Accreditation Success Stories…and lessons going forward.

Medical school accreditation has been described, with some justification, as the colonoscopy of medical education. The parallels are rather striking:

  • Both require a long and distinctly uncomfortable period of preparation.
  • Both require a public exposure of personal features most would prefer to keep modestly hidden.
  • Both can get messy.
  • Both carry high potential for embarrassment.
  • In both cases, the procedure itself can be tortuous and painful.
  • And finally, for the asymptomatic and fundamentally healthy, their value is highly debatable.

Also like colonoscopy, one emerges from a successful examination with a sense of great relief. That relief, in part, is simply related to having completed the process. Doing so with a successful report of findings adds immeasurably to that sense of relief.

At Queen’s, we are fortunate to have recently emerged from our own collective internal examination with that great relief, having achieved a full eight year approval, with no further invasive procedures required until 2023.

Reflecting now on a process that really started after our last review in 2007, it’s possible (and probably healthy in a preventive sense) to set aside for a moment the struggles and various deficiencies that required attention, and focus rather on the positives that have emerged. A few come particularly to mind and merit attention because they bear important messages we should carry into the future.

Firstly, our success was based on our ability to mount a common effort. Without question, the very real threats to our school imposed by the 2007 review galvanized our efforts and collective will in a way that made possible the changes that we needed to make.

Our Deans (both Drs. Walker and Reznick), engaged accreditation efforts with resolve and unconditional support. Our university leadership (particularly Principal Woolf whose first duty in his new role was to publicly defend a medical school he had just inherited), have been staunch supporters of the accreditation effort. Our Department Heads, to a person, have been nothing but supportive of the school. Our curricular leadership, undergraduate office, medical education team, medical technology unit, hospital partners and, critically, our students, all came together to meet the various challenges, and did so with methodical efficiency, driven by a shared desire to support (dare I say, defend) our school. One sees such common, focused effort only rarely, and usually only when necessitated by great and imminent peril. It is nonetheless rather inspiring to consider what our common efforts achieved and speculate on what might be possible if we could continue to work collaboratively without the need for external motivation.

Secondly, one must acknowledge that many significant and enduring changes emerged from these efforts. A robust and effective new curriculum, effective assessment methodologies, creative and updated approaches to teaching, a revised and much more effective governance structure, a refurbished framework of policies and procedures, our highly impressive and sought after MedTech curricular management system, and even our new School of Medicine Building itself were all, at least in part, motivated or accelerated in their development by our accreditation efforts.

The process brought welcome attention to a number of areas of strength within our school, often overlooked as we focus attention on problem areas. Refreshingly, and unexpectedly, the recent report made reference to our teaching, which it identified as an area of strength. To quote from our report:

As reported by students in the ISA [Independent Student Analysis] and by the survey team, the program benefits from many capable and dedicated teachers. For example, in the MEDS 125 [Blood and Coagulation] course, with 99% of students commenting on the course, no negative comments were made within the 9 pages of comments, and the survey report suggests that the Course Director and the faculty involved in this course are to be congratulated…. Another course that received similar accolades was MEDS 127 [Musculoskeletal], where the team reported: “Dr. L Davidson who continually monitors and enhances the course. This is a “poster child course” and Dr. Davidson deserves significant recognition for the evolution of this highly innovative and interactive course.”

In fact, we are truly blessed with many dedicated and talented teachers, knowledgeable and committed faculty leaders in all key portfolios, committed and hard working undergraduate administrative and educational support teams, and a receptive and engaged student body.

In the final analysis, the most enduring lesson we should take away from our eight-year struggle with the accreditation process must be that we never again require a “crisis” to spur us to collective action in order to ensure we are providing the very best educational experience for our students. Complacency is poison. The continual, collective pursuit of quality improvement and courageous innovation must be our continuing goals. These are the lessons of the day.

 

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

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Medical Students Recognize Exemplary Teaching

Contributing Authors:

Laura Bosco, Class of 2017 Co-President

Michael Baxter, Class of 2017 Co-President

Jonathan Krett, Aesculapian Society President

The Aesculapian Society (AS), the medical student society at Queen’s, administers a number of awards throughout the course of an academic year. One of our most treasured awards is for some influential educators in our preclerkship

Latest Recipients: 2015 Term 4B and Term 2B Lectureship Award Recipients (from left to right): Drs. J. Gordon Boyd, Stuart Reid, Lindsay Davidson, and Bob Connelly
Latest Recipients: 2015 Term 4B and Term 2B Lectureship Award Recipients (from left to right): Drs. J. Gordon Boyd, Stuart Reid, Lindsay Davidson, and Bob Connelly

curriculum: the AS Lectureship Awards. Twelve of these awards are distributed each year, two during each semester from each preclerkship class. These are important for us to award because, as students, we are privileged to have many dedicated and passionate people involved in our education. To be able to formally recognize the educators that have a lasting impact on our classes – those that go above and beyond for our education, is very meaningful to all students.

Near the end of each term of medical school (3 in each of Year 1 and Year 2), an open call for nominations is sent out to the class. Nominations are received by the respective class president, who tallies the nominations and creates an online vote. All students in that class then get to vote for one or two professors who they feel are most deserving of the award.

Take a look at the following list of recipients from the past two years. While every instructor is different, there were several common threads that lead to students feeling like they went above and beyond. These teachers engaged students in classroom sessions using highly interactive small-group learning. They delivered didactic lectures with skill and with a digestible level of simplicity. At all times, these professors remained approachable and open to student questions. They were receptive to feedback and allowed course content to evolve to suit the unique group of students in the classroom.

We as students definitely sense when an instructor challenges us and brings us along as a junior colleague and not just as a passive observer. Students appreciate being active participants even early on in medical training, and all of these professors were skilled in encouraging us to do just that.

2013-2014 Academic Year Recipients

Term 1 Recipients (Class of 2017)

  • Dr. Michael Sylvester (Family Medicine)
  • Dr. Conrad Reifel (Anatomy)

Term 2A Recipients (Class of 2017)

  • Dr. David Lee (Blood & Coagulation)
  • Dr. John Matthews (Blood & Coagulation)

Term 2B Recipients (Class of 2017)

  • Dr. Bob Connelly (Pediatrics)
  • Dr. Kathleen Nolan (Pediatrics)

Term 3 Recipients (Class of 2016)

  • Dr. Robyn Houlden (Endocrine)
  • Dr. Paul Malik (Cardiology)

Term 4A Recipients (Class of 2016)

  • Dr. Alex Menard (Radiology)
  • Dr. Greg Davies (Genitourinary and Reproduction)

Term 4B Recipients (Class of 2016)

  • Dr. Sean Taylor (Neurology)
  • Dr. Stuart Reid (Neurology)

2014-2015 Academic Year Recipients

Term 1 Recipients (Class of 2018)

  • Dr. Michael Sylvester (Family Medicine)
  • Dr. Heather Murray (Critical Appraisal, Research, & Lifelong Learning [CARL])

Term 2A Recipients (Class of 2018)

  • Dr. David Lee (Blood & Coagulation)
  • Dr. Jacalyn Duffin (History of Medicine)

Term 2B Recipients (Class of 2018)

  • Dr. Bob Connelly (Pediatrics)
  • Dr. Lindsay Davidson (Musculoskeletal)

Term 3 Recipients (Class of 2017)

  • Dr. Robyn Houlden (Endocrine)
  • Dr. David Holland (Renal)

Term 4A Recipients (Class of 2017)

  • Dr. Romy Nitsch (Genitourinary and Reproduction)
  • Dr. Heather Murray (Critical Enquiry and Expanded CARL)

Term 4B Recipients (Class of 2017)

  • Dr. J. Gordon Boyd (Neurology)
  • Dr. Stuart Reid (Neurology)

 

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The Museum of Health Care: Documenting our Inspirational History

Inspiration is one of those things we all intuitively understand, but defies clear definition. The best I’ve come across is “stimulation or arousal of the mind to special or unusual activity or creativity”. Sounds a little too clinical. Perhaps better capturing the spirit of inspiration are a couple of quotes from fairly famous folks who have more than a passing familiarity with the topic:

“You never have to change anything you got up in the middle of the night to write.”

– Saul Bellow

“I never made one of my discoveries through the process of rational thinking”

– Albert Einstein

What seems clear is that Inspiration drives creative discovery and innovation in all fields of human endeavor, from the arts to fundamental science. It comes upon us unexpectedly, almost like a gift from above, but we need to be prepared to receive it, open to possibilities, open to novel ideas, willing to challenge convention.

I was “inspired” to consider “inspiration” recently when asked to provide some remarks at a showcase highlighting the role of the Museum of Health Care in our community.

MuseumAs one looks over the various displays and artifacts in its impressive collection, it’s easy to feel a little smug and even amused by the quaintness and crudeness of some of the devices and approaches that are no longer in use. In reality, each new retractor, forceps, sterilization technique or monitoring device represents an occurrence of inspiration and creative innovation. Behind each display lurks a physician or scientist who had an idea and, by virtue of their unique contribution, advanced the standard of care for the patients of their day. They also contributed to a line of continuing innovation that reaches us today. They remind us that we have no monopoly on creativity, industry, or dedication to the care of our patients. Certainly no monopoly on inspiration.

inspiration2The showcase provided an opportunity for our students and faculty to not only view and experience the richness of our heritage but also reflect on our place in it. Dr. Susan Lamb, our interim Hannah Chair in History of Medicine provided a fascinating perspective on the impact of Laennec and his contribution to the development of the stethoscope.

It’s particularly reassuring that the inspiration for this showcase came from one of the youngest among us. Chantalle Valliquette, one of our QuARMS students, shown here with Dr. Jennifer McKenzie (QuARMS Co-Director) and inspiration3Theresa Suart (Educational Developer), developed and promoted this idea as part of her community outreach project, together with the support and capable assistance of Museum of Health Care staff Maxime Chouinard, Jenny Stepa, Ashley Mendes, Deanna Way, Kathy Karkut and Diana Gore.

Knowing that such dedicated folks are safeguarding and promoting our heritage is, well, inspiring.

 

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

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Tony’s Top Ten Tips for Success and Happiness in the Clinical Clerkship

This week, the class of Meds 2017 begins their Clinical Clerkship. This is a highly significant milestone in their medical education, representing not only the half-way point, but also a transition from a program dominated by knowledge and skills acquisition carried out in classrooms and simulation settings, to “real life” learning in a variety of clinical placements and elective experiences. Last Friday, this occasion was marked by a White Coat Ceremony, conducted by Drs. Armita Rahmani and Sue Moffatt, and featuring personal presentations and “pearls” from Drs. Heather Murray, Andrea Winthrop and Dean Reznick.

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Top Ten lists have become ubiquitous, including those providing unsolicited advice for medical students. In fact, a quick Google search revealed no fewer than 76,200 such compilations, ranging from the authoritarian to the humourous. Undeterred, I offer my own list, all based on more than a few years of experience and observation as to what works and what sometimes goes wrong. So, here goes, in no particular order…

  1. Show up, and show up on time. It all starts with dependability. Even the most brilliant among us are useless if absent or unreliable. On the other hand, there will always be a welcome for the honest, steady contributor. If you are late, apologize, and do not show up with the coffee or snack that you picked up on the way.
  1. Repeat after me: “I don’t know. Self-awareness is right up there with dependability. There will be things you don’t know. There will be things nobody knows. You will not get into trouble or lessen your reputation by admitting to a lack of knowledge or experience with a particular clinical situation or procedure. After all, you’re a medical student, you’re not supposed to know everything! You do need to know what you don’t know. You will have major problems if you compromise a patient’s care through your unwillingness to admit limitations.
  1. Make it your business to learn about things you didn’t know first time. In fact, become an expert in that issue and look for opportunities to apply your new knowledge. When you do, you’ll find it intoxicating, and will search out even more knowledge. Careers have been built on less. Regard every patient and fresh problem you encounter as your curriculum. Keep track. You’ll be amazed at what you’ll be learning, and how fast.
  1. Remember that no decision that’s made honestly and in the patient’s best interest can be wrong. Anything we recommend for our patients, even the simplest decision, test or therapeutic intervention must meet one of three (and only three) criteria – it must relieve symptoms, improve functional capacity or increase life expectancy. There is no other justification for any intervention. You can’t be wrong for trying honestly to achieve one of those goals.
  1. And yet, things can go wrong... Even the best and most obvious decision may not go the way we intend or hope for. When things do go wrong and patients suffer adverse outcomes, it must be openly acknowledged and understood to ensure everyone (including you) learns from that outcome and becomes a better provider. As a medical student, you will not be the responsible party, but are nonetheless in a position to learn. Don’t be afraid to engage such situations, and don’t hesitate to discuss your feelings and reactions with more experienced people.
  1. Ask questions. Not to impress or stand out, but because you really want to know, and are concerned about the impact on your patient. Ask respectfully, but don’t be afraid to challenge decisions. Good clinicians don’t mind being asked to explain what they’re doing. Really, they don’t.
  1. Get along. With everybody, not just those you think are important. Do this all the time. Everyone you encounter knows more about the practical aspects of health care delivery than you do. They all have something valuable to pass along if you’re attentive and receptive. I’m going to use a key word here: Humility. People can sense it and respond positively to it. The opposite is arrogance, which people can also sense but respond to quite differently.
  1. Eat, sleep, laugh. You’ll be busy, but not so busy that you won’t have opportunity to look after your own well-being. Use your down time wisely. Plan meals and recreation. Surround yourself with people who know you well and have the capacity to make you laugh. They will become increasingly precious to you. Talk to them.
  1. Be open to possibilities. If you think you’ve decided on career choice, don’t be shocked (or worse yet, disappointed) if something unexpected emerges. If you feel strongly conflicted, there’s probably a good reason. Talk it out with someone and remember it’s never really too late to change. If you can’t decide because everything seems great, that’s a good thing, but you might also need to talk it out. We’re available.
  1. And finally… look after each other. You know each other very well, and will know when someone is having difficulties, likely before they know it themselves. Don’t be afraid to reach out, or to seek advice or help. Our Student Affairs staff, headed by Dr. Fitzpatrick, Janet Roloson and myself are all available to you or your colleague. Remember QMed Help, the red button available on MedTech.

 

So there you have my list. Happy to receive revisions, additions or comments from readers. Final word to our students – enjoy. Clerkship is a great time to grow and learn.

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

 

 

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Medical Student Research Showcase

By Dr. Heather Murray and Dr. Melanie Walker
Scholar Competency Team

Queen’s School of Medicine is proud to host the 4th Annual Medical Student Research Showcase on September 22, 2015. This event offers opportunities for medical students engaged in extra-curricular research activities to showcase their work in posters displayed in the School of Medicine Building. These posters will be displayed all day during the 22nd, and students will be standing at their posters and discussing their work from 10:30 until noon in the David Walker Atrium of the School of Medicine Building.

It is also an opportunity to celebrate excellence in the form of an oral plenary session, which will feature the top 3 student projects as selected by a panel of faculty judges.

Showcase 3This year’s faculty judges include:

  • Dr. Anne Ellis
  • Dr. Rob Brison
  • Dr. Tanveer Towheed
  • Dr. Paula James
  • Dr. Jennifer Fleming
  • Dr. Gordon Boyd

We are very grateful to have these experienced researchers evaluating our oral plenary applicants. Showcase 2

The three students selected by the faculty judges to present at the oral plenary beginning at noon will each receive an Albert Clark Award for Medical Student Research Excellence. Their names and project titles, along with their faculty supervisors, are listed below in alphabetical order:

  1. Steven Alexander Hanna: Extended sensory blockade using a hydrogel combined with bupivacaine. Supervisor: Dr. Gregory H. Borschel
  2. Sophie Palmer: A cross-sectional survey of reproductive-aged women’s willingness to participate in medication or vaccine research trials during pregnancy. Supervisors: Dr. Robert Reid & Dr. Graeme N. Smith
  3. J. Connor Wells: Repurposing off-patent drugs in the treatment of cancer: the ongoing story of disulfiram. Supervisor: Dr. Stephen Robbins

We look forward to seeing you in the School of Medicine Building on September 22nd to celebrate the outstanding research achievements of our students.


Check back here on Tuesday afternoon for updates and pictures from the event!


Albert clark winners 2015 w murray and walker
Dr. Melanie Walker, Dr. Heather Murray, Steven Hanna, Sophie Palmer, J. Connor Wells, and Dr. Albert Clark following the Showcase Plenary on Tuesday.

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Summer School for Surgical Skills:

More student directed learning

About a month ago, we published the first installment in a series of articles we’ll be providing over this academic year featuring student directed learning that’s occurring in our school. We heard at that time of Alyssa Louis’ exploration of aerospace medicine. This week, I’ve asked Meds ’16 student Riaz Karmali to report on behalf of a group who have worked together and collaborated with faculty to develop a special learning experience in practical surgical skills. Riaz adds some personal perspectives based on his own experience with a medical student fellowship at the MD Anderson Cancer Centre.


Stepping from Idea to Reality: My Experience with the Surgical Skills and Technology Elective Program (SSTEP)

Only a handful of medical schools in North America have structured surgical bootcamps available to pre-clerkship medical students. Two summers ago, the Surgical Skills and Technology Elective Program (SSTEP) was piloted at Queen’s for second year students. This 2-week simulation-based program is designed to build technical skill and prepare students for the operating room. Participants practice suturing, vascular anastomoses, bone fixation, local skin flap design, and nasogastric and chest tube placement amongst other procedures in the surgical skills laboratory. The inaugural program had 22 participants and ran again this summer with increased faculty support and expanded simulation workshops.

SSTEP

How did SSTEP, an entirely student-led initiative, transform from a progressive educational idea into a sustainable program? The success of any early-stage venture, like a high-stakes horse race, is based on two players: the idea itself (the horse) and the team behind it (the rider). Jennifer Siu, Daniel You, and Stefania Spano were the “instigators.” As driven students, outside-of-the-box thinkers, and great team players, they developed a comprehensive proposal and pitched it to Queen’s faculty. Thankfully, they allowed me to come along for the ride. The goal was to prove that SSTEP was worth its $10,000 budget, faculty time commitments, and use of surgical training and laboratory resources.
The SSTEP curriculum has both a didactic and hands-on component integrated into each day. It was eventually tailored to align with clerkship learning objectives. The idea is to provide students with a non-threatening academic environment where they can practice with up-to-date surgical simulation technology. Students can also be able to explore their interest in surgery and surgical subspecialties. In addition, they can receive guidance from senior medical staff and take advantage of a low faculty to student ratio. The curriculum went through multiple iterations before faculty and administration approval.
But how do we know that SSTEP actually builds technical skills? The concept of hands-on instruction in a simulation-based laboratory accelerating the acquisition of technical skill is intuitive. I had experienced this as a first year medical student. I won a summer research fellowship to MD Anderson Cancer Center in Houston, Texas where my project required me to learn basic microsurgery techniques. In the laboratory, I started out with silicon tubes and progressed to arteries and veins in a live rat. However, I was disappointed that I could not quantify my improvement.
Practicing basic microsurgery techniques but unable to quantify improvement.
Practicing basic microsurgery techniques but unable to quantify improvement.
Naturally, we then decided that SSTEP participants should complete an Objective Structured Assessment of Technical Skill (OSATS) before and after the program. It was mandatory to complete a 12-minute basic suturing station in order to track skill acquisition. This research was particularly important given our cost-sensitive healthcare environment that is increasingly dominated by outcomes assessment.
Screen SParticipants completing an OSATS before and after SSTEP to track outcomeshot 2015-09-14 at 9.16.55 AM
Participants completing an OSATS before and after SSTEP to track outcomes
Outside of technical skill, SSTEP also develops surgical knowledge, confidence, and career interest. With the guidance of our supervisor, Dr. Paul Belliveau, we created a written test (partly adapted from Principles of Surgery Royal College Exams) and exit survey to measure these outcomes directly. Our results were accepted to the Association of Surgical Education (ASE) and Canadian Conference on Medical Education (CCME). Jenn and Dan recently presented at the CCME. Hopefully, our experience with SSTEP can be a template for other medical schools interested in launching a pre-clerkship surgical boot camp. At Queen’s, we punch above our weight!
Outcomes of SSTEP:
→ The SSTEP written exam had a maximum test score possible of 73 and students scored significantly higher on the post-test compared to the pre-test (52.1 5.9 vs. 35.8 6.5 p =0.01)
→ Participants showed an increase in technical skill:

→  At the end of the program, 50% of participants said they considered a new surgical subspecialty while 72% of participants reconsidered elective choices

→ SSTEP was recommended to fellow pre-clerks by 100% of participants

→ Comparative and long-term analyses of SSTEP outcomes will continue with subsequent generations of the program
Looking forward, new “disruptive” ideas and technologies will continue to change the way medicine is taught and practiced. The mobile web, big data, robotics, and accelerated drug development are just a few domains where we have seen an unprecedented explosion of investment. Therefore, it is important that the next generation of physicians be dynamic thinkers that can anticipate future challenges and meet them with relevant experience. Any venture that improves the way we take care of a patient, treat disease, or deliver therapy is well worth the successes and failures that go along with it.
I would like to thank the leaders of SSTEP, Jenn, Dan, and Stefania, for bringing me onto their team. I would like to thank Dr. Belliveau for his support with the research study, Dr. Reznick, Dr. Rudan, and Dr. Sanfilippo for their dedication and wisdom, Ms. Kim Garrison for help with the surgical skills lab, Dr. Winthrop for curriculum development, Dr. Leslie Flynn and Bill Leacy for their financial expertise, all of the residents and faculty facilitators, and the amazing support staff who made SSTEP possible!
The inaugural SSTEP Class of 2014
The inaugural SSTEP Class of 2014

A vastly expanded number of practice options are now available to our students. At graduation, they are faced with a choice between no fewer than thirty direct entry postgraduate training programs. Providing opportunities to explore career options and to tailor their learning experience has therefore become a common and major objective of both students and medical schools. Working with our students, building on their imagination and initiative, is proving to be a winning strategy.

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

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Introducing Queen’s Meds 2019

In late August and early September each year, the university seems to reawaken as returning students repopulate the campus. Our medical school curriculum is one of the first to get underway and, this past week, we welcomed members of Meds 2019, the 161th class to enter the study of Medicine at Queen’s since the school opened its doors in 1854.

meds2019

A few facts about our new colleagues:

They were selected from the largest applicant pool in recent memory – 4669 highly qualified students submitted applications last fall.

Their average age is 23 with a range of 19 to 31 years, with almost equal numbers of men and women (51% women, to be exact).

They hail from no fewer than 46 communities across Canada, including; Ajax, Ancaster(2), Aurora, Bowen Island, Brampton, Brantford, Calgary(2), Cambridge, Campbellton, Coquitlam(2), Courtice, Elora, Gormley, Guelph-Eramosa, Halifax, Kanata(2), Kelowna(2), Kingston, Lasalle, London(2), Markham, Midland, Mississauga(6), Newmarket(2), North Vancouver, Okotoks, Orillia, Orleans, Ottawa(10), Pembroke, Pickering, Richmond Hill(7), Rosseau, Scarborough(5), St. Catharines, Thornhill (2), Thunder Bay, Toronto (19), Trenton, Vancouver, Vaughan, Victoria, Virgil, Waterdown, Windsor (2) and Winnipeg (2) .

Seventy-six of our new students have completed an Undergraduate degree, and twenty-seven have postgraduate degrees, including five PhDs.  The average cumulative grade point average achieved by these students in their pre-medical studies was 3.77.  Their undergraduate universities and degree programs are listed in the tables below:

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An eclectic and academically very qualified group, to be sure.

At their welcoming session they were called upon to demonstrate commitment to their studies, their profession and their patients.  They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers.  At that first session, they were welcomed by Mr. Jonathan Krett, Asesculapian President, and Dr. Rene Allard, who provided them an introduction to fundamental concepts of medical professionalism. Over the course of the week, they met curricular leaders who will particularly involved in their first year, including Dr. Michelle Gibson (Year 1 Director) and Dr. Cherie Jones (Clinical Skills Director). They were also introduced to Dr. Renee Fitzpatrick (Director of Student Affairs) and our excellent learner support team, including Drs. Kelly Howse, Susan Haley, and Susan MacDonald, who oriented them to the Learner Wellness, Career Counseling and Academic Support services that will be provided throughout their years with us. They met members of our superb administrative and educational support teams led by Jacqueline Findlay, Jennifer Saunders, Amanda Consack, Kate Slagle, and first year Curricular Coordinator Corinne Bochsma.

Dr. Jaclyn Duffin led them in the annual Hippocratic Oath ceremony. Dr. Susan Moffatt organized and coordinated the very popular and much appreciated “Pearls of Wisdom” session, where fourth year students nominate and introduce faculty members who have been particularly impactful in their education, and invite them to pass on a few words of advice to the new students. This year, Drs. Erin Beattie, Jaclyn Duffin, Jay Engel, Renee Fitzpatrick, Jason Franklin, Michelle Gibson, Mala Joneja, Steve Mann, Alex Menard, Terry O’Brien, John Smythe, David Taylor and were selected for this honour.

They met and were greeted by Dean Richard Reznick who welcomed them and challenged them to be “restless” in their pursuit of personal goals and advancement of the profession.

On Friday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Michelle Gibson and Richard Van Wylick. They were welcomed to our Anatomy Learning Centre and facilities by Drs. Steve Pang, Conrad Reifel and facility manager Rick Hunt, and participated in the annual memorial service with a moving dedication by University Chaplin Kate Johnson.

Their Meds 2018 upper year colleagues welcomed them with a number of formal and not-so-formal events. These include orientations to Queen’s and Kingston, introductions to the mentorship program, and a variety of evening social events which, judging by appearances the next morning, were much enjoyed.

For all these arrangements, flawlessly coordinated, I’m very grateful to Rebecca Jozsa, our Admissions Officer, and second year President and Vice-President Jonathan Krett and Monica Mullin.

I invite you to join me in welcoming these new members of our school and medical community.

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The Making of a Closer

Roberto Osuna is a closer.

The term “closer”, in this case, refers to a person who has a critical, very specialized, and highly visible position of responsibility on a baseball team. These folks are called upon to come into the game at the most critical juncture, when the outcome is very much in doubt, and are entrusted with ensuring that all the hard work accomplished by their teammates in establishing a lead is completed by striking out the last few opposition batters. As the closer goes about his task, he stands alone, the focus of attention. His teammates, managers, the opposing team, forty or so thousand people in the stadium and millions of people viewing, are transfixed in attention to every move. If successful, there is great jubilation, and he emerges as a hero, at least for today. If he fails, it is with great public exposure and he bears the burden of responsibility for the loss.

OsunaMr. Osuna has an uncanny way of engaging this role with cool and detached resolve. He is very successful, performing at the highest level, on a professional baseball team, in the midst of a highly scrutinized playoff race.

Did I mention that he’s 20 years old?

 

All this begs the question: what allows anyone to engage and excel in such a role, much less someone so young? An obvious answer is that Mr. Osuna is blessed with the ability to throw baseballs with prodigious velocity and accuracy. While certainly true, this fails to capture the entirety, or even the essence, of what’s required. There are many professional pitchers whose skills match those of Mr. Osuna and yet are ineffective in the closer role. How many of us, if magically endowed with the ability to throw the 97 mph fastball, would be able to do so effectively in the highly stressful setting Mr. Osuna faces on a regular basis? The physical skills, it would seem, are essential but not sufficient. There’s something about the attitude and personal qualities of the individual that enable him to translate these innate skills to success in his chosen occupation.

Recent attention in the press to Mr. Osuna’s dramatic emergence sheds some light (references below). Growing up in a poor coastal city in northern Mexico, quitting school at age 12 to work harvesting crops to support his family, practicing and playing baseball in the evenings, competing in leagues far away from home against men much older than himself in Mexico, Japan and the United States, overcoming language issues and, just last year, undergoing and rehabilitating from major elbow surgery, are all evidence that he has packed much life experience into his 20 years. He himself attributes his success to his family support and deep religious faith. He displays self-awareness and perspective well beyond his years: “I don’t think I deserve anything. But I try to do the best I can, get ready each day and be ready inside the stadium and outside too. I know where I came from and where I want to go.”

LaTroy Hawkins, a veteran relief pitcher who has seen his own share of adversity and began his career before Mr. Osuna was born, provides these insights regarding his new teammate: “I’ve always said, guys who are from rough areas, they’re comfortable being uncomfortable…Pitching in the big leagues is nothing compared to living where I did. Trying to live and survive in the inner city…that’s stress.”

In “Aequanimitas”, William Osler’s 1889 valedictory address at the University of Pennsylvania, he describes “imperturbability” as an essential attribute of the successful physician, and defines it as “coolness and presence of mind under all circumstances, calmness amid storm, clearness of judgment in moments of grave peril”….“it has the nature of a divine gift, a blessing to the possessor, a comfort to all who come in contact with him.” He goes on, however, to describe how a “mental equivalent to this bodily endowment”, which he terms equanimity, can be characterized and cultivated by the student physician.

This week, a hundred of Mr. Osuna’s contemporaries began the study of Medicine at our school. They’ve been selected partially because they’ve demonstrated that they possess the academic equivalent of the 97 mph fastball. As with Mr. Osuna, their career success will be determined by much more, by an array of personal qualities also considered in the application process, Osler’s “imperturbability” among them. Their medical education will be as much about developing equanimity and those “mental equivalents to the bodily endowments”, as about acquiring factual knowledge and skills – a truth as relevant in our time as in Osler’s.

 

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

 

Thanks to Meds ’16 student and former Aesculapian Society President Carl Chauvin who shared with me some key insights that contributed to this article.

http://www.theglobeandmail.com/sports/baseball/blue-jays-rookie-reliever-roberto-osuna-thriving-on-the-games-biggest-stage/article26041351/

http://www.thestar.com/sports/blue_jays_baseball_blog/2015/08/blue-jays-bullpen-latroy-hawkins-says-roberto-osuna-has-it-factor-.html

http://www.thestar.com/sports/bluejays/2015/08/10/blue-jays-roberto-osuna-pitching-well-beyond-his-years.html

Sir William Osler 1849-1919. A Selection for Medical Students. Edited by Charles G. Roland. Hannah Institute for the History of Medicine. Toronto.

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“When you wish upon a star…” Alyssa’s Journey

When you wish upon a star
Makes no difference who you are
Anything your heart desires
Will come to you.

From: Pinocchio (1940), Walt Disney Pictures. Sung by: Cliff Edwards

The idea of allowing students to determine and design their own educational experiences may seem counter-intuitive to many, including students themselves. It’s certainly not easy to implement. However, setting aside the initial reaction and obvious practical issues, what eventually emerges is the realization that this is an approach with potential to bring out the best in the motivated student, extend the educational experience far beyond the traditional paradigms, and model the sort of life-long learning we’re hoping to ingrain in all our students.

“Self-directed learning, in its broadest meaning, describes a process in which individuals take the initiative with or without the help of others, in diagnosing their learning needs, formulating learning goals, identifying resources for learning, choosing and implementing learning strategies and evaluating learning outcomes.”  (from: Knowles, M. S. 1975. Self-directed learning: A guide for learners and teachers, Prentice Hall, Englewood Cliffs, New Jersey).

For those who require further convincing, I’ve asked Alyssa Louis, one of our Meds ’16 students to provide a guest blog this week. With the help and cooperation of Clerkship Director Andrea Winthrop and assistance of Clerkship Coordinator Jane Gordon, Alyssa arranged to undertake a rather unique elective experience during her Clerkship, pursuing an interest (perhaps “dream” or “obsession” would be better descriptors) she’s had for some time. As you’ll see as you read on, that pursuit has been very valuable and promises to pay huge dividends as her very promising career unfolds. And so, in Alyssa’s words…

Everyone I’ve worked with, spoken to or passed quickly in a hallway in the past 6 months has heard, at least on a few occasions, about my upcoming aerospace medicine elective. I was over the moon with excitement and probably made a few too many bad puns. However, before I launch into my personal experiences, I should explain that Aerospace Medicine is a sector within occupational health and preventative medicine that aims to preserve the health, safety and performance of individuals involved in air and space travel. Specialists, also known as “flight surgeons” must also be experts in delivering care in extreme environments, as many analog training missions occur at deep sea, high altitudes, remote deserts and polar locations.
This past July I participated in the Principles of Aviation and Space Medicine short course offered by the University of Texas Medical Branch (UTMB) as affiliated with the National Aeronautics and Space Administration (NASA.) The course, which is offered to final year medical students, residents and practicing physicians is run by UTMB faculty, many of whom have held the impressive titles of NASA flight surgeon or are acting medical directors for commercial space companies such as Virgin Galactic and Space Adventures.
In order to understand the unique health considerations for astronauts, we learned the basic physics and physiology of launching into space. Given that our millions of years of evolution selected human traits for life in earth’s gravitational field, it is truly remarkable that humans are able to adapt to life in space. Some of the many physiologic stressors include high G-force exposures of launch and landing, exposures to microgravity, galactic and solar radiation, circadian disruptions, noise exposure, carbon dioxide exposure, stress and isolation.
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Twice flown astronaut and physician Dr. Michael Barratt gave us an overview of the physiologic adaptation and maladaptation to spaceflight, including the important responses of the neurovestibular system, caudal fluid redistribution, blunting of autonomic responses, and of course the concerning loss of bone density and muscle mass. In order to counteract this loss, astronauts aboard the international space station train for approximately 2 hours every day. The challenge of creating weight-bearing exercise in a weightless environment is achieved with bungee straps and vacuum cylinders, which make for a surprisingly high fidelity training experience. Though I had worked up a fair appetite, I was not able to sample the “just-add-water” nutritionist-designed and astronaut approved freeze-dried shrimp cocktail or steak in a pouch.
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We received the historical perspective on aerospace medicine in a lecture by Dr. Charles Berry, a NASA flight surgeon during the Apollo and Gemini missions. At the tender but not subdued age of 92, Dr. Berry certainly did not withhold his objections to his Hollywood portrayal in Apollo 13. I got to sit in Dr. Berry’s old desk at mission control, the very same room where the moon landings were directed.
blog65-img3Back on earth, Aerospace Medicine also encompasses health maintenance and medical flight certification of airplane pilots. There is a truly complex relationship between pilot health and safety, and as we learned first hand in the full motion flight simulator, even perfectly healthy medical students can have vestibular mediated spatial disorientation leading to fatal crashes. We also learned the physiologic effects of airplane decompression, and its impact on time of useful consciousness through an altitude chamber run to 7620 metres (25,000 feet.) I thought fleetingly of Dr. Moffat’s respiratory physiology lessons as we reached atmospheric pressure of 276mmHg and my O2 saturation plummeted to 63%.
Now that I’m back home at Queen’s, I am looking forward to continuing to share my experiences with the rest of our community. I was extremely pleased to learn from a fellow tricolour, Queen’s emergency medicine graduate Dr. Christian Otto who is currently acting as a United Space Research Association principal investigator for the ocular health project with NASA. I will remain deeply grateful for the opportunity to blend my passions for medicine and physiology at environmental extremes. Of course, none of this would have been possible without support from Dr. Winthrop, Dr. Hollins, Jane Gordon and the UTMB faculty. Thanks Queen’s!
Did you know that…
  • Aboard the ISS, the sun rises every 90 minutes. And you thought your on-call room was a bad place to get a decent night sleep! In fact, one of the major challenges being addressed right now is circadian rhythm modulation for crew health.
  • CPR is very challenging in space because classic compressions would essentially push the operator across the room rather than pump the patient’s heart. The current literature suggests that the most efficient delivery is in the handstand position with feet braced against the ceiling.
  • Above 19.2km (63,000 feet) above sea level, the boiling point for water is approximately 37 degrees Celsius. One individual who survived exposure to this pressure described the feeling of saliva boiling off his tongue. Full pressure suits are required for survival above this altitude.
  • Astronauts train for their space walks in a massive swimming pool called the neutral buoyancy lab. There are mockups of the ISS underwater for astronauts to practice repairs.
  • Aboard the international space station, the main source of potable water is recycled urine. This water is used for drinking and rehydrating freeze-dried meals.blog65-img4
  • The current price tag to visit space as a commercial spaceflight participant is approximately $20 million dollars. This would not be covered on the average line of credit. The first Canadian to do so was Guy Laliberte, co-founder of Cirque du Soleil.

Medical school should be a place where students not only learn the “knowledge, skills and attitudes required of a physician”, but are also inspired to grow individually, gain self-awareness, pursue their own goals and develop their particular talents and interests in a way that will allow them to make unique, unanticipated contributions to society and to the profession. Alyssa’s story is a great example of what can happen when we work together with our students to go “outside the box” and make the extra effort to make the difficult and unconventional possible. When they “wish upon a star”… we’ll find a way.

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

 

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Are we forcing our students to choose between Learning and Success?

As the father of four sons, I have found that thought-provoking, articulate conversations with 17 year-old males are rare and remarkable occurrences indeed. Nonetheless, I was fortunate enough to have just such an experience this past week.

It all began when I came upon an article by Kristin Rushowy that appeared on the front page of the Toronto Star on July 19th describing the accomplishments of four young people who had achieved the highest averages among Toronto public high school graduates. A quote from one of these young scholars particularly drew my attention. It’s important, he said, to “follow your passion for knowledge, and not your passion for success”.

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Image Credit: Toronto Star July 19, 2015 [i]
Never having thought of these as mutually exclusive entities, I was intrigued enough to call the source of this comment, Elias Hess-Childs who had managed to attain an average of 99.5%, as had fellow graduating students Michael Nuh, Albert Loa and Sarah Tang. Turns out Elias is an engaging young man who not only knows his way around a high school curriculum, but has some rather prescient views about the educational process and is not at all hesitant to expound on them. He finds the attainment of high grades a “shallow” way to go about educating oneself and strives for deep understanding rather than simply achieving high grades. He is attracted to “interesting” courses and teachers rather than “bird courses”. Like the other students quoted in the article, he finds studying and memorization to be tedious, and largely unnecessary if one has achieved a true understanding of the subject matter. When asked what he finds most difficult, Elias tells me that conceptual and “qualitative” material such as history to be more challenging than the sciences (presumably that’s what dragged his average down to 99.5), but nevertheless plans to challenge himself with social science courses at university next year. A confident and self-aware young man with a bright future, to be sure.

However, there’s a somewhat more troubling side to the “learning versus success” concept. Notwithstanding students like my friend Elias who are able to achieve both, are our young people really being required to make this choice? Are they sacrificing their interests in order to ensure they attain great marks? Are they focusing on short-term retention and exam results rather than deeper, conceptual learning? Is all this diminishing what should be a time for open exploration and discovery? Perhaps most concerning, to what extent are those of us involved in higher education responsible?

Without question, our young people are growing up in an increasingly pragmatic and competitive world. Universities, graduate schools and professional schools such as Medicine are all utilizing academic achievement as a major component of their entrance criteria and, in fact, proudly publish the average scores of their entering students as a marker of excellence. High school marks, entrance examinations such as the MCAT, LSAT and SAT in the United States, are taking on great importance and threaten to indelibly categorize our student into those destined for “success” and those who must content themselves with alternatives. The educational process has, for many students (and, importantly, their parents), shifted from a process of discovery and enlightenment about themselves and the world, to a proving ground in which they must demonstrate their aptitude and competitiveness for future opportunities. And all this is happening during their formative teenage years.

This is further complicated by the inconsistency in high school academic standards that has occurred since the discontinuation of common examinations, and the gradual mark “inflation” that continues to occur. Medical schools, for example, face steadily increasing numbers of applicants with steadily increasing average marks, and diminishing band-width within those marks. Are young people truly getting a little smarter each year, or are high school examiners succumbing to the perhaps understandable desire to provide their students and schools competitive advantages?

One of our recent graduates, Dr. Julianna Sienna, has an interest in the topic of admission equity and a way of poking my conscience from time to time. She recently sent along a fascinating review entitled “Who Gets to Graduate?” that appeared recently in the New York Times Magazine (http://www.nytimes.com/2014/05/18/magazine/who-gets-to-graduate.html?_r=0). In that article, author Paul Tough reviews efforts undertaken at the University of Texas to address the issue of low graduation rates. Although drawn from an American context, the issues they describe certainly resonate and seem entirely relevant to the Canadian scene.

Among the many interesting points raised in that article, a few are particularly relevant to this discussion:

  • High school marks and entrance examination results have a powerful and enduring effect on self-image and sense of “worthiness” for various universities, programs and, by extension, career options.
  • Lower family income and having less well-educated parents are factors associated with lower graduation rates, even for students with similar entry grades and SAT scores.
  • Students with more modest marks and SAT scores, particularly those from poorer socio-economic backgrounds, tend to “undermatch” meaning, in the words of the author, “ they don’t attend or even apply to the most selective college that would accept them.”

To help underachieving students succeed, educational leaders have found that it is necessary to do more than simply deal with their financial and academic issues. “You also need to address their doubts and misconceptions and fears. To solve the problem of college completion, you first need to get inside the head of a college student”. The good news is that a number of innovative programs, focusing on dealing with adversity, building confidence and promoting inclusion are showing definite signs of success where traditional remediation streams and less demanding “developmental” courses were failing and, in fact, only perpetuating the sense of inadequacy.

To summarize, early academic performance during these formative years is a hugely powerful determinant of self-image and confidence, particularly when coupled with socioeconomic circumstances that reinforce the impression, but (and this is a big “but”) does not necessarily exclude young people from eventual academic success comparable to higher-performing entry students.

So what are the messages for those involved in the selection, education and career success of our young people? Certainly we should be celebrating the success of young scholars like Elias, Michael, Albert and Sarah and providing them post-secondary programs and environments in which they can continue to flourish and realize their considerable potential. However, we also need to recognize that not all students are in a position to take full advantage of our educational programs, that our evaluative processes at the high school and university level are far from precise, and that many very capable students with much to contribute to society may be discouraged or lost in the crowd. Our entrance processes should actively search for such students by going beyond the simple ranking of marks and explore more broadly the personal attributes, experiences and life goals of our students. Expecting that a young person will have demonstrated his or her career potential by the end of high school, and using our educational systems as competitive proving grounds is unfair to our students and a disservice to a society that benefits from the broad education of all its members. We can, and should, do better.

 

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

[i] http://www.thestar.com/news/investigations/2015/07/18/torontos-top-students-say-they-dont-study-that-much.html

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