Now what? Making the most of a conference, now that you’re home

Many of us from Queen’s UG – faculty, staff and students – are just returning to campus after a few days in Halifax, NS for the annual Canadian Conference on Medical Education (CCME).

CCME brings together those involved in all aspects of medical education from across Canada and beyond for workshops, meetings, plenaries, research orals and posters, and general sharing of innovations and challenges.

Like most jam-packed conferences, the information overload can be overwhelming. Here are five ways to make the most of your conference experience, once you’re back home:

  1. That Bag O’Stuff: If you didn’t do this prior to packing to come home, take two minutes to sort the “stuff” acquired at the exhibitors’ hall, at the poster presentations, and handouts from workshops. Are you really interested in that program/service/product/innovation or did you add it to your bag from habit? I sort my conference bag while standing over the recycle bin and keep only things I’m going to follow-up on. Put what remains aside for tip #2.

  2. Get out your Post-Its! For everything that’s left from your paper purge, put a note on it RIGHT NOW. In two weeks you’ll forget exactly why you picked that up – especially if you thought it might be of interest for a colleague. Write yourself those notes!

    Hmmmm. Why did I take this picture? Do I need to save it? Sort your files right now!
  3. Sort 2: Electronic edition: Did you use your smart phone to take pictures of posters or of presenter’s slides that spoke to you? Move them to a labelled folder NOW and offload to your computer to ensure they don’t get lost amongst your upcoming summer shots. Label things a la electronic stickies (see #2)

  4. Follow-through: Did you collect emails from anyone you met along the way? Did you make tentative plans to get together, pursue a project, or generally stay in touch? Send off that quick networking email now, before those potentially productive contacts are lost in the busy of day-to-day responsibilities.

  5. Plan ahead: Mark your calendar now for next year’s CCME in Niagara Falls April 16-19, 2019. (Abstracts open later this month!)

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Why medical students go unmatched, and why they deserve an opportunity to complete their training.

There is no longer any doubt that the number of unmatched Canadian medical graduates is on an upward trajectory that will certainly continue in the absence of significant interventions. We now know (https://afmc.ca/news/2018-04-17) that 115 students remain without residency positions after two attempts to “match” this year. That’s an increase from 68 from last year, 46 in 2016, and 39 in 2015, which means the number has almost tripled over those four years.

We also know of the tremendous individual burden of failing to engage a residency position which, while always very well understood by medical students and medical school faculty, has been made public through numerous articles and individual accounts:

https://atlantic.ctvnews.ca/medical-students-go-unmatched-despite-doctor-shortage-1.3884737

https://meds.queensu.ca/ugme-blog/archives/date/2017/06

https://www.thestar.com/news/canada/2017/06/17/tragic-case-of-robert-chu-shows-plight-of-canadian-medical-school-grads.html

https://www.universityaffairs.ca/features/feature-article/canadas-medical-residency-system-leaving-graduates-limbo/

Both the Association of Faculties of Medicine of Canada (AFMC) and Canadian Federation of Medical Students have developed position papers on this issue.

https://afmc.ca/sites/default/files/documents/en/Publications/AFMC_reportreducingunmatchedcdnmg_en.pdf

https://www.cfms.org/files/position-papers/agm_2017_support_unmatched.pdf

The upward trend is in keeping with the rather dire predictions of the AFMC position paper and has caused that organization, in a recent news release, to term the situation a “crisis”.

https://afmc.ca/news/2018-04-17

It has also spurred the Ontario Minister of Health, with urging from the provincial medical school Deans, to introduce a 23 million dollar program to provide supernumerary positions to, at least temporarily, provide relief.

https://news.ontario.ca/mohltc/en/2018/04/ontario-funding-additional-residency-positions-for-medical-graduates.html

This effort by our provincial government is very much welcome by both students and medical school faculty, and certainly provides very tangible evidence that the issue has gained attention and is being seriously engaged. However, it is clearly a temporizing measure, intended to stop the bleeding, not resolve the problem.

In medicine, we teach that problems can only be effectively engaged with a full understanding of their cause, or etiology. That process always starts with an examination of available facts, which are sometimes difficult to tease out from the subjective impression of a stressful experience.

So, what are the facts?

  • The number of residency positions available to medical school graduates is established by our provincial governments. They also very strongly influence the distribution of those positions between the 30 or so entry level residency programs. This is entirely appropriate to their responsibility to safeguard the public interest, both in terms of provision of health care and financial stewardship. No doubt they and their advisors make every effort to ensure that those positions match the needs of the communities they serve. Given the lag time inherent in the medical education process, this requires predicting future needs which, all would agree, is a difficult and inherently imprecise process.
  • Provincial governments have also made the decision to make some residency positions available to Canadian citizens and landed immigrants who have graduated from medical schools outside Canada (International Medical Graduates).
  • Students enter medical school with the clear expectation that any medical specialty is available to them but with little idea of which medical specialty they wish to engage, and with no obligation to undertake any particular specialty. Considerable effort and thought is expended by students during medical school to make those determinations. Those efforts are strongly supported by undergraduate programs through counseling and provision of career exploration opportunities.
  • Medical students make their own choices with respect to which programs they apply to, and how many programs they apply to. In doing so, they receive counseling from their schools, but are free to accept or reject any recommendations, and are well aware of which residency programs are more competitive.
  • Although the absolute number of residency positions is numerically similar to the number of Canadian graduates, the choices of students do not match the distribution of positions, resulting in a number of specialty programs being heavily over-subscribed and therefore highly competitive.

 

The phenomenon of the unmatched student is therefore the direct consequence of a mismatch between the specialty mix deemed to be in the public interest by our government, and the personal preferences of students.

It is also clear, given the current process and recent history, that the goal of matching every student to their specialty of choice is an impossibility. Intense competition for residency spots and increasing numbers of unmatched students are inevitable unless one or more of the operative realities noted above are changed. Fortunately, the Ministry of Health has, in the recent statement, committed to engage substantive change:

Ontario is collaborating with partners throughout the country to develop and implement a longer-term solution to this pan-Canadian challenge.”

Those charged with developing this “longer term solution” will, no doubt, be facing a considerable challenge, attempting to balance the government’s primary responsibility to public accountability, with the full freedom of students to choose any specialty. As they do, they will need to consider a few other facts concerning the educational experience of our students.

Medical school graduates are not yet able to engage practice. Medical education is a continuing process that transitions from university-based degree programs to residency positions that last a minimum of two additional years and which must be completed before a learner is even eligible to engage practice. While it is certainly possible for medical school graduates to take up alternate careers, that is clearly not their intention at outset, nor is it the societal expectation that establishes the number of medical school positions to match needs and heavily subsidizes medical education. The graduate who fails to achieve a residency is therefore denied the opportunity engage medical practice, and the training they have received to date is essentially wasted.

One could argue persuasively that the public interest, honestly and objectively interpreted, should always take precedence over individual preferences. However, most would also agree that every individual in a free society should at least have the opportunity to engage the profession for which they have undertaken training at considerable effort and personal sacrifice, and for which they have successfully demonstrated qualification.

Our students deserve the opportunity to engage a career in medicine and our society deserves a return on the investment they’ve made in their education. For those things to happen, our graduating students must have an opportunity to engage a residency program. Our ultimate solution to the unmatched student problem must, at a minimum, provide that opportunity.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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Third annual History of Medicine Week starts April 23

The What Happened In Medicine (WHIM) Historical Society is proud to host the third annual History of Medicine Week! This year’s theme is inspired by Dr. Duffin’s Heroes & Villains assignment, where students must grapple with some controversial characters in our history. Students, Faculty, and Community members are all warmly welcomed to attend any and all events! Please join us during the week of April 23rd for four exciting events:

Museum of Healthcare Showcase 

Monday, April 23rd (8:30AM – 3:00PM)
Grande Corridor, New Medical Building, 15 Arch St.

Hero or Villain? You be the judge! Wander through the Grand Corridor of the New Medical Building and enjoy the showcase curated by the Museum of Healthcare. At your leisure, take a look at artifacts of some of history’s biggest medical heroes and villains.

Panel Discussion

Tuesday, April 24th (5:30PM – 7:30PM) 
132A, New Medical Building, 15 Arch St.
Don’t miss out on our most controversial event of the week! After a half hour period to gather refreshments and FREE food, a panel, moderated by the incredible Dr. Jenna Healey, resident Queen’s Hannah Chair of the History of Medicine, will question the basis for a designation of hero or villain. The panel will begin with Dr. Jaclyn Duffin, haematologist, historian, and past Hannah Chair of the History of Medicine, describing why and how she invented the Heroes and Villains project as an introduction both to history in medicine and to information literacy — with some of its triumphs and disasters. Next, Dr. Allison Morehead, Associate Professor and Graduate Coordinator of Art History at Queen’s University, will talk about Florence Nightingale and the “incursion” of women into the “fraternity” of medicine in the 19th and 20th centuries, as well as the ways in which historical accounts of Nightingale heroicize (or angelicize!) her to the exclusion of other figures in the history of nursing, such as Mary Seacole. Closing the panel is Edward Thomas, PhD candidate in Cultural Studies at Queen’s, will discuss his research examining Queen’s barring of black medical students between 1918 and 1964 in regards to how institutional narratives shape organizational memory and culture. 

Open Mic Night 

Wednesday, April 25th (7:00PM – 9:30PM)
The Grad Club, 162 Barrie St
Need an outlet for your historical arguments? Ready to re-enact your heroes and villain assignment? Want some free beer and endless historical entertainment? Come out to the Heroes & Villains: Open Mic Night! A relaxing event, some fantastic entertainment, and a wonderful evening spent with your Queen’s peers, what more can you ask for?!

Movie Night: History of Kingston Psychiatric Hospital

Thursday, April 26th (5:30PM – 7:30PM) 
032A, New Medical Building, 15 Arch St.

Don’t miss out on this weeks closing event! We will be screening the film “The History of KPH” by Queen’s Film Studies’ own Janice Belanger. Come to learn more about the Kingston Psychiatric Hospital, and have a relaxing end to this jam-packed week!

 

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The special challenges of researching teaching and learning

[Italics indicates a hyperlink]

We’re passionate about teaching and learning and equally passionate about evidence-based medicine. So, it follows that we’re also interested in evidence-based teaching methods. That translates into interest in Scholarship of Teaching and Learning (SoTL) at the School of Medicine.

This means we have teachers interested in conducting research studies about their teaching and in finding better ways to help students learn. This is a particularly challenging type of research that raises unique issues about power, confidentiality, captive populations, and the burden on participants.

The Queen’s General Research Ethics Board (GREB) issued a four-page guideline document on Scholarship of Teaching and Learning (SoTL) in June 2017.

As much of the research conducted by those involved in the UGME program focuses on SoTL – and the HSREB is aligned with the Queen’s GREB – these Guidelines are relevant to research considerations for both faculty, staff, and student-led projects.

The Guidelines document draws attention to studies with direct student involvement, as well as self-studies, which both have implications for student privacy, including during the research dissemination process.

For studies with direct student involvement, other considerations that are highlighted include:

Power Differential

The power-over relationships between instructors/researchers and students can impact the students’ decision to participate in the research. This differential can be managed by keeping the instructors/researchers at arm’s length from the students by person or time [with suggestions provided]

Captive Populations

This term can be applied when participants are dependent on an ‘authority figure’ (e.g., instructor/researcher) who can infringe on their freedom to make decisions. [Guideline include ways to mitigate this risk.]

Participant Burden

The main purpose of formal education is for students to gain knowledge, not to be participants in research. If students are repeatedly asked to participate in research studies, their educational pursuits may be compromised. It may be of value for instructors/researchers to consider what other types of research are being conducted with students to diminish the impact of participant burden. Also, instructors/researchers should try to design studies that help enrich the students’ educational experiences instead of distracting from those experiences.

Confidentiality

Students may have concerns about whether or not their instructors/researchers know if they took part in the research. Students may feel their decision not to participate in the research could impact their academic trajectory. [Includes suggestions for how to mitigate this risk].

[Excerpts from pages 2-3 of the Guideline]

If you’re interested in creating a study related to your teaching in the UGME program, feel free to get in touch with the Education Team to talk through some of these challenges. We’re here to help.


The complete four-page document is available here under “Guidelines” or use this direct link to download the PDF file

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The never-ending march for a better world.

“One of my best friends was killed by gun violence right around here”

With those few simple words to a reporter asking why he was participating in the recent gun control demonstrations, Paul McCartney not only perfectly summarized his intention, but also managed to unite the generations of people marching with him and remind us that you’re never get too old, or secure, to aspire for a better world.

He was participating in one of many demonstrations taking place as part of the “March for our Lives” movement staged last week in many American and Canadian cities. Responding to the Parkland Florida mass shootings and so many that have gone before, millions of young people took to the streets to demand action from their political leaders. The sight of these folks, many of them really just children, publicly and boldly prodding their leaders to action was inspiring and one of the most hopeful developments to come from our southerly neighbours in some time.

 

 

But among them were also many not-so-young people, spurred on by their own convictions and reminding all that there were older people among those lost in the shootings at Marjory Stoneman Douglas High School, and that gun violence is indiscriminate, targeting all.

The “best friend” Mr. McCartney referred to was, of course, John Lennon, who was killed by a gunman outside his New York apartment in 1980. Together with George Harrison and Ringo Starr, they formed the Beatles, the group which transformed the music world in the 1960s and, many believe, were key contributors to a massive social movement that influenced an entire generation – a generation that engaged protest and became quite familiar with marches and mass demonstrations.

What I recall from that time, and still persists for me today, is firstly how revolutionary their music was. Because their songs are now so familiar to us, it’s difficult to appreciate today just how fresh and original they were at that time. They really didn’t sound like anyone else, and didn’t fit any particular pre-existing style. They wrote all their own songs, which was apparently unheard of for a group of young people at the time. Their harmonization and musical instincts seemed like uncomplicated, pure perfection. For those who were young at the time and searching for an identity that distinguished them from previous generations, they provided the perfect vehicle. They brought hope and the sense than true change was possible. Over the years, particularly for those of my generation, their music still evokes that sense of optimism and promise that a better future is always achievable.

The other aspect I recall is their incredible irreverence. They were amazingly unpretentious, unapologetic and in no way intimidated by convention. They were audacious and genuine. I recently watched a documentary about them featuring film footage of interviews with seasoned, much older reporters who were completely unprepared for their refusal to condescend and were completely incapable of controlling the interview.

  • Asked to characterize their musical genre, the response was “well, it’s just music, isn’t it?”
  • Told that a music critic felt their music had “unresolved leading tones, a false modal frame ending in a plain diatonic”, John responded “he ought to see a doctor about that”.
  • Asked who was their leader, Paul responded “whoever shouts the loudest.”
  • Asked the meaning of their group’s name, John said “it means Beatles, doesn’t it? But that’s just a name, like shoe”.

Their rejection of convention, and refusal to be drawn into values not their own, was remarkable.

Over fifty years later, that spirit seems secure in the young people marching and speaking out last week, and in Mr. McCartney’s willingness to stand with them. It should remind us that issues such as gun control, climate change and social justice transcend age and generational stereotypes. It should remind those in positions of authority that the young people of today may indeed have concerns worthy of attention and are not really so different than they were. It should remind us all that young people have the considerable advantage of seeing the world through fresh and optimistic eyes, not yet worn down by the weight of responsibility and prior disappointments. They simply want a better world and ask “Why not?”. Didn’t we all? Shouldn’t we all? Don’t we all?

As I write this, one of my favourite Beatles discs plays in the background. I linger on the lyrics and plaintive melody of “All You Need is Love”.

If only…

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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