Month: November 2015
The past few months have seen a number of changes within the undergraduate program as people transition from and into key roles.
I’d like to particularly acknowledge the contributions of Jennifer Carpenter, John Smythe, Peter O’Neill, Richard Thomas and Melinda Fleming.
Jennifer has been providing incredibly valuable personal support to students for many years, often as the only counselor for the entire school. Over that time, she has made herself available for any personal crisis, literally around the clock. Her work, by its nature, often goes completely unnoticed by all except the student she supports. I know, with certainty, that there are a number of physicians currently practicing and providing valuable care to their communities who simply wouldn’t be doing so if not for Jennifer’s intervention and support. Her dedication and effort really paved the way for the comprehensive student wellness programs we now provide.
John Smythe has been a highly effective student advocate and promoter of student wellness. In addition to providing personal counseling, he has developed and provided a number of sessions and courses for both students and faculty in Mindfulness and personal wellness that have been much appreciated and highly valuable.
I outlined Peter O’Neill’s contributions in a previous article. I mentioned then how his pioneering efforts in career counseling provided an excellent base for Kelly Howse to build upon. This week, Kelly completed a pan-Canadian consensus effort that she led and which describes standards for the provision of career counseling for MD programs. Peter’s approaches and innovations certainly informed that process.
Richard Thomas has guided our Obstetrics and Gynecology Clerkship for several years. He further refined an already excellent clinical rotation, guiding it through a phase of expansion both in terms of content and regional scope. In addition, Richard was a valuable contributor to our Clerkship Committee and provided personal support to a number of students requiring specific support and accommodations.
Melinda Fleming took up the Directorship of our Peri-operative Medicine Clerkship Rotation with enthusiasm and creativity. This is a particularly challenging course that combines three student experiences- Anaesthesiology, Emergency Medicine and Sub-specialty Surgery. It therefore presents rather unique administrative as well as educational challenges. Learners will continue to benefit from Melinda’s dedication to clinical education in her new assignment.
We’re very fortunate to welcome a number of faculty members who have stepped forward to fill these and other positions.
Jason Franklin received his MD from Queen’s University and went on to complete the Otolaryngology program at the University of Western Ontario. He then completed a two-year fellowship in Head and Neck Surgical Oncology and Reconstructive Surgery at the University of Toronto. He returned to Queen’s in 2013 and has been actively engaged in our teaching program as well as providing valuable mentoring to students. Jason will be building on those interests as he takes on the role of Wellness Advisor.
Martin ten Hove will also be joining the Student Affairs team as a Wellness Advisor. Martin received his MD from Queen’s University in 1989 and then completed his postgraduate training in neuro-ophthalmology as a McLaughlin Fellow at the University of Miami in 1995. He returned to Queen’s as an Assistant Professor in the Department of Ophthalmology. He was promoted to Associate Professor and awarded tenure in 2001. Dr. ten Hove currently serves as Head of Ophthalmology at Queen’s University, Hotel Dieu Hospital and Kingston General Hospital. He is an active researcher in the neural mechanisms underlying visual attention and has served on the Examination Committee of the Royal College of Physicians and Surgeons of Canada, on the Royal College Specialty Committee for Ophthalmology, and on the editorial boards for the Canadian Journal of Ophthalmology and the Journal of Neuro-ophthalmology. He has worked with ORBIS, the CNIB and the University of West Indies to bring tertiary level ophthalmology to remote locations to help fulfill their educational and clinical needs, and served as the Department’s Postgraduate Program Director from the time of his appointment until 2000.
Joshua Lakoff will be working with Kelly Howse as a Career Counselor. Josh joined the Department of Medicine in January 2015 as Assistant Professor in the Division of Endocrinology and Metabolism. His academic focus is medical education with clinical interests in thyroid cancer, diabetes and pituitary disease. He completed medical school at the University of Toronto. His Internal Medicine and subspecialty training in Endocrinology were completed at Dalhousie University in Halifax.
Craig Goldie will be working with Susan MacDonald in the Academic Advisor portfolio. He is a Palliative Care physician and an Assistant Professor at Queen’s. He obtained his undergraduate medicine degree at Queen’s before completing his family medicine and palliative fellowship in Vancouver through the University of British Columbia. Prior to medical school his first degree was in computer engineering. Dr. Goldie is the coordinator for undergraduate medical teaching in palliative care and is involved in the Student Assessment Committee. His area of interests include medical education, use of technology in medical practice, education, and medical quality improvement, and student mentorship.
Gregory Davies will be replacing Richard Thomas as Director of the Obstetrics and Gynecology Clinical Clerkship. Greg is a Professor and Chair of the Division of Maternal-Fetal Medicine. He has cross-appointments to the Department of Diagnostic Imaging and the School of Kinesiology, and is Director of The Fetal Assessment Unit at the Kingston General Hospital. He received his medical degree from McMaster University after a BA Hons. at Queen’s University. He did his residency in Obstetrics and Gynecology at Queen’s University and his Maternal-Fetal Medicine sub-specialty training at Duke University. Dr. Davies returned as full-time GFT at Queen’s University in 1996. His clinical practice focuses on high-risk pregnancy management, and the detection and management of fetal anomalies. Dr. Davies is an active clinical researcher whose areas of interest include preterm birth prediction, management issues in labour and delivery, aneuploidy screening protocols, and exercise and obesity in pregnancy. Dr. Davies is an awarded teacher and has taught presentation skills internationally to residents and faculty alike on subjects such as effective large group learning, small group dynamics and teaching at the bedside.
Nishardi Waidyaratne-Wijeratne will become co-director of the pre-clerkship Psychiatry course. Nisha is an Assistant Professor in the Department of Psychiatry. She works as a Consultation-Liaison Psychiatrist at KGH and Hotel Dieu Hospital. She completed her Psychiatry residency training at Queen’s in June 2015 and is a three-time recipient of the UGME Resident Teaching Award. Her academic interests include Psychopharmacology and Innovations in Medical Education.
Vidur Shyam has taken on the Directorship of Peri-operative Medcine. He is an Assistant professor in the Department of Anaesthesiology. Vidur has been on staff at KGH as an anesthesiologist since 2006. He completed his training in West Germany and received his FRCPC in 2009. He has have been teaching undergraduate clinical skills and FSGL for several years. He is also director of regional anesthesia and his special interests are regional anesthesia and acute pain management.
In his 1910 review of our school, Abraham Flexner quite reasonably questioned whether a small school surrounded by larger centres could survive. The fact that we have not only survived but excelled, is a testimony to our dedicated and talented clinical/teaching faculty. The willingness of so many busy and accomplished folks to step forward to fill these key roles confirms that dedication to education and to our students is alive and well.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
It’s time to re-invent the Clinical Clerkship
The need to provide supervised learning within the clinical setting has always been regarded as essential to the development of future physicians. Indeed, early versions of medical education consisted entirely of what could only be termed apprenticeships under the direction of a fully- qualified physician who was engaged by the student as the tutor, mentor and assessor. It was largely as a result of Abraham Flexner’s (pictured) transformational 1911 review of medical education in North America that medical schools were required to provide formal instruction in the basic and medical sciences. However, Flexner continued to emphasize the critical role of learning with the clinical setting. This became consolidated into the discrete role that came to be known as the Clinical Clerkship.
Being a “Clerk” was to have a job or role within a hospital’s complex system of service delivery. The role consisted of “clerking” patients (carrying out admission histories and physicals), following the progress of patients through their hospital stay, arranging and following up on investigations, and coordinating discharge and post hospitalization follow-up. In addition, Clerks had unofficial but widely accepted service delivery roles of their own within hospitals, including phlebotomy, administering intravenous medications, performing simple procedures such as Foley catheter insertion, cast removal, simple suturing and recording electrocardiograms. Appropriately supervised and monitored, this role provided opportunities to engage patient care in all its complexity in a transitional fashion, leading eventually to more independent practice after graduation. The service delivery component of the clerkship was eventually recognized as such with the provision of a modest stipend, which continues today. Importantly, the role of the Clerk varied very little between services, specialties and differing patient populations, the goal being to develop strong foundational skills in patient assessment and management, which were felt to be consistent and “learnable” within any patient care context.
In short, being a Clinical Clerk was a job. Clerks had a widely understood and (dare we say) useful role within the hospital. As a Clinical Clerk, a medical student felt part of the service delivery because they were making a tangible contribution. They therefore felt, and were, valued.
Many factors have combined to, gradually and without deliberate intention, dramatically alter the role:
- The service components came to be recognized as excessive and non-educational, to the point of diminishing true educational opportunities. Accreditation standards confirm and reinforce this perspective.
- Our hospitals have become much more focused on efficient, focused, therapeutic management of patients with complex and critical diseases. Diagnostic processes, so important to the Clerkship learning experience, have largely shifted to the outpatient setting.
- Career selection and the CaRMS application process have become a major focus for our students, making multiple, shorter service assignments preferable to the longer, continuing assignments that allowed the Clerk to develop a clear role within service teams.
- Hospitals are much more regulated environments that require clear definitions of roles and scope of practice for all providing care.
Although these issues are all valid, one must now ask what price we’ve paid for this evolution. A few questions come quickly to mind, and are being asked by our students, faculty and hospital personnel on a daily basis :
- What aspects of patient charting are Clerks expected to provide?
- To what extent are Clerks empowered to write patient orders?
- What diagnostic tests are Clerks empowered to order?
- Is a Clerk permitted to submit a consultation request or requisition for an invasive investigation?
- What medications can a Clerk prescribe, if any?
- What procedures are Clerks expected to provide?
- Can a Clerk obtain informed consent for procedures? If so, what procedures?
- To what extent should a Clerk be expected to provide care for a patient in an emergency (arrest) situation?
- In all these issues, what degree of supervision is required, and by whom?
Clearly, the application of all these aspects of service provision will vary between clinical assignments, but their fundamental nature (or, to use hospital terminology “scope of practice”) should be consistent throughout. It should not be necessary to re-define the Clerk role for every rotation.
Our Hospital Liaison Committee, capably chaired by Christopher Gillies with representation from all teaching hospitals, faculty, administration and students, has recently been considering solutions to the Learning Environment concerns described in previous articles (meds.queensu.ca/blog/undergraduate/?p=2026). They recognized that many of these concerns may have their roots in this lack of clarity regarding the Clerk role and have therefore advocated a redefinition of the role. To this end, our Clerkship Committee (Chaired by Andrea Winthrop and consisting of all Clerkship Course Directors) met this past week to re-define the role or “job” of the Clinical Clerk, recognizing our current educational requirements and current reality of the hospital based learning environment. They have already made excellent progress in addressing the various issues listed above.
To short, our senior medical students (Clinical Clerks) are able to make valuable contributions to patient care in the hospital environment. It is in doing so that they truly grow as physicians. That can only happen with a clearly articulated and widely accepted role description, appropriate to the modern hospital environment, developed jointly by medical education and hospital leadership.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Students compete in 7th Annual Health Care Team Challenge
Three interprofessional teams of students faced off on Monday, November 16 in the 7th Annual Queen’s Health Care Team Challenge.
The teams tackled a case developed by the Health Service Centre team at Canadian Forces Base Kingston. Each team had students from Nursing, Medicine, Occupational Therapy, Physical Therapy and Psychology.
The five-member judging panel included two local clinicians who developed the case, along with faculty, student and patient representatives.
The teams had been preparing for the competition since October 16.
The winners were “Team Three”, which included: Ahyoung Cho, Nursing; Wilson Lam, Medicine; Heather Shepherd, Occupational Therapy; Kayla Hertendy, Physical Therapy; Stephanie Gauvin, Psychology; Additional Team member: Elishea Mardling, Occupational Therapy; Back-up member: Verdah Bismah, Medicine; Faculty mentor: Lynne Harwood-Lunn, MN, RN, School of Nursing.
The two other teams were: Team One: Kyrinne Lockhart, Nursing; Alex Trajkovski, Medicine; Allie Rogers, Occupational Therapy; Heather Greene, Physical Therapy; Melissa Milanovic, Psychology; Additional Team member: Richa Kukkar, Physical Therapy; Back-up member: Shikha Kuthiala, Medicine; Faculty mentor: Brent Wolfrom, MD, School of Medicine. And Team Two: Charlotte Wilson, Nursing; Stephanie Piper, Medicine; Joshua Lee, Occupational Therapy; Erin Makins, Physical Therapy; Robyn Jackowich, Psychology; Additional Team member: Claudia Romkey, Nursing; Back-up member: Greg Smith, Physical Therapy; Faculty mentor: Heidi Cramm, PhD, OT, School of Rehabilitation Therapy.
Co-moderator Anne O’Riordan noted that all three teams’ presentations were exceptional, each presenting the case in a unique way which made for an educational evening for all. Co-moderator Ralph Yeung was a member of the very first Queen’s team in 2009.
The Health Care Team ChallengeTM is an interprofessional education event, originally developed at the University of British Columbia in the 1980s. Students volunteer to participate in order to enhance and practice their collaborative team skills. Each student interprofessional (IP) team is provided with the same case to work on for a period of three weeks, with the goal of developing a collaborative, interprofessional person-centered plan of care. A faculty mentor is matched with each team for consultation and advice.
The Queen’s Health Care Team Challenge is jointly sponsored by the Faculty of Health Sciences’ Office of Interprofessional Education and Practice (OIPEP) and the Queen’s Health Interprofessionals Student Society (QHIP).
Team Three (soon to be renamed the Queen’s Team) will compete in the National Health Care Team Challenge™ in March 2016, hosted this year by Dalhousie University.
“Major Marlene Lefebvre was instrumental in connecting the health services team at the base with OIPEP, after initial email connections made by Alice Aiken,” O’Riordan said. “It really took a ‘health care community’ to do develop, organize, and implement this event and the learning was apparent for everyone.”
Here’s the beginning of the case the teams had to address:
You are a medical officer (MO, i.e. a military physician) in the health care team in Care Delivery Unit (CDU) 2 at 33 CFH Svcs C in Kingston, Ontario. The Base Surgeon (BSurg) informed the team yesterday the she was talking to the task force surgeon in Afghanistan and that an injured female service member would be arriving at the clinic this morning for an assessment. It will be sometime mid-morning before she arrives, hot off a CC-117 Globemaster transport aircraft landing in CFB Trenton at around 0730.
You don’t know much about the case other than that she is a 25 y.o. captain logistics officer who was injured two days previously in Cyprus, where she was undergoing a decompression stop after finishing her tour in theatre in Afghanistan. You note that she is a member of the Canadian Forces Joint Operations Support Group (CFJOSG) based at Canadian Forces Base (CFB) Kingston, and you remember that members of the unit were attached to a provincial reconstruction team (PRT). She is ambulatory as far as you know…
Credit where it’s due:
It takes a lot of effort from a great many people to pull an event like this together. In addition to the teams, here are the folks who made it happen:
Health Services, Canadian Forces Base Kingston
CFB Kingston Liaison:
Major Marlene Lefebvre
Anne O’Riordan, OIPEP Clinical Educator, QHIP Advisor (OT)
Ralph Yeung, HCTC winner, 2009; IP Award of Leadership, 2013 (X-Ray Tech)
Welcoming Keynote Address:
Dr. Alice Aiken, Director, Canadian Institute for Military and Veteran Health Research, Queen’s University, Royal Military College, Kingston. (PT)
Dr. Lucie Pelland (SRT) – Faculty Representative (PT)
L.Cdr. Bradley Stewart, Clinical Rep. (Medicine)
Capt. Dwayne Rennick, Clinical Rep. (Social Work)
Amanda Shamblaw, Student Rep., QHIP Exec., Past HCTC participant (Psychology)
Dr. Peter Dunnett, Community/Patient Rep. (Economics Professor, ret., RMC)
Chloe Hudson, QHIP Executive Member, Past HCTC winner (Psych)
Presentation of Team Certificates & Team Photos:
OIPEP & QHIP
Presentation to Winning Team:
Dr. Rosemary Brander, OIPEP Director (PT)
Why I can’t build an addition and the fall filing cabinet
This fall, I’ve been cleaning out closets and filing cabinets and purging, as they say on Houzz. I didn’t want to—I hoard my teaching materials as if they were gold. But, my husband said, “If you don’t get rid of some of this stuff, we’ll have to build an addition onto the house.”
I don’t quite know why that’s a bad thing…:) Teachers are packrats—you never know when you’re going to need something again to help students and other teachers.
However, apparently we can’t build an addition just for more filing cabinets. So, I’ve started cleaning out my notes on teaching from…well… I started teaching in 1980…
I’ve rediscovered some wonderful things, and I thought I’d share some with you. Here are a few from my filing cabinets:
- First of all for our students (and anyone else who reads): I found this poem by the late great poet Maya Angelou which actually a student drew to my attention years ago (a shout-out to Jessica Chiu formerly at OCA!). It’s about reading, and if there’s anything I know about UG medicine, it’s about the amount of reading you have to do. I hope you find lots of ideas sticking to your mind.
Popcorn leaps, popping from the floor
of a hot black skillet
and into my mouth.
Black words leap,
snapping from the white
page. Rushing into my eyes. Sliding
into my brain which gobbles them
the way my tongue and teeth
chomp the buttered popcorn.
When I have stopped reading,
ideas from the words stay stuck
in my mind, like the sweet
smell of butter perfuming my
fingers long after the popcorn
I love the book and the look of words
the weight of ideas that popped into my mind.
I love the tracks
of new thinking in my mind.
- More for students…and teachers using small group learning: Roles to Assist in Group Learning
Many medical students have told me about their horror stories of group work, either in high school or university. And it’s true…sometimes teachers throw students into groups without advice or support to work things out. Sometimes one student dominates the group; others are couch potatoes and hitch-hikers. Some block consensus, some goof around and still others withdraw. Bearing in mind our adult learners in medical school, and also the concept of self-directed learning, here are 20 (!) roles which students can adopt in groups. So even if a student is an introvert (see the book Quiet: The Power of Introverts in a World That Can’t Stop Talking), he or she will find some useful roles below. Teachers, you can encourage students by helping them see these roles in their work. (Thanks to my old bosses, Gray Cavenaugh and Ken Styles at the Ontario Ministry of Education. I’d forgotten how good you were!)
Students, practice putting yourself in each of these roles, think of others in the group, and begin developing your group leadership strengths. Teachers, when I used these with students in the past, I asked them to read them over and put a star beside the ones they do, and an exclamation point for a few they’d like to try.
Teachers, do you recall hearing that students learn best with this saying: Tell me; show me; let me try?
It’s actually the first thing I heard about (that I remember) when I hit Teacher’s College all those years ago. Here’s how I translate it into Medical Education:
|What it means||In medical school|
|Tell me: lecture or telling—even assigning reading especially with guides. Learners say, Get me oriented, motivated and let me absorb facts and concepts.||Provide students with facts, characteristics, vocabulary, symptoms, etc. through (mini-) lectures, or readings with questions attached, about medical conditions, systems, and approaches. Our RATs, or quizzes help students process what they’ve been told.|
|Show me: Learners say, Demonstrate how this works so I can see it in action. Give me examples of how it works!||Show students through written or verbal examples–cases you have encountered on how to recognize patterns, how to differentiate among diverse conditions, etc. Video clips and demonstrations are also really useful! A summary of your key findings and learning and the strategy of Think-Aloud (just what it sounds like) from the cases is useful for students to follow your thought processes. Don’t forget to tell them what you ruled in, and what you ruled out and why.|
|Let me try. Learners say, Give me a chance to apply the learning to see if I can do it myself, or if make it work in different situations.||· Provide students with written or verbal cases through which to work, often with a partner or in a group, so that they can learn how to apply the facts and examples you have given them.
· Change up the circumstances: paediatric or geriatric patient; chronic conditions vs. acute conditions, co-morbidities, different presentations or similar presentations with different associated conditions, different points in the illness journey.
· Put students in a simulated learning environment—such as with standardized patients.
· In clerkship, under supervision, allow clerks to apply their learning to patient care.
Key here is to find out if the students have learned through their application (mid-terms, graded team assignments, individual assignments) and observe them in practice (MiniPEx, MiniCEx, field notes, etc.).
So three tips from the files. I found a few more 🙂 Stay tuned…
Have a great fall! I’m looking forward to continuing the dialogue about teaching and learning.
We write these blog articles with ideas, thoughts and strategies, usually for teachers, but often for students too.
We’re always interested in your thoughts, so please feel free to respond.
What’s in your filing cabinet?
Using Copyrighted Images in an Educational Setting: A Primer
By Mark Swartz, Copyright Specialist
Understanding a few of the basic concepts behind Copyright law can help explain why some images can be used in certain situations and others cannot. The most useful concept to consider when thinking about how images can be used is balance.
A Balancing Act
In the landmark Supreme Court case Théberge v Galerie d’Art du Petit Champlain Inc, Justice Ian Binnie characterizes Copyright Law with the following statement:
The Copyright Act is usually presented as a balance between promoting the public interest in the encouragement and dissemination of works of the arts and intellect and obtaining a just reward for the creator.
When you create a work, whether it is a book or an article, a photograph, a painting or any of the other types of expression covered by copyright (Copyright Act, RSC 1985, c C-42, s 5 retrieved on 2015-10-16), you automatically get a bundle of exclusive rights to that work. These rights include the right to copy, to distribute, and to assign your rights to others. The full sets of rights that you get are listed in the Act (Copyright Act, RSC 1985, c C-42, s 3 retrieved on 2015-10-16). And, while these rights are exclusive, they are limited in both time and scope. The balance between exclusive rights and limitations ensures that creators are fairly compensated for their work, while still allowing for some permission-free uses in ways that contribute to the public good.
Limitations to the exclusive rights of copyright holders include the following:
- Copyright protection does not last forever. In Canada, the general rule is that Copyright lasts for 50 years after the death of the copyright holder. After that point, the work will fall into the public domain and can be used for any purpose.
- The Copyright Act lists a number of situations where Copyrighted works can be used with permission from Copyright holders. These situations are called exceptions. The most well-known exception is called the fair dealing exception, which allows for some use of copyrighted material, as long as the use falls under one of the purposes listed in the Act, and if the dealing is fair (Copyright Act, RSC 1985, c C-42, s 29.1 retrieved on 2015-10-16).
If you have determined that you are using a copyright protected image, you need to get permission from the copyright holder or you must ensure that your use falls under one of the exceptions in the Copyright Act.
So what does this mean if I want to use images in my class?
There are a wide variety of exceptions that apply to the use of copyrighted images in a closed, educational setting like a classroom or a Learning Management System. In the classroom, there is an exception that permits the reproduction of copyrighted images for use in PowerPoint presentations on campus (Copyright Act, RSC 1985, c C-42, s 29.4 retrieved on 2015-10-16). Additionally, fair dealing and the publically available materials exception will allow for the inclusion of many images in PowerPoint slides uploaded to Learning Management Systems like MEdtech. For more information, please see the In the Classroom and the On the Internet sections of the copyright and teaching section of my website.
As for images used in student assignments and presentations, most of the images used by students are likely to fall under the fair dealing exception. I do, however, always recommend that students do their best to find copyright free (or suitably licensed) images, so that when students leave the university and are asked to use images in the workplace, they know how to find images that can be easily used without having to get permission. Suggestions for finding these types of images are available on the Resources page of the copyright and teaching section of my website.
What about using images in materials that I post to the open web? What about images in conference presentations, posters and in research projects?
When you move from a closed environment like a Learning Management System to an open environment, it becomes more difficult to rely on exceptions like fair dealing, particularly if you intend to use your work for commercial purposes at any point.
In these situations, I would avoid using copyright protected images without permission and instead rely on finding works that are either licensed through the Creative Commons or that are in the public domain. The “resources” link I included in the section above provides some resources for finding these types of images. Images used in conference presentations and posters are much more likely to be fair than those on the open web, but I would be careful posting these presentations and posters on conference websites.
Finally, most images used in research projects and theses are likely to be fair dealing. One complication is that if you are going to publish in a traditional journal or publication, it is likely that the publisher will require that you get permission for everything. Fair dealing is often perceived to be too much of a risk for these publishers, so, if you are going to go that route, make sure you find materials where permission can be granted easily or is not required.
This is just a brief overview outlining some of the main image-related considerations that you might come across as an instructor or researcher. If you have any further questions about the use of images, please get in touch with me at extension 78510 or at firstname.lastname@example.org.
Théberge v. Galerie d’Art du Petit Champlain inc.,  2 SCR 336, 2002 SCC 34 (CanLII), <http://canlii.ca/t/51tn> retrieved on 2015-10-16.
Copyright Act, RSC 1985, c C-42, s 29.1 <http://canlii.ca/t/52hd7> retrieved on 2015-10-16.