Author: Sheila Pinchin
Socrates, questioning and you
Socrates, Questioning and You: Revisiting the question of questioning
Happy 2016 all! Are you thinking about some educational resolutions? How about reflecting on how you question medical students, especially in a clinical setting?
When we last spoke in December, the topic was Socrates, “pimping” and teaching in medical education (http://meds.queensu.ca/blog/undergraduate/?p=2575).
I ended by saying I’d be back to talk about Socrates and questioning. Well, I’m back…
We often use the term “Socratic questioning” but what does it mean? Socrates used questions as a way to teach, in that he questioned his students so that they would uncover truths for themselves.
Six Types of Socratic Questions: Here below, are R. W. Paul’s six types of Socratic questions as a modern day interpretation. (There are now 8 types! I’ve combined a few. ) These are from several sources listed below.
What I love is that they are grouped by purpose. You’ll note that none of the less desirable purposes (humiliation, venting, anger, etc.) are present. I’ve put a star beside some of my particular favourites—perhaps you could do the same? Because, as you’ll see next, planning your questions (and that starts with types and purpose) is part of being a Socratic questioner. Can you see how you could use these in your questioning?
|1. Questions for clarification:||
|2. Questions that probe purpose and assumptions:||
|3. Questions that probe reasons and evidence:||
|4. Questions about Viewpoints and Perspectives:||
|5. Questions that probe implications and consequences, inferences and interpretations||
|6. Questions about the question: (especially if the students are struggling…)||
TIP 1: Try to pose questions that are more meaningful than those a novice of a given topic might develop on his or her own.
TIP 2: Start with key answers you hope students will give–in other words the key teaching points of the session.
TIP 3: Phrase 3 key questions.
TIP 4: Use some of the above questions to fill out your Socratic roster.
Are you a “Socratic Teacher?” The teacher who uses the Socratic method is looking for “systematicity”, “depth”, and has a keen interest in assessing the truth or plausibility of things.
- Model critical thinking
- Respects students’ viewpoints,
- Probe their understanding,
- Show genuine interest in their thinking.
- Helps students feel challenged, yet comfortable in answering questions honestly and fully in front of their peers.
Implementing Socratic Questioning in your clinical (or classroom or seminar) setting. Try some of these strategies to build a positive questioning climate:
- Distinguish upfront between Socratic Questioning and “Hounding”. Ask students to bear with you while you ask keep asking questions as soon as they have answered and tell them why. Let them know this is your educational approach and that there are no ulterior purposes such as humiliation. In other words, set the climate for this kind of questioning by being explicit with students right from the start.
- Not all questions have a single “right” answer. Prepare students for the difficult position of having to determine which is most right…sorting through the grey areas, and being wrong, at least first time around.
- Set some ground rules: If a case coming up for rounds is an important case (and it’s helpful if you can identify important cases, as medical students may not be able to), it’s fair game, and students are expected to “read around” that case.
- You DO ask questions of individual students (but you don’t center out students): Let students know that you will be asking individual students questions as well as asking for volunteers. However, like Socrates did, it’s helpful to have the group help. It’s all in the way you phrase it: “I can see you’re stuck—you’ve done well to get us to this point. Is there someone who can take us to the next question?”
- Mature student responses for when they’re stuck: To create the “safe climate for questioning,” students should have mature answers for not knowing an answer that you are willing to accept:
- Student A. “That’s as far as I can go from my reading, Dr. Z___.”
- Student B. “In my reading, the ____was the most likely diagnosis. Can you help me with this?” (Don’t be fooled into giving an answer—Socrates would just keep asking questions to get at a deeper concept.)
- Student C: “I think I do need to call a friend.”
- Student D:“I didn’t do the reading, Dr. B___I apologize and I’ll pick up tonight.” (However, if this latter student keeps giving this answer, then it’s moved to scholar and professional competencies and you have to switch from Socrates to assessment, and they need to explain what’s going on.)
OR…explain to students what answers you will accept.
It’s important to teach students to acknowledge shortcomings and to motivate them to correct these. It’s also important to give them the language to respond to questions and to accept it.
6. If there is a problem: If the questioner is disturbed by a learner’s preparation, attitude, or any other issue, humiliation in front of a peer group, or a near peer group is not recommended in any circumstance. Rather, discussion, with feedback, follow-up and tracking with that student should be conducted separately, apart from the rest of the group. (I know…it’s time-consuming. But it’s better for the learner and for the teacher.)
7. Forge a relationship on mutual respect, and allow the learner to question the questioner, and to ask for clarification and where to go to learn more.
Do you agree with these strategies? What do you like about the 6 types of questions? Will I ever stop asking questions? 🙂
Feel free to write back with your questions or answers about questions.
How to Use Socratic Questions: http://serc.carleton.edu/introgeo/socratic/fourth.html
Kost, A & Chen,F.M. (2015). Socrates Was Not a Pimp: Changing the Paradigm of Questioning in Medical Education. Acad Med. 2015; 90:20–24.
The role of Socratic Questioning in Thinking, Teaching and Learning
Socratic Questions: http://changingminds.org/techniques/questioning/socratic_questions.htm
The Six Types of Socratic Questions http://www.umich.edu/~elements/5e/probsolv/strategy/cthinking.htm
Schumacher DJ, Bria C, Frohna JG. The quest oward unsupervised practice: Promoting autonomy, not independence. JAMA. 2013; 310: 2613–2614.
Tredway, L. (1995). “Socratic Seminars: Engaging Students in Intellectual Discourse.” Educational Leadership. 53 (1).
Socrates, “pimping” and teaching in medical education
Recently, one of the words in the title of an article in Academic Medicine really caught my eye: “Socrates Was Not a Pimp: Changing the Paradigm of Questioning” by Dr. Amanda Kost and Dr. Frederick M. Chen. (Kost & Chen, 2015)
Of course, the word that caught my eye was “Socrates,” he of sitting with students under an olive tree fame
Much of the scant information we have about Socrates is from his students, Plato and Xenophan. Plato portrayed Socrates as an excellent teacher and questioner, in the Dialogues, where a series of questions is asked not only to draw out individual answers, but also to encourage fundamental insight into the issue at hand.
Can it be, Ischomachus, that asking questions is teaching? I am just beginning to see what is behind all your questions. You lead me on by means of things I know, point to things that resemble them, and persuade me that I know things that I thought I had no knowledge of.
Of course, I can’t deny that another word caught my eye in the title: It’s not always that you see the word “pimp” in a medical education journal.
However, it’s a common term in medical education, since 1989 at least, where Brancati used it to refer to a questioning method that is supposedly Socratic but is defined as “whenever an attending poses a series of very difficult questions to an intern or a student.” (Brancanti, 1989) He suggests questions “should come in rapid succession and be essentially unanswerable.” There are other definitions, and the “not a pimp” authors Drs. Kost and Chen, write that in these definitions the purpose of the practice is to reinforce the power hierarchy of the team and, more specifically, the attending physician’s place at the top. (Kost and Chen, p. 21)
In a 2005 study, by Wear et al. fourth year medical students were questioned about the practice of this form of questioning:
Students divided pimping into “good” and “malignant” categories. “Good pimping” actions included questioning that advanced or enhanced the learning process and also encouraged students to be proactive about their learning…“Malignant pimping” frequently employed techniques designed to humiliate the learner. All students in this study identified humiliation as an outcome of any type of pimping—even good pimping had a component of shame because of the public embarrassment of not knowing the answer. (Wear, et al, 2005 cited in Kost & Chen)
I’d like to discuss “pimping” both from a syntactical and a pedagogical perspective.
I was trained as a language educator to acknowledge that language has a very pronounced impact on constructs in our thinking. I have to admit that I don’t get the use of the term. The other definition of pimp: a person, especially a man, who solicits customers for a prostitute or a brothel, usually in return for a share of the earnings; pander; procurer (Online Dictionary and Merriam-Webster Dictionary) seems to have very little to do with questioning, whether benign, or malignant.
“Pimping” then… you know, that’s the last time I’m going to use the word! I dislike the relationship it implies that could so easily settle into the hindbrains of all us who have been using it. With your permission, I’m going to try “hounding” instead. Drs. Kost and Chen agree with me: “This word may evoke a negative affective response, and we would also argue that the use of such a derogatory term to describe an experience in medical education is unprofessional.”
Because, you see, questioning is one thing, and is an excellent and powerful educational tool. However, when does questioning move into “hounding”? It happens when the questioner is pursuing a different goal than a pedagogical one: perhaps humiliation(“She needs to know this stuff”), or going way beyond the knowledge of the level of the learner (“Shouldn’t clerks know this, or is it residents? Fellows?”) or venting frustration and anger (“You guys think you’re so smart? Well, let’s see…). They include the well-known “Read my mind” type of question, and the question that is so obscure that very few know the answer (except perhaps the questioner?).
In the Wear study, students felt questioning “was useful to “promote learning, logical thinking, defending one’s decisions, quick recall, self-assessment, and communicating well with one’s peers.” They didn’t like the hounding part of it, and wanted to use volunteering answers as an alternate to centering someone out and hounding them. (I know, I know…this can be an important part of questioning…I hear you and I’ll come back to this.)
So, let’s get back to Socrates. The Socratic questioning method is used often today, tho’ it appears it can be misunderstood. In a recent vehement and lively DR-ED listserve discussion, the Socratic method was linked heavily with “hounding” by one participant.
Socrates used the dialectic method of teaching, whereby he assumed the role of someone who knew nothing about a topic, and drew the students’ ideas out, through a series of questions, each one probing more in depth or looking at different options. (Fun fact: Did you know that the word “education” comes from the Latin ex ducere (to lead or draw out?)
Since Socrates was mainly concerned with students uncovering their own beliefs, and the validity of those beliefs, the correction of misconceptions and reliable knowledge construction all around large concepts such as truth and justice, modern teachers have created a sort of system for modern Socratic questioning of all types of learning. Here are some of the characteristics:
1. Students are questioned in a group, and in modern times, others in the group can collaborate with each other to find answers. But not always…Socrates challenged his listeners and students. And he picked them out, as well as had them volunteer. But learners could help each other. You’ll see in this sculpture, Socrates teaching in the Agora, by Henry Bates, below how avidly everyone listens to each other.
2. Socrates believed questioning would motivate learners and help them to the joy of learning. Thus, questioners should create a safe and comfortable context for questioning, where wrong answers are simply a signpost to heading down another path of learning. In other words, they wouldn’t mind being centred out because they were enjoying learning.
3. Use of by “why”, “what if” “how”, “then, if…” or open-ended questions vs. closed ended questions such as “What is this object?” “What is 1+1?” (Perhaps we can start with close-ended questions especially for novice learners, but they shouldn’t be the end goal of the questions.)
3. Socratic questions must be: 1) Interesting, 2) Incremental, 3) Logical (moving from the student’s prior knowledge towards a goal), and 4) Designed to illuminate particular points.
4. Questions should be well-planned with a goal of benefiting the student at his/her learning level in mind. Sometimes you have to start factually, but there should be progression toward critical thinking.
Let’s summarize, and then I’m going to prepare for you to write in to tell me what you think about “hounding” and questioning:
1. Let’s not use that word again…it’s really ugly semantically.
2. Hounding is not questioning. Hounding is hounding and it’s not supported pedagogically. Questioning is an excellent way to teach. It doesn’t have to be sweet, nor does it have to be easy. It has to be respectful and with the appropriate underlying purposes.
3. If we’re going to claim that “hounding” is Socratic, or even our questioning strategies are Socratic, let’s start using Socrates’ methods more. Let’s aim for critical thinking questions, one of Socrates’ key purposes in questioning.
4. Let’s focus on our learners and tailor questions to their learning level.
5. Let’s create a climate where questioning is accepted and even welcomed. Let’s give our learners appropriate language to acknowledge they haven’t prepared, or are at the limits of their abilities thus far and need assistance.
In my next column (look for it in January 2016), I’ll provide more suggestions—based on Socratic principles—for keeping Questioning productive.
So, what do you think? Are you a Socratic questioner? Do you think hounding has a purpose? Are there aspects of your teaching and questioning that can be enhanced through Socrates?
Looking forward to hearing from you about this.
And it’s not a smooth segue, but while I’m here with you, I’d like to take this opportunity to wish you all the best of the season!
And here’s to great teaching in 2016!
Brancati FL. (1989). The art of pimping. JAMA. 262:89–90.
Dictionary.com http://dictionary.reference.com/browse/pimp and Merriam-Webster Dictionary http://www.merriam-webster.com/dictionary/pimp
Kost, A.& Chen, F.E. (2015). Socrates was not a pimp: Changing the paradigm of questioning in medical education. Academic Medicine, 90: 1.
Wear D, Kokinova M, Keck-McNulty C, Aultman J. (2005). Pimping: perspectives of 4th year medical students. Teach Learn Med. 17:184–191.
Why I can’t build an addition and the fall filing cabinet
This fall, I’ve been cleaning out closets and filing cabinets and purging, as they say on Houzz. I didn’t want to—I hoard my teaching materials as if they were gold. But, my husband said, “If you don’t get rid of some of this stuff, we’ll have to build an addition onto the house.”
I don’t quite know why that’s a bad thing…:) Teachers are packrats—you never know when you’re going to need something again to help students and other teachers.
However, apparently we can’t build an addition just for more filing cabinets. So, I’ve started cleaning out my notes on teaching from…well… I started teaching in 1980…
I’ve rediscovered some wonderful things, and I thought I’d share some with you. Here are a few from my filing cabinets:
- First of all for our students (and anyone else who reads): I found this poem by the late great poet Maya Angelou which actually a student drew to my attention years ago (a shout-out to Jessica Chiu formerly at OCA!). It’s about reading, and if there’s anything I know about UG medicine, it’s about the amount of reading you have to do. I hope you find lots of ideas sticking to your mind.
Popcorn leaps, popping from the floor
of a hot black skillet
and into my mouth.
Black words leap,
snapping from the white
page. Rushing into my eyes. Sliding
into my brain which gobbles them
the way my tongue and teeth
chomp the buttered popcorn.
When I have stopped reading,
ideas from the words stay stuck
in my mind, like the sweet
smell of butter perfuming my
fingers long after the popcorn
I love the book and the look of words
the weight of ideas that popped into my mind.
I love the tracks
of new thinking in my mind.
- More for students…and teachers using small group learning: Roles to Assist in Group Learning
Many medical students have told me about their horror stories of group work, either in high school or university. And it’s true…sometimes teachers throw students into groups without advice or support to work things out. Sometimes one student dominates the group; others are couch potatoes and hitch-hikers. Some block consensus, some goof around and still others withdraw. Bearing in mind our adult learners in medical school, and also the concept of self-directed learning, here are 20 (!) roles which students can adopt in groups. So even if a student is an introvert (see the book Quiet: The Power of Introverts in a World That Can’t Stop Talking), he or she will find some useful roles below. Teachers, you can encourage students by helping them see these roles in their work. (Thanks to my old bosses, Gray Cavenaugh and Ken Styles at the Ontario Ministry of Education. I’d forgotten how good you were!)
Students, practice putting yourself in each of these roles, think of others in the group, and begin developing your group leadership strengths. Teachers, when I used these with students in the past, I asked them to read them over and put a star beside the ones they do, and an exclamation point for a few they’d like to try.
Teachers, do you recall hearing that students learn best with this saying: Tell me; show me; let me try?
It’s actually the first thing I heard about (that I remember) when I hit Teacher’s College all those years ago. Here’s how I translate it into Medical Education:
|What it means||In medical school|
|Tell me: lecture or telling—even assigning reading especially with guides. Learners say, Get me oriented, motivated and let me absorb facts and concepts.||Provide students with facts, characteristics, vocabulary, symptoms, etc. through (mini-) lectures, or readings with questions attached, about medical conditions, systems, and approaches. Our RATs, or quizzes help students process what they’ve been told.|
|Show me: Learners say, Demonstrate how this works so I can see it in action. Give me examples of how it works!||Show students through written or verbal examples–cases you have encountered on how to recognize patterns, how to differentiate among diverse conditions, etc. Video clips and demonstrations are also really useful! A summary of your key findings and learning and the strategy of Think-Aloud (just what it sounds like) from the cases is useful for students to follow your thought processes. Don’t forget to tell them what you ruled in, and what you ruled out and why.|
|Let me try. Learners say, Give me a chance to apply the learning to see if I can do it myself, or if make it work in different situations.||· Provide students with written or verbal cases through which to work, often with a partner or in a group, so that they can learn how to apply the facts and examples you have given them.
· Change up the circumstances: paediatric or geriatric patient; chronic conditions vs. acute conditions, co-morbidities, different presentations or similar presentations with different associated conditions, different points in the illness journey.
· Put students in a simulated learning environment—such as with standardized patients.
· In clerkship, under supervision, allow clerks to apply their learning to patient care.
Key here is to find out if the students have learned through their application (mid-terms, graded team assignments, individual assignments) and observe them in practice (MiniPEx, MiniCEx, field notes, etc.).
So three tips from the files. I found a few more 🙂 Stay tuned…
Have a great fall! I’m looking forward to continuing the dialogue about teaching and learning.
We write these blog articles with ideas, thoughts and strategies, usually for teachers, but often for students too.
We’re always interested in your thoughts, so please feel free to respond.
What’s in your filing cabinet?
When you are yourself, I’m free to be myself
“When you are yourself, I’m free to be myself”
The Reverend Bill Hendry spoke these words as a “first patient” at the First Patient Program’s 3rd annual Grand Finale on Wed. May 13. He was addressing the 100 students of the class of 2017 who had completed their 18 plus months of relationship with their first patient, whom they’d met in September, 2013. Since then, the students in partners have visited 50 first patient/teachers at their homes, during health care visits, at the ER, in support groups and even grocery shopping to learn about the health care journey through the eyes of the patients.
Wednesday was a day to focus on the doctor patient relationship for the students. Hosted by Dr. Tony Sanfilippo, the developer and director of the program, the afternoon began with Dr. Leslie Flynn speaking to the students about the trust that is necessary in a doctor patient relationship, and how extraordinary that trust is. She urged students to take the lessons of their first patient experience—the challenges as well as the good times– as they build that trust in their future relationships.
Reverend Bill Hendry, first patient and maple syrup maker extraordinaire, and his wife Lorna spoke to the students about the same relationship. Bill and Lorna have been involved in the program since its inception.
Bill said that his students were very much themselves when they met with the Hendry’s and how much that is appreciated by patients. Patients appreciate the honesty, the care, and the commitment—the trustworthiness of their physician.
Students afterward shared their experiences of their first patients with their teammates. With prompts such as “Challenges” and “Impact” students were able to tell their stories to their classmates. Using Poll Everywhere, students generated a word cloud, where words such as “humbling” “enlightening”, “perspective” and “eye-opening” came to the fore.
Then it was time to have a party! Erin Matthias, Kathy Bowes, Jason Kwok (Meds 2017) and Vincent Wu ( Meds 2018) organized a great party—with a wonderful buffet, balloons, music, and many volunteers from the first year class to escort patients to the 2nd floor. We also had a photographer–thanks to Wilfred Ip, Meds 2018 for his excellent photographs used here in this article!
About 30 patients, some with family members, several physicians, many of whom have been part of the program since its inception, Dr. Phil Wattam the incoming Director of the program, 100 students in 2nd year meds, 12 volunteers from first year meds, Kathy, Erin, and yours truly mingled in the Lantern Lounge, and several of the rooms on the 2nd floor.
I was musing on the doctor/patient relationship too…earlier that morning, Dr. Ingrid Harle had introduced a very provocative article in the Health Sciences Education Journal Club, called Professionalism: A framework to guide medical education by Brody and Doukas, in Medical Education: 48: 980-987, 2014. The authors wrote, “The concept of the social contract reminds the student that trust involves a two-way relationship. Ideally, trust exists on the patient’s side and trustworthiness on the physician’s. A dedication to professionalism, viewed as character, establishes the conditions for trustworthiness.” And further…
“Students will best understand a virtue approach when they are reminded of how hard it is to keep one’s public promise to put the interests of patients first, as the maintenance of public trust requires. To do this not only on good days, but also on bad days when we are tired and irritable and no-one is watching, requires more than simple rules; it requires that we devote ourselves to becoming certain sorts of persons. If students engage in honest reflection, they will agree that little in their previous lives has taught them to be the sorts of persons who routinely put the interests of others first, even if to do so requires some significant sacrifice. If students see that professionalism, properly understood, requires them to grow into the sorts of persons who not only engage in that hard work, but who do so willingly and cheerfully, they then understand what character and virtue have to do with their education.”
In one quiet moment during the very successful if hectic afternoon, as I looked around the room, I was thinking of Bill Hendry’s words, of the theme of the professionalism article, and of our goals in UG as we had set out to design this program with our now graduating class of 2015 three years ago. I was looking around at the students helping their patients at the buffet, solicitously helping them to a chair, listening intently to their patients and laughing with them, at the end of a long day and scant days before exams, and I thought, “Whew! We’re ok then. This group of future physicians has got it. Compassion, trustworthiness, the sorts of persons who put the interests of others first–those characteristics are all here in our future physicians at Queen’s.”
Congratulations to the First Patient Program on another successful year…each year you make it better!
Student attention in class: Whose responsibility?
I just received a posting from Faculty Focus with the engaging title: Why can’t students just pay attention? Dr. Chris Hakala, the author, gives a really good overview of the dilemma many of us face when teaching: students are not engaged, are multi-tasking at best, and distracted at worst, and are not learning or retaining key concepts. How much responsibility should teachers bear for this lack of attention, and if we assume responsibility, what can we do about it? http://www.facultyfocus.com/articles/effective-teaching-strategies/why-cant-students-just-pay-attention/
Dr. Hakala defines attention, from the cognitive literature, as the idea that students have a finite amount of cognitive resources available at any given moment to devote to a particular stimuli from their sensory environment. To that end students’ attention is constantly shuttling between what they are experiencing externally and internally…At any given moment, [they] select from a large number of potential stimuli and focus on a small number of them. If class is interesting and there is activity, students can focus on those activities and work to remember that information for later use. However, when class isn’t engaging, students will find other things to occupy their attention.
You may recall reading my thoughts and others’ on multitasking and how it’s not really effective tasking at all. (http://meds.queensu.ca/blog/undergraduate/?p=822 and http://meds.queensu.ca/blog/undergraduate/?p=113
However, it’s a very challenging mind-set to change, as students appear convinced that they can multitask (they can) and learn well (a much more difficult proposition).
Dr. Hakala claims, as do many educators, that we as teachers should accept some of the responsibility for engaging students, and allowing them to focus on our teaching. He suggests the following:
- Ask questions and require students to write responses. Then ask again and have them read their answers to the class (not all, obviously, but a sampling).
- Have students respond to questions about readings or a previous class activity and bring those answers to foster peer discussions.
- Craft mini-lectures to include time for student comment, feedback, and response.
- Focus learning on student perspectives.
- Create rapport with students and build a classroom climate where students feel comfortable sharing their ideas.
I would add,
- Use small group learning, especially when all groups report to the whole class (this can be done by having the group answer a challenging multiple choice question that is the focus of the group task)
- Ask students to answer a question or solve a problem and share the answer with a peer. (See Peer Instruction by Eric Mazur.) Peer answers can be shared with the whole class. (Think, Pair, Share).
- Break up a lecture into 15 minute “chunks” punctuated by student activity.
- Create an outline, follow it, and demonstrate to students where in the activities of the outline you are.
- Use quizzes, or Readiness Assessment Tests to determine understanding
AND (and I’m going to be radical here) ask students to close their devices at certain points in the class when they’re not needed for taking notes, looking up references, etc.
Dr. Hakala states that there is evidence to support that deep processing, which happens when students are engaged (with only one task!), leads to better learning and cites Brown, Roedigger & McDaniel, 2014; Benassi, Overson, & Hakala, 2013. I highly recommend the Brown, Roedigger and McDaniel text: Make it stick: the science of successful learning. Cambridge, MA: Belknap Press. I’ve directed students and faculty to Prof. Roediggers’ writing before–he makes learning about learning accessible.
You can find a description of Benassi, Overson & Hakala’s book, Applying Science of Learning in Education: Infusing Psychological Science into the Curriculum (2014) at http://teachpsych.org/ebooks/asle2014/index.php.
Back to the blog article:
My stance is that teachers bear a some responsibility for student engagement…Yes, I know we all learned from 4 hour lectures; yes, we all had boring professors… and yes, look at how well we learned. However, we understand a lot more about learning now, and we have a different group of learners now. In the interests of good pedagogy as well as good role modelling and personal satisfaction, it’s important to set the stage so that learners will learn well.
What happens after that, however, is a student’s own responsibility. Part of the challenge in medical school comes from students not always being able to distinguish what is important at early stages. But as adult learners in medicine, and with patient safety, professionalism, and their future sound practice at stake, it’s important that we challenge students to take on part of the responsibility for learning, put the distractors away, and focus. It’s a hard habit to break for some of our “wired generation” but I believe it is worthwhile.
What are your thoughts on student and teacher responsibilities for engagement? And what ideas do you have to stimulate learning in class?
Making Change in the UGME Curriculum
Recently the UGME Curriculum Committee sent out a note to Course Directors asking for their advice on what curricular objectives and MCC presentations should be assigned to their courses. this is part of the curriculum review process and demonstrates the collaborative relationship between the Course Directors and the Curriculum Committee.
This request applies this time only for the pre-clerkship Course Directors, as clerkship Course Directors have engaged in a rigourous process this fall to ensure that everything is well represented in the clerkship rotations.
What can a Course Director change within his/her course? What requires approval from Curriculum Committee? What is the role of the Competency Lead?
The Course Director is empowered to make changes independently as long as:
• They occur within the “footprint” of the course,
• Do not change the assigned objectives or MCC presentations and
• Adhere to the Teaching and Learning Policy and the Student Assessment Policy.
As well, Course Directors can bring larger changes forward to the Curriculum Committee, often representing requests from their teaching faculty, or in response to student requests or needs. Faculty and students can also bring matters forward to the Curriculum Committee. Year Directors can provide Course Directors with a broad view of the curriculum (For example, if they want to delete an objective and it’s not taught anywhere else.)
The Competency Lead’s “course” is the strand of learning and assessment for the respective Intrinsic Roles, over the four years of the curriculum. Competency Leads communicate with Course Directors for desired change within existing structures, and propose to Curriculum Committee for larger changes.
- Oversees large-scale changes
- Ensures that change brings only positive growth and minimal negative impacts on any parts of the curriculum
- Ensures that all the MCC’s and Curricular Objectives are assigned over the 4 years
- Looks after balance in the curriculum
- Consults widely and enacts larger changes such as:
- Assigning objectives and MCC presentations to courses,
(after collaborative feedback processes with others),
- Determining the length of a school year,
- Confirmation of course names and codes,
- Review of the curriculum annually based on a variety of feedback.
- Revising the Red Book (Competency Framework) where necessary
- Receipt of reports from its sub-comittees (TLIC, SAC, CFRC) to ensure that those agents are working within their policies and parametres.
- The Curriculum Committee also makes decisions on large-scale matters brought forward by faculty, students, Course Directors and Competency Leads.
Some examples of recent changes are:
|Course Directors/Competency Leads Make These Types of Changes||Curriculum Committee Makes These Types of Changes:|
|1. Projects: Responding to student feedback and faculty evidence, projects such as Nutrition Project in Pediatrics, Evidence Search and Rescue in CARL, the Portfolio assignments in Professional Foundations 1 and Professional Integrations and the Literature Review of the Critical Enquiry course are revised.||1. Revision of a Course: In 2013, the Curriculum Committee approved a major change in the way Clinical and Communication Skills 2 was conducted in Term 4. The change involved moving to a patient-based approach with a student to faculty ratio of 3:1, and flexible timetabling.|
|2. Learning Event Types: Lectures are changed into SGLs (or sometimes in reverse) such as the cluster of neoplasia lectures in pathology in Mechanisms of Disease changing to an SGL.||2. Expanding Time in a Course for a New Session: A proposal for a learning event on the care of LGBTQ patients in the Professional Foundations Course was brought before the Curriculum Committee and accepted. The proposal required more time to be added to the course.|
|3. New Learning Events: New learning events are added such as seminars in clerkship rotations or “Expanded CARL” sessions in clinical foundations courses to better align with objectives||3. Additional Time and/or Re-labelling Existing Learning Events Across Years: A process has been initiated to add the topic of Ensuring Patient Safety is represented within the curriculum. This could require more time to be added to the footprints of a number of courses and each request for time is being considered separately.|
|4. New Seminars: In Clerkship, Course Directors added formal academic seminars to their courses in order to better accommodate learning of specific assigned||4. Change in Timetable/Examination Schedule for a Term: For this academic year, Curriculum Committee approved the proposal brought forward by the Year Director of Year 2 to change the examination schedule of the Circulation and Respiration course and the Renal and Endocrine course in Year 2.|
|5. Revision or Development of Assessment Tools: Assessment tools are changed, such as the workplace-based assessment tools in clerkship Ob/Gyn into rubrics with behavioural anchors.||5. Development of New Courses: Curriculum Committee approved the creation of three clerkship electives courses, from the one course, in order to ensure including satisfactory completion of the course requirements|
|6. Changes due to Blueprints: Competency Leads have blueprinted their competencies and objectives and may determine that some learning events require change, as may assessments. Course Directors may change the percentage of learning events aligned to a specific assessment as per blueprint.||6. Revision of Curriculum Framework: This academic year, the Red Book, our competency Framework, was revised with input from Competency Leads and the faculty to help the objectives reflect the reality of the classroom.|
We undergo this process annually, as well as check on what changes the Medical Council of Canada (MCC) has made in the clinical presentations that serve as objectives aligned to the MCC Qualifying Examination.
Thanks for making changes to the curriculum that are helpful, meaningful, and relevant!
Do you have questions about change in our curriculum? Drop a note here or write to email@example.com
Students are welcome here
“You seem to have students involved in everything!” (a recent visitor to Queen’s Undergraduate Medical Education)
One of the very striking aspects of Queen’s UGME is the consistent presence of students in the life of the program and how it is run. Queen’s has the positive philosophy that students are an asset and indeed an absolute necessity for assistance in the UGME curriculum; they are a strength in our program.
Why do we do this? One reason is that it fosters student leadership, a desirable trait in post-secondary education (Astin & Astin, 2000; Zimmerman-Oster & Burkhardt, 1999) and that in turn enhances the self-efficacy, civic engagement, character development, academic performance, and personal development of students (see references below.)
And yes, thus it is a deliberate UGME procedure that, for example, all UGME committees but one (the Progress and Promotions Committee) will have student representation sitting on them. However, there is another, and perhaps even greater reason that students are invited to participate as fully in UGME as they are.
“When educators partner with students to improve learning, teaching and leadership in schools, school change is positive and effective.” (Fletcher, 2003).
Our program, and our faculty and staff, not to mention our students, benefit immeasurably from student participation in our program: student feedback is valuable to our ideas and plans, our current processes and programs and our ability to be responsive and flexible. It allows us to trial ideas, to disseminate information, and to receive valuable input on aspects of our curriculum. It helps dispel myths and presuppositions we might have, it makes us flexible, and gives us a window into the world of student life.
At Queen’s UGME, in addition to active participation on all but one committee, students are involved in Admissions Weekends, they run Orientation Week for the next year’s cohort, they participate in peer teaching, they monitor learning events, they act as representatives for their class in everything from Technology Rep to Academic Rep to First Patient Program rep, they volunteer for focus groups and participate in surveys for program evaluation, they evaluate our courses and our faculty regularly and professionally and they are a part of our Accreditation process and visit. And I’m sure I’ve missed some of the roles students play.
The question then becomes, “Why would we NOT have students involved in our program?”
How do we receive the benefit of these future leaders?
UGME works in collaboration with the Queen’s Aesculapian Society (AS), the student government, which makes the selection of students for all roles. The AS engages in a process to determine a selection of students who will participate in all roles when called upon for student representation. The UGME program leaders respect the independent professional behavior of the students as they demonstrate self-regulation in their own governance structure to take on responsible roles. Indeed this is an important aspect of their leadership.
Many of the student leadership roles have evolved as our committee structure and programs grew. It became evident very early that student representation would allow for a valuable two-way street for discussion of nearly every aspect of the program.
We’re very grateful to our students for the insights they bring, the creativity and innovation, the energy and the professionalism they provide in our many activities. Together, we are stronger, and better.
Did I miss an aspect of student participation in UGME? Write in and let us know.
(See Benson & Saito, 2001; Fertman & Van Linden, 1999; Komives, owen, Longerbeam, Mainella, & osteen, 2005; Scales & Leffort, 1999; Sipe, Ma, & Gambone, 1998; Van Linden & Fertman, 1998. See also Duggan and Komives. (2007).)
Educational Resolutions for the New Year
Resolution 1: Be learner-centred.
I’ve written about this before, but translating learner-centred theory into practical advice is very helpful. Education happens in the brain, and giving learners the opportunity to use their brains, from listening to and participating in an interactive lecture, to engaging in activities and tasks makes for a learner-centred classroom.
Two fabulous resources are: Classroom Assessment Techniques, by Angelo & Cross (1993 but still great!) and Student Engagement Techniques, by Elizabeth Barkley – over 100 techniques with step-by-step instructions and examples.
Classroom Assessment Techniques is the text where I first heard of Student Generated Test Questions. Each small group of students generates a question that has the potential to be used on a test or on the exams. Some of our faculty use this as a way to summarize learning, find out about what has been learned and to add to questions in the exam bank. This text was also the first place I heard about using an opinion poll–long before “clickers” or other polling devices were used. For an article that provides 10 of the 50 strategies, see: http://www.ncicdp.org/documents/Assessment%20Strategies.pdf
Student Engagement Techniques offered me the Graphic Syllabus and Outcomes Map, and of course I devoured the pages on graphic organizers. You might find the Poster Sessions (and my adaptation of it–virtual poster walk anyone?) or the Critical Incidents Questionnaire useful.
As part of my resolution, I’m sending for a few other books that will have some great ideas–Collaborative Learning Techniques, Essential Questions, Learner-Centred Teaching: 5 Changes… Stay tuned for ideas from these.
I just have to give you an example of how learner-centredness became the inspiration for a very successful activity for us. Part of learner-centred education means involving students in the educational process. Recently I asked a group of students how to make the portfolio assignment in clerkship more relevant to them. They came up with several ideas. I used a few of them and collaborated with Dr. Lindsay Davidson to come up with the CaRMS and Portfolio Oral Report. From what I’ve heard so far, the students seem to feel it is an extremely relevant and useful way to use their portfolio activities.
Resolution 2: Be more reflective.
I discuss reflection with the students in all years in our program. This is met by varying degrees of acceptance. 🙂 But I’ve been forgetting to add one key aspect: I need to show them my reflective practices as well.
What do I reflect on? I ask myself often, “How can I do this better?” and “Where can I find ideas to make this better?” I ask others about improvement and about strengths too. In fact, this blog article is by way of reflection for me.
I start off each week with a list of work, and end it with a list of accomplishments and what got in the way of accomplishments–that reflection helps me when the next week comes around. This is the beginning of a weekly log for me and I am resolving to stick to it! 🙂
Here are some questions we can ask ourselves to become reflective teachers:
1. Were all the students on task (i.e. doing what they were supposed to be
2. If not, when was that and why did it happen?
3. Which parts of the lesson did the students seem to enjoy most? And least?
4. How much (insert topic or skill of choice here) did the students use?
5. Did activities last the right length of time?Was the pace of the lesson right?
6. Did I use whole class work, group work, pair work and/or individual work?
7. What did I use it for? Did it work?
8. Were my instructions clear?
9. Did I provide opportunities for all the students to participate?
10. Was I aware of how the students were participating?
BONUS: If I taught the lesson again, what would I do differently?
What’s next? The next important step in reflection is making the reflection practical and asking “What do I do next?” Identifying challenges, setting goals, finding out new information from the literature, from people, from observations, and putting some strategies into place are ways to make the reflection come to life.
I ask the students to fill in these blanks, “My first step was to consult this piece of medical education literature to find out more about this topic: _________________. From this I learned this specific strategy/skill, concept that I would like to employ: _________________
I will now put these strategies into place:
- Consult _______________(people as resources) to find out more about _________________(this subject, skill, concept, etc.)
- Read ____________ (specific literature) by ________________(time)
- Practice ______________(skill) by doing this: _____________ (strategy) over __________(time)
- Set up this regular ________________ over_______________(time)
- Implement _________________(strategy) into my teaching by X___________________
I will know I have succeeded by:
- Short term: ___________________________
- Long Term: ____________________________
Complete the reflective cycle by asking about the innovations:
- What am I doing?
- Why am I doing it?
- How effective is it?
- How are the students responding?
- How can I do it better?
Resolution 3: Be evidence-based.
Teaching can be and should be evidence-based just as medicine. Read or sign up for an RSS feed from medical education journals such as Academic Medicine, Medical Education, Advances in Health Sciences Education: Theory and Practice, Medical Teacher, Journal of Interprofessional Care, or others (these examples are cited in order of impact factor, 2012, found at http://www.med.uottawa.ca/dime/eng/journals.html) Need to know about how to set up an RSS feed that sends you the journal updates and tables of contents? Contact a librarian at Bracken or see http://library.queensu.ca/news/web-feeds/ The articles, studies and tips in these journals will enhance your teaching. Some texts that feature evidence through studies to inform educational practice are: Teaching at its Best: A Research-Based Resource for College Instructors, What the Best College Teachers Do (a personal favourite!), How Learning Works: Seven Research-based Principles for Smart Teaching
I’ll stop there for now…Too many resolutions, and I’ll end up with none!
Please share your resolutions if you can.
Have a great educational year!
Medical Students Walk in the Shoes of Kingstonians Living with Less
At this holiday time, when we focus on gift-giving, and celebrations, it is also good to reflect on those for whom gifts and celebrations are almost impossible. A few short weeks ago, Queen’s medical students participated in the Poverty Challenge which allowed them to experience living with less.
The following article was written by Dr. Jenn Carpenter and Dr. Melanie Walker who brought the Poverty Challenge to Queen’s School of Medicine.
On December 2nd2014, the first year medical students participated in a Poverty Challenge, organized by Judi Wyatt and Craig. The Poverty Challenge provided them with the opportunity to experience first-hand what some of their future patients live through on a daily basis. As part of their Population and Global Health Course, the students spent the afternoon playing the role of Kingston residents living with less and trying to solve a multitude of daily issues including access to transportation, housing, food, employment and medical care.
Throughout the fall term, the students have been learning about the Social Determinants of Health, their role as Advocate, social accountability and the fact that health is a human right in the Population and Global Health Course. The course stresses the fact that Global Health is local and that there are under-served populations in their own community as well as overseas. Students have learned about the fact that living with less increases one’s chances of ill-health and can also hinder an individual’s chances of success in many of the other social determinants of health such as education, early childhood development and positive social support networks. The Poverty Challenge was an opportunity for experiential learning of these concepts and was a way to put the knowledge that they have gained through their readings and in-class discussions into practice.
Prior to the event, each student was given information about the life and struggles of a person that they were going to role-play. They knew some of that person’s life history, why the person found themselves in the cycle of poverty and what specific obstacles the person was facing at the time. For example, one woman, who had a child at 16 and had no family support, had her child taken away by the Children’s Aid Society because her housing situation was deemed unacceptable. This, in turn, led Ontario Works to reduce her income because she was no longer supporting a child. The students assigned to this woman’s profile were tasked with visiting the appropriate social services agencies (stations located throughout the School of Medicine building and operated by community volunteers) to find employment and affordable housing while undergoing discussions with the Children’s Aid Society to get her child back.
Other students role-played the life of a women who was obese and living in an abusive relationship and was unable to find a family doctor who was willing to accept her as a patient. In addition, due to an undiagnosed learning disability, she was illiterate. The students were tasked to apply to Ontario Works for financial support (remembering the woman’s inability to read and complete necessary forms) and to go to a Temp Agency to apply for work. In addition, the students profiling this Kingston resident had to go to Legal Aid for help to leave her abusive relationship.
Over 20 local agencies were represented in stations throughout the medical building. At each of these agencies, the students encountered roadblocks similar to what the Kingston residents, of their profiles had encountered during difficult times. However, they also found out about the wonderful things that each of these agencies were able to do for them and were able to revel in the feeling of success, if and when they actually found the correct path.
Not only did the students learn important lessons about the barriers to health that people living with less face, but they also learned about community agencies that exist to help lift people out of the cycle of poverty. The feedback from the students was overwhelmingly positive. 96% percent of the students felt that the experience taught them about the challenges faced by people living in poverty and, despite the fact that the event was timetabled for the week prior to exams, 93% percent of them said that they were very glad that they took part.
A sample of the narrative feedback received from the students follows.
- “In general, the whole event was surprising in terms of the impact I noticed and what I heard from my classmates”.
- “I thought this was a terrific event. The experiential aspect really drove home just how many challenges (and of what magnitude) those “living with less” really face on a day-to-day basis […] Sometimes it is easy to forget that poverty is a problem that affects Canadians, not just those living “elsewhere,” and that many of our perceptions of and assumptions about poverty are inaccurate and based on the false assumption that “it couldn’t happen to us,” that poverty is something that one “allows” to happen rather than something that can happen to us in spite of every best intention and effort. I leave today remembering that I am very, very lucky. Thank you for reminding me of that.”
- “I came into the session feeling quite stressed about upcoming exams, and ambivalent as to the potential benefit of taking part in the Poverty Challenge. After […] experiencing (very briefly) some of the frustration involved with truly living in poverty, I’m very glad to have had the opportunity to participate. I have learned more about the holistic nature of suffering in poverty and also about the complex issues that give rise to difficult financial situations. This is an extremely well done event and I will take these lessons with me into the next few years of medical school and beyond. Thank you.”
Doctors are considered to be one of the most important advocates for their patients’ health, but this is a very difficult task without understanding the greater context (physical, emotional and environmental) in which their patients live. Our hope is that by providing these doctors-in-training with a more first-hand experience of some of the hardships that many in the community face and their implications on health we will encourage more open dialogue between doctors and patients and consideration of patient context when planning treatment.
Photos by Dr. Melanie Walker
Congratulations to our UGME committees for their hard work and action plans!
Soren Kierkegaard wrote “Life can only be understood backwards; but it must be lived forwards.” It was in this spirit that the UGME Curriculum and MD PEC Committees met a few weeks ago to review and celebrate the past work of the major subcommittees and their action plans for moving forward.
We teach our students that it’s important to pause, reflect, and then use those reflections to employ change, solve dilemmas, reinforce their strengths and begin new actions. It’s salutory to note too that in these reflections should be a sense of honest satisfaction at jobs well done, lessons learned, innovations practiced and accomplishments of which to to be proud.
It was extremely gratifying to see these principles put into effect when the major sub-committees gave their reports on November 3rd, 2014 to the combined membership of the UGME MD PEC and the UGME Curriculum Committee. Served with refreshments came a series of reports that truly emphasize how busy, productive and conscientious our committees are, how hard-working their memberships are, and how they consistently consider student feedback and keep student learning as a focus.
Here are the reports of the Student Assessment Committee (SAC), the Course and Faculty Review Committee, the Teaching, Learning and Innovations Committee, the Academic Affairs Committee, the Admissions Committee, and Student Affairs.
Student Assessment Committee Report:
Dr. Michelle Gibson kicked off the evening as Director and Chair of the Student Assessment Committee with a report from the SAC. She thanked Dr. Susan Chamberlain, inaugural Chair of the committee and Catherine Isaacs, longtime administrative support for the committee. Dr. Gibson introduced the new administrative support person, Amanda Consack; Eleni Katsoulas, Assessment and Evaluation Consultant came in for words of praise for her continuing support, advice and work on the committee.
Dr. Gibson noted that this was a year of review and information-gathering, with the focus primarily on revising the Assessment Policy and Procedures, working with the OSCE working group, and the Progress, Promotions and Remediation Committee. Her Annual Report SAC report Nov 2014 is attached.
Course and Faculty Review Committee Report:
Dr. Lewis Tomalty is our newest Director and Chair of the UGME Course and Faculty Review Committee. He has taken over from the excellent work done by Dr. Andrea Winthrop in her role as inaugural Chair and the developer of our internal review process. Dr. Tomalty and Dr. Winthrop have worked together to revise and streamline the process of review and it was included in a flowchart that was presented. Dr. Tomalty noted that the review process ensures that all courses receive full reviews every three years (unless there is a new course or significant curriculum change, a new course director, or major recommendations/red flags from the previous year) and a screened review every year. In clerkship rotations are evaluated and follow the same process as for pre-clerkship. A minimum of 2 and a maximum of 4 faculty are evaluated per rotation, and specific evaluation data are not provided to faculty unless aggregated in larger amounts (annually) or until students have graduated. His flowchart_CFRC Process is attached as is his Annual Report from the Course and Faculty Review Committee to MD PEC.
Teaching, Learning and Innovations Committee Report:
Dr. Lindsay Davidson, Director and Chair of the newly branded Teaching, Learning and Innovations Committee, noted that there had been many foci of the committee this year: analysis of MCCQE part 1 data; online modules review, consideration of residents as teachers of our clerks, and longitudinal curricular threads. Upcoming topics include: Recommendations regarding a pilot implementation of i-Human cases, Review and recommendations of specific teaching in the UGME curriculum, a process for feedback on the MCC data, documentation of action plans. guidelines regarding minimum acceptable standard for DIL sessions and guidelines regarding the creations/review of online modules for UGME teaching. Some scholarly projects have been discussed: a survey of current processes for the assessment of resident teaching performance at Queen’s/across other institutions, an audit of the form and function of SGL sessions across the pre-clerkship curriculum and the development and implementation of created or curated resources to assist in the learning/review of neuroanatomy/neurophysiology. For the full report, see Annual Report_TLIC Nov 14.
Student Affairs Report:
Dr. Renee Fitzpatrick, new Director of Student Affairs cleared up nomenclature and focus for us as a beginning of her report: The Learner Wellness Centre houses the Student Affairs Team whose mission it is to provide a resource in supporting the individual and professional growth of medical students throughout the undergraduate medical course. The team act as advocates and advisors throughout medical school and provide a link between students and faculty when concerns are raised or when new innovations are conceived. Dr. Fitzpatrick introduced a new embedded counsellor for medical students, working out of Student Health and Counseling Service. She reviewed the Wellness Days, which focused on resilience; these were implemented for the clerks in September. Dr. Fitzpatrick celebrated the student/faculty driven Wellness and Mental Health Group, and noted that Student Affairs has forged stronger links with Queen’s Disability Services. Dr. Fitzpatrick reviewed the work of the Career Advisors, the Academic Advisor and looked at future directions. This involve a learning climate working group and a focus on student debt. For more on this report, please see Annual Report Student Affairs.
Progress, Promotions and Remediation and the Academic Affairs Committee:
Dr. Richard Van Wylick, the Director of Progress, Promotions and Remediation spoke about the major accomplishments of his committee: the revision of the Progress and Promotion Policy, and the Professionalism Policy and the development of an Accommodation Policy as well as a new procedure for access to student records. The committee worked with the SAC to ensure consistency of their revised policy especially around the role of Examiners’ teams.
A new committee, the Academic Affairs Committee, was created via the approval of new Terms of Reference that bring the policy-making process for student progress and promotion, professionalism, communicable diseases and immunization, student registration, leave of absence and reintegration, student awards, content of transcripts, medical student performance records , academic accommodation, complaints, ethical conduct and the content and management of student records under a single structure that includes broad stakeholder representation including students. Progress and Promotion Committee Terms of Reference were revised as well and the Professionalism Advisory Committee’s terms of reference were revised. Dr. Van Wylick listed other accomplishments, and spoke of these initiatives in progress: Student Appeal Board Terms of Reference, Criminal Records Check Policy, Awards Committee terms of reference and process review, a Communicable Disease Advisory Group and review of Communicable Disease and Immunization Policies and Attendance and Absences in Undergraduate Medicine Policy. For the full report, please see Annual Report from Academic Affairs to MD PEC_CC.
Admissions Committee Report:
Dr. Hugh MacDonald rounded off the evening with a report from the UGME Admissions Committee. He discussed the four admissions streams, the Regular Admission Stream, the Aboriginal Admissions Stream, the MD/MSc and MD/PhD Stream and the Queen’s University Accelerated Route to Medical School (QUARMS). Dr. MacDonald discussed the June 2014 Admissions Retreat where the focus was Continuation of Queen’s Medicine’s three staged process for selection (academic qualifications, personal attribute evaluation through file review and interview), and further alignment of the desired attributes for chosen Medical Students with the various elements of our selection process. Future work for the Admissions Committee includes and improved admissions process, a social accountability mandate with alignment of initiatives with the newly created Diversity Panel and in accord with the recently released Diversity Statement for the School of Medicine. For a summary of the report, please access Annual Report Admissions Committtee Summary.
John Dewey has said, “We do not learn from experience…we learn from reflecting on experience.”
Reviewing the past year was a beneficial exercise…it’s important to stop and reflect on how much has been done. So often we lose that sense of achievement and accomplishment in the busy rush of the day-to-day, and in the pressure of new work to be done. We have hard-working Directors and hard working committee members. Each of these committees reflects the work of several faculty who meet monthly in order to help our program, support our faculty, aid our students and generally help to make Queen’s Medicine the success it is. For a list of faculty who are involved in these committees, please see the Community in MEdTech for each committee.
“Learning without reflection is a waste. Reflection without learning is dangerous.”–Confucius
It’s also important to stop and reflect and to plan for the future: making informed decisions about which direction to take, pursuing goals that arose from reflective retreats, making change that benefits our program. Our committees have accomplished much but are not resting on their laurels…Already they are busy at work, with new meetings, new agendae, and new plans. It’s an exciting time of year, and an enervating group of people as partners!
Dr. Renee Fitzpatrick is the new Director of