Residency Match Day 2019: What our students are experiencing, and how to help them get through it

If life were a roller coaster, our fourth year students have, for the past few months, been on quite a wild ride, slowly rumbling upward, gradually ascending to the summit, stopping for a moment as they stare downward to a distant, small landing point, readying themselves for a rapid and rather scary descent.

The process by which learners transition from undergraduate to postgraduate medical education has evolved into a rather jarring and extremely stressful experience (don’t get me started – a subject for another blog/rant). It has required them to not simply consider what specialties are best suited to their interests and skills, but engage an application process that requires strategic selection of elective experiences, preparation of voluminous documents, meeting multiple deadlines (twelve, no less), and commitment of personal time and expense to travel and interviewing which, for many, spans the country in the midst of the Canadian winter.

This year, the roller coaster reaches its summit at 12:00 noon on February 26th. The much anticipated Residency “Match Day” is when all fourth year medical students in Canada learn which postgraduate program they will be entering. By approximately 12:00:05 that day, all students will know their fate.  As you can imagine, there will be much anticipation and anxiety leading up to the release.  For most (hopefully all), the roller coaster ride will end with the exhilaration and satisfaction of having successfully overcome the process. For a few (and hopefully none), it will bring a realization that their efforts to date have not been successful, that their ride is not yet over, and they have to begin again. They will be profoundly disappointed, they will be afraid, they will be confused. They will need the understanding and help of the faculty who are currently supervising their training, and much help from our Student Affairs staff.    

This year, we are again prepared to provide all necessary supports, but there are a few changes to the process which I’d like to clarify for both students and the faculty that will be supervising them that day:

  • Unlike previous years, our Undergraduate Office will not automatically receive match results the day before the full release. However, students have the option of directing CaRMS to release their results the day before (February 25th) if they fail to match. They can do so by going into the CaRMS website and providing the appropriate permission.
  • Any unmatched students who have allowed early release will be contacted directly by myself to notify them of the result. This is for three purposes:
    • to arrange for immediate release from clinical duties
    • to allow the student some time to prepare for the release moment the following day when most of their classmates will be hearing positive results
    • to arrange for the student to meet our student counselors who will provide personal support and begin the process for re-application through the second iteration of the residency match. 
  • Unmatched students who did not opt to provide early release will similarly be contacted and offered the same support and services after we get their results on match day.
  • Because we may not have full information in advance, we have decided to release all students from clinical obligations beginning noon on match day, until the following morning.

I’d also like to remind all faculty supervising our fourth year students on or around match day to anticipate that your student will be distracted. Please ensure your student is able to review the results at noon. If you sense he or she is disappointed with the result, please be advised that the student counselors and myself are standing by that day to help any student deal with the situation and provide support.

Fortunately, we have an outstanding Student Affairs team which has been working hard to guide the students through the career exploration and match process, and will be standing by to provide support for match day and beyond.


Dr. Renee Fitzpatrick Assistant Dean, Student Affairs rf6@queensu.ca

Dr. Erin Beattie, Careers Counselor, ebeattie@queensu.ca
Dr. Josh Lakoff Career Counselor, jml7@queensu.ca
Dr. Mike McMullen, Careers Counselor, Michael.mcmullen@kingstonhsc.ca
Erin Meyer, Assistant to Directors, Student Affairs
Lynne Ozanne, Assistant to Directors, Student Affairs

The team can be accessed through our Student Affairs office learnerwellness@queensu.ca, or 613-533-6000 x78451. 

Thanks for your consideration, and please feel free to get in touch with myself or any of the Student Affairs Team if you have questions or concerns about Match Day or beyond.

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Scholars at Risk speaker

By Danielle Weber-Adrian (Meds 2021)

It’s easy to start medical school with a fixed idea of what it means to be a physician. For many, we visualize the patient-physician interaction as a series of investigations, treatments and confidences on the individual’s journey towards health. Although there is truth in this, the reality is that medicine represents so much more within the greater community. Being a physician, as many come to realize during medical school, means becoming an ally to those who are marginalized, and an advocate for the change we wish to see in our global and local macrocosm. So, it seems fitting that the Queen’s Medicine Class of 2021 project as of last year has been to promote the Scholars at Risk program at Queen’s with the help of the International Office.

Dr. Evren Altinkas

Scholars at Risk is an organization which provides assistance to over 300 vulnerable scholars per year. These include physicians, journalists, lawyers and professors who have been targeted and threatened by their national governments because of their advocacy work or research. The scholars are matched with universities around the world where they receive temporary teaching and research positions. This provides the scholar with sanctuary and immediate stability, while benefiting the host institution by granting access to a world leader in their field. By joining the Scholars at Risk consortium Queen’s University is prioritizing academic freedom and human rights on a global scale.

As a new member of the Scholars at Risk organization, Queen’s University and the School of Medicine is hosting our first guest lectureship by Dr. Evren Altinkas. Dr. Altinkas is a Turkish historian and scholar at risk who is currently working at the University of Guelph. He studies the historical limitations of academic freedom as experienced by minorities in Europe and the Middle East. His lecture is open to the public and will take place on Friday, February 1st at 12:30 to 1:30 in the upper auditorium (room 132A) of the New Medical Building (15 Arch Street, Kingston, ON). Attendees are invited to join him later that evening for dinner and conversation. The dinner will be hosted at a local restaurant in Kingston; however, guests will be asked to cover the cost of their own meals.  To sign up please see the following form: https://goo.gl/forms/vdkzjy3AHCyCQK252

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Indigenous Health Care focus of February FHS events with Dr. Barry Lavallee

 

Dear Colleagues,

My name is Terry Soleas, I’m an Education Consultant with the Office of Professional Development and a PhD Candidate in Education. I have the privilege to work in your Faculty of Health Sciences.

In a collaboration between the Indigenous Health Education Working Group, Faculty of Health Sciences Decanal Leadership, and the Office of Professional Development and Educational Scholarship, we are pleased to present three days of extraordinary reconciliation in healthcare events. Our keynote speaker at all three events is Dr. Barry Lavallee of the University of Manitoba who is our guest for the three action-packed days on campus. Dr. Lavallee has proven to be a dynamite speaker who speaks plainly, practically, and passionately on issues of social justice in medicine, with a particular focus on rural and northern indigenous communities.

The three interactive events are:

1) Public Reception and Lecture

2) Faculty Development Half-Day

3) Education Round

These are remarkable and free events that go a long way in Queen’s ongoing Reconciliation efforts. I hope you will join us at many of these events and help us make our future at Queen’s and beyond better, kinder, and brighter!

I’d be delighted to answer any questions you might have😊

With grateful thanks,

Eleftherios K. Soleas, OCT
Educational Consultant
Professional Development & Educational Scholarship
Faculty of Health Sciences, Queen’s University
613-533-6000 x 79035

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A Brief History of Walls

Are walls effective? As we’re all aware, this seemingly innocent question has become a focus of considerable controversy for our neighbours to the south. Of course, it’s not about the sort of walls that separate rooms of your house, or the barriers around your property that deter trespassers and prevent your dog from molesting your neighbour’s flower bed. Rather it’s about massive barricades erected by political leaders to prevent or control the movement of large populations of people at borders. As it happens, there’s a rather interesting and intriguing history of such structures, both real and mythical.

 

Hadrian’s Wall

Publius Aelius Hadrianus Augustus (76-132 AD) ruled when the Roman Empire was at its peak and is considered by many historians to be one of the “good emperors”. He seemed less interested in further expansion than in consolidation and security of his already vast empire. As part of that approach, he commissioned the building of a wall to define and secure the northernmost extent of the empire. Construction of Hadrian’s Wall began in AD 122. The wall is composed mostly of stone and is about 10 feet wide and up to 10 to 20 feet in height. The wall connects a series of fortifications located every 5 (Roman) miles. It runs about 73 miles, from the banks of the River Tyne near the North Sea in the east, to the Solway Firth on the Irish Sea to the west. It required a garrison of about 1,500 men and was intended to prevent the “barbarians” (ancient Britons and Picts) from troubling Roman Britain.

Hadrian’s successor, Antoninus Pius, seemed to like the concept but felt the boundary should be expanded and so, in 138 AD constructed a second wall about 100 miles to the north. The Antonine Wall was 40 miles in length. Despite the wall, Antoninus was unable to contain the northern tribes and so subsequent emperors abandoned his wall and re-occupied Hadrian’s Wall.

Today, Hadrian’s Wall is a tourist destination. It was declared a World Heritage Site in 1987, but remains unguarded. Tourists commonly climb and stand on the wall, although this is not encouraged for fear of damage to the historic structure.

 

 

The Walls of Troy

Troy was an ancient city located on the northwest coast of Turkey.

Archeological research of that site has revealed that it has been inhabited since about 3000 BC. Dutch researcher Gert Jan van Wijngaarden notes in a chapter of “Troy: City, Homer and Turkey” (University of Amsterdam, 2013) that there are at least ten settlements layered on top of each other.  

It is not clear whether the ten year siege by Greeks led by King Agamemnon and described so famously in Homer’s Iliad is wholly or even partially true, but both the legend and the archeologic evidence indicate that the city was, at one time, surrounded by a rather impressive defensive wall. Van Wijngaarden notes that deep under the surface evidence exists of a“small city surrounded by a defensive wall of unworked stone.” In the period after 2550 B.C, the city “was considerably enlarged and furnished with a massive defensive wall made of cut blocks of stone and rectangular clay bricks”.

The legend, of course, indicates that the Trojans were able to hold out for ten years, but the wall was eventually overcome not by force but by clever deception: Ulysses famous “Trojan Horse”.

 

The Walls of Babylon

Babylon was a city and city-state located in Mesopotamia and a dominant presence in the world for over twelve centuries, ending about 600 BC. It was a key commercial and cultural centre and it is believed that, at various times, Babylon was the largest city in the world, and perhaps the first with a population exceeding 250,000.

A prominent feature of Babylon were its extensive walls. Various rulers would add successively to the work of their predecessors. Nebuchadrezzar II surpassed most by fortifying the existing double wall and actually adding a third. He also added a separate wall north of the city between the Euphrates and Tigris rivers. Considered to be over 100 feet high at points and extending 41 miles, both the sheer magnitude and artistic features of the walls were remarkable, notable particularly for the “hanging gardens”. They are considered one of the “Seven Wonders of the Ancient World”.

Extensive efforts have been made to excavate various components of the ancient city, which has been partially reconstructed as a historic and tourist site. Unfortunately, the reconstruction has been damaged by the development of oil pipelines and military conflicts.  In April 2006, American Colonel John Coleman, former Chief of Staff for the 1st Marine Expeditionary Force, issued an apology for the damage done by military personnel under his command.

 

The Great Wall of China

Perhaps the most famous extant wall in the world was built to protect the then northern border of China from invasion by various nomadic tribes. The “Great Wall” was actually built in portions over several centuries beginning in the 7th century BC

and finally enlarged and united into a single structured with embedded towers and fortifications. The main construction of the existing wall dates to the Ming Dynasty (1368-1644).

In addition to its defensive purpose, the wall also had a border control function, controlling immigration and, serving as a tariff collection station for goods being transported along the “Silk Road” between eastern and western markets.

It extends 21,196 km making it clearly the most extensive wall ever constructed. Whether it is the only man-made structure visible from space is a point of contention. There has never actually been a recorded “sighting” from space, although a Chinese astronaut in the space station claims to have taken a photograph using high resolution equipment. What is clear is that it is a UNESCO World Heritage Site and a symbol of modern China. Although many portions of the wall are in disrepair and eroding, it remains an extremely popular tourist attraction, arguably, the world’s most sought-after selfie opportunity.

SONY DSC

 

 

The Berlin Wall

A more contemporary example is the Berlin wall that physically divided that city between 1961 and 1989. Its history is both fascinating and instructive.

After World War II, the Potsdam Agreement determined that the victorious allies would divide Germany into four zones of occupation controlled by the United States, the United Kingdom, France and the Soviet Union. The German capital, Berlin, was the centre of administrative control of all four powers and so was similarly divided into four sectors. However, Berlin was entirely within the Soviet controlled portion of former Germany. Within a short period of time, political tensions mounted between the Soviets and the other three nations, largely related to the Soviets’ reluctance to agree to the Marshall Plan which called for the reconstruction, self-governance and economic support of post-war Germany. The United States, United Kingdom and France decided to proceed nonetheless, uniting their portions into a single country which came to be called West Germany (officially, the Federal Republic of Germany), with a capital located in Bonn. East Germany (known as the German Democratic Republic) emerged as a separate and Soviet controlled state, with its capital in Berlin. This left Berlin under divided governance but entirely within a separate and rather unfriendly state.

East Germans began to use West Berlin as a means to defect to western countries. It is estimated that 3.5 million circumvented emigration regulations by simply crossing into West Berlin and then on to West Germany and other countries. To prevent this exodus, the GDR (East German) leadership constructed a concrete, militarized wall essentially separating and isolating West Berlin within East Germany. During the time it was in place, over 100,000 people attempted to escape and about 5,000 succeeded in doing so. They were taking serious risks. According to the Centre for Contemporary History, a research institute concentrating on recent European history, at least 140 people are known to have been killed attempting to cross the wall, ranging from a one-year old child to 80-year old woman. Most believe the number to be considerably higher.

Eventually bowing to anti-communist sentiments in neighbouring countries and civil unrest, the East German government lifted restrictions on movement within Berlin in November of 1989, which led to open and euphoric celebration. People began chipping away parts of the wall until the government removed what was left of it. Germany officially became re-unified October 3, 1990.

Today, only small segments of the wall remain, including “Checkpoint Charlie”, its best known militarized crossing point. The Berlin wall is seen as a failed attempt by a government to impose its will on its citizens. Because it is so recent in our collective memory and so well documented, it has become a powerful image of oppression and courageous defiance. It too has become a popular tourist destination.

 

“The Wall” (Game of Thrones version)

The most famous albeit imaginary wall of our time no doubt comes from “Game of Thrones”, a hugely popular HBO series based on the fantasy novels of George R.R. Martin. A key feature is “The Wall”, a massive fortified structure composed of solid ice stretching across the northern border of the “Seven Kingdoms”. It is intended to provide protection from the various miscreants beyond, including “Wildlings” and a wandering army of frozen zombies referred to as the “White Walkers”.

Seemingly inspired by Hadrian’s Wall, this frozen barricade stretches from coast to coast, has fortifications along the way, and is manned by a garrison of exiled misfits referred to as the “Night’s Watch”. Apparently, Wildlings and White Walkers don’t swim or paddle. In any case, the wall has held up for millennia but, guess what happened at the end of last season?

 

(SPOILER ALERT: stop reading if you’re catching up on the series).

 

 

It comes down!!!….courtesy of a resuscitated and demonically-possessed fire-breathing dragon, no less! We’ll have to wait until next season to see if it becomes a tourist attraction.

 

 

And so, what does all this teach us about massive walls (real or imaginary) intended to separate populations of people? What themes and lessons emerge?

  1. They don’t work. People (even zombies) are smarter than walls, and are very capable of finding ways to overcome them. This is particularly true of people who are seeking better lives for themselves or families. Walls are static structures that can be overcome by imagination, determination and technology.
  2. Walls are hugely symbolic. They serve as a very visible expression of the values and priorities of those who construct them. The fences around our homes may not actually prevent a determined person from entering our property, but they certainly clarify for all the world that uninvited folks are unwelcome.
  3. They endure over time as artefacts, searched out and studied by historians and archeologists. They express and expose for posterity the true, unvarnished values and motives of those who constructed them. This persists long after they stop providing their original, intended purpose.
  4. They seem to serve as ideal, although expensive, tourist attractions.

If the planned wall does get built, can’t help but wonder how future generations will interpret the existence of a massive barricade on the southern border of a nation that also erected this other symbol at its major eastern port, proudly declaring to the world, “Give me your tired, your poor, your huddled masses yearning to breathe free.”

 

 

 

 

 

 

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Promoting wellness with the National Wellness Challenge

By Lori Minassian (MEDS 2021), Aescupalian Society Wellness Officer 2018-2019

As medical students, residents and physicians we are always told to put our patients first. In medical school, we sacrifice sleep and social activities to study to ensure that we will have the tools to properly serve future patients. Once we become residents, we work as hard as possible to be there for patients and this continues on throughout our careers as physicians.

Unfortunately, oftentimes, this means that we forget to take care of ourselves. For this reason, we see high rates of burnout in the medical community. In fact, the Canadian Medical Association National Physician Health Survey conducted in 2017 found that of the 3000 Canadian residents and physicians who responded, 30% reported burnout, 34% experienced symptoms of depression, and 8% had had suicidal ideations within the last 12 months. These issues are discussed at length in a recent position paper by the CFMS responding to medical student suicide.

These statistics highlight just how important it is to promote wellness as early as possible. If we can come up with tools to be well as medical students, we can hopefully use those tools as we progress in our careers as physicians. At Queen’s we are lucky enough to have a wellness curriculum, where we can discuss issues affecting the undergraduate classes and learn strategies to cope with wellness issues. We also have a wellness committee that strives to provide opportunities for student wellness through different events.

Wellness within the medical school becomes a priority during our annual Wellness Month, which runs in conjunction with the CFMS National Wellness Challenge. This year, wellness month runs from January 14 – February 10. You can participate as an individual or in teams of 3-5. Each week will focus on a different area of wellness. We kick off the month with Social Wellness week, followed by Physical Wellness, Mental Wellness and Nutritional Wellness. Each week, participants can follow national challenges set by the CFMS and track their points through the scoresheet provided upon registration. To register for the CFMS national wellness challenge, please follow the links below (Team sign up: bit.ly/NWC_team; Individual sign up: bit.ly/NWC_individual).

At the same time, we encourage students, residents and faculty to attend our Queen’s specific events. Some of the events we are running this year include a Multicultural Potluck Lunch, Zumba/Crossfit/Spin classes, a Movie Night, Lunch and Learn with a Dietitian and many more! The schedule of events can be found within this post. In addition, all of the information regarding Wellness Month can be found at our Facebook page: 2019 Wellness Challenge – Queens (https://www.facebook.com/groups/2019NWCQueens/). This year, we would love to see participation from as many students, residents and faculty as possible! All events are open to anyone who would like to attend, though some require you to sign up in advance. If you have any questions or concerns regarding wellness month, please e-mail me at wellness@qmed.ca. Let’s come together, promote our wellness and have fun as we do it!

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Service Before Self: The Legacy of George H.W. Bush

I’ve always liked George Herbert Walker Bush.

I realize, as I write those words, that it’s somewhat inappropriate and maybe even a little pretentious to use the term “liked” in reference to a former President of the United States who I never met or knew personally. It implies a familiarity I certainly can’t claim. Words like “respected” or “admired” might be more suitable, and are certainly applicable. But, in truth, “liked” is what comes immediately to mind. So, why is that? I think it’s because what has resonated with me as I’ve watched and read the various tributes since his passing a couple of weeks ago, and what probably resonates with most Canadians, are the fundamental human qualities- honesty and vulnerability-he maintained through his life. A few quotations provide insight into the character of the man.

In describing his neurologic symptoms that confined him to a wheelchair during his later years:

“It just affects the legs. It’s not painful. You tell your legs to move and they don’t move. It’s strange, but if you have some bad-sounding disease, this is a good one to get.”

While he was president, he famously indulged a life-long food preference by banning broccoli on Air Force One:

“I do not like broccoli. I’m president of the United States, and I’m not going to eat any more broccoli.”

In ending a contentious discussion with his Secretary of State James Baker:

“If you’re so smart, Baker, why am I president and you’re not?”

How can you not like someone so genuine?

Despite being what we might term a person of privilege, he seemed and acted like a regular, decent, fair and unfailingly respectful person caught up in powerful roles and great events. In terms of attitude and character he was, one might respectfully conjecture, an American that many Canadians can identify with and feel a certain kinship.

But none of that should detract from what he did or accomplished through his life. He was, arguably, the most qualified and best prepared person ever to assume the presidency, having previously served his country as a World War II combat pilot, two terms in congress, Ambassador to the United Nations, Special Envoy to China, Director of the CIA and two terms as Vice-President.

He advanced environmental concerns and worked to reduce trade barriers in North America. He led the US at a time when it was the only significant superpower in the world and could therefore have exerted unilateral authority. But he chose not to. Instead, he responded to the Iraqi invasion of Kuwait by firstly seeking the advice of the Canadian Prime Minister of the time, Brian Mulroney, and then working through the United Nations to form a multi-national coalition to engage the threat. When the former Soviet Union collapsed, he cautioned against gloating and maintained a respectful attitude. In a recent statement current Russian President Vladimir Putin provided the following tribute:

“George Bush Sr. was well aware of the importance of a constructive dialogue between the two major nuclear powers and took great efforts to strengthen Russian-American relations and cooperation in international security,”

 

He never wrote an autobiography, but wrote thousands of personal letters, casually composed but highly articulate and poignant, cherished by those who received them.

What is perhaps most remarkable about him is that, despite being what we might consider a “person of privilege” who could easily have chosen a life of quiet and private comfort, he made deliberate choices to engage public service, beginning with his decision to drop out of school and voluntarily enlist in the Navy at the age of 18 against family advice. He became a naval aviator undertaking 58 combat missions, during one of which he was shot down and had to be rescued at sea. That would have been enough for most people. Returning home after the war, he could easily and understandably have entered a comfortable private life as a successful businessman, but instead chose public service leading to the numerous positions and culminating in the presidency in 1988.

His family members, who have themselves taken up positions of social and political responsibility, remember his exhortation of “Service before Self”.

Perhaps the most revealing GHW Bush quotation are the words of a note he left in the Oval Office for his successor, Bill Clinton, who defeated him in the 1992 presidential election:

 

The last five sentences are perhaps the most telling of all and speak volumes about the author

You will be our President when you read this note. I wish you well. I wish your family well. Your success is now our country’s success. I am rooting hard for you.

Good luck,
George

Truly a life of Service before Self. A legacy and example for his nation. Indeed, for us all.

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A holiday reading list on leadership and change

Dr. Gary Tithecott

In his keynote address at the UGME fall faculty retreat on December 10, Dr. Gary Tithecott addressed the topic of Leading change for success in medical education during challenging times. Dr. Tithecott is Associate Dean, Undergraduate Medical Education at Schulich School of Medicine and Dentistry, Western University.

During his presentation, Dr. Tithecott cited a few books and mentioned others as worth delving into. As I like to do here, I’ve created a “Top 5” list from those he mentioned (OK, it’s actually six books, as he recommended two from a single author). These books are practical and accessible reads with clear advice, he said.

There’s still time to add some or all of these to your holiday wish list.

 

 

 

Mindset: The New Psychology of Success by Carol S. Dweck

The traditional attitude – Fixed Mindset – dictated that your fate is determined by skill you have genetically and that you demonstrate, Dr. Tithecott explained. With a Growth Mindset , by contrast, asserts that with dedication, encouragement and effort you can learn from and with others to increase your ceiling.

Since one key responsibility for a leader is to develop other people, a Growth Mindset is essential, he said. Citing an article from Forbes magazine, he noted a Growth Mindset allows leaders to

  1. Be open-minded
  2. Be comfortable with ambiguity & uncertainty
  3. Have strong situational awareness
  4. have a greater sense of preparedness
  5. have clarity on what others expect
  6. Take ownership
  7. Grow with people
  8. Eliminate mediocrity and complacency
  9. Break down silos

Grit: The Power of Passion and Perseverance by Angela Duckworth

One key to success in leadership, Tithecott said, is in the power of working hard and sticking to it. For a leader it’s supporting someone to go outside of their box. He quoted Duckworth:

Grit, in a word, is stamina. But it’s not just stamina in your effort. It’s also stamina in your direction, stamina in your interests. If you are working on different things but all of them very hard, you’re not really going to get anywhere. You’ll never become an expert.

Leading Change  and XLR8 by John P. Kotter

OK, this is actually TWO books, not one. Noting that no talk on change and change leadership is complete without including Kotter, Dr. Tithecott recommended both Leading Change and the more recent XLR8.

He reviewed Kotter’s list of why change fails:

  1. Not Establishing a Great Enough Sense of Urgency
  2. Not Creating a Powerful Enough Guiding Coalition
  3. Lacking a Vision
  4. Under communicating the Vision by a Factor of Ten
  5. Not Removing Obstacles to the New Vision
  6. Not Systematically Planning for, and Creating, Short-Term Wins
  7. Declaring Victory Too Soon
  8. Not Anchoring Changes in the Corporation’s Culture

Leaders Eat Last: Why Some Teams Pull Together and Others Don’t by Simon Sinek

 The symbolism of leaders eating last – exemplified by the US Marine Corp chow line, described by Sinek – points to leaders who put their team first. This in turn, leads to more acceptance of the challenges of change, Tithecott said.

The Leader Who Had No Title by Robin Sharma

Leadership can be found in different places and doesn’t necessarily mean the person “at the top”. Where and how leadership for change can be developed can vary, Tithecott said, recommending Sharma’s book.

 

 

 

 

 

 

 

 

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The Essential Elements of Medical Education Transcend Politics and Culture

How do you judge a medical school? Specifically, how do you know if it’s providing an effective educational experience for its students? There’s no shortage of perspectives on that question. Everyone involved in medical education, from first year students to Deans, will happily weigh in. Theories and opinions abound, ranging from the rigorous application of systematic Program Evaluation involving the collection, processing and consideration of multiple pre-determined sources of data, to the “I know it when I see it” approach. Our accrediting agencies certainly favour a data driven approach, now requiring the analysis of twelve standards which break down to 95 elements requiring the collection and reporting of literally hundreds of individual points of information.

I was recently faced with this question, with the added complexity that the medical school was situated in a country with very different political and social structures than our own, and very different challenges to the delivery of health care. The school was in a large (very large) city in China, and I was part of a small team asked to provide perspectives on a recently developed English language program.

The obvious and perhaps easiest approach is to measure it against our established, North American accreditation standards. However, I found many of the standards, particularly those relating to issues such as diversity, admission procedures, faculty appointments and governance, simply did not translate to that cultural context. So, I decided to concentrate instead on the essentials – those elements that are foundational to any medical education process and should retain relevance regardless of social or political context. With that in mind, I concentrated on four “essential ingredients” of medical education.

The first, and most obvious, is students. Medical education is fundamentally about student learning and their personal development as physicians. They therefore need to be capable of learning and, probably more importantly, motivated by a true commitment of service to their future patients and communities. The students I encountered certainly had those attributes. They were very well-qualified academically, highly-motivated, ambitious and adaptable. They also seemed to have high levels of social responsibility and commitment to utilizing their medical training in the interests of their society. They are also all only children which, I came to learn, puts them under considerable pressure to succeed.

Students need to encounter teaching faculty, basic scientists and clinicians committed to the process of passing along their accumulated knowledge, experience and wisdom to the next generation of physicians. Their commitment must be based not simply on conditions of employment or obligations, but an almost instinctive impulse to teach that they see as part of their professional role and personal mission.

In China, I met numerous clinical faculty and curricular leaders during the visit who were uniformly committed to providing education both through formal teaching and in conjunction with their clinical responsibilities. They saw this as an embedded component of their appointments, and felt supported in their roles through provision of faculty development. When pressed, they admit that educational responsibilities are provided “over and above” their clinical or academic roles.

Together, students and teachers must encounter patients. Those patients must be accessible, representative of the conditions and circumstances students will eventually encounter, and be willing to participate in the educational process. In the Chinese school I reviewed, there was virtually unlimited and unfettered access to patients of all types. This is the result of the sheer volume of patients and pathology in a city whose population approaches that of all Canada. Whereas many Canadian schools struggle to ensure students are exposed to all clinical problems, clinical instructors in China are able to select patients for students to see and work with based on their educational needs. The Internal Medicine clerkship director pointed out how she is able to first identify what clinical problems any particular student needs to encounter, then select among multiple appropriate patients.

The fourth essential element is resources. These include space for teaching, facilities for basic science instruction and the equipment and technology necessary to provide contemporary medical care. This requires a commitment on the part of school and medical leadership to ensure resource stewardship, and mechanisms to ensure they have the means to ensure updating and refreshing into the future.

And so, in the end, the similarities were much more significant than the differences. It comes down to students, teachers and patients coming together in an environment providing adequate resources to allow the educational process to flourish. When they do, it seems education just happens, almost spontaneously. Without any of the first three fully in place, it’s not possible, even with outstanding resources.

The purpose of a medical school and its leadership is to ensure the essential elements are in place and well-supported. Once they are, education happens. The urge to learn and to teach, it would seem, transcend geography, culture and politics.

 

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KHSC Nominations open for Exceptional Healer Awards

Nominations for the third iteration of the Kingston Health Sciences Centre (KHSC) Exceptional Healer Awards are open with a deadline of December 14.

Launched in 2017, the Exceptional Healer Awards are sponsored by the KHSC Patient & Family Advisory Council and was designed to honour a physician who demonstrates in clinical practices the core concepts of patient- and family-centred care: dignity and respect, information sharing, participation, and collaboration.

Prior honorees include ophthalmologist Dr. Tom Gonder and anesthesiologist Dr. Richard Henry (2017, tie) and urogynecologist Dr. Shawna Johnston (2018).

The award has been expanded this year to include one for physicians and one for nurses.

Physician nominees must, as a faculty member at Queen’s, have a current appointment at KHSC and have been credentialed at KHSC for at least the past two years. Nurse nominees must be KHSC staff members.

Patients and family members can nominate a KHSC physician and/or nurse who have provided care to them in the last two years while KHSC staff can nominate a physician and/or a nurse on a patient care team.

The awards committee is looking for nominees who:

  • Demonstrate compassion as a skillful clinician by displaying personal qualities such as approachability, flexibility and empathy
  • Use novel or innovative methods in attempting to deliver compassionate care
  • Demonstrate a pattern of listening to and honouring patient and family perspectives and choices
  • Exhibit a value of integrating patients and families into the clinical care model to ensure they are equal, informed participants in their health care
  • Honour the uniqueness of patients and families by incorporating their knowledge, values, beliefs and cultural backgrounds into the planning and delivery of care

For the 2018 award, patients, families and staff nominated 21 physicians for the award. Thirty-four nominations were receive, with about 25 percent coming from KHSC staff.

Medical students and nursing students are eligible to submit nominations in the “staff” category.

Further information and links to the nomination forms can be found here: http://www.kgh.on.ca/healer

 

 

 

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The stories we tell…

I’ve been thinking a lot about stories lately.

It’s partly because of an independent study I’m completing at the Queen’s Faculty of Education on narrative inquiry. It’s partly because I’m increasingly conscious of several aging family members whose stories I want to record—and of other members whose stories have been lost. It’s partly because I’ve watched some excellent biographical documentaries on Netflix recently. It’s also partly because I just love good stories.

As an educator, I embrace stories and that’s easy to do since we’re surrounded by stories: The stories we tell. The stories we hear. The stories we learn—and learn from.

We all have stories we’ve seem to have known forever that we know we will share and pass along. This is because stories are personal, usually relatable, and “knowable”—it’s a way to memorize without strict rote memory.

We tell stories to impart lessons, to entertain, to remember. And sometimes all three.

Like the story I tell of leaving a political science essay to the last minute when I was in my second year at the University of King’s College. The one I stayed up until 3 a.m. writing, then got up at 5 a.m. to type it (on my electric typewriter, no personal computers in those days). It was on the Cuban Missile Crisis. Except in my sleep-deprived state, I didn’t type it that way. Instead, I wrote of the Cuban Missal Crisis.

And my professor circled “missal” every single time it appeared through the paper. (Which was a lot). I respected this man profoundly and his was my favourite course. I was mortified when he returned the papers and I saw all the  circles (every single time). Still, he gifted me with a B+ (which was rare for him), so the content, if not the spelling, was fairly sound.

Why do I tell this story? (1) It’s kind of funny. (What would a Cuban missal crisis look like? Too many prayer books? Too few? Typos within them?) (2) It cautions against procrastination. (Which is why I shared it with my daughter when she started university and use it to remind myself, constantly). And (3) it advocates good proofreading – which we should all do, all the time. Plus, it’s relatable to many who have “pulled an all-nighter” who nod and smile through the telling (or reading) of this anecdote.

Medicine, and medical education, relies heavily on stories. Every medical encounter I’ve had as a patient has started with my story – what brought me there. Taking patient histories is one of the first clinical skills our students undertake.

What are case studies if not stories? Some are bare bones, some rich and colourful in detail. Like patients. Like people. We can’t see (or read) all, but we can see (read) enough. Stories are entrées into another person’s life, their point of view, the path they are on.

What goes into a good story? There’s characters, and place, and time, and plot – something has to happen. And woven into this, deliberately or incidentally, is meaning.

Stories can be loud “A-HA!” moments, or a gentle unfolding. They can be meandering streams-of-consciousness (perhaps a bit like this blog post), or a clear, linear narrative. Or something in between.

The best stories are conversations. What are the stories you tell? What stories will be told about you? As a student, as a teacher, as a person?

Do you have a story you want to tell related to medical education? Drop me a line at theresa.suart@queensu.ca – it may fit here in our Guest Blogger posts.

What stories do you want to tell?

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