Month: October 2014
MD Program Executive Committee Meeting Highlights – October 15, 2014
Faculty and staff interested in attending MD PEC meetings, should contact the Committee Secretary (Faye Orser, (orserf@KGH.KARI.NET)) for information relating to agenda items and meeting schedules.
MD PEC and, when applicable, the School of Medicine Academic Council (SOMAC) has now approved all of the following:
- Terms of Reference
- Academic Affairs Committee (new)
- Progress and Promotion Committee (updated)
- Professionalism Advisory Committee (updated)
- Student Assessment Committee (updated)
- Teaching, Learning and Innovations Committee (updated)
- Program Evaluation Committee (new)
- Diversity Panel (new)
- Student Progress and Promotion Policy (updated)
- Policy on Academic Accommodations (new)
- Student Professionalism Policy (updated)
- Student Assessment Policy (updated)
- Access to Student Records and Privacy Procedure (new)
- Conflict of Interest Procedural Statement
- Diversity and Equity Statement (new)
All Undergraduate Medical Education policies and terms of reference are available on the UGME website: http://meds.queensu.ca/undergraduate
The Committee will be hosting an annual retreat November 3 at 5:30 pm to receive and hear annual reports of all of its sub-committees. Anyone wishing to attend should contact Faye Oser (orserf@KGH.KARI.NET).
Next Meeting: November 19, 2014
New Features on MEdTech
At the fall Curricular Leaders’ Retreat, Lynel Jackson highlighted four new and improved MEdTech features that can assist faculty in presenting information for students and in planning learning events and courses.
Adding Resources to Learning Events
The EdTech team has completely redesigned the way resources (such as files, links, and quizzes) are added to the Learning Events and displayed to learners in Student View. This new view uses much of the information the EdTech team has collected for years during the upload process, like “Should this resource be considered optional or required?” and “When should this resource be used by the learner?” then displays it to learners in a clear and user-friendly timeline on the Learning Event page. The new format clearly shows what learners need to do to prepare for class, and also clearly marks what resources are required versus what is for information only.
In Development: In the future, these classifications will be used to provide learners with a checklist on their Dashboard, identifying all the activities they need to complete before classes for the week.
The EdTech team has enhanced MEdTech’s Curriculum Explorer tool which is now able to show not only where objectives (at any level) are mapped to Courses, and Learning Events, but also Gradebook Assessments. Faculty members and staff can use this tool to really explore the curriculum at all levels.
There are a number of new and enhanced reports – such as MCC Presentations by Course, Course Objectives by Events Tagged, and Learning Event Types by Course – that can assist in evaluating past course iterations as well as planning the next one. Curriculum coordinators can generate these reports for Course Directors, on request.
One of the most frequently requested features by faculty has been the ability to easily upload images or documents, and embed video into rich text areas throughout the MEdTech platform. With this Fall release, the team was pleased to announce this can now be done within any of the rich text areas.
To upload images or documents, click the “Browse Server” button from within the “Image” or “Link” icons. This will open your personal “My Files” storage area where you can upload images or documents from your local computer. Once you upload the image or document, clicking it will embed the image or document directly in the rich text area. You can also embed video from the Queen’s Streaming Server, YouTube, or Vimeo into any rich text area by clicking the “Embed Media” icon, and pasting in the “Embed Code”.
For questions on these updates and other aspects of MEdTech, reach the Education Technology team at firstname.lastname@example.org
Engaging Diversity to “enlighten” Medical Education
The word “education” has etymological roots that are both interesting and revealing. It evidently derives from the Latin “educo”, roughly translated “I lead forth” or “I raise up”. “Educatio” is “a breeding; a bringing up; a rearing”.
The word “education” has been defined in various ways, but definition that I prefer is simpler and more consistent with the origin and intent of the process; “an enlightening experience”.
In a previous article (http://meds.queensu.ca/blog/undergraduate/?p=1569) we explored the role of diversity as a component of that “enlightening experience”. The main points:
- the environment in which education is provided can be as powerful as the instruction itself.
- early adulthood is a critical time in the development of social and personal identity. Erikson wrote of that time being a “psychosocial moratorium”, during which they feel free to “sample” and experiment with various social roles for themselves before taking on a more fixed and permanent role.
- early diversity experiences are both impactful and enduring, as evidenced by Newcombe and colleagues work with the Bennington College cohort, and both the Michigan Student Survey and Cooperative Institutional Research Programs.
Perhaps most importantly, higher education diversity experiences are most influential when the social milieu differs from the students home and social background. In the words of Gurin, it needs to be “diverse and complex enough to encourage intellectual experimentation and recognition of varied future possibilities.” Simply put, the real power to influence goes far beyond lofty mission statements and curriculum, and arises largely from developing an environment where students are able to interact both passively and actively with individuals who are “different” and therefore force new thought and new perspectives during this critical developmental phase.
Building on the last point, it would seem that any attempt to improve the educational environment from a diversity perspective must begin with an understanding of the pre-university home and social backgrounds of our learners. What do we know of the background of students undertaking medical education in Canada?
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 (http://www.caper.ca/~assets/documents/CAPER_Poster_AAMC_Physician_Workforce_Conference_May-2012.pdf.), and more recently by Young and colleagues who surveyed 1,552 Canadian medical students (Academic Medicine 2012, 87; 1501), concluding that they are “overrepresentative of higher-income groups and underrepresentative of populations of Aboriginal, black or Filipino ethnicities in Canada.”
Our students have also weighed in on this issue. 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.”
And so it appears that if we’re to develop this “enlightening” environment within Canadian medical schools, we’d be well served by facilitating entry of socioeconomically less advantaged population, and particularly member of our Aboriginal populations.
But how? An examination of the literature and our own local experiences seems in order.
Lessons from Other Programs
Recognizing that any attempt to encourage and support historically disadvantaged groups must begin very early in the educational process, the “cascading mentorship” model has been advocated by many. In their recent article Afghani and colleagues (Academic Medicine 2013; 88: 1232) describe a model they have developed at the University of California “in which high school students are coached by premed undergraduate students, who are in turn mentored by medical students, who are mentored by faculty.” The program expanded over a short period of time and both undergraduates and medical students reported very high ratings in self-confidence, motivation for a career in academic medicine, understanding different cultures, leadership ability, teaching ability and commitment to serve the underserved.
In “How leaky is the Health Career Pipeline?” (Academic Medicine 2009; 84: 797), Alexander and colleagues sought to explore how students from underrepresented minority (URM) groups performed in “gateway courses” (general chemistry, organic chemistry, general biology, introductory physics and calculus) required for application to California medical schools. They found that URM students received significantly lower grades in these courses, even after adjusting for prior academic performance (ie. poorer background in those subject areas). However, despite this greater academic adversity, URM students were at least as likely as white students to complete all the gateway courses and become eligible for application. They conclude that “interventions at the college level to support URM student performance in gateway courses are particularly important for increasing the diversity of medical and dental schools”.
In 2001, the Medical University at South Carolina embarked on an ambitious and aggressive strategic planning program to increase the diversity of their student population and faculty (Academic Medicine 2012; 87: 1548). At the admissions level, they provided “added value” to an application for certain characteristics intended to diversify the pool of qualified applicants. These included advanced community service, cultural experiences attending to the needs of underserved and underrepresented populations, sustained work experience, artistic/athletic achievements, overcoming adversity, and rural or inner-city backgrounds. In addition, individual Departments were called on to develop specific diversity plans, and financially supported to do so. Other initiatives included the development of pipeline programs and strategic partnerships with more than 40 colleges and universities to develop interest in the health professions among URM individuals. This comprehensive, multi-dimensional and leader-driven approach has proven highly successful in increasing the diversity of both student body and faculty over a 10 year follow-up.
Since 1973, the Sophie Davis School of Biomedical Education has been operating an innovative program within the City University of New York (Roman SA, Academic Medicine 2004;79:1175). They offer an innovative 5 year combined BS/MD program to promising high school graduates who express a definite interest in a medical career. Successful graduates of this program are guaranteed advanced transfer into the final two clinical years at one of five cooperating medical schools in New York State. The mission of the program “to expand access to medical careers to among talented inner-city youths and youths who have experienced educational disadvantages despite demonstrated evidence of high levels of academic achievements”. The program has been remarkably successful in providing access to socioeconomically disadvantaged students (27% of their students coming from families with incomes below federal poverty levels, and 70% eligible for state sponsored tuition support), underrepresented minorities (only about 15% of their students identified as “white”) while maintaining academic success (90% pass rate in USMLE Step1) and producing graduates who provide service in underserviced and underprivileged areas.
Current programs at Queen’s
Closer to home, Queen’s has had an Aboriginal Admissions Process since 1998. Under the process, applicants who self-identify and who meet reduced cut offs for GPA and MCAT scores have file reviews conducted by a team that includes members of the Aboriginal community. Interviews with selected candidates also involve members of the Aboriginal community. Since the program’s inception, data have been kept on the number of self-identified applicants, the number of offers and the number of acceptances.
MedExplore is a student-led program created in 2012. It provides opportunities for skill development, networking, and career exposure to students from disadvantaged groups that are under-represented in health care professions, so that they can make informed educational and career decisions. Queen’s medical students run workshops and serve as mentors to high school students from a variety of backgrounds, including
Altitude Healthcare Mentoring is a student-led initiative that has been operating at Queen’s since 2011. It provides mentoring and programming to first-year students from disadvantaged groups, including Aboriginal students and students of low socioeconomic means.
Queen’s University Accelerated Route to Medical School (QuARMS) has the potential to address the many barriers inherent in the medical school admissions process. Writing MCAT tests, submitting applications and attending interviews all involve significant cost. As well, low-income students may not be able to afford to take a summer off from working to prepare for the MCAT or to participate in volunteering and extracurricular activities that less financially constrained students employ to enhance their applications. QuARMS is available to students in all schools, from all parts of the country. Full travel bursaries are provided for students who demonstrate financial need. A student from an underrepresented group who applies through QuARMS therefore has the opportunity to access medical education on a more equal footing with higher-income candidates, avoiding many of the barriers that might otherwise deter them from applying to medicine.
In my previous article on this topic, I closed by posing the not-so-rhetorical question “Can we do better?” The home-grown initiatives noted above are certainly praise worthy steps in the right direction, but I think all would agree that they would benefit from more visibility and more structured, consistent support. Moreover, they would seem to fall short of the deep, institutional commitment typified by the programs like those described at South Carolina and the Sophie Davis School. For all these reasons, a number of initiatives are being brought forward within the School of Medicine to better define and bolster our approach to advancing Diversity.
- A Diversity Statement has been developed and approved by the MD Program Executive Committee that will be brought to the School of Medicine Academic Council for approval this week that statement reaffirms the university commitment to underrepresented groups and focuses the School of Medicine on two target populations, the Aboriginal peoples of Canada, and the socioeconomically disadvantaged.
- A Diversity Advisory Panel, consisting of interested students and faculty is being struck to develop and support initiatives to advance Diversity within our school, including those student led projects already underway. Dr. Leslie Flynn has agreed to take on the chairmanship of this panel, and no fewer than 9 student volunteers have already stepped forward to participate, and that group has its first meeting scheduled for later this month.
- A Diversity Fund has been developed that will be available to the panel for support of projects or initiatives it recommends.
- Dean Reznick has given high priority to the recruitment of a faculty Diversity Lead to coordinate our approaches.
- I will be asking our Admissions Committee to consider means by which they could more directly support our Diversity goals through modification of our current MD Program and QuARMS admission processes.
As always, your views on these and any other initiatives you’d like to bring forward are most welcome.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Many thanks to Sarah Wickett and Sandra Halliday, Health Informatics Librarians, Bracken Library, for their valuable assistance in the compilation of information for this article.
We’re thankful for our students!
We’re thankful for our students!
It’s Thanksgiving again, and an opportunity for us to express gratitude. This year, we have had the gift of several groups of students working with us in Undergraduate Medical Education and we’d like to showcase their efforts and publicly thank them for their help in making our program even better!
Making DIL work! Beginning with work from last summer, and continuing into this fall, Marie Leung (Meds 2015) has helped us better understand and plan for improvement of the Directed Independent Learning events incorporated in many pre-clerkship courses. Marie performed a review of 247 hours of DIL learning events, providing the Educational Team with a detailed breakdown of the range of structure in these sessions. She followed up with a student focus group, identifying ‘best practices’ from the point of view of our learners. We have recently collated this material and delivered two faculty development sessions to spread the word to course directors. In the next few months the Teaching and Learning Committee will draft guidelines to help teachers and course directors structure this type of mandatory independent learning to ensure quality across the board.
Physiology “Bootcamp”: This summer a group of dedicated students worked with Dr. Chris Ward, Lynel Jackson and myself to create a series of Physiology “bootcamp” modules for those who’d like more of a background in physiology. Kelly Harper (Meds 2017), Lauren Kielstra (Meds 2016) , Amro Qaddoura (Meds 2017), Rajini Retnosothie (Meds 2017) and Peter Vo (Meds 2017) developed online modules, with text, images and animation on these topics: Endocrine Physiology, Respiratory Physiology, The Autonomic Nervous System, Gastrointestinal Physiology and The Renal System and the Heart. The students also worked with Sarah Wickett, Informatics Librarian at Bracken Health Sciences Library to ensure that all images and animation met copyright guidelines. Dr. Ward’ theory is that students would have the best sense of what basic foundational information would be helpful to upcoming classes. Stay tuned for publication of these modules through the work of Lynel Jackson at MEdTech.
Procedural Skills Modules: Dr. Lindsey Patterson is grateful for her students and her Resident! Dr. Curtis Nickel, Meds 2013, and a Resident in Anesthesiology, has been overseeing the work of Sarah-Taïssir Bencharif, Lauren Welsh and Richard Di Lena, all of Meds 2016, as they developed online modules on procedural skills. Beginning with the skill of intubation, Dr. Nickel and Dr. Patterson were working with the students to incorporate video, text, images and step-by-step instructions. The goal of these modules is to provide a consistent method and set of skills to students and faculty alike, accessible anywhere and at any time.
QBank and Test Anxiety: Two of our Meds 2017 students, Adam Chruscicki and Natasha (Natalia) Ovtcharenko as student curricular representatives noticed a high demand for practice questions to help diffuse some of the anxiety around first term mid-term examinations. To answer this demand they decided to start a student-generated question repository, that will serve as a resource for self-testing and hopefully help students prepare for all the different exams through the years. To show the effectiveness of generating questions and self-testing, the students designed a study to look at exam-anxiety (which is negatively correlated with academic outcomes) and the use of QBank as a means to reduce exam anxiety. The study is looking at two separate ways of reducing anxiety: i) self-testing and ii) generating questions. The student investigators are using the STAI (State-Trait Anxiety Inventory), as a measure of success. They anticipate that users who access QBank the most will show the largest decrease in anxiety/lowest levels of anxiety around exams.
Adam writes, “We are looking to expand QBank into all four years of undergraduate medicine, we want QBank to become a ubiquitously-used study resource by all QMeds, and eventually become a tool that can be used to study for out LMCC, and we hope to expand the functionalities of the website and the bank, eventually linking all the questions to the MCC objectives. Most of all we hope that QBank will make our classmates fell more at ease with testing…and turn it from a stressful experience into what it is meant to be–an educational tool. “
Stay tuned because the team anticipates results prior to the winter holiday!
Online Module Audit: Seven students worked on a special project for the Teaching, Learning and Innovation Committee (TLIC) this summer to review eLearning modules in the UGME data base. Corey Bricks (Meds 2015), David Carlone (Meds 2017), Elizabeth Clement (Meds 2016), Kelly Harper (Meds 2017), Alicia Nickel-Lingenfelter (Meds 2016), Laurent St-Martin (Meds 2017) and Rebecca Wang (Meds 2016) reviewed 131 modules to determine if the modules should be revised or archived. Working with Theresa Suart of the UGME Ed Team, and Dr. Lindsay Davidson, through the audit process, the students noted whether revisions involved content, format, resources or assessment tools. With a huge bank of online modules, some of which are out of date, have been superseded or have other issues, the work of the students is so useful! As a result of their work, TLIC will draft best practices for online module development including review and archive protocols. The students’ work is a first step to enable the TLIC and MEdTech to offer an up to date bank of useful modules.
First Patient Project Impact on Career Choices: This summer and fall, First Patient Project Student Rep, Jason Kwok developed a study to determine if and how the First Patient Project affects students’ career choices.
This study is significant because making informed career choices is a key milestone for medical students within the Leader role of the CanMEDS 2015 Series III draft Framework. Jason created an online survey which was by Queen’s medical students who have participated in the FPP for at least 6 months. Statistical and thematic analyses have been conducted to pinpoint and record patterns within responses. 23% of medical students indicated that the participation in the FPP has a direct impact on their career direction. Thematic analysis of narrative responses indicated that FPP had motivational and inspirational impact on students while responses provided curriculum renewal feedback for the Program Directors and Coordinators
Nursing Home Module: One of alternative projects in the First Patient Project this year was to help peers understand about nursing home care, and the roles of physicians and nurse practitioners in nursing home. After giving an oral presentation with her partner Brandon Maser, Chelsie Warshafsky(Meds 2016) put together a learning module for other students to let them know important facts about nursing home care and about nursing homes as a future career path. It will be available through MEdTech soon.
Student Handbook and Roles, Responsibilities and Safety Modules: Tyson Savage (Meds 2017) has had a busy summer! He has developed the new Student Handbook with Alice Rush-Rhodes and built it into an i-book. A one-stop-shop for students to find information, it was released this fall. As well, Tyson developed much needed one-stop-shop modules for preclerkship and clerkship students on their roles and responsibilities in clinical situations as well as important safety information both on campus and in any of the hospitals in which they may have clinical placements. Tyson even built the quizzes that allow students to demonstrate they’ve read the modules and know where this information is housed. All students from 2016-2018 have been introduced to these modules.
Student Monitors: There is a group of students who must remain unsung but are integral not only to the workings of the curriculum, but to our accreditation standards. These students are our learning event monitors, 2 from each year, who record any inconsistencies in the types of learning events recorded. The students maintain anonymity so as not to be influenced by any personal bias. Their work helps UGME remain true to its Teaching and Learning Policy standard, whereby every course must have under 50% lecture as a teaching methodology. The work of the students confirms self-identification and helps us to maintain a balanced “constellation” of teaching strategies.
Aesculapian Society Student Representatives: We are so fortunate to have student representation on all of our committees in the UGME program! Our students are not passive on these committees—they have voices, voting rights, and are called upon to represent the perspectives of their year, or of larger groups of students. As well, there are student representatives for Competencies, for the First Patient Project and new this year, for the Portfolio. These student representatives help plan events, connect with the students about innovations, help with revisions and other tasks. We can’t forget the technology reps who podcast so politely and who are often called upon by harassed faculty when technology fails. (We do have technology assistance, tho’ and we are ensuring we are respectful of our tech reps’ learning time.) Another group of invaluable students are the student academic reps who meet with their Course and Year Directors faithfully through the year to give feedback to faculty and to bring responses back to their peers. I’m grateful personally for last year’s AS Vice President Internal, Graydon Simmons (Meds 2016), who not only helped pilot the student peer mentorship in orientation week’s confidentiality session, but came up with a great communication system which his successor Mike Baxter is continuing. Through VP Internal, I’ve connected with the Year “Pres” group who so diligently pass along messages about opportunities for students.
The UGME Ed Team is always most grateful to the students who help us out with focus groups, provide feedback and who thoughtfully contribute to reviewing and improving our projects.
And then, of course, there are all our students…the ones who come up to thank faculty for their efforts, who pay attention and ask insightful questions, who look for opportunities to “do more” and who greet faculty and staff with smiles and flashes of neon (and more subdued hues of) backpacks. It’s fun to come into work each day knowing our students are there, and we’re grateful.
Do you know about a student or group of students for whom you are grateful? Please write into the blog to tell us of students who have helped the UGME program.
How to make “DIL” work for you
Best Practices in DIL: Directed Independent Learning
Thanks to Dr. Lindsay Davidson, Director of UG Teaching, Learning and Innovation for writing this blog article.
Have you ever wondered about the mysterious learning event type used in the undergraduate MD program known as a DIL?
You may even have your name associated with such an event but be unsure what you’re supposed to do with it? If so, this blog posting is for you. We’ll tell you about how to create “blue ribbon” DILs. DIL is short form for “Directed Independent Learning” (although some students have nicknamed the sessions “Do It Later”).
First some background. Previously, our curriculum was almost entirely taught using large class lectures. Over the past decade, prompted by educational research, best practices and accreditation standards, we have shifted towards more active forms of classroom case-based learning. These sessions are preceded by required student preparation. Initial attempts to ‘protect’ curricular time to allow these independent study activities were foiled by the introduction of new curricular learning events. This led to the strategy of formally protecting curricular time for student preparation – and the “directed independent learning” (or DIL) learning event was born.
Originally intended as simple ‘placeholders’, directed independent learning events are now formally defined as scheduled curricular sessions associated with a course, with the goal of allowing specific student preparation prior to a companion classroom learning event. Put another way, DIL sessions are one component of a flipped classroom blended learning model. In fact, they are literally another “teaching opportunity” for you. These sessions are different than the 8 hours of freeform independent learning time built into the student week – this is intended for student-directed inquiry around personal learning goals, observerships, research or community based-projects.
Directed independent learning sessions, in their ideal form, are an excellent format to help students scaffold learning. The concept of scaffolding is very evocative – implying the application of a supportive structure to facilitate learning with the understanding that over time the scaffolding can be withdrawn. Scaffolding can involve a variety of instructional techniques such as providing a reading guide, fill-in-the-blank worksheet or graphic organizer to complete. When done well, scaffolding helps students reach higher levels of comprehension and skill acquisition than they would without help.
Some examples of scaffolding appropriate for a DIL include:
· Develop a table or algorithm to compare different conditions from the same presentation
· Check for understanding with quiz questions
· Provide a reading guide to help students perceive the critical pieces of a longer reading, and direct them to key understandings and concepts
Marie Leung, a student in MEDS 2015, conducted an audit of DIL sessions in 2013. She determined that these comprise 13% of all structured pre-clerkship curricular time. Of these, 39% included text-based readings, 25% online modules and 19% audio-visual instruction. She also noted that 5% of DIL sessions included no identified resources. Subsequent student focus groups identified six problems with certain DIL sessions:
1. No details
2. Lack of objectives
3. No resources
4. Too many resources
5. No opportunity for self- assessment
6. Stand-alone resource (i.e. not linked to subsequent session)
Additionally, students identified five best practices when designing a DIL. These include:
1.Be directed and purposeful – use learning objectives and provide focused, carefully selected readings
2.Give instructions and/or guides to reading or viewing.
3.Encourage students to produce a deliverable – worksheet, comparison tables, etc
4.Allow opportunities for students to assess their learning – self-administered quizzes
5.Connect directed independent learning sessions to in class sessions which are opportunity to debrief, clarify, apply, reinforce.
We encourage all teachers to strive to meet these guidelines. Please contact our educational development team if you require assistance constructing an effective DIL learning event – email@example.com or firstname.lastname@example.org.