Doctors, patients, ritual and showing up

Ritual is a big part of life; this is especially evident at universities at this time of year. I recently took part in the ritual of attending convocation at another university to watch my daughter receive her Bachelor of Health Sciences degree. In addition to the parental joy of seeing my daughter on stage for about six seconds of hooding and handshaking, I had the pleasure of hearing the convocation speaker, Dr. Abraham Verghese, a physician, author and professor at Stanford School of Medicine.

The importance of ritual, both in life and in particular in the doctor-patient relationship, is something Dr. Verghese is passionate about. He’s written about this, presented TED talks, and, late last month, incorporated this message into his convocation address at McMaster University.

Dr. Abraham Verghese (Screenshot from webcast)

Dr. Verghese noted that it’s possible to get your degree without attending the ceremony, but “rituals matter.” He added: “It says something about you that you believe in this ritual, that you showed up, because showing up for rituals that matter is perhaps the best advice I can give you.”

He acknowledged that he was speaking from “the vantage point of a window of practicing medicine” but hoped his message about ritual would resonate with everyone. He pointed out that the very ritual of convocation itself makes no sense in other contexts: “You’re dressed in a way that you otherwise never dress like. And I’m dressed as I rarely dress. With distinguished faculty on the stage, you marched in proceeded by a beadle carrying the mace, an instrument of battle that’s also a metaphor of power.”

“Our anthropology colleagues teach us that rituals are all about crossing a threshold,” he explained. “They represent a transformation, whether it’s a baptism, or a bar mitzvah, an inauguration, a funeral, a graduation.”

He challenged the graduates to consider what the rituals are in their lives, in their work, before sharing insight into his own understanding of ritual in his medical practice:

“If you think about the usual clinic visits, two strangers are often coming together, one person in the room will be wearing this white shamanistic outfit with tools in their pockets, and the other individual will be wearing a paper gown that no one knows how to tie or untie. The furniture in the room looks nothing like the furniture in your house or mine. The individual in the paper gown will then begin to tell the other one things that they would never tell their rabbi, or their preacher, and in my specialty of infectious disease, they will tell me things they would never tell their spouse. And then, incredibly, they will disrobe and allow touch, which in any other context in society would be assault, but the physician gets the privilege in the setting of this ritual.”

He further explained that this is not unique to any one culture. “I care for people from all kinds of ethnic groups, and I’m struck by how many different beliefs they have about illness, about disease, about treatment, but they all know about ritual,” he said. “And you put them in that room with all its setup and they know they’re about to embark in a ritual and if you do it poorly, if you just do a prod of their belly, and stick your stethoscope on the gown, they’re on to you, they can tell when you’re doing it well just as you can tell when you’re in the hands of a thoughtful barista, a good chef, a good hairdresser, a good mechanic.

“Rituals, done well, signify people who are doing their jobs well.”

Rituals can also be transformative, he said. “I learned this firsthand in the early years of the AIDS epidemic before we had any treatment,” he said, recalling a young man who he had followed for months at the clinic and who was now dying in the hospital.

“Each day I would come to his bedside and I’d visit him and I’d talk to his mother, and not knowing what else to do in this sacred hallowed space that surrounded him with his mother holding vigil, after a while, I would begin to examine him, albeit briefly. I would listen to his heart, I would percuss his lungs, feel his abdomen, feel his spleen, even though it was very unlikely I would discover anything that would change what we did,” he said.

“I engaged in this ritual out of habit, relieved that it gave me something to do, some purpose at the bedside.”

“One day, when I came by, his mother, that eternal figure there, told me that he’d not spoken or come to consciousness since the previous noon. It seemed certain that he was about to die, and in fact, he did pass away a few hours later,” Dr. Verghese continued. “But strangely, at that moment, as he heard us talking, as he heard my voice, we saw his hands begin to move. She was astonished, ‘cause she had not seen anything before. And I was astonished, and we’re wondering what is he gonna do? And we saw his skeletal fingers flutter up and then move to this wicker basket of a chest of his. And it took us a while to understand that he was fumbling with his pajama buttons. He was trying to unbutton his shirt, he was reflexively allowing me the privilege of examining him, giving me permission. I tell you, I did not decline the gift.”

“I percussed, I palpated, I listened to his heart, his lungs. I felt connected to the timeless message the physician conveys, the same message the horse and buggy doctor, riding out to towns on the western edge of Lake Ontario 150, 200 years ago, conveyed to his or her patients of that era, when there was so little to offer,” he said.

“The message is that beyond the data, beyond the evidence or lack of evidence, beyond the medicines that stop working, here I am and no matter what, I care, I will be there with you through thick and thin, I will not stop coming, I will show up.”

Dr. Verghese then spoke about emerging artificial intelligence and how it will change medicine.

“Here’s what’s not going to change, is the need for human beings to care for each other,” he said.

“We all need it in every walk of life, but especially in the care of the sick. I’m hoping that in my field, artificial intelligence will free us from some of the drudgery of medical record keeping and allow us to fulfill the Samaritan function of being a physician, to minister to those who suffer,” he added.

He exhorted the graduates to “embrace the rituals of your life, be conscious of them.”

“Be in charge and be cognizant of those human values and rituals that you want to preserve,” he added. “Remember that fluttering hand of the dying patient, I remember it every single day.”

Unlike machines, he said, “You can care, you can love, you can preserve the rituals that showcase these things. And you can show up. Always show up.”


You can watch Dr. Verghese’s full address here. It begins around 29:05.

 

 

 

 

 

 

 

 

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Sorry to interrupt but I just had this great idea: How learning about and adapting communication styles can help move group learning forward

When I last wrote to you in March, I asked if you were a constructive or destructive problem-solver in groups.  We do a lot of small group (and larger group) learning in Queen’s UGME and I hoped to give a great framework to help prevent groups from imploding before or while constructive work could be done.

We looked at identifying the types of problem-solving that might occur in a group and some strategies that could help prevent destructive problem-solving.  The ideas came from Team writing:  A guide to working in groups by Joanna Wolfe.  For this article, I wanted to share another set of ideas she has put forward in the same book, about Conversation Styles, and why they’re important to successful group functioning.

Why am I writing about challenges that small group learners can face?  In the research project that was the foundation for Wolfe’s book, she noted that nearly half the teams [she] observed experienced major breakdowns and that instructors responsible for teams were rarely aware of the problems students were facing, mainly because students almost never notified instructors of the problems and instructors had no independent information that could help them anticipate and head off trouble. (Preface, p. v)

I’d like to offer another of Wolfe’s frameworks to help anticipate and head off trouble and prevent implosion in constructive group work.

This framework concerns assumptions we make about communication styles including how we should talk to one another, what constitutes productive behavior and rude behavior.  Wolfe posits we need to understand others’ assumptions about “normal communication” behaviours and preferences in order to modify our own, and adapt to others’.

She provides a sampling of common communication norms (that are mostly extreme ends of a spectrum) and challenges us to self-assess, and also assess others in assumptions of appropriate and effective communication and teamwork.  While Wolfe discusses 3 types of communication styles (Discussion Styles, Presentation Styles and Problem-Solving Styles), I’ll focus on Discussion Style here.

We start with self-assessment and recognition.

In a self-assessment tool about discussion style,  Wolfe asks us to rate how well our behaviour is described in statements such as “When I get a good idea during a team meeting, I say it as soon as possible, even if I have to interrupt to do so.” Or “My teammates accuse me of not listening.” Or When a teammate expresses a new idea my first instinct is to point out the flaws” or “I think it is rude when my teammates never stop to ask me for my opinion,” or “If I need to express criticism, I am always careful to avoid hurting my teammates feelings.” (p. 84)

The outcome of the self-assessment is to place oneself on a spectrum of “norms”.  For example, the “Competitive Norm” is defined as “conversation [which] is a miniature battle over ideas. Speakers tend to be passionate in supporting their ideas and interruptions are frequent.”

 

The “Highly Considerate Norm” features “speakers who acknowledge and support one another’s contributions, and disagreements are often indirect.  Interruptions are rare and the conversation often pauses to allow new people to speak.” (p. 87)

There are pros and cons to each norm:  in the former while this style leads to fast-paced conversation and the often exciting challenge of publicly defending ideas in the face of competition, the most aggressive speaker rather than the best idea often wins out and speakers are more concerned with defending their own ideas than carefully listening to their teammates. In the latter, while there is concern for others, a polite tone and equitable conversations, the conversations may be perceived as slow-moving and even unimportant, and this norm sometimes privileges feelings and emotions over constructive criticism of ideas. (p. 87)

The idea is to recognize that there are values and assumptions to each style first and in this recognition understand the others in the group.  Then you have to learn to work with the others in the group.

So…if you identify yourself more with the “Competitive Norm”, what can you do to adopt a more considerate style? (Note, some of these strategies are from beyond Wolfe’s book.)

  1. Repeat back or restate ideas before disagreeing with them.
  2. Repair interruptions and other competitive behaviours with an apology (“Sorry, I didn’t mean to interrupt” or “I’m sorry—you were saying?”)
  3. Check in with the quieter speakers—often a job for a manager or chair of a group, but a person on the competitive norm spectrum could surprise everyone by doing this, asking, “Do you have any thoughts?”
  4. Pay attention to body language…pay attention to others.
  5. Listen.  (LISTEN!)  Write down good ideas.  Affirm non-verbally. 
  6. Write down questions or ideas you have, to save them for after the speaker has finished.
  7. Engage in uncritical brainstorming (all brainstorming is supposed to be non-judgemental but often people jump in with criticisms. Give a limited period for any ideas to be put forward with no judgement (say 10 minutes).  Members can build on another’s ideas and ask questions but do no fault finding.

And if you identify with the “Considerate Norm, how can you adjust to a competitive conversation?

  1. Prevent or forestall interruptions by saying, “I’m not finished yet,” or “One minute please.”
  2. Speak within the first 5 minutes of a meeting, so people don’t ignore you or think you’re peripheral.
  3. Find gentle ways to interrupt in a competitive conversation. Humour, such as waving a hand wildly, or timing interruptions so they don’t seem rude may help. Say (when someone pauses for breath) “May I contribute here?” “Is now a good time to hear from others?”
  4. Ask the chair to institute a round robin (everyone goes around the circle and contributes a set amount of time) or raising of hands or perhaps using the Indigenous strategy of a Talking Stick.
  5. I like these respectful but firm reminders to someone who is holding the floor too long from Sharing the Floor: Some Strategies for Effective Group Facilitation https://www.uua.org/re/adults/group-facilitation
  • “Excuse me, Francois, but I’m concerned about the time.”
  • “I’m going to stop you there, Laila, because I’m concerned that we are moving off our focus.”
  • “Francois, can you summarize your point in 25 words or less, because we need to move on.”
  • “Laila, is this an issue we can put on the Unfinished Business list? We can’t address it now.”

I would like to propose some steps from Wolfe’s discussion, to adapt our communication styles to the needs of a group and a group task:

  1. Self Assess: and be honest about your style
  2. Analyze: What’s positive about your style? How might your style be perceived negatively?
  3. Resolve: Decide what you can do to ameliorate some of the less constructive aspects of your style, while still retaining some of the positives.
  4. Enact: Practice in a group setting. Practice until it becomes habit.
  5. Seek feedback: Ask others:  Am I helping the group along?  Am I listening more? Am I contributing more?

Well! Speaking of communication styles, I apologize. I’ve talked for too long:  It’s your turn now 🙂

Do you think that this discussion about communication styles may be helpful to students? Perhaps helpful to your meetings (communication styles feature heavily in business literature about meetings)?
Let me know if you decide to use these strategies and steps.  I’d really like to see them in action and there are more wonderful ideas in Wolfe’s book!

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Curriculum Committee Meeting Information – April 26, 2017

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

A meeting of the Curriculum Committee was held on April 26, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of this 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, Kate Rath-Wilson at vpacademic@qmed.ca.

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Teaching Einstein

How would you like to have been young Albert Einstein’s teacher? Walter Isaacson’s excellent biography, “Einstein. His Life and Universe” provides some intriguing glimpses of the great physicist’s early education that should be of interest to anyone involved in teaching gifted and naturally curious young people.

Popular myth holds that Albert Einstein was a poor student in early life. Apparently not so, but it appears he was certainly an uninspired and disengaged student. In fact, he failed to gain entrance to the Zurich Polytechnic on first attempt, failing to pass the general section of the entrance examination, which included sections on literature, French, zoology, botany and politics (as might be expected, he did well in the science and math sections).

As is the often the case, this apparent setback turned out to be a blessing in disguise, because it caused him to decide to prepare for the entrance subjects by enrolling in a school in the village of Aarau, located in northern Switzerland. This school, as it turned out, embraced a very different educational approach based on the philosophy of Johann Heinrich Pestalozzi (1746-1827), a Swiss educational reformer who believed strongly in individual discovery and in encouraging students to use visual imagery in their learning process. He pioneered a number of approaches that might sound familiar to us because

Pestalozzi memorial in Zurich. “Founder of New Primary Education”.

they’ve strongly influenced pedagogy, particularly early childhood education, over the years. For example:

  • He stressed that instruction should be progressive, moving from the familiar to new concepts
  • He believed in making allowance for individual differences
  • He felt learning should be rooted in performance and lived experiences, thus emphasizing participatory activities such as drawing, writing, projects and field trips.
  • He advocated (shockingly at the time and perhaps still for medical schools today) formal teacher training in education

It appears young Einstein found himself much better suited to the approach at Aarau. Isaacson quotes Einstein’s sister Anna’s observations:

“Pupils were treated individually…more emphasis was placed on independent thought and punditry, and young people saw the teacher not as a figure of authority but, alongside the student, a man of distinct personality”

Einstein himself is quoted as remarking:

“it made me clearly realize how much superior an education based on free action and personal responsibility is to one relying on outward authority.”

The use of visual imagery in the learning process seemed to particularly resonate with Einstein. It was at Aarau that he first utilized visualized thought as a means of conceptualizing and actually trialing this theories. “In Aarau I made my first rather childish experiments in thinking that had a direct bearing on the Special Theory.”

As he went on to carry out the “thought experiments” that eventually led to the development of his most significant scientific contributions, he actually avoided the

Albert Einstein in 1904 (age 25) while employed at the Patent Office in Bern.

conventional academic university environment, which he found too restrictive and inflexible. Instead, he chose to take a fairly undemanding job in a patent office, largely because it provided him time alone each day to think and document his evolving theories. In a remarkable few months in 1905, while employed in that way, he developed no fewer than five remarkable papers that literally changed how we perceive the physical universe, including early works on quantum theory and special relativity. His doctorate was granted based on that work, as was his Nobel Prize.

Einstein, one might argue, is unique and it’s not reasonable to consider educational approaches for the masses based on such an example. It’s also very reasonable to observe that education, particularly at professional schools, must necessarily involve the learning of factual information and skills. Medical schools, in particular, have an obligation to ensure their graduates possess critical knowledge and can competently perform certain tasks. Consequently, a certain degree of pedantic delivery and directed instruction may be unavoidable.

Valid points, to be sure, but I would raise two further considerations. Although Einstein was clearly a remarkable exception in many ways, the drivers of his educational process were qualities that are not unique but, in fact, common in our students – curiosity, imagination and a pervasive desire to understand the world around them.

Secondly, it’s entirely possible to deliver factual information and have high performance expectations without stifling those critical personal drivers. Einstein’s teachers at Aarau obviously succeeded, not by diminishing the standards expected of him, but by additionally providing the latitude and encouragement to explore personal interests and learning. This required, on their part, a certain degree of open mindedness to novel and unconventional ideas, a willingness to engage the student as an individual with valid and fresh thoughts, and the humility to concede that their approaches may require individual modification.

In medical education, we face these educational challenges on a regular basis. Our students, without question, need to acquire considerable factual information and technical skills. They understand and accept that responsibility. As their teachers, we share with them the responsibility to ensure they meet certain minimal standards of competence. However, they are multi-dimensional, highly-motivated and thoughtful young people who develop interests and ambitions beyond these minimal standards, and we need to support them in those pursuits as vigorously as we support the core curriculum.

In educational parlance, this is termed “Independent Student Learning”, but if expressed simply as provision of unscheduled time students are free to use as they wish, the essence and potential of the concept is poorly served. It requires openness to new and innovative approaches to learning, even if outside standard curricular objectives. It requires institutional support and even encouragement for what might be termed “personalized” learning. It requires a (sometimes uncomfortable) engagement of what might be considered “destructive” innovation.

At Queen’s we have a number of examples of student initiated learning that illustrate nicely the potential advantages that can arise from such innovations for both students and the school. The Barry Smith Symposium, now in its third year, was conceived by two students (now graduates), Drs. Adam Chruscicki and Steven Hanna. Dr. Alyssa Lip, also a recent grad, was instrumental in the development of our wellness curriculum and Wellness Week, which has been embraced by other schools. The Queen’s annual Global Health conference which has been running now for many years by successive classes arose from student interest, supported by engaged faculty. This past week, Maggie Hulbert and Ashna Asim of the first year class have come forward with an idea to develop an event to explore the role of the humanities in medical education that we’ll be jointly exploring, likely as a new symposium event available next academic cycle.

For their part, students must accept the reality that medical education will require them to learn considerable material and demonstrate they have done so effectively. As faculty, we should support them in doing so, but also welcome support broader pursuits that both stimulate their genuine interests and can bring benefit to our school.

By doing so, we’ll hopefully avoid driving imaginative and motivated young people to the Patent Office.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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Queen’s UGME well-represented at CCME

Queen’s UGME was well-represented in the oral and poster presentations at the recent Canadian Conference on Medical Education (CCME) held in Winnipeg, MB.

Four oral presentations showcased UG work with another oral highlighting a teaching innovation in the QuARMS Program while a dozen posters featured Queen’s UG research and innovations featuring work by faculty, students, and staff.

As explained on the CCME website, “the purpose of the CCME is to highlight, and allow participants to benefit from, developments in medical education and to promote academic medicine by establishing an annual forum for medical educators and their many partners to meet and exchange ideas.”

The Queen’s oral presentations included:

  • The Next SSTEP: The Surgical Skills and Technology Elective Program decreases cognitive load during suturing tasks in 2nd year medical students by Henry Ajzenberg, Peter Wang, Adam Mosa, Frances Dang, Tyson Savage, Peter Thin Vo, Justin Wang, Stephen Mann, Andrea Winthrop
  • The Newborn Book – An evaluation of an interactive eBook as course material by Lauren Friedman, Jonathan Cluett, Bob Connelly
  • Altering the scoring of global rating scales on an Undergraduate OSCE: Does it affect the identification of candidates with borderline performance? By Michelle Gibson, Eleni Katsoulas, Stefan Merchant, Andrea Winthrop
  • Sampling Patient Experience to Assess Communication (SPEAC): A Targeted Needs Assessment by Adam Mosa, Andrea Winthrop, Sachin Pasricha, Eleni Katsoulas
  • Fireside chats – High Impact Informal Learning by Jennifer MacKenzie, McMaster University, Theresa Nowlan-Suart, Anthony Sanfilippo

Posters, presented both during facilitated poster sessions and the new, dedicated poster session, included:

  • An Inter-professional, Cross-cultural Service Learning Project: Development of a Nutrition Education Program in Rural Tanzanian Schools by Jenn Carpenter, Queen’s University, Donna Clarke-McMullen, Renee Berquist, Saint Lawrence College
  • Pathways to community service learning: The Queen’s Service-Learning Framework by Lindsay Davidson and Theresa Nowlan Suart
  • Introducing Medical Students to Stories of Indigenous Patients by Lindsay Davidson, Melanie Walker, Steven Tresierra, Jennifer McCall, Michael Green, Laura Maracle,
  • Predictors of medical student engagement in an e-Portfolio for intrinsic CanMEDS roles by Steven Bae, Danielle LaPointe-McEwan, Sheila Pinchin, Anthony Sanfilippo, John Freeman, Queen’s University Ulemu Luhanga, Emory University Jennifer MacKenzie, McMaster University
  • Evaluating the effectiveness of the First Patient Program’s use of resources in achieving learning objectives for medical students by Stephanie Chan, Vincent Wu, Sheila Pinchin, Phillip Wattam, Leslie Flynn
  • Evaluation of a multi-modality nutrition program for first year medical students by Andrea Guerin, Theresa Nowlan Suart, Shannon Willmott, Karen Kaur Grewal
  • Assessing the Effect of the Eye Matching System on Clinical Competency with the Ophthalmoscope in Medical Students by Etienne Benard-Seguin, Jason Kwok, Walter Liao, Stephanie Baxter
  • Curriculum to Cookbook by Moncia Mullin, Meghan Bhatia, Renee Fitzpatrick, Shelia Pinchin
  • The CFMS National Wellness Challenge: evaluating a new initiative to promote development of healthy habits in medical professionals by Alyssa Lip, Renee Fitzpatrick
  • Ontario Medical Students Association Wellness Retreat: A Program Evaluation by Shannon Chun, Renée Fitzpatrick, Queen’s University, Christine Prudhoe, University of Ottawa
  • Evaluating Student’s Perspective of Team-Based Learning In Undergraduate Medical Education by Kate Trebuss, Vincent Wu, Jordan Goodridge, Gemma Cramarossa, Lindsay Davidson
  • Preclerkship Interprofessional Observerships: What I Know Now by Shannon Willmott, Ameir Makar, Etienne Benard-Seguin, Sarah Edgerley, Lindsay Davidson

Next year’s conference is set for April 28 – May 1 in Halifax, NS. The abstract submission portal is already open. Find it here.

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Recognizing Outstanding Contributions to the MD Program

 At the end of each academic year, the graduating medical class selects faculty it wishes to recognize for outstanding contributions to their educational experience. This is always a difficult task for them, given the number and quality of the teaching faculty they encounter during the four-year curriculum.

 

The most prestigious such recognitions are the Connell Awards. Named in honour of two former heads of Medicine and outstanding teacher/role models, these awards recognize three individuals who have, in the view of the graduating class, made outstanding contributions in classroom teaching, clinical teaching and mentorship. This year, I know the class had particular difficulty coming to final decisions, but I’m very pleased to announce that the awards went to three very deserving individuals who are all relatively early in their careers, already making tremendous contributions to our program.

 

The 2017 Connell Award for Classroom Teaching:  Dr. Gordon Boyd

Born and raised in Thunder Bay, Ontario, Dr. Boyd received his undergraduate degree in Psychology from Lakehead University and his PhD in Neuroscience from the University of Alberta, where he studied the role of growth factors in peripheral nerve regeneration.  In 2001 he moved to Kingston to do a post-doctoral fellowship in the Queen’s Department of Anatomy and Cell biology, examining the potential of glial cell transplantation to treat spinal cord injury.  He stayed in Kingston to do his undergraduate degree in Medicine, which was followed by his residency in Neurology and fellowship in Adult Critical Care.  He has been on Faculty at Queen’s University since 2013 as a clinician-scientist.  His research interests are focussed on the neurological consequences of critical illness, cardiac surgery, and kidney disease. He also teaches at all levels of graduate and post-graduate medical education, on topics ranging from neuroanatomy to organ donation and has developed a well-earned reputation as a gifted teacher and mentor to students, both in the clinical and research settings.

 

The 2017 Connell Award for Mentorship:  Dr. Jason Franklin

Dr. Franklin is also a Queen’s MD program grad (1998) having previously graduated with high distinction from the U of T HBSc program as an Immunology Specialist. He undertook his residency in Otolaryngology at Western University and went on to do a fellowship in head and neck oncology and microvascular reconstruction at U of T. He returned to Queen’s in 2013 to take on a lead role in head and neck surgical oncology. He and his wife, Kristina Polsinelli have three children, Nicolas (8), Alexander (7) and Talia (3) who Jason describes as his “claim to fame”. He describes his role as a Wellness Advisor in the undergrad program as his “most gratifying work”. Jason took on the role with great dedication and commitment. He has been a terrific advocate for our students individually, and participated effectively in our evolving Wellness curriculum.

 

The 2017 Connell Award for Clinical Teaching:  Dr. Laura Milne

Dr. Milne is an Assistant Professor of Medicine at Queen’s University. She is originally from Durham, a small farming and industrial town in Southern Ontario. Prior to admission to medical school, she completed three years of undergraduate studies in physiology at the University of Toronto.

She studied undergraduate medicine at Queen’s University graduating in the class of 2008. She went on to pursue post-graduate medical studies in Internal Medicine at Queen’s University and graduated with a Fellowship in General Internal Medicine in 2012. Immediately after graduating, Dr. Milne worked as a general Internist in the community at Belleville General Hospital. She returned to Kingston General Hospital in early 2013 as a fulltime GFT faculty member in the Department of Medicine.

Since returning to Queen’s she has pursued her clinical interests in General Internal Medicine, Resistant Hypertension, and Stroke Prevention. She enjoys her work in the Undergraduate Medicine Program initially as a tutor for the Term IV Clinical Skills Course and, subsequently, as course director. She is currently course director for the Core Internal Medicine Clerkship Course. She also organizes the Internal Medicine yearly OSCE exam for the Postgraduate Medicine Program.

Dr. Milne brings that quality of “common sense competence” to her clinical, teaching and administrative roles. In a short period of time, she has earned tremendous credibility among the students and respect of the curricular leadership.

 

The Inaugural D. Laurence Wilson Award:  Dr. Christopher Smith

I’d also like to introduce a new recognition being awarded for the first time this year. The D. Laurence Wilson Award was conceived and developed by the class of Meds ’66 on the fiftieth anniversary of their graduation. The award is named in honour of a distinguished clinician, teacher, role model and leader in the university and broader medical community who they feel exemplified the qualities of medical professionalism. To quote from the terms of reference of the award:

“Professionalism is the cornerstone of doctors who provide health care. The award with be provided annually to a faculty physician who best exemplifies the attributes of the profession that graduating class members aspire to emulate.”

Dr. Smith graduated from medical school at the University of London in 1990 and worked in the UK for several years before moving to the United States. He completed a 3-year residency in internal medicine at the University of Illinois at Chicago and completed a Chief Resident year before transferring to Cook County Hospital / Rush University for a fellowship in general internal medicine. He was an Attending Physician at Cook County Hospital for over 10 years and was intimately involved in the residency training program as an Associate Program Director. He was recruited to Queen’s in 2008 as the Program Director for the Core Internal Medicine program. He recently accepted a position as Head of the Division of General Internal Medicine. He performs most of his clinical duties on the clinical teaching units (CTU’s) and on the GIM consult service. His main interests are in medical education, evidence based medicine and clinical skills. He is widely regarded for his teaching, patient advocacy and mentorship to students.

 

Please join me in congratulating these four outstanding medical educators.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

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100+ Medical Students Who Care

By Dr. Melanie Walker, Course Director, Population & Global Health

Each first year class in Queen’s UGME embarks on the ‘Community Based Interventions Project’ (CBIP) as part of their Population and Global Health (PGH) course. The project provides students with an opportunity to gain insight into social and health services that serve patients in the greater Kingston community. The students learn about the importance of social determinants of health and patient context through the eyes of a special population that they are interested in exploring. This experience provides them with better insight into supports which affect the health and management of their future patients.

Outside of the medical school, I am a member of a local charity: 100+ Women Who Care Kingston. This organization consists of a group of Kingston-based women who meet four times a year to support non-profit and charitable organizations in our community. The principle is simple – any member is permitted to nominate one local organization per meeting. If this organization is chosen as one of three picked at random, the nominating member is allotted five minutes to speak to the membership to express why their particular organization is worthy of the group’s charitable donation and what that organization would do with the funding if received. The three nominees are then put to a vote by the membership and the majority wins. Over one hour, one worthy local organization receives a financial ‘boost’ of approximately $20,000. Simple…yet powerful.

In light of this, last year we initiated a new advocacy component to the PGH course through the CBIP – the opportunity, as a class, to nominate one of the researched organizations that they thought could benefit from an infusion of funding to address a gap in service identified by the organization. The class vote would become my vote at 100+ Women. Both the 2019 class and, just recently, the 2020 class overwhelmingly voted for the Sexual Assault Centre Kingston (SACK) to be brought forward to 100+ Women.

SACK is a “not-for-profit, charitable organization committed to free, confidential, non-judgemental support for all survivors of recent and/or historic sexual violence in Kingston, Frontenac, Lennox & Addington (KFL&A).” While it may not be surprising to learn that girls and young women between the ages of 15-24 are the most likely victims of sexual assault it was eye-opening to learn from our students that Kingston has the highest rate of sexual assault per capita in Canada. The majority of funding received by SACK is thus, understandably, directed at the support services with little left over for education and prevention. In fact, the Kingston Youth Sexual Violence Prevention Assessment put out a report in May of 2015 that stated “the Kingston community needed to engage youth before sexual & dating violence occurs. Organizations need to explicitly address important concepts including consent, healthy sexuality, healthy relationships, rape culture, alcohol & drug-facilitated sexual assault, and sexual violence.”

After six 100+ Women Who Care Kingston meetings and six attempts (between last year and this), the stars aligned on Feb 23, 2017 and SACK was the 3rd random pick of the night of the 30+ nominated charities.  The end result was an overwhelming majority vote of the 100+ women in the room to support this organization.  Two of the students from the class of 2019 that had an instrumental role in getting SACK nominated by their classmates, Tiffany Lung and Kate Liu, were present with me at the recent cheque-presenting ceremony by the leading ladies of 100+ Women Who Care Kingston to SACK on March 31st. The donation of $20,000+ will be directed at the development of a much-needed youth prevention program across the greater Kingston area which will include sexual assault resistance programming – the only evidence-based program that has been shown to significantly reduce the incidence of rape and other forms of sexual assault.

The night that SACK was voted to receive this donation I was approached by many community members who were not only impressed with the important work that SACK does but by the School of Medicine’s investment in teaching our physicians-in-training about the importance of population health and health advocacy. Amazing what can be accomplished when 100+ medical students who care connect with a local group of women who care to create an opportunity for change in our community.

The recent Whig Standard Article can be found here.

Many thanks to the following for making this possible:

  • Meds 2019 class (special thanks to Tiffany Lung, Kate Liu, Zoe Lau and Sallya Aleboyeh)
  • Meds 2020 class (special thanks to Alexandra Basden, Azraa Janmohamed, Denisha Puvitharan, Khatija Anjum, Sana Khan and Jagpreet Kaler)
  • 100+ Women Who Care Kingston and the leading ladies (special thanks to Lindsay Duggan)
  • Sexual Assault Centre Kingston (special thanks to Jennifer Byrd and Elayne Furoy)

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Curriculum Committee Information – March 23, 2017

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

A meeting of the Curriculum Committee was held on March 23, 2017.  To review the topics discussed at this meeting, please click HERE to view the agenda.

Faculty interested in reviewing the minutes of this 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, Kate Rath-Wilson, at vpacademic@qmed.ca.

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“Why do you like baseball?”

I get asked this question a lot, mostly by those much younger than I – students, my children, nieces, nephews. It’s usually accompanied by an expression of pity that one would normally reserve for viewing the fossilized remains of extinct species. What they’re really wondering is “How could anybody in their right mind like baseball?”, or “Are you really that boring?”

I’ve often wondered myself, and have come to realize that, like most relationships, it’s complex and ever evolving. My grandfather got me started. He had two great passions beyond his family – opera and baseball. I remember visiting his sanctum – a small, dark, wood-paneled den filled with swirling pipe smoke where, settled in his overstuffed leather throne, he would watch a baseball game with the sound turned off while simultaneously listening to a recording of Pagliacci. I was never sure if the occasional tear in his eye related to the game or lyrics.

He immigrated from Italy in the 1920’s and settled initially with his wife and five daughters in Chicago. The opera he brought with him; the baseball he acquired as part of his new life. He loved to tell, with equal enthusiasm, of hearing Enrico Caruso perform and attending ball games at Wrigley. By the time he moved and settled in Huntsville, Ontario he had nine daughters (yes, NINE but that’s another story). I’ve often thought there was poetic symmetry in the number of daughters, the number of players on a baseball team and the number of innings in a baseball game, but he never claimed credit for the coincidence.

The daughters never intruded into the den while he was watching games but I was allowed to join him. At that time, I never really understood either interest. The grainy black and white images on the television screen didn’t hold much interest for me and seemed monotonous and slow compared to hockey games. The old phonograph recordings were scratchy and the lyrics didn’t make sense. The pipe smoke made my eyes water although I liked and can still vividly recall the smell of the tobacco. It was being with him that made it all worthwhile.

I was a reluctant recruit to both interests but, over the years have found myself, without deliberate intention, drawn to them. The opera might be considered a genetic inevitability. The baseball is acquired and harder to understand. On the surface, the young people have a point. Compared to other big league team sports, it’s slow and stuttering – monotony occasionally interrupted by moments of activity. Detractors love to note that during a complete baseball game, the actual active play only comprises about 10 minutes, but I’ve come to find that you have to scratch deeper to discover the charm and true depth of the game. It doesn’t give up its personality easily but, to the persistent observer, it reveals a character quite different than that of other so-called “major” sports. For instance:

 

There’s no clock. Baseball refuses to be governed by time. It’s over when it’s over, regardless of the hour. It eschews the concept of “clock management”, thank you very much.

It’s nerd friendly. No sport embraces statistics and relentless documentation of each and every event like baseball. There is an accounting and assigned acronym for every action and nuance in the game. True aficionados love to wallow in the numbers. And these statistics are not without meaning. “Moneyball: The art of winning an unfair game” by Michael Lewis is a fascinating account of how statistical analysis is being used effectively to change how players are selected and teams constructed. What all this means is that even those of us who aren’t gifted enough to play the game can understand what’s happening and comment with some validity. It brings together the athlete and the nerd and puts them on a more-or-less equal footing.

Personalities matter. In no game are individuals so much on display. Whether they’re pitching, batting, fielding or managing, there are moments in the game where attention is entirely focused on the actions of a single player, and there the outcomes are entirely dichotomous – success or failure. What becomes interesting is not whether they succeed or fail at whatever they’re doing, but how they respond to the moment. They become people with quirks and human reactions, not unlike those watching. And there’s the bound. Performer and spectator are brought together in this singularly human moment.

It’s quirky. The best nicknames: bar none. Consider: Catfish, Dizzy, Satchel, Pops, Smokey, Hammer, Sparky, Oil Can, Whitey, Yogi, Campy, Crabs, Eck, Gibby, Goose, Bambino, Mr. October, The Georgia Peach, The Say-Hey Kid, The Kentucky Colonel, The Splendid Splinter. And that’s just Hall of Famers. And the ballparks refuse to engage conformity. The Green Monster. The ivy at Wrigley. The brewery walls in the background of many outfields. Compare that to the obsessive conformity of football fields or hockey rinks. It all translates to personality and thumbing a nose at convention.

You don’t have to listen to it and watch it; either will do just fine, as my grandfather taught me so long ago. It’s also ideally suited to radio. In fact, it’s almost better.

It’s the most democratic of sports. Virtually anybody can play, and the game can be adapted and modified to fit the skills and energies of the participants.

It ain’t over ‘til it’s over. Hope springs eternal in baseball. Until the final batter makes the final out, there is always the potential for a team to come back from a deficit and snatch victory from defeat. In most other sports, points of hopelessness can develop where play becomes meaningless, but players are nonetheless required to go through the actions. An abomination.

It overcomes adversity. More than any other team sport, professional baseball has had its share of tragedies and miseries, all played out under public scrutiny. Segregation, corruption, betting scandals, the performance enhancing drugs debacle, have all tarnished its reputation and challenged the assumption of inherent innocence. In every case, the game has been the vehicle by which deep societal flaws have found expression and come to attention. As such, perhaps the game has served a purpose, reaffirming that the innocent are not immune from evil, but need not be defeated by it. Incredibly, improbably, it endures, scared but not broken, and arguably better for the experience. A metaphor for us all.

 

In the end, there’s a beguiling charm about a game that’s so quirky, unpretentious and stubbornly enduring. It survives despite the changes the world tries to impose. So, in answer to my young inquisitors, that’s why I like baseball. That, and memories of tobacco smoke, and Pagliacci.

 

Anthony J. Sanfilippo, MD, FRCP(C)

Associate Dean,

Undergraduate Medical Education

 

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Building Bridges, Making Pathways

By Denisha Puvitharan (Meds 2020), Darsan Sadacharam (Meds 2020) and Sahra Nathoo (Meds 2019)

Twenty-four curious high school students joined the ranks of diligent medical students in the halls of the Medical Building on March 31st. These students were taking part in the first ever “Pathways to Medicine” event hosted by Queen’s School of Medicine’s Diversity Panel.

Through a new partnership with a local chapter of a national organization, Pathways to Education, the panel organized a full day event aimed at increasing interest in a future career in medicine among students engaged with Pathways, along with some students from Immigrant Services Kingston and Area (ISKA).

Participating students heard from Dr. Michelle Gibson, Director of Year 1, who introduced them to the day. They participated in a small group learning session with Dr. David Bardana and the class of 2020, clinical skills training with tutors Drs. Rick Rowland and Nicola Murdoch, and resuscitation simulation and laparoscopic training sessions with residents, Drs. Kristen Weeksink and Gary Ko, during their visit. Dr. Mala Joneja, Director of Diversity in UGME, sped them on their way with inspiring words. The inaugural “Pathways to Medicine” event was an excellent teaching and outreach event that was highly praised by all staff and students involved.

The Diversity Panel is an interdisciplinary team of interested students, educational staff and faculty, which exists to improve undergraduate medical education at Queen’s, through increasing diversity and making careers in medicine more accessible to those from underrepresented populations. There have been many conversations regarding the importance of medical student bodies representing the diversity of the patient communities they will serve in the future. In addition to the upstream effects of making the healthcare profession more adept in providing quality care to the existing diverse population, increased physician diversity is also particularly important when considering the physician shortages that low income neighbourhoods face in Canada. By enticing more students from these neighbourhoods to attend post-secondary education and medical school, there is an increased likelihood they will return to practice in these neighbourhoods, thus helping relieve some health inequities.

Though many efforts have been made to make medical school more accessible to students from lower socio-economic backgrounds, many barriers remain. The cost of medical school alone is astronomical, when considering the tuition for an undergraduate degree, MCAT registration fees, application fees, and potential income-earning hours spent studying; students from low income families are already discriminated against. Attempting to address these concerns, the Pathways to Medicine event also included a presentation on financing medical education by Ms. Margie Gordon from the Registrar’s Office, specifically regarding OSAP, grants and other resources available to help these students reach their goals.

However, when making efforts to increase the accessibility of medical school for students from diverse socioeconomic backgrounds, the true challenge is in leveling the playing field at the starting line for these students. From the onset of a student’s educational journey, his/her family’s financial and social resources can play a significant role in dictating their success. Strong financial support can assist a student’s ability to excel in school, while also participating in various extracurricular activities, which can benefit the student in future endeavours. Furthermore, students from higher socioeconomic backgrounds are privy to strategic knowledge of what it takes to become competitive applicants as a result of having access to various social resources. These resources can come in the form of connections with academics, physicians and others that have experience navigating the application system. An anecdotal example of how strong social resources can provide an advantage to students is provided by Dylan Hernandez’s opinion column in the NY Times.

“Pathways to Medicine” represents Queen’s UGME Diversity Panel’s continued efforts to find creative strategies in addressing this complex challenge. Although this may be a small step towards addressing these barriers, it is our hope that through events like this and other similar initiatives held at medical schools across Canada, students from diverse backgrounds may soon see medicine as a realistic goal.

 

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