The strategy has been integrated into Diabetes Canada’s Clinical Practice Guidelines and the trial (Diabetes, Obesity & Metabolism) received much press attention (top 5% Altmetric score). Dr. Nandini Dendukuri published a key methods paper on reference standards in diagnostic testing research. Dr. Jay Brophy examined the risks of myocardial infarction with NSAID use using advanced Bayesian meta-analysis methods. Dr. Deborah Da Costa published another top 5% Altmetric paper in the Journal of Medical Internet Research examining what fathers want to know, on a website to promote emotional well-being and healthy behaviours during the transition to parenthood (healthyDads.ca). Drs. Susan Bartlett, Sara Ahmed, and Mayo led a series of studies for the Montreal Accord on Patient-Reported Outcomes. The topics included terminology, shared decision making, and self-management. Drs. Dasgupta and Elham Rahme published on conjoint associations of gestational diabetes and gestational hypertension with diabetes, hypertension, and cardiovascular disease in parents. This was another top 5% Altmetric paper and was published alongside a special commentary. Dr. Isabel Fortier continued her ground-breaking work in rigorous retrospective data harmonization.

Division members were awarded multiple new operating grants. Among these as nominated principal investigator awarded in 2017 were: $1.7 million and a $500,000 grant awarded to Dr. Sasha Bernatsky by the CIHR for Comparative Effectiveness and Safety of Biosimilars and Legacy Drugs and for Hydroxychloroquine in SLE. $310,000 awarded to Dr. Brophy from the CIHR Ticagrelor compared to clopidogrel in ACS - the TC4 comparative effectiveness study. Dr. Dasgupta: $235,454 from the CIHR Sugar in solid foods and beverages: examining relationships to gestational diabetes and cardiovascular disease; $400,000 Lawson Foundation ACTIVating and Engaging PAtients Through clinical Interaction redesign and Electronically-integrated Novel Technologies- Gestational Diabetes (ACTIVE PATIENT GDM); $255,000 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.

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Pilote: $70,000 Canadian Vascular Network Microvascular angina and oxygenation sensitive CMR. Dr. Pai: $375,000 CIHR Impact of gender on health outcomes international meeting. Dr. Paul Brassard: $200,000 CIHR Working with Inuit communities to improve cervical cancer screening coverage in Nunavik, Quebec; $72,000 CIHR Secondary Data Analysis for Cancer Prevention and Control: Onset of cancer after an IBD diagnosis; potential impact on screening strategies. Particularly notable in terms of Co-Principal Investigator grants was that awarded to Dr. Ruth Sapir-Pichhadze (Division of Nephrology) by Genome Canada ($9.7 million) for research on kidney transplantation. At the JGH, the total of new funding awarded this year is $475,950. 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. Dr. Filion was awarded three grants in 2017 by the CIHR.

Teaching - Dr. Mark Goldberg was the principal developer of the newly approved non-thesis MSc program in environmental and occupational health. Dr. Goldberg, with Drs. Suzanne Morin and Bartlett launched a new course in epidemiological research methods through the Division of Experimental Medicine. Dr. Suissa leads the Pharmacoepidemiology Summer Program.

Involvement in the community - Members participated in clinical and public health guideline development (Dr. Pai on HIV self-testing guidelines of the World Health Organization and chapters for the WHO Implementation Guidance document for HIV Self testing for low and middle income countries; Dr. Dasgupta on Diabetes Canada and Hypertension Canada clinical practice guidelines; Dr. Steven Grover on Hypertension Canada clinical practice guidelines. Dr. Tamblyn continued as the Director of the CIHR Institute of Health Services and Policy Research and Dr. Rahme continued as Methodological Co-Lead for the Quebec SPOR support network.

DERMATOLOGY Noteworthy events - Dr. Mathieu Powell was awarded the Canadian Dermatology Association Excellence in Clinical Teaching Award. Dr. Ivan Litvinov was recruited to the Division as an academic dermatologist. Research - Dr. Litvinov was the recipient of an FRQS chercheur-boursier award. His laboratory studies the genetic bases of Cutaneous-T Cell Lymphoma (CTCL) carcinogenesis and cancer progression with a focus on application/translation of the newly discovered molecular knowledge into clinical practice. Dr. Litvinov and his team are actively developing a novel diagnostic/prognostic molecular test for CTCL patients, which would help distinguish this disease from its benign mimickers and help identify select (i.e. ~20%) patients, who are at risk of disease progression. They are also studying the expression and function of Cancer Testis (CT) and Embryonic Stem Cell (ESC) genes in CTCL. In addition, working with collaborators, they are investigating novel treatment approaches using oncolytic viruses for CTCL, Basal Cell and Squamous Cell carcinomas. Teaching - The resident training program has a substantial cohort of trainees that are receiving clinical teaching. At the JGH, innovation related to teaching programs were introduced, amongst others the introduction of the best international professors to discuss use of biologics in dermatology.

Clinical innovation - Introduced this year, teaching fellowship candidates advanced dermatologic surgery and teaching pneumatic anesthesia injections for administering Botulism toxin for hyperhidrosis.

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Involvement in the community - Each staff contributes to ongoing community Dermatology clinics in respective locations within Montreal and South Shore regions. Dr. Khue Nguyen is preparing exam questions and participates as an examiner for the Kuwait Board of Dermatology Certifying Exams.

What we envision as major threats to academic activities - Lack of flexibility to enroll new staff to the program; lack of steady clerical support at all levels; lack of adequate, modern facility for patient care and teaching.

ENDOCRINOLOGY AND METABOLISM Noteworthy events - Dr. Richard Kremer received the Catherine Coyne Memorial Fellowship Award and he was nominated to the CIHR College of Reviewers and as Fellow of the Royal Society of Medicine (UK). Dr. Natasha Garfield received the MUHC Department of Medicine Award for innovation in clinical care and quality. Dr. David Goltzman was awarded the Henry Friesen Award of the Canadian Society for Clinical Investigation and the Royal College of Physicians and Surgeons of Canada, and is the editor of Vitamin D 4th Edition.

Research - The Division was successful in obtaining new grants in 2017 from CIHR (Drs. Goltzman, Maia Kokoeva, Stéphane Laporte, Shafaat Rabbani, Hugh Bennett), the US Department of Defense (Drs. Robert Sladek, Errol Marliss), NSERC (Dr. Jun-Li Liu), the Weston Brain Research Institute (Drs. Andrew Bateman, Bennett) and Diabetes Canada (Dr. Vanessa Tardio), Parkinson Canada (Dr. Simon Wing) and FRQS - Nature et Technologie (Dr. Bernard Turcotte). At the JGH, most of the full time clinicians have published at least on paper in the year. Physician scientists are very productive. In all, the JGH Division has close to 40 publications for the year 2017. All of the physician scientists (Drs. Mark Trifiro, Andrew Karaplis, Brent Richards and Oriana Yu) receive national funding (CIHR and others) and some clinicians have managed to secure funding for some studies as well.

Teaching - The members were invited to give lectures internationally in Italy (Dr. Goltzman), Brazil, Iran and Qatar (Dr. Rabbani), France (Dr. Wing), United States (Drs. Jacques How, Kokoeva, Jean-François Yale), Israel (Dr. Wing), Philippines, Morocco and Indonesia (Dr. Yale). Dr. Goltzman is the only McGill professor writing a chapter in the textbook Up-to-Date. At the JGH, members play a very active role in teaching at all levels. These include undergraduate medical students, internal medicine residents, and endocrinology fellows. All of our full-time members participate in clinical teaching and subspecialty teaching, as well as supervising graduate students. Academic rounds are held every week throughout the academic year.

Involvement in the community - Members of the Division were involved in the writing of national and international guidelines on hyperparathyroidism (Dr. Goltzman) and Diabetes (Dr. Yale), in the organization of international and national meetings, such as the World Congress on Cancer (Dr. Kremer), the Canadian Neurometabolic Club (Dr. Kokoeva), and Diabetes Update (Dr. Yale). Many are members of the editorial board of a large number of journals : Frontiers in Bone Research (Dr. Kremer), Canadian Journal of Diabetes (Drs. Sara Meltzer, Bateman), Journal of Diabetes (Dr. Liu), Clinical Diabetes and endocrinology (Dr. Meltzer), Journal of Osteoporosis (Dr. Kremer), Journal of Osteoporosis and Physical Activity (Dr. Kremer), World Journal of Orthopedics (Dr. Kremer), American Journal of Cancer Research (Dr. Kremer), JCEM (Dr. Geoffrey Hendy), Cell Biochemistry and Function (Dr. Hendy). Clinical innovation - A new multidisciplinary clinic on Diabetes Chronic Kidney Disease was initiated at the MGH (Dr. Yale). Birth of 3 babies resulted from ovarian cloaking in premature ovarian insufficiency (Dr. David Morris). Patient education forms were developed for thyroid cancer radio-ablation, adrenal insufficiency, central hypothyroidism, and adrenal crisis (Dr. Juan Rivera).

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What we envision as major threats to academic activities - There is a lack of funding to recruit basic research scientists as our current professors age, and the decreasing clerical support of divisions makes it difficult to develop and sustain academic activities.

GASTROENTEROLOGY Noteworthy events - Dr. Carlo Fallone was the recipient of the Teacher of the Year award in Gastroenterology. Dr. Kevin Waschke was elected as President-elect of the Canadian Association of Gastroenterology. Dr. Maida Sewitch received the outstanding faculty mentor award from the Epidemiology, Biostatistics and Occupational Health Student’ Society. Dr. Giada Sebastiani and Dr. Waqqas Afif were promoted to Associate Professor and Dr. Peter Lakatos was promoted to Full Professor.

Research - Dr. Alan Barkun is a PI on a CIHR grant: Consensus Recommendations in managing patients with non-variceal upper GI bleeding. Dr. Sebastiani is PI on an FRQS grant: Exploring the association of severity of non-alcoholic fatty liver disease and gut dysbiosis in HIV mono-infected patients. Dr. Sewitch received a grant from Fonds de la recherche en santé du Québec-Échanges FRQS-NSFC Missions ponctuelles. Dr. Alain Bitton is PI on Canadian Quality Care project in IBD, funded by Crohn’s Colitis Canada.

Teaching - Dr. Peter Ghali was undergraduate medical education director for Internal Medicine and clerkship director. He continued to develop and implement the new Internal Medicine curriculum. Dr. Waschke served as the Canadian Association of Gastroenterology Vice-President for educational affairs and was educational lead for the skills enhancement in endoscopy program. Dr. Phil Wong was appointed chair of the Area Focus Competence (AFC) diploma in Hepatology for the Royal College of Canada. Dr. Dean Soulellis was a member of the Royal College Nucleus committee for initiation and development of the Royal College Competence by Design Program (curriculum development nationwide). Dr. Lakatos is a member of the European Crohn’s and Colitis Organization Educational committee.

Involvement in the community - The Division was involved in many scholarly activities including steering committees on (i) development of web-based tool for evaluation of IBD Care in Canada - Global Rating Scale (GRS) (Dr. Bitton, chair); (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) scientific director (provincial) (Dr. Bitton) and co-chair (national) for conferences, mentoring in IBD (Dr. Bitton), scientific organizer of the second liver fibrosis forum in Quebec (Dr. Sebastiani), member of scientific committee, 5th Liver Fibrosis Symposium, Bordeaux, France (Dr. Sebastiani), development of the AGEQ post graduate course in hepatology (Drs. Sebastiani and Marc Deschenes); (iv) VP secretary of the Canadian Association of Gastroenterology and executive board member of the Canadian Digestive Disease Foundation and VP Canadian Helicobacter Study Group (Dr. Fallone); (v) Treasurer Canadian Association liver disease (Dr. Ghali); (vi) Chair of Quebec Colorectal Cancer screening guideline committee (Dr. Barkun); (vii) President of the Quebec Association of Gastroenterology (Dr. Josée Parent), (viii) Chair MUHC Association of Physicians (Dr. Fallone) and (ix) Transplant Quebec MELD subcommittee member (Dr. Ghali). Dr. Barkun continued his volunteer work teaching gastroenterology and endoscopy in Morocco (University of Rabat and World Gastroenterology Organization, January 2017) and Ethiopia (University of Addis Ababa and Black lion Hospital, July 2017). Dr. Sewitch helped organize The Giant Colon Tour in Kahnawake, Quebec to raise awareness of cancer prevention; attended by >1000 individuals.

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Clinical innovation - Dr. Yen-I Chen returned from a fellowship in advanced endoscopy at John Hopkins. In collaboration with Interventional Radiology (IR), he has helped establish an advanced Endoscopic Ultrasound and Interventional Radiology Interventional Program directed at patients with complex gastric and pancreatico-biliary conditions including patients with advanced digestive malignancies, performing the first EUS-IR gastrojejunostomy bypass in Canada. Novel technology in cholangioscopy is now available allowing endoscopic visualization of the bile ducts at both MUHC and JGH. The MUHC IBD center was officially inaugurated in November 2017, with an integrated program of patient care research and teaching. An IBD database has been developed for research and as electronic medical records. The JGH Gastroenterology Division has received private funding to establish an IBD center at JGH in 2019. Dr. Soulellis leads 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 Université de Montréal, has continued to provide non-invasive diagnostic tests for individuals at risk of liver disease (HIV infected, IBD).

What we envision as major threats to academic activities - Cuts in budget /resources and clerical reorganization have required significant time and energy, taking time away from research and academic activities. Other threats include the Ministry’s clinical service requirements, the reduction in PEMS, and the decrease in residency spots for the 2017 year reduced the critical mass needed to have a well-balanced clinical and academic residency program.

GENERAL INTERNAL MEDICINE (GIM) Noteworthy events - Dr. Louise Pilote was one of two recipients of the Berlin Institute of Health (BIH) Excellence Award 2017 for Sex and Gender Aspects in Health Research in recognition of her work incorporating gender aspects into biomedical research. Dr. Ernesto Schiffrin received the 2017 Prix Galien Canada - Research Award for the most significant contributions to pharmaceutical research in Canada. Dr. Susan Kahn was named Grands noms de la médecine au Québec by the Fédération des médecins spécialistes du Québec. Dr. Linda Snell received the 2017 McGill University Lifetime Achievement Award for Leadership in Education. Dr. Jeff Wiseman is co-investigator on the LEADS Partnership, which was awarded the 2017 Outstanding International Research Collaboration Award sponsored by the American Educational Research Association Technology, Cognition and Learning Special Interest Group. Dr. Stella Daskalopoulou received the 2017 John J. Day Award of Excellence, Heart and Stroke Foundation. Dr. Emily McDonald received of the 2017 CSIM New Investigator Award. Dr. Joyce Pickering received the 2017 Physician-in-Chief Award from the MUHC Department of Medicine in recognition of her exemplary and outstanding service to the Department. Dr. Amal Bessissow received the 2017 Douglas G. Kinnear Award for Outstanding Teacher from the MUHC Department of Medicine. Dr. Ruxandra Bunea received the 2017 Internal Medicine Transition to Clinical Practice Teaching Award for her dedication in teaching history taking and physical exam. Dr. Cristina Mindru, Director of the MNI GIM Consult Service, and the Stroke Team at the MNI won the Cuvée 2017 PRIX Profession Santé. Dr. Michelle Elizov was appointed to the newly created position of Assistant Dean, Faculty Development. Dr. Thomas Maniatis was promoted to Associate Professor of Medicine. Dr. Daskalopoulou was appointed Chair of the Central Review Committee of the Hypertension Canada Guidelines and Dr. Patrick Willemot was appointed Associate Exam Chair (Francophone Board) for the Royal College Internal Medicine Examination. A Division Retreat was held in October 2017 to help the Division determine next steps and actions to promote connectivity and integration across sites with the aim of maintaining sustainable growth and innovation in research, medical education, clinical activities and patient safety, and physician wellness.

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Research - Dr. Kahn is a co-applicant on two new major grants from the CIHR, totaling over $3.25 million. Dr. Vicky Tagalakis is co-applicant on three CIHR grants and co-leads the CIHR funded CanVECTOR Quality Improvement platform. Dr. Daskalopoulou received a senior clinical research scholar salary award from the FRQS and she obtained a grant from the Heart and Stroke Foundation on carotid atherosclerosis. Dr. Pilote headed the team that started the new research project on gestational hypertension and diabetes in Haiti. A Haitian internist was trained to perform echocardiograms to screen for post-partum cardiomyopathy. Drs. Todd Lee and Emily McDonald designed MedSafer, electronic software that guides clinicians through the process of safe and effective tapering and stopping of medications in older adults with polypharmacy. Dr. Lee received an FRQS clinician-investigator award Junior 1. Dr. McDonald is principal investigator on two new Brunswick Health Research Institute grants for de-prescribing in long-term care. She gave the Canadian Society of Internal Medicine New Investigator Award Key Note Speech in Toronto in November 2017. Dr. Natalie Dayan received four CIHR grants, two as PI and two as co-PI, and one grant from CIORA. Dr. Steven Grover continues to expand the McGill Comprehensive Health Improvement Program (CHIP). The staff at the CHIP is supporting a total of 8 clinical research projects, including several CIHR-funded ones. Medical Education Research - Dr. Snell was on sabbatical during the first quarter of 2017 at the University of Tokyo, where she was involved in moving forward medical education in Japan, which included lectures and workshop at 7 Japanese universities. She also made invited international presentations in Korea, China, Singapore, Chile, Sweden and Finland. Dr. Snell was co-editor on a series on competency based medical education (CBME) published in Medical Teacher. 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. Dr. Wiseman was invited to present medical education workshops at LACRE in Santiago, Chile and he was invited by the Dean of the UniAndes Medical School in Bogota, Columbia to present his work there. Dr. Beth Cummings, in addition to her role as Associate Dean, Undergraduate Medical Education, is an active member of the Centre for Medical Education and participates in 4 major grants as co-investigator or collaborator that examine the following important medical education topics: (i) Rater cognition in longitudinal work-based assessment: The impact of sharing information regarding residents’ previous performance; (ii) Assessor cognition in longitudinal performance-based assessment: the impact of sharing information regarding learners’ previous performance; (iii) Advancing longitudinal work-based assessment systems: Assessing progress in clerkship; and (iv) Which, why and how are item analyses guidelines applied when monitoring the quality of examinations? Teaching - The General Internal Medicine Residency Program (R4-R5) is directed by Dr. Willemot. In July 2017, 8 new residents joined the General Internal Medicine (GIM) Program with a total of 17 for the 2017-18 academic year. GIM Program initiatives, achievements and innovations in 2017 include: career counseling, annual GIM-specific workshops on job interviews, CV writing, and ongoing annual career planning workshop with new graduates (academic and community), job placement: good overall 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. In collaboration with the Faculty of Management, a high level communications and inter-professional conflict resolution workshop was implemented. An Indigenous cultural competency workshop was developed as well as senior-level teaching and learner assessment workshops. Clinical innovation - The Centre of Excellence in Thrombosis and Anticoagulation Care (CETAC) is a tertiary care subspecialty program headed by Drs. Kahn (Director) and includes Drs. Maral Kolian and

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Tagalakis. The research activities relate to diagnosis, risk factors and treatment of venous and arterial thromboembolic disease, management of thrombophilia and long-term anticoagulation. Dr. Maniatis has focussed the activities of the MUHC Complex Care Centre on patients in Canada with cystinosis. Dr. Willemot is Chief of GIM for Eeyou Istchee (Cree territories) and Nunavik (Inuit lands) and is working to improve access to specialized care for these remote populations in Kuujjuaq, Chisasibi and Mistissini. He provides administrative leadership with the regional health boards and provincial bodies (MSSS, FMSQ). Dr. Jed Lipes is the Director of the Diagnostic and Therapeutic Clinic and continues to develop the rapid access internal medicine clinic. Involvement in the community - Dr. Schiffrin is Editor-in-Chief, American Journal of Hypertension, Editorial Board member for Hypertension, J. of Hypertension and J. of Vascular Research, and involved in the writing of national and international guidelines on hypertension. Dr. Kahn is Associate Editor, Research and Practice in Thrombosis and Haemostasis (RPTH) and is on the Editorial Board of Thrombosis Research. She is the lead organizer and program co-chairman, 2nd Annual CanVECTOR Conference, Toronto, Nov 2017. Dr. Tagalakis is Associate Editor of Thrombosis Research. Dr. Kenneth Flegel is Senior Editor, Canadian Medical Association Journal. Dr. Snell is co-editor on a series on competency based medical education published in Medical Teacher and is on the Editorial Board of the Canadian Journal of Internal Medicine. She is co-chair for the International Conference on Residency Education and co-chair, Latin American Conference on Residency Education, May 2017. Dr. Dasgupta is Associate Editor, PLoS One, member of the International Planning Committee for 2017 International Diabetes Epidemiology Group Meeting (Dubai) held in conjunction with the International Diabetes Federation meeting. Dr. Pilote is on the Advisory Editorial Board of the Canadian Medical Association Journal, on the Editorial Board of the Canadian Journal of General Internal Medicine and American Heart Journal. Dr. Daskalopoulou is co-chair of the Hypertension Canada Guidelines, and chair of the Central Review Committee of the Hypertension Canada Guidelines Committee, member of the organizing committee of the North American Artery Conference in Chicago, Associate Leader of the Cardiovascular Health Across the Lifespan Program RI-MUHC. Dr. McDonald is Vice-President, Research and Quality Improvement Committee, Canadian Society of Internal Medicine and is on the Comité directeur du nouveau réseau régional québecois Choisir avec soins. Dr. Lee organized the 2nd departmental annual Clinical Symposium on High-Value Medical Care. Dr. Grover is a writing member for Canadian Hypertension Guidelines (Chair, Global Risk Assessment), Canadian Cardiovascular Society Lipid Guidelines (Chair, Risk Assessment) and Canadian Diabetes Association Guidelines (Vascular Protection). The GIM Global Health Haiti McGill team supervised by Dr. Pilote completed a full rotation at St-Nicolas Hospital. GIM Research is also growing in the community. As noted above, in the GIM Global Health Initiative in Haiti, Dr. Pilote heads the team that is conducting research that involves working closely with the local health care providers. Dr. Dasgupta is partnering with the Cree to develop, implement, and evaluate a sustainable diabetes prevention strategy in young families with a gestational diabetes history and will develop, in partnership with the Cree Board of Public Health, a diabetes prevention program in families with a history of gestational diabetes in the mother. What we envision as major threats to academic activities - Imbalances in patient mix between sites, stifling of clinical programs impacts on our teaching programs, and patient recruitment into our research programs; lack of mentoring resources and space is a challenge with respect to new clinician-researchers; resources and protected time for clinician teachers with CBD implementation; and the PEM system of recruitment undermines academic mission.

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GERIATRICS Noteworthy events - Dr. Julian Falutz was promoted to Associate Professor.

Research - Dr. Olivier Beauchet leads a group of experts called the Canadian Gait Consortium and the Biomathics research platform to explore the relationship between cognitive function and gait regulation. Dr. José Morais, in collaboration with the group of kinesiology led by Dr. Aubertin-Leheudre from UQAM, explores the mechanisms associated with muscle strength and force development in high- and low-functioning elderly men. The team of Dr. Andrea LeBlanc from the Lady Davis Institute has made important discoveries related to axonal degeneration in human neurons and cognitive impairment in mice. Dr. Howard Chertkow of the JGH is the leader of the Canadian Consortium on Neurodegeneration in Aging (CCNA) that aims 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. Howard Bergman and Isabelle Vedel participate in the Health Care Utilization Team. Drs. Stephanie Chevalier and Morais, using the data from the Quebec Longitudinal Study on Nutrition and Aging (NuAge), have shown that a more even mealtime distribution of protein intake is associated with greater muscle strength in older adults and help to define appropriate diets for older adults aiming at maintenance of autonomy. The team led by Drs. Nancy Mayo and Morais on physical performance and function capacity in older adults have published results of the trial called Managing Mobility Outcomes in Vulnerable Seniors (MMOVeS): A Randomized Controlled Pilot Study. This study validates a model of home based exercises for vulnerable older adults following hospitalisation to prevent physical deterioration. 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 ensures a rotation at the Gatineau Hospitals as part of the RUIS McGill. 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. Involvement in the community - The McGill Division of Geriatrics held six Grand Rounds during the Academic year that were well attended and open to the 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.

Dr. Beauchet is a member of the McGill Research Center for Physical Activity and Health and of the Canadian Falls and Memory Impairment Network; he is chair of the Scientific Planning Committee of The Canadian Geriatrics Society’s Annual Scientific Meeting (ASM) 2018 and chair of the Comité Mesure, Évaluation et Systèmes information - programme provincial «Usage approprié des antipsychotiques en Centre d’Hébergement de Soins de Longue Durée chez les résidents ayant des symptômes comportementaux et psychologiques de la démence». Through the RUIS McGill Centre of Excellence on Longevity CEEXLO under the leadership of Dr. 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 Centre-Ouest-de-Ile as well as on the Ministry of Health OPUS-AP initiative to reduce use of antipsychotics in long term care institutions. Dr. Chertkow is the Scientific Director of the Canadian Consortium on Neurodegeneration in Aging (CCNA) since 2013. He is executive member (elected) of ISTAART (Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment, a professional society for individuals interested in Alzheimer's and dementia science). He is also a member of the Executive committee (representing CIHR and Canada) of the Alzheimer’s Disease

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NeuroImaging Initiative (ADNI). Dr. Elise Levinoff is a Board member of the Société québécoise de gériatrie. Dr. Mélanie Mondou organized a workshop on Faculty development for interprofessional facilitation at the Canadian Conference on Medical Education in 2017. Dr. Morais is a member of the Scientific Committee of the 2018 Congrès international francophone de gérontologie et gériatrie (CIFGG) in Montreux, Switzerland. He organized the conference entitled: Sarcopenia: Revisiting Criteria Definition and Association with Protein Intake and Insulin Resistance at the International Association of Gerontology and Geriatrics (IAGG) World Congress in San Francisco in July 2017. He is a member of the Scientific Planning Committee of the 2018 Annual Meeting of the Canadian Geriatrics Society (CGS) in Montreal. He is Associate Director of the FRQS - Quebec Network for Research on Aging. He is a member of the Steering Committee of the Regroupement des unités de courte durée gériatriques et des services hospitaliers de gériatrie du Québec (RUSHGQ). He is a member of the CGS Foundation and was a reviewer of the Division of Geriatric Medicine of The Ottawa Hospital in January 2017.

Clinical innovation - In the spring of 2017, the Division created a new Geriatric Oncology Clinic based at the MUHC Glen site. This clinic performs geriatric comprehensive assessments of vulnerable older adults afflicted with cancer under the leadership of Dr. Doreen Wan-Chow-Wah and participates in a Canadian initiative to improve cancer care in older adults. The Division is actively participating in each of the main teaching hospital centres of McGill University to implement the Approache adaptée pour personnes agées, to address the problem of loss of autonomy of elderly inpatients during hospitalization.

What we envision as major threats to academic activities - Despite evolving in tertiary level of care institutions with heavy teaching and research commitments, the demands at the clinical level with pressure from recent policies of the Ministry of Health hinders the capacity to fulfill the academic commitments.

HEMATOLOGY Noteworthy events - The McGill Hematology Division site directors (St. Mary’s, RVH, JGH) have met three times a year since 2015. This innovation considerably increased the cohesion, target focusing, and complementary activities within the Division. Dr. Susan Solymoss, St. Mary’s Hospital, was appointed as the first McGill Optilab Hematology Grappe Director and the HLA Laboratory Team at the MUHC was recognized by the American Society for Histocompatibility and Immunogenetics (ASHI) for solid organ transplant accreditation. Dr. Jean-Pierre Routy, RVH, was elected as the Chair Steering Committee, CTN/CIHR Canadian HIV Trials Network and Dr. Chaim Shustik, RVH, was appointed as a member of the International myeloma working group. Dr. François Mercier, JGH, was distinguished by the Cole Foundation Transition Award entitled “Functional genomics of acute myeloid leukemia”, and, together with Dr. Sarit Assouline, by The Leukemia & Lymphoma Society of Canada New Idea Award for the project entitled “Tracking of clonal evolution in acute myeloid leukemia using single-cell RNA sequencing”. Dr. Kenneth Anderson, Harvard Medical School, President of the American Society of Hematology, was the invited speaker for the third Clinical Arthur Rosenberg Lecture at the JGH, November 6th, 2017. Research - At the JGH, the basic and translational research group in Hodgkin’s lymphoma composed of Drs. Nathalie Johnson, Tina Haliotis and Hans Knecht discovered two molecularly disparate mechanisms leading to the formation of Hodgkin- and Reed-Sternberg cells. Dr. Routy published extensively on HIV infection. The MUHC Hemophilia and Hemoglobinopathies program headed by Drs. Margaret Warner and Véronique Naessens has implemented new approaches to state of the art care for these vulnerable

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patients and thus allowing them to participate in multi-center research across Canada. Dr. Mercier has joined the McGill Hematology Division after a successful 5 year fellowship in basic leukemia research at the Scadden laboratory in Harvard. The arrival of Dr. Mercier, who specialized in single cell transcriptome analysis, CRISPR-Cas technology and corresponding mice experiments, is a major asset in strengthening and completing the clinical and translational leukemia research by these basic elements. He and Dr. Assouline will form an innovative leukemia research group at the JGH Hematology Division and the Lady Davis Institute. The infrastructure and intellectual manpower for both, future top clinical research in Hemoglobinopathies/Hemophilia and basic/translational Leukemia research is now in place.

Teaching - Dr. Chantal Cassis, Program Director of the McGill University Teaching Program and Director of the Hematology Fellow Program had well prepared the RCPC mandated internal review early in 2017. A cornerstone of this achievement is undoubtedly the successful completion of her Master’s project entitled “Identifying the supports and barriers to the implementation of an educational intervention to promote hematology and oncology residents' use of Evidence-Based Medicine: a knowledge translation study” in July 2017 at the University of Ohio. This major accomplishment is the result of Dr. Cassis’ relentless and dynamic engagement as a Program Developer/Director and passionate clinical teacher. Her program including PGY-1/2 (post graduate year) specific expectations for all clinical rotations, new ITERS (In-Training Evaluation Reports) to reflect the changes in the goals and objectives, and research mentorships for residents to increase resident research productivity, is now implemented. Dr. Gizelle Popradi developed a Stem Cell Transplant rotation with focused one-on-one teaching with the fellows as well as a strong laboratory component including HLA and Stem Cell Laboratory. Dr. Geoff Blake has devoted time to create a structured morphology/flow cytometry review for fellows. Drs. Patricia Pelletier and Warner give dedicated Transfusion Medicine teaching on subjects relevant to transfusion practice including basic laboratory testing, quality assurance, fresh and stable blood products and their indications and risks. The nationally recognized Myelodysplastic Syndrome teaching program for hematology-, oncology and radiation-oncology residents, headed by Dr. April Shamy, is already in its fifth year and still rapidly growing. Involvement in the community - All members of the McGill Hematology Division serve the community either through participation as board members of national or international committees related to their area of specialty, or as invited speakers for national and international lectures or meetings.

Clinical innovation - The paperless anticoagulation clinic, directed by Dr. Mark Blostein, attracts medicine fellows and young hematology staff physicians from other Canadian universities and overseas for completing their specialization in managing complex interdisciplinary hemostasis and thrombosis issues. A further training asset is the recent opening of a New Oral Anticoagulants Clinic in order to integrate the increasing use of these drugs. The JGH is the first Québec university hospital to dispose of the reversal agents for the DOACs. The MUHC laboratories were designated as the “Centre Serveur” for the Optilab Grappe Laboratories. The MUHC also implemented the new Department of Laboratory Services. Both are under the medical direction of Dr. André Dascal, with the Grappe Hematology Laboratory Director being Dr. Solymoss. This new structure will lead to centralization of laboratory testing, human resources and budget, with the goal of creating a highly efficient, quality laboratory service for the MUHC Grappe.

What we envision as major threats to academic activities - i) Most importantly, the lack of new job opportunities for talented new hematologists in the near future to ensure knowledge transfer of clinical and laboratory expertise before some very key retirements. Given the ever increasing complexity of patient care, our current PEM allocation continues to be a major concern. ii) The increasing restriction of

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academic freedom and protected time for research. iii) The organizational grey zone with the ongoing implementation of Optilab.

INFECTIOUS DISEASES Noteworthy events - Dr. Marcel Behr was elected to the Royal Society of Canada. Dr. Cecilia Costiniuk was awarded an FRQS Junior I chercheur-clinicien career award. Dr. Don Sheppard received the Royal College Mentor of the Year Award for Quebec, was awarded a FRQS Chair in research, and was elected to the Canadian Academy of Health Sciences. Dr. Bertrand Lebouche (Associate Member) was awarded a CIHR SPORE Mentorship Chair in Innovative Clinical Trials. Dr. Yves Longtin was awarded an FRQS Junior II chercheur-clinicien career award. Dr. Charles Frenette and his team were awarded the Prix Hippocrates for their multidisciplinary project in reducing surgical site infections.

Research - Researchers in the Division continued their track record of success in attracting new peer-reviewed funding including CIHR operating grants (Drs. Sheppard, Christina Greenaway, Costiniuk, Longtin, Vivian Loo), a CIHR Team grant in implementation science (Dr. Marina Klein) and a team grant from the Joint Program in Antimicrobial Resistance (Dr. Makeda Semret). These successes brought the total of operating funding awarded to division members to over 6.7 million dollars in 2017. Members also continued their tradition of publishing innovative and significant research. Fundamental science investigators continued to shed light on the pathogenesis of fungal (Dr. Sheppard), parasitic (Dr. Martin Olivier) and viral infections (Dr. Brian Ward). Notable among these was a report of the development of new anti-biofilm therapeutic reported in PNAS by Dr. Sheppard; which was selected as one of the top 10 discoveries of the year by Science Québec Science.

In clinical studies, Dr. Behr reported on the effects of multiple exposures and the risk of progression to active tuberculosis. Dr. Don Vinh reported on the identification and characterization of multiple genetic mutations that confer susceptibility to infectious or malignant disease. The infection control group reported on the utility of rapid diagnostics for viral respiratory infections in reducing antibiotic prescriptions (Dr. Semret), their experiences with implementation of antimicrobial stewardship programs (Dr. Frenette) and the effectiveness of hand washing techniques to eliminate C. difficile carriage (Dr. Longtin). Drs. Greenaway and Klein reported on the risk of Hepatitis C infection in new immigrants to Canada, and the need for targeted screening in this population. Pivotal clinical studies from members of the CVIS group reported on risk factors for hepatitis C virus reinfection after sustained virologic response in patients co-infected with HIV (Dr. Klein) and methods to diagnose non-alcoholic fatty liver disease and fibrosis in HIV and non-HIV infected patients (Dr. Sebastiani). Dr. Ward is overseeing a global phase 3 study of a plant-made influenza virus -like particle (VLP) vaccine (10,000 subjects in 7 countries), the first of its kind. Drs. Sheppard and Behr launched the McGill Interdisciplinary Initiative in Infection and Immunity (MI4), a McGill-wide initiative that brings together 250 clinicians, researchers and clinician-scientists to tackle infectious and immune threats to human health. This initiative was selected as one of McGill’s Grand Challenges for the next strategic research plan and the McGill 200 capital campaign and held its inaugural strategic forum in November 2017. Teaching - We saw the expansion of the McGill Summer Institute in Infectious Diseases & Global Health to include a full day symposium dedicated to antimicrobial resistance (Dr. Semret). The Division is involved in many international teaching activities: 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. Michael Libman); and the Neurology Clinical Update Course, Port-au-Prince, Haiti (Dr. Anne-

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Marie Bourgault). The Division launched the McGill-Addis Ababa University collaboration in Infectious Diseases (AAU-McGill Partnership for Infectious Diseases). Involvement in the community - Members participated as lead authors in developing national and international clinical care guideline including: ESCMID Guidelines for the management of invasive aspergillosis (Dr. Sheppard); IDSA Clinical Practice Guidelines for C. difficile (Dr. Loo); CATMAT statement on disseminated strongyloidiasis: Prevention, assessment and management guideline (Drs. Libman, Greenaway); INESSS guidelines on sinusitis, bronchitis, pneumonia, urinary tract infections (Dr. Karl Weiss). Dr. Ward was appointed chair of the CIHR Institutional Advisory Board for Infection and Immunity and co-chair of Scientific Advisory Board for GLOPID-R (Global Preparedness for Infectious Disease Research). Dr. Klein was chair and co-organizer of the 4th International HIV/Viral Hepatitis Co-Infection Meeting (IAS 2017 Satellite Meeting) in Paris, France and the CAHR 2017 ancillary event “Leaving no one behind: Building on the strength of Indigenous communities to collectively broaden the response to HIV and HCV in Canada” in Montreal. Dr. Greenaway was appointed scientific program chair for International Conference on Migration Health to be held in Rome in 2018. Dr. Frenette served as chair of CNISP: the Canadian Nosocomial Infection Surveillance Program. Dr. Cedric Yansouni was appointed as an advisor to WHO for cholera and malaria diagnostics. Dr. Libman was elected as chair of the PHAC Committee to Advise on Tropical Medicine and Travel and named to the executive committee of the GeoSentinel Network, as well as chairing the Data Use Committee for GeoSentinel. Other activities include participation in the Royal College of Physicians (Drs. Gerasimo Zaharatos and Matthew Oughton), Comité des infections nosocomiales du Québec (Dr. Longtin), International Society of Travel Medicine (Dr. Greenaway), PHAC 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 Committee; Association des Médecins Microbiologistes-Infectiologues du Québec (Dr. Yansouni), AMMI Canada Grants and Awards Committee (Dr. Vinh). Dr. Weiss served as President of the FMSQ Association des médecins microbiologistes-infectiologues du Québec (AMMIQ). Clinical Innovation - The Division implemented a standardized management protocol for Staphylococcus aureus bacteremia and a novel program for screening and prevention of infections in patients receiving biologic agents, with special emphasis on assessment for infections associated with migration and travel through the Tropical Diseases Centre. A clinic for tropical diseases was established at the JGH, which became a GeoSentinel Network Site (CDC and International Society for Travel Medicine) in 2017. Following a blitz intervention program in ICUs and high-risk units, central line bloodstream infections in the MUHC were reduced from 89 events in 2016 to 40 in 2017. Improvements in VRE and C. difficile transmission rates have been sustained at the Glen at a 10-year record low level. We achieved a 68 % compliance rate with hand hygiene through the CSI implementation program. The MUHC was the Canadian leader for a global point prevalence study of antimicrobial usage that involved 14 Canadian Hospitals and 53 countries worldwide and finally, the JGH and MUHC Divisions launched an initiative to link their respective HIV populations into a single cohort. 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.

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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. Research - 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 centers across Canada to work. The Proteomics Unit at the JGH has ongoing research projects. Teaching - At the MUHC, Dr. Rose Djiana lectured Medical Technology students at Dawson College. Dr. Richard Kremer was an invited speaker at the Second World Congress on Cancer Research and Therapy in San Diego, California in October 2017. Involvement in the community - At the MUHC, Dr. David Blank is a member of the Travelling Lectureship Committee, the Educating the Public On Clinical Chemistry and the 2018 Annual Meeting Planning Committee of the Canadian Society of Clinical Chemistry. Dr. Djiana is a member of the Canadian Society of Clinical Chemistry, Maintenance of Competence Committee, secretary of the Canadian Academy of Clinical Chemistry, and member of the Comité provincial pour le contrôle de qualité interne en biochimie. Dr. Brian Gilfix is now the Past President of the Canadian Association of Medical Biochemists. Dr. Richard Kremer is a member of the Canadian Bone Strength Working Group and International Vitamin D workshop program advisory committee. He was also on the planning committee for the 2nd World Congress on Cancer, San Diego, California and recently was elected as a member of the Quebec Association of Medical Biochemists Executive Committee. Dr. Denis Thibeault organizes the continuing education program for the Société québécoise de biochimistes cliniques. Dr. Fabienne Parente was a member of OPTMQ (Order of Quebec Medical Technologists) working group to update the Guide for transportation and preservation of clinical specimens and of the provincial Comité consultatif sur les dépistages néonataux sanguin et urinaire. Dr. Julie St-Cyr was selected as the Director of the Division of Biochemistry for the MUHC Optilab Cluster. She is also a member of the advisory committee for the Medical Technology program at Dawson College. 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).

Clinical innovation - At the MUHC, Dr. Joseph Shuster was involved in assessments of patients with apparent beta lactam allergy prior to their scheduled surgery. About 98% of patients who gave a history of penicillin allergy were found not to be allergic to penicillin. What we envision as major threats to our academic activities - At the MUHC, the 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. The separation of resident laboratory training from a University department could become an issue if the hospital laboratory department administration interferes with the provision of adequate laboratory exposure for the residents. Also, it is important that the research priorities of the two hospital departments (Medicine and Laboratory Medicine) be aligned. NEPHROLOGY Noteworthy events - Dr. Ramsey Sabbagh joined the JGH in the Fall 2017. Dr. Ahsan Alam was the recipient of the MUHC Department of Medicine W.H. Philip Hill Award recipient for teaching in clinical medicine. Dr. Andrey Cybulsky was renewed as the Catherine McLaughlin Hakim Chair in Medicine. Dr.

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Gershon Frisch was presented with the Transition to Clinical Practice (TCP) Award for Excellence in Teaching.

Research - Basic science studies focus on glomerular pathophysiology employing glomerular podocyte knockout or transgenic mice to characterize the role of cytoskeletal mediators or stress pathways in glomerular pathophysiology. Dr. Tomoko Takano is the leader of Translational research, Canadian Childhood Nephrotic Syndrome Project. Dr. Cybulsky gave an invited lecture titled “Opportunities and Challenges of ER Stress in Proteinuric Kidney Disease” at the American Society of Nephrology Annual Meeting in New Orleans in November 2017. A number of clinical research studies have started in the Division, including STARRT-AKI (determine role of early dialysis in critically ill patients), coronary artery disease in kidney transplant candidates, prevention of delayed graft function, immunosuppression and cancer risk in kidney transplant recipients, Can-SOLVD CKD glomerulonephritis study, intervention for depression and anxiety symptoms in patients undergoing dialysis, treatment of anemia in dialysis. At the JGH, Dr. Mark Lipman, in collaboration with Dr. Schiffrin (GIM Division), is working on gene expression profile in small resistance arteries of patients with hypertension with or without nephroangiosclerosis. 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 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 been integrated into the new 4th year medical school curriculum in the “Putting It All Together” (PIAT) section. Dr. Alam organized the annual internal medicine resident retreat, which focused on intrinsic CanMEDs roles – mindfulness and resiliency in residency.

Involvement in the community - Dr. Marcelo Cantarovich is the Transplantation Society (TTS) vice-President and co-chair of the Education Committee, and member of the planning scientific committee for the 2018 TTS congress. Dr. Serge Lemay is a council member of the Quebec Society of Nephrology. Dr. Ruth Sapir-Pichhadze is the co-chair of Can-SOLVD research training and mentoring work group, and Canadian Society of Transplantation summit organizer and annual meeting organizer. Drs. Sapir-Pichhadze and Takano are members of the Kidney Foundation of Canada Horizons 2022 panel. Drs. Elena Torban (chair), Cybulsky and Takano are lead organizers of the 12th International Podocyte Conference in Montreal. The JGH Division participated in the Dialysis Outcomes and Practice Patterns Study Program (Dr. Sharon Nessim) and in the Canadian Organ Replacement Register.

Clinical innovation - A number of projects that were established at the MUHC in previous years have developed further in 2017. Dr. Alam leads a dedicated clinic for referred patients with adult polycystic kidney disease (ADPKD) providing the novel treatment tolvaptan to slow progression of kidney cyst growth. This also provides a platform for existing (i.e. C-MAJOR Registry) and future (e.g. Can SOLVE CKD network or Nephrology SPOR ADPKD theme) research. Dr. Ratna Samanta has established a specialty glomerulonephritis clinic. The HLA laboratory at the MUHC is accredited by the American Society for Histocompatibility and Immunogenetics and has expanded its activity (Dr. Dana Baran). A Canadian Hemolytic-Uremic Syndrome (HUS) registry is ongoing (Dr. Baran). Its goal is to define the spectrum of so-called atypical HUS as well as the role of novel anti-complement therapy in the treatment of atypical HUS. At the JGH, three hemodialysis stations were approved by the Ministry in the Sandra and Steven Mintz Nephrology Centre. The Division has been participating in a new provincial initiative, «Comité sur la communication avec les donneurs et receveurs de don vivant» (Drs. Shaifali Sandal and Alam) to boost the rate of living kidney donation. The kidney disease biorepository (Drs. Sapir-Pichhadze and Takano) continues to collect clinical data and kidney biopsy samples, which will facilitate molecular

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diagnosis, and novel therapeutic approaches in transplantation and glomerular disease. A new, more focused Cree Renal Care Committee works on chronic kidney disease programs and dialysis in northern satellites, including 3 satellite hemodialysis units, i.e. Chisassibi, Chibougamou and Missistini (Dr. Murray Vasilevsky). There is a plan to establish home dialysis in northern Quebec.

What we envision as major threats to academic activities - The inability to recruit faculty engaged in basic science. NEUROLOGY Noteworthy events - The Division’s activities in 2017 occurred against a backdrop of an ongoing reorganization and rationalization of resources for the in-patient care of stroke, which is driven in part by the increasing ability to intervene acutely in patients with stroke, and partly by budgetary factors. The most significant piece for this group is the plan to move MGH in-patient neurology beds to the MNH, now not expected to occur before the end of 2018. Research - Dr. Ron Postuma continues to publish prolifically on clinical and diagnostic issues in Parkinson’s disease. Drs. T. Wein (first author) and Robert Coté published new Canadian Best Practice Stroke Prevention Guidelines. Drs. Lucy Vieira, Eric Ehrensperger and Coté have ongoing involvement in clinical trials of stroke prevention. Dr. Stuart Lubarsky was appointed to the Education Research Development Committee of the Royal College of Physicians and Surgeons of Canada, which adjudicates an annual grant portfolio of over $1 million. He 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. Colin Chalk developed and implemented a new OSCE (objective structured clinical examination) for 4th year McGill medical students. A medical student supervised by Dr. Coté won a 2017 McGill research bursary (Sir Edward W. Beatty Memorial Scholarship). Dr. Postuma was elected chair of the Movement Disorder Society’s Education Committee. Dr. Lubarsky organized a colloquium (An Introduction to Research in Medical Education) at the 2017 American Academy of Neurology annual meeting. Involvement in the Community - Dr. Chalk finished his term as president of the Canadian Neurological Society in 2017. Dr. Anne-Louise Lafontaine is the chair of the Comprehensive Care Committee and member of the Steering Committee for the 2019 World Parkinson Congress. Dr. Coté is a member of the Scientific Advisory Committee for the 2018 World Stroke Congress and is also the spokesperson for the Heart and Stroke Foundation of Canada. Dr. Postuma published a layperson’s book about Parkinson’s disease (Parkinson’s Disease: An Introductory Guide). Clinical innovation - Drs. Vieira and Coté have been leading the re-organization of acute stroke care at the MUHC, which has included ensuring the functioning of the MNH as a ‘tertiary’ stroke centre (one of two on the island of Montreal able to perform endovascular procedures like thrombectomy), and the MGH as a ‘secondary’ stroke centre, implying a hospital with expertise in stroke care but without endovascular services. Dr. Lubarsky, who established the MUHC Tele-Neurology Clinic in 2011, joined the MUHC Telehealth Tactical Committee in 2017. This committee’s mandate is to promote, prioritize and coordinate telehealth services for the benefit of MUHC patients. Currently about 80 neurology patients from northern Quebec are seen annually by tele-health, significantly reducing burdens to the health service and to patients.

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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. RESPIRATORY DISEASES Noteworthy events - Dr. Elias Matouk received two awards in recognition of his lifetime dedication and excellence of care to cystic fibrosis patients, from the Cystic Fibrosis Foundation and from the City of Montreal (Prix Michel-Paquette). Research - Dr. Dick Menzies completed an individual patient-data meta-analysis which informed WHO guidelines for the treatment of isoniazid-resistant tuberculosis. Dr. Benjamin Smith demonstrated that variations in airway branching patterns were significantly associated with the development of COPD. Dr. Sushmita Pamidi demonstrated that sleep-disordered breathing diagnosed during pregnancy has a high probability of persistence post-partum. Drs. Anne Gonzalez and Pierre Ernst demonstrated that long-term use of high-dose inhaled corticosteroids is associated with mild elevation in fracture risk. Drs. Matthieu Storme (resident), Deborah Assayag and Faiz Ahmad Khan investigated the incidence of interstitial lung diseases in the Cree of Eeyou Istchee. Dr. Marta Kaminska demonstrated that obstructive sleep apnea is associated with poorer cognitive function, among patients with Parkinson’s disease. The JGH participates in multiple multi-centre clinical trials and in one clinical trial of a biologic agent for the treatment of severe asthma (Dr. Pierre Ernst). In COPD, the investigator-conceived research program is looking at individualization of therapy based on inflammatory phenotypes. In addition, the Division has expanded its involvement in multi- centre clinical trials to include trials focused on the treatment of patients with COPD. Dr. Ernst is productive in pharmaco-epidemiologic studies in a wide variety of diseases.

Teaching - Dr. Salman Qureshi directed Block B of the Foundations of Medicine and Dentistry curriculum (Med-I/Dent-I) with very high ratings. Dr. Linda Ofiara took over as residency program director for adult respirology. Dr. Nathalie Saad continues to be Head of Undergraduate Medical Education for the JGH Department of Medicine.

Involvement in the community - Dr. Stéphane Beaudoin organized and coordinated the second provincial bronchoscopy simulation seminar which was attended by all 22 respirology trainees in Quebec. Dr. Ronald Olivenstein co-authored the CTS Severe Asthma Guidelines. At Chest 2017 in Toronto, Dr. Kaminska organized and chaired the session, “Respiratory management of the neuromuscular patient: From assessment to effective ventilation and prevention of complications.” She also chaired the session, “Sleep disordered breathing diagnosis,” at the 15th International Symposium on Sleep and Breathing in Madison, WI. Dr. Pamidi became a member of the ATS Clinical Practice Guideline Committee for obesity hypoventilation, and was selected to the ATS 2017 Programming Committee for Sleep and Respiratory Neurobiology Assembly (SRN). She published as first author, an ATS Workshop report for non-invasive identification of inspiratory flow limitation in sleep studies. At the invitation of the School of Medicine Sydney of University of Notre Dame Australia (UNDA), Dr. Donald Boudreau spent two months at UNDA to review the learning objectives of the school’s Personal and Professional Development domain and enhance the role of professionalism in student assessment and in academic progression requirements, consider the formation of a Professionalism Council, explore the establishment of a mentorship program, and deliver related lectures and workshops. Dr. Boudreau also co-authored the book, “Physicianship: The Rebirth of Medical Education,” which was published by Oxford University Press and released March 28, 2018. Dr. Salman Qureshi chaired a pneumonia diagnostics workshop at ATS 2017, and was nominated to the ATS Mycobacterium tuberculosis and

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Pulmonary Infections Assembly Planning Committee. Dr. Ahmad Khan participated in a taskforce to eliminate TB in the Inuit Nunangat. Under the direction of Dr. Saad, the pulmonary rehabilitation program at Mount Sinai Hospital is active in the community, and includes a specialized group of patients with interstitial lung diseases.

Clinical innovation - Dr. Beaudoin introduced two new nursing activities, intrapleural flushing and medication administration (a first in Quebec), which were approved by the MUHC. Dr. Beaudoin developed a standardized pleural drainage MUHC policy. A tele-ask program for COPD remote home monitoring was started by Dr. Nicole Ezer. The PaTROL Clinic (pediatric to adult transition and orphan lung disease), run by Dr. Jennifer Landry, is now an accredited centre by the Primary Ciliary Dyskinesia Foundation. The teleconferencing program for pulmonary rehabilitation at Mount Sinai, led by Dr. Saad, was launched January 16, 2017, and now offers a decentralized eight week program to regional hospitals anywhere in Quebec.

What we envision as major threats to academic activities - Limited financial support and flexibility for innovative clinical programs in the hospital setting; increased bureaucracy particularly with respect to resident education; and limits on the numbers of respirology residents.

MEAKINS-CHRISTIE LABORATORIES (MCL) Noteworthy events - Dr. Basil Petrof was appointed Director of the Meakins-Christie Laboratories effective May 15, 2017 for a five year term. Dr. Sabah Hussain received the MUHC Department of Medicine Award for Excellence in Research by a staff member. Dr. Dao Nguyen received a teaching award from the McGill Department of Microbiology and Immunology. Dr. Larry Lands (Associate Member) received the 2017 Lifetime Achievement Award in Pediatric Respirology from the Canadian Thoracic Society. This award recognizes his significant contributions to pediatric respirology in the domains of clinical and fundamental research and support for the education of trainees. It also recognizes his exceptional leadership and dedication to patient care. Dr. Elizabeth Fixman‘s research program with Dr. Brian Ward was featured in the 2017 CDMRP Annual Report for her DoD funded research on STAT6-dependent bridging of innate and Th2 adaptive immunity in the lung. Dr. Christine McCusker’s research was featured on CIHR’s Celebrating Health Research in honor of Canada’s 150th. CIHR featured her research that is developing a molecule (STAT6-IP) to help people with allergies breathe easier.

Research -MCL investigators continued to be successful in receiving grants from a variety of sources, including Cystic Fibrosis Canada, the US Cystic Fibrosis Foundation, the American Asthma Foundation, Amorchem, and two team grant from the Réseau en santé respiratoire du FRQS. A study by Dr. Fixman and Dr. Ward (collaboration with the MUHC-RI IDIGH program and co-funded by a Department of Defense grant) demonstrated that STAT6-IP, a peptide developed by Dr. Fixman, reduces the development of allergic-type lung inflammation and airway hyperresponsiveness in mice re-challenged with respiratory syncytial virus. The MCL welcomed its newest faculty member, Dr. Ilan Azuelos. His research aims to elucidate the molecular basis for the development and progression of pulmonary fibrosis by examining the metabolism of fibrotic lesions in the lung. Dr. Azuelos was awarded 1 year of funding from the Réseau en santé respiratoire du FRQS Programme de développement de jeunes chercheurs en mentorat. Teaching - Dr. Anne-Marie Lauzon continues to be the Director of the Division of Experimental Medicine, and MCL investigators serve as primary coordinators for 8 separate McGill University courses. MCL trainees were successful in receiving FRQS funding, including FRQS postdoctoral awards to Dr. Eva Kaufmann and Dr. Nargis Khan (postdoctoral fellows with Dr. Maziar Divangahi). Necola Guerrina (PhD

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student with Dr. Carolyn Baglole) placed 2nd at the McGill University 3 Minute Thesis finals and won an award for best basic research poster at the Canadian Thoracic Society meeting being held in conjunction with the American Thoracic Society meeting in Washington, DC. Cystic Fibrosis Canada interviewed Dr. Dorival Martins (postdoctoral fellow with Dr. Nguyen) about his research project. He and Dr. Nguyen uncovered new mechanisms that P. aeruginosa uses to escape antibiotic killing that may be targeted to improve the effectiveness of currently used drugs. Lisa Hennemann (MSc student with Dr. Nguyen) received the “Concours compléments de bourse” from the Réseau en santé respiratoire du FRQS. Dr. Emmanuel Faure (postdoctoral fellow with Drs. Simon Rousseau and Nguyen) and Dr. Perrine Bortolotti (postdoctoral fellow with Drs. Rousseau and Baglole) each received Strauss Fellowships from McGill. Ellen Zhou, a former trainee under the supervision of Dr. Rousseau, and now a MD-PhD student at McGill, received the 2017 Canadian Medical Hall of Fame Award. Involvement in the community - Several investigators continue to be involved in national research networks, including the Allergy, Genes and Environment Network (Dr. Bruce Mazer), the Canadian Epigenetics, Environment and Health Research Consortium (Dr. Baglole), and the Canadian Respiratory Research Network (Dr. James Martin is co-director). The 28th annual Respiratory Research Day provided a forum for the presentation of clinical, basic, and translational research from all trainees and saw over 50 oral and poster presentations. Following the success of a joint Child Health (CHHD) program and Respiratory (RESP) program summer student research day in 2016, the MCL co-lead the organization of the 2nd Joint Summer Student Research day with 4 other RI-MUHC research programs (CHHD, CRP, MeDIC, and CHAL). There were 53 oral and poster presentations, 13 of which came from the MCL and respiratory summer students. Yearly workshops organized by the MCL are open to all trainees, staff and faculty to attend. The 19th Annual MCL Workshop was dedicated to Systems Biology approaches to pulmonary host-pathogen interactions and was held in conjunction with the endowed Seymour Heisler Lecture. Clinical innovation - In collaboration with the clinical Respiratory Division, the Child Health (CHHD) RI-MUHC program, and the Infectious Diseases (IDIGH) RI-MUHC program, the MCL are in the process of developing a MUHC Rare Diseases consortium, which will include patients with rare respiratory diseases and patients from the MUHC Pediatric to Adult Transition and Orphan Lung (PATROL) disease clinical care and research platform. The objective of this consortium is to facilitate patient-oriented, collaborative, trans-disciplinary health care and research in rare diseases across the lifespan. Initial effort are aimed at identifying clinicians and researchers with expertise in rare diseases to ultimately develop a platform to facilitate clinical studies and research while at the same time providing an infrastructure for coordinated rare disease patient care. An official American Thoracic Society report on this topic, based on a MCL workshop spearheaded by Dr. Arnold Kristof, was published. Dr. Petrof was part of the planning committee for a meeting sponsored by the US FDA and the parents of children with muscular dystrophy to accelerate the clinical application of anti-inflammatory drugs for treatment of Duchenne muscular dystrophy. Drs. Peter Goldberg and Petrof introduced the use of magnetic stimulation of the phrenic nerves in order to assess diaphragmatic strength in intubated ICU patients. 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.

RHEUMATOLOGY Noteworthy events - Dr. Christian Pineau organized and ran the successful retreat for CESAR (Center of Excellence in Systemic Autoimmune diseases and Rheumatology). Dr. Marie Hudson was awarded the

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2017 « Prix de mérite » from the Association des médecins rhumatologues du Québec. Dr. Giovanni Di Battista is Editor-in-Chief, Inflammation Research (Springer) and raised impact factor to all time highest level. Dr. Ines Colmegna received the MUHC Department of Medicine Award for her work related to the ILAR-EAST Africa Initiative-July 2017. Dr. Mary Ann Fitzcharles was invited as a keynote speaker at the International Association of Study of Pain (IASP) (European chapter) in Copenhagen 2017. Research - Dr. Joyce Rauch was a co-author on three original articles that were submitted for publication: (1) T cells in murine SLE; (2) one based primarily on studies done in her collaborator’s [Dr. J. Levine’s] laboratory; and (3) one based primarily on studies done in her collaborator’s [Dr. E. Boilard’s] laboratory. There is a collaborative study in progress with Dr. Colmegna on anti-citrullinated antibodies. Much of this work was also presented at conferences during 2017. She co-edited and co-authored a chapter on the origin of antiphospholipid antibodies in a book called “Antiphospholipid Syndrome - Current Research Highlights and Clinical Insights”, which was published in 2017. Dr. Evelyne Vinet was awarded a CIHR Catalyst Grant in Musculoskeletal Health, ranking 1st out of 107 investigators, to establish an international prospective cohort of SLE pregnancies to study patterns of aspirin use and placenta-mediated complications. Dr. Pantelis Panopalis enrolled patients to the Canadian Early Arthritis Cohort (CATCH) and maintained the involvement of the MUHC in this national inception cohort of patients with Rheumatoid Arthritis. Drs. Michael Starr and Alex Tsoukas are working on the development of new Spondyloarthropathy cohort for future clinical research with Spondyloarthritis Research Consortium of Canada (SPARCC). Teaching - Division members teach at all levels from undergraduate to postgraduate. Involvement in the community - Dr. Di Battista is chairing the Scientific Advisory Committee of the Arthritis Society of Canada (TAS) and presiding over the selection of a new Scientific Director. He was a member of the organizing committee, DDTP International Drug Discovery and Development Forum; Challenges to Drug Discovery & Development in the Genomics Era in June 2017 and a member of the organizing committee of the 13th World Congress on Inflammation, July 2017, London, UK. Dr. Pineau was President of the Laurentian Conference of Rheumatology and successful organization and running of its 48th edition. Dr. Elizabeth Hazel played a lead role for the Royal College Specialty Committee Core Group in the CBD design of the new national rheumatology program, co-organized and ran the National Rheumatology Residents’ Weekend, holds a Chair position on the Education Committee of the CRA and is a member of the Training Rheumatologists of Tomorrow program. Dr. Colmegna leads the ILAR (International League of Associations for Rheumatology) East Africa Project. She and Dr. Panopalis organized and ran the Annual meeting for patients with Inflammatory Arthritis and their family members, a McGill – Constance Lethbridge Rehabilitation Centre collaboration. Dr. Vinet joined the Board of Directors of Fondation En Vue. Clinical Innovation - Dr. Sasha Bernatksy helps lead a longitudinal program to monitor quality of care in the MUHC SLE clinic, for example for retinal monitoring with hydroxychloroquine treatment, cancer screening, smoking cessation, pregnancy planning, flu vaccination. Dr. Vinet is running the Rheumatology & Reproduction clinic at the MGH. The Constance Lethbridge TEVA clinic (Transition en vie adulte) and its association with the MGH YARD (Young adult rheumatic disease) clinic is a model of care for young adults with rheumatic diseases. Dr. Hazel is currently working on a quality improvement project to improve the content and reliability of outpatient clinical notes in rheumatology. She manages patients with inflammatory polyarthritis in a comprehensive fashion that includes thorough assessments of disease activity, management of co-morbidities, patient education (one-on-one with health

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professionals as well as through an annual patient education forum), and opportunities for patients to participate in clinical research at their discretion. What we envision as major threats to academic activities - Low rates of funding at the different funding agencies. Lack of administrative support and nursing support to best implement our clinical activities and research units. Decreased and relatively low number of PEM’s make it challenging to concentrate on academic activities while providing optimal care to a growing patient population. 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 4-12, followed by an OSCE period from December 13, 14 and 15 with 185 students. The focus of this course is to review of clinical exam skills. We continue to face some challenges in recruitment, especially for the OSCE. Nonetheless, the course was successful as in previous years.

Transition to Clinical Practice (TCP) - The TCP course took place as usual from January - June 2017. 180 students completed the course. There was positive feedback from students for activities such as Harvey, Patient Partner in Arthritis and Patient Safety etc. 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. Clinical Clerkship in Internal Medicine - The number of students taking the course was 186. In 2017 we expanded the evaluation process to include a formative observed clinical encounter, similar to an oral examination. As a result, feedback from students has been quite positive in that they feel they benefit greatly from direct observation. For 2018, we will be expanding our online teaching from its current four interactive cases to include a cardiology teaching module, and a module on transfusion medicine. MCGILL INTERNAL MEDICINE RESIDENCY TRAINING PROGRAM The McGill Internal Medicine Residency Program remains the largest specialty training program at McGill. There are over 120 residents in training across our three main adult teaching hospital sites. This year, McGill Internal Medicine again matched all its CaRMS residency spots in the first iteration. In July 2018, we will be welcoming our new cohort that consists of 19 candidates trained at McGill, 5 from the other universities in Quebec (Université de Montréal and Université Laval), 4 candidates from the rest of Canada (McMaster, Queen’s, Western, and Ottawa), and 13 international candidates (United States, Colombia, Australia, Lebanon, Iran, Kuwait and Saudi Arabia). We have no doubt that these diverse residents will continue to enrich the training environment at McGill. We also are very proud of the great success of our outgoing PGY3 residents that matched to subspecialty programs across the country. They will be pursuing further training in some of the most competitive programs in the country, matching to McGill, Université de Montréal, Université Sherbrooke, Toronto, Ottawa, Calgary and British Columbia. They will become future subspecialists in GIM, gastroenterology, medical oncology, hematology, infectious diseases, rheumatology, cardiology, respirology, and geriatrics. Teaching - This year McGill Internal Medicine held its Annual Clinical Vignettes Evening on April 17 at the McGill Faculty Club. It was a wonderful night of clinical intrigue and edification. Drs. Ariane Barbacki, Alina Beliavsky, Parvaneh Fallah, Éliane Nguyen, Aurélie Paré, and Marcel Tomaszewski provided

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wonderful presentations that showcased the clinical and diagnostic dilemmas we struggle with and how they were solved. The Dr. Harold Frank Award for the best clinical vignettes case this year was awarded to Dr. Ariane Barbacki. Involvement in the community - McGill Internal Medicine again sent residents to Haiti as part of our Global Health Initiative. Our program is proud to collaborate with the MUHC and JGH Departments of Medicine in working with Partners in Health (PIH) and St. Nicolas Hospital in order to send senior residents and faculty to Haiti to teach and learn from the local physicians and trainees. This remains an extremely popular feature of our program. Any staff interested in joining a future excursion should contact our program office. In the spring of 2019, McGill will undergo accreditation of its postgraduate programs. Then in July 2019, we officially launch the Royal College’s Competency by Design curriculum for competency-based medical education. https://www.mcgill.ca/deptmedicine/files/deptmedicine/im_training_program_annual_report_2017.pdf

CONCLUDING REMARKS

The Department continues to have a substantial output in teaching, research and clinical innovation. Two major symposia were run successfully. The success with FRQS personal support awards surpassed prior success rates. There were new hires of talented investigators. Publication numbers are maintained but funding has declined somewhat. The Division of Experimental Medicine is receiving additional administrative support, allowing the Division to respond more quickly to applications for graduate studies. New courses are in place and others in the planning stages. Clinical innovation is strong and quality improvement is a departmental priority. Many members were honored for their accomplishments. Hiring of basic scientists remains a great need to replace retiring faculty members. 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 and senior 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. 2. Bureaucratic processes are becoming increasingly heavy with inadequate administrative support for investigators. The policy of post-award support is inadequate for clinician scientists who are already juggling several major functions in addition to their research portfolios. 3. Restrictions on hiring and micromanagement by the Ministry of Health have further limited possibilities for growth. Increased service requirements are reducing time available for academic activity.

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APPENDICES

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

Appendix 3: Milestones (new hires, promotions, departures and salary awards)

Appendix 4: Honours, awards and prizes

Appendix 5: Consulting activities table

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

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

44%

5%

44%

7%

Appendix 1 2017 Research Education and Development

Recruitment and Research Activities

Educational Activities

Stipends & Administrative Activities

Infrastructure

Appendix 2

RESEARCH AND TEACHING SUPPORT FROM PRACTICE PLANS

MUHC JGHResearch:Research Start Up 855,520 927,701 Bridge/Extended Bridge Funding 275,000 -

Teaching:

Educational Stipends - 73,800 Resident Activities 15,479 70,672

Total Support $1,145,999 $1,072,173