Residency Match Day: 2020 What our students are experiencing, and how to help them get through it
Anticipation is the title of a memorable Carly Simon song that tends to come to mind this time of year. That’s probably because that simple word nicely describes the prevailing mood of our fourth year class. What they’re anticipating, of course, is the results of the CaRMS match, which will be released March 3rd.
The process by which learners transition from undergraduate to postgraduate medical education has evolved into a rather jarring and extremely stressful experience (a subject for another blog/rant). It has required them to not simply consider what specialties are best suited to their interests and skills, but engage an application process that requires strategic selection of elective experiences, preparation of voluminous documents, meeting multiple deadlines (twelve, no less), and commitment of personal time and expense to travel and interviewing which, for many, spans the country in the midst of the Canadian winter. And so, as you can easily imagine, there will not only be anticipation, but also anxiety leading up to the release.
By approximately 12:00:05 on March 3rd, our students will know which program they’ll be entering next July. For most (hopefully all), the anticipation will end with the exhilaration and satisfaction of having successfully overcome the process. For a few (and hopefully none), it will bring a realization that their efforts to date have not been successful, that this part of their journey is not yet over, and they have to begin again. They will be profoundly disappointed. They will be afraid. They will be confused. They will need the understanding and help of the faculty who are currently supervising their training, and much help from our Student Affairs staff.
This year, we are again prepared to provide all necessary supports, but there are a few changes to the process which I’d like to clarify for both students and the faculty that will be supervising them that day:
- Unlike previous years, our Undergraduate Office will not automatically receive match results the day before the full release. However, students have the option of directing CaRMS to release their results the day before (March 2nd) if they fail to match. They can do so by going into the CaRMS website and providing the appropriate permission.
- Any unmatched students who have
allowed early release will be contacted directly by myself to notify them of
the result. This is for three purposes:
- to arrange for release from clinical duties
- to allow the student some time to prepare for the release moment the following day when most of their classmates will be hearing positive results
- to arrange for the student to meet our student counselors who will provide personal support and begin the process for re-application through the second iteration of the residency match.
- Unmatched students who did not opt to provide early release will similarly be contacted and offered the same support and services after we get their results on match day.
- Because we may not have full information in advance, we have decided to release all students from clinical obligations beginning noon on match day, until the following morning.
I’d also like to remind all faculty supervising our fourth year students on or around match day to anticipate that your student will be distracted. Please ensure your student is able to review the results at noon. If you sense he or she is disappointed with the result, please be advised that the student counselors and myself are standing by that day to help any student deal with the situation and provide support.
Fortunately, we have an outstanding Student Affairs team which has been working hard to guide the students through the career exploration and match process, and will be standing by to provide support for match day and beyond.
Dr. Renee Fitzpatrick
Assistant, Student Affairs
The team can be accessed through our Student Affairs office email@example.com, or 613-533-6000 x78451.
Thanks for your consideration, and please feel free to get in touch with myself or any of the Student Affairs Team if you have questions or concerns about Match Day or beyond.
I leave you, and especially our fourth year soon-to-be colleagues, with the lyrics and sounds of Carly Simon’s “Anticipation”:
We can never know about the days to come
But we think about them anyway
And I wonder if I’m really with you now
Or just chasin’ after some finer day
Is makin’ me late
Is keepin’ me waitin’
Why we teach. Why we learn.
What is it that motivates practicing doctors, nurses or any professional health care provider to take time away from their usual duties and obligations in order to teach young people whose goal is to one day replace them?
In approaching that question, a few things are clear:
It’s not because they have to. There is no obligation or requirement for active doctors or nurses to contribute to the education of student learners.
It’s not because they need ways to fill their time. There is no shortage of patients in need to fill their days with valuable work.
It’s not for the money. Educational activities are not a route to financial prosperity. In fact, time devoted to teaching is usually at the expense of time that could be spent in much more lucrative clinical work.
It’s not for the glory. Teaching requires most clinicians to move out of their “comfort zone”, engage activities for which they have little specific training or expertise, and subject themselves to criticism from learners who, it must be said, have high standards and expectations.
In fact, many days, it can be hard to find reasons. The day-to-day challenges can dominate attention and sap energy. They can lead to serious questioning and “why bother” attitudes.
And what motivates the students of medicine or nursing? Whether young or old, just entering medical school or in established practice, learning is a continuing, life-long pursuit. Although initially motivated by the need to pass examinations or receive various certifications, most of the learning that occurs through the career of a doctor or nurse is self-motivated and apparent only to themselves.
But then, once in a while, something happens to re-affirm the fundamental value of the medical education process.
Such a moment occurred last weekend in, of all places, a local supermarket. Two of our students, Alexandra Morra (Meds 2021) and Nabil Hawwa (Meds 2022) had just completed a busy day and were going about their grocery shopping when they heard a commotion in another part of the store. Approaching the scene, they came upon a number of people surrounding a man lying on the floor, unresponsive. Mr. Jim Morgan (who has provided us permission to share this story) was also shopping at that store that day. Mr. Morgan had suddenly lost consciousness and fell heavily to the floor. Alex and Nabil had never previously encountered a real-life cardiac arrest but responded instinctively. Relating the incident to me a couple of days later, they recall “zoning in” on the patient and going through their check list. Is he breathing? No. Is there a pulse. No. Start chest compressions. Call for an AED. Get somebody to call 911. Get the AED unpacked and hooked up. In doing all this, they found themselves working with a recent nursing school graduate who was visiting Kingston and was also shopping at that time. The three worked as a team, sharing a mutual understanding of the situation and common training in CPR techniques. There was no panic, no jostling for authority, no arguing. There was simply a common interest and focus on the welfare of this patient. An AED was quickly provided, deployed and a shock delivered with restoration of a rhythm just before paramedics arrived and continued the resuscitation which, we’re all delighted to report, was successful. Mr. Morgan was taken to hospital, stabilized and underwent cardiopulmonary bypass surgery two days later by Dr. Petsikas. Recovering in the CCU a couple of days later, he had opportunity to meet and thank Alex and Nabil, whose efforts and those of the (unfortunately as yet unidentified) nurse who they worked with were no doubt instrumental in his recovery.
On reflecting on all this with me a few days later, Alex and Nabil remarked on how this incident profoundly altered their perception of the learning process. Suddenly, the long hours of work and effort were no longer merely for personal or academic achievement. Learning now had a purpose. A very real, tangible purpose. It also had a face. They now want more and are re-thinking previous assumptions about career direction.
In fact, I’ve found that students will, at some point in the course of their education and training come to what I’ve come to call the “magic moment” when something happens to make them realize that they’re now able to actually, personally influence someone’s life for the better. For most, it’s something relatively modest that perhaps only they are aware of – an accurate and previously unknown diagnosis, a test ordered that led to key information, a minor procedure well executed, comfort provided to someone in distress. For Alex and Nabil, that moment was quite public and dramatic, but all are significant, provide validation and motivate further learning as can no test result or external accolade.
I learned of all this initially from Cheryl Pulling, who is a faculty member in the School of Nursing. I have had the pleasure of getting to know Cheryl over the years because of her leadership roles in education. Cheryl is Associate Director of Undergraduate Nursing Programs and so my counterpart in the School of Nursing. In addition to meeting in the context of various committees and interprofessional initiatives, Cheryl and I have an annual “date” at convocation where we have the great privilege of hooding our respective graduates. Cheryl also happens to be Mr. Morgan’s sister.
Cheryl emailed me last weekend to let me know what had happened. She was communicating because, as a fellow educator, she knew I’d be thrilled to hear of this and proud of our students. Of course, she was absolutely right about that, but she was also expressing the satisfaction we all share in knowing that our efforts are yielding results. In Cheryl’s own words:
“While they are medical students, as a faculty member I am also very proud of them. I know you would be proud if they were nursing or rehab students. We are a team in the FHS with the same goal of educating HCP for the future.”
How right she is.
And that, my friends, is why we teach.
In 2010, the World Health Organization provided the following definition of Interprofessional Education:
“Interprofessional education occurs when students from two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes”
Sounds pretty straightforward, doesn’t it? Just need a large enough room, right? In reality, developing meaningful interprofessional educational events is, to say the very least, highly challenging.
There are a number of reasons for this, some logistical and others attitudinal.
The logistic challenges are formidable. Professional schools have separate and independently developed curricular content and scheduling. Finding common ground and common space within those busy and packed programs is akin trying to get a group of busy commuters to stop and pause as they rush for the train. Moreover, any changes have to be approved by three independent Curriculum Committees, all (very understandably) aware of any impact new programming may have on their overall program. They are also very cognizant of their accreditation responsibilities which require them to ensure “centralized and independent” control of their curricula.
As difficult as these logistic challenges may be, the attitudinal barriers are even more daunting. Many students fail to see the value, being understandably focused on their individual program objectives. Many faculty members, while conceding the value, feel it is something better learned passively within the clinical environment through role modeling, and that valuable dedicated classroom time is best spent delivering what they consider more essential “core content”. These attitudes undermine the commitment that is required to overcome the logistics. In the words of Nilofer Merchant, “Culture trumps strategy, every time”. (Harvard Business Review: https://hbr.org/2011/03/culture-trumps-strategy-every)
Certainly, history is littered with partial successes or abject failures. During my tenure, I have personally been involved or witnessed numerous enthusiastic, well-intentioned and carefully thought-out approaches that have not achieved sustained success. This has been the case whether the efforts were local, or at the provincial or national levels.
Most recently, Dr. Leslie Flynn has been chairing a group that has again taken up the formidable challenge of developing a program of interprofessional education for the three schools within the Faculty of Health Sciences (Medicine, Nursing, Rehabilitation Therapy). They have developed an innovative and attractive program of learning events intended to provide both educational relevance to students of all three schools, and an opportunity for them to engage interactively. Their initial program offering begins this week.
Given the rather checkered history and recognized challenges, many might be tempted to ask, “why bother?”
A cogent rationale is provided in the preamble to the description of objectives that constitute the Collaborator competency in the CanMEDS framework:
Collaboration is essential for safe, high-quality, patient-centred care, and involves patients and their families, physicians and other colleagues in the health care professions, community partners, and health system stakeholders.
Collaboration requires relationships based in trust, respect, and shared decision-making among a variety of individuals with complementary skills in multiple settings across the continuum of care. It involves sharing knowledge, perspectives, and responsibilities, and a willingness to learn together. This requires understanding the roles of others, pursuing common goals and outcomes, and managing differences.
The College of Family Physicians takes a very similar position in its “Undergraduate Competencies from a Family Medicine Perspective” document:
As Collaborators, family physicians work with patients, families, healthcare teams, other health professionals, and communities to achieve optimal patient care.
The College of Nurses of Ontario describes the following in Entrance to Practice Competencies for Registered Nurses:
Collaborates with other health care team members to develop health care plans that promote continuity for clients as they receive conventional, social, complementary and alternative health care.
Physiotherapy Education Accreditation Canada (PEAC) is the organization responsible for accreditation of Rehabilitation Therapy programs in this country. In Essential Competency Profile for Physiotherapists in Canada, an essential Collaborator role is described as follows:
Physiotherapists work collaboratively and effectively to promote interprofessional practice and achieve optimal patient care.interprofessional practice and achieve optimal client care.
It seems then, that we all agree on the concept of Collaboration. But even more significant is the alignment about the “why bother” issue. It’s apparent from these statements that our mutual commitment is based on a shared acceptance of a fundamental truism – that collaboration provides for better patient care. Agreeing to Collaboration conceptually is not enough and, to borrow from Hamlet, “There’s the rub”. Those noble objectives ring hollow unless followed by deliberate action. That action should consist largely of what we have come to recognize as Interprofessional Education, or “IP”. IP is basically the walk that makes the talk. It actualizes our commitment to promote patient care through collaborative effort of all professionals whose training allows them to positively impact our mutual patients. It requires that we understand what others have to contribute, respect those contributions, and find ways to communicate and work together effectively.
We don’t commit to these efforts simply because they’re “the right thing to do” (although they are), or because fairness demands it (which it does), or because we wish to achieve accreditation standards (which we do). We commit to IP because, first and foremost, it’s in the interests of our patients to do so.
And that should be reason enough.
Recent lessons in the meaning of Community
What does it mean to be part of a community?
This past week, two widely reported events should cause us to consider the very nature and meaning of “community”.
The first such event, of course, is the crash of Ukraine International Airlines Flight 752 in which all 176 people on board perished, including a large number of Canadian citizens and others with close ties to Canada. Because many were involved in educational programs of various types, the Canadian university community was hard hit. The response was immediate, unified and sincere. Within my own community of undergraduate deans, there was a flurry of emails and texts expressing concern and offering support. Members of the medical student community came forward expressing concern for friends and colleagues across the country. Although some schools were more directly affected than others, all shared in the sense of loss.
Particularly revealing is that the concern and response to this disaster cut through any issues of cultural or religious background. The victims were remembered not as members of any particular group, but as people we came know as individuals, with personal traits and aspirations with which we could all identify. Obvious differences simply didn’t matter.
Later that same week, we learned of the death of Neil Peart, a member of the legendary Canadian rock band Rush and arguably one of the greatest drummers of all time. Although a member of my generation, Mr. Peart’s appeal was not confined to any age group. In fact, it was my children who drew my attention to his virtuosity and expansive lyrics. When news of his death was announced, tributes appeared on social media from diverse sources – everyone from lead singer and drummer of the Foo Fighters Dave Grohl to Prime Minister Justin Trudeau. Beyond his great talent, Peart was an iconoclast who always engaged life in his own way with an authenticity and integrity that inspired a community of admirers, young and old. From an interview with Rolling Stone in 2015, “It’s about being your own hero. I set out to never betray the values that a 16-year-old had, to never sell out, to never bow to the man. A compromise is what I can never accept.” This spirit was a rallying call that held an ageless appeal.
The very word “community” has meaning beyond its reference to a group of people living in the same location. A deeper meaning, the one that came so vividly to light in the events of this past week is “a feeling of fellowship with others, as a result of sharing common attitudes, interests, and goals.”
Tragic and sad events are an inevitable aspect of the human condition. Physicians and all health providers accept as a professional responsibility the support and assistance of individual patients and their families through such events. We are prepared and trained to do so. But when tragedy impacts the communities in which we live, we share in the loss and struggle together to find meaning.
These two recent events teach us that the concept of community transcends barriers of culture and age and helps us find some such meaning.
They remind us that community is about the forces that bind us in common interest and intent. Community provides unconditional support and strength.
Community occurs when we choose to focus on what we share rather than what separates us.
In the end, community is a choice.
I have my faculty evaluations, now what?
Did you teach last semester? If so, you likely have feedback from your faculty evaluation forms awaiting your attention. Parsing out feedback from evaluation questionnaires is an annual challenge for all university instructors. It was the topic of a Faculty Focus article by Isis Artze-Vega, associate director of the Center for the Advancement of Teaching at Florida International University. She offered solid advice for those of who feel angst over student evaluations
Dr. Artze-Vega suggests seven key approaches to responding to student evaluations.
- First, she advises faculty to analyze the data. The Education Team routinely does this for course evaluations for course directors and the Course and Faculty Review Committee, but not for individual faculty evaluations. Analyzing comments is a great starting point; otherwise, human nature often has people hyper-focusing on the wrong things. Are you reading an outlier opinion, or is there a theme in multiple students’ comments? “Identifying themes will help you determine whether they warrant a response,” Artze-Vega writes.
- Ask any actor or director and they’ll tell you: negative feedback is easy to remember. American film director Peter Farrelly has said: “With all of my films, if I get one bad review and a bunch of good reviews the bad one is the only one that will stay with me.” Artze-Vega cautions to resist the lure of the negative. Don’t automatically dismiss a negative comment, but “consider: Am I focusing on this because it’s ‘louder,’ or because it’s a legitimate concern?”
- Considering feedback this way flows into Artze-Vega’s third key: Let your critics be your gurus. Citing a New York Times article, she points out that, “we often brood over negative comments because we suspect they may contain an element of truth.”
- A fourth approach is to find counter-evidence to negative comments. You can look for or remember comments that contradict the negative one. (If your faculty evaluation report is anything like some course evaluation reports, sometimes, you’ll find these comments in the same evaluation report from other students).
- Artze-Vega stresses that “we should devote at least as much time to students’ positive comments as their negative ones,” so her fifth key is dwell on the positive ones. If you hyper-focus on negative feedback, you can lose sight of the many things you are likely doing well – and that students appreciate.
- To aid in this, she further advises to read them with a friend. “A more objective party can help you make sense of or notice the absurdity of the comments because they’re not as personally invested in them.”
- Finally, Artze-Vega advises to be proactive. “If you don’t conduct this analysis yourself, you’ll be at the mercy of whomever is charged with your evaluation—and they probably won’t be as thorough,” she points out. “Also, take the time to provide explanations about any off-the-wall student complaints, so that your reviewers don’t draw their own conclusions.”
To all of this, I’d add: having read through your feedback, what’s your plan? What will you keep doing? What will you change? How will you do that? If you teach in the Queen’s UGME program and would like some assistance in using student feedback to improve your teaching practice, I’m available to assist you with this. Drop me an email. Reach me at firstname.lastname@example.org
Because good advice is worth repeating, this is based on a post from January 12, 2015
Christmas wishes for our Medical Students – by the year.
Through late November and December, as darkness consumes more and more of our days, the School of Medicine Building seems to get brighter. From the outside, it seems lit for the season. Inside, the rooms and study spaces are fully occupied. It’s that time of year, of course, when first and second years are preparing for examinations. There’s also a sense of anticipation. Anticipation for the end of exams, to be sure, but also for what’s to come.
Indeed, all the world seems in anticipation as we approach the winter solstice, that moment in time when the combination of orbit and axis of the earth take us farthest from the sun and we receive the least daylight. But after December 22, the light starts to slowly return.
In the Christian tradition, this is the season of Advent, a time of expectant waiting and preparation. In the Jewish culture, Hanukkah is celebrated, known as the “Festival of Lights”, commemorating the rededication of the Second Temple. Many cultures mark the time of year in various ways, both religious and secular. For all, it’s a time that we instinctively wish to return to the familiar and comforting warmth of home. It’s a time to retreat, refresh, renew.
In the spirit of the season, I offer Christmas wishes for our students:
For first years, increasing comfort with their transition to the profession, with learning for the sake of learning, and for future patients.
For second years, deepening fascination with clinical medicine and comfort with multiple career options.
For third years, increasing confidence in the clinical environment and a growing sense of their own, individual roles within it.
For our fourth years, first choice discipline, first choice program, first time.
For all, a restful, restorative and safe break, and best wishes for the new year all it will bring.
Pivotal Court Battle Raging in British Columbia: Should preferential health care be available to those who can afford it?
A rather fierce and highly significant battle is raging in the courts of British Columbia. At stake is the future of private payer medical care in Canada. Many feel that what’s really at stake is the future of universal health care in Canada. Pragmatically, the issue boils down to whether decisions about when and how patients get care should be determined solely by need, or whether those with resources should be able to access alternative routes, and whether physicians should be allowed to provide those alternatives.
At the centre of all this is Dr. Brian Day, an orthopedic surgeon and former president of the Canadian Medical Association, who is the Medical Director and Chief Executive Officer of the Cambie Surgery Centre in Vancouver, which opened in 1996 and has been offering and providing services to insured and privately paying patients. It has been doing so despite (in the case of the privately paying patients) being in violation of the B.C. Medicare Protection Act, which prohibits physicians from working in public and private systems at the same time or, more precisely, from charging patients for publicly covered services. It also prohibits the sale of private insurance for medically necessary hospital and physician care (insurance is permitted for care not covered by the public system). It seems that for the past 20+ years the government has either made only half-hearted attempts to enforce the law, or simply “looked the other way”.
It appears that current governments are much more committed to enforce the letter of the law, and Dr. Day has mounted a challenge based on the Charter of Rights and Freedoms. He and his lawyers argue that the Charter-provided right to pursue life, liberty and personal security extends to the right to pay for care when someone feels the public system doesn’t provide it to their satisfaction. They make it clear that they are not opposed to medicare or interested in dismantling it. They point to effective blended public/private provision in many countries, claim no evidence of harm and opine that it may actually benefit the public system by “off-loading” some patients. In their closing arguments (as reported in the Globe and Mail November 13, 2019) his lawyers claim:
“Allowing British Columbians to obtain private medically necessary services would not result in any harm to either the accessibility or viability of the public health-care system, as demonstrated by the experience over the past 20 years in British Columbia, when the prohibitions on access to diagnostic and surgical services were not enforced.”
“Further, the government cannot justify imposing severe mental and physician harm on some residents on the basis of an ideological commitment to perfect equality in access to treatment, which is neither created by the legislation in question nor obtained in practice.”
There is, as one might imagine, considerable opinion to the contrary. It comes from groups such as the BC Health Coalition, Canadian Doctors for Medicare, and many individual physicians and patients who have put forward rather strongly worded counter-arguments. They feel the presence of condoned private care in BC will set precedents for the rest of Canada and undermine the principle of universal care by siphoning physicians, nurses, therapists and technicians to potentially more lucrative opportunities in the private sector. In the case of physicians, they feel this is a betrayal of the publicly financed education they’ve been provided.
The case, which has been ongoing for several months, is now in the hands of BC Supreme Court Justice John Steeves who must decide whether the BC Medicare Protection Act indeed violates Canada’s Charter of Rights and Freedom.
This impending decision, indeed this very issue, is highly significant not only for those in the medical community, but for every Canadian. Medicare has taken on a special place in Canadian cultural identity. It has become a defining element of the national character, and a source of pride of all citizens. If there are any “sacred cows” in Canadian politics, Medicare would certainly be one. But its introduction and maintenance have been far from easy.
Chief among the challenges has been the division of federal and provincial responsibility and, therefore, funding. The British North America Act of 1867 establishes among the exclusive powers of provincial legislatures,
“the Establishment, Maintenance, and Management of Hospitals, Asylums, Charities and Eleemosynary Institutions in and for the Province, other than Marine Hospitals.”
The provision of so-called comprehensive Medicare began in a piecemeal fashion in the 1940s, but gained momentum in the 1960s, largely through the efforts of the then premier of Saskatchewan, Tommy Douglas. A key step along the way was the passage in Saskatchewan in 1961 of the Saskatchewan Medical Care Insurance Act which basically guaranteed health coverage to all citizens. That included physician fees, and so Section 18 of the act includes the following:
“No physician or other person who provides an insured service to a beneficiary shall demand or accept payment for that service.”
Thus, direct physician billing to patients was essentially outlawed. Mr. Douglas turned his attention to the federal scene as he became leader of the New Democratic Party and his efforts were instrumental in the passage of the Medical Care Act of 1966, which obligated the federal government to provide half the provincial and territorial costs for medical services provided for a doctor outside hospitals. By 1972, all the provinces and territories had some form of plan to reimburse for physician services. The Canada Health Act of 1984 states in its preamble the primary objective:
“to protect, promote and restore the physical and mental well-being of residents of Canada and to facilitate reasonable access to health services without financial or other barriers.”
Like British Columbia, the provinces have developed legislation designed to ensure universal and funded provision of care. In Ontario the Health Care Accessibility Act of 1986 essentially outlawed billing of patients outside the provincial insurance plan, and has been subsequently reinforced by versions of the Commitment to Future of Medicare Act.
And so, what are the considerations that are likely going through Justice Steeves mind as he ponders this momentous decision?It seems obvious that government-supported medicare has the considerable advantage of ensuring a standard level of care to all patients regardless of their economic means, and of ensuring physicians are compensated.
- It seems obvious that government-supported medicare has considerable advantage of ensuring a standard level of care to all patients regardless of their economic means, and of ensuring physicians are compensated for their services.
- There seems little doubt that a decision in favour of privately funded clinics will give rise to many similar operations throughout the country, particularly in large urban centres.
- The risk of an exodus of talent from the public to private system seems real.
- There are, indeed, many examples from other countries supporting the concept that the two systems can co-exist. However, it would seem that’s only true if there is some provision for mandatory participation of physicians in the public system.
- It’s becoming apparent that the ability to fully fund “universal” care solely through the public coffer is not sustainable. We’re seeing examples of this almost daily. Hospitals, despite best efforts, are going beyond budgets to provide care, and there are clearly insufficient options for the care of needy outpatients. Not only is the population getting larger and older, but highly effective (and very costly) therapies have emerged and are continuing to emerge for the treatment of conditions that previously had no options other than palliation. Wait times are certainly lengthening, and “hallway medicine” becoming the norm.
- There’s no question that for many procedures with very long wait times, such as hip and knee surgeries, the critical bottleneck is not the availability of qualified physicians, but rather access to hospitals and operating rooms which could, theoretically, be at least partially addressed by providing privately funded facilities.
- What effect a private system would have on public system wait times is, we must honestly admit, unknown and can’t be reliably projected. It will depend, to a large extent how many private facilities emerge, what services are provided, and what constraints are put on the providers.
A critical and rather sobering consideration in all this is that the success or failure of any blended private/public model may hinge on the willingness of physicians to continue to provide care to patients regardless of ability to pay. It will test and expose their motivations and priorities. It will test their allegiance to the principles the profession has always espoused, expressed in the words of the World Health Association Oath, and taken in by most medical students, including those at Queen’s:
“I will not permit considerations of religion, nationality, race, gender, politics, socioeconomic standing, or sexual orientation to intervene between my duty and my patient”
Those who so vehemently oppose privately funded care apparently believe physicians will abandon these principles in favour of personal income. I believe, and hope, that they’re wrong. Whatever the outcome of this court case, I choose to believe that physicians will continue to use their training and skills as they were intended, for the benefit of all.
The issue of whether well-resourced citizens have a charter-assured right to more expeditious health care, and whether that privilege impinges on the rights of the less-well-resourced, seems beyond objective analysis and, in my view, is best left in the hands of a fair- minded and impartial judiciary. In the end, our system for deciding such dilemmas has been well thought out, and is worthy of our trust.
Godspeed, Justice Steeves.
Our Aesculapian Society – Contributing to a Long Tradition of Collaboration and Service
The medical student society at Queen’s dates back to 1872 and is named in honor of Aesculepius, the mythological Greek figure considered the god of medicine. In fact, Aesculepius had five daughters each of whom represented some aspect of medicine considered essential to health. Hygieia was the goddess of cleanliness, Iaso the goddess of recuperation from illness, Aceso the goddess of the healing process, Aegle the goddess of good health and Panacea the goddess of remedies. The Greeks, it seems, knew something about social determinants of health and the value of personal wellness.
I’m very pleased to see that our current students are keeping the long tradition alive and contributing to the health of their fellow students and the learning community. The article that follows from our current and immediate past Aesculapian Society presidents (Danny Jomaa and Rae Woodhouse) describes their recent successful efforts to establish a fitness facility within the hospital. In doing do, they got great support from Mr. Chris Gillies and Mr. Adam Bondy of KGH.
Congratulations to Danny, Rae and all their AS colleagues. Aesculepius would be proud. I know we are.
Undergraduate Medical Education
The Aesculapian Society is thrilled to announce the opening of a dedicated gym for medical students and residents in Kingston General Hospital (KGH). This project has been a year in the making and has been a collaborative effort between the Aesculapian Society, the Professional Association of Residents of Ontario (PARO), and the KGH administration. In early 2018, the Aesculapian Society set out to utilize a pool of funding to benefit current and future medical students. From student consultation, two projects were selected to be pursued further. The first was a revitalization of the kitchenette in the School of Medicine Building and the second was the creation of a gym in KGH. The latter was selected due to its focus on student wellbeing – a widely recognized priority at the School of Medicine. This idea stemmed from an Aesculapian Society Initiatives Grant proposal that was originally submitted in 2017 by Dr. Matthew McIntosh (MEDS 2018). The first step was finding a suitable space for the creation of this gym. In collaboration with Chris Gilles (KGH Director of Medical Affairs) and the Queen’s PARO Executive team, an under-utilized lounge in KGH was selected to be the new space for the medical student and resident gym. The timing could not be more serendipitous; the hospital’s insurance policy had recently approved the creation of a gym, which had been a long-time priority for physicians and residents alike. The newly completed gym, located on Connell 6, includes a range of cardio equipment, strength equipment, and fitness accessories.
The success of this project was possible because of the many individuals that contributed to each step of the gym’s creation. We would like to especially thank Chris Gillies and Adam Bondy (Project Coordinator) from KGH for championing the implementation and set-up of this project. We would also like to thank PARO for their generous provision of space and collaboration. Finally, this project would not have been realized without the dedication and enthusiasm of the Aesculapian Society Councils of 2018-2019 and 2019-2020. We would like to extend our gratitude to the students that supported this initiative by providing their input, ideas, and encouragement.
The Aesculapian Society recognizes that students have a variety of wellness needs and this gym primarily supports students’ physical wellness. We look forward to collaborating with student body and the UGME to expand upon, and create initiatives that support other aspects of student wellbeing. We look forward to seeing the lasting impact that this project will have on Queen’s medical students and residents for years to come. The Aesculapian Society encourages students and residents to provide feedback on how the gym can be improved to better serve our community’s needs.
Danny Jomaa, President
Rae Woodhouse, Past-President
Aesculapian Society 2019-2020
An election no one won. Is it finally time for electoral reform?
We’ve recently come through a federal election where there appear to have been very few winners.
Certainly not the Liberal party, who saw their seats in the House reduced and must now attempt to govern with no majority and little support from the three prairie provinces.
Certainly not the Conservatives who failed to capitalize on what many saw as a golden opportunity to unseat the incumbent government.
Certainly not the NDP who saw their number of seats reduced drastically despite having a charismatic and articulate leader.
Certainly not the fledgling People’s Party of Canada, who won no seats, not even the one contested by their leader.
Probably not the Green party, although they did gain a seat outside British Columbia.
In fact, the only party that could be assessed as having emerged with a positive result is the Bloc Quebecois, whose main goal is to protect the interests of a single cultural group within a single province, even if it means breaking up the country.
Perhaps the most disappointing aspect of this election is the voter turnout or, perhaps more accurately stated, non-turnout. Fully 34% (that’s one in three!) of eligible Canadian voters decided to take a pass on this election. This is not exactly new. Voter turnout in the 43 Canadian federal elections that have been held since confederation has averaged 70.3%, ranging from highs of 79% in the early 1960s to a low of 58.8% in 2008. In that light, our current results might not seem too disappointing, if not that they appear to be part of a concerning downward trend which seemed to begin in the late 1980s.
And so, we must ask, what is it that keeps folks from exercising their right to influence our country’s government in the only way that will be available to most of them? It’s certainly not any lack of significant contemporary issues or a sense of satisfaction with the conduct of our current government. It’s certainly not that voting isn’t as easy as possible, including widespread availability of advanced polls. So what is it?
That very question was the subject of a 1989 Royal Commission on Electoral Reform. The authors identified a number of factors that prevent people from voting. Many are very practical, logistic issues such as illness, being away from home at the time, or just being too busy. However, a leading cause that emerged was simply labeled simply as “wasn’t interested”. A leading author of the document, Jon H. Pammett, described what he termed “administrative disenfranchisement”, meaning that the procedures involved in the voting process inhibit participation.
The results of the recent election highlight another cause of voter discontent that has been the focus of increasing attention and political lobbying over the past few years. Our parliamentary, party-based system combined with the marked variations in population density that exist in our country gives rise to a disturbing disconnect between the popular vote and final outcome.
For example, the Liberal party’s 33.1% of the popular vote translated into 46.4% (157) of the seats in the House of Commons. The Conservative party, which actually received a higher percentage of the popular vote (34.4%), won 26 fewer seats (121 or 35.8% of the available seats). The NDP’s 15.9% of the vote, in a proportional sense, should have earned them 54 seats, but they’ll go into the next parliament with only 24 seats, whereas the Bloc Quebecois’ 7.7% of the vote yielded 32 seats in voter rich Quebec. Perhaps the most egregious injustice relates to the Green Party. In an evenly distributed system their 6.5% share would translate into 22 seats, rather than the 3 seats they won. Even the fledgling People’s Party, which won no seats at all, can cry foul given that their 1.6% of the voting share would proportionately correspond to 5 seats.
Regardless of your political affiliation or preferences, it’s easy to understand why so many people are finding this disturbing, and why voters, particularly those is less populated parts of the country, are left feeling frustrated, discouraged and the sense that their individual votes are devalued or even meaningless. Adding to all this electoral confusion is the persisting problem that, in a parliamentary system, the voters don’t directly elect the highest political office in the country. This brings, with every election, the perennial and vexing conundrum of whether to vote for the local candidate on the basis of their personal capabilities, or the party they represent. In a democratic society, should voters be forced to make that choice? Might that be contributing to their frustration and apathy?
Changing such a deeply established process will, of course, not be easy. It would require determined action from the very politicians who have benefited from the status quo. Nonetheless, it seems that the time has come for at least an open debate on the issue. Those with the courage to take this on might be worth voting for!
Plastic Snow? It’s official…we’ve gone too far. It’s time to act.
Meet my grand-nephew, Tristan. He’s been visiting from Nova Scotia with his parents. He’s 7 months old and, this past week, is starting to crawl and had his first haircut. He’s also the inspiration for this week’s blog. But more about him later…
We’ve grown accustomed to reading reports of grave environmental threats. For most of us, there is as yet little direct impact and we’re able to regard these concerns in the abstract. With time and repetition, we develop something akin to resigned indifference, participating in recycling efforts with reluctant acquiesce.
I’ve recently come across some information that should cause us all to pause, consider what’s happening to our environment and our own, personal culpability.
In a 2017 article appearing in Science Advances (Geyer, Jambeck, Law, Sci. Adv. 2017; 3: e1700782), researchers from three American universities and institutions with expertise in environmental issues reported on the “Production, use and fate of all plastics ever made.” Their conclusions are, to say the least, rather sobering. To summarize:
- 8.3 billion metric tons of plastics have been manufactured to date
- Of that, 6.3 billion metric tons remain as plastic waste accumulated in landfills.
- Only 9% has been recycled, 12% incinerated
- If current trends continue, it’s projected that 12 billion metric tons of plastic waste will find its way either into landfills or the natural environment by 2050.
The projections they have developed are rather frightening as portrayed in this graph from their paper:
Plastic products are, of course, designed to be durable. Basically, they don’t go away, and this article makes it clear that our current recycling efforts aren’t nearly adequate.
To put this into more comprehensible terms, researchers at the Rochester Institute of Technology have recently estimated that 22 million pounds of plastic debris enter the Great Lakes every year. Our own Lake Ontario, which we Kingstonians walk or drive by every day, receives the equivalent of 28 Olympic size swimming pools of plastic bottles each year, and they don’t go away.
If that’s not enough to get our attention, consider work recently published by Dr. Melanie Bergmann and her colleagues at the Alfred Wegener Institute in Germany, also in Science Advances (Bergmann et al, Sci. Adv. 2019; 5: eaax1157).
They point out that plastics don’t dissolve harmlessly into the environment, but under a number of physical stresses (mechanical abrasion provided by waves, for example, or temperature fluctuations) they can be broken into much smaller particles, termed microplastic, measuring less than 5mm. It’s already been well established that these can be found not only near large urban centres, but also in northerly ocean seabeds and coastal sediment. What hasn’t been clear is how they get there. It’s been postulated that microplastics have the capacity to be carried into the atmosphere and find their way to points very remote from their original dumping grounds. The capacity to become airborne not only explains this wide distribution, but potentially threatens human and animal exposure through inhalation.
To test this possibility, they set out to look for microplastics associated with snow because, in the words of the authors “snow is a scavenger for diverse impurities, and acts as a filter on the ground by dry deposition”. Using techniques far beyond my understanding, they measured levels of various microplastics in snow samples gathered from ice floes and islands in the Arctic, and compared with samples from urban centres in northern Europe and from the Alps.
They found plastic microparticles in snow gathered from all sites. Although there was much more from the cities, there were detectable levels in the snow scooped up from ice floes drifting in the Fram Strait and on Svalbard Island in the far north, far from any population centre, in quantities they described as “substantial for a secluded location”.
They conclude that snow has the ability to bind these airborne particles and carry them back to earth, a process they term “scavenging”. They conjecture that this process can allow for microparticles to find their way into water supplies and food chains. They even recommend that large northern cities give thought to where they deposit collected snow in the winter, to avoid contamination of water sources.
If we needed any further convincing about the need to curb use of plastics, I think it’s now available. Particles from the bottles or straws that we use to conveniently transport beverages to quench our thirst are finding their ways to the most remote, unpopulated regions of our planet, previously considered pristine. The ice and snow, always symbols of purity, are now tainted. Children who will soon be running outdoors to frolic in the first winter snowfall may be putting themselves at risk.
Getting back to young Tristan, what sort of world are we shaping for he and his peers? What can we do, given the virtually ubiquitous presence of plastics in our society? Personal action, to be sure. We should make all efforts to minimize our own usage and maximize recycling efforts. But also political awareness, particularly in this election year. No political leader or party that fails to understand the true impact of environmental contamination is worthy of our support. We should expect well-articulated platforms that address both local and international approaches. We have a responsibility to be vigilant, not only for ourselves, but also for those not yet able to speak for themselves but have so much at stake.