When I was a young father fretting about whether I was doing all I could to advise and guide my children, a very wise man provided some sage advice. “If there’s one thing I know about young kids, it’s that they don’t listen to much of what you say, but they watch everything you do.” His point was that we teach through example. Our behaviour, the decisions we make and the principles that we rely upon to guide those decisions are what really matter. They are what impress and persist in the memory of learners.
That advice has withstood the test of time and, I’ve found, extended beyond parenthood to influence my perspectives on medical education. As factual information becomes more widely and easily accessible, medical students have less and less need for didactic teaching, but more and more need to understand how to manage that information and, importantly, how to “live the life” of a practicing physician. How decisions are made. How uncertainty is engaged. How stress and fatigue are managed. They’re watching, and they’re very astute observers.
All this has never been truer than during the current COVID-19 crisis.
The roles and routines of our students have been altered dramatically. In a short period of time, the first and second years have shifted from a curriculum featuring predominantly whole-class presentations, small group learning and regular clinical skills sessions with standardized and volunteer patients, to a remotely delivered curriculum that they’re accessing individually from their homes scattered across the country. Clinical Skills is being “parked”, to be made up when circumstances allow, in a manner not yet determined.
Our final year students have, fortunately, completed their clinical rotations and are also utilizing remote access to complete their curricular requirements. They are on schedule to graduate and enter their residencies July 1, but are facing adjustment and disappointment, with the cancellation of Convocation ceremonies, delay of the MCC Part 1 examination to some future date, no doubt after they start residency, and the uncertainty of what sort of hospital environment they will be engaging.
Perhaps the greatest impact has been on our third year class. About three weeks ago, we had to make the very difficult decision to suspend their clinical placements. This was not because of a lack of perceived value, but because the simple logistics of maintaining safe and educationally viable experiences in the face of the stresses currently being faced by our hospitals and faculty became insurmountable. For them, we are developing a completely original on-line, remotely delivered curriculum intended to provide learning that would normally have been undertaken in conjunction with their clinical placements. By doing so, we hope to be in a better position to complete their training within whatever time remains when clinical placements are eventually resumed.
How has all this been possible? Two simple answers: people and technology.
Our curricular leadership has taken on this unprecedented challenge with great creativity and tenacious dedication. Our newly appointed Assistant Dean Curriculum, Dr. Michelle Gibson, as well as Year Directors Drs. Lindsey Patterson, Andrea Guerin, Heather Murray, Susan Moffatt and Andrea Winthrop have all stepped up despite their own individual obligations at this time to develop and manage this transformation. Assistant Deans Hugh MacDonald (Admissions), Renee Fitzpatrick (Student Affairs) and Cherie Jones (Academic Affairs and Accreditation) have all overseen adjustments in their respective portfolios.
Our administrative staff has managed all this with dedication, a cooperative spirit and good humour. Although working remotely in compliance with university directives, they have managed to maintain excellent working relationships and communication.
All this has largely been made possible through technologic advancements that have been under steady development for the past few years. Zoom technology, in particular, is what makes remote educational delivery possible. Our faculty has engaged this with remarkable alacrity, even the technology-challenged (myself, for example). This past week, I was able to hold a virtual Town Hall with 76 members of the fourth year class, in which I was able to both update them about key issues and hear from them on a variety of topics.
It also makes it possible for our administrative staff to “get together” for daily meetings to ensure the curriculum is being delivered effectively, and all administrative aspects of the program are attended to.
Curricular Coordinators Tara Hartman, Tara Callaghan, Jane Gordon, Vanessa Thomas, Assessment Coordinator Amanda Consack, Educational Developers Theresa Suart, Eleni Katsoulas, Student Affairs Coordinator Erin Meyer, Standardized Patient Manager Eveline Semeniuk, Admissions Team Rachel Bauder and Kristin Baker, Facility Manager Jennifer Saunders, Student Support Assistants Dana Halliday and Jessica Griscti and UG Program Manager Jacqueline Findlay are all managing their areas of responsibility with great skill at this most difficult time.
What makes the technology possible is the remarkable skill and dedication of our IT support staff, headed by Peter MacNeil.
All this is certainly impressive and worthy of recognition but, it must be recognized, it is far too early to celebrate or claim any victory. This crisis is far from over. In the weeks and months ahead, there will no doubt be new, vexing challenges that come our way. It is nonetheless appropriate to pause and recognize the efforts being made by so many, and to take comfort in the knowledge that we have the capacity and dedication to engage change.
It’s also appropriate to consider some early lessons that are emerging.
Education continues. Even if there were no formal structures or sessions in place, our students are witnessing a unique event. Their training to date allows them insights they otherwise wouldn’t have. In essence, the crisis itself is the curriculum. They are observing and learning. Much of that learning will relate to how the medical community is engaging the crisis, both collectively and individually. As I was told so many years ago, it’s not what we say but what we do that will persist.
We’re adaptable. Problems that seemed insolvable a short time ago are being solved. Impenetrable barriers are being easily breached. We’re learning to do things we didn’t have either the motivation or inclination to learn previously. And it’s working.
Communication is critical. The need to communicate efficiently and clearly has never been more apparent, or critical. Technology has allowed this to happen and, thankfully, was available when needed.
Opportunities are emerging. Circumstances are causing us to engage issues that have previously been ignored because the solutions seemed too disruptive and risky. We’re now forced to take on those issues by necessity and are beginning, in some cases, to find that those misgivings were preventing us from engaging valuable alternatives. Case in point, the role and electives in medical education will require a re-thinking and re-imagining that’s been long overdue.
And, most importantly…
Medical Students belong in the clinical workplace. All the efforts to maintain formal education remotely are certainly of great value and allow us to ensure our students are progressing in their basic learning, but it does not substitute for active engagement in the workplace. Students themselves, all across the country are coming forward to provide what service they can. They are providing home support for busy clinicians. They are manning phone lines for Public Health. They are collecting valuable equipment for use in hospitals. They’re donating blood to address current shortages. Over and above all this altruistic volunteerism, it’s becoming increasingly clear that there are many very useful roles they can play within the clinical workplace. Every medical school in the country is working tirelessly to determine when they can re-enter safely and in a supportive learning environment. Unfortunately, that doesn’t seem imminent at the time of this writing.
Finally, it must be recognized that the students of today will be the leaders and front-line providers of whatever health care crises face our society in the future. We must not deny them the learning that this crisis provides. By “watching everything we do” and through active involvement, they will emerge better prepared to engage the challenges the future.