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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Including learners with “remote” patient encounters

We’ve been focusing on classroom-based teaching tips in recent blog posts, this week, we focus on some practical tips for clinical teaching for clinicians working with learners while using telephone and computers for patient appointments.

By Debra Hamer, MD FRCPC, and Theresa Suart, MEd

Image is an overhead view of a laptop computer, smart phone, coffee cup and stethoscope.

Since March and continuing for some patient populations, physicians have shifted to “remote” technologies to conduct patient encounters, which used to take place face-to-face. This has complicated how to readily include learners – clinical clerks and residents – in those encounters.

First – let’s just put this out there – we don’t like the word “virtual” to describe working with patients using telephone or computer interfaces. This is not simulated care, it’s actual care!

Whether you’re using telephone appointments or a computer-facilitated patient interface, it can be a challenge to incorporate learners. We’re providing some suggestions based on telephone and OTN (in this case); these can be modified for your own tech situations. (As always, feel free to reach out to the UG Education team for help brainstorming solutions.)

The tasks associated with each can be divided into three parts: before, during, and after. These are things you likely do automatically with in-clinic or in-hospital patient visits that include learners because you’ve been doing it for years. Working with “remote” technologies just requires a bit of deliberate thought to what that preparation, appointment, and debrief looks like.

Depending on what social distancing is in effect, you may be in the same room as your learner, or you, the learner, and the patient may be in three different locations. The suggestions below assume you are in three different locations. If you and the learner can be in the same room, this will be simplified.

Telephone Appointments

(You may book your appointments yourself or have an administrative assistant who does so.)

Prior to Encounter:

  • When the patient’s appointment is booked, ask if a learner can be involved with the appointment.
  • If there’s a reminder call, include a reminder that a learner will be involved (if they said yes, of course!)
  • Make sure you’re in a room by yourself with no intrusions or distractions. This might seem self-evident, but work-from-home situations can change day-by-day.
  • Ensure your phone is set up to block your caller ID. On an iPhone, you need to deselect this under settings.
  • Ten minutes before the patient call, call the learner and review the referral and any pertinent information from the chart, since students won’t have access to the chart if they are not physically in the clinic. At that point, you can answer any questions or concerns the learner has

The encounter:

  • If you’re using a phone with “conference” capabilities (adding a participant) you can keep the learner on the phone while you initiate the call with the patient. (On iPhone, this is “add a call, put in the patient’s number, then press merge calls).
  • Once the patient answers, check to ensure both the patient and learner are on the call. All three participants should be able to hear each other.
  • In the greeting, you can remind the patient of the learner’s role on the call.
  • Make sure the patient understands the potential privacy issues with cell phones and consents to continue, then outline what to expect during the appointment.
  • Proceed with the patient interview/discussion/assessment as you would do ordinarily.
  • Depending on the learner’s stage, at this point they may be listening in; if not, let the patient know you will mute yourself and unmute yourself near the end to join back in. (If the learner is going for too long or going off the rails, you don’t need to wait until the end, simply unmute yourself and redirect them, as you would in a face-to-face encounter).
  • At the end of the appointment, if you haven’t already, you can unmute yourself, ask any questions and finish off.

The debrief:

  • After ending the call with the patient, call the learner back and debrief the encounter.
  • If it’s a senior learner, you may take the option to call the patient back – talk to the learner, find out a diagnosis and plan and then call back together with this. This will vary on the learner’s level. (Be sure the patient knows you are going to do this!)

Variation:

  • With a more senior learner, with the patient’s consent, you could use a three-step appointment: the learner initiates the call with patient, then ends that call to confer with you (by phone or other means), then the learner or you calls the patient back with the plan for going forward.

Pro-tip: If you use headphones, then there’s less reverberation and you can use your hands while you’re listening to the phone calls.

Computer-mediated appointment:

(Dr. Hamer uses OTN, you may use another platform. These instructions assume the patient has agreed to an internet-mediated appointment and has received the log-in instructions by email).

Preparation

  • Make sure your computer is set up with a neutral background with nothing to distract the patient.
  • Also, make sure you’re in a room by yourself with no intrusions or distractions.
  • Telephone the learner 10 minutes before the appointment time and review the case with them. End this call

The appointment:

  • Launch the appointment with the patient. (In OTN, this is either “make a video call” or clicking on the link from your schedule). Use your program’s function to add the learner. (On OTN, it’s “add a guest”
  • Ensure the patient still consents to continue with the appointment online, and outline how the appointment will go. Then mute yourself and block your video so it’s just a black box at the bottom of the screen. The learner and patient will just see each other. (This is less distracting)
  • Re-enter as needed (similar to the telephone suggestions above).
  • If there is time available on the appointment, ask the patient to stand by for a few minutes. You and the learner both mute and block your video and have a telephone discussion about the case.
  • Come back to the call to see the patient. (Make sure the gap is no more than five minutes).

Debrief

  • Once the computer-mediated appointment has finished, call the learner back to talk about the case.

Do you have advice or suggestions for facilitating learning with these types of patient encounters? Share your advice in the comments.

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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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The Humble, Inspiring Leadership of Sir Tom

The spectacle of a 94 year old Queen wielding a large sword to “knight” a 100 year old gentleman, stooped and standing with the assistance of a walker, might seem somewhat anachronistic and perhaps even a little inappropriate to those whose tolerance for tradition and ritual is strained even in the best of times. Certainly, the double-whammy of the COVID crisis and racism activism are very much front of mind for most people and understandably so. Jaded suspicion and negativism have easy footholds in our consciousness. Hope and optimism struggle for attention.

Nonetheless, that’s exactly what’s to be found behind this brief ceremony conducted Friday at Windsor Castle.

ibitimes.co.in

The gentleman being knighted is Captain (now Sir) Tom Moore. He is a veteran of World War II, having been “conscripted” at the age of twenty. He was assigned to an armoured corps, but eventually served as part of what came to be known as the “forgotten army” in Burma (now Myanmar) surviving, among other things, a bout with dengue fever. After the war, he became a businessman and motorcycle enthusiast. Recently, not content to simply observe the COVID pandemic from the comfort of his retirement home, he resolved to do something to assist the overburdened National Health Service. Options being limited, he decided to do 100 laps of his garden on his 100th birthday, which he did with the support of his walker, but otherwise unaided. The project was widely picked up by social media and the press. Contributions started rolling in. To date, 33 million Pounds ($56.2 million CDN) have been raised.

theworldnews.net

These efforts, together with tons of natural charm, have made him the very embodiment of British pluck and resilience in the face of adversity, and this past week he was knighted by his slightly younger Queen, who herself knows a thing or two about maintaining a stiff upper lip in the face of adversity.

dailymail.co.uk

There are many words that come to mind in describing Sir Tom’s actions. “Charitable”, “altruistic”, “selfless” would all seem to apply but there are other aspects of his remarkable story that, although equally valid, may not immediately come to mind.

One is “humility”. Sir Tom was not looking for acclaim or to make a “big splash”. He simply saw a need, felt obligated to make a contribution, and set out to do whatever was in his power to do. In the case of a now one hundred year old man with obvious limitations, that consisted of walker-wheeling around his backyard.

The other word that comes to mind is “leadership”. Although its doubtful he would describe himself in such terms he has, despite advanced age and physical limitations, done much more than simply raise funds. He has provided leadership in a time of crisis. By choosing to act rather than simply bemoan his situation, by acting without artifice or expectation of self-promotion, by rejecting victimhood and bitterness, his actions inspire us all to simply get up and keep moving ahead. With his walker firmly in hand, he shows us the way.

The “Greatest Generation” indeed.

Thank you, Sir Tom.

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Engaging Diversity, Then, Now, Always.

This week, I’m reprising an article that first appeared on this blog September 8, 2014. It was part of a series of articles that were developed at the time to examine the concept of diversity in the context of medical education. The motivation was to develop a more focused approach to diversity within all aspects of our school. As will become apparent in subsequent installments, all this led to a number of changes and innovations within the school, most of which are still operational today.

Recently, as described in a recent article (https://meds.queensu.ca/ugme-blog/archives/4880), we have re-committed to engaging diversity within our school. As we do so, it’s important to emphasize the particular importance of this initiative within medical education, and to review and reassess steps previously taken.

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The Educational Value of Diversity

UGME Blog: September 8, 2014

In October of 1931, a 16-year-old college student joined a group of friends for a night of carousing and entertainment at the Driskill Hotel, in Austin Texas.  He had no idea what to expect of the entertainment, the focus of the evening being on the “carousing” component.  Rather unexpectedly, he is deeply moved by the performance, and particularly by the featured musician.  Many years later, that student writes about that experience in his memoirs:

“He played mostly with his eyes closed. Letting flow from that inner space of music things that had never existed.  He was the first genius I’d ever seen.”

The “genius” he was referring to was Louis Armstrong, who was himself only 31 at the time, at the beginning of a career that would eventually identify him as one of the greatest virtuosi and innovators in the history of American music.

The young man was Charles Lund Black, who would go on to become a Professor of Law at Yale and expert in American constitutional law and contribute importantly to a number of cases involving key civil rights issues.

Professor Black would later say the following about his experience that evening:

“It is impossible to overstate the significance of a sixteen year old Southern boy’s seeing genius, for the first time, in a black.  We literally never saw a black man, then, in any but a servant’s capacity…Blacks, the saying went, were ‘alright in their place’, but what was the place of such a man, and of the people from which he sprung?”  http://www.nytimes.com/2001/05/08/nyregion/charles-l-black-jr-85-constitutional-law-expert-who-wrote-on-impeachment-dies.html

In Black’s eulogy, a former student would say of him, “He was my hero…He had the moral courage to go against his race, his class, his social circle.”

In Medical Education, the concept of Diversity has become entrenched in our collective vision as expressed in both the Future of Medical Education in Canada recommendations and in accreditation standards.  The rationale for such initiatives has been largely perceived to be the need to ensure equity of opportunity, and a need for medical schools to respect and reflect the gender, cultural, religious influences of the societies they serve.  Laudable and worthy justifications, to be sure.  However, Mr. Black’s encounter with Mr. Armstrong hints at deeper, even greater benefits.  Does diversity within a learning environment, or as a deliberate component of a curriculum, have educational value?  Does it shape thought and attitudes?  Does it make students better practitioners of whatever career they undertake?  Does it make them better citizens?

These questions have had particular relevance and attention in the United States for the past several decades, where they have been the focus of legal as well as pedagogical attention.  Affirmative Action initiatives and subsequent legal challenges have required both jurists and educators to engage this question critically and analytically.

In 1978, Chief Justice Lewis Powell wrote the following opinion regarding the case Regents of the University of California vs. Bakke.  He argued “the atmosphere of speculation, experiment and creation – so essential to the quality of higher education – is widely believed to be promoted by a diverse student body…It is not too much to say that the nation’s future depends upon leaders trained through wide exposure to the ideas and mores of students as diverse as this Nation of many peoples.”

Chief Justice Powell’s decision, however, did not settle the issue.  Challenges have continued and the wisdom of mandated diversity initiatives has been repeatedly questioned.  This is largely due to the lack of a theoretical framework or evidential basis demonstrating value.  Since then, considerable work has either emerged or been resurrected to provide such evidence, which is summarized in an excellent paper by Gurin and colleagues (Harvard Educational Review 2002; 72: 330).

From the theoretical perspective, the work of a number of sociologists and psychologists is particularly relevant, and fascinating to review.  In attempting to describe their work, I freely admit to venturing far beyond my expertise and apologize in advance to those much more knowledgeable. 

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.  But how can they promote this critical social development?  In the words of Gurin and colleagues:

“Higher education is especially influential when its social milieu is different from students’ home and community background and when it is diverse and complex enough to encourage intellectual experimentation and recognition of varied future possibilities.”   

In other words, the real power to influence goes far beyond lofty mission statements and curriculum, and arises largely from developing an environment where students are able to interact both passively and actively with individuals who are “different” and therefore force new thought and new perspectives during this critical developmental phase.

Sociologist Theodore Newcomb carried out a series of studies and long-term follow-ups of Bennington College students between 1943 and 1991.  (Newcombe et al 1967. Persistence and change: Bennington College and its students after 25 years. New York: John Wiley and Sons), (Alwin et al 1991. Political attitudes over the life span. Madison: University of Wisconsin Press).  To medical folks, this is the sociologic equivalent of the Framingham studies.  He and his colleagues found that political and social attitudes were most likely to change and remain so in students who had encountered novel concepts and attitudes, largely through peer influences, while attending college, thus supporting Erikson’s theory and demonstrating long term durability of the early life experience. 

In the Gurin paper, the authors draw on the work of Jean Piaget and Diane Ruble in extending the concept of disequilibrium, to the early learning experience.  In Guerin’s words:

“Transitions are significant because they present new situations about which individuals know little and in which they will experience uncertainty.  The early phase of transition, what Ruble calls construction, is especially important, since people have to seek information in order to make sense of the new situation.  Under these conditions individuals are likely to undergo cognitive growth unless they are able to retreat to a familiar world.”

In simple terms (that even a cardiologist would understand) the greater the difference between the students prior life experience and the learning environment in which they find themselves, the greater potential for new thought, new concepts and personal growth.

The Michigan Student Survey (MSS) and Cooperative Institutional Research Program (CIRP) are longitudinal studies examining, among other things, how diverse education processes influence attitudes and career success.  The MSS is a single site study involving 1,582 students.  The CIRP is a national cooperative involving 11,383 students from 184 American institutions.  Both involved racially and culturally diverse populations of students assessed on the basis of their pre-university and university cultural environments i.e. their “diversity experience”.   For detailed description of results, I would refer the reader to Gurin et al. Harvard Educational Review 2002;72:330.  The key findings relevant to those considering diversity initiatives in university programs:

  • There was a positive relationship between diversity experiences and educational outcomes
  • The influence of a diverse educational environment was consistent across schools and cultural groups
  • “interactional” diversity was more influential than “classroom diversity”  

But are these effects also relevant to medical education, where one might suppose that students are older and further along developmentally, and perhaps pre-selected for cultural diversity and preparedness?

  • In 2003, Whitla and colleagues (Academic Medicine 78:460) reported on a study involving medical students at Harvard Medical School and the University of California, San Francisco.  Students surveyed reported that contact with diverse peers enhanced their educational experience and supported ongoing affirmative action initiatives. 
  • A graduation questionnaire administered by the Association of American Medical Colleges to 20,112 graduates from 118 medical schools (Saha et al, JAMA 2008; 300: 1135), demonstrated that, for white students, attendance at a school with high proportions of peers from underrepresented minorities was associated with greater confidence in caring for minority patients and positive attitudes regarding equity issues.  These associations were not found for non-white students. 
  • Niu and colleagues (Academic Medicine 2012; 87: 1530) surveyed 460 Harvard medical students and found that those who reported spending more than 75% of their study time with students from diverse backgrounds or having participated in diversity related extracurricular activities felt more prepared to care for diverse patients.  

And so, it seems Mr. Black’s experience in 1931 was not simply an isolated event, but indicative of the potential for great things to emerge when open minds are exposed to new situations, new social constructs, new paradigms.  The value of Diversity in education is about much more than a need to exhibit “fairness” and some notion of social justice, but rather an active educational intervention capable of expanding the vision, imagination and therefore potential of students. 

So, what does all this psychosocial theory and American experience say to those of us engaged in medical education in Canada in 2014?  We might feel, with some justified smugness, that we are not faced with the same social divides and engrained class issues as our southern neighbours.  We might also take solace in the knowledge that our schools are uniformly committed to the concepts of equity, fairness and diversity in the workplace, and have rather rigorous policies in place intended to ensure the issue of structural diversity.  However, we might also see this as an opportunity to enhance our approaches to medical education, where the ability to effectively engage people of diverse backgrounds and with diverse needs would seem particularly relevant.  Finally, many in 2014 Canada might define Diversity as more of a socioeconomic as opposed to racial/ethnic issue, given the well-documented struggles of our First Nations and immigrant populations.  With all this in mind, I pose a few perhaps unsettling questions for consideration:

  • Do our students engage in medical school in the type of passive and active learning environment that theories and studies suggest could truly influences their development as physicians?
  • Do our policies, which focus largely on identifying numbers and proportions of various groups in our school relative to the general population, truly promote the development of that effective learning environment, or simply attempt to demonstrate token compliance with regulations?
  • Our students, raised in and drawn from a Canadian culture that promotes equity and fairness, are good and instinctively fair people, unfailingly tolerant of diverse individuals and eager to contribute, but do they develop a deep understanding of the issues of those less-advantaged, and are we, as the stewards of their education, doing all we can to develop a learning environment that will promote that understanding?

Can we do better?  Can’t help but think so. 

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Next article will focus on initiatives that were undertaken at that time, and then update on current evolving plans.

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Planning your teaching in uncertain times

Summer is upon us and, with it, planning for fall semester teaching. There’s a lot of uncertainty in the world these days vis-à-vis the COVID-19 pandemic – which has contributed to some uncertainty in planning for curricular delivery. At the School of Medicine, we have permission to run some learning activities face-to-face (such as clinical skills) with new restrictions in place to maintain social-distancing, but our traditional classroom-based teaching will be impacted as well.

The Education Team is here to support Course Directors and all teaching faculty as we face these new challenges. While we don’t have all the answers yet about room assignments and scheduling, there are still many things we can do right now to help with your planning and preparation for both your synchronous (all students learning at an appointed time, either in a classroom or via Zoom) or asynchronous teaching (students provided with learning materials that need to be completed by a certain deadline, but otherwise, they can learn on their own schedule and own pace). If we don’t have solutions to your queries, we’ll help find them.

Things we can help you with now:

  • Discovering options for asynchronous teaching

Course Directors have been asked to consider different avenues for asynchronous learning. While this already exists in many courses in the form of Directed Independent Learning electronic modules, there are other options, too. If you would like to increase the amount of asynchronous learning in your course – or just explore possibilities – we can help with this.

  • Learning techniques for interactive teaching via Zoom

We learned a lot from our two-and-a-half months of remote teaching using Zoom from March – May. If you’re concerned about how to keep your teaching engaging and interactive while “talking to a box”, we can help with this – and provide some practice opportunities, too, so it’s not so intimidating. Tools you may already be using in the classroom, such as videos and polling, are easily leveraged on the Zoom platform.

  • Exploring approaches to assessment

Your current assessment plan may be just fine, but there may be things you’d like to tweak given the logistics of remote delivery. We’ve sorted out quizzes, graded team assignments (GTAs), and proctored exams already, so we can address these and any other concerns you have and make any appropriate modifications.

  • Guiding you to resources

We can point you towards Faculty of Health Sciences and campus-wide faculty development opportunities and services that are available and talk about which approaches already fit with the UG program, and navigate through other possibilities.

  • Brainstorming and problem solving

While the landscape may have changed with the COVID-19 pandemic, our goals as your Education Team remain the same: we’re here to help you prepare for, deliver, and improve your teaching and assessment.

Please get in touch:

Theresa Suart theresa.suart@queensu.ca

Eleni Katsoulas eleni.katsoulas@queensu.ca

Rachel Bauder rachel.bauder@queensu.ca

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The Legacy of George Floyd – What will it be?

We watch, horrified, recordings of the last few seconds of George Floyd’s life. We hear his last words– “I can’t breathe”. The symbolism of the white, uniformed figure whose knee is at this neck, unresponsive to his pleas, could not be more stark. For many, George Floyd is the most recent, most poignant example of a history of racial subjugation, mistreatment and killing that spans the past four centuries. For many, it’s a sad reminder that similar crimes and protests of five decades ago were not the final expression of that discontent. For us all, it forces a confrontation with the reality that the dream of Martin Luther King “that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character” has, sadly, not yet been realized.

Locally, we have been challenged by these events to consider what, if any, implications they have for each of us personally, and for our school. Many faculty and students have expressed very clearly their concerns, their discontent and have called for change. In the interest of exploring this further, I met recently with our student leadership and medical students. Those discussions were candid, sincere and highly illuminating. They expressed realities about the experience of Black medical students at Queen’s with clarity and openness. The tragic killing of George Floyd, it seems, has opened a discourse and raised to the surface issues and concerns that are not new, but not previously expressed as bluntly. It has also, it must be said, caused all of us to listen with greater sensitivity.

Out of those discussions, a number of themes and practical measures are being developed and advanced. I have since had opportunity discuss these with our current Dean Dr. Reznick and our incoming Dean Dr. Philpott who are both very supportive.

  • All medical schools have a responsibility for social accountability. The exact nature of the commitment, expressed in a Diversity Statement, is school specific and should reflect the regions served and values of the particular school. That statement should drive a variety of school activities, including curriculum, recruitment and admissions. In the light of recent events, it seems appropriate to re-assess our Diversity statement. Our Diversity and Equity Committee, chaired by Dr. Mala Joneja, will be charged to draft a renewed statement to be considered by our faculty council
  • Our curriculum should prepare our students to provide comprehensive care to patients of all ethnic and racial backgrounds. This should be reflected in both the content and delivery of the curriculum. Our Curriculum Committee will be charged with re-assessing both aspects through the lens of the Black population. It will also be asked to ensure that opportunities exist for open and constructive dialogue between students for discussion of difficult and contentious topics.
  • The Black population of Canada is under-represented in our medical school. This is despite the fact that our admissions processes are scrupulously unbiased with respect to racial considerations. In fact, I realized as we discussed this issue recently that it was impossible to even determine the racial make-up of our incoming class, simply because this information is in no way documented or considered. The under-representation of Black people is almost certainly a complex and multi-factorial issue. Our Admissions Committee will be tasked with giving consideration to what factors may be active and to consider how they might be addressed.
  • Very concerningly, and despite numerous (and I believe very sincere) efforts to address this over the past few years, our students report a lingering perception within the Black applicant community that Queen’s is an unwelcoming environment. This no doubt contributes to the under-representation issue and merits deep consideration at all levels.
  • It seems clear that the promotion of mentorship opportunities for our Black students and applicants would be of benefit and should be pursued actively, both within our schools, and through effective collaborations outside our school.

None of this will occur if efforts are restricted only to a vocal minority who have themselves been the subject of racism in their lives and therefore need no convincing of its existence. It is rather for those of us in the “silent majority” of society who abhor racism but have not been its direct victims to take stock. We need to listen and, in those ways that are available to us, act.

Many will question why a murder in Minneapolis, tragic as it is, should influence the discourse and decisions at our small, somewhat secluded and seemingly tranquil medical school in Kingston, Ontario. I will admit to initially sharing that skepticism. I have come, through reflection on my own experiences with racism and through discussion with our students, to a different perspective. I would now say to those people who question these directions that no community in the western world can consider itself immune or unaffected by racism. I would say that injustice of any form diminishes and affects us all. I would say that we bear a collective obligation to the memory of George Floyd, to all the George Floyds of the past and to every person today afraid to jog alone through a park or be pulled over for a minor traffic violation. We owe it to them to take whatever action is in our power to take. We act for them but, in the end, we are acting for us all and for those who will follow.

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The Event Was Virtual. The Graduation Was Real!

In its 166 year history, the Queen’s School of Medicine has no doubt hosted many memorable events to mark the achievement of graduating students. None, I’m sure we can assume, compared to last week’s celebration.

For the past few months, a small committee let by Drs. Renee Fitzpatrick and Andrea Winthrop has been meeting and struggling to develop some appropriate way to recognize the graduation of our Meds 2020 class, given the limitations imposed by the pandemic. The result was a “virtual” event made possible by Zoom technology, our dedicated MedVC team and coordinated by Jacqueline Findlay, UG Program Manager.  

Dr. Harry Chandrakumaran, Meds 2020, and parents”attending”, with hood provided by Mrs. Chandrakumaran

Our virtual graduation celebration was “attended” by 300 sites that signed in, as well as an unknown number live streaming the event. Attendees were located in cities all across Canada, as well as several in the US and Europe.

Dr. Heather Murray, in full regalia, attending from Grant Hall

It featured an opening welcome to families and supporters of our graduates, followed by individual recognitions of each graduate. Dean Richard Reznick paid tribute to the class, challenging them to make a difference. Dr. Susan Moffatt was selected by the students to provide remarks on behalf of faculty. Drs. Heather Murray, Erin Beattie and Brigid Nee were selected by the graduates to receive the prestigious Connell awards for outstanding lecturing, mentorship and clinical teaching. Dr. Akshay Rajaram was selected by the students to receive the award for outstanding teaching by a resident.

Dean Richard Reznick addressing Meds2020
Dr. Susan Moffatt, Faculty Speaker

Dr. Cale Templeton and Julia Milden were selected by their classmates as Permanent Class President and Class Valedictorian.

Dr. Cale Templeton, Permanent Class President, Meds 2020
Dr. Julia Milden, Meds 2020

In her address, Dr. Milden spoke of the gratitude of her classmates for family, friends and teachers. She acknowledged admiration for her classmates and the bonds of friendship that had developed during medical school and would persist through their careers.

“I am struck today reflecting on what exactly it means to be called a doctor, the thrill and duty of carrying this new title and the letters MD. This particular moment in time seems to make incredibly clear the power and responsibility of this role. On the wards or on television, writing orders or writing policy, doctors of all kinds are illuminating the challenges of their patients and of the system, and working together to help shape what we do as a whole world to take care of one another.

So what gives us this influence?

I think it’s the message we send when we say ‘I’m a doctor’ – to whomever we’re meeting, it means: I’m listening, I respect your wishes and your opinions, I know how to learn and am motivated to investigate your problem,  and I will do everything in my power to help you.

And most remarkably, the skills and qualities this social trust is based on are ones that we have right now: our willingness to listen, and our ability to care.”

Certainly, we must acknowledge that the event was decidedly not what anyone envisioned when Meds 2020 began medical school one September morning over four years ago. Nonetheless, it was every bit as real as the degrees earned by our graduates and received by them last week. It occurred because of a very real refusal to allow any mere pandemic to diminish the significance of what these young people have accomplished, nor overcome our desire to express our pride and extend our good wishes.

To them, our admiration and congratulations…really.

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Balancing Social Responsibility and Personal Rights in a Time of Crisis

Reading the New York Times these days can be a rather jarring emotional experience. It is replete with stories of people and families devastated by the COVID crisis. Excruciatingly detailed and poignant accounts of people dying in their homes or hospitals, isolated from surroundings and those who have been significant to them. Married couples dying within hours of each other leaving shattered families behind, all deprived of the end of life processes that would normally help with the grieving process and achievement of some emotional closure. Hospital workers struggling to provide some modicum of solace and dignity before having to move along to the next patient.

Turn the page, and you read accounts of protests by those decrying the restrictions that have been imposed by their governments, claiming their rights to choose to assemble and assume personal risk.

Protesters at Queen’s Parki on Saturday, April 25 demand an end to public health rules put in place to stop the spread of COVID-19.

These stories are not limited to New York or even the United States. They come from Italy, Britain, Mexico, South America, the Far East. It seems no place is spared, although the impact and time course varies considerably.

In our own characteristically muted fashion, the same dramas are playing out in Canada. Political leaders, hearing loud and clear from all constituencies and all perspectives, struggle to strike a balanced and responsible approach.

All this serves to highlight two great realities of this pandemic. Firstly, it is affecting virtually every human being on the planet. The sheer scope is mind boggling and it’s difficult to think of any prior catastrophe that even comes close. The second reality is that its very nature is such that it renders each of us both a target and a mechanism for spread. We are simultaneously potential victims and potential perpetrators. We are all therefore forced to make choices, and those choices are expressed not through words so much as through our actions.

For the vast majority, the choice is clear. Simply remaining secluded and abiding by social isolation directions from authorities is not only in their personal best interest, but also their means of contributing to the public good. It can be inconvenient, unsettling and, depending on personal and family circumstances, very demanding. It also requires a degree of trust and faith that decisions are being made with best information and with the best of intentions. It requires political leadership that evokes that trust. But most importantly, it requires a willingness to endure some degree of personal hardship for a perceived greater good.

For those who provide essential services, the choice is very different. For those people, the greater good is to continue their duties while exercising appropriate precautions. The willingness of health workers and the many essential service providers who allow our society to continue to function in these very challenging times is a testimony not only to their dedication and courage, but to their belief that they have a role in contributing to the welfare of others. They are nothing short of heroic. 

All of us are affected. All of us are making sacrifices that require us to balance our personal interests with our obligations to those around us. Our fundamental values, both individually and collectively, are being exposed. The ideological and moral differences between individuals, communities and even countries are being laid bare in the face of this crisis. The early results are largely positive and even inspiring. But the real test is yet to come. As the acute crisis abates to some extent, and it becomes clear that a complete return to “normal” is a long way off, how will we engage this “new normal”? Our leaders and governments are making decisions that require them to determine the very nature of what constitutes “common good”.  What seems clear is that what will determine success is not our ability to protect our personal interests, but the extent to which we are willing to sacrifice those personal interests for that common good.

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It’s science, not speculation, that will get us through this.

Why do COVID patients experience such profound hypoxia without feeling dyspneic?

Why is there such heterogeneity in clinical severity among young, previously healthy patients?

Are asymptomatic people able to carry and transmit the virus, and for how long?

Does immunity develop after infection, and how long does it persist?

Does antibody status indicate complete protection from re-infection?

Do currently available anti-viral agents have effect?

Will previous approaches to vaccine development be effective?

These are some of key questions still under investigation as we now pass 6 months since this infection originally came to attention. The answers to these questions are the keys to resolving the greatest heath and economic catastrophe the world has faced. The answers will not be provided by scientists or politicians working in isolation, but rather by the application of scientific approaches, supported by political and economic action.

This past week, we’ve seen examples of how this can work well, and how a lack of synergy will impede progress.

In Canada, our government has announced a billion dollar investment in COVID-19 medical research, and support for a Task Force to determine the extent of the disease.

In Germany, a nation-wide public health investigation has begun to carry out widespread serologic testing intended to define the true extent of disease and implications of prior infection.

(New York Times Photo from story link)

In the United Kingdom, vaccine development is well underway with massive investments already in place.

All these have come about through effective collaborations between government, funding agencies and scientific and medical communities. We’ve also seen examples of what can transpire when those collaborations are not effective. We’ve seen that, even if well intentioned, speculative assertions by a political leader can be assumed by the public to be scientifically informed and thereby lead to dangerous actions.

There has been much debate in recent years within the medical education community regarding the relevance of research and critical appraisal in undergraduate medical education. These topics have been gradually and rather insidiously receiving  decreased attention in favour of the many other competencies and “hot items” that have been emerging, all with justification. I would suggest that recent events have resolved that debate. The questions posed at the beginning of this article were not posed exclusively by basic scientists and epidemiologists, but also by clinicians trained to accurately observe patient responses, critically assess current understanding and pose valid, useful hypotheses for testing. Clinicians will also be very much involved in developing protocols and executing investigations to find answers. Medical schools have a responsibility to ensure that fundamental training continues to be a core component of their programs, now more than ever.

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