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.
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.
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. “
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:
Elisabeth 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,
Let 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.
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
Dr 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.
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
Dr. 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!
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)
Undergraduate Medical Education
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 performed 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 Towheed
- 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.
Reflections on reflection on reflection
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…:)
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
- 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:
- Identify and describe a professional scenario
- What are the perceived consequences of these behaviours?
- 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.]
- 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?
- So What? Journal: Identify the main idea of the lesson or incident. Why is it important? Why is it important to others?
- 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.
- 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____________
- Muddy Moment: What frustrates and confuses you about this incident? What will you do about it?
- Double Entry Journal: Jot down main points, questions, etc. in left hand column. In right hand column write about these, including actions for the future
- Twitter Post: encapsulate in under 140 characters.
- 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.)
- Top Ten List: What are the most important takeaways, written with humor?
- Quickwrite: Without stopping, write what most confuses you. Use a concept map or other format to try sorting it out.
- 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!).
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!
Malcolm’s Italian Adventure, and the art of teaching through storytelling.
When I first met Malcolm Williams, he was trying valiantly to teach me how to examine the back of a child’s throat without getting bitten or having the patient throw up on my white shirt and tie. He was only partially successful. Over the years, I’ve gotten to know Malcolm well, in various contexts. Such continuing and evolving relationships are one of the real blessings of training, practicing and living in a relatively small medical community. Malcolm is now an Emeritus Professor and former Head of Otolaryngology. He’s also an accomplished musician, traveller and observer of humanity. Moreover, and more relevant to this article, he is a master storyteller. In fact, he’s what you might call a raconteur. Blessed with a resonant baritone voice, impeccable delivery, and personal connections with most of the citizenry of Kingston, he truly spins a great yarn, and can do so anywhere, anytime.
Recently, he told me about an encounter he and his wife Denny (also an accomplished musician) had experienced during a trip to Italy. He mentioned he had written about it, and I asked if he’d agree to me sharing it on this blog. He graciously agreed. And so, in the words of the master…
Every string player knows (or should know) of Cremona, Italy. After all, that is where Antonio Stradivari hung out his shingle in the late 17th century, when Canada was only in its infancy. My wife Denny and I moved to Kingston (now in a somewhat more developed country!) in 1969, without ever having visited Italy. Two years later, the International Congress of Otolaryngology was being held in Venice, so we went.
Venice was extraordinary that June. The sun shone every day, the water sparkled, and there weren’t too many tourists. St. Mark’s Square was filled with music from a dozen café orchestras playing in the open air, just far enough apart to avoid cacophony, and the shops were full of wonderful leather, glass and fashionable garments, which we thought were unfortunately too expensive at several million lire each. We had actually returned home before it dawned on us that the lira was worth so little (at several hundred to the dollar) that we could have purchased that lovely pair of red high-heeled shoes after all!
After the meeting ended, I asked our very obliging hotel concierge to arrange a self-drive car for us. The conversation went something like this:
Concierge: “Where to, Signore?”
Concierge: “But, Signore, there is nothing in Cremona!” (This, with much waving of hands and other negative body language.)
Me: “Look, my wife and I are players of stringed instruments, and we are determined to make a pilgrimage.”
Concierge: (with heavy sigh) “Signore, you will be wasting your time, but I see you are quite determined, so please let me advise you on your journey. I will have a very comfortable automobile waiting for you after breakfast. You will drive it to Verona, where you will have coffee at the Amphiteatro, which is very beautiful and historic, so you will enjoy it a lot. After coffee, you will drive along the Autostrada to the Village of Sirmione, on Lago di Garda. The village is inside the walls of an old castle, and there is a beautiful hotel with a terrace bar, which overlooks the lake, where you will sit and have an aperitif before lunch. And you will enjoy it. You will ask to see the luncheon menu, you will decide it is too expensive and go down instead to the Trattoria Verdi in the village, which is owned by my sister. You will have a delicious lunch, which you will enjoy very much. And, after that – if you still want to go to Cremona, go!” (And on your own heads be it!)
We are still glad that Giovanni planned our day so well. We did everything he suggested, including eating a wonderful lunch (trout from the lake and a simple salad, with local white wine) at Trattoria Verdi. We did go on to Cremona, to find only a miserable display of two violins in glass cases in the silent, cavernous Town Hall, where we were the only visitors. The fiddles were nice enough – a Nicolo Amati and an ordinary Stradivarius (if there is such a thing), but there was no display of tools, wood, drawings etc. The attendant spoke little English, and did not even know where Stradivari had lived.
The following morning, we were warmly greeted by Giovanni, who asked about the trip. I said “We enjoyed the day as you said we would – but there is nothing in Cremona!” With a smile and a shrug, he sighed: “Ah, Signore!” as he took my generous tip.
He was not to know that the tradition of violin-making would be revived later in Cremona, including a well-respected school and a very impressive museum! This was brought to light in an interesting documentary on TVO as recently as January 2013, which I would urge readers to look at, whilst noting that the presenter’s style is a little brash and superficial for my taste! I wish we could go back and see it all in the flesh, though.
Venice itself was not a total loss in instrumental terms, however. Half-way up the stairs inside the tower of St Mark’s Basilica is a glass-covered niche in the wall containing the most extraordinary double-bass I have ever seen. It was made for the virtuoso Dragonetti in the early 1700s by Gasparo Da Salo, and is one of only two or three in existence. The ROM in Toronto owns a similar one, and I have seen it, although it is no longer on display there. I have only recently become aware that as Denny and I sat on that hotel terrace in Sirmione, we were looking directly up Lake Garda to Salo, where Gasparo was born.
We have no Italian instruments now, although for years my wife played a 19th-century violin made in Genoa by Eugenio Praga. We do have a well-thumbed copy of the book “Italian Violin Makers” by Jalovec, and also the fascinating “The Violin Hunter” by William Silverman, and we treasure them. My 1849 English bass, which I played in the Kingston Symphony Orchestra for a long time, was sold when I left the orchestra, as it needed to be used professionally. However, I soon realized that I still wanted an instrument of my own to play in The Community Strings, and bought one on eBay! This had been brought through the Iron Curtain in disguise, its varnish covered over with black sticky house paint and its strings tattered and frayed, to avoid confiscation at the border, finishing up in Mississauga, Ontario. Three years and a lot of work later, it has been restored to its former glory, and I am not ashamed to take it out of its bag any more. It sounds good, too.
The Venice connection was reborn recently as well. I was asked if I would lend my bass for a “show” at the Grand Theatre. The last time I did anything like this was to lend my big bass travelling trunk to the theatre as a prop for a murder mystery play, in which it would conceal a dead body. This time, the instrument itself was needed by the very good Venetian group, Interpreti Veneziani. I was happy to see it used, and to find that it sounded very good in hands more expert than mine. Music is alive and well in Venice, Kingston, and, I know, now also in Cremona! Long may it last.
Malcolm has always reminded me of the essential role of storytelling as an educational tool. From kindergarten to medical school, much of what (and how) we learn is delivered as accounts of real life or imagined experiences, expressed in ways that stimulate the imagination, provide vivid imagery, and therefore not only entertain, but embed key messages in our memory to be recollected, re-considered and extended to future situations and circumstances. In the words of the Youth, Educators and Storytellers Alliance of the National Storytelling Network: ”Storytelling is an art, a tool, a device, a gateway to the past and a portal to the future that supports the present. Our true voices come alive when we share stories.”
In medical education, how much of our early and ongoing learning relates to accounts of clinical experiences, formally and not-so-formally passed between teacher and learner, and between colleagues? Our best teachers and mentors are not simply reservoirs of facts and figures – they’re able to contextualize into familiar and memorable accounts, weaving what we need to learn into engaging and memorable narratives that engage and persist in our memory.
Malcolm is one of those people. He reminds us that whether the message is about respecting local culture, maintaining our artistic passions, or assessing pharyngeal pathology, the delivery can be as important as the content, and certainly as enduring.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Tartan, threads, and an integrated curriculum
By Lindsay Davidson
Director, Teaching, Learning and Integration
Summer is a funny time – for some, relaxing with family on the dock, for others seeking out new adventures. I’ve been amused as I’ve watched from a distance, as my university-age son embraces his Scottish roots by running in “kilt runs” in Perth and Quebec City. This exploration of his ancestors’ fashion choices has led to a whole new appreciation of tartan in our family. Queen’s University, of course, is home to its own tartan, worn by band members and enthusiastic alumni alike. Just as the tartans of Scotland identify clan membership, the unique pattern of coloured warp and weft threads are instantly identifiable as the plaid cloth associated with our Queen’s.
Over the past year, the members of the Teaching, Learning and Integration Committee (TLIC) have been busy identifying teaching threads for a virtual “curricular tartan”, just as unique and emblematic of our medical school. Integrated threads represent topics that are taught in a longitudinal fashion, spanning multiple courses, terms and even years of the curriculum. These include intrinsic physician roles, some medical disciplines (typically those that do not have an identified course as well as those that relate to multiple courses) as well as other “hot topics”. Last September, the Committee presented the notion of integrated curricular threads to the Curriculum Committee, as well as an inaugural list of 28 threads which are shown here. (The active Integrated Threads list will be reviewed and possible revised by the Curriculum Committee each September).
To date, members of the TLIC and the Educational Development team have worked with course directors, discipline leads and other content experts to identify how these topics are taught and assessed across the length of our curriculum. The exercise has created exciting opportunities to connect teachers across courses and terms and has led to new opportunities for collaboration: a pharmacologist teaching about complementary and alternative medicines in the context of the CARL course, pathologists co-teaching about lung cancer in the Oncology course, Palliative care and Genetics experts identifying how relevant their disciplines are to multiple courses and creating explicit pockets of teaching.
The threads, now identified, are beginning to be woven into an intricate cloth. You can explore some examples of these by searching for a particular Integrated Thread as part of a Learning Event search on MEdTech. We hope that students will benefit from having an opportunity to understand how teaching on these topics progresses over the curriculum.
Queen’s UGME Curriculum Committee Retreat Updates
Hello all! I’m writing this on behalf of Dr. John Drover, Chair, UGME Curriculum Committee and Candace Miller, Administrative Support, UGME Curriculum Committee as part of the UGME Curriculum Committee’s commitment to outreach.
May 31, 2016 saw an action-packed morning as the UGME Curriculum Committee held its annual retreat from 9:00 a.m. to 1:00 p.m. One purpose of the annual retreat is to consider for approval recommendations made by the Curricular Change Working Group. The Working Group had met previously to collate, synthesize and review requests for changes to the Curricular Framework and changes to course assignments of MCC’s and objectives. These had been submitted by Competency Leads, the Educational Development Team, Year and Course Directors and required a review from the whole curriculum perspective.
Another purpose for the retreat is to hear reports from the sub-committees that report to the Curriculum Committee as well as from the Competency Leads. In the policies and procedures of the Curriculum Committee, a report through the UGME Blog is required about the retreat and its outcomes.
As a result of this retreat, and the subsequent Curriculum Committee Meetings June 23 and July 21, faculty and students at Queen’s UGME will see a new edition “Red Book” or Curricular Framework coming out at the end of August. Many of the changes in wording to our Curricular Objectives were made to align with new Entrustable Professional Acts (EPAs) which were adopted at the July 18 meeting. Please stay tuned to a later blog for information about these EPA’s.
A few new objectives have been added under Medical Expert, and some objectives were consolidated, deleted, or combined, especially at the request of the Competency Leads. Medical Expert, Communicator, Advocate, Scholar and Professional roles and competencies each saw some changes.
Course and Year Directors had requested changes to assigned course MCCs and Objectives for courses based on a review of the teaching/learning and assessment in their courses. Those which were approved will be made in MEdTech for each of our courses as submitted, by the end of August, ready for the new academic year. That will automatically change the dropdown menus for each learning event for easier access. There will be a system that maps the old objectives to the new, and this will be done automatically. However, faculty will see a NEW as well as OLD set of objectives, while we transition. Make sure you focus on the NEW set.
Course Directors will be notified about the changes pertinent to their courses from their respective Year Director by the end of August.
The Advocate, Professional, Collaborator and Scholar Competency Leads (Drs. Carpenter, Allard, Davidson, and Murray respectively) reported on work in the intrinsic roles. The template requires them to report on: a follow up to last year’s report, operational aspects, student progress, and curriculum. As well each report gives a status report and a discussion of future plans.
Please note: If you are faculty with access to Queen’s MEdTech, you can view all the agendas and the minutes from the Curriculum Committee Meetings, the Curricular Working Group notes and the Curriculum Committee Retreat, online at https://meds.queensu.ca/central/community/facultyresources:curriculum_committee.
Where have all the people gone?
Anyone who has grocery shopped at a large supermarket recently will notice that you’re now confronted with a decision at check-out time. You can line up as usual to have a clerk check and bag your items, or you can opt to go to the do-it-yourself kiosk, where you have the privilege of scanning and packing your items yourself. I’ve been tempted to canvass folks who choose the clerkless option. I suspect some feel it’s faster (by my observation, that’s dubious at best). Some may be obsessive-compulsive enough to want to handle and pack their own things in some preferred manner. I suspect some may simply wish to avoid the need to interact with another person, however briefly.
Whatever the reason, it seems likely that the option we’re currently being provided is not going to continue, but rather is a transition process preparing us for a time when grocery chains will no longer hire actual human beings for the purpose. When that happens, your friendly check-out person will join the growing list of community roles that are no more, or exist in a much more limited capacity:
In fact, it’s now entirely possible to leave your home in the morning and carry out all your domestic and business chores without ever having to be troubled with the need to interact with an actual human being. Moreover, we don’t require another person’s help to accomplish many of the functions of day-to-day life. In essence, we’re paradoxically becoming more isolated in the midst of increasingly crowded and busy urban environments.
Recently, we’ve witnessed a further blurring of the boundary between our personal space and the wider world. The introduction of Pokemon-Go basically makes the wider world a personal playground. In the words of the manufacturers, “Travel between the real world and the virtual world of Pokémon with Pokémon GO for iPhone and Android devices. With Pokémon GO, you’ll discover Pokémon in a whole new world—your own!”
So, what are we to think of all this increasing detachment from the people with whom we coexist, sharing our communities and services? Is it a problem, or simply evolution towards a greater, technologically driven efficiency? Is there a price to be paid for our virtual isolation from the growing number of people around us?
At the risk of sounding like a sentimental reactionary, I’ll admit that a few concerns come to mind.
Firstly, on a purely pragmatic level, these jobs provided income and, for those who engaged them as full time occupations, a sense of identity and purpose within our communities. They, in turn, were able to support their families and local economies. Jobs, all jobs, are likely our best social investment. A loss of jobs, even unglamorous jobs, should concern us.
They also provided part-time employment opportunities for young people, valuable experiences in self-sufficiency and human relations that informed and supported future careers. Interacting with various folks in the course of our routine day promotes “people skills”. One learns how to “read” people, sense concerns, respond appropriately.
Moreover, the need to interact and communicate on a regular basis with other folks of diverse ages and backgrounds, I believe, promotes tolerance, civility and fundamental sensitivity to the challenges faced by others in our midst. How much do children learn by simply observing how their parents interact with all the folks they encounter in daily life? How much is lost if that never occurs?
I believe we’re seeing some consequences in our medical schools.
One of the most stressful moments for medical students is their first encounter with a patient. At our school, this takes place in first term Clinical Skills. Very early on, students are taught and expected to introduce themselves to a patient, obtain some basic information, and begin the encounter that will eventually allow them to obtain a complete and accurate clinical history. It all starts with simply introducing oneself and beginning a basic conversation, which, one might think, would come quite naturally to bright and gifted young people. Amazingly, many students find this quite difficult and even unnatural. In fact, students vary considerably in their comfort and aptitude for the patient encounter, and this has very little to do with their academic qualifications. It does, however, have much to do with their prior experience engaging people on a personal level, particularly those of diverse ages or backgrounds. That ability is (or should be) learned through real life everyday experiences, at home, in their communities, in their workplace. In our competency-based world of medical education, it’s easy to forget that the most essential physician competency is the affinity for effective and comfortable exchanges with people of all types. That particular skill is first developed, not in medical school, but in our homes and communities.
It would be silly to expect that technology will not continue to advance and that the now redundant occupations described above will make some sort of magical resurgence. However, we should recognize that something has been lost and not replaced. These roles were not just jobs or functions. They were actual people, with faces, personalities, roles in our communities for which they became known and identified. They contributed something far beyond the tasks they performed. They contributed to our learning, our sense of community, and our comfort with personal interactions. In their absence, we must find ways to identify and develop those skills in our students who are products of a rapidly changing social structure.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Best wishes to our 2016 Grads – beginning residency, and continuing a long tradition.
The image below is taken from one of the many graduation photographs hanging on the walls of the School of Medicine Building. The young men in the photo are members of the 1884 graduating class. On the surface, one may be struck by the obvious differences to our current world, in terms of gender and ethnic diversity, medical knowledge, and the needs of the society they were about to enter as physicians. But I’m more struck by the similarities. Although their careers and lives have long since ended, those young faces frozen in the photograph seem eager, confident in their training, and perhaps a little nervous, about what challenges the future will bring, and how they will contribute to it. In all those regards, they are not at all unlike our current students.
This week, our most recent graduates begin the next phase of their medical careers. They also seemed eager and a little nervous when they started their medical education here at Queen’s in September of 2012, as may be apparent in the photograph taken that first day.
That eager nervousness has probably not disappeared completely, but is hopefully supplemented by the same confidence in their abilities and desire to contribute that characterized so many of their predecessors. As they do, they’ve spread across this great country. Their areas of specialization and locations are summarized below.
I’m particularly pleased to welcome back those who will be pursuing postgraduate education here at Queen’s.
Dr. Carl Chauvin, former Aesculapian Society President, will be starting the Anaesthiology program.
Drs. Kelly Fernandes, Matthew Legassic, Hollis Roth, Calvin Chan and Betty Chiu are entering Family Medicine.
Drs. Alex Astell, Roxana Chis, Josh Durbin, Ioulia Pronina and Kamran Shaikh are beginning their careers in Internal Medicine.
Drs. Alida Pokoradi, Stefania Spano and Ainsley Alexander have joined the Obstetrics and Gynecology, Orthopedic Surgery, and Psychiatry programs, respectively.
All of our graduates, I’m confident, will enhance and contribute to the programs they enter, and they do so with the best wishes of their undergraduate teaching faculty.
Their graduation photograph has joined those of all their predecessors on the walls of our School of Medicine Building. These photographs remind those of us who serve as stewards of our medical education heritage that we have an entrusted responsibility to produce graduates who are not just academically successful, but who bring real value to the profession and society. That mission hasn’t fundamentally changed over the years, but requires very different approaches than it did in the past. Our purpose remains to attract eager, dedicated, capable young people to the profession, and to prepare them intellectually and personally for a career of service, promoting and providing for the health of our society and fellow citizens.
That’s what we’ve done. That’s what we do.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education