Small connections matter
My Dad died last week in New Brunswick.
I write that not as an invitation to sympathy (but, thank you), but to share a few thoughts from the patient’s family perspective – not on death during a pandemic, although that intensified and complicated things, so much as death in general.
Dad had a stroke nearly four years ago and his memory wasn’t what it once was. I’ll leave parsing out what was effects of the stroke versus medication versus dementia to course case studies. When he fell two weeks ago and broke his hip, the cause of his cognitive difficulties didn’t matter so much as the fact that he was an old man who was scared who was in hospital with visitor restrictions. That is: no visitors at all, unless the patient had palliative status (and Dad didn’t until his last day). Dad didn’t really understand the pandemic, and sometimes forgot what was really going on with his care – doing such things as trying to pull out his IV and catheter, for example. He was scared and in pain and confused.
One bright part of these terrible days was the day his nurse was from Miramichi, his hometown. He was so delighted to talk with her and talk about the places of his boyhood with someone who knew where he was talking about. Who shared the same connection to the River, to the place, to home.
This reminded me of decades ago and my last visit with my maternal grandmother in a Moncton, NB hospital a week before she died. My grandmother was Acadian but lived most of her life in a predominately English community. Her children spoke English. Her grandchildren were truly assimilated with only classroom-based, mediocre French. One of my indelible memories from that last visit was that her conversations with the nurses were always in French. And she seemed so happy to be able to do that. That her first language mattered; that she mattered.
I don’t want to suggest that for meaningful connections healthcare professionals need to share hometowns and language with all of their patients. This is both unrealistic and absurd. These connections highlight just that: connections. Those two nurses, decades apart, connected with scared, dying patients by honoring their shared humanity. My father wasn’t a broken hip; my grandmother wasn’t a failed kidney.
When my mother-in-law was in palliative care in a Toronto hospital in 2010, one of the volunteers did music therapy with the patients. When I arrived for a visit one of the last afternoons, there was a Rachmaninov CD on the table with a Post-It note: “When she wakes up, play track 4 for Sylvia”. He hadn’t had one in his kit and she had spoken about it with him; she was sleeping when he came back with it. (We still have the CD, as he wanted us to keep it).
There isn’t always time in busy clinics and wards to make substantial connections with each and every patient – especially for students who are wrestling with mounds and mounds of material to learn, remember, apply. I’d argue that small connections are just as meaningful. Small moments matter – a shared favourite song, listening to reminiscing. Dignity and connections matter.
None of those things I mentioned were “medical care” for Dad, Nanny, or Sylvie, but it was medicine in the compassion, the care, and the connections. And it’s these connections which give comfort to those of us left behind.
If you want to read a bit about my Dad, check out this link: https://nble.lib.unb.ca/browse/n/michael-o-nowlan
5 Tips: Coping with learning in COVID Times
I’m writing this from what I dubbed my “basement bunker” back on March 23 when we started our remote teaching and learning. At the time, it was a way of injecting some humor into a stressful, face-paced pivot to working from home and supporting teaching and learning online. Six months later, I’m still here, but conscious that a few quips won’t get us through the potential tedium and distractions of working and learning from home.
As we all settle in for a semester unlike any other (are you tired of “unprecedented times” yet?), the Education Team offers these 5 additional learning strategies to help during COVID-Times:
1. Carve out spaces: Staying home for most of the semester’s classes (except for your short “Red Zones” with small-cohorted face-to-face instruction) could make it difficult to focus and concentrate. One strategy to break up the day is to carve out more than one “school” space where you’re living: one for “class” and one for “homework”. Simply moving to the other side of the room can signal your brain that you’re switching activities. If you have a roommate and limited spaces (say, one desk and the kitchen table), maybe trade off your class and study spaces.
2. Get up and move: There’s a reason FitBit buzzes every hour when you wear one, and it’s not just marketing. Too much sitting is bad for everybody. At least once an hour, turn off your camera and walk around a bit, do some standing yoga stretches, or a few jumping jacks – you can still listen! Pro-tip: make sure this isn’t when you might need to turn on your mic. I was on the far side of my (admittedly small) basement bunker on a walking break during a meeting, when the chair said: “Theresa, what do you think?”
3. Pack your lunch: This one may seem silly, but I’m serious. You don’t have to go to the extreme of putting everything in a lunch bag, but think about prepping your lunch either the evening before, or while you’re making breakfast – just like you would if you had to take it to campus. Chances are, you’ll eat healthier that way. After a morning of zooming, and facing an afternoon of more, if you have nothing prepped, you may be tempted to gobble that leftover pizza, or half-finished bag of chips instead of the great lunch you (would have) packed.
4. Get outside: Whether it’s after class or during, make sure you get outside at least once a day. While the weather is still nice, if you have access to an outdoor space and your Wi-Fi extends that far, consider setting up outdoors for your afternoon classes. (I saw a few of our students on a couple of Zoom classes last week doing this). Keep social-distancing rules in mind, but get some fresh air to wake up your brain.
5. Do something social: Don’t get bogged down in “just” doing schoolwork – schedule something social. It’s good to connect with people outside your program. Again, keep social-distancing rules in mind, but book time for something fun. Schedule a Zoom story time with nieces and nephews, set up a walking phone visit with a pal, or sign up for a non-academic class or activity. Lots of organizations are getting creative about programming. My sister (a high school teacher in Toronto) and I signed up for the Kingston-based Cantabile Choirs “Virtual Voices” season of weekly online voice lessons. Not only do we each now have a scheduled “fun” activity, we’re doing it together while apart. Think outside the box for planned not-school-work! (If you like singing, there’s still time to check out Virtual Voices, which begins Wednesday evening: https://cantabilechoirs.ca/virtual-voices/)
Do you have a learning from home tip? Share your advice in the comments!
~ With thanks to my teammates Rachel Bauder and Eleni Katsoulas for their contributions to this post.
Five non-pedagogical things to do to get ready to teach using Zoom
The UGME Education Team has prepared “how to” documents that outline the technical aspects (with such things as downloading the Zoom app, and things like checking that your microphone works). And we’ve previous written with tips about how to engage students in a virtual classroom which might seem rather unfriendly. This post is about other practical things – things we don’t need to think about, or just do automatically – when going to teach in a physical classroom with students there face-to-face.
Here’s our top-five non-pedagogical things to keep in mind before teaching live on Zoom:
1. Look behind you! Give a bit of thought to what’s behind you when your camera is on. Most things are fine, but consider if there’s a lamp that’s coming out of your head like an antennae or something equally distracting. Think about any privacy concerns, if you’re teaching from your home. My work-from-home space is in my basement all-purpose room. If I’m situated in one direction, you’ll see my husband’s degrees on the wall; another you’ll see a collection of elephant figurines (yes, there’s a story to that), and a third shows my Nancy Drew, Cherry Ames, and LM Montgomery books from my childhood. Most stuff is innocuous, but think about if you want to share those things with everyone.
Zoom virtual backgrounds are, of course, an option for an instant non-personal look. Keep in mind, however, that the green-screen technology isn’t perfect. If you move around or (like me) talk with your hands, you may have visual blips of hands or your head momentarily disappearing.
2. Turn off all things that beep, buzz, or whirr Just like in a movie theatre (remember those?!), it’s helpful if you can turn off sounds that are within your control – like your cellphone or email notifications. Also, any environmental noises you can control. My home workspace is adjacent to the laundry room. At the exact moment I was typing this sentence, the dryer buzzer went off (loudly!). It’s also helpful to remind housemates that you’ll be teaching so they can make good noise-related choices.
3. Refreshments, anyone? If you’re settling in for a two-hour session, that could be a lot of talking. It’s good to have a glass of water handy, or throat lozenges nearby. Or, if you’re teaching an 8:30 class: COFFEE. Also, tissues or paper towels perhaps – you likely don’t want to dig into a pocket while sitting down for a sneeze or spill of aforementioned coffee.
4. Office supplies, what office supplies? If you typically take notes of questions students have or keep track of which groups you’ve already called on, make sure you have pen and paper on your desk. Also, do you have any small props you want to show? Figure out where in your teaching space you can put these to keep them nearby, but out of the way of things like your refreshments (above) to avoid needing the tissues or paper towels.
5. Time, please. It’s easy to get caught up in teaching material and lose track of the time. Keep your eye on the clock on your computer, or set a timer (this sound we’ll allow) so you finish on time. There will likely be another instructor waiting to begin their session right after yours and you won’t have the usual visual cue of your colleague appearing at the back of 032 or 132.
Keep in mind, this is real life, real time teaching, not a Hollywood film. Things will happen and it will be fine – paging, for example, is unavoidable if you’re teaching in your hospital office. Also, you won’t be the first of our instructors (or students) who’ve had a child or pet wander into camera range. (I routinely warn of random “teen boy” appearances when I’m on Zoom calls. He wandered in while I was drafting this, too).
Are there things you would add to this list? Use the comments box below to share your tips.
For a different (more humorous, maybe more accurate?) take on preparing your environment for online teaching, check out this video by Dr. Andrew Ishak at Santa Clara University. https://vimeo.com/447645552?fbclid=IwAR3lKAaNY0zCPgVJWdPUjog-AD0g7FjsSNBtUL5HAEdcFlUgWaUHi–7JqU
Zooming our way through pandemic remote teaching
On March 23 – coincidentally immediately after our students’ March Break – Queen’s UGME moved its classroom-based teaching to all remote learning to comply with social-distancing measures put in place as a result of the COVID-19 pandemic..
This also coincided with the majority of faculty, and administrative and support staff moving to working from home, except for those deemed essential to university operations.
By the end of May, we’d conducted close to 250 learning events via Zoom that would have ordinarily been taught in our classrooms by dozens of faculty members. The Meds Video Conferencing (MedsVC) team, led by Peter MacNeil were instrumental in making this possible, providing technical support for every learning event.
Lectures were recorded to accommodate students who found themselves in different time zones (many having travelled home for March Break and subsequently stayed there rather than engage in unnecessary travel) and those with family responsibilities, for example.
Instructors faced the same challenges most have read about regarding online conferencing. As Dr. Jenna Healey, Chair in the History of Medicine, describes: “Technical issues, navigating the software, making sure there were no interruptions on my end—like my very loud cat meowing!”
Faculty sought creative solutions to previously-scheduled in-class sessions. For example, in MEDS 246 Psychiatry, there were two expanded clinical skills sessions scheduled which each included a Standardized Patient actor (SP) to help demonstrate aspects of psychiatric interviews. Course Director Dr. Nishardi Wijeratne led both sessions – the first before the switch to remote delivery and the second one via Zoom. Each session was 50 minutes.
“Having taught both at the SOM and fully zoom, I did not find a significant difference between the two as a teacher,” Dr. Wijeratne says. “Given that my clinical practice as psychiatrist has moved to mostly virtual care right now, the Zoom version actually felt closer to my daily clinical practice right now.”
She noted three aspects that helped greatly with the session:
- MedVC staff to help with tech issues
- Connecting with the SP about 10 minutes before the session to discuss goals and structure
- Assigning tasks to the students ahead of the session to maintain engagement thoughout the 50-minute classes. Students observed the psychiatric interviews and documented mental status, identified risk factors, and considered possible differential diagnoses.
In addition to his own teaching, MEDS122 Pediatrics Course Director Peter MacPherson pitched in with a solution to a Clinical Skills session – about half the class missed their opportunity to complete a toddler observation session because of the pandemic restrictions.
“Usually, the medical students get down on the floor and play with a toddler while they infer the child’s real age based on their developmental achievements,” he explains. “We were able to cover the same curricular objectives remotely. The students were able to observe and interact with my toddler via Zoom in his ‘natural environment’ (aka our playroom) and do a similar assessment.
“It was a lot of fun to teach while playing dress up with my child!”
One part of the classroom experience that’s more challenging to achieve remotely is direct interaction with students as a class. “In particular, it is rather difficult to judge the level of understanding of the class,” MEDS245 Neurosciences Course Director Stuart Reid notes. “It cannot provide the personal contact that comes with in real life interaction.”
“On the other hand, it has been an invigorating challenge. We introduced more online learning modules and sought creative approaches to making distance learning both active and interactive,” he adds. One such creative approach was a “Jeopardy” style game in place of a hands-on expanded clinical skills session. It didn’t replicate the face-to-face session, but it actively engaged students in the session.
Dr. Healey echoes Dr. Reid’s comments about missing that face-to-face factor. “I very much miss interacting with my students in class. As an instructor, what I have found most challenging is not being able to see student’s faces. I didn’t realize how much I relied on non-verbal communication to adjust my pacing or gauge the level of student’s interest or understanding.”
Dr. Healey started encouraging students to use the Zoom “raise hand” function more often in her classes. “I want students to feel comfortable interrupting me if they have questions or comments.”
Dr. Reid speaks for all of us at UG when he notes that the students were a key factor in the success of our remote curriculum delivery: “They have been patient, accommodating, and enthusiastic enablers of our altered circumstances. Many thanks to them!”
At the end of the semester, the Education Team conducted several focus groups with Year 1 and Year 2 students to get additional feedback on what worked well, what didn’t, and suggestions for improving this type of remote learning. This, combined with the course evaluations (which included additional questions about the new required remote learning activities) will be used to inform teaching decisions in the coming academic year, as the COVID-19 pandemic situation continues to evolve.
CanMEDS roles in action during COVID-19
By Dr. Gray Moonen
Welcome to the Medical Residency Twilight Zone: There are no medical students. Academic half-days are virtual. Research projects are delayed indefinitely. Your oral presentation at the conference is cancelled. The entire conference is cancelled. Oh, that’s because flights are also cancelled. Licensing examinations are delayed. Clinics are cancelled. Where did all the patients go? You can hear a pin drop in the emergency department.
My hands are raw. No, I am not moisturizing them during the day and, yes, they are showing cracks. I am turning reptilian. These masks make me so hot, I can barely breathe. My glasses are constantly foggy. Oh hey, I didn’t recognize you with the mask on. Leaving the hospital and coming home are newly ritualized. Wash hands (arms, neck?), then take off scrubs, then take off shoes, wash hands again, put street clothing on… wait did I miss a step? Did I contaminate myself? Will I contaminate my home? Get my wife sick? I don’t know. I have internal monologues about how often to sanitize my equipment. Is my cell phone going to survive all this virox? It is the least of my worries right now, but it would really suck if I broke it.
I end every email with “stay safe”.
I’ve been reading about how to stay resilient and accept the inevitable stress. The evidence is sound, but it seems distant. “Focus on the things you can control”…that’s part of the day-to-day challenge as a resident. We often lack the clinical knowledge, experience, and confidence to control our clinical encounters. We require evaluations; all our work and research projects are supervised and graded in some capacity. We require licensing exams to proceed to be independent practitioners. These are the many things out of our control that all draw on our attention and make a crisis like the COVID-19 pandemic even more anxiety provoking. Not to mention our most pressing concern – for the deluge of illness and suffering this will cause patients.
And yet…. what a privilege it is to be a resident.
We are guided by a seven-pillar competency-based framework: “CanMEDS” or “CanMEDS – Family Medicine”. Although it may seem like everything is up in the air, I think there are equal, if not greater opportunities to develop our competencies during this crisis compared to usual times. Instead of going through the motions of learning objectives, checking off an Entrusted Professional Activity, receiving an In-Training Evaluation Report, instead we are actively motivated to do the things that need doing, because it simply needs to be done. Doing it well and thoughtfully, because it matters. A lot.
I have seen residents and staff physicians working side by side, tirelessly advocating for change at the individual, community and broader societal level. Grassroots campaigns are successfully encouraging people to stay home, and wash their hands; we’re advocating for PPE procurement. The trust, respect and unity being displayed across healthcare workers has enabled genuine collaborative efforts; “we are truly all in this together”. Residents are also liaising with public health, government agencies and the public to find innovative solutions, not to apply for a grant or win an award. It’s because this needs to be done.
I’ve noticed many residents become leaders and lean in to their voices, providing calm, measured and sound advice to their patients, peer groups, junior learners, family and friends, organizing systems to let patients know where to reach out to for help if they feel ill. Residents are stepping up and covering call shifts for ill or quarantined colleagues, offering to work COVID19 clinics or be redeployed to other services.
As developing professionals, we are sacrificing time, energy and our health in this evolving pandemic. Managing the competing demands of training such as patient care, evaluations, research and the stress of having academic requirements delayed or cancelled is unique, but I have observed grace inspired action rather than a compromise in integrity or overt displays of frustration.
As scholars we are staying informed on the emerging evidence and synthesizing this information for patients, peers and the broader public. As medical experts, we are not only maintaining many of our skills within our developing scope of practice, but actually expanding our skillset as we prepare to participate in more critical care, triaging, counselling and telemedicine.
Uncertainty and anxiety are undeniable. We are concerned we will not reach our training milestones or develop the competencies to practice independently. Yet, despite these dark times, I believe there are silver linings. We will all become better physicians and community members as a result of this crisis, and Canadians will benefit in the long term.
Gray Moonen, PGY1 in Family Medicine at the University of Toronto, graduated from Queen’s School of Medicine in 2019. He is also a past-president of the Aesculapian Society.
This column originally appeared on the CMAJ blog and is used here with Dr. Moonen’s permission.
Five ways to ramp up your teaching
It’s February, and despite the recent Family Day holiday, we’re still stuck in the depths of winter. Things are just a little harder to get excited about when it’s bleak, cold and snowy. Add in the task of teaching something that’s become routine, and the doldrums can be nearly certain to set in.
It can be a challenge for experts to teach introductory content. This can be further exacerbated by the cycle of teaching: each year brings another round of the same—or very similar—material. When the key advice of reminding yourself that while this is the hundredth time you’ve taught this, it’s the first time for these learners just isn’t enough, how can you get excited about teaching for the 101st time?
Here are five suggestions to ramp up your enthusiasm and freshen your teaching:
- Back to basics: What do you want your learners to know or be able to do when you’re done? Sometimes when teaching becomes routine, we’re in danger of losing focus on the goal. Make a quick list of your key take-away points. If you’re not sure, take some time to reflect and then make any necessary revisions to your teaching plan.
- Add some feedback: Add in some formative assessment either partway through your learning event, or partway through your sessions if you are teaching multiple times. This gives you—and them—feedback partway through to make sure things are clear. Formative assessment can be individual or team-based and doesn’t necessarily have marks attached. It can be as simple as an online poll to gauge understanding of a key concept.
- Refresh the page: Since the underlying concepts haven’t changed, it’s easy to slip into a rut of repeating yourself. Even if it’s new to this group of learners, you’ll be more engaged if you freshen your cases, or revise the background materials you assign. Is there something in the news or new research that’s timely and on-point?
- Toss in technology: It may strike you as gimmicky, but using technology can freshen “old” material. Consider incorporating PollEverywhere’s polling (which you can use for #2 above) or incorporating a short video for discussion. (I can set you up with a PollEverywhere account in about two minutes and teach you how to use it in 5-10 minutes).
- Ask for input: Bounce ideas around with colleagues, brainstorm with others teaching in your course. Ask your course director for feedback. If you’re the course director, that conversation can work both ways: ask for input from your team.
Keeping things fresh for yourself can help your learners. Your excitement and enthusiasm contributes to a climate of learning. If you’re looking for more ways to shake things up but you’d like some customized advice, get in touch with the Education Team.
Focus groups: what they are and how we use them
By Theresa Suart, Educational Developer & Eleni Katsoulas, Assessment & Evaluation Consultant
Amongst the plethora of student feedback we solicit about our courses, you may wonder why we sometimes add in focus groups. What could be added to the more than a dozen questions on course evaluation and faculty feedback surveys?
The information we gather in student focus groups doesn’t replace the very valuable narrative feedback from course evaluations, rather, it allows us to ask targeted questions, clarify responses and drill down into the data.
Developed from “focused interviews” around the time of the Second World War, focus groups emerged as a key qualitative research tool in the latter half of the 20th century. Robert K. Merton, a sociologist from Columbia University, is hailed as the “father of the focus group.” (He died in 2003 at age 92.)
Merton used focused interviews to gain insight into groups’ responses to text, radio programs and films. Politicians and marketing companies soon seized upon focus groups to gauge voter and consumer trends. The Queen’s UGME Education Team uses focus groups in a targeted way to augment information gleaned from course evaluation feedback, course director’s meetings with academic reps and other feedback tools.
According to a briefing paper from Carnegie Mellon University, focus groups are “particularly effective” for eliciting suggestions for improvement. “They are also much more flexible than surveys or scales because they allow for question clarification and follow-up questions to probe vague or unexpected responses.” It also helps that faculty rate focus groups as “accurate, useful and believable”.
If you’re asked to participate in a focus group, only agree if you think you have something to contribute to the investigator’s project or purpose. (Sure, it’s fun to come for the free food, but be prepared to contribute in a meaningful way).
What you can expect when you take part in a focus group:
- To be informed if the focus group is for research or curricular innovation (or both). Research studies must have approval from the Research Ethics Board and require specific paperwork to document informed consent. Curricular innovation focus groups are less formal, but will still respect confidentiality of participants. These might not have the same paperwork.
- The facilitator to set the ground rules, and guide the discussion. Savvy facilitators will do this with a minimum of fuss: they will listen more than they speak. (But you can certainly ask for clarification if you’re not sure of a question).
- A co-facilitator will likely take notes and monitor any recording equipment used. The co-facilitator may summarize after each question and solicit further input as required.
- You’ll be asked specific questions, and engage in conversation with the other participants.
What you shouldn’t expect:
- A venting session. This isn’t the time to just complain. A focus group is looking for constructive feedback and suggested solutions.
- To always have your say: the facilitator may realize they have reached saturation on a particular question and will move on. This is to respect your time. (You’ll have an opportunity to send additional comments electronically afterwards if you felt there is an important point that was missed).
What you can do to prepare:
- If the questions are provided in advance (this is best practice but not always possible on tight timelines!) you should take some time to think about them.
- Be sure you know where the meeting room is, and arrive on time.
What you can do during:
- Contribute, but make sure you don’t end up dominating the conversation. The facilitator will be looking for a balance of views and contributors.
- Listen attentively to others and avoid interrupting. The facilitator will make sure everyone has a chance to contribute – you’ll get your turn.
What you can expect from data collected at a focus group:
- It will be confidential. Different strategies are employed. For example, you may be assigned a number during the focus group and participants asked to refer to people by number (“Participant 2 said…”).
- In a formal research study, you should be offered an opportunity to review the data transcript after it is prepared. (This is sometimes waived on the consent form, so read carefully so you can have realistic expectations of the investigator).
- The end product is a summary of the conversation, with any emergent themes identified to answer the research questions.
What you can’t expect:
- A magic bullet solution to a challenge in a course or class.
- One hundred percent consensus from all participants – you can agree to disagree.
- For all outlier opinions to be represented in the final report. These may be omitted from summary reports.
We’re always grateful to our students for donating their time to our various focus group requests throughout the year. These contributions are invaluable.
For course directors: If you think this type of data collection could be useful in your course review and revisions, feel free to get in touch. It’s one of the tools in our qualitative research toolbox and we’re happy to deploy it for you as may be appropriate.
Eleni Katsoulas email@example.com
Theresa Suart firstname.lastname@example.org
Students enthusiastically endorsed Dr. James Makokis as inaugural M. Nancy Tatham & Donna Henderson Lecturer
Public Lecture on Decolonizing Medicine is October 23 at 5 p.m.
Creating an inclusive space for transgender and Two-spirit people in medicine will be the focus of the inaugural Dr. M. Nancy Tatham & Donna Henderson Lectureship October 23 at the Queen’s School of Medicine Britton Smith Lecture Theatre (Room 132 at 15 Arch Street), at 5 p.m.
Dr. James Makokis, a Two-spirit Cree Family physician (and recent winner of the Amazing Race Canada with his partner Anthony Johnson) is the first Dr. M. Nancy Tatham & Donna Henderson Lecturer. The lectureship is organized by the School of Medicine’s Undergraduate Diversity Panel.
The students of the medical school class of 2022 who participate in the Diversity Panel enthusiastically put forward Dr. Makokis to be the first speaker for this lectureship. The students felt that inviting Dr. Makokis to speak would promote important conversations about equity, diversity and inclusion in medicine. They see this as an opportunity to learn from the experience and work of Dr. Makokis as it relates to indigenous and LGBTQ+ communities, intersectionality, and making medicine a safe space for all patients.
The students who are organizing and supporting this talk are doing so in order to promote safe, equitable care for all patient populations. It is known that diversity is an important factor in medicine, as different patient populations have different experiences and viewpoints. The goal of providing excellent compassionate care for all in medicine, can be hindered by biases and lack of awareness, and events such as this increase awareness and bring to light our biases.
The diversity panel and the generous donors promoting this event see this as a chance for students, faculty, and members of the community to come together and learn, to take a step toward making the practice of medicine more inclusive. Dr. Mala Joneja, Director of Diversity and Equity for the School of Medicine invites everyone to attend and be a part of this step forward. She invites everyone, students and faculty in the Faculty of Health Sciences to come and simply listen and understand. Events such as these are important for members of marginalized groups but also for those who wish to be allies. An ally is someone who, though not a member of an underrepresented group, takes action to support that group. She emphasized that all physicians can be allies to underrepresented and marginalized communities and attending the upcoming lecture is a great first step towards allyship.
Dr. Makokis holds a Bachelor of Science in Nutrition and Food Sciences, a Master of Health Science in Community Nutrition and a Doctorate in Medicine. He also received certification from the Aboriginal Family Medicine Training Program. He is a leader and well-known expert within the Indigenous, LGBTQ2 and medical community.
Dr. Makokis has maintained his cultural beliefs and spiritual practices in all areas of his life. His strong connections to preventative health, spirituality, and Two-spirit perspective has helped him save lives within the LGBTQ2 and First Nation communities. He also leads one of North America’s most progressive and successful transgender focused medical practices.
The Dr. M. Nancy Tatham & Donna Henderson Lectureship was established in 2018 through a donation from Dr. Tatham and Ms. Henderson to support bringing speakers to campus on issues related to diversity and inclusion, specifically in areas related to LGBTQ+ topics, Indigenous issues, and other areas of diversity relevant to the practice of medicine. Although the primary intended audience is medical students, everyone is very welcome to attend.
Disorientation can be the first step to learning
Have your ever found yourself in a new course or job and wondered how the heck you got yourself into this terrible situation? It could be something you strived for actively for years and sought out for yourself. (Yes, I know that describes many medical students, but also people in new jobs, and students in other graduate programs like the one I’m in at the Faculty of Education).
Often, in a new situation – even one we’ve chosen – we can feel less competent than we did in our previous circumstances, and scramble around to figure out why something we wanted has turned out so poorly right off the bat. Generally, adult learners are used to feeling competent in their lives, work, and previous educational endeavors. New situations can rob (or mask) that previously-developed competence.
Using Taylor’s Model of the Learning Cycle can help with these feelings and ensure you stay focused on moving ahead, rather than getting stuck in the “I’ve made a terrible mistake” self-talk.
First articulated by Marilyn Taylor in 1979, then refined in 1987, this cycle explores learning from the learner’s perspective.
Taylor described the learning cycle as one of Disorientation, followed by Exploration, then Reorientation, culminating in Equilibrium – then, for lifelong learners, a new period of Disorientation as the cycle begins again. Within each of these four stages are other predictable and/or possible stages, opportunities and solutions.
Although Taylor focused on inquiry-based learning, I’ve found the model can apply to any new learning situation for adults including, as mentioned above, starting a new job or new professional role.
Here’s Taylor’s Model of the Learning Cycle in a nutshell, based on a chapter from Dorothy MacKeracher’s Making Sense of Adult Learning (2004) (Disclosure of potential for bias: I was introduced to this model by Dr. MacKeracher during my BEd studies and she was later my supervisor for my master’s degree).
The model begins with the learner entering a new situation, often described as a “disconfirming event or destabilizing experience” which highlights a “major discrepancy between expectations and reality”. The change can be starting a new course or program, starting a new job, new technology being introduced at work, or a change of circumstances related to aging or health.
The disorientation comes about when the new situation isn’t routine. The learner no longer feels competent or capable, which can result in a crisis in self-confidence. (The questions of “why did I sign up for this?” or “who thought I’d be good here?” are common in this phase.)
When a learner experiences confusion, anxiety and rising tension, the learner frequently withdraws from others because of feelings of inadequacy.
As MacKeracher notes: “in formal learning programs, the person most frequently blamed is the facilitator” for things such as not providing enough direction or clear instructions, or “not being helpful”.
Some people get stuck in this phase and focus on immediate – but misguided – solutions. For example, assuming the problem is lack of control, so trying to be more organized, but not really moving forward. (I’ve called this my “rearrange the chairs on the Titanic” mode. It’s not a productive place).
The exploration phase begins when the learner “can name the central issue and make contact with others,” MacKeracher explains. “The individual becomes engaged in searching for information or ideas that could assist in resolving the identified problem.” The key here is to look for information or ideas that will make things better, not a superficial quick fix. This could involve exploring new study habits, identifying training gaps and solutions, or considering new points of view or attitudes (depending on the learning situation).
Towards the end of the exploration phase, the learner may withdraw from others somewhat to think things over, but this is not the avoidance of the disorientation phase, rather a time for thoughtful reflection and planning to make a transition.
The transition to the reorientation phase is characterized by “integrat[ing] ideas and experience to provide a new understanding of the issue [or circumstance]” that caused the disorientation in the first place. “The learner consciously acknowledges that learning is a process in which he or she is the agent.”
As implied by its name, this phase is far more settled than the previous three, or, as MacKeracher writes: “this phase involves a much reduced emotional intensity.” Learners may consolidate, refine, and apply their new perspective and skills and share them with others in different context “or tested out as new behaviour in new settings.”
(And then back to disorientation…)
Sometimes people move through these phases instinctively, but if you’re feeling stuck – disorientated – working through Taylor’s Learning Model consciously can be helpful. Sometimes, it’s just reassuring to know “this is a phase” and you’ll come out the other side stronger, resilient, and competent in your new circumstances.
This is, admittedly, a simplified overview of Taylor’s Learning Cycle Model. Feel free to drop by my office for further discussion or to borrow my copy of MacKeracher’s Making Sense of Adult Learning.
Celebrating teaching and learning
This week the School of Medicine joins the other schools in the Faculty of Health Science for a Teaching & Learning Celebration featuring guest speaker Dr. Nicole Harder.
Dr. Harder, Assistant Professor, College of Nursing, and the Mindermar Professor in Human Simulation, Rady Faculty of Health Sciences at the University of Manitoba, will present the Susman Family Lecture on October 3 at 4 p.m. at the Britton Smith Lecture Theatre (Room 132) at the School of Medicine.
Dr. Harder’s position is an interdisciplinary one which includes simulation-based education and research for the Colleges of Dentistry, Medicine, Rehabilitation Sciences, Nursing, and Pharmacy. Her current work is creating, implementing, and studying the use of a psychologically safe debriefing framework following expected and unexpected patient death in simulation and clinical experiences with health care students and practitioners.
For the Susman Family Lecture on Thursday, Dr. Harder’s topic is “Safety for all: Interprofessional simulation and non-technical competency development.
According to the Canadian Institute for Health Information, in Canada, medical errors contribute in upwards of 23,750 deaths per year, one million added days in hospital, and approximately $750 million in extra health spending. While various strategies and technologies have been implemented to reduce these errors, they have demonstrated inconsistent improvements or even reductions in patient safety. In contrast, simulation-based learning has demonstrated effectiveness in improving safety competencies. In this presentation, Dr. Nicole Harder will discuss the role of interprofessional simulation in patient safety, and argue that a significant shift is needed to ensure that students and healthcare practitioners are afforded the opportunities to engage meaningfully in interprofessional simulation activities that will allow them to grow and develop the skills required for today’s healthcare practitioners.
Following Dr. Harder’s presentation, teaching innovators from medicine, rehabilitation, and nursing will also share presentations:
School of Medicine – Using Wikipedia as a platform for teaching EBM, presented by Dr. Heather Murray
School of Rehabilitation – Innovation in Teaching a Research course to a Large Class with Diverse Backgrounds, presented by Dr. Setareh Ghahari and Dr. Mohammad Auais
School of Nursing -From competence to capability in the clinical setting, presented by Ms. Jennie McNichols
Friday morning, Dr. Harder will lead Health Sciences Education Rounds ( 8 – 9 a.m.) in Room 104, Richardson Laboratories. Her Friday presentation will explore “Using simulation as a pedagogy: Who’s who in the (sim) zoo?” Video-streaming is available at Providence Care Hospital: PCH D2.069 Videoconference Rm A. Anyone unable to attend Education Rounds at either Richard Labs or Providence Care Hospital may listen remotely by joining this ZOOM call at the appropriate time: https://zoom.us/j/165499888
Simulation as a teaching and learning pedagogy is not new. What is new is the availability of technology and the changing landscape of the education learning environment. While the term active learning activities are frequently discussed among educators as a means to bring learning to life, there is nothing more active that a simulation based experience. From students to faculty, to researchers and administrators, we all have different roles in developing and implementing simulation. This session will discuss the various roles that we all have in developing and implementing simulation as an active learning strategy, and provide the audience with some suggestions on how to make the most of their time with students.
Registration for each event is appreciated but not required.
Thursday: Susman Family Lecture and FHS innovators: https://healthsci.queensu.ca/faculty-staff/cpd/programs/tlc2019
Friday: Health Science Education Rounds: https://healthsci.queensu.ca/faculty-staff/cpd/programs/hsernicoleharder