Introducing Queen’s Meds 2019

In late August and early September each year, the university seems to reawaken as returning students repopulate the campus. Our medical school curriculum is one of the first to get underway and, this past week, we welcomed members of Meds 2019, the 161th class to enter the study of Medicine at Queen’s since the school opened its doors in 1854.

meds2019

A few facts about our new colleagues:

They were selected from the largest applicant pool in recent memory – 4669 highly qualified students submitted applications last fall.

Their average age is 23 with a range of 19 to 31 years, with almost equal numbers of men and women (51% women, to be exact).

They hail from no fewer than 46 communities across Canada, including; Ajax, Ancaster(2), Aurora, Bowen Island, Brampton, Brantford, Calgary(2), Cambridge, Campbellton, Coquitlam(2), Courtice, Elora, Gormley, Guelph-Eramosa, Halifax, Kanata(2), Kelowna(2), Kingston, Lasalle, London(2), Markham, Midland, Mississauga(6), Newmarket(2), North Vancouver, Okotoks, Orillia, Orleans, Ottawa(10), Pembroke, Pickering, Richmond Hill(7), Rosseau, Scarborough(5), St. Catharines, Thornhill (2), Thunder Bay, Toronto (19), Trenton, Vancouver, Vaughan, Victoria, Virgil, Waterdown, Windsor (2) and Winnipeg (2) .

Seventy-six of our new students have completed an Undergraduate degree, and twenty-seven have postgraduate degrees, including five PhDs.  The average cumulative grade point average achieved by these students in their pre-medical studies was 3.77.  Their undergraduate universities and degree programs are listed in the tables below:

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An eclectic and academically very qualified group, to be sure.

At their welcoming session they were called upon to demonstrate commitment to their studies, their profession and their 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 Mr. Jonathan Krett, Asesculapian President, and Dr. Rene Allard, who 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. Kelly Howse, Susan Haley, and Susan MacDonald, 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, Amanda Consack, Kate Slagle, and first year Curricular Coordinator Corinne Bochsma.

Dr. Jaclyn Duffin led them in the annual Hippocratic Oath ceremony. 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, Jaclyn Duffin, Jay Engel, Renee Fitzpatrick, Jason Franklin, Michelle Gibson, Mala Joneja, Steve Mann, Alex Menard, Terry O’Brien, John Smythe, David Taylor and were selected for this honour.

They met and were greeted by Dean Richard Reznick who welcomed them and challenged them to be “restless” in their pursuit of personal goals and advancement of the profession.

On Friday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Michelle Gibson and Richard Van Wylick. They were welcomed to our Anatomy Learning Centre and facilities by Drs. Steve Pang, Conrad Reifel and facility manager Rick Hunt, and participated in the annual memorial service with a moving dedication by University Chaplin Kate Johnson.

Their Meds 2018 upper year colleagues welcomed them with a number of formal and not-so-formal events. These include 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, and second year President and Vice-President Jonathan Krett and Monica Mullin.

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

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The Making of a Closer

Roberto Osuna is a closer.

The term “closer”, in this case, refers to a person who has a critical, very specialized, and highly visible position of responsibility on a baseball team. These folks are called upon to come into the game at the most critical juncture, when the outcome is very much in doubt, and are entrusted with ensuring that all the hard work accomplished by their teammates in establishing a lead is completed by striking out the last few opposition batters. As the closer goes about his task, he stands alone, the focus of attention. His teammates, managers, the opposing team, forty or so thousand people in the stadium and millions of people viewing, are transfixed in attention to every move. If successful, there is great jubilation, and he emerges as a hero, at least for today. If he fails, it is with great public exposure and he bears the burden of responsibility for the loss.

OsunaMr. Osuna has an uncanny way of engaging this role with cool and detached resolve. He is very successful, performing at the highest level, on a professional baseball team, in the midst of a highly scrutinized playoff race.

Did I mention that he’s 20 years old?

 

All this begs the question: what allows anyone to engage and excel in such a role, much less someone so young? An obvious answer is that Mr. Osuna is blessed with the ability to throw baseballs with prodigious velocity and accuracy. While certainly true, this fails to capture the entirety, or even the essence, of what’s required. There are many professional pitchers whose skills match those of Mr. Osuna and yet are ineffective in the closer role. How many of us, if magically endowed with the ability to throw the 97 mph fastball, would be able to do so effectively in the highly stressful setting Mr. Osuna faces on a regular basis? The physical skills, it would seem, are essential but not sufficient. There’s something about the attitude and personal qualities of the individual that enable him to translate these innate skills to success in his chosen occupation.

Recent attention in the press to Mr. Osuna’s dramatic emergence sheds some light (references below). Growing up in a poor coastal city in northern Mexico, quitting school at age 12 to work harvesting crops to support his family, practicing and playing baseball in the evenings, competing in leagues far away from home against men much older than himself in Mexico, Japan and the United States, overcoming language issues and, just last year, undergoing and rehabilitating from major elbow surgery, are all evidence that he has packed much life experience into his 20 years. He himself attributes his success to his family support and deep religious faith. He displays self-awareness and perspective well beyond his years: “I don’t think I deserve anything. But I try to do the best I can, get ready each day and be ready inside the stadium and outside too. I know where I came from and where I want to go.”

LaTroy Hawkins, a veteran relief pitcher who has seen his own share of adversity and began his career before Mr. Osuna was born, provides these insights regarding his new teammate: “I’ve always said, guys who are from rough areas, they’re comfortable being uncomfortable…Pitching in the big leagues is nothing compared to living where I did. Trying to live and survive in the inner city…that’s stress.”

In “Aequanimitas”, William Osler’s 1889 valedictory address at the University of Pennsylvania, he describes “imperturbability” as an essential attribute of the successful physician, and defines it as “coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril”….“it has the nature of a divine gift, a blessing to the possessor, a comfort to all who come in contact with him.” He goes on, however, to describe how a “mental equivalent to this bodily endowment”, which he terms equanimity, can be characterized and cultivated by the student physician.

This week, a hundred of Mr. Osuna’s contemporaries began the study of Medicine at our school. They’ve been selected partially because they’ve demonstrated that they possess the academic equivalent of the 97 mph fastball. As with Mr. Osuna, their career success will be determined by much more, by an array of personal qualities also considered in the application process, Osler’s “imperturbability” among them. Their medical education will be as much about developing equanimity and those “mental equivalents to the bodily endowments”, as about acquiring factual knowledge and skills – a truth as relevant in our time as in Osler’s.

 

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

 

Thanks to Meds ’16 student and former Aesculapian Society President Carl Chauvin who shared with me some key insights that contributed to this article.

http://www.theglobeandmail.com/sports/baseball/blue-jays-rookie-reliever-roberto-osuna-thriving-on-the-games-biggest-stage/article26041351/

http://www.thestar.com/sports/blue_jays_baseball_blog/2015/08/blue-jays-bullpen-latroy-hawkins-says-roberto-osuna-has-it-factor-.html

http://www.thestar.com/sports/bluejays/2015/08/10/blue-jays-roberto-osuna-pitching-well-beyond-his-years.html

Sir William Osler 1849-1919. A Selection for Medical Students. Edited by Charles G. Roland. Hannah Institute for the History of Medicine. Toronto.

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“When you wish upon a star…” Alyssa’s Journey

When you wish upon a star
Makes no difference who you are
Anything your heart desires
Will come to you.

From: Pinocchio (1940), Walt Disney Pictures. Sung by: Cliff Edwards

The idea of allowing students to determine and design their own educational experiences may seem counter-intuitive to many, including students themselves. It’s certainly not easy to implement. However, setting aside the initial reaction and obvious practical issues, what eventually emerges is the realization that this is an approach with potential to bring out the best in the motivated student, extend the educational experience far beyond the traditional paradigms, and model the sort of life-long learning we’re hoping to ingrain in all our students.

“Self-directed learning, in its broadest meaning, describes a process in which individuals take the initiative with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing learning strategies and evaluating learning outcomes.”  (from: Knowles, M. S. 1975. Self-directed learning: A guide for learners and teachers, Prentice Hall, Englewood Cliffs, New Jersey).

For those who require further convincing, I’ve asked Alyssa Louis, one of our Meds ’16 students to provide a guest blog this week. With the help and cooperation of Clerkship Director Andrea Winthrop and assistance of Clerkship Coordinator Jane Gordon, Alyssa arranged to undertake a rather unique elective experience during her Clerkship, pursuing an interest (perhaps “dream” or “obsession” would be better descriptors) she’s had for some time. As you’ll see as you read on, that pursuit has been very valuable and promises to pay huge dividends as her very promising career unfolds. And so, in Alyssa’s words…

Everyone I’ve worked with, spoken to or passed quickly in a hallway in the past 6 months has heard, at least on a few occasions, about my upcoming aerospace medicine elective. I was over the moon with excitement and probably made a few too many bad puns. However, before I launch into my personal experiences, I should explain that Aerospace Medicine is a sector within occupational health and preventative medicine that aims to preserve the health, safety and performance of individuals involved in air and space travel. Specialists, also known as “flight surgeons” must also be experts in delivering care in extreme environments, as many analog training missions occur at deep sea, high altitudes, remote deserts and polar locations.
This past July I participated in the Principles of Aviation and Space Medicine short course offered by the University of Texas Medical Branch (UTMB) as affiliated with the National Aeronautics and Space Administration (NASA.) The course, which is offered to final year medical students, residents and practicing physicians is run by UTMB faculty, many of whom have held the impressive titles of NASA flight surgeon or are acting medical directors for commercial space companies such as Virgin Galactic and Space Adventures.
In order to understand the unique health considerations for astronauts, we learned the basic physics and physiology of launching into space. Given that our millions of years of evolution selected human traits for life in earth’s gravitational field, it is truly remarkable that humans are able to adapt to life in space. Some of the many physiologic stressors include high G-force exposures of launch and landing, exposures to microgravity, galactic and solar radiation, circadian disruptions, noise exposure, carbon dioxide exposure, stress and isolation.
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Twice flown astronaut and physician Dr. Michael Barratt gave us an overview of the physiologic adaptation and maladaptation to spaceflight, including the important responses of the neurovestibular system, caudal fluid redistribution, blunting of autonomic responses, and of course the concerning loss of bone density and muscle mass. In order to counteract this loss, astronauts aboard the international space station train for approximately 2 hours every day. The challenge of creating weight-bearing exercise in a weightless environment is achieved with bungee straps and vacuum cylinders, which make for a surprisingly high fidelity training experience. Though I had worked up a fair appetite, I was not able to sample the “just-add-water” nutritionist-designed and astronaut approved freeze-dried shrimp cocktail or steak in a pouch.
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We received the historical perspective on aerospace medicine in a lecture by Dr. Charles Berry, a NASA flight surgeon during the Apollo and Gemini missions. At the tender but not subdued age of 92, Dr. Berry certainly did not withhold his objections to his Hollywood portrayal in Apollo 13. I got to sit in Dr. Berry’s old desk at mission control, the very same room where the moon landings were directed.
blog65-img3Back on earth, Aerospace Medicine also encompasses health maintenance and medical flight certification of airplane pilots. There is a truly complex relationship between pilot health and safety, and as we learned first hand in the full motion flight simulator, even perfectly healthy medical students can have vestibular mediated spatial disorientation leading to fatal crashes. We also learned the physiologic effects of airplane decompression, and its impact on time of useful consciousness through an altitude chamber run to 7620 metres (25,000 feet.) I thought fleetingly of Dr. Moffat’s respiratory physiology lessons as we reached atmospheric pressure of 276mmHg and my O2 saturation plummeted to 63%.
Now that I’m back home at Queen’s, I am looking forward to continuing to share my experiences with the rest of our community. I was extremely pleased to learn from a fellow tricolour, Queen’s emergency medicine graduate Dr. Christian Otto who is currently acting as a United Space Research Association principal investigator for the ocular health project with NASA. I will remain deeply grateful for the opportunity to blend my passions for medicine and physiology at environmental extremes. Of course, none of this would have been possible without support from Dr. Winthrop, Dr. Hollins, Jane Gordon and the UTMB faculty. Thanks Queen’s!
Did you know that…
  • Aboard the ISS, the sun rises every 90 minutes. And you thought your on-call room was a bad place to get a decent night sleep! In fact, one of the major challenges being addressed right now is circadian rhythm modulation for crew health.
  • CPR is very challenging in space because classic compressions would essentially push the operator across the room rather than pump the patient’s heart. The current literature suggests that the most efficient delivery is in the handstand position with feet braced against the ceiling.
  • Above 19.2km (63,000 feet) above sea level, the boiling point for water is approximately 37 degrees Celsius. One individual who survived exposure to this pressure described the feeling of saliva boiling off his tongue. Full pressure suits are required for survival above this altitude.
  • Astronauts train for their space walks in a massive swimming pool called the neutral buoyancy lab. There are mockups of the ISS underwater for astronauts to practice repairs.
  • Aboard the international space station, the main source of potable water is recycled urine. This water is used for drinking and rehydrating freeze-dried meals.blog65-img4
  • The current price tag to visit space as a commercial spaceflight participant is approximately $20 million dollars. This would not be covered on the average line of credit. The first Canadian to do so was Guy Laliberte, co-founder of Cirque du Soleil.

Medical school should be a place where students not only learn the “knowledge, skills and attitudes required of a physician”, but are also inspired to grow individually, gain self-awareness, pursue their own goals and develop their particular talents and interests in a way that will allow them to make unique, unanticipated contributions to society and to the profession. Alyssa’s story is a great example of what can happen when we work together with our students to go “outside the box” and make the extra effort to make the difficult and unconventional possible. When they “wish upon a star”… we’ll find a way.

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

 

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Get to the point with Ask-Tell-Ask feedback

By Theresa Suart & Eleni Katsoulas

 

Giving and receiving feedback effectively is a key part of the UGME curriculum. It’s also key in nearly every workplace, which could explain why there are so many different frameworks and recommendations for feedback “best practices”. Some of these are more effective than others.

Have you heard of the feedback sandwich? It’s one of the more popular feedback techniques and involves “sandwiching” negative or constructive feedback with two pieces of positive or complementary feedback. It’s also sometimes known as “PIP” for “praise, improve, praise”.

 

The idea behind this is laudable – cushion the blow of negative feedback and reassure the individual that they are doing some things well.

 

In practice, however, it’s fraught with difficulties, making it not very useful for the person receiving the feedback. Think about it:

  • I’ve just received two pieces of praise and one of criticism or a suggestion for improvement: what should I focus on?
  • The negative feedback is about something I did today, the positive things were from last week – the positive stuff must not be as important.
  • Two pieces of praise and one of criticism – guess that I’m mostly doing well!
  • The last thing they said was praise – must be doing great!

 

Writing in Harvard Business Review, Roger Schwarz also points out the fallacies of this approach. Schwarz notes leaders who use the sandwich approach to negative feedback do so for a variety of reasons. These include:

  • Thinking it’s easier for people to hear and accept negative feedback when it comes with positive feedback.
  • Assuming the sandwich approach provides balanced feedback
  • Believing giving positive feedback with negative feedback reduces discomfort and anxiety.

 

Schwarz then debunks each:

  • Easier: Most people on the receiving end would prefer to skip the sandwich – get to the point.
  • Balanced: Saving up positive feedback to sandwich negative feedback undermines timely delivery of the positive feedback. As Schwarz points out, research shows that feedback, either positive or negative, “is best shared as soon as possible.” He also asks: “Do you also feel the need to balance your positive feedback with negative feedback?”
  • Reducing anxiety: “The longer you talk without giving the negative feedback, the more uncomfortable you’re likely to become as you anticipate giving the negative news.” Meanwhile, the person on the receiving end “will sense your discomfort and become more anxious.

 

The UGME Education Team advocates the use of a new feedback sandwich replacing “praise, improve, praise” with Ask – Tell – Ask. This method was brought forward by Dr. Ayca Toprak and Dr. Susan Chamberlain, adapted from French, Colbert and Pien (ASE April 24, 2015)Feedback ata graphic

 

 

 

The ATA Feedback Model is similar to the traditional feedback model as it has three parts. After that, it’s quite a bit different. Using Ask-Tell-Ask, the Preceptor asks the learner for their input, then the preceptor tells them their impressions, then wraps up by asking the learner to help develop an improvement plan:

 

Ask – Tell – Ask

  • Ask the learner for their perceptions about strengths and challenges
  • Tell them your impressions backed by observations, and specific examples
  • Ask them what can be improved and how– assist you in developing a learning plan

 

Examples of topics to discuss (referencing objectives of the rotation, course, or activity):

  • Professionalism
  • Functioning in the team context
  • Skills (communication, technical, clinical)
  • Clinical Reasoning
  • Record keeping
  • Process or Content (knowledge or the way they use the knowledge; application of knowledge).
  • Background knowledge (this is knowledge of the discipline, scientific foundations, knowledge base).

The ATA model helps preceptors focus the discussion while scaffolding self-regulation and self-assessment. It also avoids the mixed-messages of the feedback sandwich approach.

The ask-tell-ask oral feedback is best paired with written narrative feedback. Watch for a blog post on this topic in September.


 

We used PowerPoint slides from a presentation prepared by Sheila Pinchin and Eleni Katsoulas, with slides from Cherie Jones, to prepare this blog. We thank Sheila and Cherie for their contributions.

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