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Maintaining your sense of self in medical education: How to recover from a microaggression
By Dr. Mala Joneja
Medical education institutions and teaching hospitals are investing a large amount of resources these days in promoting equity, diversity and inclusion. Medical schools and teaching hospitals are trying to be inclusive workplaces. Yet medical students and residents who are women, or who are from BIPOC communities, are still routinely exposed to microaggressions.
A microaggression is defined as a “mundane and often unintentional prejudice conveyed during an interaction”.
With the prefix micro- in the name attached to this phenomenon, I should point out that the effect or consequence of personally dealing with a microaggression can be rather large.
In fact, a frequent question that I am asked by medical students is: what do I do if I’m if faced with a microaggression in the workplace?
As educators, we would hope that students would report it and that it would be addressed by the clinical preceptor. But what does the person on the receiving end of the microaggression do? What do they actually do to move forward?
I would like to share an experience with Queen’s medical students, that may provide some helpful guidance regarding how to recover from a microaggression.
As a physician in the Department of Medicine for 15 years, I have become accustomed to people knowing who I am. It took a while, but I have established myself. Etherington Hall is where I have my office (there is my name on the wall outside my door) and Etherington Auditorium is where every Thursday morning at 7:45am, I co-chair Medical Grand Rounds with Dr. Stephen Archer (Chair, Department of Medicine). One Thursday morning, I arrived early as I usually do to meet the speaker. On this particular Thursday (before the COVID pandemic), our department was hosting a visiting professor from Harvard. He walked in at the back of the auditorium and came down the steps with his briefcase. He saw me at the bottom of the stairs and straightaway asked me if I was there to set up the food.
I explained to him that I was there as one of the professors and co-chairs, and I was there to meet him. He proceeded to give his talk and went back to Boston. The fact that he assumed that I was there with the food, bothered me and made it difficult for me to concentrate on whatever his topic was for grand rounds.
Several months later, I found an article in Academic medicine with the title: “Mistaken Identity: Frequency and Effects of Gender-Based Professional Misidentification of Resident Physicians”
In this article the authors describe how common role misidentification is for women residents in medical education, and they describe the possible psychological and behavioral responses that can occur after this, but the article does not describe how to recover from this.
Although I didn’t take in much of our guest speaker’s lecture, I did recover by the end of the day. The incident had left me with this message: I do not, at first glance, look like an Associate Professor in the Department of Medicine. The fact is though, I did not, at first glance, look like an Associate Professor in the Department of Medicine, to this particular visiting speaker.
I actually had done nothing but my usual activity, showing up for work. In his mind, I looked like I was there to put out the food. His assumption, his error. I do believe, though, however gifted of a professor he may be, it should not be a huge stretch for him to entertain what is in fact a common narrative, the daughter of East Indian immigrants becoming a physician.
I recovered from this for a few reasons. First, I decided thatthe problem was not me, but the Harvard Professor who could not at first glance, think that I could be anything but the food person. This is the danger of having a fixed narrative in mind regarding who should be a professor. Or a doctor, or a surgeon. Or any profession.
By deciding that the problem was not me, I took back my power as Dr. Ivan Joseph would say.
Dr. Ivan Joseph,(https://www.drivanjoseph.com/) recently gave a keynote lecture at the Dean’s Action Table Forum on EDI and told the audience quite frankly: don’t give other people the power to change the way you look at yourself. As Dr. Joseph told us at the forum, I stopped giving the Harvard professor the power to assess who I was. (Note: this is not easy when you career trajectory is built upon impressing and demonstrating one’s worth).
Other things helped me recover. After rounds I talked with my department chair who told me toremember who I was (who I was really, meaning all my work and accomplishments and not what the visiting speaker assumed).
And what also help a lot was after rounds and dealing with the slight derailment that comes with microaggressions, I went to work. I found that as I worked through my charts, my patient calls, the negative feelings became smaller and smaller until they finally dissolved. I was back to myself and going ahead with the work that gives me purpose and meaning.
When the Internal Medicine residents and I discuss microaggressions, we say that they are not so ‘micro’ and the story I have told illustrates why we say that. But it is possible to recover and I hope this post helps any student or resident who may experience a microaggression (which can make one feel excluded from their own profession) recover and keep going.
Any students from Queen’s Undergraduate Medicine who would like to reach out after reading this for further discussion are welcome to email Dr. Joneja: email@example.com
Also consider checking out Ivan Joseph’s book You Got This: Mastering the Skill of Self-Confidence. (We’re not providing a link as to not promote any particular bookseller).
We Are Not Amused
Let’s be clear, I am no royalist. I find the concept of a hereditary monarchy unjustifiable, care nothing about who is where in the “line of succession” and find the media attention paid to every public appearance and utterance of members of royal family as they struggle with the “anguish” and “burdens” of their unearned privilege to be silly at best and offensive at worst.
But I like the Queen. In fact, I like her a lot. And it’s not just because she looks like my mother, although that doesn’t hurt. It’s not simply because she’s “the Queen”. It’s because she has been, in the admittedly perverse context of the life and times in which she has found herself, a rare and remarkable example of commitment to service who has, through her words and actions, attempted to understand the real needs of the people she is meant to serve, intervene as best she could, and consistently given expression to the very best aspects of the national character. In all this she provides an example for us all as we engage our stations in life particularly, I hasten to point out, those of us in the health professions.
She has been forced to do so as the epicentre of continuing storms of controversy caused not by her, but by the shenanigans of the innumerable members of her extended family and in-laws. Her words, over the near 70 years of her reign, have provided solace and support in times of need. She has provided what, by all accounts, has been very sensible and citizen-focused counsel to no fewer than 14 British Prime Ministers, (beginning with Winston Churchill!). She has refused to submit to demands for “reforms” that would compromise the standards she has set for herself and for the position she holds. She has persevered. At the age of 95 and reputably quite wealthy, she certainly doesn’t need the work and, I imagine, could do without the aggravation. Who among us would not have retired to our estates and Corgis decades ago?
She has, in the vernacular of our day, been “one class act” in the evolving soap opera that has become the modern monarchy, the future of which now appears to hinge on her great-grandchildren– two toddlers and an infant whose duties to date have not yet extended beyond being adorable (a duty in which, I must admit, they have excelled).
And she’s smart! This past week we had a great example of regal grace and wit. Informed that she’d been elected, by a magazine and editorial team that should know better, to receive an “Oldie of the Year” Award, she crafted the following response:
“Her Majesty believes you are as old as you feel and, as such the Queen does not believe she meets the relevant criteria to be able to accept and hopes you find a more worthy recipient.
With Her Majesty’s warmest best wishes.”
A measured, dignified slap-down for the ages. Take that, you ageist boors!
Among all the unearned privilege our modern world seems to be tolerating, it’s both refreshing and encouraging to find someone who not only appreciates their station but attempts to the best of their ability to rise to the responsibility that it provides, staying true to their values.
You go, girl!
Sorry. You go, Your Majesty.
Summing things up: wrapping up case-based learning sessions effectively
We often spend a lot of time planning our learning events, especially our case-based small group learning (SGL) sessions. We tailor our sessional learning objectives to the course objectives that have been assigned, selected solid preparatory materials, build great cases and craft meaningful questions for groups to work through.
This makes sense, as the small group learning (SGL) format used in Queen’s UGME program is modeled on Larry Michaelsen’s team-based learning (TBL) instructional strategy that uses the majority of in-class time for decision-based application assignments done in teams.
One comment we often read on course evaluation forms and hear directly from students, however, is that sometimes they walk away from an SGL session and still aren’t sure what’s important.
Much of the focus in the literature on TBL is on the doing – setting things up, building great cases, asking good questions to foster active learning. There’s not as much written about how to finish well.
Wrapping up your SGL session should be as much a planned part of your teaching as preparing the cases themselves. If you build the time into your teaching plan, you won’t feel like you’re shouting to learners’ backs as they exit the classroom, or cut off as the next instructor arrives. Nor will you find yourself promising to post the “answers” to the cases on Elentra. Sometimes it’s not the answers that are important, but the steps students take to get there.
Wallace, Walker, Braseby and Sweet remind us that the flipped classroom we use for SGL (preparation before class, application in class) is one “where students adopt the role of cognitive apprentice to practice thinking like an expert within the field by applying their knowledge and skills to increasingly challenging problems.” One such challenge is figuring out what the key take-away points are from an SGL session. With this in mind, it’s a good idea to plan your session summary, but then have students take the lead since “the expert’s presence is crucial to intervene at the appropriate times, to resolve misconceptions, or to lead the apprentices through the confusion when they get stuck.”
So, have your own summary slide ready – related to your session objectives – but keep it in reserve. In keeping with the active-learning focus of SGL, save the last 10 minutes or os of class to have the groups generate the key take-away points, share them, and fill in any gaps from your own list.
Here’s a suggested format:
- Prompt the groups to generate their own study list: “Now that we’ve worked through these three cases, what are the four key take away points you have about this type of presentation?”
- Give the groups 3-4 minutes to generate their own lists
- Have two groups share with each other
- To debrief the large group, do a round up of four or five groups each adding one item to a study list.
- Share your own list – and how it relates to the points the student raised. This is a time to fill in any gaps and clarify what level of application you’ll be using on assessments.
- If you’d like, preview an exam question (real or mock): “After these cases, and considering these take-away points, I expect that you could answer an exam question like this one.” This can make the level of application you’re expecting very concrete.
Why take the time to wrap up a session this way? Students often ask (in various ways) what the point is of a session. With clear objectives and good cases, they should also develop the skills to draw those connections themselves. This takes scaffolding from the instructor. As Maryellen Weimer, PhD, writes in Faculty Focus, “Weaning students from their dependence on teachers is a developmental process. Rather than making them do it all on their own, teachers can do some of the work, provide part of the answer, or start with one example and ask them for others. The balance of who’s doing the work gradually shifts, and that gives students a chance to figure out what the teacher is doing and why.”
If you would like assistance preparing any part of your SGL teaching, please get in touch. You can reach me at firstname.lastname@example.org
 Wallace, M. L., Walker, J. D., Braseby, A. M., & Sweet, M. S. (2014). “Now, what happens during class?” Using team-based learning to optimize the role of expertise within the flipped classroom. Journal on Excellence in College Teaching, 25(3&4), 253-273.
Tenth annual Medical Student Research Showcase October 13
By Drs. Andrea Winthrop & Melanie Walker
This year the School of Medicine is proud to invite you to the 10th annual Medical Student Research Showcase on Wednesday October 13, 2021.
The event this year will be a hybrid one, held both within the School of Medicine Building and virtually. Only those individuals who are presenting research (poster presentation or oral plenary), other medical students and faculty judges are permitted to attend the showcase in person. We welcome all additional Queen’s Health Sciences faculty, staff and students to attend the oral plenary session virtually (details below).
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 2021 will be presenting their work, as well as many other research initiatives. This year we had a record 98 poster submissions and students will be presenting their posters from 10:30 a.m. – 12:30 pm. The link to the 2021 Medical Student Research Showcase Abstract Book is on our Medical Student Research Showcase Community in Elentra at the following link https://elentra.healthsci.queensu.ca/community/researchshowcase:meeting_book__oral_plenary_link
The oral plenary features the top research projects selected by a panel of faculty judges and will run virtually from 12:30 p.m. – 1:20 p.m. Zoom Details can be found at the following link https://elentra.healthsci.queensu.ca/community/researchshowcase:meeting_book__oral_plenary_link (You must be logged in to Elentra to access this page).
This year’s faculty judges included:
- Dr. Sheela Abraham
- Dr. Susan Bartels
- Dr. Anne Ellis
- Dr. Laura Gaudet
- Dr. Doris Jabs
- Dr. Sonja Molin
- Dr. Lois Mulligan
- Dr. Nishardi Wijeratne
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.
Brian Laight – “Disruption of the non-Receptor Tyrosine Kinase Fes Enhances Cancer Immunotherapy” Laight, BJ; Hoskin, V; Alotaibi, F; Harper, D; Gao, Y; Greer, PA.*
Keshinisuthan Kirubalingam – “Opioid Prescriptions Following Otologic Surgery: A Population-Based Study” Kirubalingam, K.; Nguyen, P.; Klar, G.; Dion, J.M.; Campbell R.J.; *Beyea J.A.
Victoria McCann – “Exploring the impact of COVID-19 on substance use patterns and service access of street-involved individuals in Kingston, Ontario: A qualitative study” McCann, V.; Allen, R.; Purkey, E.*
Please set aside some time to review the abstract meeting book and attend the oral plenary via Zoom on October 13th. The students will appreciate your interest and support, and you will be amazed at what they have been able to achieve.
Honing skills for writing learning objectives
Many people – from award-winning educators to rookies and everyone in between – find writing learning objectives a challenge. The typical advice of write out who will do what under what conditions is vague, so it’s often not very helpful.
“General” learning objectives – from our UGME Competency Framework, aka the Red Book* – are already assigned to your course, and possibly to your session by your course director. (The Red Book’s 7th edition is forthcoming; the link will be updated automatically).
The key task for instructors is to take these general objectives and annotate them with specific objectives for their sessions, including what level of learning, such as comprehension, application or analysis. (This is from something called “Bloom’s Taxonomy”, if you’re interested in the research behind this).
A natural starting point is: What do you want your learners to take away from your session? (Or, if you’re creating an independent learning plan, as in the case of the new Scholar block in Clerkship: “ What do I want to accomplish in this block?”)
Frequently the response is:
- “I want them to know….” / “I want to know…”
- “I want them to understand….” / “I want to understand…”
- “I want them to be able to…” / “I want to be able to…”
Once you’ve wrestled something like this into sentences, I realize it’s disheartening to have someone like me come along and say, “Uh, no, that’s not up to scratch.”
What’s wrong with “know” and “understand”? Isn’t that exactly what we’d like learners to walk away with – knowledge, understanding, skills? Absolutely. The challenge with these so-called “bad objective verbs” is that we can’t measure them through assessment. How do we know they know?
That’s the starting point for writing a better learning objective. If you want to assess that learners know something, how will you assess that?
For example, while we can’t readily assess if a learner “understands” a concept, we can assess whether they can “define”, “describe”, “analyze”, or “summarize” material.
Here’s my “secret” that I use all the time to write learning objectives – I can’t memorize anything to save my life, so I rely on what I informally call my Verb Cheat Sheet. The one I’ve used for many years was published by Washington Hospital Centre, Office of Continuing Medical Education. It list cognitive domains (levels) and suggests verbs for each one. There are many such lists available on the Internet if you search “learning objectives” (here’s another one that’s more colourful than my basic chart, below).
Well-written learning objectives can help learners focus on what material they need to learn and what level of mastery is expected. Well-written objectives can assist instructors in creating assessment questions by reminding you of the skills you want students to demonstrate.
Here’s my quick three step method to annotating your assigned objectives on your Elentra Learning Event page with your learning-event specific objectives:
- Start with writing your know or understand statements: what do you want learners to know or understand after your session?
- Think about what level of understanding you want students to demonstrate and how you would measure that (scan the verb chart for ideas)
- Write a declarative sentence of your expectation of students’ abilities following your session. In your draft, start it off with “The learner will”. For example: The learner will identify the bones of the hand on a reference diagram. Your objective would be: “Identify the bones of the hand on a reference diagram.”
As a fourth step, feel free to email your draft objectives to me at email@example.com for review and assistance (if needed). I’m happy to help.
Table excerpted from Washington Hospital Center, Office of Continuing Medical Education’s “Behavioral Verbs for Writing Objectives in the Cognitive, Affective and Psychomotor Domains” (no date).
* The “Red Book” got its name because for the first edition (we’re now on the fourth), the card stock used for the cover was red. Over time, everyone started calling it the “Red Book”.
A version of this post was originally available in 2017… but writing learning objectives is an ongoing challenge for all!
Kingston and its Students: A Tempestuous but Enduring Symbiosis
With tongue firmly in cheek, a friend recently remarked that “Town-Gown” relations seem somewhat strained in our community these days. A remarkable example of impish understatement if one was ever uttered. Indeed, the usual energy and sense of renewal that accompanies the return of students each September has been muted if not completely submerged under layers of pandemic-related anxiety and efforts intended to mitigate them. The juxtaposition of such efforts with images of unrestrained street parties, fenced off beach areas and rising local COVID case counts has been, for many, rather jarring and unsettling.
Amid all this, I recently received a letter from a local physician that cut through that gloom like a glimmer of sunshine on a stormy day. Dr. Stephen Yates, a longstanding Family Physician in our community, wrote to Dr. Philpott and myself about his experiences working in vaccination clinics alongside volunteer medical students. In Dr. Yates own words (provided in part and abridged with his permission):
I am writing to you both after a very busy 6 months working as the Clinical Lead at several community covid19 Mass Immunization Clinics that have run from March to August this year. Those MIC’s put Kingston on the “Vaccine Map” of Canada as one the very highest vaccine rates in a Canadian community.
We could not have accomplished this extremely successful vaccine roll out without volunteers and the Queen’s Medical School Students stepped up to the plate and helped us out. When the medical school academic year ended numerous 1st and 2nd year students, with a few 3rd and 4th year, and even a few students entering the school this year, came forward to donate their time.
To try and name all the students who took part will leave many students out by mistake but suffice it to say…all the students were an absolute delight to get to know and to work with.
Whether organizing student volunteers, helping with vaccine draws, functioning as principal vaccinators, organizing recipient stand by lists for extra vaccines, calling literally hundreds of recipients in for shots, reviewing side effects or even managing vaccine hesitancy, your students were exemplary and were key to helping this community get through the pandemic.
The community of Kingston owes a great debt of gratitude to your medical students!
Very best regards,
Dr Stephen Yates, MD, CCFP, FCFP
Kingston and its student population. A raucous, tempestuous, never-fully-resolved, but also never-boring relationship. A marriage, it would seem, doomed to constant struggle, never to achieve either complete happiness or peaceful separation. To the cynical or those hopelessly frustrated by all this, the idiom “can’t live with them, can’t live without them” might seem appropriately applied, by either party. But, like any relationship experiencing difficulty, causes are deep, complex and worthy of some thoughtful reflection. Like many, I encountered our city initially as a student, have embraced it as adopted home, raised a family here, have seen numerous family members attend as students, and now live both sides of the “Town-Gown” dichotomy. And so, some observations, respectfully offered.
Firstly, it must be said, Kingston would not be Kingston without its students. This is not simply an economic or political reality. The student population brings energy, purpose and, on a regular cycle, youthful renewal to one of the oldest communities in our country. The city of Kingston, for many generations of students, has provided a supportive environment and wonderful example of community life. It has been an incubator of citizens who learn what it means to be part of and to care for their “home”. Its productivity or place in Canadian society will never be measured in terms of manufactured goods or agricultural productivity. Its true “product” are the young people whose lives are, in ways great and small, shaped by their lived experience among us.
For most students, their time in Kingston is their first experience living, to some extent at least, on their own. They are going through a very challenging phase of life during which most struggle with understanding and developing their own interests, strengths, values, and purpose in life. For most of them, the time they spend in Kingston will be the most transformational of their lives.
That transformation doesn’t occur entirely or even mostly in the classrooms of Queen’s, RMC or St. Lawrence College. It also happens in the streets, shops, restaurants, waterfront, trails, lakes, and rivers of our community. It happens through interactions with their fellow students and faculty they encounter to be sure, but also within the community in which they must function, independent of the influences and supports of home. Those encounters, as we’ve observed recently, can be ill-advised and troublesome. Judgement may be lacking, consequences may not be understood or ignored, actions may be impulsively taken, untempered by experience. This is not to say that actions should be free of consequences. In fact, it would be a disservice not to maintain standards based on the best interests of the greater community. But those responses should be directed at the actions not the individuals, motivated by a desire to correct not condemn, and tempered with the understanding that most of us will have no difficulty recalling similar lapses of judgement if challenged to cast the first stone.
Symbiosis is a biologic term that might have relevance here. It implies a mutually beneficial relationship between different people or groups. Hummingbirds, for example, have a symbiotic relationship with wildflowers. The birds are feeding on nectar provided by the flowers and gaining nourishment. Without that occasional noisy intervention, the flowers would not cross-pollinate and and would not flourish so beautifully.
It’s also helpful to be reminded that the vast majority of students integrate well and even contribute positively to our community. For a group of eager medical students, that contribution occurred recently in an immunization clinic.
Thank you, Dr. Yates, for the reminder. When it comes to students and Kingston, it’s not “them” and “us”. They are us.
What are those learning event types, anyway?
Tucked on the right-hand side of every Learning Event Page on Elentra are notations about the date & time and location of the class, followed by the length of the session and then the “Breakdown” of how the time will be spent. In other words: the learning event type.
After the last 18 months of learning event types being broadly divided into “Zoom” and “not-Zoom”, it’s worth having a look at what these notations (really) mean as we get back to more face-to-face on-campus teaching.
We use 18 learning event types* in the Queen’s UGME program. The identification of a learning event type indicates the type of teaching and learning experience to be expected at that session.
Broadly speaking, our learning event types can be divided into two categories: Content Delivery and Content Application.
For content delivery, students are presented with core knowledge and/or skills with specific direction and/or commentary from an expert teacher. Content delivery learning events include:
Independent Learning (DIL) — these are
independent learning sessions which are assigned curricular time. Typically,
students are expected to spend up to double the assigned time to complete the
tasks – i.e. some of the work may occur in “homework time”. DIL’s have a
specific structure and must include:
- Specific learning objectives
- A resource or set of resources chosen by the teacher
- Teacher guidance indicating the task or particular focus that is required of students. This may be a formal assignment, informal worksheet or study guide.
- The session must link to a subsequent content application session.
- Formative testing in the form of MCQ or reflective questions are an optional component of DILs
While students have nicknamed these “do it later”, it’s important that learners complete the assigned material prior to the related in-class sessions in order to be ready for what comes next. DILs aren’t an alternative delivery of material covered elsewhere, but essential curricular delivery.
- Lecture – Whole class session which is largely teacher-directed. We encourage the use of case illustrations during lectures, however these alone do not fulfil the criteria for content application or active learning.
- Demonstration – Session where a skill or technique is demonstrated to students.
For content application (sometimes described as “active learning”), students work in teams or individually to use and clarify previously-acquired knowledge, usually while working through case-based problems. These learning event types include:
- Small group learning (SGL): Students work in teams to solve case-base problems which are revealed progressively. Simultaneous reporting and facilitated inter-team discussion is a key component of this learning strategy which is modeled on Team-Based Learning. SGL cases may be preceded by in class readiness assessment testing (RAT) done individually and then as a team. This serves to debrief the preparation and provide for individual accountability for preparation.
- Facilitated small group learning (FSGL): Students work in teams and with a faculty tutor to solve case-base problems which are revealed progressively. While there is structure to FSGL cases, students are encouraged to seek out and share knowledge based on individual research.
- Simulation: Session where students participate in a simulated procedure or clinical encounter.
- Patient or Panel Presentation (PPP): Session where students interact with guest patients and/or health care providers who share their experience. Builds on prior learning and often includes interactive Q+A component.
- Laboratory: Hands-on or simulated exercises in which learners collect or use data to test and/or verify hypotheses or to address questions about principles and/or phenomena, such as Anatomy Labs.
The other learning event types we use don’t fit as neatly into the content delivery/content application algorithm. These include:
- Clerkship seminar – instruction provided to a learner or small group of learners by direct interaction with an instructor. Depending on design, clerkship seminars may be either content delivery or content application.
- Self-Directed Learning (SDL) is scheduled time set aside for students to take the initiative for their own learning. A minimum of eight hours per week (pro-rated in short weeks) is designated SDL time. (This is referred to as “Independent Learning” or “IL Time” in the UGME Policy Governing Curricular Time).
- Peer Teaching is learner-to-learner instruction for the mutual learning experience of both “teacher” and “learner” which includes active learning components. This includes sessions that require students to work together in small groups without a teaching, such as Being a Medical Student (BAMS) sessions, the Community Based Project and some Critical Enquiry sessions.
- Career Counseling sessions, which provide guidance, direction and support; these may be in groups or one-on-one.
Two other notations you’ll see are “Other-curricular” and “Other—non-curricular”. Other—curricular is used for sessions that are directly linked to a course but that are not included in calculations of instructional methods. This includes things like examinations, post-exam reviews, and orientation sessions. Other—non-curricular are sessions of an administrative nature that are not directly linked to a particular course and are outside of curricular time, for example, class town hall meetings and optional events or conferences.
Incorporating a variety of learning event types in each course is important to ensure a balance of knowledge acquisition and application. Course plans are set by course directors with their year director, in consultation with the course teachers and with support from the UG Education Team.
*In 2015, Queen’s UGME adopted the MedBiquitous learning event naming conventions to ease sharing of data amongst institutions. For this reason, some learning event type categories may be different from ones used here prior to 2015, or ones used at other, non-medical schools or medical schools which have not adopted these conventions.
Together again, in person and with gusto
The last in-person, full-class teaching session in the Queen’s School of Medicine took place over 18 months ago. Seems much longer. Since then, as is known to all reading this article, we’ve been providing our curriculum with a combination of virtual and appropriately regulated small group teaching events. These arrangements, contrived and cumbersome as they may appear, have allowed programming to continue and student learning to progress.
Just last week, we received very welcome news from the province and university that restrictions could be reduced to allow full class, in person sessions to proceed as of September 7th. Unfortunately, this didn’t arrive in time for our Orientation Week which was scheduled to begin August 30th. We had therefore planned and received approval from the university for a modified program which would be compliant with current requirements. The week kicked off with a welcoming event for all first, second and third year students (our fourth years being on clinical rotations and unable to attend) held in the main gymnasium of the ARC (Athletics and Recreation Centre). Our fully vaccinated, screened, disease-free, and masked students were welcomed back to the school year and to a “more normal” learning environment by faculty and student leadership. The significance and poignancy of assembling after such a long period of relative isolation cannot be overstated. To add to the celebration, music was provided by “Old Docs New Tricks” (ODNT), a group of SOM faculty physicians who not only entertained the crowd but demonstrated how busy practicing physicians can maintain personal interests while achieving great things in their professional lives.
Below is a small album of photos from the event, all by Lars Hagberg, go-to photographer extraordinaire and friend of the School of Medicine.
ODNT performing for the crowd
Many thanks to our Student Affairs group, capably led by Dr. Renee Fitzpatrick and supported by Erin Meyer and Hayley Morgenstern, who worked tirelessly and with great adaptability to make these arrangements.
We all recognize that the pandemic is far from resolved. We remain guided by continuing public health requirements. We recognize that further adaptations will likely be required in the weeks and months to come. We remain committed to providing the best possible educational experience for our students and learning environment for all involved.
But, for now, we’re just grateful to be in our classrooms and in person. We’re back!
Looking for a Few Good People
We’re incredibly fortunate at Queen’s to be blessed with a faculty that engages educational leadership with enthusiasm, creativity and dedication. When new positions emerge, or when people who have been key contributors come to the end of their terms, the program faces both challenges and opportunities. The challenge is obviously to fill the position and assist the incumbent. The opportunity, of course, is that it allows another faculty member to engage a new challenge, to influence medical education and advance their careers in new ways.
A number of such positions become available at the end of each academic year. I will describe some of these below and invite any interested faculty members to forward any inquiries or expressions of interest to myself or Dr. Michelle Gibson.
Chair, Student Assessment Committee
The Student Assessment Committee has a key role within an undergraduate medical program. It’s basically responsible for the oversight of all assessment practices in UGME, including setting policy & procedures. Peter McPherson has been very capably filling this role for the past few years. The Chair of SAC also works closely with course directors and other curricular leaders on the implementation of exams and other assessments. This includes reviewing the design and content, and assisting in the post-exam analysis process, supported by our Assessment and Evaluation Consultant (Eleni Katsoulas). They also work with our assessment team, headed by Amanda Consack. In addition, the chair of SAC sits on Curriculum Committee and has a key voice within that key group. SAC meetings take place quarterly, with additional duties for the chair throughout the year in terms of the day-to-day oversight of our assessment systems. Expertise and interest in assessment practices is required for this position, as well as the willingness to work with our very capable administrative team, our assessment consultant and numerous faculty colleagues who serve as Course Directors.
We are looking for three Competency Leads. These individuals are responsible for oversight of relevant learning objectives, by way of working with course directors and other curricular leaders to enhance the teaching and assessment of these roles in our curriculum. Competency leads often work together as there are natural links between many different of these roles.
The Communicator lead will review how we teach and assess communication objectives across our curriculum, to ensure our students are excellent communicators in many different settings. This includes looking at communication in different contexts such as with patients, families, health care professionals, colleagues, and the community.
This role has been held and developed by Heather Murray since it was developed as part of our curricular renewal several years ago. Heather has developed a robust and innovative set of curricular offerings that meet our program objectives that relate to critical appraisal, research methodology and life-long learning. The Scholar lead will review how we teach and assess all these components. This role also addresses students’ skills for self-assessment and ensures they have the skills to implement a plan to address their own personal learning needs throughout their careers. The scholar lead will also oversee and direct the annual Research Showcase.
The alliteratively named Leader Lead will review how we teach and assess different objectives designed to help our students develop their skills as leaders. This includes developing skills that will lead to effective management of the care of their patients, their practice, and themselves in the context of the Canadian health care system, community, and society in which they practice. This includes an understanding of the principles of patient safety, stewardship, and quality improvement systems. The competency also includes working with our well-established Student Affairs group in providing students with opportunities for career exploration to inform their career choice, and development of personal insight and behaviours that will promote wellness and self-management, leading them to healthy life-long and rewarding careers.
Clerkship OSCE lead
This faculty member would work with our established OSCE support team and clerkship course directors to design and implement an OSCE for clinical clerks, once a year. This is a new position, ideal for a faculty member interested in student assessment who would like to be more involved in UGME. The date of the clerkship OSCE for the 2021/2022 academic year will be in February 2022.
Course & Faculty Review Committee members
Three committee members are needed for this committee that reviews course evaluations to make recommendations to the curriculum committee. These positions are open to any faculty members who have familiarity with UGME. This committee meets quarterly, with additional need for electronic review between meetings.
All these positions will receive credit within our Workforce accountability system. For information or further discussion regarding any of these positions, please contact me directly at firstname.lastname@example.org or Michelle Gibson, Assistant Dean Curriculum at email@example.com.
They’re Going to be OK. A Thank-you to Our First Patients and Remarkable First Year Class
These days, more than ever, bits of good news are truly welcome. Like rays of sunshine breaking through the clouds on a gloomy day, they remind us that things are still basically right with the world and brighter days are ahead.
I had one of those experiences last week attending a wrap-up session for our First Patient Program. The FPP is a rather unique curricular offering at Queen’s supervised by Dr. Brenda Whitney and superbly organized by Ms. Kathy Bowes, an RN who has been working in various capacities in the undergraduate program for many years.
Patients are recruited from the Kingston community who have chronic medical problems requiring regular encounters with physicians and other health care providers. These patients generously agree to allow two of our first-year students to meet with them and their families, to get to know them personally and to follow them through the year. At the end of each year, a reception is held to thank them. Following are some pictures from the 2019 event.
The students are expected to learn about the illness experience through the eyes of the patient. They check in regularly and accompany patients to their various medical encounters. They are expected to gain insights not only about the specific condition afflicting the patient, but the impact of that condition on them and their family members, and of the practical challenges involved in the process of receiving care. For most of our first-year students, it is their first personal experience with chronic illness and its impact.
This year, the pandemic posed considerable logistic challenges. Dr. Whitney and Ms. Bowes were remarkably creative and adaptable in adjusting the program to allow the students to gain valuable experiences despite the limitations.
This past week a virtual wrap-up of the program was held, involving both students and their “first patients”. The highlight of the program, for me, was hearing from the students themselves about insights they had gained and taken away from their encounters. Here are a few samples, taken from the slide presentation prepared for the session.
What’s particularly remarkable is that all this was gleaned by a group of students whose introduction to the study and profession of medicine has been, to say the least, unconventional. Indeed, the pandemic and its myriad of imposed restrictions have drastically altered the educational experience for all our students. Although everyone involved has done everything possible to make the best of it, our students have not had opportunity to assemble as a class, work together or engage patient encounters as planned. They have accepted all this, by and large, with understanding and patience.
The first year class has been particularly affected because they’ve not yet had the opportunity to fully meet as a class or personally encounter many faculty members. Those of us responsible for their learning experience have had some apprehension and a few sleepless nights about the adequacy of what was being provided. Certainly, the course content and necessary knowledge was being imparted and learned. Assessments were satisfactorily completed. Skills that could be demonstrated and practiced were being mastered. But were they learning about what it is to engage patients? Were they learning to regard their patients as individuals with lives, hopes and families, to understand their suffering, to search for ways to help? Were they learning how necessary all this is to providing effective care?
Last week’s session made me realize that much has already been learned, including real-life lessons that could never have been imparted in a classroom or by reading scholarly works. They’ve learned that only by engaging real people with real problems can the full scope and value of medical care be truly realized. They’ve learned that our patients can be our best teachers.
And I learned that this group of students, despite all the accommodations that have been made to our curriculum, are going to be OK. They get it. They are on their way to becoming fine doctors.