Welcome to the Undergraduate Blog
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.
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
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 email@example.com – it may fit here in our Guest Blogger posts.
What stories do you want to tell?
Patients are key to our students’ learning
Students have been part of my health care journey long before I became an educational developer at Queen’s School of Medicine.
When my daughter was born in 1995 in Fredericton, NB, I had not one but two nursing students from the University of New Brunswick assigned to me. For each of them, I was their first ever patient. I was also their only assigned patient. As a first-time mom, this was both gratifying (they pretty much catered to my every need from running baths to making me snacks) and faintly terrifying (like when they, under their preceptor’s watchful eye, demonstrated to me how to give my newborn a sponge bath) and slightly uncomfortable (post-partum abdominal palpations aren’t fun at the best of times, let alone by a learner who isn’t quite sure what they’re looking for).
My mantra at the time was: “They have to learn somewhere – why not with me?”
And it’s true – there’s only so much to be learned in a classroom, a mock clinic, or simulation lab. Ultimately, our medical students consolidate all that learning during their two-year clerkship period where they engage with real patients, in real hospitals and real clinics, supervised by staff and resident physicians.
In my role as an educational developer, this is a part of their education that I don’t typically see first-hand. I’m generally classroom-based in the coaching I provide to faculty, and it’s hard to be an unobtrusive fly-on-the-wall observer of patient encounters when you aren’t a member of the healthcare team.
As a patient (and parent of a patient, and partner of a patient), however, I’ve had several opportunities to see our clinical clerks in action first hand.
I’ve watched a senior clerk valiantly (and ultimately successfully) conduct a physical exam on my pleasant-but-non-cooperative then-nine-year-old son.
I saw another clerk—working on a rotation with anesthesia—get a reluctant laugh out of my grumpy (from fasting) and nervous (because, well, surgery) husband during the pre-op airway examination and checklist.
Most recently, one of our clerks independently led off an appointment I had at my family physician’s office. I’ve hit a milestone birthday (full disclosure: 50) that can trigger a number of screening tests and things. The clerk was well-prepared, asked me good questions, and had good information. It was clear to me that they had at least scanned my file before coming into the room and had done their homework on the types of screening tests that might be relevant to me.
Along the way, I’ve also seen some of the various ways the clinical clerkship preceptors supervise and monitor our students’ learning.
For the clerk who examined my son: after a consultation outside the exam room, the clerk and physician came in together for the rest of the appointment. There was a Q&A amongst all of us which included gentle coaching and good feedback for the clerk.
Prior to my husband’s surgery, after the clerk’s exam, the anesthesiologist followed up with their own exam and pointed out a couple of things to the clerk – who then had another look down my husband’s throat which they and the physician then discussed.
For my encounter, I know my clinic has video monitoring (as there are signs posted in the examination rooms) and the clerk themselves noted they were going out to consult with the physician.
These are all different ways that clinic-based teaching and learning takes place. And that’s due in large part to patients who willingly engage in these encounters. As part of the UGME team, I feel a certain obligation and responsibility for their education and training. Most other patients don’t have this same motivation and it’s their generosity that makes this learning possible.
Through not only their classroom based studies, but especially their clinical skills training over two years, their simulation lab work, and our First Patient Project, our students are ready to engage with patients and be part of the healthcare team in their clerkship years. A sincere thank you to patients in Kingston and at our regional sites who engage with them as they learn.
Engaging Disruptive Innovation. The evolving role of POCUS in clinical medicine and medical education.
Who among us didn’t get through high school without regularly reaching for a well-thumbed encyclopedia plucked from a shelf in our parents’ basement or local library reference room? Not me, to be sure. Whether it was how rubber is manufactured, legislative accomplishments of a long-deceased prime minister, or the agricultural exports of Guatemala, the encyclopedia could always be counted on to provide reliable information, in time for whatever deadline was looming.
The word “encyclopedia” itself has an interesting and revealing etymology. It apparently contains elements of word origins for “circle” (interpreted to mean “complete” or “all-inclusive”), “child” and “education”. We all know the word to refer to a comprehensive, single source that brings together diverse information. An encyclopedia is a one-stop-shop for a little bit of everything you might need to know about anything.
The most venerable example is Encyclopædia Britannica, first published in 1768 (https://www.britannica.com/topic/Encyclopaedia-Britannica-English-language-reference-work). The 2010 edition consisted of 32 volumes and 32,640 pages. It was written by about 100 full-time editors and more than 4,000 contributors. Contributors have included Nobel laureates and five American presidents.
That 2010 edition version was its last print edition. After 242 continuous years, Encyclopedia Britannica went out of the print business. It was a victim of what has come to be known as Disruptive Innovation.
That concept emerged in the 1990s and is most commonly attributed to Clayton M. Christensen who has written extensively on the topic as it plays out in the business world and explains the rise and failure of various enterprises.
In a 1995 Harvard Business Review article that is well worth the read (https://hbr.org/1995/01/disruptive-technologies-catching-the-wave), Christensen defines disruptive technologies in the following way:
The technological changes that damage established companies are usually not radically new or difficult from a technological point of view. They do, however, have two important characteristics: First, they typically present a different package of performance attributes—ones that, at least at the outset, are not valued by existing customers. Second, the performance attributes that existing customers do value improve at such a rapid rate that the new technology can later invade those established markets. Only at this point will mainstream customers want the technology. Unfortunately for the established suppliers, by then it is often too late: the pioneers of the new technology dominate the market.
The disruptive innovation that lead to the demise of print versions of Encyclopedia Britannica was, of course, Wikipedia. It provided an easily accessible, comprehensive and continually updated source of information at no direct cost to the consumer. The fact that it lacked historical status, cachet or even a reputation for the accuracy of its sources was glossed over by the consuming public who were very willing to set aside all those considerations for the convenience and economic advantages.
Disruptive Innovation, almost by definition, upsets existing patterns of practice or behaviour and resets the way people go about a common task or access a service. There is always a reaction from those involved in the traditional paradigm, usually characterized by statements such as
“what’s the proof this is better”
“there’s no problem with what we’re doing now”
“it hasn’t been fully researched”
“there will be unintended consequences”
The disruptive innovators, for their part, have the courage of their convictions. They believe they understand market forces better than the established providers, and are willing to gamble that they’re right. Basically, they believe in letting the market decide.
The medical world, of course, is certainly not excluded from disruptive innovations. In fact, it has benefited greatly, but not always willingly. An example I’m very familiar with from the cardiology world is Percutaneous Coronary Angioplasty. When first introduced by Dr. Andreas Gruentzig in 1977, this innovation truly set the cardiovascular world on its collective ear. Prior to that, therapies for coronary occlusive disease were limited to medical therapies (provided by cardiologists) and coronary bypass surgery (provided by cardiac surgeons). The dichotomy and division of labour were clear and well accepted. The catheterization laboratory was a place for diagnostic investigations to determine the extent of disease, not a place for therapeutics. Gruentzig’s innovation completely upset the existing paradigm. Moreover, it put the interventional cardiologists in the driver’s seat, because they could link the therapeutic intervention to the diagnostic procedure, therefore engaging the issue first and therefore, potentially, circumventing the role of the cardiac surgeon. The simple intuitive appeal of being able to dilate an obviously obstructed vessel without the need for even a second interventional procedure, much less surgery, was powerfully compelling, and both the medical community and patients were very willing to set aside the usual and well-established need for controlled comparative trials before embracing this new technology enthusiastically.
The development of Hand-Held Ultrasound (HHU) and its clinical counterpart, Point of Care Ultrasound (POCUS), could be considered further disruptive innovations facing the medical community. Ultrasonic imaging, by virtue of its ability to provide information on a variety of structures in a non-invasive, non-toxic manner and at relatively low cost, has taken on a key role in medical diagnostics, ranging from cardiac (where it is known as Echocardiography) to abdominal, thoracic and vascular imaging. It was initially provided only with large and complex machines that were not easily transported, and provided images and measurements which were imprecise, difficult to obtain and required “expert” recording and interpretation. The technology therefore required third party interpretation and consultation before results could be reliably utilized to guide patient care.
Over the past decade or so progressive technical advances have made it possible to obtain excellent quality images from small devices that can be carried easily and used at the bedside. This technology is such that it can be used by an individual to guide the diagnostic approach and decision-making process, analogous to how physicians use stethoscopes. Although the HHU technology is not yet able to provide the full package of information that would allow it to completely replicate the comprehensive examination, it’s not unreasonable to expect that will occur in the not-too-distant future.
In addition to challenging the role of ultrasonic imaging as a diagnostic procedure, this technology is also challenging our approach to the clinical examination in medical school, where students and educators are asking very valid questions as to the role of these “competing” technologies.
I recently participated in a symposium at the Canadian Cardiovasular Congress recently exploring this very topic. Together with my colleague Dr. Amer Johri, as well as Dr. Sharon Mulvagh from Dalhousie, Dr. Rob Arntfield from Western University, and our former Echocardiography Fellow (now staff Cardiologist at McGill) Dr. Hanane Benbarkat, we explored current and further applications of HHU and POCUS, all centred on its fundamental impact on patient care.
Dr. Johri has been active in the development of guidelines for its application in medical education (Journal of the American Society of Echocardiography 2018;31:749), and has been working with Dr. Steven Pang of our department of Biomedical and Molecular Science to introduce the technology within our curriculum.
The session was, as you might imagine, not without controversy. However, I believe the discussion ultimately centred on the only truly relevant issue: how we can utilize emerging technology to better serve the needs of patients. The concluding messages I provided our audience at that symposium are:
- HHU and POCUS are excellent examples of disruptive innovation
- They challenge our conventional approaches, but have considerable potential to bring added value to both the clinical setting and educational process
- They are here to stay – but how, and who will be guiding their use is not yet determined
- They have the potential to evolve from disruptive to sustaining innovations
- The key consideration in assessing value should be the impact on patient care
- Based on work carried out by Dr. Benbarkat during her fellowship at KHSC and hopefully extended to further collaborative studies with other centres, integrated utilization of POCUS by hospital-based Echo Labs is feasible and beneficial.
I’ll conclude with the words of Mr. Christensen who has given much thought to what causes organizations to fail in the face of disruptive innovation. In his book “The Innovator’s Dilemma” he provides a rather disturbing paradox:
“in the case of well managed firms…good management was the most powerful reason they failed to stay atop their industries.”
“widely accepted principles of good management are, in fact, only situationally appropriate.”
In other words, it was, at least in part, a failure to deviate from previously successful practices that prevented well-established firms from engaging disruptive innovations, ultimately to their detriment. Such innovations challenge us to step away from what we consider to be the “tried and true” methods and approaches we have come to rely upon. They will always entail an element of risk and uncertainty, and therefore require what might be termed a leap of faith. In the medical world, that leap is only justified by a considered, clear potential to improve patient outcome. All other considerations must take a back seat.
20th Annual Travill Debate set for November 7
The 20th annual A.A. Travill Debate is set for November 7 in the Ellis Hall Auditorium, 58 University Avenue, beginning at 5:45 p.m.
This year’s topic is:
Be it resolved that… Publicly funded hospitals should not be able to have religious affiliation
On the “Yea” side, arguing for the proposition will be Dr. Andrea Winthrop and Meds 2022 student Nathan Katz while Dr. Michael Fitzpatrick and Meds 2021 student Sara Brade will argue the “Nay” side.
As described on the Travill Debate website, the debate will “run on a polite and rigorously timed schedule” which features:
- 10 minutes for each member of the team, alternating back and forth – Yea and Nay – until all four participants have laid out their arguments.
- Then two minutes for summary from one member of each side.
- The Travill Debate Gavel is banged very loudly when the time limits are reached.
- No Power Point or technological aids.
- Humour is welcome. Formal attire and costumes have also been used to good effect.
This annual debate – featuring a controversial topic in medicine – was created in memory of A.A. “Tony” Travill. As described on the debate’s web page:
Dr. Travill came to Canada in 1957 after serving as aircrew in the RAF (WWII) and reading Medicine at the London Hospital Medical School. He did a residency year in Montreal and practised in Orillia with Dr. Philip Rynard (Queen’s ’26) before coming to Queen’s to study Anatomy under Dr. John Basmajian. After two years at Creighton University in Omaha, Nebraska, Dr. Travill returned to Queen’s in the Department of Anatomy in 1964, becoming Professor and Head from 1969-1978. His research interests were in embryology, teratology and education. Dr. Travill was a strict parliamentarian and noted Faculty Historian (Medicine at Queen’s; 1854-1920, the Hannah Institute for the History of Medicine, 1988: Just a Few: Queen’s Medical Profiles, 1991). He served the community as a Trustee of the Separate School Board and in 1964 was a founding member of the John Austin Society, the still thriving local history of medicine club. In particular, Dr. Travill had a passion for debate on current social, political and educational issues, and for many years he delivered a rigorous and challenging lecture to incoming first year medical students during orientation week.
As further noted by Dr. Jaclyn Duffin, then-Hannah Chair for the History of Medicine, in the original proposal for the memorial debate:
“As his friends and colleagues know, A.A. ‘Tony’ Travill was intelligent, quick, witty, a great teacher, who loved to talk—preferably to argue. Proud of his credentials in clinical medicine and his origins in practice, he rose to head a basic science department (Anatomy). He was an erudite historian, with distinguished publications… Travill also had a deep interest in Philosophy, especially logic, ethics, and epistemology. He loved to cast doubt, to stir up trouble, but he didn’t really mind losing.”
Please join us! All are welcome!
Well trained and committed clinicians can indeed succeed in the research world. Celebrating the accomplishments of two Queen’s Grads
Most organizations we join in the course of our professional careers are a natural consequence or requirement of what we do. There are others that carry some degree of prestige or special recognition that we may choose to apply to with the hope of being selected. A few organizations – very few indeed – come looking for special people. These are called “Honorific” societies, because they seek and recognize individuals whose lifetime work merits special recognition.
The Royal Society of Canada is such an organization. According to its website:
The RSC is the recognized pre-eminent body of independent scholars, researchers and creative people in Canada whose Fellows comprise a collegium that can provide intellectual leadership for the betterment of Canada and the world.
RSC Fellows are men and women from all branches of learning who have made remarkable contributions in the arts, the humanities and the sciences, as well as in Canadian public life.
In the United States, the National Academy of Medicine is another such organization. It describes it’s goals as follows:
- An independent, evidence-based scientific advisor. To carry out our work, we harness the talents and expertise of accomplished, thoughtful volunteers and undertake meticulous processes to avoid and balance bias. Our foundational goal is to be the most reliable source for credible scientific and policy advice on matters concerning human health.
- A national academy with global scope. Although the National Academies were originally created to advise the U.S. government and advance the well-being of the U.S. population, our mandate is now much broader. The NAM includes members from across the globe and partners with organizations worldwide to address challenges that affect us all.
- Committed to catalyzing action and achieving impact. We identify and generate momentum around critical issues in health; marshal diverse expertise to build evidence-based solutions; inspire action through collaboration and public engagement; and foster the next generation of leaders and innovators.
- Collaborative and interdisciplinary. In partnership with the National Academy of Sciences, the National Academy of Engineering, and other stakeholders, the NAM draws on expertise across disciplines and domains to advance science, medicine, technology, and health.
- An honorific society for exceptional leaders. The NAM has more than 2,000 members elected by their peers in recognition of outstanding achievement. Through a commitment to volunteer service, NAM members help guide the work and advance the mission of the NAM and the National Academies.
Recently, two graduates of our medical school have been named to these societies. Dr. Stephen Archer is a friend and classmate from Meds 81. I’ll again quote from the citation provided by the RSC in announcing his appointment:
Stephen Archer is Professor and Head of Medicine at Queen’s University and a world renowned cardiologist and leader in several research fields, including oxygen sensing, vascular biology, and the experimental therapeutics of pulmonary hypertension and, more recently, cancer. He has made numerous discoveries that can undisputedly be considered firsts, particularly in regard to defining the roles of mitochondrial fission/fusion and metabolism in oxygen-sensing and cell proliferation.
Dr. Azad Bonni is a Meds 86 grad and well-remembered by many current faculty. He also has the distinction of being the younger brother of my colleague Dr. Hoshiar Abdollah. Again, I quote from a announcement provided by his current school:
Bonni is the Edison Professor and head of the Department of Neuorsciences at Washington University School of Medicine and director of the university’s McDonnell Center for Cellular and Molecular Neurobiology. An international leader in molecular neuroscience, Bonni has made seminal contributions to our understanding of how the brain is built at the level of individual connections between nerve cells, and how deregulation of those mechanisms contributes to neurological diseases. His group has discovered fundamental signaling networks within nerve cells that program neural circuit assembly and function in the developing brain. Using brain development as a guide, the Bonni laboratory also has provided novel insights into neurological disorders including neurodevelopmental disorders of cognition such as intellectual disability and autism spectrum disorders, brain tumors and neurodegenerative diseases.
Neither Archer nor Bonni acquired their research expertise while in medical school. However, I believe both would agree that their ability to formulate important and relevant research themes and the commitment required to pursue those issues in a scientifically rigourous fashion was rooted in their understanding and personal involvement in clinical medicine and likely fostered by exposure to people and situations they encountered as medical students.
The role of research in undergraduate medical education has always been controversial. In an increasingly packed undergraduate curriculum, it is often sacrificed in favour of the many therapeutic applications and competency objectives medical schools are expected to provide. In fact, many current curricular frameworks have chosen to exclude it completely.
At Queen’s, we made the deliberate decision to include it in our list of essential EPAs, our only departure and addition to the nationally accepted list. We include research involvement as a core component of our curriculum (the Critical Enquiry), provide opportunities for summer research involvement, and integrate aspects of translational research into our teaching in various courses.
We do so not with the expectation that every student will become an independent researcher, but because we believe understanding research methodology makes us all better “consumers” of new information and that these early experiences may be formative and awaken a passion for research in those who had not previously imagined it either within their reach or as component of their career.
Congratulations to Drs. Archer and Bonni, and thanks for affirming that solidly trained and committed clinicians can, indeed, achieve great things in the research world.
History of Medicine Week: 100 years later… Looking Back on the First World War and the Spanish Influenza October 22-26th
By Kelly Salman (Meds 2021)
The What Happened in Medicine (WHIM) Historical Society is proud to host the fourth annual History of Medicine Week! This year’s theme highlights a significant anniversary for both medicine and the world. A century ago in 1918, two major and interconnected events in history occurred: the Spanish flu and WWI. Learn more about what happened in medicine then and consider how things have (or haven’t) changed in our present day 2018 — 100 years later…
Students, Faculty, and Community members are all welcome to attend.
Museum of Health Care Showcase
Monday October 22nd, 8:30am-3:30pm
New Medical Building Grande Corridor, 15 Arch St.
Many of our greatest medical technologies and advancements have come out of times of crisis. Come and peruse a sampling of century-old artifacts from both the Spanish Flu and WWI. Curated by the Museum of Healthcare.
Speaker Panel Followed by Wine and Cheese Reception
Tuesday October 23rd, 5:30-8:00pm
Speaker panel: New Medical Building, Rm 132 A, 5:30-7:00pm
Reception: Museum of Healthcare, 7:00-8:00pm
“We Forgot to Remember – young Canadians commemorating the stories of the 1918 Pandemic”
Award-winning Neil Orford will discuss the Spanish Flu and its impact in medicine.
“Brock Chisholm and the Legacy of War Trauma”
Military historians Dr. Robert Engen and Matthew Barrett will discuss the trauma of war through their research on the experiences of Lt. Brock Chisholm in the first world war before he became a physician and the first director general of the WHO. Dr. Engen and Mr. Barrett created a graphic novel to illustrate this narrative, as featured in the Queen’s Alumni Review this summer: https://www.queensu.ca/gazette/alumnireview/stories/battle-hill-70
About the Speakers:
In 2017, Neil Orford retired from teaching History at Centre Dufferin District High School in Shelburne, ON. His work as a teacher has seen him win numerous awards for his teaching, most recently the 2015 Government of Canada History Award for Teaching; as well as the prestigious 2013 Canadian Governor General’s Award for History Teaching and the 2012 Ontario Premier’s Award for Teaching Excellence. In July 2013, Neil Orford founded a consulting business, Canadian Historical Educational Services, Ltd. to assist school boards, museums, non-profits & government agencies with designing educational programs for historical thinking and commemoration. This work has led him to consultation work with the Federal Ministry of Canadian Heritage in 2017, helping to design digital commemorations for students across Canada.
Dr. Robert Engen, MA’08, PhD’14 (History) is an assistant professor of history at Royal Military College and an adjunct professor in the Department of History at Queen’s. He is the author of Canadians Under Fire: Infantry Effectiveness in the Second World War and Strangers in Arms: Combat Motivation in the Canadian Army, 1943–1945, both published by McGill-Queen’s University Press.
Matthew Barrett is an SSHRC-funded PhD candidate in the Department of History at Queen’s. His doctoral research examines the concepts of honour and dishonour within military culture. In particular, he studies the dismissal and cashiering of Canadian officers during both World Wars. Additional research focuses on Canadian public and institutional attitudes toward suicide in the military. His academic work has appeared in Canadian Military Journal, Canadian Military History, Journal of Canadian Studies and British Journal of Canadian Studies. He has also illustrated two First World War graphic novels with Robert Engen.
Friday October 26th, 7:00-9:00pm
The Grad Club, 162 Barrie St.
Impress your friends with your history know-how during a historically themed Trivia Night! Snacks will be provided!
Poetry, journalism, and a Pepsi commercial… or, a meandering parable about balance
I started writing poetry again recently. I do this, then abandon it, then reclaim it at various intervals. I’m always better with it.
This may seem to have very little – if anything – to do with medical education. And, you’re right in one sense. Join me on a little self-indulgent meandering to get to my point.
As I write this, it’s Thanksgiving Day – a day when people traditionally reflect on their blessings and things they’re grateful for. And, I’m on the cusp of a milestone birthday, so perhaps that has made me more introspective than other weeks, when I write about course evaluations and how we value them (we do!), or team-based learning and how it contributes to long-term learning and understanding more than straight lectures (it does!), or ways service-learning contributes to both social accountability and professional development (yes!). So, I find myself thinking about poetry.
On the road to becoming any professional – and medicine is no exception – we ask people to shed a lot of things along the way.
We ask people to shed attitudes that aren’t aligned with their goals. To ditch beliefs that aren’t compatible with where they’re going. To replace erroneous information or practices with those that are proven to be more valid.
The profession of medicine itself demands other things – things I watch colleagues work through and cope with – long days, longer nights, emotional and physical demands they may never have imagined at the start of their careers.
Because, really, none of us truly ever know what we’re getting into.
All of this coalesces in a kaleidoscope of who we were and who we are and who we will be. The parts and colours shifting as the years turn.
My first career was in journalism. In the spring of Grade 12, I was accepted into the four-year Bachelor of Journalism program at the University of King’s College. They only accepted 35 students a year, out of nearly 1,000 applicants, so this was exciting! As parents are wont to do, my father, an English teacher, mentioned my acceptance to a colleague he saw at a conference. That colleague was the late Don Murray, then a professor of Journalism at the University of New Hampshire. Professor Murray later sent me a number of articles and a book on journalism (that I still have and use to this day), but he passed along advice through my father that was even more valuable.
“They’re going to teach her how to write a certain way,” he said. “And that’s important, and she needs to do that. But tell her not to give up her other stuff. She needs to keep doing that, too. It will make her a better writer.”
I haven’t always adhered to that advice, but over 32 years after first hearing it, I know its value. So I put pencil to paper to work out ideas, and thoughts, and metaphors. But, really, I’m claiming a part of myself I refuse to shed. It’s something I need to keep to be me. To be better.
Are there things you’ve accidentally shed along the way that you didn’t need to? Are there parts of you you’d like to reclaim, to give you that edge, that solace, that space to be you, preserved in the full person you want to be?
As I write this, I’m reminded of the 2004 diet Pepsi “old van” commercial… where a thirty-something dad is asked if there’s anything else youthful he’d like to experience and he says his old van. He then imagines his 1980s-era rocker painted van and what driving that in his current life (like dropping his kids off at school) would be like (not good!). Then he drinks his can of pop and is happy with that.
Some things can’t – and likely shouldn’t – be reclaimed. But if there’s something like poetry, or running, or music, or nosing around in antique shops, or reading trashy fiction (however you define that), or some other seemed-not-that-important-at-the-time thing that you miss about being you, consider ways to recapture that. And fit that “old” part amongst the newer parts.
Just maybe not that van.
Adjusting to Medical School
Adjusting to a new environment never comes easily. Our bodies will eventually adapt to seasonal climate changes, travelling to different time zones, or high altitude, but it invariably takes some time, and involves a little discomfort along the way. Adjustments of any kind are easier if anticipated and understood in advance.
Medical school is an adjustment and, unfortunately, not always anticipated by those “taking the plunge”.
What’s the most difficult adjustment for first year medical students?
Asked that question, most would point to issues such as workload, engaging initial patient encounters, or perhaps aspects of technical competence involving physical examination or procedures. All important, to be sure, but these challenges are understood in advance, anticipated by our curriculum, and well within the abilities of the young people entering medicine, who are already very accomplished and have engaged the process and been selected with all these issues firmly in mind.
Beyond these anticipated challenges, there are other adjustments that are even more critical to success but much less well-appreciated or even unanticipated by students.
Why do we undertake educational programs? For many undergraduate university students, it is to either to pursue an area of personal interest, or to achieve prerequisites or qualification for a subsequent program. That’s certainly the case for students contemplating entry to medical school. These are certainly worthy goals, but they are personal and intended to promote individual objectives. In a professional program such as medicine, the goals of learning shift to encompass the interests of other parties, specifically future patients. The approach and motivation for learning must also shift. In the words of an astute former mentor “Medicine is a service industry”. Medical school is about preparing young people to provide that service. The learning is facilitated by that goal. In fact, it can’t occur without it.
Students entering medical school have achieved much recognition for their academic and personal accomplishments, the most recent and notable being their success in the admission process. As they undertake their studies together with equally accomplished classmates and in a system that defines success simply as “pass” with very little numerical grading, external kudos and other tangible evidence of success become increasingly rare. The perception of success must therefore shift from the external to internal as will, eventually, the responsibility for ensuring they remain knowledgeable and technically competent.
The expectation of professional behaviour
Medical education is patient-centred. Students learn early that their interactions with patients must be carried out with high standards of confidentiality, respect and personal behaviour. Although that expectation is easily understood within the patient contact itself, it is perhaps less immediately understood that the same expectations are in play with all their interpersonal and social interactions. The lines between their personal and student lives therefore become blurred. For most, this is a novel experience, and perhaps the first realization of what it means to have engaged a professional role.
Dealing with uncertainty
Students, particularly those from backgrounds in the physical or biologic sciences, have come to expect precision and certainty in their studies. The concept of “right” and “wrong” provides reassuring clarity and promotes the expectation that learning is a finite endeavor, culminating with the discovery of that single, correct response. In the study of medicine, they find a much less dichotomous world where many clinical issues are nuanced and require interpretation based on many variables. They must develop “approaches” based on “best evidence” always contextualized to the “patient’s unique circumstances”. For those accustomed to singular solutions, this can be quite unsettling.
All this can sound quite daunting but, like any life adjustment, will be eased with patience and support. Fortunately, much support is available. The quick “bonding” with classmates allows for the comforting realization that these challenges are not unique or some critical personal shortcoming, but rather ubiquitous features of the early medical school experience. Interactions with upper class colleagues, both planned and informal, provide further validation. Our Student Affairs programs, mentor groups, observerships and Clinical Skills groups all provide opportunities to discuss transition difficulties.
In the end, the adjustment is not merely about engaging a new educational program, but rather a more clearly defined identity and perspective of one’s role in the world.