Names matter

What’s in a name? That which we call a rose

By any other name would smell as sweet.

 So mused the ill-fated heroine in Romeo and Juliet, about her equally ill-fated love.

In medicine and in teaching, however, names can mean a lot.

The late Dr. Kate Granger of the United Kingdom was one of the strongest advocates for using names with her #hellomynameis campaign – launched while she lived with terminal cancer. As explained in a BBC article following her death in July 2016, the campaign “encouraged healthcare staff to introduce themselves to patients.”

“A by-product of her own experiences of hospital in August 2013, it grew out of the feelings of unimportance she experienced when the doctor who informed her that her cancer had spread did not introduce himself,” the BBC wrote. Granger had explained it this way: “It’s the first thing you are taught in medical school, that when you approach a patient you say your name, your role and what you are going to do. This missing link made me feel like I did not really matter, that these people weren’t bothered who I was. I ended up at times feeling like I was just a diseased body in a hospital bed.”

Learning and using names is important for both teachers and students, long before they reach patients’ hospital beds. For this reason, we emphasize the importance of names in our UGME classrooms and clinical skills environments, too.

“Learning students’ names signals your interest in their performance and encourages student motivation and class participation,” writes Barbara Gross Davis in Tools for Teaching. “Even if you can’t learn everyone’s name, students appreciate your making the effort.”

One of the strategies of learning students names that Gross Davis (and others) suggests is one we’ve adopted at Queen’s UG: having students use name tent cards in the classrooms. This was adopted for two reasons, Dr. Lindsay Davidson, Director of Teaching, Learning, and Integration explains.

“It’s because we start developing professional identity from Day 1, and being a doctor means introducing who you are.”

“And because it helps build relationships,” she adds. “Student-student but also teacher-student—teachers can respond to students as individuals with names not ‘the guy in the ball cap’.”

“We expect all medical students to wear identification nametags for all clinical skills sessions, both in-house and when at health facilities,” says Clinical Skills Director Dr. Cherie Jones. She notes that the Year 1 students don’t have these on Day 1 as these are provided by KGH. “We use paper ones until they are done!” Once the official badges are available, they must be worn.

And it’s not just for students: clinical skills tutors are expected to wear their ID that they use in their clinical settings.

And for all those (like me) who’ve become accustomed to wearing an ID card on a lanyard or on a hip-level clip: IDs are to be worn on the lapel of the jacket—where they can best be seen

“Name tags are important in clinical skills sessions because the Standardized Patients (SPs) and Volunteer Patients (VPs), like to know the names of the students and tutors they are working with and don’t always understand or hear the name when the student introduces themselves,” Dr. Jones explains.

The Clinical Skills policy mimics the name-badge policies at the hospitals in Kingston. “Name tags in clinical settings like KGH are mandatory for anyone interacting with patients, staff, even with visitors,” Dr. Jones points out.

“Not only is it policy in the hospital, but patients like being able to read anyone’s name – not just the students’,” adds Kathy Bowes, Clinical Skills Coordinator.

So, remember your ID badge, use your name tent cards in the classrooms, use people’s names. And me, I’ll be pinning my hospital ID badge in the right place the next time I’m heading over to KGH for a meeting.

Because names matter. To everyone.

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Teaching, Learning and Integration Committee Summer Update

By Lindsay Davidson, Director of Teaching, Learning, and Integration

As classes (at least in years 1 and 2) have now ended, and teachers are perhaps thinking about courses that will resume in the fall, I wanted to provide you with an update of items from the TLIC. Some of these may already be familiar to you, but perhaps some are “new”. If you need any further information, please feel free to contact me directly or one of our Educational Developers (Theresa Suart from Years 1 and 2 and Sheila Pinchin for Clerkship and the “C” courses).

  1. Resources attached to learning events – these include lecture notes, classroom slides, required pre-class readings and optional post-class readings/resources. MEdTech is enabling a new feature for the upcoming academic year. Teachers will be required to review and “publish” each resource every year – with the option of adding in delayed release if appropriate. The goal of this is to provide students with an up-to-date, curated set of resources, deleting old files. Please direct any questions about this to Dr. Lindsay Davidson.
  • Remember: “less is more”: Students report that when there are an excessive number of files, they often read few/none of them in advance.
  • Clearly designate what is MANDATORY to review PRE-CLASS by indicating this in the “Preparation” field on the learning event, and checking the appropriate boxes on the menu when you review the resources.
  • AVOID using dates on your slides/slide file names – students are sometimes disappointed to see that the file dates from 2009 or prior.
  1. The Curriculum Committee has approved a new learning event type – “Games” – reflecting several sessions already existing in the curriculum. This is defined as “Individual or group games that have cognitive, social, behavioral, and/or emotional, etc., dimensions which are related to educational objectives”. This type of activity might include classroom Jeopardy or other similar activities designed to allow students to review previously taught knowledge (content delivered either independently or in the classroom) and to provide them with formative feedback on their understanding. The instructional methods approved by the Curriculum Committee include:

Please direct any questions about this to Theresa Suart.

  1. Workforce – The Workforce Committee has recently adopted some changes including the following:
  • Addition of credit for teachers who grade short answer questions or team worksheets
  • Doubling of credit for teachers who develop new (or significantly renovate) teaching session
  • Limit of one named teacher per DIL event
  • Limit of one teacher per SGL event (gets additional credit to reflect session design, learning event completion, submission exam questions); additional teachers credited as tutors (credit for time in the classroom) – the Course Director may be asked to clarify who is the “teacher” and who is/are the “tutors”
  • Reduction of credit for large classroom sessions (that are not new/newly renovated and/or do not involve grading)

Please direct any questions about this to Dr. Sanfilippo.

  1. Tagging of Intrinsic Role objectives. The TLIC and the Intrinsic Role leads recently held a retreat. One of the items that was identified was “overtagging” of sessional objectives with intrinsic role objectives such as communicator, collaborator, professional etc. by well meaning teachers. We are undertaking a comprehensive review of how these Intrinsic Roles are taught/assessed in the curriculum and would ask teachers/course directors NOT to tag sessions with these unless there has been a direct communication with the relevant Intrinsic Role lead.

Please direct any questions about this to Dr. Lindsay Davidson.

  1. DIL feedback from students. Over the past year, we have received useful feedback from students regarding the content and structure of Directed Independent Learning (DIL) sessions in Years 1 and 2. This will be collated and communicated to Course Directors shortly. Theresa Suart will be in contact with teachers/Course Directors should any sessions be identified for review/revision.
  2. Online modules. We have developed a process to facilitate the development of high quality online modules, often used as resources in DIL session. These are highly appreciated by students and are used for review in clerkship as well as pre-MCC exam. The current list of modules is available here: https://meds.queensu.ca/central/community/ugme_ecurriculum If you would like to create (or revise) a module for your course, please complete the linked intake form: https://healthsci.queensu.ca/technology/services/elearning/online_learning_modules/get_help
  3. New wording of learning event notices. You may have noticed this over the past year. The wording of the 3 email notices received by teachers has been revised. In particular, it has been streamlined and customized to provide specific, focused reminders prior to the scheduled teaching. We would appreciate any feedback or suggestions that you have about this change.
  4. Video capture In 2016-17, lecture sessions were video captured in select year 1 and 2 classes. We will be analyzing how these videos were used by students over the summer and will likely be continuing this into the fall. Please provide any feedback or comments that you have about this pilot to Theresa Suart.

Feel free to get in touch:

 

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Decoding Learning Event Types

Tucked on the right-hand side of every Learning Event Page on MEdTech are notations about the date & time and location of the class, followed by the length of the session and then the “Breakdown” of how the time will be spent. In other words: the learning event type.

We use 14 learning event types* in the UGME program. The identification of a learning event type indicates the type of teaching and learning experience to be expected at that session.

Broadly speaking, our learning event types can be divided into two categories: Content Delivery and Content Application.

For content delivery, students are presented with core knowledge and/or skills with specific direction and/or commentary from an expert teacher. Content delivery learning events include:

  • Directed Independent Learning (DIL) — these are independent learning sessions which are assigned curricular time. Typically students are expected to spend up to double the assigned time to complete the tasks – i.e. some of the work may occur in “homework time”. DIL’s have a specific structure and must include:
    • Specific learning objectives
    • A resource or set of resources chosen by the teacher
    • Teacher guidance indicating the task or particular focus that is required of students. This may be a formal assignment, informal worksheet or study guide.
    • The session must link to a subsequent content application session
    • Formative testing in the form of MCQ or reflective questions are an optional component of DILs
  • Lecture – Whole class session which is largely teacher-directed. We encourage the use of case illustrations during lectures, however these alone do not fulfil the criteria for content application or active learning.
  • Demonstration – Session where a skill or technique is demonstrated to students.

For content application (sometimes described as “active learning”), students work in teams or individually to use and clarify previously-acquired knowledge, usually while working through case-based problems. These learning event types include:

  • Small group learning (SGL): Students work in teams to solve case-base problems which are revealed progressively. Simultaneous reporting and facilitated inter-team discussion is a key component of this learning strategy which is modeled on Team-based learning. SGL cases may be preceded by in class readiness assessment testing (RAT) done individually and then as a team. This serves to debrief the preparation and provide for individual accountability for preparation.
  • Facilitated small group learning (FSGL)Students work in teams and with a faculty tutor to solve case-base problems which are revealed progressively. While there is structure to FSGL cases, students are encouraged to seek out and share knowledge based on individual research.
  • Simulation: Session where students participate in a simulated procedure or clinical encounter.
  • Case-based Instruction (CBI): Session where students interact with guest patients and/or health care providers who share their experience. Builds on prior learning and often includes interactive Q+A component.
  • Laboratory: Hands-on or simulated exercises in which learners collect or use data to test and/or verify hypotheses or to address questions about principles and/or phenomena, such as Anatomy Labs.

The other learning event types we use don’t fit as neatly into the content delivery/content application algorithm. These include:

  • Clerkship seminar – instruction provided to a learner or small group of learners by direct interaction with an instructor. Depending on design, clerkship seminars may be either content delivery or content application.
  • Self-Directed Learning (SDL) is scheduled time set aside for students to take the initiative for their own learning. A minimum of eight hours per week (pro-rated in short weeks) is designated SDL time.
  • Peer Teaching is learner-to-learner instruction for the mutual learning experience of both “teacher” and “learner” which includes active learning components. This includes sessions that require students to work together in small groups without a teaching, such as Being a Medical Student (BAMS) sessions, the Community Based Project and some Critical Enquiry sessions.
  • Career Counseling sessions, which provide guidance, direction and support; these may be in groups or one-on-one.

Two other notations you’ll see are “Other-curricular” and “Other—non-curricular”. Other—curricular is used for sessions that are directly linked to a course but that are not included in calculations of instructional methods. This includes things like examinations, post-exam reviews, and orientation sessions. Other—non-curricular are sessions of an administrative nature that are not directly linked to a particular course and are outside of curricular time, for example, class town hall meetings and optional events or conferences.

Incorporating a variety of learning event types in each course is important to ensure a balance of knowledge acquisition and application. Course plans are set by course directors with their year director, in consultation with the course teachers and with support from the UG Education Team and the Teaching, Learning, and Integration Committee (TLIC).


— With contributions from Lindsay Davidson, Director of Teaching, Learning, and Integration

*In 2015, Queen’s UGME adopted the MedBiquitous learning event naming conventions to ease sharing of data amongst institutions. For this reason, some  learning event type categories may be different from ones used here prior to 2015, or ones used at other, non-medical schools or medical schools which have not adopted these conventions.

 

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Online modules can enhance curriculum content delivery

Do you want to build an eModule?

Online modules, or eModules, are one of the content delivery methods available for use in our UGME curriculum.

As with any content delivery method, the teacher’s job is to define objectives, then organize and deliver new content to students. Online modules can deliver content efficiently and creatively but they’re not without potential pitfalls, so planning is key.

Unlike traditional lectures, online modules can curate other online content like a museum exhibit: you can select useful works from others and present these with guidance. The potential pitfall here is if not done carefully, modules can be information overload.

Modules can have interactivity, such as multiple choice questions with automated feedback. This can help keep students engaged as they work through the new content. Remember, though, for UGME, we aren’t building complete online courses – our eModules are prefaces to in-class interactive case/problem-based learning.

Carefully created eModules can be particularly useful where there is no resource appropriate for this level of learner.

Using an online module to deliver new content means you can use classroom time for interactive problem-solving: having completed the module, students come in prepared to apply their new knowledge.

Online modules are intended to be fully integrated with the rest of the UG curriculum – they don’t stand alone, but are one tool to deliver content students later apply in other settings, both classroom and clinical. Modules used to deliver new content in pre-clerkship can later be used by students as review during particular clerkship rotations, for example.

Here are some examples of the types of online modules in use in Undergraduate Medicine:

We also have a newly-created MEdTech community “Queen’s UGME E-Curriculum” designed to provide links to all UGME online modules. (Requires MEdTech log-in to access). As it’s currently under construction, there may be a few modules missing at the moment.

To help avoid some of the pitfalls of online modules – such as content overload, not providing sufficient guidance for students, and lack of linkage to subsequent sessions, the Teaching, Learning, and Innovation Committee, the UGME Education Team, and EdTech have implemented a streamlined process for creating and adopting new eModules for the UGME curriculum.

The process starts with content creation and/or compilation, followed by design, then support and follow-up for incorporating the module in your teaching.

If you already have a good idea of what you’d like to do, you can use the form found here to start the process.

If you’d just like to brainstorm and talk about possibilities, feel free to get in touch with me at theresa.suart@queensu.ca or with Lindsay Davidson, TLIC Director (lindsay.davidson@queensu.ca)

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Pearls of wisdom, tearing up textbooks, and getting messy

We talk a fair bit about Pearls of Wisdom at the School of Medicine. The last class for the Class of 2016 ended with Pearls, presented by faculty selected by the class. Later this week, during orientation week, Pearls will be shared with our newly-minted class of 2020.

Pearls are succinct pieces of advice, aphorisms or other sage musings designed to guide, caution, or inspire.

IMG_4250
Artist Nancy Douglas (centre) offers suggestions to creative expressions participants at the first workshop in May.

Sometimes these pearls are explicitly stated as “here’s a pearl” as in those two learning events. Sometimes they are shared in a one-on-one feedback session during clerkship; or it’s that certain nugget of wisdom imparted during an FSGL session. Or the gem from an SGL case, or advice from a near-peer in a mentor group.

By their very nature, these Pearls of Wisdom are best experienced – in a true handing on of guidance in the moment, rather than as a bullet-list on a Post-it note. Given that medicine is both science and art, however (as made clear in many Pearls), we wondered if we could preserve these words of wisdom in a more permanent, concrete way while still maintaining the spirit of these fleeting sessions.

With this in mind, last spring, we started a different representation of these Pearls of Wisdom: a School of Medicine collage. Working with Kingston artist Nancy Douglas, participants selected images, situated them on a six-foot long canvass and used collage techniques to bring the images to life. The images came from old textbooks and journals — lots of tearing and gluing and hands-on creativity.

That first session in May was a start, but our collage is not finished!

FullSizeRenderThe second creative session for the collage will take place Monday, September 12 from 4:30 – 8:30 p.m. in the Atrium of the School of Medicine building. Students, faculty and staff from all years of the program are encouraged to take part.

Bring your ideas about medicine, your journey in medical education, and the pearls of wisdom you’ve received from faculty (and others) along the way. Also, bring any old textbooks and journals you’re willing to rip up for the collage! This is hands-on, so be prepared to get your hands mucky. (Collage is a bit like casting – without a broken bone).

This is a drop-in event, so you don’t need to plan to be there for the whole four hours. Please come when you can. Refreshments will be served, too!

Creative Expressions of Learning is hosted by Dr. Lindsay Davidson (Director, Teaching, Learning and Integration), Vincent Wu (Meds 2018), Stephanie Chan (Meds 2019); and Sheila Pinchin (UGME Education Team Manager).

The event is funded by the Creative Expressions Grant from Queen’s Centre for Teaching and Learning.

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Tartan, threads, and an integrated curriculum

By Lindsay Davidson
Director, Teaching, Learning and Integration

Summer is a funny time – for some, relaxing with family on the dock, for others seeking out new adventures. I’ve been amused as I’ve watched from a distance, as my university-age son embraces his Scottish roots by running in “kilt runs” in Perth and Quebec City. This exploration of his ancestors’ fashion choices has led to a whole new appreciation of tartan in our family. Queen’s University, of course, is home to its own tartan, worn by band members and enthusiastic alumni alike. Just as the tartans of Scotland identify clan membership, the unique pattern of coloured warp and weft threads are instantly identifiable as the plaid cloth associated with our Queen’s.

Over the past year, the members of the Teaching, Learning and Integration Committee (TLIC) have been busy identifying teaching threads for a virtual “curricular tartan”, just as unique and emblematic of our medical school. Integrated threads represent topics that are taught in a longitudinal fashion, spanning multiple courses, terms and even years of the curriculum. These include intrinsic physician roles, some medical disciplines (typically those that do not have an identified course as well as those that relate to multiple courses) as well as other “hot topics”. Last September, the Committee Screen shot 2016-08-08 at 9.10.00 AMpresented the notion of integrated curricular threads to the Curriculum Committee, as well as an inaugural list of 28 threads which are shown here. (The active Integrated Threads list will be reviewed and possible revised by the Curriculum Committee each September).

To date, members of the TLIC and the Educational Development team have worked with course directors, discipline leads and other content experts to identify how these topics are taught and assessed across the length of our curriculum. The exercise has created exciting opportunities to connect teachers across courses and terms and has led to new opportunities for collaboration: a pharmacologist teaching about complementary and alternative medicines in the context of the CARL course, pathologists co-teaching about lung cancer in the Oncology course, Palliative care and Genetics experts identifying how relevant their disciplines are to multiple courses and creating explicit pockets of teaching.

The threads, now identified, are beginning to be woven into an intricate cloth. You can explore some examples of these by searching for a particular Integrated Thread as part of a Learning Event search on MEdTech. We hope that students will benefit from having an opportunity to understand how teaching on these topics progresses over the curriculum.

 

 

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Navigating multiple paths to service-learning projects

Anyone with their ear to the medical education ground in the past year will know that service learning is a very, very hot topic. Ever since the Committee on Accreditation of Canadian Medical Schools (CACMS) endorsed service-learning as an important (but optional) element of the education of future physicians, medical schools across the country have sought to incorporate this as a feature of their curriculum. However, service-learning, by its very nature, can leave students feeling uncomfortable: it’s structured but open-ended.

Consulting with community members to set goals and design projects is not always as straight forward as mastering the objectives of a standard medical course. Unlike other curricular and co-curricular activities, service-learning projects often start with pretty broad objectives. Add in consultation with multiple community stakeholders and the projects themselves can seem quite nebulous at the start.

We’ve written about service-learning on the blog before (here and here) as we’ve continued to develop our approach to encouraging and supporting our students in engaging in service-learning. Service-learning projects are one way our medical students (and pre-medical students, in the case of QuARMS) enhance their understanding of working with community members, explore intrinsic physician roles, and contribute in a very real way to our medical school’s social accountability to our communities.

On a national level, the Canadian Alliance for Community Service Learning (CACSL) provides support and networking opportunities for students, educators and communities engaged in these endeavors. At their recent biennial conference held in Calgary, multiple presenters addressed students’ issues with the ambiguity of service-learning projects compared to other learning activities.

When students have the autonomy to define what is happening with a project in cooperation with an organization, they can feel a little lost, one presenter, Chelsea Willness, an assistant professor at the Edwards School of Business at University of Saskatchewan, noted.

“Students are very uncomfortable with the ambiguity: ‘What do you mean, I don’t know what I’m going to be doing?’”

They want templates and checklists because that’s familiar, she added.

It’s clear that while many students are excited about the opportunity to engage with community partners, they both need and want support. Equally important is providing them with reassurances that  each project will have its own path – which includes some levels of uncertainty.

Here’s the Queen’s UGME operational definition of service-learning (as there are multiple interpretations of this term):

“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.”

One key word in that definition is structured. Providing as much structure as possible can help ease students’ discomfort with some of the ambiguous nature of service-learning. To that end, the Teaching, Learning, and Integration Committee (TLIC) has been assigned oversight of service-learning for undergraduate medical students and has implemented three possible avenues students may use to have a service-learning project recorded on their MSPR.

To launch this, a one-hour session on service-learning was added to the first-year Professional Foundations course earlier this year. This learning event included information on why we’re deliberately supporting extra-curricular and co-curricular service-learning activities as well as information on potential service-learning avenues. As part of this session, members of the Class of 2019 were polled to see what types of service-learning projects they might be interested in and how these might fit in the three paths.three_roads

Here are the three paths to a recognized service learning project:

  • Participate in an existing student-led volunteer initiative and complete the additional tasks necessary to extend this to a service-learning project
  • Complete an individual service-learning project, which meets the requirements (including consultation and reflection)
  • Take part in a service-learning pilot project brokered by the TLIC

Dr. Lindsay Davidson (Director of the TLIC) and I have met with representatives from several established student groups whose existing activities were quite close to our service-learning definition and threshold to map out ways their participants could extend their volunteer service into a service-learning project (this is always optional). Typically, this meant documenting some form of consultation and implementing some form of reflection on learning. These groups include SwimAbility (formerly Making Waves) and Jr. Medics. Other groups can be added to this list (email me: theresa.suart@queensu.ca to set up a meeting about this if your group might fit).

The two initial pilot projects are with Loving Spoonful (an organization with the goal of enhancing access to healthy food) and the Social Planning Council (with a focus on social housing in the Kingston area). These will be longer-term projects with sequential groups of students completing phases of a larger, continuing project.  (The first participants have already been identified through the PF class poll. Recruitment of UGME students will be through the TLIC, not through the agencies).

For each of the three paths, students must submit evidence of meeting the threshold for each aspect, using forms provided by the TLIC. These will be made widely available in September using a MEdTech community page. Here are the requirements for any project to be recognized:

  • The project must serve the needs of a group in the wider community (i.e., not medical school-focused)
  • Complete some form of consultation with community participants and/or stakeholders (this will look different depending on the type of project and service)
  • Complete between 15-20 hours of service (with no more than 20% devoted to training)
  • Completed a required reflection on learning

In the future, as more students engage in formal service-learning projects, students’ reflections on their learning may be presented at a service-learning showcase, similar to the Undergraduate Research Showcase that is held each year.

While having three different routes to recognized projects may seem to add to the ambiguity of “what does a service-learning project look like”, providing multiple avenues for recognition was important.

“Our students have many different interests and we wanted to leverage that by providing multiple avenues for service-learning projects to be completed and recognized by the school,” Dr. Davidson said.

We’re never going to completely eliminate the ambiguous nature of service-learning projects, but we’re working to put structures in place that can meet a variety of students’ interests and community needs.


With thanks to Dr. Davidson for her contributions to writing this post.

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