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History of Medicine Tour of NYC
By Adam Gabara and Kelly Salman
The bus started to move, leaving the School of Medicine and commencing our long excursion to New York City. With an upcoming Mechanisms of Disease test, stress levels were high, but the excitement of the trip overrode most of those worrisome feelings. After all, this was the annual History of Medicine trip to a city that some of us, including myself, will be seeing for the first time.
Driving over the Jersey bridge, seeing Manhattan in all of its concrete jungle glory, all I could think about was all the historical events that took place within this massive cityscape. It may have been my public health background coming out, but I imagined the immigrants arriving at Ellis Island to be screened and processed, infectious disease spreading rampant through the crowded streets and apartments, and rats carrying disease to food establishments. Nonetheless, this trip was going to provide a great learning opportunity not possible in the lecture halls back in Kingston.
Even though we arrived late at night, we all split up to explore the city. Some went to celebrate a classmate’s birthday, while others explored the famous Times Square, and enjoyed a late-night meal before heading back to the hotel. For some, it may be easy to forget the history engrained in a city as modern and metropolitan as NYC. Times Square has been a central hub for many decades and known for major landmarks such as the Broadway Theatre, and we tried to see as much as we could in the short time we had.
The next morning, after a nice breakfast at a small Lime stone café and a trek through Central park, the whole group rejoined at the docks to make our way around the Statue of Liberty and towards Ellis Island Immigrant Hospital. While on Ellis Island, we were able to explore the National Immigration Museum and learn of the courageous, and sometimes tragic, stories of immigrants from all over the world coming to America to start a better life.
Our guided tour of the abandoned immigration hospital was actually an enlightening reminder of how far medicine has come. It also demonstrated how differently physicians approached immigrant health back then, keeping them segregated from the populace of New York on the basis of more than just symptoms of severe illness. Many of these immigrants came from countries in Europe, such as England, Ireland, and Germany, among others. This immigration hospital has been utilized for expectant mothers to give birth, for mental health screening, and for the treatment and quarantining of infectious diseases. The mental health screening, we learned, was based on what would now be considered archaic classifications of mental illness (idiocy, imbecile, moron, and feeble-minded). Immigrants were screened with math questions, and assessed further for behaviour and more questioning.
Saturday night was a huge bonding experience between the first and second years, as many of us attended an improv comedy act. We were able to mingle at the nearby bar, with special attention from the owner/bar tender, and to unwind after such a busy day. After the comedy, we all regrouped at a fancy top floor cocktail lounge overlooking Times Square. From here, we were able to take in the city and reflect not only on the history we learned so far, but the relationships being formed this weekend, and how important it is to take wellness break. Something we often forget in our busy lives with constant assignments, tests, research, and extra-curriculars (I was worrying about landing all the movements and vocals to Living on a Prayer for the QMed A Capella group).
The next day, we were able to see both the Museum of the City of New York and the New York Academy of Medicine. The museum, coincidentally, was displaying their main exhibit titled Germ City, a huge public health historical piece. This exhibit covered the history of various outbreaks in the city of New York and taught some of the basic science behind infectious diseases and their spread. At the academy, we were taken through a picturesque journey through various illustrated medical teaching texts including topics such as dermatology and obstetrics. It was surreal, looking at guides that medical learners would have been using many centuries ago to visualize pathologies and procedures that we ourselves will be learning on our laptops and medical texts in the year(s) to come.
And just like that, our journey was ending. We made our way back to the hotel for the long trek back home. This experience gave me much to think about, from all the medical tragedies and triumphs that occurred here, to seeing the profound impact medicine has had over hundreds of years, and how various modalities for medical instruction have changed over time. I will always think fondly of my first experience in New York, and I am reminded how lucky we are as medical students to have these opportunities to enhance our medical journey. Even on the ride back, whilst studying for the MOD midterm amongst my studious or sleeping colleagues, I realized we need to enjoy journey of medical schooland little things along the way. Like the unique experience of sitting next to a classical piano in a McDonald’s- now that’s something that will stick with me forever.
Can admissions committees measure adversity? Should they?
“If you can’t measure it, it doesn’t exist.”
This was the mantra of a former mentor and research supervisor with whom I had the opportunity to work during my fellowship. In the early days of Echocardiography we, and many others, were working hard to bring some degree of quantitative rigour and credibility to a developing imaging modality which, at that time, consisted of rather blurry black and white recordings of the beating heart on a small screen. The images could be photographed and even videotaped. As such, they were remarkably informative to the person obtaining the image and treating the patient under observation, but the technology provided no inherent measurements and could not be transmitted to referring physicians. If Echocardiography was to have sustaining value as a service to the larger medical community, most contended, it must yield measurements that would differentiate normal structure and function from the pathologic. Hence countless postulates, projects, manuscripts, publications and fellowships, including mine.
In most cases these efforts to derive measurements and “normal ranges” from moving images have been of great clinical value and has advanced patient care. However there have been, and continue to be, numerous instances where over-zealous attempts to quantitate have caused misinterpretation, often due to over-simplification of a complex image or set of images that has much more value to the observer than any static measurement can convey. Trying to compress the meaning of an image into a set of simple measures will always have inherent limitations. What numeric value could one apply to da Vinci’s Mona Lisa that would convey even a fraction of what the human eye and mind can perceive in a few seconds of observation?
Recently, considerable controversy has arisen in the United States as a result of attempts to incorporate measurements of adversity into the college admission process. The Scholastic Aptitude Test (SAT) is undertaken by American high school graduates and is a key component of their application to colleges and universities. It is widely considered to be a primary driver of admission decisions in an environment where admission to “top tier” universities is highly competitive and, recently, the subject of criminal prosecution in the United States.
This new score, dubbed the “Adversity Index” is a composite of 15 factors, including measures of crime rate and poverty in the neighbourhood in which the applicant has been raised and an assessment of the “quality” of the high school attended.
It provides a score scaled between 1 and 100, with higher scores indicating greater degrees of “disadvantage”. The Adversity Index is not used to adjust SAT test scores in any way, but provided separately to admission committees, presumably to “contextualize” the scores as they see fit.
The intent appears to be to level the admissions playing field that most agree favours applicants from wealthier backgrounds who can attend more academically rigourous high schools and benefit from more time and support for academics. It is also felt to identify students who have overcome personal adversity and demonstrated commitment and resourcefulness in order to achieve their success. The New York Times article cited above quotes Mr. David Coleman, CEO of the College Board:
“Merit is all about resourcefulness. This is about finding young people who do a great deal with what they’ve been given. It helps colleges see students who may not have scored as high, but when you look at the environment that they have emerged from, it is amazing.”
As one might imagine, not all agree. American College Testing (ACT) provides an alternative admission test for college applicants. Its CEO, Mr. Marten Roorda states the counter-argument in a recent blog post:
“The algorithm and research behind this adversity score have not been published. It is basically a black box. Any composite score and any measurement in general requires transparency; students, teachers and admissions officers have the right to know. Now we can’t review the validity and the fairness of the score. And even if that changes, there is also an issue with the reliability of the measure, since many of the 15 variables come from an unchecked source — for example, when they are self-reported by the student.”
All this comes about at a time when college and university admission processes are under siege as a result of a number of highly publicized reports of inappropriate influence exerted by wealthy and influential parents.
The repercussions and resulting enquiries have uncovered dubious practices, even in venerable institutions.
And so, what are we to make of all this? Does any of this translate to Canada, and specifically to medical school admission, certainly among the most competitive choices available to young people? A few key questions and postulated answers. (Please note: following are the opinions of the author, and the author alone).
Q. Does wealth and privilege facilitate admission?
A. Almost certainly yes. For further discussion see previous blogs:
Does every Canadian have equal opportunity to pursue a Medical Education?
Medical School Admissions: Unintended Consequences
Medical Student Debt: A problem, or shrewd investment?
Q. Do we wish to admit a more diverse student population, including students from traditionally socioeconomically disadvantaged groups?
A. Yes. All medical schools have engaged this challenge in various ways. At Queen’s both the medical school and university have made clear statements to this effect.
Q. Do adversity experiences build qualities desirable in medical school applicants?
A. They may, but not necessarily. Simply experiencing adversity is not sufficient. That experience must have resulted in a valuable learning experience that has contributed to the applicants ability to choose and undertake a career in medicine. In fact we must recognize that adversity experiences, unfortunately, have the potential to be highly damaging.
Q. How does “disadvantage” equate to “adversity”.
A. They correlate, but not precisely. To use an example from the cardiology world, sedate hypercholesterolemic people are at higher risk of developing premature ischemic heart disease, but they may not, and many active folks with normal cholesterol levels will. This is the nature of a “risk factor”. Lower socioeconomic status certainly puts one at risk for greater life adversity, probably at a linear fashion where poverty levels virtually guarantees adversity. Conversely, socioeconomic stability certainly provides no immunity from adversity experiences.
Q. Will an Adversity Index developed from compiled demographic and self-reported data provide a valid reflection of a student’s development and preparation for a career in medicine?
A. In and of itself, probably not. The information upon which it is based is inherently flawed, imprecise, and subject to manipulation.
Q. Will an examination of personal adversity and its impact on personal growth be helpful?
A. Yes. The study and practice of medicine requires commitment and resilience, both of which can be developed by adversity experiences successfully engaged.
And so, examining disadvantage is essential to addressing diversity goals, but Admissions Committees must develop robust methods to determine if adversity has been experienced, and what impact has resulted from those experiences. A numerical index such as that developed by SAT may provide a useful starting point, but is no more revealing than is a linear dimension obtained from recordings of the beating human heart.
Spring UGME retreat May 28
The spring UG Education retreat is coming up on May 28 at the Donald Gordon Conference Centre.
Designed primarily for course directors, unit leads, intrinsic role leads and others in educational leadership roles in our Undergraduate Medical Education program, this annual day-long event provides opportunities for information sharing and faculty development in planning for the next academic year.
The morning agenda includes an update from Associate Dean Anthony Sanfilippo as well as sessions on the progress test and quality assurance, accreditation & program evaluation. There will also be brief updates from the Librarian team at Bracken Library about new resources, and from the course team about the Human Structure & Function curriculum renewal.
The afternoon will begin with our guest speaker, Melissa Forgie, MD, FRCPC, MSc, Vice dean, UGME, University of Ottawa. She will speak on Embracing Diversity in Medical Education
Break out sessions will follow, including a working session for pre-clerkship course directors to build or revise assessment plans for next year and a clerkship course directors’ session on continued EPA/CBME implementation.
If you contribute to the Queen’s UGME program, please join us for all or part of the day. To register, use this link: https://queensfhs.wufoo.com/forms/ugme-may-28-retreat-registration/
Climate Change: What is our role?
By Sasha Létourneau with Gabe Lam and the Environmental Advocacy in Medicine group
“When the health effects of tobacco became known, the CMA quickly changed its investments. In times of climate change, health organizations around the world are divesting in fossil fuels.” – Courtney Howard, Emergency Medicine physician and President of the Canadian Association of Physicians for the Environment
We (Canadians) are addicted to fossil fuels. There. I said it. Isn’t admitting it supposed to be the first step? Much like a smoker with a 20 pack-year history, humans stand on the brink of irreversible damage to that which sustains us, having to make the choice as to whether to quit or continue down a destructive path.
When I first started medical school, I took a history from a man who had been diagnosed with lung cancer after a 50 pack-year history of smoking. I was quite astonished when he admitted he had been shocked by the diagnosis. How is that possible? I thought, thinking back on all the anti-smoking ads I’d grown up with in school, and the terrifying pictures of black lungs and rotted teeth I’d seen on cigarette packages strewn on the sidewalk. How did he somehow ignore all the signs around him? These are questions I hope my children never have to ask my generation about climate change.
Continuing down the fossil fuel-burning track we are on today is easy in that the ramifications of our actions are not yet apparent in most of our everyday lives. Despite the fact that CO2 levels have risen far beyond where they have ever been in the past 400,000 years,1 we are only just starting to experience the effects of climate change. And much like COPD or lung cancer, the threats of climate change most likely to impact Canadians seem just far enough away that they are still only a hazy blur. Yet, like a smoker who is only just starting to experience the first signs of shortness of breath, we too have reached a tipping point and we need to act as soon as possible.
Studies have shown that among the top most important reasons Canadians begin the extremely difficult process of smoking cessation is their concern for their personal health.2,3 If health care professionals so adamantly advocate for smoking cessation to prevent our patients from its long-term health consequences, should we not, for the same reason, also advocate for cessation of fossil fuel dependency? And how do we convince a society (and, quite frankly ourselves) that this issue needs to be addressed now?
We’ve seen a number of recent examples that climate change is starting to threaten human health, including climate-related natural disasters like cyclone Idai which claimed hundreds of lives in Mozambique in March 2019. Touching a bit closer to home, the extreme temperatures of the Quebec heat wave in the summer of 2018 took the lives of more than 90 Canadians. And even closer to Kingston, many of us have watched with horror the footage of the recent flooding in the Ottawa River that has displaced hundreds of Canadians from their homes. I, personally, might even decry the number of lectures Queen’s Medicine students endure on Lyme disease as a direct result of climate change facilitating the spread of this tick-borne infectious disease.4
But most of us fossil-fuel “addicts” are already convinced that we need to begin to transition away from our weighty reliance on fossil fuels. So now comes the hardest part – beginning the process of actually quitting. The Intergovernmental Panel on Climate Change (IPCC) released a report in 2018 telling us that, in order to ensure global temperatures remain below 1.5˚C above pre-industrial levels, we need to significantly curb our fossil fuel use by the year 2030 and achieve net-zero carbon emissions by 2050. Why is this 1.5˚C cap so important? While 1.5˚C is still higher than current temperatures, keeping global temperatures at or below this level is humans’ best chance of mitigating further catastrophic events, including land loss from rising ocean levels, extreme heat waves, drought, increased ocean acidity and both land and ocean biodiversity loss. These climate events will inevitably threaten human health, food security, water security, job security, economic growth and physical safety from war and climate disasters.5
Unfortunately, (as far as I know) there is no magical solution and no promise that this transition will be immediate or smooth. And, like a smoker trying to quit, it is probably not realistic for us to quit cold turkey – we still are years away from being in any way independent of fossil fuels. We also need to ensure we enact a just transition for our fellow Canadians currently working in the fossil fuels industry. But if we never start the transition, if we never grasp hold of the “greatest global health opportunity of the 21st century” – tackling climate change – we will never know if we could have succeeded.6
If you’ve reached this point in the article, you may be wondering: what can I, a lowly Queen’s student/faculty/alumnus, contribute to the struggle against climate change? What can one single Canadian do? Luckily, the answer is: a lot! In this article, I’ll present you with a few ways you can start to engage as a climate advocate.
One avenue that our medical student group, Environmental Advocacy in Medicine, has undertaken is working with the Queen’s Backing Action on Climate Change (QBACC) group to ask that Queen’s divest from fossil fuel companies. We are joining them to ask that Queen’s:
- Freeze fossil fuel investment immediately
- Fully divest the Queen’s Endowment and Investment funds by 2025
QBACC needs support from students, faculty and alumni. A mass divestment movement can stigmatize and delegitimize fossil fuel use and the profiting corporations in the court of public opinion, a strategy that has also been crucial in combating smoking culture and destabilizing tobacco companies. The list of organizations calling for divestment is long and growing with new players being added every day, including commitments from the Canadian Medical Association, McGill University, Oxford University, the RockFeller Brothers Fund, the British Medical Association, New York City’s pension fund, the country of Ireland and many more. This movement on Queen’s campus has been growing since the first formal request for divestment of Queen’s funds from fossil fuels was rejected by the Board of Trustees in 2014. A diverse basis of support that includes a broad community of current and future health professionals will be imperative when QBACC approaches the Board of Trustees at their annual meeting in 2020.
If this cause speaks to you, ways you can support it are:
1. Becoming informed about divestment by reading a bit more about their campaign here: https://drive.google.com/drive/folders/17PDgVGUXaLyefEp_IwzD4JZ2OANh0qsh?usp=sharing
2. Signing and/or personalizing a letter to the Board of Trustees stating your support of the divestment campaign at Queen’s University (here: https://drive.google.com/open?id=1wDYfBT5h005XyudA-ac32fSIEU_Y6QUc)
3. Signing QBACC’s support forms:
- For faculty: https://www.qbacc.org/divestment-petition
- For alumni: https://docs.google.com/forms/d/1onGYQBJAiDpPK0r7TbLqf1V0lj_sAWSCEYS_TkQdeMI/viewform?edit_requested=true
If that’s not enough for you or you are still not sure about divestment, here are some other ways you can choose a cause, join an advocacy group and work to have your voice heard:
1. Become informed about climate change by:
- signing up for the Canadian Association of Physicians for the Environment newsletter here, or
- reading CAPE’s Climate Change Toolkit for Health Professionals here.
2. Or, better yet, join CAPE’s team (if you are a physician) here.
3. Support the Queen’s Environmental Advocacy in Medicine effort to increase climate change education in the curriculum by including information on climate change in your teaching material (contact us for more information at: firstname.lastname@example.org)
4. Talk to your fellow students and colleagues about their thoughts on climate change!
We are that patient with the 20-pack-year history leaving the doctor’s office, having been told the risks of letting the status quo take its course. We stand at the edge of a frightening precipice in human history, where our actions (or inaction) today will determine the world our children and grandchildren get to live in. But like that patient, we are fortunate. We know the importance of taking action and we have a timeline during which to do so. It is now up to us whether we seize the “greatest global health opportunity of the 21st century.”6
1. NASA. (2019, May 3). Graphic: The Relentless Rise Of Carbon Dioxide. Climate Change: Vital Signs Of the Planet. Retrieved from: https://climate.nasa.gov/climate_resources/24/graphic-the-relentless-rise-of-carbon-dioxide/
2. Wellman, R. J., O’Loughlin, J., O’Loughlin, E. K., Dugas, E. N., Montreuil, A., & Dutczak, H. (2018). Reasons for quitting smoking in young adult cigarette smokers. Addictive Behaviors, 77, 28-33. doi:10.1016/j.addbeh.2017.09.010
3. Kasza, K. A., Hyland, A. J., Borland, R., McNeill, A., Fong, G. T., Carpenter, M. J., . . . Cummings, K. M. (2017). Cross-country comparison of smokers’ reasons for thinking about quitting over time: Findings from the international tobacco control four country survey (ITC-4C), 2002–2015. Tobacco Control, 26(6), 641-648. doi:10.1136/tobaccocontrol-2016-053299
4. Brownstein, J. S., Holford, T. R., & Fish, D. (2005). Effect of Climate Change on Lyme Disease Risk in North America. EcoHealth, 2(1), 38–46. doi:10.1007/s10393-004-0139-x
6. Watts, N., MA, Adger, W. N., Prof, Agnolucci, P., PhD, Blackstock, J., PhD, Byass, P., Prof, Cai, W., PhD, . . . Stockholm Resilience Centre. (2015). Health and climate change: Policy responses to protect public health.Lancet, the, 386(10006), 1861-1914. doi:10.1016/S0140-6736(15)60854-6
1. Link to “Investing in a Sustainable Future” document prepared by QBACC: https://drive.google.com/drive/folders/17PDgVGUXaLyefEp_IwzD4JZ2OANh0qsh?usp=sharing
2. Link to letter of support faculty/alumni can edit and send to QBACC: https://drive.google.com/open?id=1wDYfBT5h005XyudA-ac32fSIEU_Y6QUc
3. QBACC faculty support form: https://www.qbacc.org/divestment-petition
4. QBACC alumni support form: https://docs.google.com/forms/d/1onGYQBJAiDpPK0r7TbLqf1V0lj_sAWSCEYS_TkQdeMI/viewform?edit_requested=true
5. Sign-up for CAPE newsletter: https://cape.ca/media/blog/
6. Link to Climate Change Toolkit for Health Professionals: https://cape.ca/campaigns/climate-health-policy/climate-change-toolkit-for-health-professionals/
7. Sign-up for CAPE membership: https://cape.ca/become-a-member/
If you are a Queen’s UGME student who would like to submit a column for consideration as a guest blog, email me at email@example.com
“We’re all Chinese”. The freedom to express our diversity…or not.
I recently had the opportunity to visit a Chinese medical school and spend some time with both faculty and students. The leadership of the school was interested in pursuing North American accreditation. I was part of a team invited to advise about the state of compliance with those standards, and to help prepare the faculty and curricular leadership for the review process.
The visit was organized in the style of a typical accreditation visit, structured as a series of interviews with groups of faculty, curricular leaders, students and administrative staff. Each meeting was typically focused on a subset of standards.
One such meeting, which I’d been dreading, involved the accreditation standards dealing with the issue of Diversity. I was not at all sure how the North American sensibility regarding diversity would translate to such a different cultural and political setting, and was concerned about inadvertently causing some offense to our hosts, who had been nothing but gracious.
The meeting involved about ten faculty and administrative staff. They were chosen, in part, because of facility in English, but their understanding and ability to express responses varied considerably. As a result, questions were often followed by spontaneous conversations in Mandarin where those with better understanding would translate to others and, presumably, responses were considered and formulated. These “huddles” sometimes got quite animated and the tone and gestures themselves seemed very revealing.
The preliminary questions for this particular session were quite straightforward, generally confirmation of factual information. All was going along quite smoothly with a generally light and friendly atmosphere in the room. Then, and in the interest of simulating a true accreditation visit, I probed further. “And how do your admission practices and curriculum recognize the diversity of your population?”
The previously relaxed and animated group went quiet, all eyes on me. After what seemed like a very long pause, the faculty member who’d been the lead discussant for the group asked me to clarify what I meant by “diversity”.
I tried to explain that North American medical school standards required a commitment to social accountability, a component of which was the recognition of cultural, gender and ethnic differences in the students and society they would eventually serve.
My explanation was translated to the group, followed by the most animated and prolonged exchange they’d had to date. The other panel members and I sat back taking all this in. The expressions and tone suggested confusion, perhaps mild offense and considerable concern about how to respond.
After what seemed like quite a long and somewhat uncomfortable time, the lead faculty member turned to me and said simply, “We’re all Chinese”.
With more than a little trepidation, I decided to press on. “But I’ve read recently that there are over 50 different ethnic and cultural groups within China. Diversity also extends to issues of gender and sexual orientation. How is that diversity accounted for in your admissions and faculty appointment processes, for example?”
After another translation, an even longer and more animated Mandarin huddle ensued. Finally, the response:
“But, we’re all Chinese”.
In the interests of maintaining good relations and ensuring the review team got home safely, I decided to leave it at that.
In the ensuing months, my thoughts have often returned to that particular exchange. Of all the conversations during that visit, that was the one that brought home most clearly the differences in our societies. Fundamentally, the Chinese political structure and the values that it espouses prioritize the state over the individual. It’s not that myriad cultural, racial, religious and language differences don’t exist or are unimportant to their 1.5 billion citizens, it’s simply that those differences are considered secondary to their common, unifying allegiance to the state. They’re all Chinese first. Other characteristics, choices or preferences come second, or not at all. They have, as a society, essentially chosen to suppress or ignore their diversity.
All this is in rather stark contrast to our culture in Canada where diversity is celebrated and even legislated, permeating even our educational programs. We are free, as Canadians, to identify in (almost) any way and with (almost) any group we chose, the exceptions being organizations that are known to advocate violence or hatred in the pursuit of their particular perceptions of diversity.
I came away from all this with a deeper appreciation of the incredible privilege our society provides. The freedom to choose how one wishes to be identified is precious. It’s also easily taken for granted, largely because most of us have never had to struggle to achieve it, and have never lived without it.
What my brief and admittedly superficial encounter with Chinese culture brought home to me is that we all have the freedom to choose how we wish to engage each other, and how we collectively wish to engage the world. For any two people, indeed for any two peoples, both common and differentiating issues can be easily identified. In any encounter, from simple to profound, the parties involved face a choice. Their encounter and their ongoing relationship can be defined by points of mutual interest, or by those characteristics that divide them.
All this brings to mind the words of President John F. Kennedy who, in a commencement address at American University in 1963, at the height of the Cold War, nuclear proliferation and the constant threat of accidental or intentional Armageddon, reached out to both his own people and his global adversaries with these words:
“So let us not be blind to our differences, but let us also direct attention to our common interests and the means by which those differences can be resolved. And if we cannot end now our differences, at least we can help make the world safe for diversity. For in the final analysis, our most basic common link, is that we all inhabit this small planet, we all breathe the same air, we all cherish our children’s futures, and we are all mortal.”
How will we, as Canadians, chose to use the freedom of choice that we have inherited? From time to time, might our chosen approach to our various diversity challenges be “We’re all Canadian”?
Inaugural FHS Interprofessional Symposium on Leadership
Interprofessional education is a priority in undergraduate medicine, as it is in our fellow health professions programs in the Faculty of Health Sciences in the School of Nursing and School of Rehabilitation Therapy.
Early this month (or last month, if you’re reading this after Tuesday), we brought together over 300 students from nursing (fourth-year undergraduates), medicine (second-year undergraduate program), occupational therapy (first-year master’s) and physiotherapy (first-year master’s) at the Leon’s Centre for a one-day symposium with a particular focus on leadership.
A key challenge in creating interprofessional learning opportunities is coordinating time, space, and learning objectives of independent programs with different classroom and clinical schedules. A committee of representatives from four programs, including student representatives, tackled this challenge earlier this year, working collaboratively to create the program and learning activities for the symposium. The day included plenary speakers, interactive case studies, and a bit of fun along the way.
Our plenary speakers included Dr. David Walker, former FHS dean; Lori Proulx Professional Practice Leader -Nursing and Kim Smith Professional Practice Leader Occupational Therapy and Physiotherapy from Kingston Health Sciences Centre; and Duncan Sinclair, former vice-principal of Health Sciences
Students were seated in interprofessional table groups to engage in discussions around cases and use IP tools for decision making.
We’ve taken lessons learned from organizing this event as well as formal and information feedback from students and other participants to carry forward to the next iteration of the symposium.
Who decides when the job is done?
How would you choose to pay the people entrusted with fire prevention and control in your community? One would hope that, whatever the method, it provided those with the appropriate knowledge and skill the freedom to operate without interference in the interests of those in need.
Imagine a world where fire fighters were directed in their efforts by a pre-determined public policy edict that required them to stop their efforts after some defined time limit, regardless of the condition of the building or its inhabitants.
Sounds absurd, but this is exactly analogous to the concerns raised in an article that appeared in the Globe and Mail April 6th, “In Ontario, a battle for the soul of psychiatry” (https://www.theglobeandmail.com/opinion/article-in-ontario-a-battle-for-the-soul-of-psychiatry/).
In it, Dr. Norman Doidge describes his frustrations with a payment system that limits the number of encounters he can provide a patient.
While agreeing wholeheartedly with the arguments raised by Dr. Doidge, I would respectfully submit that the battle goes far beyond the practice of psychiatry. The concept that decisions about the nature and duration of any patient’s condition can or should be made on the basis of fiscal concerns and by individuals or groups under governmental influence should be seen by all physicians and their patients as repugnant. While government certainly has a responsibility to exercise fiscal oversight, it is (to use a contemporary metaphor) venturing far outside “its own lane”. Patients are individuals with unique illness experiences that cannot be conveniently categorized into tidy management algorithms. Doctors, of any specialty, must be free to undertake treatment for patients based on individual needs.
Doctors, in turn, must earn and safeguard that right. Our professional organizations should rise to the challenge posed by Dr. Doidge’s article with the same vigour that they have engaged issues of reimbursement, and the distribution of a few percentage points of income. Providing optimal patient care must trump income issues. Failure to do so rightfully condemns.
The profession and government should jointly recognize that the “covenant” between the government and people of Canada to provide universal, comprehensive health care is being broken daily, suffering death from a thousand cuts. Only with collective and collaborative recognition of that reality and engagement by a profession and government mutually focused on the interests of the people of Ontario can solutions even begin.
The fire fighters battling to save Notre Dame cathedral in Paris this past week didn’t stop their efforts until they had done everything possible. Those men and women were in a position of public trust that was not defined by the clock or budgets. Doctors are in a similar position of public trust which must be defended. I suspect Dr. Doidge will continue to care for his patient, but it will be despite and not because of our “system”. Our patients deserve better. We all deserve better.
(Portions of this article were published in the Globe and Mail April 9, 2019 as a letter to the editor)
I have no time…
By Adrian Baranchuk MD FACC FRCPC FCCS
Division of Cardiology, Kingston Health Science Center, Queen’s University
“A man who dares to waste one hour of time has not discovered the value of life.” ~ Charles Darwin, The Life & Letters of Charles Darwin
“I have no time.”
I have heard this sentence on several occasions.
I have heard this from my co-workers, staff, fellows, residents, nurses, and managers. I have heard this from friends – who used to spend long hours chatting, laughing and playing music – but now, they have no time.
I have heard this from close family members who have exclaimed, “I have no time.”
Finally, I have heard this sentence – the same four words – said by myself. It has become part of the dialectic armamentarium that I use upon invitations – “I have no time.”
Time has become a valuable commodity.
As academicians, our job descriptions specify the “time” allocated to different roles: (i) “time” for clinical work, (ii) “time” for teaching, (iii) “time” for research. We call the latter “protected time.” The notion that our time is “protected” is comforting. We are protected. Our “time” is protected.
The structure of our life is built around time; it accepts different metrics, depending the cultural background, the level of education, and the earnings and savings.
It is “time” for you to move to your own house.
It is “time” for you to further your career.
It is “time” for you to get married and start a family.
It is “time” for you to retire.
Although time can provide structure and discipline, it has become a regulator of our abilities to do something during our life.
Inadvertently, or not, we also use time to structure the life of others, such as family members, employees, or trainees. The ability to guide – or manipulate – someone by regulating the time they spend under one’s supervision is more powerful than any other form of intervention, such as encouragement, motivation, salary, or recognition. Nothing compares to the impact that “time” regulation has over our actions, either voluntary or mandatory.
In that sense, we self-allocate “time” to activities that we perceive as meaningful or enjoyable, such as going to the gym, conversing with partners, reading a book, et cetera. Violating this principle is a trigger for anxiety and frustration. The feeling of guilt that we experience when doing something that we perceive is in place of another timely activity – despite being part of human emotions – is a source of discontent.
There is not a generalized approach to using “time” wisely – it is individualized. We go through life, with more or less success, defying our own chronometer to do some of the things that we have dreamt, and we allocate the “time” that we speculate we have to reach those goals.
Few years ago, I found myself overwhelmed with work. My mentor called from the other side of the Atlantic and I responded without much enthusiasm. The wise man of only 83 years of age recognized my exhaustion and told me, “You sound too busy…you are doing too many things at the same time…you should slow down.” Rather than taking the advice with sincerity and consider reducing my workload, it agitated me. I replied, “What do you want me to do? I have no time.”
I said “I have no time” to my 83-year-old mentor who has, from a statistical point of view, much less time than me to accomplish his dreams.
There was a period of silence on the phone line. Some say that more than 23 s of silence between two individuals is the most tolerable duration before one of the two individuals breaks the moment with a comment; after about 10 to 12 s, I said “are you there?” He replied, “I was wondering whether you have time to think?” I have not forgotten this phrase since it was spoken many years ago.
When did I lose my capacity for contemplation? When did I sacrifice my ability to enjoy doing nothing? The “dolce far niente” (“sweet doing nothing”) that the Italians have immortalized. Albert Einstein said, “Time is an illusion.” Does the perceived lack of time represent the absence of illusions? How do we regain, in this world of immediacies, the ambition of living in a world of illusions? How relevant, for the creative process of enjoying your life (and be productive) is to have illusions?
While Mahatma Gandhi taught us that “there is more to life than simply increasing its speed;” Benjamin Franklin has counteroffered that “lost time is never found again.”
If we live in this world with a constant perception of not having “time,” how are we going to construct memories that at some point may be our only companion in life? Are we losing the ability to contemplate? Does this affect our ability to relate to our patients if we have no time to connect with them?
One of my other mentors – after consultation with a patient in the hospital ward – once asked me what book the patient was reading. “I have no clue” was my immediate answer, all the while skeptical about how this would relate to patient care. I did not understand at the time that our ability to contemplate and have holistic views will aid us as physicians to relate to the patient, which is a skill that is of immense value.
Where do ideas come from? How do we connect an idea with the creative process and the systematic work flow to move it into action? How does an idea move forward into realization?
Apparently, “time” is the key that regulates this process. Time is the precious commodity that we all want to attain – despite where we live and work, and how our family is structured – and we are all “offered” the same total amount every day.
So far, we have not been able to create “time.” We have not succeeded in having 25 h in a day. We have to resolve the enigma of how to distribute our efforts and energy throughout the same amount of minutes and seconds in a day. A strict 24 h per day.
I would like to teach my students to use their time wisely so as to enjoy their life and balance their ambitions. I want my students to be happy, and help them evolve not only as great scientists but also happy and content individuals. I want my students to have time to contemplate and think freely as such that time is not a factor that regulates their decisions.
I only wrote this piece today because I had convinced myself that I had no time before.
I propose to the readers to exercise the search of finding time for what they really want to do with their lives. Perhaps allowing a few minutes a day to do what they did not find “time” to do lately.
Because the “time” that we think we do not have, is out there. It is a matter of learning how to grasp it and to make it ours.
It is time to do it.
To Sohaib Haseeb for editing the first draft. To Gustavo Bonzon for his translation into Spanish.
Creative Commons Image from: https://www.deviantart.com/mariana-a/art/She-saw-the-time-passing-by-new-350524188
It Takes a Village: Thanks to all involved in our Medical School Admission process
Over two weekends in March, over 500 applicants are invited to our school to undertake interviews, the final phase of our medical school admission process. They have been selected from over 5,000 who submitted applications.
That process, designed by our Admissions Committee, is the product of much thought and deliberation, with the goal of fairly and objectively matching the aspirations and attributes of applicants to those required to assure success not only in medical school, but in the practice of medicine and service of patients.
The process is a massive undertaking, requiring the participation of no fewer than 179 of our faculty and virtually all members of our first- and second-year classes. In fact, our admission process is the most resource intensive activity undertaken by our school.
Each year, I’m amazed and grateful for the willingness of our faculty and students to give of their time and energy for this purpose. File reviews and interviews are both carried out after regular work hours and on weekends, requiring sacrifice of precious personal time. Why do they do it? They recognize, I believe, that this admission process is critical not only to our success as a school, but for the future well-being of our profession and the society we serve.
Our applicants are also impressed. They consistently comment on the effort, which brings credit to our school and demonstrates a learning environment where faculty and students work together in mutual dedication to our school and profession.
I would like to recognize and extend sincere thanks to all the faculty members involved, who will be listed below. The numbers indicate those who filled multiple assignments. I’d like to particularly note the contributions of Drs. Fred Watkins and Mariana Silva, who were both involved in all aspects of both the File Review and Interview process.
I’d also like to thank our first- and second- year classes. I’d initially thought about listing them as well, but quickly realized that was unnecessary since there was essentially no one to exclude! Their presence and support of applicants speaks volumes about their support of our school, and confirms to me that the process is working well. Special thanks to first year president and vice-president Andriy Katyukha and Victoria-Lee Kim who organized their class events and made no fewer than eight presentations to applicants.
Finally, I’d like to recognize three individuals who deserve particular recognition, our Assistant Dean of Admissions, Dr. Hugh MacDonald, Admission Officer Rebecca Jozsa, and Admissions Assistant Rachel Bauder. They oversee a very complex process that ran flawlessly.
Faculty Members Involved in the Admission Process
Amy Acker (2)
Sussan Askari (2)
Allan Baer (2)
Lysa Boisse Lomax
Mark Bona (2)
Rozita Borici-Mazi (2)
J. Gordon Boyd
Cheryl Cline (3)
Ken Collins (2)
Robert Connelly (3)
Christine D’Arsigny (2)
Alexandra Di Lazzaro
Jennifer Flemming (3)
Kan Frederick (2)
Tom Gonder (2)
Mike Green (2)
Richard Gregg (3)
Andrea Grin (2)
Dianne Groll (3)
Andrea Guerin (2)
Karen Hall Barber (2)
Marisa Horniachek (4)
Robyn Houlden (3)
David Hurlbut (4)
Felicia Iftene (2)
Omar Islam (4)
Mala Joneja (2)
Cherie Jones-Hiscock (4)
Sarosh Khalid-Khan (3)
Faiza Khurshid (2)
Alenia Kysela (3)
Kirk Leifso (3)
Athen Macdonald (2)
Gillian MacLean (3)
Paul Manley (2)
Sarah McKnight (2)
Stephen McNevin (2)
Alex Menard (2)
Anne Moffat (5)
Benvon Moran (2)
Raveen Pal (2)
Stephen Pang (2)
Armita Rahmani (2)
Benjamin Ritsma (2)
David Ruggles (3)
M. Khaled Shamseddin (2)
Mariana Silva (9)
Marco Sivilotti (2)
Yi Ning Strube
Rob Tanzola (2)
Naji Touma (2)
Jessica Trier (3)
Todd Urton (3)
Janet van Vlymen
Maria Velez (2)
Ashley Waddington (3)
Ami Wang (4)
Fred Watkins (9)
Shayna Watson (2)
Hasitha Welihinda (2)
Gavin Wood (3)
David Yen (3)
Medical Variety Night 2019 presents: Circadian Rhapsody!
By Charlotte Coleman, Emily Wilkerson, Stephanie Jiang, and Therese Servito, 2019 MVN Co-Directors
Medical Variety Night is an annual variety charity show hosted by the Queen’s University School of Medicine students and faculty.
On April 5th and 6th, 2019, we will be holding the 49th annual Medical Variety night! MVN is a longstanding tradition, with participation from over 200 students as well as faculty members. Acts include musical performances, comedic shorts, and dance productions, such as a 4-act Bollywood dance, an a cappella group, and a touching tribute from the outgoing class of 2019. Drawing an audience of over 500 attendees each year, MVN has consistently been one of the largest events hosted by the Queen’s School of Medicine. The event is frequented by the Queen’s medical community, students from the university, and many Kingston residents.
This year all proceeds go to the Good Minds Program for the Mohawks of the Bay of Quinte. (For more on Good Minds, check out their website: http://www.mbq-tmt.org/administration-and-services/community-wellbeing/good-minds)
The show will run on April 5th and 6th at Duncan McArthur Hall (511 Union St.), with doors opening at 6:30PM and the show starting at 7:00PM both evenings. Tickets are $15/students, $20/general admission online (medicalvarietynight.wordpress.com), or all tickets $20 cash only at the door. This year promises to be more exciting than ever before! For more information, and to meet our performers, check out our website: medicalvarietynight.wordpress.com
You can follow us on twitter @QmedMVN and attend our FB event:
Thank you so much, and we hope to see you at the show!