Month: February 2015
CARMS Match Day 2015: 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 4th 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 Victoria Atchison at firstname.lastname@example.org, Jacqueline Schutt at email@example.com, or 613-533-2542. The faculty counselors can also be contacted 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
Put your own oxygen mask on first: Helping medical students develop good self-care habits
By Janet Roloson, M.Ed., Chartered Psychologist
When you are on an airplane, you may have noticed how the flight attendant instructs you to put your own oxygen mask on first before assisting others. This is important because if you run out of oxygen, you cannot help others with their oxygen masks – or with anything else. The same general principle applies to self-care in any context. Research suggests that good habits of self-care may begin to suffer in medical school; the pace and pressure of work can “push” self-care off to the side of a medical student’s priority list. In the longer term, the self-care habits medical students employ can also influence their performance as physicians. Taking good care of oneself is a central foundation for being able to provide good care to one’s patients (Ball & Bax, 2002).
If you are feeling as though you are treading water in medical school, you are not alone. Virtually all students will experience significant stress and pressure during their time in medical school; in some cases, this can develop into anxiety or depressive symptoms. This can interfere with a student’s ability to function effectively, and may prevent them from achieving at their full potential.
My name is Janet Roloson and I am the designated counsellor for The School of Medicine. My office is located with Health, Counselling, and Disability Services (HCDS) in the LaSalle Building on the second floor.
I am employed to offer counselling to medical students and residents; my affiliation is with HCDS. As such, services are offered at an arm’s length from the School of Medicine for the purposes of maintaining anonymity and confidentiality.
I am an experienced psychologist and I offer a range of services. These include evidence-based approaches for treating anxiety disorders, depression, and other diagnosable mental health issues; I also see many students who may not have a mental health problem, but who are experiencing difficulties/stresses which disrupt their functioning. Counselling may also be conducted in combination with psychotropic medications, prescribed by your physician. Students may also be referred to a physician or psychiatrist (in HCDS) if they are wishing to explore this possibility.
It is important to highlight that therapy is not exclusive to those with a mental health problem. If you are working to develop good habits and maintain healthy self-care strategies I’d be happy to see you to help with this process. As we all know, preventative measures are important to both overall physical and mental health. It is not necessary to wait on problems because they are not “big enough” or because “others need counselling more than me.” Dealing with smaller issues may assist in the prevention of more firmly-established and undesirable habits, plus anyone can benefit from counselling.
Some common examples of areas in which students may benefit from receiving further support include: procrastination, increasing motivation, perfectionism, establishing healthy boundaries, family issues, self compassion, dealing constructively with difficult feedback, disordered eating, grief, sexual identity, and relationship issues. Sessions are client-driven and one session may be all that is needed.
If you wish to schedule an appointment, contact Counselling Services at 613.533.6000 ext. 78264 or firstname.lastname@example.org and request an appointment with Janet. Therapy is available free of charge. Hours of availability are M, W, F 10:00 am-3:30 pm & T, Th 11:00 am-7:00 pm. Lunch appointments are also available from 12:30-1:30. Additionally, sessions are also available virtually or via phone for those who are unable to attend sessions in person. One initial face to face session is often preferable prior to scheduling these alternatives. For those who may prefer a self-help approach, the following self-help workbooks are free and accessible online: http://www.queensu.ca/hcds/workbook.php.
Good2Talk is another resource that is available 24/7/365 at 1.866.925.5454 or good2talk.ca. It is a toll free number funded through the provincial government that offers free, professional, and confidential support.
Ball S, Bax A. Self-care in Medical Education: Effectiveness of Health-habits Interventions for First-year Medical Students. Acad Med 2002; 77: 911-7.
In Defense of the Lecture
Medical Grand Rounds are a longstanding (dare I say, traditional) feature of the academic medical centre. In fact, their durability and continuing appeal might be considered somewhat perplexing in an age of increasing, almost frantic, busy-ness, and easy access to medical information and prepared presentations ready for review at our convenience. Here at Queen’s, they have become rejuvenated and are now a highlight of the academic week with the support of Dr. Archer and guidance of Dr. Mala Joneja.
The format is very simple: a formal lecture, followed by commentary and discussion from the audience. That audience tends to be quite eclectic, including medical students, residents, nurses, hospital administrators, and attending physicians ranging from junior staff to senior clinicians, some very much expert in the topic under discussion. The discussion following provides opportunity for those attending to add depth and perspective to the topic. Because it’s a gathering of thoughtful clinicians who lack for neither opinions nor willingness to express them, the dialogue following can be rich, far-reaching and highly entertaining. The challenge of the presenter is therefore considerable. With minimal technical “tricks”, relying largely on the content and style of their presentation, they must not simply inform but provide texture, context and deeper meaning to the topics under discussion.
Three recent, excellent Grand Rounds on contrasting topics delivered by individuals of different backgrounds and practice profiles provide insights about the “art and science” of the well- crafted and well-delivered lecture.
Dr. Zachary Liederman, a senior Internal Medicine resident, presented the topic of Myelodysplastic Syndrome. He described very nicely the current state of knowledge and clinical approach, and did not shy away from describing the complexities facing the treating physician when counseling a patient who has a condition that is causing minimal if any symptoms, and carries uncertain risk for progression. In the discussion that followed, senior departmental members questioned the obligation of treating physicians to disclose to every patient all information about conditions that are identified, but not the cause of symptoms, and of uncertain clinical significance.
Dr. Al Jin is a Neurologist with a impressive research background and clinical training in stroke. He is actively involved in “leading edge” approaches to diagnosis and management of this condition, sharing with the audience his insights about these emerging innovations, balancing thoughtfully the established and speculative, referencing the underlying scientific principles with practical clinical experience. As an acknowledged and respected expert in this field, he combined high levels of personal credibility with an engaging, respectful and balanced presentation. There was truly something for everyone, from the novice learner to seasoned clinician who treats stroke patients regularly.
Dr. David Holland is a well-established and highly-respected Nephrologist and educator. He presented a superb lecture on the topic of Disruptive Innovation in Patient Centred Care. He drew upon his clinical experience with chronic kidney disease and dialysis, but extended far beyond, providing insights drawn from industry and various models of change and innovation. Presenting with considerable panache and directness, he provided concepts and insights novel to most in the audience, and did so in a highly engaging and thought provoking discussion.
Three very different topics.
Three individuals of very different backgrounds.
All were highly effective in engaging their audience and presenting them with novel, fresh insights about topics in which many in attendance may have felt reasonably informed beforehand. In short, they all made a room full of people sit back, listen, and think again about something important to them.
How did they manage it? What makes any lecture effective? I would suggest there are a few common denominators.
· The content has relevance to the audience. It is something that is, for whatever reason, important to them in their occupation, private lives or, better yet, both.
· The content goes beyond simple transfer of knowledge. It extends facts and figures to a thoughtful discussion of the application, implications or meaning of the basic information.
· The presentation differentiates that which is factual and proven from that which is speculative, hypothetical or aspirational. In doing so, the presenter draws the audience into the discussion, allowing them to develop their own conclusions and thus extend thought and provoke further discussion
· The presenter is credible. This arises not simply from their background and qualifications, but from the way in which they interpret and present the information. The effective presenter, in fact, earns the trust of the audience by manner in which they present.
· The presenter is passionate about the topic under discussion. The audience must perceive that, at some level, the presenter cares about the subject on a personal level, to an extent that assures integrity about conclusions that are drawn.
· The presenter respects the audience. They truly wish to inform and advance understanding of the topic under discussion.
· The material is presented in a “user-friendly” and entertaining manner. This is not showmanship or a simple sprinkling of humorous anecdotes. It involves a skillful use of familiar concepts, analogies and parallel discussion lines to weave a narrative that informs while telling a story. It also requires a sense of the needs and preferences of the audience.
Despite a longstanding and venerable place in the history of medical education, the lecture format has come under considerable criticism, and is somewhat at odds with modern educational theory. It has been rightfully pointed out we no longer need lectures for simple knowledge transfer, since students have available to them a myriad of other information sources. It is also true that the lecture format can be a very passive experience for the learner, and may not engage them in the “active learning” process which is essential to deep and retained understanding of any topic. Medical schools, including Queen’s, have all engaged a variety of active, small group learning techniques. Many have abandoned the lecture format entirely.
The three examples and characteristics described above illustrate that the lecture format, appropriately structured and delivered, can be an integral part of a medical education curriculum, going far beyond passive information transfer, challenging students to extend their basic knowledge to the implications and application of the factual, thus deepening their understanding and providing a model for thoughtful reflection that should model processes they take into their professional lives.
At Queen’s, we have given considerable thought to the place of lectures and various learning techniques in our curriculum. A number of key decisions were made about 7 years ago when we engaged curricular renewal:
1. We would engage a variety of learning methods, including team based learning, case based presentations, facilitated small group learning, and lectures. In short, we would strive for a balanced blend of teaching methods. In addition to taking advantage of the benefits of all approaches, this allows us to model all methodologies for our students, who need to learn to teach themselves, a component of the scholar competency (the “medium is the message” approach).
2. We would use lectures not to provide basic information, but to allow experienced faculty to extend that information into discussions of significance, professional implications and clinical applications of knowledge.
3. We would structure into our courses sufficient resources, time and guidance for students to acquire basic information in a variety of formats, including on-line material, learning modules, reference material and reliable information sources that we would recommend. We would, to use the educational terminology, engage Directed independent learning.
4. We would dedicate significant components of our curriculum to helping students identify and recognize reliable information. In fact, much of the Scholar competency and most of our Critical Appraisal, Research and Learning (CARL) course (developed and guided by Dr. Heather Murray) is devoted to this goal.
5. We would promote faculty development opportunities for teaching faculty and recognize outstanding lectureship.
In short, we wanted fewer but better and more meaningful lectures, delivered to students already prepared with basic information and able to both discern credible information and make valid clinical decisions. To accomplish this, we required a committed, engaged and well-supported faculty, clarification among our students about the learning goals, and teaching spaces that allowed all this to happen.
Our School of Medicine Building, opened in September of 2011, was purpose built with these objectives in mind. The large group rooms were designed to allow for both lecture and small group teaching, and easily allow a teacher to transition between the two methods, so students can move easily between attending to a single lecturer and small group discussions on the issue under discussion.
The building also includes 30 small group rooms for both formal and informal learning.
Has it worked? Lectures continue to be featured in every course we offer but are now part of a teaching mix that includes all the other small group based methods we promote. The graph provided depicts the current percentages, a significant change over the past few years and a tribute to our faculty.
Do our students value lectures? Each year, the Aesculapian Society presents a “Lectureship Award” for the teacher in each course who they felt provided the most effective sessions. These are awarded after each course and are very highly valued by faculty.
The Canadian Graduation Survey, completed by all medical students at the completion of their final year, including 102 (99%) of our 2014 class, asks them to rate the overall quality of their medical education. Seventy-two percent of our graduates rate their experience as “excellent”, comparing to a national average of 29.6%.
So it seems we’re doing something right, and that the lecture has a secure future in undergraduate education, thanks in no small part to the example and contributions of excellent lecturers like Drs. Holland, Jin and Liederman.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Happiness, Wonderment, and Career Choice
By J. Peter O’Neill, M.D., M.Div.
During the first week of medical school, I introduce myself to the first year class, and proudly say that I am happy in my career and then I give my entire careers curriculum in one breath. I say: “You were selected to medical school because of outstanding individual academic performance and excelling in the admissions process, but you will be selected for residency only if you can look ‘happy and interested’ and can be wanted by a residency team.”
Each year, most students look back at me with disbelief. They think there must be some MCAT or GPA equivalent in medical school that “will get them in” to residency. They were not part of a team that got in. Nowhere in their preparation for medical school did anyone tell them to look happy.
But being happy and interested can make anyone look great; especially if it is true. It is probably what residency programs look for most. Happy and interested come first, then honesty and diligence. It is not just my personal opinion either.
In our published study on career choice[i] we showed that students choose their residency program based on the variety of clinical experiences, resident morale, and closeness of family. In other words, they wanted a program where residents looked happy and interested, and connected to their families.
We were not the first ones to notice this, but we quantified it with a new method. The Harvard Study on Happiness[ii] showed that happy people enjoyed their careers. People who were open to growth, wanted to do something significant, but also wanted relationships and humor in their lives were happy and successful. Residency programs desperately do not want unhappy residents.
Humor and wonderment are characteristics of the best teachers and mentors in medicine. Drs Neil Piercy and Mike McGrath taught me that. They could enjoy their work with humour, and find affirmation and wonder in the smallest surgeries. I encourage my students to practice wonderment by asking them what they find “cool”. But I wasn’t the first to notice this either. Dr. Ian Cameron writes that many Canadian medical icons share this life long affinity to humour and wonderment.[iii]
Some students come to medical school full of humor and wonderment, and by tending to their physical, mental, academic and spiritual health they still have it. They don’t have to beat CaRMS, they just have to be themselves. Faculty should nourish them by demonstrating the same. Students should practice being part of a team that values humour and wonderment and connectedness to others, by doing that everyday, with their peers.
[i] BMC Medical Education, 2011, 11:61
[ii] George Vaillant, Adaptation to Life, 1977
Curriculum Committee Meeting Highlights – January 22, 2015
Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller at email@example.com for information relating to agenda items and meeting schedules.
Highlights from January 22, 2015:
The Curriculum Committee has now approved all of the following:
- Policy #CC-12 v1: Policy governing curricular time in Years 1 and 2, and in the Clerkship Curricular Courses (minor amendments)
All Undergraduate Medical Education policies and terms of reference are available on the UGME website: http://meds.queensu.ca/undergraduate.
Next Meeting: February 26, 2015
Adding Your Photo to MEdTech Central
Adding a picture of yourself to MEdTech Central is an important part of completing your online profile, primarily because it assists our learners with identifying who you are while they are completing course and faculty evaluations.
To add your photo to your MEdTech Central profile:
- Log into MEdTech Central.
- Click on “My Profile” in the top right, near the picture box.
- Hover your mouse over the picture box, and click “Upload Photo”.
- “Browse” for your photo on your computer, then click “Upload”.
If you would like some assistance uploading your photo to MEdTech Central, the Education Technology Unit would be happy to assist. Contact us today at 613-533-6000 x74294 or firstname.lastname@example.org.
A Physicians life, well lived – Dr. Bruce L. Cronk
We all need role models. These are people who guide us through our lives by helping us understand the type of people we aspire to become. They may do so by providing wisdom or advice, but mostly they guide by the example of the lives they live. They are precious to us, and particularly so for those aspiring to a career in medicine. A physician’s life is a complex interplay of roles, values and encounters with the human condition in all its variations. To fulfill and balance these roles, and to derive joy and personal satisfaction while doing so, is indeed a great gift. Those among us who do it well are worthy of our admiration and should serve as models for our learners.
Dr. Bruce Cronk, who passed away recently, was certainly one of those people. Although I only had occasion to meet him personally a couple of times, I had opportunity to consult with him in the management of patients, and heard him speak on a number of occasions. His quiet competence, dignified civility, compassion for his patients and ability to connect on a personal level with people of all types were apparent to all who had opportunity to encounter him. Reading the various tributes that have come forward since his passing reaffirms these impressions and paints the picture of a person who was deeply committed to his various communities – his home town, his profession, his university, his faith, his country, indeed the world community. I can think of no better role model for the students and learners at Queen’s, and respectfully provide for them in particular the following tribute with the permission of Dr. Cronk’s family. It is the lived expression of every attribute and “competency” we profess.
CRONK, Dr. Lawson Bruce – M.D.C.M., F.R.C.P.C., F.A.C.P, F.A.C.C
March 7, 1923 – January 24, 2015
It is with great sadness that the family of Dr. Lawson Bruce Cronk announces his passing on January 24, 2015 at Belleville, Ontario in his 92nd year. He was predeceased by his dearly beloved parents Dr. George Sampson Cronk and Lillian (Guthrie), and his sister Harriet Simmons.
Bruce was born and raised in Belleville, Ontario. He attended Queen’s University, graduating in Medicine, Class of ’47. Bruce served in the RCAMC in WW II and the RCN(R). From 1947 – 1949 he conducted, on behalf of the Defence Research Board, research in the Eastern Arctic as a member, then leader, of the Queen’s University Arctic Expeditions. While undertaking postgraduate training at the Ottawa Civic Hospital he met his cherished life partner Sylvia Elizabeth Byrnes, and they married in 1949. Bruce continued his medical training, first at Kingston General Hospital, and then at Johns Hopkins Hospital and University, Baltimore, Maryland. He returned to Belleville in 1951 to practice internal medicine, in collaboration with his surgeon father.
Bruce was a Fellow of the Royal College of Physicians of Canada, a Fellow of the American College of Physicians and a Fellow of the American College of Cardiology. During his practicing career he was Chief of Medicine and president of the medical staff of Belleville General Hospital on recurring occasions, and a consultant to the Picton, Trenton, Campbellford, and Cobourg hospitals, as well as the CFB Trenton base hospital. He was Chairman of the Section of Internal Medicine of the Ontario Medical Association in 1965, and from 1980 to 1985 represented District 6 of the Council of the College of Physicians and Surgeons of Ontario. He was a member of the Regional Advisory Committee and Committee of Fellowship Affairs, of the Royal College of Physicians and Surgeons of Canada. He was a life member of the Ontario Medical Association and a Senior Member of the Canadian Medical Association.
Bruce viewed medicine as a ‘calling,’ and firmly believed it could be delivered on no lesser terms. A cornerstone of this philosophy was his tremendous dedication to education and its institutions generally, and medicine in particular. His remarkable support and affection for Queen’s University spanned his adult life. He was permanent president of the Class of Meds ’47, graduating with the Gold medal in Surgery; the W.W. Near and Susan Near Prize for the second highest standing throughout his medical degree program, and the Hanna Washborn Colson Prize for Proficiency in Clinical Diagnosis in Medicine, Surgery and Obstetrics. He was president of the Queen’s Aesculapian Society (the undergraduate body of the faculty of Medicine), and a member of the Queen’s Alma Matter executive. He was recipient of the Queen’s Tricolour Society Award and played three seasons with the Golden Gaels football team. He was a member of the Faculty of Medicine as a clinical assistant, then lecturer, then Assistant Professor, from 1953 until his retirement in 1988. He was a life member of the Queen’s Grant Hall Society and a member of the Council of Queen’s University. In 2013 Queen’s established the Dr. Bruce Cronk Distinguished Lecture Series in his honour. This endowed annual event is designed to host eminent scholars involved with all areas of medicine.
Closer to home Bruce served on Loyalist College Board of Governors 1975-1979, and in 1993 was awarded Loyalist College’s highest honour, a Diploma in Applied Arts and Technology. He also served as a member of the Board of Governors of Belleville’s Albert College.
Bruce’s community service extended far beyond the schools with walls. From 1965 to present date Bruce and Sylvia sponsored, through Plan International, young children from countries which spanned the globe. As a long-time member of the Quinte Interfaith Refugee Sponsorship Committee, he was instrumental in bringing and establishing families from Rwanda, Ethiopia, Laos, and Kosovo in the Quinte area. He was a Director of Hospice Quinte and of the Museum of Health Care at Kingston; a Trustee of Bridge Street United Church; and a President of the Quinte Branch of the Canadian Red Cross. He served in Community policing; the Canadian Food Grains Bank; and in 1997-98 as President of the Christian Medical Foundation of Canada. On conclusion of his hospital and office practice in 1988, Bruce spent the ensuing 10 years volunteering his medical skills for 5 to 6 months a year in United Church Health Services hospitals located in Newfoundland and in indigenous communities on the north-west coast of British Columbia. Of this decade Bruce said “it was a wonderful time with wonderful people.”
Bruce made a difference, and it was recognized. In 1978 he was awarded the Queen Elizabeth II Silver Jubilee Medal and in 1987 the Humanitarian Award of the RCAF Association. He received the Sir William Osler Award of the Christian Medical Foundation (International) in 1990, the prestigious Alumni Achievement Award of Queen’s University in 1992, and although not a Rotarian, a Paul Harris Fellowship from the Foundation of Rotary International in 1994. In 1996 he was recognized by the Royal College of Physicians and Surgeons “for outstanding service to his community” and in 2004 was nominated by the Canadian Blood Service and received the ‘Volunteer 50+ Award’ by the Province of Ontario, for 63 years of volunteer service in blood donor clinics and 181 official blood donations. In 2009 he was one of eleven residents of Ontario to receive the Ontario Medal for Good Citizenship. The citation accompanying this award spoke to his role as a member of a team that pioneered cardiovascular and pulmonary surgery in the Belleville-Kingston area. Bruce was awarded the Queen Elizabeth II Diamond Jubilee Medal in 2012.
Bruce’s hobbies ranged from history, to music, to woodworking, to a number of sports – including bicycling, kayaking, windsurfing, skiing and wilderness canoeing. He paddled the Nahanni, Mountain, Natla, Keele, Hood and Mackenzie rivers in the Northwest Territories, and the Dumoine and other rivers in Quebec and Ontario. In recent years he did confess to being content to paddle flat water.
Bruce will be dearly missed by his loving wife Sylvia; devoted children Anne and her husband Bob Freeland, Robert and his wife Patti (Aspinall), and Michael Sam; eight grandchildren and three great grandchildren.
The Cronk family wishes to thank all of Bruce’s many close friends and colleagues who have been an intrinsic part of the marvelous life he has led and enjoyed.
A Celebration of Life ceremony will be held at Bridge Street United Church, Belleville on Saturday, March 7th, 2015 at 2:00p.m. with Rev. David Mundy officiating.
It was his wish that any donations in his memory be made to Bridge St. United Church, Belleville, Doctors Without Borders, or the charity of your choice.
To our current medical students who are searching for that model of the ideal physician, I would suggest you need look no further. Want to be a great physician and a great citizen? Be like Dr. Cronk.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
1. Image Credit: The Intelligencer http://www.intelligencer.ca/2015/01/25/dr-bruce-cronk-1923-2015