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Remembering three great mentors and teachers
Over the past few months, our faculty and medical school have lost three people who made tremendous contributions over the course of their careers. Peter Munt, Robert Hudson, and Ed Yendt were all master clinicians, leaders in our medical community and contributors to our understanding of illness and disease. They were also gifted teachers and mentors who were always willing and eager to pass on their wisdom. As we approach the beginning of another academic year and are about to welcome a new class of medical students, it seems appropriate to reflect on the lessons and legacies that they’ve so ably provided.
Dr. Peter Munt was recruited to Queen’s after postgraduate training in Respiratory Medicine to head the newly formed Division of Respirology and Critical Care Medicine. He went on to head the Department of Medicine through a time of tremendous transition, and then became Chief of Staff at KGH. As his medical resident many years ago, I recall caring for a patient with a pulmonary infection eventually traced to a rather novel organism. Not content to simply identify and treat the infection, he encouraged me to identify the source and explore for any patients who may have suffered from similar infections. By doing so and documenting the results of our search, we were able to contribute to the care of many more patients, and raise awareness among other physicians of a little appreciated source of infection. Moreover, he taught me and my fellow residents the importance of pursuing root causes and the value of documentation and publication in disseminating knowledge. His career, both as a physician and administrator, was characterized by this quality of uncompromising attention to all facets of an issue, and unwillingness to accept the expedient solution.
Dr. Bob Hudson was head of our Division of Endocrinology for many years. In addition to his clinical responsibilities, he maintained a very active research career making important contributions to the understanding of androgen function. I’ll remember him for his dedication to physical examination and bedside teaching. His ward rounds were highly valued by housestaff. Not content with mere identification and demonstration of physical findings, Dr. Hudson challenged us to understand the underlying cause and pathogenesis. “So I agree this patient has exophthalmos” he would concede, but always follow with something like “but why do patients with thyroid disease develop this finding? What’s the mechanism?” His great skill was to help the learner work his or her own way through the problem without intimidation or belittlement. In fact, you emerged from these sessions not simply knowing something about a particular finding, but with a mechanism that could be applied to a variety of findings and conditions.
Dr. Ed Yendt had already developed a reputation as a leading specialist in calcium disorders by the time he was recruited to Queen’s to head the Department of Medicine. He led that department through a period of rapid growth, and development of many of the subspecialty divisions. He continued to do basic research through his career, becoming an internationally recognized expert in osteoporosis. Always a dedicated clinician, he continued to see patients long after usual retirement age and long after financial considerations provided any motivation. He was the embodiment of what we would today refer to as “translational” or “bench to bedside” research. I had opportunity to talk to him on numerous occasions in recent years, and was continually impressed at his knowledge of recent literature and eagerness to apply new findings to his patients. He was intrigued by patients with unusual presentations or responses to therapy, and continually used those experiences to learn more and apply that knowledge. He never lost his excitement for discovery or dedication to patient care.
Three great teachers, three different styles, but all sharing an insatiable curiosity, dedication to advancing the science of medicine, and to applying that science to their first concern – the care of their patients. Their families might find some solace in the knowledge that those lessons are not lost and that their examples and teaching will continue to inspire our students and those currently charged with their learning.
2nd Annual Medical Student Research Showcase
Queen’s School of Medicine is proud to host the 2nd Annual Medical Student Research Showcase on September 26, 2013. This event has been designed to offer opportunities for medical students engaged in summer research activities to showcase their work in posters displayed in the School of Medicine Building, and to celebrate excellence in the form of an oral plenary session. This plenary session, moderated by Dean Reznick, will feature up to three outstanding submitted projects, each delivered in a ten minute oral presentation. The students selected for the oral plenary and the top student poster presenter, as adjudicated by a judging panel, will jointly receive the Albert Clark Award for Medical Student Research Excellence.
The conference organizers are pleased to announce the development of a **NEW** Medical Student Research Showcase Community accessible via MEdTech. Here you will find all important information regarding the research showcase. We have also implemented a new electronic system for all abstract submissions. We encourage you to visit the new community regularly to stay up to date on important information regarding the showcase. Abstract submissions open on August 12, 2013 (08:00am) and more information will be forthcoming in the coming weeks.
We look forward to seeing you on September 26, 2013!!
Heather Murray & Melanie Walker
Clinical Problem Solving: A student and a teacher talk about lessons learned from an online course
By Heather Murray, MD, and Eve Purdy, MD Candidate, 2015
For many medical students, the process involved in turning a presenting complaint into an appropriate and focused differential diagnosis seems like a big black box. For clinicians who do this many times every day, the process is unconscious, and it is hard to explain to medical student learners how to break it down. Both students and teachers sometimes struggle with how to transition early medical learners to competent diagnosticians.
So, when a clinician (Heather Murray) and a second year medical student (Eve Purdy) independently stumbled across the link to a Massive Open Online Course (MOOC) on Clinical Problem Solving offered through Coursera both of us jumped at the opportunity to learn more about diagnostic reasoning. Eve registered with the hope of shedding light on the type of problem solving that she might be faced with in clerkship, while Dr. Murray registered with the intention of improving her teaching around diagnostic reasoning for students.
Though it is difficult to summarize the six-week course in one blog post there were a few takeaways from the course that we will outline. These key points might help medical students improve clinical reasoning and the same tips might help teachers in clarifying the process for learners. Much of this approach to clinical reasoning comes from the NEJM article “Educational Strategies to Promote Clinical Reasoning” by Judith Bowen (2006).
1. Organize the way you learn about diseases using Disease Illness Scripts
If you have a structured approach to the way you learn about diseases, then you will be more efficient at recalling that information and comparing diseases effectively. One way to organize information is into “Disease Illness Scripts”. This requires organizing information about the conditions into four broad categories.
|-who gets the disease?-what are the risk factors?
-making a mental picture of who you would expect to see with the disease can help
|-over what time period does the condition present?
acute on chronic
-a good way to think about this is where you would expect to see the patient (ER, vs walk-in vs family doctor)
|-what are the symptoms?
*key features are signs and symptoms that are essential to the diagnosis
*differentiating signs and symptoms are those that make this disease different then diagnoses that present similarly
*excluding signs and symptoms are those that, if present, exclude the disease
|-describe and understand the underlying disease mechanism|
2. Organize the way you think about patients using Patient Illness Scripts
When thinking about patients try to frame their presentation using the same structure as the disease illness scripts.
|What important risk factors does the patient have-age
-relevant medical history
-presentation specific risk factors i.e. recent transcontinental air travel in a patient with shortness of breath
|How long has the patient had the symptoms, have they changed?||What symptoms and clinical signs does the patient have?
-try to group as many as possible to shorten the list (e.g. group febrile, tachycardic and hypotensive as septic)
3. Compare disease illness scripts and patient illness scripts to generate a tiered differential diagnosis
Generate a differential diagnosis based on the chief complaint. You can compare your understanding about each disease on your differential with your patient using the illness scripts easily. Pay close attention to key features, differentiating features and excluding features. The closer a disease illness script is to the patient illness script the higher it should end up on your differential. Your final differential has three tiers:
Tier 1: Diseases that are those most likely belong here. The epidemiology, time course and clinical presentation are concordant with the patient illness script.
- Tier 1e: Diseases on tier 1e are diagnoses that may be less likely than tier 1 but if missed will cause immediate and serious harm. These are dangerous diagnoses! The “e” in this tier stands for “emergency” and diseases on this list must be ruled out, even if they are less likely.
Tier 2: Diseases that have some similarities to the patient illness script but aren’t a perfect fit belong here. They are still possible but less likely than tier 1 diagnoses.
Tier 3: Diseases on your original list that do not fit the illness script. They may have excluding features or lack key features.
4. Use your tiered differential to determine what tests to order
The tier that a possible diagnosis falls into will help you decide what tests to order to determine the final diagnosis. Think of each tier as a pretest probability.
Tier 1 diagnoses have a “high” pretest probability
- No tests or few tests may be needed to convince you that a diagnosis in tier 1 is responsible for the patient’s presentation and similarly you would need very convincing information to take it off your list completely.
- These and Tier 1e diagnoses should drive your initial investigations
Tier 1e diagnoses may have varying pretest probability
- These diseases may or may not be likely but regardless tests with high sensitivity are needed to rule them out (remember “SnOUT”)
Tier 2 diagnoses have a “medium” pretest probability
- Diseases on this tier are tricky. You really have to evaluate the sensitivity, specificity and information given from each test. You may need a few good tests get from a “medium” pretest probability to final diagnosis.
Tier 3 diagnoses have a “low” pretest probability
- Even relatively good tests may not move diagnoses from Tier 3 up to tier 1. The positive result that you get might be due to chance. Investigating these diagnoses should be a last resort.
These four tips won’t magically turn a medical student into an expert at clinical reasoning but they might serve to expose the way that experts think. They offer concrete ways for medical students to approach clinical reasoning and a common language for experts to discuss their approach with their learners.
For more information about MOOCs and why explicit discussion of clinical reasoning is important, see these links.
- Many MOOCs are available at Coursera on everything from jazz improvisation, to biostatistics, to the principles of cardiopulmonary resuscitation and everything in between.
- “Teaching Clinical Reasoning” by Michelle Lin (@M_Lin) at Academic Life In Emergency Medicine
- “Teaching Clinical Reasoning” by Nadim Lalani (@ERMentor)
- “Thinking about teaching thinking” by Robert Centor (@medrants)
- Lauren Westafer’s (@LWestafer) great medical student thoughts on “Thinking About Thinking” and “Metacognition for the Pragmatist”
- For a review of the Course and thoughts about how it might be applied to Facilitated Group Learning at Queen’s see Eve’s blog posts here and here.
- MOOC’s as they relate to Free Open Access Medical Education, “What is a MOOC” by Chris Nickson (@precordialthump)
A book that’s in my beach bag — Teaching What You Don’t Know
You know how there are books that everyone says you should read, and you just can’t get to it? I finally got to sit down with Teaching What You Don’t Know by Therese Huston after hearing about it, well, since she published it in 2009.
The author wrote the book for those faculty in a university/college who are asked to teach on subjects far outside their research areas, and end up teaching by the skin of their teeth, staying a day or two ahead of their students.
This may not seem as relevant for our meds, nursing or rehab therapy teachers, at first glance, but as I read through the book there were so many messages that I thought our colleagues in Health Sciences Education would value.
So here’s a smattering…(I’m still dipping back into this book, and it’s going up to the cottage with me.)
First of all, why not volunteer to teach in an area that is not that familiar to you? For example, could a cardiologist teach in a respiratory course? Could a neurologist teach in an anatomy course? What would an obstetrician bring to a gastro course?
Teaching in an area you’re not as familiar with can be very beneficial:
You learn something new and interesting, you connect with faculty outside of your traditional area, and you broaden your own areas of research and interest. But most importantly (to me anyway), you may spend more time thinking about the topic, more time thinking about the students and their learning level, and you may end up learning along with the students, perhaps thinking a bit more like them than you usually do. When I’ve seen some of our clinical faculty instructing outside their own comfort zone, what impresses me most is that they’re breaking down material into very understandable chunks–really helpful to our students.
Teaching as telling breaks down when you’re more of a novice in an area. It’s actually “disastrous” especially if you’re anxious already. As Huston says, students don’t learn as well when we’re doing all the work for them, and falling back on default lecture mode isn’t helping them any. If we’re teaching outside our comfort zone (or frankly in it :)) we should avoid asking ourselves “What do I have to cover today?” Huston offers these questions to start the planning with instead:
What do students already know about this topic?
How can I connect this new material to their knowledge?
Which examples will be meaningful to them and how can I structure time in class so they’ll get the most from these examples
Huston gives a great summary that is an effective introduction to “planning backward” or “backward design” made popular by two those two innovators in the field, Wiggins and McTeague. In Chapter 4, she cites 3 mistakes that novices to a subject area can make: over-preparing, lecturing too much, and focusing on lists. I blush to say that it’s not only novices who can make this mistake (ahem:).
Some of the best tips are in Chapter 5, “Thinking in Class”, where Huston looks at some great strategies to get students active, whether in a lecture, or small group session. Two of my own personal favourite activities are listed here: Think Pair Share, where students think about a question, work with a partner on the answer and present a shared answer to the class and Category Building, where students work to create charts/tables/schema and generate categories from the work they’ve done OR where you give students a list of categories and ask them to put the work into the right spaces. (This works well with an algorithm).
I enjoyed learning about Sequence Reconstruction, where students reconstruct a list of items into a proper sequence. This got me started thinking on how students learn well from errors, a fact borne home to me in a recent conversation with our Meds students about Directed Independent Learning. Several said they like having quizzes where the wrong answers have explanations for why the answer is wrong–“I go through all the wrong answers, even if I’ve gotten it right, because I learn so much more then,” said one. This is a whole other conversation, Teaching from Errors!
There are other chapters with gold in them, in the book: “Teaching Students You Don’t Understand” and “Getting Better” (Huston says she was going to call the chapter “Getting Feedback” but she realized that if we’re being honest, many of us shy away from feedback, especially if we’re already anxious:). I think I’d like to try her “clarity grid” exercise with students–it will give me a great understanding of what students are getting and where they are getting lost. And there is a good advice for Course Directors, Department Heads, and Faculty Developers etc. in “Advice for Administrators.”
In her appendices, Huston give us some great stuff: Ten solid books on teaching strategies (2 of our blog’s favourites are in there), a great activity for a Syllabus Review, and a sample mid-term evaluation (which is a very useful time to get student feedback).
I hope I’ve convinced you that even if you’re not a novice teacher, and even if you’re teaching in an area in which you’re knowledgeable, this book has great value. And who knows? Maybe you’ll be inspired to teach a bit outside your comfort zone. Either way, this is a good book to take on your vacation.
Have a good one!
image from http://cruise-dude.com/
Mentoring – a “win-win-win” proposition
What do practicing physicians remember about their medical school experience? What do they feel had the greatest impact on their development? What do they retain? My guess, based on many reunions and even more conversations with graduates, is that it’s not the classes, labs or examinations, but rather the faculty they encountered along the way. Of course we all remember the “characters” and the “larger than life” personalities that populate every medical school, but it’s those faculty with whom we were fortunate enough to develop a personal, one-on-one relationship that have the most enduring and significant impact on our development as physicians, and on our personal lives. We call such folk “Mentors”.
The derivation of the word “mentor” is interesting. The origin is Greek and is traced to Homer’s Odyssey. Mentes was a wise and valued friend of Odysseus to whom he entrusted the education of his son Telemachus when he set out on his epic voyage. The elements of wisdom and trust are therefore intertwined in the term, qualities obviously central to the role as we understand it today.
The value of mentorship is well known in all facets of professional education. It’s this realization that leads many schools and departments to deliberately develop programs designed to promote these mentoring relationships. At Queen’s, we have developed a program that assigns a mixture of students from all years in groups led by two faculty members. Like all such programs, much depends on the specific and usually unpredictable “chemistry” that develops among the group. When it works (and it usually does) the relationships that emerge are highly rewarding. Below I provide testimonials from two students and one faculty member regarding their mentorship experience that may provide some insights.
In a 1973 article “Indoctrination of the Medical Student” Dr. Vilter pointed out that turning a new, eager medical student into a competent, caring physician takes more than just training in science, more even than just training in science and clinical skills. The mentorship program at Queen’s has been a special part of my indoctrination to the profession. Our group’s main goal is to have fun in a relaxed way but I am always surprised at the impact of these casual interactions. Whether it be a night of bowling, an intense night of trivia or a simple evening over shared drinks and food, I always leave more energized and excited about what’s to come.
When a clerk in your mentorship group gives you a tip for the wards next year, you don’t forget. When the fourth year students graduate, you celebrate with them and picture yourself walking across the stage in a few years’ time. When a mentorship group leader encourages you to dream big, you might just.
And a few more interesting links that I have come across about mentorship in medicine:
Trivia…or is it? – this is a link to a post on my blog about trivia night earlier this year
Being a Mentor for Undergraduate medical Students Enhances Personal and Professional Development
Mentoring Programs for Medical Students- a review of the literature
Informal Mentoring Between Faculty and Medical Students
The Queen’s Medicine Mentorship Program has provided me the opportunity to have informal interaction and communication with Queen’s faculty and residents that I wouldn’t be able to experience anywhere else. In the hospital or after a lecture, it is hard to just walk up to a physician to inquire about what they enjoy about their profession or how they balance their personal lives with their work. Through the mentorship program, I have been able to build relationships with faculty and residents in a more relaxed atmosphere that is conducive to conversations about one’s future directions in medicine. Additionally, the mentorship program has also increased that sense of Queen’s community for me. As a pre-clerkship medical student, it can be intimidating to enter the hospital during your first clinical experiences. With something like the mentorship program in place, you begin to see the quality of physicians we have here at Queen’s and the encouraging, open teaching environment that they create. Ultimately, this interaction and positive community that the mentorship program has created for me has contributed to my learning and career exploration as a Queen’s medical student.
It is About Mentorship
Being a mentor in the mentorship program has been one of the most exciting aspects of being on faculty at Queen’s. At my mentorship group’s last meeting, we had breakfast. For our group, breakfast was a good time to get everyone together without the distractions that can happen with an evening out.
One of the first year students asked if we should have an agenda for the meeting, but the senior students just laughed. The agenda is always the same. I ask the senior students: “what is cool in what you are doing right now”? They answer, in the usual spectrum of experiences, and the junior students say: “wow, how do I get to do that”! That is mentorship in action.
While I enjoy checking in with all the students to see what is cool or if they are struggling, I think the students would rather hear from their near peers. I see our relationships not so much as a vertical structure, but a horizontal one. The clerk explains how to get an elective to the second year student. The second year student describes the observership program as a kind of “back stage pass” to the first year student.
Our group has enjoyed the group events and while I couldn’t make the “Great Mentorship Race & BBQ” in the park this spring, our group was well represented. Over the years we have had fun with Guitar Hero, and had pot luck suppers (which means that everyone has some food that they can surely eat without looking into all the dietary restrictions).
At the Convocation in May, I enjoyed meeting the family of one of my mentees. He said: “Dad, this is Dr. O’Neill, I beat him at guitar hero the second month of medical school. You couldn’t believe it when I told you we were playing guitar hero in his basement. I smoked him at guitar hero. In spite of that, three years later he taught me how to deliver a baby.”
In the years to come, memories of delivering a baby might fade in this future internist, but I will bet he will remember beating me at guitar hero. He may never know that I let him win.
And so it seems mentoring is truly a “win-win-win” proposition, benefiting both parties involved, as well as our school, which is becoming known for the value we place on faculty-student interactions at many levels. We’re always looking for more faculty willing to become involved in this program. If you’re interested, or simply wish to learn more about it, feel free to contact myself, Peter O’Neill or Erin Meyer in the UG office who coordinates the program. Erin can be reached at email@example.com.
Nourish your educational health and wellbeing
It’s summer time, and a good time to think of health and wellbeing. I heard of this concept from MaryEllen Weimer who writes in Faculty Focus when she wrote about taking care of our teaching vitality. She reminds us, “for too long we have assumed that by force of will we can make it through, semester after semester. Like someone out of shape climbing too fast, we gasp for air between semesters, over spring break, or that 2 week family vacation but it’s never enough.”
In our blog today, we’d like to challenge you to consider how you can nourish your educational wellness. What will you do for your educational self this year? What muscles can you stretch? What nourishing ideas can you take in?
Last week Theresa Suart featured several books that take medicine in different directions—novels, poetry…
(What’s on your summer reading list?)
It started me thinking of some other nourishing ideas for us all.
1. First is attending conferences. Many of you have attended or will attend conferences in your area of medical expertise. Don’t neglect conferences in education. Here are a few to think of:
a. CCME (Canadian Conference on Medical Education (CCME), Ottawa, April 26-30, 2014. http://www.mededconference.ca/ccme2013/
b. STLHE (Society for Teaching and Learning in Higher Education) (at Queen’s next!) http://www.queensu.ca/stlhe2014/stlhe2014 Kingston, June 17-20, 2014
c. ICRE (International Conference on Residency Education): http://www.royalcollege.ca/portal/page/portal/rc/events/icre Calgary, Sept. 26-28, 2013
d. The Ottawa Conference: Transforming Healthcare through Excellence in Assessment and Evaluation (not always in Ottawa but this coming year it is) April 25-29, 2014 http://www.ottawaconference.org/#!ottawa-2014/c16br
2. Other nourishment: great educational writers. Here’s what’s on my bookshelf for “dipping into”:
Bain, K. What the best college teachers do (great advice based on a huge study with lots of exemplars—very readable)
Kotter, J.P. Leading Change (anything by Kotter—a leader in the field of leading change—another definition of education?)
Holmboe, E.S. & Hawkins, R.E. Practical guide to the evaluation of clinical competence (Holmboe is intensely readable, intensely useful—and clinically oriented)
Marzano, R. et al. Classroom instruction that works: Research-based strategies for increasing student achievement (anything by Marzano et al is very useful!)
Angelo, T. & Cross, P. Classroom Assessment Techniques: A handbook for college teachers. (These two have a lot of practical ideas based on sound theory about assessment!)
Brookfield, Stephen & Preskill, Stephen. Discussion as a Way of Teaching (Brookfield has 2 new books out that I want to get my hands on: Teaching for Critical Thinking: Tools and Techniques to Help Students Question Their Assumptions (2011) and Powerful Techniques for Teaching Adults (2013))
Palmer, Parker. The courage to teach: exploring the inner landscape of a teacher’s life. (10th edition is now out. I think I have the third! One of the first teaching books I ever read)
Wiggins, G. and McTighe, J. The Understanding by Design Guide to Creating High-Quality Units (“Backward Design” is a great concept you’ll find so intuitive!)
3. Stretch those educational muscles: Follow a Blog or list:
There are a few I follow:
Faculty Focus, edited by MaryEllen Weimer, published by Magna http://www.facultyfocus.com/ I’ve quoted from MaryEllen before—she has a real gift and reads prolifically
Tomorrow’s Professor (actually it’s a list) from Stanford: http://cgi.stanford.edu/~dept-ctl/tomprof/postings.php
Medical Education Blog by Deirdre Bonnycastle (U. Sask) Lots of great ideas! Last one I read had a list of songs that match to different medical disciplines http://words.usask.ca/medicaleducation/
Team Based Learning Collaborative http://www.teambasedlearning.org/ (drink the TBL cool-aid—it’s very refreshing!:)
4. Consistent high quality nourishment is a good idea for the whole year. Subscribe (Try RSS feed) to Journals
Here are the top ranked medical education journals and one education journal I never skip. Our Bracken Library subscribes to all and the librarians can show you how to get an RSS feed so you get alerts and topics only! (Someday I’ll write about some general education journals—fascinating reading!:)
o Academic Medicine
o Medical Teacher
o Medical Education
o Advances in Health Sciences Education
o Medical Education Online
o Teaching and Learning in Medicine
o Medical Science Educator
o Basic Science Educator
o Journal of the International Association of Medical Science Educators
Do you have advice for nourishing our educational wellbeing? Please let us know through posting to the blog.
Revised Policy: Immunization and Communicable Disease Policy
Immunization and Communicable Disease Screening Committee is requesting comments on revisions made to the policy on Immunization and Communicable Disease Policy. A summary of the changes are listed below. The full revised policy may be viewed by clicking here. Please submit all comments no later than July 22, 2013 by using the “Discussion” Comments: Communicable Disease Screening Policy
The changes to this policy are as follows:
- Students are now required to submit evidence of their status, in accordance with the Ontario Hospital Association (OHA) Communicable Disease Surveillance Protocols.
- Document review is now in conjunction with an Occupational Health, Safety and Infection Control consultant.
What’s on your summer reading list?
Theresa Suart, our Educational Developer weighs in on how to nurture your educational self over the summer. We compiled a list of reading that may help stretch your medical/educational muscles over the summer. To make our list a book had to be recommended by a clinical faculty member as one that has changed or enhanced her/his perception of medicine or medical matters. Dr. Shayna Watson was very helpful in bringing to light some of the Medicine in Literature books. We’ve asked for your help in referring other books, so please jump in!
Remember days lazing at the beach, latest bestselling novel in hand? Or too-short summers with too-long required reading lists? Whatever your summer reading memories, longer days seem to go hand-in-hand with book list suggestions, so the Education Team decided to add its five-cents’ worth to the conversation.
Whether you’re getting away for a couple of weeks to the cottage, or still slogging away on the wards of KGH, summer can be a great time to expand perspectives, explore new ideas and nurture your soul with a good book.
So here’s our “Summer Ten” list (it’s not a “top 10” or a “10 must read”, it’s a “consider this” list… just to get you started). If you pull one of these from the shelves, please let us know what you think of it.
1. The Emperor of All Maladies: A biography of cancer by Siddhartha Mukherjee (available in the Stauffer Library)
2. The Curious Incident of the Dog in the Night-time by Mark Haddon (available in the Education Library)
3. Nocturne: On the life and death of my brother by Helen Humphreys (On order by Stauffer Library)
4. Care of the Soul in Medicine by Thomas Moore
5. Kitchen Table Wisdom by Rachel Naomi Remen (available in the Kingston Frontenac Public Library)
6. Intoxicated by My Illness by Anatole Broyard (available in the Kingston Frontenac Public Library)
7. Cutting for Stone by Abraham Verghese (available in the Kingston Frontenac Public Library)
8. Bloodletting and Miraculous Cures: Stories by Vincent Lam (available in the Stauffer Library)
9. The Checklist Manifesto: How to get things right by Atul Gawande (available in the Bracken Health Science Library)
10. Any of Atul Gawande’s essays from the New Yorker: http://www.newyorker.com/magazine/bios/atul_gawande/search?contributorName=atul%20gawande)
And a bonus #11 since any reading list needs some poetry (thank my Dad, the English teacher and poet, for instilling this in me):
In Whatever Houses We May Visit: Poems that have inspired physicians, edited by Michael A. LaCombe, and Thomas V. Hartman.
(Here’s a sample, from the previews on the acponline.org site, Pathology Report by Veneta Masson:
If you pull any of these from the shelves, please let us know what you think of it.
What’s on your list? Share your suggestions in the comments section below.
Student Directed Learning ”Everything old is new again”
My undergraduate education was enlivened by a number of professors who were fond of taking rather unconventional points of view, many of which would be considered “politically incorrect” in today’s parlance. They were even fonder of defending those perspectives with spirited and colourful debate. Perhaps the leading proponent of this approach was Dr. Tony Travill, professor of Anatomy, who would spend more of his curricular time discussing points of professional practice and social foibles than the assigned topics of embryology or anatomy. On the rare occasion that one of us mustered the temerity to point this out, he would make the rather emphatic point that “universities aren’t centres of teaching, they’re centres of learning”. The message was clear – it wasn’t his business to teach so much as it was our responsibility to learn. Our goal should be to learn for the benefit of our future patients, not simply to satisfy curricular goals. I recognize in retrospect that his not-to-subtle shift of emphasis helped us to transition from being passive consumers of information to what today’s educational theorists would term “active learners”, although we had no idea this was happening at the time.
Turing our attention to the present, one of our 2015 students, Eve Purdy, spoke eloquently at the recent Celebration of Teaching Day of how she addressed her interest in the process of clinical decision-making. She searched the internet and came upon a free web-based seminar series from the University of California (San Francisco) that she accessed over several weeks and found quite useful. She shared the information with others, both students and faculty who also made use of this resource. As teaching faculty, we should take considerable comfort in the fact that our students are, on their own, seeking opportunities to advance their learning, often going beyond the baseline requirements of our curriculum.
In fact, our students make use of a wide variety of unstructured learning opportunities in addition to standard curricular offerings such as Courses, Integrated Learning Streams, various types of Small Group Learning, clinical rotations and assigned projects.
Last academic year, about 20 Student Interest Groups were active, each developing a series of at least 8 learning sessions outside standard curricular time that were devoted to a particular discipline or theme. Although supported by faculty on a voluntary basis, students developed the themes and content of these sessions. The following is a list of some of the groups that were active this past academic year:
In addition, our students informally access the world of information available to them through the internet and social media. A world of information is literally at their fingertips, and they make use of this almost continuously, both to search information and to dialogue with each other, with faculty (sometime during lectures), and people farther afield. The challenge is not access, but rather discernment of relative value.
Perhaps the most powerful non-curricular learning experience our students engage is what’s been termed the Hidden Curriculum. This term refers to all of the unintentional but incredibly powerful messaging that occurs in the context of their environment and clinical experiences. Observing a respectful and effective interaction between an attending physician and nursing staff provides a much more effective and durable lesson than hours of formal teaching on the topic of professionalism.
The challenge for teaching faculty in the midst of all this is to keep pace what’s happening around us, and to shift our focus from delivering content to guiding the learning process. To borrow an old adage – we can’t control the wind, we can only set our sails. In this environment, it becomes more important to set the objectives and provide direction than to attempt to rigidly control the process.
And so, as the song says “Everything old is new again” when it comes to student directed learning in medical education, although technical advances and connectivity expand the potential (and our challenge) tremendously. I like to think Dr. Travill would be amused.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
MedEdPortal: a great resource
MedEdPortal is a repository of online modules, and other tools that are vigourously peer-reviewed and suitable for medical and other health professions education. To find out more about this great resource, to to their short video: www.mededportal.org/about