“To boldly go where no (Doctor) has gone before”

Those as nerdy as I will recognize the title of this article as paraphrased from the introduction to the original Star Trek television series. That program, set in a technologically advanced future, was about a long journey of discovery. Perhaps the most peculiar aspect of that journey is that it had no particular destination. The voyagers were simply wandering aimlessly, hoping to run into something interesting. Consequently, they often found themselves woefully unprepared for the challenges they faced – an excellent means to provide dramatic tension to a fictional story, but a dubious strategy for real life.

A medical school curriculum is basically a journey. For our students, it’s a journey that will take them into an unknown future. Like any real journey (and in contrast to the intrepid Star Trek crew), establishing a destination is the first, critical step. A long journey may consist of many stages and stops along the way that demand our immediate attention, but those stages are only meaningful if they move the traveler toward some ultimate goal. That goal, of course, is to become effective, fulfilled providers of medical care to members of our society.

The students currently in medical school will be practicing into the mid 21st century. If we’re to provide them an education that will best prepare them to make meaningful contributions, we need to give some thought what that world will look like, and what it will require of them as physicians and professional leaders.

This was the topic of a presentation and subsequent discussion at our semi-annual Curricular Retreat this past week. In preparing some remarks to begin that discussion, I attempted to draw on changes that have occurred in the course of my career and use those observations to extrapolate into the future. I came up with five that I think are particularly relevant. This is, by no means, a complete list, but perhaps sets the tone and the challenge.

 

In no particular order:

 

  1. The role of physicians as purveyors of medical knowledge.

Knowledge is the fundamental fuel of medical practice, and the commodity that gives legitimacy to those providing care. A generation ago, medical knowledge was elusive. It had to be searched out, a process that was paper based and time consuming. Physicians were the primary source and conveyors of medical knowledge. People who wished to become physicians went to medical schools largely to seek out the knowledge and skills that were embodied in the practicing physicians who taught there.

That has all changed. Medical knowledge is now available, almost instantly, who anyone who wishes to find it. Physicians are no longer the primary source of that knowledge. They no longer hold any monopoly on knowledge.

 

  1. The expanding applications of Artificial Intelligence and robotic technology.

We were all impressed when Watson defeated chess masters and Jeopardy champions. In my field of cardiology, I think many dismissed automated interpretations of electrocardiograms as simple algorithm-driven time savers that would always require physician verification. The same is happening with respect to interpretation of diagnostic imaging such as chest x-rays and CT scans.

But AI is moving far beyond these applications that are based simply on prodigious memory storage and processing capacity. Applications are becoming much more sophisticated and are developing the ability to learn and adapt to dynamic situations. Diagnostic algorithms are available that will provide reasonable differential diagnoses for patient presentations, and computer interfaces are under development that are frighteningly life like in their ability to interpret individual patient speech and even facial expressions.

Robotic applications in the operating rooms and procedure suites hold the promise of increasing technical expertise and consistency while reducing infection rates. They also allow for interventions in locations where the human hands are simply incapable of performing.

Extrapolating forward, it’s not at all hard to imagine a world where most diagnostic imaging and many therapeutic interventions will require much less, or perhaps no human intervention.

 

  1. Our fundamental understanding of human disease.

For generations, physicians have understood and characterized disease states based on what they could observe clinically. “Consumption”, “Whooping Cough” and “Scarlet Fever” are examples of conditions described solely on symptoms and visual inspection. As the ability to image patients and do laboratory analyses improved, patients with Consumption were found to have pulmonary damage caused by Tuberculosis, Whooping Cough became Pertussis and Scarlet Fever became associated with streptococcus infection.

I have lectured students for over 20 years on the classification, diagnosis and management of cardiomyopathies based on morphologic distinctions (Dilated, Hypertrophic, Restrictive) established by clinical examination and imaging appearances. My teaching is now changing, based on new classification schemes based not on morphology, but on the genetic mutations that result in abnormal development of cardiac muscle cells and channels.

This is not only highly appropriate, but promises to bring genetically based therapeutics that promise to alter the natural history of these conditions in ways currently not available. It also represents an entirely new science, involving genomics and an understanding of sub-cellular processes that practitioners of the future will need to understand and develop comfort with if they’re to provide optimal care.

 

  1. Standardized approaches to disease management.

Physician order sheets used to be blank and on paper. They have not only become electronically integrated into patient management systems of various designs, but have also become prepopulated with standard orders for many, even most, clinical conditions. Often, all that’s required are patient specific data such as body size and renal function, and a physician’s signature (real or virtual) at the bottom of the page.

 

This is good in the sense that it promotes consistent and evidence based approaches to these conditions, and reduces transcription errors. However, it can also diminish the educational experience of medical students, and may not fully account for the needs of patients with multiple medical problems or individual characteristics that require an individualized approach.

 

 

  1. Expanding role of non-physicians in health care delivery.

The widespread availability of medical knowledge in general and guideline based management strategies specifically has allowed for other health care providers, such as nurse practitioners, pharmacists and physician assistants, to participate more fully many situations. Another example from my field would be the expanding role of nurse practitioners in heart failure clinics. NPs are fully capable of managing the introduction and maintenance of standard therapies in this population of patients who often require close and continuing surveillance. They do so very effectively, and their participation has been shown to improve patient functional status and reduce hospital admissions.

 

And so, what to do…

It’s important to state from the outset that this is all good. These five changes will make health care more effective and efficient. Like any development they have potential pitfalls, but, appropriately managed, they will bring significant advantages to our patients. It’s also important to recognize that they are not going away. Technologic progress does not wait for us, or any group, to be ready.

And so, we must engage some very difficult and disturbing questions, summarized in this slide I presented at our recent retreat:

 

Obviously, there are no definitive answers, but I provide a few thoughts that emerged from recent discussions.

  • Students no longer need to undertake medical education in order to locate knowledge – they are quite capable of doing that on their own. They do, however, require guidance as to what will be relevant to their careers, and an ability to interpret and evaluate the merits of the tsunami of information that will come their way.

 

  • AI has the potential to dramatically improve the delivery of care, but can be highly threatening, partly because applications can develop out of context and without clear applications. Physicians of the future need to be more than consumers of AI, they need to involved in the development of applications, the purpose of which should always be to advance care. To do so, they will need fundamental education that develops familiarity with the technology and its potential.

 

  • Medical education has always been rooted in science, but the nature of that science is changing rapidly. Fundamental knowledge about normal human structure and function will always be required, but will need to extend beyond the superficially observable to penetrate the genetic and subcellular levels of normal and abnormal human function.

 

  • As Physicians are needed less and less to interpret test results or manage standard, well-defined clinical issues, their role will extend to ensuring patients enter the care system appropriately, and managing situations where the complexity or multiplicity of issues goes beyond standard management. This will require them to be even more acute assessors of patients at the primary presentation, develop high levels of sensitivity to patient outcomes that deviate from optimal, and have a depth of understanding of the scientific underpinnings of disease and system management that will allow them to step in and provide “customized” management when required. Indeed, “personalized medicine” may become the primary focus of the physician of the future.

 

All this, and no doubt much more, will require a vastly different approach to medical education, one that we need to begin to consider today. The future is closing in very rapidly. I’ll end with a quote regarding the future role of physicians from someone who was always technologically ahead of his time and not shy about expressing disruptive views:

“The doctor of the future will give no medicine, but will instruct his patient in care of the human frame, in diet, and in the cause and prevention of disease.”

Thomas Alva Edison (1847-1931)

 

Edison may have been somewhat overly optimistic about the “give no medicine” prediction, but was certainly perceptive in predicting fundamental change in approach. Over the next few months, we’re going to engage a series of dialogues about the doctor, and medical school, of the future, beginning with our recent retreat and this article. Please feel free to participate with your thoughts as we “boldly go” about charting a course into the next few decades of medical practice and education.

 

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

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

Grade Inflation – the “dirty little secret” of academia

“Would any of us have gotten into medical school today?”

This was the tongue-in-cheek question I posed to my classmates at our medical school reunion last year. They were rather amused by it and, being very much aware of the high academic standards required by our current admissions processes, believed the answer was an obvious “no”. I tried to raise some doubt arguing (with what I thought at the time was more fantasy than reality) that our marks, like the dollar, had been “devalued” over the years. They weren’t really buying it. However, I’ve since come to learn that what I thought at the time was fanciful conjecture was closer to truth than I realized.

We’ve all become quite accustomed to the term “inflation” as it relates to economics. The dictionary definition goes like this:

 

“a continuing rise in the general price level usually attributed to an increase in the volume of money and credit relative to available goods and services.”

 

To those of us less financially sophisticated, it basically means a dollar doesn’t buy as much as it used to. The important corollary is that the amount of money we possess or earn becomes progressively less valuable as its purchasing power steadily diminishes.

It’s perhaps a little surprising to find the same term applied to academic grades. In fact, considerable information is available on the topic, which has been termed by some as the “dirty little secret” of university and college academic programs.

Well, if it’s a dirty little secret, it’s certainly not a very well kept secret. A Google search of the term took less than half a second to come up with over 4.5 million references:

 

 

 

There’s actually a website called GradeInflation.com that features the following chart prominently:

 

And so, a closer look at the phenomenon would seem to be in order. With the capable assistance of Sarah Wickett, Health Sciences Librarian, we identified a few key papers to shed a little more light on the topic. We set out to address three questions: Is there real evidence of grade inflation? If so, what are the causes? Does it matter?

 

Is it real?

Paul Anglin and Ronald Meng of the University of Windsor undertook a study of this issue that was published this year in Canadian Public Policy (volume xxvi:3). They compared the grades awarded by seven Ontario universities in 12 first year courses between 1974 and 1994. To summarize their findings:

  • The average GPA rose in 11 of the 12 courses. Of the 80 course-university combinations studied, 53% had grade inflation of at least 10%, 31% had no statistically significant change, and grades fell in 16%. The rate of inflation was not uniform, with the greatest increases occurring in English, Biology and Chemistry.
  • The percentage of students receiving an “A” increased overall from 16% in 1974 to 21% in 1994, while the percentage receiving “F”s declined from 9.5% to 6.7% during the same time. This trend was true in 11 of the 12 courses of study, with Sociology being the only exception. English, Biology, Music and French have the greatest increases at the upper end of the distribution. In Biology courses, for example, the percentage of students getting “A”s increased from 12.8 to 22.6%, while the percentage receiving “F”s declined from 9.1 to 5.7%.
  • The variance, or distribution of marks, within courses declined or stayed the same in all courses. In other words, the “bandwidth” between high and low achievement tended to diminish.

 

This phenomenon does not appear to unique to Ontario. In Studies in Higher Education (2017, 42:8;1580) Dr. Ray Buchan of the University of Brighton reports on the proportion of “good” or Honour degrees awarded by 100 universities in the United Kingdom. He reports an increase from 47.3% in 1994/95 to 61.4% in 2011/12, which in absolute terms represents an increase of 113%. Perhaps more significantly, the proportion of “first-class” degrees awarded more than doubled over the same time, increasing from 7 to 15.8%. In his article he quotes the Universities Minister David Willets who states: “the whole system of degree classification does need reform”.

There has been considerable study of this issue in American universities. Dr. Stuart Rojstaczer reported on 29 schools, showing and increase of 0.15 points on the 4 point GPA scale since the 1960s, with greater rates on increase in private versus public schools (Grade Inflation at American colleges and universities. Available at www.gradeinflation.com).

The University of Arkansas was concerned enough about grade inflation that it commissioned a Task Force on Grades in 2004 to examine the phenomenon. The results, reported by Mulvenon and Ferritor (International Journal of Learning 2005/2006;12(6):55) confirm steadily increasing undergraduate GPAs, increasing from 2.76 to 2.95 between 1992-93 and 2003-04.

 

What’s the cause?

So, it seems, this is a real phenomenon, but what’s the cause? One could conjecture three possible mechanisms:

 

Possibility 1: The students are better prepared.

Over the years, young people have had greater access to early education and have been exposed to more advanced educational methodologies. They have also had the benefit of rapidly expanding technology that not only enhances their educational experience but also enables them to access information and learning much more continuously and easily. In fact, young people are literally immersed in learning opportunities, both inside and outside the classroom. They have also had opportunities to engage more intellectually stimulating extra-curricular learning opportunities, both through the educational system and their private lives. Perhaps all this has resulted in young people who begin their post-secondary education with considerable advantages relative to their predecessors.

 

Possibility 2: Universities and colleges are doing a better job of educating.

There has certainly been an increased emphasis on teaching at most colleges and universities. Faculty are expected to have real teaching skills and qualifications, which are sought after and recognized. They have also benefited greatly from advances in educational methodologies and technologic advances.

All sounds good so far, but then there’s…

 

Possibility 3: It’s just easier for everyone involved to give good marks.

Good marks = happy students = fewer challenges for faculty = better faculty evaluations = happy faculty

We therefore have a “virtuous cycle” which would, on the surface, appear to be a “win-win” for all involved. The course, program and institution also benefit in an environment where pass rates are seen as a key marker of success (eg. Macleans magazine rankings) and students are drawn to places where they are more likely to achieve high grades that will make them more competitive for graduate studies and eventual employment.

Unfortunately, there’s been much less investigation into the causes of grade inflation. However, there have been some interesting analyses.

In an intriguing article entitled “Whose fault is it?” R.T. Jewell and colleagues attempt to determine whether higher grades are related to improved academic aptitude of students or changing practices among university teachers (Applied Economics 2013; 45: 1185). Using data from 1683 separate courses taught in 28 different departments by 3176 instructors at a large public university over a 20 year period they develop a series of complex mathematical models that leads them to conclude that “the average GPA in our sample…increased by 0.1459 grade points due solely to unobservable instructor characteristics.” They go on to identify instructor-specific issues as the main determinants of grade inflation. Their analysis did not allow them to be more specific about the nature of those characteristics.

In the Arkansas Task Force reported cited above, the authors speculate on a number of potential causes, including higher entrance ACT scores, but conclude “ a definitive case can be made that increasing entrance scored, academic expectations and better secondary institutions are contributing increased composite grade point averages. However, given this is true, it still does not explain all of the grade inflation”

 

And so, it would appear that the third cause where students, faculty and universities all benefit from a more liberal distribution of grades is at least a contributor.

 

Does it matter?

In one respect, it might be tempting to shrug this off as a “win-win-win” situation, in which students benefit, teaching faculty avoid the inherently difficult and stressful task of comparing and quantitating differences in the accomplishment of their learners, and institutions can develop flattering metrics that keep them competitive.

However, we recognize there’s no free lunch, and there are clearly costs to all this that merit consideration. A few that come to mind:

  1. Devaluation of degrees and diplomas. Just as our dollars lose value in the context of economic inflation, grade inflation threatens to diminish the value of our degrees and diplomas
  2. Fairness. The truly outstanding and highly committed students get lost amid all the high marks. Some of those A’s really are A’s, but can’t be distinguished from those that perhaps shouldn’t be.
  3. Misconceptions among students. Grade inflation may be giving students misinformation regarding their strengths and weaknesses, and therefore leading them to inappropriate career decisions.
  4. Confusion on the part of downstream programs and potential employers. Providing misleading academic profiles can lead to poor selections, which, ultimately, are unfortunate and potentially very damaging for all involved. What may seem like a charitable act can therefore turn out to be quite the opposite.

 

In case I’ve left anyone with the impression that this is an entirely modern phenomenon, let me end by quoting a report from the Committee on Raising the Standard, commissioned by Harvard University officials in 1894:

 

“Grades A and B are sometimes given too readily – Grade A for work of not very high merit, and Grade B for work not far above mediocrity”

 

If that group stemmed the tide, it would appear from recent studies that the issue has re-emerged.

Getting back to the question I initially posed at the beginning of this article, all this may provide some solace to my classmates, but as an institution that prides itself on high standards and academic excellence, should we be concerned?

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

 

Many thanks to Sarah Wickett, Health Informatics Librarian, Bracken Library, for her valuable assistance in the compilation of information for this article.

 

 

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Students striving to make a difference in our community

One of the attributes that our Admissions Committee works very hard to identify in applicants is a commitment to service. This has multiple dimensions, involving service to both individual patients and communities. It’s therefore always very gratifying to learn of efforts such as that described below in todays guest article provided by students Lauren Wilson, Katherine Rabicki and Melissa Lorenzo.

 

In Canada, access to health care is seen as a universal right.  When people think of access to care, however, we tend to define it by the availability of medically necessary procedures and frequently neglect consideration of preventative measures.

Cervical cancer has few symptoms, therefore it often progresses to a late stage before it is diagnosed. Yet cervical cancer is the most preventable of all cancers. By having pap smear screening tests, minor cervical abnormalities can be identified early and followed to ensure proper treatment. Pap smears have proven to be incredibly effective screening measures… so long as patients have access. Patients without a family physician or who cannot attend regular clinic hours often slip through the cracks, and as a result they may receive a cancer diagnosis that could have been easily prevented. Moreover, with the screening guidelines constantly in flux, patients may have outdated information regarding their eligibility.

Barriers to women’s health and access to care, including regular pap smears, are abundant.  To name a few: patients may not have a primary care provider, be able to attend daytime clinic hours, had a negative experience in the past, or have a history of abuse.  A significant barrier, that cannot be understated, is that pap smears are part of an intimate examination. Extra effort must therefore be made to cultivate a care environment that is sensitive and safe, in addition to accessible.

Started in 2015 during Cervical Cancer Awareness Week to help reduce barriers to care, Pap Party aims to educate the public on the importance of cervical cancer screening and to provide a safe space for eligible patients to be screened. Unfortunately, many women facing these barriers (and more) are from marginalized or underserved populations, including First Nations’ communities. While reducing the barriers completely will take years due to their multifactorial nature, expanding Pap Party clinics to outside the Kingston city limits serves as a critical step towards providing marginalized populations safe, accessible care. As all of our clinics, including in Kingston, Deseronto, Napanee, and Tyendinaga were situated in Indigenous territory, we worked hard to ensure the clinics were run in a culturally sensitive manner so that patients could receive the best possible care.

In 2016, 18% of the individuals who came to our Pap Party clinics were found to have abnormal pap smears that required follow-up by Gynecologic Oncology at Kingston Health Sciences – Kingston General Hospital site. Had it not been for these clinics, these patients may have never been identified!

In addition to running these clinics, this year we also promoted Cervical Cancer Awareness Week to all clinics in the South Eastern region to encourage clinics to host their own Pap Party. We are incredibly happy to announce that several clinics also hosted Pap parties including Kingston Street Health, and clinics in Belleville and Verona.

Every year more and more women are getting tested. We are proud to announce that this past week, Oct 16-19 2017, we had over 30 women attend our clinics and receive a pap test. Many of these women did not have family physicians and would have otherwise not had accessible access to pap tests.

If you are interested in hosting your own Pap Party, or finding an available clinic, you can find more information at https://fmwc.ca/events/pap-campaign/

We could not be more excited to have been a part of such an important campaign! Thank you to all the Queen’s University Obstetricians and Gynecologist residents and medical student volunteers who made this event possible.

 

Lauren Wilson, Katherine Rabicki (Queen’s Medicine Class of 2019), and Melissa Lorenzo (Queen’s Medicine Class of 2018)

 

 

 

 

 

 

 

 

 

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Mentorship isn’t rocket science – or is it?

One of the most consequential communications in modern history took the form a letter sent by Albert Einstein to American President Franklin Roosevelt on August 2, 1939.

“Sir: Some recent work by E. Fermi and L. Szilard, which has been communicated to me in manuscript, leads me to expect that the element uranium may be turned into a new and important source of energy in the immediate future. Certain aspects of the situation which has arisen seem to call for watchfulness and if necessary, quick action on the part of the Administration. I believe therefore that it is my duty to bring to your attention the following facts and recommendations.”

They go on to describe how a “nuclear chain reaction” could be produced that could result in the development of “extremely powerful bombs”. They further warn that German scientists were engaged in this work and were actively preserving sources of uranium in Czechoslovakia.

The message was not lost on Roosevelt, who was said to have declared to his aides, “This requires action.”

He responded to Einstein shortly after receiving the letter:

“I found this data of such import that I have convened a Board consisting of the head of the Bureau of Standards and a chosen representative of the Army and Navy to thoroughly investigate the possibilities of your suggestion regarding the element of uranium.”

This led to the development of the Manhattan Project, a massive research project which eventually involved 130,000 people at over 20 sites around the United States (and Canada) requiring an investment of 27 billion (current day equivalent) dollars. Although the purpose was to develop weaponry to ensure success in the Second World War, it also resulted in advances in the understanding of nuclear technology and energy.

Although many will have reservations about the motivation or eventual outcome of the project, it’s an impressive story as to how history can turn on a single, well placed communication.

What’s not widely appreciated is that the original motivation to write the letter came not from Einstein, but from Leo Szilard.

Szilard was a Hungarian born physicist and former pupil of Einstein. As a student at

Leo Szilard

the University of Berlin in the 1920s, he impressed Einstein (no small feat), who awarded him highest honours for his doctoral dissertation. The two then began a seven year professional collaboration that resulted in a number of inventions, including the Einstein-Szilard linear induction pump. Szilard went on to distinguish himself independently, and is credited with conceiving the concept of the neutron chain reaction, which led to pioneering work in atomic energy.

During the 1930’s, his belief in the power and potential of nuclear energy was not universally shared among the scientific community. Szilard was becoming concerned about the increasing research and military interest emerging in Hitler’s Germany. In an attempt to enlist support and sound the alarm, he turned to his old friend and mentor.

During the summer of 1939, Einstein was vacationing on Long Island. Szilard would drive from where he was working in Manhattan to visit his former teacher, who would greet him in rumpled clothes and invite him to tea on his porch.

Einstein and Szilard, from a documentary recreating the events of 1939

There, Szilard presented available research, his theories and concerns, eventually convincing Einstein of the threat. Together, they decided to take action, and enlisted the help of Alexander Sachs, an economist and close advisor of the President, who agreed to take a letter personally to Roosevelt. They agreed the best approach would be a short, direct communication, signed by Einstein alone.

 

This account has much to teach us about social responsibility of scientists and the importance of effective communication between the academic and political communities. However, the message that struck me, and which is most relevant to a medical education blog, relates to the relationship between a student and their trusted teacher-mentor. None of these events would have transpired if there had not been a relationship of trust between Einstein and Szilard.

 

Here at Queen’s, we have many examples of very effective mentoring of our students by engaged faculty members. An example that recently came to my attention involves a cardiologist colleague of mine, Dr. Adrian Baranchuk, whose mentoring of two students Bryce Alexander and Sohaib Haseeb has recently resulted in a review article in Circulation, one of the most prestigious journals in the cardiovascular world (Haseeb S, Alexander B, Baranchuk A. Circulation 2017;136:1434-48). In fact, Dr. Baranchuk has a long history of supporting countless students and residents. These collaborations have resulted in many publications and, more importantly, continuing mentoring relationships that now extend across the country.

Dr. Adrian Baranchuk
Bryce Alexander
Sohaib Haseeb

 

 

 

 

 

 

 

 

 

 

 

Universities should strive to not only transfer knowledge to our students, but to help them develop as responsible and free thinkers who will themselves contribute to society and, in turn, pass along those values, perhaps eventually even teaching the teachers. These intergenerational, continuing mentor-mentee relationships are essential to those goals, as the Einstein-Szilard story illustrates. I’m pleased to report that, thanks to dedicated teachers like Dr. Baranchuk, it’s also very much alive at Queen’s.

 

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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The Meds 2019 Clinical Clerks hit the streets.

Here they come.

This week, the class of Meds 2019 begin their Clinical Clerkship. Although this is only the half-way point in their medical education, it is a highly significant milestone, marking transition from a program dominated by largely classroom based knowledge and skills acquisition, to “real life” learning in a variety of clinical placements and elective experiences. Last Friday, this occasion was marked by a White Coat Ceremony, conducted by Dr. Armita Rahmani.

 

Photo by Bernard Clark

 

To further mark the occasion, I reprise my Top Ten list of tips for Clerkship. In doing so, I recognize that these points are intended not only for the students themselves, but also for the faculty members who will be supervising and supporting them in their various clinical placements. It can sometimes be difficult to remember the challenges faced by our students entering the clinical environment for the first time. I would draw particular attention to points 9 and 10.

 

So, here goes, in no particular order…

  1. Show up, and show up on time. It all starts with dependability. Even the most brilliant among us are useless if absent or unreliable. On the other hand, there will always be a welcome for the honest, steady contributor. If you are late, apologize, and do not show up with the coffee or snack that you picked up on the way.

 

  1. Repeat after me: “I don’t know. Self-awareness is right up there with dependability. There will be things you don’t know. There will be things nobody knows. You will not get into trouble or lessen your reputation by admitting to a lack of knowledge or experience with a particular clinical situation or procedure. After all, you’re a medical student, you’re not supposed to know everything! You do need to know what you don’t know. You will have major problems if you compromise a patient’s care through your unwillingness to admit limitations.

 

  1. Make it your business to learn about things you didn’t know first time. In fact, become an expert in that issue and look for opportunities to apply your new knowledge. When you do, you’ll find it intoxicating, and will search out even more knowledge. Careers have been built on less. Regard every patient and fresh problem you encounter as your curriculum. Keep track. You’ll be amazed at what you’ll be learning, and how fast.

 

  1. Remember that no decision that’s made honestly and in the patient’s best interest can be wrong. Anything we recommend for our patients, even the simplest decision, test or therapeutic intervention must meet one of three (and only three) criteria – it must relieve symptoms, improve functional capacity or increase life expectancy. There is no other justification for any intervention. You can’t be wrong for trying honestly to achieve one of those goals.

 

  1. And yet, things can go wrong... Even the best and most obvious decision may not go the way we intend or hope for. When things do go wrong and patients suffer adverse outcomes, it must be openly acknowledged and understood to ensure everyone (including you) learns from that outcome and becomes a better provider. As a medical student, you will not be the responsible party, but are nonetheless in a position to learn. Don’t be afraid to engage such situations, and don’t hesitate to discuss your feelings and reactions with more experienced people.

 

  1. Ask questions. Not to impress or stand out, but because you really want to know, and are concerned about the impact on your patient. Ask respectfully, but don’t be afraid to challenge decisions. Good clinicians don’t mind being asked to explain what they’re doing. Really, they don’t.

 

  1. Get along. With everybody, not just those you think are important. Do this all the time. Everyone you encounter knows more about the practical aspects of health care delivery than you do. They all have something valuable to pass along if you’re attentive and receptive. I’m going to use a key word here: Humility. People can sense it and respond positively to it. The opposite is arrogance, which people can also sense but respond to quite differently.

 

  1. Eat, sleep, laugh. You’ll be busy, but not so busy that you won’t have opportunity to look after your own well-being. Use your down time wisely. Plan meals and recreation. Surround yourself with people who know you well and have the capacity to make you laugh. They will become increasingly precious to you. Talk to them.

 

  1. Be open to possibilities. If you think you’ve decided on career choice, don’t be shocked (or worse yet, disappointed) if something unexpected emerges. If you feel strongly conflicted, there’s probably a good reason. Talk it out with someone and remember it’s never really too late to change. If you can’t decide because everything seems great, that’s a good thing, but you might also need to talk it out. We’re available.

 

  1. And finally… look after each other. You know each other very well, and will know when someone is having difficulties, likely before they know it themselves. Don’t be afraid to reach out, or to seek advice or help. Our Student Affairs staff, headed by Dr. Fitzpatrick, and myself are all available to you or your colleague, as well as Beck Haist, Student Counselor. Remember QMed Help, the red button available on MedTech.

 

So there you have my list. Happy to receive revisions, additions or comments from readers. Final word to our students – enjoy. Clerkship is a time to grow and learn.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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Welcoming Queen’s Meds 2021

The academic cycle is such that, for a few short weeks each summer, our student population reduces by a quarter. Last May, we graduated and congratulated the class of Meds 2017, who have now gone on to engage the next phase their careers. This week, our school continues its cycle of annual renewal, welcoming another eager and very promising group of aspiring physicians, the class of Meds 2021.

 

Picture by Lars Hagberg of incoming med students for Queen’s School of Medicine.

 

A few facts about our new colleagues:

They were selected from a pool of 4752 highly qualified students who submitted applications last fall.

Their average age is 23 with a range of 19 to 34 years.  Fifty-eight percent are women. They hail from no fewer than 39 communities across Canada, including; Ajax, Aurora, Bancroft, Brampton, Brantford, Burnaby, Calgary, Deseronto, Dunnville, Edmonton, Etobicoke, Guelph, Hamilton, Kelowna, Kingston, Maple, Markham, Milton, Mississauga, North Bay, North Saanich, North Vancouver, North York, Oakville, Orillia, Orleans, Oshawa, Ottawa, Peterborough, Pickering, Pointe Aux Roches, Richmond Hill, Scarborough, Severn, Surrey, Thornhill, Toronto, Vancouver and Vaughn.

Eighty-four of our new students have completed an Undergraduate degree, and twenty-nine have postgraduate degrees, including seven PhDs. The universities they have attended and degree programs are listed below:

Universities of Undergraduate Studies

Carleton University
McGill University
McMaster University
Novosilbirsk State University
Queen’s University
Ryerson University
Simon Fraser University
Trent University
Trinity Western
University of British Columbia
University of Calgary
University of Cambridge
University of Guelph
University of Ottawa
University of Toronto
University of Waterloo
Vassar College
Western University
York University

 

Undergraduate Degree Majors

Biochemistry
Biology
Biomedical Science
Business Administration
Chemical Biology
Chemical Engineering
Cognitive Science
Electrical Engineering
English
French Studies
Gender Studies
Global Development
Health Science
Integrated Science
Kinesiology
Life Science
Medical Science
Neuroscience
Nursing
Physiology
Psychology

 

An academically diverse and very qualified group, to be sure.  Last week, they undertook a variety of orientation activities organized by both faculty and their upper year colleagues.

On their first day, they were called upon to demonstrate commitment to their studies, their profession and their future patients.  They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers.  At that first session, they were welcomed by Dean Reznick who challenged them to be restless in the pursuit of their goals and the betterment of our society and shared with them a message from his favourite poet and recent Nobel Laueate Bob Dylan. Mr. Cale Templeton, Asesculapian Society President, welcomed them on behalf of their upper year colleagues, and Dr. Rachel Rooney provided them an introduction to fundamental concepts of medical professionalism.

Over the course of the week, they met curricular leaders who will particularly involved in their first year, including Dr. Michelle Gibson (Year 1 Director) and Dr. Cherie Jones (Clinical Skills Director). They were also introduced to Dr. Renee Fitzpatrick (Director of Student Affairs) and our excellent learner support team, including Drs. Martin Ten Hove, Jason Franklin, Kelly Howse, Susan Haley, Josh Lakoff, Craig Goldie and Erin Beattie, who oriented them to the Learner Wellness, Career Counseling and Academic Support services that will be provided throughout their years with us. They met members of our superb administrative and educational support teams led by Jacqueline Findlay, Jennifer Saunders, Sheila Pinchin, Amanda Consack, and first year Curricular Coordinator Corinne Bochsma.

Dr. Susan Moffatt organized and coordinated the very popular and much appreciated “Pearls of Wisdom” session, where fourth year students nominate and introduce faculty members who have been particularly impactful in their education, and invite them to pass on a few words of advice to the new students. This year, Drs. Erin Beattie, Bob Connelly, Filip Gilic, Robyn Houlden, Vickie Martin, Alex Menard, Laura Milne, Heather Murray, Cliff Rice and Ruth Wilson were selected for this honour.

On Friday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Michelle Gibson.

Their Meds 2020 upper year colleagues welcomed them with a number of formal and not-so-formal events. These included sessions intended to promote an inclusive learning environment, as well as orientations to Queen’s and Kingston, introductions to the mentorship program, and a variety of evening social events which, judging by appearances the next morning, were much enjoyed.

For all these arrangements, flawlessly coordinated, I’m very grateful to Rebecca Jozsa, our Admissions Officer.

I invite you to join me in welcoming these new members of our school and medical community.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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Welcoming Queen’s Meds 2021

The academic cycle is such that, for a few short weeks each summer, our student population reduces by a quarter. Last May, we graduated and congratulated the class of Meds 2017, who have now gone on to engage the next phase their careers. This week, our school continues its cycle of annual renewal, welcoming another eager and very promising group of aspiring physicians, the class of Meds 2021.

 

Picture by Lars Hagberg of incoming med students for Queen’s School of Medicine.

 

A few facts about our new colleagues:

They were selected from a pool of 4752 highly qualified students who submitted applications last fall.

Their average age is 23 with a range of 19 to 34 years.  Fifty-eight percent are women. They hail from no fewer than 39 communities across Canada, including; Ajax, Aurora, Bancroft, Brampton, Brantford, Burnaby, Calgary, Deseronto, Dunnville, Edmonton, Etobicoke, Guelph, Hamilton, Kelowna, Kingston, Maple, Markham, Milton, Mississauga, North Bay, North Saanich, North Vancouver, North York, Oakville, Orillia, Orleans, Oshawa, Ottawa, Peterborough, Pickering, Pointe Aux Roches, Richmond Hill, Scarborough, Severn, Surrey, Thornhill, Toronto, Vancouver and Vaughn.

Eighty-four of our new students have completed an Undergraduate degree, and twenty-nine have postgraduate degrees, including seven PhDs. The universities they have attended and degree programs are listed below:

Universities of Undergraduate Studies

Carleton University
McGill University
McMaster University
Novosilbirsk State University
Queen’s University
Ryerson University
Simon Fraser University
Trent University
Trinity Western
University of British Columbia
University of Calgary
University of Cambridge
University of Guelph
University of Ottawa
University of Toronto
University of Waterloo
Vassar College
Western University
York University

 

Undergraduate Degree Majors

Biochemistry
Biology
Biomedical Science
Business Administration
Chemical Biology
Chemical Engineering
Cognitive Science
Electrical Engineering
English
French Studies
Gender Studies
Global Development
Health Science
Integrated Science
Kinesiology
Life Science
Medical Science
Neuroscience
Nursing
Physiology
Psychology

 

An academically diverse and very qualified group, to be sure.  Last week, they undertook a variety of orientation activities organized by both faculty and their upper year colleagues.

On their first day, they were called upon to demonstrate commitment to their studies, their profession and their future patients.  They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers.  At that first session, they were welcomed by Dean Reznick who challenged them to be restless in the pursuit of their goals and the betterment of our society and shared with them a message from his favourite poet and recent Nobel Laueate Bob Dylan. Mr. Cale Templeton, Asesculapian Society President, welcomed them on behalf of their upper year colleagues, and Dr. Rachel Rooney provided them an introduction to fundamental concepts of medical professionalism.

Over the course of the week, they met curricular leaders who will particularly involved in their first year, including Dr. Michelle Gibson (Year 1 Director) and Dr. Cherie Jones (Clinical Skills Director). They were also introduced to Dr. Renee Fitzpatrick (Director of Student Affairs) and our excellent learner support team, including Drs. Martin Ten Hove, Jason Franklin, Kelly Howse, Susan Haley, Josh Lakoff, Craig Goldie and Erin Beattie, who oriented them to the Learner Wellness, Career Counseling and Academic Support services that will be provided throughout their years with us. They met members of our superb administrative and educational support teams led by Jacqueline Findlay, Jennifer Saunders, Sheila Pinchin, Amanda Consack, and first year Curricular Coordinator Corinne Bochsma.

Dr. Susan Moffatt organized and coordinated the very popular and much appreciated “Pearls of Wisdom” session, where fourth year students nominate and introduce faculty members who have been particularly impactful in their education, and invite them to pass on a few words of advice to the new students. This year, Drs. Erin Beattie, Bob Connelly, Filip Gilic, Robyn Houlden, Vickie Martin, Alex Menard, Laura Milne, Heather Murray, Cliff Rice and Ruth Wilson were selected for this honour.

On Friday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Michelle Gibson.

Their Meds 2020 upper year colleagues welcomed them with a number of formal and not-so-formal events. These included sessions intended to promote an inclusive learning environment, as well as orientations to Queen’s and Kingston, introductions to the mentorship program, and a variety of evening social events which, judging by appearances the next morning, were much enjoyed.

For all these arrangements, flawlessly coordinated, I’m very grateful to Rebecca Jozsa, our Admissions Officer.

I invite you to join me in welcoming these new members of our school and medical community.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

Posted on

Hope Amidst the Chaos of Charlottesville

Archbishop Desmond Tutu has defined hope as “being able to see that there is light despite all the darkness”.

It is difficult to find such light amid the darkness of the recent events in Charlottesville and their aftermath.

But such dark times are certainly not unprecedented in the history of our American neighbours.

Two hundred and fifty-five years ago, 56 rebellious colonists courageously broke their allegiance with a powerful monarch who they felt had been treating them unjustly. In what was an act of treason, they declared and justified their independence with the following words:

“We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness.”

Fewer than ninety years later, the nation that emerged from that rebellion found itself engaged in a highly destructive civil war, caused largely by a failure to achieve those founding principles. In a brief but highly influential speech their leader at the time, Abraham Lincoln, justified the struggle and sacrifice by re-affirming those founding principles. He spoke of a nation “conceived in liberty and dedicated tothe proposition that all men are created equal”,and vowed that his nation would have “a new birth of freedom” ensuring that “government of the people, by the people, for the people, shall not perish from the earth.”

About a hundred years later, that same nation found itself again engaged in civil unrest arising from unresolved racial tensions and failed attempts to finally achieve its founding ideals. On a hot August day, standing at the base of a memorial dedicated to the very same President Lincoln, the Reverend Martin Luther King said:

“I have a dream that one day on the red hills of Georgia, the sons of former slaves and sons of former slave owners will be able to sit down together at the table of brotherhood”

In each case, the authors of these words were not expressing the realities of their times. Far from it. Rather they were giving eloquent expression to what they believed to be the values to which their nation, and any truly just society, should strive. They were expressing an aspiration, which faithful believers would contend, should remain in the collective consciousness, guiding decisions to continually approach the goal of full equality. Put simply, they were expressing hope.

This time, there is no soaring, inspirational eloquence recalling higher ideals and keeping hope alive. In fact, the actions and words of the current leadership evoke quite the opposite. Many, both within and without the borders of the United States, must be wondering whether the great American experiment in democracy and individual freedom has finally “perished from the earth”? Was the goal expressed in the original declaration (ironically penned by the most famous former citizen of Charlottesville) and re-affirmed so many times over the years, simply too much to expect of any group of mortal, flawed people. Where’s the hope?

For me, at least, hope was re-kindled in a single image captured by an amateur photographer with her cellphone, It depicts a Charlottesville police officer, himself African-American, standing guard at a barricade maintaining order despite the actions of those “protestors” whose overtly racist attitudes would bring harm to him and those closest to him.

A post shared by Jill Mumie (@lil_mooms) on

Photo by Jill Mumie

The officer, Darius Nash, later wrote in response to his unexpected notoriety:

“I don’t feel like I’m a hero for it…I swore to protect my city and that’s what I was there to do. I don’t think it makes me a hero, just doing what I believe in.”1

At the same time that this police officer was doing what he believed in, his president and Commander-in-Chief was reluctant to condemn the actions of the other folks in this image and was finding fault in those who challenged them.

Who, of these two, is truly representative of today’s America? One would normally presume that the words and actions of the elected leader of a free people would represent the collective values of that nation. Hope for continuation of the American dream, it would seem, rests on whether the attitudes of this great people are best and most accurately expressed by its current president, or by the words and actions of a Charlottesville police officer.

I, for one, chose to believe, or hope, it’s the policeman. Like many Canadians, I follow American history and events closely. I know and count as friends (and even family members) many Americans. I have, for a time, lived among them. I have found that the vast majority of Americans are fair, decent and tolerant people. They are candid and pragmatic in addressing their social issues. They are proud of their nation and believe in its founding principles. They have been through remarkably difficult challenges and their political structures, although imperfect, have proven resilient under both internal and external threat. Ultimately, they are not a people to stand idly by and watch their values corrupted.

And we’re already seeing signs of that resolve.

Former presidents GHW Bush, GW Bush2 and Obama3 have all issued statements condemning bigotry and re-affirming the principles of equality – astounding gestures that attempt to fill the moral vacuum left by their successor.

Prominent business leaders, such as Merck CEO Kenneth Frazier, have resigned from influential presidential advisory panels4, risking loss of influence and the ire of the standing president.

Many athletes and celebrities have refused honours and invitations to the White House in protest5.

Most recently, more enlightened forces seem to be emerging in the White House itself, resulting in the firing of Steve Bannon, Chief strategist and former election campaign chair who was a driving force in this administration’s nationalistic, anti-globalization and anti-environmental agenda6. Mr. Bannon, one might recall, was formerly executive chairman of Breitbart News, which promoted the efforts and collaboration of “alt-right” groups such as neo-Nazis7.

So perhaps the tide is beginning to turn. Governments are like huge ocean-going vessels, built for the long voyage and therefore slow to adjust course.

In the words of Mr. Bannon, related to the Weekly Standard after his firing, “The Trump presidency that we fought for and won, is over”8.

Let’s hope that he’s at least right about that.

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

  1. http://time.com/4899668/charlottesville-virginia-protest-officer-kkk-photo/
  2. http://time.com/4903103/george-bush-president-statement-hatred-charlottesville/
  3. https://www.techspot.com/news/70602-obama-statement-response-charlottesville-protest-now-most-liked.html
  4. http://money.mlive.com/dynamic/stories/U/US_TRUMP_MERCK_CEO?SITE=AP&SECTION=HOME&TEMPLATE=DEFAULT&CTIME=2017-08-14-22-01-01
  5. http://www.smh.com.au/world/trump-to-skip-kennedy-centre-honours-ceremony-20170819-gy01v5.html
  6. Globe and Mail, Aug 19, 2017
  7. http://www.newstatesman.com/world/2017/03/alt-right-leninist
  8. http://www.weeklystandard.com/bannon-the-trump-presidency-that-we-fought-for-and-won-is-over./article/2009355

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