Improving your medical teaching practice one minute at a time

Making changes in how we do things can seem overwhelming – whether these are personal wellness habits, work habits, or teaching practice habits. In the face of a huge list or a major innovation it can seem easier to throw in the towel before you begin.

Sustaining change means adopting new practices and habits that you can stick with.

I recently took a six-week online fitness course that focused on these types of incremental changes. The course is designed for working and stay-at-home moms and recognizes that everybody is really, really busy. Our first challenge was to pick a new habit to adopt that could be easily incorporated into our regular day (I chose skip the elevator—take the stairs). Another challenge was to adopt a one-minute daily task and stick with it – because, as the course leader pointed out: everybody has one minute. I (finally) started doing daily balancing exercises for my multiple-injury-damaged ankles. I’m five weeks in on that new daily one-minute habit, so I think it’s going to stick.

Along the way, I started thinking about one-minute habits and how this could apply to medical education. So here’s my challenge to those looking to improve or change their teaching practice:

Think of one thing that you can do in one minute (a day, or one minute at a time) that could improve your work in medical education. Adopt that one-minute habit. Here are some suggestions:

  1. Immediately after teaching, take ONE MINUTE to jot down quick notes on what you want to change the next time you teach. Do it right after your session, or you may forget what it is.

  2. Create a Med Ed “feel good file” in Google docs or another electronic format (this might take more than a minute): put in things like great feedback fro course evaluations, notes to yourself when something went really, really well with a class or a clerk, notes on teaching things you’re really proud of. If you’re having a bad (teaching) day, pull up the file and take ONE MINUTE to remind yourself of the good things you do as a medical educator.

  3. Reserve the last minute of class, seminar, or rounds to get two-sentence student feedback on index cards – what’s their top take-away from your session/seminar/rounds and what’s their muddiest point right now? Have them take ONE MINUTE to give you this feedback. Over the next week, take ONE MINUTE a day to read through some of the cards. Use the feedback to inform changes to your teaching or to shape a follow-up session.

  4. If you’re logged into MEdTech, take ONE MINUTE to annotate your session objectives on MEdTech. You likely already have these objectives in your PowerPoint slides, so you can just match them up to the assigned ones. (If you have multiple objectives, use your ONE MINUTE to do what you can now!)

  5. Start a teaching ideas journal (could be a notebook, or a word file, or the Notes app on your smart phone). After you’ve read a journal article, or talked with a colleague, or attended a workshop, take ONE MINUTE to write down ideas for how to incorporate this new information into your teaching

  6. Email or phone me and ask for help. No, seriously, do this. True story: While I was writing this post, a faculty member called and said: “Do you have one minute right now for a question?” We might not solve your challenge in a ONE MINUTE phone call, but if not, we can set a time to get together.

Sure, you could take more time on some of these ideas — but not at the expense of feeling overwhelmed by “one more thing” on a big project to-do list. Also, remember, these are suggestions to select from. Don’t take on all of them, because that has potential to turn into an overwhelming, throw-away plan. Pick one or two, or create your own. Because everyone has one minute.

 

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Great Teaching. You know it when you see it.

What makes for a great teaching session? In medical school, we make prodigious efforts to answer that question. We collect reams of information, ranging from the extensive student feedback collected about all aspects of their learning experience, to analyses of objective measures of student success in both internal and external examinations. There is also much written about educational methodology, and which approaches are felt to optimize effectiveness. We establish policy and take effort to ensure those are applied throughout our curriculum.

But beyond all this, there is something about a successful teaching session that defies formal analysis and simply goes beyond the aggregate of measurable parameters. To use a phrase originally applied by a Supreme Court Justice to the understanding of pornography, “you know it when you see it”.

My walking route from the hospital to the undergraduate office takes me by the main lecture hall in the School of Medicine Building at least a couple of times each day. I often stop as I go by to see what’s happening. Sometimes, I’ll drop in and look in on the teaching session for a few minute

It is easy to spot a session that’s going well. There’s a certain energy in the room that is immediately apparent. The students are engaged, attentive, anticipating what’s to come. But even easier to read is the teacher. Whether it’s a basic scientist or clinician, something special happens when a natural teacher encounters a group of eager learners. Like the activation of a long dormant instinct, the encounter seems to set off a response in the teacher that energizes the session. It is no longer a recitation of facts and directives but rather a sincere effort to pass along acquired wisdom. Students, for their part, sense the effort and value of what the teacher is trying to do. They reciprocate with attention that energizes the teacher, setting up a feedback loop that makes the whole thing work.

I’m pleased to report that, by both the objective and “know it when you see it” assessment, the vast majority of the teaching sessions we provide are highly effective. It is also apparent to me that the vast majority of our faculty truly enjoys their teaching experience and finds it personally satisfying. That fact, more than anything, is the source of our success as a medical school.

And it happens a lot. Over the course of our four-year curriculum, over 700 full time and part time faculty members provide teaching sessions to our students, most of them practicing physicians with schedules full of more immediately urgent and financially rewarding pursuits. So how does it happen, and happen so frequently?

In an insightful commentary entitled What Makes a Good Teacher? Lessons from Teaching Medical Students” (Academic Medicine 2001:76(8);809) Ronald Markert identifies several factors that he believes characterize the best teachers. Although all are valid, two have always stood out to me as particularly relevant to the physician teacher. Quoting from Dr. Markert’s article:

 

A good teacher wants to be a good teacher. Teaching has to be its own reward. While recognition for outstanding teaching is commendable, faculty who are motivated only by formal honors will not achieve teaching excellence.

The focus of instruction should always be on student learning, not faculty teaching. Too often faculty members concentrate on what they want students to know. However, medical education is professional education, and we who teach medical students should go beyond our conceptions of what we think they should know and instead should search for what they actually need to know as practicing physicians.

 

Teaching, at its core, is a distinctly human interaction. It requires a connection, a mutual, unspoken relationship between two parties, one possessed of knowledge and the generosity to share, and one receptive to that knowledge. Essential to the learner is trust. They must assume their teacher is not only knowledgeable but is also motivated by their best interests.

Doctors are natural teachers. I believe this is, at least in part, because the selfless sharing of information and focus on the needs of the learner so well-described by Dr. Markert are also features of the physician-patient relationship. They also instinctively understand the concept of assumed trust, as critical to the teaching role as it is to provision of care to patients.

This week at medical school convocation, the graduating class will honour three such great teachers whom they have identified to receive the Connell Award. Named in honour of two previous heads of medicine, this award recognizes outstanding contributions to mentorship, lectureship and clinical teaching over their medical school experience. This year, Drs. Susan Moffatt, David Lee and Barry Chan have been selected and are, indeed, very worthy recipients.

 

 

Congratulations to them, and to all our faculty who contribute their time and natural talents to not only educating our students, but modelling for them the commitment and teaching skills that they will carry into their careers.

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Curriculum Committee Information – March 22, 2018 & April 17, 2018

Faculty, staff, and students interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on March 22, 2018 and April 17, 2018.  To review the topics discussed at this meeting, please click HERE to view the agenda for March 22, 2018 and HERE to view the agenda for April 17, 2018.

Faculty interested in reviewing the minutes of the March 22 and April 17 meetings can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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Learning through Community Service: From the classroom to Rideau Heights.

“Education is not preparation for life. Education is life itself.”

Those words are attributed to John Dewey (1859-1952), an American philosopher-educator who argued persuasively that the purpose of education is not simply to prepare young people to earn a living, but also to gain a deep understanding of the society in which they live and how they can function and contribute to it. In fact, he believed that achievement of a “democratic” society was not possible without that deep understanding, and that it could only be gained through personal experiences (Dewey J. Democracy and Education: An Introduction to the Philosophy of Education. MacMillan. 1916).

In the medical world, its axiomatic that doctors require a full understanding of the patients they serve. That understanding must go beyond the physiology and pathology of their medical diseases and extend to the circumstances of their patient’s lives and how those circumstances influence the genesis and treatment of their medical ailments.  If medical education is to prepare students fully for this challenge, it can’t be achieved simply through expressions of commitment and recitation of facts. It requires personal encounters and lived experiences.

The concept of “service learning” in medical education is fundamentally a commitment to provide those experiences. The challenge, of course, is that it can’t be forced upon the unwilling. Medical schools need to firstly select young people in whom the consciousness of community service and social accountability already exists, and to then provide opportunities in which fruitful educational encounters can develop. Basically, we outline the concepts and point to opportunities. It’s up to our students to take up the challenge. And they do, which, I must say, is one of the most satisfying and affirming experiences for any medical educator.

A few weeks ago, I had opportunity to drop by just such an event. It occurred at the opening of the Rideau Heights Community Centre, a facility established by the city to serve an area that has been considered underserviced. Our students, through linkages established with the Loving Spoonful, a Kingston agency committed to providing healthy food security, had opportunity to contribute to that event. I’ll let them describe the experience in their own words, written by the lead organizer, Danielle Weber-Adrian of Meds 2021 (photos courtesy of Danielle and myself).

 

Last November 4th there was a Health and Human Rights weekend seminar hosted at the School of Medicine Building. This is where I met Mara Shaw (Executive Director of Loving Spoonful) and we started chatting in a food security workshop. During graduate studies, my class fundraised for and hosted a meal at a local soup kitchen. It had been a wonderfully rewarding way to engage with the local community, and I thought the class of 2021 would also enjoy something like this. I pitched the idea to Mara and she immediately said yes. She mentioned that the opening of the Rideau Heights Community Centre would be the prefect venue for this idea. She explained that the demographics of the Rideau Heights neighbourhood included some of those most in need in the Kingston area, and that she’d love to work with us. 

Getting the class on board was a cake walk. Bethany Ricker was also at the seminar and she was the first person I approached about this idea. She showed immediate interest and the two of us formed the Rideau Heights Community Meal Committee. After that, five more of our classmates were avid to join the team and we were “off to the races”! Mara put us in touch with a local culinary chef, Tibrata Gillies, and assigned Thea Zuiker from Loving Spoonful to help us organize logistics. Bethany had been a cook at a summer camp before medical school, and the chili was actually her idea. She also single-handedly secured sizable donations of ground beef and vegetables to support our efforts. Tibrata then guided us as to how to prepare our meal, scale up a recipe, and then lead us on the day-of. When I had originally spoken to Mara about this I thought we were going to make a meal for about 200 people, but she told us we were expecting closer to 500 (“if that would work for us”). So, the committee rallied fundraising efforts and took on the challenge! To help mitigate costs, Emily Wilkerson and Bethany spear-headed a mini telephone campaign targeting local bakeries and grocery stores to inquire about bread donations (this was ultimately unsuccessful, but speaks to their resourcefulness and ingenuity!).

Fundraising started in full force in January, and it was a true collective effort. Emily  organized a 50/50 draw during a mentorship trivia night, which was wildly successful. Natasha Tang, Sarah Wong, Emma Spence, Angela Brijmohan and Bethany Ricker planned weekly (or biweekly) bake sales and organized volunteer bakers, and I sold “all you can drink” coffee most mornings until we had raised $974.60. Meanwhile, Emma had the fantastic idea of applying for the ASIA (Aesculapian Society Initiative Award) through which we were awarded another $900. This was almost double our initial fundraising goal of $1,000. 

For the event itself, Loving Spoonful was a dream to work with. Once we had delivered the funds, they contacted a grocery wholesaler and had most of the food delivered right to the community centre, meaning I only had to make one trip to Walmart for plates and a few other essentials to prepare for the meal. Loving Spoonful was also in contact with the city while designing and planning the community centre kitchen, so they knew exactly what we would have available. Tibrata also got to weigh in and advise the city which kitchen hardware options to invest in. 

In the end, we were able to provide a warm, nourishing meal for over 500 Rideau Heights community members, and we had plenty of 2021 (and 2018!) volunteers to cook, serve, and clean up. It was a fantastic experience, and I’ve heard really great feedback from both the class and the event participants. 

 


The School of Medicine Building on Arch Street and the Rideau Heights Community Centre are separated geographically by 4.2 km. Culturally and socioeconomically, the separation is much greater. The students who took the initiative and made the effort to serve the families of north Kingston closed that gap and, in the process, both confirmed the wisdom of our admissions process and made great strides in their journey to becoming great physicians. In short, they did us proud. Congratulations to them.

 

 

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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“What Happened in Medicine?” Medical students ask Philadelphia

By Kelly Salman, photos by Rawy Shaaban, Queen’s medicine class of 2021

“The history quiz is due this weekend?!” a classmate pulled it up on his phone, while a few followed suit on laptops. We were waiting for the bus to take us to Philadelphia and while my peers debated the turbulent past of drug advertising, the rest of us talked about what we were excited to see. Many had plans for dramatic poses on the “Rocky steps” or near the Liberty Bell.

“What even is the liberty bell?” I shamelessly asked while googling the best spot to find cheesesteaks. The real reason we were heading over the border was for a history of medicine trip, the continuation of a long tradition for Queen’s Medicine students, one that started in 1996.

I can’t lie and say I’ve always appreciated history. Although I could fool you, or scare you, with my wide-eyed ramblings about how cool the plague must have been, history is an interest I’ve found late. But along my route to medicine, something romantic about the past has drawn me in, and I got the impression during this trip that I wasn’t alone. Perhaps it has something to do with entering a field that makes you take an oath to an ancient Greek guy, but as a group medical students seem somewhat enamoured with their own history.

Contrary to popular belief, history waits for no one, and we started our adventure early Saturday morning, coffees in hand. Pennsylvania Hospital was a great place to set the tone; I challenge anyone to sit in an old surgical amphitheatre and not get swept up in historical daydreams. It helped that our guide painted an incredible picture for us as we sat on elevated benches, peering down at a classmate sprawled out on the operating table. It’s the details that get you… for instance, the floor would have been covered in wood chips for soaking up, well, you can imagine. Or that the hospital opened its doors to those of the public curious to observe the spectacle. In a different life, I wondered, how many of us would have been in that audience.

We continued to a stately mansion, famous for housing a man modestly named “the Father of American Surgery”, or to his friends and family Dr. Philip Physick. The guide here had a slightly more blunt approach, but it fit with the narrative he was giving. As we perused Dr. Physick’s various inventions (surgical instruments and… soda), he told us about how uncommon it was for a patient to survive surgery in those early days of the field: “He tried some neurosurgery, but often ended up accidentally nicking a blood vessel and then it’s ‘you’re going to get very sleepy now’”. I left with the unsettling impression that surgery in the 18th century sounded a lot like making a recipe from scratch – trial and error.

If you’ve ever idly wondered what a slice of Einstein’s brain looks like, then the Mütter Museum is for you. So, basically everyone. It’s a medical smorgasbord, filled with oddities and ailments through time: atypical skeletons, preserved organs, a jar of human skin (why?!), and even a giant human colon. Perhaps more interesting was the history of how society responds to such anomalies, in an exhibit dedicated to the folklore and varied cultural attitudes surrounding birth defects across the world. No photos allowed, but check out their website for some extraordinary highlights!

As millennials we often forget what books look like, so it was a real treat to see the libraries. We marvelled at the mahogany grandeur of the Pennsylvania Hospital library, but my favourite was less insta-worthy (partly because pictures were ‘discouraged’). While half of the group looked through beautiful, hand-drawn anatomy pop-up texts, the rest of us were led along a meandering pathway through the College of Physicians of Philadelphia to a door reminiscent of a submarine airlock. We quietly filed into the largest collection of books I have ever set eyes on. It was a room of steel bookshelves, dusty and dimly lit, filled with medical literature and journals from the past. Peering through the holes in the floor, the stacks continued infinitely further down than my eyes, and frankly my brain, could comprehend. I tried to imagine all of the words below our feet, and thought it must be akin to what an astronaut feels looking back at the earth.

I know my words can’t compete with those of my medical ancestors hidden away in Philadelphia. But hopefully if you take anything from them, it’s an inkling of interest into the world behind us. Good and bad, whimsical, and downright gruesome at times, the history of medicine is incredibly important. Because, well, in the words of someone more eloquent than me “History never really says goodbye. History says ‘See you later.”

Oh and in case you were concerned, I did find time for a cheesesteak.

 

 

 

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