Third annual History of Medicine Week starts April 23

The What Happened In Medicine (WHIM) Historical Society is proud to host the third annual History of Medicine Week! This year’s theme is inspired by Dr. Duffin’s Heroes & Villains assignment, where students must grapple with some controversial characters in our history. Students, Faculty, and Community members are all warmly welcomed to attend any and all events! Please join us during the week of April 23rd for four exciting events:

Museum of Healthcare Showcase 

Monday, April 23rd (8:30AM – 3:00PM)
Grande Corridor, New Medical Building, 15 Arch St.

Hero or Villain? You be the judge! Wander through the Grand Corridor of the New Medical Building and enjoy the showcase curated by the Museum of Healthcare. At your leisure, take a look at artifacts of some of history’s biggest medical heroes and villains.

Panel Discussion

Tuesday, April 24th (5:30PM – 7:30PM) 
132A, New Medical Building, 15 Arch St.
Don’t miss out on our most controversial event of the week! After a half hour period to gather refreshments and FREE food, a panel, moderated by the incredible Dr. Jenna Healey, resident Queen’s Hannah Chair of the History of Medicine, will question the basis for a designation of hero or villain. The panel will begin with Dr. Jaclyn Duffin, haematologist, historian, and past Hannah Chair of the History of Medicine, describing why and how she invented the Heroes and Villains project as an introduction both to history in medicine and to information literacy — with some of its triumphs and disasters. Next, Dr. Allison Morehead, Associate Professor and Graduate Coordinator of Art History at Queen’s University, will talk about Florence Nightingale and the “incursion” of women into the “fraternity” of medicine in the 19th and 20th centuries, as well as the ways in which historical accounts of Nightingale heroicize (or angelicize!) her to the exclusion of other figures in the history of nursing, such as Mary Seacole. Closing the panel is Edward Thomas, PhD candidate in Cultural Studies at Queen’s, will discuss his research examining Queen’s barring of black medical students between 1918 and 1964 in regards to how institutional narratives shape organizational memory and culture. 

Open Mic Night 

Wednesday, April 25th (7:00PM – 9:30PM)
The Grad Club, 162 Barrie St
Need an outlet for your historical arguments? Ready to re-enact your heroes and villain assignment? Want some free beer and endless historical entertainment? Come out to the Heroes & Villains: Open Mic Night! A relaxing event, some fantastic entertainment, and a wonderful evening spent with your Queen’s peers, what more can you ask for?!

Movie Night: History of Kingston Psychiatric Hospital

Thursday, April 26th (5:30PM – 7:30PM) 
032A, New Medical Building, 15 Arch St.

Don’t miss out on this weeks closing event! We will be screening the film “The History of KPH” by Queen’s Film Studies’ own Janice Belanger. Come to learn more about the Kingston Psychiatric Hospital, and have a relaxing end to this jam-packed week!

 

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Actors, musicians & dancers?? QMed is gearing up for the 48th annual Medical Variety Night!

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By Edrea Khong, MVN co-director

It’s that time of year again! Medical Variety Night (MVN) is the School of Medicine’s annual charity variety show featuring UGME student performers from across all four years of training. This year’s theme, So You Think You Can Match, was selected by popular vote amongst the students and is a spin on the popular television show, So You Think You Can Dance. The theme may be particularly apropos yet contentious right now, given the increasing difficulties surrounding the CaRMS match. However, while the show is sure to feature references to this, it certainly is not the focus. The spotlight will remain on the performers, and the show aims to celebrate all that is Queen’s Medicine.

Wandering the halls of the School of Medicine during after-class hours, one may be treated to a glimpse of the beautiful madness that is MVN preparation. From large group dance rehearsals for hip-hop, contemporary (new this year!), or Bollywood, to table-reads and short filming sequences for class skits, the students have been working tirelessly to perfect their acts for the show. The acts seem to get bigger and more elaborate each year, and this year’s line-up surely will not disappoint!

As always, details about the act set list are being kept tightly under wraps, but showgoers can be assured that there will be a great variety with something for

MVN 2018 Directors Edrea Khong, Daisy Liu, Emily Wilkerson, & Charlotte Coleman

everyone. In addition, although there will be some “medical culture”-styled humour, the show is designed to be accessible by and entertaining for all. In the past, the show has been very well attended by people outside of the “Medicine Bubble™” to rave reviews.

Outside of the performers, there are many others who have been hard at work on the show, such as the promotions, tech, and backstage crews already doing vital behind-the-scenes work in preparation. In addition, Edrea Khong and Daisy Liu (2020s) have been joined this year by Charlotte Coleman and Emily Wilkerson (2021s) as the MVN 2018 Directors. The four have spent countless hours since mid-September organizing and preparing for the show. With the two-week countdown now underway, they are hard at work ensuring the show runs as smoothly as possible. During the show week, many more students will also lend a hand as bakers, ushers, ticket takers, raffle sellers, and much more. MVN is a project of love, dedication, and talent from all of QMed.

MVN 2018 Emcees Roya Abdmoulaie & Lauren Mak

All proceeds from this year’s show are going to Kingston Interval House, an organization committed to supporting women, children, and youth experiencing violence and working collaboratively with the community to eliminate all forms of violence and oppression. While great strides have been made worldwide towards establishing greater equality especially in these past few months, there is still much to be done and services like these are so vital. The decision to support Kingston Interval House feels very apt. In addition to ticket sales, MVN depends on the generosity of the Kingston community and Queen’s faculty. Raffle prizes featuring local Kingston businesses and a bake sale featuring QMed culinary talent can be found at the shows. Donations are also being accepted on the MVN website, with donations of $50 or greater receiving a tax receipt.

MVN 2018 takes place on April 6th and 7th at Duncan McArthur Hall (511 Union St.), with doors opening at 6:30PM and the show starting at 7:00PM both evenings. Tickets can be purchased for $13 on the MVN website, or for $15 at the door.

Get excited for a fantastic evening of performances celebrating another year of Queen’s Medicine! Gather your family and friends and purchase your tickets to MVN 2018 today. Looking forward to seeing you at the show!

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The Evolution of SPs and The Standardized Patient & OSCE Program

Open House at Queen’s School of Medicine

Clinical Teaching Centre

Monday, March 26 from 1:00-4:00 pm

By Kate Slagle, SP & OSCE Program Manager

When I’m out in public and people ask what I do, I tell them what a standardized patient is which is typically met with a perplexed look to which my husband chimes in with, “Have you ever seen that episode of Seinfeld where Kramer works with the medical students?”

Although this parallel makes me slightly cringe they start to think about how standardized patients (SPs) — actors who are trained to convincingly portray the physical, historical and emotional features of a real person for educational purposes — can be applied across all fields.

For the past five years I have had the privilege of managing the Queen’s SP & OSCE Program and on a daily basis get to see the rewards SP simulation provides our students, such as:

  • Improved interviewing skills
  • Gained confidence in discussing difficult topics and de-escalating conflict
  • Empathy to deliver difficult news
  • Refined physical exam techniques and maneuvers
  • Next level, critical thinking
  • Constructive feedback and much more!

Over the past few years the request for SP encounters within the Faculty of Health Sciences has exponentially increased as well as interest from organizations outside the university. The time came when we had to ask ourselves, “What do we need to do to take our program to the next level and offer SP services outside the Faculty of Health Sciences?”

If we were going to expand we wanted to do things right. Over the past year we’ve been working with the university to formally expand the program to:

  • Continue to provide high quality SP sessions and work in partnership to develop new sessions within the Faculty of Health Sciences.
  • Offer SP services to the wider university and Kingston community.

The infrastructure is now in place and we’re ready to open our doors. The launch is set to begin this month with an open house for new and existing clients at the Queen’s School of Medicine Clinical Teaching Centre on Monday, March 26, 2018 from 1:00-4:00pm.

Although during the open house you won’t be hearing from Kramer, you’ll be able to hear from real SPs and learn more about what the program has to offer. We look forward to seeing you then.

Important Links

Facebook event link: https://www.facebook.com/events/155933065095723/

Queen’s Event Calendar Link: http://www.queensu.ca/eventscalendar/calendar/events/standardized-patient-osce-program-open-house

SP & OSCE Program Website: https://meds.queensu.ca/academics/spprogram

Video linkhttps://www.youtube.com/watch?v=lDd6vsmLhwg

The Burning” is the 172nd episode of the NBC sitcom Seinfeld. It aired on March 19, 1998.

 

 

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Five ways being a Geneticist helped me improve my teaching skills

By Andrea Guerin, Year 2 Director and Clinical Geneticist

Dr. Andrea Guerin

When growing up, the career choices offered are often dichotomous, do you want to be a lawyer or a firefighter, nurse or entrepreneur, doctor or teacher? In reality, most jobs are a blend of a few different skills. In medicine, doctors can be scientists, can run a business, and for most of us, being a teacher is a large part of our job. At first blush, being a Geneticist and a teacher doesn’t seem to have much in common, but my training in Medical Genetics has significantly influenced my role in education. Here are five examples I’d like to share:

  1. Words matter

Geneticists are wordsmiths. Language is very highly selected, “cause” not “reason”, “typical” not “normal” and “chance” not “risk”. The language I use with my patients is specific and inclusive, positive and hopefully, precise. Words are important, to convey meaning without an agenda, to educate without prejudice. I use the same thought in the classroom. I am mindful of the implicit biases that can be drawn from words. Words are powerful and their power needs to be recognized and headed.

Medicine is learning a new language. So is education. I’m not going to lie, I had never designed a small group session before coming to Queen’s and I certainly did not know what a Directed Independent Learning event was. When I came, I was disoriented, DILs, SGLs, RATs, GTAs. The terminology was overwhelming. But, like learning the language of medicine, I learnt the language of education too. We’ve added a few more in the past year in undergraduate medical education CBME, EPA, with only more to come.

  1. Technology is forever changing, but good ideas stand the test of time

When I started my residency 10 years ago the understanding of genetic testing was very different. Many tests were not available. Testing was laborious, going from gene to gene, with months of anxious anticipation in between. Now, a decade later, I can order a test that looks at all the necessary genes of the body that have a purpose. Results can be available more quickly. Interpretation is more of a challenge, as we learn more, it becomes more evident the gaps in our knowledge and tying findings to patient symptoms can be a challenge. The concept of having parents and environment contributing to the health of the child is an old one, with influences from Ancient Greece to India. This testing is a reinvention of an old idea — we have only identified the individual factors (genes) that support what has been seen for thousands of years.

When I went to medical school, problem based learning was new. Powerpoint was a staple of lectures. There were almost no laptops. We would never have thought to work in groups while in the same classroom. That was an activity reserved for afternoon sessions, segregated into rooms under the watchful eye of a faculty facilitator. Marks were given from formal assessments, not team assignments or readiness assessment tests. That’s not to say assessments were not happening, they were just less formalized. It was a gut feeling. Did the clinical skills tutor think you were professional? Did the small group facilitator see that you participated? Now, assessments, both summative and formative are happening all the time. The actual process has become more concrete and transparent, but the idea has not changed.

  1. It’s all developmental

Genetics is  one of only a few specialties where the patient population spans from before cradle to grave. When I see a patient with a concern, I endeavour to find out when it started. An understanding of development, both physical and emotional, is key to my practice. You must walk, before you run.

Education is no different. The expectation must be adjusted to where the student is in their education journey. It’s okay to not know the differential in the first year, but in fourth year, students must be equipped with the knowledge and expertise to generate a differential and initiate management. Expectations need to match where the learner is, just like my patients.

  1. No person is an island

Genetics is a team sport. In clinic, amongst clinician and researchers spanning the province, country or world, we work together to solve diagnostic mysteries and provide good patient care.

Education is the same. Teachers, admin support, education support, technical support and student support and feedback are essential to the teaching process. Behind every teacher, there is a team supporting them in their journey.

  1. Comfortable with the uncomfortable concept of unknowns

After years of education, I will never be done learning. There is always more to learn, and no physician, despite years of practice and experience knows everything. When I counsel patients I always raise the possibility of an unknown. A confusing result, a question left unanswered. There is no crystal ball.

Education continues to surprise me, but I am open to the concept of something new, unknown. Can we produce excellent physicians using different teaching methods? Of course we can. Each of my colleagues had different curricula, different forms of instruction. There is more than one way to teach — the “best way” is still unknown.

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“Lifestyle as Medicine” Symposium February 12

By Daniel Rusiecki and Leah Allen (Meds 2021), “Lifestyle as Medicine” Symposium co-organizers

 

“The doctor of the future will give no medication, but will interest his patients in the care of the human frame, diet and in the cause and prevention of disease.” Thomas A. Edison

However far-fetched Mr. Edison’s vision may be, the idea of the first line of treatment being the intrinsic care of the human body and what we put into it is not off the mark whatsoever. Being the new kid on the block in first-year medical school, travelling through this area of modern medicine has one questioning how much exogenous medication would be needed if our society hasn’t progressed the way it has. What if cars never existed, and everyone had to walk to their daily job? Would over 20% of our Canadian population still be classified as obese? What if our food didn’t come out of a factory, or from a fast-food restaurant drive-thru window? Would we still be dealing with a diabetes epidemic where 3.4 million of our sisters, brothers, parents, friends and neighbours are injecting themselves with insulin  daily? The questions can go on and on, but they don’t answer one vital question: how do we move forward?

Practicing physicians will have approximately 2200 patient visits per year. With a career length of 35 years that’s almost 80,000 opportunities to influence the health and lives of these individuals. It’s crazy to think about how much influence one future physician can have, let alone the whole Queen’s undergraduate cohort, the residents, and affiliated physicians. If you are a future physician or practicing physician reading this post, would you rather prescribe your patient medication for their hypertension when they are 45 years old, or have the skills and knowledge to help them prevent hypertension when they are 30?

Equipping our workforce with the knowledge, skills and fearlessness to invoke a healthy lifestyle change is at the root of how we can move forward. Not only can we prolong and enhance the lives of our patients directly, but we can advocate to improve societal systems as a whole. We also have the opportunity to reduce the cost of our healthcare over the long-term due to the reduction of drug prescriptions and improvements in health of the general population.

The “Lifestyle as Medicine” symposium will be the start of a journey to better equip future or practicing physicians with the artillery necessary for these changes. The symposium will be take place Monday, February 12 from 5:30 – 7:30 p.m. in the School of Medicine Building, room 132A.

Dr. Robert Ross, a prominent researcher in the area of diabetes and related co-morbidities will speak on how cardiorespiratory fitness can be a significant vital sign for a patient’s health status. Andrea Brennan, a registered dietitian, will then take the floor to deliver key nutritional principles every physician should know, as well as shed light on current diet trends and the evidence supporting them. Dr. Chris Frank, a geriatric and palliative care physician, will then give insight on how he maintains healthy habits while being a busy physician. Finally, to get a taste of the patients perspective, Doug Dowling will speak about his passion for fitness and how the diagnosis of Crohn’s disease in his early 20s impacted him.

We hope you will join us for this thought-provoking, educational event.

 

 

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Making the most of features on Queen’s Library website

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

[Editor’s note: text in italics indicates a hyperlink]

After I demonstrated the Queen’s University Library (QUL) website at the December 2017 UGME Curriculum retreat, Dr Sanfilippo asked me to prepare an entry for this blog with further information about the site. The changes to the website that occurred in the fall of 2016 were quite dramatic and many of you sent us feedback about the new QUL web pages. During the 16 months since the new QUL website was launched, the librarians collected this user feedback and worked closely with the Library staff to implement a few features that would benefit all our users.

The QUL website was redesigned to offer access to all services and resources via the main page. The main library page has an extensive top bar menu that remains on all library pages and can lead users to all the central services, including the library catalogue (QCAT) and Summon, our discovery tool, as well as to the specific subject areas, such as health sciences. For the Health Sciences community there are now two types of library web pages:

  • The Bracken Library physical space page: this is where you reserve a library group room, check our hours and other services related to the physical collection (e.g. signing books out, requesting materials) and using the library spaces.
  • The health sciences collections subject page: this is where you find access to health sciences databases and resources such as the point-of-care tools, mobile apps, multimedia materials. This page is grouped with all the other subject pages on campus, which you can find on any library page under “Search/Research by Subject” in the top banner and menu.

Based on user feedback, the Health Sciences subject guide was edited in 2017 to provide quick access to health sciences resources. Some of the most important resources are now at the top of the page, e.g. Medline, CINAHL, PubMed1 and Point-of-Care tools. You will however want to look at the subject guides prepared by librarians to support your research and teaching information needs. There are subject guides for Nursing, Medicine, Rehabilitation Therapy, and Life Sciences and Biochemistry. To access health sciences resources quickly, add the relevant subject guide link to your web browser favourites list and learning management software for students in your classes. We also have guides that highlight resources for specific programs or topics (e.g. Aging and Health, History of Medicine), and guides that are more about tools such as citation management, avoiding predatory publishers and the one with approaches and resources to develop systematic reviews and other syntheses. Check out the complete list of guides on the Health Sciences Subject page.

These guides are prepared for you BUT we would love your input: if anything you find worthwhile could be added to the list of resources, please let us know. Any resource format can be included in addition to books and journals: websites, videos, images… if you find something useful, whether in our library collection or on the web (for the latter we will ensure that it can be shared widely), please send us a note. And of course, if you think that a new guide could be developed to support your teaching and research areas, please contact us.

Best wishes for happy searching and be sure to reach out if librarians can help you locate and organize information (remember, we love doing this and just maybe… you have other things to do!). Please continue to tell us what you think of the new library web pages.


1Note that searching Pubmed via a library page brings all the links to full-text available via the QUL collections.

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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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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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From campus to community: the Loving Spoonful Service Learning Project

By Steven Bae and Lauren Wilson, MEDS 2019

“Let food be thy medicine, and medicine be thy food” – Hippocrates

Food. It is a vital part of our existence, and is a focal point in many cultures. Over the course of one year, a person who eats three meals a day consumes 1092 meals. It plays such a large role in everyday life that sometimes it is easy for us to overlook.

The importance of food security to one’s overall health is well known. Food security is defined as “all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active healthy life.” [1] A recent JAMA study reported that suboptimal intake of nutrients and healthy foods was associated with over 45% of deaths due to heart disease, stroke, or type 2 diabetes. [2] Yet for too many people, adequate access to nutritious food is out of reach. Some of these people live right in our community.

Photos courtesy of Loving Spoonful

The neighbourhoods in North Kingston make up 20% of the total population, and their average income is 22% lower than the city average. [3] The people living in North Kingston are twice as likely not to have completed high school, and twice as likely to be living on low incomes. [3] Many physicians that know their patients may not always be able to afford food ask their patients at appointments if they have enough food. Some family health teams even have an emergency supply cupboard in their office for extra food to give to patients who need it.

To increase awareness of these issues, we became closely involved in helping develop a service learning project in partnership with Loving Spoonful,  an organization that works to achieve a healthy, food-secure community. The project is structured around community cooking programs for low-income Kingston residents with medical students as volunteers. On top of building food literacy and confidence in preparing healthy foods among class participants, the goals of the project were to expose medical students to the Kingston community, provide information about food security in Kingston, and encourage them to create a dialogue with the participants in order to learn more about what they can do as future physicians.

The project also allows for students to accompany a physician from the Kingston Community Health Centres to visit the home of a patient living on a fixed income. The students have found that this experience has been eye-opening to appreciate firsthand the ways in which barriers can be specific to individuals. For example, if an individual has difficulty standing, the food s/he buys has to be prepared quickly, which limits his or her choices. Underpinning all of these experiences is a facilitated debrief and written reflection at the end, which allows students to share and document their insights, challenges, and surprises.

Ten medical students have participated in the service learning project thus far, with more students registered for this fall. All of the students have enjoyed this project in many aspects, from improving their own food preparation skills, to developing rapport with the local Kingston residents.

Overall, we are walking away with a greater appreciation for the social determinants of health. As future physicians, the social inequities that underlie many chronic diseases may seem insurmountable. However, this work is not solely our own. Organizations like Loving Spoonful play an important role in our community to address upstream factors that we eventually see presenting as illness. Being knowledgeable about the resources available in our community is a small but helpful step we can take to help our patients address challenging socio-economic circumstances.

Thank you to Loving Spoonful for your invaluable partnership in developing this project and the Kingston Community Health Centres health team for contributing to student learning. We would also like to gratefully acknowledge the City of Kingston and United Way for their Community Investment Fund, as well as the Kaufman Endowment fund, which helped fund this program.


References
[1] Committee of World Food Security
[2] Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 2017;317(9):912-924.
[3] Kingston Community Health Centres. A community needs assessment of North Kingston neighbourhoods. June 2010

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