Teaching, Learning and Integration Committee Summer Update

By Lindsay Davidson, Director of Teaching, Learning, and Integration

As classes (at least in years 1 and 2) have now ended, and teachers are perhaps thinking about courses that will resume in the fall, I wanted to provide you with an update of items from the TLIC. Some of these may already be familiar to you, but perhaps some are “new”. If you need any further information, please feel free to contact me directly or one of our Educational Developers (Theresa Suart from Years 1 and 2 and Sheila Pinchin for Clerkship and the “C” courses).

  1. Resources attached to learning events – these include lecture notes, classroom slides, required pre-class readings and optional post-class readings/resources. MEdTech is enabling a new feature for the upcoming academic year. Teachers will be required to review and “publish” each resource every year – with the option of adding in delayed release if appropriate. The goal of this is to provide students with an up-to-date, curated set of resources, deleting old files. Please direct any questions about this to Dr. Lindsay Davidson.
  • Remember: “less is more”: Students report that when there are an excessive number of files, they often read few/none of them in advance.
  • Clearly designate what is MANDATORY to review PRE-CLASS by indicating this in the “Preparation” field on the learning event, and checking the appropriate boxes on the menu when you review the resources.
  • AVOID using dates on your slides/slide file names – students are sometimes disappointed to see that the file dates from 2009 or prior.
  1. The Curriculum Committee has approved a new learning event type – “Games” – reflecting several sessions already existing in the curriculum. This is defined as “Individual or group games that have cognitive, social, behavioral, and/or emotional, etc., dimensions which are related to educational objectives”. This type of activity might include classroom Jeopardy or other similar activities designed to allow students to review previously taught knowledge (content delivered either independently or in the classroom) and to provide them with formative feedback on their understanding. The instructional methods approved by the Curriculum Committee include:

Please direct any questions about this to Theresa Suart.

  1. Workforce – The Workforce Committee has recently adopted some changes including the following:
  • Addition of credit for teachers who grade short answer questions or team worksheets
  • Doubling of credit for teachers who develop new (or significantly renovate) teaching session
  • Limit of one named teacher per DIL event
  • Limit of one teacher per SGL event (gets additional credit to reflect session design, learning event completion, submission exam questions); additional teachers credited as tutors (credit for time in the classroom) – the Course Director may be asked to clarify who is the “teacher” and who is/are the “tutors”
  • Reduction of credit for large classroom sessions (that are not new/newly renovated and/or do not involve grading)

Please direct any questions about this to Dr. Sanfilippo.

  1. Tagging of Intrinsic Role objectives. The TLIC and the Intrinsic Role leads recently held a retreat. One of the items that was identified was “overtagging” of sessional objectives with intrinsic role objectives such as communicator, collaborator, professional etc. by well meaning teachers. We are undertaking a comprehensive review of how these Intrinsic Roles are taught/assessed in the curriculum and would ask teachers/course directors NOT to tag sessions with these unless there has been a direct communication with the relevant Intrinsic Role lead.

Please direct any questions about this to Dr. Lindsay Davidson.

  1. DIL feedback from students. Over the past year, we have received useful feedback from students regarding the content and structure of Directed Independent Learning (DIL) sessions in Years 1 and 2. This will be collated and communicated to Course Directors shortly. Theresa Suart will be in contact with teachers/Course Directors should any sessions be identified for review/revision.
  2. Online modules. We have developed a process to facilitate the development of high quality online modules, often used as resources in DIL session. These are highly appreciated by students and are used for review in clerkship as well as pre-MCC exam. The current list of modules is available here: https://meds.queensu.ca/central/community/ugme_ecurriculum If you would like to create (or revise) a module for your course, please complete the linked intake form: https://healthsci.queensu.ca/technology/services/elearning/online_learning_modules/get_help
  3. New wording of learning event notices. You may have noticed this over the past year. The wording of the 3 email notices received by teachers has been revised. In particular, it has been streamlined and customized to provide specific, focused reminders prior to the scheduled teaching. We would appreciate any feedback or suggestions that you have about this change.
  4. Video capture In 2016-17, lecture sessions were video captured in select year 1 and 2 classes. We will be analyzing how these videos were used by students over the summer and will likely be continuing this into the fall. Please provide any feedback or comments that you have about this pilot to Theresa Suart.

Feel free to get in touch:

 

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100+ Medical Students Who Care

By Dr. Melanie Walker, Course Director, Population & Global Health

Each first year class in Queen’s UGME embarks on the ‘Community Based Interventions Project’ (CBIP) as part of their Population and Global Health (PGH) course. The project provides students with an opportunity to gain insight into social and health services that serve patients in the greater Kingston community. The students learn about the importance of social determinants of health and patient context through the eyes of a special population that they are interested in exploring. This experience provides them with better insight into supports which affect the health and management of their future patients.

Outside of the medical school, I am a member of a local charity: 100+ Women Who Care Kingston. This organization consists of a group of Kingston-based women who meet four times a year to support non-profit and charitable organizations in our community. The principle is simple – any member is permitted to nominate one local organization per meeting. If this organization is chosen as one of three picked at random, the nominating member is allotted five minutes to speak to the membership to express why their particular organization is worthy of the group’s charitable donation and what that organization would do with the funding if received. The three nominees are then put to a vote by the membership and the majority wins. Over one hour, one worthy local organization receives a financial ‘boost’ of approximately $20,000. Simple…yet powerful.

In light of this, last year we initiated a new advocacy component to the PGH course through the CBIP – the opportunity, as a class, to nominate one of the researched organizations that they thought could benefit from an infusion of funding to address a gap in service identified by the organization. The class vote would become my vote at 100+ Women. Both the 2019 class and, just recently, the 2020 class overwhelmingly voted for the Sexual Assault Centre Kingston (SACK) to be brought forward to 100+ Women.

SACK is a “not-for-profit, charitable organization committed to free, confidential, non-judgemental support for all survivors of recent and/or historic sexual violence in Kingston, Frontenac, Lennox & Addington (KFL&A).” While it may not be surprising to learn that girls and young women between the ages of 15-24 are the most likely victims of sexual assault it was eye-opening to learn from our students that Kingston has the highest rate of sexual assault per capita in Canada. The majority of funding received by SACK is thus, understandably, directed at the support services with little left over for education and prevention. In fact, the Kingston Youth Sexual Violence Prevention Assessment put out a report in May of 2015 that stated “the Kingston community needed to engage youth before sexual & dating violence occurs. Organizations need to explicitly address important concepts including consent, healthy sexuality, healthy relationships, rape culture, alcohol & drug-facilitated sexual assault, and sexual violence.”

After six 100+ Women Who Care Kingston meetings and six attempts (between last year and this), the stars aligned on Feb 23, 2017 and SACK was the 3rd random pick of the night of the 30+ nominated charities.  The end result was an overwhelming majority vote of the 100+ women in the room to support this organization.  Two of the students from the class of 2019 that had an instrumental role in getting SACK nominated by their classmates, Tiffany Lung and Kate Liu, were present with me at the recent cheque-presenting ceremony by the leading ladies of 100+ Women Who Care Kingston to SACK on March 31st. The donation of $20,000+ will be directed at the development of a much-needed youth prevention program across the greater Kingston area which will include sexual assault resistance programming – the only evidence-based program that has been shown to significantly reduce the incidence of rape and other forms of sexual assault.

The night that SACK was voted to receive this donation I was approached by many community members who were not only impressed with the important work that SACK does but by the School of Medicine’s investment in teaching our physicians-in-training about the importance of population health and health advocacy. Amazing what can be accomplished when 100+ medical students who care connect with a local group of women who care to create an opportunity for change in our community.

The recent Whig Standard Article can be found here.

Many thanks to the following for making this possible:

  • Meds 2019 class (special thanks to Tiffany Lung, Kate Liu, Zoe Lau and Sallya Aleboyeh)
  • Meds 2020 class (special thanks to Alexandra Basden, Azraa Janmohamed, Denisha Puvitharan, Khatija Anjum, Sana Khan and Jagpreet Kaler)
  • 100+ Women Who Care Kingston and the leading ladies (special thanks to Lindsay Duggan)
  • Sexual Assault Centre Kingston (special thanks to Jennifer Byrd and Elayne Furoy)

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Building Bridges, Making Pathways

By Denisha Puvitharan (Meds 2020), Darsan Sadacharam (Meds 2020) and Sahra Nathoo (Meds 2019)

Twenty-four curious high school students joined the ranks of diligent medical students in the halls of the Medical Building on March 31st. These students were taking part in the first ever “Pathways to Medicine” event hosted by Queen’s School of Medicine’s Diversity Panel.

Through a new partnership with a local chapter of a national organization, Pathways to Education, the panel organized a full day event aimed at increasing interest in a future career in medicine among students engaged with Pathways, along with some students from Immigrant Services Kingston and Area (ISKA).

Participating students heard from Dr. Michelle Gibson, Director of Year 1, who introduced them to the day. They participated in a small group learning session with Dr. David Bardana and the class of 2020, clinical skills training with tutors Drs. Rick Rowland and Nicola Murdoch, and resuscitation simulation and laparoscopic training sessions with residents, Drs. Kristen Weeksink and Gary Ko, during their visit. Dr. Mala Joneja, Director of Diversity in UGME, sped them on their way with inspiring words. The inaugural “Pathways to Medicine” event was an excellent teaching and outreach event that was highly praised by all staff and students involved.

The Diversity Panel is an interdisciplinary team of interested students, educational staff and faculty, which exists to improve undergraduate medical education at Queen’s, through increasing diversity and making careers in medicine more accessible to those from underrepresented populations. There have been many conversations regarding the importance of medical student bodies representing the diversity of the patient communities they will serve in the future. In addition to the upstream effects of making the healthcare profession more adept in providing quality care to the existing diverse population, increased physician diversity is also particularly important when considering the physician shortages that low income neighbourhoods face in Canada. By enticing more students from these neighbourhoods to attend post-secondary education and medical school, there is an increased likelihood they will return to practice in these neighbourhoods, thus helping relieve some health inequities.

Though many efforts have been made to make medical school more accessible to students from lower socio-economic backgrounds, many barriers remain. The cost of medical school alone is astronomical, when considering the tuition for an undergraduate degree, MCAT registration fees, application fees, and potential income-earning hours spent studying; students from low income families are already discriminated against. Attempting to address these concerns, the Pathways to Medicine event also included a presentation on financing medical education by Ms. Margie Gordon from the Registrar’s Office, specifically regarding OSAP, grants and other resources available to help these students reach their goals.

However, when making efforts to increase the accessibility of medical school for students from diverse socioeconomic backgrounds, the true challenge is in leveling the playing field at the starting line for these students. From the onset of a student’s educational journey, his/her family’s financial and social resources can play a significant role in dictating their success. Strong financial support can assist a student’s ability to excel in school, while also participating in various extracurricular activities, which can benefit the student in future endeavours. Furthermore, students from higher socioeconomic backgrounds are privy to strategic knowledge of what it takes to become competitive applicants as a result of having access to various social resources. These resources can come in the form of connections with academics, physicians and others that have experience navigating the application system. An anecdotal example of how strong social resources can provide an advantage to students is provided by Dylan Hernandez’s opinion column in the NY Times.

“Pathways to Medicine” represents Queen’s UGME Diversity Panel’s continued efforts to find creative strategies in addressing this complex challenge. Although this may be a small step towards addressing these barriers, it is our hope that through events like this and other similar initiatives held at medical schools across Canada, students from diverse backgrounds may soon see medicine as a realistic goal.

 

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The Value of Medical History

By Sallya Aleboyeh, MEDS 2019

A group of passionate and curious medical students chose to venture to Ottawa on the Family Day weekend this past February. Instead of visiting their families, they dove into history, with a group of equally-passionate curators and assistant legislators to Elizabeth May who also gave up time to give us private tours of:

  • The Preservation Centre in Gatineau, which houses vaults filled with paintings, media and lots of important archives
  • Parliament
  • The Museum of Science and Technology’s Storage Facility (which is apparently cooler than the museum itself)

This year was the final time Dr. Jacklyn Duffin, Hannah Professor in the History of Medicine, organized the history of medicine trip, making the fate of future trips uncertain.  So instead of telling you how cool everything was (hopefully the photos can show that), I thought I’d share the value I see in keeping the tradition alive.

1. Cool Architecture: The Role of design, décor and architecture in medicine

(All photos by J. Duffin)

Arriving at our first stop, the Gatineau Preservation Centre, what stood out most was the architecture.  The vaults were inside a huge cement box that looked like the set of a parkour film; while the top floor, where restoration was done, resembled a Lego village complete with primary colour paints and street names for corridors.  Whether you cared about the science behind restoring artifacts or not, the design was very hard to ignore.

On a day-to-day basis, physicians not only interact with patients, but with their environment as well.  While it’s not practical or financially viable to have an architect design each hospital as a unique piece of art, the impact of space is large enough to warrant investing some thought.  There are already lots of examples of environment helping with patient or doctor experiences:

  • Having windows in the ICU rooms to help with delirium
  • Having paintings/magazines in waiting rooms to make wait times seem shorter
  • Having healing gardens to reduce stress for patients and health care workers
  • Having cartoon characters on walls in children’s hospitals
  • Having the nursing station in the middle of a room, visible to all patients, to reduce anxiety
  • Decorating your office with pictures of family to make working there more enjoyable.

(for more evidence of the importance of environment in health- check out this NYT article here!)

Obviously, during an emergency, it won’t matter how aesthetically pleasing the sheets or walls are, but the vast majority of hospital interactions with patients and among health care workers aren’t immediately urgent.  In these instances, a little interior design can work its subtle magic on people’s mood and their interactions because we all (I think) appreciate pretty things.  It’s why chefs create garnishes and why companies invest in packaging.  In the long run these small effects can add up to increase overall wellbeing and happiness.

2. Studying History is humbling and reminds you that your actions might outlive you

The Apology: Commemorates the legacy of the former Indian Residential School students and their families, as well as the Prime Minister’s historic Apology in 2008.

If you’ve ever been to a really old place, you’ll know that you get a strange surreal feeling, like you are experiencing something bigger than yourself (hopefully it’s not just me). When I was 16 and my mom took me to the ruins of Persepolis (wiki: “the ceremonial capital of the Achaemenid Empire”) and I felt it for the first time while trying to imagine what it looked like thousands of years ago before Alexander attacked it.  It reminds you at once of how insignificant you are and how capable you are of creating something that can last for generations after you are gone.

The profession of medicine can be demanding:  long hours, bad news, on call shifts, high stake decisions and emotional fatigue to name but a few.  It’s in these moments when remembering that you’re working towards something bigger helps.  One day when we’ve all left this planet, curators, historians and medical students may look through the ultrasound machines, pacemakers and lounge room coffee machines we used and try to uncover the story of our daily lives.  We can’t predict which of the thousands of items we see and use in our lifetime will survive as artifacts, but we can choose what kind of story they tell.

3. History is full of lessons and wisdom

Finally, most important of all is that history is an endless resource of wisdom and lessons.  We constantly look to our tutors, teachers and mentors for guidance for medicine because it’s easily accessible; but why stop there?

From history you can learn to be creative, and to draw inspiration from new places.  Over the course of the weekend, we saw multiple examples of technology from other industries being adapted to medicine.

  • The cloth used to make sails being used as a backing for fragile paintings
  • Ultrasound machines being used to detect aircraft defects and in the navy before being applied to medicine
  • The Fibroscan for the liver coming from cheese manufacturing (I technically learnt this in class after the trip but it helps prove the point)

History’s mistakes teach us to not just accept what we’ve been told but to dig deeper and ask questions because things may not be what they seem.  During our visit to the Storage room, the curator’s personal research on artifacts in the storage revealed that Sir William Osler – a great Canadian medical teacher – may have used the remains of aboriginal bodies for research purposes.  Another inquiry led the curator to discover that models of babies with syphilis were used to promote eugenics and not medical education as previously believed.  If we remain passive in our learning and acceptance of new information, it’s often the patient who will pay the price.

(In conclusion) I hope there will be many more history of medicine trips to come because there is still a lot that history can teach us (and lots of cities to be seen) before we begin our practices.


A version of this blog post appeared previously on the Medicine and Literature blog. Find it here. Thanks to Sallya Aleboyeh for her permission to repost it here.

 

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History of Medicine week highlights psychiatry

Dangerous Ideas in the History of Psychiatry is the theme of this year’s History of Medicine week here at Queen’s UGME.

Highlights for the week include a panel discussion with speakers from Queen’s, York University, and University of Toronto and an artifact showcase.

The Panel Discussion will take place on Wednesday, March 8 from 5 – 7 p.m. in Room 132 of the Medical Building on Arch Street; refreshments will be served.

Panelists will include:

Dr. Megan Davies, York University

  • “Messy History: Democratising the Story of Deinstitutionalization”

Dr. Edward Shorter, University of Toronto

  • Dangerous Ideas in the History of Psychiatry: ‘Hysteria’”

Prof. Steven Maynard, Queen’s University

  • Just Who Are You Calling a Dangerous Sexual Psychopath?: Psychiatry and the History of Homosexuality in Canada”

The Artifact Showcase will be found in the Medical Building Atrium on Thursday, March 9 from 9 a.m. – 3p.m. This drop-in exhibit will feature items from the history of psychiatry curated by the Museum of Health Care.

Both events are open to the public.

A student committee organized the week, supported by the School of Medicine and the Museum of Health Care. Student organizers included Ashna Asim, Yannay Khaikan, Harry Chandrakumaran, Chantal Valiquette along with executive members Daisy Liu, Hissan Butt and Laura Swaka. Dr. Jacklyn Duffin, Hannah Professor of the Hannah Chair in the History of Medicine at Queen’s, served as their faculty advisor.

 

 

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Interprofessional observerships provide insight

By Dr. Lindsay Davidson, Collaborator Lead

 

For several years, first year medical students have had the opportunity to shadow a non-physician health care provider for a half day as part of the Introduction to Professional Roles course. This initiative, championed by Dr. Sanfilippo, initially involved nurses at one institution and has grown to include 3 sites (KGH, HDH and PCCC) and 11 different groups of health care providers. First year students are charged with beginning to understand their role (as future physicians) as well as the role(s) of the myriad types of health care providers that they will work with over the course of their careers. Most years, the Observerships have been preceded by an in-class brainstorming session, where student infer what various professionals’ roles might be. Following this, students are assigned to work with one of the available health care providers during curricular time. This practical experience allows students to act as ‘anthropologists’, observing for themselves what various health care providers actually do, day-to-day as well as how they collaborate with patients, family members and other members of their team. Finally, at the end of term, students convene in groups to compare and debrief their experiences, collating new lists of the roles and functions that they have observer, to be contrasted with their initial brainstorming. Invariably, the end-of-term collations reflect the insight of the experiences that they have shared.

Here are some of the observations students have made:

“I liked being able to be a part of the meetings with families so that I could better understand what role the social worker played.”

“My preceptor was very approachable and forthcoming with information about her profession; she seemed very enthusiastic about participating in the IP program.”

“… I just had not thought about how the social worker-patient encounter would rely on the same trust- and rapport-building methods as the physician physicians do.”

“I had pictured a dietitian’s work to be office-based, with patients coming for consults at her desk. It never occurred to me that in the hospital, they would accompany the rest of the health teams to do rounds.”

“And I now appreciate the importance of an OT in helping a patient adapt to their new health and return to their normal life as best as possible.”

“I had envisioned a solemn chaplain giving last rites, but clearly this is not the role of the spiritual care practitioner at KGH. Instead, I was surprised by the breadth of the role – there are people who do not consider themselves spiritual or religious at all, yet still speak at length with the spiritual care practitioner about their life and their thoughts about death.”

“I believe it is important to be aware of how physicians can collaborate with allied health professionals to provide the best care, recognizing that we cannot do everything.”

The Interprofessional (IP) Observership has been met with enthusiasm by students and our hospital partners alike and this year, we are offering students the opportunity to participate in an optional second observership, to broaden their experience an understanding of their future IP colleagues. Additionally, in 2017-18, we will be piloting an advanced IP Observership at the Kingston Community Health Centre, where groups of students will spend half a day observing a team-based Interprofessional clinic in our community.


With thanks to students Sarah Edgerley,  Shannon Willmott, Ameir Makar, and Etienne Benard-Seguin who have been working on tracking and analyzing the Interprofessional Observership experience.

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5th Annual Medical Student Research Showcase

By Drs. Heather Murray & Melanie Walker

This year the School of Medicine is proud to invite you to the 5th annual Medical Student Research Showcase on Wednesday September 21st.

This event celebrates the research achievements of our undergraduate medical students, with both posters and an oral plenary session featuring research showcase-judgingperformed by students while they have been enrolled in medical school. All students who received summer studentship research funding through the School of Medicine in 2016 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 1030 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 1:30pm on Sept 21st, immediately following the poster session Q&A. We are pleased to announce that we have a faculty guest speaker, Dr. Adrian Baranchuk, who will give a short presentation on his research and career to launch the oral plenary session.

This year’s faculty judges included:

  • Dr. Tanveer Towheedshowcase-discussion
  • Dr. Andrea Winthrop
  • Dr. Yuka Asai
  • Dr. Ryan Bicknell
  • Dr. Megan Carter
  • Dr. Jennifer Flemming
  • Dr. Nader Ghasemlou
  • Dr. Dianne Groll
  • Dr. Paula James
  • Dr. David Maslove
  • Dr. Katrina Gee

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.

Peter Wang – A database review using the CHADS2 score to detect new Atrial Fibrillation (Supervisor: R. S. Pal)

Frances Dang – Impacts of Preeclampsia on the Brain of Offspring (Supervisor: A. Croy)

Zhubo Zhang – Differential DNA methylation profiles reflect distinct molecular subtypes and clinical outcomes of urothelial bladder carcinoma (Supervisor: R.J. Gooding)

Please set aside some time to attend the Medical Student Research Showcase on September 21st. 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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Tartan, threads, and an integrated curriculum

By Lindsay Davidson
Director, Teaching, Learning and Integration

Summer is a funny time – for some, relaxing with family on the dock, for others seeking out new adventures. I’ve been amused as I’ve watched from a distance, as my university-age son embraces his Scottish roots by running in “kilt runs” in Perth and Quebec City. This exploration of his ancestors’ fashion choices has led to a whole new appreciation of tartan in our family. Queen’s University, of course, is home to its own tartan, worn by band members and enthusiastic alumni alike. Just as the tartans of Scotland identify clan membership, the unique pattern of coloured warp and weft threads are instantly identifiable as the plaid cloth associated with our Queen’s.

Over the past year, the members of the Teaching, Learning and Integration Committee (TLIC) have been busy identifying teaching threads for a virtual “curricular tartan”, just as unique and emblematic of our medical school. Integrated threads represent topics that are taught in a longitudinal fashion, spanning multiple courses, terms and even years of the curriculum. These include intrinsic physician roles, some medical disciplines (typically those that do not have an identified course as well as those that relate to multiple courses) as well as other “hot topics”. Last September, the Committee Screen shot 2016-08-08 at 9.10.00 AMpresented the notion of integrated curricular threads to the Curriculum Committee, as well as an inaugural list of 28 threads which are shown here. (The active Integrated Threads list will be reviewed and possible revised by the Curriculum Committee each September).

To date, members of the TLIC and the Educational Development team have worked with course directors, discipline leads and other content experts to identify how these topics are taught and assessed across the length of our curriculum. The exercise has created exciting opportunities to connect teachers across courses and terms and has led to new opportunities for collaboration: a pharmacologist teaching about complementary and alternative medicines in the context of the CARL course, pathologists co-teaching about lung cancer in the Oncology course, Palliative care and Genetics experts identifying how relevant their disciplines are to multiple courses and creating explicit pockets of teaching.

The threads, now identified, are beginning to be woven into an intricate cloth. You can explore some examples of these by searching for a particular Integrated Thread as part of a Learning Event search on MEdTech. We hope that students will benefit from having an opportunity to understand how teaching on these topics progresses over the curriculum.

 

 

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Teaching the Way You Practice: Collaborative Active Learning in Different Teaching Settings

By Michelle Gibson (gibson@queensu.ca) and Melissa Andrew (andrewm@providencecare.ca)

Most health professionals are actively engaged in collaborative practice: working with many different team members from different disciplines to support patients or clients in achieving their health goals.

However, we often teach our learners in isolation from one another, and, if we are being honest, co-teaching and integration between disciplines in an educational setting can be challenging.  When it ‘works’, however, it is very rewarding, and it is an opportunity to role-model explicitly for learners how different disciplines with differing approaches can work together to enhance care. When co-teaching is combined with active learning that mimics the wonderful messiness of real clinical practice, learners can start to envision how complex problems are approached in “real-life”.  In our experience, this is particularly powerful when we have students also working in teams on complex, real-world cases.

We offer up tips and lessons learned in six years shared teaching between geriatric medicine and geriatric psychiatry in undergraduate and post-graduate settings, to different audiences. We have also co-taught with other health care disciplines but our examples come from our co-teaching.

Examples of what we teach together:

  • Second year medical students:  We built on-line modules for students to use first on dementia and delirium, and then we co-teach the session that applies this learning to real-life cases.  Dr. Andrew co-teaches a 2nd session on “Brain and Behaviour” with a psychogeriatric resource consultant.
  • Family Medicine residents: We have 2 half-days which deal with common, complex, outpatient problems in older adults: the patient who arrives on a Friday afternoon with falls, confusion, and a letter from an anxious daughter; the patient who is extremely cognitively impaired, falling frequently, with a nightmarish medication list, and no family members who can provide history; this same patient who has a valid drivers’ license, and who may or may not be depressed.

top-tips

Tip # 1:  Start with being clear about your purpose(s), goals, objectives.

While this is important for all teaching, it becomes essential when more than one individual is involved.  For example, when we started to design academic half-days for family medicine residents, we worked out that we were aiming to help them approach complex patients with multiple problems in an outpatient setting, while highlighting how geriatric psychiatry and geriatric medicine are similar, how they are different, and how we work together.  These sessions work best with a shared vision.

Tip #2:  Be explicit about roles and expectations.

Similar to Tip #1, this does get increasingly complex when more than one (extremely passionate and very dedicated) teacher is involved in any learning event.  Who is preparing what? By when? How are the different parts going to be taught?  There is nothing worse than realizing the day before that you were the one expected to prepare the quiz. J

Tip #3:  Avoid ‘parallel play’.

Some attempts at integration or co-teaching end up being a series of lectures or teaching sessions that happen to be scheduled in approximately the same time period and are not really integrated.   The best sessions involve a back-and-forth approach, with many opportunities to address areas of controversy in a respectful manner. (See Tip #4)

Tip #4:  Embrace controversy, respectfully.

Junior learners in particular, in our experience, become stressed when it appears there is no one “right” answer.  We live, wallow, and celebrate the land of the gray-zone in geriatrics (pun intended), so we rarely have one correct answer.  However, how we address this in our teaching is important.  We frequently check in with one another: “How would you approach this in your setting?” and acknowledge strengths in differing approaches.

Tip #5:  Embrace complexity, carefully.

We have been pleasantly surprised as to how groups of learners are able to work together to approach very complex cases, when there is a safe learning environment.  For example, we give learners a very complex medication list, while providing an approach for them to practice, and we emphasize that there are many ‘right’ answers.  When we debrief this exercise, we use our different backgrounds/expertise to help students navigate the pros and cons of different decisions.  The team setting for teaching appears to allow students to feel safe to address areas of discomfort – that wondrous gray zone in which we revel. We all consult when there is a great deal of complexity, and we should role-model this for our learners.

Tip #6:  Play your best cards.

This is a great time to determine who is best at which parts, and use these skills to your advantage.  This applies both to clinical expertise, but also to teaching styles: who is the best person to teach X? Who is better at addressing this particular issue?  Why not compensate for each other’s’ weaknesses? You also have the huge benefit of learning from your colleague.

lessons-learned

Lesson #1:  It takes more time up front, but less time the more you do it.  The discussions, planning, negotiations about “what is the way we want to approach X” does require more time initially, but it gets easier each time.

Lesson #2: If possible, it’s best (in our opinion), and more fun, to co-teach with people that you work with regularly. The established trust and long-standing respectful relationships, we believe, shine through for learners, allowing them to feel comfortable when we ‘disagree’ on certain issues.  This is much easier to do in a collegial way when you know how the other teachers work and think.  Plus, teaching with friends is fun.

Lesson #3:  Going out for lunch to plan teaching is optimal.  ‘Nuff said.  Seriously, though – it’s hard to plan teaching in the midst of busy clinical work.  Set aside time to think about things, and to meet in a positive environment.

Lesson #4:  Where there is assessment involved, co-marking is hugely informative – as in, set aside time, sit down together, and mark together.  It allows us to delve into why students thought X, when clearly we thought we were teaching Y.  There is also the distinct advantage of being able to share the marking load, whilst sipping on pleasant beverages.  More importantly, though, by discussing the answers, we are able to immediately adapt our teaching plans for the following year.

 

 

 

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Reducing the Burden of Concussions Through Education

By Chris Griffiths

The Concussion Education, Safety and Awareness Program (CESAP) seeks to reach a broad audience on the prevention, identification and management of concussion injuries. According to the Centre for Disease Control, 65% of all concussions occur in those aged 5-18, and concussions make up 13.2% of high school sports injuries (CDC, 2015). As high school populations are at increased risk of injury, it is important that they are properly educated on the risks they incur by participating in sport, and how to best minimize these dangers. However, a study in Florida examining high school football players, a sport at the highest risk of injury, found that only 1 in 4 received proper concussion education (Cournoyer & Tripp, 2014). As 20% of those injured eventually develop long-term sequelae of concussion, such as depression and anxiety disorders, it is important that schools develop supportive environments for those injured (Hudak et al., 2011). Increased awareness has been demonstrated to increase the likelihood students will adhere to management and prevention strategies, and increase the level of compassion received from their peers (Taylor & Sanner, 2016).

Chris Griffiths and Jesse Topley presenting at Super Elite Football Camps in Aurora, ON
Chris Griffiths and Jesse Topley presenting at Super Elite Football Camps in Aurora, ON

This past fall, a group of medical and graduate students teamed up to work on reducing the burden of concussion in our community. Two second year medical students, Logan Seaman and Chris Griffiths, began working with MSc Neurosciences candidate, Allen Champagne, to develop a free education program for high school students and athletes. With the advice of physicians at Queen’s University, namely Dr Mike O’Connor, Dr Fraser Saunders and Dr Andrea Winthrop, and endless support from the Centre of Neurosciences Studies, CESAP developed a classroom session focused on the biomechanics, symptoms, and management of concussions. With help from students at the School of Rehabilitation Therapy and their faculty, we have put emphasis on the many healthcare professionals who can help in injury rehabilitation around Kingston.

What we believe sets CESAP apart, however, is our behaviour modification and prevention arm. CESAP runs clinics for youth football teams with classroom sessions followed by on field drills led by Queen’s football players to teach proper tackling technique. The drills were developed based on research at the University of New Hampshire, showing that equipmentless drills that focus on fundamentals, or “heads up tackling”, reduced the number of head impacts by 4.4 per game in collegiate athletes (Swartz et al, 2016). CESAP has committed to expanding these principles to other sports, with drills developed for soccer and hockey.

Logan Seaman presenting to Ottawa Titans Water Polo Club in Ottawa, ON
Logan Seaman presenting to Ottawa Titans Water Polo Club in Ottawa, ON

CESAP’s classroom sessions are modified specially for each target audience. While some sections are shortened for particular groups, the structure of each talk is the same. We begin by introducing basic neuroanatomy, localizing different areas of the brain to their function. For senior high school classes, we go into greater depth into axonal structure, and show different imaging modalities such as MRI and Diffusion Tensor Imaging. Emphasizing that concussion is a functional injury, we explain how injury can occur and the symptoms that are caused. The goal is that students can identify unusual behaviour in themselves or their teammates, and encourage them to make a safe choice by removing themselves from play if necessary. We outline red flags or concerning symptomatic developments, and equip students with questions to ask their peers if they suspect injury.

Unfortunately, the reality is that injury does happen. With help from physicians, occupational therapists and physiotherapists in the field, we have compiled the best resources for management plans in concussion rehabilitation. Parents are provided with information on all of the health care professionals in the area who they can consult, and youth are educated on what to expect in their recovery. Perhaps the most powerful part of our program, however, are the testimonies offered by concussed athletes on our team, such as former Queen’s Football player Jesse Topley. The stories our athletes give make the effects of concussion a reality, as we hope to foster supportive environments around concussions in the community. By outlining the difficulties that follow injury, we hope that athletes understand they have the power to prevent severe sequelae by playing it safe in their recovery. We hope that athletes and youth are able to identify the injury in themselves and take it seriously, and reverse the “warrior culture” that exists in sports that encourages young athletes to play through any injury.

Allen Champagne (middle) teaching proper blocking technique with Sherbrooke Varsity Football players in Sherbrooke, QC
Allen Champagne (middle) teaching proper blocking technique with Sherbrooke Varsity Football players in Sherbrooke, QC

Since the middle of January at program launch, CESAP has presented to over 1,100 students, athletes, parents and coaches in Kingston, Sherbrooke, Quebec City, and across the GTA. Our program hopes to continue to expand into the Limestone District School Board, with regular classes in grade 9 PHE and senior biology classes. In athletics, we are advocating for more education of coaches, referees and trainers in leagues in the Kingston area.

With help from our colleagues at the Centre for Neurosciences, and in partnership with students in the School of Rehabilitation Therapy, we hope that CESAP can continue to grow across Canada. Our dream is to make CESAP, and programs like it, standard education for high school students and athletes. Through increased education, we believe that youth, parents and coaches can make safer decisions regarding head injury and reduce the burden of concussion and its chronic effects on society at large.

If you are interested in booking CESAP for an education session, please contact us at cesapkingston@gmail.com. We will accept any audience and are happy to tailor a presentation to your needs! Please follow us on Twitter @cesap100 to learn more about our sessions and concussions in the news.


 References:
  1. Centres for Disease Control and Prevention. “Online Concussion Training for Health Care Providers.” Centers for Disease Control and Prevention. N.p., 4 May 2015. Web. 31 Mar. 2016.
  2. Cournoyer, Janie, and Brady L. Tripp. “Concussion knowledge in high school football players.”Journal of athletic training 5 (2014): 654-658
  3. Hudak, A., Warner, M., Marquez de la Plata, C., Moore, C., Harper, C., & Diaz-Arrastia, R. Brain morphometry changes and depressive symptoms after traumatic brain injury. Psychiatry Research, 191(3), 160–165 (2011).
  4. Swartz, E. E., Broglio, S. P., Cook, S. B., Cantu, R. C., Ferrara, M. S., Guskiewicz, K. M., & Myers, J. L. (2015). Early Results of a Helmetless-Tackling Intervention to Decrease Head Impacts in Football Players. Journal of Athletic Training, 50(12), 1219–1222. http://doi.org/10.4085/1062-6050-51.1.06
  5. Taylor, M. E., & Sanner, J. E. (2015). “The Relationship Between Concussion Knowledge and the High School Athlete’s Intention to Report Traumatic Brain Injury Symptoms: A Systematic Review of the Literature.”The Journal of school nursing : the official publication of the National Association of School Nurses. PubMed. Web.

 

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