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. Abraham Verghese (Screenshot from webcast)

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.

 

 

 

 

 

 

 

 

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100+ Medical Students Who Care

By Dr. Melanie Walker, Course Director, Population & Global Health

Each first year class in Queen’s UGME embarks on the ‘Community Based Interventions Project’ (CBIP) as part of their Population and Global Health (PGH) course. The project provides students with an opportunity to gain insight into social and health services that serve patients in the greater Kingston community. The students learn about the importance of social determinants of health and patient context through the eyes of a special population that they are interested in exploring. This experience provides them with better insight into supports which affect the health and management of their future patients.

Outside of the medical school, I am a member of a local charity: 100+ Women Who Care Kingston. This organization consists of a group of Kingston-based women who meet four times a year to support non-profit and charitable organizations in our community. The principle is simple – any member is permitted to nominate one local organization per meeting. If this organization is chosen as one of three picked at random, the nominating member is allotted five minutes to speak to the membership to express why their particular organization is worthy of the group’s charitable donation and what that organization would do with the funding if received. The three nominees are then put to a vote by the membership and the majority wins. Over one hour, one worthy local organization receives a financial ‘boost’ of approximately $20,000. Simple…yet powerful.

In light of this, last year we initiated a new advocacy component to the PGH course through the CBIP – the opportunity, as a class, to nominate one of the researched organizations that they thought could benefit from an infusion of funding to address a gap in service identified by the organization. The class vote would become my vote at 100+ Women. Both the 2019 class and, just recently, the 2020 class overwhelmingly voted for the Sexual Assault Centre Kingston (SACK) to be brought forward to 100+ Women.

SACK is a “not-for-profit, charitable organization committed to free, confidential, non-judgemental support for all survivors of recent and/or historic sexual violence in Kingston, Frontenac, Lennox & Addington (KFL&A).” While it may not be surprising to learn that girls and young women between the ages of 15-24 are the most likely victims of sexual assault it was eye-opening to learn from our students that Kingston has the highest rate of sexual assault per capita in Canada. The majority of funding received by SACK is thus, understandably, directed at the support services with little left over for education and prevention. In fact, the Kingston Youth Sexual Violence Prevention Assessment put out a report in May of 2015 that stated “the Kingston community needed to engage youth before sexual & dating violence occurs. Organizations need to explicitly address important concepts including consent, healthy sexuality, healthy relationships, rape culture, alcohol & drug-facilitated sexual assault, and sexual violence.”

After six 100+ Women Who Care Kingston meetings and six attempts (between last year and this), the stars aligned on Feb 23, 2017 and SACK was the 3rd random pick of the night of the 30+ nominated charities.  The end result was an overwhelming majority vote of the 100+ women in the room to support this organization.  Two of the students from the class of 2019 that had an instrumental role in getting SACK nominated by their classmates, Tiffany Lung and Kate Liu, were present with me at the recent cheque-presenting ceremony by the leading ladies of 100+ Women Who Care Kingston to SACK on March 31st. The donation of $20,000+ will be directed at the development of a much-needed youth prevention program across the greater Kingston area which will include sexual assault resistance programming – the only evidence-based program that has been shown to significantly reduce the incidence of rape and other forms of sexual assault.

The night that SACK was voted to receive this donation I was approached by many community members who were not only impressed with the important work that SACK does but by the School of Medicine’s investment in teaching our physicians-in-training about the importance of population health and health advocacy. Amazing what can be accomplished when 100+ medical students who care connect with a local group of women who care to create an opportunity for change in our community.

The recent Whig Standard Article can be found here.

Many thanks to the following for making this possible:

  • Meds 2019 class (special thanks to Tiffany Lung, Kate Liu, Zoe Lau and Sallya Aleboyeh)
  • Meds 2020 class (special thanks to Alexandra Basden, Azraa Janmohamed, Denisha Puvitharan, Khatija Anjum, Sana Khan and Jagpreet Kaler)
  • 100+ Women Who Care Kingston and the leading ladies (special thanks to Lindsay Duggan)
  • Sexual Assault Centre Kingston (special thanks to Jennifer Byrd and Elayne Furoy)

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Building Bridges, Making Pathways

By Denisha Puvitharan (Meds 2020), Darsan Sadacharam (Meds 2020) and Sahra Nathoo (Meds 2019)

Twenty-four curious high school students joined the ranks of diligent medical students in the halls of the Medical Building on March 31st. These students were taking part in the first ever “Pathways to Medicine” event hosted by Queen’s School of Medicine’s Diversity Panel.

Through a new partnership with a local chapter of a national organization, Pathways to Education, the panel organized a full day event aimed at increasing interest in a future career in medicine among students engaged with Pathways, along with some students from Immigrant Services Kingston and Area (ISKA).

Participating students heard from Dr. Michelle Gibson, Director of Year 1, who introduced them to the day. They participated in a small group learning session with Dr. David Bardana and the class of 2020, clinical skills training with tutors Drs. Rick Rowland and Nicola Murdoch, and resuscitation simulation and laparoscopic training sessions with residents, Drs. Kristen Weeksink and Gary Ko, during their visit. Dr. Mala Joneja, Director of Diversity in UGME, sped them on their way with inspiring words. The inaugural “Pathways to Medicine” event was an excellent teaching and outreach event that was highly praised by all staff and students involved.

The Diversity Panel is an interdisciplinary team of interested students, educational staff and faculty, which exists to improve undergraduate medical education at Queen’s, through increasing diversity and making careers in medicine more accessible to those from underrepresented populations. There have been many conversations regarding the importance of medical student bodies representing the diversity of the patient communities they will serve in the future. In addition to the upstream effects of making the healthcare profession more adept in providing quality care to the existing diverse population, increased physician diversity is also particularly important when considering the physician shortages that low income neighbourhoods face in Canada. By enticing more students from these neighbourhoods to attend post-secondary education and medical school, there is an increased likelihood they will return to practice in these neighbourhoods, thus helping relieve some health inequities.

Though many efforts have been made to make medical school more accessible to students from lower socio-economic backgrounds, many barriers remain. The cost of medical school alone is astronomical, when considering the tuition for an undergraduate degree, MCAT registration fees, application fees, and potential income-earning hours spent studying; students from low income families are already discriminated against. Attempting to address these concerns, the Pathways to Medicine event also included a presentation on financing medical education by Ms. Margie Gordon from the Registrar’s Office, specifically regarding OSAP, grants and other resources available to help these students reach their goals.

However, when making efforts to increase the accessibility of medical school for students from diverse socioeconomic backgrounds, the true challenge is in leveling the playing field at the starting line for these students. From the onset of a student’s educational journey, his/her family’s financial and social resources can play a significant role in dictating their success. Strong financial support can assist a student’s ability to excel in school, while also participating in various extracurricular activities, which can benefit the student in future endeavours. Furthermore, students from higher socioeconomic backgrounds are privy to strategic knowledge of what it takes to become competitive applicants as a result of having access to various social resources. These resources can come in the form of connections with academics, physicians and others that have experience navigating the application system. An anecdotal example of how strong social resources can provide an advantage to students is provided by Dylan Hernandez’s opinion column in the NY Times.

“Pathways to Medicine” represents Queen’s UGME Diversity Panel’s continued efforts to find creative strategies in addressing this complex challenge. Although this may be a small step towards addressing these barriers, it is our hope that through events like this and other similar initiatives held at medical schools across Canada, students from diverse backgrounds may soon see medicine as a realistic goal.

 

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Singers, dancers, musicians & a dean: It’s MVN!

It’s Medical Variety Night (MVN) time of year at the School of Medicine and UGME students have been putting in long hours of practice and preparation. And they’re not the only ones – this year the show includes a feature performance by Faculty of Health Sciences Dean Richard Reznick.

Co-director Manisha Tilak (2019) says you’ll have to show up to see the Dean’s act – no other information is being shared. “He’s actually in an act, though, it’s not just that he’ll be attending,” she adds.

Tilak and co-directors Andrew McNaughton (2019), Edrea Khong (2020) and Daisy Liu (2020) have been hard at work since September to ensure the success of this year’s show. This year’s theme is The Phantom of the Operation.

Dancers in the now-traditional Bollywood number have been in rehearsal since November. Auditions for the other acts were held around the same time. There will be music solos, duos and trios as well as the class skits. Other dance numbers will feature Hip hop and Swing.

While the show may have a few ‘culture of medicine’ in-jokes, it’s designed to be interesting and entertaining for everyone.

This is the 47th incarnation of the Medical Variety Night, which benefits local charities. This year, proceeds are being donated to Almost Home, which provides accommodations for families with children receiving medical treatment at Kingston area hospitals.

“The most fun part comes the night of the show when you see all the hard work pay off and everyone enjoying themselves,” Tilak noted. Also, the tally at the end of the night: “When we’re able to send a good donation to the Almost Home.”

The show will take place April 7 and 8 at Duncan McArthur Hall, 511 Union Street, Kingston. Doors open at 7 p.m. Tickets are available online (buy them here: https://mvn2017.squarespace.com) and at the door.

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Singers, dancers, musicians & a dean: It’s MVN!

It’s Medical Variety Night (MVN) time of year at the School of Medicine and UGME students have been putting in long hours of practice and preparation. And they’re not the only ones – this year the show includes a feature performance by Faculty of Health Sciences Dean Richard Reznick.

Co-director Manisha Tilak (2019) says you’ll have to show up to see the Dean’s act – no other information is being shared. “He’s actually in an act, though, it’s not just that he’ll be attending,” she adds.

Tilak and co-directors Andrew McNaughton (2019), Edrea Khong (2020) and Daisy Liu (2020) have been hard at work since September to ensure the success of this year’s show. This year’s theme is The Phantom of the Operation.

Dancers in the now-traditional Bollywood number have been in rehearsal since November. Auditions for the other acts were held around the same time. There will be music solos, duos and trios as well as the class skits. Other dance numbers will feature Hip hop and Swing.

While the show may have a few ‘culture of medicine’ in-jokes, it’s designed to be interesting and entertaining for everyone.

This is the 47th incarnation of the Medical Variety Night, which benefits local charities. This year, proceeds are being donated to Almost Home, which provides accommodations for families with children receiving medical treatment at Kingston area hospitals.

“The most fun part comes the night of the show when you see all the hard work pay off and everyone enjoying themselves,” Tilak noted. Also, the tally at the end of the night: “When we’re able to send a good donation to the Almost Home.”

The show will take place April 7 and 8 at Duncan McArthur Hall, 511 Union Street, Kingston. Doors open at 7 p.m. Tickets are available online (buy them here: https://mvn2017.squarespace.com) and at the door.

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Interprofessional observerships provide insight

By Dr. Lindsay Davidson, Collaborator Lead

 

For several years, first year medical students have had the opportunity to shadow a non-physician health care provider for a half day as part of the Introduction to Professional Roles course. This initiative, championed by Dr. Sanfilippo, initially involved nurses at one institution and has grown to include 3 sites (KGH, HDH and PCCC) and 11 different groups of health care providers. First year students are charged with beginning to understand their role (as future physicians) as well as the role(s) of the myriad types of health care providers that they will work with over the course of their careers. Most years, the Observerships have been preceded by an in-class brainstorming session, where student infer what various professionals’ roles might be. Following this, students are assigned to work with one of the available health care providers during curricular time. This practical experience allows students to act as ‘anthropologists’, observing for themselves what various health care providers actually do, day-to-day as well as how they collaborate with patients, family members and other members of their team. Finally, at the end of term, students convene in groups to compare and debrief their experiences, collating new lists of the roles and functions that they have observer, to be contrasted with their initial brainstorming. Invariably, the end-of-term collations reflect the insight of the experiences that they have shared.

Here are some of the observations students have made:

“I liked being able to be a part of the meetings with families so that I could better understand what role the social worker played.”

“My preceptor was very approachable and forthcoming with information about her profession; she seemed very enthusiastic about participating in the IP program.”

“… I just had not thought about how the social worker-patient encounter would rely on the same trust- and rapport-building methods as the physician physicians do.”

“I had pictured a dietitian’s work to be office-based, with patients coming for consults at her desk. It never occurred to me that in the hospital, they would accompany the rest of the health teams to do rounds.”

“And I now appreciate the importance of an OT in helping a patient adapt to their new health and return to their normal life as best as possible.”

“I had envisioned a solemn chaplain giving last rites, but clearly this is not the role of the spiritual care practitioner at KGH. Instead, I was surprised by the breadth of the role – there are people who do not consider themselves spiritual or religious at all, yet still speak at length with the spiritual care practitioner about their life and their thoughts about death.”

“I believe it is important to be aware of how physicians can collaborate with allied health professionals to provide the best care, recognizing that we cannot do everything.”

The Interprofessional (IP) Observership has been met with enthusiasm by students and our hospital partners alike and this year, we are offering students the opportunity to participate in an optional second observership, to broaden their experience an understanding of their future IP colleagues. Additionally, in 2017-18, we will be piloting an advanced IP Observership at the Kingston Community Health Centre, where groups of students will spend half a day observing a team-based Interprofessional clinic in our community.


With thanks to students Sarah Edgerley,  Shannon Willmott, Ameir Makar, and Etienne Benard-Seguin who have been working on tracking and analyzing the Interprofessional Observership experience.

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Decoding Learning Event Types

Tucked on the right-hand side of every Learning Event Page on MEdTech are notations about the date & time and location of the class, followed by the length of the session and then the “Breakdown” of how the time will be spent. In other words: the learning event type.

We use 14 learning event types* in the UGME program. The identification of a learning event type indicates the type of teaching and learning experience to be expected at that session.

Broadly speaking, our learning event types can be divided into two categories: Content Delivery and Content Application.

For content delivery, students are presented with core knowledge and/or skills with specific direction and/or commentary from an expert teacher. Content delivery learning events include:

  • Directed Independent Learning (DIL) — these are independent learning sessions which are assigned curricular time. Typically students are expected to spend up to double the assigned time to complete the tasks – i.e. some of the work may occur in “homework time”. DIL’s have a specific structure and must include:
    • Specific learning objectives
    • A resource or set of resources chosen by the teacher
    • Teacher guidance indicating the task or particular focus that is required of students. This may be a formal assignment, informal worksheet or study guide.
    • The session must link to a subsequent content application session
    • Formative testing in the form of MCQ or reflective questions are an optional component of DILs
  • Lecture – Whole class session which is largely teacher-directed. We encourage the use of case illustrations during lectures, however these alone do not fulfil the criteria for content application or active learning.
  • Demonstration – Session where a skill or technique is demonstrated to students.

For content application (sometimes described as “active learning”), students work in teams or individually to use and clarify previously-acquired knowledge, usually while working through case-based problems. These learning event types include:

  • Small group learning (SGL): Students work in teams to solve case-base problems which are revealed progressively. Simultaneous reporting and facilitated inter-team discussion is a key component of this learning strategy which is modeled on Team-based learning. SGL cases may be preceded by in class readiness assessment testing (RAT) done individually and then as a team. This serves to debrief the preparation and provide for individual accountability for preparation.
  • Facilitated small group learning (FSGL)Students work in teams and with a faculty tutor to solve case-base problems which are revealed progressively. While there is structure to FSGL cases, students are encouraged to seek out and share knowledge based on individual research.
  • Simulation: Session where students participate in a simulated procedure or clinical encounter.
  • Case-based Instruction (CBI): Session where students interact with guest patients and/or health care providers who share their experience. Builds on prior learning and often includes interactive Q+A component.
  • Laboratory: Hands-on or simulated exercises in which learners collect or use data to test and/or verify hypotheses or to address questions about principles and/or phenomena, such as Anatomy Labs.

The other learning event types we use don’t fit as neatly into the content delivery/content application algorithm. These include:

  • Clerkship seminar – instruction provided to a learner or small group of learners by direct interaction with an instructor. Depending on design, clerkship seminars may be either content delivery or content application.
  • Self-Directed Learning (SDL) is scheduled time set aside for students to take the initiative for their own learning. A minimum of eight hours per week (pro-rated in short weeks) is designated SDL time.
  • Peer Teaching is learner-to-learner instruction for the mutual learning experience of both “teacher” and “learner” which includes active learning components. This includes sessions that require students to work together in small groups without a teaching, such as Being a Medical Student (BAMS) sessions, the Community Based Project and some Critical Enquiry sessions.
  • Career Counseling sessions, which provide guidance, direction and support; these may be in groups or one-on-one.

Two other notations you’ll see are “Other-curricular” and “Other—non-curricular”. Other—curricular is used for sessions that are directly linked to a course but that are not included in calculations of instructional methods. This includes things like examinations, post-exam reviews, and orientation sessions. Other—non-curricular are sessions of an administrative nature that are not directly linked to a particular course and are outside of curricular time, for example, class town hall meetings and optional events or conferences.

Incorporating a variety of learning event types in each course is important to ensure a balance of knowledge acquisition and application. Course plans are set by course directors with their year director, in consultation with the course teachers and with support from the UG Education Team and the Teaching, Learning, and Integration Committee (TLIC).


— With contributions from Lindsay Davidson, Director of Teaching, Learning, and Integration

*In 2015, Queen’s UGME adopted the MedBiquitous learning event naming conventions to ease sharing of data amongst institutions. For this reason, some  learning event type categories may be different from ones used here prior to 2015, or ones used at other, non-medical schools or medical schools which have not adopted these conventions.

 

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Recognizing our Course Directors

“The People Who Make Organizations Go – or Stop” was the intriguing title of an article that appeared in the Harvard Business Review in 2002, authored by management experts Rob Cross and Laurence Prusak. In it, they describe the key people and largely informal networks that are necessary to the functioning of any organization, regardless of its purpose or product. They make the point that the success or failure of organizations can usually be attributed to the effectiveness of a group of key people they refer to as “central connectors”. In their own words:

“In most cases, the central connectors are not the formally designated go-to people in the unit. For instance, the information flow… at a large technology consulting company we worked with depended almost entirely on five midlevel managers. They would, for instance, give their colleagues background information about key clients or offer ideas on new technologies that could be employed in a given project. These managers handled most technical questions themselves, and when they couldn’t, they guided their colleagues to someone else in the informal network—regardless of functional area—who had the relevant expertise. Each of these central connectors spent an hour or more every day helping the other 108 people in the group. But while their colleagues readily acknowledged the connectors’ importance, their efforts were not recognized, let alone rewarded, by the company. “

(from Cross and Prusak, Harvard Business Review, June 2002)
(from Cross and Prusak, Harvard Business Review, June 2002)

In a medical school, these critical central connectors are called Course Directors. They are the folks with the practical knowledge, functional relationships and, importantly, “street cred” required to translate the high level educational goals of our program into the multiple packets (courses) of education that, in aggregate, will come together to produce the fully formed graduate, ready for residency and great things beyond. Their job is basically to take a subset of the overall program objectives that are assigned to them by the Curriculum Committee, and develop the multiple components of teaching and assessment designed to ensure our students achieve the objectives. In doing so, they must engage and coordinate the efforts of their professional colleagues, other members of the educational community, educational specialists and our administrative support staff. By effectively orchestrating all these efforts, guided by the “score” provided by the curricular framework, they develop an effective and coordinated educational experience for our students. They are truly “connectors” as described by Cross and Prusak. They are absolutely indispensible to the success of the program.

Last week, we recognized the contributions of four of our Course Directors who are moving on from those roles, three of whom are retiring. Fittingly, students, representing those who had benefited so greatly from the efforts and dedication of these remarkable people, provided the tributes. In their words:

mernerElisabeth Merner, Meds 2019, speaking on behalf of Dr. Jennifer MacKenzie:

It’s a pleasure to thank Dr. Mackenzie for all of her work as the inaugural Co-Director of the QuARMS program on behalf of the QuARMS students.

Most people have heard of the QuARMS program, but very few people understand the QuARMS vision as well as you do, Dr. Mackenzie.  From the very beginning of the program, you helped to deepen students’ understanding of the role of the physician, the qualities of a leader in the medical community, and the values and ethics that are to be upheld in medicine.

For some, it would be daunting to teach these topics to a group of teenagers, but you were more than ready for the challenge.  Your passion for education and innovation has been clear to all of us. We appreciate the fact that you attended every single three hour Wednesday session for the first two years of the QuARMS program. Honestly, with young adults of your own, we would have understood if you claimed that you had administrative duties to perform and missed out on one or two of the sessions – but you were there, leading by example.

We also recognize your role in designing the QuARMS curriculum, which is unlike any other program in Canada. Through service-learning projects, you helped students to understand the importance of social accountability within the medical profession.  You also led a transformation in how students think about volunteer work. Your vision and your values have shaped the QuARMS program.  Thanks to you, service-learning projects have now become a much more important part of our medical school here at Queen’s.

On behalf of four generations of QuARMS students, we want to thank you, Dr. Mackenzie, for your tireless dedication to the development of the QuARMS program and to shaping our lives, both as future professionals and as mature students.”

____________________________________________________________________________

Jeff Mah, Meds 2019, speaking on behalf of Dr. Conrad Reifel,

mahLet me start off by saying, anatomy is one of the most overwhelming topics in medicine. From head to toe, there is a seemingly endless number of muscles, bones, nerves, blood vessels and organs that each serve a specific purpose and thus need to be learned. Needless to say, without a good teacher, this subject can be very difficult to master.

At Queen’s, we have been extremely fortunate to have had Dr. Conrad Reifel as an anatomy instructor for the last 43 years. Over his time here, Dr. Reifel has guided thousands of medical students through the vast, unfamiliar world of gross anatomy and has done so with patience and commitment. What I always appreciated about Dr. Reifel was his ability to take an area of the body that is incredibly complex and systematically break it down so that by the time he finished talking, it seemed quite manageable.rifle

Dr. Reifel also has a fantastic ability to keep a class engaged even when teaching a somewhat dry topic with his unique sense of humour and vast repertoire of personal anecdotes. I’ll never forget Dr. Reifel, standing at the front of the class with his arms outstretched using his own body to demonstrate the anatomy of the uterus. While the memory of that lecture does conjure up some odd images, I’ve never had trouble visualizing the uterine anatomy since then.

Dr. Reifel, on behalf of the medical students of Queen’s University, past and present, thank you for the decades of excellent instruction. Please know that you are respected and loved by the students you have taught and have positively impacted the lives of so many. You will be truly missed and we wish you all the best in your retirement.

____________________________________________________________________________

Calvin Santiago, Meds 2018, speaking on behalf of Dr. Lewis Tomalty

tomaltyDr Tomalty has been teaching in the Mechanisms of Disease course since 2010 and took over as Course Director in 2012. In this role, Dr. Tomalty worked tirelessly to make improvements to the course. He attended all the MoD lectures and met weekly with the class curricular reps. He set up consultations with students and faculty, organized a strategic planning curricular retreat and established a framework to link together a diverse range of subjects including pathology, immunology, microbiology and infectious disease.

In addition to his role as Course Director for the Mechanisms of Disease Course, Dr. Tomalty also previously served as Vice Dean of Medical Education for the Faculty of Health Sciences and is the current Chair of the Course and Faculty Review Committee. As well, Dr. Tomalty is heavily involved in global health initiatives and provides his consultation services on infection control in Mongolia.socks

On a more personal note, and speaking on behalf of the many students who have had the privilege of knowing him over the years, I have found him to be an absolute pleasure to work with. Even in his last year as the Course Director, he still met with the curricular reps on a weekly basis to discuss ways to fine-tune an already well-received course. I know from their stories that they looked forward to these meetings with Dr. Tomalty, calling it their weekly “T-Time”. To quote another student, he is the “bestest, most efficient chair of a meeting ever.” I look to him as an exemplary role model of a leader and educator and as an inspiration for stylishly funky socks.

Dr. Tomalty, thank you so much for your leadership as Course Director and I wish you all the best in your future endeavours.

____________________________________________________________________________

Kate Rath-Wilson, Meds 2019, speaking on behalf of Dr. Chris Ward

rath-wilsonDr. Chris Ward was one of the inaugural course directors for our new curriculum when it was introduced in 2009, and was responsible for developing and consistently aiming to improve the Normal Human Function course in Term 1.  He has coordinated multiple faculty members, built a strong curriculum for the course, been part of the initiative to bring in Drs Moffatt and Parker to apply physiology to cases (which has added immeasurably to our learning), and helped to build introductory physiology modules for students struggling with physiology. This led him to be asked to join many, many, many UGME committees, including (but not limited to) the Curriculum Committee, The Teaching, Learning and Innovation Committee, and the Student Assessment Committee – currently, Dr. Gibson believes this to be a record for any one course director.  He was instrumental in preparing our brief for the CACMS/LCME accreditation, reviewing all the sections that pertained to foundational science and its impact across the curriculum. Dr. Ward is known at Curriculum Committee for being the person to move that the meeting be adjourned! It started with only a few times, but now we look to him for this and he’s become everyone’s favourite motion-maker!chris-ward

As a medical student, I have not had much of a chance to get to know Dr. Ward personally. His name will always be associated with hypovolemic shock for me – which some may deem as unfortunate but I think is one of the highest honours a teacher can be granted. He elucidated complex cardiac physics with clarity and patience, and acted as a model to the other professors in his course. He expertly managed a complex course, juggling the schedules of many faculty members and even more stressed out A-type students.

Dr. Ward has worked tirelessly behind the scenes to build our medical curriculum from the bottom up. This is a position that often lacks glory and recognition. We owe Dr. Ward a lifetime’s worth of thanks. The positive impact he has had as director of the Normal Human Function course on his colleagues and his students is immeasurable, and we thank him today for his contributions to the foundational medical knowledge of hundreds of medical students and wish him all the best for his future work.

 

Let me add my thanks and personal appreciation to those of our students. I’d also like to acknowledge the ongoing efforts of all our Course Directors, who carry out their roles so effectively and provide those key “central connections” so essential to our program.

All photographs by Lars Hagberg

 

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

 

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5th Annual Medical Student Research Showcase

By Drs. Heather Murray & Melanie Walker

This year the School of Medicine is proud to invite you to the 5th annual Medical Student Research Showcase on Wednesday September 21st.

This event celebrates the research achievements of our undergraduate medical students, with both posters and an oral plenary session featuring research showcase-judgingperformed by students while they have been enrolled in medical school. All students who received summer studentship research funding through the School of Medicine in 2016 will be presenting their work, as well as many other research initiatives. The posters will be displayed in the David Walker atrium of the School of Medicine building from 8 am until 5 pm, with the students standing at their posters answering questions between 1030 and noon.

The oral plenary features the top research projects selected by a panel of faculty judges, and will run in room 132A from noon until 1:30pm on Sept 21st, immediately following the poster session Q&A. We are pleased to announce that we have a faculty guest speaker, Dr. Adrian Baranchuk, who will give a short presentation on his research and career to launch the oral plenary session.

This year’s faculty judges included:

  • Dr. Tanveer Towheedshowcase-discussion
  • Dr. Andrea Winthrop
  • Dr. Yuka Asai
  • Dr. Ryan Bicknell
  • Dr. Megan Carter
  • Dr. Jennifer Flemming
  • Dr. Nader Ghasemlou
  • Dr. Dianne Groll
  • Dr. Paula James
  • Dr. David Maslove
  • Dr. Katrina Gee

We are very grateful to these faculty members for evaluating our oral plenary applicants this year.

The three students who have been selected for the oral plenary session, and the titles of their research presentations and faculty supervisor names are listed below. Each of these three students will receive The Albert Clark Award for Medical Student Research Excellence.

Peter Wang – A database review using the CHADS2 score to detect new Atrial Fibrillation (Supervisor: R. S. Pal)

Frances Dang – Impacts of Preeclampsia on the Brain of Offspring (Supervisor: A. Croy)

Zhubo Zhang – Differential DNA methylation profiles reflect distinct molecular subtypes and clinical outcomes of urothelial bladder carcinoma (Supervisor: R.J. Gooding)

Please set aside some time to attend the Medical Student Research Showcase on September 21st. The students will appreciate your interest and support, and you will be amazed at what they have been able to achieve.

 

 

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Reflections on reflection on reflection

elbow lake reflection2

Hi all:  I’m back from a few weeks at our family cottage near Sudbury. Now for those of you from north of Parry Sound, you know that it’s not a cottage, it’s a camp, but I’m translating for all the Southerners here at the UGME blog.

I find that there’s nothing like total exhaustion from installing a new water pump, sanding and staining a deck, staining 6 new Muskoka chairs, and bringing water by hand, up a steep hill, to the garden which one has foolishly planted up that hill.  I find total exhaustion quite conducive to reflection.  I simply sit and stare at the water.  After awhile, my brain starts to work again, and after solving basic issues like food and water (shades of Mazlow), I can even start to get creative.  I think about what’s gone wrong, or what needs to be better and I plan.  I can plan a brand new cottage (hah!), a new way to pump water (hah!), and even a new garden location.  I can plan things to say to my husband when he says, “These Muskoka chairs are so cheap—we couldn’t build them for this money.  Let’s get 6.”  And then, furtively, because UG at Queen’s is never far from my thoughts, I can even start to reflect on things at UG, and plan to make things even better.

Now this urge to action based on reflection is my favourite perspective on reflection. Unfortunately, I’ve never been one to meditate, or think about the moment, or think about nothing, or “relax”.  (However, I did take Dr. John Smythe’s 6 week course on mindfulness and just to show you how good he and the course are, by week 6, I found I actually could be mindful, focus on an object and poof!  Gone for 15 minutes! I highly recommend it, and I try very hard to put his precepts into practice!)

But generally, I’m a Kolb-ian.  I like Kolb’s model of experiential learning—it speaks to me as a call to action.  He advises, in essence, to act, reflect on the action, take it to other reference points and then make an action plan.  I think I’ve shown you this before, but just in case…:)

kolb_cycle

 

So, on what did I reflect, in my moments of recovery from projects at the cottage?  (Did I mention my perennial and consistent devotion to ridding the cottage of mice droppings as part of my activities?  I abstractly conceptualize that as draining the ocean with a teaspoon. (See Stage 3 above.)

Well, one thing I did was bring a book that I promised I’d give you some feedback on, up to the cottage.  It’s entitled English and Reflective Writing Skills in Medicine by Clive Handler, Charlotte Handler and Deborah Gill (CRC Press).  I took some great things from this, to share with you.  They are reflections and pieces of reflections, morphed into this article, which is something I strongly advice with reflection.  Reflections are private.  An action or a blog article, for example, is something that can be crafted from reflections into a public piece of writing.

One thing that really spoke to me was the list of areas and experiences that can generate good critical reflection especially for learners in medical education.  I think, too, that even for experienced practitioners these questions can trigger reflection.

About a patient:

  • A patient happy or unhappy with their treatment by you or others
  • A question of confidentiality, consent or inappropriate risk
  • Doing something for the first time
  • Communicating with older or frail people
  • Consultations involving more than one person (for example, a relative)
  • Sudden death or deterioration

About you:

  • An aspect of a patient encounter that revealed gaps in your knowledge or skills
  • An even that caused you anxiety or enjoyment
  • An aspect of care that left you surprised, puzzled or confused
  • A patient that challenged our assumptions or whose actions are at odds with your personal beliefs and values

About the team

  • When you feel an aspect of the treatment or management is wrong
  • A dysfunctional team that affects patient outcomes or experiences
  • The actions of a team under pressure

Good medical practice

  • Times you have exhibited good medical practice or found yourself in a situation that may be at odds with good medical practice
  • Times when you have seen medical practice or behavior that may be at odds with medical practice. (pp. 6-7)

What do you think?

Now the authors also tackle the dicey area of marking and giving feedback on reflective writing.  Medical students are often extremely concerned about who will see their reflective writing, and whether that will impact on the faculty member’s opinion of the student.  This seems to me to be quite understandable, and it’s why I mentioned above, that taking a reflection and crafting it into a set of goals or more concretely, an action plan, with some work already done, is often a very positive spin to put onto a problem area that a student has identified.  I used to tell my education students, “It’s not a question of whether any of us will make a mistake or not. It’s a question of how we recover, and deal with the mistake that makes the good teacher.”  I think that is also true of the good doctor.

So…in order to create an action plan the authors advise using the Kolb cycle but changing it slightly to:

  1. Identify and describe a professional scenario
  2. What are the perceived consequences of these behaviours?
  3. What are the implications for professional practice? [Sheila’s note: at this point I would challenge students to walk the walk and provide some evidence from medical and medical education literature to demonstrate the implications and help provide solutions for 4.]
  4. What evidence can you provide to show how you have used this experience to develop your practice and inform your behavior in professional scenarios? [Sheila’s note again: OR What is your plan of action to change the behavior?] (p. 12)

At this point the book delves into how to assess the writing skills of the students and it’s full of good advice about grammar and tons of examples of reflective essays.

Speaking of assessment, I’ve been hearing that some students don’t feel that receiving feedback on the lack of clarity and the amount of spelling and grammar errors in their med ed writing is within the realm of medical education.   Well, it is one of our Curricular Objectives (CM 1.3a: Provide accurate information… in a clear, non-judgmental and understandable manner.) And I can only imagine what you readers are saying to yourselves right now, about the importance of clear writing in transitions of care, etc.

What I do have for you is a row for a rubric I created for clarity of expression.  So should you ever be assessing student writing, and want to use it, feel free.

10 prompts write reflections

Lastly, here are some ways to write about reflections that give a format or form to the thoughts.  Students may find these more enjoyable, or at least more guided.  What do you think?  Do you have others?

  1. So What? Journal:  Identify the main idea of the lesson or incident. Why is it important? Why is it important to others?
  2. Analogy (or Simile):  Explain the main idea using an analogy. (Has the benefit of making everyone look up “analogy”.) OR could be explain this idea as a simile:  It’s as if, or it’s like… Then, folow the thread of the anaology or simile.
  3. Question Stems
    • I believe that ________ because _______.
    • I was most confused by _______.
    • What surprised me was _______
    • A patient (a nurse, a physiotherapist, etc.) would see this incident as _____________.
    • When I read up on this, here was one interesting solution____________
  4. Muddy Moment:  What frustrates and confuses you about this incident?  What will you do about it?
  1. PAS_Double-Entry-JournalDouble Entry Journal: Jot down main points, questions, etc. in left hand column.  In right hand column write about these, including actions for the future
  2. Twitter Post: encapsulate in under 140 characters.
  3. Praise from your Mother (or Father or other person who loves you):  “My son’s (daughter’s etc.) done this_______” (In other words, have someone else brag about you if you won’t.)
  4. Top Ten List:  What are the most important takeaways, written with humor?
  5. Quickwrite:  Without stopping, write what most confuses you.  Use a concept map or other format to try sorting it out.
  6. If I were writing a blog about this ____(opinion, incident, topic), I would write__________________.
(Adapted from “Dipsticks: Efficient Ways to Check Understanding; http://www.edutopia.org/blog/dipsticks-to-check-for-understanding-todd-finley)

Well, those are some reflections on reflections from my time up North.  I’ve also partially solved the mouse dropping problem (all the dishes are now in bins when we leave!)  And I’ve figured out what to say to my husband when he advises buying 6 chairs we have to build and stain:  “You are right, dear!”  (because he was right, and  they look awesome!).  muskoka 1

I’ve also once again realized how rejuvenating short physical projects can be (they have an end! 🙂 and how much I love to sit by a lake and think.  I just have to figure out how to keep this reflective spirit going all year long!  As for the water pump…well, maybe part of the reflection is that some things you just have to live with!

Any reflection on reflections to share?  Feel free to write in!

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