The Practicum

Dr. Althea Vinjose Martin, MBBS, is a recent international graduate of the MPH(FCM): Master of Public Health in Family and Community Medicine program in 2025. With a background in medicine and public health, her focus is on community-based care and health equity, particularly for marginalized and vulnerable populations. Althea is currently preparing for residency training in Family Medicine, with a strong interest in primary care, preventative health, and inclusive service delivery.

Supervisor: Dr. Katherine Rouleau and Dr. Erica Barbazza

Exploring interventions to tackle antimicrobial resistance (AMR) through primary health care (PHC)-oriented health system strengthening: a qualitative secondary analysis on a global sample of PHC country case studies.

Abstract

Background: Antimicrobial resistance (AMR) is a growing global health threat, undermining the effectiveness of medical treatments and posing significant risks to public health and health system resilience. While national and international policies emphasize the urgency of AMR containment, the extent to which AMR interventions are embedded within broader health system strengthening efforts, particularly through a primary health care (PHC) approach, remains unclear. This study examines how AMR interventions are prioritized within PHC transformations, the common barriers countries face, and the key lessons learned from integrating AMR-related strategies into health system strengthening efforts.

Methods: A qualitative secondary analysis was conducted using country case studies from diverse health system contexts. Data were extracted using a structured assessment tool and categorized into six key themes: governance and policy, AMR surveillance and information systems, antimicrobial stewardship, infection prevention and control (IPC), public awareness and education, and access to medicines. The analysis was guided by three core review questions: (1) What AMR interventions have been prioritized in PHC transformations? (2) What common barriers hinder AMR integration? (3) What lessons from PHC-oriented health system strengthening efforts can inform AMR responses?

Findings: The study identified variations in how AMR is addressed within PHC. While national action plans exist, regulatory enforcement remains weak, leading to continued overuse of antibiotics in human and animal health sectors. Surveillance systems show progress in some contexts but remain fragmented in others due to infrastructure and resource limitations. Antimicrobial stewardship programs are largely confined to hospitals, with limited implementation at the PHC level. The COVID-19 pandemic disrupted AMR strategies, highlighting gaps in IPC and exacerbating antibiotic misuse. Public awareness initiatives remain underfunded, and challenges in medicines supply chains further impede effective AMR containment.

Conclusion: AMR efforts must be further integrated into PHC and broader health system strengthening initiatives to ensure sustainable progress. Strengthening governance, improving surveillance infrastructure, expanding antimicrobial stewardship in PHC, and securing sustainable financing are critical priorities. A coordinated, multisectoral approach is needed to align AMR strategies with national health priorities, ultimately enhancing patient outcomes and mitigating the global AMR threat.

References:

1. Walsh TR, Gales AC, Laxminarayan R, Dodd PC. Antimicrobial Resistance: Addressing a Global Threat to Humanity. PLoS Med. 2023;20(7):e1004264. doi:10.1371/journal.pmed.1004264

2. Salam MdA, Al-Amin MdY, Salam MT, et al. Antimicrobial Resistance: A Growing Serious Threat for Global Public Health. Healthcare. 2023;11(13):1946. doi:10.3390/healthcare11131946

3. Murray CJL, Ikuta KS, Sharara F, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. The Lancet. 2022;399(10325):629-655. doi:10.1016/S0140-6736(21)02724-0

4. World Health Organization. (2015). Global Action Plan on Antimicrobial Resistance

5. World Health Organization. (2023). Implementing the global action plan on antimicrobial resistance: first quadripartite biennial report. https://creativecommons.org/licenses/by-nc-sa/3.0/igo/.

6. World Health Organization. (2023). National action plans and monitoring and evaluation (NPM) (WHO Team, Ed.). World Health Organization. https://www.who.int/publications/i/item/9789240082496

7. The Secretariat has worked with Member States to collate information on the status of national action plans on antimicrobial resistance and on regulations and policies for use of antimicrobial medicines. A report based on these data provides a baseline against which future progress at national and global levels can be monitored and reported, see http://www.who.int/drugresistance/documents/situationanalysis/en/

8.  Antimicrobial resistance: global report on surveillance 2014. Geneva: World Health Organization; 2014.

9. Dadgostar P. (2019). Antimicrobial Resistance: Implications and Costs. Infection and drug resistance, 12, 3903–3910. https://doi.org/10.2147/IDR.S234610

Dr. Renee Logan, CCFP, FCFP, is a Hospitalist and Medical Director of Infection Prevention and Control at CAMH, and an assistant professor, DFCM, Faculty of Medicine, University of Toronto. She recently graduated from the MPH-AS(FCM): Master of Public Health, Advanced Standing in Family and Community Medicine program in Summer 2025. She provides primary care to patients with serious mental illness across acute and forensic inpatient units at CAMH. Dr. Logan is interested in improving healthcare access for vulnerable populations. Her current research and quality improvement work focuses on enhancing hepatitis C care in populations with addictions and serious mental illness.

Supervisor: Dr. Sanjeev Sockalingam, Senior Vice President, Education, Chief Medical Officer and Senior Scientist, CAMH 

This project directly addresses the longstanding health disparities experienced by people who use drugs (PWUD). Recognizing the critical barriers faced by this population, our team implemented a QI project to integrate comprehensive HCV screening, testing, and treatment within the COMPASS addiction care setting. This approach shifts care from traditional hepatology clinics and embeds it within a collaborative, interdisciplinary model that delivers care directly within the patient’s existing addition treatment setting.

Abstract 

Background

Hepatitis C virus (HCV), a preventable and curable disease, is responsible for more life-years lost in Canada than any other infectious disease¹. In Canada people who inject drugs (PWID) have the highest prevalence² and experience significant barriers to care. ^3,4. Point-of-care HCV antibody testing (POCT) provide rapid results, allowing timely counselling ⁵. Treatment as prevention strategies, reduce the burden of HCV and supports the movement of treatment into non-specialist settings⁶. Enablers to testing include accessible testing options and good rapport with providers⁴. This project aims to reduce barriers and harness enablers to improve HCV care management in this priority population.

Methodology

This quality improvement project conducted in the Concurrent Outpatient Medical & Psychosocial Addiction Support Services (COMPASS) at CAMH (July 2024- Dec 2025). Initial interventions included (1) HCV education series for prescribers, (2) new HCV lab order set, and (3) on-site POCT.

Measures include: i) Outcome: % screened; % HCV Ab + with RNA testing; % RNA+ initiated on treatment, ii) Process: tests/week, % prescribers trained iii) Balancing: patient/staff satisfaction surveys.

Results

Significantly fewer tests were ordered than predicted.  Root cause analysis revealed limited prescriber time and a need for screening support. This informed a nurse led screening model, increasing testing from 14 in 4 months to 35 in in 3 months. Preliminary qualitative feedback from patients is positive.

Discussion

Through iterative Plan-Do-Study-Act (PDSA) cycles we developed an effective nurse led screening process. There was no pre-existing HCV screening process. Change ideas were implemented, tested and refined across 2 PDSA cycles. This model enhances the provision of HCV care where patients meet the health care system, reducing barriers. Our findings highlight the feasibility and impact of embedding HCV care within addiction services and support public health efforts toward HCV elimination.

References

1. Kwong, J. (2012). ,The impact of infection on population health: results of the Ontario burden of infectious diseases study. PLoS One, vol. 7, no. 9, p. e44103.

2. Lourenço L, K. M. (2021). The hepatitis C epidemic in Canada: An overview of recent trends in surveillance, injection drug use, harm reduction and treatment. . Can Commun Dis Rep, 47(12):561-570.

3. Amoako, A. O.-P. (2021). Patient and provider perceived barriers and facilitators to direct acting antiviral hepatitis C treatment among priority populations in high income countries: A knowledge synthesis. The International Journal of Drug Policy, 96, 103247–103247.

4. Balsom, C. R. (2023). Barriers and enablers to testing for hepatitis C virus infection in people who inject drugs – a scoping review of the qualitative evidence. . BMC Public Health, 23(1), Article 1038.

5. Forns, X. C.‐R.‐H. (2022). Point‐of‐care Hepatitis C Testing and Treatment Strategy for People Attending Harm Reduction and Addiction Centres for Hepatitis C Elimination. Journal of Viral Hepatitis, 29(3), 227–230.

6. Zelenev, A. L. (2018). Hepatitis C virus treatment as prevention in an extended network of people who inject drugs in the USA: a modelling study. The Lancet. Infectious diseases,, 18(2), 215–224.

Dr. Kiran Clair has been a family physician in downtown Toronto for 20 years and is a recent 2025 graduate of the MPH-AS(FCM): Master of Public Health, Advanced Standing, in Family and Community Medicine program. The majority of her clinical career has been in student health at the University of Toronto, longitudinal family medicine, and executive medicine. She has always had an interest in public health, which was highlighted during the pandemic. She started the MPH program in 2023, enrolling part-time as she continued to work in her family practice areas.

Supervisor: Dr. Vinita Dubey, Associate Medical Officer of Health, Vaccine Preventable Diseases, TPH and Lisa Swimmer, Manager, School Health Team, TPH

The placement involved working with and learning from the supervisors and health promotion specialists, as they executed the planning stages of an HPV catch-up campaign in equity deserving Toronto areas. As part of the placement, I explored and then presented to the team an initial strategy to integrate community family medicine and public health to achieve the projects' stated goals.

Abstract: 

Purpose: To support a strategy for primary care/Toronto Public Health (TPH) partnerships within the project “Increasing HPV vaccination rates among Toronto youth in equity deserving neighborhoods”.

Issue: As of June 2024, the HPV vaccination rate in Toronto for students grade 9-12 is 50.6%. The pause in TPH’s School Immunization Program during the Covid-19 pandemic may have contributed to this low rate. Therefore, catch-up HPV vaccination for this age-group is necessary.

Methods: As part of a TPH placement rotation, a combination of literature review, and consultation with internal and external stakeholders has been utilized.

Results: There are local examples of successful integration of primary care and public health in equity deserving areas of Toronto, through Ontario Health Teams, during the Covid-19 vaccination campaign of 2021/2022 that serve as models for future collaborations, including the HPV vaccination catch-up project.

Conclusions: Ontario Health Teams/primary care networks would be the ideal partner in collaboration for the HPV Vaccination Catch-up Campaign.

Dr. Dena Sommer is a 2024 graduate of the the MScCH (HPTE): Master of Science in Community Health in Health Practitioner Teacher Education program. She is an adjunct lecturer at the University of Toronto and works as a Geriatrician at Baycrest Hospital.  Her clinical work and teaching are centered around general Geriatric Medicine, and scholarly work is focused on undergraduate education on the subject of older adults.   

Supervisor: Dr. Thirumagal Yogaparan

Using Delphi methodology, our study aims to create and validate a comprehensive set of learning objectives to be used by curriculum developers across Canada to enhance undergraduate medical education in the care of older adults. 

Abstract 

Despite an aging population with increasingly complex medical needs, the care of older adults is underrepresented in the curriculum in many medical schools across Canada. The Canadian Geriatrics Society recently published a comprehensive list of competencies for graduating medical students using the Aging Care 5Ms framework (https://www.canadiangeriatrics.ca/aging-care-5ms-competencies). This current project builds on the previous work, aiming to develop and validate learning objectives to be used by educators across Canada in the creation of educational programs to address these competencies. This ongoing study uses modified Delphi methodology to validate learning objectives by a panel of experts with national representation. In three planned survey rounds, learning objectives are rated by the panel, with revisions based on panel member feedback carried forward to the panel in subsequent survey rounds. Our anticipated outcome will be a complete, validated list of learning objectives that can be modified and applied at the local level to create Geriatrics curricula for medical students in Canada.

Dr. Jutamas Saoraya is an emergency physician and intensivist at King Chulalongkorn Memorial Hospital, Assistant Professor of Emergency Medicine at the Faculty of Medicine, Chulalongkorn University, and a Core Team Member at Chulalongkorn University International Medical Program (CU-MEDi), Bangkok, Thailand. In 2023-2024, she completed the MScCH(HPTE): Master of Science in Community Health in Health Practitioner Teacher Education program, DFCM. Her career intention is to provide the best care for critically ill patients, provide excellent education for next-generation health professionals and to advance knowledge of emergency medicine and resuscitation.

Supervisor: Dr. Dominique Piquette

This project examines medical students' experiences during elective ICU rotations, focusing on their impact on professional development and identity.

Abstract

Exposure to critical care during training in a medical school is increasingly recognized as essential, though the nature and extent of this training varies globally. The intensive care unit (ICU) offers unique learning opportunities, such as interdisciplinary teamwork and advanced communication skills. However, ICU is a challenging learning environment due to its chaotic, stressful, and potentially emotionally traumatic nature, and may present, due to  time constraints, limited support for medical students. While previous studies highlight students’ perceived clinical gains, little is known about how ICU rotations shape their professional identity and approach to care. This project aims to explore the experiences of medical students during elective ICU rotations at three university-affiliated centers, focusing on the roles of physicians (e.g., communicator, collaborator) and the transformative impact on their professional identity. We have recruited medical students for semi-structured interviews, and the deidentified interview transcripts will be analyzed using a thematic analysis. The results will provide critical insights into the benefits, challenges, and long-term effects of early ICU exposure, helping educators optimize these rotations within medical curricula. Our findings will guide medical schools in structuring ICU rotations to enhance learning and mitigate potential risks, ultimately improving medical education and professional development.