“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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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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Curriculum Committee Information – February 22, 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 February 22, 2018.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of the February 22 meeting 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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Actors, musicians & dancers?? QMed is gearing up for the 48th annual Medical Variety Night!

{Italics indicates a hyperlink}

By Edrea Khong, MVN co-director

It’s that time of year again! Medical Variety Night (MVN) is the School of Medicine’s annual charity variety show featuring UGME student performers from across all four years of training. This year’s theme, So You Think You Can Match, was selected by popular vote amongst the students and is a spin on the popular television show, So You Think You Can Dance. The theme may be particularly apropos yet contentious right now, given the increasing difficulties surrounding the CaRMS match. However, while the show is sure to feature references to this, it certainly is not the focus. The spotlight will remain on the performers, and the show aims to celebrate all that is Queen’s Medicine.

Wandering the halls of the School of Medicine during after-class hours, one may be treated to a glimpse of the beautiful madness that is MVN preparation. From large group dance rehearsals for hip-hop, contemporary (new this year!), or Bollywood, to table-reads and short filming sequences for class skits, the students have been working tirelessly to perfect their acts for the show. The acts seem to get bigger and more elaborate each year, and this year’s line-up surely will not disappoint!

As always, details about the act set list are being kept tightly under wraps, but showgoers can be assured that there will be a great variety with something for

MVN 2018 Directors Edrea Khong, Daisy Liu, Emily Wilkerson, & Charlotte Coleman

everyone. In addition, although there will be some “medical culture”-styled humour, the show is designed to be accessible by and entertaining for all. In the past, the show has been very well attended by people outside of the “Medicine Bubble™” to rave reviews.

Outside of the performers, there are many others who have been hard at work on the show, such as the promotions, tech, and backstage crews already doing vital behind-the-scenes work in preparation. In addition, Edrea Khong and Daisy Liu (2020s) have been joined this year by Charlotte Coleman and Emily Wilkerson (2021s) as the MVN 2018 Directors. The four have spent countless hours since mid-September organizing and preparing for the show. With the two-week countdown now underway, they are hard at work ensuring the show runs as smoothly as possible. During the show week, many more students will also lend a hand as bakers, ushers, ticket takers, raffle sellers, and much more. MVN is a project of love, dedication, and talent from all of QMed.

MVN 2018 Emcees Roya Abdmoulaie & Lauren Mak

All proceeds from this year’s show are going to Kingston Interval House, an organization committed to supporting women, children, and youth experiencing violence and working collaboratively with the community to eliminate all forms of violence and oppression. While great strides have been made worldwide towards establishing greater equality especially in these past few months, there is still much to be done and services like these are so vital. The decision to support Kingston Interval House feels very apt. In addition to ticket sales, MVN depends on the generosity of the Kingston community and Queen’s faculty. Raffle prizes featuring local Kingston businesses and a bake sale featuring QMed culinary talent can be found at the shows. Donations are also being accepted on the MVN website, with donations of $50 or greater receiving a tax receipt.

MVN 2018 takes place on April 6th and 7th at Duncan McArthur Hall (511 Union St.), with doors opening at 6:30PM and the show starting at 7:00PM both evenings. Tickets can be purchased for $13 on the MVN website, or for $15 at the door.

Get excited for a fantastic evening of performances celebrating another year of Queen’s Medicine! Gather your family and friends and purchase your tickets to MVN 2018 today. Looking forward to seeing you at the show!

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The Evolution of SPs and The Standardized Patient & OSCE Program

Open House at Queen’s School of Medicine

Clinical Teaching Centre

Monday, March 26 from 1:00-4:00 pm

By Kate Slagle, SP & OSCE Program Manager

When I’m out in public and people ask what I do, I tell them what a standardized patient is which is typically met with a perplexed look to which my husband chimes in with, “Have you ever seen that episode of Seinfeld where Kramer works with the medical students?”

Although this parallel makes me slightly cringe they start to think about how standardized patients (SPs) — actors who are trained to convincingly portray the physical, historical and emotional features of a real person for educational purposes — can be applied across all fields.

For the past five years I have had the privilege of managing the Queen’s SP & OSCE Program and on a daily basis get to see the rewards SP simulation provides our students, such as:

  • Improved interviewing skills
  • Gained confidence in discussing difficult topics and de-escalating conflict
  • Empathy to deliver difficult news
  • Refined physical exam techniques and maneuvers
  • Next level, critical thinking
  • Constructive feedback and much more!

Over the past few years the request for SP encounters within the Faculty of Health Sciences has exponentially increased as well as interest from organizations outside the university. The time came when we had to ask ourselves, “What do we need to do to take our program to the next level and offer SP services outside the Faculty of Health Sciences?”

If we were going to expand we wanted to do things right. Over the past year we’ve been working with the university to formally expand the program to:

  • Continue to provide high quality SP sessions and work in partnership to develop new sessions within the Faculty of Health Sciences.
  • Offer SP services to the wider university and Kingston community.

The infrastructure is now in place and we’re ready to open our doors. The launch is set to begin this month with an open house for new and existing clients at the Queen’s School of Medicine Clinical Teaching Centre on Monday, March 26, 2018 from 1:00-4:00pm.

Although during the open house you won’t be hearing from Kramer, you’ll be able to hear from real SPs and learn more about what the program has to offer. We look forward to seeing you then.

Important Links

Facebook event link: https://www.facebook.com/events/155933065095723/

Queen’s Event Calendar Link: http://www.queensu.ca/eventscalendar/calendar/events/standardized-patient-osce-program-open-house

SP & OSCE Program Website: https://meds.queensu.ca/academics/spprogram

Video linkhttps://www.youtube.com/watch?v=lDd6vsmLhwg

The Burning” is the 172nd episode of the NBC sitcom Seinfeld. It aired on March 19, 1998.

 

 

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Basic Science in the Undergraduate Medical Curriculum. How much and how?

 

“There can be no doubt that the future of pathology and of therapeutics, and, therefore, of practical medicine, depends upon the extent to which those who occupy themselves with these subjects are trained in the methods and impregnated with the fundamental truths of biology.”

That statement, attributed to biologist and anatomist Thomas Huxley, appears in a 1909 paper entitled “The Preparation for the Study of Medicine” (Popular Science, volume 75). The author, Dr. Frederic T. Lewis, goes on to support this position by presenting the results of a study of first year medical students based on the number of science courses they’d taken before entering. Because Dr. Lewis didn’t have the benefit of Power Point, I’ve transcribed his findings into the chart below:

I provide this not because his findings are directly relevant to us today, but to make the point that the issue of how much science is needed or appropriate for the study of clinical medicine has been contentious since the beginning of formal medical education.

In his transformative review and 1910 report on the status of North American medical schools, Abraham Flexner strongly supports a scientific basis of medical education. In his second chapter “The Proper Basis of Medical Education”, he makes a strong case that, in order to provide optimal care and engage future developments, a physician must have a deep understanding of the scientific underpinnings of human function in health and disease.

Flexner goes on to say that those entering medical school must have a “competent knowledge” of the “fundamental sciences” of chemistry, biology and physics, so that the clinical sciences of anatomy, physiology, pathology, bacteriology and “physiological chemistry” can be engaged in medical school.

Flexner’s influence on medical education in the 20th century cannot be overstated. The fundamental model of basic science prerequisites to admission, followed by first and second year courses in anatomy, physiology, biochemistry, microbiology, pathology and pharmacology became standard, and the basis for accreditation standards. Medical students took courses and labs in these subjects that were very similar to those taken by undergraduates taking degrees in those subjects, sometimes even in combined classes.

In recent years, a number of factors have influenced the choice of basic science content in undergraduate medical education, and how it should be taught:

  1. A desire to ensure the science being taught was relevant to medical practice
  2. A very practical need to be selective with respect to curricular content, given the tremendous expansion of material to be taught.
  3. A desire to integrate the teaching of basic science with the clinical skills and reasoning courses
  4. The development of new areas of science that are highly relevant to practice and must now also be taught, such as immunology, genetics and advanced imaging.
  5. The desire to take advantage of more effective teaching methodologies, recognizing that the lecture format is limited as a means of promoting individual understanding, and that traditional laboratory experiments are both logistically impractical and of limited relevance to those learning clinical applications.

Medical schools have therefore been very much challenged with two key issues of what basic science should they teach and, critically, how should it be taught?

At Queen’s, we re-organized our basic science teaching at the time of last major curricular revision in 2008. The Foundations Curriculum developed at that time included two consolidated first year Scientific Foundations courses, Normal Human Structure and Normal Human Function.

This came at a time when our basic science departments were amalgamating into a single consolidated Department of Biomedical and Molecular Sciences which, under the leadership of Department Head Dr. Michael Adams, took on the directorship of these courses.

Last year, in an effort to integrate the courses both with each other and with the other courses running in the same terms (particularly Clinical Skills) and our Facilitated Small Group Learning curriculum, it was decided to amalgamate the two into a single Human Structure and Function course that would run through the entire first year.

This past week, I met with Course Director Dr. Chris Ward, Year 1 Director Dr. Michelle Gibson, and Dr. Adams to discuss our approach to next year’s course. We recognized that there is a wonderful opportunity here to better link it not only to contemporaneous courses, but also to those clinical courses that will follow in subsequent terms and years.

We’ll therefore be putting out a call to invite clinical teaching faculty to provide input as to basic science content they feel would facilitate teaching in their courses and would better prepare students to engage the teaching of clinical presentations.

In fact, we invite all faculty to share their views regarding the nature of basic science that is now relevant to clinical practice and their perspectives as to when and how that science should be introduced. We also welcome opportunities for clinicians and pathologists to participate in the basic science teaching in first year in partnership with our basic science instructors. This type of cooperative teaching is not only highly effective but models the collaborative practice that we wish our students to emulate.

So, whether you share Dr. Huxley’s perspective above or not, we’d love to hear from you.

 

Anthony Sanfilippo

Associate Dean

Undergraduate Medical Education

 

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