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Back to the Future: Our Early Entry to Medical School Program (QuARMS)
What’s True and What’s Not
The School of Medicine is currently in the process of accepting applications for a two year, entry level educational initiative which, if successfully completed, would lead to admission to the first year of the MD Program. This initiative, dubbed QuARMS (Queen’s University Accelerated Route to Medical School) by governance committee co-chair Dr. Mike Kawaja, would be the only one of its kind in Canada. Students admitted to QuARMS in September 2013 would enter the MD Program, if successful, in September 2015, joining the class of Meds 2019.
Although it would be unique in Canada, this approach is certainly not novel. In fact, direct entry is the most common approach in many parts of the world, including Australia and most European nations. North American medical schools, including Queen’s, admitted students directly from high school until the early 1970’s. The factors that led to a shift to delayed entry included the increasing demand for medical school positions, the increasing emphasis on basic science preparation, and the demise of common examinations at the secondary school level.
This initiative, which has been under development for approximately two years, has attracted considerable attention across the country and has raised a number of questions among our student body. This led to a very well attended Town Hall recently during which Dr. Hugh MacDonald (QuARMS governance committee co-chair) and I answered a number of questions and accepted a number of very helpful insights. It was suggested that it would be appropriate to follow up that discussion with a newsletter to the entire student body to provide further clarification. I thought it might be best to structure this as a number of questions that seem to be arising repeatedly, and to make it available to faculty as well as students.
1) How many students will be admitted?
A maximum of ten students will be admitted each year. They will be part of the 100 ministry funded positions and not increase the overall class size.
2) How will they be selected?
The application process is linked with two scholarship programs, the Queen’s University Chancellor’s Scholarship and the Loran Scholarship. The Chancellor’s scholarship program invites every high school in Canada to nominate a student who has demonstrated a combination of academic accomplishment and community involvement. This is a well-established program. We are inviting students applying to that program to indicate interest in QuARMS. The Loran scholarship is a national level high profile scholarship which provides undergraduate funding for students who demonstrate a similar combination of academic accomplishment, social awareness and community involvement. These applicants will be similarly invited to apply to QuARMS. From these two sources, a group of 50 candidates will be invited to Queen’s for a series of interviews and encounters with faculty and students that will result in a ranking list that will be used to guide offers of admission.
3) What program will these students undertake?
These students will undertake a two year program with a combination of courses, seminar work and community projects. The intention is provide these students foundations in all of the component competencies that we recognize as essential to the practice of medicine and which are developed within the MD Program. This provides an opportunity to develop a premedical curriculum which is more relevant, integrated and linked to the MD Program. It also provides an opportunity for these students to learn in what we believe will be a more effective manner and one more consistent with the collaborative and lifelong learning that will required of them as physicians.
4) Is there an intention for this program to grow beyond these ten students and to replace our standard application process?
No. We recognize that it is the uncommon student who is sufficiently aware at the high school level to make a valid career decision regarding medicine. We do not wish to close off medical school to individuals who come to that decision later in life.
5) Who will oversee this program?
A governance committee has been established and co-chaired by Dr. Hugh MacDonald of the Department of Surgery and Dr. Michael Kawaja of the Department of Biomedical Science. Dr. Jennifer MacKenzie is in charge of the curriculum and is a member of the governing committee. Other members of the governing committee include the Associate Dean for Undergraduate Medical Education, three faculty members and two students.
6) Will all students in this program “automatically” enter medical school?
Students within this program will have to be academically successful and meet standards established by the governance committee. If they meet those standards they will enter the first year of the MD Program after two years. We anticipate that some students will either not achieve those standards or decide in the course of this program to undertake an alternative career.
7) Why are we doing this?
I feel there are a number of advantages to this initiative.
- A small number of students are aware and ready to undertake medical training early. We believe this provides them an opportunity to complete their training in a shorter period of time.
- This initiative addresses, to some extent, the socioeconomic disparities in admission to medical school in that it provides entry after a shorter period of time with less overall expense. We hope this will make medical education available to students who might not otherwise consider the option.
- It provides an opportunity to develop a premedical education that is more appropriate and aligned to medical school without the highly competitive and stressful environment that sometimes accompanies premedical education.
- It provides an opportunity to begin the development of core qualities and competencies essential to medical practice such as collaboration, communication and lifelong learning, qualities that are sometimes challenging to provide for students who have come through a traditional premedical education.
This is, and will remain, a controversial undertaking. It represents a significant break from convention and is somewhat uncharacteristic of a school that has tended to avoid controversy, and been described by some as being “on the leading edge of tradition”. In the final analysis, the leadership of our school and most faculty and students comprising it’s main decision making body felt that the potential of this rather bold and “back to the future” approach outweighed the risks and effort required. Appropriately, it was a characteristically medical “risk/benefit” analysis that carried the day. So, let’s buckle up, we’re in for an interesting ride.
Anthony J. Sanfilippo, MD, FRCP(C)
Undergraduate Medical Education
What really drives learning?
Lessons from the famously self-taught.
Holidays are a great time to catch up on reading. My own preferences are history and biographies. This past couple of weeks, I’ve found it rather humbling to learn that some of the most influential thinkers and shapers of our society were essentially self-taught. In fact, they seemed in some cases to thrive despite the benefits of traditional education or academic success.
Benjamin Franklin (1706-1790) led a peripatetic life, meandering through a variety of career interests, excelling in all. He’s perhaps best remembered as, arguably, the most important and essential influence on the Continental Congress that would draft and ratify the American Declaration of Independence. Along the way, he was a writer/journalist/publisher/politician/diplomat and, in his spare time, a scientist of considerable renown, receiving honorary degrees from both Harvard and Yale, and becoming the first person living outside Britain to receive the prestigious Copley Medal from London’s Royal Society. Remarkably, all this was accomplished without the benefit of college or university level education. In his excellent biography of Franklin, author Walter Isaacson describes three key educational components: the formative influence of his father who encouraged conversation and debate in the home, Franklin’s insatiable curiosity that spanned a huge variety of topics, and his access to books. “Indeed”, Isaacson writes, “books were the most formative influence in his life, and he was fortunate to grow up in Boston, where libraries had been carefully nurtured”. Despite this abundance, Franklin was required to actively seek out these books, generally housed in private libraries. His apprenticeship in his brother’s print shop provided him opportunities to “sneak books from the apprentices who worked for the booksellers, as long as he returned the volumes clean”.
The facts regarding the education of Abraham Lincoln (1809-1865) are almost lost in the mythology that’s developed regarding his early life. In Team of Rivals, author Doris Kearns Goodwin describes the challenges faced by the impoverished Lincoln as a “Herculean feat of self-creation”. “Books”, she writes, “became his academy, his college. The printed word united his mind with the great minds of generations past”. He also treasured conversation and stories he shared with interesting, informed people, and would analyze and reconstruct arguments afterward. He also undertook “solitary researches” in the study of geometry, astronomy, political economy, and philosophy. “Life was to him a school, and he was always studying and mastering every subject which came upon him.”
Although Albert Einstein (1879-1955) did have the benefit of formal education, attending the Swiss Federal Polytechnic School, he was a mediocre, somewhat embittered student and was unable to secure a teaching position after graduation. It seems he found formal curriculum far too rigid and stifling. He eventually undertook relatively menial work at a patent office, which allowed him time alone to read and think. It was during those years that he developed many of the theories that would revolutionize the field of physics and define his life’s work. He also developed a social consciousness that, although less publicized than his scientific work, is in many ways equally intriguing.
So should these notable examples, drawn from three separate centuries, diminish our commitment to formal education? Obviously not. However, it would also be a disservice to simply dismiss them as prodigious intellects who managed to excel despite more primitive educational systems. Simply put, it took more than brainpower for them to rise above their circumstances and become pre-eminent learners and, as a result, leaders of their times. They also shared three essential qualities:
- Relentless curiosity and desire to understand. Although the focus of that drive may have differed, the intensity and commitment were consistent. They simply could not be deterred from learning.
- Willingness to apply themselves to their goal. We tend to believe that people as gifted as Franklin, Lincoln and Einstein came by their success effortlessly, but this is far from the case. Franklin was known by his contemporaries to habitually arrive at work earlier than anyone else and to work long into the night. Lincoln often read or worked through the night, and photographs from the time document dramatically the physical toll.
- Commitment to betterment of their communities. All three were motivated by a desire to improve their societies. In fact, the energy and commitment that was so evident in their work appears to arise from this altruism rather than any personal self-interest.
It would seem that when these three qualities triangulate in an individual, great things are possible. However, those possibilities are only realized if their environment provides a few necessary things, including access to information and people with whom they can converse, share and test ideas.
How does all this relate to our work as medical educators? I think two important lessons emerge. Firstly, it would seem that any admissions process would benefit by concentrating on means to identify within applicants the three essential attributes listed above. Any student with these attributes is essentially programmed to succeed and will do so within, or in spite of, any educational system we choose to impose. Put simply, the appropriately motivated, reasonably capable learner is essentially unstoppable. Conversely, the absence of these attributes virtually dooms the process from the start, despite our best efforts. Secondly, these examples would suggest that the learning environment we develop is at least as important as the methods we employ to deliver and assess knowledge. Providing our learners with direction and opportunities to explore concepts and develop their personal learning skills is critical and, from the perspective of their ongoing career, much more durable than simply requiring them to reproduce pre-determined dollops of factual information.
All this should reassure us that the changes we’ve undertaken over the past few years with our admissions processes, curriculum, information technology, physical space, mentoring programs and educational methodologies are all positive developments, clearly moving in the right direction. We should also be encouraged to creatively and boldly go further.
Great Health Care Requires Great Medical Educators
Education is not an industrial process; it is a human one.
In the Dec. 10 edition of The Atlantic Monthly, Richard Gunderman, MD. PhD., examines different sets of components of excellence in medical education: curriculum, instructional methods, and assessment techniques AND creativity, commitment, and inspiration of medical educators. He focuses on the critical importance of fostering a generation of medical educators through support of medical education. For the article see
Congratulations to Drs. Ted Ashbury and Heather Murray
Congratulations to Dr. Ted Ashbury (Anesthesia) and Dr. Heather Murray (Emergency), both of whom are very involved in Medical Education! They have been awarded the Canadian Association for Medical Education (CAME) Certificate of Merit, which promotes, recognizes and rewards faculty committed to medical education in Canadian medical schools.
In Undergraduate Medical Education, Ted has developed and is the Course Director for Professional Foundations 2 and 3, pre-clerkship courses which teach about the intrinsic or non-medical expert roles of a physician. He has also served as the Competency Lead for the Professionalism Role since the inception of the Competency Lead Role. Ted has also served as a founding member of the UGME Curriculum Committee.
In Undergraduate Medical Education, Heather developed and is the Course Director of Critical Appraisal, Research and Learning (CARL) and the Critical Enquiry Course in pre-clerkship UGME. She is also the Competency Lead for the Scholar role from years 1-4 and serves on the UGME Curriculum Committee.
These deserving colleagues will be recognized at the upcoming CAME Annual General Meeting which is held in conjunction with the Canadian Conference on Medical Education (CCME) in Québec, QC on Sunday, April 21, 2013 at 17:30 at the Hilton Hotel Québec. Please join us in congratulating these individuals for their commitment to medical education in Canada.
Reminder: Course Directors’ Retreat Jan. 18, 8:00-2:30, University Club
The Course Directors’ Retreat will take place on Jan. 18 from 8:00-2:30 at the University Club. Course Directors have been asked to bring a designate who will be able to bring back additional information to the course team.
Credit for the workshops will be given.
Here is the agenda: Course Directors Retreat January 18 2013 Agenda
Please RSVP to Elaine Carroll at email@example.com
Many thanks for tremendous work: Farewell but not goodbye
Dr. Stephanie Baxter, has moved from her position as Co-Course Director for Neurology and Ophthalmology in Undergraduate Medical Education to serve as the new Residency Program Director for the Department of Ophthalmology. She has also therefore left her position on the UGME Teaching and Learning Committee of which she was an inaugural member.
It’s difficult to express all that Stephanie has quietly accomplished in undergraduate medicine–from piloting the extremely successful Ophthalmology Skills Fair to complete course revision as she acted as one of the first exemplars of creating balanced teaching methods. Stephanie has served the Teaching and Learning Committee well for 5 years, representing clinical teaching and supporting initiatives through her own teaching practice.
Perhaps most telling, however, is Stephanie’s contribution to student learning. She is the recipient of the 2011 Aesculapian Society’s Lectureship Award, and has already made an impact with her work in teaching residents, winning the Garth Taylor Resident Teaching Award of 2012, both attesting to the way Stephanie is able to interact with students to help them learn.
We wish Stephanie well in her work in Post Graduate Medical Education, and hope that our undergraduate students will still have the benefit of her teaching. Many thanks Stephanie, for all your tremendous work!
Looking for a Few Good People
We’re incredibly fortunate at Queen’s to be blessed with a faculty that engages educational leadership with enthusiasm, creativity and dedication. When new positions emerge, or when people who have been key contributors come to the end of their terms or move off to other phases of their career or life, the program faces both challenges and opportunities. The challenge is obviously to fill the position, which is particularly difficult when it’s been filled so capably in the past. The opportunity, of course, is that it allows another faculty member to engage a new challenge, which allows them to influence medical education and advance their careers in new ways. A number of such positions will become available by the end of this academic year. I will describe them below and invite all faculty members to forward any enquiries or expressions of interest to me. In all cases, there will be opportunity for a phase transition working with the incumbent, support from our Educational Team, and opportunities to develop individual faculty development plans to complement the role.
Curricular Lead for the Professionalism Role Competency
For the past 6 years, Dr. Ted Ashbury has been providing inspirational and creative leadership as we have refined and consolidated the Professionalism role within our new Foundations Curriculum. Ted would now like to transition to reduced responsibilities and eventually retirement, and so we would like to identify a successor who could work with Ted for the remainder of this academic year, taking over the portfolio completely in September 2013. Major components of this role:
- Facilitation and maintenance of all current curricular components that address the Professionalism competency.
- Opportunities to develop innovative curricular components as the vision of the role suggests, particularly with extension into the clerkship
- Teaching within the curriculum on Physicianship and Professionalism
Director, Clinical and Communication Skills (CCS)
Given the obvious importance of CCS within undergraduate education, this is a key role and responsibility within our curriculum. Dr. Henry Averns has been filling this role with creative energy and unique panache for the past 4 years, enhancing the content and assessment within the program while guiding it through a particularly challenging time of curricular transition. As he comes to the end of his term at the end of this academic year, we have opportunity to identify a successor who will work with Henry through next term, taking over the role independently in September 2013. Key components of this role:
- Working with the CCS Co-Directors to ensure the component courses CCS 1,2 and 3 are well maintained.
- Fostering the elements of the over-arching CCS mandate.
- Ensuring integration of the CCS curriculum with other curricular courses
- Working with and coordinating the efforts of administrative staff who support or work closely with the CCS program, such as the CCS Curricular Coordinator, Standardized Patient Program Coordinator, and UG Operations Manager.
Course Director, Geriatrics, Oncology and Palliative Care
This course was newly introduced as a part of our curricular revision and is in its third iteration this year. Dr. Michelle Gibson, Director for Year 1, has been capably filling in the Course Director role on an interim basis. However, the maturity of the role and Michelle’s expanding responsibilities with the Curriculum Committee require us to appoint someone to take sole responsibility for the course. Again, we have the opportunity for the person coming into this role to work closely with Michelle, who will continue to direct Year 1. Key components of this role:
- Oversight of the curriculum of the course, including learning objectives, teaching methods, faculty assignments and assessment
- Teaching within the course
Course Director, Clerkship Curriculum 3
In distinction to the roles above, this course is a completely new assignment, since it is under development and will be offered for the first time, March 26 to April 13 2013. The Clerkship Curriculum Courses are being provided as a part of our expanded two year clerkship and provide an opportunity for the students to engage advanced concepts and to consolidate their learning, particularly in areas that tend to lose focus during clinical rotations, such as critical thinking, comprehensive approaches to clinical presentations, and basic clinical skills. CC3 will be the final such course in the series, offered at the end of clerkship, and will identify and consolidate key themes in preparation for the MCC examination and residency. The overall Clerkship Curriculum is under the direction of Dr. Sue Moffatt, who has developed the first two courses in conjunction with Directors Dr. Armita Rahmani and Dr. Chris Parker. The CC3 Director will join this team and benefit from their experience. Key components of this role:
- Developing and supervising course curriculum, including learning objectives, teaching methods, faculty assignments and assessment.
- Teaching within the course.
- Working with the Curricular Coordinator responsible for the Clerkship Curriculum courses
Co-Director, Facilitated Small Group Learning
Facilitated Small Group Learning is an instructional methods (based on Problem Based Learning) used in Terms 2,3 and 4, where students work in small groups with a trained facilitator over the course of a term, on cases that relate directly to the material they are learning in their courses. Dr. Michelle Gibson directs this program and is responsible for it’s overall structure and outstanding success. Last year, she was assisted by Dr. Ellen Tsai who made significant further improvements. This year, Dr. Brent Wolfram, who was a FSGL facilitator in Term 2 last year, has been working with Dr. Gibson to revise and improve the Term 2 cases. We are looking for interested faculty to assist with case reviews and development in Terms 3 and 4.
Associate Director, Student Counseling
For several years, Dr. Jennifer Carpenter has been providing outstanding service to our students and our school as Director of Student. She has also begun the process of building a Wellness program that will span all learners at our school. It’s becoming clear that her role is expanding to such an extent that we should be identifying another faculty member to work with Jenn in further developing these programs. Key components of the role include:
- Providing personal counseling to students in need
- Providing advice and support to faculty dealing with difficult student issues
- Contributing to the development of our student wellness program.
Curricular Lead for Manager Role Competency
For the past two years, Dr. Ruth Wilson has not only chaired the Professional Foundations Committee, but she has been the lead for the Manager role and associated competencies. Ruth has pioneered the Manager Checklist for the Community Week and also introduced a new session on health care for the students. However, as the Chair of the Professional Foundations Committee’s role increases, she must step aside from being the Curricular Lead for the Manager Role. We would like to identify a successor who could work with Ruth for the remainder of this academic year, taking over the Curricular Lead completely in September 2013. Major components of this role:
- Facilitation and maintenance of all current curricular components intended to address the Manager competency including careers, self-care, and time and study management, all of which currently have point people and faculty associated with them.
- Opportunity to develop innovative curricular components where the vision of the role suggests, especially into clerkship
- Some teaching within the curriculum on aspects of the Manager role.
All these positions will receive credit within our Workforce accountability system. For information or further discussion regarding any of these positions, please contact me directly at firstname.lastname@example.org.
Best wishes to all for a restful Christmas break and for continuing success in the new year.
What do p and R-values mean anyhow? : Understanding how to interpret multiple-choice test scores using statistics.
Have you ever wondered whether or not your multiple-choice questions (MCQs) are too easy? The answer to this question can be found in the p-values or item difficulty: the percentage of students who answered correctly. The difficulty of a MCQ can range from 0.00 to 1.00; the higher the p-value, the easier the question. What we should be concerned with are high difficulty questions with p-values less than 0.3.
Have you ever wondered which questions tricked students who otherwise performed well on a test overall? The R-value or item discrimination looks at the relationship between how well students performed on a question and their total score. Item discrimination indicates students who know the tested material and those who do not. The higher the R-value, the more discriminating the test question. We should try to remove questions on the test with discrimination values (R-values) near or less than 0.3. This is because students who did poorly on the test did better on this question than students who performed better overall.
Did you Know?
Multiple-choice questions that use words in the stem such as best, most, first, or most correct require higher-level thinking but often confuse students because they are ambiguously worded. Our students have struggled lately with ambiguity in the wording of MCQs on RATs and exams such as “Which is the most likely….”. They assume “most likely” to be “most common”, whereas the most likely answer could be an uncommon situation. It’s important to word the question clearly so that students are not confused. So for example, the question could state, “In light of the clinical information provided above, which diagnosis would you make?
You can also ask students about “most common”, “most concerning”, or “what is the first test you would perform” etc. but it is always good to anchor these stems by referring to the data presented previously. Then the key is to require them to choose, evaluate, interpret, judge, infer from data, solve problems, and apply principles.
Did you Know?
The Student Assessment Committee has posted several articles, checklists and PowerPoint slides to assist you with Multiple Choice Questions.
For more guidance on writing high-quality multiple-choice questions refer to MCQ Guidelines and Writing MCQ’s in School of Medicine Faculty and Staff Resources at:
Queen’s School of Medicine: Faculty and Staff Resources.
Translating students’ comments on course evaluations
Navigating students’ comments could be one of the most challenging aspects of interpreting course evaluations. In an article in Innovative Higher Education, Linda Hodges and Katherine Stanton (2007) suggest using these comments as “windows into the process of student learning and intellectual development” rather than as reviews of “how they have been entertained” by an instructor.
Hodges is Director of the Harold W. McGraw, Jr. Center for Teaching and Learning at Princeton University; Stanton is the center’s assistant director. They point out that sometimes students’ comments stem from “students’ expectations of or prior experiences with college classes” that “entail teachers standing in front of the room ‘telling.’”
For example, is a comment like “I did not learn in this class because the teacher did not teach” evidence of a lack of effective teaching, or evidence that the style of teaching – including lots of team-based work – wasn’t what the student was expecting? Reframing student comments in this light can ultimately help improve teaching, Hodges and Stanton suggest.
“We may see our evaluations less as judgments of our performance and more as insight into our students’ intellectual growth—insight that may engage us in intellectual growth as teachers and scholars.”
Hodges, L.C., and Stanton, K. (2007). “Translating comments on student evaluations into the language of learning” in Innovative Higher Education 31:279-286.
Boy Scouts, Role Models and the Hidden Curriculum
Last Saturday morning, entering our local Loblaws supermarket, my wife and I were confronted by an adorable and entirely engaging boy of about 8 years of age dressed in a Boy Scout uniform. He handed us a plastic bag and explained in a most earnest and obviously practiced speech that they were collecting for the Food Bank and we were invited to fill the bag during our shopping. He was polite, articulate, sincere and clear, both about the process and ultimate destination of the donations. In short, he was utterly irresistible, and we would have been convinced even if his cause had not been so worthy.
As he was speaking, I hadn’t really noticed the gentleman standing behind him, dressed in a version of the same uniform, who now spoke up and greeted me by name. I recognized Bill Racz, my former Professor of Pharmacology, who had taught me many years ago about adrenergically active medications and the evils of pharmaceutical advertising. I’ve continued to encounter Bill around campus over the years in contexts ranging from teaching and committee work to our mutual incompetence at noontime basketball at the gym. In talking to Bill that morning, I learned for the first time that he’s been involved in the Boy Scouts movement for over 35 years.
On the way home, I couldn’t help reflecting on the tremendous generosity of spirit that motivates an accomplished and highly respected academic to donate time and energy to such a community cause and, more importantly, to modeling those values to young people in the most powerful way possible, by actually living the experience. It’s easy to imagine that young boy one day taking on the same role and passing those lessons on to another generation.
The powerful influence of role modeling in medical education is well appreciated. Medical graduates invariably recall particular teacher/mentors as much more influential to their eventual development than any curricular element or teaching methodology. At a medical leadership symposium I attended recently, panelists were invited to individually list key components of effective leadership. Common to every list was some variation on “lead by example”. An extensive body of research is emerging on the “Hidden Curriculum”, a term used to refer to all the factors that influence learner development but are outside planned curriculum, arising as a result of observed behaviors and attitudes expressed unintentionally. What’s becoming clear in the education world, and has always been clear to good parents, is that what we do is much more powerful that what we profess. Good teachers and good leaders know this and therefore strive to “walk the walk”.
By “walking the walk” that Saturday morning, Bill Racz was providing an invaluable example and living lesson to a group of young boys. He continues to teach and inspire me.