Curriculum Committee Meeting Information – October 27, 2016

Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller at candace.miller@queensu.ca for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on October 27, 2016.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of this meeting can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Kate Rath-Wilson, at vpacademic@qmed.ca.

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Tips to help with Teaching Dossiers in your upcoming reports:

Here’s a riddle for you:riddle

It may not be the type of writing you’re used to, and it requires thinking and reflection about an aspect of your work that you may not think as much about.  It has an intimidating word in the title and is the first hurdle in preparing an outline of your work.  What is it?

Answer: A Teaching Philosophy Statement

 What is a teaching philosophy statement?

A Teaching Philosophy Statement is a reflective statement of your beliefs about of vision of teaching, your educational goals, and preferred educational practices/approach(es). Included are reasons for your teaching approaches. Critical self-reflection is a key component here. Your Teaching Philosophy can inform all of the subsequent materials in your dossier—acting as the spine of your dossier.  It should also discuss how you put your beliefs into practice by including concrete examples of what you do or anticipate doing in the classroom.

 Introduction:

Often medical faculty are required to prepare a teaching dossier or portfolio.  These are often requirements for awards, for competitions or for promotion.

The actual dossier may be a familiar piece of writing for many of you:  Describe what I do, prove what I do, summarize what I do.

But most dossiers start off requiring you to write a Teaching Philosophy Statement.

businessman-thinking1

And this is where you may come up against a form of writing that is somewhat unfamiliar, unless you specialize in narratives or reflection.

Annual reports are coming up, and awards are being bruited about.  So I thought it was timely for some ideas, tips and definitions for you, some from a much longer piece I’ve written on the Teaching Dossier for OHSE, and others from readings that have struck me.

(If you’ve done all your thinking and just want some writing tips, skip to TIP 4.)

Tip 1: Don’t do it…first

First of all, I suggest leaving your teaching philosophy alone until you’ve prepared some of the other parts of your dossier. So my tip is: Get your materials, your explanations, proof and evidence of your teaching together. Then…

Look through all your data.  What similarities do you see?  Any patterns?

What does this say about you as a teacher?  What have your students said about you over the years? (or year, if you just started).  What have your colleagues or your Course Director or Dept. Head said about your teaching?

These are all other parts of the dossier, necessary, and helpful to reflection.

Tip 2:  Reflect

Yes, there’s that word again…Reflect.  Or, if you don’t like to reflect, try: Analysing or recalling.  You can also  mull, ponder or ruminate.

I find it helps me reflect if I have prompts or hooks to anchor my thoughts.  Try these 3 questions first, and just jot ideas down as they come to you. (You can “word splash”–just what the phrase says.)

Make your teaching philosophy personal to you

1) Why do I teach?
2) What do I want my students to leave my class with?
3) What do I believe my role is in the classroom?
Now try this:  What in your experience and/or in your study of education has lead you to believe this?  Describe your preferred approach, practices, and methods.

Need more help with your reflection? 

Try these prompts to make your writing soar: (but don’t use all of them to write your statement or it will be a book, not a statement!)prompts-make-your-writing-fly

 

  1. Put students first: In many courses on pedagogy, teachers are advised to place the students as learners at the centre or forefront of their teaching. If you begin with knowing how your students learn, how does that impact on you? What would be some of the first steps you would take in your classes?
  2. Learning: What is your definition of learning?  How do you facilitate this in the classroom? How have your experiences influenced your view of learning?
  3. Teaching: What is your definition of an effective teacher? What are the roles and activities of an effective teacher? How do you challenge or engage learners? How do you teach? This should be a reflective statement describing your preferred approach, practices, and methods.
  4. Your teaching experiences: Think of times when you have been an effective teacher. What were you doing? Why and how? Times when you were ineffective? What were you doing? How can you improve that?
  5. Your teaching strengths:  What are your strengths as a teacher? How will you capitalize on this? What are your weaknesses? How will you improve this?

And lastly, try these prompts:
Educational Goals:

  • What are the chief goals you have for your students?
  • What content knowledge and process skills, including career and lifelong goals, need your students achieve?
  • How do you help your students achieve their goals?

NOTE:  Please don’t try to answer all of these questions in one Teaching Philosophy Statement. Select a few that will guide you personally as they relate to you.  See Tip 10 below in #4.

So what we’ve done so far is Collect, Select, and Reflect*.  (*Sheila’s patented approach to dossiers and portfolios.)

TIP 3:  Use and outline or a graphic organizer

Some people are gifted enough to have full statements spring full blown from their minds.  I on the other hand, need an outline.  Now, my outline is usually just a mass of words that I start organizing into themes.  Thematic organization is actually just pattern recognition.  However, you may find some helpers such as word clouds or concept maps useful.  Here are some I found on the web as examples:

cloud-teaching-philosophy

http://eportfoliorobbins.weebly.com/traditional-teaching-philosophy.html

Image result for concept map teaching philosophy

https://computingteacher.wordpress.com/my-philosophy/

If we’re still using my approach, now we’ve done: Collect, select, reflect, connect.

TIP 4:  10 TIPS for crafting your writing:

i.         Write in the first person with “I”, “my” etc.

ii.         Some people use a metaphor to guide tyeats1heir statement. (teacher as coach, fitness trainer, gardener, strike a spark, not filling a pail but lighting a fire, tour guide, 911 dispatcher… Teaching is like….)

iii.         Use the teaching philosophy statement as a guide to link with your responsibilities, strategies and effectiveness sections to form a cohesive dossier by drawing connections this statement.

iv.         Buff or polish it to ideally 3-4 paragraphs—max. full page for physician educators’ teaching dossiers. (Some requirements are for 2 pages.  That violates writing tip # 10.)

v.         Provide specific supportive evidence, either from personal teaching experience or relevant teaching literature (See prompts above).  Treat this like evidence in a study, if that expository kind of writing is more familiar.

vi.         Use language appropriate to the audience.

vii.         Work with another person as an editor and/or brainstormer.  And view others’ statements as exemplars.

viii.       Ensure that you can refer back to the key points of your philosophy in later components.

ix.         If you can, make it a narrative, engaging and rhetorically effective text.  Whoever is reading this might as well enjoy the experience.

x.          Be brief and concise.

OK, I’m pushing it, but we’ve done all these steps:  Collect, select, reflect, connect and now we’re beginning to “perfect” or “confect”.

I hope these are helpful tips and strategies for you. Please let me know if they are helpful and also if you have tips and strategies as well!  Happy writing!

 

References

 

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Was Plato being Pimped?

A medical student and attending physician arrange to meet near a nursing station to discuss a recently admitted patient the student has reviewed. The patient has presented earlier that day to the emergency department with a severe headache and visual disturbance. The student relates a description of the symptoms, past history and physical findings, after which the attending asks:

 

“So, what do you think is going on?”

      “I think its migraine”.

“Really? Does the patient have any history of migraine?”

     “Not that I’m aware.”

“Did you ask?”

     “No.”

“Is it common for someone to get their first migraine at age 70?”

     “Guess not.”

“Is the patient on anticoagulants?”

     “Yes.”

“So what else might be in the differential?”

 

For the next 10 minutes or so they engage in a question and answer session regarding the findings and management plan. They develop a number of other possibilities and a diagnostic plan, which includes an urgent CT scan. At the end, the attending suggests the student reviews the features of both migraine headache and intracranial bleeding.

 

So, what just happened there?

 

It’s very likely that the attending physician and student left the encounter with vastly different impressions of what had transpired.

 

The attending physician likely feels they have provided a “teaching moment” in which some important issues of clinical management have been passed on to the student. They may feel they have left the student better prepared for having had this encounter, and may very well feel more confident in the ability of the student going forward. They likely leave feeling they have fulfilled their obligation as a teaching clinician. They may even feel they have engaged in a version of what’s been termed the Socratic method; a term used loosely to refer to a method of teaching that utilizes questioning as a means to promote learning.

 

The student involved in the interaction may feel differently. They will likely describe what they experienced as having been “pimped”.

 

Pimping, in this sense, isn’t referring to the practice of soliciting clients for prostitutes (a very unfortunate association). It refers, rather, to the practice of posing a series of increasingly difficult and obscure questions to a learner with the purpose of identifying knowledge deficiencies.

 

The term has a considerable history. A rather infamous 1989 JAMA article by Frederick Brancati1 provides a tongue-in-cheek review of the practice and is well worth reading. As he points out, the first known use of the term was by no less than the esteemed William Harvey who lamented in 1628 his students failure to understand his early theories about the circulation:

 

“They know nothing of Natural Philosophy, these pin-heads. Drunkards, sloths, their bellies filled with Mead and Ale. O that I might see them pimped”.

 

Robert Koch, the prominent Dutch microbiologist of the mid nineteenth century recorded a series of “Pumpfrage” (pump questions) for use on ward rounds. Apparently William Osler was a master pimper. Abraham Flexner commented on his style after his 1916 visit to Johns Hopkins:

 

“Rounded with Osler today. Riddles house officers with questions. Like a Gatling gun. Welch says students call it ‘pimping’. Delightful.”

 

It’s often done in the presence of others, and has the potential to leave the learner feeling embarrassed and, possibly, humiliated. It’s felt by many that the main purpose of pimping is not to impart learning, but to establish an operational hierarchy – to put the learner “in their place”. It’s been characterized by many as an initiation ritual.

 

Its value is, at best, debatable. Detsky2, reprising Brancato’s article, concludes “the purpose of pimping is to increase retention of the key teaching points by being provocative”. In a contemporary commentary Kost and Chen3 take a much more negative view and suggest the term be reserved for undesirable behaviours, specifically:

 

“questioning of a learner with the explicit intent to cause discomfort such as shame or humiliation as a means of maintaining the power hierarchy in medical education”.

 

Medical students bring helpful perspective to the issue. In an interesting study carried out by fourth year students at a midwestern American medical school4, a differentiation was drawn between “malignant” pimping, and that done “with good intentions”. To quote from their conclusions:

 

“At its best, pimping assesses students’ knowledge and skills, stimulates critical thinking, and encourages self-assessment. At its worst, the competitiveness that pimping generates may inhibit students from learning how to work as a team, and how to rely on each other.”

 

It also seems that medical students not only accept that they will be subjected to directed questioning in their clinical rotations, but have adapted mechanisms to “manage” these situations. Interestingly, that management is intended not only to optimize their learning, but also to project a positive image of their skills and teachability. To quote a student interviewed as part of this study by Lo and Reghr5:

 

“I think my goal is basically to come away from that session with the instructor thinking that I do know my stuff, I know my material. And even if I got some questions wrong, it’s okay, because in the greater context I have a good understanding of the subject.”

 

It would seem that directed questioning is certainly eliciting an adaptive response, but perhaps not entirely what was intended.

 

In Canada, about 57% of graduating students report have been “publicly embarrassed” and 29% report having been “publicly humiliated” at least once during medical school6. Although not explicitly stated, it’s reasonable to presume that the majority of these relate to episodes of pimping.

 

 

In a recent perspective, Soddard and O’Dell posit “the term ‘Socratic method’ has been so often misapplied that Socrates himself might not recognize the clinical education techniques that often bear his name.”7.

 

Socrates, prominent Greek philosopher of the fourth century BCE, believed his role as a teacher was not to simply deliver information, but tosocraticmethod1 help his students develop their own methods of thinking and examining the world. In fact, it seems he seldom made statements of fact but, rather, provoked his students by posing a series of challenging questions, many of which had no clear answer, but required examination of their own assumptions and values. These “dialogues” subsequently recorded by Plato (his most famous student) were probably not comfortable experiences for his students who may have felt challenged, cross-examined, and perhaps even attacked. (Interesting to speculate what sort of teaching evaluations Socrates would get today). The opposite of the Socratic method is the Didactic, which entails the teacher delivering information with a minimum of student participation. It is certainly more comfortable for the student and simpler for the teacher, but fraught with limitations regarding the appropriateness of information provided, and benefit for the learner.

 

Moreover, it’s a long way from the Athenian agora to the wards and hallways of our teaching hospitals. It’s therefore more than a little presumptuous to refer to what we’re doing as Socratic teaching. However, perhaps the message for us is that there is great value and potential in questioning if questions are appropriately posed, and posed for the right purpose. We need to carefully consider what features differentiate effective questioning in clinical education from what students rightfully identify as “malignant pimping”.

 

  • Why is the question being asked, and for whose benefit? The issue of intention is central and critical. Questions should be posed for one of two purposes: to advance the student’s understanding and comfort with clinical medicine or to ensure optimal patient care. The concept of “toughening up” students in preparation for perceived future abuses is archaic and never justifies, but potentially perpetuates, demeaning behaviour.
  • Is the question reasonable and relevant? Does it relate to the clinical issue under discussion? Will the answer advance the student’s understanding or patient care? Does it really matter whose name is historically associated with pulsatile nailbeds?
  • Is this the time and place? Questions asked in highly public places or with patients in attendance can be highly-charged for students, and are not rendered more educationally valuable by that added scrutiny.
  • How well do you know the student? Within the context of a continuing relationship, a degree of trust develops between teacher and learner that allows the student to contextualize criticism and eventually demonstrate improvement. Brief, or one-time encounters, have no such trust, resulting in considerable vulnerability on the part of the student.
  • Questioning in the workplace should be provided in the spirit of formative educational experiences. However, students may perceive they are being formally assessed through these questions.

Based on these considerations, I would not consider the exchange described at the beginning of this article to be an example of pimping, but rather directed questioning intended to both teach and ensure optimal patient care

To return to my initial question, was Plato being pimped? Given the definitions we’ve developed and what we understand of the Socratic approach, almost certainly not. But he was certainly being questioned, likely aggressively, but by a benevolent teacher intent on making him a better person and more accomplished philosopher.

Seems that turned out fairly well.

 

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

 

 

  1. Brancato FL. The Art of Pimping. JAMA 1989; 262(1). 89.
  2. Destsky AS. The Art of Pimping. JAMA 2009; 301(13). 1379.
  3. Kost A, Chen FM. Socrates was not a Pimp: Changing the Paradigm of Questioning in Medical Education. Academic Medicine 2015; 90(1). 20.
  4. Wear D, Kokinova M, Keck-McNulty C, Aultman J. Pimping: Perspectives of 4th Year Medical Students. Teaching and Learning in Medicine 2005; 17(2). 184.
  5. Lo L, Regehr G. Medical Students Understanding of Directed Questioning by Their Clinical Preceptors. Teaching and Learning in Medicine 2016. (http://dx.doi.org/10.1080/10401134.2016.1213169)
  6. Canadian Graduation Survey National Report. Association of Faculties of Medicine of Canada. 2016.
  7. Stoddard HA, O’Dell DV. Would Socrates have Actually Used the “Socratic Method” for Clinical Teaching? J Gen Intern Med 2016; 31(9). 1092.

 

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

 

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Fall Education Retreat set for December 6

The annual UGME Fall Education Retreat will be held December 6 with plenary and breakout sessions designed to help our faculty improve their teaching and assessment skills as well as to provide opportunities for networking and informal discussions.

The retreat brings together course directors from pre-clerkship and clerkship, unit leads, intrinsic role leads, and administrative staff who support the program. Session topics were developed based on course evaluation feedback, faculty team suggestions and accreditation priorities.

The full-day program will be held at the Donald Gordon Centre on Union Street.

New to the program, this year’s retreat will feature guest speaker Dr. Jay Rosenfield addressing the topic of The future of medical education in Canada and our places in it. Dr. Rosenfield is a professor of paediatrics (and former vice-dean, MD Program) at the University of Toronto and a Developmental Paediatrician at the Hospital for Sick Children and Holland-Bloorview Kids Rehab.

Associate Dean Dr. Tony Sanfilippo will provide an update on UGME news and initiatives and two other plenary sessions will address using a competency-based education lens to frame completion of Years 1 & 2 and incorporating principles of diversity in the curriculum.

Break-out workshops will address effective SGL sessions, Entrustable Professional Activities (EPAs) in clerkship, creating key features questions and improving resident teaching of clerks.

For more information and to register, click here.

  • Credits for Family Physicians: This Group Learning program meets the certification criteria of the College of Family Physicians of Canada and has been certified by Queen’s University for up to 5 Mainpro+ credits.
  • Credits for Specialists: This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada, and approved by Queen’s University, You may claim a maximum of 5 hours.
  •  Credits for Others: This is an accredited learning activity which provided up to 5 hours of Continuing Education
 

 

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Lovable Losers no Longer: The remarkable (and instructive) transformation of the Chicago Cubs

The Chicago Cubs have won the World Series.

Let me say that again with appropriate emphasis – The CHICAGO CUBS have won the World Series!

After 108 years of comfortable, predictable mediocrity, the lovable losers are now simply lovable. For anyone with even a passing interest in

Copyright 2016 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed without permission. Mandatory Credit: Photo by Matt Slocum/AP/REX/Shutterstock (6908435aa) Chicago Cubs celebrate after Game 7 of the Major League Baseball World Series against the Cleveland Indians, in Cleveland. The Cubs won 8-7 in 10 innings to win the series 4-3 World Series Cubs Indians Baseball, Cleveland, USA - 03 Nov 2016
Photo by Matt Slocum/AP/REX/Shutterstock (6908435aa)

baseball, this is hard to fathom. There has been a disruption in the Force. The space-time continuum is in disarray. Dogs and cats will live together. Is there nothing we can count on? Could our grandparents have actually been right when they assured us that anything is possible if we just set our minds to the task?

As we reel in disbelief and attempt to reconstruct our personal realities, it’s instructive to examine how this came about. The Cubs, I would suggest, were successful for two reasons, and there are lessons in their story.

Firstly, they established highly competent leadership. Five years ago, they hired Theo Epstein, a 42 year old lawyer-turned-baseball executive, whoepstein1 had previously extricated the Boston Red Sox from their own seemingly endless 86 year exile in baseball purgatory. Epstein began by taking his entire front office on retreat and re-establishing a new culture, centred on regaining respectability and building on fundamental competence. He then put in place a five-year plan to achieve those goals. Everybody, I would suggest, bought into the plan. The approach he took is not unique to baseball or sports. In fact, it reads like John Kotter’s eight-step approach to change management.

For the plan to work, however, the leadership had to have the courage to challenge conventional wisdom, and bank on teamwork and human qualities rather than pure athletic skill.

Let me try to explain. There are two types of players in baseball – pitchers and everybody else. Success is so dependent on a team’s ability to prevent players from getting on base, that conventional wisdom holds that you build a team around pitching. Teams therefore covet pitchers like bears (or cubs) covet honey. They will stop at nothing to obtain them, whether it’s by drafting, trading or prowling the playing fields of Caribbean elementary schools. They will pay astronomical, rather obscene sums to retain their services. Convicted felons with sociopathic personalities, if blessed with a 98 mph fastball, can be embraced as innocent victims of an unforgiving society. I fear the day that a baseball executive discovers cloning technology and considers exhuming the remains of Sandy Koufax or Satchel Paige.

The prevailing concept is that if you prevent players from getting on base, you needn’t worry about the defensive aspects of the game. Concentrate on pitching and take your chances on all the other parts of the game, like catching and fielding. These are considered lesser skills and an opportunity to preserve budget. This approach is also tactically less demanding because, by concentrating on pitching, what should be a team sport becomes essentially a single player issue. Teams can stop trying to  find nine skillful, committed athletes who need to work together, and instead concentrate their attention (and money) on securing that one key piece.

Except for the Cubs. The Cubs took quite a different approach in building the team that finally found success. They recognized that even the very cubs2best, most highly paid pitchers will inevitably falter some of the time. They also tend to unravel when things go wrong, and things tend to go wrong at the worst times when pressure is greatest like the playoffs. They also recognized that shoddy fielding turns small pitching mistakes into disasters. Moreover, they seem to recognize that fielding requires more than requisite physical skills. It takes a strong and resilient personality to perform at peak efficiency if the opportunities to do so are infrequent and interspersed with long periods of inactivity and tedium. (Parallels to a few medical specialties come to mind.) They therefore emphasized and valued all aspects of the game, and searched for position players with skill and dedication to team play. In doing so, they took some unusual steps.

They searched diligently for the best defensive players available. In fact, they were quite exacting, seeking out very specific skills. Epstein describes one of their recruits, Javier Baez, as “the best tagger in baseball”.

They prioritized defensive play in their coaching, hiring no fewer than nine coaches, including a “Run Prevention Coordinator”.

They devoted time and resources to scouting opposing teams hitting tendencies to better position and prepare their players to defend against hits.

Most importantly, they were able to identify and recruit players who bought into the plan and understood their role in it. They supported and valued those players.

In doing all this, they developed a resilient, mutually supportive team, remarkably free of the high-priced prima donnas that can be so disruptive, and eventually falter.

 

Make no mistake, I would have preferred a Blue Jays victory, but the Cubs are a great consolation prize. They provide inspiration and instruction for us all. They illustrate how leadership and teamwork are not mutually exclusive. Effective leadership begets teamwork. Without good leadership, there is no team. And that holds whether it’s baseball, government, academic groups or health care.

Leadership and teamwork: interdependent, indispensible keys to success.

 

Go Jays.

 

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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Curriculum Committee Meeting Information – September 22, 2016

Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller at candace.miller@queensu.ca for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on September 22, 2016.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of this meeting can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Kate Rath-Wilson, at vpacademic@qmed.ca.

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