8th Annual Medical Student Research Showcase

By Drs. Heather Murray & Melanie Walker

This year the School of Medicine is proud to invite you to the 8th annual Medical Student Research Showcase on Wednesday September 18.

This event celebrates the research achievements of our undergraduate medical students, with both posters and an oral plenary session featuring research performed by students while they have been enrolled in medical school. All students who received summer studentship research funding through the School of Medicine in 2019 will be presenting their work, as well as many other research initiatives. The posters will be displayed in the David Walker atrium of the School of Medicine building from 8 am until 5 pm, with the students standing at their posters answering questions between 10:30 and noon.

The oral plenary features the top research projects selected by a panel of faculty judges, and will run in room 132A from noon until 1:30 pm on September 18, immediately following the poster session Q&A.

This year’s faculty judges included:

  • Dr. Sheela Abraham
  • Dr. Nazanin Alavi
  • Dr. Anne Ellis
  • Dr. Jennifer Flemming
  • Dr. Laura Gaudet
  • Dr. Faiza Khurshid
  • Dr. Diane Lougheed
  • Dr. David Maslove
  • Dr. Lois Mulligan
  • Dr. Chris Nicol
  • Dr. Stephen Pang
  • Dr. Michael Rauh
  • Dr. Damian Redfearn
  • Dr. Claudio Soares
  • Dr. Sonal Varma
  • Dr. Maria Velez

We are very grateful to these faculty members for evaluating our oral plenary applicants this year.

The three students who have been selected for the oral plenary session, and the titles of their research presentations and faculty supervisor names are listed below. Each of these three students will receive The Albert Clark Award for Medical Student Research Excellence.

Alison Michels – von Willebrand factor regulates deep vein thrombosis in a mouse model of diet-induced obesity

Katrina Sajewycz – Multidisciplinary Ambulatory Management of Malignant Bowel Obstruction: A Qualitative Study of Gynecologic Cancer Patients’ Experiences and Perceptions

Mehras Motamed – Inhibiting Pyruvate Kinase Muscle Isoform 2 with Shikonin Regresses Supra-coronary Aortic Banding induced Group 2 Pulmonary Hypertension

Please set aside some time to attend the Medical Student Research Showcase on September 18th. The students will appreciate your interest and support, and you will be amazed at what they have been able to achieve.

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Plastic Snow? It’s official…we’ve gone too far. It’s time to act.

Meet my grand-nephew, Tristan. He’s been visiting from Nova Scotia with his parents. He’s 7 months old and, this past week, is starting to crawl and had his first haircut. He’s also the inspiration for this week’s blog. But more about him later…

We’ve grown accustomed to reading reports of grave environmental threats. For most of us, there is as yet little direct impact and we’re able to regard these concerns in the abstract. With time and repetition, we develop something akin to resigned indifference, participating in recycling efforts with reluctant acquiesce. 

I’ve recently come across some information that should cause us all to pause, consider what’s happening to our environment and our own, personal culpability.

In a 2017 article appearing in Science Advances (Geyer, Jambeck, Law, Sci. Adv. 2017; 3: e1700782), researchers from three American universities and institutions with expertise in environmental issues reported on the “Production, use and fate of all plastics ever made.” Their conclusions are, to say the least, rather sobering. To summarize:

  • 8.3 billion metric tons of plastics have been manufactured to date
  • Of that, 6.3 billion metric tons remain as plastic waste accumulated in landfills.
  • Only 9% has been recycled, 12% incinerated
  • If current trends continue, it’s projected that 12 billion metric tons of plastic waste will find its way either into landfills or the natural environment by 2050.

The projections they have developed are rather frightening as portrayed in this graph from their paper:

Plastic products are, of course, designed to be durable. Basically, they don’t go away, and this article makes it clear that our current recycling efforts aren’t nearly adequate.

To put this into more comprehensible terms, researchers at the Rochester Institute of Technology have recently estimated that 22 million pounds of plastic debris enter the Great Lakes every year. Our own Lake Ontario, which we Kingstonians walk or drive by every day, receives the equivalent of 28 Olympic size swimming pools of plastic bottles each year, and they don’t go away.

(https://phys.org/news/2016-12-metric-tons-plasticgreat-lakes.html)

If that’s not enough to get our attention, consider work recently published by Dr. Melanie Bergmann and her colleagues at the Alfred Wegener Institute in Germany, also in Science Advances (Bergmann et al, Sci. Adv. 2019; 5: eaax1157).  

They point out that plastics don’t dissolve harmlessly into the environment, but under a number of physical stresses (mechanical abrasion provided by waves, for example, or temperature fluctuations) they can be broken into much smaller particles, termed microplastic, measuring less than 5mm. It’s already been well established that these can be found not only near large urban centres, but also in northerly ocean seabeds and coastal sediment. What hasn’t been clear is how they get there. It’s been postulated that microplastics have the capacity to be carried into the atmosphere and find their way to points very remote from their original dumping grounds. The capacity to become airborne not only explains this wide distribution, but potentially threatens human and animal exposure through inhalation.

To test this possibility, they set out to look for microplastics associated with snow because, in the words of the authors “snow is a scavenger for diverse impurities, and acts as a filter on the ground by dry deposition”.  Using techniques far beyond my understanding, they measured levels of various microplastics in snow samples gathered from ice floes and islands in the Arctic, and compared with samples from urban centres in northern Europe and from the Alps.

They found plastic microparticles in snow gathered from all sites. Although there was much more from the cities, there were detectable levels in the snow scooped up from ice floes drifting in the Fram Strait and on Svalbard Island in the far north, far from any population centre, in quantities they described as “substantial for a secluded location”.

They conclude that snow has the ability to bind these airborne particles and carry them back to earth, a process they term “scavenging”. They conjecture that this process can allow for microparticles to find their way into water supplies and food chains. They even recommend that large northern cities give thought to where they deposit collected snow in the winter, to avoid contamination of water sources.

If we needed any further convincing about the need to curb use of plastics, I think it’s now available. Particles from the bottles or straws that we use to conveniently transport beverages to quench our thirst are finding their ways to the most remote, unpopulated regions of our planet, previously considered pristine. The ice and snow, always symbols of purity, are now tainted. Children who will soon be running outdoors to frolic in the first winter snowfall may be putting themselves at risk.

Getting back to young Tristan, what sort of world are we shaping for he and his peers? What can we do, given the virtually ubiquitous presence of plastics in our society? Personal action, to be sure. We should make all efforts to minimize our own usage and maximize recycling efforts. But also political awareness, particularly in this election year. No political leader or party that fails to understand the true impact of environmental contamination is worthy of our support. We should expect well-articulated platforms that address both local and international approaches. We have a responsibility to be vigilant, not only for ourselves, but also for those not yet able to speak for themselves but have so much at stake. 

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Use the microphones, and other audio advice

Microphones can be intimidating to use and sometimes we think we don’t need to use them. (Especially those of us who have developed a “teacher voice” over the years). However, using the microphones available in the School of Medicine Building’s large teaching theatres (032 and 132) is essential to provide an optimal learning experience for all, especially those who may be using Assisted Listening Devices (ALDs), catching up with captured lectures, or video-conferencing in using Zoom.

These teaching spaces were actually designed to limit sound travel, so the microphones become essential equipment. “The theatres were designed to be like a recording studio, which means there’s minimum audio transfer throughout the room,” Jason Palmer, Classroom Technology and Media Coordinator* explained.

The building materials were selected with this minimal audio transfer in mind. It’s accomplished through acoustic panels in the ceiling and the wall paneling around the room.

“It isn’t actually wood, it’s an acoustic material. If you look at the wood up close, you’ll see microlaser perforations through the wood and if you look at the backside, it looks like a half-inch thick slice of pegboard MDF, but there’s a one milimetre skin of walnut over the top of the whole thing, with these perforations,” he pointed out.

Behind the paneling itself are two other sound dampening materials as well as insulators. One reason for these design choices was to ensure that when up to 16 small groups of 7-8 people were talking to work on cases (for example) that the noise level in the room “would not be outrageous.”

“If you had a room that was very echo-y, like a standard room with standard drywall, you would create a cacophony pretty quickly. It would be untenable because the first group starts talking, the second group has to talk a little louder to be heard over the first group, to the point that it would just be a chaotic sound,” he said.

“A lot of traditional old-school classrooms were like that, because they built them out of concrete walls, and they didn’t really think about [noise] or if anyone was talking other than the lecturer – and that was the point. We’ve changed the teaching model, to use this group learning methodology, and because of that, they had to make a lot of considerations for audio.”

The rooms were also designed to act as recording studios to facilitate lecture capture and broadcasting of learning events through technology such as Zoom meeting. For these recordings, the audio is taken from a direct feed from the microphone system, rather than recording the room at large.

There are three different types of microphones used the theatres, two for presenters and one for students/audience members.

Each theatre has a lavalier lapel microphone and a handheld one. The most often used by instructors is the lavalier mic.

The quickest way to remember where to clip the lavalier microphone is to put the microphone dead centre under your chin, Palmer said. “It means wearing things like button down shirts and ties to make it really easy. Wearing things like t-shirts and solid front shirts makes it more difficult.”

A sample passport pouch–a solution to where to clip the microphone and where to hold the unit for clothing without lapels and pockets.

A lanyard cord or strap from a passport pouch can also work. (Thank you, Dr. Sue Moffatt for this advice!) It’s helpful helpful to have either a pocket or a waistband/belt to clip the unit to, or if you’re using a passport pouch, the unit can go there.

“The reason you want it dead centre, is because a microphone is a cone, at 45 degrees. If I turn my head to either side and it’s dead centre, the microphone will still always pick me up. If I put the microphone off to the side, as soon as I turn to the other side, I’m gone.”

Some instructors prefer the hand-held microphones and these are also used for panel presentations. (There are now an additional four handheld mics available in 132 specifically for panel presentations).

When using the handheld microphone, the advice is to almost rest it on your chin and talk at a normal volume.

“The reason you almost rest it on your chin, is a microphone is really a very heavy thing. It doesn’t seem like it at first, but after an hour of teaching… the microphone starts to slowly lower down to your belly button.”

For both the lavalier and hand-held microphones, “red means stop, green means go,” Palmer said. “When you first turn it on it’s still red because it hasn’t synchronized to the receiver– this takes a bit less than two seconds. Turn it on, wait for the green, then start talking.”

Palmer does caution that a microphone isn’t a miracle worker. “If you are someone who is naturally soft-spoken at all times, a microphone won’t instantly make you louder. Contrary to what people believe a microphone is for. It’s not for amplification, it’s for sound for sound reinforcement.”

“What I tell people: When you pick up a microphone, you are talking at a dinner party to five friends, you’re not talking one-on-one to your friend. You’re also not talking at a Starbucks where it requires a lot more volume. You just need to elevate slightly – don’t yell, but at the same time, don’t talk really quietly.”

The microphones are equipped with AGC (automatic gain control) if you talk too loud and risk feedback and ‘brains’ in the microphone scale you back – so don’t worry, he added.

Do not blow into a microphone, as this can damage the equipment. “If you want to see if it’s on talk, or lightly tap it,” he advised.

The student desk microphones are activated from the main console by ensuring the “push-to-talk” mode is selected. (This is typically done by one of the technical staff first thing in the morning). Similar to the other microphones, there a one or two second delay from pushing to the microphone working. When the button is pressed, it flashes three times red, then stays on steady: at that point, it’s on. Push the button again to disengage. (It’s also automatically disengaged when another student microphone is pressed.)

The last thing he’d like students to remember about their table-top microphone system is that the mics are vulnerable to drink spills.

“All their drinks should have a lid. We don’t want to damage the microphones. Inside a microphone is a very complex arrangement of copper wire over a very thin membrane in order to facilitate sound,” he said.

Whenever there is a problem with a microphone or a button, please let the tech team know so they can fix them as soon as possible. For now, use the medsvc@queensu.ca email – there is a ticket system coming.

* * *

Still, some people insist they’re loud enough to go without the tech. Palmer, who has been working in these theatres since the building opened in 2011, disagrees.

“We have ONE presenter who is, absolutely, loud enough to present in that room without a microphone. That person also did Shakespeare at Stratford – has projection! I heard them through the glass [of the audio booth] as if they were standing next to me,” he said. But even that person needs to use the microphone, he added. Palmer cites three main reasons for everyone to always use the microphone systems:

1 Individuals with hearing difficulties may have problems hearing even someone who is projecting well, due to clarity, reverberation, and other ambient interference. “You want as much clarity as possible,” he said. Plus, the microphones feed directly to the Assisted Listening Devices (ALDs) that are available for use in both theatres. “It’s a ‘direct drop’ from the matrix, so it’s the cleanest line feed you can possibly get.” (I tried one out in the basement lobby outside 032 while a class was going on, and the feed even outside the classroom was excellent).

From left to right: an ALD unit; Jason Palmer demonstrates the earpiece for the ALD; two views of the ALD receiver unit. (T. Suart pictures)

There are four ALDs for each theatre. These can be signed out from the tech booth at the back. Students can just ask at the booth, or email ahead of time if they prefer (medsvc@queensu.ca). It takes moments to set up and with fresh batteries (provided) they’re good for eight hours. Each ALD has a sanitizable hearing cup that covers one ear.

There is also a portable Assisted Listening System (ALS) available if needed in another teaching space. It includes a microphone the instructor wears that feeds directly to the student’s system.  The ALS has one transmitter and eight listener units. To arrange to use the ALS, email medsvc@queensu.ca.

Palmer wants to make sure students aren’t hesitant to use the devices if they need them. “We always have a technician in the back room, so it’s always available.”

2 The microphone provides a direct feed for recordings for lecture capture – for both instructors and students. “It’s an opt-in system with lecturers, but just so people get in the habit of using the microphones. We need the students’ questions recorded, as well, because dead air and then an answer is not effective.”

“We are capable of doing Zoom video conferencing in each of the lecture theatres and without the microphones, people at the other site wouldn’t hear. We generally want everyone to have the same experience, plus, we really want that clean audio in that Zoom meeting.”

A fourth great reason to use microphones whenever they are available (not only in 032 and 132) is this helps to make our teaching spaces more accessible to all users — a requirement of the Accessibility for Ontarians with Disabilities Act (AODA).


* He says he also answers to “Tech Guy”, “Computer Guy”, and “Guy in the Booth”.

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Welcoming Meds 2023

As the days get shorter and leaves begin to fall we reluctantly acknowledge that summer is giving way to autumn. In any university community another sure sign is the return of students, heralding the beginning of another academic cycle. At Queen’s School of Medicine, this past week marked the 165th time a group of young people arrived to begin their careers.

Photo by Garrett Elliot

This year’s group consists of 108 students, drawn from an applicant pool of over 5500. They come all regions of our country and backgrounds. One hundred and eight individual paths leading to a common goal that they will now share for the next four years. Eighty-four of them have completed undergraduate degrees, 30 Masters degrees, and five PhDs

They hail from no fewer than 53 communities spanning the breadth and width of Canada. The universities they have attended and degree programs are listed below:

   
   

 An academically diverse and very qualified group, to be sure.  Last week, they undertook a variety of orientation activities organized by both faculty and their upper year colleagues. 

On their first day, They were welcomed by Dr. Richard Reznick who challenged them to be restless in the pursuit of their goals and the betterment of our patients and society.

They were called upon to demonstrate commitment to their studies, their profession and their future patients.  They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers.  They were welcomed by Mr. Danny Jomma, Asesculapian Society President, who spoke on behalf of their upper year colleagues, and Dr. Rachel Rooney provided them an introduction to fundamental concepts of medical professionalism. 

Over the course of the week, they met curricular leaders, including Drs. Andrea Guerin, Lindsey Patterson and Laura Milne.  They were also introduced to Dr. Renee Fitzpatrick (Director of Student Affairs) and our excellent learner support team, including Drs. Martin Ten Hove, Jason Franklin, Mike McMullen, Josh Lakoff, Erin Beattie, Lauren Badalato and Susan MacDonald who oriented them to the Learner Wellness, Career Counseling and Academic Support services that will be provided throughout their years with us.  They met members of our superb administrative and educational support teams led by Jacqueline Findlay, Jennifer Saunders, Theresa Suart, Eleni Katsoulas, Amanda Consack, and first year Curricular Coordinator Jane Gordon

They attended an excellent session on inclusion and challenges within the learning environment, organized by third year student Alisha Kapur and student members of the diversity panel, supported by Drs. Mala Joneja and Renee Fitzpatrick. The presentation included dialogue from a panel of upper year students (Leah Allen, Palika Kohli, Vivesh Patel and Naveen Sivaranjan) who provided candid and very useful insights to their first year colleagues. That was followed by a thought-provoking and challenging presentation by Stephanie Simpson University Advisor on Equity and Human Rights.

Dr. Susan Moffatt organized and coordinated the very popular and much appreciated “Pearls of Wisdom” session, where fourth year students nominate and introduce faculty members who have been particularly impactful in their education, and invite them to pass on a few words of advice to the new students.  This year, Drs. Erin Beattie, Wiley Chung, Bob Connelly, Jackie Duffin, Michelle Gibson, Brigid Nee, Siddhartha Srivastava and David Walker were selected for this honour.

On Friday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Michelle Gibson, Cherie Jones and Lindsey Patterson.

Their Meds 2021 upper year colleagues welcomed them with a number of formal and not-so-formal events.  These included sessions intended to promote an inclusive learning environment, as well as orientations to Queen’s and Kingston, introductions to the mentorship program, and a variety of evening social events which, judging by appearances the next morning, were much enjoyed.

For all these arrangements, skillfully coordinated, I’m very grateful to Rebecca Jozsa, our Admissions Officer and Admissions Assistant Rachel Bauder.  

I invite you to join me in welcoming these new members of our school and medical community. I leave you (and they) with the Bob Dylan lyrics that Dr. Reznick shared with the class this past week:

May your heart always be joyful
May your song always be sung
And may you stay forever young

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DILs, RATs, and SGLs: a primer on team-based learning

Three-letter acronyms* figure heavily in medicine and medical education. Three of these that are intertwined in much of our pre-clerkship classroom-based learning are DIL, RAT and SGL.

QMed students engaged in an SGL application exercise.

These abbreviations are for three key learning event types that, when combined, comprise Michaelsen’s Team-Based Learning (TBL) model. This form of teaching unfolds in three steps and is designed to make best use of students’ and teachers’ time and expertise. The steps are:

Preparation:

Students receive preparatory materials either in a lecture, in a Directed Independent Learning (DIL) assignment, in a module, in previous courses, or preparatory readings. This material is typically fact/knowledge-based information.

Readiness:

Students’ understanding of this material is assessed in some way. This could be through formal Readiness Assessment Tests (RATs). These tests consist of 10-12 multiple choice questions. Each student completes an individual RAT (iRAT), then complete the same quiz in their SGL group (gRAT). The instructor then takes up any questions with which groups had difficulties. This could also be assessed via an online self-assessment quiz or some other method (e.g. completing a previous unit).

Application:

Having completed the preparation material, been assessed on their readiness, and having problem areas explained, students are ready to apply this knowledge through cases and problem solving application exercises, what we call Small Group Learning (SGL) session.

Directed Independent Learning (DIL) sessions provide content delivery, followed by Readiness Assessment Tests (RATs), culminating in Small-Group Learning (SGL) events where students engage in application exercises.

SGL sessions provide an opportunity for students to apply material they have already learned in order to extend their learning. Specifically, application exercises:

  • Help students develop understanding and apply the course material.
  • Address any misconceptions that may have developed, as students apply and integrate knowledge (Kubitz & Lightner p. 66).
  • Provide opportunities for students through practice, to transfer what they learned to application questions (Kubitz & Lightner p. 67).
  • Ensure students integrate “several different skills to answer application questions that require transfer of learning,” including accessing prior knowledge and identifying which knowledge applies and which does not (Kubitz and Lightner p. 67, citing Ambrose, Bridges, DiPietro, Lovett, & Normal, 2010).

This model means most of non-lecture classroom-based time will be students working in their small groups of seven to eight students. The instructor’s role is to design the cases, ask challenging questions and then emphasize, reinforce, highlight, and clarify key teaching points throughout the session through the case debriefs.

Case application questions balance the line between too easy and too hard:

If questions are too easy: Can’t have spirited discussion when all teams agree on answers.

If questions are too hard: Predictable frustration if groups of well-prepared students cannot arrive at the most reasonable answer because question has design flaws or requires outside knowledge

Here are eight great types of questions that can be incorporated into application exercises:

Key Phrase:

  • What is the key phrase in the case that will cause you to proceed down a particular path?

Change a variable:

  • If variable X is changed in the case, how would your approach change?

Forced choice:

  • You can only order one test from this list. Which is the best one to choose? Why?

Evaluation:

  • What is the BEST choice, given the case history? Why?
  • What’s the NEXT best choice to make?

Justification:

  • Give groups the decision, then ask them to provide a rationale for it.

Backward-looking:

  • Given a particular pathophysiological insult, have groups determine what caused it.

Prediction:

  • Given the case history and a particular course of action, what will the outcome be?

Ranking:

  • Rank tests, procedures, medications, in order of importance vis-à-vis the case history or learned protocol. Have the group explain why they decided on that order.

If you’re a faculty member looking for assistance with preparing to teaching using TBL methods, please get in touch. If you’re a student with feedback on a particular SGL session or TBL in general, please get in touch, too. Reach me at theresa.suart@queensu.ca


* As an aside, TLA is the three-letter acronym for three-letter acronyms.


References

Sweet, M. & Michaelsen L.K. (eds) (2012) Team-Based Learning in the Social Sciences and Humanities. Sterling, Virginia: Styllus Publishing LCC (and Kubitz & Lightner in this volume)

Harris, S.A. and Watson, K.J. (1-1-1997), Small Group Techniques: Selecting and Developing Activities Based on Stages of Group Development. University of Nebraska- Lincoln. digitalCommons@University of Nebraska – Lincoln Paper 378

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Changes

Dedication and organizational effectiveness are key leadership qualities, but do not always combine in the same individual. When they do, the result is a person who is a hugely valuable resource to the organization they serve. At Queen’s, we’ve been very fortunate (some would say “blessed”) to have many such dedicated and effective people involved in medical education. One would hope such people could continue in their roles indefinitely. However, from time to time, change is necessary. In the Undergraduate program, a number of changes are occurring at this time, partly because of life transitions, but also in order to ensure that we continue to refresh perspectives, allow gifted people the opportunity to learn multiple roles, and position ourselves optimally for our next major accreditation review about three years from now. I would like to use this article to announce a number of those changes.

Assistant Deans

Dr. Hugh MacDonald, Dr. Renee Fitzpatrick, Dr. Cherie Jones, and Dr. Michelle Gibson

Although these have already announced, I thought it appropriate to re-iterate that, over the past year, we have appointed four Assistant Deans with responsibility for key components of the UG program. In the cases of Dr. Hugh MacDonald, Assistant Dean UG Admissions, and Dr. Renee Fitzpatrick, Assistant Dean Student Affairs, these appointments recognized the increased scope of responsibility that had evolved in positions previously designated as committee chairs or directorships. In the case of Dr. Cherie Jones, Assistant Dean Academic Affairs and Programmatic Quality Assurance, and Dr. Michelle Gibson, Assistant Dean Curriculum, these are de novo positions addressing key components of our program that were previously undertaken either solely by the Associate Dean or committee chairs. These consolidated responsibilities will provide focused attention and responsibility for critical aspects of program delivery.

Clerkship

Dr. Andrea Guerin, Dr. Susan Moffatt, Dr. Heather Murray

The clinical clerkship, spanning the final two years of medical school, consists of two components. The Clinical rotations consist of discipline-based rotations and/or integrated, longitudinal community-based rotations, and Electives. For the past several years, this aspect of the clerkship has been very capably directed by Dr. Andrea Winthrop. During that time, it has grown and evolved steadily, notably with expanded regional experiences and integration of EPAs as the basis for assessment. Dr. Winthrop is now moving to take on a new, needed role in our curriculum (see below). Dr. Andrea Guerin, who has been directing Year 2 of our curriculum, will be taking on the Clerkship directorship. 

The Clerkship Curriculum consists of three blocks interspersed through the final two years where the students re-assemble as a class and undertake learning in Clerkship Preparation, Complex Presentations, and Preparation for Residency. They have been very skillfully and thoughtfully developed, planned and directed by Dr. Susan Moffatt, and have become very highly valued by our students. Over the next year, directorship of the Clerkship Curriculum will be transitioning to Dr. Heather Murray who, as Dr. Moffatt, is a highly accomplished and recognized educator. (Dr. Murray won the Chancellor Charles A. Baillie Award from the Queen’s University Centre for Teaching and Learning this year).

Pre-Clerkship Director

Dr. Lindsey Patterson

In the early years of our curricular reform, the extensive structural and content change required separate directorship of Years 1 and 2. As our curriculum becomes more established, and our curricular coordinators become more familiar with roles and operational issues, we have arrived to a point that the roles can be combined into that of a Pre-Clerkship Director, which is consistent with practice at most other medical schools. I’m very pleased to announce that Dr. Lindsey Patterson, current Year 1 Director, will be taking on this expanded responsibility.

Intrinsic Role Director

Dr. Andrea Winthrop

Our last major curricular revision introduced explicit objectives and teaching regarding the so-called “non-Medical Expert competencies”, and development of committee and chair to oversee the activity of individuals charged with the development of each role (Competency Leads). Dr. Ruth Wilson initially chaired that group and was instrumental in the development of those aspects of our curriculum. When Dr. Wilson stepped away from that role, we elected to allow the Competency Leads to function independently. It’s now clear that the importance and complexity of these roles, together with the administrative requirements to ensure appropriate curricular design and delivery, necessitate centralized support. We are therefore re-establishing the role of Intrinsic Role Director, and Dr. Andrea Winthrop will be taking this on. Dr. Winthrop’s extensive knowledge and experience with our curriculum, together with excellent organization skills, make her an excellent choice for this key role 

Term 3 Clinical Skills

Dr. Laura Milne, Dr. Basia Farnell, and Dr. Meg Gemmill

Dr. Laura Milne directs our Clinical Skills program, which spans all four terms of the pre-clerkship, and is consistently very highly reviewed by our students and seen as a highlight or our curriculum. For the past few years, Dr. Basia Farnell been directing the Term 3 component of Clinical Skills, and has provided energy and creativity in revising the format and curricular content. As Dr. Farnell moves on to other challenges, Dr. Meg Gemmill, a member of the Department of Family Medicine who has been a highly regarded teacher in that course, will be a taking on it’s leadership.

Chair, Progress and Promotions Committee

Dr. Fred Watkins
Dr. Richard van Wylick

For the past several years, Dr. Richard van Wylick has been providing exemplary service as chair of our Progress and Promotions Committee. In addition to very capably directing the complex activities of that group, he has developed a robust collection of policies and procedures to guide various aspects of student promotion, curricular management, student conduct and professionalism in our school. As Dr. Van Wylick has taken on other leadership roles, he has continued to direct P&P, but it is no longer either reasonable or fair to ask him to continue. Fortunately for us all, Dr. Fred Watkins, who has longstanding experience on the committee, consistently demonstrating excellent judgement and sensitivity, has agreed to take on the chairmanship.

Chair, Student Assessment Committee

Dr. Peter MacPherson

With Dr. Gibson’s move to the new position of Assistant Dean Curriculum, Dr. Peter MacPherson will replace her as Chair, Student Assessment Committee. Dr. McPherson completed a Master of Education degree at Memorial University during his Pediatrics residency with an academic and research focus on medical education. He brings his experience from across the curriculum, both pre-clerkship and clerkship, to his new duties as Chair.

New Course Directors

Dr. Brigid Nee

Dr. Greg Davies has been directing the Obstetrics and Gynecology clinical clerkship rotation for the past few years. During that time, Dr. Davies has built on the success established by that department. As Dr. Davies moves toward retirement, we welcome Dr. Brigid Nee to this new role.

Dr. Gillian MacLean

Over the past few years, the Pediatrics clinical rotation has benefited from the input of many members of that department, including Drs. Richard Van Wylick, Karen Grewal and, most recently, Dr. Peter McPherson. As Dr. McPherson concentrates his attention on the pre-clerkship course and new interests, we welcome Dr. Gillian MacLean.

These changes will provide much more corporate knowledge within the leadership group, since most individuals will have had experience directing multiple portfolios spanning different aspects of our curriculum. This should allow for much more effective and helpful sharing of experience and knowledge, and thus better problem solving and anticipation.

These changes are intended to begin with the new academic cycle that starts in September, but the various incoming and outcoming individuals are already developing specific transition plans to provide for smooth and effective turnover. 

I thank all those who’ve been filling these positions in past years for their dedication to our students and our school. Please join me in welcoming and supporting all those moving into these new challenges.

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The Rapture of the Raptors. Why do we care?

It shouldn’t matter that Kawhi Leonard decided to play basketball in Los Angeles instead of Toronto.

And yet it does.

The anticipation leading up to his decision was unprecedented. The media were in a frenzy. Speculation was rampant. Helicopters followed his every move. There were “spottings” of house sales and reported purchases of moving containers!

It shouldn’t matter that a dozen or so very highly-paid Americans won a championship for playing basketball while employed by a Toronto-based sporting corporation.

And yet it does.

The public celebration, the pride, the pure, unadulterated joy this brought to the people of Toronto and, indeed, all of Canada, went far beyond anything experienced by most living people, and rivalled the memory of celebrations triggered by the end of world wars.

ctvnews.ca

It shouldn’t matter whether Canadian-born hockey players fail to win the gold medal at a two week long international tournament played every four years.

And yet it does.

It’s viewed as a national shame and calamity, eliciting much hand-wringing, introspection, and calls for reviews, re-focusing on “priorities” and enhanced commitment.

There is, undeniably, something about sports and our identification with teams that simply transcends logic or rational thought. It goes far beyond our collective interest in politics, environmental concerns or the economy. 

Just this past week Lisa MacLeod, a provincial cabinet minister, was required to apologize for unleashing an obscenity-riddled diatribe upon the owner of a professional hockey team. In her tweet, she tries to justify the attack:

“Let me set the record straight, I gave @MelnykEugene some feedback at the Rolling Stones concert and I apologized to him for being so blunt. I have serious concerns about the state of our beloved Ottawa Senators!”

Beloved? Really?

One of my favourite history writers, Pulitzer Prize winner Doris Kearns Goodwin, writes in her memoir “Wait Till Next Year” of her “childhood love” of the Brooklyn Dodgers and her “desolation when they moved to California”.

And I certainly can’t claim to be immune. I find the current mediocrity of the Blue Jays a personal offense and, for the past 50+ years, have gone into an annual spring funk when the Maple Leafs make their inevitable and ignominious exit from the playoffs.

Why do I care? Why do any of us care?

Certainly, there’s no question that the passion is real. For those who need convincing, I would refer them to a 2008 article by Ute Wilbert-Lampen and colleagues (NEJM 2008;358:475-483). They looked at the incidence of cardiac events in the greater Munich area during the 2006 World Cup of soccer. On days when the German team was playing, the incidence was 2.66 higher than during control periods (p<0.001). Men were more likely to be affected (3.26 times higher), but women were affected as well (1.82 times higher). There were clear spikes on days, and times, that the German team played, as illustrated below, points 5 and 6 being days Germany was playing the most critical games (Game 6 being their loss to eventual champion Italy, I might point out):

from Wilbert-Lampen etal. NEJM 2008; 358: 475.

Need more convincing? Consider a study carried out by Paul Bernhardt as part of his doctoral project. He measured testosterone levels in male spectators of sporting events, specifically basketball games at Georgia State University (Physiology and Behaviour 1998;65:59-62). He found that levels rose in a pattern similar to that of the players during the game, and decreased in the fans of the losing team. It seems that rabid fans are very much “in the game”. 

But what’s driving all this?

Psychologists and sociologists have explored the topic. Theories abound. Some believe team fanaticism allows for permission to step out of everyday lives and take on a different, more outgoing persona. The term “deindividuation” has been bandied about, which seems to mean that you can behave in a crowd in a way you never would alone. There’s a certain connection that occurs between fans of the same team that appears to promote self-esteem and carries over to everyday life. Terms like “relationship” and “bonding” have been applied to what happens between fans and their team.

Daniel Murray is a psychology professor at Murray State University. In his book “Sport Fans: The Psychology and Social Impact of Fandom”, he presents a combination of research and theory and makes a case that fandom promotes a sense of belonging, and overall psychological health. It appears to happen even if your team is unsuccessful – witness the Chicago Cubs whose fan base remained loyal despite not having won the World Series for 108 years or, dare I say it, our long-suffering Maple Leaf fans.

The term “Basking in Reflected Glory” (BIRG) has been used to describe the tendency to identify with successful teams and is ascribed to Professor Robert Cialdini who observed that the usage of team apparel in high school and college students varied in concert with the success of school teams. No surprise, I’m sure, to vendors of Raptors jerseys these past few weeks.

There are certainly positives to all this. In addition to transcending logic, sports fandom also appears to transcend issues of race and economic disparity. Sports appear to have a power to unite our society in a way that goes far beyond anything that can be achieved through any public policy. The Raptor players, taking in the adoring multitudes that turned out to celebrate their recent success, commented on the visible diversity of the crowds, something they’d not seen previously.

In the end, I would suggest that all this is about something much more fundamental. We have a basic human need to belong, to connect with others, to be part of something greater than ourselves. We can call it family, community, religion, social group, tribe, any or all of the above. We need to belong. We may wander, but will always identify with “home” and, to some extent, yearn to return. Allegiance with a particular team seems, to some extent, to address that need. For some of us, it’s ingrained in childhood and difficult to expunge (as much as we might like to). For others it’s acquired along the way, but no less real.

Returning to the topic at hand, what are we to make of Mr. Leonard’s recent departure? Certainly, it wasn’t motivated by monetary considerations or need to find a winning team, since he’d already achieved both those goals. In the end, his motivation seems to be something that the millions of fans who wished him to remain in Canada can easily understand.  Having been born and raised in Southern California, he didn’t so much reject Toronto as he chose to return to his own home, his own roots. Not many professional athletes have that option, and we should not begrudge him the choice. How many of us, given the same circumstances, would do the same? In the end, it’s about home It’s about belonging.

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Five ways to get moving on your summer reading plans

I worked at my campus’ library to help pay for my first university degree. The evening hours worked well with my coursework, the commute was great (walk across the quad!), and I was surrounded by books.

This last point was both a blessing and a curse: my “to be read” list grew and grew with each shift, whether I was shelving returns or stamping the university logo on newly-acquired tomes for the collection. Each book I came across was ripe with possibilities.

We all have a TBR “pile”: either physically in the form of stacks of books or journals, or virtually as a list (written or mental). Summer can be an ideal time to catch up on “required” reading or savour something from the “just for fun” section but sometimes getting started can stall you in the stacks. Try these five steps to get down to precious reading time.

1. Cull the pile. If it’s been a while since you organized your pile, don’t be afraid to remove titles. Your needs and interests may have changed in the intervening months. And something that seemed highly relevant back in January might not be as appealing now. Also, if you start a book and find it’s not living up to its promise, ditch it. Why waste your time? I give a book 40-50 pages to impress me; otherwise, I move on. (This works for non-fiction and fiction alike).

2. Set the time. We schedule times for meetings, but reading – even to keep up with our professions – often drops to the “squeeze it in somewhere” category. Consider scheduling 30 minutes a day of dedicated reading time. Can’t manage one half-hour slot? If it’s something you plan for, you could break it into two 15-minute chunks. Stow the book in your briefcase or make sure it’s downloaded to your eReader. Experiment to see what works.

Do you have a favourite way of managing your TBR pile? Is there an app or computer program or maybe a filing system that works for you? Please share!

3. Balance topics. Are you reading for professional development or diversion – or maybe both? Make time for each. Feeding your spirit can be just as valuable as the latest journal article in your field. Or, if you’re like me, you’ll set out to read something “for fun” and find that it actually has relevance to your current course work literature review…

4. Curate excerpts. Sure, there are some books that require a start-to-finish reading strategy, but sometimes reading a single chapter can give us the information or tools we’re looking for. Some books are even designed this way. Make use of Introductions and Tables of Contents to find what’s relevant to you and just read that.

5. Turn to tech. How can tools you already use help with your TBR list? I routinely use my iPhone to read journal articles in those “gap” times — when I’m early for an appointment, waiting to catch the bus home or to pick up my son from an activity.

Next on my reading schedule:

Peripheral visions: Learning along the way by Mary Catherine Bateson (1995)

Recommendations from my recent reading (aka, my attempt to add to your TBR pile):

Invisible women: Data bias in a world designed for men by Caroline Criado Perez (2019)

Spark by Patricia Leavy (a novel that explores the challenges of designing and conducting research). (2019)

Daring Greatly: How the Courage to Be Vulnerable Transforms the Way We Live, Love, Parent, and Lead by Brené Brown (2012)

What’s on your summer reading schedule?

A version of this post original appeared here in July 2014

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How to spend your summer not-vacation

There’s a different rhythm to summer at the medical school. Yes, this involves some vacation time, but it also involves getting many things done that get set aside during the university academic year.

For those involved in classroom-based teaching, the summer interval is an opportunity to review, reflect and revise teaching for the upcoming semesters. With this in mind, here’s my suggestion for tackling this task this summer:

A 4-R To-Do List for Summer 2019

1. Review

What you review will depend on your role in the UGME program. If you’re a course director, for example, re-read your course evaluation report, your own teaching evaluation report, and any notes you may have made through the year about how things went. Did the student curricular reps have any feedback for you during your course? Re-read these emails. Have a look to see if any of the MCC presentations assigned to your course may have changed (we update our list as the Council updates its presentations).

If you’re an instructor in a course, read through your notes on your learning events and your instructor evaluation report. Read through your teaching materials and your learning event pages on Elentra (our LMS, formerly called MEdTech).

Did you set aside any journal articles relevant to your field with a sticky-note saying “save for next year”? Now is the time to pull that out!

2. Reflect

Once you’ve reviewed relevant materials, think about your teaching. Did things go the way you wanted them to? Are there aspects of the past year that you’re really proud of and want to retain? Are there things that didn’t go as smoothly that you’d like to address next time? Are there things that went quite well, but you’d like to shake things up or experiment with something new? For anything that’s changed in your field, how might this impact your planning and teaching?

3. Revise

Decide what you’d like to change or address in next year’s teaching. Think about what’s manageable within the scope of your course or other responsibilities. Maybe you’ve seen some of the e-modules used in other courses and think one would fit with yours and make your teaching more effective. Maybe you’d like to enhance your existing cases to incorporate other curricular objectives assigned to your course. Maybe things are going pretty well, but you’d just like to shift things around a bit. Call me! I can help brainstorm and talk about timelines to set your plan in motion.

4. Relax

Many of us in medical education – and academia in general – have a lengthy summer to-do list that involves not only preparation for the next teaching cycle, but catching up on many other things, too. Sometimes that summer list can become overwhelming, so remember to take some time to relax and disconnect a bit from the “med ed” side of you: take some strolls along the lake, eat a popsicle or an ice cream cone. Do quintessential summer things that have nothing to do with any to-do list.

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The TRC Calls to Action require a personal response

The 94 Calls to Action from the historic Truth and Reconciliation Commission demand response and action from governments and institutions. Seven of these Calls to Action focus on Health and Healthcare issues. For those of us with the privilege to be involved in medical education, there is a particular focus on #23 and #24:

23. We call upon all levels of government to:

i. Increase the number of Aboriginal professionals working in the health-care field.

ii. Ensure the retention of Aboriginal health-care providers in Aboriginal communities.

iii. Provide cultural competency training for all healthcare professionals.

24. We call upon medical and nursing schools in Canada to require all students to take a course dealing with Aboriginal health issues, including the history and legacy of residential schools, the United Nations Declaration on the Rights of Indigenous Peoples, Treaties and Aboriginal rights, and Indigenous teachings and practices. This will require skills-based training in intercultural competency, conflict resolution, human rights, and anti-racism.

Yes, an institutional response is required and is underway and has been and will be written about here and elsewhere. (In particular, look for future Education Team posts about curricular and teaching responses). But the Calls to Action also require a personal, individual response and this is, in some ways, harder.

I’ve been wrestling with my own response. Here’s some of that…

* * *

Near the shore of Lake Ontario, Kingston. (Photo T. Suart, 2018)

The Truth and Reconciliation Commission hearings exposed events long ignored in mainstream history curricula. I prided myself on being a student of history, of recognizing the foibles of historical records – the victor writes the books – and yet I found myself saying over and over again: “How did I not know this?” How was this never a part of the quaint lessons about Indians in my Grade 3 Reader, nor in the more sophisticated history books at King’s and Dal? How is it I could be so oblivious?

At the same time, I wanted to distance myself from any responsibility for these historical wrongs. For example: I’ve been at events where people introduce themselves with descriptors, such as their clan or First Nation affiliation, or, for people like me using the term “Settler”. I’ve always bristled at this. I don’t self-identify as a “Settler.” For me, “settler” implies agency, suggests choice. What choice did I have about where I was born? Extending this further, my pre-Confederation poor Acadian and Irish ancestors in rural New Brunswick likely weren’t concerned with much beyond day-to-day survival, and I’m sure were good people, so, they’re not responsible either. Right?

But I did have a choice when I moved to Kingston in 2006: when I moved to these traditional lands of a different nation. I don’t even know the historical relationship, if any, between the Wolastqiyik (the preferred name of the people I grew up knowing as Maliseet) and the Anishinaabe and Haudenosaunee. I never even thought about it vis-à-vis my discomfort with “settler”.

During his recent three-day visit to Queen’s, sponsored by the Faculty of Health Sciences, Dr. Barry Lavallee, a member of Manitoba First Nation and Métis communities, and a family physician specializing in Indigenous health and northern practice, pointed out that we can’t accept the status quo. We must consider who supports our ignorance and for what purpose. We are also responsible to recognize what phenomena support our own positions of privilege and power. And what to do with that power.

* * *

When I picked my Twitter handle in 2010, I wanted something unique – not @Theresa487 or something like that – and, wistfully, I wanted something that reminded me of home. I opted for the “original” Indigenous name of my New Brunswick hometown (the colonial-corrupted spelling, I later learned, but home nonetheless). So I became @Welamooktook. It reminded me of the place, the land, where I had roots, and family, and history.

But those same reasons I picked it became reasons to let it go. My original feelings and sentiments were sound, but I couldn’t escape the cultural appropriation, the feeling of wrongness it came to mean, as I reflected and wrestled with it.

* * *

A year ago, as part of an Education course I was taking, my classmates and I were encouraged to go to an exhibition of Kent Monkman’s artwork at the Agnes Etherington Art Gallery, Shame and Prejudice: A Story of Resilience.

The entire installation was thought-provoking, emotional, and disturbing. One painting, in particular, haunted me: The Scream (2017). As I stood looking at this large painting depicting “the exact moment Indigenous children were taken from their parents”, I focused on three young people in the background, at the right, running away. Running away from the red-serge Mounties I had grown up looking up to. The trio running in the back are dressed in jeans and hoodies and look like teenagers I would see anywhere in Kingston.

They looked like my son.

This made it real for me. Made it close enough to touch. Close enough to imagine.

My son has a hoodie like that.

* * *

The TRC demands a response but that response is not guilt – or denial. It’s self-reflection. And compassion. And empathy. And action.

It’s relinquishing a cherished Twitter handle because it’s the right thing to do.

It’s stumbling through a territory acknowledgement because I’m still getting my Maritime tongue around Anishinaabe and Haudenosaunee when Wolastqiyik is easier. And trying to go beyond the scripted suggestion to address relationships, and thoughts about land and people.

It’s accepting the self-descriptor “descendant of settlers” because that’s accurate and real and it matters.

It’s working with my physician colleagues to ensure sound curricular and clinical experiences that, as Dr. Lavelle described, gives our students “the ability to treat the person in front of them based on their experiences without judgment.”

It’s wrestling with getting all of these meandering ideas and feelings into words to share in this blog, because we all need to be part of this conversation — all the while worrying it’s arrogant or insulting or inadequate.

In his workshop, Dr. Lavallee urged us to use reflection to address our response to new information. And he challenged us: “When you feel the discomfort, move into it, because that’s where the learning occurs.” 

We tell our students to ask questions and then listen: Patients have the information and will share it. I learned the same in my previous career as a journalist. Ask questions, but most importantly listen to the answers. Even when the answer is uncomfortable, is difficult, is challenging. That’s the personal response.

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