Small Changes Big Impact
Small Changes Big Impact
Producing future family physicians with Dr. Vanessa Rambihar
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In studio today, we have Dr. Vanessa Rambihar, a family physician at Women's College Hospital, assistant professor at the University of Toronto and associate director for Admissions, Awards and Recruitment. Today's episode explores the changes that she championed that impact our admission process to produce future family physicians.
Small Changes, Big impact: a DFCM podcast. I'm your host, Dr. Jeremy Rezmovitz. In studio today, We have Dr. Vanessa Rambihar, a family physician at Women's College Hospital, assistant professor at the University of Toronto and Associate Director for Admissions, Awards and Recruitment. Today's episode explores the changes that she championed that impact our admission process to produce future family physicians. I hope you enjoy the show. Welcome. Welcome to Small Changes, Big Impact, a DFCM podcast and DFCM studios here at 500 University Avenue. Um, so what do you think, what did you think when I invited you to come and converse?
Dr. RambiharI actually only recently started getting into podcasts, so I was quite intrigued , um , while I was traveling this summer. So I was off for six weeks and found we had quite a lot of time, which is a bit of a luxury , uh , and started getting into audio books and that was sort of my first foray into podcasts . So I'm actually quite interested because I'm going to start to be a commuter, so we'll have a little bit excess time. Uh, and I think podcasts are a great way to, to help pass that time.
Dr. RezmovitzSo what did you listen to? What podcast ?
Dr. RambiharSo a couple of parenting podcasts have been what I've been getting interested in recently.
Dr. RezmovitzReally. So what have you been doing up until then? How many years have you been a physician?
Dr. RambiharSo I have been a practicing independent physician for five years, so I'm now in my sixth year of practice. Uh, and yeah.
Dr. RezmovitzSo what kind of advice are you giving parents right now?
Dr. RambiharThat's a very good question. I think a lot of advice that I have been given is that yes, you can read all these books, but the best, the best teacher or the best education, but being a parent is actually experiencing it.
Dr. RezmovitzYeah, I think so. Kolb's experiential theory I think is the underpinning theory that relates here. You really got to experience it to give advice sometimes.
Dr. RambiharExactly.
Dr. RezmovitzSo , um, so we're going to talk about you today. We're gonna talk about , um, really why you're here. And so the big question I have in my mind is what small change did you make and, and what happened?
Dr. RambiharGreat . Um, so the main change that I, that came to mind when I was thinking about changes that I've made is probably a bigger change, but , uh , - it in the department, probably a smaller change - , uh , and that was revamping the admission system. So the admissions for family med residency. Uh , I think over the last five years, that was sort of more small incremental changes each year that led to sort of a big revamp over the whole five years. So the admission system now looks totally different than what it looked like five years ago. Uh , and the, probably the biggest piece of that change was creating a online scoring, ranking and scheduling system from scratch , uh , to help facilitate the whole process.
Dr. RezmovitzSo for anyone listening, why don't you walk us through what it was five, six years ago and, and where it is now - now it's online and there's a scoring system. I've participated in this scoring system, I think.
Dr. RambiharYes.
Dr. RezmovitzUm , but I'm curious, maybe not everybody understands where it was.
Dr. RambiharYeah. So when I applied, so over five years ago , uh, when I applied to residency, the process was still done sort of online, but the backend was all done manually. So think about family medicine, U of T, it's a huge process. We probably get about over a thousand applicants to the program and the process itself uses over 400 faculty and residents every year. And that entire process - so matching candidates for fall review and interviews - to faculty and residents to review was all done manually through Excel document through hand. So tons of room for error. Uh , and essentially at that time as well, we used to have , uh , much less residents participating in the actual interview process, welcoming new candidates to the program. And so a candidate would come to the, the admissions sessions and see faculty and that's what we thought, what your view of the department of family medicine was was the faculty. Uh, at the same time we had less faculty involvement because it was just hard to come downtown. Everybody's busy. So we really wanted to focus on engaging faculty, getting residents to be more involved in the process because they really are the brunt of our residency program. Uh, and also sort of making the process much more efficient and streamlined , uh, from an efficiency perspective. So back to that , and I think when you thought about admissions, there were about 10 different interview days. There were probably 80 people per session that would come be interviewed. And for the candidate themselves, they'd be here for about four hours and have to sort of sit around and wait for their interview, which is obviously a very nerve wracking time , um, and not in their best interests. So that's sort of where we came from.
Dr. RezmovitzOkay. So yeah, where are we? Where do we go? Everyone was just like, where are we going?
Dr. RambiharUm , so I think what we were able to do was streamline everything to an online system. So scheduling was done through a very efficient signup, so much better for the candidates as opposed to emailing back and forth to get interview dates and to switch interview dates. Uh, we were able to recruit much more faculty. So we opened up the interview process to invite many more of our distributed faculty. So we have almost 1400 faculty members and we reached out to a lot more of them to say, come participate in the interview process. Uh, and we sort of shifted the, I think the biggest change that we made is that we shifted the focus to why should you participate in admissions rather than 'we need you to participate in admissions'. And I think that was a small change that we made was just switching to the why that totally revamped the process.
Dr. RezmovitzSo what are the reasons why someone should participate in admissions ?
Dr. RambiharYeah, so I think the most important thing is that the way that I see my role is really to help determine who the future family physicians of Canada are going to be. And by participating in the admissions process, you're really deciding who will be the next family doctors for our community. But because we know U of T has such a broad reach and our grads spread all across Canada and the world, we know that this is really setting the stage for primary care for Canada. So one of my big passive passions is really the fact that I think primary care is a foundation of our health care system and of a good healthcare system. And in order to have strong primary care, you need primary care physicians that are also strong. So really shifting that focus to say you're not just coming to interview and help to decide who's going to be a resident in our program, you're helping to decide who's going to look after your mom, your grandmother, your , your child down the road.
Dr. RezmovitzSo you're pulling on heartstrings.
Dr. RambiharA little bit.
Dr. RezmovitzA little bit. You're trying to use marketing to manipulate our faculty to come down. I'm joking, obviously, but I'm not. Um, so, so, okay , so you're engaging, I think it's important that you're engaging people at their values. It's something that they value. And so how do you engage the residents then to come and participate?
Dr. RambiharRight. And I think for residents, a lot of them are really proud to have been accepted into the U of T family med residency program. It is a very competitive program and we know across Canada it's tough to get into your desired residency program. We also know that it's, if you want to do family medicine, you likely will get into a family medicine program. And from CaRMS data, the challenges, the likelihood that you'll get into your top selected family medicine program is a lot lower. So all of the residents that are in our program for the most part are pretty happy to be here because they know that it was a competitive process. So for them it's really actually quite, quite nice to see them come out and be involved and they really want to showcase the fact that they're proud of what they've done in their residency program. We've a lot of resident leaders, so they really like to come out and showcase the change that you've been able to make in their smaller residency program. Uh , and we're always sort of fighting that notion that U of T is this big university with so many residents. And I think our residents do a really good job of showing that we have sort of the best of both worlds, where our residents are at a smaller site and get to have really great exposure, experience to patients and leadership experience as well. But they're still part of this bigger program that has a wide reach and excellent faculty teachers.
Dr. RezmovitzAgreed. So, and I just want to hear about the , um , efficiencies that you put in that weren't in place. I know it, it was handwritten, it was or handcrafted Excel sheets five years ago. So then talk to me how, how you've , uh , changed the system to , to benefit everyone involved now.
Dr. RambiharYeah, so this was where one area where I was really out of my depth , uh, and in, in this situation we basically stepped back and went to the drawing board. Pretty literally took a whiteboard and walked through the admissions process from start to finish. So candidates applying, submitted an application, then faculty and residents signing up, assigning them to fall review and then interview all the way through to ranking and then accepting them writing a rank list. Uh , and we then basically put together an RFP - so request for proposal - which my medical background I had never done before. Uh, and with our team, which was a few of the stakeholders in the department or admin , uh, and a few physicians who have participated in , in foul review and interviewing in the past, we created this very long document that was actually sent out to a number of tech companies. And what was created out of that was actually a portal that really met our needs. And through a couple of different revisions, we basically pilot tested the actual portal itself , uh, which was basically all , uh, it was a one stop shop. So it put together the scheduling for the candidates. It allowed us to match residents and faculty with their candidates assigned to them as well as to interviews and make sure those were different people. And all of this was done electronically through the back end, through the programming, which really reduced errors from the human error side of things. So that made it much, much more efficient for the scheduling planning purposes. Uh, and then even as the simple things like printing, name tags, everything could be done from this one portal that we built.
Dr. RezmovitzSo can I assume then that there's , uh , a lot of data that could be mined for scholarship?
Dr. RambiharYeah. So there , so there is a lot of data, but because of privacy and because it's all CaRMS related data, we do have to anonymize it every year. So we do, we do have anonymized data now we don't have the direct names or links, et cetera, cause that'll have to be destroyed.
Dr. RezmovitzNo, of course. So what's kind of the data that's coming out of the, out of the system now? Like what, what's it telling you?
Dr. RambiharYeah, I mean the, the biggest data that we actually have is because we actually do survey our candidates, faculty and residents . Uh , and that has been really helpful to actually evaluate how the system has improved the admissions process. And our data says that almost all of our faculty and residents are very positively impacted by being part of this. And the one thing that made me actually focus on the why was because a lot of our faculty and residents at the end of the day say participating in the admissions process has reminded me why I chose to go into family medicine in the first place and has made me really re- encouraged about my own, my own career. So being able to see that has been really helpful. And I think the reason that that is possible is because all of the inefficiencies have been removed because of the development of this system.
Dr. RezmovitzOkay. So I'm going to switch gears a little bit here, but kind of stay on the same track in that I want to know about a time that you interviewed someone, like have you, you know, you're the admissions director, is that the term?
Dr. RambiharYeah, so it's a complicated term. It's, it's, I don't even know what my, my title is, it's, I don't actually remember my title, a very long title.
Dr. RezmovitzIt's - like I don't want to make any accusations here, but was there a point where you did remember?
Dr. RambiharYeah. Yeah. So it's associate program director. So it's not really clearly linked to director. It's associate program director for the family med residency program. But the area is admissions, recruitment and awards.
Dr. RezmovitzGotcha.
Dr. RambiharSo I do do the award system too. So that's a whole other system.
Dr. RezmovitzWell , talk to me about interviews. How many years , uh , had you done interviews or how many interviews have you done before you took on this job?
Dr. RambiharHow many interviews have I conducted or have I been in?
Dr. RezmovitzThat you were in, that you conducted, that you were a faculty.
Dr. RambiharYeah, so I have participated in interviews for quite a bit of time. So I , during undergrad medical school I was part of the admissions team to help with undergrad medical school admissions. Uh , and so we ran a full weekend of that with , uh , at U of T. Uh , and then as a resident I participated quite a bit in interviews. And as I mentioned, we used to only have a couple residents at each interview session. And I was always there. I was keen to represent U of T and family med. Uh, so I was, I was always happy to participate in that. And then since being in the job and in this role, I also have been very involved in interviews for the transfer residents and visa trainees, which are a little bit more of a unique population and a little bit more of a flexible interview. Uh, and that's been really, really interesting.
Dr. RezmovitzSo , so my question is, tell me something funny that happened there . One of these interviews, like the most outrageous thing that happened that you remember that's like, Oh my God, I can't believe this.
Dr. RambiharThere's a couple, there's a couple that I cannot talk about, so I will not talk about those ones on air. But the, there's one that I was, I was not in the interview, but I was outside and I was sort of watching it happen from the outside.
Dr. RezmovitzWas I interviewing at that one?
Dr. RambiharIt could have been you. It actually might, I'll tell the story and you can tell me. Uh, but there was, you could see that someone is - so the interviewer asked the candidate to demonstrate something from their resume that they were proud of.
Dr. RezmovitzOh so this was me, I'm pretty sure. And it happened to be in karate.
Dr. RambiharIt was martial arts!
Dr. RezmovitzIt was totally me.
And from, from the other side of the window we could see this happening. But I actually thought it was a very creative question because it was really trying to, to get to the fact as to whether the person actually really did what they said on their resume and whether they really cared about it and it allowed them to pick something that they were passionate about and show it.
Dr. RezmovitzYeah. It wasn't a demand. It was an ask .
Dr. RambiharYeah.
Dr. RezmovitzOh that was me. Yeah. I have a weird interview style. I'm glad you enjoyed it from the other side.
Dr. RambiharWe enjoyed it. Cause you know what, it puts them at ease. It's something that they know and you can't really prepare for that question. Yeah.
Dr. RezmovitzUm , okay. Well I didn't expect that to go the way it went. I was more expecting you to tell us a really funny story, but it turns out I was there. Um, so what's the biggest barrier in implementing all of this?
Dr. RambiharYeah, I think anytime there's change in an organization that has done something for a long time, there will be barriers. A part of the change that I thought was a bit challenging was because I was a, an a fairly new grad when I started in my role , uh, and to be able to build credibility and , uh, really convince the department that this change was necessary. Uh , I think as a physician I have much less training in the financial aspect of change management. And so being able to express how this change would lead to efficiencies that would eventually reduce the financial burden. So the upfront investment was probably going to be productive was , uh , a bit of a challenge for me cause it was sort of totally out of my depth at the beginning of the job. Uh, but I think that being in a supportive environment really, really helps, helps with that. That's probably the biggest challenge that I faced. Um, yeah.
Dr. RezmovitzOkay. If you had advice for , um, residents applying to the program, what's, what's your advice?
Dr. RambiharYeah. I actually, you give talks on this to the undergrads, both here and across sort of the province. And I think the biggest thing that I recommend to anyone applying for a new job or for a new position is to map out who they are and a few key things that they want to get across in that interview. And almost like a mind map, draw out sort of what their areas of interest and areas of passion are so that when they leave the interview, they know that those few things got across in that interview. Uh, even if they don't answer all the typical questions that they would normally get in an interview, we know that those questions are going to come regardless , um, but focus on who they are and really show that in the interview. Uh, and I think that really, really helps because they come off as much more genuine. Uh, and that's really what people are looking for in a job interview is to know that that person is who they say they are and they're going to work hard and they're going to fit in. Uh , and they're really looking for that right fit. So if they are the right fit by demonstrating who they are, I think that can be the most helpful piece of advice.
Dr. RezmovitzI agree with you. Any last closing words, statements? Um, you know , inspirational words , um, you want to impart on our listeners?
Dr. RambiharYeah, I mean there's one quote that I use at the end of a lot of my presentations right now and it's 'The true value of experience is not in seeing much, it's in seeing wisely.' And that's actually by William Osler and he was the father of modern medicine. He flipped the classroom way back before it was in Vogue and moved to bedside teaching away from , uh, from reading books and , and studying in the, in more didactic learning.
Dr. RezmovitzI still think reading books is important.
Dr. RambiharI still think it's important. The only reason I like this quote is because it really highlights the fact that especially because we're family medicine, we're in a pretty short residency program. There's no way that our residents are going to see everything. But I think our role as teachers and leaders and administrators in the profession is really to help our residents see wisely. And so as an early career physician doing quite a lot in terms of leadership and development, I think remembering that you don't have to have experienced something to know how to see wisely , um , but being able to use the few experiences that you have to gain that, that wisdom is , is what the role and the goal of your residency really is.
Dr. RezmovitzYou mean kind of like giving out parenting advice when you don't have any kids?
Dr. RambiharExactly. Yeah, exactly. And I think you've learned from the people around you to be able to help the people around. You may not have ever experienced MS, but you can still be able to really empathize with someone who has it, et cetera.
Dr. RezmovitzThank you so much for coming today.
Dr. RambiharNo problem - thank you.
Dr. RezmovitzI think the department is really lucky to have , uh , someone who's able to innovate and uh, and make those small changes in order for the, have a bigger impact on our residents, on our faculty, and obviously on the , uh , future physicians of Canada. So thank you so much.
Dr. RambiharPerfect. Thank you so much for having me.
Dr. RezmovitzThis podcast was made possible through the support of the department of family and community medicine at the university of Toronto. Special thanks to Allison Mullin, Brian Da Silva and the whole podcast committee. Thanks for tuning in. See you next time.