Month: May 2020
The Event Was Virtual. The Graduation Was Real!
In its 166 year history, the Queen’s School of Medicine has no doubt hosted many memorable events to mark the achievement of graduating students. None, I’m sure we can assume, compared to last week’s celebration.
For the past few months, a small committee let by Drs. Renee Fitzpatrick and Andrea Winthrop has been meeting and struggling to develop some appropriate way to recognize the graduation of our Meds 2020 class, given the limitations imposed by the pandemic. The result was a “virtual” event made possible by Zoom technology, our dedicated MedVC team and coordinated by Jacqueline Findlay, UG Program Manager.
Our virtual graduation celebration was “attended” by 300 sites that signed in, as well as an unknown number live streaming the event. Attendees were located in cities all across Canada, as well as several in the US and Europe.
It featured an opening welcome to families and supporters of our graduates, followed by individual recognitions of each graduate. Dean Richard Reznick paid tribute to the class, challenging them to make a difference. Dr. Susan Moffatt was selected by the students to provide remarks on behalf of faculty. Drs. Heather Murray, Erin Beattie and Brigid Nee were selected by the graduates to receive the prestigious Connell awards for outstanding lecturing, mentorship and clinical teaching. Dr. Akshay Rajaram was selected by the students to receive the award for outstanding teaching by a resident.
Dr. Cale Templeton and Julia Milden were selected by their classmates as Permanent Class President and Class Valedictorian.
In her address, Dr. Milden spoke of the gratitude of her classmates for family, friends and teachers. She acknowledged admiration for her classmates and the bonds of friendship that had developed during medical school and would persist through their careers.
“I am struck today reflecting on what exactly it means to be called a doctor, the thrill and duty of carrying this new title and the letters MD. This particular moment in time seems to make incredibly clear the power and responsibility of this role. On the wards or on television, writing orders or writing policy, doctors of all kinds are illuminating the challenges of their patients and of the system, and working together to help shape what we do as a whole world to take care of one another.
So what gives us this influence?
I think it’s the message we send when we say ‘I’m a doctor’ – to whomever we’re meeting, it means: I’m listening, I respect your wishes and your opinions, I know how to learn and am motivated to investigate your problem, and I will do everything in my power to help you.
And most remarkably, the skills and qualities this social trust is based on are ones that we have right now: our willingness to listen, and our ability to care.”
Certainly, we must acknowledge that the event was decidedly not what anyone envisioned when Meds 2020 began medical school one September morning over four years ago. Nonetheless, it was every bit as real as the degrees earned by our graduates and received by them last week. It occurred because of a very real refusal to allow any mere pandemic to diminish the significance of what these young people have accomplished, nor overcome our desire to express our pride and extend our good wishes.
To them, our admiration and congratulations…really.
Balancing Social Responsibility and Personal Rights in a Time of Crisis
Reading the New York Times these days can be a rather jarring emotional experience. It is replete with stories of people and families devastated by the COVID crisis. Excruciatingly detailed and poignant accounts of people dying in their homes or hospitals, isolated from surroundings and those who have been significant to them. Married couples dying within hours of each other leaving shattered families behind, all deprived of the end of life processes that would normally help with the grieving process and achievement of some emotional closure. Hospital workers struggling to provide some modicum of solace and dignity before having to move along to the next patient.
Turn the page, and you read accounts of protests by those decrying the restrictions that have been imposed by their governments, claiming their rights to choose to assemble and assume personal risk.
These stories are not limited to New York or even the United States. They come from Italy, Britain, Mexico, South America, the Far East. It seems no place is spared, although the impact and time course varies considerably.
In our own characteristically muted fashion, the same dramas are playing out in Canada. Political leaders, hearing loud and clear from all constituencies and all perspectives, struggle to strike a balanced and responsible approach.
All this serves to highlight two great realities of this pandemic. Firstly, it is affecting virtually every human being on the planet. The sheer scope is mind boggling and it’s difficult to think of any prior catastrophe that even comes close. The second reality is that its very nature is such that it renders each of us both a target and a mechanism for spread. We are simultaneously potential victims and potential perpetrators. We are all therefore forced to make choices, and those choices are expressed not through words so much as through our actions.
For the vast majority, the choice is clear. Simply remaining secluded and abiding by social isolation directions from authorities is not only in their personal best interest, but also their means of contributing to the public good. It can be inconvenient, unsettling and, depending on personal and family circumstances, very demanding. It also requires a degree of trust and faith that decisions are being made with best information and with the best of intentions. It requires political leadership that evokes that trust. But most importantly, it requires a willingness to endure some degree of personal hardship for a perceived greater good.
For those who provide essential services, the choice is very different. For those people, the greater good is to continue their duties while exercising appropriate precautions. The willingness of health workers and the many essential service providers who allow our society to continue to function in these very challenging times is a testimony not only to their dedication and courage, but to their belief that they have a role in contributing to the welfare of others. They are nothing short of heroic.
All of us are affected. All of us are making sacrifices that require us to balance our personal interests with our obligations to those around us. Our fundamental values, both individually and collectively, are being exposed. The ideological and moral differences between individuals, communities and even countries are being laid bare in the face of this crisis. The early results are largely positive and even inspiring. But the real test is yet to come. As the acute crisis abates to some extent, and it becomes clear that a complete return to “normal” is a long way off, how will we engage this “new normal”? Our leaders and governments are making decisions that require them to determine the very nature of what constitutes “common good”. What seems clear is that what will determine success is not our ability to protect our personal interests, but the extent to which we are willing to sacrifice those personal interests for that common good.
CanMEDS roles in action during COVID-19
By Dr. Gray Moonen
Welcome to the Medical Residency Twilight Zone: There are no medical students. Academic half-days are virtual. Research projects are delayed indefinitely. Your oral presentation at the conference is cancelled. The entire conference is cancelled. Oh, that’s because flights are also cancelled. Licensing examinations are delayed. Clinics are cancelled. Where did all the patients go? You can hear a pin drop in the emergency department.
My hands are raw. No, I am not moisturizing them during the day and, yes, they are showing cracks. I am turning reptilian. These masks make me so hot, I can barely breathe. My glasses are constantly foggy. Oh hey, I didn’t recognize you with the mask on. Leaving the hospital and coming home are newly ritualized. Wash hands (arms, neck?), then take off scrubs, then take off shoes, wash hands again, put street clothing on… wait did I miss a step? Did I contaminate myself? Will I contaminate my home? Get my wife sick? I don’t know. I have internal monologues about how often to sanitize my equipment. Is my cell phone going to survive all this virox? It is the least of my worries right now, but it would really suck if I broke it.
I end every email with “stay safe”.
I’ve been reading about how to stay resilient and accept the inevitable stress. The evidence is sound, but it seems distant. “Focus on the things you can control”…that’s part of the day-to-day challenge as a resident. We often lack the clinical knowledge, experience, and confidence to control our clinical encounters. We require evaluations; all our work and research projects are supervised and graded in some capacity. We require licensing exams to proceed to be independent practitioners. These are the many things out of our control that all draw on our attention and make a crisis like the COVID-19 pandemic even more anxiety provoking. Not to mention our most pressing concern – for the deluge of illness and suffering this will cause patients.
And yet…. what a privilege it is to be a resident.
We are guided by a seven-pillar competency-based framework: “CanMEDS” or “CanMEDS – Family Medicine”. Although it may seem like everything is up in the air, I think there are equal, if not greater opportunities to develop our competencies during this crisis compared to usual times. Instead of going through the motions of learning objectives, checking off an Entrusted Professional Activity, receiving an In-Training Evaluation Report, instead we are actively motivated to do the things that need doing, because it simply needs to be done. Doing it well and thoughtfully, because it matters. A lot.
I have seen residents and staff physicians working side by side, tirelessly advocating for change at the individual, community and broader societal level. Grassroots campaigns are successfully encouraging people to stay home, and wash their hands; we’re advocating for PPE procurement. The trust, respect and unity being displayed across healthcare workers has enabled genuine collaborative efforts; “we are truly all in this together”. Residents are also liaising with public health, government agencies and the public to find innovative solutions, not to apply for a grant or win an award. It’s because this needs to be done.
I’ve noticed many residents become leaders and lean in to their voices, providing calm, measured and sound advice to their patients, peer groups, junior learners, family and friends, organizing systems to let patients know where to reach out to for help if they feel ill. Residents are stepping up and covering call shifts for ill or quarantined colleagues, offering to work COVID19 clinics or be redeployed to other services.
As developing professionals, we are sacrificing time, energy and our health in this evolving pandemic. Managing the competing demands of training such as patient care, evaluations, research and the stress of having academic requirements delayed or cancelled is unique, but I have observed grace inspired action rather than a compromise in integrity or overt displays of frustration.
As scholars we are staying informed on the emerging evidence and synthesizing this information for patients, peers and the broader public. As medical experts, we are not only maintaining many of our skills within our developing scope of practice, but actually expanding our skillset as we prepare to participate in more critical care, triaging, counselling and telemedicine.
Uncertainty and anxiety are undeniable. We are concerned we will not reach our training milestones or develop the competencies to practice independently. Yet, despite these dark times, I believe there are silver linings. We will all become better physicians and community members as a result of this crisis, and Canadians will benefit in the long term.
Gray Moonen, PGY1 in Family Medicine at the University of Toronto, graduated from Queen’s School of Medicine in 2019. He is also a past-president of the Aesculapian Society.
This column originally appeared on the CMAJ blog and is used here with Dr. Moonen’s permission.