17th Health and Human Rights Conference held

By Aalok Shah (Meds 2020), HHRC Conference Co-Chair

Human Rights, a concept that has existed for millennia and documented in seminal political and religious documents such as the Magna Carta and the Vedas, got a more modern treatment in November 2017 at the Health & Human Rights Conference (HHRC). The HHRC is a proud tradition of Queen’s medicine students, who have organized this conference autonomously for the past 16 years. Since its inception in 2001, this conference has evolved in both

Advocacy through art: Wall of Courage

scope and reach, reflecting the push for interdisciplinary learning and collaboration in education. The 17th iteration of the conference reached out to professionals both within and outside of medicine to educate and engage delegates on its theme of “affirming the human right to health for the poor.” With generous donations from organizations such as the Ontario Medical Students Association (OMSA) and the Canadian Federation of Medical Students (CFMS), the 17th HHRC was the first student-run conference in Canada to welcome over 150 students from all over the nation to discuss human rights and health.

The conference itself was divided into two days.

Community Initiatives Fair

The first day was more didactic in nature, featuring events aimed at educating delegates on traditional social assistance programs and the newer model of the basic income guarantee. Sheila Regehr, the chair of Basic Income Guarantee Canada, gave a keynote address explaining both the philosophical and practical reasons for incorporating a basic income model of social assistance, and its impact on health of the poorest populations in Canada. After this address, delegates witnessed a debate between economists, politicians, and professors on whether a basic income guarantee should replace traditional social assistance programs in Ontario. While parts of the debate were very technical and required knowledge of economics, many delegates reported learning a lot more about the issue with a better appreciation of the pros and cons of both sides.

Global Health workshop

The second day was more interactive, offering several workshops that engaged delegates in topics including indigenous health, global health, mental health, and art-based interventions in health promotion. Additionally, the “community initiatives fair” provided a great opportunity for delegates to interact and network with organizations in Kingston that are involved in local development work. Some students signed up to volunteer at such organizations during this time, and appreciated the chance to channel their motivation and energy from the conference into action right away. Finally, the second day also featured Dr. Samantha Green, who gave a keynote address on mental health, and offered practical tips for healthcare providers in engaging with patients who may be facing financial or emotional calamities.

Overall, the conference was successful in renewing a discussion about intrinsic rights of humans to health, and how to best achieve equity in an era of equality. This conference would not have been possible without the hard work of the executive committee of 13 people featured below and generous sponsors including the Aesculapian Society, the Dean’s Fund, OMSA, CFMS, Queen’s Innovation Centre, Principal’s Office, Society of Graduate Studies, School of Kinesiology, Global Development Studies, Queen’s Human Rights Office, and the Office of the Vice-Provost.

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New and improved resources for teaching, research and clinical application

By Suzanne Maranda, Head Health Sciences Librarian, Queen’s University Library

(Italics indicates a hyperlink)

Are you looking for images to include in your presentations or online modules? Two Thieme products are now available online and any materials from these two resources, one in Anatomy and the other in Pharmacology, can be extracted and included in any materials that will be used in a Queen’s course or presentation. Please contact me if you would like the complete license agreement.

Usage statistics of these resources will be collected to inform our decision about renewing or not. There are two other products (Physiology and Biochemistry) from the same publisher that could be added if requested and if funds permit. The two subjects purchased were chosen in consultation with the staff preparing online modules for the BHSC program.

The other tool I would like to highlight is relatively new as it was added in September 2017. Read by QxMD is a mobile app that enables a more direct link to the journal articles subscribed by the Library and to open access journals. The link provided here is to the page of all our mobile apps, please scroll to the instructions on how to get Read to work with the Queen’s resources. When you set up a profile, you can receive email notifications of new articles that match your profile. Check out the new “medical education” option that I requested be added. This company is quite responsive, I would be happy to pass on other topic/category suggestions.

Isabel is a diagnostic support tool that can be useful in clinics and possibly for teaching clinical skills. In December 2017 the librarians participated in a webinar with the developer of Isabel to review software enhancements.

Once a few symptoms are entered, a list of possible conditions is presented for follow-up, the coloured bar on the side (see green arrow) of the list indicates the strength of the likelihood (red is best). Notice the separate tab at the top of the results box for possible drugs ( ) that may cause the symptoms you entered. By clicking on a condition, you are taken to the Dynamed entry by default. If there is no Dynamed entry, then we link to BMJ Best Practice. A few other resources have been added for linking, you see these in the left hand box, so that one can choose to look at a different resource, or even consult more than one. There is a mobile version of this clinical tool, see instructions on our mobile apps guide.

I hope you will try Isabel and consider completing the online survey (at the red arrow) that is linked from the Isabel pages to ask for your feedback about this resource.

As always, do contact us if you have any questions about the above resources or anything else information-related.

 

 

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The Winter Solstice – Nature’s promise of better things to come

What do the Temple of Karnack in Luxor, Stonehenge in England, Chichen Itza in Mexico and Machu Picchu in Peru have in common?

Answer: They are all constructed, in part, to align with and mark the winter solstice. At Stonehenge, the central altar and “slaughter stone” are aligned precisely with the rays of the sunset on the winter solstice, the shortest day of the year.

The winter solstice, which occurs this week, is the day of the year with the least number of daylight hours for people in the northern hemisphere, and the most for those in the southern hemisphere. The exact timing of the solstice varies somewhat from year to year. This year, it occurs on Thursday December 21 at 16:28 GMT. It occurs because the vertical axis of the earth is not aligned perfectly perpendicular to the sun, but inclined about 23.5 degrees. This results in the hemispheres getting variable periods of daylight as the earth rotates during its annual journey around the sun.

There is much speculation as to why these various ancient civilizations chose to erect such monuments to mark the solstice. Clearly, they saw it as a pivotal event in their lives. They would have perceived the life-giving sun to be gradually withdrawing from their lives through the previous few months and then, on this particular day, and for no reason they could comprehend or control, re-emerging with the promise that life would continue once again.

Whatever their motivation, these structures should remind us that the peoples of the past were keen and respectful observers of the natural world. They recognized that the rhythms of the cosmos, even if beyond their understanding, were key to their survival. The ability to cultivate crops, find game and the essential need to store food and prepare for long winters was closely tied to their understanding of natural climate cycles. Observing the natural world was therefore not a casual pastime, but an essential survival skill. For these reasons, they were much more attuned to nature than those of us living in an era where, for most of us, technical advances have reduced diminishing daylight to a minor nuisance.

However, the solstice is in some ways a great leveler of humanity. It has been a feature of our collective life experience since human beings first walked the earth. It is also one of the very few events that occur at the exact same instant each year for everyone on the planet. It is therefore an event that transcends geography, culture, economic advantage, national boundaries, or even time itself. It links us all and reminds us that there are much greater forces at play in our lives than anything we can hope to control or even fully understand.

It also brings hope. It is the time of year when, through no effort, merit or intent on our part, light begins to re-emerge into our lives and, with it, the promise of new life in the spring. It is a time when, like nature itself, we should stop, rest and look hopefully forward.

It’s in that spirit that I wish our faculty and students a restful, safe and restorative break from the routine of busy lives, and very best wishes, as we will again come together to engage the new year.

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

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“To boldly go where no (Doctor) has gone before”

Those as nerdy as I will recognize the title of this article as paraphrased from the introduction to the original Star Trek television series. That program, set in a technologically advanced future, was about a long journey of discovery. Perhaps the most peculiar aspect of that journey is that it had no particular destination. The voyagers were simply wandering aimlessly, hoping to run into something interesting. Consequently, they often found themselves woefully unprepared for the challenges they faced – an excellent means to provide dramatic tension to a fictional story, but a dubious strategy for real life.

A medical school curriculum is basically a journey. For our students, it’s a journey that will take them into an unknown future. Like any real journey (and in contrast to the intrepid Star Trek crew), establishing a destination is the first, critical step. A long journey may consist of many stages and stops along the way that demand our immediate attention, but those stages are only meaningful if they move the traveler toward some ultimate goal. That goal, of course, is to become effective, fulfilled providers of medical care to members of our society.

The students currently in medical school will be practicing into the mid 21st century. If we’re to provide them an education that will best prepare them to make meaningful contributions, we need to give some thought what that world will look like, and what it will require of them as physicians and professional leaders.

This was the topic of a presentation and subsequent discussion at our semi-annual Curricular Retreat this past week. In preparing some remarks to begin that discussion, I attempted to draw on changes that have occurred in the course of my career and use those observations to extrapolate into the future. I came up with five that I think are particularly relevant. This is, by no means, a complete list, but perhaps sets the tone and the challenge.

 

In no particular order:

 

  1. The role of physicians as purveyors of medical knowledge.

Knowledge is the fundamental fuel of medical practice, and the commodity that gives legitimacy to those providing care. A generation ago, medical knowledge was elusive. It had to be searched out, a process that was paper based and time consuming. Physicians were the primary source and conveyors of medical knowledge. People who wished to become physicians went to medical schools largely to seek out the knowledge and skills that were embodied in the practicing physicians who taught there.

That has all changed. Medical knowledge is now available, almost instantly, who anyone who wishes to find it. Physicians are no longer the primary source of that knowledge. They no longer hold any monopoly on knowledge.

 

  1. The expanding applications of Artificial Intelligence and robotic technology.

We were all impressed when Watson defeated chess masters and Jeopardy champions. In my field of cardiology, I think many dismissed automated interpretations of electrocardiograms as simple algorithm-driven time savers that would always require physician verification. The same is happening with respect to interpretation of diagnostic imaging such as chest x-rays and CT scans.

But AI is moving far beyond these applications that are based simply on prodigious memory storage and processing capacity. Applications are becoming much more sophisticated and are developing the ability to learn and adapt to dynamic situations. Diagnostic algorithms are available that will provide reasonable differential diagnoses for patient presentations, and computer interfaces are under development that are frighteningly life like in their ability to interpret individual patient speech and even facial expressions.

Robotic applications in the operating rooms and procedure suites hold the promise of increasing technical expertise and consistency while reducing infection rates. They also allow for interventions in locations where the human hands are simply incapable of performing.

Extrapolating forward, it’s not at all hard to imagine a world where most diagnostic imaging and many therapeutic interventions will require much less, or perhaps no human intervention.

 

  1. Our fundamental understanding of human disease.

For generations, physicians have understood and characterized disease states based on what they could observe clinically. “Consumption”, “Whooping Cough” and “Scarlet Fever” are examples of conditions described solely on symptoms and visual inspection. As the ability to image patients and do laboratory analyses improved, patients with Consumption were found to have pulmonary damage caused by Tuberculosis, Whooping Cough became Pertussis and Scarlet Fever became associated with streptococcus infection.

I have lectured students for over 20 years on the classification, diagnosis and management of cardiomyopathies based on morphologic distinctions (Dilated, Hypertrophic, Restrictive) established by clinical examination and imaging appearances. My teaching is now changing, based on new classification schemes based not on morphology, but on the genetic mutations that result in abnormal development of cardiac muscle cells and channels.

This is not only highly appropriate, but promises to bring genetically based therapeutics that promise to alter the natural history of these conditions in ways currently not available. It also represents an entirely new science, involving genomics and an understanding of sub-cellular processes that practitioners of the future will need to understand and develop comfort with if they’re to provide optimal care.

 

  1. Standardized approaches to disease management.

Physician order sheets used to be blank and on paper. They have not only become electronically integrated into patient management systems of various designs, but have also become prepopulated with standard orders for many, even most, clinical conditions. Often, all that’s required are patient specific data such as body size and renal function, and a physician’s signature (real or virtual) at the bottom of the page.

 

This is good in the sense that it promotes consistent and evidence based approaches to these conditions, and reduces transcription errors. However, it can also diminish the educational experience of medical students, and may not fully account for the needs of patients with multiple medical problems or individual characteristics that require an individualized approach.

 

 

  1. Expanding role of non-physicians in health care delivery.

The widespread availability of medical knowledge in general and guideline based management strategies specifically has allowed for other health care providers, such as nurse practitioners, pharmacists and physician assistants, to participate more fully many situations. Another example from my field would be the expanding role of nurse practitioners in heart failure clinics. NPs are fully capable of managing the introduction and maintenance of standard therapies in this population of patients who often require close and continuing surveillance. They do so very effectively, and their participation has been shown to improve patient functional status and reduce hospital admissions.

 

And so, what to do…

It’s important to state from the outset that this is all good. These five changes will make health care more effective and efficient. Like any development they have potential pitfalls, but, appropriately managed, they will bring significant advantages to our patients. It’s also important to recognize that they are not going away. Technologic progress does not wait for us, or any group, to be ready.

And so, we must engage some very difficult and disturbing questions, summarized in this slide I presented at our recent retreat:

 

Obviously, there are no definitive answers, but I provide a few thoughts that emerged from recent discussions.

  • Students no longer need to undertake medical education in order to locate knowledge – they are quite capable of doing that on their own. They do, however, require guidance as to what will be relevant to their careers, and an ability to interpret and evaluate the merits of the tsunami of information that will come their way.

 

  • AI has the potential to dramatically improve the delivery of care, but can be highly threatening, partly because applications can develop out of context and without clear applications. Physicians of the future need to be more than consumers of AI, they need to involved in the development of applications, the purpose of which should always be to advance care. To do so, they will need fundamental education that develops familiarity with the technology and its potential.

 

  • Medical education has always been rooted in science, but the nature of that science is changing rapidly. Fundamental knowledge about normal human structure and function will always be required, but will need to extend beyond the superficially observable to penetrate the genetic and subcellular levels of normal and abnormal human function.

 

  • As Physicians are needed less and less to interpret test results or manage standard, well-defined clinical issues, their role will extend to ensuring patients enter the care system appropriately, and managing situations where the complexity or multiplicity of issues goes beyond standard management. This will require them to be even more acute assessors of patients at the primary presentation, develop high levels of sensitivity to patient outcomes that deviate from optimal, and have a depth of understanding of the scientific underpinnings of disease and system management that will allow them to step in and provide “customized” management when required. Indeed, “personalized medicine” may become the primary focus of the physician of the future.

 

All this, and no doubt much more, will require a vastly different approach to medical education, one that we need to begin to consider today. The future is closing in very rapidly. I’ll end with a quote regarding the future role of physicians from someone who was always technologically ahead of his time and not shy about expressing disruptive views:

“The doctor of the future will give no medicine, but will instruct his patient in care of the human frame, in diet, and in the cause and prevention of disease.”

Thomas Alva Edison (1847-1931)

 

Edison may have been somewhat overly optimistic about the “give no medicine” prediction, but was certainly perceptive in predicting fundamental change in approach. Over the next few months, we’re going to engage a series of dialogues about the doctor, and medical school, of the future, beginning with our recent retreat and this article. Please feel free to participate with your thoughts as we “boldly go” about charting a course into the next few decades of medical practice and education.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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Queen’s Medicine Pre-Clerkship South East Asia Observership 2017

By Cesia Quintero (MEDS 2020)

In June and July of 2017, a cohort of six first year medical students from Queen’s University conducted a month-long observership in Vietnam and Cambodia. The goals of the trip were to provide the students with a valuable clinical experience and exposure to Global Health, and to establish connections that might expand the availability of Global Health experiences for future Queen’s medical students. We also hoped to explore the possibility of creating unique partnerships with overseas institutions that would boost the global profile of Queen’s University.

We examined a Neurocysticercosis patient at NIMPE

 Overview

The bulk of our two-week Vietnam stay was at St. Paul’s Hospital in Hanoi, Vietnam, where we had a chance to observe in a variety of departments, including ICU, ER, Pediatric Infectious Disease, Pediatric Cardiology, and Endocrinology. Our visit was initially sponsored by the director of the Endocrinology department at St. Paul’s, and throughout our stay we managed to make good connections with several other physicians, including the director of the ICU. All of these physicians expressed interest in a similar arrangement next year. We also had a chance to have a one-day observership at the National Institute of Malariology and Parasitology (NIMPE), where we saw patients with parasitic infections that we would not have an opportunity to see in Canada.

The connections we made in this portion of the trip allowed for the possibility of more in-depth observerships at NIMPE in the future, and for expanding this opportunity to the National Hospital of Tropical Diseases. We also made connections that could allow us to similarly access the health system in the Lao People’s Democratic Republic.

During our Cambodia stay, we spent one week at Battambang Provincial Hospital, which is one of the larger provincial hospitals in the country, and at the Pailin Referral Hospital, a very under-resourced hospital that serves 75,000 rural residents. We quickly learned that Battambang Hospital routinely hosts students from Australia and the UK; during our stay there, there was a group of four medical students from the UK and 22 nursing students from Australia. Both the coordinator for foreign students and the director of the hospital indicated that they would love to form a relationship with a Canadian medical school. In Pailin we became closely acquainted with the Deputy Minister of Health of the province, as well as with the director of the hospital, and several department directors. At both Cambodian hospitals we spent our time in the ER, Pediatrics, Labour and Delivery, and OR.

Clinical Experience

Battambang Surgery Observership

In all of the hospitals, our role was strictly that of observers. The physicians who oversaw us facilitated a learning model in which the goal was for us to begin to recognize common signs and symptoms and gain first-hand experience with positive findings. Our activities consisted of observing patient care, impromptu mini-lectures from supervising physicians to illustrate relevant findings, and non-invasive supervised physical examinations. We were introduced to patients as foreign medical students by our supervising physicians, and in Battambang by our medical translator. We found that it was very helpful to point to our student IDs and highlight the word ‘student’ whenever it seemed that a patient was mistaking us for a doctor.

Throughout the day we did a lot of research on our own to answer any questions that came up. We found that having the ability to observe the same patients multiple times a day, several days in a row, was a huge advantage, as it allowed us to observe the progression of disease and treatment. For example, we had the opportunity to follow a patient with diabetic ketoacidosis from his admission to the ER to the ICU, and his eventual passing away, at each stage observing and researching the changing signs and symptoms, treatment efforts, and reactions from his family. We also found that seeing so many positive findings and performing so many physical examinations on actual patients greatly increased our confidence and clinical skills. Depending on our setting, we had the opportunity to observe a variety of procedures, including intubations, central line placement, wound care and debridement, deliveries and surgeries.

Managing Impact

A former soldier was awaiting a toe amputation in Battambang

In all of this, we strove to be mindful of how busy and overworked the physicians were, and to operate by the principle that no patient experience or outcome should be negatively affected by our presence; if possible, we tried to be a positive presence for the patients. We are proud to say that we honestly believe we were able to live up to this goal. By separating into small groups, rotating departments frequently, and being independent learners for the majority of the time, we were able to avoid being a major burden to hospital staff. We also respected patient privacy as much as we could. Nevertheless in all hospitals there were a number of patients to whom a group of foreign students was an exciting event, and there were many occasions in which we thought our presence had been beneficial to a patient’s experience or outcome. In Battambang, a former soldier and his family burst into tears after some of us gave him a very respectful greeting in Khmer language; they said they had never received so much respect from someone in a white coat, and this was very meaningful to them. In Hanoi, we were able to comfort a very anxious ICU patient by listening to her heart several times a day when the physicians did not have time to attend to her emotional distress. There were multiple emergency situations throughout in which physicians borrowed our stethoscopes and other equipment, such as during a failed intubation.

Pailin’s TB ward houses both patients and their families, who don’t have protective equipment.

It was in the understaffed and under-resourced Pailin Referral Hospital where there was the biggest opportunity for us to be a beneficial presence, and where one of the most impactful experiences of the trip took place. I went to check in on a TB patient who was faring poorly, and found that the physician on duty had not looked in on her for several hours. When I arrived, there were no nurses of other staff in the ward. She was alone, struggling to breathe, and her family was very distressed. I immediately phoned her admitting physician, who arrived minutes later. Nasal cannula were the only available tool to provide oxygen, but luckily we had a rebreather mask with us that could be connected to the oxygen tank. There were no monitors to keep track of her vitals, but we had brought a pulse oxymeter with us. When, despite the oxygen, her pulse and breathing stopped, three of us medical students were the only ones available to assist the doctor in performing CPR. The doctor himself would have been performing CPR without an N-95 mask if we had not been able to provide one to him.  Unfortunately the patient passed away despite these efforts, but we were satisfied that our presence there had afforded her a better chance, and that at least her family witnessed medical staff making their best effort to save their wife and mother, who would have otherwise died alone and without medical help.

Global Health Experience

Empty shelves at Pailin Hospital’s Outpatient Pharmacy, which serves 75,000 people

Due to the low-resource setting of these observerships, a lot of our learning went beyond the clinical. Both Cambodia and Vietnam are undergoing rapid economic development and demographic changes; the consequent epidemiological transition was highlighted time and again by physicians. We also witnessed the impact of patient crowding and severely exacerbated conditions due to lack of access. Particularly poignant were the struggles of physicians to provide medical care under extremely exacting conditions, such as limited resources and training, and political difficulties. We gained a better understanding of the multifaceted nature of these challenges, and of how difficult it is to bridge these gaps effectively. We also saw, however, that it is possible to make a difference. For example, we brought medical equipment with us that is currently filling some gaps at the Pailin Referral Hospital.

 Future Possibilities

With the director of Pailin Hospital. Fundraising efforts throughout the school year allowed the students to donate medication and equipment

While all institutions that we visited expressed an interest in hosting Queen’s medical students in the future, near the end of our trip the director and several physicians at the Pailin Referral Hospital requested a meeting with us. They wished to explore the possibility of a closer relationship with our university. There were a variety of areas for collaboration that were proposed at this meeting, including the possibility of hosting clerks and residents who, unlike us, might be able to provide medical assistance to patients while being exposed to new situations and gaining useful skills. The director and staff indicated that the most critical needs for the hospital are 1) diagnostic equipment, and 2) advanced training for staff. The only imaging available at the hospital is a rather outdated x-ray machine that generates fuzzy images. In terms of training, their most emergent need related to the management of diabetes. Due to the epidemiological shift, widespread diabetes is a fairly recent phenomenon in rural Cambodia. Nevertheless, Pailin Hospital physicians estimated that currently up to up to 60% of their patients have diabetes. They are very motivated to improve their knowledge of and experience with managing this disease at such high frequencies, and asked about possible training methods they might be able to access, such as online modules or intensive training by diabetes specialists.

In response, we took notes of their concerns and promised to pass them on to the appropriate stakeholders at Queen’s Medical School. We also began independent efforts to find a digital x-ray machine for donation, and continue to look for ways to support the development of this hospital.

Conclusion

The trip exceeded our expectations in terms of the quality of clinical experience and global health exposure that was achieved, the receptiveness of our hosts to continuing this project, and the possibility for future in-depth, mutually beneficial collaborations at the institution level.


 All photographs were taken for fundraising and educational purposes only, after obtaining informed consent from all parties.

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Curriculum Committee Information – October 26, 2017

Faculty, staff, and students interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on October 26, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of the October meeting can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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Lindsay Shepherd and the delicate balance of free speech and personal rights

What’s the purpose of universities?

There appears to be no simple answer to what might seem to be a straightforward question. The pragmatic, contemporary purpose would be to prepare young people for careers of various types. Certainly that would be the likely first response of most current students, and postgraduate employment has become a key (and very public) metric of university success.

But many would remind us that universities have a greater purpose, both in the lives of young people who attend and within our society. William von Humboldt was a German philosopher and diplomat who, in 1810, defined the purpose of universities rather succinctly as “communities of scholars and students engaged in a common search for truth”. The 1963 Robbins Report commissioned by the British government to examine education concluded that universities had four objectives: “instruction in skills, promotion of the general powers of the mind, advancement of learning, and transmission of a common culture and common standards of citizenship.”

These greater goals require universities to provide environments where both students and faculty feel free to explore any and all topics openly, freely and safely.

Lindsay Shepherd’s recent experience with her university hierarchy would suggest we have some work to do if those lofty goals are to be achieved.

For those not yet familiar with her story, she is a 22 year old teaching assistant at an Ontario university who is undertaking a master’s degree in Communications. A few weeks ago, a student (or students, we don’t know) in her class complained that she was using material they found offensive. The offensive material consisted of a three minute video clip that had been broadcast on TVO and featured a debate about the use of non-gender, contrived pronouns, featuring Professor Jordan Peterson, a highly controversial psychologist and university professor who characterizes himself as a defender of free speech but whose views on social issues have been seen as “far right” and highly threatening by many.

For this offense, Ms. Shepherd was required to attend a meeting with her supervisor, another professor, and a university official who holds a position as director of gender violence prevention and support.

She recorded the meeting, and made that recording publicly available. Although it’s somewhat painful to listen to, it holds important lessons for those holding positions of authority in universities or colleges.

Through the 40+ minute session, the three senior university officials take turns trying to convince this young woman of the error of her ways. It’s clear that the intention of the meeting was not to get Ms. Shepherd’s perspective on the events, but to convince her that she was guilty of using an inappropriate teaching approach and disseminating offensive material. It appears that guilt had already been established through nothing more than the evidence of the student complaint. Why else would the director of gender violence prevention and support be already involved in the matter?

In their defense, they appeared to be sincere in their beliefs that the material was intrinsically offensive and in questioning of the choice of methodology given the purpose of the teaching session. They also appeared to be trying to avoid any reputational damage to their institution.

For her part, Ms. Shepherd was unrepentant and consistent in defending the use of provocative material to stimulate what she believed to be healthy debate. She felt young people should be prepared to hear and engage differing and even radical opinions. She made it clear that she herself did not agree with the views of Professor Petersen and was in no way endorsing his point of view. She was, throughout what was obviously a highly uncomfortable and fundamentally unfair encounter, principled and courageous. As I listed to the encounter, I couldn’t help but think that her parents would be proud of her.

https://goo.gl/images/9zTyHM
@FaithGoldy

There has been, as you might imagine, considerable backlash. Editorials, student protests and national columnists have defended Ms. Shepherd and attacked the university for how this issue was handled. The individuals involved and university president promptly issued apologies.

http://www.cbc.ca/news/canada/kitchener-waterloo/wilfrid-laurier-university-president-explains-apology-to-lindsay-shepherd-1.4417809

https://www.theglobeandmail.com/news/national/education/free-speech-protest-at-wilfrid-laurier-university-caps-turbulent-week/article37085605/

https://www.theglobeandmail.com/opinion/editorials/globe-editorial-university-heal-thyself/article37075138/

http://thechronicleherald.ca/opinion/1523543-walkom-wilfrid-laurier-tas-case-is-%E2%80%98problematic

http://montrealgazette.com/opinion/christie-blatchford-heres-where-laurier-can-stick-their-apology-to-lindsay-shepherd/wcm/580912e2-390f-4584-ac57-955912bbdeca

 

I decided to write on this issue not because Ms. Shepherd requires further defending, nor to add to the vilification of those involved – the fundamental unfairness of the encounter itself requires no further comment. However, I think this regrettable incident offers important lessons for those of us who teach and hold positions of authority at the university level.

If universities are to truly provide more than simple vocational training, they must establish safe and welcoming environments for students and faculty of all background and beliefs. They must foster, indeed welcome, new and even radical ideas. To do so, they must strike a delicate balance between free speech and personal harassment. When does one person’s expressed opinion become unacceptable? A standard we might all accept is when the expression of those views harms or threatens another individual or group. In most cases this is self-evident. But (and this is a big “but”), harm or threat can be a subjective experience. Were the students who complained to university official about Ms. Shepherd’s tutorial harmed or threatened by hearing the video clip she presented to them?

Universities appear to be struggling with this dilemma. The University of British Columbia recently rescinded a proposed Freedom of Speech statement that attempted to put limits on what would be considered permissible dialogue:

https://www.theglobeandmail.com/news/national/education/ubc-shelves-new-freedom-of-expression-statement/article36871422/

On perhaps another extreme, the University of Chicago appointed a Committee on Freedom of Expression in 2014.

https://provost.uchicago.edu/sites/default/files/documents/reports/FOECommitteeReport.pdf

In their “Report of the Committee on Freedom of Expression” they make the following statements:

“the University’s fundamental commitment is to the principle that debate or deliberation may not be suppressed because the ideas put forth are thought by some or even by most members of the University community to be offensive, unwise, immoral or wrong-headed. It is for the individual members of the University community, not for the University as an institution, to make judgments for themselves…”

They do, however, set limits with respect to harm or threat:

“The University may restrict expression that violates the law, that falsely defames a specific individual, that constitutes a genuine threat or harassment, that unjustifiably invades substantial privacy or confidentiality interests…”

The University of Chicago approach would seem to be appropriate given American values and their current political-social environment. But how are we to negotiate the delicate balance of free expression and personal rights in the Canadian context, given our collective recognition of minority oppression, and natural inclination to civility and compromise? In the university environment, there are additional motivations to protect young people who we may see as vulnerable, and to guard our institutional interests.

There are no easy answers, but I believe Ms. Shepherd’s experience provides warning that the pendulum may have swung too far toward toward suppression of vigorous and healthy debate in the interest of avoiding any potential appearance of offense. In our universities, where open and free discourse should be encouraged as a key goal, this is particularly alarming. Ultimately, we must re-examine what serves the interests of our students and society, and what keeps our universities vital institutions where personal growth and von Humboldt’s “common search for truth” can truly flourish.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

 

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Lindsay Shepherd and the delicate balance of free speech and personal rights

What’s the purpose of universities?

There appears to be no simple answer to what might seem to be a straightforward question. The pragmatic, contemporary purpose would be to prepare young people for careers of various types. Certainly that would be the likely first response of most current students, and postgraduate employment has become a key (and very public) metric of university success.

But many would remind us that universities have a greater purpose, both in the lives of young people who attend and within our society. William von Humboldt was a German philosopher and diplomat who, in 1810, defined the purpose of universities rather succinctly as “communities of scholars and students engaged in a common search for truth”. The 1963 Robbins Report commissioned by the British government to examine education concluded that universities had four objectives: “instruction in skills, promotion of the general powers of the mind, advancement of learning, and transmission of a common culture and common standards of citizenship.”

These greater goals require universities to provide environments where both students and faculty feel free to explore any and all topics openly, freely and safely.

Lindsay Shepherd’s recent experience with her university hierarchy would suggest we have some work to do if those lofty goals are to be achieved.

For those not yet familiar with her story, she is a 22 year old teaching assistant at an Ontario university who is undertaking a master’s degree in Communications. A few weeks ago, a student (or students, we don’t know) in her class complained that she was using material they found offensive. The offensive material consisted of a three minute video clip that had been broadcast on TVO and featured a debate about the use of non-gender, contrived pronouns, featuring Professor Jordan Peterson, a highly controversial psychologist and university professor who characterizes himself as a defender of free speech but whose views on social issues have been seen as “far right” and highly threatening by many.

For this offense, Ms. Shepherd was required to attend a meeting with her supervisor, another professor, and a university official who holds a position as director of gender violence prevention and support.

She recorded the meeting, and made that recording publicly available. Although it’s somewhat painful to listen to, it holds important lessons for those holding positions of authority in universities or colleges.

Through the 40+ minute session, the three senior university officials take turns trying to convince this young woman of the error of her ways. It’s clear that the intention of the meeting was not to get Ms. Shepherd’s perspective on the events, but to convince her that she was guilty of using an inappropriate teaching approach and disseminating offensive material. It appears that guilt had already been established through nothing more than the evidence of the student complaint. Why else would the director of gender violence prevention and support be already involved in the matter?

In their defense, they appeared to be sincere in their beliefs that the material was intrinsically offensive and in questioning of the choice of methodology given the purpose of the teaching session. They also appeared to be trying to avoid any reputational damage to their institution.

For her part, Ms. Shepherd was unrepentant and consistent in defending the use of provocative material to stimulate what she believed to be healthy debate. She felt young people should be prepared to hear and engage differing and even radical opinions. She made it clear that she herself did not agree with the views of Professor Petersen and was in no way endorsing his point of view. She was, throughout what was obviously a highly uncomfortable and fundamentally unfair encounter, principled and courageous. As I listed to the encounter, I couldn’t help but think that her parents would be proud of her.

https://goo.gl/images/9zTyHM
@FaithGoldy

There has been, as you might imagine, considerable backlash. Editorials, student protests and national columnists have defended Ms. Shepherd and attacked the university for how this issue was handled. The individuals involved and university president promptly issued apologies.

http://www.cbc.ca/news/canada/kitchener-waterloo/wilfrid-laurier-university-president-explains-apology-to-lindsay-shepherd-1.4417809

https://www.theglobeandmail.com/news/national/education/free-speech-protest-at-wilfrid-laurier-university-caps-turbulent-week/article37085605/

https://www.theglobeandmail.com/opinion/editorials/globe-editorial-university-heal-thyself/article37075138/

http://thechronicleherald.ca/opinion/1523543-walkom-wilfrid-laurier-tas-case-is-%E2%80%98problematic

http://montrealgazette.com/opinion/christie-blatchford-heres-where-laurier-can-stick-their-apology-to-lindsay-shepherd/wcm/580912e2-390f-4584-ac57-955912bbdeca

 

I decided to write on this issue not because Ms. Shepherd requires further defending, nor to add to the vilification of those involved – the fundamental unfairness of the encounter itself requires no further comment. However, I think this regrettable incident offers important lessons for those of us who teach and hold positions of authority at the university level.

If universities are to truly provide more than simple vocational training, they must establish safe and welcoming environments for students and faculty of all background and beliefs. They must foster, indeed welcome, new and even radical ideas. To do so, they must strike a delicate balance between free speech and personal harassment. When does one person’s expressed opinion become unacceptable? A standard we might all accept is when the expression of those views harms or threatens another individual or group. In most cases this is self-evident. But (and this is a big “but”), harm or threat can be a subjective experience. Were the students who complained to university official about Ms. Shepherd’s tutorial harmed or threatened by hearing the video clip she presented to them?

Universities appear to be struggling with this dilemma. The University of British Columbia recently rescinded a proposed Freedom of Speech statement that attempted to put limits on what would be considered permissible dialogue:

https://www.theglobeandmail.com/news/national/education/ubc-shelves-new-freedom-of-expression-statement/article36871422/

On perhaps another extreme, the University of Chicago appointed a Committee on Freedom of Expression in 2014.

https://provost.uchicago.edu/sites/default/files/documents/reports/FOECommitteeReport.pdf

In their “Report of the Committee on Freedom of Expression” they make the following statements:

“the University’s fundamental commitment is to the principle that debate or deliberation may not be suppressed because the ideas put forth are thought by some or even by most members of the University community to be offensive, unwise, immoral or wrong-headed. It is for the individual members of the University community, not for the University as an institution, to make judgments for themselves…”

They do, however, set limits with respect to harm or threat:

“The University may restrict expression that violates the law, that falsely defames a specific individual, that constitutes a genuine threat or harassment, that unjustifiably invades substantial privacy or confidentiality interests…”

The University of Chicago approach would seem to be appropriate given American values and their current political-social environment. But how are we to negotiate the delicate balance of free expression and personal rights in the Canadian context, given our collective recognition of minority oppression, and natural inclination to civility and compromise? In the university environment, there are additional motivations to protect young people who we may see as vulnerable, and to guard our institutional interests.

There are no easy answers, but I believe Ms. Shepherd’s experience provides warning that the pendulum may have swung too far toward toward suppression of vigorous and healthy debate in the interest of avoiding any potential appearance of offense. In our universities, where open and free discourse should be encouraged as a key goal, this is particularly alarming. Ultimately, we must re-examine what serves the interests of our students and society, and what keeps our universities vital institutions where personal growth and von Humboldt’s “common search for truth” can truly flourish.

 

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

 

Posted on

Curriculum Committee Information – September 28, 2017

Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on September 28, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of the September meeting can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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Grade Inflation – the “dirty little secret” of academia

“Would any of us have gotten into medical school today?”

This was the tongue-in-cheek question I posed to my classmates at our medical school reunion last year. They were rather amused by it and, being very much aware of the high academic standards required by our current admissions processes, believed the answer was an obvious “no”. I tried to raise some doubt arguing (with what I thought at the time was more fantasy than reality) that our marks, like the dollar, had been “devalued” over the years. They weren’t really buying it. However, I’ve since come to learn that what I thought at the time was fanciful conjecture was closer to truth than I realized.

We’ve all become quite accustomed to the term “inflation” as it relates to economics. The dictionary definition goes like this:

 

“a continuing rise in the general price level usually attributed to an increase in the volume of money and credit relative to available goods and services.”

 

To those of us less financially sophisticated, it basically means a dollar doesn’t buy as much as it used to. The important corollary is that the amount of money we possess or earn becomes progressively less valuable as its purchasing power steadily diminishes.

It’s perhaps a little surprising to find the same term applied to academic grades. In fact, considerable information is available on the topic, which has been termed by some as the “dirty little secret” of university and college academic programs.

Well, if it’s a dirty little secret, it’s certainly not a very well kept secret. A Google search of the term took less than half a second to come up with over 4.5 million references:

 

 

 

There’s actually a website called GradeInflation.com that features the following chart prominently:

 

And so, a closer look at the phenomenon would seem to be in order. With the capable assistance of Sarah Wickett, Health Sciences Librarian, we identified a few key papers to shed a little more light on the topic. We set out to address three questions: Is there real evidence of grade inflation? If so, what are the causes? Does it matter?

 

Is it real?

Paul Anglin and Ronald Meng of the University of Windsor undertook a study of this issue that was published this year in Canadian Public Policy (volume xxvi:3). They compared the grades awarded by seven Ontario universities in 12 first year courses between 1974 and 1994. To summarize their findings:

  • The average GPA rose in 11 of the 12 courses. Of the 80 course-university combinations studied, 53% had grade inflation of at least 10%, 31% had no statistically significant change, and grades fell in 16%. The rate of inflation was not uniform, with the greatest increases occurring in English, Biology and Chemistry.
  • The percentage of students receiving an “A” increased overall from 16% in 1974 to 21% in 1994, while the percentage receiving “F”s declined from 9.5% to 6.7% during the same time. This trend was true in 11 of the 12 courses of study, with Sociology being the only exception. English, Biology, Music and French have the greatest increases at the upper end of the distribution. In Biology courses, for example, the percentage of students getting “A”s increased from 12.8 to 22.6%, while the percentage receiving “F”s declined from 9.1 to 5.7%.
  • The variance, or distribution of marks, within courses declined or stayed the same in all courses. In other words, the “bandwidth” between high and low achievement tended to diminish.

 

This phenomenon does not appear to unique to Ontario. In Studies in Higher Education (2017, 42:8;1580) Dr. Ray Buchan of the University of Brighton reports on the proportion of “good” or Honour degrees awarded by 100 universities in the United Kingdom. He reports an increase from 47.3% in 1994/95 to 61.4% in 2011/12, which in absolute terms represents an increase of 113%. Perhaps more significantly, the proportion of “first-class” degrees awarded more than doubled over the same time, increasing from 7 to 15.8%. In his article he quotes the Universities Minister David Willets who states: “the whole system of degree classification does need reform”.

There has been considerable study of this issue in American universities. Dr. Stuart Rojstaczer reported on 29 schools, showing and increase of 0.15 points on the 4 point GPA scale since the 1960s, with greater rates on increase in private versus public schools (Grade Inflation at American colleges and universities. Available at www.gradeinflation.com).

The University of Arkansas was concerned enough about grade inflation that it commissioned a Task Force on Grades in 2004 to examine the phenomenon. The results, reported by Mulvenon and Ferritor (International Journal of Learning 2005/2006;12(6):55) confirm steadily increasing undergraduate GPAs, increasing from 2.76 to 2.95 between 1992-93 and 2003-04.

 

What’s the cause?

So, it seems, this is a real phenomenon, but what’s the cause? One could conjecture three possible mechanisms:

 

Possibility 1: The students are better prepared.

Over the years, young people have had greater access to early education and have been exposed to more advanced educational methodologies. They have also had the benefit of rapidly expanding technology that not only enhances their educational experience but also enables them to access information and learning much more continuously and easily. In fact, young people are literally immersed in learning opportunities, both inside and outside the classroom. They have also had opportunities to engage more intellectually stimulating extra-curricular learning opportunities, both through the educational system and their private lives. Perhaps all this has resulted in young people who begin their post-secondary education with considerable advantages relative to their predecessors.

 

Possibility 2: Universities and colleges are doing a better job of educating.

There has certainly been an increased emphasis on teaching at most colleges and universities. Faculty are expected to have real teaching skills and qualifications, which are sought after and recognized. They have also benefited greatly from advances in educational methodologies and technologic advances.

All sounds good so far, but then there’s…

 

Possibility 3: It’s just easier for everyone involved to give good marks.

Good marks = happy students = fewer challenges for faculty = better faculty evaluations = happy faculty

We therefore have a “virtuous cycle” which would, on the surface, appear to be a “win-win” for all involved. The course, program and institution also benefit in an environment where pass rates are seen as a key marker of success (eg. Macleans magazine rankings) and students are drawn to places where they are more likely to achieve high grades that will make them more competitive for graduate studies and eventual employment.

Unfortunately, there’s been much less investigation into the causes of grade inflation. However, there have been some interesting analyses.

In an intriguing article entitled “Whose fault is it?” R.T. Jewell and colleagues attempt to determine whether higher grades are related to improved academic aptitude of students or changing practices among university teachers (Applied Economics 2013; 45: 1185). Using data from 1683 separate courses taught in 28 different departments by 3176 instructors at a large public university over a 20 year period they develop a series of complex mathematical models that leads them to conclude that “the average GPA in our sample…increased by 0.1459 grade points due solely to unobservable instructor characteristics.” They go on to identify instructor-specific issues as the main determinants of grade inflation. Their analysis did not allow them to be more specific about the nature of those characteristics.

In the Arkansas Task Force reported cited above, the authors speculate on a number of potential causes, including higher entrance ACT scores, but conclude “ a definitive case can be made that increasing entrance scored, academic expectations and better secondary institutions are contributing increased composite grade point averages. However, given this is true, it still does not explain all of the grade inflation”

 

And so, it would appear that the third cause where students, faculty and universities all benefit from a more liberal distribution of grades is at least a contributor.

 

Does it matter?

In one respect, it might be tempting to shrug this off as a “win-win-win” situation, in which students benefit, teaching faculty avoid the inherently difficult and stressful task of comparing and quantitating differences in the accomplishment of their learners, and institutions can develop flattering metrics that keep them competitive.

However, we recognize there’s no free lunch, and there are clearly costs to all this that merit consideration. A few that come to mind:

  1. Devaluation of degrees and diplomas. Just as our dollars lose value in the context of economic inflation, grade inflation threatens to diminish the value of our degrees and diplomas
  2. Fairness. The truly outstanding and highly committed students get lost amid all the high marks. Some of those A’s really are A’s, but can’t be distinguished from those that perhaps shouldn’t be.
  3. Misconceptions among students. Grade inflation may be giving students misinformation regarding their strengths and weaknesses, and therefore leading them to inappropriate career decisions.
  4. Confusion on the part of downstream programs and potential employers. Providing misleading academic profiles can lead to poor selections, which, ultimately, are unfortunate and potentially very damaging for all involved. What may seem like a charitable act can therefore turn out to be quite the opposite.

 

In case I’ve left anyone with the impression that this is an entirely modern phenomenon, let me end by quoting a report from the Committee on Raising the Standard, commissioned by Harvard University officials in 1894:

 

“Grades A and B are sometimes given too readily – Grade A for work of not very high merit, and Grade B for work not far above mediocrity”

 

If that group stemmed the tide, it would appear from recent studies that the issue has re-emerged.

Getting back to the question I initially posed at the beginning of this article, all this may provide some solace to my classmates, but as an institution that prides itself on high standards and academic excellence, should we be concerned?

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

 

Many thanks to Sarah Wickett, Health Informatics Librarian, Bracken Library, for her valuable assistance in the compilation of information for this article.

 

 

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