And the University of Saskatchewan college of medicine is now saying how that overhaul will happen.
The school released a 19-page plan Wednesday that aims to ensure accreditation standards are met, that supports faculty and student research, as well as accountability.
"I think that we have two key problems to tackle, which is what the plan is designed to begin addressing," said Martin Phillipson, the college's vice-provost.
"The first one is obviously our accreditation issues, where we are currently...on warning of probation with the real threat of being put on full probation in October. And that's clearly a problem that we're not delivering on our education mission for our undergraduate students and we need to address that.
"The second issue is our research performance."
Phillipson says medical schools are traditionally "the research powerhouse" of universities, but the Saskatoon-based school is "not producing the right amount of research and the right quality of research."
The University of Saskatchewan college of medicine is accredited, but has been on warning of probation for almost two years.
The organization that accredits medical schools found the college to be weak or deficient on 10 standards.
Among the weaknesses were that faculty didn't provide timely feedback to the students, as well as instructors getting written standardized teaching and grading objectives was a problem. There was also concern around adequate student space for study, lounge and lockers at the Regina campus.
An earlier report on the school's future noted that it may well become the first college of medicine in Canada to be placed on probation twice.
That report also said student performance in national exams is at the bottom of all Canadian medical schools.
The plan for change says the root cause is "a structural flaw — underlying structures place priority on clinical service delivery to the detriment of the teaching and research missions of the college."
"This has created a culture that pits clinical service delivery against teaching and research and which is perpetuated by a misalignment in the amount of resources and the time devoted to these activities," read the plan.
The plan outlines recruitment, hiring and compensation strategies.
It says recruiting more clinician scientists and biomedical scientists is an immediate priority to kickstart research.
A new governance model for the college includes the creation of three vice-dean positions in education, research and faculty engagement.
One of the major governance changes that the plan recommends is to dismantle the five basic science departments and amalgamate them into one or two.
It says "the status quo is not serving the current needs of the college and will inevitably fail to meet future needs."
Phillipson says the accreditation concerns are being addressed first.
The structural changes will take time, he said, noting that the school hasn't had a significant overhaul since it was created more than 50 years ago.
"Four years may seem like a long time, but in order to change an operation that has annual revenue of over $180 million, several hundred staff, over 300 faculty — which is over a quarter of all the faculty on campus — and has a provincewide mandate to deliver educational programming at several sites across the province, you can't do that overnight and more importantly you shouldn't," said Phillipson.
"You have to take it at the right pace and make sure the changes that you make are the right ones."
The Committee on Accreditation of Canadian Medical Schools visited the college in March and is expected to make a decision on the school's status in October. That decision will be based solely on the progress actually completed at the time of the visit — before the plan was released.
Phillipson would not speculate on the decision.
"Judged on March, we'll have to see what the outcome is," he said.
"But we have made significant progress since March and the changes and the new structure that this document recommends, we're convinced will provide a long-term solution to our accreditation issues."
— By Jennifer Graham in Regina