Month: May 2016
Canada’s Medical Schools collaboratively engaging the issue of Student Wellness.
For this week’s article, I’ve asked Renee Fitzpatrick, Director of Student Affairs, to write to us about a topic of critical importance. Indeed, the issue of student wellness and risk should be a major concern of both individuals and institutions engage in the education and development of young people. As she points out, our efforts in this regard need to be ongoing, and she introduces a recent initiative taken up jointly by the Canadian Undergraduate Deans and Student Affairs leaders to consolidate and strengthen our approach to this problem.
In April 2016, Laura Taylor, a third year medical student at UBC, died just days before her 34th birthday. Her parents, devastated by the loss of their kind, loving, brilliant, athletic daughter shared that the bipolar disorder that she had struggled with for more than half of her life, became too much. She had worked tirelessly to reduce the stigma of mental illness.
Her photograph shows a girl with a full smile, the kind that would inspire confidence in any patient, a smile that is referred to repeatedly in her book of condolence, a hockey helmet, reflecting her passion for hockey and a stethoscope, the signature of the medical profession.
The tributes speak to her energy, her athletic ability, her generosity in volunteering, her openness about her mental illness, her academic brilliance, her wit, her courage and her humility.
Any medical school in the country would have been proud to have Laura as a student, and UBC was particularly proud of her. She had all the attributes that we have identified as important to sustain a career in medicine. She also had a serious mental illness, one that she had prior to medical school, which she actively tried to manage.
Just days before Laura’s death, at this year’s CCME, the Canadian Federation of Medical Students, presented results of a mental health survey of medical students across Canada, results that challenged us to take action. The report described increased rates of anxiety, depression, suicidal ideation and burnout, compared to the general population, replicating results from other countries. The Undergraduate Deans committed to a review of suicide risk factors in medical students in an attempt to understand what factors are associated with the conversion of suicidal ideation, a sign of distress to suicide.
Over the last few decades there has been increasing emphasis on the need to identify and treat mental illness in medical students, residents and physicians. Accreditation requirements include a need to demonstrate that there is access to help for mental health issues. However, there is still stigma about seeking help, with concerns ranging from impact on license to fear of judgment. The ACGME Council of Review Committee Residents made suggestions to identify ways to improve resident wellness and resiliency following the death by suicide of 2 resident physicians in New York in August 2014. These were. (1) increasing awareness of the risk of depression during training and destigmatizing it; (2) building systems to confidentially identify and treat depression in trainees; (3) establishing a more formal system of peer and faculty mentoring; (4) promoting a supportive culture during training; and (5) fostering efforts to learn more about resident wellness.
We had made some strides in the last few years to increase wellness initiatives, promote resilience and reduce burnout. The CFMS survey indicates that we have no reason to be complacent. It is crucial to identify the risk factors that convert ideation to suicide. We must reflect on the degree of perfectionism that we require to achieve one of the coveted spots in our medical schools. We must ask how students survive our scrutiny as we demand competent collaborators, communicators, managers, experts, leaders and advocates. Is the perfection that we demand reasonable? Is the environment conducive to negotiating the developmental tasks of early adulthood in addition to training as physicians?
I do not suggest for one moment that we reduce our standards or dilute the fact that medicine is demanding and that we need to be able to tolerate uncertainty, failures, distress and pain. I believe that this is achievable in an environment that promotes and facilitates the growth of healthy physicians. The leadership and support of the Undergraduate Deans is crucial in enhancing the health and resilience of the next generation of physicians, who have taken a courageous step in identifying the issues.
Our Undergraduate Deans have made a commitment that deserves all of our support and challenges us also to become healthy physicians.
Finding hope amid the chaos: The baffling, reassuring, authentic appeal of Bernie Sanders
The ongoing and rather turbulent journey that is the American presidential election provides many opportunities to despair for the future of democratic institutions. However, a lone beacon for optimism arising from the whole spectacle may be the completely unanticipated appeal of one Mr. Bernie Sanders.
Mr. Sanders, the 75-year-old Brooklyn born son of Polish-Jewish immigrants and current junior senator from the tiny, off-the-beaten-track state of Vermont, doesn’t look, sound or behave like someone who should be contending for the presidency in 21st century America. His political biography sounds like an extended version of Frank Capra’s “Mr. Smith Goes to Washington”. A former carpenter, filmmaker, writer and populist mayor (Burlington, Vermont) gets elected to congress as a self-professed socialist with no affiliation to major political parties (until 2015 when he finally became a Democrat). He opposes tax cuts, campaign funding, infringement of privacy and foreign wars. He promotes social welfare programs, environmental and LGBT issues, parental leave and universal healthcare. He filibusters on points of political principle. Since declaring his candidacy for the presidency, his views have not deviated. His speaking style is unpolished, his campaign rudimentary compared to the well funded approaches of his opponents, and his policies, although appealing in their idealism, seem overly simplistic and perhaps naïve approaches to rather profound social and economic issues.
He is, in many ways, a poster child for the Baby Boomer generation. That’s the huge segment of society born in the post World War II years who are now largely in their 60s and 70s. These folks, who were rebellious, idealistic, free living, pot smoking “hippies” in their youth, largely moved away from those socialistic ideals as they grew older and become hard working supporters of “the system” and are now the conforming leaders of our private and public institutions. Except, of course, for Mr. Sanders. It seems he’s never moved away from the liberal, leftist ideals and unapologetic honesty of his youth. All of this is causing fits for his fellow Baby Boomer opponent Ms. Clinton, whose political experience, strong corporate support and polished dialogue almost become liabilities in contrast.
The most remarkable aspect of Mr. Sander’s success is his base of support. It’s not, as one might expect, his fellow unrepentant Baby Boomers. His main support is, surprisingly, coming from young people. In particular from those much maligned Millennials. In fact, he far outpolls Ms. Clinton in the 18-29 year old demographic, in marked contrast to his performance in all others. (http://www.statista.com/statistics/521935/michigan-democratic-primary-2016-exit-polls-votes-by-age/).
Exit polls of the 2016 Michigan Democratic primary in the United States on March 8, 2016, share of votes by age
The Millennials, you’ll recall, are that generational group born between 1982 and 2004. Their major cultural influences have been massive advances in technology and economic uncertainty. They have been regarded as privileged, entitled and narcissistic. Their enthusiastic support of Mr. Sanders is truly one of the most intriguing themes in this bewildering election campaign.
What’s the explanation?
In my view, it comes down to a single word, that word being Authenticity. For this purpose, authenticity can be defined as “the degree to which one is true to one’s own personality, spirit, or character, despite external pressures”. Authenticity is about being truthful, genuine and credible. It’s very difficult to fake over the long term, and the millennial generation appears to be particularly adept at seeking it out. They also value it greatly, and for good reason. Authenticity is rooted in truthfulness, and engenders trust. We may not always agree with authentic people, but we believe what they say and feel we can rely on them to act on their professed beliefs. Mr. Sanders, I think we all would agree, is nothing if not unfailingly authentic.
There are lessons here for those of us involved in education, which is largely about gaining the trust and confidence of these bright, young and eager millennials. The authenticity that works so well for Mr. Sanders can be thought of as comprising three key elements:
- Credibility, or fundamental believability. Also referred to as “street cred”. This arises from a combination of reputation, behaviour and qualifications. Not sufficient in itself, but a necessary starting point.
- Genuineness, which is honest dedication or devotion to what we profess to teach or believe. Again, hard to fake if not sincere.
- Validity. This refers to the “real goods”. It’s not enough to appear credible or sincere. An effective teacher must prove their effectiveness by achieving real learning for their students. Fundamentally, if they’re not learning, you’re not teaching.
Mr. Sanders will likely not become President, but his valiant campaign, dogged adherence to his principles and unexpected resonance with young people provide lessons for us all on how to bridge generational gaps, and a hopeful tone to an otherwise demoralizing electoral process.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Reducing the Burden of Concussions Through Education
By Chris Griffiths
The Concussion Education, Safety and Awareness Program (CESAP) seeks to reach a broad audience on the prevention, identification and management of concussion injuries. According to the Centre for Disease Control, 65% of all concussions occur in those aged 5-18, and concussions make up 13.2% of high school sports injuries (CDC, 2015). As high school populations are at increased risk of injury, it is important that they are properly educated on the risks they incur by participating in sport, and how to best minimize these dangers. However, a study in Florida examining high school football players, a sport at the highest risk of injury, found that only 1 in 4 received proper concussion education (Cournoyer & Tripp, 2014). As 20% of those injured eventually develop long-term sequelae of concussion, such as depression and anxiety disorders, it is important that schools develop supportive environments for those injured (Hudak et al., 2011). Increased awareness has been demonstrated to increase the likelihood students will adhere to management and prevention strategies, and increase the level of compassion received from their peers (Taylor & Sanner, 2016).
This past fall, a group of medical and graduate students teamed up to work on reducing the burden of concussion in our community. Two second year medical students, Logan Seaman and Chris Griffiths, began working with MSc Neurosciences candidate, Allen Champagne, to develop a free education program for high school students and athletes. With the advice of physicians at Queen’s University, namely Dr Mike O’Connor, Dr Fraser Saunders and Dr Andrea Winthrop, and endless support from the Centre of Neurosciences Studies, CESAP developed a classroom session focused on the biomechanics, symptoms, and management of concussions. With help from students at the School of Rehabilitation Therapy and their faculty, we have put emphasis on the many healthcare professionals who can help in injury rehabilitation around Kingston.
What we believe sets CESAP apart, however, is our behaviour modification and prevention arm. CESAP runs clinics for youth football teams with classroom sessions followed by on field drills led by Queen’s football players to teach proper tackling technique. The drills were developed based on research at the University of New Hampshire, showing that equipmentless drills that focus on fundamentals, or “heads up tackling”, reduced the number of head impacts by 4.4 per game in collegiate athletes (Swartz et al, 2016). CESAP has committed to expanding these principles to other sports, with drills developed for soccer and hockey.
CESAP’s classroom sessions are modified specially for each target audience. While some sections are shortened for particular groups, the structure of each talk is the same. We begin by introducing basic neuroanatomy, localizing different areas of the brain to their function. For senior high school classes, we go into greater depth into axonal structure, and show different imaging modalities such as MRI and Diffusion Tensor Imaging. Emphasizing that concussion is a functional injury, we explain how injury can occur and the symptoms that are caused. The goal is that students can identify unusual behaviour in themselves or their teammates, and encourage them to make a safe choice by removing themselves from play if necessary. We outline red flags or concerning symptomatic developments, and equip students with questions to ask their peers if they suspect injury.
Unfortunately, the reality is that injury does happen. With help from physicians, occupational therapists and physiotherapists in the field, we have compiled the best resources for management plans in concussion rehabilitation. Parents are provided with information on all of the health care professionals in the area who they can consult, and youth are educated on what to expect in their recovery. Perhaps the most powerful part of our program, however, are the testimonies offered by concussed athletes on our team, such as former Queen’s Football player Jesse Topley. The stories our athletes give make the effects of concussion a reality, as we hope to foster supportive environments around concussions in the community. By outlining the difficulties that follow injury, we hope that athletes understand they have the power to prevent severe sequelae by playing it safe in their recovery. We hope that athletes and youth are able to identify the injury in themselves and take it seriously, and reverse the “warrior culture” that exists in sports that encourages young athletes to play through any injury.
Since the middle of January at program launch, CESAP has presented to over 1,100 students, athletes, parents and coaches in Kingston, Sherbrooke, Quebec City, and across the GTA. Our program hopes to continue to expand into the Limestone District School Board, with regular classes in grade 9 PHE and senior biology classes. In athletics, we are advocating for more education of coaches, referees and trainers in leagues in the Kingston area.
With help from our colleagues at the Centre for Neurosciences, and in partnership with students in the School of Rehabilitation Therapy, we hope that CESAP can continue to grow across Canada. Our dream is to make CESAP, and programs like it, standard education for high school students and athletes. Through increased education, we believe that youth, parents and coaches can make safer decisions regarding head injury and reduce the burden of concussion and its chronic effects on society at large.
If you are interested in booking CESAP for an education session, please contact us at email@example.com. We will accept any audience and are happy to tailor a presentation to your needs! Please follow us on Twitter @cesap100 to learn more about our sessions and concussions in the news.
Centres for Disease Control and Prevention. “Online Concussion Training for Health Care Providers.” Centers for Disease Control and Prevention. N.p., 4 May 2015. Web. 31 Mar. 2016.
Cournoyer, Janie, and Brady L. Tripp. “Concussion knowledge in high school football players.”Journal of athletic training 5 (2014): 654-658
Hudak, A., Warner, M., Marquez de la Plata, C., Moore, C., Harper, C., & Diaz-Arrastia, R. Brain morphometry changes and depressive symptoms after traumatic brain injury. Psychiatry Research, 191(3), 160–165 (2011).
Swartz, E. E., Broglio, S. P., Cook, S. B., Cantu, R. C., Ferrara, M. S., Guskiewicz, K. M., & Myers, J. L. (2015). Early Results of a Helmetless-Tackling Intervention to Decrease Head Impacts in Football Players. Journal of Athletic Training, 50(12), 1219–1222. http://doi.org/10.4085/1062-6050-51.1.06
Taylor, M. E., & Sanner, J. E. (2015). “The Relationship Between Concussion Knowledge and the High School Athlete’s Intention to Report Traumatic Brain Injury Symptoms: A Systematic Review of the Literature.”The Journal of school nursing : the official publication of the National Association of School Nurses. PubMed. Web.
Teachers and Learners “Spring” Forward for Each Other
By Jonathan Krett, Aesculapian Society President, Meds’18
Recently I attended the Canadian Federation of Medical Students Spring General Meeting in Montreal, QC. Sitting around a table with medical student society presidents from across the country discussing a variety of issues really drove home that at Queen’s School of Medicine, we students have it pretty good.
One of our strengths is certainly the huge part that learners play in driving the student experience. The peer-peer support at our medical school is a true standout and I believe it fosters a strong sense of community. Another one of our notable strengths is without a doubt, the engagement and responsiveness of the faculty that come into the classroom to teach us each day.
Twice a year, the Aesculapian Society (AS) Council hosts general assemblies in which we have an opportunity to recognize both faculty and student contributions to our life as learners at the Queen’s School of Medicine.
It’s on these rare occasions where I have the opportunity to reflect on, and be proud of, the above-and-beyond efforts of a handful of very special people. I wanted to take this chance to celebrate peers and faculty who fuel the very essence of our wonderful community at Queen’s.
Without further adieu…
First-year President and AS President-Elect, Gray Moonen presented two AS lectureship awards on behalf of the Class of 2019.
Dr. Filip Gilic (Family Medicine), applied his direct and practical teaching style, helping to render common presentations in Family Practice accessible to medical students in their very first term of school.
Dr. David Lee (Hematology), engaged students in the classroom with a life-sized red blood cell piñata to demonstrate hemolysis. His careful and thoughtful approach to lecturing went a long way towards enabling material to percolate into the heads of his students.
Second-year President, Monica Mullin, presented four AS lectureship awards on behalf of the Class of 2018.
Dr. David Holland (Renal Course), won over students with his simplified framework for approaching renal disease. Leaving us with the wise words, “Teach Once, Learn Twice,” Dr. Holland thanked his students for the lessons they have taught him along the way.
Dr. Robyn Houlden (Endocrinology Course), was recognized for her organized course framework and emphasis on key concepts for practice in endocrinology. Her sense of humour in the classroom brought a certain levity to otherwise intimidating, complex material.
Dr. Alex Menard (Radiology), made several appearances before the second-year class and de-mystified diagnostic imaging using an interactive teaching method. He left us with pragmatic approaches to common clinical scenarios.
Finally, Dr. Heather Murray (Extended CARL, 2nd-year Course Director), was applauded for her extensive contributions to the well designed second-year curriculum. This year she incorporated a brand new initiative called “Case of the Month.” This series runs longitudinally through second-year, helping students to consolidate approaches to several core clinical presentations and get comfortable with applying our non-medical expert physician competencies.
In addition, non-academic awards were distributed to non-graduating students. (Note that students in fourth year receive their awards at graduation, and will not be specifically mentioned here.)
Wei Sim, AS VP Internal Affairs, presented the A. A. Travill Award to Graham Skelhorne-Gross. Graham was congratulated for his immense work and sacrifice on behalf of the entire student body at Queen’s in his role as our VP External. He spent countless weekends out of town representing us on provincial committees, such as the Ontario Medical Students Association (OMSA).
The AS Awards of Merit were presented to several students who excelled in their efforts to promote student life and learning in a variety of areas.
Adam Mosa (Meds’18), was applauded for his work as Queen’s Medical Review Co-Editor-in-Chief and as one of the Class of 2018’s Clerkship Curricular Representatives.
Peter Wang (Meds’18), was heavily involved in enhancing extra-curricular learning for his peers (SSTEP, Emergency Medicine Interest Group), along with his work in the community teaching first-aid to youths with Junior Medics.
Henry Ajzenberg (Meds’18), provided a great deal of leadership on the advocacy scene this year. He co-chaired the successful Health Policy Interest Group (HPIG) and acted as Chief Outreach Officer for the Ontario Political Advocacy Committee (OPAC).
Wei Sim (Meds’18), also received an award for heading up the popular acapella group, Hippochromatic Notes, and his many behind-the-scenes efforts on student council.
When all was said and done, I had to stop and think once again, at Queen’s we have things pretty good.
Please don’t hesitate to contact me at firstname.lastname@example.org with any questions or comments.
A list of past faculty winners can be found here.
Celebrating Student LEADership
This week, I’ve invited one of our soon-to- be-graduating students, Elizabeth Clement (Meds 2016), to report on the LEAD (LEadership Enhancement and Development) program, an initiative she and a group of her colleagues have conceived and completed over the past year. When Liz, Alia Busuttil and Graydon Simmons first came to me with this idea, I must admit to thinking it was overly ambitious, particularly given they were just beginning their clerkship. Once again, I underestimated the commitment and tenacity of our students when they are pursuing a deeply held and worthy cause. I attended the presentations of the Service Learning projects that Liz describes below, and was greatly impressed at the ingenuity and commitment to community service that went into them. Inspiring, indeed. The LEAD program is being passed along to other students, who will work with myself and other faculty to ensure this great work continues.
I’m often asked what keeps our Queen’s faculty so engaged and energized about medical education. For a glimpse into the explanation, read on.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Mind the Gap by Elizabeth Clement
There’s always a natural tension between student and teacher. While there is a clear common goal, which in medicine is that of graduating a competent doctor, it is easily muddied by the varied opinions on how to achieve such a goal. Students have many competing interests – that extracurricular activity, research project, or family commitment. Faculty, too, are juggling their many hats – hospital service, clinics days, conferences and their home life. Over time, many, if not all, show up to the classroom with slightly less enthusiasm, and as teaching begins to deviate further from one’s preconceived notion, it’s easy to see how that unity of working toward a shared goal begins to erode.
If you’ve ever been on the subway in London, England, I find this reminiscent of the vaguely haunting mind the gap. As the train pulls up to the platform, the two bodies never perfectly line up, leaving a small space between the two: a gap. The overhead voice reminds you to mind the gap: don’t fall in. Because of the nature of the subway’s short stops, you’re either on one side of the gap or the other. You’re either on the train or off the train. You’re either a student or a teacher. Mind the gap.
In my first year at Queen’s, I remember being floored by the openness and candidness of our faculty. Town halls and curricular feedback and personal email exchanges. Even more surprising was that changes were made within courses reflecting this feedback. Often this would happen in real time; courses would morph not after, but as we advanced through them.
It was not surprising to me, therefore, that when a dialogue began about students’ interest in leadership training, the idea of a student-run leadership course received faculty support. The first of many conversations about this project happened more than two years ago, and was the seed for the Leadership Enhancement and Development (LEAD) course. Now, at the conclusion of its first iteration, 12 preclerkship students have wowed us.
In the first of those two years, members of the Class of 2016 (Graydon Simmons, Alia Busuttil and myself) worked together to create a curriculum structure: one part seminar, one part self-reflection, and one part project. In the second year, the team grew as three members of the Class of 2017 (Rajini Retnasothie, Laura Bosco and Lauren Kielstra) joined us to help plan, administer and facilitate the course. Then, in November of this past year, 12 preclerkship students joined the course and we met for the first time as a large group. Amidst explanation of the structure of the course, we were clear about one thing: you will get out what you put in, and what you put in is completely up to you.
During the course, we heard from Queen’s School of Business’ Borden Professor of Leadership Julian Barling, who taught us about motivating with responsibility, and the importance of showing gratitude. We heard from our very own Dr. Sanfilippo about the pillars of leadership; optimism is imperative. We broke into groups of three to discuss our thoughts and reflections while working through the CMA’s “Leadership begins with self-awareness” modules. Meanwhile, outside of the course, students were independently working on “service learning projects,” which required community consultation, strategic design and a significant time commitment. The final seminar, held in mid-April, was a platform for the students taking the course to give short presentations on their service learning projects.
This was inspiring:
- Reza Tabanfar’s Telemedicine to Improve Access-to-Care and Treatment of Ear Disease in Remote Ontario Communities: We hope to use digital otoscopy and existing telemedicine infrastructure to leverage ENT’s expertise in diagnosing ear disease, facilitating much quicker review and prioritization of patients presenting with ear complaints in remote Ontario communities.
- Zain Siddiqui’s Jumu’ah Prayer Service at the Kingston General Hospital (KGH): The project’s aim is to have Jumu’ah, the weekly Islamic congregational prayer, in the KGH chapel so that that KGH staff and visitors can attend.
- Sejal Doshi and Elisabeth Merner’s Street Soccer Kingston: This project is an opportunity to build routine and social supports for Kingston’s homeless/transition housing community all while promoting the importance of physical health.
- Mahvash Shere’s Global Health Simulations – Queen’s Chapter: This project will allow students to engage in hands-on negotiation and problem-solving, by putting them in the middle of a humanitarian crisis and asking them to engage with different stakeholders attempting to resolve the crisis. Post-simulation debriefs will give students the opportunity to reflect on the complexity of problem-solving and power dynamics in these situations.
- Stephanie Pipe’s Revamping Altitude’s Mentee Recruitment Process: This project involves implementing new recruitment strategies, such as more advertisement of the program at the high school level and working with other groups and resources on Queen’s campus, to better reach our target population and hopefully increase the representation of our target population in the program.
- Katherine Rabicki’s Women and HIV/AIDS Situational Analysis: We are collecting data on the experiences of women living with, or at heightened risk of contracting, HIV/AIDS, with the goal of adapting Kingston’s community-based services to better suit the self-identified needs of this population.
- Connor Well’s Inspiring Future Medical Students Through High School Community Outreach: this project will determine the feasibility of encouraging high school students, especially from underrepresented backgrounds, to consider medicine as a career through knowledge translation of the medical school application process at high school career fairs.
- Akshay Rajaram’s Quality Improvement Practical Experience Program (QIPEP): QIPEP offers Queen’s students a chance to develop quality improvement and patient safety through participation in real quality improvement and patient safety initiatives that impact patient care.
As I walked around the room hearing students talk about Jumu’ah, global health simulations, and street soccer, (I’m a little embarrassed to admit it, but) I was getting euphoric. Maybe it was these students’ optimism or show of hard work. Maybe it was their passionate pursuits in the absence of obligation. At the end of the day, I think it was quite simply that I was learning about topics that, without these students, I would know nothing about. THEY were teaching and I was learning; not the original design of our course!
I had not occurred to me until then that perhaps faculty who teach are motivated because they, too, want to learn. When we consider life-long learning as a part of our professional responsibility, most of us consider that to mean staying up-to-date with medical practice changes, but there’s a lot more to be learned that can impact the practice of medicine. When faculty solicit student feedback, it’s in an effort to connect with students and better appreciate how learning is changing. Perhaps like a student’s satisfaction when performing well on an exam or rotation, faculty find satisfaction when making improvements to curricula; both demonstrate knowledge gain. And beyond this, I wonder if there is a deeper satisfaction borne from the notion that better learners will make better teachers.
In any case, a cyclic theme emerges: those who are committed to teaching are those who are committed to learning.
At Queen’s, it is clear that the doors are open to peer-teaching; the anatomy and Being a Medical Student professionalism curricula are two of many examples. But I think we can do more. Students are a resource; our diverse walks of life foster perspectives that can help reinvigorate content and delivery – this has particular relevance with the non-medical expert competencies.
Under no circumstance am I trying to suggest that Queen’s does not involve its students; in fact, I know the opposite to be the truth. Instead, I’m suggesting that a deeper involvement may serve both faculty and student in a novel way – by helping us appreciate the complexities of one another’s roles. Not only would the end product have curricular value, but the process would help us all to collectively mind the gap.