We Are Not Amused

Let’s be clear, I am no royalist. I find the concept of a hereditary monarchy unjustifiable, care nothing about who is where in the “line of succession” and find the media attention paid to every public appearance and utterance of members of royal family as they struggle with the “anguish” and “burdens” of their unearned privilege to be silly at best and offensive at worst.

But I like the Queen. In fact, I like her a lot. And it’s not just because she looks like my mother, although that doesn’t hurt. It’s not simply because she’s “the Queen”. It’s because she has been, in the admittedly perverse context of the life and times in which she has found herself, a rare and remarkable example of commitment to service who has, through her words and actions, attempted to understand the real needs of the people she is meant to serve, intervene as best she could, and consistently given expression to the very best aspects of the national character. In all this she provides an example for us all as we engage our stations in life particularly, I hasten to point out, those of us in the health professions.

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She has been forced to do so as the epicentre of continuing storms of controversy caused not by her, but by the shenanigans of the innumerable members of her extended family and in-laws. Her words, over the near 70 years of her reign, have provided solace and support in times of need. She has provided what, by all accounts, has been very sensible and citizen-focused counsel to no fewer than 14 British Prime Ministers, (beginning with Winston Churchill!). She has refused to submit to demands for “reforms” that would compromise the standards she has set for herself and for the position she holds. She has persevered. At the age of 95 and reputably quite wealthy, she certainly doesn’t need the work and, I imagine, could do without the aggravation. Who among us would not have retired to our estates and Corgis decades ago?

She has, in the vernacular of our day, been “one class act” in the evolving soap opera that has become the modern monarchy, the future of which now appears to hinge on her great-grandchildren– two toddlers and an infant whose duties to date have not yet extended beyond being adorable (a duty in which, I must admit, they have excelled).

And she’s smart! This past week we had a great example of regal grace and wit. Informed that she’d been elected, by a magazine and editorial team that should know better, to receive an “Oldie of the Year” Award, she crafted the following response:

“Her Majesty believes you are as old as you feel and, as such the Queen does not believe she meets the relevant criteria to be able to accept and hopes you find a more worthy recipient.

With Her Majesty’s warmest best wishes.” 

GRAHAM PHOTO LIBRARY:GETTY IMAGES

A measured, dignified slap-down for the ages. Take that, you ageist boors! 

Among all the unearned privilege our modern world seems to be tolerating, it’s both refreshing and encouraging to find someone who not only appreciates their station but attempts to the best of their ability to rise to the responsibility that it provides, staying true to their values.

You go, girl!

Sorry. You go, Your Majesty.

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Kingston and its Students: A Tempestuous but Enduring Symbiosis

With tongue firmly in cheek, a friend recently remarked that “Town-Gown” relations seem somewhat strained in our community these days. A remarkable example of impish understatement if one was ever uttered. Indeed, the usual energy and sense of renewal that accompanies the return of students each September has been muted if not completely submerged under layers of pandemic-related anxiety and efforts intended to mitigate them. The juxtaposition of such efforts with images of unrestrained street parties, fenced off beach areas and rising local COVID case counts has been, for many, rather jarring and unsettling.

Amid all this, I recently received a letter from a local physician that cut through that gloom like a glimmer of sunshine on a stormy day. Dr. Stephen Yates, a longstanding Family Physician in our community, wrote to Dr. Philpott and myself about his experiences working in vaccination clinics alongside volunteer medical students. In Dr. Yates own words (provided in part and abridged with his permission):

I am writing to you both after a very busy 6 months working as the Clinical Lead at several community covid19 Mass Immunization Clinics that have run from March to August this year. Those MIC’s put Kingston on the “Vaccine Map” of Canada as one the very highest vaccine rates in a Canadian community.

We could not have accomplished this extremely successful vaccine roll out without volunteers and the Queen’s Medical School Students stepped up to the plate and helped us out. When the medical school academic year ended numerous 1st and 2nd year students, with a few 3rd and 4th year, and even a few students entering the school this year, came forward to donate their time.

To try and name all the students who took part will leave many students out by mistake but suffice it to say…all the students were an absolute delight to get to know and to work with.

Whether organizing student volunteers, helping with vaccine draws, functioning as principal vaccinators, organizing recipient stand by lists for extra vaccines, calling literally hundreds of recipients in for shots, reviewing side effects or even managing vaccine hesitancy, your students were exemplary and were key to helping this community get through the pandemic.

The community of Kingston owes a great debt of gratitude to your medical students!

Very best regards,

Dr Stephen Yates, MD, CCFP, FCFP

Kingston and its student population. A raucous, tempestuous, never-fully-resolved, but also never-boring relationship. A marriage, it would seem, doomed to constant struggle, never to achieve either complete happiness or peaceful separation. To the cynical or those hopelessly frustrated by all this, the idiom “can’t live with them, can’t live without them” might seem appropriately applied, by either party. But, like any relationship experiencing difficulty, causes are deep, complex and worthy of some thoughtful reflection. Like many, I encountered our city initially as a student, have embraced it as adopted home, raised a family here, have seen numerous family members attend as students, and now live both sides of the “Town-Gown” dichotomy. And so, some observations, respectfully offered.

Firstly, it must be said, Kingston would not be Kingston without its students. This is not simply an economic or political reality. The student population brings energy, purpose and, on a regular cycle, youthful renewal to one of the oldest communities in our country. The city of Kingston, for many generations of students, has provided a supportive environment and wonderful example of community life. It has been an incubator of citizens who learn what it means to be part of and to care for their “home”. Its productivity or place in Canadian society will never be measured in terms of manufactured goods or agricultural productivity. Its true “product” are the young people whose lives are, in ways great and small, shaped by their lived experience among us.  

For most students, their time in Kingston is their first experience living, to some extent at least, on their own. They are going through a very challenging phase of life during which most struggle with understanding and developing their own interests, strengths, values, and purpose in life. For most of them, the time they spend in Kingston will be the most transformational of their lives.

That transformation doesn’t occur entirely or even mostly in the classrooms of Queen’s, RMC or St. Lawrence College. It also happens in the streets, shops, restaurants, waterfront, trails, lakes, and rivers of our community. It happens through interactions with their fellow students and faculty they encounter to be sure, but also within the community in which they must function, independent of the influences and supports of home. Those encounters, as we’ve observed recently, can be ill-advised and troublesome. Judgement may be lacking, consequences may not be understood or ignored, actions may be impulsively taken, untempered by experience. This is not to say that actions should be free of consequences. In fact, it would be a disservice not to maintain standards based on the best interests of the greater community. But those responses should be directed at the actions not the individuals, motivated by a desire to correct not condemn, and tempered with the understanding that most of us will have no difficulty recalling similar lapses of judgement if challenged to cast the first stone.

Symbiosis is a biologic term that might have relevance here. It implies a mutually beneficial relationship between different people or groups. Hummingbirds, for example, have a symbiotic relationship with wildflowers. The birds are feeding on nectar provided by the flowers and gaining nourishment. Without that occasional noisy intervention, the flowers would not cross-pollinate and and would not flourish so beautifully.

It’s also helpful to be reminded that the vast majority of students integrate well and even contribute positively to our community. For a group of eager medical students, that contribution occurred recently in an immunization clinic.

Thank you, Dr. Yates, for the reminder. When it comes to students and Kingston, it’s not “them” and “us”. They are us.

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Together again, in person and with gusto

The last in-person, full-class teaching session in the Queen’s School of Medicine took place over 18 months ago. Seems much longer. Since then, as is known to all reading this article, we’ve been providing our curriculum with a combination of virtual and appropriately regulated small group teaching events. These arrangements, contrived and cumbersome as they may appear, have allowed programming to continue and student learning to progress. 

Just last week, we received very welcome news from the province and university that restrictions could be reduced to allow full class, in person sessions to proceed as of September 7th. Unfortunately, this didn’t arrive in time for our Orientation Week which was scheduled to begin August 30th. We had therefore planned and received approval from the university for a modified program which would be compliant with current requirements. The week kicked off with a welcoming event for all first, second and third year students (our fourth years being on clinical rotations and unable to attend) held in the main gymnasium of the ARC (Athletics and Recreation Centre).  Our fully vaccinated, screened, disease-free, and masked students were welcomed back to the school year and to a “more normal” learning environment by faculty and student leadership. The significance and poignancy of assembling after such a long period of relative isolation cannot be overstated. To add to the celebration, music was provided by “Old Docs New Tricks” (ODNT), a group of SOM faculty physicians who not only entertained the crowd but demonstrated how busy practicing physicians can maintain personal interests while achieving great things in their professional lives.

Below is a small album of photos from the event, all by Lars Hagberg, go-to photographer extraordinaire and friend of the School of Medicine.

Dr. Jane Philpott, Dean, Faculty of Health Sciences

Mr. Bryan Wong, President, Aesculapian Society

ODNT: Drs. David Maslove, Gerald Evans, Jim Biagi, Danielle Kain, Gord Boyd, Rachel Holden (unable to attend: Dr. Chris Frank)

ODNT performing for the crowd

Many thanks to our Student Affairs group, capably led by Dr. Renee Fitzpatrick and supported by Erin Meyer and Hayley Morgenstern, who worked tirelessly and with great adaptability to make these arrangements.

We all recognize that the pandemic is far from resolved. We remain guided by continuing public health requirements. We recognize that further adaptations will likely be required in the weeks and months to come. We remain committed to providing the best possible educational experience for our students and learning environment for all involved.

But, for now, we’re just grateful to be in our classrooms and in person. We’re back!

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Looking for a Few Good People

We’re incredibly fortunate at Queen’s to be blessed with a faculty that engages educational leadership with enthusiasm, creativity and dedication.  When new positions emerge, or when people who have been key contributors come to the end of their terms, the program faces both challenges and opportunities.  The challenge is obviously to fill the position and assist the incumbent.  The opportunity, of course, is that it allows another faculty member to engage a new challenge, to influence medical education and advance their careers in new ways.  

A number of such positions become available at the end of each academic year.  I will describe some of these below and invite any interested faculty members to forward any inquiries or expressions of interest to myself or Dr. Michelle Gibson. 

Chair, Student Assessment Committee 

The Student Assessment Committee has a key role within an undergraduate medical program. It’s basically responsible for the oversight of all assessment practices in UGME, including setting policy & procedures. Peter McPherson has been very capably filling this role for the past few years. The Chair of SAC also works closely with course directors and other curricular leaders on the implementation of exams and other assessments.  This includes reviewing the design and content, and assisting in the post-exam analysis process, supported by our Assessment and Evaluation Consultant (Eleni Katsoulas). They also work with our assessment team, headed by Amanda Consack. In addition, the chair of SAC sits on Curriculum Committee and has a key voice within that key group.  SAC meetings take place quarterly, with additional duties for the chair throughout the year in terms of the day-to-day oversight of our assessment systems.  Expertise and interest in assessment practices is required for this position, as well as the willingness to work with our very capable administrative team, our assessment consultant and numerous faculty colleagues who serve as Course Directors.

We are looking for three Competency Leads.  These individuals are responsible for oversight of relevant learning objectives, by way of working with course directors and other curricular leaders to enhance the teaching and assessment of these roles in our curriculum. Competency leads often work together as there are natural links between many different of these roles.

Communicator Lead

The Communicator lead will review how we teach and assess communication objectives across our curriculum, to ensure our students are excellent communicators in many different settings.  This includes looking at communication in different contexts such as with patients, families, health care professionals, colleagues, and the community. 

Scholar lead

This role has been held and developed by Heather Murray since it was developed as part of our curricular renewal several years ago. Heather has developed a robust and innovative set of curricular offerings that meet our program objectives that relate to critical appraisal, research methodology and life-long learning. The Scholar lead will review how we teach and assess all these components. This role also addresses students’ skills for self-assessment and ensures they have the skills to implement a plan to address their own personal learning needs throughout their careers. The scholar lead will also oversee and direct the annual Research Showcase.

Leader Lead

The alliteratively named Leader Lead will review how we teach and assess different objectives designed to help our students develop their skills as leaders. This includes developing skills that will lead to effective management of the care of their patients, their practice, and themselves in the context of the Canadian health care system, community, and society in which they practice. This includes an understanding of the principles of patient safety, stewardship, and quality improvement systems. The competency also includes working with our well-established Student Affairs group in providing students with opportunities for career exploration to inform their career choice, and development of personal insight and behaviours that will promote wellness and self-management, leading them to healthy life-long and rewarding careers.

Clerkship OSCE lead 

This faculty member would work with our established OSCE support team and clerkship course directors to design and implement an OSCE for clinical clerks, once a year.  This is a new position, ideal for a faculty member interested in student assessment who would like to be more involved in UGME.  The date of the clerkship OSCE for the 2021/2022 academic year will be in February 2022. 

Course & Faculty Review Committee members

Three committee members are needed for this committee that reviews course evaluations to make recommendations to the curriculum committee.  These positions are open to any faculty members who have familiarity with UGME.   This committee meets quarterly, with additional need for electronic review between meetings.

All these positions will receive credit within our Workforce accountability system.  For information or further discussion regarding any of these positions, please contact me directly at ajs@queensu.ca or Michelle Gibson, Assistant Dean Curriculum at gibsonm1@providencecare.ca.

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They’re Going to be OK. A Thank-you to Our First Patients and Remarkable First Year Class

These days, more than ever, bits of good news are truly welcome. Like rays of sunshine breaking through the clouds on a gloomy day, they remind us that things are still basically right with the world and brighter days are ahead.

I had one of those experiences last week attending a wrap-up session for our First Patient Program. The FPP is a rather unique curricular offering at Queen’s supervised by Dr. Brenda Whitney and superbly organized by Ms. Kathy Bowes, an RN who has been working in various capacities in the undergraduate program for many years.

Patients are recruited from the Kingston community who have chronic medical problems requiring regular encounters with physicians and other health care providers. These patients generously agree to allow two of our first-year students to meet with them and their families, to get to know them personally and to follow them through the year. At the end of each year, a reception is held to thank them. Following are some pictures from the 2019 event.

From First Patient Reception 2019

The students are expected to learn about the illness experience through the eyes of the patient. They check in regularly and accompany patients to their various medical encounters. They are expected to gain insights not only about the specific condition afflicting the patient, but the impact of that condition on them and their family members, and of the practical challenges involved in the process of receiving care. For most of our first-year students, it is their first personal experience with chronic illness and its impact.

First Patient Reception 2019

This year, the pandemic posed considerable logistic challenges. Dr. Whitney and Ms. Bowes were remarkably creative and adaptable in adjusting the program to allow the students to gain valuable experiences despite the limitations.

First Patient Reception 2019

This past week a virtual wrap-up of the program was held, involving both students and their “first patients”. The highlight of the program, for me, was hearing from the students themselves about insights they had gained and taken away from their encounters. Here are a few samples, taken from the slide presentation prepared for the session.

What’s particularly remarkable is that all this was gleaned by a group of students whose introduction to the study and profession of medicine has been, to say the least, unconventional. Indeed, the pandemic and its myriad of imposed restrictions have drastically altered the educational experience for all our students. Although everyone involved has done everything possible to make the best of it, our students have not had opportunity to assemble as a class, work together or engage patient encounters as planned. They have accepted all this, by and large, with understanding and patience.

The first year class has been particularly affected because they’ve not yet had the opportunity to fully meet as a class or personally encounter many faculty members. Those of us responsible for their learning experience have had some apprehension and a few sleepless nights about the adequacy of what was being provided. Certainly, the course content and necessary knowledge was being imparted and learned. Assessments were satisfactorily completed. Skills that could be demonstrated and practiced were being mastered. But were they learning about what it is to engage patients? Were they learning to regard their patients as individuals with lives, hopes and families, to understand their suffering, to search for ways to help? Were they learning how necessary all this is to providing effective care?

Last week’s session made me realize that much has already been learned, including real-life lessons that could never have been imparted in a classroom or by reading scholarly works. They’ve learned that only by engaging real people with real problems can the full scope and value of medical care be truly realized. They’ve learned that our patients can be our best teachers.

And I learned that this group of students, despite all the accommodations that have been made to our curriculum, are going to be OK. They get it. They are on their way to becoming fine doctors.

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Silent Victims of the Pandemic

“Jean died last night.”

That was my first email message of the morning. It came from Jean’s daughter. Jean (not her real name) had been in hospital being treated for heart failure. She didn’t want to be in hospital, to be sure. It took her daughter, her family physician and I to convince her that she could no longer manage on her own, up most of the night sitting in her chair panting for breath, the skin of her swollen legs beginning to break down.

Although I wasn’t her attending cardiologist during this admission, I had treated her for many years and dropped by to visit with her the day before. Propped up in her high backed hospital chair with her feet elevated, she almost reluctantly admitted she was feeling a bit better. Her legs were clearly less edematous. But she didn’t think she was going to go home this time and that, she said, was OK. She had made her wishes clear to all. Her “comfort care” status was well documented.

Although in her late 80’s, Jean retained a perceptive intelligence and disdain for convention. Anything she didn’t approve of was quickly dismissed as “nonsense”. The word that immediately comes to mind to describe her is “feisty”.

She’d immigrated to Canada with her husband and infant daughter shortly after the second world war. They worked various jobs eventually opening and operating a successful small business . When her husband passed away, she operated the business, eventually turning it over to her daughter.

Jean had rheumatic fever in her youth which left her with valvular heart disease. In the early part of the twentieth century, rheumatic mitral stenosis was a major cause of morbidity and mortality in young women, resulting not only in heart failure but also stroke due to cardiac thrombi precipitated by the onset of atrial fibrillation, often during pregnancy. Many years ago, when she began to develop symptoms,  Jean underwent a closed mitral commissurotomy. This was one of the first surgical approaches available. The surgeon would attempt to break the fusion of the mitral leaflets caused by the rheumatic inflammatory process, either with dilators or a finger passed across the valve.

This approach, which sounds rather crude to us today, was very effective in relieving symptoms and is the same basic approach used today with catheter based balloon valvuloplasty.

She did well for many years after the commissurotomy and even had a baby despite conventional medical wisdom at the time advising against pregnancy. Her mitral stenosis gradually progressed, and she went on to have a valve replacement with a mechanical prosthesis about 25 years ago. Over the years, she evolved varied and expected cardiac manifestations including atrial fibrillation, progressive aortic valve disease, coronary disease and, most recently, right-sided heart failure.  She faced each challenge with grace and acceptance. As she said many times, she never expected to live to be an “old lady” and was grateful for whatever treatments were available to her. But, in recent years, she was quite clear that there would be no more interventions, catheterizations or surgeries. The goals of care were very clear: “I’ll take whatever pills you suggest, just keep me independent and out of hospital”

And independent she was. In her own home until moving into a rather posh retirement complex a few years ago. I attended a reception in her honour organized by her daughter and friends for her 85th birthday. She was the epitome of charm, holding court like a duchess at a ball.

Her daughter’s message was accompanied by a request to call. She let me know how very important it was that she was able to visit with her mother the evening before she passed away. Given the pandemic restrictions, what they both feared most about the hospitalization was the separation from each other. This, no doubt, was the main reason they delayed so long in asking for help. However, the medical and nursing staff went out of their way to make arrangements for them to see each other. She asked me to express how important this was to them and to pass along their gratitude, which was one of the motivations for this article. What may have seemed to be a small act of kindness was highly meaningful.

The other objective of this article is to highlight the impact this pandemic is having on management of chronic disease and end-of-life care. Jean’s reluctance to come to hospital despite a clear need for help is typical of many patients suffering from cardiac and other chronic diseases.

A recent article examining emergency room visits for acute heart failure found a 43.5% reduction in 2020 compared to the previous year, and a 39.3% reduction in hospital admissions (Frankfurter et al. Can J Cardiol 2020;36:1680).

From: Frankfurter et al. Can J Cardiol 2020;36:1680

The authors conclude with this important observation:

“The precipitous decline observed in ADHF (acute decompensated heart failure)-related ED visits and hospitalizations raises the timely question of how these patients are managing beyond the acute-care setting and reinforces the need for broad public education on the continued availability and safety of emergency services throughout the COVID-19 pandemic.”

This issue is not limited to heart failure patients. In fact, while preparing this article, I was contacted by another patient with known multi-vessel coronary artery disease and previous myocardial injury who was awaiting much needed surgical intervention. He’d been experiencing chest pain for two hours and was calling to ask whether it was “safe” to go to the emergency department. He’s now being admitted awaiting surgery while being treated for his unstable ischemic syndrome.

In an examination of patients with coronary artery disease presentations, Natarajan et al (Canadian Journal of Cardiology Open 2020: 678e683) reported both lower rates of myocardial infarction and delays to coronary angiography in 2020 compared with the previous year.

From: Natarajan et al. Canadian Journal of Cardiology Open 2020: 678e683

Clearly, the coronavirus has not reduced the prevalence of either heart failure or coronary disease. It has, however, imposed barriers to access. Although we do not yet have precise information as to the nature of these barriers, it’s apparent that each step along the path from initial symptom assessment to final treatment is made more difficult by necessary pandemic precautions, and that patients, advised strongly to isolate, are understandably more fearful about venturing into emergency departments and diagnostic facilities.

And so, the accounts of these two patients have much to teach us.

It’s important to remember that, even during a terrible pandemic, most of the patients we’re treating do not have COVID-19. Most of them are suffering from the same medical and surgical conditions they’ve always had, and these diseases don’t wait for the pandemic to pass. However, the pandemic does impose barriers to their ability and/or willingness to access care. As the medical and public health communities message the public about the need to adhere to all the preventive measures, it’s important also emphasize the importance of continuing to manage all health concerns and work to diminish access barriers wherever possible.

As always, our patients are our greatest teachers. Jean taught me and the countless learners she was always pleased to engage along the way much about the natural history, features and available treatments for rheumatic heart disease. That’s a legacy that will benefit many future patients. For that, she deserves our gratitude, and the kindness shown her during her final admission seems well earned.

I will miss her.

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Lessons in Diversity and Inclusion: The Legacy of Joey Moss

Joey Moss, by all accounts, achieved his dream job. He was an avid hockey fan who became locker room attendant for the Edmonton Oilers.  The Oilers, it must be understood, are not just any hockey team. They were Mr. Moss’s favourite team and personal passion. During the 1980s, they were phenomenally successful, winning no fewer than five championships.  

As a locker room attendant, he will have had a variety of tasks, including organizing equipment, looking after needs of players during games and generally bringing some order to the chaos that ensues when 20 or so young athletes are engaged in a fast-paced, high-pressure sport.

Mr. Moss, who was born with Down Syndrome, passed away last week. It appears, based on numerous testimonials that have come forward since his death, that his influence extended well beyond his designated tasks. His unrelenting good humour, infectious enthusiasm and continual encouragement of the players brought value far beyond his assigned duties. Wayne Gretzky, a star member of those teams, summed it up nicely when, upon hearing of Mr. Moss’s passing said simply “He made our lives better”.

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Mr. Gretzky was, in fact, instrumental in bringing Mr. Moss to the attention of the hockey club. The two met when Gretzky became acquainted with Moss’s sister. Gretzky, at that time, was in the ascendancy of a career that was to eventually define him arguably (and these things are always arguable) as the greatest hockey player of all time. He arranged the introduction, but it was Mr. Moss’s work ethic, dedication and attitude that made him such a fixture and success with the team.

How did all this come about? What motivates a rising star and celebrity to go the trouble to advocate for someone they’ve just met? Gretzky is not known to be a comfortable public figure nor a vocal advocate for social change. At that time, he was a young man adapting to celebrity in a large city. He’d been born and raised Brantford, a town in southwestern Ontario best known (pre-Gretzky) as the birthplace of the telephone. His father Walter worked for Bell Canada and, together with wife Phyllis, taught their five children lessons of life and hockey in their busy home and on the ice rinks installed annually on their lawn. Those lessons, one might imagine, involved how to relate to the people in one’s community and a responsibility to help those in need when the opportunity presented itself. In advocating for Mr. Moss, it appears Gretzky was perceiving and responding to such an opportunity. What he did was not about publicity or self-promotion. It was something personal, a selfless act of kindness.  

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The struggle for inclusion and acceptance of diversity will not be won solely by legislation, public campaigns or vitriolic dialogue. It will be won through individual encounters that challenge assumptions and dispel fears. Mr. Gretzky and Mr. Moss did not set out to convince a team of young athletes, a business organization, a city or a nation that a person who looked different and was considered disabled could make a valuable contribution. And yet, that’s what they did, all beginning with a chance encounter and simple act of kindness. Indeed, making lives better.

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Imagining the Post-Pandemic University: What COVID-19 is telling us about young people and higher education.

Like any species that migrates annually in search of a more nurturing habitat, young people around the world have, for centuries, left their homes in the late summer to attend university or college. For the vast majority, this has meant moving to another city and, for the first time, separating from family, friends and familiar surroundings.

The presumed primary reason for this migration has been to seek advanced education in order to pursue interests and prepare for chosen careers. A second purpose, less overtly expressed, is to further personal independence. Over the years, those two purposes have been intimately interwoven. Moving away, for the vast majority, was an indisputable requirement of advanced education. For some it has been seen as difficult and a major personal hurdle. For others, it is welcome and long overdue. For virtually all, it has been seen as necessary, beyond personal choice or preference.

COVID-19 has changed all that. Because of the massive shift to alternative forms of curricular delivery required by the pandemic, most (all but those in programs where personal attendance is considered essential) have been provided a choice. They are, for the first time, able to continue their studies whether or not they move to the community in which their learning institution is located. By making personal attendance optional, COVID-19 has provided a fascinating natural experiment. What have we observed?

Here at Queen’s, about 1,900 students have returned to university residences, despite the fact that only a small minority of them need to be on campus to engage any part of their curriculum. In addition, the Office of the University Registrar estimates that a further 8,600 students have moved to local Kingston accommodations. Although exact figures aren’t available, a reasonable guess would be that about 1,000 of these are required to do so to engage required in-person curriculum. It’s therefore reasonable to estimate that over 9,000 young people have chosen to move to Kingston to take up their education even though it has been deemed pedagogically unnecessary for them to do so by those overseeing their programs.

We also know that there is historical experience to support the desire of students to move away from home to pursue their education even if it isn’t essential to do so. Young people who happen to live in communities that house excellent institutions of higher learning will very often choose to move away for the “university experience”. Even those who remain in the same city will often choose to “move out”, seeking separate accommodations away from home.

All this should, of course, come as no surprise. It’s all part of the process of normal human development. Erik Erikson, as far back at the early 1950s, postulated that late adolescence and early adulthood were critical times in the development of personal and social identity.  He theorized that such identity develops most effectively when people at that stage of life are provided what he called a “psychosocial moratorium”, by which he meant a time and situation during which they could feel free to “sample” and experiment with various social roles for themselves before taking on a more fixed and permanent role, i.e., before they “committed” to a profession, personal philosophy, or relationship.  Colleges and universities are critical to providing this environment for most young people, certainly in North America. For that environment to fully meet the needs of students, it must allow them to interact, both passively and actively, with other young people and with teachers with differing life experiences and perspective who can challenge assumptions and promote new thought during this critical developmental phase. Much of those encounters are passive and unanticipated, occurring in various social contexts, small and large.  

And so, the “education” that young people seek by leaving home and moving to universities isn’t simply limited to the acquisition of new knowledge or qualifications. They’re also seeking, and very much need, an environment where their personal development can continue to grow and expand. The “social” components of university life, the “partying” so troubling to many, are not simply troublesome indulgences. They are very much part of the overall growth/educational experience.

The 9,000 or so young people moving back to Kingston this month are basically “voting with their feet” in stating what’s important to them, and what they’re seeking at this point in their lives. As they return, their integration into the community given the threats of COVID has never been more difficult or potentially divisive. Their presence brings an understandable degree of fear. Although their return has been rather muted compared to previous years, many social behaviours previously easily tolerated are now considered unacceptable and, on occasion, infringements of new public health requirements.

Given all this, what are the implications for universities and colleges once the stresses and problems of the pandemic are finally resolved and we are able to resume “normal” operations? If they wish to remain relevant and attractive to young people, what lessons are they to take forward in considering their post-COVID world? I offer a few (very personal) perspectives.

  • The concept of university education being defined by rigid schedules and classrooms of defined capacity should now be considered antiquated and obsolete. The educational adaptations to COVID have shown rather conclusively that the transmission and learning of information and fundamental knowledge can be accomplished quite well without these time-honoured constructs, vestiges of early childhood education.
  • We are also learning that higher level teaching about integrative or complex concepts, knowledge application and simple exchanges of thought between learner and teacher are clearly not fully accomplished through computer interfaces. The absence of personal interaction lessens the educational experience, for both learner and teacher. To be truly a community of higher learning, universities must find effective ways for students and teachers to interact, at the right times, and for the right reasons.
  • Behaviour has to be interpreted realistically. Expecting young people to not socialize is like expecting a fish not to swim. It’s in their nature. It’s how they navigate the world. Expecting that they won’t be overly boisterous from time to time is like expecting a puppy to be placid and stationary. Socializing is not inherently evil but rather a necessary part of development. In young adults who may be somewhat lacking in both experience and judgement, borderline behaviour is an inevitable consequence. This is not to say that anti-social or criminal behaviour should be condoned. Far from it. It should be condemned in the strongest terms. But our condemnation should consider whether there was intent to do harm, be directed at the behaviour and not the individual, and should reflect support, understanding and efforts to educate.

The campus of the future should reflect these lessons learned. The ability to deliver foundational information and basic knowledge more efficiently and flexibly through various remote interfaces shouldn’t be seen as a temporary bridge back to “normal” but rather the beginning of new and promising innovations. Technologies for remote delivery should be embraced and enhanced. At the same time, the critical importance of personal interactions between teachers and learners for higher level teaching of core concepts, knowledge application and exchange of ideas merits preservation and emphasis. The development of creative and effective ways to enhance such exchanges, using both traditional and innovative formats warrants encouragement and support. Finally, the university environment should recognize the critical requirement of young people to socialize and allow them to do so in a safe and responsible manner. Campuses that evolve from being collections of buildings and rooms accessed according to rigid schedules, to more open communities where learning is a more natural lived experience will better meet the needs of students and find themselves in high demand.

The pandemic is, along with many troubling challenges, also providing valuable insights and opportunities. We should learn from this natural experiment playing out around us. We should aspire to more than to simply return to “normal”.

 

I’m very grateful to Stuart Pinchin, University Registrar, for his assistance in the preparation of this article.

Opinions expressed in this article are those of the author.

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A Quirky, Unique and Heartfelt Welcome to Meds 2024

Everything is different during a pandemic. Last week’s orientation events for our first-year students proved to be no exception. In fact, I on the first day I found myself standing alone in large hall speaking to a medical school class and their families, none of whom I could see.

To explain, the Orientation Week usually starts off with a gathering of the entire class in the main lecture hall of the School of Medicine Building with a series of welcomes and presentations. I’ve always found it a particular pleasure to meet the newly gathered class for the first time and share in their enthusiasm and excitement. Because of pandemic restrictions, we had decided some time ago to hold the first session in Grant Hall, with the hope that we’d be able to bring the entire group together in a large venue that could provide appropriate social distancing. Since the hall was updated over the summer with appropriate audiovisual capacity for large class use during the semester, that seemed like a reasonable idea. Alas, the escalating requirements necessitated by the changing characteristics of the pandemic made that impossible. Nonetheless, we felt we could still use that space as a base for the presentations and livestreaming to family members (a pandemic bonus!). When we arrived Monday morning for what would prove to be the first such session from that site, we found that the set up was such that the speaker could only be seen by viewers by standing not on the stage, which would provide scale and an academically appropriate backdrop, but from the floor.

And so, I found myself a small figure in a large space speaking to people I couldn’t see. Fortunately, I wasn’t completely alone. I was followed by Dr. Renee Fitzpatrick, Assistant Dean Student Affairs, Mr. Anthony Li, Aesculapian Society President and finally Dr. Jane Philpott, our new Dean who delivered an inspiring address about the privilege and responsibilities of a medical career. Many thanks to our MedsVC team, and Bill Deadman in particular, for very capable assistance and guidance through all this.

This year’s group consists of 107 students, drawn from an applicant pool of over 5500. They come all regions of our country and backgrounds. One hundred and seven individual paths leading to a common goal that they will now share for the next four years. Sixty-two of them have completed undergraduate degrees, 27 have Masters degrees, and three have received PhDs

They hail from no fewer than 47 communities spanning the breadth and width of Canada:

They have attended a variety of universities and undertaken an impressive diversity of educational programs prior to medical school:

An academically diverse and very qualified group, to be sure.  Last week, they undertook a variety of orientation activities organized by both faculty and their upper year colleagues.  They were called upon to demonstrate commitment to their studies, their profession and their future patients.  They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers. 

Over the course of the week, they met a number of curricular leaders, including Drs. Lindsey Patterson and Laura Milne.  They were also introduced by Dr. Fitzpatrick to our excellent learner support team, including Drs. Martin Ten Hove, Jason Franklin, Mike McMullen, Josh Lakoff, Erin Beattie, Lauren Badalato and Susan MacDonald who oriented them to the Learner Wellness, Career Counseling and Academic Support services that will be provided throughout their years with us.  They met members of our superb administrative and educational support teams led by Jacqueline Findlay

They attended an excellent session on inclusion and challenges within the learning environment, organized by third year student Chalani Ranasinghe supported by Drs. Mala Joneja and Renee Fitzpatrick. Stephanie Simpson, University Advisor on Equity and Human Rights, provided a thought-provoking and challenging presentation intended to raise self-awareness regarding diversity and inclusion issues. This was followed by a very informative dialogue from a panel of upper year students (Nabil Hawaa, Sabreena Lawal, Andrew Lee and Ayla Raabis) who provided candid and very useful insights to their first-year colleagues.

On Thursday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Renee Fitzpatrick, Cherie Jones and Lindsey Patterson.

Dr. Susan Moffatt organized and coordinated the very popular and much appreciated “Pearls of Wisdom” session, where fourth year students nominate and introduce faculty members who have been particularly impactful in their education and invited them to pass on a few words of advice to the new students.  This year, Drs. Peter Bryson, Casi Cabrera, Bob Connelly, Jay Engel, Chris Frank, Debra Hamer, Nazik Hammad, Mala Joneja, Michelle Gibson, and Narendra Singh were selected for this honour.

Their Meds 2021 upper year colleagues, led by Miriam Maes, welcomed them with a number of (generally virtual) events.  A highlight included the always popular distribution of backpacks, this year in brilliant school-bus-yellow (the group is already becoming knows as “the Hive”). Thanks to Molly Cowls (Meds 2024) for sharing this collage.

For all these arrangements, skillfully coordinated, I’m very grateful to Erin Meyer and Hayley Morgenstern of our Student Affairs team.

I’m also grateful to Erin for not allowing the first years to be deprived of the traditional Orientation Week group picture which, this year, required some creativity and extra effort:

I invite you to join me in welcoming these new members of our school and medical community. Their first week be long remembered for the most unique in the history of our school, and hopefully also for the commitment, persistence and adaptability of all involved.

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This is Not Normal. Let’s Not Get Used to it.

We are growing accustomed to the sight of people wearing masks in public.

We are growing accustomed to maintaining a distance between ourselves and others.

We are becoming wary, even fearful, of personal contact.

We are no longer expecting that we will be able to celebrate accomplishments or significant events in large gatherings.

We are growing accustomed to not assembling to grieve the loss of friends or loved ones.

We are accepting the need to interact with our patients through remote interfaces.

All this is necessary given our current circumstances. These measures deserve and require our support. We may even be coming to regard many of these changes as beneficial, efficient, a “new normal” in how we engage our professional and casual relationships.

But they are not desirable. They are not virtuous. They come with a price.

Nelson Mandela, who learned a thing or two about isolation during his 27 years of imprisonment on Robben Island, is quoted as saying “Nothing is more dehumanizing than isolation from human companionship”. Although our restrictions may seem like trifling inconveniences in comparison to his experience, the parallel is valid.

Personal relationships require personal contact. An image on a screen can never convey the same meaning or depth of understanding. The concept of caring or concern for another person cannot fully be expressed or understood remotely. Learning how to encounter, assess and care for a person in need can only be accomplished through individual, personal contact.

Beyond these individual considerations, our social structure is built on the concept of “community”. Communities can be defined in purely geographic terms as a group of people inhabiting the same location. The deeper and more significant meaning relates to the commonality of values, attitudes and goals. Communities, in short, are made up of people who share certain understandings of how they wish to live and what they hope to accomplish collectively. Community requires its members to be accepting and concerned about each, which can only come through personal interaction.  

The education of its young people is, by any measure, a defining characteristic of a community.

The very word “education” has etymological roots that are both interesting and revealing.  It evidently derives from the Latin “educo”, roughly translated “I lead forth” or “I raise up”.  “Educatio” is “a breeding; a bringing up; a rearing”.  The definition that I prefer is simpler and more consistent with the origin and intent of the process; “an enlightening experience”

Facts and information can be learned in isolation. True education requires contact with teachers, mentors and, in the case of medical education, patients.

A community without social interaction and personal exchanges is not a community. A society without healthy and vibrant communities is not a society.

Getting back to Mandela, the remarkable thing is not that he survived 27 years of social isolation, but that he emerged from it all not embittered but with an even greater sense of purpose and understanding. The quote cited above continues as follows…“there I had time to just sit for hours and think.”

Let’s hope we emerge from our own prisons soon, a little more appreciative of what we are sacrificing, and a little more enlightened.

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