Recognizing our Course Directors
“The People Who Make Organizations Go – or Stop” was the intriguing title of an article that appeared in the Harvard Business Review in 2002, authored by management experts Rob Cross and Laurence Prusak. In it, they describe the key people and largely informal networks that are necessary to the functioning of any organization, regardless of its purpose or product. They make the point that the success or failure of organizations can usually be attributed to the effectiveness of a group of key people they refer to as “central connectors”. In their own words:
“In most cases, the central connectors are not the formally designated go-to people in the unit. For instance, the information flow… at a large technology consulting company we worked with depended almost entirely on five midlevel managers. They would, for instance, give their colleagues background information about key clients or offer ideas on new technologies that could be employed in a given project. These managers handled most technical questions themselves, and when they couldn’t, they guided their colleagues to someone else in the informal network—regardless of functional area—who had the relevant expertise. Each of these central connectors spent an hour or more every day helping the other 108 people in the group. But while their colleagues readily acknowledged the connectors’ importance, their efforts were not recognized, let alone rewarded, by the company. “
In a medical school, these critical central connectors are called Course Directors. They are the folks with the practical knowledge, functional relationships and, importantly, “street cred” required to translate the high level educational goals of our program into the multiple packets (courses) of education that, in aggregate, will come together to produce the fully formed graduate, ready for residency and great things beyond. Their job is basically to take a subset of the overall program objectives that are assigned to them by the Curriculum Committee, and develop the multiple components of teaching and assessment designed to ensure our students achieve the objectives. In doing so, they must engage and coordinate the efforts of their professional colleagues, other members of the educational community, educational specialists and our administrative support staff. By effectively orchestrating all these efforts, guided by the “score” provided by the curricular framework, they develop an effective and coordinated educational experience for our students. They are truly “connectors” as described by Cross and Prusak. They are absolutely indispensible to the success of the program.
Last week, we recognized the contributions of four of our Course Directors who are moving on from those roles, three of whom are retiring. Fittingly, students, representing those who had benefited so greatly from the efforts and dedication of these remarkable people, provided the tributes. In their words:
Elisabeth Merner, Meds 2019, speaking on behalf of Dr. Jennifer MacKenzie:
It’s a pleasure to thank Dr. Mackenzie for all of her work as the inaugural Co-Director of the QuARMS program on behalf of the QuARMS students.
Most people have heard of the QuARMS program, but very few people understand the QuARMS vision as well as you do, Dr. Mackenzie. From the very beginning of the program, you helped to deepen students’ understanding of the role of the physician, the qualities of a leader in the medical community, and the values and ethics that are to be upheld in medicine.
For some, it would be daunting to teach these topics to a group of teenagers, but you were more than ready for the challenge. Your passion for education and innovation has been clear to all of us. We appreciate the fact that you attended every single three hour Wednesday session for the first two years of the QuARMS program. Honestly, with young adults of your own, we would have understood if you claimed that you had administrative duties to perform and missed out on one or two of the sessions – but you were there, leading by example.
We also recognize your role in designing the QuARMS curriculum, which is unlike any other program in Canada. Through service-learning projects, you helped students to understand the importance of social accountability within the medical profession. You also led a transformation in how students think about volunteer work. Your vision and your values have shaped the QuARMS program. Thanks to you, service-learning projects have now become a much more important part of our medical school here at Queen’s.
On behalf of four generations of QuARMS students, we want to thank you, Dr. Mackenzie, for your tireless dedication to the development of the QuARMS program and to shaping our lives, both as future professionals and as mature students.”
Jeff Mah, Meds 2019, speaking on behalf of Dr. Conrad Reifel,
Let me start off by saying, anatomy is one of the most overwhelming topics in medicine. From head to toe, there is a seemingly endless number of muscles, bones, nerves, blood vessels and organs that each serve a specific purpose and thus need to be learned. Needless to say, without a good teacher, this subject can be very difficult to master.
At Queen’s, we have been extremely fortunate to have had Dr. Conrad Reifel as an anatomy instructor for the last 43 years. Over his time here, Dr. Reifel has guided thousands of medical students through the vast, unfamiliar world of gross anatomy and has done so with patience and commitment. What I always appreciated about Dr. Reifel was his ability to take an area of the body that is incredibly complex and systematically break it down so that by the time he finished talking, it seemed quite manageable.
Dr. Reifel also has a fantastic ability to keep a class engaged even when teaching a somewhat dry topic with his unique sense of humour and vast repertoire of personal anecdotes. I’ll never forget Dr. Reifel, standing at the front of the class with his arms outstretched using his own body to demonstrate the anatomy of the uterus. While the memory of that lecture does conjure up some odd images, I’ve never had trouble visualizing the uterine anatomy since then.
Dr. Reifel, on behalf of the medical students of Queen’s University, past and present, thank you for the decades of excellent instruction. Please know that you are respected and loved by the students you have taught and have positively impacted the lives of so many. You will be truly missed and we wish you all the best in your retirement.
Calvin Santiago, Meds 2018, speaking on behalf of Dr. Lewis Tomalty
Dr Tomalty has been teaching in the Mechanisms of Disease course since 2010 and took over as Course Director in 2012. In this role, Dr. Tomalty worked tirelessly to make improvements to the course. He attended all the MoD lectures and met weekly with the class curricular reps. He set up consultations with students and faculty, organized a strategic planning curricular retreat and established a framework to link together a diverse range of subjects including pathology, immunology, microbiology and infectious disease.
In addition to his role as Course Director for the Mechanisms of Disease Course, Dr. Tomalty also previously served as Vice Dean of Medical Education for the Faculty of Health Sciences and is the current Chair of the Course and Faculty Review Committee. As well, Dr. Tomalty is heavily involved in global health initiatives and provides his consultation services on infection control in Mongolia.
On a more personal note, and speaking on behalf of the many students who have had the privilege of knowing him over the years, I have found him to be an absolute pleasure to work with. Even in his last year as the Course Director, he still met with the curricular reps on a weekly basis to discuss ways to fine-tune an already well-received course. I know from their stories that they looked forward to these meetings with Dr. Tomalty, calling it their weekly “T-Time”. To quote another student, he is the “bestest, most efficient chair of a meeting ever.” I look to him as an exemplary role model of a leader and educator and as an inspiration for stylishly funky socks.
Dr. Tomalty, thank you so much for your leadership as Course Director and I wish you all the best in your future endeavours.
Kate Rath-Wilson, Meds 2019, speaking on behalf of Dr. Chris Ward
Dr. Chris Ward was one of the inaugural course directors for our new curriculum when it was introduced in 2009, and was responsible for developing and consistently aiming to improve the Normal Human Function course in Term 1. He has coordinated multiple faculty members, built a strong curriculum for the course, been part of the initiative to bring in Drs Moffatt and Parker to apply physiology to cases (which has added immeasurably to our learning), and helped to build introductory physiology modules for students struggling with physiology. This led him to be asked to join many, many, many UGME committees, including (but not limited to) the Curriculum Committee, The Teaching, Learning and Innovation Committee, and the Student Assessment Committee – currently, Dr. Gibson believes this to be a record for any one course director. He was instrumental in preparing our brief for the CACMS/LCME accreditation, reviewing all the sections that pertained to foundational science and its impact across the curriculum. Dr. Ward is known at Curriculum Committee for being the person to move that the meeting be adjourned! It started with only a few times, but now we look to him for this and he’s become everyone’s favourite motion-maker!
As a medical student, I have not had much of a chance to get to know Dr. Ward personally. His name will always be associated with hypovolemic shock for me – which some may deem as unfortunate but I think is one of the highest honours a teacher can be granted. He elucidated complex cardiac physics with clarity and patience, and acted as a model to the other professors in his course. He expertly managed a complex course, juggling the schedules of many faculty members and even more stressed out A-type students.
Dr. Ward has worked tirelessly behind the scenes to build our medical curriculum from the bottom up. This is a position that often lacks glory and recognition. We owe Dr. Ward a lifetime’s worth of thanks. The positive impact he has had as director of the Normal Human Function course on his colleagues and his students is immeasurable, and we thank him today for his contributions to the foundational medical knowledge of hundreds of medical students and wish him all the best for his future work.
Let me add my thanks and personal appreciation to those of our students. I’d also like to acknowledge the ongoing efforts of all our Course Directors, who carry out their roles so effectively and provide those key “central connections” so essential to our program.
All photographs by Lars Hagberg
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Reflections on reflection on reflection
Hi all: I’m back from a few weeks at our family cottage near Sudbury. Now for those of you from north of Parry Sound, you know that it’s not a cottage, it’s a camp, but I’m translating for all the Southerners here at the UGME blog.
I find that there’s nothing like total exhaustion from installing a new water pump, sanding and staining a deck, staining 6 new Muskoka chairs, and bringing water by hand, up a steep hill, to the garden which one has foolishly planted up that hill. I find total exhaustion quite conducive to reflection. I simply sit and stare at the water. After awhile, my brain starts to work again, and after solving basic issues like food and water (shades of Mazlow), I can even start to get creative. I think about what’s gone wrong, or what needs to be better and I plan. I can plan a brand new cottage (hah!), a new way to pump water (hah!), and even a new garden location. I can plan things to say to my husband when he says, “These Muskoka chairs are so cheap—we couldn’t build them for this money. Let’s get 6.” And then, furtively, because UG at Queen’s is never far from my thoughts, I can even start to reflect on things at UG, and plan to make things even better.
Now this urge to action based on reflection is my favourite perspective on reflection. Unfortunately, I’ve never been one to meditate, or think about the moment, or think about nothing, or “relax”. (However, I did take Dr. John Smythe’s 6 week course on mindfulness and just to show you how good he and the course are, by week 6, I found I actually could be mindful, focus on an object and poof! Gone for 15 minutes! I highly recommend it, and I try very hard to put his precepts into practice!)
But generally, I’m a Kolb-ian. I like Kolb’s model of experiential learning—it speaks to me as a call to action. He advises, in essence, to act, reflect on the action, take it to other reference points and then make an action plan. I think I’ve shown you this before, but just in case…:)
So, on what did I reflect, in my moments of recovery from projects at the cottage? (Did I mention my perennial and consistent devotion to ridding the cottage of mice droppings as part of my activities? I abstractly conceptualize that as draining the ocean with a teaspoon. (See Stage 3 above.)
Well, one thing I did was bring a book that I promised I’d give you some feedback on, up to the cottage. It’s entitled English and Reflective Writing Skills in Medicine by Clive Handler, Charlotte Handler and Deborah Gill (CRC Press). I took some great things from this, to share with you. They are reflections and pieces of reflections, morphed into this article, which is something I strongly advice with reflection. Reflections are private. An action or a blog article, for example, is something that can be crafted from reflections into a public piece of writing.
One thing that really spoke to me was the list of areas and experiences that can generate good critical reflection especially for learners in medical education. I think, too, that even for experienced practitioners these questions can trigger reflection.
About a patient:
- A patient happy or unhappy with their treatment by you or others
- A question of confidentiality, consent or inappropriate risk
- Doing something for the first time
- Communicating with older or frail people
- Consultations involving more than one person (for example, a relative)
- Sudden death or deterioration
- An aspect of a patient encounter that revealed gaps in your knowledge or skills
- An even that caused you anxiety or enjoyment
- An aspect of care that left you surprised, puzzled or confused
- A patient that challenged our assumptions or whose actions are at odds with your personal beliefs and values
About the team
- When you feel an aspect of the treatment or management is wrong
- A dysfunctional team that affects patient outcomes or experiences
- The actions of a team under pressure
Good medical practice
- Times you have exhibited good medical practice or found yourself in a situation that may be at odds with good medical practice
- Times when you have seen medical practice or behavior that may be at odds with medical practice. (pp. 6-7)
What do you think?
Now the authors also tackle the dicey area of marking and giving feedback on reflective writing. Medical students are often extremely concerned about who will see their reflective writing, and whether that will impact on the faculty member’s opinion of the student. This seems to me to be quite understandable, and it’s why I mentioned above, that taking a reflection and crafting it into a set of goals or more concretely, an action plan, with some work already done, is often a very positive spin to put onto a problem area that a student has identified. I used to tell my education students, “It’s not a question of whether any of us will make a mistake or not. It’s a question of how we recover, and deal with the mistake that makes the good teacher.” I think that is also true of the good doctor.
So…in order to create an action plan the authors advise using the Kolb cycle but changing it slightly to:
- Identify and describe a professional scenario
- What are the perceived consequences of these behaviours?
- What are the implications for professional practice? [Sheila’s note: at this point I would challenge students to walk the walk and provide some evidence from medical and medical education literature to demonstrate the implications and help provide solutions for 4.]
- What evidence can you provide to show how you have used this experience to develop your practice and inform your behavior in professional scenarios? [Sheila’s note again: OR What is your plan of action to change the behavior?] (p. 12)
At this point the book delves into how to assess the writing skills of the students and it’s full of good advice about grammar and tons of examples of reflective essays.
Speaking of assessment, I’ve been hearing that some students don’t feel that receiving feedback on the lack of clarity and the amount of spelling and grammar errors in their med ed writing is within the realm of medical education. Well, it is one of our Curricular Objectives (CM 1.3a: Provide accurate information… in a clear, non-judgmental and understandable manner.) And I can only imagine what you readers are saying to yourselves right now, about the importance of clear writing in transitions of care, etc.
What I do have for you is a row for a rubric I created for clarity of expression. So should you ever be assessing student writing, and want to use it, feel free.
10 prompts write reflections
Lastly, here are some ways to write about reflections that give a format or form to the thoughts. Students may find these more enjoyable, or at least more guided. What do you think? Do you have others?
- So What? Journal: Identify the main idea of the lesson or incident. Why is it important? Why is it important to others?
- Analogy (or Simile): Explain the main idea using an analogy. (Has the benefit of making everyone look up “analogy”.) OR could be explain this idea as a simile: It’s as if, or it’s like… Then, folow the thread of the anaology or simile.
- Question Stems
- I believe that ________ because _______.
- I was most confused by _______.
- What surprised me was _______
- A patient (a nurse, a physiotherapist, etc.) would see this incident as _____________.
- When I read up on this, here was one interesting solution____________
- Muddy Moment: What frustrates and confuses you about this incident? What will you do about it?
- Double Entry Journal: Jot down main points, questions, etc. in left hand column. In right hand column write about these, including actions for the future
- Twitter Post: encapsulate in under 140 characters.
- Praise from your Mother (or Father or other person who loves you): “My son’s (daughter’s etc.) done this_______” (In other words, have someone else brag about you if you won’t.)
- Top Ten List: What are the most important takeaways, written with humor?
- Quickwrite: Without stopping, write what most confuses you. Use a concept map or other format to try sorting it out.
- If I were writing a blog about this ____(opinion, incident, topic), I would write__________________.
(Adapted from “Dipsticks: Efficient Ways to Check Understanding; http://www.edutopia.org/blog/dipsticks-to-check-for-understanding-todd-finley)
Well, those are some reflections on reflections from my time up North. I’ve also partially solved the mouse dropping problem (all the dishes are now in bins when we leave!) And I’ve figured out what to say to my husband when he advises buying 6 chairs we have to build and stain: “You are right, dear!” (because he was right, and they look awesome!).
I’ve also once again realized how rejuvenating short physical projects can be (they have an end! 🙂 and how much I love to sit by a lake and think. I just have to figure out how to keep this reflective spirit going all year long! As for the water pump…well, maybe part of the reflection is that some things you just have to live with!
Any reflection on reflections to share? Feel free to write in!
Teaching the Way You Practice: Collaborative Active Learning in Different Teaching Settings
By Michelle Gibson (email@example.com) and Melissa Andrew (firstname.lastname@example.org)
Most health professionals are actively engaged in collaborative practice: working with many different team members from different disciplines to support patients or clients in achieving their health goals.
However, we often teach our learners in isolation from one another, and, if we are being honest, co-teaching and integration between disciplines in an educational setting can be challenging. When it ‘works’, however, it is very rewarding, and it is an opportunity to role-model explicitly for learners how different disciplines with differing approaches can work together to enhance care. When co-teaching is combined with active learning that mimics the wonderful messiness of real clinical practice, learners can start to envision how complex problems are approached in “real-life”. In our experience, this is particularly powerful when we have students also working in teams on complex, real-world cases.
We offer up tips and lessons learned in six years shared teaching between geriatric medicine and geriatric psychiatry in undergraduate and post-graduate settings, to different audiences. We have also co-taught with other health care disciplines but our examples come from our co-teaching.
Examples of what we teach together:
- Second year medical students: We built on-line modules for students to use first on dementia and delirium, and then we co-teach the session that applies this learning to real-life cases. Dr. Andrew co-teaches a 2nd session on “Brain and Behaviour” with a psychogeriatric resource consultant.
- Family Medicine residents: We have 2 half-days which deal with common, complex, outpatient problems in older adults: the patient who arrives on a Friday afternoon with falls, confusion, and a letter from an anxious daughter; the patient who is extremely cognitively impaired, falling frequently, with a nightmarish medication list, and no family members who can provide history; this same patient who has a valid drivers’ license, and who may or may not be depressed.
Tip # 1: Start with being clear about your purpose(s), goals, objectives.
While this is important for all teaching, it becomes essential when more than one individual is involved. For example, when we started to design academic half-days for family medicine residents, we worked out that we were aiming to help them approach complex patients with multiple problems in an outpatient setting, while highlighting how geriatric psychiatry and geriatric medicine are similar, how they are different, and how we work together. These sessions work best with a shared vision.
Tip #2: Be explicit about roles and expectations.
Similar to Tip #1, this does get increasingly complex when more than one (extremely passionate and very dedicated) teacher is involved in any learning event. Who is preparing what? By when? How are the different parts going to be taught? There is nothing worse than realizing the day before that you were the one expected to prepare the quiz. J
Tip #3: Avoid ‘parallel play’.
Some attempts at integration or co-teaching end up being a series of lectures or teaching sessions that happen to be scheduled in approximately the same time period and are not really integrated. The best sessions involve a back-and-forth approach, with many opportunities to address areas of controversy in a respectful manner. (See Tip #4)
Tip #4: Embrace controversy, respectfully.
Junior learners in particular, in our experience, become stressed when it appears there is no one “right” answer. We live, wallow, and celebrate the land of the gray-zone in geriatrics (pun intended), so we rarely have one correct answer. However, how we address this in our teaching is important. We frequently check in with one another: “How would you approach this in your setting?” and acknowledge strengths in differing approaches.
Tip #5: Embrace complexity, carefully.
We have been pleasantly surprised as to how groups of learners are able to work together to approach very complex cases, when there is a safe learning environment. For example, we give learners a very complex medication list, while providing an approach for them to practice, and we emphasize that there are many ‘right’ answers. When we debrief this exercise, we use our different backgrounds/expertise to help students navigate the pros and cons of different decisions. The team setting for teaching appears to allow students to feel safe to address areas of discomfort – that wondrous gray zone in which we revel. We all consult when there is a great deal of complexity, and we should role-model this for our learners.
Tip #6: Play your best cards.
This is a great time to determine who is best at which parts, and use these skills to your advantage. This applies both to clinical expertise, but also to teaching styles: who is the best person to teach X? Who is better at addressing this particular issue? Why not compensate for each other’s’ weaknesses? You also have the huge benefit of learning from your colleague.
Lesson #1: It takes more time up front, but less time the more you do it. The discussions, planning, negotiations about “what is the way we want to approach X” does require more time initially, but it gets easier each time.
Lesson #2: If possible, it’s best (in our opinion), and more fun, to co-teach with people that you work with regularly. The established trust and long-standing respectful relationships, we believe, shine through for learners, allowing them to feel comfortable when we ‘disagree’ on certain issues. This is much easier to do in a collegial way when you know how the other teachers work and think. Plus, teaching with friends is fun.
Lesson #3: Going out for lunch to plan teaching is optimal. ‘Nuff said. Seriously, though – it’s hard to plan teaching in the midst of busy clinical work. Set aside time to think about things, and to meet in a positive environment.
Lesson #4: Where there is assessment involved, co-marking is hugely informative – as in, set aside time, sit down together, and mark together. It allows us to delve into why students thought X, when clearly we thought we were teaching Y. There is also the distinct advantage of being able to share the marking load, whilst sipping on pleasant beverages. More importantly, though, by discussing the answers, we are able to immediately adapt our teaching plans for the following year.
From Bookends to Bookcases: On Finding Some Great Summer Reading
Oh hello! Still in that hammock from our last blog?
Well don’t worry—this time I’m not here to get you up to plan next year’s courses. 🙂 I do have more to say about bookends, but that can wait until closer to September, when you start planning your classes.
For now, I’m here to help with your summer reading list to fill up your bookcase. I’ve asked a few colleagues for ideas, and (as always) I have some ideas of my own.
Dr. Lindsay Davidson contributed: Getting started with TBL by Jim Sibley http://learntbl.ca/book/ as an excellent way to introduce yourself to teaching with small groups as we do in Queen’s UGME.
Dr. Sue Fostaty-Young contributed one of her go-to books on teaching: Therese Huston’s Teaching What You Don’t Know. Sue says, Intended as a book for new and junior faculty members who frequently have to teach large service classes that may be far removed from their areas of interest or expertise, the book is simply one of the best all round books on teaching that I’ve come across.
Paola Durando, librarian at Bracken suggests: How to Teach: A Handbook for Clinicians (Success in Medicine) 1st Edition by Shirley Dobson, Michael Dobson, and Lesley Bromley. (Now in Bracken Library!)
Sandra Halliday, and Suzanne Maranda, also librarians at Bracken, remind us about the reading guides for medical education: http://guides.library.queensu.ca/healthed A quick skim of this really great resource turns up some intriguing titles: Medical education : a dictionary of quotations by Kieran Walsh, Medical Education: theory and practice with Tim Dornan, Karen V. Mann, Albert Scherpbier and John A. Spencer (Editors) (I think I’ve mentioned this one before—it’s another what I call a great “Dipping” book and anything by Karen Mann has my vote),
Dr. Richard Van Wylick contributes these 4 books. He says,
- This one got me off to a good start: Guidebook for Clerkship Directors:
- I have not read it yet, but was recommended and I certainly need help personally with this these days!: Make it Stick by Peter Brown: (Sheila’s note: I’ve read this and it’s really helpful, practical and interesting for teachers as well as learners—turns traditional teaching “beliefs” on their head. Here’s what Amazon says, Many common study habits and practice routines turn out to be counterproductive. Underlining and highlighting, rereading, cramming, and single-minded repetition of new skills create the illusion of mastery, but gains fade quickly. More complex and durable learning come from…
And now you’ll have to read it! SP)
- This is a light read,with funny short anecdotes and stories: The Surprising Lives of Small Town Doctors:
- And well, because I have two of them: The Teenage Brain: A Neuroscientist’s Survival Guide to Raising Adolescents and Young Adults by Frances Jensen with Amy Ellis Nutt: https://www.amazon.com/Teenage-Brain-Neuroscientists-Survival-Adolescents/dp/0062067842
Sheila’s completely idiosyncratic picks:
- As for me, I’ve finished dipping into The Question of Competence: Reconsidering Medical Education in the Twenty-First Century, with Brian Hodges as editor. With Competency-Based Education so critical, it’s a great book to get at some of the implications of CBE and it truly is dippable—you don’t need to read it cover to cover in one setting, but can dip into chapters as interest guides you. I call these my “Dipping” books.
2. Someone recently gave me Gratitude by Oliver Sacks (Thanks SM!) which has motivated me to pick up his Musicophilia: Tales of Music and the Brain. I find him an inspiring writer so I’m looking forward to reading this. And Gratitude is certainly worth picking up for its three lovely reflections.
3. Recently, one of our faculty heard that it wasn’t her job to comment on students’ spelling, grammar and syntax as a medical educator. That’s actually not correct (it’s in our Red Book objectives) but to bolster the case, I found this book by Clive E. Handler that looks interesting: English and Reflective Writing Skills in Medicine: A Guide for Medical Students and Doctors. I’m ordering it to read over the summer so I can let you know. But anything that has writing skills and reflection in the same title is a hook for me!
4. Because I’m fascinated by the odd reputation that reflection has in medical education, (I’ve seen medical students blanch and strong doctors flinch at the term :), I’ve been dipping into A Teacher’s Reflection Book, Exercise, Stories, Invitations by Jean Koh Peters, and Queen’s own Mark Weisberg. I’ve just finished Chapter 5, The Teacher and Vocation (I have a bad habit of reading chapters out of sync—I read Margaret Atwood’s Alias Grace, from the end backward—turned out to be a great book!). While the word vocation might make some shy nervously, I’m really liking the exercises. It starts off by asking “What if you had nothing to prove?” What a great question!
Since I’m reflecting on writing about reflecting for a later blog, I’ll save the full review for later, but try this one exercise: Write your personal mission statement or your “call” as a bumper sticker. And here’s a teaser. There is a paradigm shift in viewing your teaching as a vocation rather than a career. Here’s one example: Career = Who am I? What’s in it for me? Vocation = Whose am I? Who am I in teaching for? (James Fowler).
I’ve just started reading When Breath Becomes Air by Paul Kalanithi. Isn’t it a wonderful book? I also have a bad habit of reading 3 books at the same time, but this one is maintaining first place in my reading triad easily! When Breath Becomes Air is a memoir chronicling Paul Kalanithi’s life as he studies at Stanford University, and then at Yale University’s medical school. Kalanithi is close to finishing his training as a neurosurgeon when he is diagnosed with stage IV lung cancer. This is a haunting book for me and one that is inspiring me as well.
And last but not least, because summer and especially vacations are a great time to exercise your right brain, and because she’s a favourite author of mine, may I recommend: The Virginia Woolf Writers’ Workshop: Seven Lessons to Inspire Great Writing by Danell Jones? This is another great dipping book, and I’ve tried each of the exercises—so much fun!
What about you? What great books are you heading for this summer? Feel free to write in with your suggestions! And thanks to my colleagues for their suggestions!
Hope these give you some ideas so you can climb back into that hammock and bury yourself in many good books this summer! Have a peaceful, restful, reading-ful summer and I look forward to seeing you come the fall.
Navigating multiple paths to service-learning projects
Anyone with their ear to the medical education ground in the past year will know that service learning is a very, very hot topic. Ever since the Committee on Accreditation of Canadian Medical Schools (CACMS) endorsed service-learning as an important (but optional) element of the education of future physicians, medical schools across the country have sought to incorporate this as a feature of their curriculum. However, service-learning, by its very nature, can leave students feeling uncomfortable: it’s structured but open-ended.
Consulting with community members to set goals and design projects is not always as straight forward as mastering the objectives of a standard medical course. Unlike other curricular and co-curricular activities, service-learning projects often start with pretty broad objectives. Add in consultation with multiple community stakeholders and the projects themselves can seem quite nebulous at the start.
We’ve written about service-learning on the blog before (here and here) as we’ve continued to develop our approach to encouraging and supporting our students in engaging in service-learning. Service-learning projects are one way our medical students (and pre-medical students, in the case of QuARMS) enhance their understanding of working with community members, explore intrinsic physician roles, and contribute in a very real way to our medical school’s social accountability to our communities.
On a national level, the Canadian Alliance for Community Service Learning (CACSL) provides support and networking opportunities for students, educators and communities engaged in these endeavors. At their recent biennial conference held in Calgary, multiple presenters addressed students’ issues with the ambiguity of service-learning projects compared to other learning activities.
When students have the autonomy to define what is happening with a project in cooperation with an organization, they can feel a little lost, one presenter, Chelsea Willness, an assistant professor at the Edwards School of Business at University of Saskatchewan, noted.
“Students are very uncomfortable with the ambiguity: ‘What do you mean, I don’t know what I’m going to be doing?’”
They want templates and checklists because that’s familiar, she added.
It’s clear that while many students are excited about the opportunity to engage with community partners, they both need and want support. Equally important is providing them with reassurances that each project will have its own path – which includes some levels of uncertainty.
Here’s the Queen’s UGME operational definition of service-learning (as there are multiple interpretations of this term):
“Service-learning is a structured learning experience that combines community service with preparation and reflection. Medical students engaged in service-learning provide community service in response to community-identified concerns and learn about the context in which service is provided, the connection between their service and their academic coursework, and their roles as citizens and professionals.”
One key word in that definition is structured. Providing as much structure as possible can help ease students’ discomfort with some of the ambiguous nature of service-learning. To that end, the Teaching, Learning, and Integration Committee (TLIC) has been assigned oversight of service-learning for undergraduate medical students and has implemented three possible avenues students may use to have a service-learning project recorded on their MSPR.
To launch this, a one-hour session on service-learning was added to the first-year Professional Foundations course earlier this year. This learning event included information on why we’re deliberately supporting extra-curricular and co-curricular service-learning activities as well as information on potential service-learning avenues. As part of this session, members of the Class of 2019 were polled to see what types of service-learning projects they might be interested in and how these might fit in the three paths.
Here are the three paths to a recognized service learning project:
- Participate in an existing student-led volunteer initiative and complete the additional tasks necessary to extend this to a service-learning project
- Complete an individual service-learning project, which meets the requirements (including consultation and reflection)
- Take part in a service-learning pilot project brokered by the TLIC
Dr. Lindsay Davidson (Director of the TLIC) and I have met with representatives from several established student groups whose existing activities were quite close to our service-learning definition and threshold to map out ways their participants could extend their volunteer service into a service-learning project (this is always optional). Typically, this meant documenting some form of consultation and implementing some form of reflection on learning. These groups include SwimAbility (formerly Making Waves) and Jr. Medics. Other groups can be added to this list (email me: email@example.com to set up a meeting about this if your group might fit).
The two initial pilot projects are with Loving Spoonful (an organization with the goal of enhancing access to healthy food) and the Social Planning Council (with a focus on social housing in the Kingston area). These will be longer-term projects with sequential groups of students completing phases of a larger, continuing project. (The first participants have already been identified through the PF class poll. Recruitment of UGME students will be through the TLIC, not through the agencies).
For each of the three paths, students must submit evidence of meeting the threshold for each aspect, using forms provided by the TLIC. These will be made widely available in September using a MEdTech community page. Here are the requirements for any project to be recognized:
- The project must serve the needs of a group in the wider community (i.e., not medical school-focused)
- Complete some form of consultation with community participants and/or stakeholders (this will look different depending on the type of project and service)
- Complete between 15-20 hours of service (with no more than 20% devoted to training)
- Completed a required reflection on learning
In the future, as more students engage in formal service-learning projects, students’ reflections on their learning may be presented at a service-learning showcase, similar to the Undergraduate Research Showcase that is held each year.
While having three different routes to recognized projects may seem to add to the ambiguity of “what does a service-learning project look like”, providing multiple avenues for recognition was important.
“Our students have many different interests and we wanted to leverage that by providing multiple avenues for service-learning projects to be completed and recognized by the school,” Dr. Davidson said.
We’re never going to completely eliminate the ambiguous nature of service-learning projects, but we’re working to put structures in place that can meet a variety of students’ interests and community needs.
With thanks to Dr. Davidson for her contributions to writing this post.
Celebrating Student LEADership
This week, I’ve invited one of our soon-to- be-graduating students, Elizabeth Clement (Meds 2016), to report on the LEAD (LEadership Enhancement and Development) program, an initiative she and a group of her colleagues have conceived and completed over the past year. When Liz, Alia Busuttil and Graydon Simmons first came to me with this idea, I must admit to thinking it was overly ambitious, particularly given they were just beginning their clerkship. Once again, I underestimated the commitment and tenacity of our students when they are pursuing a deeply held and worthy cause. I attended the presentations of the Service Learning projects that Liz describes below, and was greatly impressed at the ingenuity and commitment to community service that went into them. Inspiring, indeed. The LEAD program is being passed along to other students, who will work with myself and other faculty to ensure this great work continues.
I’m often asked what keeps our Queen’s faculty so engaged and energized about medical education. For a glimpse into the explanation, read on.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Mind the Gap by Elizabeth Clement
There’s always a natural tension between student and teacher. While there is a clear common goal, which in medicine is that of graduating a competent doctor, it is easily muddied by the varied opinions on how to achieve such a goal. Students have many competing interests – that extracurricular activity, research project, or family commitment. Faculty, too, are juggling their many hats – hospital service, clinics days, conferences and their home life. Over time, many, if not all, show up to the classroom with slightly less enthusiasm, and as teaching begins to deviate further from one’s preconceived notion, it’s easy to see how that unity of working toward a shared goal begins to erode.
If you’ve ever been on the subway in London, England, I find this reminiscent of the vaguely haunting mind the gap. As the train pulls up to the platform, the two bodies never perfectly line up, leaving a small space between the two: a gap. The overhead voice reminds you to mind the gap: don’t fall in. Because of the nature of the subway’s short stops, you’re either on one side of the gap or the other. You’re either on the train or off the train. You’re either a student or a teacher. Mind the gap.
In my first year at Queen’s, I remember being floored by the openness and candidness of our faculty. Town halls and curricular feedback and personal email exchanges. Even more surprising was that changes were made within courses reflecting this feedback. Often this would happen in real time; courses would morph not after, but as we advanced through them.
It was not surprising to me, therefore, that when a dialogue began about students’ interest in leadership training, the idea of a student-run leadership course received faculty support. The first of many conversations about this project happened more than two years ago, and was the seed for the Leadership Enhancement and Development (LEAD) course. Now, at the conclusion of its first iteration, 12 preclerkship students have wowed us.
In the first of those two years, members of the Class of 2016 (Graydon Simmons, Alia Busuttil and myself) worked together to create a curriculum structure: one part seminar, one part self-reflection, and one part project. In the second year, the team grew as three members of the Class of 2017 (Rajini Retnasothie, Laura Bosco and Lauren Kielstra) joined us to help plan, administer and facilitate the course. Then, in November of this past year, 12 preclerkship students joined the course and we met for the first time as a large group. Amidst explanation of the structure of the course, we were clear about one thing: you will get out what you put in, and what you put in is completely up to you.
During the course, we heard from Queen’s School of Business’ Borden Professor of Leadership Julian Barling, who taught us about motivating with responsibility, and the importance of showing gratitude. We heard from our very own Dr. Sanfilippo about the pillars of leadership; optimism is imperative. We broke into groups of three to discuss our thoughts and reflections while working through the CMA’s “Leadership begins with self-awareness” modules. Meanwhile, outside of the course, students were independently working on “service learning projects,” which required community consultation, strategic design and a significant time commitment. The final seminar, held in mid-April, was a platform for the students taking the course to give short presentations on their service learning projects.
This was inspiring:
- Reza Tabanfar’s Telemedicine to Improve Access-to-Care and Treatment of Ear Disease in Remote Ontario Communities: We hope to use digital otoscopy and existing telemedicine infrastructure to leverage ENT’s expertise in diagnosing ear disease, facilitating much quicker review and prioritization of patients presenting with ear complaints in remote Ontario communities.
- Zain Siddiqui’s Jumu’ah Prayer Service at the Kingston General Hospital (KGH): The project’s aim is to have Jumu’ah, the weekly Islamic congregational prayer, in the KGH chapel so that that KGH staff and visitors can attend.
- Sejal Doshi and Elisabeth Merner’s Street Soccer Kingston: This project is an opportunity to build routine and social supports for Kingston’s homeless/transition housing community all while promoting the importance of physical health.
- Mahvash Shere’s Global Health Simulations – Queen’s Chapter: This project will allow students to engage in hands-on negotiation and problem-solving, by putting them in the middle of a humanitarian crisis and asking them to engage with different stakeholders attempting to resolve the crisis. Post-simulation debriefs will give students the opportunity to reflect on the complexity of problem-solving and power dynamics in these situations.
- Stephanie Pipe’s Revamping Altitude’s Mentee Recruitment Process: This project involves implementing new recruitment strategies, such as more advertisement of the program at the high school level and working with other groups and resources on Queen’s campus, to better reach our target population and hopefully increase the representation of our target population in the program.
- Katherine Rabicki’s Women and HIV/AIDS Situational Analysis: We are collecting data on the experiences of women living with, or at heightened risk of contracting, HIV/AIDS, with the goal of adapting Kingston’s community-based services to better suit the self-identified needs of this population.
- Connor Well’s Inspiring Future Medical Students Through High School Community Outreach: this project will determine the feasibility of encouraging high school students, especially from underrepresented backgrounds, to consider medicine as a career through knowledge translation of the medical school application process at high school career fairs.
- Akshay Rajaram’s Quality Improvement Practical Experience Program (QIPEP): QIPEP offers Queen’s students a chance to develop quality improvement and patient safety through participation in real quality improvement and patient safety initiatives that impact patient care.
As I walked around the room hearing students talk about Jumu’ah, global health simulations, and street soccer, (I’m a little embarrassed to admit it, but) I was getting euphoric. Maybe it was these students’ optimism or show of hard work. Maybe it was their passionate pursuits in the absence of obligation. At the end of the day, I think it was quite simply that I was learning about topics that, without these students, I would know nothing about. THEY were teaching and I was learning; not the original design of our course!
I had not occurred to me until then that perhaps faculty who teach are motivated because they, too, want to learn. When we consider life-long learning as a part of our professional responsibility, most of us consider that to mean staying up-to-date with medical practice changes, but there’s a lot more to be learned that can impact the practice of medicine. When faculty solicit student feedback, it’s in an effort to connect with students and better appreciate how learning is changing. Perhaps like a student’s satisfaction when performing well on an exam or rotation, faculty find satisfaction when making improvements to curricula; both demonstrate knowledge gain. And beyond this, I wonder if there is a deeper satisfaction borne from the notion that better learners will make better teachers.
In any case, a cyclic theme emerges: those who are committed to teaching are those who are committed to learning.
At Queen’s, it is clear that the doors are open to peer-teaching; the anatomy and Being a Medical Student professionalism curricula are two of many examples. But I think we can do more. Students are a resource; our diverse walks of life foster perspectives that can help reinvigorate content and delivery – this has particular relevance with the non-medical expert competencies.
Under no circumstance am I trying to suggest that Queen’s does not involve its students; in fact, I know the opposite to be the truth. Instead, I’m suggesting that a deeper involvement may serve both faculty and student in a novel way – by helping us appreciate the complexities of one another’s roles. Not only would the end product have curricular value, but the process would help us all to collectively mind the gap.
CCME 2016: We came, we saw, we presented!
It’s been a busy four days at the Canadian Conference on Medical Education in Montreal – five or six days for those involved in business meetings and pre-conference workshops that started on Thursday.
In addition to attending sessions, plenaries and business meetings, Queen’s contributors were lead authors, co-authors, supervisors, and collaborators with colleagues from other universities. We presented posters, led workshops, and gave oral presentations.
All told, close to 80 members of the Faculty of Health Sciences – faculty, administrative staff, and students – contributed to producing 36 workshops, oral presentations and posters. While not all of these people were in Montreal, Queen’s was well represented in the conference rooms.
We invited those participants to share information on their presentations as well as any thoughts they had about the conference itself. (Keep in mind that it’s been a jam-packed weekend and we weren’t able to track everybody down.) Here’s a sampling of what went on:
Alyssa Lip and Shannon Chun (MEDS 2017) gave an oral presentation on the progress of the Wellness Month Challenge which was developed by the Queen’s Mental Health and Wellness Committee. “This year, this challenge has expanded to 12 medical schools across Canada and reached 1085 medical students,” Alyssa noted. “In addition, we found a significant increase in resiliency in students surveyed before and after participation in the initiative.”
Laura Bosco and Jane Koylianskii (MEDS 2017) presented on the “Impact of Financial Management Module on Undergraduate Medical Students’ Financial Preparedness.”
“We created a novel web-based financial management educational module with the aim to educate medical students on the expenses of medical school, as well as the various sources of available funding, and outline the necessary steps to achieve the most financial support throughout undergraduate medical education,” Laura explained. “Our primary objective aimed to compare medical students’ financial stress prior to and following the completion of this financial management educational module. This issue is important because medical students often make residency and career decisions that are influenced by their accumulated financial debt, and we feel that the process of career selection and development should revolve around students’ interests, not financial barriers.”
Brandon Maser (MEDS 2016) presented a poster on the CFMS-FMEQ National Health and Wellbeing Survey. “The Canadian Federation of Medical Students and the Fédération médicale étudiante du Québec have worked together developing and implementing a national survey on medical student health and wellbeing at all 17 Canadian medical schools,” he said. “With approximately 40% national response, we now have a wealth of data on medical student health, and will be working with faculties and medical societies in order to elucidate risk and protective factors for medical student health, and to create recommendations for the improvement of supports and resources.”
Louisa Ho and Michelle D’Alessandro (MEDS 2017) presented on the Class of 2017’s Reads for Paeds project. “Reads for Paeds is a Queen’s medical student-led initiative that seeks to develop engaging, illustrated, and age-appropriate books for children with specific medical conditions,” Louisa explained. “Our study shows that participation in a student-developed and student-led service-learning project like Reads for Paeds can enhance students’ understanding and application of CanMEDS roles, thus benefitting their overall development as medical trainees.”
Jimin Lee (MEDS 2017) was one of several students who prepared the poster presention on Jr. Medics. “We evaluated the Jr. Medics program at Queen’s medical school as a service learning project,” she said. “We found that while engaging with the community by teaching basic first aid skills to local elementary school students, medical students developed competence in the CanMEDS roles as a communicator and professional. Our findings support the development of service learning opportunities for medical students with explicit learning values for students and quantifiable outcome in the community.”
Justin Wang (MEDS 2017) shared information on “SSTEPing into Clerkship”: A Technical Skills Elective Program for Second Year Medical Students, which was prepared with coauthors Tyson Savage, Peter (Thin) Vo, Dr. Andrea Winthrop, and Dr. Steve Mann“The Surgical Skills and Technology Elective Program is a 5-day summer elective program designed for second year medical students to teach and reinforce both basic and advanced technical skills ranging from suturing to chest tube insertion,” he said. “Anxiety as well as a lack of both knowledge and confidence in the performance of technical skills has been found to inhibit medical student involvement in real clinical settings. Our research found that anxiety was significantly decreased, confidence and knowledge were significantly increased, and objective technical skills were significantly improved immediately after program completion as well as 3-months later, demonstrating retention of these effects. These results support the use of a week-long surgical skills program prior to the start of clerkship for second year medical students.”
Alessia Gallipoli (MEDS 2017) presented her poster on an “”Investigation of the Cost of the CaRMS Process for Students”, completed with Dr Acker. “It looks at the average costs that graduating medical students can expect to pay in regards to different aspects of the residency application and interview process,” she said. “The results of this study may help students make informed decisions throughout the CaRMS process, to balance career ambitions with smart financial planning. It can also inform initiatives to support students both financially and with career planning throughout their training.”
Jason Kwok (MEDS 2017) presented on a novel method of teaching direct ophthalmoscopy to medical students in the current medical curriculum, where there is decreasing emphasis and time dedicated to ophthalmology. “Our learning method, which consists of a peer competition using an online optic nerve matching program that we created here at Queen’s University, effectively increases the self-directed practice, skill, and learning of direct ophthalmoscopy in medical students,” he said. “This learning exercise has been implemented in the first year Queen’s medical curriculum for the past two years with great success.”
Vincent Wu (MEDS 2018) noted, “The CCME serves as an avenue for us to present the accomplishments of the First Patient Program, as well as some of the unintended student learning themes. This research helps to further refine student learning within the undergraduate medical curriculum, in order to better understand healthcare delivery from the patient’s perspective.”
Adam Mosa (MEDS 2018) presented his research on using patient feedback for communication skills assessment in clerkship in a project entitled Sampling Patient Experience to Assess Communication: A Systematic Literature Review of Patient Feedback in Undergraduate Medical Education. “This project highlighted a paucity of studies on how to use patient feedback, which is an untapped source of learner-specific assessment of this fundamental CanMEDS competency,” Adam said. “CCME 2016 was a great place to meet like-minded educators. In particular, my suggestion for an “unconference” was chosen, and I spent time discussing the future of patient feedback with a diverse group of enthusiastic participants.”
Amy Acker (Pediatrics) presented a workshop with two other pediatric program directors (Moyez Ladhani and Hilary Writer from McMaster and Ottawa) to help give concrete suggestions for teaching and assessing some of the challenging non-medical expert competencies. “We came up with the idea and thought it was a session we would have liked to have attended when we started as PDs,” she explained. “We took participants through a blueprinting exercise to identify what they need to teach, resources they will need to teach and how to assess, in case-based format… hopefully everyone learned something!”
Catherine Donnelly (School of Rehabilitation Therapy) was the PI on the Compassionate Collaborative Care project, which was funded by AME “The Phoenix Project”. “The aim of the project is to support the development of compassionate care,” she said. “The output of the project was an online module intended for use by health care students, clinicians, educators and administrators. The module consists of 6 chapters that can be used independently or collectively. The modules have been pilot tested and evaluated with students and health care providers. The modules are open access and can be found here.
Karen Smith (Associate Dean, Continuing Professional Development), shared information on her team’s work: “I am here with my CPD and FD colleagues. We presented at the CPD Dean’s Business meeting on how to meet CACME accreditation standards. We will be sharing some of our scholarly work with posters and a workshop exploring aspects of what makes self-directed learning effective and what CanMEDS competencies are addressed in SDL and the impact of note-taking style on memory retention and reflection,” she said. “In addition to seeking the excellent feedback from our peers to advance our own work, we are learning from our peers. Networking and building relationships with others across Canada is key to our ongoing success.”
Sita Bhella (Department of Medicine) presented a usability study on an online module she designed and created with colleagues in Toronto aimed at improving the knowledge and comfort of general internal medicine residents in managing sickle cell disease on the wards and in outpatient settings. “Presenting at CCME introduced me to new ideas and research methodologies and I hope to continue to present my work there in the future,” she said in an email. “It was an honour to present my work at CCME and to interact and engage with colleagues across the country on research in medical education.”
Kelly Howse (Family Medicine) presented both a poster and workshop. The poster explored issues of Family Medicine Resident Wellness: Current Status and Barriers to Seeking Help.
“Residency training can be a very stressful time and may precipitate or exacerbate both physical and mental health issues. Residents, however, often avoid seeking help for their own personal health concerns,” she said. “The purpose of this study was to assess the current status of resident wellness in our Queen’s family medicine program, with particular attention to identifying barriers to seeking help.”
The Seminar she presented focused on Supporting Medical Students with Career Decisions: National Recommendations for Medical Student Career Advising. “Specialty decision-making and preparation for residency matching are significant sources of stress for medical students. Through the FMEC PG Implementation Project, Queen’s led the development of national recommendations regarding the guiding principles and essential elements of Medical Student Career Advising,” she said. “This workshop helped disseminate these recommendations nationally and will help guide the exploration of relevant career advising resources.”
In addition to presenting their own work, School of Medicine faculty served as mentors for the many student presentations. Lindsay Davidson (Director, Teaching, Learning & Innovation Committee) shared “This year, I’m proudly watching some of our second year students present the poster that we collaborated on, Pre-clerkship interprofessional observerships: evaluation of a pilot project. It has been a pleasure to watch the students come up with the idea, which grew out of their own experiences as participants in a new inter-professional shadowing initiative for first year students, develop the project and reach conclusions that are helping to shape our teaching here at Queen’s. In addition to providing students with experience in conducting educational research, the partnership of students and faculty on such projects is a strength of our UGME program.”
So that’s a bit of what we’ve been up to in Montreal. Oh, and the food was great, too!
With thanks to everyone who was able to make time to send me some information, and apologies to all I’ve left out, especially given that I sent my email request on Friday when many were already in Montreal or enroute. Feel free to send me information I can add as an update (the beauty of blog over print.)
Five great reasons to attend medical education conferences
This weekend many involved in undergraduate medical education at Queen’s are heading to Montreal for the annual Canadian Conference on Medical Education (CCME). From faculty, to students, to administrative staff, we’re attending as presenters, workshop facilitators, and in several other roles.
As described on its website, CCME is the largest annual gathering of medical educators in Canada. Attendees include Canadian and international medical educators, students, other health educators, health education researchers, administrators, licensing and credentialing organizations and governments. The goal is to “share their experiences in medical education across the learning continuum (from undergraduate to postgraduate to continuing professional development).”
This year’s conference in Montreal from April 16-19 is hosted by the University of Sherbrooke (other partners are the Association of Faculties of Medicine of Canada (AFMC), the Canadian Association for Medical Education (CAME), The College of Family Physicians of Canada (CFPC), The Medical Council of Canada (MCC), and The Royal College of Physicians and Surgeons of Canada (RCPSC).)
With the theme is Accountability: From Self to Society, the program includes workshops, posters, oral presentations and plenary sessions designed “to highlight developments in medical education and to promote academic medicine by establishing an annual forum for medical educators and their many partners to meet and exchange ideas.”
Here are five good reasons we take the time from busy spring schedules to take part in this conference:
To present innovations in medical education at Queen’s: We’re doing some great things here at Queen’s and it’s great to share these successes. From early-adoption of the flipped classroom to our First Patient Program, to our Accelerated Route to Medical School – CCME gives a forum to celebrate what we’re doing well.
To learn from colleagues from other Canadian and international medical schools. While we share our innovations, it’s equally beneficial to learn from our colleagues at other schools. We don’t always have to reinvent the wheel.
To wrestle with common issues and gain comfort from being in the same boat. There’s a synergy in working together to sort out challenging issues in medical education.
To network with colleagues from across the country and around the world – this is closely related to both #2 and #3 – networking may not be about a specific challenge at a specific time, it’s making connections with like-minded individuals involved in similar circumstances.
And the food. OK, so this might not be a “good” reason to commit to attend a conference, but it’s certainly a fun part of it. Combining #4’s networking with colleagues with exploring local cuisine is an added bonus.
If you can’t attend this year, consider it for next time. Also, explore conference options closer to home. Our own Queen’s Faculty of Health Sciences Celebration of Teaching, Learning and Scholarship is coming up on June 15.
Improving existing MCQs
By Theresa Suart & Eleni Katsoulas
Writing and editing test questions is an ongoing challenge for most instructors. Creating solid multiple choice questions (MCQs) that adequately address learning objectives can be a time-consuming endeavor.
Sometimes you may have existing questions that are pretty good, but not quite where you need them to be. Similar to a house reno versus new construction, sometimes it might be worth investing the time improve what you already have. How do you know which questions need attention and how can you rework them?
Previous exams are analyzed to determine which questions work well and which don’t. This can provide some guidance about questions that can be improved.
To select questions for an MCQ renovation, you can start with checking out the statistics from last year’s exams (available from your curricular coordinator or from Eleni).
Two statistics are useful indicators for selecting individual questions for tweaking, rewriting or other fixes: Item Difficulty and Discrimination Index.
Item difficulty is a check on if questions are too easy or too hard. This statistic measures the proportion of exam takers who answered the question correctly.
Discrimination index differentiates among text takers with high and low levels of knowledge based on their overall performance on the exam. (Did people who scored well on the exam get it right? Did people who scored poorly get it right?)
These two statistics are closely intertwined: If questions are too easy or too hard (see item difficulty), they won’t provide much discrimination amongst examinees.
If questions from previous years’ tests were deemed too easy or too hard, or had a low discrimination index, they’re ripe for a rewrite. Once you have a handful of questions to rewrite, where do you start? Recall that every MCQ has three parts and any of these could be changed:
- The stem (the set-up for the question)
- The lead-in (the question or start of the sentence to be finished with the answer)
- The options (correct answer and three plausible but incorrect distractors*)
The statistics can inform what changes could be necessary to improve the questions. For one-on-one help with this, feel free to contact Eleni, however, here are some general suggestions:
Ways to change the stem:
- Can you change the clinical scenario in the stem to change the question but use the same distractors? (e.g. – a stem for a question that asks students what the most likely diagnosis is based on a patient presenting with confusion with the correct answer being dementia, can be then re-written to change the diagnosis to delirium)
- Ensure the stem includes all information needed to answer the question.
- Is there irrelevant information that needs to be removed?
Ways to change the lead-in:
- Decide if the questions is to test recall, comprehension, or application.
- Recall questions should be used sparingly for mid-terms and finals (but are the focus for RATs)
- Verbs for comprehension questions include: predict, estimate, explain, indicate, distinguish. How can these be used with an MCQ? For example: “Select the best estimate of…” or “Identify the best explanation…”
- You can use the same stem, but change the lead in (and then, of course, the answers) – so if you had a stem where you described a particular rash and asked students to arrive at the correct diagnosis, you can keep the stem, but change the lead-in to be about management (and then re-write your answers/distractors).
Ways to change one or more distractors:
- Avoid grammatical cues such as a/an or singular/plural differences
- Check that the answer and the distractors are homogeneous to each other: all should be diagnoses, tests or treatments, not a mix.
- Make the distractors a similar length to the correct answer
- Ensure the distractors are reasonably plausible, not wildly outrageous responses
- Skip “none of the above” and “all of the above” as distractors
As you dig into question rewriting, remember the Education Team is available to assist. Feel free to get in touch.
Watch for MCQ Writing 2.0 later this spring.
* Yes, there could be more than three distractors, but not at Queen’s UGME. The Student Assessment Committee (SAC) policy limits MCQs to four options.
QMed students cooking up wellness strategies
by Meghan Bhatia, AS Wellness Officer
and Monica Mullin, Nutritional Wellness Lead
What is wellness? This is a question that proves far more complex than it would appear to be. Although on the surface it may seem easy to define, wellness is an interesting topic to discuss because it can be very personal and take different roles in students’ lives. Buzzwords often surround the wellness curriculum, things like work-life balance, healthy eating, ‘Get Your 150’ and mental or emotional well-being. These categories do indeed contribute to wellness, but with 400 different students and multiple faculty, one size does not fit all.
The idea of taking ownership of one’s own wellness was what piloted Wellness Month at Queen’s University. We may all know the areas of personal wellness, but this month added structure and challenge to these categories, in a hope that people would get new ideas, form habits and lifelong learning would result naturally.
The #keepsmewell challenge was piloted at Queen’s Medicine last year and this year was taken nationally through the CFMS, and run across the country concurrently. At Queen’s we had 160 QMed students participate (including clerks) as well as 18 faculty/staff and 16 QuARMS students.
What was the #keepsmewell challenge? It was a positive habits challenge that had four themed weeks: nutrition week, mental health week, physical week and social academic balance week. Students would receive points for completing tasks on the spreadsheet and were often asked to promote these activities on social media with #keepsmewell.
It was always interesting seeing students stay active and well through their photos with all of the creative paths they took. In particular, the amazing cooking photos from last year were the inspiration behind the QMed cookbook. We decided to compile what students did throughout the challenge so they would have a reference for the rest of the year, of ideas and inspirations; QMED COOKS is available in ibooks or pdf and is free for anyone. It is available here and has been shared nationally and provincially. One of our contributions to the book was adding in nutrition facts and tips that we learnt in school, through resources, or the dietician talk during nutrition week to keep it fun and educational!
Our wellness curriculum is wide and quite diverse, but it is really only a part of QMed students’ wellness. The interest in this month and the positive feedback we have received from this book really does show that students are invested in their own wellness. We both hope that this is just a launching pad for even more nutritional integration into the curriculum, and that many wellness months will continue on, as wellness is difficult to teach, but so essential to learn.