In light of the media attention this week surrounding vaccines, I thought that this would be an opportune time to expand on what we, in the Faculty of Health Sciences, teach our students about immunization.
In FHS, we deliver education about immunization in our medical school, our nursing school, our school of rehabilitation therapy, our MPH program and in many of our residency programs, such as family medicine, paediatrics and public health & preventive medicine.
A guiding principle of our educational delivery is to provide current information to students, rooted in the scientific literature, and oriented towards informing evidence-based decision-making. We draw heavily on practice guidelines that emanate from recognized national organizations such as the Canadian Paediatric Society and the Centers for Disease Control and Prevention.
As I am not an expert in the area of vaccinations, I have reached out to faculty members who deal with these issues day in and day out. I have also reached out to our students.
Our head of the department of paediatrics, Dr. Robert Connelly, says that “vaccines are a safe, effective and important health measure for children; they are one of the most significant public health initiatives that we’ve had in the history of medicine. We reinforce this and teach this in our postgraduate pediatrics program. In our teaching, we focus on how to appropriately deal with vaccine-hesitant parents in order to address their concerns, and endorse the Canadian Paediatric Society’s approach to this issue.1”
Within the School of Nursing, Cheryl Pulling, Associate Director of Undergraduate Nursing Programs, informs me that vaccination is addressed across many courses within the curriculum: Microbiology, Care of the Elderly and Children’s Nursing, to name a few. Students in our nurse practitioner program encounter teaching on immunization in the Therapeutics and Diagnostic courses. The content ranges from covering risks and benefits to vaccination recommendations for various age groups to the administration of the vaccines themselves. The school ensures that the curriculum is aligned with current clinical guidelines, and liaises with Kingston, Frontenac and Lennox & Addington Public Health on a regular basis for updates.
Much like in the School of Nursing, the Family Medicine Residency Program provides both a knowledge-based perspective and practical perspective in providing care for patients. “At all four of our sites, our family medicine residents are given didactic sessions on the importance of vaccination, and they are taught about relative risks of vaccinating vs. of not being vaccinated, and how the risks of not being vaccinated far outweigh the risks presented by the vaccinations themselves,” says Dr. Karen Schultz, Postgraduate Program Director for the department of family medicine. “In practice, it is our nursing colleagues who work with our residents to teach good injection techniques in order to ensure the safe administration of vaccines.”
In Dr. Heidi Cramm’s RHBS 822 course in the School of Rehabilitation Therapy, students learn about the current vaccination evidence and discuss the anti-vaccination sentiment that remains residual in some of the broader community. “Public health continues to struggle with the reality that the scientific evidence for vaccination has not been fully disseminated and/or taken up across all community members,” says Dr. Cramm. “This is particularly important for clinicians who will work with children and families, especially when autism is present within families.”
In our undergraduate medical education program, we are guided by the Medical Council of Canada clinical presentations, which are distributed to courses within our curriculum. One such clinical presentation stresses that an important objective for our medical students is as follows: “Given an infant or child presenting to a physician, the candidate will be able to recommend an appropriate schedule of vaccinations, and discuss with parents the risks and benefits of vaccination.”
Our Associate Dean of Undergraduate Medical Education, Dr. Tony Sanfilippo, informed me that Dr. Lewis Tomalty teaches about how immunizations work in the Mechanisms of Disease course; Dr. Ian Gemmill teaches about vaccinations in a course on Population Health as does Dr. Richard Van Wylick in the undergraduate Paediatrics course. The issues in and around vaccinations are also brought up in our clinical skills course under the subsection of ‘difficult conversations’. Dr. Sanfilippo is confident that the Queen’s School of Medicine has a robust and evidence-based curriculum, taught by regional experts.
Our Aesculapian Society President Jonathan Cluett reported on behalf of a group of his student colleauges. “Our vaccination curriculum begins with the molecular science and expands to the epidemiological benefits and public health impacts. We are taught the process by which any new medication is meticulously tested to ensure safety before they are offered to the public. No medication is 100% safe, but vaccines – given that they will be provided to such a large population – are more rigorously tested than any other medication in Canada. Ultimately, Queen’s Medical students are taught that the recommendations for vaccinations are grounded in hard evidence and decades of highly scrutinized research.
Beyond these lectures, a significant portion of our curriculum is dedicated to learning the language of evidence-based medicine. We are taught how to critically analyze the information presented to us because it is essential that, as future physicians, we are able to use these skills in sifting through the noise to make the best choices for our patients. We must be able to look beyond singular pieces of research and instead, synthesize the results of one study in the context of other research on the same topic.”
Our medical students add, “when meeting with vaccine-hesitant families, we are taught that it is important to initiate discussions on vaccinations early in the newborn’s life and ascertain the parent’s major worries. It is crucial to engage in a thoughtful conversation, taking the time to address each concern. We are taught to educate the family on the rigorous process behind creating and testing vaccines, clearly review the risks and benefits, and provide them with real statistics to help put the risks in context. For example, whereas as many as 100 in 1,000,000 can die of a complication of a disease that is largely preventable through vaccination, only one in 1,000,000 will have a serious vaccine complication. The conversation about vaccinations is ultimately about doing what evidence shows is best for our patients’ health. Every part of our education is driven by this mission – to communicate clearly with our future patients, share accessible and reliable resources, and provide all the facts necessary for patients to be able to make the most informed choice.”
As Dean of the Faculty of Health Sciences, I believe that the issue of vaccination is serious business. For example, measles, which had been previously eradicated is now making a recurrence, and can have severe repercussions. In one in 10 cases measles can result in ear infections, in one in 20 it can result in pneumonia, and in one in 1000 it can result in encephalitis.2
Another important issue is that not every child in our population can be vaccinated; in a small number of paediatric conditions, vaccination is not advisable. This potentially puts those children, who for medical reasons cannot be vaccinated, at risk of contracting a disease that for the general population is preventable. Dr. Gerald Evans, Chair of the division of infectious disease, says “widespread immunization against vaccine preventable infections is arguably the greatest scientific and public health success of the last 100 years. A return to the dark ages of infection that existed before global vaccination through discredited and false beliefs about vaccine safety is in turn, our greatest public health threat.”
Our goal in the Faculty of Health Sciences is to equip our students with the skills, knowledge and attitudes they need to be competent practitioners and compassionate healthcare advocates.
If you have any thoughts on this issue, comment on the blog…or better yet please drop by the Macklem House. My door is always open.