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Dedication and organizational effectiveness are key leadership qualities, but do not always combine in the same individual. When they do, the result is a person who is a hugely valuable resource to the organization they serve. At Queen’s, we’ve been very fortunate (some would say “blessed”) to have many such dedicated and effective people involved in medical education. One would hope such people could continue in their roles indefinitely. However, from time to time, change is necessary. In the Undergraduate program, a number of changes are occurring at this time, partly because of life transitions, but also in order to ensure that we continue to refresh perspectives, allow gifted people the opportunity to learn multiple roles, and position ourselves optimally for our next major accreditation review about three years from now. I would like to use this article to announce a number of those changes.
Although these have already announced, I thought it appropriate to re-iterate that, over the past year, we have appointed four Assistant Deans with responsibility for key components of the UG program. In the cases of Dr. Hugh MacDonald, Assistant Dean UG Admissions, and Dr. Renee Fitzpatrick, Assistant Dean Student Affairs, these appointments recognized the increased scope of responsibility that had evolved in positions previously designated as committee chairs or directorships. In the case of Dr. Cherie Jones, Assistant Dean Academic Affairs and Programmatic Quality Assurance, and Dr. Michelle Gibson, Assistant Dean Curriculum, these are de novo positions addressing key components of our program that were previously undertaken either solely by the Associate Dean or committee chairs. These consolidated responsibilities will provide focused attention and responsibility for critical aspects of program delivery.
The clinical clerkship, spanning the final two years of medical school, consists of two components. The Clinical rotations consist of discipline-based rotations and/or integrated, longitudinal community-based rotations, and Electives. For the past several years, this aspect of the clerkship has been very capably directed by Dr. Andrea Winthrop. During that time, it has grown and evolved steadily, notably with expanded regional experiences and integration of EPAs as the basis for assessment. Dr. Winthrop is now moving to take on a new, needed role in our curriculum (see below). Dr. Andrea Guerin, who has been directing Year 2 of our curriculum, will be taking on the Clerkship directorship.
The Clerkship Curriculum consists of three blocks interspersed through the final two years where the students re-assemble as a class and undertake learning in Clerkship Preparation, Complex Presentations, and Preparation for Residency. They have been very skillfully and thoughtfully developed, planned and directed by Dr. Susan Moffatt, and have become very highly valued by our students. Over the next year, directorship of the Clerkship Curriculum will be transitioning to Dr. Heather Murray who, as Dr. Moffatt, is a highly accomplished and recognized educator. (Dr. Murray won the Chancellor Charles A. Baillie Award from the Queen’s University Centre for Teaching and Learning this year).
In the early years of our curricular reform, the extensive structural and content change required separate directorship of Years 1 and 2. As our curriculum becomes more established, and our curricular coordinators become more familiar with roles and operational issues, we have arrived to a point that the roles can be combined into that of a Pre-Clerkship Director, which is consistent with practice at most other medical schools. I’m very pleased to announce that Dr. Lindsey Patterson, current Year 1 Director, will be taking on this expanded responsibility.
Intrinsic Role Director
Our last major curricular revision introduced explicit objectives and teaching regarding the so-called “non-Medical Expert competencies”, and development of committee and chair to oversee the activity of individuals charged with the development of each role (Competency Leads). Dr. Ruth Wilson initially chaired that group and was instrumental in the development of those aspects of our curriculum. When Dr. Wilson stepped away from that role, we elected to allow the Competency Leads to function independently. It’s now clear that the importance and complexity of these roles, together with the administrative requirements to ensure appropriate curricular design and delivery, necessitate centralized support. We are therefore re-establishing the role of Intrinsic Role Director, and Dr. Andrea Winthrop will be taking this on. Dr. Winthrop’s extensive knowledge and experience with our curriculum, together with excellent organization skills, make her an excellent choice for this key role
Term 3 Clinical Skills
Dr. Laura Milne directs our Clinical Skills program, which spans all four terms of the pre-clerkship, and is consistently very highly reviewed by our students and seen as a highlight or our curriculum. For the past few years, Dr. Basia Farnell been directing the Term 3 component of Clinical Skills, and has provided energy and creativity in revising the format and curricular content. As Dr. Farnell moves on to other challenges, Dr. Meg Gemmill, a member of the Department of Family Medicine who has been a highly regarded teacher in that course, will be a taking on it’s leadership.
Chair, Progress and Promotions Committee
For the past several years, Dr. Richard van Wylick has been providing exemplary service as chair of our Progress and Promotions Committee. In addition to very capably directing the complex activities of that group, he has developed a robust collection of policies and procedures to guide various aspects of student promotion, curricular management, student conduct and professionalism in our school. As Dr. Van Wylick has taken on other leadership roles, he has continued to direct P&P, but it is no longer either reasonable or fair to ask him to continue. Fortunately for us all, Dr. Fred Watkins, who has longstanding experience on the committee, consistently demonstrating excellent judgement and sensitivity, has agreed to take on the chairmanship.
Chair, Student Assessment Committee
With Dr. Gibson’s move to the new position of Assistant Dean Curriculum, Dr. Peter MacPherson will replace her as Chair, Student Assessment Committee. Dr. McPherson completed a Master of Education degree at Memorial University during his Pediatrics residency with an academic and research focus on medical education. He brings his experience from across the curriculum, both pre-clerkship and clerkship, to his new duties as Chair.
New Course Directors
Dr. Greg Davies has been directing the Obstetrics and Gynecology clinical clerkship rotation for the past few years. During that time, Dr. Davies has built on the success established by that department. As Dr. Davies moves toward retirement, we welcome Dr. Brigid Nee to this new role.
Over the past few years, the Pediatrics clinical rotation has benefited from the input of many members of that department, including Drs. Richard Van Wylick, Karen Grewal and, most recently, Dr. Peter McPherson. As Dr. McPherson concentrates his attention on the pre-clerkship course and new interests, we welcome Dr. Gillian MacLean.
These changes will provide much more corporate knowledge within the leadership group, since most individuals will have had experience directing multiple portfolios spanning different aspects of our curriculum. This should allow for much more effective and helpful sharing of experience and knowledge, and thus better problem solving and anticipation.
These changes are intended to begin with the new academic cycle that starts in September, but the various incoming and outcoming individuals are already developing specific transition plans to provide for smooth and effective turnover.
I thank all those who’ve been filling these positions in past years for their dedication to our students and our school. Please join me in welcoming and supporting all those moving into these new challenges.
The Rapture of the Raptors. Why do we care?
It shouldn’t matter that Kawhi Leonard decided to play basketball in Los Angeles instead of Toronto.
And yet it does.
The anticipation leading up to his decision was unprecedented. The media were in a frenzy. Speculation was rampant. Helicopters followed his every move. There were “spottings” of house sales and reported purchases of moving containers!
It shouldn’t matter that a dozen or so very highly-paid Americans won a championship for playing basketball while employed by a Toronto-based sporting corporation.
And yet it does.
The public celebration, the pride, the pure, unadulterated joy this brought to the people of Toronto and, indeed, all of Canada, went far beyond anything experienced by most living people, and rivalled the memory of celebrations triggered by the end of world wars.
It shouldn’t matter whether Canadian-born hockey players fail to win the gold medal at a two week long international tournament played every four years.
And yet it does.
It’s viewed as a national shame and calamity, eliciting much hand-wringing, introspection, and calls for reviews, re-focusing on “priorities” and enhanced commitment.
There is, undeniably, something about sports and our identification with teams that simply transcends logic or rational thought. It goes far beyond our collective interest in politics, environmental concerns or the economy.
Just this past week Lisa MacLeod, a provincial cabinet minister, was required to apologize for unleashing an obscenity-riddled diatribe upon the owner of a professional hockey team. In her tweet, she tries to justify the attack:
“Let me set the record straight, I gave @MelnykEugene some feedback at the Rolling Stones concert and I apologized to him for being so blunt. I have serious concerns about the state of our beloved Ottawa Senators!”
One of my favourite history writers, Pulitzer Prize winner Doris Kearns Goodwin, writes in her memoir “Wait Till Next Year” of her “childhood love” of the Brooklyn Dodgers and her “desolation when they moved to California”.
And I certainly can’t claim to be immune. I find the current mediocrity of the Blue Jays a personal offense and, for the past 50+ years, have gone into an annual spring funk when the Maple Leafs make their inevitable and ignominious exit from the playoffs.
Why do I care? Why do any of us care?
Certainly, there’s no question that the passion is real.
For those who need convincing, I would refer them to a 2008 article by Ute
Wilbert-Lampen and colleagues (NEJM 2008;358:475-483). They looked at the
incidence of cardiac events in the greater Munich area during the 2006 World
Cup of soccer. On days when the German team was playing, the incidence was 2.66
higher than during control periods (p<0.001). Men were more likely to be
affected (3.26 times higher), but women were affected as well (1.82 times
higher). There were clear spikes on days, and times, that the German team
played, as illustrated below, points 5 and 6 being days Germany was playing the
most critical games (Game 6 being their loss to eventual champion Italy, I
might point out):
Need more convincing? Consider a study carried out by Paul Bernhardt as part of his doctoral project. He measured testosterone levels in male spectators of sporting events, specifically basketball games at Georgia State University (Physiology and Behaviour 1998;65:59-62). He found that levels rose in a pattern similar to that of the players during the game, and decreased in the fans of the losing team. It seems that rabid fans are very much “in the game”.
But what’s driving all this?
Psychologists and sociologists have explored the topic. Theories abound. Some believe team fanaticism allows for permission to step out of everyday lives and take on a different, more outgoing persona. The term “deindividuation” has been bandied about, which seems to mean that you can behave in a crowd in a way you never would alone. There’s a certain connection that occurs between fans of the same team that appears to promote self-esteem and carries over to everyday life. Terms like “relationship” and “bonding” have been applied to what happens between fans and their team.
Daniel Murray is a psychology professor at Murray State University. In his book “Sport Fans: The Psychology and Social Impact of Fandom”, he presents a combination of research and theory and makes a case that fandom promotes a sense of belonging, and overall psychological health. It appears to happen even if your team is unsuccessful – witness the Chicago Cubs whose fan base remained loyal despite not having won the World Series for 108 years or, dare I say it, our long-suffering Maple Leaf fans.
The term “Basking in Reflected Glory” (BIRG) has been used to describe the tendency to identify with successful teams and is ascribed to Professor Robert Cialdini who observed that the usage of team apparel in high school and college students varied in concert with the success of school teams. No surprise, I’m sure, to vendors of Raptors jerseys these past few weeks.
There are certainly positives to all this. In addition to transcending logic, sports fandom also appears to transcend issues of race and economic disparity. Sports appear to have a power to unite our society in a way that goes far beyond anything that can be achieved through any public policy. The Raptor players, taking in the adoring multitudes that turned out to celebrate their recent success, commented on the visible diversity of the crowds, something they’d not seen previously.
In the end, I would suggest that all this is about something much more fundamental. We have a basic human need to belong, to connect with others, to be part of something greater than ourselves. We can call it family, community, religion, social group, tribe, any or all of the above. We need to belong. We may wander, but will always identify with “home” and, to some extent, yearn to return. Allegiance with a particular team seems, to some extent, to address that need. For some of us, it’s ingrained in childhood and difficult to expunge (as much as we might like to). For others it’s acquired along the way, but no less real.
Returning to the topic at hand, what are we to make of Mr. Leonard’s recent departure? Certainly, it wasn’t motivated by monetary considerations or need to find a winning team, since he’d already achieved both those goals. In the end, his motivation seems to be something that the millions of fans who wished him to remain in Canada can easily understand. Having been born and raised in Southern California, he didn’t so much reject Toronto as he chose to return to his own home, his own roots. Not many professional athletes have that option, and we should not begrudge him the choice. How many of us, given the same circumstances, would do the same? In the end, it’s about home It’s about belonging.
Five ways to get moving on your summer reading plans
I worked at my campus’ library to help pay for my first university degree. The evening hours worked well with my coursework, the commute was great (walk across the quad!), and I was surrounded by books.
This last point was both a blessing and a curse: my “to be read” list grew and grew with each shift, whether I was shelving returns or stamping the university logo on newly-acquired tomes for the collection. Each book I came across was ripe with possibilities.
We all have a TBR “pile”: either physically in the form of stacks of books or journals, or virtually as a list (written or mental). Summer can be an ideal time to catch up on “required” reading or savour something from the “just for fun” section but sometimes getting started can stall you in the stacks. Try these five steps to get down to precious reading time.
1. Cull the pile. If it’s been a while since you organized your pile, don’t be afraid to remove titles. Your needs and interests may have changed in the intervening months. And something that seemed highly relevant back in January might not be as appealing now. Also, if you start a book and find it’s not living up to its promise, ditch it. Why waste your time? I give a book 40-50 pages to impress me; otherwise, I move on. (This works for non-fiction and fiction alike).
2. Set the time. We schedule times for meetings, but reading – even to keep up with our professions – often drops to the “squeeze it in somewhere” category. Consider scheduling 30 minutes a day of dedicated reading time. Can’t manage one half-hour slot? If it’s something you plan for, you could break it into two 15-minute chunks. Stow the book in your briefcase or make sure it’s downloaded to your eReader. Experiment to see what works.
Do you have a favourite way of managing your TBR pile? Is there an app or computer program or maybe a filing system that works for you? Please share!
3. Balance topics. Are you reading for professional development or diversion – or maybe both? Make time for each. Feeding your spirit can be just as valuable as the latest journal article in your field. Or, if you’re like me, you’ll set out to read something “for fun” and find that it actually has relevance to your current course work literature review…
4. Curate excerpts. Sure, there are some books that require a start-to-finish reading strategy, but sometimes reading a single chapter can give us the information or tools we’re looking for. Some books are even designed this way. Make use of Introductions and Tables of Contents to find what’s relevant to you and just read that.
5. Turn to tech. How can tools you already use help with your TBR list? I routinely use my iPhone to read journal articles in those “gap” times — when I’m early for an appointment, waiting to catch the bus home or to pick up my son from an activity.
Next on my reading schedule:
Peripheral visions: Learning along the way by Mary Catherine Bateson (1995)
Recommendations from my recent reading (aka, my attempt to add to your TBR pile):
Invisible women: Data bias in a world designed for men by Caroline Criado Perez (2019)
Spark by Patricia Leavy (a novel that explores the challenges of designing and conducting research). (2019)
Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead by Brené Brown (2012)
What’s on your summer reading schedule?
A version of this post original appeared here in July 2014
How to spend your summer not-vacation
There’s a different rhythm to summer at the medical school. Yes, this involves some vacation time, but it also involves getting many things done that get set aside during the university academic year.
For those involved in classroom-based teaching, the summer interval is an opportunity to review, reflect and revise teaching for the upcoming semesters. With this in mind, here’s my suggestion for tackling this task this summer:
A 4-R To-Do List for Summer 2019
What you review will depend on your role in the UGME program. If you’re a course director, for example, re-read your course evaluation report, your own teaching evaluation report, and any notes you may have made through the year about how things went. Did the student curricular reps have any feedback for you during your course? Re-read these emails. Have a look to see if any of the MCC presentations assigned to your course may have changed (we update our list as the Council updates its presentations).
If you’re an instructor in a course, read through your notes on your learning events and your instructor evaluation report. Read through your teaching materials and your learning event pages on Elentra (our LMS, formerly called MEdTech).
Did you set aside any journal articles relevant to your field with a sticky-note saying “save for next year”? Now is the time to pull that out!
Once you’ve reviewed relevant materials, think about your teaching. Did things go the way you wanted them to? Are there aspects of the past year that you’re really proud of and want to retain? Are there things that didn’t go as smoothly that you’d like to address next time? Are there things that went quite well, but you’d like to shake things up or experiment with something new? For anything that’s changed in your field, how might this impact your planning and teaching?
Decide what you’d like to change or address in next year’s teaching. Think about what’s manageable within the scope of your course or other responsibilities. Maybe you’ve seen some of the e-modules used in other courses and think one would fit with yours and make your teaching more effective. Maybe you’d like to enhance your existing cases to incorporate other curricular objectives assigned to your course. Maybe things are going pretty well, but you’d just like to shift things around a bit. Call me! I can help brainstorm and talk about timelines to set your plan in motion.
Many of us in medical education – and academia in general – have a lengthy summer to-do list that involves not only preparation for the next teaching cycle, but catching up on many other things, too. Sometimes that summer list can become overwhelming, so remember to take some time to relax and disconnect a bit from the “med ed” side of you: take some strolls along the lake, eat a popsicle or an ice cream cone. Do quintessential summer things that have nothing to do with any to-do list.
The TRC Calls to Action require a personal response
The 94 Calls to Action from the historic Truth and Reconciliation Commission demand response and action from governments and institutions. Seven of these Calls to Action focus on Health and Healthcare issues. For those of us with the privilege to be involved in medical education, there is a particular focus on #23 and #24:
23. We call upon all levels of government to:
i. Increase the number of Aboriginal professionals working in the health-care field.
ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.
iii. Provide cultural competency training for all healthcare professionals.
24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.
Yes, an institutional response is required and is underway and has been and will be written about here and elsewhere. (In particular, look for future Education Team posts about curricular and teaching responses). But the Calls to Action also require a personal, individual response and this is, in some ways, harder.
I’ve been wrestling with my own response. Here’s some of that…
* * *
The Truth and Reconciliation Commission hearings exposed events long ignored in mainstream history curricula. I prided myself on being a student of history, of recognizing the foibles of historical records – the victor writes the books – and yet I found myself saying over and over again: “How did I not know this?” How was this never a part of the quaint lessons about Indians in my Grade 3 Reader, nor in the more sophisticated history books at King’s and Dal? How is it I could be so oblivious?
At the same time, I wanted to distance myself from any responsibility for these historical wrongs. For example: I’ve been at events where people introduce themselves with descriptors, such as their clan or First Nation affiliation, or, for people like me using the term “Settler”. I’ve always bristled at this. I don’t self-identify as a “Settler.” For me, “settler” implies agency, suggests choice. What choice did I have about where I was born? Extending this further, my pre-Confederation poor Acadian and Irish ancestors in rural New Brunswick likely weren’t concerned with much beyond day-to-day survival, and I’m sure were good people, so, they’re not responsible either. Right?
But I did have a choice when I moved to Kingston in 2006: when I moved to these traditional lands of a different nation. I don’t even know the historical relationship, if any, between the Wolastqiyik (the preferred name of the people I grew up knowing as Maliseet) and the Anishinaabe and Haudenosaunee. I never even thought about it vis-à-vis my discomfort with “settler”.
During his recent three-day visit to Queen’s, sponsored by the Faculty of Health Sciences, Dr. Barry Lavallee, a member of Manitoba First Nation and Métis communities, and a family physician specializing in Indigenous health and northern practice, pointed out that we can’t accept the status quo. We must consider who supports our ignorance and for what purpose. We are also responsible to recognize what phenomena support our own positions of privilege and power. And what to do with that power.
* * *
When I picked my Twitter handle in 2010, I wanted something unique – not @Theresa487 or something like that – and, wistfully, I wanted something that reminded me of home. I opted for the “original” Indigenous name of my New Brunswick hometown (the colonial-corrupted spelling, I later learned, but home nonetheless). So I became @Welamooktook. It reminded me of the place, the land, where I had roots, and family, and history.
But those same reasons I picked it became reasons to let it go. My original feelings and sentiments were sound, but I couldn’t escape the cultural appropriation, the feeling of wrongness it came to mean, as I reflected and wrestled with it.
* * *
A year ago, as part of an Education course I was taking, my classmates and I were encouraged to go to an exhibition of Kent Monkman’s artwork at the Agnes Etherington Art Gallery, Shame and Prejudice: A Story of Resilience.
The entire installation was thought-provoking, emotional, and disturbing. One painting, in particular, haunted me: The Scream (2017). As I stood looking at this large painting depicting “the exact moment Indigenous children were taken from their parents”, I focused on three young people in the background, at the right, running away. Running away from the red-serge Mounties I had grown up looking up to. The trio running in the back are dressed in jeans and hoodies and look like teenagers I would see anywhere in Kingston.
They looked like my son.
This made it real for me. Made it close enough to touch. Close enough to imagine.
My son has a hoodie like that.
* * *
The TRC demands a response but that response is not guilt – or denial. It’s self-reflection. And compassion. And empathy. And action.
It’s relinquishing a cherished Twitter handle because it’s the right thing to do.
It’s stumbling through a territory acknowledgement because I’m still getting my Maritime tongue around Anishinaabe and Haudenosaunee when Wolastqiyik is easier. And trying to go beyond the scripted suggestion to address relationships, and thoughts about land and people.
It’s accepting the self-descriptor “descendant of settlers” because that’s accurate and real and it matters.
It’s working with my physician colleagues to ensure sound curricular and clinical experiences that, as Dr. Lavelle described, gives our students “the ability to treat the person in front of them based on their experiences without judgment.”
It’s wrestling with getting all of these meandering ideas and feelings into words to share in this blog, because we all need to be part of this conversation — all the while worrying it’s arrogant or insulting or inadequate.
In his workshop, Dr. Lavallee urged us to use reflection to address our response to new information. And he challenged us: “When you feel the discomfort, move into it, because that’s where the learning occurs.”
We tell our students to ask questions and then listen: Patients have the information and will share it. I learned the same in my previous career as a journalist. Ask questions, but most importantly listen to the answers. Even when the answer is uncomfortable, is difficult, is challenging. That’s the personal response.
History of Medicine Tour of NYC
By Adam Gabara and Kelly Salman
The bus started to move, leaving the School of Medicine and commencing our long excursion to New York City. With an upcoming Mechanisms of Disease test, stress levels were high, but the excitement of the trip overrode most of those worrisome feelings. After all, this was the annual History of Medicine trip to a city that some of us, including myself, will be seeing for the first time.
Driving over the Jersey bridge, seeing Manhattan in all of its concrete jungle glory, all I could think about was all the historical events that took place within this massive cityscape. It may have been my public health background coming out, but I imagined the immigrants arriving at Ellis Island to be screened and processed, infectious disease spreading rampant through the crowded streets and apartments, and rats carrying disease to food establishments. Nonetheless, this trip was going to provide a great learning opportunity not possible in the lecture halls back in Kingston.
Even though we arrived late at night, we all split up to explore the city. Some went to celebrate a classmate’s birthday, while others explored the famous Times Square, and enjoyed a late-night meal before heading back to the hotel. For some, it may be easy to forget the history engrained in a city as modern and metropolitan as NYC. Times Square has been a central hub for many decades and known for major landmarks such as the Broadway Theatre, and we tried to see as much as we could in the short time we had.
The next morning, after a nice breakfast at a small Lime stone café and a trek through Central park, the whole group rejoined at the docks to make our way around the Statue of Liberty and towards Ellis Island Immigrant Hospital. While on Ellis Island, we were able to explore the National Immigration Museum and learn of the courageous, and sometimes tragic, stories of immigrants from all over the world coming to America to start a better life.
Our guided tour of the abandoned immigration hospital was actually an enlightening reminder of how far medicine has come. It also demonstrated how differently physicians approached immigrant health back then, keeping them segregated from the populace of New York on the basis of more than just symptoms of severe illness. Many of these immigrants came from countries in Europe, such as England, Ireland, and Germany, among others. This immigration hospital has been utilized for expectant mothers to give birth, for mental health screening, and for the treatment and quarantining of infectious diseases. The mental health screening, we learned, was based on what would now be considered archaic classifications of mental illness (idiocy, imbecile, moron, and feeble-minded). Immigrants were screened with math questions, and assessed further for behaviour and more questioning.
Saturday night was a huge bonding experience between the first and second years, as many of us attended an improv comedy act. We were able to mingle at the nearby bar, with special attention from the owner/bar tender, and to unwind after such a busy day. After the comedy, we all regrouped at a fancy top floor cocktail lounge overlooking Times Square. From here, we were able to take in the city and reflect not only on the history we learned so far, but the relationships being formed this weekend, and how important it is to take wellness break. Something we often forget in our busy lives with constant assignments, tests, research, and extra-curriculars (I was worrying about landing all the movements and vocals to Living on a Prayer for the QMed A Capella group).
The next day, we were able to see both the Museum of the City of New York and the New York Academy of Medicine. The museum, coincidentally, was displaying their main exhibit titled Germ City, a huge public health historical piece. This exhibit covered the history of various outbreaks in the city of New York and taught some of the basic science behind infectious diseases and their spread. At the academy, we were taken through a picturesque journey through various illustrated medical teaching texts including topics such as dermatology and obstetrics. It was surreal, looking at guides that medical learners would have been using many centuries ago to visualize pathologies and procedures that we ourselves will be learning on our laptops and medical texts in the year(s) to come.
And just like that, our journey was ending. We made our way back to the hotel for the long trek back home. This experience gave me much to think about, from all the medical tragedies and triumphs that occurred here, to seeing the profound impact medicine has had over hundreds of years, and how various modalities for medical instruction have changed over time. I will always think fondly of my first experience in New York, and I am reminded how lucky we are as medical students to have these opportunities to enhance our medical journey. Even on the ride back, whilst studying for the MOD midterm amongst my studious or sleeping colleagues, I realized we need to enjoy journey of medical schooland little things along the way. Like the unique experience of sitting next to a classical piano in a McDonald’s- now that’s something that will stick with me forever.
Can admissions committees measure adversity? Should they?
“If you can’t measure it, it doesn’t exist.”
This was the mantra of a former mentor and research supervisor with whom I had the opportunity to work during my fellowship. In the early days of Echocardiography we, and many others, were working hard to bring some degree of quantitative rigour and credibility to a developing imaging modality which, at that time, consisted of rather blurry black and white recordings of the beating heart on a small screen. The images could be photographed and even videotaped. As such, they were remarkably informative to the person obtaining the image and treating the patient under observation, but the technology provided no inherent measurements and could not be transmitted to referring physicians. If Echocardiography was to have sustaining value as a service to the larger medical community, most contended, it must yield measurements that would differentiate normal structure and function from the pathologic. Hence countless postulates, projects, manuscripts, publications and fellowships, including mine.
In most cases these efforts to derive measurements and “normal ranges” from moving images have been of great clinical value and has advanced patient care. However there have been, and continue to be, numerous instances where over-zealous attempts to quantitate have caused misinterpretation, often due to over-simplification of a complex image or set of images that has much more value to the observer than any static measurement can convey. Trying to compress the meaning of an image into a set of simple measures will always have inherent limitations. What numeric value could one apply to da Vinci’s Mona Lisa that would convey even a fraction of what the human eye and mind can perceive in a few seconds of observation?
Recently, considerable controversy has arisen in the United States as a result of attempts to incorporate measurements of adversity into the college admission process. The Scholastic Aptitude Test (SAT) is undertaken by American high school graduates and is a key component of their application to colleges and universities. It is widely considered to be a primary driver of admission decisions in an environment where admission to “top tier” universities is highly competitive and, recently, the subject of criminal prosecution in the United States.
This new score, dubbed the “Adversity Index” is a composite of 15 factors, including measures of crime rate and poverty in the neighbourhood in which the applicant has been raised and an assessment of the “quality” of the high school attended.
It provides a score scaled between 1 and 100, with higher scores indicating greater degrees of “disadvantage”. The Adversity Index is not used to adjust SAT test scores in any way, but provided separately to admission committees, presumably to “contextualize” the scores as they see fit.
The intent appears to be to level the admissions playing field that most agree favours applicants from wealthier backgrounds who can attend more academically rigourous high schools and benefit from more time and support for academics. It is also felt to identify students who have overcome personal adversity and demonstrated commitment and resourcefulness in order to achieve their success. The New York Times article cited above quotes Mr. David Coleman, CEO of the College Board:
“Merit is all about resourcefulness. This is about finding young people who do a great deal with what they’ve been given. It helps colleges see students who may not have scored as high, but when you look at the environment that they have emerged from, it is amazing.”
As one might imagine, not all agree. American College Testing (ACT) provides an alternative admission test for college applicants. Its CEO, Mr. Marten Roorda states the counter-argument in a recent blog post:
“The algorithm and research behind this adversity score have not been published. It is basically a black box. Any composite score and any measurement in general requires transparency; students, teachers and admissions officers have the right to know. Now we can’t review the validity and the fairness of the score. And even if that changes, there is also an issue with the reliability of the measure, since many of the 15 variables come from an unchecked source — for example, when they are self-reported by the student.”
All this comes about at a time when college and university admission processes are under siege as a result of a number of highly publicized reports of inappropriate influence exerted by wealthy and influential parents.
The repercussions and resulting enquiries have uncovered dubious practices, even in venerable institutions.
And so, what are we to make of all this? Does any of this translate to Canada, and specifically to medical school admission, certainly among the most competitive choices available to young people? A few key questions and postulated answers. (Please note: following are the opinions of the author, and the author alone).
Q. Does wealth and privilege facilitate admission?
A. Almost certainly yes. For further discussion see previous blogs:
Does every Canadian have equal opportunity to pursue a Medical Education?
Medical School Admissions: Unintended Consequences
Medical Student Debt: A problem, or shrewd investment?
Q. Do we wish to admit a more diverse student population, including students from traditionally socioeconomically disadvantaged groups?
A. Yes. All medical schools have engaged this challenge in various ways. At Queen’s both the medical school and university have made clear statements to this effect.
Q. Do adversity experiences build qualities desirable in medical school applicants?
A. They may, but not necessarily. Simply experiencing adversity is not sufficient. That experience must have resulted in a valuable learning experience that has contributed to the applicants ability to choose and undertake a career in medicine. In fact we must recognize that adversity experiences, unfortunately, have the potential to be highly damaging.
Q. How does “disadvantage” equate to “adversity”.
A. They correlate, but not precisely. To use an example from the cardiology world, sedate hypercholesterolemic people are at higher risk of developing premature ischemic heart disease, but they may not, and many active folks with normal cholesterol levels will. This is the nature of a “risk factor”. Lower socioeconomic status certainly puts one at risk for greater life adversity, probably at a linear fashion where poverty levels virtually guarantees adversity. Conversely, socioeconomic stability certainly provides no immunity from adversity experiences.
Q. Will an Adversity Index developed from compiled demographic and self-reported data provide a valid reflection of a student’s development and preparation for a career in medicine?
A. In and of itself, probably not. The information upon which it is based is inherently flawed, imprecise, and subject to manipulation.
Q. Will an examination of personal adversity and its impact on personal growth be helpful?
A. Yes. The study and practice of medicine requires commitment and resilience, both of which can be developed by adversity experiences successfully engaged.
And so, examining disadvantage is essential to addressing diversity goals, but Admissions Committees must develop robust methods to determine if adversity has been experienced, and what impact has resulted from those experiences. A numerical index such as that developed by SAT may provide a useful starting point, but is no more revealing than is a linear dimension obtained from recordings of the beating human heart.
Spring UGME retreat May 28
The spring UG Education retreat is coming up on May 28 at the Donald Gordon Conference Centre.
Designed primarily for course directors, unit leads, intrinsic role leads and others in educational leadership roles in our Undergraduate Medical Education program, this annual day-long event provides opportunities for information sharing and faculty development in planning for the next academic year.
The morning agenda includes an update from Associate Dean Anthony Sanfilippo as well as sessions on the progress test and quality assurance, accreditation & program evaluation. There will also be brief updates from the Librarian team at Bracken Library about new resources, and from the course team about the Human Structure & Function curriculum renewal.
The afternoon will begin with our guest speaker, Melissa Forgie, MD, FRCPC, MSc, Vice dean, UGME, University of Ottawa. She will speak on Embracing Diversity in Medical Education
Break out sessions will follow, including a working session for pre-clerkship course directors to build or revise assessment plans for next year and a clerkship course directors’ session on continued EPA/CBME implementation.
If you contribute to the Queen’s UGME program, please join us for all or part of the day. To register, use this link: https://queensfhs.wufoo.com/forms/ugme-may-28-retreat-registration/
Climate Change: What is our role?
By Sasha Létourneau with Gabe Lam and the Environmental Advocacy in Medicine group
“When the health effects of tobacco became known, the CMA quickly changed its investments. In times of climate change, health organizations around the world are divesting in fossil fuels.” – Courtney Howard, Emergency Medicine physician and President of the Canadian Association of Physicians for the Environment
We (Canadians) are addicted to fossil fuels. There. I said it. Isn’t admitting it supposed to be the first step? Much like a smoker with a 20 pack-year history, humans stand on the brink of irreversible damage to that which sustains us, having to make the choice as to whether to quit or continue down a destructive path.
When I first started medical school, I took a history from a man who had been diagnosed with lung cancer after a 50 pack-year history of smoking. I was quite astonished when he admitted he had been shocked by the diagnosis. How is that possible? I thought, thinking back on all the anti-smoking ads I’d grown up with in school, and the terrifying pictures of black lungs and rotted teeth I’d seen on cigarette packages strewn on the sidewalk. How did he somehow ignore all the signs around him? These are questions I hope my children never have to ask my generation about climate change.
Continuing down the fossil fuel-burning track we are on today is easy in that the ramifications of our actions are not yet apparent in most of our everyday lives. Despite the fact that CO2 levels have risen far beyond where they have ever been in the past 400,000 years,1 we are only just starting to experience the effects of climate change. And much like COPD or lung cancer, the threats of climate change most likely to impact Canadians seem just far enough away that they are still only a hazy blur. Yet, like a smoker who is only just starting to experience the first signs of shortness of breath, we too have reached a tipping point and we need to act as soon as possible.
Studies have shown that among the top most important reasons Canadians begin the extremely difficult process of smoking cessation is their concern for their personal health.2,3 If health care professionals so adamantly advocate for smoking cessation to prevent our patients from its long-term health consequences, should we not, for the same reason, also advocate for cessation of fossil fuel dependency? And how do we convince a society (and, quite frankly ourselves) that this issue needs to be addressed now?
We’ve seen a number of recent examples that climate change is starting to threaten human health, including climate-related natural disasters like cyclone Idai which claimed hundreds of lives in Mozambique in March 2019. Touching a bit closer to home, the extreme temperatures of the Quebec heat wave in the summer of 2018 took the lives of more than 90 Canadians. And even closer to Kingston, many of us have watched with horror the footage of the recent flooding in the Ottawa River that has displaced hundreds of Canadians from their homes. I, personally, might even decry the number of lectures Queen’s Medicine students endure on Lyme disease as a direct result of climate change facilitating the spread of this tick-borne infectious disease.4
But most of us fossil-fuel “addicts” are already convinced that we need to begin to transition away from our weighty reliance on fossil fuels. So now comes the hardest part – beginning the process of actually quitting. The Intergovernmental Panel on Climate Change (IPCC) released a report in 2018 telling us that, in order to ensure global temperatures remain below 1.5˚C above pre-industrial levels, we need to significantly curb our fossil fuel use by the year 2030 and achieve net-zero carbon emissions by 2050. Why is this 1.5˚C cap so important? While 1.5˚C is still higher than current temperatures, keeping global temperatures at or below this level is humans’ best chance of mitigating further catastrophic events, including land loss from rising ocean levels, extreme heat waves, drought, increased ocean acidity and both land and ocean biodiversity loss. These climate events will inevitably threaten human health, food security, water security, job security, economic growth and physical safety from war and climate disasters.5
Unfortunately, (as far as I know) there is no magical solution and no promise that this transition will be immediate or smooth. And, like a smoker trying to quit, it is probably not realistic for us to quit cold turkey – we still are years away from being in any way independent of fossil fuels. We also need to ensure we enact a just transition for our fellow Canadians currently working in the fossil fuels industry. But if we never start the transition, if we never grasp hold of the “greatest global health opportunity of the 21st century” – tackling climate change – we will never know if we could have succeeded.6
If you’ve reached this point in the article, you may be wondering: what can I, a lowly Queen’s student/faculty/alumnus, contribute to the struggle against climate change? What can one single Canadian do? Luckily, the answer is: a lot! In this article, I’ll present you with a few ways you can start to engage as a climate advocate.
One avenue that our medical student group, Environmental Advocacy in Medicine, has undertaken is working with the Queen’s Backing Action on Climate Change (QBACC) group to ask that Queen’s divest from fossil fuel companies. We are joining them to ask that Queen’s:
- Freeze fossil fuel investment immediately
- Fully divest the Queen’s Endowment and Investment funds by 2025
QBACC needs support from students, faculty and alumni. A mass divestment movement can stigmatize and delegitimize fossil fuel use and the profiting corporations in the court of public opinion, a strategy that has also been crucial in combating smoking culture and destabilizing tobacco companies. The list of organizations calling for divestment is long and growing with new players being added every day, including commitments from the Canadian Medical Association, McGill University, Oxford University, the RockFeller Brothers Fund, the British Medical Association, New York City’s pension fund, the country of Ireland and many more. This movement on Queen’s campus has been growing since the first formal request for divestment of Queen’s funds from fossil fuels was rejected by the Board of Trustees in 2014. A diverse basis of support that includes a broad community of current and future health professionals will be imperative when QBACC approaches the Board of Trustees at their annual meeting in 2020.
If this cause speaks to you, ways you can support it are:
1. Becoming informed about divestment by reading a bit more about their campaign here: https://drive.google.com/drive/folders/17PDgVGUXaLyefEp_IwzD4JZ2OANh0qsh?usp=sharing
2. Signing and/or personalizing a letter to the Board of Trustees stating your support of the divestment campaign at Queen’s University (here: https://drive.google.com/open?id=1wDYfBT5h005XyudA-ac32fSIEU_Y6QUc)
3. Signing QBACC’s support forms:
- For faculty: https://www.qbacc.org/divestment-petition
- For alumni: https://docs.google.com/forms/d/1onGYQBJAiDpPK0r7TbLqf1V0lj_sAWSCEYS_TkQdeMI/viewform?edit_requested=true
If that’s not enough for you or you are still not sure about divestment, here are some other ways you can choose a cause, join an advocacy group and work to have your voice heard:
1. Become informed about climate change by:
- signing up for the Canadian Association of Physicians for the Environment newsletter here, or
- reading CAPE’s Climate Change Toolkit for Health Professionals here.
2. Or, better yet, join CAPE’s team (if you are a physician) here.
3. Support the Queen’s Environmental Advocacy in Medicine effort to increase climate change education in the curriculum by including information on climate change in your teaching material (contact us for more information at: email@example.com)
4. Talk to your fellow students and colleagues about their thoughts on climate change!
We are that patient with the 20-pack-year history leaving the doctor’s office, having been told the risks of letting the status quo take its course. We stand at the edge of a frightening precipice in human history, where our actions (or inaction) today will determine the world our children and grandchildren get to live in. But like that patient, we are fortunate. We know the importance of taking action and we have a timeline during which to do so. It is now up to us whether we seize the “greatest global health opportunity of the 21st century.”6
1. NASA. (2019, May 3). Graphic: The Relentless Rise Of Carbon Dioxide. Climate Change: Vital Signs Of the Planet. Retrieved from: https://climate.nasa.gov/climate_resources/24/graphic-the-relentless-rise-of-carbon-dioxide/
2. Wellman, R. J., O’Loughlin, J., O’Loughlin, E. K., Dugas, E. N., Montreuil, A., & Dutczak, H. (2018). Reasons for quitting smoking in young adult cigarette smokers. Addictive Behaviors, 77, 28-33. doi:10.1016/j.addbeh.2017.09.010
3. Kasza, K. A., Hyland, A. J., Borland, R., McNeill, A., Fong, G. T., Carpenter, M. J., . . . Cummings, K. M. (2017). Cross-country comparison of smokers’ reasons for thinking about quitting over time: Findings from the international tobacco control four country survey (ITC-4C), 2002–2015. Tobacco Control, 26(6), 641-648. doi:10.1136/tobaccocontrol-2016-053299
4. Brownstein, J. S., Holford, T. R., & Fish, D. (2005). Effect of Climate Change on Lyme Disease Risk in North America. EcoHealth, 2(1), 38–46. doi:10.1007/s10393-004-0139-x
6. Watts, N., MA, Adger, W. N., Prof, Agnolucci, P., PhD, Blackstock, J., PhD, Byass, P., Prof, Cai, W., PhD, . . . Stockholm Resilience Centre. (2015). Health and climate change: Policy responses to protect public health.Lancet, the, 386(10006), 1861-1914. doi:10.1016/S0140-6736(15)60854-6
1. Link to “Investing in a Sustainable Future” document prepared by QBACC: https://drive.google.com/drive/folders/17PDgVGUXaLyefEp_IwzD4JZ2OANh0qsh?usp=sharing
2. Link to letter of support faculty/alumni can edit and send to QBACC: https://drive.google.com/open?id=1wDYfBT5h005XyudA-ac32fSIEU_Y6QUc
3. QBACC faculty support form: https://www.qbacc.org/divestment-petition
4. QBACC alumni support form: https://docs.google.com/forms/d/1onGYQBJAiDpPK0r7TbLqf1V0lj_sAWSCEYS_TkQdeMI/viewform?edit_requested=true
5. Sign-up for CAPE newsletter: https://cape.ca/media/blog/
6. Link to Climate Change Toolkit for Health Professionals: https://cape.ca/campaigns/climate-health-policy/climate-change-toolkit-for-health-professionals/
7. Sign-up for CAPE membership: https://cape.ca/become-a-member/
If you are a Queen’s UGME student who would like to submit a column for consideration as a guest blog, email me at firstname.lastname@example.org
“We’re all Chinese”. The freedom to express our diversity…or not.
I recently had the opportunity to visit a Chinese medical school and spend some time with both faculty and students. The leadership of the school was interested in pursuing North American accreditation. I was part of a team invited to advise about the state of compliance with those standards, and to help prepare the faculty and curricular leadership for the review process.
The visit was organized in the style of a typical accreditation visit, structured as a series of interviews with groups of faculty, curricular leaders, students and administrative staff. Each meeting was typically focused on a subset of standards.
One such meeting, which I’d been dreading, involved the accreditation standards dealing with the issue of Diversity. I was not at all sure how the North American sensibility regarding diversity would translate to such a different cultural and political setting, and was concerned about inadvertently causing some offense to our hosts, who had been nothing but gracious.
The meeting involved about ten faculty and administrative staff. They were chosen, in part, because of facility in English, but their understanding and ability to express responses varied considerably. As a result, questions were often followed by spontaneous conversations in Mandarin where those with better understanding would translate to others and, presumably, responses were considered and formulated. These “huddles” sometimes got quite animated and the tone and gestures themselves seemed very revealing.
The preliminary questions for this particular session were quite straightforward, generally confirmation of factual information. All was going along quite smoothly with a generally light and friendly atmosphere in the room. Then, and in the interest of simulating a true accreditation visit, I probed further. “And how do your admission practices and curriculum recognize the diversity of your population?”
The previously relaxed and animated group went quiet, all eyes on me. After what seemed like a very long pause, the faculty member who’d been the lead discussant for the group asked me to clarify what I meant by “diversity”.
I tried to explain that North American medical school standards required a commitment to social accountability, a component of which was the recognition of cultural, gender and ethnic differences in the students and society they would eventually serve.
My explanation was translated to the group, followed by the most animated and prolonged exchange they’d had to date. The other panel members and I sat back taking all this in. The expressions and tone suggested confusion, perhaps mild offense and considerable concern about how to respond.
After what seemed like quite a long and somewhat uncomfortable time, the lead faculty member turned to me and said simply, “We’re all Chinese”.
With more than a little trepidation, I decided to press on. “But I’ve read recently that there are over 50 different ethnic and cultural groups within China. Diversity also extends to issues of gender and sexual orientation. How is that diversity accounted for in your admissions and faculty appointment processes, for example?”
After another translation, an even longer and more animated Mandarin huddle ensued. Finally, the response:
“But, we’re all Chinese”.
In the interests of maintaining good relations and ensuring the review team got home safely, I decided to leave it at that.
In the ensuing months, my thoughts have often returned to that particular exchange. Of all the conversations during that visit, that was the one that brought home most clearly the differences in our societies. Fundamentally, the Chinese political structure and the values that it espouses prioritize the state over the individual. It’s not that myriad cultural, racial, religious and language differences don’t exist or are unimportant to their 1.5 billion citizens, it’s simply that those differences are considered secondary to their common, unifying allegiance to the state. They’re all Chinese first. Other characteristics, choices or preferences come second, or not at all. They have, as a society, essentially chosen to suppress or ignore their diversity.
All this is in rather stark contrast to our culture in Canada where diversity is celebrated and even legislated, permeating even our educational programs. We are free, as Canadians, to identify in (almost) any way and with (almost) any group we chose, the exceptions being organizations that are known to advocate violence or hatred in the pursuit of their particular perceptions of diversity.
I came away from all this with a deeper appreciation of the incredible privilege our society provides. The freedom to choose how one wishes to be identified is precious. It’s also easily taken for granted, largely because most of us have never had to struggle to achieve it, and have never lived without it.
What my brief and admittedly superficial encounter with Chinese culture brought home to me is that we all have the freedom to choose how we wish to engage each other, and how we collectively wish to engage the world. For any two people, indeed for any two peoples, both common and differentiating issues can be easily identified. In any encounter, from simple to profound, the parties involved face a choice. Their encounter and their ongoing relationship can be defined by points of mutual interest, or by those characteristics that divide them.
All this brings to mind the words of President John F. Kennedy who, in a commencement address at American University in 1963, at the height of the Cold War, nuclear proliferation and the constant threat of accidental or intentional Armageddon, reached out to both his own people and his global adversaries with these words:
“So let us not be blind to our differences, but let us also direct attention to our common interests and the means by which those differences can be resolved. And if we cannot end now our differences, at least we can help make the world safe for diversity. For in the final analysis, our most basic common link, is that we all inhabit this small planet, we all breathe the same air, we all cherish our children’s futures, and we are all mortal.”
How will we, as Canadians, chose to use the freedom of choice that we have inherited? From time to time, might our chosen approach to our various diversity challenges be “We’re all Canadian”?