JGH Chief to head McGill’s new Provisional Department of Emergency Medicine

Dr. Marc Afilalo, Chief of the JGH Emergency Department, has been appointed the inaugural Chair of the newly established Provisional Department of Emergency Medicine at McGill University.

Although the green light to set up the department has been given to Dr. Afilalo and two other Chiefs—Dr. Jean-Marc Troquet of the MUHC and Dr. Rick Mah of the West Island CIUSSS—the term “Provisional” means that full status must wait until 2020, when follow-up documentation is expected to be approved.

The department will pool the expertise of staff in five of Montreal’s leading emergency departments: one in CIUSSS West-Central Montreal (the JGH), two at the MUHC (the Glen site and Montreal General Hospital) and two in the West Island CIUSSS (St. Mary’s Hospital and Lakeshore General Hospital).

“This is a great source of satisfaction to me,” says Dr. Afilalo, referring to McGill’s decision in June to approve the creation of the department. “It’s a characteristic of emergency physicians that we don’t let go when we believe strongly in something. But I don’t take sole credit for what we’ve achieved. It came about through the efforts of our group, which is very, very solid.”

Dr. Afilalo notes that in academia, a medical specialty is usually launched first as a division within a larger department; only later does it go on to achieve full departmental status.

However, given the importance of emergency medicine as a specialty, as well as the persuasiveness of the proposal that was presented to McGill, the university agreed for the first time to have the new department go straight to Provisional status. For this, Dr. Afilalo credits senior McGill officials, notably Dr. David Eidelman, Vice-Principal of Health Affairs and Dean of the Faculty of Medicine.

“Dr Eidelman has been a tremendous source of support from the very beginning of the process,” Dr. Afilalo says. “He has worked tirelessly to guide us on the right path to what we have achieved today. It could not have happened without his support.”

Although emergency departments have long been key players in general hospitals, only in the relatively recent past have academic institutions begun to recognize emergency medicine as a specialty worthy of a department of its own.

According to Dr. Afilalo, emergency departments in large Canadian university hospitals, such as the JGH, are currently staffed by two types of physicians:

• Specialists who complete the five-year program of the Royal College of Physicians and Surgeons, often followed by a fellowship (FRCP). The careers of these doctors are generally more oriented toward academia, including research, teaching and clinical innovation.
• Doctors who complete their residency in family medicine and then take an extra year of training to achieve special competency in emergency medicine (CCFP.EM). In recent years, these physicians have spent more time doing hands-on emergency work than was previously the case.

Dr. Afilalo says that as an academic department at McGill, Emergency Medicine will take a prominent leadership role in its field and will become a credible voice in helping to shape government policy. It will also develop evidence-based guidelines to assist doctors in improving the quality of the emergency care that they provide.

“Our goal,” he says, “is to create a McGill platform that enables all of us to work in a more structured environment to improve patient care and safety, to build on our knowledge and to pass along that knowledge nationally and internationally.”

Priority in the new department will be given to developing greater depth in research that involves emergency medicine, says Dr. Afilalo. As well, he hopes that training will be offered in additional sub-specialties, complementing well established, emergency-related areas such as ultrasound, trauma and toxicology.

Working with his colleagues, Dr. Afilalo would also like to create new evidence-based protocols to harmonize clinical care across the McGill network. “The goal is not to say that all doctors must do the same thing; their own personal judgment and experience are crucial. However, we can propose guidelines to them, backed by evidence, to enable them to investigate and treat more appropriately.”

Dr. Afilalo says he expects the new department to “unite our efforts and place the emphasis on people, not structure. Our success will be based on not having borders—just doctors bringing their expertise and giving their time for the good of emergency medicine at McGill. It’s as simple as that.”