Graduation traditions worth keeping – Permanent Class President and Convocation Speaker

In their final few weeks as students, graduating medical classes elect two of their peers for special recognitions.

For many years, one member has been designated to represent them and take responsibility for ensuring that their identity as a family of friends and professional colleagues is maintained through the years to come. Being elected Permanent Class President is therefore an expression of trust and of faith in a particular individual. That person is chosen, I believe, for a couple of reasons. Firstly, because he or she understands and respects the desire of the class to maintain the ties and connections that have been forged through their common four-year experience. Secondly, the class members believe that person has the organizational ability and drive to ensure the role is fulfilled. Considering how well students get to know each other during their time together, achieving this position of trust is obviously a considerable tribute. Meds 2015 is fortunate to have many worthy people to choose from, but ultimately the honour fell to Josie Xu.

Over her four years with us, I’ve had the opportunity to get to know Josie quite well. She comes from a community to the west of Kingston called Toronto. She did an undergraduate degree in Health Sciences at McMaster where she graduated Summa Cum Laude. Since coming to our school, she has given freely of her time in support of her medical school community, serving as Vice-President of the First Year Class Council, Josie XuInterview Weekend Organizer, Mentorship Program Coordinator, Student Building Coordinator, Producer of Medical Variety Night Videos, and Aesculapian Society Vice-President of Internal Affairs. She has also been involved in the organization of the Manuary Kingston Campaign, in support of awareness and support for the treatment of head and neck cancer, working with Dr. Jason Franklin. In all these capacities, Josie has demonstrated herself to be selfless in the support of her various communities. She is also what people in senior management and leadership positions would call a “finisher”. Josie can be relied upon to complete what she undertakes to do, and to do so very well. Put quite simply, she can be trusted at her word to finish what she starts. An expression of that commitment is that Josie’s first call when she heard she’d been elected to the role of Permanent Class President was to call me to find out what would actually be involved. She wanted to ensure she could take this on. Clearly, she can. Josie will be continuing her postgraduate training in Otolaryngology in Toronto, a move that will take her closer to her family, which will be important to her. I’m sure Josie’s close family ties were important in developing the sense of community responsibility and engagement that has been and, I’m sure, will continue to be an important part of her career.

The position of Convocation Speaker has a much shorter tradition. This began four years ago, recognizing and addressing a desire to allow our graduating students to become more actively involved in their graduation ceremonies. The first three speakers, Jason Booy, Alex Summers and Yan Sim proved to all in attendance that the student voice adds immeasurably to this very special event. This year, the 2015 class has chosen Aaron Wynn to speak on their behalf.

Aaron hails from Whitby, Ontario, having come to Queen’s to complete an Honours degree in Life Sciences. While in medical school, Aaron was co-founder of Making Waves Kingston, a non-profit program that provides affordable swimming lessons to children with special needs. He also supported his peers by serving as their Clinical Skills representative during the pre-clerkship years, essentially serving as a liaisonAaron Wynn between students a faculty – a position that requires considerable tact and diplomacy. During that time, he participated in the development of our OSCE programs, again working with students, administrative staff and faculty. Aaron has also participated as a facilitator in our “Being a Medical Student” program, helped organize Orientation Week activities for the 2016 class, and was selected by his peers to provide “Pearls of Wisdom” to junior students. My particular memory of Aaron relates to his experience with the First Patient Program. In this program, pairs of first year students are assigned to patients in the community who have chronic medical conditions of some type, and have volunteered to allow the student to meet with them and follow them over 18 months, spanning all of the first and half of the second medical year. Students are expected to visit the patients in their homes, learn of their illness and struggles, accompany them to encounters with their doctors, hospital or health providers, and meet with their attending physicians. The program is intended to allow the students to see the illness experience through the eyes of the patient and their family, before they have begun to assume the provider role. As will sometimes occur in a program of this nature, Aaron’s first patient passed away during the period of follow-up. This required Aaron and his FPP partner to encounter the grief experience for the first time, and very early in their training. They engaged this by seeking help and carrying out a review of the grief experience, which they were able to share with their peers. This also caused us to reconsider the teaching of grief within our curriculum. Aaron was therefore able to transform a difficult and personally challenging adversity into a formative opportunity, not only for himself, but also for his peers, our school and, by extension, for learners that will follow. Next July, Aaron will be entering the Family Medicine residency program at McMaster University.

There’s been much talk recently about the meaning of “Leadership” in the context of medical education (see Is Leadership a Physician Competency?). The concept that appears to be emerging is of a service-based model of leadership that involves a sense of personal mission and willingness to engage responsibility within various communities, attributes that might actually be better termed “citizenship”. Josie and Aaron are personifications of that concept. Their rewards for the service-based leadership they’ve provided consists of the appreciation of their peers, and the “honour” of being asked to provide even greater service, filling important new roles. Although Josie and Aaron have been singled out for these recognitions, I appreciate as I write this article that I could develop impressive tributes for virtually every member of our graduating class, all of whom have made contributions to our school and to their various communities during their time with us. All “leaders” in their individual ways. All bringing to mind the spirit that Alex Summers expressed so well in his convocation address a couple of years ago when he invoked the title bestowed on Norman Bethune – a “light who pursues kindness”. The Class of 2015 indeed shines brightly.

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Students are welcome here

“You seem to have students involved in everything!” (a recent visitor to Queen’s Undergraduate Medical Education)

One of the very striking aspects of Queen’s UGME is the consistent presence of students in the life of the program and how it is run. Queen’s has the positive philosophy that students are an asset and indeed an absolute necessity for assistance in the UGME curriculum; they are a strength in our program.strengthen

Why do we do this? One reason is that it fosters student leadership, a desirable trait in post-secondary education (Astin & Astin, 2000; Zimmerman-Oster & Burkhardt, 1999) and that in turn enhances the self-efficacy, civic engagement, character development, academic performance, and personal development of students (see references below.)

And yes, thus it is a deliberate UGME procedure that, for example, all UGME committees but one (the Progress and Promotions Committee) will have student representation sitting on them. However, there is another, and perhaps even greater reason that students are invited to participate as fully in UGME as they are.

“When educators partner with students to improve learning, teaching and leadership in schools, school change is positive and effective.” (Fletcher, 2003).

Our program, and our faculty and staff, not to mention our students, benefit immeasurably from student participation in our program: student feedback is valuable to our ideas and plans, our current processes and programs and our ability to be responsive and flexible. It allows us to trial ideas, to disseminate information, and to receive valuable input on aspects of our curriculum. It helps dispel myths and presuppositions we might have, it makes us flexible, and gives us a window into the world of student life.

At Queen’s UGME, in addition to active participation on all but one committee, students are involved in Admissions Weekends, they run Orientation Week for the next year’s cohort, they participate in peer teaching, they monitor learning events, they act as representatives for their class in everything from Technology Rep to Academic Rep to First Patient Program rep, they volunteer for focus groups and participate in surveys for program evaluation, they evaluate our courses and our faculty regularly and professionally and they are a part of our Accreditation process and visit. And I’m sure I’ve missed some of the roles students play.

The question then becomes, “Why would we NOT have students involved in our program?”

How do we receive the benefit of these future leaders?

UGME works in collaboration with the Queen’s Aesculapian Society (AS), the student government, which makes the selection of students for all roles. The AS engages in a process to determine a selection of students who will participate in all roles when called upon for student representation. The UGME program leaders respect the independent professional behavior of the students as they demonstrate self-regulation in their own governance structure to take on responsible roles. Indeed this is an important aspect of their leadership.

Many of the student leadership roles have evolved as our committee structure and programs grew. It became evident very early that student representation would allow for a valuable two-way street for discussion of nearly every aspect of the program.

We’re very grateful to our students for the insights they bring, the creativity and innovation, the energy and the professionalism they provide in our many activities. Together, we are stronger, and better.

 

Did I miss an aspect of student participation in UGME?  Write in and let us know.

References

(See Benson & Saito, 2001; Fertman & Van Linden, 1999; Komives, owen, Longerbeam, Mainella, & osteen, 2005; Scales & Leffort, 1999; Sipe, Ma, & Gambone, 1998; Van Linden & Fertman, 1998. See also Duggan and Komives. (2007).)

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Service-learning: Asking questions to learn what’s happening

As discussed in a previous blog post, formalizing opportunities for service-learning is increasingly important to schools of medicine, both for the inherent merits of service-learning itself (for both learners and communities), as well as for accreditation considerations.

Queen’s UGME has been exploring ways to address service-learning more systematically, including appointing a Service Learning Advisory Panel. One of the interesting things about service, however, is because of its very nature, it often happens quietly, behind the scenes.

In order to better support undergraduate medical students engaged in service-learning projects, the Panel wants to shine a light on these projects. With this in mind, the Panel, whose members include students, faculty and administrative representatives is issuing a call for information about current community service projects.

Not all volunteer projects meet criteria to be considered service-learning. There are many definitions of service-learning (in fact, there are close to 200 in the literature). The definition Queen’s UGME has adopted (based on one used by the LCME) states:

“Service-learning is a structured learning experience that combines community service with preparation and reflection. Medical students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens and professionals.”

The key triad includes planning (including consulting relevant stakeholders), service, and reflecting on learning. Using this definition, there may be volunteer projects are or could be service-learning as well.

For example, Queen’s Medicine Health Talks sprang from a student interest group. When these first started, the students prepared lectures (under the supervision of practicing physicians) on a number of clinically-relevant topics and invited members of the community to the School of Medicine to hear these lectures. The aim was to welcome and integrate the Kingston community in medical learning. Extending this into service-learning, the students now engage in collaborative planning with both faculty and community members. As well, the lecture series now includes community centres as venues. A post-service evaluation helps students reflect on their learning.

The students involved in the Health Talks took that extra step and asked community members: “What do you want to learn about?”

In the same way that great service-learning projects include a key step of consulting the community about what’s important, the Service Learning Panel wants to hear from members of the UGME community about what they’re already doing by way of service-learning. The next question is how can UG help? Then, what else would you like to do and what support do you need to make this happen?

The Service Learning Advisory Panel’s goal isn’t to change our students’ focus on service: we just want provide support and recognition for these important endeavours in our communities.

The first call is for Established community actions. A second call will focus on new projects. Look for these in the regular UG email communication to all classes. We’re looking forward to hearing from you.

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MD Program Executive Committee Meeting Highlights – March 19, 2015

Faculty and staff interested in attending MD PEC meetings, should contact the Committee Secretary (Faye Orser, (orserf@KGH.KARI.NET)) for information relating to agenda items and meeting schedules.

UPDATE:

Learning Environment Panel:  A panel, assembled to discuss concerns relating to instances of mistreatment of medical students, has released its report and recommendations.  The panel reports that “although Queen’s ranks favorably compared to its peers, more work needs to be done to ensure a positive, safe, and collegial learning environment for our medical students.”  In response to a recommendation from the panel to enhance collaboration with our Educational partners, a Hospital Liaison Committee has been established and the report disseminated to three larger teaching sites.  An implementation group has been assembled to address the other recommendations.

Student Debt Panel:  A panel, assembled to explore the impact of increasing medical student debt, has released its report. The panel found that while the debt is manageable for most students, there are several areas in which the Faculty may be able to provide advice and direction to students.  The recommendations include the development of a more progressive and coordinated curriculum on financial management beginning with counselling on financing to incoming first year students as well as the exploration of ways to moderate the impact of CaRMS and elective expenses.  The report and recommendations will be forwarded to various UGME Committees for response in the upcoming weeks.

Policy on Guest Teachers:  The Committee approved a new policy addressing the inclusion of non-faculty teachers during core learning events.

Student Affairs Committee:  The Committee approved the Terms of Reference for a new Committee to develop all policies and procedures related to health, safety and wellness of MD students.  This Committee will be chaired by Dr. R. Fitzpatrick in her capacity as the Director, Student Affairs.

All Undergraduate Medical Education policies and terms of reference are available on the UGME website:  http://meds.queensu.ca/undergraduate

 

 

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No crying in medical school?

The 1992 motion picture “A League of Their Own” features a very memorable scene that has been coming to mind in light of recent discussions. In it, Tom Hanks brilliantly portrays a crusty former major league baseball star who, in the early 1940s, has been conscripted to manage a team of young women participating in a league set up to replace League Of Their Own“real” baseball, which has been suspended while most men are participating in the war effort. In this particular scene, he berates a young woman who has made a fielding error causing his team to lose the game. His dialogue, carried out on the field and in front of both his team and the spectators, starts out gently and subdued, but quickly escalates. The urges her to “use her head – that lump about 3 feet above your ass”, and makes it clear for all to hear that she is solely responsible for losing the game. She breaks into tears, at which point he becomes rather bewildered. He can’t process her reaction. “There’s no crying in baseball” he shouts and repeats several times. He goes on to point out that he himself was commonly treated in the same way by his managers who would refer to him as a “talking pile of pig shit” – and that’s when his parents were in the stands. Hank’s comic flair and over-the-top performance makes humourous what would otherwise be a rather cruel exchange.

On reflection, there are some interesting observations that one might derive from all this.

  • He’s right. She made a mistake. She clearly blew the play. His credibility and authority in the matter are unquestioned.
  • His intention appears to be correction of the behaviour. He doesn’t appear to bear any personal animosity toward the player – he simply wants her to play better and, by extension, for the team to win.
  • Despite his intentions, it’s quite clear that the attack is very personal, and also very public.
  • It seems unlikely that this interaction will result in the intended outcome, since nothing about it provides her any useful direction.
  • Perhaps most interesting of all is his reaction to her emotional breakdown. To him, his response is appropriate to the situation and to the “culture”. It’s her response that is out of place – “There’s no crying in baseball”. These two people, who are brought together in this situation, are from different worlds, with different values, and therefore very different perspectives on the incident.

So what brings all this to mind? At the end of medical school, all Canadian graduates are asked to complete a survey that reviews a broad range of issues related to their education. As part of that survey, they are asked to report on whether they had, at any point during their medical school experience, been subjected to “mistreatment”, defined as any of a list of 16 behaviours varying from “public embarrassment” to having been the subject of discrimination on the basis of race, ethnicity or sexual orientation. In the 2014 survey, a rather shocking 45.1% reported at least one such incident. Within that number, 20.5% reported at least one incident during which they felt they had been “publicly humiliated in a clinical setting”.

Such a finding would be a concern in any setting, but particularly so in the context of medical education where we profess to uphold and practice the highest standards of personal behavior, sensitivity and empathy. Given that we should maintain a “zero tolerance” standard for such behaviours, the fact that our school reports lower incidents than the Canadian average provides little solace.

As a result, a decision was made to actively address this issue at our school and, that in order to do so, we needed to understand the context more completely. A Learning Environment Advisory Panel (LEAP) was formed last fall, chaired by Dr. Ruth Wilson, and populated by students from all medical years, faculty members, administrative staff and, importantly, representatives of all three of our major teaching hospitals. That group undertook an extensive literature review, and also surveyed our third and fourth year classes to not only ask that they report on these incidents, but to provide narrative accounts so that the panel might better understand their nature. The report of that panel has been received and accepted by our MD Program Executive Committee and we are in the process of undertaking their first recommendation, to raise awareness within our learning community of these concerns (this article being one of the first steps). The following are highlights of that report, illustrated with some representative student narratives:

There’s much more good than bad…

“Students and residents on the Panel emphasized that by and large medical students experience a positive learning environment, encountering faculty who provide a comfortable and encouraging place to learn. One resident summarized this by saying, “Queen’s is known as a “nice” place to learn”.

LEAP Report

“I don’t remember ever having felt humiliated. There have certainly been times when I’ve felt embarrassed, but these were mostly times when I did not know the answer to a question or felt that I did not do something as well as I should have been able to. While not pleasant experiences, I feel that they were useful in that they encouraged me to address areas of my learning that were deficient. Importantly, my discomfort in these situations stemmed from not meeting personal standards, and were not the result of harsh criticism or belittlement by a preceptor.”

Our students report predominantly very positive experiences within the clinical learning environment. Contrary to what many might think, they don’t object to being “quizzed” or “pimped”. They admit to feeling embarrassed when lacking a component of knowledge or skill, but largely accept that as part of the learning experience. Having said that, there are a small number of encounters that are truly egregious and clearly unacceptable.

“One day on a surgical rotation, I was assigned to assist in the OR with one of the staff surgeons. Since I had only received my assignment at 7:30 and the case was slated to start at 7:45, I didn’t get the chance to review the patient’s full chart before coming to the OR. When I arrived, the surgeon started quizzing me on the patient’s medical history, and I explained that I hadn’t reviewed the whole history. Before I could continue, the surgeon said to me “if you ever pull a stunt like this again, I will kick you out of my OR and you will never scrub into the OR again.””

“A physician raised his/her voice at me for not knowing something that he/she thought should be common knowledge and belittled me”

“One time only I felt humiliated at the nursing station in front of everyone during a rotation by a staff for not doing physical exam the way the way the staff expected, when I merely misunderstood expectations.”

There’s a big difference between “embarrassment” and “humiliation”.

The factors that turn a potential teaching/learning opportunity into a humiliating experience appear to be the following:

  1. When the focus of conversation shifts from the issue at hand to the individual.
  2. When the interaction occurs in a public setting.
  3. When the encounter provides no useful instruction or opportunity to correct the behaviour.
  4. When there’s no pre-existing relationship or “understanding” between the learner and the person providing the commentary.

The latter point is particularly relevant in today’s clinical learning environment, where learners may be engaged in rotations or placements with particular teachers for very short periods of time that don’t allow a useful (or trusting) teacher-student relationship to develop.

“Longitudinal relationships with preceptors are particularly valuable. The relationship of student and teacher is built over weeks to months rather than hours to days. If I don’t perform well one clinic I know that I will have another shot at it the next. I become less worried about my performance minute-to-minute and more embedded in the experiential learning that is clerkship.”

“The best teachers I have had ask me lots of questions that I don’t know the answer to. I answer incorrectly and we both get over it. If they asked me the same question the next day I would know the answer because I went home and read about it. But these same best teachers are ones who have demonstrated to me in other ways that they care about me as a learner. They are ones that don’t just ask me lots of questions I don’t know the answers to but include me in discussions of patient care, teach me at the bedside and know just how far to push me.”

Students feel under considerable stress to “perform”.

The competition for postgraduate training positions appears to intensify each year and, rightly or wrongly, students are focused on making a good impression. They may interpret each question posed as a mini-examination, with potentially dire consequences for rotation evaluations and references. What may seem to the instructor to be a simple encounter and minor issue, may therefore become considerably magnified to the student.

It’s truly an environmental issue – not just senior physicians and not just operating rooms.

no-crying-graph

Both the CGQ and our own survey show quite clearly that the negative encounters occur in all clinical settings, and with a variety of individuals, including newly recruited faculty, residents, nursing staff and even, rarely, other students.

There’s under-reporting of serious concerns.

Although one must acknowledge that the number of serious instances of mistreatment is very small, it’s very disappointing that these appear to go unreported, coming to attention only in end of medical school surveys. This is, in part, due to fear of reprisal relating to the competitive environment noted above, and exists despite available and widely publicized mechanisms for anonymous reporting.

And finally…“there’s no crying in baseball”

There appears to exist a cultural acceptance that such behavior “goes with the territory”. Like the Tom Hanks character described earlier, established physicians and nurses may feel they’ve “paid their dues” and are now somehow at liberty to pass along the same instructional methods they encountered along the way. They may honestly feel these methods are most effective in making their points and ensuring lessons are learned. Whatever the rationale, it’s quite clear that humiliation fails to provide useful instruction, is inconsistent with the attributes of effective health care providers, and poisons our learning environment. As the Advisory Panel rightfully points out, raising awareness is the necessary and most effective first step. They go on to make a number of other recommendations, including:

  1. Collaboration between university and hospital leadership in addressing this issue.
  2. Faculty and resident development as to optimal mechanisms for provision of feedback
  3. Development of debriefing strategies appropriate to various clinical settings
  4. Improved reporting mechanisms
  5. Continued surveillance

Our MD Program Executive Committee has committed to work toward these goals in the upcoming months, and to establish mechanisms to continue to monitor progress.league-of-their-own-2

Those who’ve seen “A League of their Own” will know that, by the end of the movie, Tom Hank’s character attempts, with much effort, to revise his interaction with the still error-prone right fielder. It’s not clear what brought about the reform. He may have been frustrated that his first attempt was so ineffective. He may simply have been moved by the realization that her perception was so much different than he’d anticipated. In any case, he was able to set aside his own life experience and adjust his teaching methods to the needs of his learner. But that was just a movie…

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Proposed New Policy – Comments requested

Prior to a new or amended policy or regulation being submitted for final approval, it must be published for review and comment by faculty and/or students within the School of Medicine.  Feedback received will be directed to the Policy Sponsor.

In the event that major changes are made based on this feedback, a new draft will be posted for additional comments.

In keeping with this procedure the following policies are being posted for comment or feedback:

 

If you wish to comment on any of these documents, please add your feedback to the discussions in this community or email saunderj@queensu.ca

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Wrapping up case-based learning sessions effectively

We often spend a lot of time planning our classes, especially our case-based small group learning (SGL) sessions. We tailor our sessional learning objectives to the course objectives that have been assigned, selected solid preparatory materials, build great cases and craft meaningful questions for groups to work through.

This makes sense, as the small group learning (SGL) format used in Queen’s UGME program is modeled on Larry Michaelsen’s team-based learning (TBL) instructional strategy that uses the majority of in-class time for decision-based application assignments done in teams.

One comment we often read on course evaluation forms and hear directly from students, however, is that sometimes they walk away from an SGL session and still aren’t sure what’s important.

Much of the focus in the literature on TBL is on the doing – setting things up, building great cases, asking good questions to foster active learning. There’s not as much written about how to finish well.

Wrapping up your SGL session should be as much a planned part of your teaching as preparing the cases themselves. If you build the time into your teaching plan, you won’t feel like you’re shouting to learners’ backs as they exit the classroom, or cut off as the next instructor arrives. Nor will you find yourself promising to post the “answers” to the cases on MEdTech. Sometimes it’s not the answers that are important, but the steps students take to get there.

Wallace, Walker, Braseby and Sweet remind us that the flipped classroom we use for SGL (preparation before class, application in class) is one “where students adopt the role of cognitive apprentice to practice thinking like an expert within the field by applying their knowledge and skills to increasingly challenging problems.” One such challenge is figuring out what the key take-away points are from an SGL session. With this in mind, it’s a good idea to plan your session summary, but then have students take the lead since “the expert’s presence is crucial to intervene at the appropriate times, to resolve misconceptions, or to lead the apprentices through the confusion when they get stuck.”[1]

So, have your own summary slide ready – related to your session objectives – but keep it in reserve. In keeping with the active-learning focus of SGL, save the last 10-15 minutes of class to have the groups generate the key take-away points, share them, and fill in any gaps from your own list.

Here’s a suggested format:

  1. Prompt the groups to generate their own study list: “Now that we’ve worked through these three cases, what are the four key take away points you have about this type of presentation?”
  2. Give the groups 3-4 minutes to generate their own lists
  3. Have two groups share with each other
  4. To debrief the large group, do a round of up four or five groups each adding one item to a study list.
  5. Share your own list – and how it relates to the points the student raised. This is a time to fill in any gaps and clarify what level of application you’ll be using on assessments.
  6. If you’d like, preview an exam question (real or mock): “After these cases, and considering these take-away points, I expect that you could answer an exam question like this one.” This can make the level of application you’re expecting very concrete.

Why take the time to wrap up a session this way? Students often ask (in various ways) what the point is of a session. With clear objectives and good cases, they should also develop the skills to draw those connections themselves. This takes scaffolding from the instructor. As Maryellen Weimer, PhD, writes in Faculty Focus, “Weaning students from their dependence on teachers is a developmental process. Rather than making them do it all on their own, teachers can do some of the work, provide part of the answer, or start with one example and ask them for others. The balance of who’s doing the work gradually shifts, and that gives students a chance to figure out what the teacher is doing and why.”


 

If you would like assistance preparing any part of your SGL teaching, please get in touch. You can reach me at theresa.suart@queensu.ca


 

[1] Wallace, M. L., Walker, J. D., Braseby, A. M., & Sweet, M. S. (2014). “Now, what happens during class?” Using team-based learning to optimize the role of expertise within the flipped classroom. Journal on Excellence in College Teaching, 25(3&4), 253-273.

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Is Leadership a Physician Competency?

Screen Shot 2015-03-02 at 3.26.32 PMAre physicians “leaders”? Put another way, is “leadership” a necessary or even desirable attribute of the aspiring or practicing medical doctor? The recent revision of the competency framework of the Royal College of Physicians and Surgeons, and specifically the proposal to change the “Manager” competency to “Leader” has sparked some interesting conversation on this issue. The root of this controversy appears to be a sense that the term “Leader” implies an assumption of authority or superiority within the healthcare community. On the surface, this change may appear somewhat presumptuous and concern is understandable. Some recent discussions on parallel issues that have been undertaken at our school may provide some relevant and very timely insights.

The issue of student Resiliency has become a growing focus of interest in our school, with the goal of providing students with awareness of its importance and methods to promote its development. Review of the available literature, and our own discussions, have defined a number of attributes and attitudes that characterize the resilient personality. These include:

  • Personal well-being. Resilient people are healthy and energetic, and adopt personal practices that promote well-being, such as attention to personal health, nutrition and fitness.
  • A sense of purpose. Resilient people are driven by a deep and abiding sense of purpose that allows them to overcome adversities.
  • Perseverance. Willingness to commit to goals and work steadily to completion
  • Self-reliance. Acceptance of personal accountability.
  • Equanimity. The ability to face both adversity and success in a balanced way, without loss of perspective or purpose.
  • Ability to engage adversity effectively. Resilient people are able to not only face adversity without loss of purpose, but learn from those experiences.

Almost at the same time, a number of students have expressed interest in examining the components of Leadership. In the development of teaching material on that topic, a number of component attributes have been developed for discussion. These include

  • Stamina. Personal energy and drive.
  • A sense of purpose that is aligned with the objectives of the organization they are leading, and which they communicate effectively to members.
  • Diligence. Also called “drive”. Leaders tend to be the engines and drivers of innovation and change within their organization.
  • Self-assurance. Leaders have and display confidence in themselves and in their organizations that is not “cocky” or pretentious, but apparent and clear to all. Outstanding leaders are able to combine that confidence with a sense of humility that allows them to accept advice, balance opinions and change course when it’s in the best interests of their organization.
  • Fairness. Leaders are unfailingly fair in the application of their authority. Their fundamental integrity is unquestionable and clear to all.
  • Ability to engage adversity effectively. Leaders are able to guide their organizations through tough times and challenges. They do so by maintaining a focus on the core objectives and values, communicating clearly, and providing support and encouragement.

Do these two sets of attributes sound similar? One can’t help but conclude that resilience and leadership go hand-in-hand. Our leaders are resilient people, and failure in leadership can often be traced to a deficiency in one or more of the resiliency attributes.

Now let’s extend to the Physician’s role, and focus on the application to patient care:

Screen Shot 2015-03-02 at 3.18.44 PM

It would seem that there are numerous parallels between the attributes of the resilient leader pursuing the interests of their organization, and the effective physician promoting the health and interests of their patient. The qualities, values and attributes are very similar. The focus of those efforts simply shifts from a group or organization, to an individual, the patient. It’s therefore no surprise that so many physicians become effective leaders in our various academic, community and political structures. The Royal College is absolutely justified in embracing the “Leader” competency.

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

 

 

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