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Combining medicine & business: CEO for a day
By Andriy Katyukha, Meds 2022
“Maybe you should try Bay Street instead of medical school?” My interviewer’s acerbic tone gave the impression I was not the candidate they were hoping to admit when assessing medical applicants. Fortunately, I was admitted, and as a result of my experiences I am committed to dismantling entrenched attitudes in medicine that stifle progress and positive change.
As I continue through my career, I remain steadfast in my conviction that functioning at the intersection of medicine, business, and policy is crucial to help move the healthcare system forward. As some of my sagacious mentors have pointed out, multi-disciplinary skill building, outside the traditional framework of what is deemed relevant for the practice of medicine, unfortunately is sometimes discouraged. Is it a lack of exposure to other skillsets or is it a profound fear that someone equipped with unique skills may threaten your position? Regardless of the reasoning behind this antiquated view, it falls on you to be introspective, decide what opportunities you will pursue, seek out mentors who inspire you, and work fervently to bring about the change you want to see in your field of work.
For me, this means seeking out opportunities that bolster my interest in strategy, governance, and health leadership, and that is how I found myself participating in the CEOx1Day program. Though I was apprehensive about applying to a competitive program geared towards future leaders in business, I submitted an application anyway. To my pleasant surprise, I was selected by Odgers Berndtson to work with Alex Munter, the President and CEO of the Children’s Hospital of Eastern Ontario (CHEO).
My day started with what now seems like a very prescient discussion with senior medical leaders and Alex—COVID19 preparedness. From there, we departed to meet the rest of the executive team for their weekly Tuesday meeting. While the discussions were incredibly insightful, I am certain that the team would be surprised to hear what resonated with me the most: amidst the business of the day, they all stopped to recognize individual employees, of all seniority levels and positions, who made a meaningful contribution to the organization. This was their ‘kudos’ time, and I got the impression that employee recognition and appreciation is not a concept that is flippantly tossed into quarterly reports, but is the underpinning of the culture at CHEO. This is where I learned my first lesson: when it comes to transformational leadership, senior leaders who focus on results, and shift the emphasis from personal credit to team recognition, make the biggest impact.
Alex and I then connected with the CEOs of the Hospital for Sick Children and Holland Bloorview Rehabilitation Centre to discuss their partnership through the Kids Health Alliance, a network that aims to bolster patient and family-centered care in pediatric populations. We then proceeded to Alex’s CEO Information Session where he updated staff members about various projects and organizational achievements. It also served as a platform to once again recognize employees who made a difference at CHEO, and further encourage employees to use their personal insights to make improvements in their respective departments. In my professional life, I have yet to see such an emphasis being placed on promoting grassroots initiatives to fuel an organization’s success and progress. Through this, I learned my second lesson in leadership—empathy. A heightened ability to listen and validate employee experiences not only creates a positive work environment, but also empowers employees to use their experiences to change things for the better, strengthening the company in the process.
My day at CHEO finished off with Dr. Jean-Philippe Vaccani, a brilliant physician leader who serves as the Deputy Chief of Staff at CHEO. After a candid discussion about our careers, goals, and health leadership, I was struck by his encouragement and eagerness to promote discussions that underscore the importance of multi-disciplinary thinking in medicine. Professional mentorship is one of the best ways to give back to others, and just as I have benefited from kind and encouraging mentors, I also hope to make mentorship a priority in my own career.
I urge non-traditional majors and STEM students to embrace opportunities like CEOx1Day to not only learn from incredible leaders, but to also share their own invaluable insights to broaden leaders’ perspectives. Even if you do not see yourself represented in a field, seek out opportunities that allow you to be the catalyst for change.
Later that evening I had the privilege of joining Alex and his partner for dinner, where I not only got to meet his adorable son, but also Lola, the family dog and self-proclaimed “Queen of the House”. It was the perfect setting to further discuss our thoughts on a variety of topics and get to know each other a little better. Through our discussions about the healthcare system, advocacy, policy, and representation, I got an incredible sense that Alex’s successes are rooted in a deep sense of service. While he serves as CEO, to me he serves as a role model who has broken barriers for LGBTQ2S+ individuals, has worked to shatter the ‘glass closet’ that often exists in corporate leadership, and has instilled in me a deep passion to work tirelessly as an advocate and leader in healthcare. This leads me to my final lesson about leadership—service. Rooting your work in service, be it serving people directly or serving a mission that fuels your passion, lays the foundation for the most meaningful impact you can achieve as a leader.
CHEO is an absolutely incredible organization to work for and I applaud the efforts of Alex Munter, the senior leadership team, and most importantly the committed and passionate employees who work day-in and day-out to bolster pediatric care in Ontario. I would like to thank Kristen, Michael, Eric, and the entire team in the Odgers Berndtson Ottawa office for affording me this invaluable opportunity!
For more information about the Odgers Berndtson CEOx1Day program, check out their program site here: https://www.odgersberndtson.com/en-ca/ceox1day/about-the-program
A version of this post was previously published here: https://www.odgersberndtson.com/en-ca/ceox1day/news-media/bay-street-or-medical-school-a-glimpse-inside-a-ceox1day-at-cheo
Planning your teaching in uncertain times
Summer is upon us and, with it, planning for fall semester teaching. There’s a lot of uncertainty in the world these days vis-à-vis the COVID-19 pandemic – which has contributed to some uncertainty in planning for curricular delivery. At the School of Medicine, we have permission to run some learning activities face-to-face (such as clinical skills) with new restrictions in place to maintain social-distancing, but our traditional classroom-based teaching will be impacted as well.
The Education Team is here to support Course Directors and all teaching faculty as we face these new challenges. While we don’t have all the answers yet about room assignments and scheduling, there are still many things we can do right now to help with your planning and preparation for both your synchronous (all students learning at an appointed time, either in a classroom or via Zoom) or asynchronous teaching (students provided with learning materials that need to be completed by a certain deadline, but otherwise, they can learn on their own schedule and own pace). If we don’t have solutions to your queries, we’ll help find them.
Things we can help you with now:
- Discovering options for asynchronous teaching
Course Directors have been asked to consider different avenues for asynchronous learning. While this already exists in many courses in the form of Directed Independent Learning electronic modules, there are other options, too. If you would like to increase the amount of asynchronous learning in your course – or just explore possibilities – we can help with this.
- Learning techniques for interactive teaching via Zoom
We learned a lot from our two-and-a-half months of remote teaching using Zoom from March – May. If you’re concerned about how to keep your teaching engaging and interactive while “talking to a box”, we can help with this – and provide some practice opportunities, too, so it’s not so intimidating. Tools you may already be using in the classroom, such as videos and polling, are easily leveraged on the Zoom platform.
- Exploring approaches to assessment
Your current assessment plan may be just fine, but there may be things you’d like to tweak given the logistics of remote delivery. We’ve sorted out quizzes, graded team assignments (GTAs), and proctored exams already, so we can address these and any other concerns you have and make any appropriate modifications.
- Guiding you to resources
We can point you towards Faculty of Health Sciences and campus-wide faculty development opportunities and services that are available and talk about which approaches already fit with the UG program, and navigate through other possibilities.
- Brainstorming and problem solving
While the landscape may have changed with the COVID-19 pandemic, our goals as your Education Team remain the same: we’re here to help you prepare for, deliver, and improve your teaching and assessment.
Please get in touch:
Theresa Suart email@example.com
Eleni Katsoulas firstname.lastname@example.org
Rachel Bauder email@example.com
Zooming our way through pandemic remote teaching
On March 23 – coincidentally immediately after our students’ March Break – Queen’s UGME moved its classroom-based teaching to all remote learning to comply with social-distancing measures put in place as a result of the COVID-19 pandemic..
This also coincided with the majority of faculty, and administrative and support staff moving to working from home, except for those deemed essential to university operations.
By the end of May, we’d conducted close to 250 learning events via Zoom that would have ordinarily been taught in our classrooms by dozens of faculty members. The Meds Video Conferencing (MedsVC) team, led by Peter MacNeil were instrumental in making this possible, providing technical support for every learning event.
Lectures were recorded to accommodate students who found themselves in different time zones (many having travelled home for March Break and subsequently stayed there rather than engage in unnecessary travel) and those with family responsibilities, for example.
Instructors faced the same challenges most have read about regarding online conferencing. As Dr. Jenna Healey, Chair in the History of Medicine, describes: “Technical issues, navigating the software, making sure there were no interruptions on my end—like my very loud cat meowing!”
Faculty sought creative solutions to previously-scheduled in-class sessions. For example, in MEDS 246 Psychiatry, there were two expanded clinical skills sessions scheduled which each included a Standardized Patient actor (SP) to help demonstrate aspects of psychiatric interviews. Course Director Dr. Nishardi Wijeratne led both sessions – the first before the switch to remote delivery and the second one via Zoom. Each session was 50 minutes.
“Having taught both at the SOM and fully zoom, I did not find a significant difference between the two as a teacher,” Dr. Wijeratne says. “Given that my clinical practice as psychiatrist has moved to mostly virtual care right now, the Zoom version actually felt closer to my daily clinical practice right now.”
She noted three aspects that helped greatly with the session:
- MedVC staff to help with tech issues
- Connecting with the SP about 10 minutes before the session to discuss goals and structure
- Assigning tasks to the students ahead of the session to maintain engagement thoughout the 50-minute classes. Students observed the psychiatric interviews and documented mental status, identified risk factors, and considered possible differential diagnoses.
In addition to his own teaching, MEDS122 Pediatrics Course Director Peter MacPherson pitched in with a solution to a Clinical Skills session – about half the class missed their opportunity to complete a toddler observation session because of the pandemic restrictions.
“Usually, the medical students get down on the floor and play with a toddler while they infer the child’s real age based on their developmental achievements,” he explains. “We were able to cover the same curricular objectives remotely. The students were able to observe and interact with my toddler via Zoom in his ‘natural environment’ (aka our playroom) and do a similar assessment.
“It was a lot of fun to teach while playing dress up with my child!”
One part of the classroom experience that’s more challenging to achieve remotely is direct interaction with students as a class. “In particular, it is rather difficult to judge the level of understanding of the class,” MEDS245 Neurosciences Course Director Stuart Reid notes. “It cannot provide the personal contact that comes with in real life interaction.”
“On the other hand, it has been an invigorating challenge. We introduced more online learning modules and sought creative approaches to making distance learning both active and interactive,” he adds. One such creative approach was a “Jeopardy” style game in place of a hands-on expanded clinical skills session. It didn’t replicate the face-to-face session, but it actively engaged students in the session.
Dr. Healey echoes Dr. Reid’s comments about missing that face-to-face factor. “I very much miss interacting with my students in class. As an instructor, what I have found most challenging is not being able to see student’s faces. I didn’t realize how much I relied on non-verbal communication to adjust my pacing or gauge the level of student’s interest or understanding.”
Dr. Healey started encouraging students to use the Zoom “raise hand” function more often in her classes. “I want students to feel comfortable interrupting me if they have questions or comments.”
Dr. Reid speaks for all of us at UG when he notes that the students were a key factor in the success of our remote curriculum delivery: “They have been patient, accommodating, and enthusiastic enablers of our altered circumstances. Many thanks to them!”
At the end of the semester, the Education Team conducted several focus groups with Year 1 and Year 2 students to get additional feedback on what worked well, what didn’t, and suggestions for improving this type of remote learning. This, combined with the course evaluations (which included additional questions about the new required remote learning activities) will be used to inform teaching decisions in the coming academic year, as the COVID-19 pandemic situation continues to evolve.
The Legacy of George Floyd – What will it be?
We watch, horrified, recordings of the last few seconds of George Floyd’s life. We hear his last words– “I can’t breathe”. The symbolism of the white, uniformed figure whose knee is at this neck, unresponsive to his pleas, could not be more stark. For many, George Floyd is the most recent, most poignant example of a history of racial subjugation, mistreatment and killing that spans the past four centuries. For many, it’s a sad reminder that similar crimes and protests of five decades ago were not the final expression of that discontent. For us all, it forces a confrontation with the reality that the dream of Martin Luther King “that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character” has, sadly, not yet been realized.
Locally, we have been challenged by these events to consider what, if any, implications they have for each of us personally, and for our school. Many faculty and students have expressed very clearly their concerns, their discontent and have called for change. In the interest of exploring this further, I met recently with our student leadership and medical students. Those discussions were candid, sincere and highly illuminating. They expressed realities about the experience of Black medical students at Queen’s with clarity and openness. The tragic killing of George Floyd, it seems, has opened a discourse and raised to the surface issues and concerns that are not new, but not previously expressed as bluntly. It has also, it must be said, caused all of us to listen with greater sensitivity.
Out of those discussions, a number of themes and practical measures are being developed and advanced. I have since had opportunity discuss these with our current Dean Dr. Reznick and our incoming Dean Dr. Philpott who are both very supportive.
- All medical schools have a responsibility for social accountability. The exact nature of the commitment, expressed in a Diversity Statement, is school specific and should reflect the regions served and values of the particular school. That statement should drive a variety of school activities, including curriculum, recruitment and admissions. In the light of recent events, it seems appropriate to re-assess our Diversity statement. Our Diversity and Equity Committee, chaired by Dr. Mala Joneja, will be charged to draft a renewed statement to be considered by our faculty council
- Our curriculum should prepare our students to provide comprehensive care to patients of all ethnic and racial backgrounds. This should be reflected in both the content and delivery of the curriculum. Our Curriculum Committee will be charged with re-assessing both aspects through the lens of the Black population. It will also be asked to ensure that opportunities exist for open and constructive dialogue between students for discussion of difficult and contentious topics.
- The Black population of Canada is under-represented in our medical school. This is despite the fact that our admissions processes are scrupulously unbiased with respect to racial considerations. In fact, I realized as we discussed this issue recently that it was impossible to even determine the racial make-up of our incoming class, simply because this information is in no way documented or considered. The under-representation of Black people is almost certainly a complex and multi-factorial issue. Our Admissions Committee will be tasked with giving consideration to what factors may be active and to consider how they might be addressed.
- Very concerningly, and despite numerous (and I believe very sincere) efforts to address this over the past few years, our students report a lingering perception within the Black applicant community that Queen’s is an unwelcoming environment. This no doubt contributes to the under-representation issue and merits deep consideration at all levels.
- It seems clear that the promotion of mentorship opportunities for our Black students and applicants would be of benefit and should be pursued actively, both within our schools, and through effective collaborations outside our school.
None of this will occur if efforts are restricted only to a vocal minority who have themselves been the subject of racism in their lives and therefore need no convincing of its existence. It is rather for those of us in the “silent majority” of society who abhor racism but have not been its direct victims to take stock. We need to listen and, in those ways that are available to us, act.
Many will question why a murder in Minneapolis, tragic as it is, should influence the discourse and decisions at our small, somewhat secluded and seemingly tranquil medical school in Kingston, Ontario. I will admit to initially sharing that skepticism. I have come, through reflection on my own experiences with racism and through discussion with our students, to a different perspective. I would now say to those people who question these directions that no community in the western world can consider itself immune or unaffected by racism. I would say that injustice of any form diminishes and affects us all. I would say that we bear a collective obligation to the memory of George Floyd, to all the George Floyds of the past and to every person today afraid to jog alone through a park or be pulled over for a minor traffic violation. We owe it to them to take whatever action is in our power to take. We act for them but, in the end, we are acting for us all and for those who will follow.
The Event Was Virtual. The Graduation Was Real!
In its 166 year history, the Queen’s School of Medicine has no doubt hosted many memorable events to mark the achievement of graduating students. None, I’m sure we can assume, compared to last week’s celebration.
For the past few months, a small committee let by Drs. Renee Fitzpatrick and Andrea Winthrop has been meeting and struggling to develop some appropriate way to recognize the graduation of our Meds 2020 class, given the limitations imposed by the pandemic. The result was a “virtual” event made possible by Zoom technology, our dedicated MedVC team and coordinated by Jacqueline Findlay, UG Program Manager.
Our virtual graduation celebration was “attended” by 300 sites that signed in, as well as an unknown number live streaming the event. Attendees were located in cities all across Canada, as well as several in the US and Europe.
It featured an opening welcome to families and supporters of our graduates, followed by individual recognitions of each graduate. Dean Richard Reznick paid tribute to the class, challenging them to make a difference. Dr. Susan Moffatt was selected by the students to provide remarks on behalf of faculty. Drs. Heather Murray, Erin Beattie and Brigid Nee were selected by the graduates to receive the prestigious Connell awards for outstanding lecturing, mentorship and clinical teaching. Dr. Akshay Rajaram was selected by the students to receive the award for outstanding teaching by a resident.
Dr. Cale Templeton and Julia Milden were selected by their classmates as Permanent Class President and Class Valedictorian.
In her address, Dr. Milden spoke of the gratitude of her classmates for family, friends and teachers. She acknowledged admiration for her classmates and the bonds of friendship that had developed during medical school and would persist through their careers.
“I am struck today reflecting on what exactly it means to be called a doctor, the thrill and duty of carrying this new title and the letters MD. This particular moment in time seems to make incredibly clear the power and responsibility of this role. On the wards or on television, writing orders or writing policy, doctors of all kinds are illuminating the challenges of their patients and of the system, and working together to help shape what we do as a whole world to take care of one another.
So what gives us this influence?
I think it’s the message we send when we say ‘I’m a doctor’ – to whomever we’re meeting, it means: I’m listening, I respect your wishes and your opinions, I know how to learn and am motivated to investigate your problem, and I will do everything in my power to help you.
And most remarkably, the skills and qualities this social trust is based on are ones that we have right now: our willingness to listen, and our ability to care.”
Certainly, we must acknowledge that the event was decidedly not what anyone envisioned when Meds 2020 began medical school one September morning over four years ago. Nonetheless, it was every bit as real as the degrees earned by our graduates and received by them last week. It occurred because of a very real refusal to allow any mere pandemic to diminish the significance of what these young people have accomplished, nor overcome our desire to express our pride and extend our good wishes.
To them, our admiration and congratulations…really.
Balancing Social Responsibility and Personal Rights in a Time of Crisis
Reading the New York Times these days can be a rather jarring emotional experience. It is replete with stories of people and families devastated by the COVID crisis. Excruciatingly detailed and poignant accounts of people dying in their homes or hospitals, isolated from surroundings and those who have been significant to them. Married couples dying within hours of each other leaving shattered families behind, all deprived of the end of life processes that would normally help with the grieving process and achievement of some emotional closure. Hospital workers struggling to provide some modicum of solace and dignity before having to move along to the next patient.
Turn the page, and you read accounts of protests by those decrying the restrictions that have been imposed by their governments, claiming their rights to choose to assemble and assume personal risk.
These stories are not limited to New York or even the United States. They come from Italy, Britain, Mexico, South America, the Far East. It seems no place is spared, although the impact and time course varies considerably.
In our own characteristically muted fashion, the same dramas are playing out in Canada. Political leaders, hearing loud and clear from all constituencies and all perspectives, struggle to strike a balanced and responsible approach.
All this serves to highlight two great realities of this pandemic. Firstly, it is affecting virtually every human being on the planet. The sheer scope is mind boggling and it’s difficult to think of any prior catastrophe that even comes close. The second reality is that its very nature is such that it renders each of us both a target and a mechanism for spread. We are simultaneously potential victims and potential perpetrators. We are all therefore forced to make choices, and those choices are expressed not through words so much as through our actions.
For the vast majority, the choice is clear. Simply remaining secluded and abiding by social isolation directions from authorities is not only in their personal best interest, but also their means of contributing to the public good. It can be inconvenient, unsettling and, depending on personal and family circumstances, very demanding. It also requires a degree of trust and faith that decisions are being made with best information and with the best of intentions. It requires political leadership that evokes that trust. But most importantly, it requires a willingness to endure some degree of personal hardship for a perceived greater good.
For those who provide essential services, the choice is very different. For those people, the greater good is to continue their duties while exercising appropriate precautions. The willingness of health workers and the many essential service providers who allow our society to continue to function in these very challenging times is a testimony not only to their dedication and courage, but to their belief that they have a role in contributing to the welfare of others. They are nothing short of heroic.
All of us are affected. All of us are making sacrifices that require us to balance our personal interests with our obligations to those around us. Our fundamental values, both individually and collectively, are being exposed. The ideological and moral differences between individuals, communities and even countries are being laid bare in the face of this crisis. The early results are largely positive and even inspiring. But the real test is yet to come. As the acute crisis abates to some extent, and it becomes clear that a complete return to “normal” is a long way off, how will we engage this “new normal”? Our leaders and governments are making decisions that require them to determine the very nature of what constitutes “common good”. What seems clear is that what will determine success is not our ability to protect our personal interests, but the extent to which we are willing to sacrifice those personal interests for that common good.
CanMEDS roles in action during COVID-19
By Dr. Gray Moonen
Welcome to the Medical Residency Twilight Zone: There are no medical students. Academic half-days are virtual. Research projects are delayed indefinitely. Your oral presentation at the conference is cancelled. The entire conference is cancelled. Oh, that’s because flights are also cancelled. Licensing examinations are delayed. Clinics are cancelled. Where did all the patients go? You can hear a pin drop in the emergency department.
My hands are raw. No, I am not moisturizing them during the day and, yes, they are showing cracks. I am turning reptilian. These masks make me so hot, I can barely breathe. My glasses are constantly foggy. Oh hey, I didn’t recognize you with the mask on. Leaving the hospital and coming home are newly ritualized. Wash hands (arms, neck?), then take off scrubs, then take off shoes, wash hands again, put street clothing on… wait did I miss a step? Did I contaminate myself? Will I contaminate my home? Get my wife sick? I don’t know. I have internal monologues about how often to sanitize my equipment. Is my cell phone going to survive all this virox? It is the least of my worries right now, but it would really suck if I broke it.
I end every email with “stay safe”.
I’ve been reading about how to stay resilient and accept the inevitable stress. The evidence is sound, but it seems distant. “Focus on the things you can control”…that’s part of the day-to-day challenge as a resident. We often lack the clinical knowledge, experience, and confidence to control our clinical encounters. We require evaluations; all our work and research projects are supervised and graded in some capacity. We require licensing exams to proceed to be independent practitioners. These are the many things out of our control that all draw on our attention and make a crisis like the COVID-19 pandemic even more anxiety provoking. Not to mention our most pressing concern – for the deluge of illness and suffering this will cause patients.
And yet…. what a privilege it is to be a resident.
We are guided by a seven-pillar competency-based framework: “CanMEDS” or “CanMEDS – Family Medicine”. Although it may seem like everything is up in the air, I think there are equal, if not greater opportunities to develop our competencies during this crisis compared to usual times. Instead of going through the motions of learning objectives, checking off an Entrusted Professional Activity, receiving an In-Training Evaluation Report, instead we are actively motivated to do the things that need doing, because it simply needs to be done. Doing it well and thoughtfully, because it matters. A lot.
I have seen residents and staff physicians working side by side, tirelessly advocating for change at the individual, community and broader societal level. Grassroots campaigns are successfully encouraging people to stay home, and wash their hands; we’re advocating for PPE procurement. The trust, respect and unity being displayed across healthcare workers has enabled genuine collaborative efforts; “we are truly all in this together”. Residents are also liaising with public health, government agencies and the public to find innovative solutions, not to apply for a grant or win an award. It’s because this needs to be done.
I’ve noticed many residents become leaders and lean in to their voices, providing calm, measured and sound advice to their patients, peer groups, junior learners, family and friends, organizing systems to let patients know where to reach out to for help if they feel ill. Residents are stepping up and covering call shifts for ill or quarantined colleagues, offering to work COVID19 clinics or be redeployed to other services.
As developing professionals, we are sacrificing time, energy and our health in this evolving pandemic. Managing the competing demands of training such as patient care, evaluations, research and the stress of having academic requirements delayed or cancelled is unique, but I have observed grace inspired action rather than a compromise in integrity or overt displays of frustration.
As scholars we are staying informed on the emerging evidence and synthesizing this information for patients, peers and the broader public. As medical experts, we are not only maintaining many of our skills within our developing scope of practice, but actually expanding our skillset as we prepare to participate in more critical care, triaging, counselling and telemedicine.
Uncertainty and anxiety are undeniable. We are concerned we will not reach our training milestones or develop the competencies to practice independently. Yet, despite these dark times, I believe there are silver linings. We will all become better physicians and community members as a result of this crisis, and Canadians will benefit in the long term.
Gray Moonen, PGY1 in Family Medicine at the University of Toronto, graduated from Queen’s School of Medicine in 2019. He is also a past-president of the Aesculapian Society.
This column originally appeared on the CMAJ blog and is used here with Dr. Moonen’s permission.
It’s science, not speculation, that will get us through this.
Why do COVID patients experience such profound hypoxia without feeling dyspneic?
Why is there such heterogeneity in clinical severity among young, previously healthy patients?
Are asymptomatic people able to carry and transmit the virus, and for how long?
Does immunity develop after infection, and how long does it persist?
Does antibody status indicate complete protection from re-infection?
Do currently available anti-viral agents have effect?
Will previous approaches to vaccine development be effective?
These are some of key questions still under investigation as we now pass 6 months since this infection originally came to attention. The answers to these questions are the keys to resolving the greatest heath and economic catastrophe the world has faced. The answers will not be provided by scientists or politicians working in isolation, but rather by the application of scientific approaches, supported by political and economic action.
This past week, we’ve seen examples of how this can work well, and how a lack of synergy will impede progress.
In Canada, our government has announced a billion dollar investment in COVID-19 medical research, and support for a Task Force to determine the extent of the disease.
- Trudeau announces $1.1-billion for COVID-19 research (https://www.theglobeandmail.com/politics/article-trudeau-announces-11-billion-for-covid-19-research/)
- Government of Canada funds 49 additional COVID-19 research projects (https://www.canada.ca/en/institutes-health-research/news/2020/03/government-of-canada-funds-49-additional-covid-19-research-projects.html)
- Ottawa to fund existing coronavirus research projects (https://www.theglobeandmail.com/politics/article-ottawa-to-fund-existing-coronavirus-research-projects/)
In Germany, a nation-wide public health investigation has begun to carry out widespread serologic testing intended to define the true extent of disease and implications of prior infection.
- With Broad, Random Tests for Antibodies, Germany Seeks Path Out of Lockdown (https://www.nytimes.com/2020/04/18/world/europe/with-broad-random-tests-for-antibodies-germany-seeks-path-out-of-lockdown.html?ref=oembed)
- Blood tests show 14% of people are now immune to covid-19 in one town in Germany (https://www.technologyreview.com/2020/04/09/999015/blood-tests-show-15-of-people-are-now-immune-to-covid-19-in-one-town-in-germany/)
In the United Kingdom, vaccine development is well underway with massive investments already in place.
- UK boost support for CEPI to spur COVID-19 vaccine development (https://cepi.net/news_cepi/uk-boosts-support-for-cepi-to-spur-covid-19-vaccine-development/)
All these have come about through effective collaborations between government, funding agencies and scientific and medical communities. We’ve also seen examples of what can transpire when those collaborations are not effective. We’ve seen that, even if well intentioned, speculative assertions by a political leader can be assumed by the public to be scientifically informed and thereby lead to dangerous actions.
- U.S. President and top doctor spar over unproven drug (https://www.theglobeandmail.com/world/article-trump-vs-fauci-us-president-and-top-doctor-spar-over-unproven-drug/)
- Nigerians poisoned after taking doses of drug praised by Trump (https://www.theglobeandmail.com/world/article-at-least-two-cases-of-chloroquine-poisoning-in-nigeria-after-trump/)
- Trump’s COVID-19 disinfectant ideas horrify health experts (https://www.reuters.com/article/health-coronavirus-trump-disinfectant-idUSKCN2261OL)
- Lysol maker warns against internal use of disinfectants after Trump comments (https://www.nbcnews.com/politics/donald-trump/lysol-manufacturer-warns-against-internal-use-after-trump-comments-n1191586)
There has been much debate in recent years within the medical education community regarding the relevance of research and critical appraisal in undergraduate medical education. These topics have been gradually and rather insidiously receiving decreased attention in favour of the many other competencies and “hot items” that have been emerging, all with justification. I would suggest that recent events have resolved that debate. The questions posed at the beginning of this article were not posed exclusively by basic scientists and epidemiologists, but also by clinicians trained to accurately observe patient responses, critically assess current understanding and pose valid, useful hypotheses for testing. Clinicians will also be very much involved in developing protocols and executing investigations to find answers. Medical schools have a responsibility to ensure that fundamental training continues to be a core component of their programs, now more than ever.
“Meducators” aim to help healthcare and other essential workers’ children with 1:1 online tutoring
Editor’s Note: Medical students (and many other Queen’s Faculty of Health Sciences students) are volunteering their time during the COVID-19 pandemic in a number of different capacities. This is in addition to continuing with course work responsibilities, as much of the UGME curriculum is now being delivered online. This post highlights one of these student-led volunteer initiatives.
By Angie Salomon and Kiera Liblik (Meds 2023)
To hardworking healthcare professionals, and all others providing essential services to our community during COVID-19: WE WANT TO HELP!
Queen’s “Meducators” are a group of Health Sciences students at Queen’s University who want to support the educational success of students of healthcare (and other essential) workers in our community through a free, one-on-one tutor program via on-line video conferencing. Our tutors can provide informal tutoring services for children of all ages and grades (K-12) across core subjects (math, science, English, French). The service may range from simply supporting the student virtually while they complete their homework, to creating full-on lesson plans to aid their learning. If this is of interest to you or your family, please submit a request using the following link: https://forms.gle/k3mdo6cLYZtULmYF6
If you are a Health Sciences student (Medicine, Nursing or Rehabilitation Therapy) who would like to volunteer as a tutor, please sign up here: https://forms.gle/Ly8d2xmXax47iGDM7
If you have any questions, please don’t hesitate to contact Angie Salomon (firstname.lastname@example.org) or Kiera Liblik (email@example.com).
Getting students back into the clinical workplace. Why? When? How?
Medical education is not just a program for building knowledge and skills in its recipients… it is also an experience which creates attitudes and expectations.
It’s long been appreciated that medical education must provide much more than academic knowledge about human biology and pathology. It must also provide opportunities to observe and participate in the application of that knowledge to real people with real problems. In fact, the earliest forms consisted entirely of “on the job’ practical experience in apprenticeship-like arrangements with practicing physicians. The contemporary model of medical education incorporates the Clinical Clerkship which, since early in the twentieth century, has provided opportunities for medical students to work alongside fully qualified physicians and make active contributions to clinical care while observing, learning and advancing their skills. It has been modified considerably over the years, extending into a variety of clinical settings and incorporating embedded formal learning activities. It has proven highly effective in preparing students to both develop fundamental skills and better understand their own place in the rapidly expanding world of clinical medicine.
Until, that is, about a month ago.
As a result of the massive disruptions caused by the COVID pandemic and as reported in the last edition of this blog (https://meds.queensu.ca/ugme-blog/archives/4797), it became unavoidably necessary to pull medical students from their clinical placements. This was not because of a lack of perceived value, but because the simple logistics of maintaining safe and educationally viable experiences in the face of the stresses currently being faced by our hospitals and faculty became insurmountable. Since then, students have been undertaking an on-line, remotely delivered curriculum intended to provide learning that would normally have been undertaken in conjunction with their clinical placements. By doing so, it’s hoped they will be in a better position to complete their training within whatever time remains when clinical placements are eventually resumed.
Over the past few weeks, medical schools across the country have been almost continuously engaged in discussions to determine when and under what circumstances students will be able to re-engage this very necessary component of their education.
Why the rush?
Firstly, these clinical placements are essential components of learning and training. To undertake medical education without experiencing clinical application would be like trying to learn to play the piano without ever touching one. One might learn everything about how the instrument is constructed, how it works and the principles of music, but could never become a musician without guided, progressive application of all that knowledge.
Secondly, Clinical Clerks are able to provide useful clinical service. Although their scope of activity is obviously limited, they are able to off-load certain tasks to allow more advanced learners and fully qualified physicians more time to concentrate on more complex patient interactions and procedures, all the time observing and learning through active participation. They will also, and very importantly, learn the value and satisfaction that comes from helping provide useful service to patients and thus further their growth as professionals.
Thirdly, and very pragmatically, failure to graduate on time will be very damaging. Our medical schools serve our society and are expected to provide a steady infusion of trained physicians to the Canadian workforce. There will be a point at which insufficient time is available to complete degree requirements. A failure to graduate the 2021 class on time, or close to it, will result in gaps in that supply line, at a time when need is particularly urgent and is likely to continue well into the future. In addition, overlapping with subsequent classes will put further stresses on already limited clinical training sites and have implications well into the future.
Finally, it must be recognized that the students of today will be the leaders and front-line providers of whatever health care crises face our society in the future. We must not deny them the learning that this crisis provides. There is valuable, perhaps unique, learning available to them that will shape not only their understanding, but their attitudes and personal preparedness.
For all these reasons, much thought has been given to the “when”. In doing so, a number of principles and practical criteria have been developed.
Principle 1: Patient Safety.
Would the presence of students in the clinical environment jeopardize or promote optimal patient care?
- Would students be able to provide valuable service by “off-loading” specific aspects of care from other providers?
- Would students increase the risk of disease transmission?
- Would students consume valuable PPE?
Principle 2: Student Safety.
Can students be protected from, or excluded from, excessive risk?
- Although some small risk is inherent in any clinical placement, would students be exposed to risks considered above the “norm”, or without protections and considerations that would be reasonably expected?
- Will students be provided with the full, minimum PPE that is suggested as required by scientific knowledge with respect to COVID-19?
- Are there local occupational health processes in place to protect students who may be exposed to COVID-19?
- If it is deemed essential to exclude students from some clinical situations and not others, can that exclusion be reliably achieved?
- Do current student liability arrangements cover the current clinical environment?
Principle 3: Safety of clinical teaching faculty and hospital staff.
Would student placements jeopardize the safety or wellness of teaching faculty or other hospital staff?
- Would students provide valuable service that would be of benefit to faculty or other providers?
- Would students integrate into care teams as currently constituted during this crisis?
Principle 4: Learning.
Can a valuable learning experience be provided?
- Are there sufficient roles in which students can engage?
- Do these roles have educational value?
- To what extent is any involvement at this time a valuable and possibly unique learning experience?
Principle 5: Supervision.
Are there sufficient clinical teaching faculty available to provide student supervision?
- Can continuing oversight of learners be provided?
- Can learners be assessed?
- Are these available in all areas necessary to provide a full clerkship experience?
In terms of the “how”, criteria such as these will be continuously assessed and the current state of readiness for re-entry evaluated on an ongoing basis. It’s understood that a certain minimum time, at least a month, will be required to “on-board” students to the altered workplace. The earliest possible return is therefore always at least a month displaced from a final decision. At this point, only the most optimistic estimates would suggest a return before July.
In addition, schools are striving very hard to coordinate their efforts and synchronize both entry and graduation dates. Given the differences in curricula and clerkship structures across the country, and the differing regional impacts of COVID, it seems unlikely all schools will reach a state of preparedness at precisely the same time, but there is strong commitment to minimize discrepancies.
There is also a growing recognition that the elements of clerkship and the residency matching process are almost certainly going to be substantially altered. Discussions about the number and type of elective opportunities that will be available, and the implications for residency selection are very much “on the radar” of undergraduate programs, postgraduate programs and CaRMS, but substantive decisions must await more clarity about timing of return and graduation dates. Whatever those dates, schools all recognize the critical importance of ensuring that all graduates are provided equivalent opportunities to achieve graduation requirements and engage residency positions.
It will be important through this process to maintain full transparency and communication between schools and, critically, with our students whose lives and careers are literally “on hold”. This article is an attempt to promote that communication, which will no doubt continue across our country in the weeks and months ahead.
Stay tuned. We will get through this, together.