Grade Inflation – the “dirty little secret” of academia

“Would any of us have gotten into medical school today?”

This was the tongue-in-cheek question I posed to my classmates at our medical school reunion last year. They were rather amused by it and, being very much aware of the high academic standards required by our current admissions processes, believed the answer was an obvious “no”. I tried to raise some doubt arguing (with what I thought at the time was more fantasy than reality) that our marks, like the dollar, had been “devalued” over the years. They weren’t really buying it. However, I’ve since come to learn that what I thought at the time was fanciful conjecture was closer to truth than I realized.

We’ve all become quite accustomed to the term “inflation” as it relates to economics. The dictionary definition goes like this:

 

“a continuing rise in the general price level usually attributed to an increase in the volume of money and credit relative to available goods and services.”

 

To those of us less financially sophisticated, it basically means a dollar doesn’t buy as much as it used to. The important corollary is that the amount of money we possess or earn becomes progressively less valuable as its purchasing power steadily diminishes.

It’s perhaps a little surprising to find the same term applied to academic grades. In fact, considerable information is available on the topic, which has been termed by some as the “dirty little secret” of university and college academic programs.

Well, if it’s a dirty little secret, it’s certainly not a very well kept secret. A Google search of the term took less than half a second to come up with over 4.5 million references:

 

 

 

There’s actually a website called GradeInflation.com that features the following chart prominently:

 

And so, a closer look at the phenomenon would seem to be in order. With the capable assistance of Sarah Wickett, Health Sciences Librarian, we identified a few key papers to shed a little more light on the topic. We set out to address three questions: Is there real evidence of grade inflation? If so, what are the causes? Does it matter?

 

Is it real?

Paul Anglin and Ronald Meng of the University of Windsor undertook a study of this issue that was published this year in Canadian Public Policy (volume xxvi:3). They compared the grades awarded by seven Ontario universities in 12 first year courses between 1974 and 1994. To summarize their findings:

  • The average GPA rose in 11 of the 12 courses. Of the 80 course-university combinations studied, 53% had grade inflation of at least 10%, 31% had no statistically significant change, and grades fell in 16%. The rate of inflation was not uniform, with the greatest increases occurring in English, Biology and Chemistry.
  • The percentage of students receiving an “A” increased overall from 16% in 1974 to 21% in 1994, while the percentage receiving “F”s declined from 9.5% to 6.7% during the same time. This trend was true in 11 of the 12 courses of study, with Sociology being the only exception. English, Biology, Music and French have the greatest increases at the upper end of the distribution. In Biology courses, for example, the percentage of students getting “A”s increased from 12.8 to 22.6%, while the percentage receiving “F”s declined from 9.1 to 5.7%.
  • The variance, or distribution of marks, within courses declined or stayed the same in all courses. In other words, the “bandwidth” between high and low achievement tended to diminish.

 

This phenomenon does not appear to unique to Ontario. In Studies in Higher Education (2017, 42:8;1580) Dr. Ray Buchan of the University of Brighton reports on the proportion of “good” or Honour degrees awarded by 100 universities in the United Kingdom. He reports an increase from 47.3% in 1994/95 to 61.4% in 2011/12, which in absolute terms represents an increase of 113%. Perhaps more significantly, the proportion of “first-class” degrees awarded more than doubled over the same time, increasing from 7 to 15.8%. In his article he quotes the Universities Minister David Willets who states: “the whole system of degree classification does need reform”.

There has been considerable study of this issue in American universities. Dr. Stuart Rojstaczer reported on 29 schools, showing and increase of 0.15 points on the 4 point GPA scale since the 1960s, with greater rates on increase in private versus public schools (Grade Inflation at American colleges and universities. Available at www.gradeinflation.com).

The University of Arkansas was concerned enough about grade inflation that it commissioned a Task Force on Grades in 2004 to examine the phenomenon. The results, reported by Mulvenon and Ferritor (International Journal of Learning 2005/2006;12(6):55) confirm steadily increasing undergraduate GPAs, increasing from 2.76 to 2.95 between 1992-93 and 2003-04.

 

What’s the cause?

So, it seems, this is a real phenomenon, but what’s the cause? One could conjecture three possible mechanisms:

 

Possibility 1: The students are better prepared.

Over the years, young people have had greater access to early education and have been exposed to more advanced educational methodologies. They have also had the benefit of rapidly expanding technology that not only enhances their educational experience but also enables them to access information and learning much more continuously and easily. In fact, young people are literally immersed in learning opportunities, both inside and outside the classroom. They have also had opportunities to engage more intellectually stimulating extra-curricular learning opportunities, both through the educational system and their private lives. Perhaps all this has resulted in young people who begin their post-secondary education with considerable advantages relative to their predecessors.

 

Possibility 2: Universities and colleges are doing a better job of educating.

There has certainly been an increased emphasis on teaching at most colleges and universities. Faculty are expected to have real teaching skills and qualifications, which are sought after and recognized. They have also benefited greatly from advances in educational methodologies and technologic advances.

All sounds good so far, but then there’s…

 

Possibility 3: It’s just easier for everyone involved to give good marks.

Good marks = happy students = fewer challenges for faculty = better faculty evaluations = happy faculty

We therefore have a “virtuous cycle” which would, on the surface, appear to be a “win-win” for all involved. The course, program and institution also benefit in an environment where pass rates are seen as a key marker of success (eg. Macleans magazine rankings) and students are drawn to places where they are more likely to achieve high grades that will make them more competitive for graduate studies and eventual employment.

Unfortunately, there’s been much less investigation into the causes of grade inflation. However, there have been some interesting analyses.

In an intriguing article entitled “Whose fault is it?” R.T. Jewell and colleagues attempt to determine whether higher grades are related to improved academic aptitude of students or changing practices among university teachers (Applied Economics 2013; 45: 1185). Using data from 1683 separate courses taught in 28 different departments by 3176 instructors at a large public university over a 20 year period they develop a series of complex mathematical models that leads them to conclude that “the average GPA in our sample…increased by 0.1459 grade points due solely to unobservable instructor characteristics.” They go on to identify instructor-specific issues as the main determinants of grade inflation. Their analysis did not allow them to be more specific about the nature of those characteristics.

In the Arkansas Task Force reported cited above, the authors speculate on a number of potential causes, including higher entrance ACT scores, but conclude “ a definitive case can be made that increasing entrance scored, academic expectations and better secondary institutions are contributing increased composite grade point averages. However, given this is true, it still does not explain all of the grade inflation”

 

And so, it would appear that the third cause where students, faculty and universities all benefit from a more liberal distribution of grades is at least a contributor.

 

Does it matter?

In one respect, it might be tempting to shrug this off as a “win-win-win” situation, in which students benefit, teaching faculty avoid the inherently difficult and stressful task of comparing and quantitating differences in the accomplishment of their learners, and institutions can develop flattering metrics that keep them competitive.

However, we recognize there’s no free lunch, and there are clearly costs to all this that merit consideration. A few that come to mind:

  1. Devaluation of degrees and diplomas. Just as our dollars lose value in the context of economic inflation, grade inflation threatens to diminish the value of our degrees and diplomas
  2. Fairness. The truly outstanding and highly committed students get lost amid all the high marks. Some of those A’s really are A’s, but can’t be distinguished from those that perhaps shouldn’t be.
  3. Misconceptions among students. Grade inflation may be giving students misinformation regarding their strengths and weaknesses, and therefore leading them to inappropriate career decisions.
  4. Confusion on the part of downstream programs and potential employers. Providing misleading academic profiles can lead to poor selections, which, ultimately, are unfortunate and potentially very damaging for all involved. What may seem like a charitable act can therefore turn out to be quite the opposite.

 

In case I’ve left anyone with the impression that this is an entirely modern phenomenon, let me end by quoting a report from the Committee on Raising the Standard, commissioned by Harvard University officials in 1894:

 

“Grades A and B are sometimes given too readily – Grade A for work of not very high merit, and Grade B for work not far above mediocrity”

 

If that group stemmed the tide, it would appear from recent studies that the issue has re-emerged.

Getting back to the question I initially posed at the beginning of this article, all this may provide some solace to my classmates, but as an institution that prides itself on high standards and academic excellence, should we be concerned?

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

 

Many thanks to Sarah Wickett, Health Informatics Librarian, Bracken Library, for her valuable assistance in the compilation of information for this article.

 

 

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Facebook thinks I’m a doctor…

 

And other unusual things that happen when you’re an educational developer at a medical school

It’s a unique and interesting thing being one of the non-medically-trained employees who work (mostly behind the scenes) to help run the undergraduate medical education program at Queen’s. On the one hand, friends and family can sometimes think I’ve magically completed medical school in the types of questions they ask me. (I only work there, I say). On the other, through day-to-day interactions, I have absorbed terminology and “insider” information.

Having quietly marked my five-year anniversary working in medical education at the end of September, it was time for a little reflection. Here are five of the more unusual things that likely wouldn’t have happened to me before I worked at Queen’s School of Medicine:

  1. A new resident was surprised when, during a follow-up visit, I referred to my condition by name (gastroesophageal reflux disease), rather than calling it heartburn. “Most people don’t call it that,” she observed with surprise. I’d just done a curricular search for where and when we teach it – and at the earlier visit, that’s the term they used, so I paid attention.
  2. I can find my way around most of HDH and most of KGH most of the time. And I know there are THREE hospitals in Kingston, not two. (I just haven’t figured out the new Providence Care layout yet.) I’ve learned the “logic” of the multiple wings, the naming conventions, and – when all else fails – where to find the volunteer desk to ask directions.
  3. I now know that what you think something is might not be what it actually is. Case in point: My colleague’s son was diagnosed with OCD – but he’s not the least bit obsessive, so how does he have obsessive compulsive disorder? There’s another OCD, diagnosed by orthopedic specialists: Osteochondritis Dissecans of the knee. (It also stands for Ontario College Diploma, but that’s another story).
  4. Facebook thinks I’m a doctor. No, really, I get ads for MD Financial Management services, and medical conference. It’s based on analytics harvested from my Google searches (because everything is frighteningly linked these days). I search for things to assist with curriculum development, and voila! Facebook has changed my profession.
  5. I actually use those ubiquitous hand sanitizer dispensers while entering and leaving the hospitals. Every single time.

Because, as an educator, I just can’t help it: here are educational take-away lessons and considerations from these musings:

  1. When you’re “inside” you can forget what it’s like to be “outside”: how can remembering this influence communication, for example, in explaining acronyms, procedures, or what happens next? There’s power in language and understanding.
  2. When we’re familiar with buildings and facilities, it’s easy to forget what it’s like to be in an unfamiliar place and worried about getting around. How can we make instructions and directions as clear as possible?
  3. Don’t assume. If you’re not sure: ask. For example, we’re talking a lot about EPAs lately in undergraduate medicine. We don’t mean the US Environmental Protection Agency, but Entrustable Professional Activities. Even if we’re trying hard to adhere to my suggestion #1, we might slip up. Speak up and ask for clarification.
  4. Facebook still thinks I’m a doctor now and again, but more recently it’s promoting space-saving storage ideas and junk removal services. (I’m still adjusting to our downsized townhouse, 15-months in). The lesson here: We leave digital footprints everywhere we go. Intentionally (e.g. through public Twitter posts) or unintentionally through Google searches, nothing we do online is private. How should this influence what we do and how we do it?
  5. Paper cuts and hangnails do not like hand sanitizer. At all. Ever. Be careful.

Here’s to the next five years.

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Nominations open for next Exceptional Healer Award

Instilling the values of patient-centered care is one of our goals in the UGME program. It’s also what the Kingston Health Sciences Centre Exceptional Healer Award recognizes in physicians from both the Hotel Dieu and KGH sites.

Launched earlier this year, the Exceptional Healer Award is sponsored by the KHSC Patient & Family Advisory Council. It honours a physician who demonstrates in clinical practices the core concepts of patient- and family-centred care: dignity and respect, information sharing, participation, and collaboration.

Patient Experience Advisor Sue Bedell brought the idea of the award to the Patient and Family Advisory Council and is now coordinator of the award project.

Patient Experience Advisor Susan Bedell

“I happened to have a particularly compassionate and empathetic doctor,” Bedell explained in an interview for how she came up with the idea. “I think it’s important for all people, for all physicians, and healthcare professionals, to be treating sick and injured people with compassion and empathy.” So, she looked for a way to recognize this. She presented her idea to the council at Hotel Dieu, and drafted terms of reference and a nomination form. “I wanted to make sure that I could persuade not on the patient council, but the administration that this was something doable, so they approved it,” she said.

For the first time through, Bedell had hoped to get five or six nominations: instead, the council received 22. Response to the creation of the award was “better than I had ever expected,” she noted.

A selection committee, including Bedell, two other patients, two staff members, and the chief of staff, reviewed these submissions. For the first award, it was a tie: ophthalmologist Dr. Tom Gonder and anesthesiologist Dr. Richard Henry were the winners for 2017. Each received multiple nominations, Bedell said.

Bedell shared that the major themes from all the 2017 nominations were the nominated physicians were dedicated listeners, showed empathy and compassion, took time to spend with patients, focused on inclusion and care of family members, shared information with patients, and demonstrated humility.

“All of these are easy to attach to the core concepts of patient- and family-centred care,” Bedell noted.

Following the first iteration, which had a February deadline, it was decided to run the next iteration earlier in the year, with a November deadline for nominations with the committee’s decision in December, and the presentation early in 2018. The deadline for nominations is Friday, November 3.

Patients and family may nominate a physician who has provided care to them in the last two years. KHSC staff can also nominate members of the health care team. Bedell said that medical students on clerkship rotations can submit nominations.

“I do hope, in the long run, that through this award, and these role models can influence medical students,” Bedell said. “When they listen, to have the intent to understand, rather than just reply – that would be an example.”

“Being a dedicated listener seemed to be most important to the nominators,” she added.

Bedell emphasized that both KHSC hospital sites are full of very competent, skilled, compassionate doctors, and this award is one way to recognize these attributes

There’s still time to nominate a physician for the 2018 award. With the amalgamation of the two sites into the Kingston Health Sciences Centre, physicians from both the Hotel Dieu and Kingston General Hospital sites are eligible to be nominated. Full details are found here on the Exceptional Healer Award website.

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Students striving to make a difference in our community

One of the attributes that our Admissions Committee works very hard to identify in applicants is a commitment to service. This has multiple dimensions, involving service to both individual patients and communities. It’s therefore always very gratifying to learn of efforts such as that described below in todays guest article provided by students Lauren Wilson, Katherine Rabicki and Melissa Lorenzo.

 

In Canada, access to health care is seen as a universal right.  When people think of access to care, however, we tend to define it by the availability of medically necessary procedures and frequently neglect consideration of preventative measures.

Cervical cancer has few symptoms, therefore it often progresses to a late stage before it is diagnosed. Yet cervical cancer is the most preventable of all cancers. By having pap smear screening tests, minor cervical abnormalities can be identified early and followed to ensure proper treatment. Pap smears have proven to be incredibly effective screening measures… so long as patients have access. Patients without a family physician or who cannot attend regular clinic hours often slip through the cracks, and as a result they may receive a cancer diagnosis that could have been easily prevented. Moreover, with the screening guidelines constantly in flux, patients may have outdated information regarding their eligibility.

Barriers to women’s health and access to care, including regular pap smears, are abundant.  To name a few: patients may not have a primary care provider, be able to attend daytime clinic hours, had a negative experience in the past, or have a history of abuse.  A significant barrier, that cannot be understated, is that pap smears are part of an intimate examination. Extra effort must therefore be made to cultivate a care environment that is sensitive and safe, in addition to accessible.

Started in 2015 during Cervical Cancer Awareness Week to help reduce barriers to care, Pap Party aims to educate the public on the importance of cervical cancer screening and to provide a safe space for eligible patients to be screened. Unfortunately, many women facing these barriers (and more) are from marginalized or underserved populations, including First Nations’ communities. While reducing the barriers completely will take years due to their multifactorial nature, expanding Pap Party clinics to outside the Kingston city limits serves as a critical step towards providing marginalized populations safe, accessible care. As all of our clinics, including in Kingston, Deseronto, Napanee, and Tyendinaga were situated in Indigenous territory, we worked hard to ensure the clinics were run in a culturally sensitive manner so that patients could receive the best possible care.

In 2016, 18% of the individuals who came to our Pap Party clinics were found to have abnormal pap smears that required follow-up by Gynecologic Oncology at Kingston Health Sciences – Kingston General Hospital site. Had it not been for these clinics, these patients may have never been identified!

In addition to running these clinics, this year we also promoted Cervical Cancer Awareness Week to all clinics in the South Eastern region to encourage clinics to host their own Pap Party. We are incredibly happy to announce that several clinics also hosted Pap parties including Kingston Street Health, and clinics in Belleville and Verona.

Every year more and more women are getting tested. We are proud to announce that this past week, Oct 16-19 2017, we had over 30 women attend our clinics and receive a pap test. Many of these women did not have family physicians and would have otherwise not had accessible access to pap tests.

If you are interested in hosting your own Pap Party, or finding an available clinic, you can find more information at https://fmwc.ca/events/pap-campaign/

We could not be more excited to have been a part of such an important campaign! Thank you to all the Queen’s University Obstetricians and Gynecologist residents and medical student volunteers who made this event possible.

 

Lauren Wilson, Katherine Rabicki (Queen’s Medicine Class of 2019), and Melissa Lorenzo (Queen’s Medicine Class of 2018)

 

 

 

 

 

 

 

 

 

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Mentorship isn’t rocket science – or is it?

One of the most consequential communications in modern history took the form a letter sent by Albert Einstein to American President Franklin Roosevelt on August 2, 1939.

“Sir: Some recent work by E. Fermi and L. Szilard, which has been communicated to me in manuscript, leads me to expect that the element uranium may be turned into a new and important source of energy in the immediate future. Certain aspects of the situation which has arisen seem to call for watchfulness and if necessary, quick action on the part of the Administration. I believe therefore that it is my duty to bring to your attention the following facts and recommendations.”

They go on to describe how a “nuclear chain reaction” could be produced that could result in the development of “extremely powerful bombs”. They further warn that German scientists were engaged in this work and were actively preserving sources of uranium in Czechoslovakia.

The message was not lost on Roosevelt, who was said to have declared to his aides, “This requires action.”

He responded to Einstein shortly after receiving the letter:

“I found this data of such import that I have convened a Board consisting of the head of the Bureau of Standards and a chosen representative of the Army and Navy to thoroughly investigate the possibilities of your suggestion regarding the element of uranium.”

This led to the development of the Manhattan Project, a massive research project which eventually involved 130,000 people at over 20 sites around the United States (and Canada) requiring an investment of 27 billion (current day equivalent) dollars. Although the purpose was to develop weaponry to ensure success in the Second World War, it also resulted in advances in the understanding of nuclear technology and energy.

Although many will have reservations about the motivation or eventual outcome of the project, it’s an impressive story as to how history can turn on a single, well placed communication.

What’s not widely appreciated is that the original motivation to write the letter came not from Einstein, but from Leo Szilard.

Szilard was a Hungarian born physicist and former pupil of Einstein. As a student at

Leo Szilard

the University of Berlin in the 1920s, he impressed Einstein (no small feat), who awarded him highest honours for his doctoral dissertation. The two then began a seven year professional collaboration that resulted in a number of inventions, including the Einstein-Szilard linear induction pump. Szilard went on to distinguish himself independently, and is credited with conceiving the concept of the neutron chain reaction, which led to pioneering work in atomic energy.

During the 1930’s, his belief in the power and potential of nuclear energy was not universally shared among the scientific community. Szilard was becoming concerned about the increasing research and military interest emerging in Hitler’s Germany. In an attempt to enlist support and sound the alarm, he turned to his old friend and mentor.

During the summer of 1939, Einstein was vacationing on Long Island. Szilard would drive from where he was working in Manhattan to visit his former teacher, who would greet him in rumpled clothes and invite him to tea on his porch.

Einstein and Szilard, from a documentary recreating the events of 1939

There, Szilard presented available research, his theories and concerns, eventually convincing Einstein of the threat. Together, they decided to take action, and enlisted the help of Alexander Sachs, an economist and close advisor of the President, who agreed to take a letter personally to Roosevelt. They agreed the best approach would be a short, direct communication, signed by Einstein alone.

 

This account has much to teach us about social responsibility of scientists and the importance of effective communication between the academic and political communities. However, the message that struck me, and which is most relevant to a medical education blog, relates to the relationship between a student and their trusted teacher-mentor. None of these events would have transpired if there had not been a relationship of trust between Einstein and Szilard.

 

Here at Queen’s, we have many examples of very effective mentoring of our students by engaged faculty members. An example that recently came to my attention involves a cardiologist colleague of mine, Dr. Adrian Baranchuk, whose mentoring of two students Bryce Alexander and Sohaib Haseeb has recently resulted in a review article in Circulation, one of the most prestigious journals in the cardiovascular world (Haseeb S, Alexander B, Baranchuk A. Circulation 2017;136:1434-48). In fact, Dr. Baranchuk has a long history of supporting countless students and residents. These collaborations have resulted in many publications and, more importantly, continuing mentoring relationships that now extend across the country.

Dr. Adrian Baranchuk
Bryce Alexander
Sohaib Haseeb

 

 

 

 

 

 

 

 

 

 

 

Universities should strive to not only transfer knowledge to our students, but to help them develop as responsible and free thinkers who will themselves contribute to society and, in turn, pass along those values, perhaps eventually even teaching the teachers. These intergenerational, continuing mentor-mentee relationships are essential to those goals, as the Einstein-Szilard story illustrates. I’m pleased to report that, thanks to dedicated teachers like Dr. Baranchuk, it’s also very much alive at Queen’s.

 

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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Meet Jenna Healey, the new Hannah Chair in the History of Medicine

The new Jason A. Hannah Chair in the History of Medicine knows most Queen’s medical students aren’t going to memorize historical dates and events as a matter of routine, and that’s perfectly okay.

Dr. Jenna Healey notes that instead focusing on dry facts – that these days can readily be looked up — one excellent use of history is “to take a step back every once in a while and to think about the bigger picture.”

“Sometimes it’s easier to do that when you’re thinking historically because you have that little bit of distance. And then you can apply those same critical thinking skills to ongoing controversial issues or new things that come up within your career.”

“We might be looking at a bio-ethical case from the 1960s and, well, ‘they were so wrong,’ right? I’ve taught history of bioethics before, and we have to think about contemporarily, how did people understand what they were doing, what were the standards of their profession? Not necessarily to defend something that we now understand to be unethical, but to understand what the environment was like for those physicians – and then to think about what we find acceptable. Because, in 50 years, inevitably, someone is going to critique us.”

“Sometimes it’s easier to think about these things historically.”

Healey herself didn’t set out to become an historian – of medicine or anything else. Her undergraduate studies found her juggling her twin interests in humanities and science. To accommodate this, she pursued a combined arts & science program at the University of Guelph. “It was a Bachelor of Arts and Sciences,” she explains, “so basically a BA and a BSc at the same time.”

“I was doing an English literature degree along with a molecular biology degree and I was thinking about going to med school, maybe going into public health, and my other career in my head was to be a science journalist,” she shares. “Part of my program requirement was to take an introductory history of science course because you sort of had to combine the two – and I really liked it. So I ended up getting a summer job in the history department as a research assistant; and then the next summer I worked there, too.”

That’s when she started learning about the history of medicine as a discipline. This led her to do a master’s degree in the history of science at the University of Toronto, and later a PhD at Yale. “And I just never left,” she says.

“It turned out to be a very good way to combine my two interests,” she adds, “And to stay within the world of medicine and science without becoming a clinician.”

Prior to being appointed to her position at Queen’s on August 1, Healey was a lecturer at Yale, where she mainly taught pre-medical students. “I’m really excited to have the opportunity to work directly with medical students,” she says.

She hopes much of what she brings to students is that focus on the big picture.

“I want them to think think critically both about the past of the profession, and as cliché as it may be, to learn from the mistakes of the past, and the paternalism of the past, and to really think about themselves as part both of a longer historical legacy, to think about the socio-economic determinants of health,” she explains. “I think history really helps with that: to think about why is our health care system the way it is? How do your patients perceive the medical profession? How does the public perceive medicine? What are the notions they are coming in with?”

Healey also hopes to help students “think critically about the ways new technologies are going to change patient care and the clinical experience, both for physicians and for patients, because technology is something I’m really interested in.”

Healey recognizes that it can be a challenge to “sell” students on the value of spending time on the history of medicine – something her predecessor, Dr. Jacalyn Duffin did in the position for 30 years before her retirement.

“I think you always have to do a bit of justification for why you’re even learning this, and I understand that, as someone who was an undergraduate in the sciences: There is just a lot to do,” Healey says. “There’s a lot to learn, there’s a lot to memorize, a lot of labs to finish. And it’s hard to see, maybe the relevance in that moment, because you just have so much to finish.

“I think, especially in a medicine curriculum, it’s to constantly say ‘it’s ok to take this hour’; this is worth learning, and to get across the idea that people who haven’t taken a lot of history think it’s just a lot of boring facts, and that the point of it is to memorize those facts – and that’s not it at all

“If you leave medical school here and you don’t remember all the details of Harvey’s discovery of circulation, I’m fine with that,” she says. “But it’s more the critical thinking and the historical thinking. And when you do encounter a problem in your career, you can think: how did things get this way? If people take that away, I’d be very happy with that.”

In addition to the lectures and other learning events she has already been working on, Healey has met with members of the student-run History of Medicine group.

“It was exciting for me to get here and see there was already an established a group of students who are very excited about the history of medicine – and that’s all a credit to Dr. Duffin and the program she already had in place and the students are so fired up and excited about it.”

There’s already talk of the next “History of Medicine” trip. “I think it’s a great tradition and I’m really excited about it,” she says, noting all the planning is student-led and logistics (including destination) are in the works.

Dr. Healey will soon be settled into her new office at 80 Barrie Street and looks forward to meeting more students and colleagues.

“I’m very excited and very happy to be here.”


For more on the Ontario Hannah Chairs, check out this link.

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Curriculum Committee Information – July 27, 2017

Faculty and staff interested in attending Curriculum Committee meetings should contact the Committee Secretary, Candace Miller (umecc@queensu.ca), for information relating to agenda items and meeting schedules.

A meeting of the Curriculum Committee was held on July 27, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of the July meeting can click HERE to be taken to the Curriculum Committee’s page located on the Faculty Resources Community of MEdTech Central.

Those who are directly impacted by any decisions made by the Curriculum Committee have been notified via email.

Students interested in the outcome of a decision or discussion are welcome to contact the Aesculapian Society’s Vice President, Academic, Justine Ring at vpacademic@qmed.ca.

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From campus to community: the Loving Spoonful Service Learning Project

By Steven Bae and Lauren Wilson, MEDS 2019

“Let food be thy medicine, and medicine be thy food” – Hippocrates

Food. It is a vital part of our existence, and is a focal point in many cultures. Over the course of one year, a person who eats three meals a day consumes 1092 meals. It plays such a large role in everyday life that sometimes it is easy for us to overlook.

The importance of food security to one’s overall health is well known. Food security is defined as “all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active healthy life.” [1] A recent JAMA study reported that suboptimal intake of nutrients and healthy foods was associated with over 45% of deaths due to heart disease, stroke, or type 2 diabetes. [2] Yet for too many people, adequate access to nutritious food is out of reach. Some of these people live right in our community.

Photos courtesy of Loving Spoonful

The neighbourhoods in North Kingston make up 20% of the total population, and their average income is 22% lower than the city average. [3] The people living in North Kingston are twice as likely not to have completed high school, and twice as likely to be living on low incomes. [3] Many physicians that know their patients may not always be able to afford food ask their patients at appointments if they have enough food. Some family health teams even have an emergency supply cupboard in their office for extra food to give to patients who need it.

To increase awareness of these issues, we became closely involved in helping develop a service learning project in partnership with Loving Spoonful,  an organization that works to achieve a healthy, food-secure community. The project is structured around community cooking programs for low-income Kingston residents with medical students as volunteers. On top of building food literacy and confidence in preparing healthy foods among class participants, the goals of the project were to expose medical students to the Kingston community, provide information about food security in Kingston, and encourage them to create a dialogue with the participants in order to learn more about what they can do as future physicians.

The project also allows for students to accompany a physician from the Kingston Community Health Centres to visit the home of a patient living on a fixed income. The students have found that this experience has been eye-opening to appreciate firsthand the ways in which barriers can be specific to individuals. For example, if an individual has difficulty standing, the food s/he buys has to be prepared quickly, which limits his or her choices. Underpinning all of these experiences is a facilitated debrief and written reflection at the end, which allows students to share and document their insights, challenges, and surprises.

Ten medical students have participated in the service learning project thus far, with more students registered for this fall. All of the students have enjoyed this project in many aspects, from improving their own food preparation skills, to developing rapport with the local Kingston residents.

Overall, we are walking away with a greater appreciation for the social determinants of health. As future physicians, the social inequities that underlie many chronic diseases may seem insurmountable. However, this work is not solely our own. Organizations like Loving Spoonful play an important role in our community to address upstream factors that we eventually see presenting as illness. Being knowledgeable about the resources available in our community is a small but helpful step we can take to help our patients address challenging socio-economic circumstances.

Thank you to Loving Spoonful for your invaluable partnership in developing this project and the Kingston Community Health Centres health team for contributing to student learning. We would also like to gratefully acknowledge the City of Kingston and United Way for their Community Investment Fund, as well as the Kaufman Endowment fund, which helped fund this program.


References
[1] Committee of World Food Security
[2] Micha R, Penalvo JL, Cudhea F, Imamura F, Rehm CD, Mozaffarian D. Association between dietary factors and mortality from heart disease, stroke, and type 2 diabetes in the United States. JAMA 2017;317(9):912-924.
[3] Kingston Community Health Centres. A community needs assessment of North Kingston neighbourhoods. June 2010

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The Meds 2019 Clinical Clerks hit the streets.

Here they come.

This week, the class of Meds 2019 begin their Clinical Clerkship. Although this is only the half-way point in their medical education, it is a highly significant milestone, marking transition from a program dominated by largely classroom based knowledge and skills acquisition, to “real life” learning in a variety of clinical placements and elective experiences. Last Friday, this occasion was marked by a White Coat Ceremony, conducted by Dr. Armita Rahmani.

 

Photo by Bernard Clark

 

To further mark the occasion, I reprise my Top Ten list of tips for Clerkship. In doing so, I recognize that these points are intended not only for the students themselves, but also for the faculty members who will be supervising and supporting them in their various clinical placements. It can sometimes be difficult to remember the challenges faced by our students entering the clinical environment for the first time. I would draw particular attention to points 9 and 10.

 

So, here goes, in no particular order…

  1. Show up, and show up on time. It all starts with dependability. Even the most brilliant among us are useless if absent or unreliable. On the other hand, there will always be a welcome for the honest, steady contributor. If you are late, apologize, and do not show up with the coffee or snack that you picked up on the way.

 

  1. Repeat after me: “I don’t know. Self-awareness is right up there with dependability. There will be things you don’t know. There will be things nobody knows. You will not get into trouble or lessen your reputation by admitting to a lack of knowledge or experience with a particular clinical situation or procedure. After all, you’re a medical student, you’re not supposed to know everything! You do need to know what you don’t know. You will have major problems if you compromise a patient’s care through your unwillingness to admit limitations.

 

  1. Make it your business to learn about things you didn’t know first time. In fact, become an expert in that issue and look for opportunities to apply your new knowledge. When you do, you’ll find it intoxicating, and will search out even more knowledge. Careers have been built on less. Regard every patient and fresh problem you encounter as your curriculum. Keep track. You’ll be amazed at what you’ll be learning, and how fast.

 

  1. Remember that no decision that’s made honestly and in the patient’s best interest can be wrong. Anything we recommend for our patients, even the simplest decision, test or therapeutic intervention must meet one of three (and only three) criteria – it must relieve symptoms, improve functional capacity or increase life expectancy. There is no other justification for any intervention. You can’t be wrong for trying honestly to achieve one of those goals.

 

  1. And yet, things can go wrong... Even the best and most obvious decision may not go the way we intend or hope for. When things do go wrong and patients suffer adverse outcomes, it must be openly acknowledged and understood to ensure everyone (including you) learns from that outcome and becomes a better provider. As a medical student, you will not be the responsible party, but are nonetheless in a position to learn. Don’t be afraid to engage such situations, and don’t hesitate to discuss your feelings and reactions with more experienced people.

 

  1. Ask questions. Not to impress or stand out, but because you really want to know, and are concerned about the impact on your patient. Ask respectfully, but don’t be afraid to challenge decisions. Good clinicians don’t mind being asked to explain what they’re doing. Really, they don’t.

 

  1. Get along. With everybody, not just those you think are important. Do this all the time. Everyone you encounter knows more about the practical aspects of health care delivery than you do. They all have something valuable to pass along if you’re attentive and receptive. I’m going to use a key word here: Humility. People can sense it and respond positively to it. The opposite is arrogance, which people can also sense but respond to quite differently.

 

  1. Eat, sleep, laugh. You’ll be busy, but not so busy that you won’t have opportunity to look after your own well-being. Use your down time wisely. Plan meals and recreation. Surround yourself with people who know you well and have the capacity to make you laugh. They will become increasingly precious to you. Talk to them.

 

  1. Be open to possibilities. If you think you’ve decided on career choice, don’t be shocked (or worse yet, disappointed) if something unexpected emerges. If you feel strongly conflicted, there’s probably a good reason. Talk it out with someone and remember it’s never really too late to change. If you can’t decide because everything seems great, that’s a good thing, but you might also need to talk it out. We’re available.

 

  1. And finally… look after each other. You know each other very well, and will know when someone is having difficulties, likely before they know it themselves. Don’t be afraid to reach out, or to seek advice or help. Our Student Affairs staff, headed by Dr. Fitzpatrick, and myself are all available to you or your colleague, as well as Beck Haist, Student Counselor. Remember QMed Help, the red button available on MedTech.

 

So there you have my list. Happy to receive revisions, additions or comments from readers. Final word to our students – enjoy. Clerkship is a time to grow and learn.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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6th annual Medical Student Research Showcase

By Drs. Heather Murray & Melanie Walker

This year the School of Medicine is proud to invite you to the 6th annual Medical Student Research Showcase on Wednesday September 20th.

This event celebrates the research achievements of our undergraduate medical students, with both posters and an oral plenary session featuring research performed by students while they have been enrolled in medical school. All students who received summer studentship research funding through the School of Medicine in 2017 will be presenting their work, as well as many other research initiatives. The posters will be displayed in the David Walker atrium of the School of Medicine building from 8am until 5pm, with the students standing at their posters answering questions between 10:30 and noon.

The oral plenary features the top research projects selected by a panel of faculty judges, and will run in room 132A from noon until 1:30pm on September 20th, immediately following the poster session Q&A.

This year’s faculty judges included:

Dr. Yuka Asai

Dr. Jennifer Flemming

Dr. Katrina Gee

Dr. David Good

Dr. Dianne Groll

Dr. Paula James

Dr. Robert Reid

Dr. Prameet Sheth

Dr. Graeme Smith

Dr. Tan Towheed

Dr. Andrea Winthrop

We are very grateful to these faculty members for evaluating our oral plenary applicants this year.

The three students who have been selected for the oral plenary session, and the titles of their research presentations and faculty supervisor names are listed below. Each of these three students will receive The Albert Clark Award for Medical Student Research Excellence.

Gregory Hawley – Plasminogen depletion following severe burn injury

Jeffrey Mah – Survival following Transjugular Intrahepatic Portosystemic Shunt (TIPS) in Patients with Cirrhosis: A Population-based Study

Sean Tom – ETS1 transcription factor-mediated upregulation of microRNA-31 controls cardiac fibrogenesis in human atrial fibrillation.

Please set aside some time to attend the Medical Student Research Showcase on September 20th. The students will appreciate your interest and support, and you will be amazed at what they have been able to achieve.

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