INTRODUCTION
The Rural Doctors’ UBC Chair in Rural Health is the culmination of five years of active collaboration between several partners: The Joint Standing Committee on Rural Issues (JSC) – a partnership between the Ministry of Health and Doctors of BC – the Rural Coordination Centre of BC (RCCbc), and UBC. It represents a commitment to providing sustained, excellent healthcare to rural, remote and First Nations community members and building a substantive knowledge base of rural health research. The endowment was made possible because of the generosity of our partners, providing academic leadership for rural health care in BC and developing a robust research and education program focusing on the current needs of rural practitioners in the province.
A unique year in the history of the Rural Doctors’ UBC Chair in Rural Health, 2020 brought unparalleled challenges and new opportunities. After a successful term, Dr. David Snadden left the role of Rural Doctors’ UBC Chair in Rural Health in June 2020. The role remained vacant until November 2020, when Dr. John Pawlovich was appointed as the new Chair.
WELCOMING THE NEW CHAIR
With the support and collaboration of the JSC and RCCbc, we are excited to welcome the new Chair, Dr. John Pawlovich, a clinical professor in the Department of Family Practice. Dr. Pawlovich represents the Chair on the Department’s Executive Committee, creating opportunities to promote and engage its rural clinical faculty, academic faculty, and learners in educational and research opportunities.
As a respected leader and connector in the communities he serves, Dr. Pawlovich brings with him a wealth of health care experience, including over 25 years working in rural communities throughout BC and over a decade as the Medical Director of Carrier Sekani Family Services. Now living in Abbotsford, BC, he continues to connect with multiple rural, remote and First Nations communities to help provide the daily primary care they deserve and makes monthly visits to northern communities to ensure the closeness of his relationship to the people remains strong.
The pandemic forced health care providers to innovate and act quickly in response to the new challenges in healthcare. While the pandemic paused progress on many activities of the Chair, it presented new and exciting opportunities to assess and innovate in the delivery of health services in rural, remote, and First Nations communities, leveraging the role to help address inequities in access to health resources and better support both rural practitioners and the communities they serve.
The activities of the Chair are based in three areas: Rural Research, Rural Advocacy, and Support and Mentoring (outlined in further detail below).
RURAL RESEARCH
UBC’s Remote Communities Drone Transport Initiative
Dr. John Pawlovich has taken on the role of co-sponsor of the Remote Communities Drone Transport Initiative (DTI). Launching this year, the DTI will transport vital health care supplies to pilot community Stellat’en First Nation by unmanned aerial vehicles. This innovative drone delivery project will serve as a new healthcare delivery model and compliment virtual and telehealth services across BC and Canada.
The COVID-19 pandemic has resulted in inequitable access to health care services for many rural, remote and First Nations communities across BC. When more than 80 First Nations communities were essentially "cut off" due to lockdown requirements to prevent the spread of the virus, this exacerbated health conditions for them, especially for those with life- threatening diseases like cancer and diabetes. Although telehealth and virtual services were swiftly ramped up to help identify the people who required testing for COVID-19, samples still need to be analyzed in laboratory facilities that are not available in these communities. Public health guidance to restrict travel also complicated supply lines for laboratory tests and essential medical supplies.
The DTI offers a solution by providing rural, remote and First Nations communities with access to necessary lab and pharmacy healthcare services. As an innovative transportation solution, it increases the accessibility of health care supplies in remote areas, minimizes the person-to-person transmission of COVID-19 by limiting in-person contact, and expedites COVID-19 screening capabilities. By developing this new health care delivery model, UBC Faculty of Medicine plans to address addresses the long-term and now urgent need for systemic change that will result in more equitable access to health care services for rural, remote and First Nations communities.
UBC’s Virtual Health Grand Rounds
The Virtual Health Grand Rounds is a collaboration between the UBC Division of Continuing Professional Development (UBC CPD), UBC Digital Emergency Medicine and the Rural Education Action Plan (REAP), for which Dr. Pawlovich is a co-founder and co-lead. Virtual Rounds are a quarterly provincial electronic series that connects health care providers, information management colleagues, health administrators, health policymakers, and academics to explore technology-enabled healthcare delivery case examples to support patient-centered care. These rounds generate discussion around the adoption of technology in healthcare throughout BC while optimizing mutual learning and enhancing relationships.
Northern Research & Innovation Centre
In partnership with Dr. Paul Winwood at the University of Northern British Columbia (UNBC) and UBC’s Northern Medical Program (NMP), in collaboration with the Northern Health Authority (NH) and Rural Coordination Centre of BC, Dr. Pawlovich is working towards the development of a nationally and internationally recognized research hub and innovation centre, integrating interdisciplinary research from UBC (NMP), UNBC and NH, that advances medical research for disadvantaged populations in northern BC, as well as those across Canada.
The Centre will be located in Prince George and will act as a vibrant axis for researchers and clinicians who are passionate about supporting translational research in the North and expanding UBC's capacity to respond to rural, remote and First Nations community members' health concerns. It will promote equity for northern BC residents through an interdisciplinary platform focused on research training and mentorship opportunities for health professionals in the North, residency programs and medical students, and an active clinical trials division that enables participation and perspectives from residents in the North.
Real-Time Virtual Supports
As the Virtual Health Lead with the Rural Coordination Centre of BC (RCCbc), Dr. John Pawlovich leads the Real-Time Virtual Supports (RTVS) program in coordination with funding from the Ministry of Health’s COVID-19 Emergency Response Fund and a multitude of partners, including the JSC, Doctors of BC, UBC, BC Emergency Medicine Network, the First Nation Health Authority, Providence Health Care and Provincial Health Services Authority. The RTVS program was established in response to COVID-19 and a recognized need to provide on-demand support to rural healthcare providers, enable timely delivery of emergency and urgent patient-centered care to rural patients closer to home, decrease inequities in access to care for rural, remote and First Nations community members and become a support tool that emboldens physicians and trainees to venture away from urban centres.
RTVS is in an ongoing state of development in response to community and physician feedback as new needs and opportunities emerge. At its one-year anniversary, RTVS continues to onboard new communities, provide new training opportunities and add non-acute care pathways to the services provided by the program.
Rural Virtual Echocardiography Research Project
In his role as the UBC Chair in Rural Health, Dr. Pawlovich provides guidance and support in the development of a research study to support the implementation of handheld ultrasound devices in rural communities with rural healthcare providers in the context of echocardiography. This work is in its early stages and represents a partnership with UBC MedIT and RCCbc with other anticipated partners to join as the project develops. The research aims to facilitate access to echocardiographic services within home communities, thereby removing the need to travel to larger centres for testing.
Publications/Key Presentations (during the term to date of the new Chair, in order of most recent):
- Sunnybrook Emergency Department Group: “Real-Time Virtual Supports for BC”, Presentation on April 16, 2021.
- Canadian Association of Emergency Physicians: “Real-Time Virtual Supports for BC”, Presentation on April 14, 2021.
- BC Rural Centre: “Virtually Enhanced Care in Rural, Remote and Indigenous Communities”, Webinar on April 7, 2021.
- UBC Medicine: “Transition into Practice”, Virtual Resident Lecture presented on March 30, 2021.
- Alberta College of Family Physicians, Virtual Family Medicine Summit: “What Patients Want: Using technology to Communicate”, Keynote Presentation on March 7, 2021.
- UBC Medicine: “The 21st Century House Call: Is Virtual Health Here to Stay?”, Webinar on February 24, 2021.
RURAL ADVOCACY
Through his capacity as Director of REAP, Dr. Pawlovich supports educational opportunities for rural medicine practitioners and encourages residents to include practice in rural communities as part of their educational journey. The program aims to produce “fit for purpose” rural physicians who are equipped to better close the gap in access faced by rural, remote, and First Nations community members and address pressure on UBC undergraduate and postgraduate programs to produce rural-ready physicians. Most recently, REAP co-hosted a “Transition to Practice” talk to a group of residents at UBC alongside RCCbc and Rural CPD to advise students of the funding and learning opportunities offered by REAP, increasing the likelihood of residents utilizing these services and in consideration to rural medicine in the implementation of their learning plans.
Through his positions as the e-Health Theme Lead at UBC and the Virtual Health Lead at RCCbc, Dr. Pawlovich has supported the development and ongoing growth of the RTVS system. The project has led to many speaking engagements on the subject of virtual health and has presented opportunities to educate additional rural-focused community advocacy groups. This work is further supported by his position as a virtual health task force member with the Canadian Medical Association that helps national discussions regarding virtual health implantation.
The work of the Chair also centers on its commitment to developing high-quality community-based primary care models for rural, remote and First Nations communities, a priority for UBC Faculty of Medicine. Through Dr. Pawlovich’s clinical work as the Medical Director of Carrier Sekani Family Services, he brings his on-the-ground experience from this role to key decision makers at UBC, RCCbc and JSC to ensure rural voices and perspectives are brought into the discussion when future program funding and educational directives are developed.
SUPPORT AND MENTORING
Rural Education Action Plan (REAP)
As Director for REAP, Dr. Pawlovich has been instrumental in the support of rural physicians through its funding for leadership and skill enhancement training, CME courses and Indigenous cultural safety training. The program also provides funding to support undergraduate medical students and postgraduate residents to gain rural practical experience, attend rurally focused conferences, events and courses, and offering bursaries to rurally-bound specialty residents and medical students who have demonstrated an interest in pursuing a career in rural medicine. Through REAP’s Rural eMentoring Program, high school, pre-med and medical students can connect with peers to gain practical advice to support their post-secondary goals.
Postdoctoral Opportunities
In collaboration with Dr. Deanne Taylor, the Co-Scientific Director of the RCCbc, Dr. Pawlovich is engaged in the development of two postdoctoral opportunities. Each Postdoctoral Fellow will receive mentorship and support from the Chair, executive leadership of the RCCbc, and the RCCbc Co-Scientific Directors. Along with RCCbc staff, they will co-lead a two-year rural health project to understand the barriers and enablers of the medical school application process for those living rurally and explore virtually enabled care systems across urban and rural perspectives.
Rural Scholars Program
Dr. David Snadden selected Dr. Ilona Hale to act as the Director of the Rural Scholars Program during his transition out of the Rural Doctors’ UBC Chair in Rural Health role. Dr. Hale continues to report to the Chair and his capacity in his role, Dr. Pawlovich provides support to Dr. Hale and her scholars and receives updates on ongoing research quarterly. The Rural Scholars Program is funded by the Joint Standing Committee on Rural Issues under the partnership of UBC’s Department of Family Practice and RCCbc and provides rural clinicians with the opportunity to develop scholarship and leadership skills and enter the field of rural research. Through this project, rural physician researchers can apply for research grants of up to $10,000 to support research activities.
Currently, The Rural Scholars Program provides research leadership to two Scholars: A Registered Midwife, who is studying the patient experience of emergency intrapartum transfer from rural communities in Southern Vancouver Island, and a Registered Nurse, who is examining patient experiences with multidisciplinary primary care maternity teams in rural BC. Each began the Rural Scholars Program in 2020 and is among the first Rural Scholars from a health discipline outside of medicine.
A MESSAGE FROM DR. JOHN PAWLOVICH
Healthcare providers going out to rural, remote and Indigenous communities face a daunting task. They often work in isolation, trying to be many things to many people. It’s often overwhelming and a historical barrier to recruitment and retention. Technology allows for the creation of a virtual team that can wrap itself around healthcare providers. Whether they’re in Atlin or Port Hardy, when a nurse or physician with a very sick patient needs assistance in a very swift, effective and coordinated manner, a virtual team could be at the bedside to collaborate on care. Moving forward, we need deeper learning through research and introducing technology to support patients and healthcare providers in communities. We also want to inspire more research that’s driven from a northern perspective, to understand how technology integrates in an effective and safe way in rural communities around the province.
Historically, training of medical students happened in large centers, and that was the context of their learning years. Nearly two decades ago, UBC took a great step forward and created Canada’s first fully-distributed medical program that hosts medical students in Prince George, Kelowna, Victoria and the Fraser Valley, in addition to Vancouver. I would like to continue to advance this model of distributed learning, so it’s even more focused on community-based learning in remote regions of the province. Learners need to experience life in communities, and they can be supported in new ways with technology and instructors on the ground.
I personally aspire to create opportunities for more medical residents to experience greater professional autonomy in rural and remote communities, with virtual support from a mentor or instructor, as they get closer to completion of their training. Some family practice and pediatrics residents have had these experiences, and I plan to work with more specialist residency programs to help residents appreciate what it feels like to collaborate with virtual interprofessional healthcare teams in the context of professional autonomy. I think this concept is really exciting.
I hope my voice of advocacy is heard in an effective manner across the province and perhaps over the mountains outside this province. That advocacy speaks to our unrelenting pursuit of equity and access to healthcare for all British Columbians and support for healthcare providers in rural, remote and Indigenous communities. That is the primary goal of my work as the Rural Doctors’ UBC Chair in Rural Health.
THANK YOU FOR YOUR SUPPORT
The UBC Faculty of Medicine and Dr. John Pawlovich are deeply grateful to the RCCbc for your support of the Rural Doctors’ UBC Chair in Rural Health. Working in partnership with the Department of Family Practice, the JSC and RCCbc, the Chair has generated significant research, informed policy through evidence and supported communities in remote areas of British Columbia through supporting and enhancing rural healthcare. Thank you.
For more information, please contact:
Lisa Slater, Director, Development, UBC Faculty of Medicine, by phone at 604.764.6611, or by email at lisa.slater@ubc.ca