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A Quirky, Unique and Heartfelt Welcome to Meds 2024
Everything is different during a pandemic. Last week’s orientation events for our first-year students proved to be no exception. In fact, I on the first day I found myself standing alone in large hall speaking to a medical school class and their families, none of whom I could see.
To explain, the Orientation Week usually starts off with a gathering of the entire class in the main lecture hall of the School of Medicine Building with a series of welcomes and presentations. I’ve always found it a particular pleasure to meet the newly gathered class for the first time and share in their enthusiasm and excitement. Because of pandemic restrictions, we had decided some time ago to hold the first session in Grant Hall, with the hope that we’d be able to bring the entire group together in a large venue that could provide appropriate social distancing. Since the hall was updated over the summer with appropriate audiovisual capacity for large class use during the semester, that seemed like a reasonable idea. Alas, the escalating requirements necessitated by the changing characteristics of the pandemic made that impossible. Nonetheless, we felt we could still use that space as a base for the presentations and livestreaming to family members (a pandemic bonus!). When we arrived Monday morning for what would prove to be the first such session from that site, we found that the set up was such that the speaker could only be seen by viewers by standing not on the stage, which would provide scale and an academically appropriate backdrop, but from the floor.
And so, I found myself a small figure in a large space speaking to people I couldn’t see. Fortunately, I wasn’t completely alone. I was followed by Dr. Renee Fitzpatrick, Assistant Dean Student Affairs, Mr. Anthony Li, Aesculapian Society President and finally Dr. Jane Philpott, our new Dean who delivered an inspiring address about the privilege and responsibilities of a medical career. Many thanks to our MedsVC team, and Bill Deadman in particular, for very capable assistance and guidance through all this.
This year’s group consists of 107 students, drawn from an applicant pool of over 5500. They come all regions of our country and backgrounds. One hundred and seven individual paths leading to a common goal that they will now share for the next four years. Sixty-two of them have completed undergraduate degrees, 27 have Masters degrees, and three have received PhDs
They hail from no fewer than 47 communities spanning the breadth and width of Canada:
They have attended a variety of universities and undertaken an impressive diversity of educational programs prior to medical school:
An academically diverse and very qualified group, to be sure. Last week, they undertook a variety of orientation activities organized by both faculty and their upper year colleagues. They were called upon to demonstrate commitment to their studies, their profession and their future patients. They were assured that they will have a voice within our school and be treated with the same respect they are expected to provide each other, their faculty and all patients and volunteers they encounter through their medical school careers.
Over the course of the week, they met a number of curricular leaders, including Drs. Lindsey Patterson and Laura Milne. They were also introduced by Dr. Fitzpatrick to our excellent learner support team, including Drs. Martin Ten Hove, Jason Franklin, Mike McMullen, Josh Lakoff, Erin Beattie, Lauren Badalato and Susan MacDonald who oriented them to the Learner Wellness, Career Counseling and Academic Support services that will be provided throughout their years with us. They met members of our superb administrative and educational support teams led by Jacqueline Findlay.
They attended an excellent session on inclusion and challenges within the learning environment, organized by third year student Chalani Ranasinghe supported by Drs. Mala Joneja and Renee Fitzpatrick. Stephanie Simpson, University Advisor on Equity and Human Rights, provided a thought-provoking and challenging presentation intended to raise self-awareness regarding diversity and inclusion issues. This was followed by a very informative dialogue from a panel of upper year students (Nabil Hawaa, Sabreena Lawal, Andrew Lee and Ayla Raabis) who provided candid and very useful insights to their first-year colleagues.
On Thursday, the practical aspects of curriculum, expectations of conduct and promotions were explained by Drs. Renee Fitzpatrick, Cherie Jones and Lindsey Patterson.
Dr. Susan Moffatt organized and coordinated the very popular and much appreciated “Pearls of Wisdom” session, where fourth year students nominate and introduce faculty members who have been particularly impactful in their education and invited them to pass on a few words of advice to the new students. This year, Drs. Peter Bryson, Casi Cabrera, Bob Connelly, Jay Engel, Chris Frank, Debra Hamer, Nazik Hammad, Mala Joneja, Michelle Gibson, and Narendra Singh were selected for this honour.
Their Meds 2021 upper year colleagues, led by Miriam Maes, welcomed them with a number of (generally virtual) events. A highlight included the always popular distribution of backpacks, this year in brilliant school-bus-yellow (the group is already becoming knows as “the Hive”). Thanks to Molly Cowls (Meds 2024) for sharing this collage.
For all these arrangements, skillfully coordinated, I’m very grateful to Erin Meyer and Hayley Morgenstern of our Student Affairs team.
I’m also grateful to Erin for not allowing the first years to be deprived of the traditional Orientation Week group picture which, this year, required some creativity and extra effort:
I invite you to join me in welcoming these new members of our school and medical community. Their first week be long remembered for the most unique in the history of our school, and hopefully also for the commitment, persistence and adaptability of all involved.
Including learners with “remote” patient encounters
We’ve been focusing on classroom-based teaching tips in recent blog posts, this week, we focus on some practical tips for clinical teaching for clinicians working with learners while using telephone and computers for patient appointments.
By Debra Hamer, MD FRCPC, and Theresa Suart, MEd
Since March and continuing for some patient populations, physicians have shifted to “remote” technologies to conduct patient encounters, which used to take place face-to-face. This has complicated how to readily include learners – clinical clerks and residents – in those encounters.
First – let’s just put this out there – we don’t like the word “virtual” to describe working with patients using telephone or computer interfaces. This is not simulated care, it’s actual care!
Whether you’re using telephone appointments or a computer-facilitated patient interface, it can be a challenge to incorporate learners. We’re providing some suggestions based on telephone and OTN (in this case); these can be modified for your own tech situations. (As always, feel free to reach out to the UG Education team for help brainstorming solutions.)
The tasks associated with each can be divided into three parts: before, during, and after. These are things you likely do automatically with in-clinic or in-hospital patient visits that include learners because you’ve been doing it for years. Working with “remote” technologies just requires a bit of deliberate thought to what that preparation, appointment, and debrief looks like.
Depending on what social distancing is in effect, you may be in the same room as your learner, or you, the learner, and the patient may be in three different locations. The suggestions below assume you are in three different locations. If you and the learner can be in the same room, this will be simplified.
(You may book your appointments yourself or have an administrative assistant who does so.)
Prior to Encounter:
- When the patient’s appointment is booked, ask if a learner can be involved with the appointment.
- If there’s a reminder call, include a reminder that a learner will be involved (if they said yes, of course!)
- Make sure you’re in a room by yourself with no intrusions or distractions. This might seem self-evident, but work-from-home situations can change day-by-day.
- Ensure your phone is set up to block your caller ID. On an iPhone, you need to deselect this under settings.
- Ten minutes before the patient call, call the learner and review the referral and any pertinent information from the chart, since students won’t have access to the chart if they are not physically in the clinic. At that point, you can answer any questions or concerns the learner has
- If you’re using a phone with “conference” capabilities (adding a participant) you can keep the learner on the phone while you initiate the call with the patient. (On iPhone, this is “add a call, put in the patient’s number, then press merge calls).
- Once the patient answers, check to ensure both the patient and learner are on the call. All three participants should be able to hear each other.
- In the greeting, you can remind the patient of the learner’s role on the call.
- Make sure the patient understands the potential privacy issues with cell phones and consents to continue, then outline what to expect during the appointment.
- Proceed with the patient interview/discussion/assessment as you would do ordinarily.
- Depending on the learner’s stage, at this point they may be listening in; if not, let the patient know you will mute yourself and unmute yourself near the end to join back in. (If the learner is going for too long or going off the rails, you don’t need to wait until the end, simply unmute yourself and redirect them, as you would in a face-to-face encounter).
- At the end of the appointment, if you haven’t already, you can unmute yourself, ask any questions and finish off.
- After ending the call with the patient, call the learner back and debrief the encounter.
- If it’s a senior learner, you may take the option to call the patient back – talk to the learner, find out a diagnosis and plan and then call back together with this. This will vary on the learner’s level. (Be sure the patient knows you are going to do this!)
- With a more senior learner, with the patient’s consent, you could use a three-step appointment: the learner initiates the call with patient, then ends that call to confer with you (by phone or other means), then the learner or you calls the patient back with the plan for going forward.
Pro-tip: If you use headphones, then there’s less reverberation and you can use your hands while you’re listening to the phone calls.
(Dr. Hamer uses OTN, you may use another platform. These instructions assume the patient has agreed to an internet-mediated appointment and has received the log-in instructions by email).
- Make sure your computer is set up with a neutral background with nothing to distract the patient.
- Also, make sure you’re in a room by yourself with no intrusions or distractions.
- Telephone the learner 10 minutes before the appointment time and review the case with them. End this call
- Launch the appointment with the patient. (In OTN, this is either “make a video call” or clicking on the link from your schedule). Use your program’s function to add the learner. (On OTN, it’s “add a guest”
- Ensure the patient still consents to continue with the appointment online, and outline how the appointment will go. Then mute yourself and block your video so it’s just a black box at the bottom of the screen. The learner and patient will just see each other. (This is less distracting)
- Re-enter as needed (similar to the telephone suggestions above).
- If there is time available on the appointment, ask the patient to stand by for a few minutes. You and the learner both mute and block your video and have a telephone discussion about the case.
- Come back to the call to see the patient. (Make sure the gap is no more than five minutes).
- Once the computer-mediated appointment has finished, call the learner back to talk about the case.
Do you have advice or suggestions for facilitating learning with these types of patient encounters? Share your advice in the comments.
This is Not Normal. Let’s Not Get Used to it.
We are growing accustomed to the sight of people wearing masks in public.
We are growing accustomed to maintaining a distance between ourselves and others.
We are becoming wary, even fearful, of personal contact.
We are no longer expecting that we will be able to celebrate accomplishments or significant events in large gatherings.
We are growing accustomed to not assembling to grieve the loss of friends or loved ones.
We are accepting the need to interact with our patients through remote interfaces.
All this is necessary given our current circumstances. These measures deserve and require our support. We may even be coming to regard many of these changes as beneficial, efficient, a “new normal” in how we engage our professional and casual relationships.
But they are not desirable. They are not virtuous. They come with a price.
Nelson Mandela, who learned a thing or two about isolation during his 27 years of imprisonment on Robben Island, is quoted as saying “Nothing is more dehumanizing than isolation from human companionship”. Although our restrictions may seem like trifling inconveniences in comparison to his experience, the parallel is valid.
Personal relationships require personal contact. An image on a screen can never convey the same meaning or depth of understanding. The concept of caring or concern for another person cannot fully be expressed or understood remotely. Learning how to encounter, assess and care for a person in need can only be accomplished through individual, personal contact.
Beyond these individual considerations, our social structure is built on the concept of “community”. Communities can be defined in purely geographic terms as a group of people inhabiting the same location. The deeper and more significant meaning relates to the commonality of values, attitudes and goals. Communities, in short, are made up of people who share certain understandings of how they wish to live and what they hope to accomplish collectively. Community requires its members to be accepting and concerned about each, which can only come through personal interaction.
The education of its young people is, by any measure, a defining characteristic of a community.
The very word “education” has etymological roots that are both interesting and revealing. It evidently derives from the Latin “educo”, roughly translated “I lead forth” or “I raise up”. “Educatio” is “a breeding; a bringing up; a rearing”. The definition that I prefer is simpler and more consistent with the origin and intent of the process; “an enlightening experience”.
Facts and information can be learned in isolation. True education requires contact with teachers, mentors and, in the case of medical education, patients.
A community without social interaction and personal exchanges is not a community. A society without healthy and vibrant communities is not a society.
Getting back to Mandela, the remarkable thing is not that he survived 27 years of social isolation, but that he emerged from it all not embittered but with an even greater sense of purpose and understanding. The quote cited above continues as follows…“there I had time to just sit for hours and think.”
Let’s hope we emerge from our own prisons soon, a little more appreciative of what we are sacrificing, and a little more enlightened.
Five non-pedagogical things to do to get ready to teach using Zoom
The UGME Education Team has prepared “how to” documents that outline the technical aspects (with such things as downloading the Zoom app, and things like checking that your microphone works). And we’ve previous written with tips about how to engage students in a virtual classroom which might seem rather unfriendly. This post is about other practical things – things we don’t need to think about, or just do automatically – when going to teach in a physical classroom with students there face-to-face.
Here’s our top-five non-pedagogical things to keep in mind before teaching live on Zoom:
1. Look behind you! Give a bit of thought to what’s behind you when your camera is on. Most things are fine, but consider if there’s a lamp that’s coming out of your head like an antennae or something equally distracting. Think about any privacy concerns, if you’re teaching from your home. My work-from-home space is in my basement all-purpose room. If I’m situated in one direction, you’ll see my husband’s degrees on the wall; another you’ll see a collection of elephant figurines (yes, there’s a story to that), and a third shows my Nancy Drew, Cherry Ames, and LM Montgomery books from my childhood. Most stuff is innocuous, but think about if you want to share those things with everyone.
Zoom virtual backgrounds are, of course, an option for an instant non-personal look. Keep in mind, however, that the green-screen technology isn’t perfect. If you move around or (like me) talk with your hands, you may have visual blips of hands or your head momentarily disappearing.
2. Turn off all things that beep, buzz, or whirr Just like in a movie theatre (remember those?!), it’s helpful if you can turn off sounds that are within your control – like your cellphone or email notifications. Also, any environmental noises you can control. My home workspace is adjacent to the laundry room. At the exact moment I was typing this sentence, the dryer buzzer went off (loudly!). It’s also helpful to remind housemates that you’ll be teaching so they can make good noise-related choices.
3. Refreshments, anyone? If you’re settling in for a two-hour session, that could be a lot of talking. It’s good to have a glass of water handy, or throat lozenges nearby. Or, if you’re teaching an 8:30 class: COFFEE. Also, tissues or paper towels perhaps – you likely don’t want to dig into a pocket while sitting down for a sneeze or spill of aforementioned coffee.
4. Office supplies, what office supplies? If you typically take notes of questions students have or keep track of which groups you’ve already called on, make sure you have pen and paper on your desk. Also, do you have any small props you want to show? Figure out where in your teaching space you can put these to keep them nearby, but out of the way of things like your refreshments (above) to avoid needing the tissues or paper towels.
5. Time, please. It’s easy to get caught up in teaching material and lose track of the time. Keep your eye on the clock on your computer, or set a timer (this sound we’ll allow) so you finish on time. There will likely be another instructor waiting to begin their session right after yours and you won’t have the usual visual cue of your colleague appearing at the back of 032 or 132.
Keep in mind, this is real life, real time teaching, not a Hollywood film. Things will happen and it will be fine – paging, for example, is unavoidable if you’re teaching in your hospital office. Also, you won’t be the first of our instructors (or students) who’ve had a child or pet wander into camera range. (I routinely warn of random “teen boy” appearances when I’m on Zoom calls. He wandered in while I was drafting this, too).
Are there things you would add to this list? Use the comments box below to share your tips.
For a different (more humorous, maybe more accurate?) take on preparing your environment for online teaching, check out this video by Dr. Andrew Ishak at Santa Clara University. https://vimeo.com/447645552?fbclid=IwAR3lKAaNY0zCPgVJWdPUjog-AD0g7FjsSNBtUL5HAEdcFlUgWaUHi–7JqU
Three ways to think about student engagement in remote curriculum delivery
While you’re preparing to deliver our UGME fall curriculum for Years 1, 2 and 3 predominantly via remote technologies (and some of that asynchronously), the challenge of keeping student engaged and involved may be top of mind. Three strategies (useful in any teaching, not just pandemic-restricted scenarios) are useful to keep in mind.
1. Set expectations early For many – students and teachers alike – remote teaching using a platform like Zoom is a new way to learn, so it helps to set the expectations when you start. In face-to-face teaching, this is sometimes done formally, but more often informally. A learner sitting alone in front of their computer can’t “read the room” to know what’s ok. If you’d prefer that students use the Zoom “raise hand” function to ask questions, let them know this at the start of class. If you’d rather they unmute their microphones to interrupt, set this as your norm. If you invite students to email you with questions after your session, set a reasonable time-frame for response. If you expect them to have downloaded a worksheet from Elentra ahead of time, make sure this is in your learning event’s “required preparation” section, since you can’t have a handout ready as back-up. Be clear, so no one gets frustrated.
2. Use tools effectively All the tools available in the classroom are also available in remote teaching – they just sometimes need a bit of tweaking to use effectively. For example, one really low-tech engagement tool is silence. In my early days teaching at the University of New Brunswick, I had a Post-It note on my lecture notes which said: “shut up, Theresa!” This was a succinct reminder to myself to give students time to hear and process questions before I went ahead and answered them myself. With remote teaching, we need to factor in time for student to click on their “raise hand” button or hit “unmute” along with that processing time. Silence can be uncomfortable for instructors as we think we should be filling every moment, however, using questioning and dialogue effectively remotely requires becoming comfortable with longer intervals waiting.
Most other tools you use routinely face-to-face can continue to be used via Zoom. For example, Poll Everywhere and videos were also used quite easily during the spring term. Do you sometimes use “show of hands” to get a response? Both the “raise hand” function and the “reactions” one can be used for this purpose. Some in-class tools might take a bit of strategic thinking and planning to rework for remote classes. If you have something in particular in mind, reach out for brainstorming and to capitalize on collective wisdom.
3. Assign roles Whether you’re in a Zoom class, or assigning asynchronous work, it can be helpful to proactively assign roles to individual students to keep everyone engaged and participating equitably. Whether it’s the randomizer app used by Dr. Gilic and Dr. Simpson in MEDS 115 to call on individual students for responses, or a “Someone from group X” call-out, these can all be tailored for Zoom.
If you’d like some Zoom-mediated face-to-face feedback, ask that one student from each SGL group be “on camera” during the class. Not everyone’s internet supports using video throughout, but teaching to a sea of names in black boxes makes it hard to gauge responses. Using a rotation within groups will share this responsibility. (And get more camera-shy students used to being “on” in a low-stakes way).
If you’d like a student to monitor the chat box for questions, create a roster of students who are willing to do it and share that task through the term.
If you’re using discussion boards for asynchronous teaching, break up the tasks needed to meet the learning outcomes of the discussion: have one or two students assigned to pose a discussion question based on the preparatory materials, another to moderate, someone else to write a one-paragraph summary of the discussion to share with the large group. You could also assign a student or two from each group to write multiple choice questions based on the assigned material. (If you’re interested in using discussion boards on Elentra, get in touch and we can set it up for you).
It’s true we’re in somewhat uncharted waters for teaching this way, but there are solutions to the teaching challenges. If you’re stumped or frustrated, please reach out – we can find some solutions together. Reach me best by email (email@example.com).
The Humble, Inspiring Leadership of Sir Tom
The spectacle of a 94 year old Queen wielding a large sword to “knight” a 100 year old gentleman, stooped and standing with the assistance of a walker, might seem somewhat anachronistic and perhaps even a little inappropriate to those whose tolerance for tradition and ritual is strained even in the best of times. Certainly, the double-whammy of the COVID crisis and racism activism are very much front of mind for most people and understandably so. Jaded suspicion and negativism have easy footholds in our consciousness. Hope and optimism struggle for attention.
Nonetheless, that’s exactly what’s to be found behind this brief ceremony conducted Friday at Windsor Castle.
The gentleman being knighted is Captain (now Sir) Tom Moore. He is a veteran of World War II, having been “conscripted” at the age of twenty. He was assigned to an armoured corps, but eventually served as part of what came to be known as the “forgotten army” in Burma (now Myanmar) surviving, among other things, a bout with dengue fever. After the war, he became a businessman and motorcycle enthusiast. Recently, not content to simply observe the COVID pandemic from the comfort of his retirement home, he resolved to do something to assist the overburdened National Health Service. Options being limited, he decided to do 100 laps of his garden on his 100th birthday, which he did with the support of his walker, but otherwise unaided. The project was widely picked up by social media and the press. Contributions started rolling in. To date, 33 million Pounds ($56.2 million CDN) have been raised.
These efforts, together with tons of natural charm, have made him the very embodiment of British pluck and resilience in the face of adversity, and this past week he was knighted by his slightly younger Queen, who herself knows a thing or two about maintaining a stiff upper lip in the face of adversity.
There are many words that come to mind in describing Sir Tom’s actions. “Charitable”, “altruistic”, “selfless” would all seem to apply but there are other aspects of his remarkable story that, although equally valid, may not immediately come to mind.
One is “humility”. Sir Tom was not looking for acclaim or to make a “big splash”. He simply saw a need, felt obligated to make a contribution, and set out to do whatever was in his power to do. In the case of a now one hundred year old man with obvious limitations, that consisted of walker-wheeling around his backyard.
The other word that comes to mind is “leadership”. Although its doubtful he would describe himself in such terms he has, despite advanced age and physical limitations, done much more than simply raise funds. He has provided leadership in a time of crisis. By choosing to act rather than simply bemoan his situation, by acting without artifice or expectation of self-promotion, by rejecting victimhood and bitterness, his actions inspire us all to simply get up and keep moving ahead. With his walker firmly in hand, he shows us the way.
The “Greatest Generation” indeed.
Thank you, Sir Tom.
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 firstname.lastname@example.org
Eleni Katsoulas email@example.com
Rachel Bauder firstname.lastname@example.org
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.