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
From Bookends to Bookcases: On Finding Some Great Summer Reading
Oh hello! Still in that hammock from our last blog?
Well don’t worry—this time I’m not here to get you up to plan next year’s courses. 🙂 I do have more to say about bookends, but that can wait until closer to September, when you start planning your classes.
For now, I’m here to help with your summer reading list to fill up your bookcase. I’ve asked a few colleagues for ideas, and (as always) I have some ideas of my own.
Dr. Lindsay Davidson contributed: Getting started with TBL by Jim Sibley http://learntbl.ca/book/ as an excellent way to introduce yourself to teaching with small groups as we do in Queen’s UGME.
Dr. Sue Fostaty-Young contributed one of her go-to books on teaching: Therese Huston’s Teaching What You Don’t Know. Sue says, Intended as a book for new and junior faculty members who frequently have to teach large service classes that may be far removed from their areas of interest or expertise, the book is simply one of the best all round books on teaching that I’ve come across.
Paola Durando, librarian at Bracken suggests: How to Teach: A Handbook for Clinicians (Success in Medicine) 1st Edition by Shirley Dobson, Michael Dobson, and Lesley Bromley. (Now in Bracken Library!)
Sandra Halliday, and Suzanne Maranda, also librarians at Bracken, remind us about the reading guides for medical education: http://guides.library.queensu.ca/healthed A quick skim of this really great resource turns up some intriguing titles: Medical education : a dictionary of quotations by Kieran Walsh, Medical Education: theory and practice with Tim Dornan, Karen V. Mann, Albert Scherpbier and John A. Spencer (Editors) (I think I’ve mentioned this one before—it’s another what I call a great “Dipping” book and anything by Karen Mann has my vote),
Dr. Richard Van Wylick contributes these 4 books. He says,
- This one got me off to a good start: Guidebook for Clerkship Directors:
- I have not read it yet, but was recommended and I certainly need help personally with this these days!: Make it Stick by Peter Brown: (Sheila’s note: I’ve read this and it’s really helpful, practical and interesting for teachers as well as learners—turns traditional teaching “beliefs” on their head. Here’s what Amazon says, Many common study habits and practice routines turn out to be counterproductive. Underlining and highlighting, rereading, cramming, and single-minded repetition of new skills create the illusion of mastery, but gains fade quickly. More complex and durable learning come from…
And now you’ll have to read it! SP)
- This is a light read,with funny short anecdotes and stories: The Surprising Lives of Small Town Doctors:
- And well, because I have two of them: The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults by Frances Jensen with Amy Ellis Nutt: https://www.amazon.com/Teenage-Brain-Neuroscientists-Survival-Adolescents/dp/0062067842
Sheila’s completely idiosyncratic picks:
- As for me, I’ve finished dipping into The Question of Competence: Reconsidering Medical Education in the Twenty-First Century, with Brian Hodges as editor. With Competency-Based Education so critical, it’s a great book to get at some of the implications of CBE and it truly is dippable—you don’t need to read it cover to cover in one setting, but can dip into chapters as interest guides you. I call these my “Dipping” books.
2. Someone recently gave me Gratitude by Oliver Sacks (Thanks SM!) which has motivated me to pick up his Musicophilia: Tales of Music and the Brain. I find him an inspiring writer so I’m looking forward to reading this. And Gratitude is certainly worth picking up for its three lovely reflections.
3. Recently, one of our faculty heard that it wasn’t her job to comment on students’ spelling, grammar and syntax as a medical educator. That’s actually not correct (it’s in our Red Book objectives) but to bolster the case, I found this book by Clive E. Handler that looks interesting: English and Reflective Writing Skills in Medicine: A Guide for Medical Students and Doctors. I’m ordering it to read over the summer so I can let you know. But anything that has writing skills and reflection in the same title is a hook for me!
4. Because I’m fascinated by the odd reputation that reflection has in medical education, (I’ve seen medical students blanch and strong doctors flinch at the term :), I’ve been dipping into A Teacher’s Reflection Book, Exercise, Stories, Invitations by Jean Koh Peters, and Queen’s own Mark Weisberg. I’ve just finished Chapter 5, The Teacher and Vocation (I have a bad habit of reading chapters out of sync—I read Margaret Atwood’s Alias Grace, from the end backward—turned out to be a great book!). While the word vocation might make some shy nervously, I’m really liking the exercises. It starts off by asking “What if you had nothing to prove?” What a great question!
Since I’m reflecting on writing about reflecting for a later blog, I’ll save the full review for later, but try this one exercise: Write your personal mission statement or your “call” as a bumper sticker. And here’s a teaser. There is a paradigm shift in viewing your teaching as a vocation rather than a career. Here’s one example: Career = Who am I? What’s in it for me? Vocation = Whose am I? Who am I in teaching for? (James Fowler).
I’ve just started reading When Breath Becomes Air by Paul Kalanithi. Isn’t it a wonderful book? I also have a bad habit of reading 3 books at the same time, but this one is maintaining first place in my reading triad easily! When Breath Becomes Air is a memoir chronicling Paul Kalanithi’s life as he studies at Stanford University, and then at Yale University’s medical school. Kalanithi is close to finishing his training as a neurosurgeon when he is diagnosed with stage IV lung cancer. This is a haunting book for me and one that is inspiring me as well.
And last but not least, because summer and especially vacations are a great time to exercise your right brain, and because she’s a favourite author of mine, may I recommend: The Virginia Woolf Writers’ Workshop: Seven Lessons to Inspire Great Writing by Danell Jones? This is another great dipping book, and I’ve tried each of the exercises—so much fun!
What about you? What great books are you heading for this summer? Feel free to write in with your suggestions! And thanks to my colleagues for their suggestions!
Hope these give you some ideas so you can climb back into that hammock and bury yourself in many good books this summer! Have a peaceful, restful, reading-ful summer and I look forward to seeing you come the fall.
End of Classes and Bookends
Whew! Classes are over, summer is beginning, the students are off on a well-deserved vacation, and so are you!
It’s time to relax, kick back,have an umbrella drink, perhaps mow the lawn occasionally, right?
What I’d like to suggest that now is the time to plan your next course.That’s right—while the course is fresh in your mind, and the foibles, and successes are shining bright, it’s time to plan.
And I have an idea about your planning. It comes from Dr. Maryellen Weimer in her blog Faculty Focus.
Let’s use Bookends.
Book-ending as a pedagogical and course design strategy is relatively simple. Add structure and “tie things together” to your course by building a thread throughout. You introduce the thread in the first class, continue it as much (or as little) in your course as you like, and then bring it to closure with an activity similar to the first class, at the end of the course in the last class.
Bookends are a common technique in writing professions, such as screenwriting, storytelling, and even essay writing and I think it has particular relevance for us in health sciences education. Think of the cases we use, especially in medical education, to ask students to apply their foundational knowledge to the “stories” of patients. Those cases have a thread, and are bookended, aren’t they?
Let’s see how it could work in your course…
Activity 1: First and Last Day Worksheet:
From MaryEllen Weimer: On the first day of class, give students a worksheet that they fill out (either in class or online). In MEdTech, you could use an online quiz to do this. Use prompts like these: “What do you know about INSERT YOUR COURSE TITLE? Or “What do you know about…INSERT KEY CONCEPT? What reasons justify making this a required class? Are there skills that will you be needing as a professional that you hope to develop in this course?”
Pass out the same sheet on the last day, give students time to complete it, and then return the one they filled out the first day. Have a brief discussion about the differences and similarities of the two sheets. We did something similar in the former Professional Foundations Course at Queen’s where Dr. Ruth Wilson introduced students to the Intrinsic Roles of a physician, and then asked them to look back a year later to see what they’d learned, as part of their Portfolio assignment on what they’d learned about the intrinsic roles.
Activity 2: First and Last Day Problem:
Also from Dr. Weimer: Pass out a problem set on the first day. Give bonus points for answers and for work that shows the student spent some time searching for the solution. Calm students’ fears by indicating that they’ll see these problems throughout the course. Pass out the same problem set on the last day and watch for smiles.
Activity 3: Meet Mr. Ms. Lavigne…
…or Mr. Gonzales or…. whoever you’d like to “star in your bookend case. Ms. Lavigne is a patient whose case is introduced in the first class. Checking in with Ms. Lavigne happens throughout the course. It could be that, after a lecture on infection or infection control, or hospital acquired infections, Ms. Lavigne has had this complication in her case. Or after a learning event about safe opioid prescription, and opioid addiction, Ms. Lavigne has to be treated. We don’t want to overload Ms. Lavigne G with every condition in the book—it becomes a bit of a joke, if she’s not treated with respect, relevance and as someone encountering real-life issues. But Ms. Lavigne’s case can also be the wrap up of the course in order to ask the students, “What have you learned?”. You can follow Dr. Sue Moffatt’s example at Queen’s with the case of Mr. McCade, and have an integrated case that bookends three different body systems such as Cardiovascular, Respiratory and Renal across a whole term.
Activity 5: Graphic Representations:
Create an algorithm or some other graphic representation of your course. Fill in the first few blanks. Leave the others blank and ask students to track their learning by filling it in through your the course. Reviewing these in small groups makes for interesting learning in itself, especially when compared to your own vision of the course. Or you can ask students to create a “concept map” of what they learned, based on the outline you provided on the first day.
Activity 6: What is working? What is not?
Introduce your students to informal evaluation of the course on the first day. Ask them to record (on an electronic survey, on a recipe card, or giving feedback to a class representative) what they have learned this week, what is confusing them (muddiest point), whatever questions you have for them. Start this early, and do it periodically as check-in’s throughout the course, and wrap up with final evaluations. In between, show students how you are responding to their concerns, especially muddiest points. (In our school, where faculty don’t always have a chance to come back to the class, they can email, or use our MEdTech Discussion Board).
So, what do you think of bookends?
Can you make them work for your course? You can always check in with our Educational Development Team to run ideas by us.
And of course, you can now get back to that well-deserved break!
Have a wonderful summer, and many thanks to all the wonderful teachers and students who made the academic year of 2015/16 at Queen’s UGME such a success!
Resources: Two of the ideas are from Dr. Maryellen Weimer’s blog article, The last class session: How to make it count, April 13, 2016. http://www.facultyfocus.com/articles/teaching-professor-blog/the-last-class-session-how-to-make-it-count/
Canada’s Medical Schools collaboratively engaging the issue of Student Wellness.
For this week’s article, I’ve asked Renee Fitzpatrick, Director of Student Affairs, to write to us about a topic of critical importance. Indeed, the issue of student wellness and risk should be a major concern of both individuals and institutions engage in the education and development of young people. As she points out, our efforts in this regard need to be ongoing, and she introduces a recent initiative taken up jointly by the Canadian Undergraduate Deans and Student Affairs leaders to consolidate and strengthen our approach to this problem.
In April 2016, Laura Taylor, a third year medical student at UBC, died just days before her 34th birthday. Her parents, devastated by the loss of their kind, loving, brilliant, athletic daughter shared that the bipolar disorder that she had struggled with for more than half of her life, became too much. She had worked tirelessly to reduce the stigma of mental illness.
Her photograph shows a girl with a full smile, the kind that would inspire confidence in any patient, a smile that is referred to repeatedly in her book of condolence, a hockey helmet, reflecting her passion for hockey and a stethoscope, the signature of the medical profession.
The tributes speak to her energy, her athletic ability, her generosity in volunteering, her openness about her mental illness, her academic brilliance, her wit, her courage and her humility.
Any medical school in the country would have been proud to have Laura as a student, and UBC was particularly proud of her. She had all the attributes that we have identified as important to sustain a career in medicine. She also had a serious mental illness, one that she had prior to medical school, which she actively tried to manage.
Just days before Laura’s death, at this year’s CCME, the Canadian Federation of Medical Students, presented results of a mental health survey of medical students across Canada, results that challenged us to take action. The report described increased rates of anxiety, depression, suicidal ideation and burnout, compared to the general population, replicating results from other countries. The Undergraduate Deans committed to a review of suicide risk factors in medical students in an attempt to understand what factors are associated with the conversion of suicidal ideation, a sign of distress to suicide.
Over the last few decades there has been increasing emphasis on the need to identify and treat mental illness in medical students, residents and physicians. Accreditation requirements include a need to demonstrate that there is access to help for mental health issues. However, there is still stigma about seeking help, with concerns ranging from impact on license to fear of judgment. The ACGME Council of Review Committee Residents made suggestions to identify ways to improve resident wellness and resiliency following the death by suicide of 2 resident physicians in New York in August 2014. These were. (1) increasing awareness of the risk of depression during training and destigmatizing it; (2) building systems to confidentially identify and treat depression in trainees; (3) establishing a more formal system of peer and faculty mentoring; (4) promoting a supportive culture during training; and (5) fostering efforts to learn more about resident wellness.
We had made some strides in the last few years to increase wellness initiatives, promote resilience and reduce burnout. The CFMS survey indicates that we have no reason to be complacent. It is crucial to identify the risk factors that convert ideation to suicide. We must reflect on the degree of perfectionism that we require to achieve one of the coveted spots in our medical schools. We must ask how students survive our scrutiny as we demand competent collaborators, communicators, managers, experts, leaders and advocates. Is the perfection that we demand reasonable? Is the environment conducive to negotiating the developmental tasks of early adulthood in addition to training as physicians?
I do not suggest for one moment that we reduce our standards or dilute the fact that medicine is demanding and that we need to be able to tolerate uncertainty, failures, distress and pain. I believe that this is achievable in an environment that promotes and facilitates the growth of healthy physicians. The leadership and support of the Undergraduate Deans is crucial in enhancing the health and resilience of the next generation of physicians, who have taken a courageous step in identifying the issues.
Our Undergraduate Deans have made a commitment that deserves all of our support and challenges us also to become healthy physicians.
Reducing the Burden of Concussions Through Education
By Chris Griffiths
The Concussion Education, Safety and Awareness Program (CESAP) seeks to reach a broad audience on the prevention, identification and management of concussion injuries. According to the Centre for Disease Control, 65% of all concussions occur in those aged 5-18, and concussions make up 13.2% of high school sports injuries (CDC, 2015). As high school populations are at increased risk of injury, it is important that they are properly educated on the risks they incur by participating in sport, and how to best minimize these dangers. However, a study in Florida examining high school football players, a sport at the highest risk of injury, found that only 1 in 4 received proper concussion education (Cournoyer & Tripp, 2014). As 20% of those injured eventually develop long-term sequelae of concussion, such as depression and anxiety disorders, it is important that schools develop supportive environments for those injured (Hudak et al., 2011). Increased awareness has been demonstrated to increase the likelihood students will adhere to management and prevention strategies, and increase the level of compassion received from their peers (Taylor & Sanner, 2016).
This past fall, a group of medical and graduate students teamed up to work on reducing the burden of concussion in our community. Two second year medical students, Logan Seaman and Chris Griffiths, began working with MSc Neurosciences candidate, Allen Champagne, to develop a free education program for high school students and athletes. With the advice of physicians at Queen’s University, namely Dr Mike O’Connor, Dr Fraser Saunders and Dr Andrea Winthrop, and endless support from the Centre of Neurosciences Studies, CESAP developed a classroom session focused on the biomechanics, symptoms, and management of concussions. With help from students at the School of Rehabilitation Therapy and their faculty, we have put emphasis on the many healthcare professionals who can help in injury rehabilitation around Kingston.
What we believe sets CESAP apart, however, is our behaviour modification and prevention arm. CESAP runs clinics for youth football teams with classroom sessions followed by on field drills led by Queen’s football players to teach proper tackling technique. The drills were developed based on research at the University of New Hampshire, showing that equipmentless drills that focus on fundamentals, or “heads up tackling”, reduced the number of head impacts by 4.4 per game in collegiate athletes (Swartz et al, 2016). CESAP has committed to expanding these principles to other sports, with drills developed for soccer and hockey.
CESAP’s classroom sessions are modified specially for each target audience. While some sections are shortened for particular groups, the structure of each talk is the same. We begin by introducing basic neuroanatomy, localizing different areas of the brain to their function. For senior high school classes, we go into greater depth into axonal structure, and show different imaging modalities such as MRI and Diffusion Tensor Imaging. Emphasizing that concussion is a functional injury, we explain how injury can occur and the symptoms that are caused. The goal is that students can identify unusual behaviour in themselves or their teammates, and encourage them to make a safe choice by removing themselves from play if necessary. We outline red flags or concerning symptomatic developments, and equip students with questions to ask their peers if they suspect injury.
Unfortunately, the reality is that injury does happen. With help from physicians, occupational therapists and physiotherapists in the field, we have compiled the best resources for management plans in concussion rehabilitation. Parents are provided with information on all of the health care professionals in the area who they can consult, and youth are educated on what to expect in their recovery. Perhaps the most powerful part of our program, however, are the testimonies offered by concussed athletes on our team, such as former Queen’s Football player Jesse Topley. The stories our athletes give make the effects of concussion a reality, as we hope to foster supportive environments around concussions in the community. By outlining the difficulties that follow injury, we hope that athletes understand they have the power to prevent severe sequelae by playing it safe in their recovery. We hope that athletes and youth are able to identify the injury in themselves and take it seriously, and reverse the “warrior culture” that exists in sports that encourages young athletes to play through any injury.
Since the middle of January at program launch, CESAP has presented to over 1,100 students, athletes, parents and coaches in Kingston, Sherbrooke, Quebec City, and across the GTA. Our program hopes to continue to expand into the Limestone District School Board, with regular classes in grade 9 PHE and senior biology classes. In athletics, we are advocating for more education of coaches, referees and trainers in leagues in the Kingston area.
With help from our colleagues at the Centre for Neurosciences, and in partnership with students in the School of Rehabilitation Therapy, we hope that CESAP can continue to grow across Canada. Our dream is to make CESAP, and programs like it, standard education for high school students and athletes. Through increased education, we believe that youth, parents and coaches can make safer decisions regarding head injury and reduce the burden of concussion and its chronic effects on society at large.
If you are interested in booking CESAP for an education session, please contact us at email@example.com. We will accept any audience and are happy to tailor a presentation to your needs! Please follow us on Twitter @cesap100 to learn more about our sessions and concussions in the news.
Centres for Disease Control and Prevention. “Online Concussion Training for Health Care Providers.” Centers for Disease Control and Prevention. N.p., 4 May 2015. Web. 31 Mar. 2016.
Cournoyer, Janie, and Brady L. Tripp. “Concussion knowledge in high school football players.”Journal of athletic training 5 (2014): 654-658
Hudak, A., Warner, M., Marquez de la Plata, C., Moore, C., Harper, C., & Diaz-Arrastia, R. Brain morphometry changes and depressive symptoms after traumatic brain injury. Psychiatry Research, 191(3), 160–165 (2011).
Swartz, E. E., Broglio, S. P., Cook, S. B., Cantu, R. C., Ferrara, M. S., Guskiewicz, K. M., & Myers, J. L. (2015). Early Results of a Helmetless-Tackling Intervention to Decrease Head Impacts in Football Players. Journal of Athletic Training, 50(12), 1219–1222. http://doi.org/10.4085/1062-6050-51.1.06
Taylor, M. E., & Sanner, J. E. (2015). “The Relationship Between Concussion Knowledge and the High School Athlete’s Intention to Report Traumatic Brain Injury Symptoms: A Systematic Review of the Literature.”The Journal of school nursing : the official publication of the National Association of School Nurses. PubMed. Web.