Curriculum Committee Information – March 22, 2018 & April 17, 2018

Faculty, staff, and students interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on March 22, 2018 and April 17, 2018.  To review the topics discussed at this meeting, please click HERE to view the agenda for March 22, 2018 and HERE to view the agenda for April 17, 2018.

Faculty interested in reviewing the minutes of the March 22 and April 17 meetings can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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“What Happened in Medicine?” Medical students ask Philadelphia

By Kelly Salman, photos by Rawy Shaaban, Queen’s medicine class of 2021

“The history quiz is due this weekend?!” a classmate pulled it up on his phone, while a few followed suit on laptops. We were waiting for the bus to take us to Philadelphia and while my peers debated the turbulent past of drug advertising, the rest of us talked about what we were excited to see. Many had plans for dramatic poses on the “Rocky steps” or near the Liberty Bell.

“What even is the liberty bell?” I shamelessly asked while googling the best spot to find cheesesteaks. The real reason we were heading over the border was for a history of medicine trip, the continuation of a long tradition for Queen’s Medicine students, one that started in 1996.

I can’t lie and say I’ve always appreciated history. Although I could fool you, or scare you, with my wide-eyed ramblings about how cool the plague must have been, history is an interest I’ve found late. But along my route to medicine, something romantic about the past has drawn me in, and I got the impression during this trip that I wasn’t alone. Perhaps it has something to do with entering a field that makes you take an oath to an ancient Greek guy, but as a group medical students seem somewhat enamoured with their own history.

Contrary to popular belief, history waits for no one, and we started our adventure early Saturday morning, coffees in hand. Pennsylvania Hospital was a great place to set the tone; I challenge anyone to sit in an old surgical amphitheatre and not get swept up in historical daydreams. It helped that our guide painted an incredible picture for us as we sat on elevated benches, peering down at a classmate sprawled out on the operating table. It’s the details that get you… for instance, the floor would have been covered in wood chips for soaking up, well, you can imagine. Or that the hospital opened its doors to those of the public curious to observe the spectacle. In a different life, I wondered, how many of us would have been in that audience.

We continued to a stately mansion, famous for housing a man modestly named “the Father of American Surgery”, or to his friends and family Dr. Philip Physick. The guide here had a slightly more blunt approach, but it fit with the narrative he was giving. As we perused Dr. Physick’s various inventions (surgical instruments and… soda), he told us about how uncommon it was for a patient to survive surgery in those early days of the field: “He tried some neurosurgery, but often ended up accidentally nicking a blood vessel and then it’s ‘you’re going to get very sleepy now’”. I left with the unsettling impression that surgery in the 18th century sounded a lot like making a recipe from scratch – trial and error.

If you’ve ever idly wondered what a slice of Einstein’s brain looks like, then the Mütter Museum is for you. So, basically everyone. It’s a medical smorgasbord, filled with oddities and ailments through time: atypical skeletons, preserved organs, a jar of human skin (why?!), and even a giant human colon. Perhaps more interesting was the history of how society responds to such anomalies, in an exhibit dedicated to the folklore and varied cultural attitudes surrounding birth defects across the world. No photos allowed, but check out their website for some extraordinary highlights!

As millennials we often forget what books look like, so it was a real treat to see the libraries. We marvelled at the mahogany grandeur of the Pennsylvania Hospital library, but my favourite was less insta-worthy (partly because pictures were ‘discouraged’). While half of the group looked through beautiful, hand-drawn anatomy pop-up texts, the rest of us were led along a meandering pathway through the College of Physicians of Philadelphia to a door reminiscent of a submarine airlock. We quietly filed into the largest collection of books I have ever set eyes on. It was a room of steel bookshelves, dusty and dimly lit, filled with medical literature and journals from the past. Peering through the holes in the floor, the stacks continued infinitely further down than my eyes, and frankly my brain, could comprehend. I tried to imagine all of the words below our feet, and thought it must be akin to what an astronaut feels looking back at the earth.

I know my words can’t compete with those of my medical ancestors hidden away in Philadelphia. But hopefully if you take anything from them, it’s an inkling of interest into the world behind us. Good and bad, whimsical, and downright gruesome at times, the history of medicine is incredibly important. Because, well, in the words of someone more eloquent than me “History never really says goodbye. History says ‘See you later.”

Oh and in case you were concerned, I did find time for a cheesesteak.

 

 

 

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Third annual History of Medicine Week starts April 23

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

Museum of Healthcare Showcase 

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

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

Panel Discussion

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

Open Mic Night 

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

Movie Night: History of Kingston Psychiatric Hospital

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

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

 

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Curriculum Committee Information – February 22, 2018

Faculty, staff, and students interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on February 22, 2018.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of the February 22 meeting can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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The Evolution of SPs and The Standardized Patient & OSCE Program

Open House at Queen’s School of Medicine

Clinical Teaching Centre

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

By Kate Slagle, SP & OSCE Program Manager

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

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

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

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

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

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

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

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

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

Important Links

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

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

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

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

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

 

 

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2018 KHSC Exceptional Healer named

[Italics indicates hyperlink]

We wrote about the Kingston Health Sciences Centre Exceptional Healer Award last fall (link here) encouraging nominations for the second iteration of the award which recognizes a physician who demonstrates in clinical practices the core concepts of patient- and family-centred care: dignity and respect, information sharing, participation, and collaboration. It’s sponsored by the KHSC Patient & Family Advisory Council.

In February, Dr. Shawna Johnston was named the 2018 winner of the award. Dr. Johnston was praised by the selection committee for putting patients and families at the centre of care.

(Left to Right) Patient Experience Advisor Sue Bedell, Chief of Staff Dr. Michael Fitzpatrick and Dr. Shawna Johnston Credit: Matthew Manor/KHSC From: http://www.kgh.on.ca/kghconnect/news/privileged-be-her-patient

Patients, families and staff nominated 21 physicians for the award. Thirty-four nominations were receive, with about 25 percent coming from KHSC staff. (Medical students are included in the “staff” category and may submit nominations). This annual award was created by the Patient & Family Advisory Council to honour physicians of KHSC for demonstrating the core concepts of patient and family-centred care (PFCC) in their clinical practice. These concepts are: dignity and respect, information sharing, participation, and collaboration.

Dr. Johnston, a urogynecologist and international expert on vaginal health, was cited for providing the highest respect and empathy for her patients who deal with pelvic floor disorders such as organ prolapse and urinary incontinence.

One patient wrote: “She took her time and explained the surgical procedure. She was innovative in drawing diagrams for me and allowed time for me to ingest this information and to ask as many questions as I needed. I never felt rushed.”

Dr. Johnston was also praised for treating family members as partners and “an extension of the clinical team.” It was also noted that Dr. Johnston models these behaviours to residents. This, one patient noted “is a gift from her to future practicing physicians and to the communities that will welcome them.”

Dr. Johnston works with Queen’s medical students in MEDS 443, the Obstetrics & Gynecology clerkship rotation. Herself a graduate of Queen’s School of Medicine, Dr. Johnston said that she was trained to be a good listener by the late Dr. Neil Piercy.

“I was taught to always put myself in my patient’s shoes, especially when surgery is involved,” she told KGH Connect. “It’s a big decision, and you can’t take a one-size-fits-all approach. That’s why my patients help me to decide what will work best for them. I’m always open to more questions—I spend a lot of time on the phone—because the patient needs to buy into the treatment. Otherwise, it’s not good care.”

“Families play a big part in treatment decisions because they’re the ones supporting the patient at home,” she added. “The choices we make need to work from both the patient and care provider perspective.”

Patient Experience Advisor Sue Bedell, chair of the award selection committee, was delighted by the staff support for the award. “It shows that fellow caregivers, along with patients and families, deeply appreciate physicians who provide respectful and compassionate health care.

Other physicians nominated for the award were:

  • Dr. Manny Bal
  • Dr. Michael Brundage
  • Dr. Barry Chan
  • Dr. Jay Engel
  • Dr. Michael Flavin
  • Dr. Michael Leveridge
  • Dr. Peter MacPherson
  • Dr. Laura Marcotte
  • Dr. Andrea Moore
  • Dr. David Reed
  • Dr. Michael O’Reilly
  • Dr. Mark Ropeleski
  • Dr. Robert Siemens
  • Dr. Sid Srivastava
  • Dr. Yi Ning Johanna Strube
  • Dr. Benjamin Thompson
  • Dr. Anna Tomiak
  • Dr. Naji Touma
  • Dr. Brent Wolfrom
  • Dr. David Yen

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Curriculum Committee Information – November 23, 2017 & February 1, 2018

Faculty, staff, and students interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on November 23, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda.

A meeting of the Curriculum Committee was held on February 1, 2018.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of the November and February meetings can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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“Lifestyle as Medicine” Symposium February 12

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

 

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

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

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

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

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

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

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

 

 

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The Winter Solstice – Nature’s promise of better things to come

What do the Temple of Karnack in Luxor, Stonehenge in England, Chichen Itza in Mexico and Machu Picchu in Peru have in common?

Answer: They are all constructed, in part, to align with and mark the winter solstice. At Stonehenge, the central altar and “slaughter stone” are aligned precisely with the rays of the sunset on the winter solstice, the shortest day of the year.

The winter solstice, which occurs this week, is the day of the year with the least number of daylight hours for people in the northern hemisphere, and the most for those in the southern hemisphere. The exact timing of the solstice varies somewhat from year to year. This year, it occurs on Thursday December 21 at 16:28 GMT. It occurs because the vertical axis of the earth is not aligned perfectly perpendicular to the sun, but inclined about 23.5 degrees. This results in the hemispheres getting variable periods of daylight as the earth rotates during its annual journey around the sun.

There is much speculation as to why these various ancient civilizations chose to erect such monuments to mark the solstice. Clearly, they saw it as a pivotal event in their lives. They would have perceived the life-giving sun to be gradually withdrawing from their lives through the previous few months and then, on this particular day, and for no reason they could comprehend or control, re-emerging with the promise that life would continue once again.

Whatever their motivation, these structures should remind us that the peoples of the past were keen and respectful observers of the natural world. They recognized that the rhythms of the cosmos, even if beyond their understanding, were key to their survival. The ability to cultivate crops, find game and the essential need to store food and prepare for long winters was closely tied to their understanding of natural climate cycles. Observing the natural world was therefore not a casual pastime, but an essential survival skill. For these reasons, they were much more attuned to nature than those of us living in an era where, for most of us, technical advances have reduced diminishing daylight to a minor nuisance.

However, the solstice is in some ways a great leveler of humanity. It has been a feature of our collective life experience since human beings first walked the earth. It is also one of the very few events that occur at the exact same instant each year for everyone on the planet. It is therefore an event that transcends geography, culture, economic advantage, national boundaries, or even time itself. It links us all and reminds us that there are much greater forces at play in our lives than anything we can hope to control or even fully understand.

It also brings hope. It is the time of year when, through no effort, merit or intent on our part, light begins to re-emerge into our lives and, with it, the promise of new life in the spring. It is a time when, like nature itself, we should stop, rest and look hopefully forward.

It’s in that spirit that I wish our faculty and students a restful, safe and restorative break from the routine of busy lives, and very best wishes, as we will again come together to engage the new year.

Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean,
Undergraduate Medical Education

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Queen’s Medicine Pre-Clerkship South East Asia Observership 2017

By Cesia Quintero (MEDS 2020)

In June and July of 2017, a cohort of six first year medical students from Queen’s University conducted a month-long observership in Vietnam and Cambodia. The goals of the trip were to provide the students with a valuable clinical experience and exposure to Global Health, and to establish connections that might expand the availability of Global Health experiences for future Queen’s medical students. We also hoped to explore the possibility of creating unique partnerships with overseas institutions that would boost the global profile of Queen’s University.

We examined a Neurocysticercosis patient at NIMPE

 Overview

The bulk of our two-week Vietnam stay was at St. Paul’s Hospital in Hanoi, Vietnam, where we had a chance to observe in a variety of departments, including ICU, ER, Pediatric Infectious Disease, Pediatric Cardiology, and Endocrinology. Our visit was initially sponsored by the director of the Endocrinology department at St. Paul’s, and throughout our stay we managed to make good connections with several other physicians, including the director of the ICU. All of these physicians expressed interest in a similar arrangement next year. We also had a chance to have a one-day observership at the National Institute of Malariology and Parasitology (NIMPE), where we saw patients with parasitic infections that we would not have an opportunity to see in Canada.

The connections we made in this portion of the trip allowed for the possibility of more in-depth observerships at NIMPE in the future, and for expanding this opportunity to the National Hospital of Tropical Diseases. We also made connections that could allow us to similarly access the health system in the Lao People’s Democratic Republic.

During our Cambodia stay, we spent one week at Battambang Provincial Hospital, which is one of the larger provincial hospitals in the country, and at the Pailin Referral Hospital, a very under-resourced hospital that serves 75,000 rural residents. We quickly learned that Battambang Hospital routinely hosts students from Australia and the UK; during our stay there, there was a group of four medical students from the UK and 22 nursing students from Australia. Both the coordinator for foreign students and the director of the hospital indicated that they would love to form a relationship with a Canadian medical school. In Pailin we became closely acquainted with the Deputy Minister of Health of the province, as well as with the director of the hospital, and several department directors. At both Cambodian hospitals we spent our time in the ER, Pediatrics, Labour and Delivery, and OR.

Clinical Experience

Battambang Surgery Observership

In all of the hospitals, our role was strictly that of observers. The physicians who oversaw us facilitated a learning model in which the goal was for us to begin to recognize common signs and symptoms and gain first-hand experience with positive findings. Our activities consisted of observing patient care, impromptu mini-lectures from supervising physicians to illustrate relevant findings, and non-invasive supervised physical examinations. We were introduced to patients as foreign medical students by our supervising physicians, and in Battambang by our medical translator. We found that it was very helpful to point to our student IDs and highlight the word ‘student’ whenever it seemed that a patient was mistaking us for a doctor.

Throughout the day we did a lot of research on our own to answer any questions that came up. We found that having the ability to observe the same patients multiple times a day, several days in a row, was a huge advantage, as it allowed us to observe the progression of disease and treatment. For example, we had the opportunity to follow a patient with diabetic ketoacidosis from his admission to the ER to the ICU, and his eventual passing away, at each stage observing and researching the changing signs and symptoms, treatment efforts, and reactions from his family. We also found that seeing so many positive findings and performing so many physical examinations on actual patients greatly increased our confidence and clinical skills. Depending on our setting, we had the opportunity to observe a variety of procedures, including intubations, central line placement, wound care and debridement, deliveries and surgeries.

Managing Impact

A former soldier was awaiting a toe amputation in Battambang

In all of this, we strove to be mindful of how busy and overworked the physicians were, and to operate by the principle that no patient experience or outcome should be negatively affected by our presence; if possible, we tried to be a positive presence for the patients. We are proud to say that we honestly believe we were able to live up to this goal. By separating into small groups, rotating departments frequently, and being independent learners for the majority of the time, we were able to avoid being a major burden to hospital staff. We also respected patient privacy as much as we could. Nevertheless in all hospitals there were a number of patients to whom a group of foreign students was an exciting event, and there were many occasions in which we thought our presence had been beneficial to a patient’s experience or outcome. In Battambang, a former soldier and his family burst into tears after some of us gave him a very respectful greeting in Khmer language; they said they had never received so much respect from someone in a white coat, and this was very meaningful to them. In Hanoi, we were able to comfort a very anxious ICU patient by listening to her heart several times a day when the physicians did not have time to attend to her emotional distress. There were multiple emergency situations throughout in which physicians borrowed our stethoscopes and other equipment, such as during a failed intubation.

Pailin’s TB ward houses both patients and their families, who don’t have protective equipment.

It was in the understaffed and under-resourced Pailin Referral Hospital where there was the biggest opportunity for us to be a beneficial presence, and where one of the most impactful experiences of the trip took place. I went to check in on a TB patient who was faring poorly, and found that the physician on duty had not looked in on her for several hours. When I arrived, there were no nurses of other staff in the ward. She was alone, struggling to breathe, and her family was very distressed. I immediately phoned her admitting physician, who arrived minutes later. Nasal cannula were the only available tool to provide oxygen, but luckily we had a rebreather mask with us that could be connected to the oxygen tank. There were no monitors to keep track of her vitals, but we had brought a pulse oxymeter with us. When, despite the oxygen, her pulse and breathing stopped, three of us medical students were the only ones available to assist the doctor in performing CPR. The doctor himself would have been performing CPR without an N-95 mask if we had not been able to provide one to him.  Unfortunately the patient passed away despite these efforts, but we were satisfied that our presence there had afforded her a better chance, and that at least her family witnessed medical staff making their best effort to save their wife and mother, who would have otherwise died alone and without medical help.

Global Health Experience

Empty shelves at Pailin Hospital’s Outpatient Pharmacy, which serves 75,000 people

Due to the low-resource setting of these observerships, a lot of our learning went beyond the clinical. Both Cambodia and Vietnam are undergoing rapid economic development and demographic changes; the consequent epidemiological transition was highlighted time and again by physicians. We also witnessed the impact of patient crowding and severely exacerbated conditions due to lack of access. Particularly poignant were the struggles of physicians to provide medical care under extremely exacting conditions, such as limited resources and training, and political difficulties. We gained a better understanding of the multifaceted nature of these challenges, and of how difficult it is to bridge these gaps effectively. We also saw, however, that it is possible to make a difference. For example, we brought medical equipment with us that is currently filling some gaps at the Pailin Referral Hospital.

 Future Possibilities

With the director of Pailin Hospital. Fundraising efforts throughout the school year allowed the students to donate medication and equipment

While all institutions that we visited expressed an interest in hosting Queen’s medical students in the future, near the end of our trip the director and several physicians at the Pailin Referral Hospital requested a meeting with us. They wished to explore the possibility of a closer relationship with our university. There were a variety of areas for collaboration that were proposed at this meeting, including the possibility of hosting clerks and residents who, unlike us, might be able to provide medical assistance to patients while being exposed to new situations and gaining useful skills. The director and staff indicated that the most critical needs for the hospital are 1) diagnostic equipment, and 2) advanced training for staff. The only imaging available at the hospital is a rather outdated x-ray machine that generates fuzzy images. In terms of training, their most emergent need related to the management of diabetes. Due to the epidemiological shift, widespread diabetes is a fairly recent phenomenon in rural Cambodia. Nevertheless, Pailin Hospital physicians estimated that currently up to up to 60% of their patients have diabetes. They are very motivated to improve their knowledge of and experience with managing this disease at such high frequencies, and asked about possible training methods they might be able to access, such as online modules or intensive training by diabetes specialists.

In response, we took notes of their concerns and promised to pass them on to the appropriate stakeholders at Queen’s Medical School. We also began independent efforts to find a digital x-ray machine for donation, and continue to look for ways to support the development of this hospital.

Conclusion

The trip exceeded our expectations in terms of the quality of clinical experience and global health exposure that was achieved, the receptiveness of our hosts to continuing this project, and the possibility for future in-depth, mutually beneficial collaborations at the institution level.


 All photographs were taken for fundraising and educational purposes only, after obtaining informed consent from all parties.

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