Pivotal Court Battle Raging in British Columbia: Should preferential health care be available to those who can afford it?

A rather fierce and highly significant battle is raging in the courts of British Columbia. At stake is the future of private payer medical care in Canada. Many feel that what’s really at stake is the future of universal health care in Canada. Pragmatically, the issue boils down to whether decisions about when and how patients get care should be determined solely by need, or whether those with resources should be able to access alternative routes, and whether physicians should be allowed to provide those alternatives.

The Globe and Mail

At the centre of all this is Dr. Brian Day, an orthopedic surgeon and former president of the Canadian Medical Association, who is the Medical Director and Chief Executive Officer of the Cambie Surgery Centre in Vancouver, which opened in 1996 and has been offering and providing services to insured and privately paying patients. It has been doing so despite (in the case of the privately paying patients) being in violation of the B.C. Medicare Protection Act, which prohibits physicians from working in public and private systems at the same time or, more precisely, from charging patients for publicly covered services. It also prohibits the sale of private insurance for medically necessary hospital and physician care (insurance is permitted for care not covered by the public system). It seems that for the past 20+ years the government has either made only half-hearted attempts to enforce the law, or simply “looked the other way”.

It appears that current governments are much more committed to enforce the letter of the law, and Dr. Day has mounted a challenge based on the Charter of Rights and Freedoms. He and his lawyers argue that the Charter-provided right to pursue life, liberty and personal security extends to the right to pay for care when someone feels the public system doesn’t provide it to their satisfaction. They make it clear that they are not opposed to medicare or interested in dismantling it. They point to effective blended public/private provision in many countries, claim no evidence of harm and opine that it may actually benefit the public system by “off-loading” some patients. In their closing arguments (as reported in the Globe and Mail November 13, 2019) his lawyers claim:

“Allowing British Columbians to obtain private medically necessary services would not result in any harm to either the accessibility or viability of the public health-care system, as demonstrated by the experience over the past 20 years in British Columbia, when the prohibitions on access to diagnostic and surgical services were not enforced.”

“Further, the government cannot justify imposing severe mental and physician harm on some residents on the basis of an ideological commitment to perfect equality in access to treatment, which is neither created by the legislation in question nor obtained in practice.”

There is, as one might imagine, considerable opinion to the contrary. It comes from groups such as the BC Health Coalition, Canadian Doctors for Medicare, and many individual physicians and patients who have put forward rather strongly worded counter-arguments. They feel the presence of condoned private care in BC will set precedents for the rest of Canada and undermine the principle of universal care by siphoning physicians, nurses, therapists and technicians to potentially more lucrative opportunities in the private sector. In the case of physicians, they feel this is a betrayal of the publicly financed education they’ve been provided.

The case, which has been ongoing for several months, is now in the hands of BC Supreme Court Justice John Steeves who must decide whether the BC Medicare Protection Act indeed violates Canada’s Charter of Rights and Freedom.

This impending decision, indeed this very issue, is highly significant not only for those in the medical community, but for every Canadian. Medicare has taken on a special place in Canadian cultural identity. It has become a defining element of the national character, and a source of pride of all citizens. If there are any “sacred cows” in Canadian politics, Medicare would certainly be one. But its introduction and maintenance have been far from easy.

Chief among the challenges has been the division of federal and provincial responsibility and, therefore, funding. The British North America Act of 1867 establishes among the exclusive powers of provincial legislatures,

“the Establishment, Maintenance, and Management of Hospitals, Asylums, Charities and Eleemosynary Institutions in and for the Province, other than Marine Hospitals.”

The provision of so-called comprehensive Medicare began in a piecemeal fashion in the 1940s, but gained momentum in the 1960s, largely through the efforts of the then premier of Saskatchewan, Tommy Douglas. A key step along the way was the passage in Saskatchewan in 1961 of the Saskatchewan Medical Care Insurance Act which basically guaranteed health coverage to all citizens. That included physician fees, and so Section 18 of the act includes the following:

“No physician or other person who provides an insured service to a beneficiary shall demand or accept payment for that service.”

Thus, direct physician billing to patients was essentially outlawed. Mr. Douglas turned his attention to the federal scene as he became leader of the New Democratic Party and his efforts were instrumental in the passage of the Medical Care Act of 1966, which obligated the federal government to provide half the provincial and territorial costs for medical services provided for a doctor outside hospitals. By 1972, all the provinces and territories had some form of plan to reimburse for physician services. The Canada Health Act of 1984 states in its preamble the primary objective:

to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”

Like British Columbia, the provinces have developed legislation designed to ensure universal and funded provision of care. In Ontario the Health Care Accessibility Act of 1986 essentially outlawed billing of patients outside the provincial insurance plan, and has been subsequently reinforced by versions of the Commitment to Future of Medicare Act.

And so, what are the considerations that are likely going through Justice Steeves mind as he ponders this momentous decision?It seems obvious that government-supported medicare has the considerable advantage of ensuring a standard level of care to all patients regardless of their economic means, and of ensuring physicians are compensated.

  • It seems obvious that government-supported medicare has considerable advantage of ensuring a standard level of care to all patients regardless of their economic means, and of ensuring physicians are compensated for their services.
  • There seems little doubt that a decision in favour of privately funded clinics will give rise to many similar operations throughout the country, particularly in large urban centres.
  • The risk of an exodus of talent from the public to private system seems real.
  • There are, indeed, many examples from other countries supporting the concept that the two systems can co-exist. However, it would seem that’s only true if there is some provision for mandatory participation of physicians in the public system.
  • It’s becoming apparent that the ability to fully fund “universal” care solely through the public coffer is not sustainable. We’re seeing examples of this almost daily. Hospitals, despite best efforts, are going beyond budgets to provide care, and there are clearly insufficient options for the care of needy outpatients.   Not only is the population getting larger and older, but highly effective (and very costly) therapies have emerged and are continuing to emerge for the treatment of conditions that previously had no options other than palliation. Wait times are certainly lengthening, and “hallway medicine” becoming the norm.
  • There’s no question that for many procedures with very long wait times, such as hip and knee surgeries, the critical bottleneck is not the availability of qualified physicians, but rather access to hospitals and operating rooms which could, theoretically, be at least partially addressed by providing privately funded facilities.
  • What effect a private system would have on public system wait times is, we must honestly admit, unknown and can’t be reliably projected. It will depend, to a large extent how many private facilities emerge, what services are provided, and what constraints are put on the providers.  

A critical and rather sobering consideration in all this is that the success or failure of any blended private/public model may hinge on the willingness of physicians to continue to provide care to patients regardless of ability to pay. It will test and expose their motivations and priorities. It will test their allegiance to the principles the profession has always espoused, expressed in the words of the World Health Association Oath, and taken in by most medical students, including those at Queen’s:

“I will not permit considerations of religion, nationality, race, gender, politics, socioeconomic standing, or sexual orientation to intervene between my duty and my patient”

Those who so vehemently oppose privately funded care apparently believe physicians will abandon these principles in favour of personal income. I believe, and hope, that they’re wrong. Whatever the outcome of this court case, I choose to believe that physicians will continue to use their training and skills as they were intended, for the benefit of all.   

The issue of whether well-resourced citizens have a charter-assured right to more expeditious health care, and whether that privilege impinges on the rights of the less-well-resourced, seems beyond objective analysis and, in my view, is best left in the hands of a fair- minded and impartial judiciary. In the end, our system for deciding such dilemmas has been well thought out, and is worthy of our trust.

Godspeed, Justice Steeves.

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Multiple avenues to service-learning for UG students

As part of its commitment to promote social responsibility and accountability as core values of its graduates, the Queen’s UGME program works to facilitate, encourage, support and acknowledge students’ service-learning.

While there are multiple definitions of service-learning, the UGME program has defined service learning as a learning experience that combines community service with preparation and reflection.

The UG Curriculum Committee first made this commitment formally in 2014 and continues to uphold it.

Service-learning is a unique type of volunteer service in its approach, specifically with the structured preparation and reflection requirements. Ideally, preparation involves consultations with community-member stakeholders. Additionally, the UG encourages students to focus on longer-term community engagement such as a term- or year-long commitment to build community relationships.

The UG, under the auspices of the Teaching, Learning, and Integration Committee (TLIC) has developed several avenues to service-learning: group service-learning projects, individual projects and individual activities.

Each SL endeavor must include preparation (including consultations with stakeholders where appropriate), service, and reflection on the service and learning that occurred. The TLIC assigned a minimum range of hours required for service (set at 15-20 hours). The hours threshold was established to ensure sufficiently meaningful engagement while recognizing students’ key responsibilities remain their academic studies.

Upon application and review, the TLIC designates student group activities as service-learning options. Sometimes these are activities designed specifically with recognized service-learning in mind. In other cases, existing student interest groups have designed service-learning options that participants can use to extend a volunteer activity into full service-learning. Some examples of our current approved group service learning projects are SWAM (which provides swimming lessons to children with disabilities), Jr. Medics (first aid workshops for elementary and middle-school students), and Altitude (mentoring for university students interested in a career in healthcare).

Students may also bring forward proposals for individual service-learning projects, typically in cooperation with a community-based agency. These are considered on a case-by-case basis applying the same criteria as for established group projects.

Individuals also have the option to pursue what the TLIC has designated as volunteer-based service learning. This option recognizes that not all community agencies’ needs fit our predominantly-project-based service-learning model.

Such organizations have a streamlined volunteer service system and any project that could be proposed by our medical students could be redundant to the agency’s mandate. The TLIC recognizes that medical students can meet the intended service and learning outcomes from working within these existing, established structures. For agencies that are pre-approved by the UGME, students may complete recognized service learning by following a non-project path.

For this non-project (activity) path, the TLIC has students complete different required preparation (typically research on the cooperating agency and/or the community need that is being met). Examples of approved settings for this type of SL include working at Martha’s Table and Pathways to Education’s tutoring programs. Students can bring forward suggested agency programs for approval for this path.

For any of these SL avenues, students are expected to initiate contact with the organizations themselves, although from time-to-time, the TLIC may work directly with an agency to set up pilot service-learning projects (such as the previous Loving Spoonful project). When these opportunities are available, students are informed through the AS and Class Presidents’ emails.

For more information on recognized service-learning options, feel free to email me at theresa.suart@queensu.ca

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Our Aesculapian Society – Contributing to a Long Tradition of Collaboration and Service

The medical student society at Queen’s dates back to 1872 and is named in honor of Aesculepius, the mythological Greek figure considered the god of medicine. In fact, Aesculepius had five daughters each of whom represented some aspect of medicine considered essential to health. Hygieia was the goddess of cleanliness, Iaso the goddess of recuperation from illness, Aceso the goddess of the healing process, Aegle the goddess of good health and Panacea the goddess of remedies. The Greeks, it seems, knew something about social determinants of health and the value of personal wellness.

I’m very pleased to see that our current students are keeping the long tradition alive and contributing to the health of their fellow students and the learning community. The article that follows from our current and immediate past Aesculapian Society presidents (Danny Jomaa and Rae Woodhouse) describes their recent successful efforts to establish a fitness facility within the hospital. In doing do, they got great support from Mr. Chris Gillies and Mr. Adam Bondy of KGH.

Congratulations to Danny, Rae and all their AS colleagues. Aesculepius would be proud. I know we are.

Anthony Sanfilippo

Associate Dean

Undergraduate Medical Education

The Aesculapian Society is thrilled to announce the opening of a dedicated gym for medical students and residents in Kingston General Hospital (KGH). This project has been a year in the making and has been a collaborative effort between the Aesculapian Society, the Professional Association of Residents of Ontario (PARO), and the KGH administration. In early 2018, the Aesculapian Society set out to utilize a pool of funding to benefit current and future medical students. From student consultation, two projects were selected to be pursued further. The first was a revitalization of the kitchenette in the School of Medicine Building and the second was the creation of a gym in KGH. The latter was selected due to its focus on student wellbeing – a widely recognized priority at the School of Medicine. This idea stemmed from an Aesculapian Society Initiatives Grant proposal that was originally submitted in 2017 by Dr. Matthew McIntosh (MEDS 2018). The first step was finding a suitable space for the creation of this gym. In collaboration with Chris Gilles (KGH Director of Medical Affairs) and the Queen’s PARO Executive team, an under-utilized lounge in KGH was selected to be the new space for the medical student and resident gym. The timing could not be more serendipitous; the hospital’s insurance policy had recently approved the creation of a gym, which had been a long-time priority for physicians and residents alike. The newly completed gym, located on Connell 6, includes a range of cardio equipment, strength equipment, and fitness accessories.

The success of this project was possible because of the many individuals that contributed to each step of the gym’s creation. We would like to especially thank Chris Gillies and Adam Bondy (Project Coordinator) from KGH for championing the implementation and set-up of this project. We would also like to thank PARO for their generous provision of space and collaboration. Finally, this project would not have been realized without the dedication and enthusiasm of the Aesculapian Society Councils of 2018-2019 and 2019-2020. We would like to extend our gratitude to the students that supported this initiative by providing their input, ideas, and encouragement.

The Aesculapian Society recognizes that students have a variety of wellness needs and this gym primarily supports students’ physical wellness. We look forward to collaborating with student body and the UGME to expand upon, and create initiatives that support other aspects of student wellbeing. We look forward to seeing the lasting impact that this project will have on Queen’s medical students and residents for years to come. The Aesculapian Society encourages students and residents to provide feedback on how the gym can be improved to better serve our community’s needs.

Danny Jomaa, President

Rae Woodhouse, Past-President

Aesculapian Society 2019-2020

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Exceptional Healer Awards nominations now open

New award this year for allied health professionals

Nominations are now open for the fourth iteration of the Exceptional Healer Awards at Kingston Health Sciences Centre (KHSC). The deadline to submit nominations is Tuesday, December 31, 2019.

The award provides patients, families, staff and health care learners an excellent chance to celebrate health care professionals at KHSC who excel in providing patient- and family-centred care. Launched in 2017 recognizing outstanding physicians, the award was extended in 2019 to include a separate award to recognize nurses at KHSC. For this fourth iteration, a third category has been added for other allied health care professionals.

The award now honours doctors, nurses, and allied health professionals from KHSC’s two hostpial sites who are innovative in their approaches to patient care and who demonstrate exceptional bedside manner, which includes being approachable, empathetic, collaborative and respectful.

Patients, families, staff and health care learners can nominate a health care professional as long as he or she has provided care at the KHSC in the last two years. 

Here are the nomination details, as posted on the KHSC site:

If a health care professional at Kingston Health Sciences Centre (KHSC) has provided you with excellent patient- and family-centred care, now is your chance to nominate that person for an Exceptional Healer Award.

KHSC is encouraging patients to nominate doctors, nurses and allied health professionals (e.g., physiotherapists, occupational therapists, psychologists, social workers, dietitians) across our Hotel Dieu Hospital and Kingston General Hospital sites who are innovative in their approaches to patient care and who demonstrate an exceptional bedside manner, which includes being approachable, empathetic, collaborative and respectful.

Who can nominate? 
Patients and family members can nominate a KHSC health care professional who has provided care to them in the last two years.  KHSC staff can nominate colleagues on a patient care team.

Who is eligible?  
Physician nominees will have a current appointment at KHSC and will have been credentialed at KHSC for at least the past two years.  Other health care professional nominees must be KHSC staff members.

What are the criteria?  
The nominee creates an excellent patient care experience over and above the norm by exhibiting some or all of the following behaviours:

• Demonstrates compassion as a skillful clinician by displaying personal qualities such as approachability, flexibility and empathy.

• Uses novel or innovative methods in attempting to deliver compassionate care.

• Demonstrates a pattern of listening to and respecting patient and family perspectives and choices. 

• Exhibits a value of integrating patients and families into the clinical care model to ensure they are equal, informed participants in their health care.

• Honours the uniqueness of patients and families by incorporating their knowledge, values, beliefs and cultural backgrounds into the planning and delivery of care. 

What is required for the nomination?  
The nominator must complete a brief nomination form that includes yes-no questions and a short explanation of the candidate’s special qualifications for the award based on the criteria listed above.

Nomination forms are now available online. The deadline to submit nominations is Tuesday, December 31, 2019.

If you have questions about the award or nomination form, please contact the KHSC Leadership & Talent Development Department at 613-544-6666, ext. 8108.

Further details and nomination forms are available by clicking here. 

Exceptional Healer Award Past Winners

2017  

Dr. Richard Henry – Anesthesiology & Chronic Pain Clinic

            Dr. Tom Gonder – Ophthalmology & Retina Specialist

2018  

Dr. Shawna Johnston – Obstetrics & Gynaecology

2019  

Dr. Maria Velez, Obstetrics & Gynaecology

            Nurse Tracey Froess – Cancer Centre


This post was created with information supplied by Susan Bedell, including a KHSC blog post by Anne Rutherford

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An election no one won. Is it finally time for electoral reform?

We’ve recently come through a federal election where there appear to have been very few winners.

Certainly not the Liberal party, who saw their seats in the House reduced and must now attempt to govern with no majority and little support from the three prairie provinces.

Certainly not the Conservatives who failed to capitalize on what many saw as a golden opportunity to unseat the incumbent government.

Certainly not the NDP who saw their number of seats reduced drastically despite having a charismatic and articulate leader.

Certainly not the fledgling People’s Party of Canada, who won no seats, not even the one contested by their leader.

Probably not the Green party, although they did gain a seat outside British Columbia.

In fact, the only party that could be assessed as having emerged with a positive result is the Bloc Quebecois, whose main goal is to protect the interests of a single cultural group within a single province, even if it means breaking up the country.

Perhaps the most disappointing aspect of this election is the voter turnout or, perhaps more accurately stated, non-turnout. Fully 34% (that’s one in three!) of eligible Canadian voters decided to take a pass on this election. This is not exactly new. Voter turnout in the 43 Canadian federal elections that have been held since confederation has averaged 70.3%, ranging from highs of 79% in the early 1960s to a low of 58.8% in 2008. In that light, our current results might not seem too disappointing, if not that they appear to be part of a concerning downward trend which seemed to begin in the late 1980s.

And so, we must ask, what is it that keeps folks from exercising their right to influence our country’s government in the only way that will be available to most of them? It’s certainly not any lack of significant contemporary issues or a sense of satisfaction with the conduct of our current government. It’s certainly not that voting isn’t as easy as possible, including widespread availability of advanced polls. So what is it?

That very question was the subject of a 1989 Royal Commission on Electoral Reform. The authors identified a number of factors that prevent people from voting. Many are very practical, logistic issues such as illness, being away from home at the time, or just being too busy. However, a leading cause that emerged was simply labeled simply as “wasn’t interested”.  A leading author of the document, Jon H. Pammett, described what he termed “administrative disenfranchisement”, meaning that the procedures involved in the voting process inhibit participation.

The results of the recent election highlight another cause of voter discontent that has been the focus of increasing attention and political lobbying over the past few years. Our parliamentary, party-based system combined with the marked variations in population density that exist in our country gives rise to a disturbing disconnect between the popular vote and final outcome.

For example, the Liberal party’s 33.1% of the popular vote translated into 46.4% (157) of the seats in the House of Commons. The Conservative party, which actually received a higher percentage of the popular vote (34.4%), won 26 fewer seats (121 or 35.8% of the available seats). The NDP’s 15.9% of the vote, in a proportional sense, should have earned them 54 seats, but they’ll go into the next parliament with only 24 seats, whereas the Bloc Quebecois’ 7.7% of the vote yielded 32 seats in voter rich Quebec. Perhaps the most egregious injustice relates to the Green Party. In an evenly distributed system their 6.5% share would translate into 22 seats, rather than the 3 seats they won. Even the fledgling People’s Party, which won no seats at all, can cry foul given that their 1.6% of the voting share would proportionately correspond to 5 seats.

Regardless of your political affiliation or preferences, it’s easy to understand why so many people are finding this disturbing, and why voters, particularly those is less populated parts of the country, are left feeling frustrated, discouraged and the sense that their individual votes are devalued or even meaningless. Adding to all this electoral confusion is the persisting problem that, in a parliamentary system, the voters don’t directly elect the highest political office in the country. This brings, with every election, the perennial and vexing conundrum of whether to vote for the local candidate on the basis of their personal capabilities, or the party they represent. In a democratic society, should voters be forced to make that choice? Might that be contributing to their frustration and apathy?

Changing such a deeply established process will, of course, not be easy. It would require determined action from the very politicians who have benefited from the status quo. Nonetheless, it seems that the time has come for at least an open debate on the issue. Those with the courage to take this on might be worth voting for!

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Students enthusiastically endorsed Dr. James Makokis as inaugural M. Nancy Tatham & Donna Henderson Lecturer

Public Lecture on Decolonizing Medicine is October 23 at 5 p.m.

Creating an inclusive space for transgender and Two-spirit people in medicine will be the focus of the inaugural Dr. M. Nancy Tatham & Donna Henderson Lectureship October 23 at the Queen’s School of Medicine Britton Smith Lecture Theatre (Room 132 at 15 Arch Street), at 5 p.m.

Dr. James Makokis, a Two-spirit Cree Family physician (and recent winner of the Amazing Race Canada with his partner Anthony Johnson) is the first Dr. M. Nancy Tatham & Donna Henderson Lecturer. The lectureship is organized by the School of Medicine’s Undergraduate Diversity Panel.

Dr. James Makokis

The students of the medical school class of 2022 who participate in the Diversity Panel enthusiastically put forward Dr. Makokis to be the first speaker for this lectureship. The students felt that inviting Dr. Makokis to speak would promote important conversations about equity, diversity and inclusion in medicine. They see this as an opportunity to learn from the experience and work of Dr. Makokis as it relates to indigenous and LGBTQ+ communities, intersectionality, and making medicine a safe space for all patients.

The students who are organizing and supporting this talk are doing so in order to promote safe, equitable care for all patient populations. It is known that diversity is an important factor in medicine, as different patient populations have different experiences and viewpoints. The goal of providing excellent compassionate care for all in medicine, can be hindered by biases and lack of awareness, and events such as this increase awareness and bring to light our biases.

The diversity panel and the generous donors promoting this event see this as a chance for students, faculty, and members of the community to come together and learn, to take a step toward making the practice of medicine more inclusive. Dr. Mala Joneja, Director of Diversity and Equity for the School of Medicine invites everyone to attend and be a part of this step forward. She invites everyone, students and faculty in the Faculty of Health Sciences to come and simply listen and understand. Events such as these are important for members of marginalized groups but also for those who wish to be allies. An ally is someone who, though not a member of an underrepresented group, takes action to support that group. She emphasized that all physicians can be allies to underrepresented and marginalized communities and attending the upcoming lecture is a great first step towards allyship.

Dr. Makokis holds a Bachelor of Science in Nutrition and Food Sciences, a Master of Health Science in Community Nutrition and a Doctorate in Medicine. He also received certification from the Aboriginal Family Medicine Training Program. He is a leader and well-known expert within the Indigenous, LGBTQ2 and medical community.

Dr. Makokis has maintained his cultural beliefs and spiritual practices in all areas of his life. His strong connections to preventative health, spirituality, and Two-spirit perspective has helped him save lives within the LGBTQ2 and First Nation communities. He also leads one of North America’s most progressive and successful transgender focused medical practices. 

Donna Henderson and M. Nancy Tatham

The Dr. M. Nancy Tatham  & Donna Henderson Lectureship was established in 2018 through a donation from Dr. Tatham and Ms. Henderson to support bringing speakers to campus on issues related to diversity and inclusion, specifically in areas related to LGBTQ+ topics, Indigenous issues, and other areas of diversity relevant to the practice of medicine. Although the primary intended audience is medical students, everyone is very welcome to attend.

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Cervical Cancer Awareness Week: Fourth annual Pap Party event will take place October 21-24th

By Hayley Hill (Meds 2021), Zoe Hutchison (Meds 2021), Eva Bruketa (Meds 2022)

A unique partnership between Queen’s University Department of Obstetrics and Gynecology program and the South East Regional Cancer program out of the Cancer Centre of Southeastern Ontario (CCSEO) is helping to minimize barriers and ensure adequate access for all individuals with a cervix to receive cancer screening. Known as Pap Party, this collaboration offers free pap smear clinics across Southeastern Ontario for any individual with a cervix who may not have access to a primary care provider.

The most recent Cancer System Quality Index notes that only 63.6% of screen-eligible individuals in the South East region are up to date with their cervical cancer screening. As a result of the Pap Party campaign, in 2018 four clinic dates were held and 92 individuals received a pap smear. The highest number of individuals screened since the initiation of the Pap Party in 2015!

This year, the fourth annual Pap Party event will take place October 21-24th, during Cervical Cancer Awareness week. Any person with a cervix aged 21-70 who has not had a pap smear in the last three years is welcome. To increase accessibility to cervical cancer screening, individuals without primary care physicians, with or without a valid health card are encouraged to attend the Pap Party events.

The clinics are run by a team of medical students, and residents and physicians from the Obstetrics and Gynecology Department at HSCH 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 Bancroft, Napanee, and Tyendinaga as well. 

The 2019 Pap Party schedule is below:

  • Monday October 21 5:30pm – 7:30pm: HPEPH Bancroft
  • Tuesday October 22 5:30pm – 7:30pm: Community Well Being Centre, Tyendinaga, Mohawk Territory
  • Wednesday October 23 5:30pm – 7:30pm: Kingston Health Sciences Centre, (KGH site) Kingston
  • Thursday October 24 5:30pm – 7:30pm: Kingston Community Health Center, Napanee

Anyone interested in attending a Pap Party is encouraged to book an appointment by contacting Rachel at 1.800.567.5722 extension 7809 or CancerCareSE@KingstonHSC.ca

To further expand Pap Party and combat declining cervical cancer screening rates, we have also reached out to 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 any individuals you feel may benefit from this initiative in your life! We would be grateful and thrilled!

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Disorientation can be the first step to learning

Have your ever found yourself in a new course or job and wondered how the heck you got yourself into this terrible situation? It could be something you strived for actively for years and sought out for yourself. (Yes, I know that describes many medical students, but also people in new jobs, and students in other graduate programs like the one I’m in at the Faculty of Education).

Often, in a new situation – even one we’ve chosen – we can feel less competent than we did in our previous circumstances, and scramble around to figure out why something we wanted has turned out so poorly right off the bat. Generally, adult learners are used to feeling competent in their lives, work, and previous educational endeavors. New situations can rob (or mask) that previously-developed competence.

Using Taylor’s Model of the Learning Cycle can help with these feelings and ensure you stay focused on moving ahead, rather than getting stuck in the “I’ve made a terrible mistake” self-talk.

First articulated by Marilyn Taylor in 1979, then refined in 1987, this cycle explores learning from the learner’s perspective.

Taylor described the learning cycle as one of Disorientation, followed by Exploration, then Reorientation, culminating in Equilibrium – then, for lifelong learners, a new period of Disorientation as the cycle begins again. Within each of these four stages are other predictable and/or possible stages, opportunities and solutions.

Although Taylor focused on inquiry-based learning, I’ve found the model can apply to any new learning situation for adults including, as mentioned above, starting a new job or new professional role.

Here’s Taylor’s Model of the Learning Cycle in a nutshell, based on a chapter from Dorothy MacKeracher’s Making Sense of Adult Learning (2004) (Disclosure of potential for bias: I was introduced to this model by Dr. MacKeracher during my BEd studies and she was later my supervisor for my master’s degree).

Disorientation

The model begins with the learner entering a new situation, often described as a “disconfirming event or destabilizing experience” which highlights a “major discrepancy between expectations and reality”. The change can be starting a new course or program, starting a new job, new technology being introduced at work, or a change of circumstances related to aging or health.

The disorientation comes about when the new situation isn’t routine. The learner no longer feels competent or capable, which can result in a crisis in self-confidence. (The questions of “why did I sign up for this?” or “who thought I’d be good here?” are common in this phase.)

When a learner experiences confusion, anxiety and rising tension, the learner frequently withdraws from others because of feelings of inadequacy.

As MacKeracher notes: “in formal learning programs, the person most frequently blamed is the facilitator” for things such as not providing enough direction or clear instructions, or “not being helpful”.

Some people get stuck in this phase and focus on immediate – but misguided – solutions. For example, assuming the problem is lack of control, so trying to be more organized, but not really moving forward. (I’ve called this my “rearrange the chairs on the Titanic” mode. It’s not a productive place).

Exploration

The exploration phase begins when the learner “can name the central issue and make contact with others,” MacKeracher explains. “The individual becomes engaged in searching for information or ideas that could assist in resolving the identified problem.” The key here is to look for information or ideas that will make things better, not a superficial quick fix. This could involve exploring new study habits, identifying training gaps and solutions, or considering new points of view or attitudes (depending on the learning situation).

Towards the end of the exploration phase, the learner may withdraw from others somewhat to think things over, but this is not the avoidance of the disorientation phase, rather a time for thoughtful reflection and planning to make a transition.

Reorientation

The transition to the reorientation phase is characterized by “integrat[ing] ideas and experience to provide a new understanding of the issue [or circumstance]” that caused the disorientation in the first place. “The learner consciously acknowledges that learning is a process in which he or she is the agent.”

Equilibrium

As implied by its name, this phase is far more settled than the previous three, or, as MacKeracher writes: “this phase involves a much reduced emotional intensity.” Learners may consolidate, refine, and apply their new perspective and skills and share them with others in different context “or tested out as new behaviour in new settings.”

(And then back to disorientation…)

Sometimes people move through these phases instinctively, but if you’re feeling stuck – disorientated – working through Taylor’s Learning Model consciously can be helpful. Sometimes, it’s just reassuring to know “this is a phase” and you’ll come out the other side stronger, resilient, and competent in your new circumstances.

This is, admittedly, a simplified overview of Taylor’s Learning Cycle Model. Feel free to drop by my office for further discussion or to borrow my copy of MacKeracher’s Making Sense of Adult Learning.

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Celebrating teaching and learning

This week the School of Medicine joins the other schools in the Faculty of Health Science for a Teaching & Learning Celebration featuring guest speaker Dr. Nicole Harder.

Nicole Harder, RN, PhD, CHSE, CCSNE

Dr. Harder, Assistant Professor, College of Nursing, and the Mindermar Professor in Human Simulation, Rady Faculty of Health Sciences at the University of Manitoba, will present the Susman Family Lecture on October 3 at 4 p.m. at the Britton Smith Lecture Theatre (Room 132) at the School of Medicine.

Dr. Harder’s position is an interdisciplinary one which includes simulation-based education and research for the Colleges of Dentistry, Medicine, Rehabilitation Sciences, Nursing, and Pharmacy. Her current work is creating, implementing, and studying the use of a psychologically safe debriefing framework following expected and unexpected patient death in simulation and clinical experiences with health care students and practitioners.

For the Susman Family Lecture on Thursday, Dr. Harder’s topic is “Safety for all: Interprofessional simulation and non-technical competency development. 

According to the Canadian Institute for Health Information, in Canada, medical errors contribute in upwards of 23,750 deaths per year, one million added days in hospital, and approximately $750 million in extra health spending.  While various strategies and technologies have been implemented to reduce these errors, they have demonstrated inconsistent improvements or even reductions in patient safety.  In contrast, simulation-based learning has demonstrated effectiveness in improving safety competencies.  In this presentation, Dr. Nicole Harder will discuss the role of interprofessional simulation in patient safety, and argue that a significant shift is needed to ensure that students and healthcare practitioners are afforded the opportunities to engage meaningfully in interprofessional simulation activities that will allow them to grow and develop the skills required for today’s healthcare practitioners. 

Following Dr. Harder’s presentation, teaching innovators from medicine, rehabilitation, and nursing will also share presentations:

School of Medicine –  Using Wikipedia as a platform for teaching EBM, presented by Dr. Heather Murray

School of Rehabilitation –  Innovation in Teaching a Research course to a Large Class with Diverse Backgrounds, presented by Dr. Setareh Ghahari and Dr. Mohammad Auais

School of Nursing -From competence to capability in the clinical setting, presented by  Ms. Jennie McNichols

Friday morning, Dr. Harder will lead Health Sciences Education Rounds ( 8 – 9 a.m.) in Room 104, Richardson Laboratories. Her Friday presentation will exploreUsing simulation as a pedagogy: Who’s who in the (sim) zoo?” Video-streaming is available at Providence Care Hospital: PCH D2.069 Videoconference Rm A. Anyone unable to attend Education Rounds at either Richard Labs or Providence Care Hospital may listen remotely by joining this ZOOM call at the appropriate time:  https://zoom.us/j/165499888

Simulation as a teaching and learning pedagogy is not new.  What is new is the availability of technology and the changing landscape of the education learning environment.  While the term active learning activities are frequently discussed among educators as a means to bring learning to life, there is nothing more active that a simulation based experience.   From students to faculty, to researchers and administrators, we all have different roles in developing and implementing simulation.  This session will discuss the various roles that we all have in developing and implementing simulation as an active learning strategy, and provide the audience with some suggestions on how to make the most of their time with students.


Registration for each event is appreciated but not required.

Thursday: Susman Family Lecture and FHS innovators: https://healthsci.queensu.ca/faculty-staff/cpd/programs/tlc2019

Friday: Health Science Education Rounds: https://healthsci.queensu.ca/faculty-staff/cpd/programs/hsernicoleharder

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Be a Mentor, Be Inspired by a Mentor

By Dr. Klodiana Kolomitro

Queen’s Faculty of Health Sciences’ educators already inspire each other on a daily basis.  The Office of Professional Development and Educational Scholarship (OPDES) is excited to launch a formal Faculty Mentorship Network to help nurture this culture of guiding and supporting colleagues.  

The Mentorship Network’s purpose is to serve as a reciprocal process for sharing experiences and fostering a trusting environment for career guidance and psychosocial support.  Engaged participation in the program will advance the educational development of both Mentees and Mentors.

What is the time commitment?  7 to 10 hours per year

Mentors will participate in an in-person pedagogical café in November, where the Director of Education Development will provide an overview of the program as well as share resources on effective mentorship.  Also in November, Mentees will participate in their first educational webinar with a focussed topic to help guide their Mentee-Mentor discussions.  Following the initial sessions, mentors and mentees are encouraged to schedule meetings on a monthly basis. Each Mentee-Mentor relationship should be driven by the Mentee and will vary based on the specific needs and strengths of the individuals. The program will wrap-up with a celebration dinner in May. We hope you will consider this opportunity to offer scholarly generosity and nurture collegial engagement.

How can you participate? APPLY online before September30:

https://queensu.qualtrics.com/jfe/form/SV_0ritqt5W5ZkDhwF

OPDES will do their best to match all interested applicants, but cannot guarantee that every Mentor and Mentee will be matched in this first cohort. 

For more information on the Faculty Mentorship Network: visit https://healthsci.queensu.ca/mentor or contact:

Klodiana Kolomitro, PhD

Director, Education Development

Office of Professional Development & Educational Scholarship

613-533-6000 x. 77899 | kk78@queensu.ca

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