Queen’s Medicine Pre-Clerkship South East Asia Observership 2017

By Cesia Quintero (MEDS 2020)

In June and July of 2017, a cohort of six first year medical students from Queen’s University conducted a month-long observership in Vietnam and Cambodia. The goals of the trip were to provide the students with a valuable clinical experience and exposure to Global Health, and to establish connections that might expand the availability of Global Health experiences for future Queen’s medical students. We also hoped to explore the possibility of creating unique partnerships with overseas institutions that would boost the global profile of Queen’s University.

We examined a Neurocysticercosis patient at NIMPE

 Overview

The bulk of our two-week Vietnam stay was at St. Paul’s Hospital in Hanoi, Vietnam, where we had a chance to observe in a variety of departments, including ICU, ER, Pediatric Infectious Disease, Pediatric Cardiology, and Endocrinology. Our visit was initially sponsored by the director of the Endocrinology department at St. Paul’s, and throughout our stay we managed to make good connections with several other physicians, including the director of the ICU. All of these physicians expressed interest in a similar arrangement next year. We also had a chance to have a one-day observership at the National Institute of Malariology and Parasitology (NIMPE), where we saw patients with parasitic infections that we would not have an opportunity to see in Canada.

The connections we made in this portion of the trip allowed for the possibility of more in-depth observerships at NIMPE in the future, and for expanding this opportunity to the National Hospital of Tropical Diseases. We also made connections that could allow us to similarly access the health system in the Lao People’s Democratic Republic.

During our Cambodia stay, we spent one week at Battambang Provincial Hospital, which is one of the larger provincial hospitals in the country, and at the Pailin Referral Hospital, a very under-resourced hospital that serves 75,000 rural residents. We quickly learned that Battambang Hospital routinely hosts students from Australia and the UK; during our stay there, there was a group of four medical students from the UK and 22 nursing students from Australia. Both the coordinator for foreign students and the director of the hospital indicated that they would love to form a relationship with a Canadian medical school. In Pailin we became closely acquainted with the Deputy Minister of Health of the province, as well as with the director of the hospital, and several department directors. At both Cambodian hospitals we spent our time in the ER, Pediatrics, Labour and Delivery, and OR.

Clinical Experience

Battambang Surgery Observership

In all of the hospitals, our role was strictly that of observers. The physicians who oversaw us facilitated a learning model in which the goal was for us to begin to recognize common signs and symptoms and gain first-hand experience with positive findings. Our activities consisted of observing patient care, impromptu mini-lectures from supervising physicians to illustrate relevant findings, and non-invasive supervised physical examinations. We were introduced to patients as foreign medical students by our supervising physicians, and in Battambang by our medical translator. We found that it was very helpful to point to our student IDs and highlight the word ‘student’ whenever it seemed that a patient was mistaking us for a doctor.

Throughout the day we did a lot of research on our own to answer any questions that came up. We found that having the ability to observe the same patients multiple times a day, several days in a row, was a huge advantage, as it allowed us to observe the progression of disease and treatment. For example, we had the opportunity to follow a patient with diabetic ketoacidosis from his admission to the ER to the ICU, and his eventual passing away, at each stage observing and researching the changing signs and symptoms, treatment efforts, and reactions from his family. We also found that seeing so many positive findings and performing so many physical examinations on actual patients greatly increased our confidence and clinical skills. Depending on our setting, we had the opportunity to observe a variety of procedures, including intubations, central line placement, wound care and debridement, deliveries and surgeries.

Managing Impact

A former soldier was awaiting a toe amputation in Battambang

In all of this, we strove to be mindful of how busy and overworked the physicians were, and to operate by the principle that no patient experience or outcome should be negatively affected by our presence; if possible, we tried to be a positive presence for the patients. We are proud to say that we honestly believe we were able to live up to this goal. By separating into small groups, rotating departments frequently, and being independent learners for the majority of the time, we were able to avoid being a major burden to hospital staff. We also respected patient privacy as much as we could. Nevertheless in all hospitals there were a number of patients to whom a group of foreign students was an exciting event, and there were many occasions in which we thought our presence had been beneficial to a patient’s experience or outcome. In Battambang, a former soldier and his family burst into tears after some of us gave him a very respectful greeting in Khmer language; they said they had never received so much respect from someone in a white coat, and this was very meaningful to them. In Hanoi, we were able to comfort a very anxious ICU patient by listening to her heart several times a day when the physicians did not have time to attend to her emotional distress. There were multiple emergency situations throughout in which physicians borrowed our stethoscopes and other equipment, such as during a failed intubation.

Pailin’s TB ward houses both patients and their families, who don’t have protective equipment.

It was in the understaffed and under-resourced Pailin Referral Hospital where there was the biggest opportunity for us to be a beneficial presence, and where one of the most impactful experiences of the trip took place. I went to check in on a TB patient who was faring poorly, and found that the physician on duty had not looked in on her for several hours. When I arrived, there were no nurses of other staff in the ward. She was alone, struggling to breathe, and her family was very distressed. I immediately phoned her admitting physician, who arrived minutes later. Nasal cannula were the only available tool to provide oxygen, but luckily we had a rebreather mask with us that could be connected to the oxygen tank. There were no monitors to keep track of her vitals, but we had brought a pulse oxymeter with us. When, despite the oxygen, her pulse and breathing stopped, three of us medical students were the only ones available to assist the doctor in performing CPR. The doctor himself would have been performing CPR without an N-95 mask if we had not been able to provide one to him.  Unfortunately the patient passed away despite these efforts, but we were satisfied that our presence there had afforded her a better chance, and that at least her family witnessed medical staff making their best effort to save their wife and mother, who would have otherwise died alone and without medical help.

Global Health Experience

Empty shelves at Pailin Hospital’s Outpatient Pharmacy, which serves 75,000 people

Due to the low-resource setting of these observerships, a lot of our learning went beyond the clinical. Both Cambodia and Vietnam are undergoing rapid economic development and demographic changes; the consequent epidemiological transition was highlighted time and again by physicians. We also witnessed the impact of patient crowding and severely exacerbated conditions due to lack of access. Particularly poignant were the struggles of physicians to provide medical care under extremely exacting conditions, such as limited resources and training, and political difficulties. We gained a better understanding of the multifaceted nature of these challenges, and of how difficult it is to bridge these gaps effectively. We also saw, however, that it is possible to make a difference. For example, we brought medical equipment with us that is currently filling some gaps at the Pailin Referral Hospital.

 Future Possibilities

With the director of Pailin Hospital. Fundraising efforts throughout the school year allowed the students to donate medication and equipment

While all institutions that we visited expressed an interest in hosting Queen’s medical students in the future, near the end of our trip the director and several physicians at the Pailin Referral Hospital requested a meeting with us. They wished to explore the possibility of a closer relationship with our university. There were a variety of areas for collaboration that were proposed at this meeting, including the possibility of hosting clerks and residents who, unlike us, might be able to provide medical assistance to patients while being exposed to new situations and gaining useful skills. The director and staff indicated that the most critical needs for the hospital are 1) diagnostic equipment, and 2) advanced training for staff. The only imaging available at the hospital is a rather outdated x-ray machine that generates fuzzy images. In terms of training, their most emergent need related to the management of diabetes. Due to the epidemiological shift, widespread diabetes is a fairly recent phenomenon in rural Cambodia. Nevertheless, Pailin Hospital physicians estimated that currently up to up to 60% of their patients have diabetes. They are very motivated to improve their knowledge of and experience with managing this disease at such high frequencies, and asked about possible training methods they might be able to access, such as online modules or intensive training by diabetes specialists.

In response, we took notes of their concerns and promised to pass them on to the appropriate stakeholders at Queen’s Medical School. We also began independent efforts to find a digital x-ray machine for donation, and continue to look for ways to support the development of this hospital.

Conclusion

The trip exceeded our expectations in terms of the quality of clinical experience and global health exposure that was achieved, the receptiveness of our hosts to continuing this project, and the possibility for future in-depth, mutually beneficial collaborations at the institution level.


 All photographs were taken for fundraising and educational purposes only, after obtaining informed consent from all parties.

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Curriculum Committee Information – October 26, 2017

Faculty, staff, and students interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on October 26, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of the October meeting can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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Lindsay Shepherd and the delicate balance of free speech and personal rights

What’s the purpose of universities?

There appears to be no simple answer to what might seem to be a straightforward question. The pragmatic, contemporary purpose would be to prepare young people for careers of various types. Certainly that would be the likely first response of most current students, and postgraduate employment has become a key (and very public) metric of university success.

But many would remind us that universities have a greater purpose, both in the lives of young people who attend and within our society. William von Humboldt was a German philosopher and diplomat who, in 1810, defined the purpose of universities rather succinctly as “communities of scholars and students engaged in a common search for truth”. The 1963 Robbins Report commissioned by the British government to examine education concluded that universities had four objectives: “instruction in skills, promotion of the general powers of the mind, advancement of learning, and transmission of a common culture and common standards of citizenship.”

These greater goals require universities to provide environments where both students and faculty feel free to explore any and all topics openly, freely and safely.

Lindsay Shepherd’s recent experience with her university hierarchy would suggest we have some work to do if those lofty goals are to be achieved.

For those not yet familiar with her story, she is a 22 year old teaching assistant at an Ontario university who is undertaking a master’s degree in Communications. A few weeks ago, a student (or students, we don’t know) in her class complained that she was using material they found offensive. The offensive material consisted of a three minute video clip that had been broadcast on TVO and featured a debate about the use of non-gender, contrived pronouns, featuring Professor Jordan Peterson, a highly controversial psychologist and university professor who characterizes himself as a defender of free speech but whose views on social issues have been seen as “far right” and highly threatening by many.

For this offense, Ms. Shepherd was required to attend a meeting with her supervisor, another professor, and a university official who holds a position as director of gender violence prevention and support.

She recorded the meeting, and made that recording publicly available. Although it’s somewhat painful to listen to, it holds important lessons for those holding positions of authority in universities or colleges.

Through the 40+ minute session, the three senior university officials take turns trying to convince this young woman of the error of her ways. It’s clear that the intention of the meeting was not to get Ms. Shepherd’s perspective on the events, but to convince her that she was guilty of using an inappropriate teaching approach and disseminating offensive material. It appears that guilt had already been established through nothing more than the evidence of the student complaint. Why else would the director of gender violence prevention and support be already involved in the matter?

In their defense, they appeared to be sincere in their beliefs that the material was intrinsically offensive and in questioning of the choice of methodology given the purpose of the teaching session. They also appeared to be trying to avoid any reputational damage to their institution.

For her part, Ms. Shepherd was unrepentant and consistent in defending the use of provocative material to stimulate what she believed to be healthy debate. She felt young people should be prepared to hear and engage differing and even radical opinions. She made it clear that she herself did not agree with the views of Professor Petersen and was in no way endorsing his point of view. She was, throughout what was obviously a highly uncomfortable and fundamentally unfair encounter, principled and courageous. As I listed to the encounter, I couldn’t help but think that her parents would be proud of her.

https://goo.gl/images/9zTyHM
@FaithGoldy

There has been, as you might imagine, considerable backlash. Editorials, student protests and national columnists have defended Ms. Shepherd and attacked the university for how this issue was handled. The individuals involved and university president promptly issued apologies.

http://www.cbc.ca/news/canada/kitchener-waterloo/wilfrid-laurier-university-president-explains-apology-to-lindsay-shepherd-1.4417809

https://www.theglobeandmail.com/news/national/education/free-speech-protest-at-wilfrid-laurier-university-caps-turbulent-week/article37085605/

https://www.theglobeandmail.com/opinion/editorials/globe-editorial-university-heal-thyself/article37075138/

http://thechronicleherald.ca/opinion/1523543-walkom-wilfrid-laurier-tas-case-is-%E2%80%98problematic

http://montrealgazette.com/opinion/christie-blatchford-heres-where-laurier-can-stick-their-apology-to-lindsay-shepherd/wcm/580912e2-390f-4584-ac57-955912bbdeca

 

I decided to write on this issue not because Ms. Shepherd requires further defending, nor to add to the vilification of those involved – the fundamental unfairness of the encounter itself requires no further comment. However, I think this regrettable incident offers important lessons for those of us who teach and hold positions of authority at the university level.

If universities are to truly provide more than simple vocational training, they must establish safe and welcoming environments for students and faculty of all background and beliefs. They must foster, indeed welcome, new and even radical ideas. To do so, they must strike a delicate balance between free speech and personal harassment. When does one person’s expressed opinion become unacceptable? A standard we might all accept is when the expression of those views harms or threatens another individual or group. In most cases this is self-evident. But (and this is a big “but”), harm or threat can be a subjective experience. Were the students who complained to university official about Ms. Shepherd’s tutorial harmed or threatened by hearing the video clip she presented to them?

Universities appear to be struggling with this dilemma. The University of British Columbia recently rescinded a proposed Freedom of Speech statement that attempted to put limits on what would be considered permissible dialogue:

https://www.theglobeandmail.com/news/national/education/ubc-shelves-new-freedom-of-expression-statement/article36871422/

On perhaps another extreme, the University of Chicago appointed a Committee on Freedom of Expression in 2014.

https://provost.uchicago.edu/sites/default/files/documents/reports/FOECommitteeReport.pdf

In their “Report of the Committee on Freedom of Expression” they make the following statements:

“the University’s fundamental commitment is to the principle that debate or deliberation may not be suppressed because the ideas put forth are thought by some or even by most members of the University community to be offensive, unwise, immoral or wrong-headed. It is for the individual members of the University community, not for the University as an institution, to make judgments for themselves…”

They do, however, set limits with respect to harm or threat:

“The University may restrict expression that violates the law, that falsely defames a specific individual, that constitutes a genuine threat or harassment, that unjustifiably invades substantial privacy or confidentiality interests…”

The University of Chicago approach would seem to be appropriate given American values and their current political-social environment. But how are we to negotiate the delicate balance of free expression and personal rights in the Canadian context, given our collective recognition of minority oppression, and natural inclination to civility and compromise? In the university environment, there are additional motivations to protect young people who we may see as vulnerable, and to guard our institutional interests.

There are no easy answers, but I believe Ms. Shepherd’s experience provides warning that the pendulum may have swung too far toward toward suppression of vigorous and healthy debate in the interest of avoiding any potential appearance of offense. In our universities, where open and free discourse should be encouraged as a key goal, this is particularly alarming. Ultimately, we must re-examine what serves the interests of our students and society, and what keeps our universities vital institutions where personal growth and von Humboldt’s “common search for truth” can truly flourish.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

 

Posted on

Lindsay Shepherd and the delicate balance of free speech and personal rights

What’s the purpose of universities?

There appears to be no simple answer to what might seem to be a straightforward question. The pragmatic, contemporary purpose would be to prepare young people for careers of various types. Certainly that would be the likely first response of most current students, and postgraduate employment has become a key (and very public) metric of university success.

But many would remind us that universities have a greater purpose, both in the lives of young people who attend and within our society. William von Humboldt was a German philosopher and diplomat who, in 1810, defined the purpose of universities rather succinctly as “communities of scholars and students engaged in a common search for truth”. The 1963 Robbins Report commissioned by the British government to examine education concluded that universities had four objectives: “instruction in skills, promotion of the general powers of the mind, advancement of learning, and transmission of a common culture and common standards of citizenship.”

These greater goals require universities to provide environments where both students and faculty feel free to explore any and all topics openly, freely and safely.

Lindsay Shepherd’s recent experience with her university hierarchy would suggest we have some work to do if those lofty goals are to be achieved.

For those not yet familiar with her story, she is a 22 year old teaching assistant at an Ontario university who is undertaking a master’s degree in Communications. A few weeks ago, a student (or students, we don’t know) in her class complained that she was using material they found offensive. The offensive material consisted of a three minute video clip that had been broadcast on TVO and featured a debate about the use of non-gender, contrived pronouns, featuring Professor Jordan Peterson, a highly controversial psychologist and university professor who characterizes himself as a defender of free speech but whose views on social issues have been seen as “far right” and highly threatening by many.

For this offense, Ms. Shepherd was required to attend a meeting with her supervisor, another professor, and a university official who holds a position as director of gender violence prevention and support.

She recorded the meeting, and made that recording publicly available. Although it’s somewhat painful to listen to, it holds important lessons for those holding positions of authority in universities or colleges.

Through the 40+ minute session, the three senior university officials take turns trying to convince this young woman of the error of her ways. It’s clear that the intention of the meeting was not to get Ms. Shepherd’s perspective on the events, but to convince her that she was guilty of using an inappropriate teaching approach and disseminating offensive material. It appears that guilt had already been established through nothing more than the evidence of the student complaint. Why else would the director of gender violence prevention and support be already involved in the matter?

In their defense, they appeared to be sincere in their beliefs that the material was intrinsically offensive and in questioning of the choice of methodology given the purpose of the teaching session. They also appeared to be trying to avoid any reputational damage to their institution.

For her part, Ms. Shepherd was unrepentant and consistent in defending the use of provocative material to stimulate what she believed to be healthy debate. She felt young people should be prepared to hear and engage differing and even radical opinions. She made it clear that she herself did not agree with the views of Professor Petersen and was in no way endorsing his point of view. She was, throughout what was obviously a highly uncomfortable and fundamentally unfair encounter, principled and courageous. As I listed to the encounter, I couldn’t help but think that her parents would be proud of her.

https://goo.gl/images/9zTyHM
@FaithGoldy

There has been, as you might imagine, considerable backlash. Editorials, student protests and national columnists have defended Ms. Shepherd and attacked the university for how this issue was handled. The individuals involved and university president promptly issued apologies.

http://www.cbc.ca/news/canada/kitchener-waterloo/wilfrid-laurier-university-president-explains-apology-to-lindsay-shepherd-1.4417809

https://www.theglobeandmail.com/news/national/education/free-speech-protest-at-wilfrid-laurier-university-caps-turbulent-week/article37085605/

https://www.theglobeandmail.com/opinion/editorials/globe-editorial-university-heal-thyself/article37075138/

http://thechronicleherald.ca/opinion/1523543-walkom-wilfrid-laurier-tas-case-is-%E2%80%98problematic

http://montrealgazette.com/opinion/christie-blatchford-heres-where-laurier-can-stick-their-apology-to-lindsay-shepherd/wcm/580912e2-390f-4584-ac57-955912bbdeca

 

I decided to write on this issue not because Ms. Shepherd requires further defending, nor to add to the vilification of those involved – the fundamental unfairness of the encounter itself requires no further comment. However, I think this regrettable incident offers important lessons for those of us who teach and hold positions of authority at the university level.

If universities are to truly provide more than simple vocational training, they must establish safe and welcoming environments for students and faculty of all background and beliefs. They must foster, indeed welcome, new and even radical ideas. To do so, they must strike a delicate balance between free speech and personal harassment. When does one person’s expressed opinion become unacceptable? A standard we might all accept is when the expression of those views harms or threatens another individual or group. In most cases this is self-evident. But (and this is a big “but”), harm or threat can be a subjective experience. Were the students who complained to university official about Ms. Shepherd’s tutorial harmed or threatened by hearing the video clip she presented to them?

Universities appear to be struggling with this dilemma. The University of British Columbia recently rescinded a proposed Freedom of Speech statement that attempted to put limits on what would be considered permissible dialogue:

https://www.theglobeandmail.com/news/national/education/ubc-shelves-new-freedom-of-expression-statement/article36871422/

On perhaps another extreme, the University of Chicago appointed a Committee on Freedom of Expression in 2014.

https://provost.uchicago.edu/sites/default/files/documents/reports/FOECommitteeReport.pdf

In their “Report of the Committee on Freedom of Expression” they make the following statements:

“the University’s fundamental commitment is to the principle that debate or deliberation may not be suppressed because the ideas put forth are thought by some or even by most members of the University community to be offensive, unwise, immoral or wrong-headed. It is for the individual members of the University community, not for the University as an institution, to make judgments for themselves…”

They do, however, set limits with respect to harm or threat:

“The University may restrict expression that violates the law, that falsely defames a specific individual, that constitutes a genuine threat or harassment, that unjustifiably invades substantial privacy or confidentiality interests…”

The University of Chicago approach would seem to be appropriate given American values and their current political-social environment. But how are we to negotiate the delicate balance of free expression and personal rights in the Canadian context, given our collective recognition of minority oppression, and natural inclination to civility and compromise? In the university environment, there are additional motivations to protect young people who we may see as vulnerable, and to guard our institutional interests.

There are no easy answers, but I believe Ms. Shepherd’s experience provides warning that the pendulum may have swung too far toward toward suppression of vigorous and healthy debate in the interest of avoiding any potential appearance of offense. In our universities, where open and free discourse should be encouraged as a key goal, this is particularly alarming. Ultimately, we must re-examine what serves the interests of our students and society, and what keeps our universities vital institutions where personal growth and von Humboldt’s “common search for truth” can truly flourish.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

 

Posted on

Nominations open for next Exceptional Healer Award

Instilling the values of patient-centered care is one of our goals in the UGME program. It’s also what the Kingston Health Sciences Centre Exceptional Healer Award recognizes in physicians from both the Hotel Dieu and KGH sites.

Launched earlier this year, the Exceptional Healer Award is sponsored by the KHSC Patient & Family Advisory Council. It honours a physician who demonstrates in clinical practices the core concepts of patient- and family-centred care: dignity and respect, information sharing, participation, and collaboration.

Patient Experience Advisor Sue Bedell brought the idea of the award to the Patient and Family Advisory Council and is now coordinator of the award project.

Patient Experience Advisor Susan Bedell

“I happened to have a particularly compassionate and empathetic doctor,” Bedell explained in an interview for how she came up with the idea. “I think it’s important for all people, for all physicians, and healthcare professionals, to be treating sick and injured people with compassion and empathy.” So, she looked for a way to recognize this. She presented her idea to the council at Hotel Dieu, and drafted terms of reference and a nomination form. “I wanted to make sure that I could persuade not on the patient council, but the administration that this was something doable, so they approved it,” she said.

For the first time through, Bedell had hoped to get five or six nominations: instead, the council received 22. Response to the creation of the award was “better than I had ever expected,” she noted.

A selection committee, including Bedell, two other patients, two staff members, and the chief of staff, reviewed these submissions. For the first award, it was a tie: ophthalmologist Dr. Tom Gonder and anesthesiologist Dr. Richard Henry were the winners for 2017. Each received multiple nominations, Bedell said.

Bedell shared that the major themes from all the 2017 nominations were the nominated physicians were dedicated listeners, showed empathy and compassion, took time to spend with patients, focused on inclusion and care of family members, shared information with patients, and demonstrated humility.

“All of these are easy to attach to the core concepts of patient- and family-centred care,” Bedell noted.

Following the first iteration, which had a February deadline, it was decided to run the next iteration earlier in the year, with a November deadline for nominations with the committee’s decision in December, and the presentation early in 2018. The deadline for nominations is Friday, November 3.

Patients and family may nominate a physician who has provided care to them in the last two years. KHSC staff can also nominate members of the health care team. Bedell said that medical students on clerkship rotations can submit nominations.

“I do hope, in the long run, that through this award, and these role models can influence medical students,” Bedell said. “When they listen, to have the intent to understand, rather than just reply – that would be an example.”

“Being a dedicated listener seemed to be most important to the nominators,” she added.

Bedell emphasized that both KHSC hospital sites are full of very competent, skilled, compassionate doctors, and this award is one way to recognize these attributes

There’s still time to nominate a physician for the 2018 award. With the amalgamation of the two sites into the Kingston Health Sciences Centre, physicians from both the Hotel Dieu and Kingston General Hospital sites are eligible to be nominated. Full details are found here on the Exceptional Healer Award website.

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Meet Jenna Healey, the new Hannah Chair in the History of Medicine

The new Jason A. Hannah Chair in the History of Medicine knows most Queen’s medical students aren’t going to memorize historical dates and events as a matter of routine, and that’s perfectly okay.

Dr. Jenna Healey notes that instead focusing on dry facts – that these days can readily be looked up — one excellent use of history is “to take a step back every once in a while and to think about the bigger picture.”

“Sometimes it’s easier to do that when you’re thinking historically because you have that little bit of distance. And then you can apply those same critical thinking skills to ongoing controversial issues or new things that come up within your career.”

“We might be looking at a bio-ethical case from the 1960s and, well, ‘they were so wrong,’ right? I’ve taught history of bioethics before, and we have to think about contemporarily, how did people understand what they were doing, what were the standards of their profession? Not necessarily to defend something that we now understand to be unethical, but to understand what the environment was like for those physicians – and then to think about what we find acceptable. Because, in 50 years, inevitably, someone is going to critique us.”

“Sometimes it’s easier to think about these things historically.”

Healey herself didn’t set out to become an historian – of medicine or anything else. Her undergraduate studies found her juggling her twin interests in humanities and science. To accommodate this, she pursued a combined arts & science program at the University of Guelph. “It was a Bachelor of Arts and Sciences,” she explains, “so basically a BA and a BSc at the same time.”

“I was doing an English literature degree along with a molecular biology degree and I was thinking about going to med school, maybe going into public health, and my other career in my head was to be a science journalist,” she shares. “Part of my program requirement was to take an introductory history of science course because you sort of had to combine the two – and I really liked it. So I ended up getting a summer job in the history department as a research assistant; and then the next summer I worked there, too.”

That’s when she started learning about the history of medicine as a discipline. This led her to do a master’s degree in the history of science at the University of Toronto, and later a PhD at Yale. “And I just never left,” she says.

“It turned out to be a very good way to combine my two interests,” she adds, “And to stay within the world of medicine and science without becoming a clinician.”

Prior to being appointed to her position at Queen’s on August 1, Healey was a lecturer at Yale, where she mainly taught pre-medical students. “I’m really excited to have the opportunity to work directly with medical students,” she says.

She hopes much of what she brings to students is that focus on the big picture.

“I want them to think think critically both about the past of the profession, and as cliché as it may be, to learn from the mistakes of the past, and the paternalism of the past, and to really think about themselves as part both of a longer historical legacy, to think about the socio-economic determinants of health,” she explains. “I think history really helps with that: to think about why is our health care system the way it is? How do your patients perceive the medical profession? How does the public perceive medicine? What are the notions they are coming in with?”

Healey also hopes to help students “think critically about the ways new technologies are going to change patient care and the clinical experience, both for physicians and for patients, because technology is something I’m really interested in.”

Healey recognizes that it can be a challenge to “sell” students on the value of spending time on the history of medicine – something her predecessor, Dr. Jacalyn Duffin did in the position for 30 years before her retirement.

“I think you always have to do a bit of justification for why you’re even learning this, and I understand that, as someone who was an undergraduate in the sciences: There is just a lot to do,” Healey says. “There’s a lot to learn, there’s a lot to memorize, a lot of labs to finish. And it’s hard to see, maybe the relevance in that moment, because you just have so much to finish.

“I think, especially in a medicine curriculum, it’s to constantly say ‘it’s ok to take this hour’; this is worth learning, and to get across the idea that people who haven’t taken a lot of history think it’s just a lot of boring facts, and that the point of it is to memorize those facts – and that’s not it at all

“If you leave medical school here and you don’t remember all the details of Harvey’s discovery of circulation, I’m fine with that,” she says. “But it’s more the critical thinking and the historical thinking. And when you do encounter a problem in your career, you can think: how did things get this way? If people take that away, I’d be very happy with that.”

In addition to the lectures and other learning events she has already been working on, Healey has met with members of the student-run History of Medicine group.

“It was exciting for me to get here and see there was already an established a group of students who are very excited about the history of medicine – and that’s all a credit to Dr. Duffin and the program she already had in place and the students are so fired up and excited about it.”

There’s already talk of the next “History of Medicine” trip. “I think it’s a great tradition and I’m really excited about it,” she says, noting all the planning is student-led and logistics (including destination) are in the works.

Dr. Healey will soon be settled into her new office at 80 Barrie Street and looks forward to meeting more students and colleagues.

“I’m very excited and very happy to be here.”


For more on the Ontario Hannah Chairs, check out this link.

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From campus to community: the Loving Spoonful Service Learning Project

By Steven Bae and Lauren Wilson, MEDS 2019

“Let food be thy medicine, and medicine be thy food” – Hippocrates

Food. It is a vital part of our existence, and is a focal point in many cultures. Over the course of one year, a person who eats three meals a day consumes 1092 meals. It plays such a large role in everyday life that sometimes it is easy for us to overlook.

The importance of food security to one’s overall health is well known. Food security is defined as “all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active healthy life.” [1] A recent JAMA study reported that suboptimal intake of nutrients and healthy foods was associated with over 45% of deaths due to heart disease, stroke, or type 2 diabetes. [2] Yet for too many people, adequate access to nutritious food is out of reach. Some of these people live right in our community.

Photos courtesy of Loving Spoonful

The neighbourhoods in North Kingston make up 20% of the total population, and their average income is 22% lower than the city average. [3] The people living in North Kingston are twice as likely not to have completed high school, and twice as likely to be living on low incomes. [3] Many physicians that know their patients may not always be able to afford food ask their patients at appointments if they have enough food. Some family health teams even have an emergency supply cupboard in their office for extra food to give to patients who need it.

To increase awareness of these issues, we became closely involved in helping develop a service learning project in partnership with Loving Spoonful,  an organization that works to achieve a healthy, food-secure community. The project is structured around community cooking programs for low-income Kingston residents with medical students as volunteers. On top of building food literacy and confidence in preparing healthy foods among class participants, the goals of the project were to expose medical students to the Kingston community, provide information about food security in Kingston, and encourage them to create a dialogue with the participants in order to learn more about what they can do as future physicians.

The project also allows for students to accompany a physician from the Kingston Community Health Centres to visit the home of a patient living on a fixed income. The students have found that this experience has been eye-opening to appreciate firsthand the ways in which barriers can be specific to individuals. For example, if an individual has difficulty standing, the food s/he buys has to be prepared quickly, which limits his or her choices. Underpinning all of these experiences is a facilitated debrief and written reflection at the end, which allows students to share and document their insights, challenges, and surprises.

Ten medical students have participated in the service learning project thus far, with more students registered for this fall. All of the students have enjoyed this project in many aspects, from improving their own food preparation skills, to developing rapport with the local Kingston residents.

Overall, we are walking away with a greater appreciation for the social determinants of health. As future physicians, the social inequities that underlie many chronic diseases may seem insurmountable. However, this work is not solely our own. Organizations like Loving Spoonful play an important role in our community to address upstream factors that we eventually see presenting as illness. Being knowledgeable about the resources available in our community is a small but helpful step we can take to help our patients address challenging socio-economic circumstances.

Thank you to Loving Spoonful for your invaluable partnership in developing this project and the Kingston Community Health Centres health team for contributing to student learning. We would also like to gratefully acknowledge the City of Kingston and United Way for their Community Investment Fund, as well as the Kaufman Endowment fund, which helped fund this program.


References
[1] Committee of World Food Security
[2] Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 2017;317(9):912-924.
[3] Kingston Community Health Centres. A community needs assessment of North Kingston neighbourhoods. June 2010

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6th annual Medical Student Research Showcase

By Drs. Heather Murray & Melanie Walker

This year the School of Medicine is proud to invite you to the 6th annual Medical Student Research Showcase on Wednesday September 20th.

This event celebrates the research achievements of our undergraduate medical students, with both posters and an oral plenary session featuring research performed by students while they have been enrolled in medical school. All students who received summer studentship research funding through the School of Medicine in 2017 will be presenting their work, as well as many other research initiatives. The posters will be displayed in the David Walker atrium of the School of Medicine building from 8am until 5pm, with the students standing at their posters answering questions between 10:30 and noon.

The oral plenary features the top research projects selected by a panel of faculty judges, and will run in room 132A from noon until 1:30pm on September 20th, immediately following the poster session Q&A.

This year’s faculty judges included:

Dr. Yuka Asai

Dr. Jennifer Flemming

Dr. Katrina Gee

Dr. David Good

Dr. Dianne Groll

Dr. Paula James

Dr. Robert Reid

Dr. Prameet Sheth

Dr. Graeme Smith

Dr. Tan Towheed

Dr. Andrea Winthrop

We are very grateful to these faculty members for evaluating our oral plenary applicants this year.

The three students who have been selected for the oral plenary session, and the titles of their research presentations and faculty supervisor names are listed below. Each of these three students will receive The Albert Clark Award for Medical Student Research Excellence.

Gregory Hawley – Plasminogen depletion following severe burn injury

Jeffrey Mah – Survival following Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Patients with Cirrhosis: A Population-based Study

Sean Tom – ETS1 transcription factor-mediated upregulation of microRNA-31 controls cardiac fibrogenesis in human atrial fibrillation.

Please set aside some time to attend the Medical Student Research Showcase on September 20th. The students will appreciate your interest and support, and you will be amazed at what they have been able to achieve.

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Names matter

What’s in a name? That which we call a rose

By any other name would smell as sweet.

 So mused the ill-fated heroine in Romeo and Juliet, about her equally ill-fated love.

In medicine and in teaching, however, names can mean a lot.

The late Dr. Kate Granger of the United Kingdom was one of the strongest advocates for using names with her #hellomynameis campaign – launched while she lived with terminal cancer. As explained in a BBC article following her death in July 2016, the campaign “encouraged healthcare staff to introduce themselves to patients.”

“A by-product of her own experiences of hospital in August 2013, it grew out of the feelings of unimportance she experienced when the doctor who informed her that her cancer had spread did not introduce himself,” the BBC wrote. Granger had explained it this way: “It’s the first thing you are taught in medical school, that when you approach a patient you say your name, your role and what you are going to do. This missing link made me feel like I did not really matter, that these people weren’t bothered who I was. I ended up at times feeling like I was just a diseased body in a hospital bed.”

Learning and using names is important for both teachers and students, long before they reach patients’ hospital beds. For this reason, we emphasize the importance of names in our UGME classrooms and clinical skills environments, too.

“Learning students’ names signals your interest in their performance and encourages student motivation and class participation,” writes Barbara Gross Davis in Tools for Teaching. “Even if you can’t learn everyone’s name, students appreciate your making the effort.”

One of the strategies of learning students names that Gross Davis (and others) suggests is one we’ve adopted at Queen’s UG: having students use name tent cards in the classrooms. This was adopted for two reasons, Dr. Lindsay Davidson, Director of Teaching, Learning, and Integration explains.

“It’s because we start developing professional identity from Day 1, and being a doctor means introducing who you are.”

“And because it helps build relationships,” she adds. “Student-student but also teacher-student—teachers can respond to students as individuals with names not ‘the guy in the ball cap’.”

“We expect all medical students to wear identification nametags for all clinical skills sessions, both in-house and when at health facilities,” says Clinical Skills Director Dr. Cherie Jones. She notes that the Year 1 students don’t have these on Day 1 as these are provided by KGH. “We use paper ones until they are done!” Once the official badges are available, they must be worn.

And it’s not just for students: clinical skills tutors are expected to wear their ID that they use in their clinical settings.

And for all those (like me) who’ve become accustomed to wearing an ID card on a lanyard or on a hip-level clip: IDs are to be worn on the lapel of the jacket—where they can best be seen

“Name tags are important in clinical skills sessions because the Standardized Patients (SPs) and Volunteer Patients (VPs), like to know the names of the students and tutors they are working with and don’t always understand or hear the name when the student introduces themselves,” Dr. Jones explains.

The Clinical Skills policy mimics the name-badge policies at the hospitals in Kingston. “Name tags in clinical settings like KGH are mandatory for anyone interacting with patients, staff, even with visitors,” Dr. Jones points out.

“Not only is it policy in the hospital, but patients like being able to read anyone’s name – not just the students’,” adds Kathy Bowes, Clinical Skills Coordinator.

So, remember your ID badge, use your name tent cards in the classrooms, use people’s names. And me, I’ll be pinning my hospital ID badge in the right place the next time I’m heading over to KGH for a meeting.

Because names matter. To everyone.

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Anatomy studies begin with focus on respect

Each September, first year students in the Queen’s Undergraduate Medical program quietly begin their studies in anatomy with a service acknowledging the donation of bodies that will be used in the lab assignments.

This year the short service will be held on Tuesday, September 5 at 3 p.m. in room 032 of the Medical Building, following the introduction to the Human Structure & Function course.

The course co-directors, Les MacKenzie, Stephen Pang, and Allan Baer will be joined by Queen’s Chaplain Kate Johnson to lead the program.

The session emphasizes respect and professionalism. “This is the first approach to professionalism,” MacKenzie explained in an interview. “The purpose of the donations is for this study and we have to respect that.”

“Respect not just for the bodies that have been donated, but for the families who have donated them,” he added.

Queen’s is one of a decreasing number of medical schools that still uses human cadavers in anatomy courses. According to a 2016 article in National Geographic, “half of Canadian medical schools have cut back on using cadavers, relying instead on new technology to make teaching basic anatomy more efficient.”

While there is definitely a place for technology, MacKenzie acknowledged, there’s also a strong argument for using donated human bodies. He pointed out, for example, that the many variations of “normal” are not experienced if everyone is using the same computer simulated program. It’s a privilege to have this learning experience, MacKenzie noted, and the students recognize this.

The emphasis on respect is tied to one of the objectives from the Queen’s UGME Competency Framework (Professional 1.1a) which notes students will “Identify honesty, integrity, commitment, dependability, compassion, respect, confidentiality and altruism in clinical practice and apply these concepts in learning, medical and professional encounters.” For the Human Structure and Function course, this is further annotated to explain that students will: “Consistently demonstrate compassion and respect for those who have donated their bodies to the medical school for use by students studying anatomy.”

“I truly believe the point does get across,” MacKenzie said. “Our medical students really get the message, there’s no horseplay. We have zero tolerance of misbehaving.”

Queen’s Chaplain Kate Johnson, who has led the opening service in recent years, takes the opportunity to emphasize the students’ own humanity and to remind them to keep in touch with it.

“Historically, medical students were at risk of a ‘super human’ culture of medicine,” Johnson said. “Now, with technological advances, there’s the danger of taking the humanity out of medicine. The anatomy lab is one place to keep the humanity.”

Johnson also reminds students they are starting on a pathway to a position of trust.

“You’re not just technically excellent, but your professional conduct is to be worthy of trust,” she noted at last year’s service. “It’s appropriate then that this part of your education starts with the bodies of people whose last wish was to entrust their physical remains to you in order that you can be fully trained in your profession,” she said. “Even more, their surviving family members have made what is often a huge decision to trust you by following through on their deceased loved ones’ wishes.

Tuesday’s service is open to all members of the Queen’s community. “It would be great if it was standing room only,” MacKenzie said.


Each spring features a more formal, graveside burial service at the Queen’s University plot at Cataraqui Cemetery which is attended by family, friends, and members of the Queen’s community. Details on this service will be available in the spring.

For more on the Human Body Donor Program at Queen’s see A body of medical knowledge in the Queen’s Alumni Review 2017 Issue 2

For information on procedures to donate, see the Queen’s Department of Biomedical and Molecular Sciences Human Body Donor Program web page.

 

 

 

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