News at Medicine - August 2007 - Who is your Dean?

Who is your Dean?
August 1, 2007
The following interview with Dean James Rourke, written by second-year student Aaron Kennedy, was published in the June 2007 issue of The Pulse, a Medical Students’ Society Publication.

James RourkeComing from a small farming town in Ontario, Dr. James Rourke has had a productive life as a rural family physician, an educator and a father. Accepted into medicine after only one year of undergraduate education, our dean has proved that being a good doctor is as much a part of the kind of person you are than just the experiences you have attained. With a strong background in rural family medicine and with many fascinating stories from this field, it is hard not to be compelled into family medicine after a brief chat with our dean. He is enthusiastic about his work and shows a great passion for his school and all members of it. So if you ever get the chance, stop our dean in the hall and have a chat with him. You may be surprised at how open and inviting he is to talk with.  Don’t be afraid to ask him about his experiences as a rural doc, or how to manage medicine with family life or even about his amazing cardiology teaching dog. Regardless the topic, our dean is a pleasure to speak with.

Where were you born, and where did you do your undergraduate degrees?

I was born in Wiarton Ontario, which is famous for Wiarton Willie, the albino groundhog who looks for his shadow on February 2nd. I grew up on a small farm on the Bruce Peninsula near Lake Huron. My mother had TB after my older brother was born so there is a big difference in our ages – he is 13 years older than me and I have another brother a year younger. Actually I was raised for the first few years of life by my grandparents until my mother was well enough to return to our home. I went to a one-room public school and was the only one in my class for 6 grades but my teacher Mrs. Georgina Smith was very flexible and encouraged me to do work at whatever grade level work I could handle. There were no doctors in my family before me. I am not really sure how I became interested in becoming a doctor, but certainly my kindly family physician, Dr. Leeson was an inspiration to me. 

After going to the University of Western Ontario, I was accepted into medicine as part of an experimental program that took six students after one year of undergraduate university into medical school at Western. The admissions criteria were very broadly based. Soon after our year, this program was cancelled as it was thought that the students might be too young and too inexperienced to study medicine. Out of the six in my program, however, two are currently deans in Canadian medical schools (Memorial and UBC) and the other four have had very successful careers.

I met my wife, Dr. Leslie Rourke at university before medical school. She went into medicine after two undergraduate years at University of Western Ontario. She was Meds 77 and I was Meds 76.  We were on two different curriculums as my class was the last of the old curriculum and hers was the first of the new curriculum. My program had a three year pre-clerkship with a big emphasis on anatomy and basic science and one year clerkship, whereas my wife was on a new curriculum, which was two years pre-clerkship and two years clerkship. For one year there were clerks from the two classes at the same time. The old curriculum clerks were sent out of the city and we had a great time and got to do lots of clinical things that the new curriculum clerks didn’t which made the administrators realize that it was beneficial to send students outside the “mother city” during training. This is much like MUN’s education model. Western had a class size of 100 and both Leslie and I have maintained close connection with our classes and enjoy class reunions every five years. 

Where did you do your post grad training?

After graduation I had to decide on rural family med or surgery. This was a hard decision as I really liked surgery (general). I also liked obstetrics and emergency medicine so I went with the family medicine program and did as much procedural preparation as I could. My wife also did family medicine so I did another year with a mixture of locums and further training until she finished. That included three months as an intensive care resident which has an interesting story to it. I was supposed to be a junior resident but when I got there, the senior resident did not show up as he took a job somewhere else, so I became the senior resident by default. This was an intensive learning experience but gave me a lot of great experience for my practice especially with how to deal with very sick patients. I did locums in the artic with Inuit communities in Frobisher Bay, which is now Iqaluit as well as in Northwest BC. I wanted as broad an experience as possible in remote places. 

I settled with my wife Leslie in Goderich, Ontario. We were looking for a small town with plenty of need for rural doctors. We practiced 25 years there and I really enjoyed my rural practice. We had a great staff and colleagues to work with. I had a 0-100 practice where the goal was to treat people from birth to age 100 and I had a few patients that celebrated their 100th birthday. I did a lot of in-hospital work and emergency medicine; I enjoyed house calls and obstetrics, 740 births in total. I miss these things a lot as I don’t get to do them as much as Dean. I do some rural practice when I travel outside of St. John’s several times a year.

Goderich was a great place to raise our family. Practicing in a small town allowed me to spend more time with my family as I only had a short commute to work and was able to get home for lunch most days. I was able to be involved with my kids’ activities. We have three children: Patrick, Ryan and Shannon who are all in university in Ontario.  Patrick is doing a PhD in physics at the University of Toronto, Ryan is at the University of Ottawa doing first-year medicine and Shannon is in Peterborough at Trent doing an undergraduate degree in biology/anthropology.

Who was your first patient?

As residents in Family Medicine, we were allowed to moonlight on some weekends. I arrived at the hospital in Goderich on my first day as a licensed physician at the start of July of my PGY 2 year as a Family Medicine resident. Just as I walked in to the emergency room, having never been there before, I saw a woman who was not looking very well in room 5. The nurse tells me to go in there quickly and as I reach the door way the patient arrested right in front of me. Fortunately we were able to resuscitate her and she survived and lived for many years after that. My wife, on her very first day of moonlighting, had a plane crash with multiple serious injuries and many fractures, who also survived. So we both had interesting starts to our first day in practice.

What was first job you ever had?

My first job was on the farm where I grew up there. I worked a lot there with my brother and father. My first paid job was picking stones on my uncle Elgin’s farm as the farmland in the area had a lot of rocks and each year there was a crop of stones to pick to pile into stone fences.

What did you want to be when you were a child?

A builder, an inventor, I was always building things, mechanical things, putting things together. I almost went to architecture school when I went to university but decided on the sciences instead.

What are you hobbies and interests?

A variety of things. We have two dogs, King Charles Spaniels, Clare and Cody. On a side note, Clare has a 5 out of 6 mitral valve regurgitation murmur. We let medical students listen to her heart when they are over to the house. One student was on their internal medicine rotation at St. Clair’s and heard a murmur on a patient and knew right away that it was a mitral valve regurgitation. The attending asked how he knew that to which he answered, “It sounds exactly the same as Dr. Rourke’s dog’s murmur”. 

Our dogs are lots of fun and as our kids are not home we walk the dogs a lot.  We live close to the golf course and in the winter time we snowshoe after the dogs in the snow.  Our whole family are avid downhill skiers and we take a family ski holiday every year.  Leslie and I have enjoyed skiing at Marble Mountain. I am an avid golfer. One of my sons is an avid golfer so we golf whenever we get the chance.

You were the star of the MUN/DAL hockey game during the MUNDAL conference.  How long have you played hockey?

I played pond hockey as a kid, where we used magazines as shin guards and I used to help coach my sons’ teams as they grew and played in a pickup league for many years, but I only get out to play once a year for the last few years. I really enjoyed the MUNDAL game. I thought I was luckier than good!

What is it like being a dean?

The dean is best compared to as the captain of a ship. The ship is the medical school; the ship is funded by the government, but is never funded enough. The ship is too small, and it leaks – at least the roof! The faculty and staff are the officers and crew of the ship and many of them are on board for a long voyage. The passengers on the ship are the people of Newfoundland and Labrador who come on and get off with their various illnesses.  The apprentices are the medical students, residents and graduate students and they come on for tours of duty lasting several years. Take the incoming class of 2007. If they do their MD and postgraduate training at MUN, they may be on the ship for about a 10-year voyage – I hope they don’t get sea sick! And so the dean is trying to set the course for the ship for a lifetime of learning. The dean’s job as a captain is to set the direction and make sure everything is in place for the voyage for the ship. From time to time storms come up like changes in government or funding. The role of the dean is best captured in the phrase “try to facilitate the success of others” – including faculty, students, and staff.

What do your duties as dean consist of?

It is a very busy schedule. When I am here I meet regularly with people who report to me, such as department chairs, assistant/associate/vice deans, chairs of all the disciplines, etc.  I sit on Senate, and I meet with the VP of the university regularly. I have regular meetings with people outside the medical school at MUN, such as Eastern Health VP and with George Tilley, the CEO of Eastern Health, and with government officials such as John Abbott, the deputy minister of health. We have an excellent staff here running the medical school. It is like being the CEO of a big corporation with a 25+ million dollar budget. I meet with the MSS and the residents periodically. I do exit interviews with each graduating class so I can learn what they found the best and the worst about the medical school so we can learn what to change or keep the same. We are always trying to improve the curriculum. I teach about three hours every second week for clinical skills with first years. This is a relatively heavy teaching schedule for a dean, but it helps me keep in touch with students. And that is when I am here. 

I also have a lot of meetings outside of the St. John’s. This includes visits to teaching sites in NL and New Brunswick. I travel to Ottawa or Toronto to meet with other deans of medical schools. I went to Vancouver for the AFMC (Association of Faculties of Medicine of Canada) in May and went to the Society of Rural Physician meetings on the way home. I am going to a colorectal cancer board meeting in June. I was in Montreal for a meeting last week for physician planning in Canada which consisted of medical school deans, deputy ministers of health and medical association leaders. As well as national meetings as dean of the medical school, I am also involved internationally as well especially as the chair of the World Organization of Family Doctors working party on Rural Health, a group of  leaders in rural health care from around the world working to improve rural health around the world. We have held international conferences on rural health in China, South Africa, Malaysia, Australia, Spain, Canada, Alaska and the next meeting is in Nigeria. This connects me with the leading practices in rural medical education and rural health care around the world. 

I also have a passion for medical education research and I have published a fair bit in this area. One of the things I now study is what graduates of MUN medicine go on to do and our research follows them through out their careers. In addition, as I am travelling I always try to reach out to MUN alumni to meet with them. I visit other medical schools, especially ones with similar context and challenges to out province

What is the most stressful part of your job and what is the most enjoyable?

The most enjoyable is patient care when I am on my rural site visits and I also especially enjoy when I am working with students and also when I get to see people’s success whether it be student, faculty or staff. The most stressful is when people get into disputes with each other, particularly when people are quite rigid and fail to see issues from the other person’s perspective. As a dean it is hard to keep a focus on steering the ship straight when there are people down in the gun powder room throwing firecrackers at each other, but mostly the officers, crew, apprentices work well together to make sure the passengers fare well.

Where do you see the medical school in 10 years?

I see Memorial’s medical school as a world leading small community based medical school that responds well to the needs of the population while making advances that are of significance nationally and internationally. I see us graduating students who will be well prepared for practice in Newfoundland and Labrador but will be leaders in medical care, research and administration where ever they practice in Canada and throughout the world.  I see us contributing to research that will make a huge difference in Newfoundland and Labrador, and around the world – especially in genomics and genetics. I see the medical school expanding in class size in the future to admit more students from Newfoundland and Labrador. There are so many qualified students who apply here every year and we just don’t have the positions for them. There will be a need for more doctors in Canada and Newfoundland and Labrador and we want to expand our class to be ready for that. I see us having a new health research complex that will allow us to develop our teaching and to develop our research more. Phase one will be a small research expansion on the top of the Janeway hostel. The second phase is a much bigger health research complex, which may take a little longer, but I see it as essential to this medical school. Bigger facilities, more faculty, more students and more research.

Do you think accreditation prevents the school from being innovative with their curriculum?

I think accreditation is an absolutely vital process and ensures that the standards of any medical school in North America are exceptionally good. I have been to other places around the world where they are not accredited and the quality control is good in some places and in others it is not so good. It does not prevent us from having a fair bit of flexibility. It comes down to how we design our curriculum and what we put in it. 

Is there anything you would like the students to know about you?

I try to make myself visible and available to the students as much as possible. I think this is a vital part of my job and part of my own personal philosophy. I try to do this by being part of the teaching process and by keeping the Dean’s Office in the centre of the building. There was an opportunity when I first came here to move it to a nicer but distant corner of the building but I decided it was best to keep it in the center of everything. I take every opportunity to meet informally and connect with students. The MUNMed choir was a fun way of doing that.