Education 

BOB BERNHARDT, BSC, MED, LLM, PHD 

As for most institutions across North America and beyond, the last 6 months have involved many challenges and many corresponding changes. I am proud of the manner in which the Canadian College of Naturopathic Medicine (CCNM) community pulled together in solidarity to position the college for the future in the midst of these challenging times. This update addresses CCNM’s response to COVID-19 as well as the need to speak to anti-Black racism within the institution. The order of presentation aligns with the chronology of events. 

Response to COVID-19 

For CCNM, the arrival of the pandemic crisis occurred at a strange time. The college had just completed the concurrent Council on Naturopathic Medical Education (CNME) and Ontario degree-granting assessment visits (March 9-11), and then the world seemed to change overnight. On-site academic classes ceased as of the end of teaching on March 13^th, as the Ontario Provincial Government announced the closure of public schools. The college was well positioned for this crisis, and the academic team performed a remarkable job at keeping the ND program on track for our students and continuing to provide valuable care to our patients.   

Recognizing the need to keep people informed, the college immediately entered into a comprehensive communication strategy. Faculty, staff, and students were updated daily from March 11^th to April 24^th – and 3 times a week since then – with the most relevant information regarding the pandemic and the institution’s response to the challenges it created. The messages have covered the gamut of issues, including mental health, working at home, online delivery of courses, examination plans, practicum plans, building access, government aid packages, and the move to telehealth for the clinics. The daily bulletins have provided considerable detail as to which moves are to be made at what point, and the same bulletin has gone to all groups, with headings allowing individuals to focus on news related to them. 

We moved all of our courses online (within 2 business days of the decision to stop in-person classes), launched video and phone visits for our patients (within 8 business days, with special medical visit software, Doxy.me), successfully ran our annual Research Day via Zoom, and welcomed our incoming international medical graduates to begin their program online starting May 4^th. The faculty have been incredibly accommodating in implementing the changes required, and the students have been very appreciative. Most of our employees are working from home. With a still-functioning student residence (80 of 190 remain), closing the building is not an option. In addition, we had discussions with North York General Hospital about whether they would have a need for our facilities in case of hospital overflow. 

The rhythm of the school is still remarkably close to normal. All of the fourth-year students who would have been eligible to graduate without the COVID-19 interruption were provided learning and evaluation opportunities to ensure they could graduate on time. We were fortunate, in that low first-year enrollment 4 years ago led to a smaller fourth-year class than normal (95 vs 135). As a result, each intern saw a greater number of patients and performed a broader range of activities than would normally have been the case. Even with the move to virtual care for the last 6 weeks of their year, most interns met the numbers expected of them. Where targeted numbers for specific skills fell short, the students were evaluated virtually in their knowledge of how to safely and effectively perform the procedure. 

For the earlier years, all courses without hands-on practicums that would have completed in April, did complete. We have shifted the style of evaluation for a number of courses so that the evaluation can be completed remotely. We are also experimenting with online invigilation (through Zoom) during the writing of the exams.   

Practicums 

Some of the practical training that students would have received at the end of the winter term has been deferred until students are able to physically return to campus. Where practicums do not require a physical presence, they were completed online with the same student-to-teaching assistant ratios as previously in place. Where the practicum requires in-person training, the students continued to receive training in the theory associated with the learning, but not the hands-on experience. A good example is acupuncture; the learning is focused on where needles are to be inserted, for what purposes, and with what safety protocols. Although students will receive some additional training in needle insertion, they practice this skill throughout their program; thus, deferring it from some practicums was not critical. For the hands-on practicums, we committed to scheduling intensive sessions in the early fall. For students who cannot make those periods, additional sessions will be scheduled for a later date. 

We have moved our OSCE (Objective Structured Clinical Examination) to virtual delivery. The University of Toronto Faculty of Medicine team that assists with our OSCEs asked to bring observers from other U of T departments to learn from what was being accomplished. In a survey of evaluators, standard patients, students, and observers, the virtual experience was almost universally praised. 

A brief timeline of the changes undertaken is provided below: 

1. In-person classes were suspended as of the end of classes on March 13^th. 
2. As of March 16^th, employees who were able to work remotely were strongly encouraged to do so. 
3. As of March 17^th, building access was restricted to the front doors only. Emergency egress was maintained throughout the building. 
4. On March 18^th, the US/Canada border closure was announced. CCNM announced that clinic would be suspended from the end of the day through until the time when telehealth visits could be set up. The launch of the telehealth visits occurred on March 26^th, utilizing a newly acquired patient visit platform called Doxy.me. 
5. On March 20^th, students were assured that examinations/assessments would be established in a way that would allow them to be completed without returning to the college. Employees were assured that the college was in strong financial health and that their pay was not in jeopardy. 
6. The end of April saw the successful completion of all courses offered during the winter term. 
7. The new International Medical Graduate class (20 students) commenced May 4^th with a very successful virtual orientation and launch of classes. 
8. On May 11^th, the new clinic class (students entering fourth year) participated in a successful clinic orientation day. 

Clinic 

As we move forward, one of the more complicated processes is the reopening of the clinic. The plan envisages 4 major stages, all of which have multiple smaller stages within them. The stages are: 

1. Reestablishment of I/V services 
2. Restarting essential visits requiring in-person visits, but without student involvement 
3. Limited student involvement with in-person visits where indicated 
4. Commencement of normal operations, with a continuation of some level of telemedicine 

Of course, each of these stages involves significant use of personal protective equipment, and the enforcement of strict protocols for screening individuals entering the building, and for movement within the building. 

Addressing Racism & Discrimination 

The Canadian College of Naturopathic Medicine believes that anti-Black racism is real and prevalent; as an institution, CCNM is committed to fighting it. 

CCNM is committed to identifying the nature of the racism that occurs within its walls. In doing so, it conducted a survey that collected the experiences of those who feel they have been impacted by racism and discrimination. The results of this survey will inform the institution with respect to the nature of the challenges it faces. Based upon this knowledge, the college will work to eliminate racism and discrimination through education and guidance. 

A committee composed of faculty, students and administration – the Inclusion, Diversity, and Equity Advocacy (IDEA) Committee – has been instrumental in assisting the college through this process. 

Through awareness, education, and open dialogue with our students, staff, faculty, and patients, we are dedicated to upholding the values that govern our college: integrity, collaboration, innovation, and adaptability and respect for equity, diversity, and inclusion. 

The college recognizes that this will be an ongoing task, and it is committed to continuing to work on the elimination of racism and discrimination until every member of the CCNM community feels safe and included.