Month: July 2016
Queen’s UGME Curriculum Committee Retreat Updates
Hello all! I’m writing this on behalf of Dr. John Drover, Chair, UGME Curriculum Committee and Candace Miller, Administrative Support, UGME Curriculum Committee as part of the UGME Curriculum Committee’s commitment to outreach.
May 31, 2016 saw an action-packed morning as the UGME Curriculum Committee held its annual retreat from 9:00 a.m. to 1:00 p.m. One purpose of the annual retreat is to consider for approval recommendations made by the Curricular Change Working Group. The Working Group had met previously to collate, synthesize and review requests for changes to the Curricular Framework and changes to course assignments of MCC’s and objectives. These had been submitted by Competency Leads, the Educational Development Team, Year and Course Directors and required a review from the whole curriculum perspective.
Another purpose for the retreat is to hear reports from the sub-committees that report to the Curriculum Committee as well as from the Competency Leads. In the policies and procedures of the Curriculum Committee, a report through the UGME Blog is required about the retreat and its outcomes.
As a result of this retreat, and the subsequent Curriculum Committee Meetings June 23 and July 21, faculty and students at Queen’s UGME will see a new edition “Red Book” or Curricular Framework coming out at the end of August. Many of the changes in wording to our Curricular Objectives were made to align with new Entrustable Professional Acts (EPAs) which were adopted at the July 18 meeting. Please stay tuned to a later blog for information about these EPA’s.
A few new objectives have been added under Medical Expert, and some objectives were consolidated, deleted, or combined, especially at the request of the Competency Leads. Medical Expert, Communicator, Advocate, Scholar and Professional roles and competencies each saw some changes.
Course and Year Directors had requested changes to assigned course MCCs and Objectives for courses based on a review of the teaching/learning and assessment in their courses. Those which were approved will be made in MEdTech for each of our courses as submitted, by the end of August, ready for the new academic year. That will automatically change the dropdown menus for each learning event for easier access. There will be a system that maps the old objectives to the new, and this will be done automatically. However, faculty will see a NEW as well as OLD set of objectives, while we transition. Make sure you focus on the NEW set.
Course Directors will be notified about the changes pertinent to their courses from their respective Year Director by the end of August.
The Advocate, Professional, Collaborator and Scholar Competency Leads (Drs. Carpenter, Allard, Davidson, and Murray respectively) reported on work in the intrinsic roles. The template requires them to report on: a follow up to last year’s report, operational aspects, student progress, and curriculum. As well each report gives a status report and a discussion of future plans.
Please note: If you are faculty with access to Queen’s MEdTech, you can view all the agendas and the minutes from the Curriculum Committee Meetings, the Curricular Working Group notes and the Curriculum Committee Retreat, online at https://meds.queensu.ca/central/community/facultyresources:curriculum_committee.
Where have all the people gone?
Anyone who has grocery shopped at a large supermarket recently will notice that you’re now confronted with a decision at check-out time. You can line up as usual to have a clerk check and bag your items, or you can opt to go to the do-it-yourself kiosk, where you have the privilege of scanning and packing your items yourself. I’ve been tempted to canvass folks who choose the clerkless option. I suspect some feel it’s faster (by my observation, that’s dubious at best). Some may be obsessive-compulsive enough to want to handle and pack their own things in some preferred manner. I suspect some may simply wish to avoid the need to interact with another person, however briefly.
Whatever the reason, it seems likely that the option we’re currently being provided is not going to continue, but rather is a transition process preparing us for a time when grocery chains will no longer hire actual human beings for the purpose. When that happens, your friendly check-out person will join the growing list of community roles that are no more, or exist in a much more limited capacity:
In fact, it’s now entirely possible to leave your home in the morning and carry out all your domestic and business chores without ever having to be troubled with the need to interact with an actual human being. Moreover, we don’t require another person’s help to accomplish many of the functions of day-to-day life. In essence, we’re paradoxically becoming more isolated in the midst of increasingly crowded and busy urban environments.
Recently, we’ve witnessed a further blurring of the boundary between our personal space and the wider world. The introduction of Pokemon-Go basically makes the wider world a personal playground. In the words of the manufacturers, “Travel between the real world and the virtual world of Pokémon with Pokémon GO for iPhone and Android devices. With Pokémon GO, you’ll discover Pokémon in a whole new world—your own!”
So, what are we to think of all this increasing detachment from the people with whom we coexist, sharing our communities and services? Is it a problem, or simply evolution towards a greater, technologically driven efficiency? Is there a price to be paid for our virtual isolation from the growing number of people around us?
At the risk of sounding like a sentimental reactionary, I’ll admit that a few concerns come to mind.
Firstly, on a purely pragmatic level, these jobs provided income and, for those who engaged them as full time occupations, a sense of identity and purpose within our communities. They, in turn, were able to support their families and local economies. Jobs, all jobs, are likely our best social investment. A loss of jobs, even unglamorous jobs, should concern us.
They also provided part-time employment opportunities for young people, valuable experiences in self-sufficiency and human relations that informed and supported future careers. Interacting with various folks in the course of our routine day promotes “people skills”. One learns how to “read” people, sense concerns, respond appropriately.
Moreover, the need to interact and communicate on a regular basis with other folks of diverse ages and backgrounds, I believe, promotes tolerance, civility and fundamental sensitivity to the challenges faced by others in our midst. How much do children learn by simply observing how their parents interact with all the folks they encounter in daily life? How much is lost if that never occurs?
I believe we’re seeing some consequences in our medical schools.
One of the most stressful moments for medical students is their first encounter with a patient. At our school, this takes place in first term Clinical Skills. Very early on, students are taught and expected to introduce themselves to a patient, obtain some basic information, and begin the encounter that will eventually allow them to obtain a complete and accurate clinical history. It all starts with simply introducing oneself and beginning a basic conversation, which, one might think, would come quite naturally to bright and gifted young people. Amazingly, many students find this quite difficult and even unnatural. In fact, students vary considerably in their comfort and aptitude for the patient encounter, and this has very little to do with their academic qualifications. It does, however, have much to do with their prior experience engaging people on a personal level, particularly those of diverse ages or backgrounds. That ability is (or should be) learned through real life everyday experiences, at home, in their communities, in their workplace. In our competency-based world of medical education, it’s easy to forget that the most essential physician competency is the affinity for effective and comfortable exchanges with people of all types. That particular skill is first developed, not in medical school, but in our homes and communities.
It would be silly to expect that technology will not continue to advance and that the now redundant occupations described above will make some sort of magical resurgence. However, we should recognize that something has been lost and not replaced. These roles were not just jobs or functions. They were actual people, with faces, personalities, roles in our communities for which they became known and identified. They contributed something far beyond the tasks they performed. They contributed to our learning, our sense of community, and our comfort with personal interactions. In their absence, we must find ways to identify and develop those skills in our students who are products of a rapidly changing social structure.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
Teaching the Way You Practice: Collaborative Active Learning in Different Teaching Settings
By Michelle Gibson (firstname.lastname@example.org) and Melissa Andrew (email@example.com)
Most health professionals are actively engaged in collaborative practice: working with many different team members from different disciplines to support patients or clients in achieving their health goals.
However, we often teach our learners in isolation from one another, and, if we are being honest, co-teaching and integration between disciplines in an educational setting can be challenging. When it ‘works’, however, it is very rewarding, and it is an opportunity to role-model explicitly for learners how different disciplines with differing approaches can work together to enhance care. When co-teaching is combined with active learning that mimics the wonderful messiness of real clinical practice, learners can start to envision how complex problems are approached in “real-life”. In our experience, this is particularly powerful when we have students also working in teams on complex, real-world cases.
We offer up tips and lessons learned in six years shared teaching between geriatric medicine and geriatric psychiatry in undergraduate and post-graduate settings, to different audiences. We have also co-taught with other health care disciplines but our examples come from our co-teaching.
Examples of what we teach together:
- Second year medical students: We built on-line modules for students to use first on dementia and delirium, and then we co-teach the session that applies this learning to real-life cases. Dr. Andrew co-teaches a 2nd session on “Brain and Behaviour” with a psychogeriatric resource consultant.
- Family Medicine residents: We have 2 half-days which deal with common, complex, outpatient problems in older adults: the patient who arrives on a Friday afternoon with falls, confusion, and a letter from an anxious daughter; the patient who is extremely cognitively impaired, falling frequently, with a nightmarish medication list, and no family members who can provide history; this same patient who has a valid drivers’ license, and who may or may not be depressed.
Tip # 1: Start with being clear about your purpose(s), goals, objectives.
While this is important for all teaching, it becomes essential when more than one individual is involved. For example, when we started to design academic half-days for family medicine residents, we worked out that we were aiming to help them approach complex patients with multiple problems in an outpatient setting, while highlighting how geriatric psychiatry and geriatric medicine are similar, how they are different, and how we work together. These sessions work best with a shared vision.
Tip #2: Be explicit about roles and expectations.
Similar to Tip #1, this does get increasingly complex when more than one (extremely passionate and very dedicated) teacher is involved in any learning event. Who is preparing what? By when? How are the different parts going to be taught? There is nothing worse than realizing the day before that you were the one expected to prepare the quiz. J
Tip #3: Avoid ‘parallel play’.
Some attempts at integration or co-teaching end up being a series of lectures or teaching sessions that happen to be scheduled in approximately the same time period and are not really integrated. The best sessions involve a back-and-forth approach, with many opportunities to address areas of controversy in a respectful manner. (See Tip #4)
Tip #4: Embrace controversy, respectfully.
Junior learners in particular, in our experience, become stressed when it appears there is no one “right” answer. We live, wallow, and celebrate the land of the gray-zone in geriatrics (pun intended), so we rarely have one correct answer. However, how we address this in our teaching is important. We frequently check in with one another: “How would you approach this in your setting?” and acknowledge strengths in differing approaches.
Tip #5: Embrace complexity, carefully.
We have been pleasantly surprised as to how groups of learners are able to work together to approach very complex cases, when there is a safe learning environment. For example, we give learners a very complex medication list, while providing an approach for them to practice, and we emphasize that there are many ‘right’ answers. When we debrief this exercise, we use our different backgrounds/expertise to help students navigate the pros and cons of different decisions. The team setting for teaching appears to allow students to feel safe to address areas of discomfort – that wondrous gray zone in which we revel. We all consult when there is a great deal of complexity, and we should role-model this for our learners.
Tip #6: Play your best cards.
This is a great time to determine who is best at which parts, and use these skills to your advantage. This applies both to clinical expertise, but also to teaching styles: who is the best person to teach X? Who is better at addressing this particular issue? Why not compensate for each other’s’ weaknesses? You also have the huge benefit of learning from your colleague.
Lesson #1: It takes more time up front, but less time the more you do it. The discussions, planning, negotiations about “what is the way we want to approach X” does require more time initially, but it gets easier each time.
Lesson #2: If possible, it’s best (in our opinion), and more fun, to co-teach with people that you work with regularly. The established trust and long-standing respectful relationships, we believe, shine through for learners, allowing them to feel comfortable when we ‘disagree’ on certain issues. This is much easier to do in a collegial way when you know how the other teachers work and think. Plus, teaching with friends is fun.
Lesson #3: Going out for lunch to plan teaching is optimal. ‘Nuff said. Seriously, though – it’s hard to plan teaching in the midst of busy clinical work. Set aside time to think about things, and to meet in a positive environment.
Lesson #4: Where there is assessment involved, co-marking is hugely informative – as in, set aside time, sit down together, and mark together. It allows us to delve into why students thought X, when clearly we thought we were teaching Y. There is also the distinct advantage of being able to share the marking load, whilst sipping on pleasant beverages. More importantly, though, by discussing the answers, we are able to immediately adapt our teaching plans for the following year.
Best wishes to our 2016 Grads – beginning residency, and continuing a long tradition.
The image below is taken from one of the many graduation photographs hanging on the walls of the School of Medicine Building. The young men in the photo are members of the 1884 graduating class. On the surface, one may be struck by the obvious differences to our current world, in terms of gender and ethnic diversity, medical knowledge, and the needs of the society they were about to enter as physicians. But I’m more struck by the similarities. Although their careers and lives have long since ended, those young faces frozen in the photograph seem eager, confident in their training, and perhaps a little nervous, about what challenges the future will bring, and how they will contribute to it. In all those regards, they are not at all unlike our current students.
This week, our most recent graduates begin the next phase of their medical careers. They also seemed eager and a little nervous when they started their medical education here at Queen’s in September of 2012, as may be apparent in the photograph taken that first day.
That eager nervousness has probably not disappeared completely, but is hopefully supplemented by the same confidence in their abilities and desire to contribute that characterized so many of their predecessors. As they do, they’ve spread across this great country. Their areas of specialization and locations are summarized below.
I’m particularly pleased to welcome back those who will be pursuing postgraduate education here at Queen’s.
Dr. Carl Chauvin, former Aesculapian Society President, will be starting the Anaesthiology program.
Drs. Kelly Fernandes, Matthew Legassic, Hollis Roth, Calvin Chan and Betty Chiu are entering Family Medicine.
Drs. Alex Astell, Roxana Chis, Josh Durbin, Ioulia Pronina and Kamran Shaikh are beginning their careers in Internal Medicine.
Drs. Alida Pokoradi, Stefania Spano and Ainsley Alexander have joined the Obstetrics and Gynecology, Orthopedic Surgery, and Psychiatry programs, respectively.
All of our graduates, I’m confident, will enhance and contribute to the programs they enter, and they do so with the best wishes of their undergraduate teaching faculty.
Their graduation photograph has joined those of all their predecessors on the walls of our School of Medicine Building. These photographs remind those of us who serve as stewards of our medical education heritage that we have an entrusted responsibility to produce graduates who are not just academically successful, but who bring real value to the profession and society. That mission hasn’t fundamentally changed over the years, but requires very different approaches than it did in the past. Our purpose remains to attract eager, dedicated, capable young people to the profession, and to prepare them intellectually and personally for a career of service, promoting and providing for the health of our society and fellow citizens.
That’s what we’ve done. That’s what we do.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education