Medical Student Research Showcase September 20

By Drs. Heather Murray & Melanie Walker

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

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

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

This year’s faculty judges included:

Dr. Stephen Pang

Dr. Sheela Abraham

Dr. Nishardi Wijeratne

Dr. Faiza khurshid

Dr. Graeme Smith

Dr. Olga Bougie

Dr. Susan Crocker

Dr. Michael Rauh

Dr. Prameet Sheth

Dr. Yuka Asai

Dr. Thiwanka Wijeratne

Dr. Jennifer Flemming

Dr. Anne Ellis

Dr. Tim Phillips

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

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

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

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

 

 

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Improving teaching, one slide at a time…

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

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

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

Like how many slides is too many?

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

I use four guiding questions to think about presentation slides:

  1. How are you going to use them?

  2. How are your learners going to use them?

  3. What else are you going to provide?

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

 

How are you going to use them?

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

How are your learners going to use them?

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

What else are you going to provide?

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

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

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

 

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

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

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

Reach me at theresa.suart@queensu.ca

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Welcoming Queen’s Meds 2022

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

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

Dr. James Sampson

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

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

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

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

Photo by Lars Hagberg

.

A few facts about our new colleagues:

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

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

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

Universities of Undergraduate Studies

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

 

Undergraduate Degree Majors

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

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

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

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

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

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

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

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

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

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

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

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

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

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

By Dr. Stephen Archer

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

Dr. Emily Howard Stowe (née Jennings)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

The goals of our Women in Medicine program are to:

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

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

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

1st Annual Event:

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

2nd Annual Event:

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

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

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

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

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

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

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

 

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

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

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

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

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

 

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

 

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

 

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

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

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

 

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

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

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


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


Resources: 


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


 

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Of Robots, Worms and Youthful Inspiration

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

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

That connection begins with one Victor Scheinman.

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

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

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

 

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

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

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

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

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

 

 

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

 

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

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

 

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

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

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

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

 

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Don’t skip over getting ready

When I was a teenager, my Dad had a poster in his high school vice-principal office that featured a picture of a bird’s nest with blue eggs in it. The caption read: “most of life is getting ready.”

I really didn’t like that poster because it was all about patience and I was all about getting on with the next thing. I was always about what comes next: finish high school, go to university, get the job.

It took a long time for those lessons in patience to sink in and for me to accept that much of life is getting ready. And a lot of the getting ready is hidden, behind the scenes, like what’s going on in those blue eggs in that poster’s nest.

It’s a lot like how we spend our summers when we’re involved in teaching that follows the traditional academic year cycle (which excludes our clerks and clerkship faculty who learn and teach year-round).

At UG, especially for the upcoming pre-clerkship academic year, we spend a lot of the summer getting ready. The Education Team, Course Directors and teaching faculty are looking at course evaluation reports and looking at where improvements and changes are needed. The Curricular Coordinators are getting everything set in MEdTech so things run smoothly. And a multitude of other behind-the-scenes support team members are quietly getting on with getting ready. While the end results of all this preparation are evident, the tremendous amount of work involved usually isn’t.

For planning purposes, we need to think ahead, look at the big picture and always be thinking of the next thing. But for teaching and learning, being in the moment matters, too. And, sometimes, you’re in the moments that are about getting ready.

Sometimes we dismiss the “getting ready” stage as a holding pattern, as mere waiting. It’s not the “good stuff” or the “important stuff”. But getting ready is every bit as important as what comes next. Without getting ready, the good stuff can’t happen.

Think about the last big celebration you took part in (maybe for a birthday or special holiday). Did it involve presents? Did you take some time to find the perfect gift, picking out wrapping paper and bows, maybe a special card? Did the recipient take a moment to appreciate that effort or tear right in? Maybe you were the recipient. Did you savor the moment, or dive right in? My Mom always insisted we read the card first, how about you? Regardless of slow savoring or exciting unwrapping, it was a special moment, that made the preparation – the getting ready – worth it.

Sometimes getting ready is taking a breather (as we hope our pre-clerkship students are doing with their summer!) or augmenting skills, and sometimes is doing all the necessary preparation to make things run smoothly for the “big” event. It’s important to recognize that, from a pedagogical perspective, this getting ready – either course prep, or “introduction to” instruction – isn’t wasted time, but necessary steps along the way.

So be in the moments of getting ready.

Meanwhile, we’ll get back to work reviewing course evaluation feedback, revising preparatory materials and SGL sessions. Looking at which learning event worked well and which need some tweaking and which need a major overhaul. Are assessments well-mapped to learning objectives? Is the rubric clear or can we improve that? What about annotating those objectives….

(And, as always, if you’re in need of help with any of the above, get in touch. We’re here to help).

 

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This post is about nothing

I discarded quite a few topics for this week’s post as I didn’t want to “waste” a key topic on the “downtime” for many of our faculty and students of the summer break between semesters (excluding all those students and faculty involved in Clerkship, of course).

Sure, I could write about learning objectives, and active learning strategies, or assessment tools and rubrics, but these informational items would likely be missed by quite a few people off on summer pursuits.

And, really, I want you to miss them as anyone’s holiday break (however long or short) should be used to pursue as little as possible. A few years ago, when I was teaching at Loyalist College, I had students ask me what I wanted them to work on over a holiday break. It turns out my colleagues had given several detailed assignments. Firmly believing in the need to relax and recharge, I told them I wanted them to sleep in and eat cookies for breakfast. (I got pretty good instructor evaluations that year; I hope it wasn’t just about the cookies).

So for this post, I thought to myself: “I should write about the benefits of doing nothing”. A short Google search later, I’ve discovered this is hardly a unique idea – and there’s evidence-based research to back up these benefits.

In fact, in a 2014 Forbes article, Manfred Kets De Vries pointed out that “slacking off and setting aside regular periods of ‘doing nothing’ may be the best thing we can do to induce states of mind that nurture our imagination and improve our mental health”.

An Australian blogger drew attention to a study by Bar-Ilan University that demonstrated that daydreaming correlates with performance. “They found a wandering mind does not hamper the ability to accomplish a task, but actually improves it by stimulated a region of the brain responsible for thought-controlling mechanisms.” (Read more about that study here.)

Other research points to relaxing (i.e. doing nothing) being good for your heart, fighting the common cold, maintaining a healthy weight, sleeping better, and contributing to improved mental health.

Pico Iyer, author of The Art of Stillness: Adventures in Going Nowhere wrote of the virtue of doing nothing in a 2014 CCN article. He noted: “It’s an old principle, as old as the Buddha or Marcus Aurelius: We need at times to step away from our lives in order to put them in perspective. Especially if we wish to be productive.”  (Watch his Ted Talk, where he emphasizes the benefits of stillness, here: https://www.ted.com/talks/pico_iyer_where_is_home)

So, the next time I post, I’ll have more tips and tools for your educational toolbox. In the meantime, focus on wellness and, well, doing nothing. You can start with this slide show of Ten Ways to Enjoy Doing Nothing.

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Dynamic Learning Environments – not just for academic centres

Several years ago, the Association of American Medical Colleges (AAMC) developed and publicized a statement on the learning environment.

 

The statement nicely articulates three key points about effective medical learning environments:

  • Medical education and exemplary patient care go hand-in-hand.
  • They feature a pervasive atmosphere (dare I say “culture”) of mutual respect and collaboration on the part of all involved in the delivery of patient care.
  • Everybody involved is both a learner and a teacher, and feel free and comfortable in both roles.

Lofty goals and expectations, to be sure. In fact, the skeptical among us may consider these to be merely aspirational statements, expressing unachievable ideals.

I’m pleased to report that this is not the case. In my experience, I often encounter learning environments that are nicely meeting those lofty goals. Most commonly, these are in large teaching hospitals where available resources, space and academic focus combine to produce close-to-ideal learning environments. Recently, I had the opportunity to see similar success in a much smaller site.

I attended the Third Annual Georgian Bay Healthcare Wellness Research and Innovation Day held at the Collingwood General and Marine Hospital.

 

Organized by Collingwood Chief of Staff Dr. Michael Lissi and supported by Dr. Peter Wells and Program Manager Michelle Hunter of the Rural Ontario Medical Program, this year’s theme was Geriatrics and involved a thoughtful panel discussion followed by a series of very well-qualified and engaging speakers.

 

The hospital cafeteria, re-purposed for the occasion, was standing-room-only as about 150 folks from all areas of the health care community, as well as interested local residents, packed the room and contributed to the discussion. The sessions were live-streamed to several sites.

In addition to the presentations, hospital corridors were used to feature about 60 posters featuring studies carried out by local practitioners and learners working in the community.

I was there largely because two of our students who are in Collingwood completing placements.

Meds 2019 students Daniel Weadick and Claire Tardif

Claire Tardif and Daniel Weadick of Meds 2019 are, by all accounts, both enjoying the experience and learning a great deal. They’re integrating well into that local learning environment, working with multiple physicians, other learners and health care providers. Dan summarized it all rather effectively. In his own words “there’s a lot to like”.

 

For me, the whole experience was a little surreal. Having grown up in Collingwood and worked in the various jobs in and out of the local hospital, I found myself reviewing posters and meeting local physicians in the same rooms and corridors in which I’d made deliveries and portered patients many years ago.

 

 

 

Medical education theorists have described the learning process in many ways, but all agree that the knowledge and skills

with conference organizer and Collingwood Hospital Chief of Staff and surgeon Dr. Michael Lissi

learned through largely classroom and simulated settings are insufficient unless integrated and applied to real patients. That process of application must be progressive, beginning with highly supervised settings where learners can begin to experience clinical care and decision making in safe and nurturing environments, while at the same time allowing them to progress to increasing levels of independence as their skills and growing confidence allows. For the medical student, highly-structured and learner-dense academic hospital settings are certainly valuable and essential, but may provide unintentional “ceilings” to professional development, and limit the appreciation of continuity of care that occurs outside the specialized ward and is so critical to patient outcomes. Community placements in smaller centres can complement their learning by providing that context.

 

In the end, medical education is fundamentally about providing and identifying environments where motivated, talented students can encounter generous and welcoming practitioners in settings that strive to provide excellent patient care and learning for all involved.

 

I’m pleased (and perhaps a little proud) to say that my home town is one of those places.

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The Twelve Roles of Teachers

(This post summarizes key points from AMEE Guide No 20: The good teacher is more than a lecturer–the twelve roles of the teacher by R.M. Harden & Joy Crosby)

In our talk of teaching, we often focus quite narrowly on classroom-based teaching – team-based learning (our SGL) and lecturing – and on clerkship seminars and bedside teaching. By doing so, we can overlook some of the other roles required in medical education.

In fact, there are 12 roles of teachers in medical education and each is worth exploring.

Harden and Crosby (2000) identified these 12 roles based on their analysis of “the tasks expected of the teacher in the design and implementation of a curriculum in one medical school”; a study of “diaries kept by 12 medical students over a three-month period”, which analyzed their comments on teacher roles; and from other literature on the roles of teachers in medical education (p. 336). They then validated the 12 roles they identified using a questionnaire completed by 251 teachers at the University of Dundee Medical School.

Harden and Crosby grouped their 12 roles into six areas of activity (two roles each) and further noted which roles required medical expertise and which teaching expertise and which involved direct student contact, with the remaining with students at a distance to the activity.

How many of these areas of activity and roles do you recognize in your own teaching practice?

Information provider – lecturer, clinical or practical teaching

“The teacher is seen as an expert who is knowledgeable in his or her field, and who conveys that knowledge to students usually by word of mouth,” they note, pointing out in all contexts the teacher selects, organizes and delivers information.” They stress that “The clinical setting, whether in the hospital or in the community, is a powerful context for the transmission, by the clinical teacher, of information directly relevant to the practice of medicine.” (p. 337)

Role model – on-the-job role model; teaching role model

“Students learn by observation and imitation of the clinical teachers they respect. Students learn not just from what their teachers say but from what they do in their clinical practice and the knowledge, skills and attitudes they exhibit,” Harden and Crosby wrote (p. 338). This role modelling extends to classroom-based activities, too:  “The good teacher who is also a doctor can describe… to a class of students, his/her approach to the clinical problem being discussed in a way that captures the importance of the subject and the choices available.” (p. 339)

Facilitator – learning facilitator; mentor

“The introduction of problem-based learning … has highlighted the change in the role of the teacher from one of information provider to one of facilitator. The teacher’s role is not to inform the students but to encourage and facilitate them to learn for themselves using the problem as a focus for the learning.” (p. 339)  Harden and Crosby note that the mentor role, while highly valued “is often misunderstood or ambiguous” (p 339) but suggest “the mentor is usually not the member of staff who is responsible for the teaching or assessment of the student” and that “Mentorship is less about reviewing the student’s performance in a subject or an examination and more about a wider view of issues relating to the student.” (p. 339)

Assessor – student assessor; curriculum evaluator

“The assessment of the student’s competence is one of the most important tasks facing the teacher,” they note. “Examining does represent a distinct and potentially separate role for the teacher,” they added, noting: “It is possible for someone to be an ‘expert teacher’ but not an expert examiner.” (p. 340)

“Monitoring and evaluating the effectiveness of the teaching of courses and curricula is now recognized as an integral part of the educational process. The quality of the teaching and learning process needs to be assessed through student feedback, peer evaluation and assessment of the product of the educational program.” (p. 340).

Planner – Course organizer; curriculum planner

For Harden and Crosby, curriculum planning and organizing courses goes hand-in-hand. The note that “Curriculum planning presents a significant challenge for the teacher and both time and expertise are required if the job is to be undertaken properly” (p. 341) while being an essential first step. This is closely followed by the importance of planning on the individual course level:  “The best curriculum in the world will be ineffective if the courses that comprise it have little or no relationship to the curriculum that is in place. Once the principles that underpin the curriculum of the institution have been agreed, detailed planning is then required at the level of the individual course.” (p. 341).

Resource developer – study guide producer; resource material creator

The increasing importance of the role of resource material creator helps students navigate in increased amount and quality of information available. “With problem-based learning and other student-centred approaches, students are dependent on having appropriate resource material available for use either as individuals or in groups.” (p. 341). The role of curator, through structured study guides, also helps navigate these resources: “Study guides…can be seen as the students’ personal tutor available 24 hours a day and designed to assist the students with their learning. (p. 341).

 

At different times, you may be called upon to fill any or all of these roles. If you’re interested in exploring any of them further, get in touch. I’m here to help you with all aspects of your teaching practice.

 

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Lectures aren’t inherently bad

In a pedagogical quest for active learning, we’ve somehow cast lectures in the role of arch-villain.

I’ve had conversations with faculty about their teaching which have started out with: “I know lectures are bad, but…”

This is definitely the case of a pendulum swinging too far. While research definitely supports active learning as the optimal way for students to retain learning – applying new knowledge either to simulated or real scenarios – the initial learning has to come from somewhere, and lectures are one of these sources.

Because of our focus on improving small group learning/TBL sessions in our curriculum, I can seem to be anti-lecture. The truth is, I’m actually a closet lecture aficionado. I own DVDs and CDs from The Teaching Company’s “Great Courses” series and love CBC’s Ideas. And the proliferation of podcasts has fed my love of lectures even more, as podcasts are nothing if not fabulous lectures. And TED Talks, who hasn’t lost a few minutes to those? Really, the world loves a good lecture.

Lectures absolutely have a place in universities in general and in medical education specifically. While we can’t – and don’t want to – return to a curriculum with 100% (or near to it) lectures, we can keep great lectures in our menu of methodologies to provide students with optimal learning experiences.

If you’re planning a lecture, or looking to improve an existing one, here are some things to consider:

Why do you want to do a lecture?

It’s ok if it’s just your first instinct, but think beyond that. Is this the best way to convey your content? How will providing this content in a lecture format enhance students’ learning?

Are you comfortable with the mechanics?

Lecturing is a skill which improves with practice. There are certainly standard “do’s” and don’ts”. For example, Don’t read your own slides; don’t keep your nose down in notes. And the classic: Don’t be boring. If you aren’t comfortable, do you have a plan to improve?

How can you keep things fresh and interesting for an hour or more?

Research on attention habits tell us that after 20 minutes of sustained listening, it’s hard to stay focused. With this in mind, how can you pace you lecture to break things up? Consider things like polls (with our PollEverywhere account), short think-pair-share activities, or other creative ideas. At least one instructor I know shows short topic-related videos and has the class stand up to watch them to get everyone out of their standard sitting positions.

What’s your follow-up plan?

If you think of lectures as content delivery, what’s your plan for students to be able to apply this new knowledge? Does your lecture lead into an application session in your own course or in another one? If you’re not the instructor for the follow-up session, be sure to coordinate with the person who is.

As with all your teaching endeavours, you’re not on your own. Get in touch – I’m here to help!

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