Inaugural FHS Interprofessional Symposium on Leadership

Interprofessional education is a priority in undergraduate medicine, as it is in our fellow health professions programs in the Faculty of Health Sciences in the School of Nursing and School of Rehabilitation Therapy.

Early this month (or last month, if you’re reading this after Tuesday), we brought together over 300 students from nursing (fourth-year undergraduates), medicine (second-year undergraduate program), occupational therapy (first-year master’s) and physiotherapy (first-year master’s) at the Leon’s Centre for a one-day symposium with a particular focus on leadership.

A student responds to a case question on behalf of his table team. Students from the four participating programs were assigned to an interprofessional table group for the day.

A key challenge in creating interprofessional learning opportunities is coordinating time, space, and learning objectives of independent programs with different classroom and clinical schedules. A committee of representatives from four programs, including student representatives, tackled this challenge earlier this year, working collaboratively to create the program and learning activities for the symposium. The day included plenary speakers, interactive case studies, and a bit of fun along the way.


Plenary speaker Kim Smith

Our plenary speakers included Dr. David Walker, former FHS dean; Lori Proulx Professional Practice Leader -Nursing and Kim Smith Professional Practice Leader Occupational Therapy and Physiotherapy from Kingston Health Sciences Centre; and Duncan Sinclair, former vice-principal of Health Sciences

Diving into a case assignment.

Students were seated in interprofessional table groups to engage in discussions around cases and use IP tools for decision making.

Plenary speaker David Walker

We’ve taken lessons learned from organizing this event as well as formal and information feedback from students and other participants to carry forward to the next iteration of the symposium.

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Who decides when the job is done?

How would you choose to pay the people entrusted with fire prevention and control in your community? One would hope that, whatever the method, it provided those with the appropriate knowledge and skill the freedom to operate without interference in the interests of those in need.

Imagine a world where fire fighters were directed in their efforts by a pre-determined public policy edict that required them to stop their efforts after some defined time limit, regardless of the condition of the building or its inhabitants.

Sounds absurd, but this is exactly analogous to the concerns raised in an article that appeared in the Globe and Mail April 6th, “In Ontario, a battle for the soul of psychiatry” (https://www.theglobeandmail.com/opinion/article-in-ontario-a-battle-for-the-soul-of-psychiatry/).

In it, Dr. Norman Doidge describes his frustrations with a payment system that limits the number of encounters he can provide a patient.

While agreeing wholeheartedly with the arguments raised by Dr. Doidge, I would respectfully submit that the battle goes far beyond the practice of psychiatry. The concept that decisions about the nature and duration of any patient’s condition can or should be made on the basis of fiscal concerns and by individuals or groups under governmental influence should be seen by all physicians and their patients as repugnant. While government certainly has a responsibility to exercise fiscal oversight, it is (to use a contemporary metaphor) venturing far outside “its own lane”. Patients are individuals with unique illness experiences that cannot be conveniently categorized into tidy management algorithms. Doctors, of any specialty, must be free to undertake treatment for patients based on individual needs.

Doctors, in turn, must earn and safeguard that right. Our professional organizations should rise to the challenge posed by Dr. Doidge’s article with the same vigour that they have engaged issues of reimbursement, and the distribution of a few percentage points of income. Providing optimal patient care must trump income issues. Failure to do so rightfully condemns.

The profession and government should jointly recognize that the “covenant” between the government and people of Canada to provide universal, comprehensive health care is being broken daily, suffering death from a thousand cuts. Only with collective and collaborative recognition of that reality and engagement by a profession and government mutually focused on the interests of the people of Ontario can solutions even begin.

The fire fighters battling to save Notre Dame cathedral in Paris this past week didn’t stop their efforts until they had done everything possible. Those men and women were in a position of public trust that was not defined by the clock or budgets. Doctors are in a similar position of public trust which must be defended. I suspect Dr. Doidge will continue to care for his patient, but it will be despite and not because of our “system”. Our patients deserve better. We all deserve better.

(Portions of this article were published in the Globe and Mail April 9, 2019 as a letter to the editor)

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I have no time…

By Adrian Baranchuk MD FACC FRCPC FCCS

Division of Cardiology, Kingston Health Science Center, Queen’s University

“A man who dares to waste one hour of time has not discovered the value of life.” ~ Charles Darwin, The Life & Letters of Charles Darwin

“I have no time.”

I have heard this sentence on several occasions.

I have heard this from my co-workers, staff, fellows, residents, nurses, and managers. I have heard this from friends – who used to spend long hours chatting, laughing and playing music – but now, they have no time.

I have heard this from close family members who have exclaimed, “I have no time.”

Finally, I have heard this sentence – the same four words – said by myself. It has become part of the dialectic armamentarium that I use upon invitations – “I have no time.”

Time has become a valuable commodity.

As academicians, our job descriptions specify the “time” allocated to different roles: (i) “time” for clinical work, (ii) “time” for teaching, (iii) “time” for research. We call the latter “protected time.” The notion that our time is “protected” is comforting. We are protected. Our “time” is protected.

The structure of our life is built around time; it accepts different metrics, depending the cultural background, the level of education, and the earnings and savings.

It is “time” for you to move to your own house.

It is “time” for you to further your career.

It is “time” for you to get married and start a family.

It is “time” for you to retire.

Although time can provide structure and discipline, it has become a regulator of our abilities to do something during our life.

Inadvertently, or not, we also use time to structure the life of others, such as family members, employees, or trainees. The ability to guide – or manipulate – someone by regulating the time they spend under one’s supervision is more powerful than any other form of intervention, such as encouragement, motivation, salary, or recognition. Nothing compares to the impact that “time” regulation has over our actions, either voluntary or mandatory.

In that sense, we self-allocate “time” to activities that we perceive as meaningful or enjoyable, such as going to the gym, conversing with partners, reading a book, et cetera. Violating this principle is a trigger for anxiety and frustration. The feeling of guilt that we experience when doing something that we perceive is in place of another timely activity – despite being part of human emotions – is a source of discontent.

There is not a generalized approach to using “time” wisely – it is individualized. We go through life, with more or less success, defying our own chronometer to do some of the things that we have dreamt, and we allocate the “time” that we speculate we have to reach those goals.

Few years ago, I found myself overwhelmed with work. My mentor called from the other side of the Atlantic and I responded without much enthusiasm. The wise man of only 83 years of age recognized my exhaustion and told me, “You sound too busy…you are doing too many things at the same time…you should slow down.” Rather than taking the advice with sincerity and consider reducing my workload, it agitated me. I replied, “What do you want me to do? I have no time.”

I said “I have no time” to my 83-year-old mentor who has, from a statistical point of view, much less time than me to accomplish his dreams.

There was a period of silence on the phone line. Some say that more than 23 s of silence between two individuals is the most tolerable duration before one of the two individuals breaks the moment with a comment; after about 10 to 12 s, I said “are you there?” He replied, “I was wondering whether you have time to think?” I have not forgotten this phrase since it was spoken many years ago.

When did I lose my capacity for contemplation? When did I sacrifice my ability to enjoy doing nothing? The “dolce far niente” (“sweet doing nothing”) that the Italians have immortalized. Albert Einstein said, “Time is an illusion.” Does the perceived lack of time represent the absence of illusions? How do we regain, in this world of immediacies, the ambition of living in a world of illusions? How relevant, for the creative process of enjoying your life (and be productive) is to have illusions?

While Mahatma Gandhi taught us that “there is more to life than simply increasing its speed;” Benjamin Franklin has counteroffered that “lost time is never found again.”

If we live in this world with a constant perception of not having “time,” how are we going to construct memories that at some point may be our only companion in life? Are we losing the ability to contemplate? Does this affect our ability to relate to our patients if we have no time to connect with them?

One of my other mentors – after consultation with a patient in the hospital ward – once asked me what book the patient was reading. “I have no clue” was my immediate answer, all the while skeptical about how this would relate to patient care. I did not understand at the time that our ability to contemplate and have holistic views will aid us as physicians to relate to the patient, which is a skill that is of immense value.

Where do ideas come from? How do we connect an idea with the creative process and the systematic work flow to move it into action? How does an idea move forward into realization?

Apparently, “time” is the key that regulates this process. Time is the precious commodity that we all want to attain – despite where we live and work, and how our family is structured – and we are all “offered” the same total amount every day.

So far, we have not been able to create “time.” We have not succeeded in having 25 h in a day. We have to resolve the enigma of how to distribute our efforts and energy throughout the same amount of minutes and seconds in a day. A strict 24 h per day.

I would like to teach my students to use their time wisely so as to enjoy their life and balance their ambitions. I want my students to be happy, and help them evolve not only as great scientists but also happy and content individuals. I want my students to have time to contemplate and think freely as such that time is not a factor that regulates their decisions.

I only wrote this piece today because I had convinced myself that I had no time before.

I propose to the readers to exercise the search of finding time for what they really want to do with their lives. Perhaps allowing a few minutes a day to do what they did not find “time” to do lately.

Because the “time” that we think we do not have, is out there. It is a matter of learning how to grasp it and to make it ours.

It is time to do it.

Acknowledgements

To Sohaib Haseeb for editing the first draft. To Gustavo Bonzon for his translation into Spanish.

This column originally appeared in Journal of Electrocardiology,Volume 53, March–April 2019, Pages 64-65. Reproduced with permission from ELSEVIER

Creative Commons Image from: https://www.deviantart.com/mariana-a/art/She-saw-the-time-passing-by-new-350524188

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It Takes a Village: Thanks to all involved in our Medical School Admission process

Over two weekends in March, over 500 applicants are invited to our school to undertake interviews, the final phase of our medical school admission process. They have been selected from over 5,000 who submitted applications.

That process, designed by our Admissions Committee, is the product of much thought and deliberation, with the goal of fairly and objectively matching the aspirations and attributes of applicants to those required to assure success not only in medical school, but in the practice of medicine and service of patients.

The process is a massive undertaking, requiring the participation of no fewer than 179 of our faculty and virtually all members of our first- and second-year classes. In fact, our admission process is the most resource intensive activity undertaken by our school.

Each year, I’m amazed and grateful for the willingness of our faculty and students to give of their time and energy for this purpose. File reviews and interviews are both carried out after regular work hours and on weekends, requiring sacrifice of precious personal time. Why do they do it? They recognize, I believe, that this admission process is critical not only to our success as a school, but for the future well-being of our profession and the society we serve.

Our applicants are also impressed. They consistently comment on the effort, which brings credit to our school and demonstrates a learning environment where faculty and students work together in mutual dedication to our school and profession.

I would like to recognize and extend sincere thanks to all the faculty members involved, who will be listed below. The numbers indicate those who filled multiple assignments. I’d like to particularly note the contributions of Drs. Fred Watkins and Mariana Silva, who were both involved in all aspects of both the File Review and Interview process.  

I’d also like to thank our first- and second- year classes. I’d initially thought about listing them as well, but quickly realized that was unnecessary since there was essentially no one to exclude! Their presence and support of applicants speaks volumes about their support of our school, and confirms to me that the process is working well. Special thanks to first year president and vice-president Andriy Katyukha and Victoria-Lee Kim who organized their class events and made no fewer than eight presentations to applicants.

Finally, I’d like to recognize three individuals who deserve particular recognition, our Assistant Dean of Admissions, Dr. Hugh MacDonald, Admission Officer Rebecca Jozsa, and Admissions Assistant Rachel Bauder. They oversee a very complex process that ran flawlessly.

Faculty Members Involved in the Admission Process

Joseph Abunassar

Amy Acker (2)

Melissa Andrew  

Yuka Asai

Sussan Askari (2)

Oyedeji Ayonrinde

Allan Baer (2)

Lauren Badalato

Stephen Bagg

Susan Bartel

Erin Beattie

Robert Bechara

Darren Beiko

Sita Bhella 

Liz Blackmore 

Lysa Boisse Lomax 

Mark Bona (2)

Rozita Borici-Mazi (2)

Olga Bougie

J. Gordon Boyd  

Michele Boyd 

Heather Braybrook

Eric Bruder

Jessica Burjorjee

Jonathan Butler

Cait Button  

Cassi Cabrera  

Rob Campbell

Susan Chamberlain

Tim Childs

Cheryl Cline (3)

Ken Collins (2)

Robert Connelly (3)

Susan Crocker

Rachael DaCunha

Christine D’Arsigny (2)

Peggy DeJong

Alexandra Di Lazzaro

Kimberly Dow

Scott Dugan

Dale Engen

Gerald Evans

Matthew Faris

Pat Farmer

Paul Fenton  

Jennifer Flemming (3)

Chris Frank

Kan Frederick (2)

Imelda Galvin

Jocelyn Garland

Stephen Gauthier

Michelle Gibson  

Craig Goldie

Tom Gonder (2)

David Good

Mike Green (2)

Richard Gregg (3)

Andrea Grin (2)

Dianne Groll (3)

Andrea Guerin (2)

Karen Hall Barber (2)

Tim Hanna

Hailey Hobbs 

Sharleen Hoffe  

Lawrence Hookey  

Marisa Horniachek (4)

Robyn Houlden (3)

David Hurlbut (4)

Felicia Iftene (2)

Omar Islam (4)

Melanie Jaeger

Zardasht Jaff  

Diederick Jalink

Paula James  

John Jeffrey  

Albert Jin 

Ana Johnson 

Amer Johri  

Ruzica Jokic  

Mala Joneja (2)

Gord Jones

Cherie Jones-Hiscock (4)

Sarosh Khalid-Khan (3)

Frederick Khan

Faiza Khurshid (2)

Julia Kirkham

Greg Klar  

Dusan Kolar

Benjamin Kwan  

Alenia Kysela (3)

Christine Law

Joshua Lakoff  

David LeBrun  

Kirk Leifso (3)

Michael Leveridge  

Catherine Lowe  

Athen Macdonald (2)

Gillian MacLean (3)

Peter MacPherson  

Olga Makaewnko  

Paul Manley (2)

Laura Marcotte  

Kristen Marosi   

Tara McGregor

Sarah McKnight (2)

Stephen McNevin (2)

Alex Menard (2)

Daniel Mendonca  

Laura Milne

Anne Moffat (5)

Andrea Moore  

Benvon Moran (2)

Karim Mukhida  

Heather Murray  

Pallavi Nadkarni  

Brigid Nee

Helene Ouellette-Kuntz

Raveen Pal (2)

Stephen Pang (2)

Archana Patel

Tim Phillips  

William Pickett

Armita Rahmani (2)

Andrea Ratzlaff  

Damian Redfearn  

David Reed

Cara Reimer

Stacy Ridi

Benjamin Ritsma (2)

Johanne Roberge

Nasreen Roberts

David Ruggles (3)

Danielle Rumbolt

Tarit Saha

Dawa Samdup

Karen Schultz

Ian Sempowski  

M. Khaled Shamseddin (2)

Gavin Shanks

Mariana Silva (9)

Ian Silver

 Matt Simpson

Sarah Simpson  

Harpreet Singh  

Marco Sivilotti (2)

Ronald Smith 

John Smythe

Siddhartha Srivastava

Yi Ning Strube  

Devin Sydor

Rob Tanzola (2)

Emidio Tarulli  

Julie Tessier

Richard Thomas

Benjamin Thomson  

Naji Touma (2)

Anthony Train

Tanveer Towheed

Jessica Trier (3)

Kim Turner

Todd Urton (3)

Janet van Vlymen 

Maria Velez (2)

Ashley Waddington (3)

Ross Walker  

Ami Wang (4)

Fred Watkins (9)

Shayna Watson (2)

Erica Weir 

Hasitha Welihinda (2)

Nishardi Wijeratne

Heather White

Andrea Winthrop  

Stephanie Wood  

Gavin Wood (3)

Jeremy Wu  

David Yen (3)

Khaled Zaza  

Shetuan Zhang

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Medical Variety Night 2019 presents: Circadian Rhapsody!

By Charlotte Coleman, Emily Wilkerson, Stephanie Jiang, and Therese Servito, 2019 MVN Co-Directors

Medical Variety Night is an annual variety charity show hosted by the Queen’s University School of Medicine students and faculty.

On April 5th and 6th, 2019, we will be holding the 49th annual Medical Variety night! MVN is a longstanding tradition, with participation from over 200 students as well as faculty members. Acts include musical performances, comedic shorts, and dance productions, such as a 4-act Bollywood dance, an a cappella group, and a touching tribute from the outgoing class of 2019. Drawing an audience of over 500 attendees each year, MVN has consistently been one of the largest events hosted by the Queen’s School of Medicine. The event is frequented by the Queen’s medical community, students from the university, and many Kingston residents.

This year all proceeds go to the Good Minds Program for the Mohawks of the Bay of Quinte. (For more on Good Minds, check out their website: http://www.mbq-tmt.org/administration-and-services/community-wellbeing/good-minds)

The show will run on April 5th and 6th at Duncan McArthur Hall (511 Union St.), with doors opening at 6:30PM and the show starting at 7:00PM both evenings. Tickets are $15/students, $20/general admission online (medicalvarietynight.wordpress.com), or all tickets $20 cash only at the door. This year promises to be more exciting than ever before! For more information, and to meet our performers, check out our website: medicalvarietynight.wordpress.com

You can follow us on twitter @QmedMVN and attend our FB event:

https://www.facebook.com/events/312726582925340/?event_time_id=312726589592006.

Thank you so much, and we hope to see you at the show!

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Failure to Thrive in Medical School Syndrome: Signs, Symptoms and Diagnostic Approach

“Failure to Thrive” is a term well-established in the world of clinical medicine. In the pediatric context, it refers to a child who is failing to achieve anticipated developmental milestones. In the adult world, it’s more informally used to describe someone who is simply not doing well in their current circumstances, be it in hospital or in their community setting. Examples would be an elderly patient at home who is slowly declining and losing ability for independent living, or a hospital in-patient who is not improving despite what seems to be appropriate treatment.

The concept, I’ve come to appreciate, can also be usefully applied in the context of medical education. Failure to Thrive in Medical School Syndrome (FTMSS), can be engaged as we would any clinical condition, with characteristic signs and symptoms.

There are six key cardinal signs or manifestations of FTMSS. These include:

  1. Poor academic performance.
  2. Absenteeism, or habitual lateness for scheduled events.
  3. Habitual failure to meet established deadlines for submission of academic reports or administrative requirements.
  4. Inter-personal conflicts with peers, administrative staff or faculty.
  5. Poor or unprofessional behaviour in the academic or clinical setting.
  6. Lack of attention to surroundings, or personal appearance.

Symptoms of the FTMSS sufferer might include lethargy, fragile confidence, diminished sense of self-worth, agitation, defensiveness, anxiety.

As with the approach to any medical syndrome, the objective is not simply to make a diagnosis, but to establish the underlying cause. Understanding the mechanism by which this syndrome develops is essential to helping the sufferer deal with the affliction, establishing appropriate treatment, and hopefully starting down the road to cure.

All the manifestations of FTMSS have the common feature of not being attributable to any intrinsic limitation on the part of the afflicted individual. Having come through the intensely competitive medical school admission process, it seems reasonable to assume that every medical student is fundamentally capable of performing academically, being on time, meeting deadlines, relating reasonably well to others, attending to their personal appearance and behaving professionally. Failure to do any of these things can therefore can reasonably be attributed to some external cause.

And so, what are the root causes of FTTMS? At this point, a disclaimer seems appropriate. In the absence of any tested and proven pathophysiological mechanism for the condition, I provide postulates based on many years of observation of afflicted individuals, perhaps as a basis for clinical management and hypotheses for future clinical trials. That being said, and in no particular order, here goes:

  1. Failure to adjust to medical education. The medical school curriculum, learning methods and, importantly, the use of assessment in medical school can vary considerably from many other undergraduate programs. Fundamentally, the goals of education are no longer strictly about the aspirations of the learner, but rather geared to preparation to meet the needs of future patients. This change in focus can be somewhat unsettling for some. Moreover, the curriculum can be intense and demanding. Educational methods include much small-group and collaborative activities, as well as required independent learning. Assessments can be frequent and geared not towards short term retention and determining comparisons with other learners, but in assessing individual achievement with respect to learning objectives. In medical school, students therefore find themselves confronted with a learning environment very different than that which they’ve experienced previously. They are also asked to established individual rather than comparative goals of achievement. All this adjustment can be difficult for the student who is accustomed to learning situations which are individual, easily self-controlled and targeted to parameters of external validation.
  2. Lack of motivation for a career in Medicine. For many students, the decision to engage the medical school application process begins at a very early age. The process can be all-consuming and require the applicant to forgo many opportunities and experiences usually undertaken in childhood and adolescence in order to undertake educational programs and volunteer activities that they, and perhaps their parents, feel relevant to their application. The decision to pursue a career in medicine can therefore prevent a young person from engaging valuable developmental experiences or from considering other interests and potential career options. Others may enter medical school with an incomplete understanding of a medical career. As they understand more clearly what doctors actually do and what is expected of them, they may begin to realize the career is not for them. Medical education and, more importantly, a career in medicine, are both rewarding and demanding. Both require deep commitment.
  3. Unresolved personal issues. Medical students, like all young people, experience a variety of personal stresses and adversities. There can be a reluctance to recognize or to admit to the full impact of such stresses and to seek help. There can be a concern that admitting that one is feeling challenged or overcome by such circumstances might be seen as signs of internal weakness or unsuitability for their chosen career. There can also be a tendency to defer feelings of loss, disappointment or grief. Over time such unresolved stresses can mount and express themselves in negative ways which may lead to the various manifestations of FTTMS.
  4. Medical students can become ill or simply run down. Many medical conditions can be gradual, subtle and insidious. Accumulated fatigue due to lack of attention to simple things like regular sleep habits, nutrition and fitness can gradually mount and imperceptibly affect performance. Not unlike practising physicians, medical students can have a remarkable ability to ignore features of illness and fatigue in themselves which they would very quickly recognize in others.
  5. Mental illness. Medical students, like all young people, could suffer from chronic mental illness or develop such conditions after entering medical school. These can be very difficult to recognize in oneself and there may be stigma associated with such conditions that inhibit affected individuals from recognizing their full significance or in seeking help.

The objective of any faculty advisor or mentor engaging the FTMSS sufferer, of course, is to help the afflicted student understand the problem and therefore engage effective therapies. The clinical approach for students exhibiting signs of FTTMS, ultimately, is not unlike that for other conditions that have behavioural manifestations. It begins with understanding and acceptance that the troublesome behaviour likely has an underlying precipitant that can be defined and therefore managed.

Diagnosis requires a thorough history focused on the potential causes listed above, and features that may help identify the underlying, culprit problem. Having identified a potential underlying mechanism, counseling is required to help the students themselves understand cause and effects. Together, management can be engaged.

What happens when none of the potential mechanisms seems to fit, and we come up with an idiopathic etiology? In my experience, this is very rare, but obviously troubling. Are we simply dealing with a poor “fit” for medicine? In such cases, we should provide compassionate support and oversight – what some clinical colleagues would term “watchful waiting”. Clarity usually emerges with time and, with it, the optimal approach becomes obvious to all.

And so, the process for assessing a medical education problem bears remarkable similarity to the process we teach and use for any clinical problem. Once again, there’s a striking parallel between patient care and medical education. Doctors instinctively engage their students as they do their patients. Without judgement, but rather thoughtful contemplation of how observed manifestations reveal underlying mechanistic causes, leading to understanding and, with it, effective intervention.

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Latest Exceptional Healer winners announced

The latest Exceptional Healer: Patient and Family-Centred Award for the Kingston Health Sciences Centre were presented recently.  The EH award competition, which is in its third year, now includes a separate award for nurses.  The two selection were unequivocal in choosing Dr. Maria Velez, Obstetrics & Gynaecology, and nurse Tracey Froess in the Cancer Centre as exemplars in patient and family-centred care, Susan Bedell shares.

Of Valez, one patient wrote: “She made me feel human in a medical world.” Another added: “I’m so pleased that Dr. Velez works for a teaching hospital as new (and experienced) doctors have much to learn from her in terms of benevolent, flexible, and accessible patient-centred care.”

One patient wrote that Froess’ “passion and dedication to her patients shines brightly!” while another noted she “routinely empowers families to take ownership of their situation identifying what will work best for them and delivering it.”

Over the last three years, the following individuals have been awarded the Exceptional Healer Award:

2017   Dr. Richard Henry – Anesthesiology & Chronic Pain Clinic

            Dr. Tom Gonder – Ophthalmology & Retina Specialist

2018   Dr. Shawna Johnston – Obstetrics & Gynaecology

2019   Dr. Maria Velez, Obstetrics & Gynaecology

            Nurse Tracey Froess – Cancer Centre

Patients, family members, staff, and students learning at KHSC are encouraged to submit nominations each year.

 Here is more about Dr. Maria Valez and Nurse Tracey Froess, from the original blog post from the KHSC site:

Masters in the art of listening

By Christine Maloney

Putting patients and families at the centre of their care has earned nurse Tracey Froess and Dr. Maria del Pilar Vélez Kingston Health Sciences Centre’s (KHSC) Exceptional Healer Awards.

Froess and Dr. Vélez were among 22 nurses and physicians nominated by patients, families and staff for the annual award. Originally created by the Patient & Family Advisory Council, it honours those who demonstrate the core concepts of patient- and family-centred care, dignity and respect, participation and collaboration.

For Dr. Vélez, an obstetrician and gynecologist focused on improving women’s reproductive health, her success goes beyond having knowledge, skills and dedication.

“I believe in showing compassion, and especially, to listening to patients and acknowledging the importance of their needs,” she says.

The patient who nominated Dr. Vélez felt supported and empowered throughout her care, writing in her nomination “She wanted to hear what I had to say first.” and “She went at my pace and in the directions and options I wanted to explore. I felt she understood what my values were and did everything she could to accommodate them.”

The winner in the nurse category this year, Tracey Froess works in one of KHSC’s cancer clinic. Her patient’s expressed their appreciation by saying “Tracey always took the time to listen to our concerns and we never felt rushed. We always felt respected and valued. She made the whole experience more comforting.”

“I learned from another esteemed colleague to really listen to your patients,” Froess wrote when asked about her secret to patient-care success. “This advice has always done me well in my career.”

Upon reflecting on what it means to receive an Exceptional Healer Award, both Froess and Dr. Vélez were quick to acknowledge those around them.

“It makes me realize that I have been lucky to work in the right place, with a great team, which has had a positive impact on my care of patients,” said Dr. Vélez.

Froess added, “KHSC is full of exceptional healers. I know… I’ve been fortunate to work along side them every day.”

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Evaluating the Student Experience: Assessing satisfaction is important, but not enough

“Universities are centres of learning, not teaching”

These were the words, uttered many years ago, by a former professor and teacher in response to some very demurely and deferentially expressed comments about the quality of lectures being provided in a particular medical school course. The message, directed to me and a couple of my classmates, was pretty clear. The university and faculty would provide opportunities to learn, in whatever manner they felt appropriate. It was not for us, as mere students and consumers, to question the methods. The responsibility for our education was ours.

In fact, in recent discussions with a number of my medical school contemporaries who I’m fortunate to meet with regularly, none of us could recall, during our four years of medical school, ever being asked for feedback of any kind about our educational program. If such processes existed, either internal or external to the school, they were largely invisible to the students of that time. This was certainly not unique to our school. For our generation, medical education was very much a “take it or leave it” proposition.  

This is not to say we didn’t get excellent teaching, role modelling and mentorship. We certainly did, and many of us found our inspiration for education in those early experiences. It’s also almost certainly true that many of the teachers of that time quietly observed and responded to the impact of their methods on their learners. However, the culture of the day simply did not provide methods by which the student experience could be collected and analyzed.

This rather parochial approach was not exclusive to medical education. Patients of the past were rarely, if ever, surveyed for feedback about the quality of care they received from institutions or individual physicians. Corporations and businesses largely allowed the public to “vote with their feet”. If the product wasn’t good, people wouldn’t buy it, or would simply walk away.

Clearly, things have changed.

In the business world “Consumer Satisfaction” is an industry in itself. Successful businesses aggressively seek out customer feedback because they have learned that responding to real or even perceived needs drives future spending. IBM has taken this a step further. They go beyond the need to ask questions and, instead, are building and offering services that track consumer behaviour and provide that information to service and product providers. To quote from their site: 

In health care, knowledge of the patient experience is now considered essential to a well- run institution. Hospitals are expected, through accrediting processes, to actively seek out patient perspectives

The Agency for Healthcare Research and Quality operates within the U.S. Department of Health and Human Services. Its mission is “to produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable”. To quote from their site:

“Understanding patient experience is a key step in moving toward patient-centered care. By looking at various aspects of patient experience, one can assess the extent to which patients are receiving care that is respectful of and responsive to individual patient preferences, needs and values. Evaluating patient experience along with other components such as effectiveness and safety of care is essential to providing a complete picture of health care quality.” (https://www.ahrq.gov/cahps/about-cahps/patient-experience/index.html)

They make an important distinction between patient satisfaction and the patient experience. Satisfaction is a subjective impression of a patient’s interaction with an institution or individual, and is largely based on whether their personal expectations were met. The patient experience relates to gathering information, available only through patient reporting, that is relevant to determining whether certain institutional goals are being achieved.

A person test driving a new automobile, for example, is able to report on both the driving experience (acceleration, braking, ease of handling, visibility etc…) and their personal satisfaction (enjoyment, comfort, excitement) driving the car. To those designing and building the car, evaluating the driving experience allows them to determine if the equipment and concepts they developed are working as expected. Evaluating driver satisfaction determines whether the consumer is getting what was expected from the car, which may be unclear to the designers. Both are relevant to success. Both are certainly relevant to the likelihood that the consumer will purchase the car.

In medical education, the value of student feedback is widely appreciated and schools go to considerable effort and expense to collect it. In fact, the systematic collection of feedback is mandated by accreditation standards, and the evidence required to establish compliance with those standards is based largely on student feedback. The distinction between measurements of the student experience and student satisfaction is relevant, both being important goals. Systematic Program Evaluation must encompass both.

At Queen’s, we recognize that many goals of our educational program can only be fully assessed with the perspective of those actually experiencing and living the process. We also recognize that a full picture only emerges if many points of feedback are provided. We have therefore put in place many and varied opportunities for students to provide both their personal perspectives and objective observations.

After each course, students are invited (and expected) to provide feedback that consists of responses to questions exploring pre-determined educational objectives, and provision for narrative commentary in which they can elaborate or explore other aspects. Those end-of-course evaluations also provide opportunity to provide similar feedback regarding the effectiveness of teaching faculty.

We receive and carefully review the results of course-related examinations undertaken by our students, not only to gauge their learning, but also the effectiveness of the teaching and learning opportunities provided.

We anticipate and review closely the results of external examinations undertaken by our students, such as the Medical Council of Canada Part 1 and 2 examinations, and all National Board of Medical Examiners tests we utilize. These provide valuable comparators to other institutions and, to a limited extent, further feedback about our teaching effectiveness.

The Canadian Graduation Questionnaire is completed annually by all graduating medical students and provides a comprehensive review of all aspects of their educational experience. We review it in great detail, and many aspects of the CGQ are incorporated into the accreditation process.

Dr. John Drover

We have established a Program Evaluation Committee that, for the past few years has been under the leadership of Dr. John Drover. That group collects, collates and analyzes data from a variety of sources to provide an overarching analysis of our performance relative to our programmatic goals. The PEC recently released a comprehensive report, which has been passed along to the Curriculum Committee for analysis and action. I am very grateful to Dr. Drover who has generously and effectively provided PEC leadership. He is now passing that role along to Dr. Cherie Jones as she assumes her role as Assistant Dean, Academic Affairs and Programmatic Quality Assurance.  

We have also developed a number of more informal ways by which students can provide feedback.

We meet regularly with student leadership and curricular leads to get “on the fly” feedback about courses as they are taught. This often causes us to undertake adjustments or provide supplemental content even before the course is completed.

We provide numerous ways in which students can report personal distress or incidences of mistreatment at any point during their medical school experience. These range from direct contact with selected faculty members, our external counselor (who can be contacted directly and is completely segregated from faculty or assessment) or submission of reports that can be embargoed until a mutually agreed to time. All these are outlined in our policies and accessible through convenient “Red Button” on MedTech.

I have found “Town Halls” to be very valuable sources of feedback on all aspects of the MD program. These are held at least once per term with each class and consist of a few “current events” items I provide, followed by “open mike” time when students are invited to bring forward any commentary or questions they may have, about any aspect of the program. The issues that emerge and dialogue among students in attendance can be highly revealing and have certainly provoked new directions and changes over the years.

Recognizing that not all students are comfortable with speaking out, or may not wish to be identified as they raise sensitive issues, a confidential portal was established on MedTech a number of years ago. Students are able to provide their commentary in a completely anonymous fashion if they wish. My commitment is to read and consider (but not necessarily act on) all commentary provided, and to respond personally if students choose to identify themselves. To date, I have received almost 500 such submissions, about 70% of which are provided anonymously. The commentary has been thoughtfully provided and has spanned all aspects of our program and learning environment. Importantly, it often brought to light issues that had not previously emerged in any other way.

In all these ways, student feedback has become a continuing, multi-faceted component of our school and, more broadly, our learning environment. It goes beyond being a mechanical, mandated exercise and data collection. It is embedded and cultural. It is what we do. It is who we are. 

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Med Students’ activities extend beyond the classroom

It’s that time of the new year when the winter doldrums can set it – weather and routine can weigh everyone down. Along with that, there’s that old cliché about “all work and no play”. There’s little risk of our medical students being thought of as anything approaching dull and they provide great ideas for how to beat the winter blahs. In addition to their full class and study load, they make time for a wide variety of extra-curricular activities for fun, recreation and community involvement.

Aesculapian Society President Rae Woodhouse recently shared some highlights of these endeavours:

In early January, 68 pre-clerks attended the annual MedGames in Montreal and placed 2nd of everyone outside of Quebec. Sponsored by the Canadian Federation of Medical Students (CFMS), MedGames brings together medical students from across the country for a friendly sports competition and network building.

Thirty-one second year students competed in BEWICS.  This is the annual Queen’s Intramural sports competition which features a variety of self-proclaimed “quirky” sports such as water volleyball and rugby basketball. The QMed team placed third overall for competitiveness and spirit.

The Class of 2021 Class Project Committee hosted Queens’ first ever Scholars At Risk Talk (see more on this here).

Pre-clerk students recently competed in the Ottawa’s Winterlude Ice Dragon Boat competition and about 30 went on the annual ski trip to Mont-Tremblant two weekends ago.

And if ice dragon boating and skiing weren’t enough of a challenge, about 45 students from across the four years spent a couple of hours recently learning the basics of curling from a fourth year student. This is the fourth time for this event!

For Wellness month, the Wellness committee put together a month of activities with each week having a theme: social, physical, mental and nutritional wellness. During physical wellness week, 40 pre-clerks did a Crossfit class and 20 did a spin class taught by the AS Wellness Officer.

The 2nd annual Jacalyn Duffin Health and Humanities conference happened recently and was very well received.

This past weekend, 20 students went to NYC to learn about the history of medicine, led by Dr. Jenna Healey (Hannah History of Medicine Chair) and the What Happened In Medicine Historical Society. 

And, over 100 mentorship group members attend trivia at the Grad Club. (Take note of that, it could be a future trivia question!)

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Singing the praises of learning objectives

This past Sunday afternoon, I had the pleasure of attending the Kingston Symphony’s matinee performance of Gene Kelly: A Life in Music at the Grand Theatre.  The show featured clips from Kelly’s most memorable performances, with live musical accompaniment by the symphony, under the direction of Evan Mitchell.

Throughout the show, Kelly’s wife and biographer, Patricia Ward Kelly, shared anecdotes and Kelly’s own insights into his choreography and performances.

She talked about the work he put into creating dances, painstakingly writing out the choreography plan, before working with his fellow performers to perfect the dances themselves. “He didn’t just show up and wiggle around on the stage,” she said.

My educational developer lens instantly compared this to the framework provided by well-written learning objectives. Objectives focus teaching and learning plans, and contribute to authentic assessment.

Yes, this is another blog about learning objectives.

In the abstract, learning objectives seem like just another box on a checklist or hoop to jump through.  Used the way intended, however, they are signposts that guide learning and teaching plans effectively—whether for a class or a single person—the same way Kelly’s planning delivered award-winning and inspiring choreography.

Yes, there’s a “gold standard” for writing objectives (that I’ve written about previously here). And there are verbs to use—and ones to avoid—and if it doesn’t come naturally to you to think this way, it can be pretty tedious.

What it’s really about is planning: knowing what you’re setting out to do. If you have an objective—a goal—then you can make your plan and communicate it to others effectively.

Well-crafted objectives also make things great for assessment, because it’s very clear what you have to measure at the end of the lesson, course, or program.

If you say, “I’m going to get better at taking patient histories” – what does that mean? What does “better” look like? If it means, “I’m going to note down details, or I’m going to ask specific questions, or I’m going to listen more than I have been, or interrupt less… then you know what you need to work on. You know what the focus needs to be, whether you’re a learner or a teacher.

Eventually, you’ll be able to do a history without thinking things through so deliberately – once you’ve achieved fluidity in that skill.  But before it’s a habit, you need to plan, your checklist, and I’m hitting all the boxes? Not just: “be better”.

For example, one of my plans in 2018 was to read more books that weren’t medical education and weren’t related to my PhD coursework. “Read more for fun.” That was it. My objective was pretty vague and, as a result, I didn’t create a workable plan. “Read more” didn’t get me very far. I read parts of eight non-work-related and non-course-related books. And three of those were cookbooks.

I set a more specific objective for 2019 that I would read more by spending five minutes every morning before I left for work reading something from my “recreational” “to be read” book stack (mountain).

I’ve finished two books, which is already a 200% improvement over last year. That specificity can make a difference.

And that’s really all objectives are: an outcome statement to focus your plan.

And that’s why we focus highlight objectives in our competency framework. It’s why we map things to them—learning events, assessments, EPAs—so we can be consistent and everybody knows what the plan is.

How much detail do you need in your objectives? This depends on how granularly you need to communicate your goals in order to be effective.

For his iconic Singin’ in the Rain, Gene Kelly had to map out the location of each of the puddles. His plan needed to be that detailed to get it right.

If you’re wrestling with learning objectives and how these relate to your teaching, give me a call.

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