Welcome to the Undergraduate Blog
Engaging Diversity, Then, Now, Always.
This week, I’m reprising an article that first appeared on this blog September 8, 2014. It was part of a series of articles that were developed at the time to examine the concept of diversity in the context of medical education. The motivation was to develop a more focused approach to diversity within all aspects of our school. As will become apparent in subsequent installments, all this led to a number of changes and innovations within the school, most of which are still operational today.
Recently, as described in a recent article (https://meds.queensu.ca/ugme-blog/archives/4880), we have re-committed to engaging diversity within our school. As we do so, it’s important to emphasize the particular importance of this initiative within medical education, and to review and reassess steps previously taken.
The Educational Value of Diversity
UGME Blog: September 8, 2014
In October of 1931, a 16-year-old college student joined a group of friends for a night of carousing and entertainment at the Driskill Hotel, in Austin Texas. He had no idea what to expect of the entertainment, the focus of the evening being on the “carousing” component. Rather unexpectedly, he is deeply moved by the performance, and particularly by the featured musician. Many years later, that student writes about that experience in his memoirs:
“He played mostly with his eyes closed. Letting flow from that inner space of music things that had never existed. He was the first genius I’d ever seen.”
The “genius” he was referring to was Louis Armstrong, who was himself only 31 at the time, at the beginning of a career that would eventually identify him as one of the greatest virtuosi and innovators in the history of American music.
The young man was Charles Lund Black, who would go on to become a Professor of Law at Yale and expert in American constitutional law and contribute importantly to a number of cases involving key civil rights issues.
Professor Black would later say the following about his experience that evening:
“It is impossible to overstate the significance of a sixteen year old Southern boy’s seeing genius, for the first time, in a black. We literally never saw a black man, then, in any but a servant’s capacity…Blacks, the saying went, were ‘alright in their place’, but what was the place of such a man, and of the people from which he sprung?” http://www.nytimes.com/2001/05/08/nyregion/charles-l-black-jr-85-constitutional-law-expert-who-wrote-on-impeachment-dies.html
In Black’s eulogy, a former student would say of him, “He was my hero…He had the moral courage to go against his race, his class, his social circle.”
In Medical Education, the concept of Diversity has become entrenched in our collective vision as expressed in both the Future of Medical Education in Canada recommendations and in accreditation standards. The rationale for such initiatives has been largely perceived to be the need to ensure equity of opportunity, and a need for medical schools to respect and reflect the gender, cultural, religious influences of the societies they serve. Laudable and worthy justifications, to be sure. However, Mr. Black’s encounter with Mr. Armstrong hints at deeper, even greater benefits. Does diversity within a learning environment, or as a deliberate component of a curriculum, have educational value? Does it shape thought and attitudes? Does it make students better practitioners of whatever career they undertake? Does it make them better citizens?
These questions have had particular relevance and attention in the United States for the past several decades, where they have been the focus of legal as well as pedagogical attention. Affirmative Action initiatives and subsequent legal challenges have required both jurists and educators to engage this question critically and analytically.
In 1978, Chief Justice Lewis Powell wrote the following opinion regarding the case Regents of the University of California vs. Bakke. He argued “the atmosphere of speculation, experiment and creation – so essential to the quality of higher education – is widely believed to be promoted by a diverse student body…It is not too much to say that the nation’s future depends upon leaders trained through wide exposure to the ideas and mores of students as diverse as this Nation of many peoples.”
Chief Justice Powell’s decision, however, did not settle the issue. Challenges have continued and the wisdom of mandated diversity initiatives has been repeatedly questioned. This is largely due to the lack of a theoretical framework or evidential basis demonstrating value. Since then, considerable work has either emerged or been resurrected to provide such evidence, which is summarized in an excellent paper by Gurin and colleagues (Harvard Educational Review 2002; 72: 330).
From the theoretical perspective, the work of a number of sociologists and psychologists is particularly relevant, and fascinating to review. In attempting to describe their work, I freely admit to venturing far beyond my expertise and apologize in advance to those much more knowledgeable.
Erik Erikson, as far back at the early 1950s, postulated that late adolescence and early adulthood were critical times in the development of personal and social identity. He theorized that such identity develops most effectively when people at that stage of life are provided what he called a “psychosocial moratorium”, by which he meant a time and situation during which they could feel free to “sample” and experiment with various social roles for themselves before taking on a more fixed and permanent role, i.e., before they “committed” to a profession, personal philosophy, or relationship. Colleges and universities are critical to providing this environment for most young people, certainly in North America. But how can they promote this critical social development? In the words of Gurin and colleagues:
“Higher education is especially influential when its social milieu is different from students’ home and community background and when it is diverse and complex enough to encourage intellectual experimentation and recognition of varied future possibilities.”
In other words, the real power to influence goes far beyond lofty mission statements and curriculum, and arises largely from developing an environment where students are able to interact both passively and actively with individuals who are “different” and therefore force new thought and new perspectives during this critical developmental phase.
Sociologist Theodore Newcomb carried out a series of studies and long-term follow-ups of Bennington College students between 1943 and 1991. (Newcombe et al 1967. Persistence and change: Bennington College and its students after 25 years. New York: John Wiley and Sons), (Alwin et al 1991. Political attitudes over the life span. Madison: University of Wisconsin Press). To medical folks, this is the sociologic equivalent of the Framingham studies. He and his colleagues found that political and social attitudes were most likely to change and remain so in students who had encountered novel concepts and attitudes, largely through peer influences, while attending college, thus supporting Erikson’s theory and demonstrating long term durability of the early life experience.
In the Gurin paper, the authors draw on the work of Jean Piaget and Diane Ruble in extending the concept of disequilibrium, to the early learning experience. In Guerin’s words:
“Transitions are significant because they present new situations about which individuals know little and in which they will experience uncertainty. The early phase of transition, what Ruble calls construction, is especially important, since people have to seek information in order to make sense of the new situation. Under these conditions individuals are likely to undergo cognitive growth unless they are able to retreat to a familiar world.”
In simple terms (that even a cardiologist would understand) the greater the difference between the students prior life experience and the learning environment in which they find themselves, the greater potential for new thought, new concepts and personal growth.
The Michigan Student Survey (MSS) and Cooperative Institutional Research Program (CIRP) are longitudinal studies examining, among other things, how diverse education processes influence attitudes and career success. The MSS is a single site study involving 1,582 students. The CIRP is a national cooperative involving 11,383 students from 184 American institutions. Both involved racially and culturally diverse populations of students assessed on the basis of their pre-university and university cultural environments i.e. their “diversity experience”. For detailed description of results, I would refer the reader to Gurin et al. Harvard Educational Review 2002;72:330. The key findings relevant to those considering diversity initiatives in university programs:
- There was a positive relationship between diversity experiences and educational outcomes
- The influence of a diverse educational environment was consistent across schools and cultural groups
- “interactional” diversity was more influential than “classroom diversity”
But are these effects also relevant to medical education, where one might suppose that students are older and further along developmentally, and perhaps pre-selected for cultural diversity and preparedness?
- In 2003, Whitla and colleagues (Academic Medicine 78:460) reported on a study involving medical students at Harvard Medical School and the University of California, San Francisco. Students surveyed reported that contact with diverse peers enhanced their educational experience and supported ongoing affirmative action initiatives.
- A graduation questionnaire administered by the Association of American Medical Colleges to 20,112 graduates from 118 medical schools (Saha et al, JAMA 2008; 300: 1135), demonstrated that, for white students, attendance at a school with high proportions of peers from underrepresented minorities was associated with greater confidence in caring for minority patients and positive attitudes regarding equity issues. These associations were not found for non-white students.
- Niu and colleagues (Academic Medicine 2012; 87: 1530) surveyed 460 Harvard medical students and found that those who reported spending more than 75% of their study time with students from diverse backgrounds or having participated in diversity related extracurricular activities felt more prepared to care for diverse patients.
And so, it seems Mr. Black’s experience in 1931 was not simply an isolated event, but indicative of the potential for great things to emerge when open minds are exposed to new situations, new social constructs, new paradigms. The value of Diversity in education is about much more than a need to exhibit “fairness” and some notion of social justice, but rather an active educational intervention capable of expanding the vision, imagination and therefore potential of students.
So, what does all this psychosocial theory and American experience say to those of us engaged in medical education in Canada in 2014? We might feel, with some justified smugness, that we are not faced with the same social divides and engrained class issues as our southern neighbours. We might also take solace in the knowledge that our schools are uniformly committed to the concepts of equity, fairness and diversity in the workplace, and have rather rigorous policies in place intended to ensure the issue of structural diversity. However, we might also see this as an opportunity to enhance our approaches to medical education, where the ability to effectively engage people of diverse backgrounds and with diverse needs would seem particularly relevant. Finally, many in 2014 Canada might define Diversity as more of a socioeconomic as opposed to racial/ethnic issue, given the well-documented struggles of our First Nations and immigrant populations. With all this in mind, I pose a few perhaps unsettling questions for consideration:
- Do our students engage in medical school in the type of passive and active learning environment that theories and studies suggest could truly influences their development as physicians?
- Do our policies, which focus largely on identifying numbers and proportions of various groups in our school relative to the general population, truly promote the development of that effective learning environment, or simply attempt to demonstrate token compliance with regulations?
- Our students, raised in and drawn from a Canadian culture that promotes equity and fairness, are good and instinctively fair people, unfailingly tolerant of diverse individuals and eager to contribute, but do they develop a deep understanding of the issues of those less-advantaged, and are we, as the stewards of their education, doing all we can to develop a learning environment that will promote that understanding?
Can we do better? Can’t help but think so.
Next article will focus on initiatives that were undertaken at that time, and then update on current evolving plans.
Combining medicine & business: CEO for a day
By Andriy Katyukha, Meds 2022
“Maybe you should try Bay Street instead of medical school?” My interviewer’s acerbic tone gave the impression I was not the candidate they were hoping to admit when assessing medical applicants. Fortunately, I was admitted, and as a result of my experiences I am committed to dismantling entrenched attitudes in medicine that stifle progress and positive change.
As I continue through my career, I remain steadfast in my conviction that functioning at the intersection of medicine, business, and policy is crucial to help move the healthcare system forward. As some of my sagacious mentors have pointed out, multi-disciplinary skill building, outside the traditional framework of what is deemed relevant for the practice of medicine, unfortunately is sometimes discouraged. Is it a lack of exposure to other skillsets or is it a profound fear that someone equipped with unique skills may threaten your position? Regardless of the reasoning behind this antiquated view, it falls on you to be introspective, decide what opportunities you will pursue, seek out mentors who inspire you, and work fervently to bring about the change you want to see in your field of work.
For me, this means seeking out opportunities that bolster my interest in strategy, governance, and health leadership, and that is how I found myself participating in the CEOx1Day program. Though I was apprehensive about applying to a competitive program geared towards future leaders in business, I submitted an application anyway. To my pleasant surprise, I was selected by Odgers Berndtson to work with Alex Munter, the President and CEO of the Children’s Hospital of Eastern Ontario (CHEO).
My day started with what now seems like a very prescient discussion with senior medical leaders and Alex—COVID19 preparedness. From there, we departed to meet the rest of the executive team for their weekly Tuesday meeting. While the discussions were incredibly insightful, I am certain that the team would be surprised to hear what resonated with me the most: amidst the business of the day, they all stopped to recognize individual employees, of all seniority levels and positions, who made a meaningful contribution to the organization. This was their ‘kudos’ time, and I got the impression that employee recognition and appreciation is not a concept that is flippantly tossed into quarterly reports, but is the underpinning of the culture at CHEO. This is where I learned my first lesson: when it comes to transformational leadership, senior leaders who focus on results, and shift the emphasis from personal credit to team recognition, make the biggest impact.
Alex and I then connected with the CEOs of the Hospital for Sick Children and Holland Bloorview Rehabilitation Centre to discuss their partnership through the Kids Health Alliance, a network that aims to bolster patient and family-centered care in pediatric populations. We then proceeded to Alex’s CEO Information Session where he updated staff members about various projects and organizational achievements. It also served as a platform to once again recognize employees who made a difference at CHEO, and further encourage employees to use their personal insights to make improvements in their respective departments. In my professional life, I have yet to see such an emphasis being placed on promoting grassroots initiatives to fuel an organization’s success and progress. Through this, I learned my second lesson in leadership—empathy. A heightened ability to listen and validate employee experiences not only creates a positive work environment, but also empowers employees to use their experiences to change things for the better, strengthening the company in the process.
My day at CHEO finished off with Dr. Jean-Philippe Vaccani, a brilliant physician leader who serves as the Deputy Chief of Staff at CHEO. After a candid discussion about our careers, goals, and health leadership, I was struck by his encouragement and eagerness to promote discussions that underscore the importance of multi-disciplinary thinking in medicine. Professional mentorship is one of the best ways to give back to others, and just as I have benefited from kind and encouraging mentors, I also hope to make mentorship a priority in my own career.
I urge non-traditional majors and STEM students to embrace opportunities like CEOx1Day to not only learn from incredible leaders, but to also share their own invaluable insights to broaden leaders’ perspectives. Even if you do not see yourself represented in a field, seek out opportunities that allow you to be the catalyst for change.
Later that evening I had the privilege of joining Alex and his partner for dinner, where I not only got to meet his adorable son, but also Lola, the family dog and self-proclaimed “Queen of the House”. It was the perfect setting to further discuss our thoughts on a variety of topics and get to know each other a little better. Through our discussions about the healthcare system, advocacy, policy, and representation, I got an incredible sense that Alex’s successes are rooted in a deep sense of service. While he serves as CEO, to me he serves as a role model who has broken barriers for LGBTQ2S+ individuals, has worked to shatter the ‘glass closet’ that often exists in corporate leadership, and has instilled in me a deep passion to work tirelessly as an advocate and leader in healthcare. This leads me to my final lesson about leadership—service. Rooting your work in service, be it serving people directly or serving a mission that fuels your passion, lays the foundation for the most meaningful impact you can achieve as a leader.
CHEO is an absolutely incredible organization to work for and I applaud the efforts of Alex Munter, the senior leadership team, and most importantly the committed and passionate employees who work day-in and day-out to bolster pediatric care in Ontario. I would like to thank Kristen, Michael, Eric, and the entire team in the Odgers Berndtson Ottawa office for affording me this invaluable opportunity!
For more information about the Odgers Berndtson CEOx1Day program, check out their program site here: https://www.odgersberndtson.com/en-ca/ceox1day/about-the-program
A version of this post was previously published here: https://www.odgersberndtson.com/en-ca/ceox1day/news-media/bay-street-or-medical-school-a-glimpse-inside-a-ceox1day-at-cheo
Planning your teaching in uncertain times
Summer is upon us and, with it, planning for fall semester teaching. There’s a lot of uncertainty in the world these days vis-à-vis the COVID-19 pandemic – which has contributed to some uncertainty in planning for curricular delivery. At the School of Medicine, we have permission to run some learning activities face-to-face (such as clinical skills) with new restrictions in place to maintain social-distancing, but our traditional classroom-based teaching will be impacted as well.
The Education Team is here to support Course Directors and all teaching faculty as we face these new challenges. While we don’t have all the answers yet about room assignments and scheduling, there are still many things we can do right now to help with your planning and preparation for both your synchronous (all students learning at an appointed time, either in a classroom or via Zoom) or asynchronous teaching (students provided with learning materials that need to be completed by a certain deadline, but otherwise, they can learn on their own schedule and own pace). If we don’t have solutions to your queries, we’ll help find them.
Things we can help you with now:
- Discovering options for asynchronous teaching
Course Directors have been asked to consider different avenues for asynchronous learning. While this already exists in many courses in the form of Directed Independent Learning electronic modules, there are other options, too. If you would like to increase the amount of asynchronous learning in your course – or just explore possibilities – we can help with this.
- Learning techniques for interactive teaching via Zoom
We learned a lot from our two-and-a-half months of remote teaching using Zoom from March – May. If you’re concerned about how to keep your teaching engaging and interactive while “talking to a box”, we can help with this – and provide some practice opportunities, too, so it’s not so intimidating. Tools you may already be using in the classroom, such as videos and polling, are easily leveraged on the Zoom platform.
- Exploring approaches to assessment
Your current assessment plan may be just fine, but there may be things you’d like to tweak given the logistics of remote delivery. We’ve sorted out quizzes, graded team assignments (GTAs), and proctored exams already, so we can address these and any other concerns you have and make any appropriate modifications.
- Guiding you to resources
We can point you towards Faculty of Health Sciences and campus-wide faculty development opportunities and services that are available and talk about which approaches already fit with the UG program, and navigate through other possibilities.
- Brainstorming and problem solving
While the landscape may have changed with the COVID-19 pandemic, our goals as your Education Team remain the same: we’re here to help you prepare for, deliver, and improve your teaching and assessment.
Please get in touch:
Theresa Suart email@example.com
Eleni Katsoulas firstname.lastname@example.org
Rachel Bauder email@example.com
Zooming our way through pandemic remote teaching
On March 23 – coincidentally immediately after our students’ March Break – Queen’s UGME moved its classroom-based teaching to all remote learning to comply with social-distancing measures put in place as a result of the COVID-19 pandemic..
This also coincided with the majority of faculty, and administrative and support staff moving to working from home, except for those deemed essential to university operations.
By the end of May, we’d conducted close to 250 learning events via Zoom that would have ordinarily been taught in our classrooms by dozens of faculty members. The Meds Video Conferencing (MedsVC) team, led by Peter MacNeil were instrumental in making this possible, providing technical support for every learning event.
Lectures were recorded to accommodate students who found themselves in different time zones (many having travelled home for March Break and subsequently stayed there rather than engage in unnecessary travel) and those with family responsibilities, for example.
Instructors faced the same challenges most have read about regarding online conferencing. As Dr. Jenna Healey, Chair in the History of Medicine, describes: “Technical issues, navigating the software, making sure there were no interruptions on my end—like my very loud cat meowing!”
Faculty sought creative solutions to previously-scheduled in-class sessions. For example, in MEDS 246 Psychiatry, there were two expanded clinical skills sessions scheduled which each included a Standardized Patient actor (SP) to help demonstrate aspects of psychiatric interviews. Course Director Dr. Nishardi Wijeratne led both sessions – the first before the switch to remote delivery and the second one via Zoom. Each session was 50 minutes.
“Having taught both at the SOM and fully zoom, I did not find a significant difference between the two as a teacher,” Dr. Wijeratne says. “Given that my clinical practice as psychiatrist has moved to mostly virtual care right now, the Zoom version actually felt closer to my daily clinical practice right now.”
She noted three aspects that helped greatly with the session:
- MedVC staff to help with tech issues
- Connecting with the SP about 10 minutes before the session to discuss goals and structure
- Assigning tasks to the students ahead of the session to maintain engagement thoughout the 50-minute classes. Students observed the psychiatric interviews and documented mental status, identified risk factors, and considered possible differential diagnoses.
In addition to his own teaching, MEDS122 Pediatrics Course Director Peter MacPherson pitched in with a solution to a Clinical Skills session – about half the class missed their opportunity to complete a toddler observation session because of the pandemic restrictions.
“Usually, the medical students get down on the floor and play with a toddler while they infer the child’s real age based on their developmental achievements,” he explains. “We were able to cover the same curricular objectives remotely. The students were able to observe and interact with my toddler via Zoom in his ‘natural environment’ (aka our playroom) and do a similar assessment.
“It was a lot of fun to teach while playing dress up with my child!”
One part of the classroom experience that’s more challenging to achieve remotely is direct interaction with students as a class. “In particular, it is rather difficult to judge the level of understanding of the class,” MEDS245 Neurosciences Course Director Stuart Reid notes. “It cannot provide the personal contact that comes with in real life interaction.”
“On the other hand, it has been an invigorating challenge. We introduced more online learning modules and sought creative approaches to making distance learning both active and interactive,” he adds. One such creative approach was a “Jeopardy” style game in place of a hands-on expanded clinical skills session. It didn’t replicate the face-to-face session, but it actively engaged students in the session.
Dr. Healey echoes Dr. Reid’s comments about missing that face-to-face factor. “I very much miss interacting with my students in class. As an instructor, what I have found most challenging is not being able to see student’s faces. I didn’t realize how much I relied on non-verbal communication to adjust my pacing or gauge the level of student’s interest or understanding.”
Dr. Healey started encouraging students to use the Zoom “raise hand” function more often in her classes. “I want students to feel comfortable interrupting me if they have questions or comments.”
Dr. Reid speaks for all of us at UG when he notes that the students were a key factor in the success of our remote curriculum delivery: “They have been patient, accommodating, and enthusiastic enablers of our altered circumstances. Many thanks to them!”
At the end of the semester, the Education Team conducted several focus groups with Year 1 and Year 2 students to get additional feedback on what worked well, what didn’t, and suggestions for improving this type of remote learning. This, combined with the course evaluations (which included additional questions about the new required remote learning activities) will be used to inform teaching decisions in the coming academic year, as the COVID-19 pandemic situation continues to evolve.
The Legacy of George Floyd – What will it be?
We watch, horrified, recordings of the last few seconds of George Floyd’s life. We hear his last words– “I can’t breathe”. The symbolism of the white, uniformed figure whose knee is at this neck, unresponsive to his pleas, could not be more stark. For many, George Floyd is the most recent, most poignant example of a history of racial subjugation, mistreatment and killing that spans the past four centuries. For many, it’s a sad reminder that similar crimes and protests of five decades ago were not the final expression of that discontent. For us all, it forces a confrontation with the reality that the dream of Martin Luther King “that my four little children will one day live in a nation where they will not be judged by the color of their skin but by the content of their character” has, sadly, not yet been realized.
Locally, we have been challenged by these events to consider what, if any, implications they have for each of us personally, and for our school. Many faculty and students have expressed very clearly their concerns, their discontent and have called for change. In the interest of exploring this further, I met recently with our student leadership and medical students. Those discussions were candid, sincere and highly illuminating. They expressed realities about the experience of Black medical students at Queen’s with clarity and openness. The tragic killing of George Floyd, it seems, has opened a discourse and raised to the surface issues and concerns that are not new, but not previously expressed as bluntly. It has also, it must be said, caused all of us to listen with greater sensitivity.
Out of those discussions, a number of themes and practical measures are being developed and advanced. I have since had opportunity discuss these with our current Dean Dr. Reznick and our incoming Dean Dr. Philpott who are both very supportive.
- All medical schools have a responsibility for social accountability. The exact nature of the commitment, expressed in a Diversity Statement, is school specific and should reflect the regions served and values of the particular school. That statement should drive a variety of school activities, including curriculum, recruitment and admissions. In the light of recent events, it seems appropriate to re-assess our Diversity statement. Our Diversity and Equity Committee, chaired by Dr. Mala Joneja, will be charged to draft a renewed statement to be considered by our faculty council
- Our curriculum should prepare our students to provide comprehensive care to patients of all ethnic and racial backgrounds. This should be reflected in both the content and delivery of the curriculum. Our Curriculum Committee will be charged with re-assessing both aspects through the lens of the Black population. It will also be asked to ensure that opportunities exist for open and constructive dialogue between students for discussion of difficult and contentious topics.
- The Black population of Canada is under-represented in our medical school. This is despite the fact that our admissions processes are scrupulously unbiased with respect to racial considerations. In fact, I realized as we discussed this issue recently that it was impossible to even determine the racial make-up of our incoming class, simply because this information is in no way documented or considered. The under-representation of Black people is almost certainly a complex and multi-factorial issue. Our Admissions Committee will be tasked with giving consideration to what factors may be active and to consider how they might be addressed.
- Very concerningly, and despite numerous (and I believe very sincere) efforts to address this over the past few years, our students report a lingering perception within the Black applicant community that Queen’s is an unwelcoming environment. This no doubt contributes to the under-representation issue and merits deep consideration at all levels.
- It seems clear that the promotion of mentorship opportunities for our Black students and applicants would be of benefit and should be pursued actively, both within our schools, and through effective collaborations outside our school.
None of this will occur if efforts are restricted only to a vocal minority who have themselves been the subject of racism in their lives and therefore need no convincing of its existence. It is rather for those of us in the “silent majority” of society who abhor racism but have not been its direct victims to take stock. We need to listen and, in those ways that are available to us, act.
Many will question why a murder in Minneapolis, tragic as it is, should influence the discourse and decisions at our small, somewhat secluded and seemingly tranquil medical school in Kingston, Ontario. I will admit to initially sharing that skepticism. I have come, through reflection on my own experiences with racism and through discussion with our students, to a different perspective. I would now say to those people who question these directions that no community in the western world can consider itself immune or unaffected by racism. I would say that injustice of any form diminishes and affects us all. I would say that we bear a collective obligation to the memory of George Floyd, to all the George Floyds of the past and to every person today afraid to jog alone through a park or be pulled over for a minor traffic violation. We owe it to them to take whatever action is in our power to take. We act for them but, in the end, we are acting for us all and for those who will follow.
The Event Was Virtual. The Graduation Was Real!
In its 166 year history, the Queen’s School of Medicine has no doubt hosted many memorable events to mark the achievement of graduating students. None, I’m sure we can assume, compared to last week’s celebration.
For the past few months, a small committee let by Drs. Renee Fitzpatrick and Andrea Winthrop has been meeting and struggling to develop some appropriate way to recognize the graduation of our Meds 2020 class, given the limitations imposed by the pandemic. The result was a “virtual” event made possible by Zoom technology, our dedicated MedVC team and coordinated by Jacqueline Findlay, UG Program Manager.
Our virtual graduation celebration was “attended” by 300 sites that signed in, as well as an unknown number live streaming the event. Attendees were located in cities all across Canada, as well as several in the US and Europe.
It featured an opening welcome to families and supporters of our graduates, followed by individual recognitions of each graduate. Dean Richard Reznick paid tribute to the class, challenging them to make a difference. Dr. Susan Moffatt was selected by the students to provide remarks on behalf of faculty. Drs. Heather Murray, Erin Beattie and Brigid Nee were selected by the graduates to receive the prestigious Connell awards for outstanding lecturing, mentorship and clinical teaching. Dr. Akshay Rajaram was selected by the students to receive the award for outstanding teaching by a resident.
Dr. Cale Templeton and Julia Milden were selected by their classmates as Permanent Class President and Class Valedictorian.
In her address, Dr. Milden spoke of the gratitude of her classmates for family, friends and teachers. She acknowledged admiration for her classmates and the bonds of friendship that had developed during medical school and would persist through their careers.
“I am struck today reflecting on what exactly it means to be called a doctor, the thrill and duty of carrying this new title and the letters MD. This particular moment in time seems to make incredibly clear the power and responsibility of this role. On the wards or on television, writing orders or writing policy, doctors of all kinds are illuminating the challenges of their patients and of the system, and working together to help shape what we do as a whole world to take care of one another.
So what gives us this influence?
I think it’s the message we send when we say ‘I’m a doctor’ – to whomever we’re meeting, it means: I’m listening, I respect your wishes and your opinions, I know how to learn and am motivated to investigate your problem, and I will do everything in my power to help you.
And most remarkably, the skills and qualities this social trust is based on are ones that we have right now: our willingness to listen, and our ability to care.”
Certainly, we must acknowledge that the event was decidedly not what anyone envisioned when Meds 2020 began medical school one September morning over four years ago. Nonetheless, it was every bit as real as the degrees earned by our graduates and received by them last week. It occurred because of a very real refusal to allow any mere pandemic to diminish the significance of what these young people have accomplished, nor overcome our desire to express our pride and extend our good wishes.
To them, our admiration and congratulations…really.
Balancing Social Responsibility and Personal Rights in a Time of Crisis
Reading the New York Times these days can be a rather jarring emotional experience. It is replete with stories of people and families devastated by the COVID crisis. Excruciatingly detailed and poignant accounts of people dying in their homes or hospitals, isolated from surroundings and those who have been significant to them. Married couples dying within hours of each other leaving shattered families behind, all deprived of the end of life processes that would normally help with the grieving process and achievement of some emotional closure. Hospital workers struggling to provide some modicum of solace and dignity before having to move along to the next patient.
Turn the page, and you read accounts of protests by those decrying the restrictions that have been imposed by their governments, claiming their rights to choose to assemble and assume personal risk.
These stories are not limited to New York or even the United States. They come from Italy, Britain, Mexico, South America, the Far East. It seems no place is spared, although the impact and time course varies considerably.
In our own characteristically muted fashion, the same dramas are playing out in Canada. Political leaders, hearing loud and clear from all constituencies and all perspectives, struggle to strike a balanced and responsible approach.
All this serves to highlight two great realities of this pandemic. Firstly, it is affecting virtually every human being on the planet. The sheer scope is mind boggling and it’s difficult to think of any prior catastrophe that even comes close. The second reality is that its very nature is such that it renders each of us both a target and a mechanism for spread. We are simultaneously potential victims and potential perpetrators. We are all therefore forced to make choices, and those choices are expressed not through words so much as through our actions.
For the vast majority, the choice is clear. Simply remaining secluded and abiding by social isolation directions from authorities is not only in their personal best interest, but also their means of contributing to the public good. It can be inconvenient, unsettling and, depending on personal and family circumstances, very demanding. It also requires a degree of trust and faith that decisions are being made with best information and with the best of intentions. It requires political leadership that evokes that trust. But most importantly, it requires a willingness to endure some degree of personal hardship for a perceived greater good.
For those who provide essential services, the choice is very different. For those people, the greater good is to continue their duties while exercising appropriate precautions. The willingness of health workers and the many essential service providers who allow our society to continue to function in these very challenging times is a testimony not only to their dedication and courage, but to their belief that they have a role in contributing to the welfare of others. They are nothing short of heroic.
All of us are affected. All of us are making sacrifices that require us to balance our personal interests with our obligations to those around us. Our fundamental values, both individually and collectively, are being exposed. The ideological and moral differences between individuals, communities and even countries are being laid bare in the face of this crisis. The early results are largely positive and even inspiring. But the real test is yet to come. As the acute crisis abates to some extent, and it becomes clear that a complete return to “normal” is a long way off, how will we engage this “new normal”? Our leaders and governments are making decisions that require them to determine the very nature of what constitutes “common good”. What seems clear is that what will determine success is not our ability to protect our personal interests, but the extent to which we are willing to sacrifice those personal interests for that common good.
CanMEDS roles in action during COVID-19
By Dr. Gray Moonen
Welcome to the Medical Residency Twilight Zone: There are no medical students. Academic half-days are virtual. Research projects are delayed indefinitely. Your oral presentation at the conference is cancelled. The entire conference is cancelled. Oh, that’s because flights are also cancelled. Licensing examinations are delayed. Clinics are cancelled. Where did all the patients go? You can hear a pin drop in the emergency department.
My hands are raw. No, I am not moisturizing them during the day and, yes, they are showing cracks. I am turning reptilian. These masks make me so hot, I can barely breathe. My glasses are constantly foggy. Oh hey, I didn’t recognize you with the mask on. Leaving the hospital and coming home are newly ritualized. Wash hands (arms, neck?), then take off scrubs, then take off shoes, wash hands again, put street clothing on… wait did I miss a step? Did I contaminate myself? Will I contaminate my home? Get my wife sick? I don’t know. I have internal monologues about how often to sanitize my equipment. Is my cell phone going to survive all this virox? It is the least of my worries right now, but it would really suck if I broke it.
I end every email with “stay safe”.
I’ve been reading about how to stay resilient and accept the inevitable stress. The evidence is sound, but it seems distant. “Focus on the things you can control”…that’s part of the day-to-day challenge as a resident. We often lack the clinical knowledge, experience, and confidence to control our clinical encounters. We require evaluations; all our work and research projects are supervised and graded in some capacity. We require licensing exams to proceed to be independent practitioners. These are the many things out of our control that all draw on our attention and make a crisis like the COVID-19 pandemic even more anxiety provoking. Not to mention our most pressing concern – for the deluge of illness and suffering this will cause patients.
And yet…. what a privilege it is to be a resident.
We are guided by a seven-pillar competency-based framework: “CanMEDS” or “CanMEDS – Family Medicine”. Although it may seem like everything is up in the air, I think there are equal, if not greater opportunities to develop our competencies during this crisis compared to usual times. Instead of going through the motions of learning objectives, checking off an Entrusted Professional Activity, receiving an In-Training Evaluation Report, instead we are actively motivated to do the things that need doing, because it simply needs to be done. Doing it well and thoughtfully, because it matters. A lot.
I have seen residents and staff physicians working side by side, tirelessly advocating for change at the individual, community and broader societal level. Grassroots campaigns are successfully encouraging people to stay home, and wash their hands; we’re advocating for PPE procurement. The trust, respect and unity being displayed across healthcare workers has enabled genuine collaborative efforts; “we are truly all in this together”. Residents are also liaising with public health, government agencies and the public to find innovative solutions, not to apply for a grant or win an award. It’s because this needs to be done.
I’ve noticed many residents become leaders and lean in to their voices, providing calm, measured and sound advice to their patients, peer groups, junior learners, family and friends, organizing systems to let patients know where to reach out to for help if they feel ill. Residents are stepping up and covering call shifts for ill or quarantined colleagues, offering to work COVID19 clinics or be redeployed to other services.
As developing professionals, we are sacrificing time, energy and our health in this evolving pandemic. Managing the competing demands of training such as patient care, evaluations, research and the stress of having academic requirements delayed or cancelled is unique, but I have observed grace inspired action rather than a compromise in integrity or overt displays of frustration.
As scholars we are staying informed on the emerging evidence and synthesizing this information for patients, peers and the broader public. As medical experts, we are not only maintaining many of our skills within our developing scope of practice, but actually expanding our skillset as we prepare to participate in more critical care, triaging, counselling and telemedicine.
Uncertainty and anxiety are undeniable. We are concerned we will not reach our training milestones or develop the competencies to practice independently. Yet, despite these dark times, I believe there are silver linings. We will all become better physicians and community members as a result of this crisis, and Canadians will benefit in the long term.
Gray Moonen, PGY1 in Family Medicine at the University of Toronto, graduated from Queen’s School of Medicine in 2019. He is also a past-president of the Aesculapian Society.
This column originally appeared on the CMAJ blog and is used here with Dr. Moonen’s permission.
It’s science, not speculation, that will get us through this.
Why do COVID patients experience such profound hypoxia without feeling dyspneic?
Why is there such heterogeneity in clinical severity among young, previously healthy patients?
Are asymptomatic people able to carry and transmit the virus, and for how long?
Does immunity develop after infection, and how long does it persist?
Does antibody status indicate complete protection from re-infection?
Do currently available anti-viral agents have effect?
Will previous approaches to vaccine development be effective?
These are some of key questions still under investigation as we now pass 6 months since this infection originally came to attention. The answers to these questions are the keys to resolving the greatest heath and economic catastrophe the world has faced. The answers will not be provided by scientists or politicians working in isolation, but rather by the application of scientific approaches, supported by political and economic action.
This past week, we’ve seen examples of how this can work well, and how a lack of synergy will impede progress.
In Canada, our government has announced a billion dollar investment in COVID-19 medical research, and support for a Task Force to determine the extent of the disease.
- Trudeau announces $1.1-billion for COVID-19 research (https://www.theglobeandmail.com/politics/article-trudeau-announces-11-billion-for-covid-19-research/)
- Government of Canada funds 49 additional COVID-19 research projects (https://www.canada.ca/en/institutes-health-research/news/2020/03/government-of-canada-funds-49-additional-covid-19-research-projects.html)
- Ottawa to fund existing coronavirus research projects (https://www.theglobeandmail.com/politics/article-ottawa-to-fund-existing-coronavirus-research-projects/)
In Germany, a nation-wide public health investigation has begun to carry out widespread serologic testing intended to define the true extent of disease and implications of prior infection.
- With Broad, Random Tests for Antibodies, Germany Seeks Path Out of Lockdown (https://www.nytimes.com/2020/04/18/world/europe/with-broad-random-tests-for-antibodies-germany-seeks-path-out-of-lockdown.html?ref=oembed)
- Blood tests show 14% of people are now immune to covid-19 in one town in Germany (https://www.technologyreview.com/2020/04/09/999015/blood-tests-show-15-of-people-are-now-immune-to-covid-19-in-one-town-in-germany/)
In the United Kingdom, vaccine development is well underway with massive investments already in place.
- UK boost support for CEPI to spur COVID-19 vaccine development (https://cepi.net/news_cepi/uk-boosts-support-for-cepi-to-spur-covid-19-vaccine-development/)
All these have come about through effective collaborations between government, funding agencies and scientific and medical communities. We’ve also seen examples of what can transpire when those collaborations are not effective. We’ve seen that, even if well intentioned, speculative assertions by a political leader can be assumed by the public to be scientifically informed and thereby lead to dangerous actions.
- U.S. President and top doctor spar over unproven drug (https://www.theglobeandmail.com/world/article-trump-vs-fauci-us-president-and-top-doctor-spar-over-unproven-drug/)
- Nigerians poisoned after taking doses of drug praised by Trump (https://www.theglobeandmail.com/world/article-at-least-two-cases-of-chloroquine-poisoning-in-nigeria-after-trump/)
- Trump’s COVID-19 disinfectant ideas horrify health experts (https://www.reuters.com/article/health-coronavirus-trump-disinfectant-idUSKCN2261OL)
- Lysol maker warns against internal use of disinfectants after Trump comments (https://www.nbcnews.com/politics/donald-trump/lysol-manufacturer-warns-against-internal-use-after-trump-comments-n1191586)
There has been much debate in recent years within the medical education community regarding the relevance of research and critical appraisal in undergraduate medical education. These topics have been gradually and rather insidiously receiving decreased attention in favour of the many other competencies and “hot items” that have been emerging, all with justification. I would suggest that recent events have resolved that debate. The questions posed at the beginning of this article were not posed exclusively by basic scientists and epidemiologists, but also by clinicians trained to accurately observe patient responses, critically assess current understanding and pose valid, useful hypotheses for testing. Clinicians will also be very much involved in developing protocols and executing investigations to find answers. Medical schools have a responsibility to ensure that fundamental training continues to be a core component of their programs, now more than ever.
“Meducators” aim to help healthcare and other essential workers’ children with 1:1 online tutoring
Editor’s Note: Medical students (and many other Queen’s Faculty of Health Sciences students) are volunteering their time during the COVID-19 pandemic in a number of different capacities. This is in addition to continuing with course work responsibilities, as much of the UGME curriculum is now being delivered online. This post highlights one of these student-led volunteer initiatives.
By Angie Salomon and Kiera Liblik (Meds 2023)
To hardworking healthcare professionals, and all others providing essential services to our community during COVID-19: WE WANT TO HELP!
Queen’s “Meducators” are a group of Health Sciences students at Queen’s University who want to support the educational success of students of healthcare (and other essential) workers in our community through a free, one-on-one tutor program via on-line video conferencing. Our tutors can provide informal tutoring services for children of all ages and grades (K-12) across core subjects (math, science, English, French). The service may range from simply supporting the student virtually while they complete their homework, to creating full-on lesson plans to aid their learning. If this is of interest to you or your family, please submit a request using the following link: https://forms.gle/k3mdo6cLYZtULmYF6
If you are a Health Sciences student (Medicine, Nursing or Rehabilitation Therapy) who would like to volunteer as a tutor, please sign up here: https://forms.gle/Ly8d2xmXax47iGDM7
If you have any questions, please don’t hesitate to contact Angie Salomon (firstname.lastname@example.org) or Kiera Liblik (email@example.com).