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Failure to Thrive in Medical School Syndrome: Signs, Symptoms and Diagnostic Approach
“Failure to Thrive” is a term well-established in the world of clinical medicine. In the pediatric context, it refers to a child who is failing to achieve anticipated developmental milestones. In the adult world, it’s more informally used to describe someone who is simply not doing well in their current circumstances, be it in hospital or in their community setting. Examples would be an elderly patient at home who is slowly declining and losing ability for independent living, or a hospital in-patient who is not improving despite what seems to be appropriate treatment.
The concept, I’ve come to appreciate, can also be usefully applied in the context of medical education. Failure to Thrive in Medical School Syndrome (FTMSS), can be engaged as we would any clinical condition, with characteristic signs and symptoms.
There are six key cardinal signs or manifestations of FTMSS. These include:
- Poor academic performance.
- Absenteeism, or habitual lateness for scheduled events.
- Habitual failure to meet established deadlines for submission of academic reports or administrative requirements.
- Inter-personal conflicts with peers, administrative staff or faculty.
- Poor or unprofessional behaviour in the academic or clinical setting.
- Lack of attention to surroundings, or personal appearance.
Symptoms of the FTMSS sufferer might include lethargy, fragile confidence, diminished sense of self-worth, agitation, defensiveness, anxiety.
As with the approach to any medical syndrome, the objective is not simply to make a diagnosis, but to establish the underlying cause. Understanding the mechanism by which this syndrome develops is essential to helping the sufferer deal with the affliction, establishing appropriate treatment, and hopefully starting down the road to cure.
All the manifestations of FTMSS have the common feature of not being attributable to any intrinsic limitation on the part of the afflicted individual. Having come through the intensely competitive medical school admission process, it seems reasonable to assume that every medical student is fundamentally capable of performing academically, being on time, meeting deadlines, relating reasonably well to others, attending to their personal appearance and behaving professionally. Failure to do any of these things can therefore can reasonably be attributed to some external cause.
And so, what are the root causes of FTTMS? At this point, a disclaimer seems appropriate. In the absence of any tested and proven pathophysiological mechanism for the condition, I provide postulates based on many years of observation of afflicted individuals, perhaps as a basis for clinical management and hypotheses for future clinical trials. That being said, and in no particular order, here goes:
- Failure to adjust to medical education. The medical school curriculum, learning methods and, importantly, the use of assessment in medical school can vary considerably from many other undergraduate programs. Fundamentally, the goals of education are no longer strictly about the aspirations of the learner, but rather geared to preparation to meet the needs of future patients. This change in focus can be somewhat unsettling for some. Moreover, the curriculum can be intense and demanding. Educational methods include much small-group and collaborative activities, as well as required independent learning. Assessments can be frequent and geared not towards short term retention and determining comparisons with other learners, but in assessing individual achievement with respect to learning objectives. In medical school, students therefore find themselves confronted with a learning environment very different than that which they’ve experienced previously. They are also asked to established individual rather than comparative goals of achievement. All this adjustment can be difficult for the student who is accustomed to learning situations which are individual, easily self-controlled and targeted to parameters of external validation.
- Lack of motivation for a career in Medicine. For many students, the decision to engage the medical school application process begins at a very early age. The process can be all-consuming and require the applicant to forgo many opportunities and experiences usually undertaken in childhood and adolescence in order to undertake educational programs and volunteer activities that they, and perhaps their parents, feel relevant to their application. The decision to pursue a career in medicine can therefore prevent a young person from engaging valuable developmental experiences or from considering other interests and potential career options. Others may enter medical school with an incomplete understanding of a medical career. As they understand more clearly what doctors actually do and what is expected of them, they may begin to realize the career is not for them. Medical education and, more importantly, a career in medicine, are both rewarding and demanding. Both require deep commitment.
- Unresolved personal issues. Medical students, like all young people, experience a variety of personal stresses and adversities. There can be a reluctance to recognize or to admit to the full impact of such stresses and to seek help. There can be a concern that admitting that one is feeling challenged or overcome by such circumstances might be seen as signs of internal weakness or unsuitability for their chosen career. There can also be a tendency to defer feelings of loss, disappointment or grief. Over time such unresolved stresses can mount and express themselves in negative ways which may lead to the various manifestations of FTTMS.
- Medical students can become ill or simply run down. Many medical conditions can be gradual, subtle and insidious. Accumulated fatigue due to lack of attention to simple things like regular sleep habits, nutrition and fitness can gradually mount and imperceptibly affect performance. Not unlike practising physicians, medical students can have a remarkable ability to ignore features of illness and fatigue in themselves which they would very quickly recognize in others.
- Mental illness. Medical students, like all young people, could suffer from chronic mental illness or develop such conditions after entering medical school. These can be very difficult to recognize in oneself and there may be stigma associated with such conditions that inhibit affected individuals from recognizing their full significance or in seeking help.
The objective of any faculty advisor or mentor engaging the FTMSS sufferer, of course, is to help the afflicted student understand the problem and therefore engage effective therapies. The clinical approach for students exhibiting signs of FTTMS, ultimately, is not unlike that for other conditions that have behavioural manifestations. It begins with understanding and acceptance that the troublesome behaviour likely has an underlying precipitant that can be defined and therefore managed.
Diagnosis requires a thorough history focused on the potential causes listed above, and features that may help identify the underlying, culprit problem. Having identified a potential underlying mechanism, counseling is required to help the students themselves understand cause and effects. Together, management can be engaged.
What happens when none of the potential mechanisms seems to fit, and we come up with an idiopathic etiology? In my experience, this is very rare, but obviously troubling. Are we simply dealing with a poor “fit” for medicine? In such cases, we should provide compassionate support and oversight – what some clinical colleagues would term “watchful waiting”. Clarity usually emerges with time and, with it, the optimal approach becomes obvious to all.
And so, the process for assessing a medical education problem bears remarkable similarity to the process we teach and use for any clinical problem. Once again, there’s a striking parallel between patient care and medical education. Doctors instinctively engage their students as they do their patients. Without judgement, but rather thoughtful contemplation of how observed manifestations reveal underlying mechanistic causes, leading to understanding and, with it, effective intervention.
Latest Exceptional Healer winners announced
The latest Exceptional Healer: Patient and Family-Centred Award for the Kingston Health Sciences Centre were presented recently. The EH award competition, which is in its third year, now includes a separate award for nurses. The two selection were unequivocal in choosing Dr. Maria Velez, Obstetrics & Gynaecology, and nurse Tracey Froess in the Cancer Centre as exemplars in patient and family-centred care, Susan Bedell shares.
Of Valez, one patient wrote: “She made me feel human in a medical world.” Another added: “I’m so pleased that Dr. Velez works for a teaching hospital as new (and experienced) doctors have much to learn from her in terms of benevolent, flexible, and accessible patient-centred care.”
One patient wrote that Froess’ “passion and dedication to her patients shines brightly!” while another noted she “routinely empowers families to take ownership of their situation identifying what will work best for them and delivering it.”
Over the last three years, the following individuals have been awarded the Exceptional Healer Award:
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
Patients, family members, staff, and students learning at KHSC are encouraged to submit nominations each year.
Here is more about Dr. Maria Valez and Nurse Tracey Froess, from the original blog post from the KHSC site:
Masters in the art of listening
By Christine Maloney
Putting patients and families at the centre of their care has earned nurse Tracey Froess and Dr. Maria del Pilar Vélez Kingston Health Sciences Centre’s (KHSC) Exceptional Healer Awards.
Froess and Dr. Vélez were among 22 nurses and physicians nominated by patients, families and staff for the annual award. Originally created by the Patient & Family Advisory Council, it honours those who demonstrate the core concepts of patient- and family-centred care, dignity and respect, participation and collaboration.
For Dr. Vélez, an obstetrician and gynecologist focused on improving women’s reproductive health, her success goes beyond having knowledge, skills and dedication.
“I believe in showing compassion, and especially, to listening to patients and acknowledging the importance of their needs,” she says.
The patient who nominated Dr. Vélez felt supported and empowered throughout her care, writing in her nomination “She wanted to hear what I had to say first.” and “She went at my pace and in the directions and options I wanted to explore. I felt she understood what my values were and did everything she could to accommodate them.”
The winner in the nurse category this year, Tracey Froess works in one of KHSC’s cancer clinic. Her patient’s expressed their appreciation by saying “Tracey always took the time to listen to our concerns and we never felt rushed. We always felt respected and valued. She made the whole experience more comforting.”
“I learned from another esteemed colleague to really listen to your patients,” Froess wrote when asked about her secret to patient-care success. “This advice has always done me well in my career.”
Upon reflecting on what it means to receive an Exceptional Healer Award, both Froess and Dr. Vélez were quick to acknowledge those around them.
“It makes me realize that I have been lucky to work in the right place, with a great team, which has had a positive impact on my care of patients,” said Dr. Vélez.
Froess added, “KHSC is full of exceptional healers. I know… I’ve been fortunate to work along side them every day.”
Evaluating the Student Experience: Assessing satisfaction is important, but not enough
“Universities are centres of learning, not teaching”
These were the words, uttered many years ago, by a former professor and teacher in response to some very demurely and deferentially expressed comments about the quality of lectures being provided in a particular medical school course. The message, directed to me and a couple of my classmates, was pretty clear. The university and faculty would provide opportunities to learn, in whatever manner they felt appropriate. It was not for us, as mere students and consumers, to question the methods. The responsibility for our education was ours.
In fact, in recent discussions with a number of my medical school contemporaries who I’m fortunate to meet with regularly, none of us could recall, during our four years of medical school, ever being asked for feedback of any kind about our educational program. If such processes existed, either internal or external to the school, they were largely invisible to the students of that time. This was certainly not unique to our school. For our generation, medical education was very much a “take it or leave it” proposition.
This is not to say we didn’t get excellent teaching, role modelling and mentorship. We certainly did, and many of us found our inspiration for education in those early experiences. It’s also almost certainly true that many of the teachers of that time quietly observed and responded to the impact of their methods on their learners. However, the culture of the day simply did not provide methods by which the student experience could be collected and analyzed.
This rather parochial approach was not exclusive to medical education. Patients of the past were rarely, if ever, surveyed for feedback about the quality of care they received from institutions or individual physicians. Corporations and businesses largely allowed the public to “vote with their feet”. If the product wasn’t good, people wouldn’t buy it, or would simply walk away.
Clearly, things have changed.
In the business world “Consumer Satisfaction” is an industry in itself. Successful businesses aggressively seek out customer feedback because they have learned that responding to real or even perceived needs drives future spending. IBM has taken this a step further. They go beyond the need to ask questions and, instead, are building and offering services that track consumer behaviour and provide that information to service and product providers. To quote from their site:
In health care, knowledge of the patient experience is now considered essential to a well- run institution. Hospitals are expected, through accrediting processes, to actively seek out patient perspectives
The Agency for Healthcare Research and Quality operates within the U.S. Department of Health and Human Services. Its mission is “to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable”. To quote from their site:
“Understanding patient experience is a key step in moving toward patient-centered care. By looking at various aspects of patient experience, one can assess the extent to which patients are receiving care that is respectful of and responsive to individual patient preferences, needs and values. Evaluating patient experience along with other components such as effectiveness and safety of care is essential to providing a complete picture of health care quality.” (https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html)
They make an important distinction between patient satisfaction and the patient experience. Satisfaction is a subjective impression of a patient’s interaction with an institution or individual, and is largely based on whether their personal expectations were met. The patient experience relates to gathering information, available only through patient reporting, that is relevant to determining whether certain institutional goals are being achieved.
A person test driving a new automobile, for example, is able to report on both the driving experience (acceleration, braking, ease of handling, visibility etc…) and their personal satisfaction (enjoyment, comfort, excitement) driving the car. To those designing and building the car, evaluating the driving experience allows them to determine if the equipment and concepts they developed are working as expected. Evaluating driver satisfaction determines whether the consumer is getting what was expected from the car, which may be unclear to the designers. Both are relevant to success. Both are certainly relevant to the likelihood that the consumer will purchase the car.
In medical education, the value of student feedback is widely appreciated and schools go to considerable effort and expense to collect it. In fact, the systematic collection of feedback is mandated by accreditation standards, and the evidence required to establish compliance with those standards is based largely on student feedback. The distinction between measurements of the student experience and student satisfaction is relevant, both being important goals. Systematic Program Evaluation must encompass both.
At Queen’s, we recognize that many goals of our educational program can only be fully assessed with the perspective of those actually experiencing and living the process. We also recognize that a full picture only emerges if many points of feedback are provided. We have therefore put in place many and varied opportunities for students to provide both their personal perspectives and objective observations.
After each course, students are invited (and expected) to provide feedback that consists of responses to questions exploring pre-determined educational objectives, and provision for narrative commentary in which they can elaborate or explore other aspects. Those end-of-course evaluations also provide opportunity to provide similar feedback regarding the effectiveness of teaching faculty.
We receive and carefully review the results of course-related examinations undertaken by our students, not only to gauge their learning, but also the effectiveness of the teaching and learning opportunities provided.
We anticipate and review closely the results of external examinations undertaken by our students, such as the Medical Council of Canada Part 1 and 2 examinations, and all National Board of Medical Examiners tests we utilize. These provide valuable comparators to other institutions and, to a limited extent, further feedback about our teaching effectiveness.
The Canadian Graduation Questionnaire is completed annually by all graduating medical students and provides a comprehensive review of all aspects of their educational experience. We review it in great detail, and many aspects of the CGQ are incorporated into the accreditation process.
We have established a Program Evaluation Committee that, for the past few years has been under the leadership of Dr. John Drover. That group collects, collates and analyzes data from a variety of sources to provide an overarching analysis of our performance relative to our programmatic goals. The PEC recently released a comprehensive report, which has been passed along to the Curriculum Committee for analysis and action. I am very grateful to Dr. Drover who has generously and effectively provided PEC leadership. He is now passing that role along to Dr. Cherie Jones as she assumes her role as Assistant Dean, Academic Affairs and Programmatic Quality Assurance.
We have also developed a number of more informal ways by which students can provide feedback.
We meet regularly with student leadership and curricular leads to get “on the fly” feedback about courses as they are taught. This often causes us to undertake adjustments or provide supplemental content even before the course is completed.
We provide numerous ways in which students can report personal distress or incidences of mistreatment at any point during their medical school experience. These range from direct contact with selected faculty members, our external counselor (who can be contacted directly and is completely segregated from faculty or assessment) or submission of reports that can be embargoed until a mutually agreed to time. All these are outlined in our policies and accessible through convenient “Red Button” on MedTech.
I have found “Town Halls” to be very valuable sources of feedback on all aspects of the MD program. These are held at least once per term with each class and consist of a few “current events” items I provide, followed by “open mike” time when students are invited to bring forward any commentary or questions they may have, about any aspect of the program. The issues that emerge and dialogue among students in attendance can be highly revealing and have certainly provoked new directions and changes over the years.
Recognizing that not all students are comfortable with speaking out, or may not wish to be identified as they raise sensitive issues, a confidential portal was established on MedTech a number of years ago. Students are able to provide their commentary in a completely anonymous fashion if they wish. My commitment is to read and consider (but not necessarily act on) all commentary provided, and to respond personally if students choose to identify themselves. To date, I have received almost 500 such submissions, about 70% of which are provided anonymously. The commentary has been thoughtfully provided and has spanned all aspects of our program and learning environment. Importantly, it often brought to light issues that had not previously emerged in any other way.
In all these ways, student feedback has become a continuing, multi-faceted component of our school and, more broadly, our learning environment. It goes beyond being a mechanical, mandated exercise and data collection. It is embedded and cultural. It is what we do. It is who we are.
Med Students’ activities extend beyond the classroom
It’s that time of the new year when the winter doldrums can set it – weather and routine can weigh everyone down. Along with that, there’s that old cliché about “all work and no play”. There’s little risk of our medical students being thought of as anything approaching dull and they provide great ideas for how to beat the winter blahs. In addition to their full class and study load, they make time for a wide variety of extra-curricular activities for fun, recreation and community involvement.
Aesculapian Society President Rae Woodhouse recently shared some highlights of these endeavours:
In early January, 68 pre-clerks attended the annual MedGames in Montreal and placed 2nd of everyone outside of Quebec. Sponsored by the Canadian Federation of Medical Students (CFMS), MedGames brings together medical students from across the country for a friendly sports competition and network building.
Thirty-one second year students competed in BEWICS. This is the annual Queen’s Intramural sports competition which features a variety of self-proclaimed “quirky” sports such as water volleyball and rugby basketball. The QMed team placed third overall for competitiveness and spirit.
The Class of 2021 Class Project Committee hosted Queens’ first ever Scholars At Risk Talk (see more on this here).
Pre-clerk students recently competed in the Ottawa’s Winterlude Ice Dragon Boat competition and about 30 went on the annual ski trip to Mont-Tremblant two weekends ago.
And if ice dragon boating and skiing weren’t enough of a challenge, about 45 students from across the four years spent a couple of hours recently learning the basics of curling from a fourth year student. This is the fourth time for this event!
For Wellness month, the Wellness committee put together a month of activities with each week having a theme: social, physical, mental and nutritional wellness. During physical wellness week, 40 pre-clerks did a Crossfit class and 20 did a spin class taught by the AS Wellness Officer.
The 2nd annual Jacalyn Duffin Health and Humanities conference happened recently and was very well received.
This past weekend, 20 students went to NYC to learn about the history of medicine, led by Dr. Jenna Healey (Hannah History of Medicine Chair) and the What Happened In Medicine Historical Society.
And, over 100 mentorship group members attend trivia at the Grad Club. (Take note of that, it could be a future trivia question!)
Singing the praises of learning objectives
This past Sunday afternoon, I had the pleasure of attending the Kingston Symphony’s matinee performance of Gene Kelly: A Life in Music at the Grand Theatre. The show featured clips from Kelly’s most memorable performances, with live musical accompaniment by the symphony, under the direction of Evan Mitchell.
Throughout the show, Kelly’s wife and biographer, Patricia Ward Kelly, shared anecdotes and Kelly’s own insights into his choreography and performances.
She talked about the work he put into creating dances, painstakingly writing out the choreography plan, before working with his fellow performers to perfect the dances themselves. “He didn’t just show up and wiggle around on the stage,” she said.
My educational developer lens instantly compared this to the framework provided by well-written learning objectives. Objectives focus teaching and learning plans, and contribute to authentic assessment.
Yes, this is another blog about learning objectives.
In the abstract, learning objectives seem like just another box on a checklist or hoop to jump through. Used the way intended, however, they are signposts that guide learning and teaching plans effectively—whether for a class or a single person—the same way Kelly’s planning delivered award-winning and inspiring choreography.
Yes, there’s a “gold standard” for writing objectives (that I’ve written about previously here). And there are verbs to use—and ones to avoid—and if it doesn’t come naturally to you to think this way, it can be pretty tedious.
What it’s really about is planning: knowing what you’re setting out to do. If you have an objective—a goal—then you can make your plan and communicate it to others effectively.
Well-crafted objectives also make things great for assessment, because it’s very clear what you have to measure at the end of the lesson, course, or program.
If you say, “I’m going to get better at taking patient histories” – what does that mean? What does “better” look like? If it means, “I’m going to note down details, or I’m going to ask specific questions, or I’m going to listen more than I have been, or interrupt less… then you know what you need to work on. You know what the focus needs to be, whether you’re a learner or a teacher.
Eventually, you’ll be able to do a history without thinking things through so deliberately – once you’ve achieved fluidity in that skill. But before it’s a habit, you need to plan, your checklist, and I’m hitting all the boxes? Not just: “be better”.
For example, one of my plans in 2018 was to read more books that weren’t medical education and weren’t related to my PhD coursework. “Read more for fun.” That was it. My objective was pretty vague and, as a result, I didn’t create a workable plan. “Read more” didn’t get me very far. I read parts of eight non-work-related and non-course-related books. And three of those were cookbooks.
I set a more specific objective for 2019 that I would read more by spending five minutes every morning before I left for work reading something from my “recreational” “to be read” book stack (mountain).
I’ve finished two books, which is already a 200% improvement over last year. That specificity can make a difference.
And that’s really all objectives are: an outcome statement to focus your plan.
And that’s why we focus highlight objectives in our competency framework. It’s why we map things to them—learning events, assessments, EPAs—so we can be consistent and everybody knows what the plan is.
How much detail do you need in your objectives? This depends on how granularly you need to communicate your goals in order to be effective.
For his iconic Singin’ in the Rain, Gene Kelly had to map out the location of each of the puddles. His plan needed to be that detailed to get it right.
If you’re wrestling with learning objectives and how these relate to your teaching, give me a call.
Residency Match Day 2019: What our students are experiencing, and how to help them get through it
If life were a roller coaster, our fourth year students have, for the past few months, been on quite a wild ride, slowly rumbling upward, gradually ascending to the summit, stopping for a moment as they stare downward to a distant, small landing point, readying themselves for a rapid and rather scary descent.
The process by which learners transition from undergraduate to postgraduate medical education has evolved into a rather jarring and extremely stressful experience (don’t get me started – a subject for another blog/rant). It has required them to not simply consider what specialties are best suited to their interests and skills, but engage an application process that requires strategic selection of elective experiences, preparation of voluminous documents, meeting multiple deadlines (twelve, no less), and commitment of personal time and expense to travel and interviewing which, for many, spans the country in the midst of the Canadian winter.
This year, the roller coaster reaches its summit at 12:00 noon on February 26th. The much anticipated Residency “Match Day” is when all fourth year medical students in Canada learn which postgraduate program they will be entering. By approximately 12:00:05 that day, all students will know their fate. As you can imagine, there will be much anticipation and anxiety leading up to the release. For most (hopefully all), the roller coaster ride will end with the exhilaration and satisfaction of having successfully overcome the process. For a few (and hopefully none), it will bring a realization that their efforts to date have not been successful, that their ride is not yet over, and they have to begin again. They will be profoundly disappointed, they will be afraid, they will be confused. They will need the understanding and help of the faculty who are currently supervising their training, and much help from our Student Affairs staff.
This year, we are again prepared to provide all necessary supports, but there are a few changes to the process which I’d like to clarify for both students and the faculty that will be supervising them that day:
- Unlike previous years, our Undergraduate Office will not automatically receive match results the day before the full release. However, students have the option of directing CaRMS to release their results the day before (February 25th) if they fail to match. They can do so by going into the CaRMS website and providing the appropriate permission.
- Any unmatched students who have
allowed early release will be contacted directly by myself to notify them of
the result. This is for three purposes:
- to arrange for immediate release from clinical duties
- to allow the student some time to prepare for the release moment the following day when most of their classmates will be hearing positive results
- to arrange for the student to meet our student counselors who will provide personal support and begin the process for re-application through the second iteration of the residency match.
- Unmatched students who did not opt to provide early release will similarly be contacted and offered the same support and services after we get their results on match day.
- Because we may not have full information in advance, we have decided to release all students from clinical obligations beginning noon on match day, until the following morning.
I’d also like to remind all faculty supervising our fourth year students on or around match day to anticipate that your student will be distracted. Please ensure your student is able to review the results at noon. If you sense he or she is disappointed with the result, please be advised that the student counselors and myself are standing by that day to help any student deal with the situation and provide support.
Fortunately, we have an outstanding Student Affairs team which has been working hard to guide the students through the career exploration and match process, and will be standing by to provide support for match day and beyond.
The team can be accessed through our Student Affairs office email@example.com, or 613-533-6000 x78451.
Thanks for your consideration, and please feel free to get in touch with myself or any of the Student Affairs Team if you have questions or concerns about Match Day or beyond.
Scholars at Risk speaker
By Danielle Weber-Adrian (Meds 2021)
It’s easy to start medical school with a fixed idea of what it means to be a physician. For many, we visualize the patient-physician interaction as a series of investigations, treatments and confidences on the individual’s journey towards health. Although there is truth in this, the reality is that medicine represents so much more within the greater community. Being a physician, as many come to realize during medical school, means becoming an ally to those who are marginalized, and an advocate for the change we wish to see in our global and local macrocosm. So, it seems fitting that the Queen’s Medicine Class of 2021 project as of last year has been to promote the Scholars at Risk program at Queen’s with the help of the International Office.
Scholars at Risk is an organization which provides assistance to over 300 vulnerable scholars per year. These include physicians, journalists, lawyers and professors who have been targeted and threatened by their national governments because of their advocacy work or research. The scholars are matched with universities around the world where they receive temporary teaching and research positions. This provides the scholar with sanctuary and immediate stability, while benefiting the host institution by granting access to a world leader in their field. By joining the Scholars at Risk consortium Queen’s University is prioritizing academic freedom and human rights on a global scale.
As a new member of the Scholars at Risk organization, Queen’s University and the School of Medicine is hosting our first guest lectureship by Dr. Evren Altinkas. Dr. Altinkas is a Turkish historian and scholar at risk who is currently working at the University of Guelph. He studies the historical limitations of academic freedom as experienced by minorities in Europe and the Middle East. His lecture is open to the public and will take place on Friday, February 1st at 12:30 to 1:30 in the upper auditorium (room 132A) of the New Medical Building (15 Arch Street, Kingston, ON). Attendees are invited to join him later that evening for dinner and conversation. The dinner will be hosted at a local restaurant in Kingston; however, guests will be asked to cover the cost of their own meals. To sign up please see the following form: https://goo.gl/forms/vdkzjy3AHCyCQK252.
Indigenous Health Care focus of February FHS events with Dr. Barry Lavallee
My name is Terry Soleas, I’m an Education Consultant with the Office of Professional Development and a PhD Candidate in Education. I have the privilege to work in your Faculty of Health Sciences.
In a collaboration between the Indigenous Health Education Working Group, Faculty of Health Sciences Decanal Leadership, and the Office of Professional Development and Educational Scholarship, we are pleased to present three days of extraordinary reconciliation in healthcare events. Our keynote speaker at all three events is Dr. Barry Lavallee of the University of Manitoba who is our guest for the three action-packed days on campus. Dr. Lavallee has proven to be a dynamite speaker who speaks plainly, practically, and passionately on issues of social justice in medicine, with a particular focus on rural and northern indigenous communities.
The three interactive events are:
1) Public Reception and Lecture
- Wednesday, February 13th from 4- 6PM
- Taking place in the Atrium and then Britton Smith Theatre in the School of Medicine Building
- Refreshments and sparked thinking provided
- Topic Area: Racism as an Indigenous Social Determinant of Health
- To register click here: https://healthsci.queensu.ca/faculty-staff/cpd/programs/lavalleelecture
2) Faculty Development Half-Day
- Thursday, February 14th from 8AM -12PM
- If you would be able to attend the whole morning please click here: ): https://healthsci.queensu.ca/faculty-staff/cpd/programs/lavalleeworkshop
- Topic Area: Teaching Methods for Addressing Cultural Safety: Promoting Indigenous Health
3) Education Round
- Friday, February 15th from 8AM to 9AM
- Taking place in the Richardson Auditorium (Room 104)
- Refreshments and sparked thinking provided
- Topic Area: Indigenizing Educational Research and Workforces in Healthcare: Struggles and a Way forward
- To register, click here: https://healthsci.queensu.ca/faculty-staff/cpd/programs/lavalleeround
These are remarkable and free events that go a long way in Queen’s ongoing Reconciliation efforts. I hope you will join us at many of these events and help us make our future at Queen’s and beyond better, kinder, and brighter!
I’d be delighted to answer any questions you might have😊
With grateful thanks,
Eleftherios K. Soleas, OCT
Professional Development & Educational Scholarship
Faculty of Health Sciences, Queen’s University
613-533-6000 x 79035
A Brief History of Walls
Are walls effective? As we’re all aware, this seemingly innocent question has become a focus of considerable controversy for our neighbours to the south. Of course, it’s not about the sort of walls that separate rooms of your house, or the barriers around your property that deter trespassers and prevent your dog from molesting your neighbour’s flower bed. Rather it’s about massive barricades erected by political leaders to prevent or control the movement of large populations of people at borders. As it happens, there’s a rather interesting and intriguing history of such structures, both real and mythical.
Publius Aelius Hadrianus Augustus (76-132 AD) ruled when the Roman Empire was at its peak and is considered by many historians to be one of the “good emperors”. He seemed less interested in further expansion than in consolidation and security of his already vast empire. As part of that approach, he commissioned the building of a wall to define and secure the northernmost extent of the empire. Construction of Hadrian’s Wall began in AD 122. The wall is composed mostly of stone and is about 10 feet wide and up to 10 to 20 feet in height. The wall connects a series of fortifications located every 5 (Roman) miles. It runs about 73 miles, from the banks of the River Tyne near the North Sea in the east, to the Solway Firth on the Irish Sea to the west. It required a garrison of about 1,500 men and was intended to prevent the “barbarians” (ancient Britons and Picts) from troubling Roman Britain.
Hadrian’s successor, Antoninus Pius, seemed to like the concept but felt the boundary should be expanded and so, in 138 AD constructed a second wall about 100 miles to the north. The Antonine Wall was 40 miles in length. Despite the wall, Antoninus was unable to contain the northern tribes and so subsequent emperors abandoned his wall and re-occupied Hadrian’s Wall.
Today, Hadrian’s Wall is a tourist destination. It was declared a World Heritage Site in 1987, but remains unguarded. Tourists commonly climb and stand on the wall, although this is not encouraged for fear of damage to the historic structure.
The Walls of Troy
Troy was an ancient city located on the northwest coast of Turkey.
Archeological research of that site has revealed that it has been inhabited since about 3000 BC. Dutch researcher Gert Jan van Wijngaarden notes in a chapter of “Troy: City, Homer and Turkey” (University of Amsterdam, 2013) that there are at least ten settlements layered on top of each other.
It is not clear whether the ten year siege by Greeks led by King Agamemnon and described so famously in Homer’s Iliad is wholly or even partially true, but both the legend and the archeologic evidence indicate that the city was, at one time, surrounded by a rather impressive defensive wall. Van Wijngaarden notes that deep under the surface evidence exists of a“small city surrounded by a defensive wall of unworked stone.” In the period after 2550 B.C, the city “was considerably enlarged and furnished with a massive defensive wall made of cut blocks of stone and rectangular clay bricks”.
The legend, of course, indicates that the Trojans were able to hold out for ten years, but the wall was eventually overcome not by force but by clever deception: Ulysses famous “Trojan Horse”.
The Walls of Babylon
Babylon was a city and city-state located in Mesopotamia and a dominant presence in the world for over twelve centuries, ending about 600 BC. It was a key commercial and cultural centre and it is believed that, at various times, Babylon was the largest city in the world, and perhaps the first with a population exceeding 250,000.
A prominent feature of Babylon were its extensive walls. Various rulers would add successively to the work of their predecessors. Nebuchadrezzar II surpassed most by fortifying the existing double wall and actually adding a third. He also added a separate wall north of the city between the Euphrates and Tigris rivers. Considered to be over 100 feet high at points and extending 41 miles, both the sheer magnitude and artistic features of the walls were remarkable, notable particularly for the “hanging gardens”. They are considered one of the “Seven Wonders of the Ancient World”.
Extensive efforts have been made to excavate various components of the ancient city, which has been partially reconstructed as a historic and tourist site. Unfortunately, the reconstruction has been damaged by the development of oil pipelines and military conflicts. In April 2006, American Colonel John Coleman, former Chief of Staff for the 1st Marine Expeditionary Force, issued an apology for the damage done by military personnel under his command.
The Great Wall of China
Perhaps the most famous extant wall in the world was built to protect the then northern border of China from invasion by various nomadic tribes. The “Great Wall” was actually built in portions over several centuries beginning in the 7th century BC
and finally enlarged and united into a single structured with embedded towers and fortifications. The main construction of the existing wall dates to the Ming Dynasty (1368-1644).
In addition to its defensive purpose, the wall also had a border control function, controlling immigration and, serving as a tariff collection station for goods being transported along the “Silk Road” between eastern and western markets.
It extends 21,196 km making it clearly the most extensive wall ever constructed. Whether it is the only man-made structure visible from space is a point of contention. There has never actually been a recorded “sighting” from space, although a Chinese astronaut in the space station claims to have taken a photograph using high resolution equipment. What is clear is that it is a UNESCO World Heritage Site and a symbol of modern China. Although many portions of the wall are in disrepair and eroding, it remains an extremely popular tourist attraction, arguably, the world’s most sought-after selfie opportunity.
The Berlin Wall
A more contemporary example is the Berlin wall that physically divided that city between 1961 and 1989. Its history is both fascinating and instructive.
After World War II, the Potsdam Agreement determined that the victorious allies would divide Germany into four zones of occupation controlled by the United States, the United Kingdom, France and the Soviet Union. The German capital, Berlin, was the centre of administrative control of all four powers and so was similarly divided into four sectors. However, Berlin was entirely within the Soviet controlled portion of former Germany. Within a short period of time, political tensions mounted between the Soviets and the other three nations, largely related to the Soviets’ reluctance to agree to the Marshall Plan which called for the reconstruction, self-governance and economic support of post-war Germany. The United States, United Kingdom and France decided to proceed nonetheless, uniting their portions into a single country which came to be called West Germany (officially, the Federal Republic of Germany), with a capital located in Bonn. East Germany (known as the German Democratic Republic) emerged as a separate and Soviet controlled state, with its capital in Berlin. This left Berlin under divided governance but entirely within a separate and rather unfriendly state.
East Germans began to use West Berlin as a means to defect to western countries. It is estimated that 3.5 million circumvented emigration regulations by simply crossing into West Berlin and then on to West Germany and other countries. To prevent this exodus, the GDR (East German) leadership constructed a concrete, militarized wall essentially separating and isolating West Berlin within East Germany. During the time it was in place, over 100,000 people attempted to escape and about 5,000 succeeded in doing so. They were taking serious risks. According to the Centre for Contemporary History, a research institute concentrating on recent European history, at least 140 people are known to have been killed attempting to cross the wall, ranging from a one-year old child to 80-year old woman. Most believe the number to be considerably higher.
Eventually bowing to anti-communist sentiments in neighbouring countries and civil unrest, the East German government lifted restrictions on movement within Berlin in November of 1989, which led to open and euphoric celebration. People began chipping away parts of the wall until the government removed what was left of it. Germany officially became re-unified October 3, 1990.
Today, only small segments of the wall remain, including “Checkpoint Charlie”, its best known militarized crossing point. The Berlin wall is seen as a failed attempt by a government to impose its will on its citizens. Because it is so recent in our collective memory and so well documented, it has become a powerful image of oppression and courageous defiance. It too has become a popular tourist destination.
“The Wall” (Game of Thrones version)
The most famous albeit imaginary wall of our time no doubt comes from “Game of Thrones”, a hugely popular HBO series based on the fantasy novels of George R.R. Martin. A key feature is “The Wall”, a massive fortified structure composed of solid ice stretching across the northern border of the “Seven Kingdoms”. It is intended to provide protection from the various miscreants beyond, including “Wildlings” and a wandering army of frozen zombies referred to as the “White Walkers”.
Seemingly inspired by Hadrian’s Wall, this frozen barricade stretches from coast to coast, has fortifications along the way, and is manned by a garrison of exiled misfits referred to as the “Night’s Watch”. Apparently, Wildlings and White Walkers don’t swim or paddle. In any case, the wall has held up for millennia but, guess what happened at the end of last season?
(SPOILER ALERT: stop reading if you’re catching up on the series).
It comes down!!!….courtesy of a resuscitated and demonically-possessed fire-breathing dragon, no less! We’ll have to wait until next season to see if it becomes a tourist attraction.
And so, what does all this teach us about massive walls (real or imaginary) intended to separate populations of people? What themes and lessons emerge?
- They don’t work. People (even zombies) are smarter than walls, and are very capable of finding ways to overcome them. This is particularly true of people who are seeking better lives for themselves or families. Walls are static structures that can be overcome by imagination, determination and technology.
- Walls are hugely symbolic. They serve as a very visible expression of the values and priorities of those who construct them. The fences around our homes may not actually prevent a determined person from entering our property, but they certainly clarify for all the world that uninvited folks are unwelcome.
- They endure over time as artefacts, searched out and studied by historians and archeologists. They express and expose for posterity the true, unvarnished values and motives of those who constructed them. This persists long after they stop providing their original, intended purpose.
- They seem to serve as ideal, although expensive, tourist attractions.
If the planned wall does get built, can’t help but wonder how future generations will interpret the existence of a massive barricade on the southern border of a nation that also erected this other symbol at its major eastern port, proudly declaring to the world, “Give me your tired, your poor, your huddled masses yearning to breathe free.”
Promoting wellness with the National Wellness Challenge
By Lori Minassian (MEDS 2021), Aescupalian Society Wellness Officer 2018-2019
As medical students, residents and physicians we are always told to put our patients first. In medical school, we sacrifice sleep and social activities to study to ensure that we will have the tools to properly serve future patients. Once we become residents, we work as hard as possible to be there for patients and this continues on throughout our careers as physicians.
Unfortunately, oftentimes, this means that we forget to take care of ourselves. For this reason, we see high rates of burnout in the medical community. In fact, the Canadian Medical Association National Physician Health Survey conducted in 2017 found that of the 3000 Canadian residents and physicians who responded, 30% reported burnout, 34% experienced symptoms of depression, and 8% had had suicidal ideations within the last 12 months. These issues are discussed at length in a recent position paper by the CFMS responding to medical student suicide.
These statistics highlight just how important it is to promote wellness as early as possible. If we can come up with tools to be well as medical students, we can hopefully use those tools as we progress in our careers as physicians. At Queen’s we are lucky enough to have a wellness curriculum, where we can discuss issues affecting the undergraduate classes and learn strategies to cope with wellness issues. We also have a wellness committee that strives to provide opportunities for student wellness through different events.
Wellness within the medical school becomes a priority during our annual Wellness Month, which runs in conjunction with the CFMS National Wellness Challenge. This year, wellness month runs from January 14 – February 10. You can participate as an individual or in teams of 3-5. Each week will focus on a different area of wellness. We kick off the month with Social Wellness week, followed by Physical Wellness, Mental Wellness and Nutritional Wellness. Each week, participants can follow national challenges set by the CFMS and track their points through the scoresheet provided upon registration. To register for the CFMS national wellness challenge, please follow the links below (Team sign up: bit.ly/NWC_team; Individual sign up: bit.ly/NWC_individual).
At the same time, we encourage students, residents and faculty to attend our Queen’s specific events. Some of the events we are running this year include a Multicultural Potluck Lunch, Zumba/Crossfit/Spin classes, a Movie Night, Lunch and Learn with a Dietitian and many more! The schedule of events can be found within this post. In addition, all of the information regarding Wellness Month can be found at our Facebook page: 2019 Wellness Challenge – Queens (https://www.facebook.com/groups/2019NWCQueens/). This year, we would love to see participation from as many students, residents and faculty as possible! All events are open to anyone who would like to attend, though some require you to sign up in advance. If you have any questions or concerns regarding wellness month, please e-mail me at firstname.lastname@example.org. Let’s come together, promote our wellness and have fun as we do it!