Month: July 2020
Three ways to think about student engagement in remote curriculum delivery
While you’re preparing to deliver our UGME fall curriculum for Years 1, 2 and 3 predominantly via remote technologies (and some of that asynchronously), the challenge of keeping student engaged and involved may be top of mind. Three strategies (useful in any teaching, not just pandemic-restricted scenarios) are useful to keep in mind.
1. Set expectations early For many – students and teachers alike – remote teaching using a platform like Zoom is a new way to learn, so it helps to set the expectations when you start. In face-to-face teaching, this is sometimes done formally, but more often informally. A learner sitting alone in front of their computer can’t “read the room” to know what’s ok. If you’d prefer that students use the Zoom “raise hand” function to ask questions, let them know this at the start of class. If you’d rather they unmute their microphones to interrupt, set this as your norm. If you invite students to email you with questions after your session, set a reasonable time-frame for response. If you expect them to have downloaded a worksheet from Elentra ahead of time, make sure this is in your learning event’s “required preparation” section, since you can’t have a handout ready as back-up. Be clear, so no one gets frustrated.
2. Use tools effectively All the tools available in the classroom are also available in remote teaching – they just sometimes need a bit of tweaking to use effectively. For example, one really low-tech engagement tool is silence. In my early days teaching at the University of New Brunswick, I had a Post-It note on my lecture notes which said: “shut up, Theresa!” This was a succinct reminder to myself to give students time to hear and process questions before I went ahead and answered them myself. With remote teaching, we need to factor in time for student to click on their “raise hand” button or hit “unmute” along with that processing time. Silence can be uncomfortable for instructors as we think we should be filling every moment, however, using questioning and dialogue effectively remotely requires becoming comfortable with longer intervals waiting.
Most other tools you use routinely face-to-face can continue to be used via Zoom. For example, Poll Everywhere and videos were also used quite easily during the spring term. Do you sometimes use “show of hands” to get a response? Both the “raise hand” function and the “reactions” one can be used for this purpose. Some in-class tools might take a bit of strategic thinking and planning to rework for remote classes. If you have something in particular in mind, reach out for brainstorming and to capitalize on collective wisdom.
3. Assign roles Whether you’re in a Zoom class, or assigning asynchronous work, it can be helpful to proactively assign roles to individual students to keep everyone engaged and participating equitably. Whether it’s the randomizer app used by Dr. Gilic and Dr. Simpson in MEDS 115 to call on individual students for responses, or a “Someone from group X” call-out, these can all be tailored for Zoom.
If you’d like some Zoom-mediated face-to-face feedback, ask that one student from each SGL group be “on camera” during the class. Not everyone’s internet supports using video throughout, but teaching to a sea of names in black boxes makes it hard to gauge responses. Using a rotation within groups will share this responsibility. (And get more camera-shy students used to being “on” in a low-stakes way).
If you’d like a student to monitor the chat box for questions, create a roster of students who are willing to do it and share that task through the term.
If you’re using discussion boards for asynchronous teaching, break up the tasks needed to meet the learning outcomes of the discussion: have one or two students assigned to pose a discussion question based on the preparatory materials, another to moderate, someone else to write a one-paragraph summary of the discussion to share with the large group. You could also assign a student or two from each group to write multiple choice questions based on the assigned material. (If you’re interested in using discussion boards on Elentra, get in touch and we can set it up for you).
It’s true we’re in somewhat uncharted waters for teaching this way, but there are solutions to the teaching challenges. If you’re stumped or frustrated, please reach out – we can find some solutions together. Reach me best by email (firstname.lastname@example.org).
The Humble, Inspiring Leadership of Sir Tom
The spectacle of a 94 year old Queen wielding a large sword to “knight” a 100 year old gentleman, stooped and standing with the assistance of a walker, might seem somewhat anachronistic and perhaps even a little inappropriate to those whose tolerance for tradition and ritual is strained even in the best of times. Certainly, the double-whammy of the COVID crisis and racism activism are very much front of mind for most people and understandably so. Jaded suspicion and negativism have easy footholds in our consciousness. Hope and optimism struggle for attention.
Nonetheless, that’s exactly what’s to be found behind this brief ceremony conducted Friday at Windsor Castle.
The gentleman being knighted is Captain (now Sir) Tom Moore. He is a veteran of World War II, having been “conscripted” at the age of twenty. He was assigned to an armoured corps, but eventually served as part of what came to be known as the “forgotten army” in Burma (now Myanmar) surviving, among other things, a bout with dengue fever. After the war, he became a businessman and motorcycle enthusiast. Recently, not content to simply observe the COVID pandemic from the comfort of his retirement home, he resolved to do something to assist the overburdened National Health Service. Options being limited, he decided to do 100 laps of his garden on his 100th birthday, which he did with the support of his walker, but otherwise unaided. The project was widely picked up by social media and the press. Contributions started rolling in. To date, 33 million Pounds ($56.2 million CDN) have been raised.
These efforts, together with tons of natural charm, have made him the very embodiment of British pluck and resilience in the face of adversity, and this past week he was knighted by his slightly younger Queen, who herself knows a thing or two about maintaining a stiff upper lip in the face of adversity.
There are many words that come to mind in describing Sir Tom’s actions. “Charitable”, “altruistic”, “selfless” would all seem to apply but there are other aspects of his remarkable story that, although equally valid, may not immediately come to mind.
One is “humility”. Sir Tom was not looking for acclaim or to make a “big splash”. He simply saw a need, felt obligated to make a contribution, and set out to do whatever was in his power to do. In the case of a now one hundred year old man with obvious limitations, that consisted of walker-wheeling around his backyard.
The other word that comes to mind is “leadership”. Although its doubtful he would describe himself in such terms he has, despite advanced age and physical limitations, done much more than simply raise funds. He has provided leadership in a time of crisis. By choosing to act rather than simply bemoan his situation, by acting without artifice or expectation of self-promotion, by rejecting victimhood and bitterness, his actions inspire us all to simply get up and keep moving ahead. With his walker firmly in hand, he shows us the way.
The “Greatest Generation” indeed.
Thank you, Sir Tom.
Engaging Diversity, Then, Now, Always.
This week, I’m reprising an article that first appeared on this blog September 8, 2014. It was part of a series of articles that were developed at the time to examine the concept of diversity in the context of medical education. The motivation was to develop a more focused approach to diversity within all aspects of our school. As will become apparent in subsequent installments, all this led to a number of changes and innovations within the school, most of which are still operational today.
Recently, as described in a recent article (https://meds.queensu.ca/ugme-blog/archives/4880), we have re-committed to engaging diversity within our school. As we do so, it’s important to emphasize the particular importance of this initiative within medical education, and to review and reassess steps previously taken.
The Educational Value of Diversity
UGME Blog: September 8, 2014
In October of 1931, a 16-year-old college student joined a group of friends for a night of carousing and entertainment at the Driskill Hotel, in Austin Texas. He had no idea what to expect of the entertainment, the focus of the evening being on the “carousing” component. Rather unexpectedly, he is deeply moved by the performance, and particularly by the featured musician. Many years later, that student writes about that experience in his memoirs:
“He played mostly with his eyes closed. Letting flow from that inner space of music things that had never existed. He was the first genius I’d ever seen.”
The “genius” he was referring to was Louis Armstrong, who was himself only 31 at the time, at the beginning of a career that would eventually identify him as one of the greatest virtuosi and innovators in the history of American music.
The young man was Charles Lund Black, who would go on to become a Professor of Law at Yale and expert in American constitutional law and contribute importantly to a number of cases involving key civil rights issues.
Professor Black would later say the following about his experience that evening:
“It is impossible to overstate the significance of a sixteen year old Southern boy’s seeing genius, for the first time, in a black. We literally never saw a black man, then, in any but a servant’s capacity…Blacks, the saying went, were ‘alright in their place’, but what was the place of such a man, and of the people from which he sprung?” http://www.nytimes.com/2001/05/08/nyregion/charles-l-black-jr-85-constitutional-law-expert-who-wrote-on-impeachment-dies.html
In Black’s eulogy, a former student would say of him, “He was my hero…He had the moral courage to go against his race, his class, his social circle.”
In Medical Education, the concept of Diversity has become entrenched in our collective vision as expressed in both the Future of Medical Education in Canada recommendations and in accreditation standards. The rationale for such initiatives has been largely perceived to be the need to ensure equity of opportunity, and a need for medical schools to respect and reflect the gender, cultural, religious influences of the societies they serve. Laudable and worthy justifications, to be sure. However, Mr. Black’s encounter with Mr. Armstrong hints at deeper, even greater benefits. Does diversity within a learning environment, or as a deliberate component of a curriculum, have educational value? Does it shape thought and attitudes? Does it make students better practitioners of whatever career they undertake? Does it make them better citizens?
These questions have had particular relevance and attention in the United States for the past several decades, where they have been the focus of legal as well as pedagogical attention. Affirmative Action initiatives and subsequent legal challenges have required both jurists and educators to engage this question critically and analytically.
In 1978, Chief Justice Lewis Powell wrote the following opinion regarding the case Regents of the University of California vs. Bakke. He argued “the atmosphere of speculation, experiment and creation – so essential to the quality of higher education – is widely believed to be promoted by a diverse student body…It is not too much to say that the nation’s future depends upon leaders trained through wide exposure to the ideas and mores of students as diverse as this Nation of many peoples.”
Chief Justice Powell’s decision, however, did not settle the issue. Challenges have continued and the wisdom of mandated diversity initiatives has been repeatedly questioned. This is largely due to the lack of a theoretical framework or evidential basis demonstrating value. Since then, considerable work has either emerged or been resurrected to provide such evidence, which is summarized in an excellent paper by Gurin and colleagues (Harvard Educational Review 2002; 72: 330).
From the theoretical perspective, the work of a number of sociologists and psychologists is particularly relevant, and fascinating to review. In attempting to describe their work, I freely admit to venturing far beyond my expertise and apologize in advance to those much more knowledgeable.
Erik Erikson, as far back at the early 1950s, postulated that late adolescence and early adulthood were critical times in the development of personal and social identity. He theorized that such identity develops most effectively when people at that stage of life are provided what he called a “psychosocial moratorium”, by which he meant a time and situation during which they could feel free to “sample” and experiment with various social roles for themselves before taking on a more fixed and permanent role, i.e., before they “committed” to a profession, personal philosophy, or relationship. Colleges and universities are critical to providing this environment for most young people, certainly in North America. But how can they promote this critical social development? In the words of Gurin and colleagues:
“Higher education is especially influential when its social milieu is different from students’ home and community background and when it is diverse and complex enough to encourage intellectual experimentation and recognition of varied future possibilities.”
In other words, the real power to influence goes far beyond lofty mission statements and curriculum, and arises largely from developing an environment where students are able to interact both passively and actively with individuals who are “different” and therefore force new thought and new perspectives during this critical developmental phase.
Sociologist Theodore Newcomb carried out a series of studies and long-term follow-ups of Bennington College students between 1943 and 1991. (Newcombe et al 1967. Persistence and change: Bennington College and its students after 25 years. New York: John Wiley and Sons), (Alwin et al 1991. Political attitudes over the life span. Madison: University of Wisconsin Press). To medical folks, this is the sociologic equivalent of the Framingham studies. He and his colleagues found that political and social attitudes were most likely to change and remain so in students who had encountered novel concepts and attitudes, largely through peer influences, while attending college, thus supporting Erikson’s theory and demonstrating long term durability of the early life experience.
In the Gurin paper, the authors draw on the work of Jean Piaget and Diane Ruble in extending the concept of disequilibrium, to the early learning experience. In Guerin’s words:
“Transitions are significant because they present new situations about which individuals know little and in which they will experience uncertainty. The early phase of transition, what Ruble calls construction, is especially important, since people have to seek information in order to make sense of the new situation. Under these conditions individuals are likely to undergo cognitive growth unless they are able to retreat to a familiar world.”
In simple terms (that even a cardiologist would understand) the greater the difference between the students prior life experience and the learning environment in which they find themselves, the greater potential for new thought, new concepts and personal growth.
The Michigan Student Survey (MSS) and Cooperative Institutional Research Program (CIRP) are longitudinal studies examining, among other things, how diverse education processes influence attitudes and career success. The MSS is a single site study involving 1,582 students. The CIRP is a national cooperative involving 11,383 students from 184 American institutions. Both involved racially and culturally diverse populations of students assessed on the basis of their pre-university and university cultural environments i.e. their “diversity experience”. For detailed description of results, I would refer the reader to Gurin et al. Harvard Educational Review 2002;72:330. The key findings relevant to those considering diversity initiatives in university programs:
- There was a positive relationship between diversity experiences and educational outcomes
- The influence of a diverse educational environment was consistent across schools and cultural groups
- “interactional” diversity was more influential than “classroom diversity”
But are these effects also relevant to medical education, where one might suppose that students are older and further along developmentally, and perhaps pre-selected for cultural diversity and preparedness?
- In 2003, Whitla and colleagues (Academic Medicine 78:460) reported on a study involving medical students at Harvard Medical School and the University of California, San Francisco. Students surveyed reported that contact with diverse peers enhanced their educational experience and supported ongoing affirmative action initiatives.
- A graduation questionnaire administered by the Association of American Medical Colleges to 20,112 graduates from 118 medical schools (Saha et al, JAMA 2008; 300: 1135), demonstrated that, for white students, attendance at a school with high proportions of peers from underrepresented minorities was associated with greater confidence in caring for minority patients and positive attitudes regarding equity issues. These associations were not found for non-white students.
- Niu and colleagues (Academic Medicine 2012; 87: 1530) surveyed 460 Harvard medical students and found that those who reported spending more than 75% of their study time with students from diverse backgrounds or having participated in diversity related extracurricular activities felt more prepared to care for diverse patients.
And so, it seems Mr. Black’s experience in 1931 was not simply an isolated event, but indicative of the potential for great things to emerge when open minds are exposed to new situations, new social constructs, new paradigms. The value of Diversity in education is about much more than a need to exhibit “fairness” and some notion of social justice, but rather an active educational intervention capable of expanding the vision, imagination and therefore potential of students.
So, what does all this psychosocial theory and American experience say to those of us engaged in medical education in Canada in 2014? We might feel, with some justified smugness, that we are not faced with the same social divides and engrained class issues as our southern neighbours. We might also take solace in the knowledge that our schools are uniformly committed to the concepts of equity, fairness and diversity in the workplace, and have rather rigorous policies in place intended to ensure the issue of structural diversity. However, we might also see this as an opportunity to enhance our approaches to medical education, where the ability to effectively engage people of diverse backgrounds and with diverse needs would seem particularly relevant. Finally, many in 2014 Canada might define Diversity as more of a socioeconomic as opposed to racial/ethnic issue, given the well-documented struggles of our First Nations and immigrant populations. With all this in mind, I pose a few perhaps unsettling questions for consideration:
- Do our students engage in medical school in the type of passive and active learning environment that theories and studies suggest could truly influences their development as physicians?
- Do our policies, which focus largely on identifying numbers and proportions of various groups in our school relative to the general population, truly promote the development of that effective learning environment, or simply attempt to demonstrate token compliance with regulations?
- Our students, raised in and drawn from a Canadian culture that promotes equity and fairness, are good and instinctively fair people, unfailingly tolerant of diverse individuals and eager to contribute, but do they develop a deep understanding of the issues of those less-advantaged, and are we, as the stewards of their education, doing all we can to develop a learning environment that will promote that understanding?
Can we do better? Can’t help but think so.
Next article will focus on initiatives that were undertaken at that time, and then update on current evolving plans.
Combining medicine & business: CEO for a day
By Andriy Katyukha, Meds 2022
“Maybe you should try Bay Street instead of medical school?” My interviewer’s acerbic tone gave the impression I was not the candidate they were hoping to admit when assessing medical applicants. Fortunately, I was admitted, and as a result of my experiences I am committed to dismantling entrenched attitudes in medicine that stifle progress and positive change.
As I continue through my career, I remain steadfast in my conviction that functioning at the intersection of medicine, business, and policy is crucial to help move the healthcare system forward. As some of my sagacious mentors have pointed out, multi-disciplinary skill building, outside the traditional framework of what is deemed relevant for the practice of medicine, unfortunately is sometimes discouraged. Is it a lack of exposure to other skillsets or is it a profound fear that someone equipped with unique skills may threaten your position? Regardless of the reasoning behind this antiquated view, it falls on you to be introspective, decide what opportunities you will pursue, seek out mentors who inspire you, and work fervently to bring about the change you want to see in your field of work.
For me, this means seeking out opportunities that bolster my interest in strategy, governance, and health leadership, and that is how I found myself participating in the CEOx1Day program. Though I was apprehensive about applying to a competitive program geared towards future leaders in business, I submitted an application anyway. To my pleasant surprise, I was selected by Odgers Berndtson to work with Alex Munter, the President and CEO of the Children’s Hospital of Eastern Ontario (CHEO).
My day started with what now seems like a very prescient discussion with senior medical leaders and Alex—COVID19 preparedness. From there, we departed to meet the rest of the executive team for their weekly Tuesday meeting. While the discussions were incredibly insightful, I am certain that the team would be surprised to hear what resonated with me the most: amidst the business of the day, they all stopped to recognize individual employees, of all seniority levels and positions, who made a meaningful contribution to the organization. This was their ‘kudos’ time, and I got the impression that employee recognition and appreciation is not a concept that is flippantly tossed into quarterly reports, but is the underpinning of the culture at CHEO. This is where I learned my first lesson: when it comes to transformational leadership, senior leaders who focus on results, and shift the emphasis from personal credit to team recognition, make the biggest impact.
Alex and I then connected with the CEOs of the Hospital for Sick Children and Holland Bloorview Rehabilitation Centre to discuss their partnership through the Kids Health Alliance, a network that aims to bolster patient and family-centered care in pediatric populations. We then proceeded to Alex’s CEO Information Session where he updated staff members about various projects and organizational achievements. It also served as a platform to once again recognize employees who made a difference at CHEO, and further encourage employees to use their personal insights to make improvements in their respective departments. In my professional life, I have yet to see such an emphasis being placed on promoting grassroots initiatives to fuel an organization’s success and progress. Through this, I learned my second lesson in leadership—empathy. A heightened ability to listen and validate employee experiences not only creates a positive work environment, but also empowers employees to use their experiences to change things for the better, strengthening the company in the process.
My day at CHEO finished off with Dr. Jean-Philippe Vaccani, a brilliant physician leader who serves as the Deputy Chief of Staff at CHEO. After a candid discussion about our careers, goals, and health leadership, I was struck by his encouragement and eagerness to promote discussions that underscore the importance of multi-disciplinary thinking in medicine. Professional mentorship is one of the best ways to give back to others, and just as I have benefited from kind and encouraging mentors, I also hope to make mentorship a priority in my own career.
I urge non-traditional majors and STEM students to embrace opportunities like CEOx1Day to not only learn from incredible leaders, but to also share their own invaluable insights to broaden leaders’ perspectives. Even if you do not see yourself represented in a field, seek out opportunities that allow you to be the catalyst for change.
Later that evening I had the privilege of joining Alex and his partner for dinner, where I not only got to meet his adorable son, but also Lola, the family dog and self-proclaimed “Queen of the House”. It was the perfect setting to further discuss our thoughts on a variety of topics and get to know each other a little better. Through our discussions about the healthcare system, advocacy, policy, and representation, I got an incredible sense that Alex’s successes are rooted in a deep sense of service. While he serves as CEO, to me he serves as a role model who has broken barriers for LGBTQ2S+ individuals, has worked to shatter the ‘glass closet’ that often exists in corporate leadership, and has instilled in me a deep passion to work tirelessly as an advocate and leader in healthcare. This leads me to my final lesson about leadership—service. Rooting your work in service, be it serving people directly or serving a mission that fuels your passion, lays the foundation for the most meaningful impact you can achieve as a leader.
CHEO is an absolutely incredible organization to work for and I applaud the efforts of Alex Munter, the senior leadership team, and most importantly the committed and passionate employees who work day-in and day-out to bolster pediatric care in Ontario. I would like to thank Kristen, Michael, Eric, and the entire team in the Odgers Berndtson Ottawa office for affording me this invaluable opportunity!
For more information about the Odgers Berndtson CEOx1Day program, check out their program site here: https://www.odgersberndtson.com/en-ca/ceox1day/about-the-program
A version of this post was previously published here: https://www.odgersberndtson.com/en-ca/ceox1day/news-media/bay-street-or-medical-school-a-glimpse-inside-a-ceox1day-at-cheo