Tag Archives: medical education

sarahC

Sarah Currie is a medical copy editor on CMAJ

The opposite of play is not work. It’s depression. — Brian Sutton-Smith

A little nonsense now and then is cherished by the wisest men.― Roald Dahl, Charlie & the Great Glass Elevator

Recess Rules

What happens when we play? What changes do we notice in our bodies? When we play a game with others, how do we experience those players? What physical or physiological responses to the actions or emotions involved do we notice? What is play? According to Jill  Vialet, author of the book 'Recess Rules', play is like pornography: you know it when you see it. The dictionary definition includes words like “aimless” and “frivolous.” Bernard Suits described playing a game as a voluntary attempt to overcome unnecessary obstacles. But we shouldn’t be so dismissive of play and its benefits and rewards.

People who play are more trusting; they are better self-regulators and can resolve conflict more effectively. Groups who play together have healthier interactions ...continue reading

glamour1Lauren Vogel is a news editor on CMAJ

What separates a good idea from an amazing one? A TEDMED2014 session I live streamed Wednesday provided plenty of clues. Although the speakers came from widely diverse backgrounds, ranging from journalism to ocean swimming, three strong threads – simplicity, specificity and daring – bound together the lessons they shared.

“Flat Out Amazing” ideas, it seems, start from simple answers to complex questions. Take the single-use syringe, for example ...continue reading

1 Comment

 

Andrew and Akshay - Hacking Health

photo credit: Victor Panlilio

Dr. Akshay Shetty (centre right) is an Internal Medicine Resident at the University of Calgary Dr. Won Hyung A. Ryu (centre left) is a Neurosurgery Resident at the University of Calgary
Dr Aleem Bharwani is Director for the Medical Teaching Unit, Internist, and assistant prof at the University of Calgary

For budding young physicians, it’s almost a rite of passage: you finish your residency, accrue research along the way and then enter the clinical workforce. But a small wrinkle has crept into this tried and tested formula. More than ever, physicians in training are disrupting their medical education to foster innovation and improve the field of health care through non-conventional means, but often at the expense of their own traditional careers. ...continue reading

Patrick_ODonnellDr Patrick O’Donnell is a Clinical Fellow in Social Inclusion at the Partnership for Health Equity, a pilot project of the the University of Limerick’s Graduate Entry Medical School in Ireland

It was a one of those endless days in the medical library in my third year of studies that I had an epiphany. I had become pretty disillusioned with my life as a medical student and I was starting to doubt my reasons for choosing this path. I remember leafing through a fairly dull journal when I came across a series of reports on student electives to far-flung impoverished parts of the world. My attention was immediately seized and I quickly set about finding out how I could become part of the wave of idealistic students who go abroad every summer to help people less fortunate than themselves. To be able to marry my passion for travel with an interesting medical experience seemed like an incredible opportunity.

This was the start of a journey that led me to India, the Solomon Islands, Haiti and Nepal to take part in IHEs (international health electives) over the next four summers. They were all very different experiences, but I returned with the same positive feeling; “I have helped in a meaningful way”. These were experiences I could not have gotten at home, I felt. These were making me a better person and hopefully a better doctor in the future. The feelings they created in me and the reactions of those I told about my experiences on my return made me feel like I was definitely making good use of my knowledge and skills.

Looking back, I doubt I made a difference at all, as a recent CMAJ editor’s blog suggested. I was ill prepared and very naive. Language was a barrier to being any way useful in all four of the countries I visited. Often a member of staff (usually a qualified nurse or doctor) was assigned to translate for me as I chatted to patient in the clinics. This ‘baby-sitting’ was a waste of skilled professional time in services that were often overstretched to begin with. I didn’t know very much about the common conditions in these far-flung parts of the world, and often the little I did know related to advanced tests and expensive treatments unavailable in the countries I visited. I brought with me some old textbooks, antibiotics and some surgical supplies to donate to clinics. I had done a little general research on each country I visited, but still managed to encounter civil unrest in both the Solomon Islands and Haiti. I had no plan B, no formal emergency contacts and my medical school did not know anything about my exploits.

Don’t get me wrong, I had the time of my life, and the experiences I had and the people I met have moulded me as a person and a doctor.

That medical student worldwide are attracted to IHEs electives is not surprising. A recent study in Ireland on the attitudes of university students to global development reported that 83% of those surveyed felt it was important to do something to improve the world in which we live and 81% felt that traveling abroad to volunteer is the most effective action to take.

It is not surprising then that bright, enthusiastic medical students act on these impulses. I know I certainly felt as a medical student I had much more to offer on a developing country elective than my colleagues studying arts or business. I also know, however, that as a medical student I was less inclined to examine my reasons for travelling, my activities while away and the effects of my trip with a critical eye. I had never been to a homeless shelter or an addiction service in my own country, yet I was delighted to fly half way around the world to meet similarly marginalised patients in distant places.

I now have the benefit of age, experience and a higher qualification in global health and yet I am still conflicted on the issue. Do IHEs serve a purpose? What do students actually gain from them? Do they cause harm? Are they safe? Who is ultimately responsible for the students and their welfare while on IHE? These are some of the many difficult questions generated by the phenomena that are IHEs.

One area that is beginning to be looked at is the ‘host’ experience of these IHEs and their effects on health services in the developing countries visited. The studies that have so far been published do show despite all the expected problems with IHEs; such as cultural incompetence and language difficulties, there are benefits (Bozinoff et al. 2014, Kraeker and Chandler 2013). Most of the positive gains reported relate to improved partnerships between developed and developing country academic institutions and that concept of reciprocity that is often mentioned, but very hard to achieve in this context.

There are now a huge variety of resources for students to encourage practical preparation and that provide thought provoking scenarios that focus on the inevitable dilemmas faced on IHE. Many medical schools now have modules on global health and cultural competencies. Post-exposure prophylaxis kits for HIV exposure are much more widely available. Students are a lot better informed on world news and issues in foreign parts. Communication with home and emergency contacts are easier. All of these factors should make for better informed, safer and more knowledgeable IHE students.

Whether IHEs are truly successful as a life changing learning experience, however, rests with the attitude of the students themselves.

In addition to those mentioned in the previous blog, some international resources include:

The Ethics of International Engagement and Service-Learning (EIESL) project from UBC, Canada
Elective guidelines from the UCL Centre for International Health and Development
• Ethical scenarios on the Responsible Electives website
General advice and actions for volunteers

 

by Barbara Sibbald, Editor, News and Humanities, CMAJ

Educational standards for physicians in Ontario originally included eight roles. When these morphed into the CanMeds physician competency standards there were only seven. The one lost competency was ‘physician as person’, said Dr. Brian Hodges in a keynote to 120 attendees at the Creating Space IV Symposium in Ottawa, Apr 25–26.

Proponents of the medical humanities, a burgeoning movement aimed at restoring the art, to the art and science of medicine, is all about that lost role.

Hodges leads the AMS Phoenix Project, A Call to Caring, an initiative to rebalance the technical and compassionate dimensions of health care. “Phoenix is trying to leverage change in education and the health care system to balance compassion and technical components,” said Hodges, who is a professor in the faculties of medicine and education at the University of Toronto, Ont. AMS supports the Hannah History of Medicine Chairs, fellowships, innovative projects and scholarly endeavors (including the Creating Space IV Symposium).

Hodges was speaking to an audience of the converted at the symposium, which was associated with the Canadian conference on medical education, but raised extensive discussion when he asked whether the medical humanities makes a meaningful contribution to health care and improving the lives of patients and health care providers. The consensus seemed to be yes, but it could do so much more if it was embedded into core curriculum, instead of being an elective, which de facto has less importance and credibility.

Medical humanities must be a department, like the department of neuroscience or orthopedics, said Dr. Jeff Nisker, another keynote speaker. Nisker, a professor at Schulich School of Medicine and dentistry at Western University in London, Ont., said first year students should get 200 hours in humanities beginning in the first week.

At least two attendees seemed to doubt that humanities would ever gain a place in the core curriculum due to lack of funding and lack of will. “How do we get health professionals to come out and play?” asked Hartley Jafine, who uses theatre to teach communication and team work to health professionals.

Inserting medical humanities into the core curriculum undoubtedly presents challenges including, breaking down barriers to other faculties, improving pedagogy and developing a robust research agenda.

But it’s essential, said another keynote speaker, Alan Bleakley, an internationally recognized expert in medical education and humanities, otherwise, we’re “just playing around the edges and it’s bad luck to those who don’t take it up.” Bleakley started a core integrated medical humanities program at Plymouth University in the UK, and is now a professor of medical humanities at Falmouth University in Cornwall.

Humanities are necessary, said Bleakley, to help cope with symptoms such as the increase in errors, moral erosion and poor self-care. Sensibility lies at the core of Humanities. By this, Bleakley means how we use our senses and how we develop a sense of what is useful, ethical and what is pleasing or disturbing. “Medical students have been rendered insensible,” said Bleakly. “They can’t think or sense for themselves. They are told what they should pick up when they go on a ward round or in the classroom.”

“Why shouldn’t patients or students talk back to the system and say this isn’t right?” Bleakley tries to teach medical students to be dissenters, to provide other options.” He said the major role of medical humanities and the arts is, in Jerome Bruner’s words, to allow people to “traffic in human possibilities, rather than settled certainties.”

The two-day symposium also featured sessions on writing, reflection and curriculum, and brought the arts to participants through writer- and poet-in-resident activities as well as a field-trip to the National Gallery to explore visual thinking strategies.

Creating Space V Symposium will be held next Apr. 25–28, 2015 in Vancouver, British Columbia as an associated event with the Canadian Conference on Medical Education.