History of Medicine Week: 100 years later… Looking Back on the First World War and the Spanish Influenza October 22-26th

By Kelly Salman (Meds 2021)

The What Happened in Medicine (WHIM) Historical Society is proud to host the fourth annual History of Medicine Week! This year’s theme highlights a significant anniversary for both medicine and the world. A century ago in 1918, two major and interconnected events in history occurred: the Spanish flu and WWI. Learn more about what happened in medicine then and consider how things have (or haven’t) changed in our present day 2018 — 100 years later…

Students, Faculty, and Community members are all welcome to attend.

Museum of Health Care Showcase

Monday October 22nd, 8:30am-3:30pm

New Medical Building Grande Corridor, 15 Arch St.

Many of our greatest medical technologies and advancements have come out of times of crisis. Come and peruse a sampling of century-old artifacts from both the Spanish Flu and WWI. Curated by the Museum of Healthcare.


Speaker Panel Followed by Wine and Cheese Reception

Tuesday October 23rd, 5:30-8:00pm

Speaker panel: New Medical Building, Rm 132 A, 5:30-7:00pm

Reception: Museum of Healthcare, 7:00-8:00pm

 

“We Forgot to Remember – young Canadians commemorating the stories of the 1918 Pandemic”

Award-winning Neil Orford will discuss the Spanish Flu and its impact in medicine.

 

“Brock Chisholm and the Legacy of War Trauma”

Military historians Dr. Robert Engen and Matthew Barrett will discuss the trauma of war through their research on the experiences of Lt. Brock Chisholm in the first world war before he became a physician and the first director general of the WHO. Dr. Engen and Mr. Barrett created a graphic novel to illustrate this narrative, as featured in the Queen’s Alumni Review this summer: https://www.queensu.ca/gazette/alumnireview/stories/battle-hill-70

 About the Speakers:

In 2017, Neil Orford retired from teaching History at Centre Dufferin District High School in Shelburne, ON. His work as a teacher has seen him win numerous awards for his teaching, most recently the 2015 Government of Canada History Award for Teaching; as well as the prestigious 2013 Canadian Governor General’s Award for History Teaching and the 2012 Ontario Premier’s Award for Teaching Excellence. In July 2013, Neil Orford founded a consulting business, Canadian Historical Educational Services, Ltd. to assist school boards, museums, non-profits & government agencies with designing educational programs for historical thinking and commemoration. This work has led him to consultation work with the Federal Ministry of Canadian Heritage in 2017, helping to design digital commemorations for students across Canada.

Dr. Robert Engen, MA’08, PhD’14 (History) is an assistant professor of history at Royal Military College and an adjunct professor in the Department of History at Queen’s. He is the author of Canadians Under Fire: Infantry Effectiveness in the Second World War and Strangers in Arms: Combat Motivation in the Canadian Army, 1943–1945, both published by McGill-Queen’s University Press.

Matthew Barrett is an SSHRC-funded PhD candidate in the Department of History at Queen’s. His doctoral research examines the concepts of honour and dishonour within military culture. In particular, he studies the dismissal and cashiering of Canadian officers during both World Wars. Additional research focuses on Canadian public and institutional attitudes toward suicide in the military. His academic work has appeared in Canadian Military Journal, Canadian Military History, Journal of Canadian Studies and British Journal of Canadian Studies. He has also illustrated two First World War graphic novels with Robert Engen.


Trivia Night

Friday October 26th, 7:00-9:00pm

The Grad Club, 162 Barrie St.

 Impress your friends with your history know-how during a historically themed Trivia Night! Snacks will be provided!

 

 

 

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Poetry, journalism, and a Pepsi commercial… or, a meandering parable about balance

I started writing poetry again recently. I do this, then abandon it, then reclaim it at various intervals. I’m always better with it.

This may seem to have very little – if anything – to do with medical education. And, you’re right in one sense. Join me on a little self-indulgent meandering to get to my point.

As I write this, it’s Thanksgiving Day – a day when people traditionally reflect on their blessings and things they’re grateful for. And, I’m on the cusp of a milestone birthday, so perhaps that has made me more introspective than other weeks, when I write about course evaluations and how we value them (we do!), or team-based learning and how it contributes to long-term learning and understanding more than straight lectures (it does!), or ways service-learning contributes to both social accountability and professional development (yes!). So, I find myself thinking about poetry.

On the road to becoming any professional – and medicine is no exception – we ask people to shed a lot of things along the way.

We ask people to shed attitudes that aren’t aligned with their goals. To ditch beliefs that aren’t compatible with where they’re going. To replace erroneous information or practices with those that are proven to be more valid.

The profession of medicine itself demands other things – things I watch colleagues work through and cope with – long days, longer nights, emotional and physical demands they may never have imagined at the start of their careers.

Because, really, none of us truly ever know what we’re getting into.

All of this coalesces in a kaleidoscope of who we were and who we are and who we will be. The parts and colours shifting as the years turn.

My first career was in journalism. In the spring of Grade 12, I was accepted into the four-year Bachelor of Journalism program at the University of King’s College. They only accepted 35 students a year, out of nearly 1,000 applicants, so this was exciting! As parents are wont to do, my father, an English teacher, mentioned my acceptance to a colleague he saw at a conference. That colleague was the late Don Murray, then a professor of Journalism at the University of New Hampshire. Professor Murray later sent me a number of articles and a book on journalism (that I still have and use to this day), but he passed along advice through my father that was even more valuable.

“They’re going to teach her how to write a certain way,” he said. “And that’s important, and she needs to do that. But tell her not to give up her other stuff. She needs to keep doing that, too. It will make her a better writer.”

I haven’t always adhered to that advice, but over 32 years after first hearing it, I know its value. So I put pencil to paper to work out ideas, and thoughts, and metaphors. But, really, I’m claiming a part of myself I refuse to shed. It’s something I need to keep to be me. To be better.

Are there things you’ve accidentally shed along the way that you didn’t need to? Are there parts of you you’d like to reclaim, to give you that edge, that solace, that space to be you, preserved in the full person you want to be?

As I write this, I’m reminded of the 2004 diet Pepsi “old van” commercial… where a thirty-something dad is asked if there’s anything else youthful he’d like to experience and he says his old van. He then imagines his 1980s-era rocker painted van and what driving that in his current life (like dropping his kids off at school) would be like (not good!). Then he drinks his can of pop and is happy with that.

Some things can’t – and likely shouldn’t – be reclaimed. But if there’s something like poetry, or running, or music, or nosing around in antique shops, or reading trashy fiction (however you define that), or some other seemed-not-that-important-at-the-time thing that you miss about being you, consider ways to recapture that. And fit that “old” part amongst the newer parts.

Just maybe not that van.

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Adjusting to Medical School

Adjusting to a new environment never comes easily. Our bodies will eventually adapt to seasonal climate changes, travelling to different time zones, or high altitude, but it invariably takes some time, and involves a little discomfort along the way. Adjustments of any kind are easier if anticipated and understood in advance.

Medical school is an adjustment and, unfortunately, not always anticipated by those “taking the plunge”.

What’s the most difficult adjustment for first year medical students?

Asked that question, most would point to issues such as workload, engaging initial patient encounters, or perhaps aspects of technical competence involving physical examination or procedures. All important, to be sure, but these challenges are understood in advance, anticipated by our curriculum, and well within the abilities of the young people entering medicine, who are already very accomplished and have engaged the process and been selected with all these issues firmly in mind.

Beyond these anticipated challenges, there are other adjustments that are even more critical to success but much less well-appreciated or even unanticipated by students.

 

Changing Purpose

Why do we undertake educational programs? For many undergraduate university students, it is to either to pursue an area of personal interest, or to achieve prerequisites or qualification for a subsequent program. That’s certainly the case for students contemplating entry to medical school. These are certainly worthy goals, but they are personal and intended to promote individual objectives. In a professional program such as medicine, the goals of learning shift to encompass the interests of other parties, specifically future patients. The approach and motivation for learning must also shift. In the words of an astute former mentor “Medicine is a service industry”. Medical school is about preparing young people to provide that service. The learning is facilitated by that goal. In fact, it can’t occur without it.

 

Seeking validation

Students entering medical school have achieved much recognition for their academic and personal accomplishments, the most recent and notable being their success in the admission process. As they undertake their studies together with equally accomplished classmates and in a system that defines success simply as “pass” with very little numerical grading, external kudos and other tangible evidence of success become increasingly rare. The perception of success must therefore shift from the external to internal as will, eventually, the responsibility for ensuring they remain knowledgeable and technically competent.

 

The expectation of professional behaviour

Medical education is patient-centred. Students learn early that their interactions with patients must be carried out with high standards of confidentiality, respect and personal behaviour. Although that expectation is easily understood within the patient contact itself, it is perhaps less immediately understood that the same expectations are in play with all their interpersonal and social interactions. The lines between their personal and student lives therefore become blurred. For most, this is a novel experience, and perhaps the first realization of what it means to have engaged a professional role.

 

Dealing with uncertainty

Students, particularly those from backgrounds in the physical or biologic sciences, have come to expect precision and certainty in their studies. The concept of “right” and “wrong” provides reassuring clarity and promotes the expectation that learning is a finite endeavor, culminating with the discovery of that single, correct response. In the study of medicine, they find a much less dichotomous world where many clinical issues are nuanced and require interpretation based on many variables. They must develop “approaches” based on “best evidence” always contextualized to the “patient’s unique circumstances”. For those accustomed to singular solutions, this can be quite unsettling.

 

All this can sound quite daunting but, like any life adjustment, will be eased with patience and support. Fortunately, much support is available. The quick “bonding” with classmates allows for the comforting realization that these challenges are not unique or some critical personal shortcoming, but rather ubiquitous features of the early medical school experience. Interactions with upper class colleagues, both planned and informal, provide further validation. Our Student Affairs programs, mentor groups, observerships and Clinical Skills groups all provide opportunities to discuss transition difficulties.

In the end, the adjustment is not merely about engaging a new educational program, but rather a more clearly defined identity and perspective of one’s role in the world.

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MD Program Executive Committee Meeting Highlights: September 18, 2018

By Jennifer Saunders

Faculty and staff interested in attending MD PEC meetings, should contact the Committee Secretary (Orser, Faye A. <Faye.Orser@kingstonhsc.ca>) for information relating to agenda items and meeting schedules.

UPDATE: 

The following revised Policies and Terms of Reference were discussed and approved by the Committee but require final approval by SOMAC.

  • Student Assessment Policy Revisions
  • QuARMS Admission Process
  • MD Program Progress & Promotion Committee TOR
  • P&P Policy and Student Professionalism Policy
  • MD Program Professionalism Advisory Committee TOR

The following policy was approved by the Committee:

  • The Attendance and Absences in Undergraduate Medical Education Policy
    • Supersedes: Policy #SA-07 v3

This policy is effective October 1, 2018.

All Undergraduate Medical Education policies and terms of reference are available on the UGME website:  https://meds.queensu.ca/academics/undergraduate/policies-committees

 

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Fourth Annual Pap Party event set for October 15-18

By Lauren Wilson (MEDS 2019, Katherine Rabicki (MEDS 2019), Ariba Shah (MEDS 2020) and Hayley Manlove (MEDS 2021)

The fourth annual Pap Party event will take place October 15-18th, during Cervical Cancer Awareness week. This is an event which runs free pap smear clinics, specifically intending to reach women who may not have access to cervical cancer screening otherwise and to increase awareness of Human Papilloma Virus in the community.

In 2015, Cancer Care Ontario estimated that 26% of screen eligible women were overdue for their pap smear. Ensuring adequate access to all women and minimizing barriers to receiving screening are crucial; a Pap Party priority. In 2017, across all four clinic dates, 30 women received pap smears through the Pap Party campaign.

Women aged 21-70 who have not had a pap smear in the last three years are welcome. To increase accessibility to cervical cancer screening, women without primary care physicians, with or without a valid health card are also encouraged to attend the Pap Party Event.

The clinics are run by a team of medical students, residents and physicians under the guidance of Dr. Julie Francis and Dr. Hugh Langley and in collaboration with the Federation of Medical Women of Canada (FMWC). The first Pap Party in 2015 took place in Kingston and has since grown to offer clinics in Belleville, Napanee, and Tyendinaga as well.

The 2018 Pap Party schedule is :

Monday October 15 5:30pm – 7:30pm: HPE Public Health, Belleville

Tuesday October 16 5:30pm – 7:30pm: Community Well Being Centre, Tyendinaga, Mohawk Territory

Wednesday October 17 5:30pm – 7:30pm: Kingston Health Science Centre, Burr 1, Kingston

Thursday October 18 5:30pm – 7:30pm: Kingston Community Health Center, Napanee

To expand Pap Party further and combat declining cervical cancer screening rates, we have also reached out to all primary care clinics in the Kingston area encouraging them to host their own pap smear clinics during Cervical Cancer Awareness Week. They will also be encouraged to offer the HPV Vaccine. Clinics that register with the FMWC receive a kit that includes a tip sheet, colour poster, news release template, and patient education brochures. To register your clinic and contribute to reducing cervical cancer rates, please visit https://fmwc.ca/events/pap-campaign/.

The FMWC website also has more information for individuals and will help them find a registered clinic nearby.

Thank you taking the time to learn about the Pap Party initiative. Please feel free to contact us if you would like any additional information and please spread information about the Pap Party event to women in your life! We would be grateful and thrilled!

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Medical Student Research Showcase September 20

By Drs. Heather Murray & Melanie Walker

This year the School of Medicine is proud to invite you to the 7th annual Medical Student Research Showcase on Thursday September 20, 2018.

This event celebrates the research achievements of our undergraduate medical students, with both posters and an oral plenary session featuring research performed by students while they have been enrolled in medical school. All students who received summer studentship research funding through the School of Medicine in 2018 will be presenting their work, as well as many other research initiatives. The posters will be displayed in the David Walker Atrium of the School of Medicine building from 8 am until 5 pm, with the students standing at their posters answering questions between 10:30 and noon.

The oral plenary features the top research projects selected by a panel of faculty judges, and will run in room 132A from noon until 1:30 pm on September 20, immediately following the poster session Q&A.

This year’s faculty judges included:

Dr. Stephen Pang

Dr. Sheela Abraham

Dr. Nishardi Wijeratne

Dr. Faiza khurshid

Dr. Graeme Smith

Dr. Olga Bougie

Dr. Susan Crocker

Dr. Michael Rauh

Dr. Prameet Sheth

Dr. Yuka Asai

Dr. Thiwanka Wijeratne

Dr. Jennifer Flemming

Dr. Anne Ellis

Dr. Tim Phillips

We are very grateful to these faculty members for evaluating our oral plenary applicants this year.

The three students who have been selected for the oral plenary session, and the titles of their research presentations and faculty supervisor names are listed below. Each of these three students will receive The Albert Clark Award for Medical Student Research Excellence.

Harry Chandrakumaran – Inter-Laboratory Variability Of Parathyroid Hormone: impact on clinical decision-making
Sachin Pasricha – Clinical indications associated with opioid initiation for pain management in Ontario, Canada: A population-based cohort study
Rachel Oh – Evaluation of ARHGAP33 missense alleles in a zebrafish model of childhood glaucoma

Please set aside some time to attend the Medical Student Research Showcase on September 20th. The students will appreciate your interest and support, and you will be amazed at what they have been able to achieve.

 

 

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Improving teaching, one slide at a time…

“How many slides can I have in my PowerPoint presentation?”

This is one question I get a lot as an educational developer, with a quick follow-up one about what’s the best way to put slides together.

Soon after it was first released in 1987, PowerPoint became both a boon and bane for teaching. (There are other software programs; PowerPoint just has well over 90% of the market). Computer program presentation software is certainly way more convenient than its predecessor overhead projector (and the accompanying slippery stack of slides), but it’s perpetuated some of the previous challenges with ill-conceived overhead transparencies while creating its own new issues.

Like how many slides is too many?

The standard advice is the 10/20/30 rule: 10 slides for a 20-minute presentation with 30-point font. This avoids the too-much issue: too many slides and too much information crowded on a single slide, but it’s simplistic advice that may not address your actual concerns.

I use four guiding questions to think about presentation slides:

  1. How are you going to use them?

  2. How are your learners going to use them?

  3. What else are you going to provide?

  4. Have you addressed the issues? (Accessibility, Copyright, Confidentiality, etc.)

 

How are you going to use them?

For example, are you using your slides as “attention getters” or information notes? Do you need an eye-catching image, or clear bullet points, or both? Are your images essential illustration, or distracting add-ons? If you’re showing a complicated image, is it to show “it’s complicated” or is it for detailed discussion and deeper learning?

How are your learners going to use them?

Take a step back and think about how your slides look projected on the three screens in the teaching theatres. Are your slides overwhelming or illuminating? Are your learners going to take notes on their electronic copy of your slides while you talk? Will these be their primary reference? Are your slides “must use” or “nice to have”?

What else are you going to provide?

Do you provide an electronic copy of your slides, before or after class? Are they complete or are there things omitted in your MEdTech published versions (either for pedagogical or other reasons, see next point!). If you’re using more visual versus text sides, are you providing accompanying notes? Do the students have other resources?

Have you addressed the issues? (Accessibility, Copyright, Confidentiality, etc.)

Issues about accessibility, copyright and confidentiality will vary based on particular circumstances. The best rule for layout is “keep it simple” – many of the built-in templates in programs don’t translate well to the screen and can be impossible to read for some people with particular vision problems. There can be issues of copyright for images – some things can be shown in class, but not saved to our learning management systems, for example. (And we have a copyright specialist here at Queen’s – Mark Swartz – who can help us navigate this). Also, regarding confidentiality, if screenshots of x-rays are used, for example, how is identifying information removed?

 

There are a vast number of resources online and multiple great reference books with tips and techniques for improving your use of presentation software. There is no single school of thought of best practices for teaching with this tool (although there are definitely pitfalls to avoid).

If you’re looking to improve your use of PowerPoint in the classroom, please feel free to get in touch. We can look at what you’re doing now, what your goals are, and talk strategies for changing things up as needed.

Meanwhile, if you have 14 slides for a 20-minute presentation, you’re likely ok. But if you’re planning 200 slides for a 50-minute lecture, chances are, that’s too many. Call me.

Reach me at theresa.suart@queensu.ca

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Welcoming Queen’s Meds 2022

At precisely 1 p.m. on Monday, November 6th 1854, Dr. James Sampson rose to address the twenty-three students who would become the first medical class entering the Queen’s School of Medicine. They were gathered in an upper room of a former military infirmary at 75 Princess Street, a building that still stands today, currently the site of a popular local hardware store.

Dr. Sampson, an Irish and British trained former military surgeon who was instrumental in the development of Kingston

Dr. James Sampson

General Hospital and would go on to serve multiple terms as Mayor of Kingston, was Professor of Clinical Medicine and Surgery. He was also President (essentially the first Dean) of the medical school. He introduced himself and his five colleagues who would form the first teaching faculty and then turned the podium over to Dr. John Stewart, Professor of Anatomy, Physiology and Practical Anatomy, who would deliver the first lecture.

In his book “Medicine at Queen’s: A Peculiarly Happy Relationship”, the late Dr. Tony Travill describes the event in vivid detail.  He notes that the room in which they met was “deplorably filthy”, but appearances did not deter the faculty members who felt appearances did not matter much “as there are no bacteria then in Kingston” meaning, presumably, there was no epidemic or plague currently active.

In that inaugural address Dr. Stewart spoke of “the importance of anatomy and physiology to the proper practice of surgery and medicine”. He went on to quote Galen who described anatomy as “the most beautiful hymn which man can chant in honor of his creator”. In finishing “He recounted the events leading to the school’s founding and exhorted the students to recognize that their future success depended more on themselves than on their professors: the only barrier to that success was idleness.”

Last week, Dr. Sampson’s successor, Dr. Richard Reznick, welcomed the one hundred and sixty-fourth group to be welcomed to their studies and to the profession by their faculty. Dr. Reznick challenged them to be restless in the pursuit of their goals and the betterment of our patients and society.

Photo by Lars Hagberg

.

A few facts about our new colleagues:

They were selected from a pool of 4836 highly qualified students who submitted applications last fall.

Of the 104 students the average age is 24 years.  Forty-nine members of the class are women and 55 are men. They hail from no fewer than 43 communities across Canada, including; Alma, Belleville, Brampton, Burlington, Cambridge, Dundas, Etobicoke, Golden Lake, Guelph, Kingston, Lively, London, Maple, Markham, Milton, Mississauga, Nepean, Nobleton, North York, Oakville, Odessa, Ottawa, Peterborough, Richmond Hill, Sarnia, Scarborough, Sittsville, Thornhill, Toronto, Whitby, Edmonton, Leduc, Calgary, Vancouver, Maple Ridge, Victoria, Coquitlam, West Vancouver, North Vancouver, Winnipeg, St John’s, New Minas, Halifax.

Eighty-six of our new students have completed an Undergraduate degree, and sixteen have postgraduate degrees, including three PhDs. The universities they have attended and degree programs are listed below:

Universities of Undergraduate Studies

Acadia University
Brown University
Carleton University
Harvard University
McGill University
McMaster University
Queen’s University
Quest University
Ryerson University
Simon Fraser University
St. Francis Xavier University
Trent University
University of Alberta
University of British Columbia
University of Calgary
University of Guelph
University of Ottawa
University of Toronto
University of Victoria
University of Waterloo
University of Ontario Inst. Of Tech
Western University
Wilfred Laurier University
York University

 

Undergraduate Degree Majors

Administration
Anatomy and Cell Biology
Biochemistry
Biochemistry and Molecular Biology
Biological Science
Biology
Biomedical Discovery and Commercialization
Biomedical Science
Chemical and Physical Biology
Chemical Biology
Chemical Engineering
Chemistry
Computer Science and Biology
English Language and Literature
Epidemiology and Biostatistics
Foods and Nutrition
Gender Studies
Global Experience
Health and Disease
Health Sciences
Health Studies
Integrated Science
Kinesiology
Kinesiology and Health Science
Knowledge Integration
Life Physics
Life Sciences
Mathematics and Physics
Medical Health Informatics
Medical Sciences
Molecular Biology and Genetics
Neuroscience
Nursing
Nutritional Sciences
Occupational and Public Health
Pharmacology
Physiology
Policy Studies
Psychology

An academically diverse and very qualified group, to be sure.  Last week, they undertook a variety of orientation activities organized by both faculty and their upper year colleagues.

On their first day, they were called upon to demonstrate commitment to their studies, their profession and their future patients.  They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers.  In addition to Dr. Reznick, they were welcomed by Ms. Rae Woodhouse, Asesculapian Society President, who spoke on behalf of their upper year colleagues, and Dr. Rachel Rooney provided them an introduction to fundamental concepts of medical professionalism.

Over the course of the week, they met curricular leaders who will particularly involved in their first year, including Drs. Michelle Gibson and Lindsey Patterson (Year 1 Directors) and Drs. Cherie Jones and Laura Milne (Clinical Skills Directors).  They were also introduced to Dr. Renee Fitzpatrick (Director of Student Affairs) and our excellent learner support team, including Drs. Martin Ten Hove, Jason Franklin, Kelly Howse, Mike McMullen, Josh Lakoff, Craig Goldie and Erin Beattie, who oriented them to the Learner Wellness, Career Counseling and Academic Support services that will be provided throughout their years with us.  They met members of our superb administrative and educational support teams led by Jacqueline Findlay, Jennifer Saunders, Theresa Suart, Amanda Consack, and first year Curricular Coordinator Corinne Bochsma.

Dr. Susan Moffatt organized and coordinated the very popular and much appreciated “Pearls of Wisdom” session, where fourth year students nominate and introduce faculty members who have been particularly impactful in their education, and invite them to pass on a few words of advice to the new students.  This year, Drs. Dale Engen, Debra Hamer, Ingrid Harle, Annette Hay, Michael Leveridge, Joseph Newbigging, Louise Rang and Andy Thomas were selected for this honour.

On Friday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Michelle Gibson and Lindsey Patterson.

Their Meds 2020 upper year colleagues welcomed them with a number of formal and not-so-formal events.  These included sessions intended to promote an inclusive learning environment, as well as orientations to Queen’s and Kingston, introductions to the mentorship program, and a variety of evening social events which, judging by appearances the next morning, were much enjoyed.

For all these arrangements, flawlessly coordinated, I’m very grateful to Rebecca Jozsa, our Admissions Officer, Admissions Assistant Rachel Bauder, and to Rae Woodhouse and her second year colleagues.

I invite you to join me in welcoming these new members of our school and medical community, and end with a quote Dr. Reznick shared with the incoming class, drawn from his favourite poet and recent Nobel Laureate Bob Dylan:

May your heart always be joyful
May your song always be sung
And may you stay forever young

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Diversity matters in undergraduate medical education. Not because it’s an accreditation standard (although it is, encompassing several aspects of the very broad concept of diversity), but because our students, classrooms, and faculty should reflect the populations of our communities and country.

As part of this, we believe students should see people like themselves reflected in who is at the front of the classroom and in clinics and other settings: As educators, as role models, as future colleagues.

One key aspect of diversity is gender and gender roles. Recently, Dr. Stephen Archer, head of Queen’s Department of Medicine, shared a post on his monthly blog on the role of women in medicine, and in his department here at Queen’s. We’re reposting it here because of its important message.

Women in Medicine: Where are we 150 years after Dr. Emily Howard Stowe, Canada’s First Female Physician?

By Dr. Stephen Archer

In 2016 I commissioned the creation of a Women in Medicine (WIM) Program in the Department of Medicine at Queen’s University. I was inspired to do so by a variety of factors including a diversity and equity course I had taken, some personal reflection on the subject of feminism, conversation with female colleagues, and my observations that the state of WIM would best be evaluated and advanced by women themselves. Launching this program felt like a positive step to enhance diversity and equity, promote professional development and perhaps even contribute to physician wellness.

Dr. Emily Howard Stowe (née Jennings)

There were those at the time, including some female physicians I consulted, who felt we did not need a WIM program. In our Alternate Funding Plan (AFP – which is our payment structure) we have pay equity, many women in leadership positions, and half of our Divisional Chairs are female (as just a few examples). Additionally, more than half the medical student class at Queen’s University is female. Therefore, some may ask, why do we need a WIM program?  Having continued to hear stories of discrimination and challenges to advancement that were perceived to be based on gender, and in discussion with my fellow Heads of Medicine at CAPM (Canadian Association of Professors of Medicine), it was ascertained that many gender differences remain and these should be addressed head on. Most obvious is the unique female role in reproduction and child rearing during early years in a woman’s career, in particular. However, there are other less intuitive differences I encountered. For example, while every female physician seems to know what “imposter syndrome” is, few male physicians were aware of this condition (a psychological pattern in which an individual doubts their accomplishments, and has a persistent internalized fear of being exposed as a “fraud”- despite being fully competent!). While imposter syndrome occurs in both women and men it seems more on the minds of female physicians in my nonscientific survey….and that’s but one of many differences.

Next, I considered how best to proceed with the idea that we should create a WIM program. I knew just enough to know that this was something I should not attempt to lead or direct! Rather, I turned for guidance to my friend and colleague (and Associate Head of Equity and Diversity in the Department), Dr. Mala Joneja. After discussion she agreed to help start a WIM program (but more on that later).

A proper discussion of WIM programs should start at the beginning. There is a very relevant biography in the archives of Canadian Medical history that is worth a quick review. Let’s go back 150 years and meet Canada’s first female physician, Dr. Emily Howard Stowe (née Jennings). Her story of overcoming adversity and of her interactions with male detractors and supporters remains relevant today.  She was born in Norwich, Ontario on May 1, 1831. By 1854 she graduated from Normal School and became Principal at Brantford Public School. Believe it or not this was a first in Canada!

Dr. Clemence Sophia Lozier and the New York Medical College for Women

Emily married John Stowe who unfortunately contracted tuberculosis. Reportedly inspired by this adversity she decided to change careers and become a physician. Just one problem: this had never occurred in Canada and was apparently impossible!  In 1865, her application to the Toronto School of Medicine was denied (more on that later). So, off she went to New York Medical College for Women, a homeopathic institution that had just opened in New York City in 1863. This College was led by a remarkable woman, Dr. Clemence Sophia Lozier. The College initially had seven students including Ms. Stowe. The school interestingly had gender balance in its faculty complement from day one – 4 male and 4 female. Dr. Lozier served as the Chair of Diseases of Women and Children and as President of the College.

In 1867, Canada’s birthday, Dr. Stowe became the school’s first graduate. During a 25-year period this school graduated 219 students. They originated from states across America and included the first African American female MD in New York, Dr. Susan McKinney.

http://www.biographi.ca/en/bio/jennings_emily_howard_13E.html

The newly minted Dr. Stowe returned to Ontario at a propitious time, with Upper Canada (Ontario) having joined the Confederation of Canada in 1867. She began her practice (see advertisement, right) on Richmond Street in Toronto. Perhaps reflecting her view of the establishment, she began practice without a medical license!

Dr. Stowe encountered several types of men in her career, as I suspect do modern female practitioners. There were men she loved and men she loathed. There were men who actively opposed her and others who helped in key times in very instrumental ways. For example, she reported that John McCaul, president of University College in Toronto, was not content to merely reject her application to medical school. When she responded to her rejection notice by “… expressing my regret & at the same time remarking that these university doors will open some day to women”, Dr. McCaul reportedly replied “Never in my day Madam”.

In contrast some men she met were advocates and allies, helping open doors. For example, a few years later in 1870 it was a man, Dr. William Thomas Aikins, an Irish immigrant and president of the Toronto School of Medicine, who allowed Ms. Stowe and another woman, Jenny Kidd Trout, to attend medical school classes. For whatever reason Ms. Trout sat and passed the exams whilst Ms. Stowe did not. Thus, Jenny Trout became the first licensed female physician in Canada.

Why did Emily not sit the exams after taking the courses? According to the Canadian Dictionary of Biography the male professors’ and students’ behaviour “had so angered her that she would not sit the exams”. Perhaps she also had concerns about her background as a homeopath and having practiced medicine without a license!

The theme of resilience is strong in Dr. Stowe’s life. She continued her practice but once again met adversity. In 1879 she was charged with performing an abortion. At this point she seemed to have acquired the respect of many colleagues and the leadership of the medical community in Toronto (men) came to her defense, testifying to her skills.  She was vindicated. Out of this adversity came a surprising result in July, 1880: her acceptance with formal licensure by the College of Physicians and Surgeons. Once again, her advocate, Dr. Aikins, was among those who testified in her support.

In 1883 her daughter, Augusta Stowe-Gullen graduated from Medical school, continuing her legacy. Also, in 1883 the Toronto Women’s Suffrage Association, led by Dr. Stowe senior created the Ontario Medical College for Women.

Dr. Stowe was not simply a medical pioneer. She recognized the need to improve the life for all women, not just those who aspired to a career in Medicine. She became an ardent and effective feminist and advocate for woman’s rights.  In 1888, Dr. Stowe, after participating in an international suffragettes’ conference in Washington, D.C., brought the movement back to Canada, founding the Dominion Women’s Enfranchisement Association in 1889.

The messages that I take from the life of Dr. Stowe include:

  • Ambition accompanied by resilience is often able to overcome staggering odds.
  • Even the most resilient and ambitious person needs allies, and in the case of WIM some allies will likely be male.
  • Activism is required to advance causes and this involves personal engagement and sacrifice.
  • Medicine is just part of the broader play of life and for females to be accepted as physicians society must embrace feminism and address the related issue of equity.
  • If you want to effect social change surround yourself with like-minded colleagues (e.g. a WIM program), whether that cause is obtaining the vote for women, securing access to admission of women to medical school or equity in the modern work place.

So how is society doing with the issues of feminism and women in Medicine?  Certainly, better than in 1867!  However, inequities and bias persist. Since women vote, constitute the majority of the medical school class, are often leaders in academic health science centres and have (to variable extents) access to childcare and maternity leave, do we even need WIM programs? We took on this sensitive subject in the 2017 Travill Debate in which the proposition was “Be it resolved that a Women in Medicine Program is Not Needed in 2017”.

This debate series, like its namesake (Dr. Tony Travill), is provocative and candid. As one can imagine the Pro, assigned to Dr. Romy Nitsch and medical student Roya Abdmoulaie, argued WIM programs was tokenism – we don’t need special treatment. We are already equal! The Con, assigned to Dr. Joneja and medical student Daniel Huang, argued that women are still misidentified as nurses or support staff, treated with less respect than their junior male physician colleagues and on occasion subject to sexual harassment.

So how is our WIM program structured and what are its goals? The WIM program began with meetings attended solely by female faculty. The theme of meetings is simple: women supporting women in medicine.

The goals of our Women in Medicine program are to:

  • Promote the advancement and success of women in academic and leadership positions
  • Create a community of women in medicine to provide support and mentorship for one another
  • Provide a forum for the expression of appreciation of the women in the DOM who have made significant contributions
  • Achieve 50% female faculty in next 5 years
  • Achieve 50% female faculty in DOM Leadership positions in the next 7 years

WIM holds quarterly meetings and has an accredited journal club. Meetings are funded by the DOM’s professional development fund. There are 9 members of the WIM Planning Committee and meeting attendance averages ~21 members (~43% of the DOM’s female cadre). One can get a feel for the meetings by reviewing some of the Guest Presenters and Topics.

Click image above to view a video about the Women in Medicine Committee at the Department of Medicine

1st Annual Event:

  • Dr. Elizabeth Eisenhauer, Head of Oncology, Queen’s University – The first woman in Medicine’s perspective on leadership and career growth
  • Ms. Jennifer Valberg, Senior Communications Officer, Queen’s University– How networking at Queen’s and building a community can help Women in Medicine thrive.
  • Dr. Robyn Houlden, Chair of Endocrinology – The History of Women in Medicine at the DOM – a timeline
  • Dr. Jacalyn Duffin –Hannah Professor of the History of Medicine- History of the first female surgeon Dr. James Barry – Born Margaret Ann Bulkley)

2nd Annual Event:

  • Dr. Sue Moffat, Associate Professor of Medicine, Respirology –Lesson’s learned as one of the first Women in Medicine in the Department of Medicine.

While I have not attended the meetings so far, they are well received. Each annual event has seen approximately 25 female faculty members in attendance. Feedback on these events has yielded a 100% satisfactory rating from attendees. The WIM have indicated that they plan to make changes in their medical practice including, but not limited to:

  • An improved focus on work-life balance
  • A renewed approach to professionalism in medicine
  • Increased utilization and provision of mentorship for other women in medicine
  • Improved focus on creation of a network of supportive colleagues in which to rely on

We have made progress toward the goals of the WIM program. For example, all our search committees are reminded to consider equity in the search process. The Department of Medicine is committed to employment equity and diversity in the workplace and welcomes applications from women, visible minorities, indigenous people, persons with disabilities and persons of any sexual orientation or gender identity. Moreover, the hiring committee membership is broad, diverse, and extends beyond the division in which the new position resides. Quite importantly half of our leaders, Division Chairs, are female.

The following table shows how the Department of Medicine is faring in our march toward gender equity:

An example of the #whatadoctorlookslike campaign on leadership roles for women in medicine.

The Department of Medicine has recently launched a Twitter and Instagram campaign (@queensudom) for female faculty members using the #whatadoctorlookslike hashtag.  You can follow that hashtag to find out more about the leadership roles of women in the Department of Medicine.

 

So how are we doing nationally with the goal of having the number of women in Medicine reflect broader society? As of Jan 2018, the Canada Physician Data Centre reported Canada has 84,260 physicians (that is 2.30 physicians per 1,000 population). Women account for 42% of all physicians. However, the inclusion of women varies widely by the type of physician, being lower in specialty disciplines (true for of all types of specialties) than in general practice (37.8% female versus 45.9%) and lowest in surgical specialties (~29%). https://www.cma.ca/En/Pages/canadian-physician-statistics.aspx

https://www.cma.ca/Assets/assets-library/document/en/advocacy/06-spec-sex.pdf 

As past president of CAPM, the Professors of Medicine of Canada (the leaders of our Academic Department of Medicine) I can attest there is diversity in terms of the progress toward equity of the genders in our academic Departments of Medicine across the country. I performed a brief survey of our 13 Academic DOMs and received several responses listed below in graph format:

The above graph shows the percentage distribution of Female Faculty based on their role description as of March 2017 from participating Universities. As you can see, University one has 37% full time faculty an 36% part time faculty that were identified in the survey.

The above chart shows the allocation of female faculty members in leadership roles in Department, Faculty and Hospital levels.  As you can see, University 1 has 21% of female faculty members in Departmental Leadership positions but no faculty members in hospital or faculty level leadership positions.

 

The above graphs show a comparison between male and female faculty regarding associate and assistant faculty promotion within the first 7 years.  You will see that associate faculty promotion in University 1 saw a rate of 62% male faculty promotion while females saw 46%.  Data set for two entries were suppressed due to incorrect entry of data.

 

In the above graph you will see that 50% of faculties provide on-site daycare to their members.

 

In this graph you can see the distribution of female faculty members throughout divisions. For allergy, University number 5 (Orange) has 100% female faculty in that specialty.

Additionally, the survey revealed the rationale for declining leadership roles for female faculty across universities:

  • Family commitments
  • Work-life balance
  • Uncertainty of being successful in the role

 

In conclusion: In the era of Me Too we still need WIM programs. There are many issues we have yet to resolve such as:

  • How to provide 24-7 on-site daycare
  • How to support job sharing
  • How to deal with equity associated with providing flexible hours
  • How to cover maternity and parental leaves and more

We need safe spaces to have these conversations in a respectful manner. WIM programs constitute one such safe space. Indeed, I believe because conversations have become more “high stakes” in the current environment, we need WIM programs more now than pre-Me Too. WIM programs provide a forum for female physicians to shape policy, provide mentorship, and support one another, a collegium in which diverse opinions can be shared and pathways forward illuminated. As a Department Head, our WIM program provides me with advice on proposed policies, gaps and inequities informing my decisions with a perspective that I may lack. Rather than being confrontational I find having a vibrant WIM program empowers women, informs men and projects a sense of fairness that makes the DOM a better place to practice.


Thank you to Dr. Mala Joneja and my colleagues in CAPM for their contributions to this blog post.


Resources: 


Link to original post: http://deptmed.queensu.ca/blog/?p=1783


 

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Of Robots, Worms and Youthful Inspiration

The Day the Earth Stood Still is a science fiction movie released in 1951. Filmed entirely in black and white, it is based on a 1940 short story by Harry Bates entitled Farewell to the Master. The story involves an alien visitor to earth named Klaatu, portrayed by Michael Rennie. The real star of the show is an eight-foot tall, death-ray-emitting robot named Gort who accompanies Klaatu. As one might imagine, mayhem ensues.

I was recently surprised to learn that it’s possible to connect that motion picture with the sophisticated systems that are rapidly developing and being used in robotically assisted surgery. As someone who grew up being told reading and viewing science fiction was a waste of time, this was of some interest to me.

That connection begins with one Victor Scheinman.

Mr. Scheinman, who grew up in New York City, recalls being terrified of Gort after seeing The Day the Earth Stood Still for the first time at the age of 9. He hid in his bed, unable to sleep due to nightmares in which he would imagine the robot standing in his room. His father, a psychiatrist who practiced in Manhattan and taught at Columbia, advised him to build a model of the robot as a means of dealing with his fears. In doing so, Mr. Scheinman began to develop mechanisms to animate the arms and legs of his models. This led to a variety of projects that were encouraged by his parents and teachers, and to a series of entries and prizes in various science fairs. He went on to earn admission to the Massachusetts Institute of Technology at the age of 16.

His work at MIT and then Stanford eventually led to development of “The Stanford Arm”.

Victor Scheinman with a hydraulic arm built in Stanford’s artificial intelligence lab Credit: Bruce Baumgart/Stanford University Archives

 

In her book, “The Robot: The Life Story of a Technology” (2007), Lisa Nocks, writes:

“In contrast to heavy, hydraulic, single-use machines, his Stanford Arm was lightweight, electric, mutliprogrammable, and could follow random trajectories instead of fixed ones. Scheinman showed that it was possible to build a machine that could be as versatile as it was autonomous.”

The technology was picked up and advanced by Joseph Engelberger and George Devol who formed Unimation in 1977, the world’s first robotics company which, with support from Scheinman and General Motors, developed the Programmable Universal Machine for Assembly (PUMA), the prototype of which now resides in the Smithsonian Institution. The PUMA was quickly introduced to the automotive industry revolutionizing the assembly line process. The 200 and 500 series PUMAs are of “desktop” size and therefore applicable to surgical applications. The first recorded applications were for assisting brain biopsies in 1985. In 2000, the daVinci surgery system became the first robotic system approved by the Food and Drug Administration. A key development that allowed for approval involved improved, high resolution and three-dimensional imaging that allows the operator to utilize the mechanical arms without laparoscopic guidance.

And so, much has developed from youthful imagination, creativity and energy, suitably nurtured and allowed to develop.

Recently, we’ve seen what might be the beginnings of another such example. Reports describe the very impressive accomplishments of four young people from Toronto. Beginning with an idea inspired by her grandfather’s illness, young Annabel Gravely decided to devote her eighth-grade science project to investigating causes of muscle deterioration in Amyotrophic Lateral Sclerosis (ALS). Hypothesizing a link with the muscle loss in ALS and that which is known to occur during prolonged periods in space, Gravely and her schoolmates (Alice Vlasov, Amy Freeman and Kay Wu) proposed to send a tube of microscopic worms (Caenorhabditis elegans, for those of you taking notes) into space aboard the International Space Station in order to examine the effect of zero gravity on the worms and particularly on the activity of a specific enzyme sphyingomyelinase (ASM) known to be linked to ALS.

 

 

(http://www.cbc.ca/news/canada/toronto/worms-space-science-students-1.4766124).

 

Dr. Jane Batt, a respirologist and scientist at St. Michael’s Hospital, learned of their interest and provided them space in her lab to carry out preparatory work, as well as connections with the space agency. All this resulted in a cannister of worms spending a ten-week sojourn aboard the space station, after which it was found they not only survived quite nicely in space, but were longer and larger than their earthbound control group, and expressed lower levels of ASM. Although the link between ASM and ALS associated muscle loss is not yet clear, the findings support further investigation, and were published last month:

Young Ms. Gravely (now 16 years old) and her colleagues have their first publication citation.

 

And so, we have two accounts of youthful inspiration, one arising in response to an imaginary threat, the other from the memory of a beloved grandparent. Both bring much credit to the young people involved and remind us that age need be no barrier to creative thinking and dedication to a goal. However, the significance of these success stories goes far beyond the young originators themselves.

Potentially groundbreaking ideas, like seeds cast into the air, must find fertile ground if they’re to flourish. Scheinman and Gravely were able to find such fertile ground in the support and encouragement of their families, schools and communities without which their brilliant insights might have never come to fruition.

Transformative innovation can be thought of as applied inspiration. The originating idea is necessary, but insufficient if not supported.

In the world of medical education, we encounter many potential Scheinmans and Gravelys, who experience their own moments of inspiration. Given the “busyness” and apparent urgency of our educational and clinical lives, it’s easy for them, and for us, to let those opportunities pass in favour of achieving more immediate short-term goals. From time to time, it serves to be reminded that great achievements can start from rather humble origins – such as scary science fiction movies and microscopic worms.

 

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