Month: February 2014
CARMS Match Day: What our students are experiencing, and how to help them get through it
For medical students in Canada, there are three days in the course of their career that stand out above all others: the day they receive their letter of acceptance to medical school; convocation (when they officially become graduate physicians); and Match Day. The most emotionally charged by far, is Match Day. For those of you not familiar, Match Day is when all fourth year students learn which postgraduate program they will be entering. The match is the final step in a long process of contemplation, exploration and application. The match and the day itself are full of drama, with all results being released simultaneously at noon. By approximately 12:00:05 all students will know their fate. As you can imagine, there will be much anxiety leading up to the release. For most (hopefully all), the day will be one of relief and celebration. For a very few (and hopefully none), there may be disappointment and confusion. Many schools release their fourth year clinical clerks from clinical duties on Match Day. At Queen’s we have taken the position that our students take on professional obligations during their training and their personal celebrations should not supervene those obligations. Having said that, I’d like to remind any faculty supervising our fourth year students on March 5th of the following:
- Anticipate that your student will be distracted that morning
- Please ensure your student is able to review their results at noon.
- Check on your student. If he or she is disappointed, please be advised that the student counselors and myself are standing by that day to help any student deal with their situation and develop a plan.
- Be advised that the students will almost certainly be holding some type of celebratory event that evening. Although your students are not excused for personal purposes, I would ask that you give them every reasonable consideration.
Fortunately, we have an excellent Student Affairs team, headed by Renee Fitzpatrick, who are available and very willing to answer any questions you may have and respond to concerns regarding our students. They can be accessed through Erin Meyer at firstname.lastname@example.org, or directly at the following:
Student Counselor and Wellness Advisor
Student Counselor and Wellness Advisor
Thanks for your consideration, and please feel free to get in touch with myself or any of the Student Affairs Team if you have any questions or concerns about Match Day or beyond.
Anthony J. Sanfilippo, MD, FRCP(C)
Associate Dean, Undergraduate Medical Education
Does every Canadian have equal opportunity to pursue a Medical Education?
I’m not normally inclined to idle conversation at 4:30 in the morning, but the cab driver who picked me up for my early morning flight home was simply too engaging. Obviously of African descent, he was possessed of that captivating quality that can only be described as charm. Although he spoke with a heavy accent, his vocabulary and language hinted at a subdued intelligence, and his warmth suggested a genuine interest in learning about the people he encountered. He drew me in with the usual questions:
“Where are you travelling today?”
“Have you enjoyed Victoria?”
“Must be nice to get away from the snow for a few days”.
Finally, I succumbed:
“So when do you get off work?”
Turned out, he gets out at noon, and would then be taking his youngest son, Grade 10, to basketball practice. Crazy about basketball, that boy.
“Do you have other kids?”
And he was off. Since immigrating from Ethiopia, he and his wife have had four children. His eldest son has graduated from a college business program. His second son is in his fourth year at university and contemplating law school. Although obviously proud of all his children, there was a particular affection for his only daughter, now in her second year at university. He was quick to point out that she had led her high school class academically and still excelling despite her part time job at a fast food establishment.
“What’s she thinking about doing?”
“Something in healthcare, not sure what.”
“Has she thought about medical school?”
At this point he looked into the rear view mirror and, for the first time during our encounter, seemed sheepish and somewhat lost for words. I felt like I’d crossed a line – asked something a little too personal, perhaps slightly embarrassing for him. After a pause he responded that she was giving it some thought, but hadn’t decided. Things went a little quiet at that point. I had the strong sense that the idea of going to medical school and becoming a doctor seemed beyond her (and his) reach.
“You know”, I said finally, “you remind me of my father”.
This seemed to take him completely by surprise.
“Sure. He immigrated with very little money, took on whatever work he could, and put six children through schooling, including sending me to medical school”.
We chatted for a while, even after arriving at the airport. Certainly we left on very friendly terms, and I don’t think it was just the sizable tip I left.
Although I’ve known for some time about socioeconomic and cultural barriers to medical education, the abstract took on a sense of reality for me sometime during that early morning cab ride through the darkened streets of Victoria.
So what do we know about this? What are the facts, and what do the studies tell us?
- Applying to medical school is not only long and demanding, but also an expensive undertaking. The application process itself, the MCAT examination, MCAT preparation and travel for interviews are all costs that applicants must bear. The process also requires time, which favours those who are able to take time away from summer or part time jobs in order to study and travel.
- The process favours students from urban settings. This relates to the fact that students from rural areas must necessarily move away from home to attend university. In addition, volunteer opportunities, MCAT preparation courses, the MCAT itself are much more available in urban centres. All this is compounded by the fact that rural Canadians are known to have lower income than their urban counterparts (Rourke J. for the Task Force of the Society of Rural Physicians of Canada. Strategies to increase the enrolment of students of rural origin in medical school. CMAJ 2005;172:62).
- Socioeconomic status has an influence on an individual’s perception of their suitability for medical school and a medical career. This is partially because students from more advantaged backgrounds have more access to role models in medicine. (Greenlagh T et al. “Not a university type”: focus group study of social class, ethnic, and sex differences is school pupil’s perceptions about medical school. BMJ 2006;328:7455).
- Students from higher income families receive more family and social encouragement to pursue medical education compared to those who self-identify as coming from “working class” families (Began B. Everyday classism in medical school: experiencing marginality and resistance. Medical Education 2005:39;777).
- The Greenlagh study noted above also suggests that students from lower income families are more likely to over-estimate the costs of post secondary education, while simultaneously underestimating the financial benefits of post-secondary education.
It appears all this is having an effect. An important study by Dhalla and colleagues (CMAJ 2002:166;1029) surveyed 1223 first year Canadian medical students and found that, compared to the general population, medical students were:
- Less likely to be of Black (1.2% vs 2.5%) or Aboriginal (0.7% vs. 4.5%) heritage
- Less likely to hail from rural areas (10.8% vs. 22.4%)
- More likely to have parents with master’s or doctoral degrees (39.0% of fathers and 19.4% of mothers, compared to 6.6% and 3.0% respectively)
- More likely to have parents who were professionals or high level managers (69.3% of fathers and 48.7% of mothers compared to 12.0% of Canadians), including 15.6% of medical students having physician parents.
- Less likely to come from households with incomes under $40,000 annually (15.4% vs. 39.7%)
- More likely to come from households with incomes over $150,000 (17.0% vs. 2.7%)
These findings have since been substantially confirmed by Steve Slade and and his colleagues, who compile the Canadian Post-MD Education Registry (CAPER). http://www.caper.ca/~assets/documents/CAPER_Poster_AAMC_Physician_Workforce_Conference_May-2012.pdf.
It appears, then, that the answer to the question posed in my title is a decided “no”, but do we accept this as an issue that should be addressed, and do we have the collective will to act? To address this, I would turn to those perhaps most familiar with these issues, specifically our young colleagues who have successfully navigated the process and recently entered medical school. None of this, of course, is lost on them, and they do not shy away from addressing the challenge. The Canadian Federation of Medical Students has published a position paper entitled “Diversity in Medicine in Canada: Building a Representative and Responsive Medical Community.” http://www.cfms.org/attachments/article/163/diversity_in_medicine_-_updated_2010__cait_c_.pdf. To quote their document:
“As medical students in a country that embraces diversity, we believe that our medical system should be representative of and responsive to the diversity within our communities. Unfortunately, the medical school admissions process has traditionally favoured students from high-income, urban dwelling, majority groups, thereby limiting the diversity of medical students across Canada and further marginalizing underrepresented patients and communities…An increased emphasis on diversity in medicine would help ensure that medical students and physicians are in tune with the needs of the communities that they strive to serve and represent.”
Clearly, a strong case can be made to address this situation, based not only on the principle of simple fairness, but also the need to ensure our physician workforce appropriately reflects the cultural diversity and particular needs of the population they will ultimately serve. Assuming we accept these points, what might be considered? In seeking solutions, it’s important to recognize the fact that the financial barriers become much less an issue after students are accepted into medical school, at which point they qualify for various sources of private and university-based funding. If the barriers to medical careers are to be truly addressed, mechanisms must be developed to help members of those underrepresented groups become more aware of medicine as a realistic career option, and provide practical assistance in working through the pre-medical educational and application processes. Such initiatives might include:
- High school programs to increase awareness of Medicine as a realistic career option, particularly targeting smaller, socioeconomically disadvantaged communities and underrepresented populations. At Queen’s, our students have taken the first steps in this direction by developing the MedExplore program http://meds.queensu.ca/announcements?id=419.
- Reconsideration of the MCAT as an admission criterion, and provision of viable alternatives
- Reassessment of our admission processes to ensure they are equally accessible to all groups
- Assistance programs for promising students to allow them to engage educational and community service options
- Mentorship programs utilizing physicians and medical students from underrepresented populations
- Programs whereby smaller and underserviced communities might identify promising students for mentoring and career assistance
Obviously, this is a complex issue that will require multiple and creative approaches, all of which seems rather daunting, but perhaps less so when viewed from the perspective of that daughter of a hardworking and devoted Ethiopian-Canadian cab driver.
As always, your perspectives are welcome.
Many thanks to Sarah Wickett, Health Informatics Librarian, Bracken Library for her valuable assistance in the compilation of information for this article.
Medical students offer Queen’s Medical Health Talks for the community
Nothando Swan, one of our first year medical students is heading up a new initiative, Community Health Talks, which begin Feb. 20 at 6:00 p.m. in room 132 of the School of Medicine Building. She writes:
Our medical students at Queen’s University are privileged to study in a state-of-the-art facility taught by experts in the medical field. But what of those who are equally interested in health education but are not medical students?
Queen’s Medicine Health Talks is a new student initiative that invites the public to the School of Medicine Building to engage in lectures on a number of clinically relevant topics. Through a service-learning model, medical students will present lectures with the aim of welcoming and integrating Kingstonians in medical learning. The presentations will be followed by question and answer sessions led by community physicians.
In honour of National Heart Month, the first talk on February 20th is entitled Let’s Talk Heart Health, featuring Dr. Sanfilippo, cardiologist and Associate Dean of the School of Medicine.
The event will run on February 20, 2014, from 6:00-7:00PM in the School of Medicine Building, room 132.
Subsequent talks will be held on March 27th and April 17th. The events are for the public and all are welcome.
If you would like to attend, or would like more information about this event, please email email@example.com
All About Learners
I’d like to devote this blog article to our students and learners in our program. They’ve been on my mind a lot lately for different reasons.
For example, Matthew Church, Meds 2015 was recently a Jeopardy star, http://meds.queensu.ca/announcements?id=648, Karen Chung Meds 2016 is a volunteer star http://www.thewhig.com/2013/11/22/a-special-birthday-meal, and Sophie Palmer, Meds 2017, is a writing star. (Her winning entry for the Dalhousie Department of Psychiatry Annual Student Writing Contest, entitled EtOH, will be posted soon at: http://www.medicine.dal.ca/departments/department-sites/psychiatry/education/medical-humanities/writing-competition.html.
Other stars in the firmament are Eric Blanchard, Meds 2015 who is playing in the OUA singles badminton championships on March 7 and Eve Purdy, Meds 2015, who was selected as the inaugural recipient of the Samuel Wigdor Scholarship for pre-clerkship scholarly excellence and plans to attend the Social Media and Critical Care Conference (SMACC) in Queensland, AU from Mar. 15 – 23, 2014 .
And those are just five of hundreds of stars in our program—students who by their volunteer work, their work in student leadership, their work in interest groups, their application to their research, and their focus on their studies are shining, however subtly and quietly.
It’s a pleasure to work with our students and to help faculty learn more about learners, and so I thought I’d write about a few things that have cropped up recently to do with learners.
I’d like to visit some learning theories that we actually use (and can always use more) in our curriculum: Experiential Learning, Learning Retention, and Learning Styles. You can dip into these as you like.
Experiential Learning: What is it? How can it help teachers and learners? How can teachers be involved?
We had a challenge a few years ago, posed by our accreditation review team, and echoed by other pedagogical concerns. Why are the first two years of medical school so lecture heavy, with little experiential learning and the remaining two years are heavy on experiential learning with little traditional but active classroom learning?
What is it?
Experiential learning involves concepts of internship, making discoveries firsthand, learning through observation and interaction, learning by doing, and shadowing as components of the learning. Formally, Experiential Learning Theory (ELT) seeks to pass on the legacy of those twentieth century scholars – notably William James, John Dewey, Kurt Lewin, Jean Piaget, Lev Vygotsky, Carl Jung, Paulo Freire, Carl Rogers, and others – who placed experience at the center of the learning process, envisioning an educational system that was learner centered. ELT is a dynamic view of learning based on a learning cycle driven by the resolution of the dual dialectics of action/reflection and experience/abstraction. (Kolb & Kolb, 2012, 149)
I was influenced by David Kolb’s Experiential Learning Model (Kolb, 1984) years ago, and Meds students may recognize it translated into our sessions on reflection and critical analysis. Kolb defined experiential learning as “the process whereby knowledge is created through the transformation of experience. Knowledge results from the combinations of grasping and transforming experience.” (Kolb 1984, p. 41). His model involves a cycle of concrete experience that looks like this:
Experiential learning involves skills as well as motivation:
- The learner must be motivated to be actively involved in the experience;
- The learner must reflect on the experience;
- The learner must employ analytical skills to conceptualize the experience; and
- The learner must activate decision making and problem solving skills to apply new ideas gained from the experience.
First Patient Program: Our way of bringing experiential learning into the curriculum:
One way to bring experiential learning into the first two years of our program was our First Patient Program, proposed by Associate Dean, Dr. Tony Sanfilippo. This program, where students are paired with a patient from the community who becomes their teacher, has so many benefits. Dr. Sanfilippo literally carries around reports from the students to show people what they are learning that they could not learn so early in a classroom. Here’s an excerpt from a new one I know he will want to carry around from a second year student:
I think the biggest change in thinking for me was a better understanding that care for patients doesn’t end when they walk out the door, not matter what specialty they’re in..
This program has highlighted the strengths and weaknesses of our health care system for me. One the one hand, I have gotten a better understanding of the ways health care professionals of all fields can cooperate in the care of a single patient. On the other hand, I’ve also seen how that communication can break down and how difficult it is for a patient to advocate for themselves in a medical system that is very complex.
I’ve realized that advocacy doesn’t have to be all grand gestures and tidal waves of change; even small things can make a big difference in the lives of your patients.
My overarching goal is to learn enough about the health care system to be able to help patients navigate it…One other goal for me is to have a better idea of the scope of practice of allied health care professionals…
Now you can be sure that the student has written extensively on all these points–I’m just giving you a taste…but you can image what she has learned!
How can faculty become involved? Our learners need patient volunteers from the community, so if you can recommend a patient, please contact Kathy Bowes, so the students can continue to have these insights. (firstname.lastname@example.org)
How do learners retain learning?
Meds student Rebecca Wang asked me recently to answer some questions for writers from the Queen’s Medical Review (http://qmr.qmed.ca/) about ways to enhance student retention of learning. Here are some recommendations I had from educational and psychology literature:
Here are my top 4 tips for students to retain and retrieve knowledge:
- First is paying attention in class and that means no Facebook, games, etc. Multi-tasking is not what it is cracked up to be according to the literature—and we tend to delude ourselves about what we accomplish (Ellis& Jauregui, 2010). While I’m mentioning classes, I should mention pay attention to the learning objectives…either in MEdTech or on the slides—they will give you the outline of required knowledge which will help you study.
- Secondly, and there is some cool data to support this, take notes. If a faculty member provides all the notes, and you “listen” only, you’re not embedding it into your memory well. A great study on partial notes suggests that students who take notes not only do better on the assessment, but also do better on the higher order skills tested. (Cornelius and Owen-DeSchryver, 2008).
- Thirdly, review—and review through questioning. Review on a weekly or “spaced” schedule and incorporate answering mock questions into your review. I know many of you are in study groups. If everyone built 1-2 questions after a session and “tested” your study partners and gave feedback about the answers, you’d be helping your retention and that of others. Don’t forget to try short answer questions as well as MCQ.
- My biggest tip is to manipulate what you’ve learned. My recommendation of this is to shape information into a graphic organizer. You may recall Dr. Lee’s algorithm for hematapoeisis or some of the schemas for approaching a clinical presentation. This is taking information and putting it into a systematic graphic figure or organizer. Anything from a table or “T chart” which compares data, to an algorithm, or a “fishbone” chart (shows cause and effect) to a diagnostic schema or flowchart which you can fill in with what you’ve learned, or a “concept” map which show relationships, will help you retain and understand.
I’d like to say something about concept maps—I used them all the time in education and I don’t know why they’re not more popular in medicine– Complex concepts can be related to one another in numerous ways, and depicting correct relationships among concepts is central to all graphic organizing techniques (Halpern and Hakel, 2010). If some of you try this and find it helps, I’d love to hear about it!
Interested in reading about this? Here are three articles I recommended to the students:
Dunlosky, J. et al. (2013). Improving Students’ Learning With Effective Learning Techniques: Promising Directions From Cognitive and Educational Psychology. Psychological Science in the Public Interest. Association for Psychological Science.
Halpern, D. F. & Hakel, M.D. (2010). Applying the Science of Learning to the University and Beyond: Teaching for Long-Term Retention and Transfer. Change: The Magazine of Higher Learning
Bjork, R.A. et al. (2013). Self-Regulated Learning: Beliefs, Techniques, and Illusions. Annu. Rev. Psychol.
And here’s something about graphic organizers:
Hall, T., & Strangman, N. (2002). Graphic organizers. Wakefield, MA: National Center on Accessing the General Curriculum. Retrieved Feb. 2, 2014 from http://aim.cast.org/learn/historyarchive/backgroundpapers/graphic_organizers#.UvBGgfuwUR8
The Graphic Organizer: http://www.graphic.org/index.html, retrieved Feb. 2, 2014.
How can teachers help students retain their learning?
Here are some suggestions that I’d like to invite you to consider for your teaching:
1. Make your learning objectives apparent and specific (They should be one of the first slides in a slide deck and also on the learning event page.) By the end of your session, what will students know, do, experience?
2. At the end of a session, or at the end of a concept, give students a chance to formulate questions (short answer as well as MCQ) that they can use to quiz themselves and each other. Share these among the groups, and within the class.
3. Become part of a spiral throughout a course and throughout a curriculum. So, refer back to relevant pieces of the course, or other courses. Refer forward to relevant pieces of the course, and other courses. Use links to other events in our Learning Management System, MEdTech to make the spiral approach explicit. In other words, situate the learner, and help them see relationships among the concepts.
4. Use graphic organizers. It helps students to situate material, and it helps them organize what can be a huge sea of learning. It gives them a “life raft.” OR give students a blank organizer and challenge them to fill it in through the class.
5. Not all learning can be retrieved through multiple choice questions. Sometimes a short answer question that requires students to think, evaluate, and put pieces together is a better test of learning.
Learning Styles: What are they? How can they help learners and teachers?
And speaking of learners, recently too, Meds 2015 student Eve Purdy wrote to me asking about learning styles. She’s bumped into them on elective. It’s a controversial topic in educational literature, because on the one hand, it’s so attractively intuitive and lends itself to so many ah-ha moments, but on the other, there are criticisms of learning style theory’s evidence base, its focus on matching teaching to learning styles, and the profit that is being made from many different companies that espouse learning style questionnaires, etc.
I don’t want to get into that debate here. Pashler does it for us, in Pashler, H., McDaniel, M., Rohrer, D.;, Bjork, R. (2008). Learning styles: Concepts and evidence. Psychological Science in the Public Interest 9: 105–119.
What I would like to speak to you about is how you can use literature around learning styles.
Learning styles theories are all very intuitive and make people very excited. I personally find the Kolb inventory based his experiential learning cycle, useful and probably the most evidence based. Here’s a nice summary
http://www.simplypsychology.org/learning-kolb.html and here’s a visual where the learning preferences are mapped to the cycle from above.
Visual Auditory Reading/Writing Kinesthetic (VARK) is another the other popular learning styles model: http://www.vark-learn.com/english/index.asp. Gardner wrote about multiple intelligences as well. And there are other theories.
This article summarizes some them and provides the counter argument. http://chronicle.com/article/Matching-Teaching-Style-to/49497/ It has a chart that summarizes 4 main theories.
Educators have been told there is a problem with the evidence behind these theories. Critics argue that there are almost no randomized control trials to support them except for Kolb’s original research. Other criticisms are that accomplished learners switch styles/preferences due to needs and contexts, that money is being made from these theories as learning style questionnaires proliferate, to name a few.
But what teachers find helpful is that thinking about learning styles alerts them to the concept that learners tend to approach material in different ways, or enjoy/prefer learning in different ways. Therefore it is practical to include a variety of modes of learning to appeal to different learning preferences. Learners approach learning in different ways depending on context, habit and training and most importantly topic. So focusing on the best way to teach a specific skill, concept, etc. is a good use of teacher planning time.
So what do I use learning theory for? I look at is my own style as a teacher and determine if that is serving all students well. (I’m an R in VARK, and Accommodating:) I think it’s safe to say that I need to fine-tune my teaching and add other styles, because I do rely on my own “style” a great deal.
I consider that some topics lend themselves more to kinesthetic learning for example. So I don’t try to lecture too much about skills–I get everyone to practise the skill. I also try to ensure that I balance my different modes of teaching so that I’m not always engaged in one mode. Finally, when students are having trouble understanding, I know that I can switch to another mode or style to give them assistance. And knowing that we all learn differently at different times is in itself very helpful.
And meanwhile, asking students to take learning style inventories helps them become more “metacognitive”, more aware of their own learning, which is a key piece in developing active and self-regulated learners.
We’re at the end!