Month: January 2015
Are you up to the challenge?
Queen’s medical students have issued a challenge to the entire UGME community to change some habits in February with the #keepsmewell positive wellness challenge.
Spearheaded by the Mental Health and Wellness committee, the challenge includes month-long goals such as eat balanced breakfasts and sleep 7 hours a night as well as weekly challenges that include such things as make a new recipe, try a new activity, call a friend and skip the elevator to take the stairs.
To take the challenge, students, faculty and staff are invited to form teams of four (the challenges are slightly altered for faculty and staff – only student teams will take part in the MED LAW Games, for example). Teams earn points for each activity members complete and there will be prizes at the end of the month. (The challenge is funded by an AMS grant and a generous anonymous donation.)
Teams need to open a Twitter account and track their activities with tweets throughout the month, including the hashtag #keepsmewell .
“We’re attempting to get all four years to engage,” says Alyssa Lip, the committee’s chair. “There are options for clerks to do this remotely so they can have team members across the country and still be a team for this competition.”
Encouraging faculty and staff to join in was a natural extension of the challenge. “We wanted faculty and staff to be involved because they’re a part of the medical community that we engage in,” says Lip. “It’s also very inspiring to see that faculty and staff care about their wellness, and about our wellness.”
“The goals of this challenge are to focus on changing our everyday habits into positive ones – preventative medicine!” Lip explains.
In addition to Lip, the committee includes: Executive: Natasha Ovtcharenko, Shannon Chun, Rufina Kim, Meghan Bhatia, Amy Jiang, Alicia Ling, Elena Bianca, Meherzad Kutky; preclerkship members: Arian Ghassemian, Beverly Guan, David Carlone, Jonathan Krett, Madelaine Baetz-Dougan, Olivia Suppa, Sarah Edgerley, Fay Zhu, Calvin Santiago; and clerks Brandon Maser, Hollis Roth, Soniya Sharma, and Debarati Chakraborty.
When Lip and Aesculapian Society VP Academic Natasha Ovtcharenko sat down at the beginning of the year to update the committee’s terms of reference, they “felt strongly that mental health and wellness activities should focus on programming to enact effective changes around our QMed community,” Lip says. “This initiative grew from an amalgamation of smaller ideas and past initiatives that we drew inspiration from. For example, the competition idea came from a successful Movember campaign by the 2017 class council last year, while the self-care aspect was an existing current trend and the social media aspect came from Ottawa Med’s smaller #keepsmewell campaign.”
The wellness challenge is in line with the committee’s three overarching themes:
- Providing wellness resources (they’ve started monthly sessions for students to relax and chat confidentially and have created resource cards and pamphlets available in the Medical building at all times)
- Creating a stigma-free environment (they’ve started a three-part “Frames of Mind” speaker series geared to all mentors in medicine—faculty, staff, colleagues. The first one was on Identifying and Responding to Students in Distress)
- Positive habits (they want to focus on maintaining wellness, and developing mechanisms and habits that can build more resilience and not just address ‘when things go wrong’).
For Lip, her key take-homes are that little things you do every day can make a big difference, such as sleeping and eating breakfast. “And taking time out of ‘work’ to do something unrelated, for yourself, is important” such as taking a yoga class or watching a movie.
The challenges for #keepsmewell reflect this philosophy. “We made a point to keep each activity simple, because those are the habits that are easiest to change and make the most difference,” she explains. “It’s an ambitious pilot to what we hope to become regular yearly program!”
Lip and the rest of the committee have been overwhelmed by the support their classmates have given and how people have responded to this initiative. “We really hope people will get something out of this by the time March rolls around.”
All members of the Queen’s UGME community are invited to attend the information session on January 29 at 12:30 p.m. in 132A in the Medical Building. To register, email Alyssa Lip (email@example.com) by February with the names of your team of four. She’ll send a tracking sheet to get you started.
The Educational Development Team is on board! The committee graciously granted us a waiver on the “mixed gender” rule as our team consists of four women and they’ve let us register as a challenge team. Are you in? (Follow us @QMedEdFabFour)
Feedback requested on New or Updated Policies
Prior to a new or amended policy or regulation being submitted for final approval, it must be published for review and comment by faculty and/or students within the School of Medicine. Feedback received will be directed to the Policy Sponsor.
In the event that major changes are made based on this feedback, a new draft will be posted for additional comments.
In keeping with this procedure the following policies are being posted for comment or feedback:
- Clerkship Clinical and Academic Activity Policy
- Supersedes: On Call Policy (Policy #CC-01)
- To provide your comments click here
- Visiting Medical Electives Policy
- Supersedes: none
- To provide your comments click here
- Observership Policy
- Supersedes: CC-02 v3 (July 25, 2013) for Class of 2018 and on
- To provide your comments click here.
If you wish to comment on any of these documents, please add your feedback to the discussions in this community or email firstname.lastname@example.org
A Fragile Trust – Reflections on the Dalhousie Controversy
A patient reports to a hospital outpatient procedure unit early one morning for an electively planned, medically necessary surgical procedure.
They divulge personal and sensitive information to a clerk.
They disrobe at the request of a registered nurse.
They allow a phlebotomist to start an intravenous line in their arm.
They allow a resident physician to carry out a physical examination, review test results and reassure them that they are fit to undertake the procedure.
They allow an anesthesiologist to administer medications that will render them insensible, unconscious and unable to breath without assistance.
They allow a surgeon to carry out an invasive procedure that may result in some degree of disfigurement and carries risk of injury or death.
When they awaken, they allow another nurse and a respiratory technician to carry out examinations and measurements, and accept their assurances that they are safe to return home that evening.
Other than the surgeon, they are meeting all these people for the first time.
How does this happen? What allows a person to suspend the usual inhibitions and natural cautions of everyday life to depend so completely on perfect strangers, and for so much?
It happens, I would suggest, because they are able to trust.
That trust is rooted in an assurance that the selection processes, training and regulatory frameworks that govern the activities of these various providers are all robust and vigilantly monitored. Although our patients can understand and accept that all these providers are people like themselves, subject to human frailty and error, they must believe that, in the context of the services they are providing, those providing care will be highly competent, attentive and focused. They will be, for that encounter, perfect.
By extension, they must believe that the institutions that train such individuals are focused not only on the acquisition of knowledge and development of technical skills, but also on the identification and development of high levels of integrity, responsibility and concern that ensure that those skills will be applied in the best interests of their patients.
That trust is no mere abstraction or theoretical construct. It is, in fact, a key component in ensuring patients are willing and able to seek help when needed, and allows them to comply with necessary treatment. It is a key factor in ensuring effectiveness of the care provided. It is a core and essential attribute of every health care professional.
Over the past few weeks, the widely-publicized and much-discussed events arising from the Dalhousie Faculty of Dentistry have demonstrated the fragility of that trust. Without attempting to judge the merits of the charges or question the approach taken by the school officials, it is clear that even the perception of such serious breaches has shaken the confidence of the public in the ability of our schools to ensure our graduates are worthy of those high levels of trust. Witness the numerous postings from individuals expressing reluctance to seek help from any dental school graduate, requests from regulatory bodies to examine the records of every graduate and withdrawal of financial support from previously loyal school supporters. Rightly or wrongly, the perceived breach of trust has extended beyond the alleged perpetrators, and threatens to affect a wide array of people and institutions. To borrow a military term, the “collateral damage” is huge.
These events also bring into sharp focus key issues that professional schools have struggled with for many years. Because graduates of programs such as Medicine, Nursing, Dentistry and Education will engage positions of public trust and, in fact, are engaging such roles even during their training, they struggle with two key issues:
1. To what extent does the need to preserve the public trust and ensure the safety of people they engage during their training “trump” personal rights, due process and assumption of innocence until proven guilty? To be more specific, if a student is suspected of a major offense, or even involved peripherally in such activities, can they be allowed to continue in their training or expect anonymity until resolution?
2. To what extent does a university degree confer assurance of public trust? Our professional schools are largely housed in universities and colleges, institutions that recognize through their degrees and diplomas intellectual mastery of a particular discipline, but not necessarily practice readiness nor assurances of exemplary personal conduct. Does a student who has demonstrated understanding of content but whose behavior has been deficient merit that degree? Since the final determination of practice readiness resides with the various regulatory agencies, should incidents and issues arising during the educational program be made available to those agencies? In short, where does the institution’s social accountability over-ride the natural tendency to support their students?
In medical schools, the increasing engagement of competency-based objectives and curricula, although initially somewhat reluctantly engaged, has served to embed social responsibility in the consciousness of both learners and faculty. It becomes clear to all that medical school is as much about personal and professional development as acquisition of knowledge and skills, and has provided a framework to identify and address behavioural lapses.
If any good is to arise from the “ill wind” of the recent controversy, perhaps it is to engage a wider conversation on these two vital issues and to engage public input on issues that, after all, have the potential to affect them directly. The public’s trust must be earned, and once earned must be vigorously preserved.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Figuring out what’s important in a faculty evaluation report
Critics only make you stronger. You have to look at what they are saying as feedback. Sometimes the feedback helps, and other times, it’s just noise that can be a distraction.
Separating the useful feedback from the noise in students’ comments on faculty evaluation questionnaires is an annual challenge for all university instructors– not just at Queen’s School of Medicine. It was recently the topic of a Faculty Focus article by Isis Artze-Vega, associate director of the Center for the Advancement of Teaching at Florida International University. She offered solid advice for those of us who feel angst over student evaluations.
As a side-note: the headline on the Faculty Focus article points to “cruel student comments” but just because there’s negative feedback doesn’t mean the comments are (or should be) cruel or rude. Student in the School of Medicine are given guidance about completing course and faculty evaluations at the beginning of every year. They’re encouraged to be professional in completing them, so while there may be constructive feedback, it should never degenerate into merely cruel criticism. Students are also encouraged to provide concrete suggestions for ways to improve.
Dr. Artze-Vega suggests seven key approaches to responding to student evaluations.
First, she advises faculty to analyze the data. The Education Team routinely does this for course evaluations for course directors and the Course and Faculty Review Committee, but not for individual faculty evaluations. Analyzing comments is a great starting point; otherwise, human nature often has people hyper-focusing on the wrong things. Are you reading an outlier opinion, or is there a theme in multiple students’ comments? “Identifying themes will help you determine whether they warrant a response,” Artze-Vega writes.
Ask any actor or director and they’ll tell you: negative feedback is easy to remember. American film director Peter Farrelly has said: “With all of my films, if I get one bad review and a bunch of good reviews the bad one is the only one that will stay with me.” Artze-Vega cautions to resist the lure of the negative. Don’t automatically dismiss a negative comment, but “consider: Am I focusing on this because it’s ‘louder,’ or because it’s a legitimate concern?”
Considering feedback this way flows into Artze-Vega’s third key: Let your critics be your gurus. Citing a New York Times article, she points out that “we often brood over negative comments because we suspect they may contain an element of truth.”
A fourth approach is to find counter-evidence to negative comments. You can look for or remember comments that contradict the negative one. (If your faculty evaluation report is anything like some course evaluation reports, sometimes, you’ll find these comments in the same evaluation report from other students).
Artze-Vega stresses that “we should devote at least as much time to students’ positive comments as their negative ones”, so her fifth key is dwell on the positive ones. If you hyperfocus on negative feedback, you can lose sight of the many things you are likely doing well – and that students appreciate. To aid in this, she further advises to read them with a friend. “A more objective party can help you make sense of or notice the absurdity of the comments because they’re not a personally invested in them.”
Finally, Artze-Vega advises to be proactive. “If you don’t conduct this analysis yourself, you’ll be at the mercy of whomever is charged with your evaluation—and they probably won’t be as thorough,” she points out. “Also, take the time to provide explanations about any off-the-wall student complaints, so that your reviewers don’t draw their own conclusions.”
One way to be proactive, is to solicit feedback earlier, when you can still make adjustments for this cohort of students, rather than waiting for the end-of-semester one to help with next year’s planning.
When she’s teaching a full course, Sheila Pinchin, Manager, Educational Development and Faculty Support has always used her own evaluation forms three weeks into a course and three weeks later to get just this type of feedback.
Terry McGlynn, an associate professor at Cal State, also advocates this approach as one of his tricks-of-the-trade to avoid bad teaching:
“I often use a supplemental evaluation form at the end of the term. There are two competing functions of the evaluation. The first is to give you feedback for course improvement, and the second is to assess performance. What the students might think is constructive feedback might be seen as a negative critique by those not in the classroom. It’s in our interest to separate those two functions onto separate pieces of paper. Before we went digital, I used to hold up the university form and say: “This form [holding up the scantron] is being used by the school as a referendum on my continued employment. I won’t be able to access these forms until after the next semester already starts, so they won’t help me out that much.” Then I held up another piece of paper [an evaluation I wrote with specific questions about the course] and said, “This one is constructive feedback about what you liked and didn’t like about the course. If you have criticisms of the course that you want me to see, but don’t think that my bosses need to see them, then this is the place to do it. Note that this form has specific questions about our readings, homework, tests and lessons. I’m just collecting these for myself, and I’d prefer if you don’t put your names on them.” I find that students are far more likely to evaluate my teaching in broad strokes in the university form when I use this approach, and there are fewer little nitpicky negative comments.”
If you do decide to use this type of mid-course feedback, keep your questions few and focused. (Otherwise, there’s potential for evaluation-fatigue on the students’ part, which lowers the quality of the very feedback you want).
If you teach in the Queen’s UGME program and would like some assistance in separating the useful feedback from the noise, I’m available to assist you with this. Drop me an email. Reach me at email@example.com
See more on this topic from an earlier UGME blog post here.
Educational Resolutions for the New Year
Resolution 1: Be learner-centred.
I’ve written about this before, but translating learner-centred theory into practical advice is very helpful. Education happens in the brain, and giving learners the opportunity to use their brains, from listening to and participating in an interactive lecture, to engaging in activities and tasks makes for a learner-centred classroom.
Two fabulous resources are: Classroom Assessment Techniques, by Angelo & Cross (1993 but still great!) and Student Engagement Techniques, by Elizabeth Barkley – over 100 techniques with step-by-step instructions and examples.
Classroom Assessment Techniques is the text where I first heard of Student Generated Test Questions. Each small group of students generates a question that has the potential to be used on a test or on the exams. Some of our faculty use this as a way to summarize learning, find out about what has been learned and to add to questions in the exam bank. This text was also the first place I heard about using an opinion poll–long before “clickers” or other polling devices were used. For an article that provides 10 of the 50 strategies, see: http://www.ncicdp.org/documents/Assessment%20Strategies.pdf
Student Engagement Techniques offered me the Graphic Syllabus and Outcomes Map, and of course I devoured the pages on graphic organizers. You might find the Poster Sessions (and my adaptation of it–virtual poster walk anyone?) or the Critical Incidents Questionnaire useful.
As part of my resolution, I’m sending for a few other books that will have some great ideas–Collaborative Learning Techniques, Essential Questions, Learner-Centred Teaching: 5 Changes… Stay tuned for ideas from these.
I just have to give you an example of how learner-centredness became the inspiration for a very successful activity for us. Part of learner-centred education means involving students in the educational process. Recently I asked a group of students how to make the portfolio assignment in clerkship more relevant to them. They came up with several ideas. I used a few of them and collaborated with Dr. Lindsay Davidson to come up with the CaRMS and Portfolio Oral Report. From what I’ve heard so far, the students seem to feel it is an extremely relevant and useful way to use their portfolio activities.
Resolution 2: Be more reflective.
I discuss reflection with the students in all years in our program. This is met by varying degrees of acceptance. 🙂 But I’ve been forgetting to add one key aspect: I need to show them my reflective practices as well.
What do I reflect on? I ask myself often, “How can I do this better?” and “Where can I find ideas to make this better?” I ask others about improvement and about strengths too. In fact, this blog article is by way of reflection for me.
I start off each week with a list of work, and end it with a list of accomplishments and what got in the way of accomplishments–that reflection helps me when the next week comes around. This is the beginning of a weekly log for me and I am resolving to stick to it! 🙂
Here are some questions we can ask ourselves to become reflective teachers:
1. Were all the students on task (i.e. doing what they were supposed to be
2. If not, when was that and why did it happen?
3. Which parts of the lesson did the students seem to enjoy most? And least?
4. How much (insert topic or skill of choice here) did the students use?
5. Did activities last the right length of time?Was the pace of the lesson right?
6. Did I use whole class work, group work, pair work and/or individual work?
7. What did I use it for? Did it work?
8. Were my instructions clear?
9. Did I provide opportunities for all the students to participate?
10. Was I aware of how the students were participating?
BONUS: If I taught the lesson again, what would I do differently?
What’s next? The next important step in reflection is making the reflection practical and asking “What do I do next?” Identifying challenges, setting goals, finding out new information from the literature, from people, from observations, and putting some strategies into place are ways to make the reflection come to life.
I ask the students to fill in these blanks, “My first step was to consult this piece of medical education literature to find out more about this topic: _________________. From this I learned this specific strategy/skill, concept that I would like to employ: _________________
I will now put these strategies into place:
- Consult _______________(people as resources) to find out more about _________________(this subject, skill, concept, etc.)
- Read ____________ (specific literature) by ________________(time)
- Practice ______________(skill) by doing this: _____________ (strategy) over __________(time)
- Set up this regular ________________ over_______________(time)
- Implement _________________(strategy) into my teaching by X___________________
I will know I have succeeded by:
- Short term: ___________________________
- Long Term: ____________________________
Complete the reflective cycle by asking about the innovations:
- What am I doing?
- Why am I doing it?
- How effective is it?
- How are the students responding?
- How can I do it better?
Resolution 3: Be evidence-based.
Teaching can be and should be evidence-based just as medicine. Read or sign up for an RSS feed from medical education journals such as Academic Medicine, Medical Education, Advances in Health Sciences Education: Theory and Practice, Medical Teacher, Journal of Interprofessional Care, or others (these examples are cited in order of impact factor, 2012, found at http://www.med.uottawa.ca/dime/eng/journals.html) Need to know about how to set up an RSS feed that sends you the journal updates and tables of contents? Contact a librarian at Bracken or see http://library.queensu.ca/news/web-feeds/ The articles, studies and tips in these journals will enhance your teaching. Some texts that feature evidence through studies to inform educational practice are: Teaching at its Best: A Research-Based Resource for College Instructors, What the Best College Teachers Do (a personal favourite!), How Learning Works: Seven Research-based Principles for Smart Teaching
I’ll stop there for now…Too many resolutions, and I’ll end up with none!
Please share your resolutions if you can.
Have a great educational year!