Author: Theresa Suart
Facebook thinks I’m a doctor…
And other unusual things that happen when you’re an educational developer at a medical school
It’s a unique and interesting thing being one of the non-medically-trained employees who work (mostly behind the scenes) to help run the undergraduate medical education program at Queen’s. On the one hand, friends and family can sometimes think I’ve magically completed medical school in the types of questions they ask me. (I only work there, I say). On the other, through day-to-day interactions, I have absorbed terminology and “insider” information.
Having quietly marked my five-year anniversary working in medical education at the end of September, it was time for a little reflection. Here are five of the more unusual things that likely wouldn’t have happened to me before I worked at Queen’s School of Medicine:
- A new resident was surprised when, during a follow-up visit, I referred to my condition by name (gastroesophageal reflux disease), rather than calling it heartburn. “Most people don’t call it that,” she observed with surprise. I’d just done a curricular search for where and when we teach it – and at the earlier visit, that’s the term they used, so I paid attention.
- I can find my way around most of HDH and most of KGH most of the time. And I know there are THREE hospitals in Kingston, not two. (I just haven’t figured out the new Providence Care layout yet.) I’ve learned the “logic” of the multiple wings, the naming conventions, and – when all else fails – where to find the volunteer desk to ask directions.
- I now know that what you think something is might not be what it actually is. Case in point: My colleague’s son was diagnosed with OCD – but he’s not the least bit obsessive, so how does he have obsessive compulsive disorder? There’s another OCD, diagnosed by orthopedic specialists: Osteochondritis Dissecans of the knee. (It also stands for Ontario College Diploma, but that’s another story).
- Facebook thinks I’m a doctor. No, really, I get ads for MD Financial Management services, and medical conference. It’s based on analytics harvested from my Google searches (because everything is frighteningly linked these days). I search for things to assist with curriculum development, and voila! Facebook has changed my profession.
- I actually use those ubiquitous hand sanitizer dispensers while entering and leaving the hospitals. Every single time.
Because, as an educator, I just can’t help it: here are educational take-away lessons and considerations from these musings:
- When you’re “inside” you can forget what it’s like to be “outside”: how can remembering this influence communication, for example, in explaining acronyms, procedures, or what happens next? There’s power in language and understanding.
- When we’re familiar with buildings and facilities, it’s easy to forget what it’s like to be in an unfamiliar place and worried about getting around. How can we make instructions and directions as clear as possible?
- Don’t assume. If you’re not sure: ask. For example, we’re talking a lot about EPAs lately in undergraduate medicine. We don’t mean the US Environmental Protection Agency, but Entrustable Professional Activities. Even if we’re trying hard to adhere to my suggestion #1, we might slip up. Speak up and ask for clarification.
- Facebook still thinks I’m a doctor now and again, but more recently it’s promoting space-saving storage ideas and junk removal services. (I’m still adjusting to our downsized townhouse, 15-months in). The lesson here: We leave digital footprints everywhere we go. Intentionally (e.g. through public Twitter posts) or unintentionally through Google searches, nothing we do online is private. How should this influence what we do and how we do it?
Paper cuts and hangnails do not like hand sanitizer. At all. Ever. Be careful.
Here’s to the next five years.
Nominations open for next Exceptional Healer Award
Instilling the values of patient-centered care is one of our goals in the UGME program. It’s also what the Kingston Health Sciences Centre Exceptional Healer Award recognizes in physicians from both the Hotel Dieu and KGH sites.
Launched earlier this year, the Exceptional Healer Award is sponsored by the KHSC Patient & Family Advisory Council. It honours a physician who demonstrates in clinical practices the core concepts of patient- and family-centred care: dignity and respect, information sharing, participation, and collaboration.
Patient Experience Advisor Sue Bedell brought the idea of the award to the Patient and Family Advisory Council and is now coordinator of the award project.
“I happened to have a particularly compassionate and empathetic doctor,” Bedell explained in an interview for how she came up with the idea. “I think it’s important for all people, for all physicians, and healthcare professionals, to be treating sick and injured people with compassion and empathy.” So, she looked for a way to recognize this. She presented her idea to the council at Hotel Dieu, and drafted terms of reference and a nomination form. “I wanted to make sure that I could persuade not on the patient council, but the administration that this was something doable, so they approved it,” she said.
For the first time through, Bedell had hoped to get five or six nominations: instead, the council received 22. Response to the creation of the award was “better than I had ever expected,” she noted.
A selection committee, including Bedell, two other patients, two staff members, and the chief of staff, reviewed these submissions. For the first award, it was a tie: ophthalmologist Dr. Tom Gonder and anesthesiologist Dr. Richard Henry were the winners for 2017. Each received multiple nominations, Bedell said.
Bedell shared that the major themes from all the 2017 nominations were the nominated physicians were dedicated listeners, showed empathy and compassion, took time to spend with patients, focused on inclusion and care of family members, shared information with patients, and demonstrated humility.
“All of these are easy to attach to the core concepts of patient- and family-centred care,” Bedell noted.
Following the first iteration, which had a February deadline, it was decided to run the next iteration earlier in the year, with a November deadline for nominations with the committee’s decision in December, and the presentation early in 2018. The deadline for nominations is Friday, November 3.
Patients and family may nominate a physician who has provided care to them in the last two years. KHSC staff can also nominate members of the health care team. Bedell said that medical students on clerkship rotations can submit nominations.
“I do hope, in the long run, that through this award, and these role models can influence medical students,” Bedell said. “When they listen, to have the intent to understand, rather than just reply – that would be an example.”
“Being a dedicated listener seemed to be most important to the nominators,” she added.
Bedell emphasized that both KHSC hospital sites are full of very competent, skilled, compassionate doctors, and this award is one way to recognize these attributes
There’s still time to nominate a physician for the 2018 award. With the amalgamation of the two sites into the Kingston Health Sciences Centre, physicians from both the Hotel Dieu and Kingston General Hospital sites are eligible to be nominated. Full details are found here on the Exceptional Healer Award website.
Meet Jenna Healey, the new Hannah Chair in the History of Medicine
The new Jason A. Hannah Chair in the History of Medicine knows most Queen’s medical students aren’t going to memorize historical dates and events as a matter of routine, and that’s perfectly okay.
Dr. Jenna Healey notes that instead focusing on dry facts – that these days can readily be looked up — one excellent use of history is “to take a step back every once in a while and to think about the bigger picture.”
“Sometimes it’s easier to do that when you’re thinking historically because you have that little bit of distance. And then you can apply those same critical thinking skills to ongoing controversial issues or new things that come up within your career.”
“We might be looking at a bio-ethical case from the 1960s and, well, ‘they were so wrong,’ right? I’ve taught history of bioethics before, and we have to think about contemporarily, how did people understand what they were doing, what were the standards of their profession? Not necessarily to defend something that we now understand to be unethical, but to understand what the environment was like for those physicians – and then to think about what we find acceptable. Because, in 50 years, inevitably, someone is going to critique us.”
“Sometimes it’s easier to think about these things historically.”
Healey herself didn’t set out to become an historian – of medicine or anything else. Her undergraduate studies found her juggling her twin interests in humanities and science. To accommodate this, she pursued a combined arts & science program at the University of Guelph. “It was a Bachelor of Arts and Sciences,” she explains, “so basically a BA and a BSc at the same time.”
“I was doing an English literature degree along with a molecular biology degree and I was thinking about going to med school, maybe going into public health, and my other career in my head was to be a science journalist,” she shares. “Part of my program requirement was to take an introductory history of science course because you sort of had to combine the two – and I really liked it. So I ended up getting a summer job in the history department as a research assistant; and then the next summer I worked there, too.”
That’s when she started learning about the history of medicine as a discipline. This led her to do a master’s degree in the history of science at the University of Toronto, and later a PhD at Yale. “And I just never left,” she says.
“It turned out to be a very good way to combine my two interests,” she adds, “And to stay within the world of medicine and science without becoming a clinician.”
Prior to being appointed to her position at Queen’s on August 1, Healey was a lecturer at Yale, where she mainly taught pre-medical students. “I’m really excited to have the opportunity to work directly with medical students,” she says.
She hopes much of what she brings to students is that focus on the big picture.
“I want them to think think critically both about the past of the profession, and as cliché as it may be, to learn from the mistakes of the past, and the paternalism of the past, and to really think about themselves as part both of a longer historical legacy, to think about the socio-economic determinants of health,” she explains. “I think history really helps with that: to think about why is our health care system the way it is? How do your patients perceive the medical profession? How does the public perceive medicine? What are the notions they are coming in with?”
Healey also hopes to help students “think critically about the ways new technologies are going to change patient care and the clinical experience, both for physicians and for patients, because technology is something I’m really interested in.”
Healey recognizes that it can be a challenge to “sell” students on the value of spending time on the history of medicine – something her predecessor, Dr. Jacalyn Duffin did in the position for 30 years before her retirement.
“I think you always have to do a bit of justification for why you’re even learning this, and I understand that, as someone who was an undergraduate in the sciences: There is just a lot to do,” Healey says. “There’s a lot to learn, there’s a lot to memorize, a lot of labs to finish. And it’s hard to see, maybe the relevance in that moment, because you just have so much to finish.
“I think, especially in a medicine curriculum, it’s to constantly say ‘it’s ok to take this hour’; this is worth learning, and to get across the idea that people who haven’t taken a lot of history think it’s just a lot of boring facts, and that the point of it is to memorize those facts – and that’s not it at all
“If you leave medical school here and you don’t remember all the details of Harvey’s discovery of circulation, I’m fine with that,” she says. “But it’s more the critical thinking and the historical thinking. And when you do encounter a problem in your career, you can think: how did things get this way? If people take that away, I’d be very happy with that.”
In addition to the lectures and other learning events she has already been working on, Healey has met with members of the student-run History of Medicine group.
“It was exciting for me to get here and see there was already an established a group of students who are very excited about the history of medicine – and that’s all a credit to Dr. Duffin and the program she already had in place and the students are so fired up and excited about it.”
There’s already talk of the next “History of Medicine” trip. “I think it’s a great tradition and I’m really excited about it,” she says, noting all the planning is student-led and logistics (including destination) are in the works.
Dr. Healey will soon be settled into her new office at 80 Barrie Street and looks forward to meeting more students and colleagues.
“I’m very excited and very happy to be here.”
For more on the Ontario Hannah Chairs, check out this link.
What’s in a name? That which we call a rose
By any other name would smell as sweet.
So mused the ill-fated heroine in Romeo and Juliet, about her equally ill-fated love.
In medicine and in teaching, however, names can mean a lot.
The late Dr. Kate Granger of the United Kingdom was one of the strongest advocates for using names with her #hellomynameis campaign – launched while she lived with terminal cancer. As explained in a BBC article following her death in July 2016, the campaign “encouraged healthcare staff to introduce themselves to patients.”
“A by-product of her own experiences of hospital in August 2013, it grew out of the feelings of unimportance she experienced when the doctor who informed her that her cancer had spread did not introduce himself,” the BBC wrote. Granger had explained it this way: “It’s the first thing you are taught in medical school, that when you approach a patient you say your name, your role and what you are going to do. This missing link made me feel like I did not really matter, that these people weren’t bothered who I was. I ended up at times feeling like I was just a diseased body in a hospital bed.”
Learning and using names is important for both teachers and students, long before they reach patients’ hospital beds. For this reason, we emphasize the importance of names in our UGME classrooms and clinical skills environments, too.
“Learning students’ names signals your interest in their performance and encourages student motivation and class participation,” writes Barbara Gross Davis in Tools for Teaching. “Even if you can’t learn everyone’s name, students appreciate your making the effort.”
One of the strategies of learning students names that Gross Davis (and others) suggests is one we’ve adopted at Queen’s UG: having students use name tent cards in the classrooms. This was adopted for two reasons, Dr. Lindsay Davidson, Director of Teaching, Learning, and Integration explains.
“It’s because we start developing professional identity from Day 1, and being a doctor means introducing who you are.”
“And because it helps build relationships,” she adds. “Student-student but also teacher-student—teachers can respond to students as individuals with names not ‘the guy in the ball cap’.”
“We expect all medical students to wear identification nametags for all clinical skills sessions, both in-house and when at health facilities,” says Clinical Skills Director Dr. Cherie Jones. She notes that the Year 1 students don’t have these on Day 1 as these are provided by KGH. “We use paper ones until they are done!” Once the official badges are available, they must be worn.
And it’s not just for students: clinical skills tutors are expected to wear their ID that they use in their clinical settings.
And for all those (like me) who’ve become accustomed to wearing an ID card on a lanyard or on a hip-level clip: IDs are to be worn on the lapel of the jacket—where they can best be seen
“Name tags are important in clinical skills sessions because the Standardized Patients (SPs) and Volunteer Patients (VPs), like to know the names of the students and tutors they are working with and don’t always understand or hear the name when the student introduces themselves,” Dr. Jones explains.
The Clinical Skills policy mimics the name-badge policies at the hospitals in Kingston. “Name tags in clinical settings like KGH are mandatory for anyone interacting with patients, staff, even with visitors,” Dr. Jones points out.
“Not only is it policy in the hospital, but patients like being able to read anyone’s name – not just the students’,” adds Kathy Bowes, Clinical Skills Coordinator.
So, remember your ID badge, use your name tent cards in the classrooms, use people’s names. And me, I’ll be pinning my hospital ID badge in the right place the next time I’m heading over to KGH for a meeting.
Because names matter. To everyone.
Anatomy studies begin with focus on respect
Each September, first year students in the Queen’s Undergraduate Medical program quietly begin their studies in anatomy with a service acknowledging the donation of bodies that will be used in the lab assignments.
This year the short service will be held on Tuesday, September 5 at 3 p.m. in room 032 of the Medical Building, following the introduction to the Human Structure & Function course.
The course co-directors, Les MacKenzie, Stephen Pang, and Allan Baer will be joined by Queen’s Chaplain Kate Johnson to lead the program.
The session emphasizes respect and professionalism. “This is the first approach to professionalism,” MacKenzie explained in an interview. “The purpose of the donations is for this study and we have to respect that.”
“Respect not just for the bodies that have been donated, but for the families who have donated them,” he added.
Queen’s is one of a decreasing number of medical schools that still uses human cadavers in anatomy courses. According to a 2016 article in National Geographic, “half of Canadian medical schools have cut back on using cadavers, relying instead on new technology to make teaching basic anatomy more efficient.”
While there is definitely a place for technology, MacKenzie acknowledged, there’s also a strong argument for using donated human bodies. He pointed out, for example, that the many variations of “normal” are not experienced if everyone is using the same computer simulated program. It’s a privilege to have this learning experience, MacKenzie noted, and the students recognize this.
The emphasis on respect is tied to one of the objectives from the Queen’s UGME Competency Framework (Professional 1.1a) which notes students will “Identify honesty, integrity, commitment, dependability, compassion, respect, confidentiality and altruism in clinical practice and apply these concepts in learning, medical and professional encounters.” For the Human Structure and Function course, this is further annotated to explain that students will: “Consistently demonstrate compassion and respect for those who have donated their bodies to the medical school for use by students studying anatomy.”
“I truly believe the point does get across,” MacKenzie said. “Our medical students really get the message, there’s no horseplay. We have zero tolerance of misbehaving.”
Queen’s Chaplain Kate Johnson, who has led the opening service in recent years, takes the opportunity to emphasize the students’ own humanity and to remind them to keep in touch with it.
“Historically, medical students were at risk of a ‘super human’ culture of medicine,” Johnson said. “Now, with technological advances, there’s the danger of taking the humanity out of medicine. The anatomy lab is one place to keep the humanity.”
Johnson also reminds students they are starting on a pathway to a position of trust.
“You’re not just technically excellent, but your professional conduct is to be worthy of trust,” she noted at last year’s service. “It’s appropriate then that this part of your education starts with the bodies of people whose last wish was to entrust their physical remains to you in order that you can be fully trained in your profession,” she said. “Even more, their surviving family members have made what is often a huge decision to trust you by following through on their deceased loved ones’ wishes.
Tuesday’s service is open to all members of the Queen’s community. “It would be great if it was standing room only,” MacKenzie said.
Each spring features a more formal, graveside burial service at the Queen’s University plot at Cataraqui Cemetery which is attended by family, friends, and members of the Queen’s community. Details on this service will be available in the spring.
For more on the Human Body Donor Program at Queen’s see A body of medical knowledge in the Queen’s Alumni Review 2017 Issue 2
For information on procedures to donate, see the Queen’s Department of Biomedical and Molecular Sciences Human Body Donor Program web page.
Bats, Blogs, and Story Ideas
While I was drafting this post, I had an unexpected visitor in my office in the form of a juvenile bat. Yep. A bat.
I followed the Queen’s Environmental Health & Safety bat protocol (yes, there is one. Find it here) and exited the room immediately, closing the door. I then had a colleague call to arrange for its removal.
Ok, there may have been some squealing-like-a-five-year-old while I was exiting the room, but since there was nobody here to see that, I can deny it happened (colleagues’ vacations and meetings were well-timed for my dignity). There may also have been some vocabulary that would earn a fine for the curse jar at my house.
Just a handful of people would know about my bat adventure… except I’m writing about it here.
My point is this: things happen all the time around the UGME offices, the medical building, and other places of importance for the UG program. Things for, to, or by our faculty, staff, and students; interesting things that are worth sharing. I’m not suggesting that we’re starting a weekly newspaper filled with notations of every bat sighting, or intramural sports scores. What I do know, however, is there are plenty of newsworthy things happening that go unnoticed.
Things like: innovative student activities or projects; research publications; special events; noteworthy field trips; students or faculty winning awards. If you’ve ever wondered why we posted about “X” but not about “Y” the simple reason most of the time, is we likely didn’t know about “Y” at all.
You may have noticed a bit of a pattern to our blog posts. Our associate dean, Dr. Sanfilippo posts roughly every other week. On the alternating weeks, members of the Education Team post, with the occasional committee update thrown in. I post under my own name, as well as curating those posted under the “Guest Blogger” ID.
Here’s where you come in. If you’re a member of the Queen’s UGME community and you have an idea or suggestion for a blog post, please feel free to get in touch. We could write something up with you as the source, or you could write the post yourself as one of our Guest Bloggers.
If your suggestion is time-dependent (like an event or something with a deadline), try to get in touch as early as you can.
I can’t promise that we’ll be able to follow-up on every suggestion with a published post, but a great starting point is letting us know. So, get in touch. Reach me by email (email@example.com ) or drop into my office on the 3rd floor at 80 Barrie. It’s currently bat-free.
Bat shown is for illustration purposes only… no pictures of my recent temporary office guest are available.
Rerun season nostalgia and course planning
In the era of Netflix, TiVo, and Internet downloading that has given rise to binge-watching an entire TV series in a weekend, my childhood appreciation for summer rerun season is distinctly absent.
For those of a certain generation, summer was the time to catch-up: on sleep, on reading, on those episodes of your favourite TV show that you missed because of basketball practice or drama rehearsal (or because your brother got to pick his favourite show alternating Tuesday nights).
While reruns may be absent from your television set, the concept of reruns can be helpful in your course planning for the fall. As you review your teaching, consider these things:
- What were the highlights? (80s Rerun Parallel: A great episode you want to see again)
- What did you include but didn’t cover as closely as you wanted? (80s Rerun Parallel: That awesome episode you half-watched while playing Candy Land while babysitting)
- What got dropped by accident? (80s Rerun Parallel: The special episodes you missed because you just couldn’t get to the TV at the right time—see reasons, above).
These rerun-inspired reflection prompts can get you thinking of areas where you can improve or enhance your teaching plan. And, in the spirit of retro TV-rerun season, here are four of my previous blog posts you may have missed that give you some tools for planning or revising your teaching after your reflecting is complete:
- Key to planning any learning activity – from a single learning event, to a workshop to a semester-long course is to write learning objectives. Get some tips and learn some techniques here: When your objective is to write learning objectives
- We have specific learning event types we use in our UG program. Some for accreditation purposes, but mainly for a solid mix of content delivery and content application. Find our decoding tools here: Decoding Learning Event Types
- If you’re reworking an existing learning event, paring down may be the key. Revisit Applying decluttering principles to learning event planning for tips
- If you’d like to explore electronic alternatives to lectures, check out Online modules can enhance curriculum content delivery
Now, excuse me while I try to figure out the scheduling of binge-watching six seasons of Game of Thrones so I can get caught up. I seem to be one of the only people around who hasn’t watched a single episode.
But, seriously, I’m always available to talk through your UG teaching challenges. Email me: firstname.lastname@example.org
When teaching isn’t fun anymore…
People come to teaching through a variety of paths. That’s especially true in medical education.
One thing that most educators – at any level – have in common is a sincere desire to teach. And, generally, most educators get some enjoyment out of it. But what happens if that’s not the case? What if you’ve been told you must teach, or (perhaps more disheartening), what if you’ve enjoyed education assignments to this point, but teaching just isn’t fun anymore?
Even if it’s something you have been passionate about, it can be a challenge to stay engaged year after year. Even the most dedicated educators can lose steam along the way. (These suggestions aren’t focused on the level of burnout. That’s another very serious topic for another day. This is more about a “general malaise” – you know there’s something not working, but you’re not quite sure what that is.)
If your enthusiasm for your teaching assignment is on the wane, and it seems more chore than challenge, here are five possible interventions to consider:
Re-focus on what attracted you to teaching in the first place. (Or, if you’ve been assigned to teach, think about what you enjoyed about learning).
What brought you to teaching in the first place? Is it sharing knowledge and expertise? Working with future colleagues? Exploring new technologies or teaching methods? Is it the place, the people, the content? Sometimes we drop our favourite things by accident. Is there something missing now that you can reintroduce to your teaching practice?
Team up with a colleague.
Despite the many faculty we have, teaching can seem a lonely enterprise. Preparation is very often done solo and it’s you standing alone with the class or group of students. Consider partnering with a colleague to prepare together and compare notes after teaching. You don’t have to be teaching in the same course or area – it’s staying connected and sharing viewpoints that can help.
If you’re able to, consider swapping teaching responsibilities with a colleague: if you’ve always focused on pre-clerkship teaching, maybe trade with a colleague who has focused on clerkship instruction. If you’ve been an FSGL tutor, swap with a Clinical Skills one. The shift in perspective could help you both (and enrich students’ experiences, too). If you pair this with #2, you can help each other through the transition. When you swap back the next year, you’ll each have new tools and a fresh outlook.
If you can, step away for a little while.
While this is not always possible, if you can take a break from teaching, it can reawaken your enthusiasm. Time away can help you remember exactly what it is you love about teaching and give you space to address those areas that have become chores. Sometimes absence truly does make the heart grow fonder.
Come talk to me or other members of the Education Team.
We may be able to help pinpoint specific areas of your teaching assignment that are dragging you down and brainstorm some solutions. Sometimes talking it out can provide its own insight. We don’t have all the answers, but we can certainly help look for them. Reach me here: email@example.com
Five things to do this summer: a Med Ed to-do list
This first year I worked in a post-secondary setting, I was somewhat bemused when students asked me how I was going to spend my summer – they were heading out on a three or four month “break” and assumed I was doing the same. Some had work plans, some travel, some both. Regardless, they would be away from campus and recharging their batteries, and, perhaps, expanding their perspectives in a variety of ways. I, however, would be at my desk.
Two decades and three universities later, I’m still working through much of the summer months as are many of my administration, staff, and faculty colleagues as we stagger vacations with other colleagues and other family members’ schedules.
For those of us at the School of Medicine (including our 2018 clerks!) who don’t have two or three months off this season but maybe a couple of weeks and the odd day here or there to make a long weekend – here’s my list of five things to do that are (loosely) related to medical education. (This list is best perused—and perhaps amended or augmented—while sitting on a patio with your favourite libation).
Read something not related to your discipline
In the crush of academic terms, it’s easy to fall into the trap of reading for work, not for recreation. There’s always just one more journal article to be read, one more new text to review. One more thing to stay on top of. Vow to read at least one novel (or collection of short stories, or poetry) this summer. Regardless of genre, you’ll learn something of the human condition (which is at the heart of medicine and medical education) and it will refresh you, too. So, move it to the top of your To Be Read pile. Among my picks: a toss-up between finally reading at least one of the Harry Potter books, or Abraham Verghese’s Cutting for Stone. Maybe both. The Art of Adapting by Cassandra Dunn is also in the running.
Binge watch a cooking show on the Food Network
Whether it’s TiVo’ed or Netflix, the ability to skip the ads is a godsend for a rainy Saturday’s binge-watching. Opt for something where you might pick up a recipe or tip or two, but pay attention to how the host explains what they’re doing. Is it conversational? Directive? Do you stay engaged? Or pick one of the competition shows (Chopped is my guilty pleasure) and check out how different judges give feedback. Some are brutal; some overly-kind without much substance. Some have thoughtful suggestions. Many adapt their critique delivery, based on the experience and competence levels of the chefs competing. How can this inform how you deliver feedback?
Enlist some pals and build a sandcastle at the beach
Sandcastles are hands-on and best accomplished as a team effort. Building one requires both attention to details and a flexibility to accommodate the sand, water, and tide schedule. The plan is rarely ever 100% completed without modifications along the way. Plus, everybody gets dirty. And, at the end of the day, there’s nothing except pictures as the tide washes it away. So, a fresh slate the next day. And, we can take the lessons learned on to the next one.
Hit the movie theatre to see a summer blockbuster
Enjoy the a/c and see something outrageous. Popcorn optional. Take note of if the story drags anywhere: did you get the urge to check your smart-phone (pre-movie admonishments aside). What made your attention wander? Was it an extraneous info-dump? An overly-long car chase? Just too much of something? A gap in knowledge? If you’re working on online modules for next year, take note of where the show lost you. Adapt this insight to material you create for your students.
Watch some fireworks
Most of us know that fireworks were invented in China centuries ago. According to the “Fireworks University” website, this was an accident when a field kitchen cook happened to mix charcoal, sulphur and saltpeter. What a happy accident*.
There’s no great medical education insight to go with this watch fireworks suggestion: they’re just fun. And maybe that’s the insight right there.
* (I feel obliged to stress the importance of following all instructions for the at-home kind of fireworks and strongly urging you to show up for community fireworks shows instead. Avoid the unplanned side trip to the ER).
Doctors, patients, ritual and showing up
Ritual is a big part of life; this is especially evident at universities at this time of year. I recently took part in the ritual of attending convocation at another university to watch my daughter receive her Bachelor of Health Sciences degree. In addition to the parental joy of seeing my daughter on stage for about six seconds of hooding and handshaking, I had the pleasure of hearing the convocation speaker, Dr. Abraham Verghese, a physician, author and professor at Stanford School of Medicine.
The importance of ritual, both in life and in particular in the doctor-patient relationship, is something Dr. Verghese is passionate about. He’s written about this, presented TED talks, and, late last month, incorporated this message into his convocation address at McMaster University.
Dr. Verghese noted that it’s possible to get your degree without attending the ceremony, but “rituals matter.” He added: “It says something about you that you believe in this ritual, that you showed up, because showing up for rituals that matter is perhaps the best advice I can give you.”
He acknowledged that he was speaking from “the vantage point of a window of practicing medicine” but hoped his message about ritual would resonate with everyone. He pointed out that the very ritual of convocation itself makes no sense in other contexts: “You’re dressed in a way that you otherwise never dress like. And I’m dressed as I rarely dress. With distinguished faculty on the stage, you marched in proceeded by a beadle carrying the mace, an instrument of battle that’s also a metaphor of power.”
“Our anthropology colleagues teach us that rituals are all about crossing a threshold,” he explained. “They represent a transformation, whether it’s a baptism, or a bar mitzvah, an inauguration, a funeral, a graduation.”
He challenged the graduates to consider what the rituals are in their lives, in their work, before sharing insight into his own understanding of ritual in his medical practice:
“If you think about the usual clinic visits, two strangers are often coming together, one person in the room will be wearing this white shamanistic outfit with tools in their pockets, and the other individual will be wearing a paper gown that no one knows how to tie or untie. The furniture in the room looks nothing like the furniture in your house or mine. The individual in the paper gown will then begin to tell the other one things that they would never tell their rabbi, or their preacher, and in my specialty of infectious disease, they will tell me things they would never tell their spouse. And then, incredibly, they will disrobe and allow touch, which in any other context in society would be assault, but the physician gets the privilege in the setting of this ritual.”
He further explained that this is not unique to any one culture. “I care for people from all kinds of ethnic groups, and I’m struck by how many different beliefs they have about illness, about disease, about treatment, but they all know about ritual,” he said. “And you put them in that room with all its setup and they know they’re about to embark in a ritual and if you do it poorly, if you just do a prod of their belly, and stick your stethoscope on the gown, they’re on to you, they can tell when you’re doing it well just as you can tell when you’re in the hands of a thoughtful barista, a good chef, a good hairdresser, a good mechanic.
“Rituals, done well, signify people who are doing their jobs well.”
Rituals can also be transformative, he said. “I learned this firsthand in the early years of the AIDS epidemic before we had any treatment,” he said, recalling a young man who he had followed for months at the clinic and who was now dying in the hospital.
“Each day I would come to his bedside and I’d visit him and I’d talk to his mother, and not knowing what else to do in this sacred hallowed space that surrounded him with his mother holding vigil, after a while, I would begin to examine him, albeit briefly. I would listen to his heart, I would percuss his lungs, feel his abdomen, feel his spleen, even though it was very unlikely I would discover anything that would change what we did,” he said.
“I engaged in this ritual out of habit, relieved that it gave me something to do, some purpose at the bedside.”
“One day, when I came by, his mother, that eternal figure there, told me that he’d not spoken or come to consciousness since the previous noon. It seemed certain that he was about to die, and in fact, he did pass away a few hours later,” Dr. Verghese continued. “But strangely, at that moment, as he heard us talking, as he heard my voice, we saw his hands begin to move. She was astonished, ‘cause she had not seen anything before. And I was astonished, and we’re wondering what is he gonna do? And we saw his skeletal fingers flutter up and then move to this wicker basket of a chest of his. And it took us a while to understand that he was fumbling with his pajama buttons. He was trying to unbutton his shirt, he was reflexively allowing me the privilege of examining him, giving me permission. I tell you, I did not decline the gift.”
“I percussed, I palpated, I listened to his heart, his lungs. I felt connected to the timeless message the physician conveys, the same message the horse and buggy doctor, riding out to towns on the western edge of Lake Ontario 150, 200 years ago, conveyed to his or her patients of that era, when there was so little to offer,” he said.
“The message is that beyond the data, beyond the evidence or lack of evidence, beyond the medicines that stop working, here I am and no matter what, I care, I will be there with you through thick and thin, I will not stop coming, I will show up.”
Dr. Verghese then spoke about emerging artificial intelligence and how it will change medicine.
“Here’s what’s not going to change, is the need for human beings to care for each other,” he said.
“We all need it in every walk of life, but especially in the care of the sick. I’m hoping that in my field, artificial intelligence will free us from some of the drudgery of medical record keeping and allow us to fulfill the Samaritan function of being a physician, to minister to those who suffer,” he added.
He exhorted the graduates to “embrace the rituals of your life, be conscious of them.”
“Be in charge and be cognizant of those human values and rituals that you want to preserve,” he added. “Remember that fluttering hand of the dying patient, I remember it every single day.”
Unlike machines, he said, “You can care, you can love, you can preserve the rituals that showcase these things. And you can show up. Always show up.”
You can watch Dr. Verghese’s full address here. It begins around 29:05.