MD Program Executive Committee Meeting Highlights Wednesday May 21, 2014 at 4:30 pm

Learner Wellness Update:

Plans are continuing to secure an additional student counselor who would work at arms-length from the School of Medicine to act as both a Student Counselor and Ombudsman.   A description of the position is being developed with the intention of filling the posting for the upcoming academic cycle.

Dr. Fitzpatrick, Director of Learner Wellness, continues to review and improve both the Learner Wellness and Career Counselling services.

Conflict of Interest Procedures:

The Committee reviewed and approved the implementation of the finalized conflict of interest procedures. These procedures are being developed in advance of the Faculty policy on Conflict of Interest.   Staff will develop plans for the operationalization of the procedures and present at a future meeting.

Admissions:

The offer process for admissions to the program is well underway. The Committee reviewed the existing deferral policy and requested that the Admissions Committee look at revising it to reflect current Admission practices.

OSCE Team Terms of Reference:

An OSCE Team has been established in order to facilitate the development and running of OSCEs within both the UGME and PGME programs. The team works as an advisory body to both the PGME office and the UGME Student Assessment Committee. Terms of reference for this group was presented to the committee and approved.   The OSCE team continues efforts establish a working panel of faculty whose role will be to develop OSCE stations as well as support the established OSCE within both programs.

Policy: Use, Revision and Dissemination of the Queen’s UGME Competency Framework (Policy #CC-11)

This policy captures what has been happening in the Curriculum Committee for the past 5 years with the major curriculum document, but has never been formalized nor systematized.

“Since the Queen’s Undergraduate Medical Education Competency Framework is the foundation on which the School of Medicine’s curriculum is based, it is essential that its use, revision and dissemination be regulated systematically through a policy and through procedures arising from the policy.”

The implementation of this policy will have medium impact to faculty, students and staff requiring limited changes to processes, forms and/or conduct.
The Committee approved the policy and it is now posted on the UGME website for review: http://meds.queensu.ca/education/undergraduate/policies

 

Next Meeting: June 18, 2014

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Dear Meds 2014… One last SAQ

Dear Meds 2014,

Since this picture was taken in September 2010, you have successfully undertaken no fewer than 38 courses of study, as well as numerous projects, reflections, surveys, and various exercises intended to prepare you to be effective physicians.  In doing so, you have engaged and answered (usually correctly) several thousand individual questions of various types.

classof2014

I have one more for you.  Don’t worry, it’s formative.  Here it is:

Identify these five famous historical figures, and describe what they have in common? Warning: The second part has an easy answer, but bonus points for the less obvious.

famous

From left to right:

Albert Einstein was, arguably, the most famous scientist of the twentieth century, revolutionizing the way we consider nuclear power, time and space.  In his later career, he became very much involved in social causes, largely related to promoting peaceful applications of this emerging technology.

Mahatma Ghandi led the Indian nation to independence.  In doing so, he became a symbol of non-violent protest.

Mother Teresa originated and led a charitable movement in Calcutta that has not only given rise to numerous similar efforts, but also drawn attention to the plight of the poor worldwide and provided an example of what can be accomplished through non-political personal effort.

Martin Luther King led the American civil rights movement in the fifties and sixties.  Through his brilliant oratory and philosophy of non-violent protest he became the rallying point for millions.  He was considered to be more influential than any elected official, including the President.

Norman Bethune was a Canadian physician who devoted his career to a series of roles, all serving underserviced populations in need.  He has become an internationally famous example and embodiment of the socially active physician.  His recently released biography (Pheonix: The Life of Norman Bethune, by Roderick Stewart and Sharon Stewart) is a great read.

The obvious similarity is that they all led positive social change.  Different contexts and different styles to be sure, but all tremendously effective leaders.

The less obvious answer is that they led without any political or organizational mandate to do so.  They had no direct authority over others (although Ghandi was eventually elected to public office, I would argue it was after he had achieved social activism). Their leadership emanated from their ability to express their vision, and their willingness to become personally involved in the solutions.  The qualities they exhibited were compassion (to the needs of their fellow citizens), courage (to express dissenting or unpopular views), and commitment (to give of themselves and become personally involved in the solutions).  Their leadership was not in the pursuit of personal advancement or glory, and their influence arose from the recognition of that truth by their fellow citizens.  To use a well-worn vernacular, they not only talked the talk, they also walked the walk, and that quality is always intuitively obvious to everyone.

So, what has all this to do with you, the graduates of Meds 2014, shown below at your White Coat Ceremony only 2 years ago, and now ready to be released upon an unsuspecting world?

2014grads

This is all obviously my fairly heavy-handed challenge as you leave the nest and take up the next stage of your professional careers.  A physician’s work, as I’m sure you’ve come to learn, is in large part about the very qualities of compassion, courage and commitment exhibited by the famous historical figures I described.  You have those qualities.  Beyond your individual practices, each of you will encounter opportunities to have a positive influence within the communities and organizations in which you find yourselves.  I hope you’ll be open to those opportunities, enticed by the potential to bring about positive change within your world, and willing to devote the effort required realizing those results.  Real leadership is tough.

Dare to lead.

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Real life lessons in Interprofessional Practice

real-life-lessonsThe term “ivory tower” apparently has its origin in the Song of Solomon (7:4) where the writer describes the beauty of his beloved with a list of poetic terms, including “your neck is like a tower of ivory”.  The image found its way into descriptions of venerable figures, as depicted in “Hunt of the Unicorn Annunciation” (circa 1500).  For obscure reasons, the term has, over the centuries, come to be used to refer to “a world or atmosphere where intellectuals engage in pursuits that are disconnected from the practical concerns of everyday life” (Wikipedia).

University faculty are often accused of such intellectual self-indulgence.  They can seem disconnected from the “real world” issues and challenges faced by practitioners of their respective disciplines.  Physicians engaged in both care delivery and medical education might think themselves somewhat protected from the “ivory tower” mentality.  I have certainly been of that opinion; at least until a recent “real life” experience has caused me to question that assumption as it relates to how we educate our learners with respect to interprofessional practice.

The development of educational processes that teach and promote Interprofessional Care and Practice has proven to be one of the biggest challenges faced by our school and faculty.  The largest obstacles, in my view, have been two-fold.  The first is purely pragmatic.  It is very difficult to bring together the complex and very full curricula of multiple educational programs.  Finding “space” in the packed schedules of our learners that coincide with compatible points in their separate learning continuums is a considerable logistic challenge, and will always be limited.  The second issue is more philosophical.  To be successful, any educational initiative must be directed toward clearly understood and mutually accepted objectives.  Both teachers and learners must have a common understanding of the desired outcome.  Simply put, they need to share a vision of the “final product”.  Although we, and most schools, have developed articulate vision statements, I believe we lack a practical and commonly accepted understanding of that “final product” of Interprofessional Education programs.  Our “ivory tower”, in this instance, has perhaps become a little too high to see what’s needed on the ground.

This brings me to my recent “real life” revelation.  My parents are now 91 and 86 years of age.  My father has increasing health issues that require regular supervision and assistance.  They have lived in the same small community all their 60+ years of marriage, and wish to remain in the home that they built for their retirement.  My siblings and I, as well as all involved in their care, agree this is the best option for them and, frankly, the desired option for all seniors wherever practical.  Achieving this is becoming increasingly complex.  They are blessed to have an absolutely incredible Family Physician with whom I communicate regularly.  On a recent visit to my parents, we agreed to meet while I was there to update on a few issues.  He took the opportunity to ask some other individuals involved in my parents care to join us.  So, on a weekday morning, in my parents’ living room in that small community, a Family Physician, visiting Home Care nurse and Personal Support Worker met with myself and one of my sisters with both my parents in attendance.  We were in telephone contact that morning with the Home Care supervisor, Respiratory Technician, Heart Failure Nurse Specialist, as well as the local Pharmacist who packages my father’s medications and is very familiar with recent changes.  The complexity and extent of care required to support my parents was not a surprise to me.  What I’ve had trouble imagining is how it could all possibly be coordinated in the home.

That morning, as I watched this process work so effectively, it became apparent that the single most essential key to success was that the contributions of each person were consistently centred on the welfare of their common patient.  People knew the technical aspects of their jobs, to be sure, but their focus never deviated from the patient.

The second key to success was in the listening.  Each individual was receptive to and respectful of the input of the other contributors, recognizing that the input of each was independently important to the central goal.  Interestingly, the input of the PSW was perhaps the most relevant and led the discussion, because that person was closest to and most familiar with the impact of everyone’s work on my parents themselves.  The Family Physician initiated the conversations, provided medical input a couple of times and, at the end, ensured everyone (including my parents themselves), had had the opportunity to get all their concerns and issues discussed.  There was no jockeying for dominance.  There was an openness and acceptance of each role that allowed everyone to make suggestions without fear of compromising their status.  There was, in short, a sense of trust and mutual respect that allowed full and effective collaborative effort.

Although this particular experience crystallized this issue in a personal way for me, I realize that these highly effective interprofessional interactions play out in our wards, clinics, offices, emergency departments and operating rooms every day.  They are becoming part and parcel of effective health care delivery, and provide a prime example of how our university based teaching programs must emulate and promote exemplary practice.

So what makes this work in the “real world”, and what lessons can we, ensconced in our Ivory Tower, take back to our educational programs that strive to teach and model optimal IP practice?  Based on our real world exemplars, I would suggest five principles that may provide useful points of departure to examine any IP teaching program:

  1. The purpose of IP practice must be to optimize patient care.  This is accomplished through common understanding and coordinated effort.  Our educational programs and those who lead them must share that single goal and reinforce it in their teaching programs.  IP must not be used to promote “political” causes.
  2. The various providers involved understand and accept that they cannot provide optimal care in isolation.  That is simply no longer a realistic goal, a reality that a visit to the home of my parents or any patients living with chronic issues will quickly make apparent.  Our educational programs must not simply state, but allow our learners to experience this reality.
  3. Health care providers must understand each other’s role in care delivery.  In practice, this is learned by practical experience.  Our educational processes must find ways to ensure providers learn these roles.  For this purpose, experiential learning in active practice is much more effective than theoretical exercises.
  4. There must be mutual respect.  This must be built on an understanding of the value of all contributions, and is best modeled through the behavior and attitudes of faculty.  The converse, of course, is that negative attitudes expressed through “hidden curriculum” behaviours can be highly damaging.
  5. Active practice opportunities are essential.  The awareness of roles, value, and mutual respect are best built through shared and successful practice opportunities where learners will find that their combined efforts bring added value. Their combined and cooperative effort, in essence, will be of greater value to their patients than the sum of individual and isolated efforts.

Our university based “ivory tower” can certainly provide a protected environment, isolated from the realities of clinical practice, and perhaps thus distracted by theoretical rather than practical concerns.  However, it can also provide a perspective from which we can appreciate the value of practices that are tested and successful in the “real life” arena, and motivated solely by the best interests of the patients we serve.  Many schools, including ours, have made great strides in IP education.  As we continue to strive to improve, we’d be well advised to pay close attention to the lived experience and successes occurring every day, so close to us all.

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“Reluctant Congratulations” to Dr. Ted Ashbury on his retirement

We would like to extend reluctant congratulations to Dr. Ted Ashbury on his retirement, and acknowledge his contributions to our Undergraduate Medical Program. 

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Here are remarks from Dr. Sanfilippo on the occasion of Dr. Ashbury’s retirement party:

Ted Ashbury has been as important as any individual to our curricular renewal over the past 7 years.  He was conscripted, somewhat deviously, to an Advisory Group that was formed in 2007 to completely review and overhaul the MD program.  In that process, Ted became the voice and strong proponent of Professionalism within the curriculum.  He chaired a working group consisting of dedicated faculty and students that developed effective and innovative teaching methods.  He participated actively in that teaching, and became the “face” of professionalism by speaking to the first year class annually on the first day of their medical school orientation.  Whether in the pre-clerkship or clinical rotations, Ted’s sincerity and the passion of his commitment to the advancement of professionalism, and to medical education in general, has always been at least as powerful as his words.  The students immediately identify him as the “real deal”, as someone who “walks the walk”.  Quite simply, they listen and try to emulate his example.  He has had an incredibly powerful and positive influence on a generation of Queen’s medical graduates.

In addition to being the voice of professionalism, Ted has been the voice of reason.  I have been incredibly grateful for his thoughtful and always tactful commentary at meetings, and for his continuing support and advice over the years.  The only thing that really gets me about Ted is this unfathomable notion that he needs to retire, but here’s hoping he comes to his senses at some point soon.  In any case, I fully intend to call from time to time for advice, whether he’s on a porch or in a boat, and welcome unsolicited commentary at any time.

I’d like to add a personal note as well.  I joined the Advisory Committee when Ted did and I was a rookie medical educational developer.  He was a constant source of support, of inspiration, and of knowledge as we all negotiated our foray into competency-based education and the development of a curriculum framework.  Throughout the next 7 years (!), collegial, collaborative, articulate, learned and wise, he taught and worked as he practised, and the students and I and many faculty and staff are much the better for it.  It’s my fervent hope that Ted will soon tire of the peace of retirement, and yearn for the excitement and pressure of life in UG, and return to us.  In the meantime, Ted, I can see you on that dock, relaxed in the sunshine, eyes looking ahead to the future!  Congratulations!

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There’s gold in those Ottawa Hills: Nuggets from the CCME and Ottawa Conference

Last week, a number of us from Queen’s School of Medicine were privileged to attend the Canadian Conference on Medical Education combined this year with the Ottawa Conference on assessment and evaluation, in Ottawa.

It was a jam-packed schedule with great ideas from medical education, teaching, assessment, evaluation, interprofessional education, Undergraduate, Post-Graduate and Continuing Medical Education and much more.  There were attendees from all over the world, as the Ottawa Conference is an international conference with conference locations that alternate among North America, Europe and Australia.

I’ve asked people for nuggets from the conference to share with you.  From my point of view, the whole conference was a panful of gold!

gold-nuggets

Here are some thoughts:
Dr. Tony Sanfilippo writes that the number and quality of submissions from Queen’s faculty and students were very impressive and indicative of an active and involved educational program.

In fact, from Queen’s there were:

  • 43 presenters of 13 posters
  • 52 presenters of 18 oral presentations
  • 2 presenters presenting at 1 symposium (Drs. Jane Griffiths and Karen Schultz on their portfolio and EPA work)
  • 16 presenters giving 9 workshops
  • 8 presenters giving 3 pre-conference workshops

(Thanks to Lori Rand for collecting these from the program!)

gold nugget 1Noteworthy:

  • Dr. Michelle Gibson and Dr. Bob Connelly were awarded the CAME Certificate of Merit Awards for teaching. Congratulations to them!
  • Dr. Danielle Blouin was awarded The Award for Outstanding Contribution to Faculty Development in Canada from the Association of Faculties of Medicine Canada (AFMC).  Congratulations!
  • Dr. Leslie Flynn gave a terrific talk at the Dean’s Reception, outlining all we’ve done in the Faculty of Health Sciences over the year.
  • Many of our meds students presented, including James Simpson, Marie Leung, Graydon Simmons  and Eve Purdy.
  • Meds students Rebecca Wang and Andrew Dhawan won the CHEC-CESC Virtual Patient Challenge, ($1000.00 prize) for  their online module Tackling Diabetes Together, Dr. Robyn Houlden, Advisor.
  • Stefania Spano, Meds 2016, exhibited her artwork, entitled Talking to Myself (\/Dialogue avec moi-meme, featured in the White Coat, Warm Art exhibit, below.

ccme-blog

Eleni Katsoulas who is the UG Assessment and Evaluation Consultant offers this advice from a great workshop on Remediation:  Make remediation learner-centred by using these steps:

  • Step 1:Identify areas of deficits in terms of three domains: 1) Communication skills/Professionalism; 2) Knowledge/Clinical Reasoning; and 3) Efficiency/Time Mgt
  • Step 2: Identify his/her Readiness to Learn (using Stages of Change Model): Pre-Contemplation; Contemplation; Preparation.
  • Step 3: Formulate a learner-centred remediation plan; include remediation and monitoring
  • Step 4: Consider possible facilitators & barriers for learner-centred remediation

Theresa Suart our Educational Developer, adds to this from another workshop on remediation:

  • It’s important to have a remediation strategy, rather than responding reactively to individual situations. Learners still need individualized remediation plans, but having a strategy for how to address these needs will improve learning and administration for all circumstances.
  • We need to understand why a student is failing before applying a solution.
  • A coach model can be effective.
  • All schools are wrestling with these challenges

gold nugget 1Eleni also offers this great, succinct selection from a symposium Bridging the Gap: How Medical Education and Measurement Science can Better Collaborate to Meet the Growing and Broadening Assessment Needs:

  1. Dr. Kevin Eva noted the importance of distinguishing between performance orientation (performed well, satisfaction from grades and task avoidance) vs. mastery orientation (become proficient, deepen engagement and stronger motivation).
  2. Dr. Eric Holmboe spoke of the importance of a shared model of responsibility between students and faculty, (for example, where portfolio is a verb not a noun) and making assessment an active process with a lot of learner engagement.
  3. Professor Dame Lesley Southgate asked, “Has Assessment killed judgment?” “No, she concludes, “Measurement informs judgment through better design of assessment programmes.”

Dr. Laura McEwen who is the PG Assessment and Evaluation Consultant, offers this insight after 4 days of attending events on assessment:  assessment is hard, and competency based assessment is harder!  smile

Actually, what she really wanted to offer was a nugget to all of us managing and prioritizing our work from one of the speakers:

Laura heard about the importance of systematically aligning responsibilities with goals.  And so periodically (3-6 month intervals) it’s important to review what you are “Doing”, “Planning”, and “Dreaming” as a means of strategically managing competing professional responsibilities and informing prioritizing in relation to managing your academic career.

Theresa Suart attended a workshop on reflection, and found these nuggets:

  • Remind learners that not all experiences are transformative. Learners may, in writing a critical reflection, uncover a transformative experience, but they may also (equally importantly) write about a confirmation of learning.
  • Consider using a short narrative prompt or a poem to help learners with reflections
  • What are we assessing? Students’ abilities to reflect, or the learning they are reflecting about?  Can we/should we do both at the same time?
  • Theresa noted that “We seem to be facing the same challenges at medical schools around the world – the best ways to support learners and faculty with the resources (time, staff, funding) at hand.”

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Dr. Peter O’Neill writes, “Queen’s success in the CaRMS match was shared across the country by sharing our careers curriculum and our student forms”

Dr. Michelle Gibson tweeted from Dr. Glen Regehr’s talk one of his many provocative slides:  (She actually took a photo of his slide and tweeted—an excellent way to collect, save and share from a presentation)

Everything we call cheating on high stakes exams we call good practice in the clinic:

  • Anticipating challenges and putting supports in place
  • Seeking collaboration and multiple perspectives on problems
  • Admitting we don’t know and looking it up instead of guessing
  • Double-checking rather than assuming you are right.

Working through pages and pages of notes, here’s what I found to share:

Adding to what we have learned about Entrustable Professional Activities (EPA), Dr. Ollie Ten Cate spoke about the “trust” part of entrustable and stressed the critical nature of observation in assessment and teaching.  Two resources I noted were:

  • Dr. Ten Cate spoke about the TED Talk, Should you trust your first impressions?  http://ed.ted.com/lessons/should-you-trust-your-first-impression-peter-mende-siedlecki#review
  • And he cited Dr. Cees van der Vleuten’s Utility Index, with Reliability• Validity• Educational impact• Cost efficiency• Acceptability as 6 components that should be balanced when creating an assessment tool.
  • He said we should observe rather than assume information about students’ knowledge and skill (competence), their truthfulness (honesty), their ability to discern limitations (show vulnerability) and how conscientious (reliable) they are. In this way, we can entrust them to carry out EPAs appropriate to their level of learning.
  • I have to warn you that a few of us attended a session on faculty development and making assessment learning enjoyable.  So stay tuned for some fun workshops around assessment!  🙂

gold nugget 1One thing we can certainly say:  We are all working hard on similar issues, ideas, and challenges across Canada and internationally.  It’s difficult to see what others are thinking and doing sometimes, and CCME gives us a venue to do this.  It’s a collaborative supportive space, with people really interested in sharing what they’ve done.  Next CCME is in Vancouver—come and join the learning!

What nuggets did you pick up at CCME/Ottawa Conference?  Write to the blog to add them!

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