QMR - Volume 13, Issue 1 (2019)

FALL 2019

ISSUE 13.1

GROWTH

QMR

Growth

in medicine

Health economics

dear QMR,

classroom to clinic

What should we as medical learners should know about the economics of providing care?

Anonymous upper-year students answer questions submitted by members of the QMed community

What does it look like to parlay schemas and guidelines adopted in the classroom into real-life clinical practice?

In This Issue Content Contributors Adam Gabara Alexandra Morra Andrew Lee Emma Spence Kimberley Yuen Minnie Fu Nicole Krysa Sarenna Lalani Sean Leung Valera Castanov Victoria Lee-Kim Dear QMR Team Design Jessica Nguyen Andrew Lee Doan-Nghi Dam-Le Amanda Mills Editors Jessica Nguyen Grace Yin Zoe Hu Sarenna Lalani Managing Editors Christine Moon Grace Yin Editors in Chief Nicole Krysa Kimberley Yuen

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from classroom to clinic

8

ch-ch-ch-changes

10 making the most out of your clin skills outfit 15 growing pains 17 growing costs of healthcare 20 the boy on beach 22 green recipes 26 qmed cares 31 dear qmr 36 growth crossword 38 horoscopes 2

From the Editors Dear lovely readers, Welcome to our Growth Issue. We are so thrilled that you have decided to pick up a copy of the QMR and give it a read. We are very proud of the content that our entire team has brought forward to our first issue of the year (and our first issue as Editors-in-Chief)!

For this issue, we challenged the Queen’s Medicine community to interpret the theme of Growth in various ways. Given the dynamic spread of talent in the QMed community, it should come as no surprise that the results were wide-ranging. In the Growing Costs of Healthcare in Canada, Victoria Lee-Kim takes a critical eye to the economics of providing care, and asks what we as medical learners should know, and how this financial climate might impact us as practicing physicians. Emma Spence meditates on the process of growth and development in all respects in her touching article, Growing Pains. Meanwhile, Alexandra Morra discusses what it looks like to parlay schemas and guidelines adopted in the classroom into real-life clinical practice in From Classroom to Clinic. As part of our first ever QMRxMedLit collaboration, Andrew Lee reviews The Boy on the Beach a beautifully tragic real-life story about a group of Syrian refugees who tried to grow a new life by seeking asylum overseas (read it if you haven’t yet, and go to the next book club meeting)! On a lighter note, Sarenna Lalani offers up some green smoothie recipes to grow the healthiest body possible. We also added our hands into the mix with an interviewbased series asking medical students at different stages of their journey about their own growth, and a fashion column that shows you how to enhance your standard clinical skills wardrobe pieces. If your brain is up for a challenge, try the crossword created by Sean Leung! Finally, we are so excited to announce the launch of our new column, Dear QMR, wherein anonymous upper-year students answer questions submitted by members of the QMed community. We are so thankful for the silent contributions from all of you. We hope that this column is both fun, powerful, and emotional all-atonce!

A special acknowledgment goes out to our hard-working managing editors, Grace Yin and Christine Moon, who have been pulling strings behind the scenes for the past couple of months, our content editors, Zoe Hu, Jessica Nguyen, and Sarenna Lalani for making sure we have all crossed our t’s and dotted our i’s (and also for making us all sound better!), and to our phenomenal artistry and layout team: Amanda Mills, Doan-Nghi Dam-Le, Jessica Nguyen and Andrew Lee who have completely revamped the look of the QMR for this issue!

Whatever it is you seek out - there is something for you in this issue. We thank you for taking the time to support our creative endeavor, and to all of those who have contributed in their many ways. It takes a village, and we happen to reside in the best one out there.

Nicole Krysa & Kimberley Yuen 3

From Classroom To Clinic:

Life is Not Multiple Choice Alexandra Morra, Meds 2021

Patient X was your quintessential ‘man’s man’ – burly and statuesque, with a face caseated by a greying beard, reflecting years of wear and experience, and a brow furrowed with wisdom. He was a tradesman, evidenced by the calluses on his palms – his badges of honour from years dedicated to his craft. He sat in the chair adjacent to the computer, wringing his hands in his lap. ‘Anxiety’, I note to myself, ensuring to address such during our assessment. It became quite apparent, however, that his anxiety was rather warranted: Patient X was being treated for prostate cancer.

A man who exudes strength and takes great pride in providing for his family, has had his raison d’être stripped from him, be it from androgen deprivation therapy or from long-term leave at work.

According to Watts et al.

(2015), one in four men will experience symptoms of anxiety after a diagnosis of prostate cancer and one in five will experience depressive symptoms. Not surprisingly, Patient X presented with

insomnia and was frustrated at his hindered ability to engage in his daily routine. He was not one for being “idle”, he explained, “if you’re not doing something then you’re in the way.” A study done by Maguire et al. (2019) revealed that almost 20% of prostate cancer survivors experienced sleep dysregulation. Factors that contributed to sleep abnormalities that were parallel to Patient X included urinary symptoms, anxiety, hormone treatment related symptoms, and a lower level of education (Maguire et al., 2019). Evidently, Patient X had more complexity to him than his original reason for visiting: a 3-month follow-up.

Admittedly, it was my first day of clinic, and I was floundering. Having no inclination of where to begin, I quickly perused the patient’s chart, and began probing accordingly. Eventually, the patient disclosed a recent onset of dizziness. Glancing at the patient’s MAR revealed that he was on medications for blood pressure, and I immediately dove down that rabbit hole of questioning. Excitement slowly crept up inside me – had I successfully achieved my first diagnosis? Confident Image Credits Creator:Bluestocking Copyright:2006 Uyen Le

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that his vitals would demonstrate orthostatic hypotension, I began his postural vitals, only to be left with a negative result.

I was stumped and was so sure of my initial diagnosis that I could not think of other possibilities to add to my differential.

Defeated and disappointed, I sulked back to my preceptor’s office waving the proverbial white flag, spewing what little oral report I could muster. He interrupted me mid-spiel. “Did you do a neuro exam? A Dix-Hallpike?” My cheeks burned with embarrassment as I disclosed my lack of diagnostic acumen, ashamed that I did not consider a neurological cause.

Though this was a painful blow to my dignity, it triggered a curiosity into the cognitive biases we carry as practitioners, and their effects on our diagnostic capabilities.

Buster Benson, an author with an interest in cognitive bias, whittled the myriad of existing biases into 4 essential categories: too much information, not enough meaning, needing to act fast, and determining important facts to remember (Benson, 2016). Arguably, maneuvering through the diagnostic process is often met with these obstacles, leading to misdiagnosis, adverse events, or even preventable death. In fact, 75% of errors in internal medicine alone are related to cognition at all steps of the diagnostic process (Graber et al., 2005, and Kassirer et al., 1989, as cited in O’Sullivan & Schofield, 2018). The studies by Graber et al.

(2005) and Kassirer et al. (1989) identified the following steps in the diagnostic process: Information Gathering, Association Triggering, Context Formulation, Processing & Verification.

I initially postulated that errors would predominantly occur during context formulation. However, Singh et al. (2013) found that, contrary to my belief, 78% of cognitive errors occurred during the actual patient encounter! In our current healthcare climate, which is plagued with systemic issues that hinder optimal patient care, I can only imagine that physicians’ resort to employing cognitive biases as a means of being efficient, secondary to cognitive biases being a symptom of burnout. Sherbino [Side bar: I worked with him in my previous job as a nurse!] et al. (2012) had observed that diagnostic accuracy was associated with decreased time spent in the diagnostic process, though I wonder if this more pertains to diagnosis formulation rather than information gathering.

More applicable to me, however, was another study by AlQahtani et al. (2016), who demonstrated that novices’ ability to correctly diagnose were hindered by having less time to do such (as cited in Norman et al., 2017).

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Essay

“According to Watts et al.

(2015), one in four men will experience symptoms of anxiety after a diagnosis of prostate cancer and one in f ive will experience depressive symptoms.”

Figure 1 depicts steps of the diagnostic process and potential associated categories of bias. Reflecting on the brief literature review above, I likely utilized availability heuristic and anchoring during my patient encounter. Availability bias is the use of “more recent and readily available solutions due to ease of recall” (O’Sullivan and Schofield, 2018), and anchoring refers to “relying too heavily on the first piece of information offered” (Pines & Strong, 2019).

I was familiar and comfortable with the diagnosis and management of orthostatic hypotension, and pigeon-holed myself after noting the antihypertensive on Patient X’s MAR. Interestingly, Benson (2016) attributed these biases as a reaction to “too much information”, and as I (excessively) ruminated over this experience, it became quite apparent to me that I was simply overwhelmed.

FIGURE 1: Potential Cognitive Biases at Each Step of the Diagnostic Process

This past week has truly shed insight into the immense breadth of knowledge a family physician must carry in their cognitive repertoire. As a newly minted clinical clerk, I need to allow myself to accept that knowledge gaps will exist, and in fact, are an invaluable component of the learning process. Since my encounter with Patient X, I have begun to review upcoming patient appointments with a reinvigorated approach.

I start by making note of the patient’s medical history, then review the literature on management of pertinent conditions from a primary care perspective. I have found American Family Physician to be quite valuable for such, as well as UpToDate. I may be in the infancy of my medical career, but I have already attained a plethora of knowledge in a mere seven days.

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“. . .75% of errors in internal medicine alone are related to cognition at all steps of the diagnostic process. . .”

Photo by Bret Kavanaugh on Unsplash

References: 1. AlQahtani, D. A., Rotgans, J. I., Mamede, S., AlAlwan, I., Magzoub, M. E. M., Altayeb, F. M., … Schmidt, H. G. (2016). Does Time Pressure Have a Negative Effect on Diagnostic Accuracy? Academic Medicine, 91(5), 710–716. https://doi.org/10.1097/ ACM.0000000000001098 2. Benson, B. (2016). Cognitive bias cheat sheet - Better Humans - Medium. Retrieved September 29, 2019, from https://medium. com/better-humans/cognitive-bias-cheat-sheet-55a472476b18 3. Dunn, J., & Chambers, S. K. (2019). ‘Feelings, and feelings, and feelings. Let me try thinking instead’: Screening for distress and referral to psychosocial care for men with prostate cancer. European Journal of Cancer Care, 28(5). https://doi.org/10.1111/ecc.13163 4. Maguire, R., Drummond, F. J., Hanly, P., Gavin, A., & Sharp, L. (2019). Problems sleeping with prostate cancer: exploring possible risk factors for sleep disturbance in a population-based sample of survivors. Supportive Care in Cancer, 27(9), 3365–3373. https://doi. org/10.1007/s00520-018-4633-z 5. Norman, G. R., Monteiro, S. D., Sherbino, J., Ilgen, J. S., Schmidt, H. G., & Mamede, S. (2017). The Causes of Errors in Clinical Reasoning. Academic Medicine, 92(1), 23–30. https://doi.org/10.1097/ACM.0000000000001421 6. O’Sullivan, E., & Schofield, S. (2018). Cognitive bias in clinical medicine. Journal of the Royal College of Physicians of Edinburgh, 48(3), 225–232. https://doi.org/10.4997/JRCPE.2018.306 7. Pines, J. M., & Strong, A. (2019). Cognitive Biases in Emergency Physicians: A Pilot Study. The Journal of Emergency Medicine, 57(2), 168–172. https://doi.org/10.1016/j.jemermed.2019.03.048 8. Sherbino, J., Dore, K. L., Wood, T. J., Young, M. E., Gaissmaier, W., Kreuger, S., & Norman, G. R. (2012). The Relationship Between Response Time and Diagnostic Accuracy. Academic Medicine, 87(6), 785–791. https://doi.org/10.1097/ACM.0b013e318253acbd

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C

h

C h h C -

Kimberley Yuen, Meds 2022

-Ch anges

I interviewed a medical student from each year and asked them about their transition and three words to describe their journey so far.

Brenna Han, 2023 What were you doing last year?

I was working at a research lab at Western as a lab coordinator - it was my “year off” while I applied to med school.

Is med school what you expected it to be?

It’s better! QMed is definitely better than what I expected it to be. It’s more supportive.

How do you think you’ve grown from last year to where you are now?

I’m less afraid of making mistakes, not knowing an answer, and uncertainty. Last year I played it very safe because I was applying, and for interviews I really couldn’t be risky. But now because of this supportive environment, I’m not scared to be first in clin skills, to ask for help, and things like that. I would say that’s the biggest difference – being more comfortable with taking risks and being okay about uncertainty.

Anything else you would like to share?

There have been times when I’m having the worst imposter syndrome – I’m hoping by next year I’ll be able to work on that. I’m coming from a non-traditional science background and I think I’m one of the only ones in my class. I’m hoping next year I won’t be experiencing that and I’ll be more caught up.

“Unexpected.

Spirited. Inspiring.”

“ Thoughtful.

Growth.

Challenging.”

Alessandro Ricci, 2022 How do you think you’ve grown from last year to where you are now?

I’m going to be in the hospital next year and that changes the way I see things and study, in the sense that I now study thinking about what a patient will look like. It’s also changed the way I look at failure, as I now see failure as an essential part of this process. I want to fail now so I don’t fail when I’m in the hospital. I’m no longer as terrified of saying the wrong thing or making a mistake. Addressing that now is part of what we’re doing – this is what it’s all about.

What do you think next year is going to be like?

I’m not scared at all. I’m actually very excited, and I’m excited to not to be nervous about clinical encounters anymore because in clerkship I’ll be used to seeing patients. While in hospital, I can learn the lifestyle and think about clinical problems, work through diagnoses. I think it’ll be the perfect combination of patient contact, critical thinking, and learning.

Is med school what you expected it to be?

No not at all. In first year I was constantly surprised by everything and didn’t know what the hell was going on in class or clin skills haha.

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Craig Rodrigues, 2021

Ramita Verma, 2020

How have you grown from last year to where you are now?

I tended to compartmentalize things. I’d say my student life was basically school-work, social stuff, working-out (usually in that order).

Having this mindset definitely worked for me in undergrad, but it meant when one element was more demanding, the other elements would suffer.

How do you think you’ve grown from last year to where you are now?

I think last year may have been the steepest learning curve I have had to date.

From a professional perspective, clerkship took me from being a classroom learner to bona fide doctor.

All of a sudden when I read a patient stem on exams, I can think of someone who presented similarly. Things started to stick a bit more once I saw a patient who had the condition. Clerkship is also where I started to feel a bit less like a student and more like a working professional.

Learning to meal prep, exercise, see friends and family, keep mentally well, while reading around cases and keeping up with professional responsibilities (and assignments) was a new balancing act.

Given that my student life is nowhere near done, I thought it would serve me better to integrate my life a bit more. I try to be more flexible with my work-life balance. Sometimes it’s hard and I’m not the best at it… But I have noticed that I’ve started to balance things a bit better than I used to, and that’s a plus!

Favorite thing so far this year?

The goodbye party some of our friends had after the White Coat ceremony, before everyone left for their regional sites!

What do you think next year is going to be like?

Exciting and nerve-wracking. While electives are meant to focus on your learning and career exploration, it’s also like a try-out for a program. I feel like I’ll eventually settle into the expectations and culture of electives and CaRMS, but for now it’s all heavily anticipated!

interview

Is med school what you expected it to be?

I’m not sure what I expected when I got in since it was so long ago. The answer is probably not.

I don’t think I knew what medicine was when I got in or even until a year ago.

Anything else you’d like to share?

While going through medical school, I encourage you to think about the hidden curriculum and how this influences us. If you don’t know what this means, talk to your peers (or upper years) about it. As my time at Queen’s comes to an end, I think the most valuable trait of our school I’ve realized is our community and collegiality with classmates and other years. The way my peers and I have supported each other through the last few years makes me confident that they’ll all be not only brilliant doctors but incredibly caring towards the patients and families they treat. Stay humble. Ask questions.

Keep an open mind. Be kind.

Anything else you’d like to share?

If you have any q’s about clerkship hit me up! crodrigues@qmed.ca

“Challenging.

Doable.

Formative.”

“Humbling.

Community. Growth.”

Full interviews are available at queensmedreview.com 9

Making the MOST OF YOUR CLIN SKILLS OUTFIT By: Nicole Krysa, Meds 2022

fun

Any medical student will be all-too familiar with the clinical “uniform” – the pressed dress shirt and trousers set that got us through our interviews and has been recycled many times since. This look is classic and timeless, but can also get a little bit, well, flat. Here are some season-appropriate ways to breathe some life into your wardrobe staples for both the classroom and the clinic, so that you can fall in love with them all over again.

Look #1: Printed suits have been a persistent trend for the past few years, but a head-to-toe check can make some feel like they are walking wallpaper. One way to ease your way into this trend is to rock a printed pant with a more subtle top. Since the pants are already loud, this look does not need much else. Pair it with loafers in a neutral colour and top it with a trench or “grandpa” sweater if you plan to take things outdoors.

Cuff those pants, and you are ready to hit the streets of Paris!

Look #2: Black turtlenecks to fall are what peanut butter is to jelly – a timeless pairing that is always perfection. Cuff your neutral trousers and pair them with a sleek black turtleneck, and you will exude art-world cool.

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Look #3: Corduroy is all-the-rage this season. Give this trend a try by pairing a slim fit pant in a bright colour with your white dress shirt. For a hip fall look, top it off with an unbuttoned flannel shirt and a denim jacket.

Finally, nothing screams Fall in Kingston like a pair of Blundstones. Latte and beanie are optional!

Look #4: Feeling edgy? Add some punk rock flavour to your standard dress pants. Pair them with a band shirt, Converse sneakers, and a leather jacket. Extra cool points if you wear dark sunglasses and an apathetic sneer.

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Look #5: Look like you own the runway (and maybe the stable too) with equestrian-inspired pieces. Throw your shirt over a pair of leggings (French tuck, of course), and top it with a printed cape – an underappreciated fall option.

Toss on some tall riding boots and a newsboy cap, and you will have all of those neighsayers doubting their statements that leggings can’t be chic!

Look #6: Sometimes a change in colour is all that is needed to update old-timey staples. Try pairing your white shirt with a coloured sport coat and pant, and you will be sure to stand out in the best way possible.

Don’t be surprised if people start inquiring where the best places are to vacation in New England. You are the preppy authority, after all!

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Look #7: Print-on-print is a big emerging trend right now – and what better way to wear it than to have your prints all be the same? Try a shirt and tie that match for a cool subtle look that is entirely modern. Since this look already stands out, you don’t need much else to own the (clinic) room!

Look #8: You knew that you could take your dress pants from the clinic to the classroom, but I bet you didn’t know that you can also wear them at the club. This look is not for the faint of heart, but if you dare to wear an outfit like this, you will surely garner positive attention. To transition your trousers from day to night, balance out the slack-like fit with a tight-fitting crop top. Add in some nineties-inspired stilettos, and people will wonder if you and Jennifer Lawrence share a stylist!

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reflection

Photo by Scott Webb on Unsplash

Gro w

g in

s n i Pa

that moment, we had come so far from those lowest markings.

The peds-savvy know that by five months of age a baby has doubled in length.

Wild, isn’t it? From the time we are born, such importance is tied to this concept of growth.

But what happens when annual pencil markings begin to crowd and overlap and when these standard measures aren’t enough to convey our development anymore?

So much of childhood, academics, finances, etc. are measured according to a common upward trajectory. Let’s frame this in a context relevant to all of us medical students. Particularly in the pre-clerkship years of medical school, we all learn the same material, at the same time, with the same exams and assessments of our progress at the end of the day. This can make it easy to have a sense of what you should know and where you stand. Come a certain point, however, most notably upon starting clerkship, this common path suddenly diverges in (a yellow wood… just kidding) multiple different directions. All these paths may lead to the same end-point eventually, but without 99 classmates moving alongside you anymore, how can you know that you’re moving in the right direction, at the right

Emma Spence, Meds 2021

L

ast year, my parents finally made the decision to downsize from their family-of-five home to a more suitably sized condo for empty nesters. Helping them move, we sifted through decades of memories that were wrapped neatly into boxes or got tossed into donation bins.

The hardest thing to leave behind though, was not a piece of furniture or a parcel of photos, but rather a strip of doorframe trim leading into our kitchen. The kitchen was the centre of our home, that warmly welcomed friends and strangers alike over the years. Countless times the doorframe was walked past without a glance.

Yet for me it was the hardest thing to leave behind, for on it was etched the pencil markings that followed the growth of my brothers and myself (a few stuffed animals too ) over the years. However reluctant we had become, on visits home from university or new homes with partners, our father would still line us up on that doorframe for a reference – even though my 6’6” brother could hardly fit through the door anymore. Tied up in these ever-fainter etchings was a testament of our growth, a written proof that no matter where, who, or how we were in 15

pace, or that you’ll actually end up in the right place? The fact of the matter is, it is really hard to be certain of these things. Wherever your path begins you will need to have a little trust that if you put in the miles, your route will eventually land you in the right spot – with all the same wonderful knowledge as your classmates.

Underlying this transition from pre-clerkship to clerkship is a shift in growth from a common upward and linear climb, to an individual expansion in any number of directions. The growth trajectory remains upward – accumulating knowledge, skills and experiences. However, rate and order of learning will vary widely based on things like sequence of core rotations, different preceptors and residents, how quickly we strike a balance between work and life, and so many other factors both within and beyond our control. If we were to chart our progress through clerkship, some days might look like a failure to thrive, and others might really feel like a growth spurt. Just remember that even on days when the only question you get right is your name, you are growing. On days when you learn a new skill or get to show off something you have been practicing, you are growing. On days when you feel like you are underperforming, the fact that you have that awareness means you are growing. And, just like during puberty, it is normal to have some growing pains. We must take heart in knowing that whatever path we are on, we will eventually all get to where we need to go.

Having said that, not all growth is painful. Growth also comes from hugs from a patient, suggesting the right diagnosis, or finding time to see friends, family or reading your favourite book.

Welcome these moments warmly and continue to seek out the positives even on the toughest of days.

Importantly, too, remember that not all pain means growth. Regardless of where we are at in our training, if we are feeling overwhelmed or run down, we must be kind to ourselves, to each other and try to connect with our support networks. There are people who care and who are there for you, whether these individuals are family, friends, partners, your class wellness representative, a counselor or others. Try to reach out and remember to keep an eye on those around us to offer a kind word.

In summary, come a certain point in medicine, our development switches from common and clearly directed progress, to self-regulated and multi-dimensional expansion.

We may not be able to measure our growth with pencil markings on a doorframe anymore, but the growth we now have the privilege of experiencing goes beyond what the eye can see. Medical school allows us to grow intellectually and emotionally, in skills and in character. Pre-clerkship is a great opportunity to practice what becomes necessary in clerkship and beyond – focusing on our own growth and learning independent of comparisons to others. Take heart in knowing that while we may not always enjoy the growing pains, it would be much more painful to always remain the same.

Photo by Jed Villejo on Unsplash 16

opinion

The growing cost of healthcare in Canada

We have diverse and strategic

student minds that may eventually be able to combine their medical knowledge with policy, and may even be able to tackle the Canada’s growing health expenditure problem. Here are some of the striking statistics and insightful ideas he introduced, mixed with thoughts of my own:

According to the Canadian Institute for Health Information (CIHI), in 2018, total health expenditure in Canada reached $253.5 billion (a growth of approximately 4.2%).

That is 11. 3% of Canada’s gross domestic product. Also, approximately $6839 per person. To put that into context: using the Organization for Economic Co-operation and Development (OECD) statistics, Canada is above the OECD country average in terms of healthcare spending as a percentage of GDP and per-person healthcare spending.

But why are we spending more than the average? Even accounting for the population spread over a massive amount of land, our split between public and private

Victoria Lee-Kim, Meds 2022

Q

Med LEAD provided Queen’s medical students with the opportunity to hear from Don Drummond on the topic of healthcare economics and the growing national health expenditures. For those of you who are unfamiliar with him, he is a renowned Canadian economist who served in the federal Department of Finance, a professor at Queen’s School of Policy Studies, and was a Chief Economist at TD bank. His talk got me thinking—why isn’t healthcare economics more integrated into our medical education?

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Ihilit que reniet acia Nonsecture

health care spending should theoretically equate to us spending less on healthcare.

Our public-sector share of total health expenditure is 70% (30% private) which is below the average of 73%. For more context, the United States healthcare system is 82 % publicly-funded and 18% private. Canada is one of the top spenders, yet we constantly fall short in rankings of international health systems. If you ask me, something doesn’t quite seem to add up!

Overall in Canada, the health-to-GDP ratio has trended upward in the last 40 years for reasons including general inflation, population growth, aging, novel drugs and infrastructure (Figure 1). Hospitals, drugs, and physician services make 18

up the largest shares of health expenditures. In 2018, the annual growth forecast was 3.7%. We have to think of this trend while we practice medicine! The aging of the Baby Boomer generation will demand more of physicians, which means more hours per person or more people to compensate. Compensation currently accounts for more than 60% of hospital budgets, and thus is a huge cost driver. Moreover, old infrastructure must be replaced and increasingly expensive prescriptions are becoming the norm. The introduction of high-cost medicines can increase prescribed drug spending.

These changes are predictable, but the issue is that our governments work in four year blocks, making it next to impossible to create systemic changes that will match the growth of healthcare expenditures.

You’re probably thinking “Ok… so what? What can we do?” Well, I’m obviously no expert and am aware that my opinion doesn’t hold a lot of weight, but I think awareness of these statistics is a good place to start!

Awareness introduces an economic perspective into our future decisions as physicians. It can play a part in our willingness to provide preventive medicine, can help guide our choices of diagnostic tests , and help us decide which policies to advocate for. Who knows, maybe a QMed graduate will be at the forefront of systemic change that improves our healthcare system on a macro level!

Figure 1. How health spending has changed in Canada over the last 40+ years

“The aging of the Baby Boomer generation will demand more of physicians, which means more hours per person or more people to compensate.”

References 1. Don Drummond (economist). (2019, September 28). Retrieved October 24, 2019, from https://en.wikipedia.org/wiki/Don_Drummond_ (economist).

2. How much does Canada spend on health care? (2018, November 20). Retrieved October 24, 2019, from https://www.cihi.ca/en/healthspending/2018/national-health-expenditure-trends/how-much-does-canada-spend-on-health-care.

3. How does Canada's health spending compare internationally? (2018, November 20). Retrieved October 24, 2019, from https://www.cihi.ca/ en/health-spending/2018/national-health-expenditure-trends/how-does-canadas-health-spending-compare-internationally.

4. Schneider, Eric C, et al. Mirror, Mirror 2017: International Comparison Reflects Flaws and Opportunities for Better U.S. Health Care. The Commonwealth Fund, 2017.

5. How has health spending growth changed over the last 40 years? (2018, November 20). Retrieved October 24, 2019, from https://www.cihi. ca/en/health-spending/2018/national-health-expenditure-trends/how-has-health-spending-growth-changed-over-the-last-40-years.

6. Canadian Institute for Health Information. National Health Expenditure Trends, 1975 to 2018. Ottawa, ON: CIHI; 2018.

7. What are the current trends in hospital spending? (2018, November 20). Retrieved October 24, 2019, from https://www.cihi.ca/en/healthspending/2018/national-health-expenditure-trends/what-are-the-current-trends-in-hospital-spending.

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The Boy on the Beach

There is something bone-chilling about seeing the death of a child. We think about all of their potential, missing their first day of school, first school dance, first partner, first graduation, first child of their own. We are left with a void and too many what ifs. This was the story of Alan Kurdi, who forced the world to look deeply into the tragic death of a young boy that came too soon.

Fatima Kurdi left her modest home on the hilltops of Damascus, Syria in the summer of 1992. Little did she know, she was not merely fulfilling her dreams of exploring the world, but she was narrowly escaping a life of violence, torture, and political unrest. Syria has been the site of a brutal civil war since 2011, with thousands of innocent people slain before their families. The life Kurdi knew in Damascus could only be described by one word, family – a definition of family that expanded past blood relation. Warm and bright smiles, the beat of a drum every morning of Ramadan, and the smell of jasmine in the crisp summer air – these memories all make up Kurdi’s childhood.

Kurdi traverses the trauma and hurt caused by the displacement of her family poignantly. She hints to her survivor’s guilt and the injustice her family faces. As her family becomes fractured, seeking safety in neighbouring countries, the book focuses on Alan Kurdi, the youngest son of her younger brother, Abdullah. Reflecting on Abdullah’s younger years, she recounts that he was a charismatic child who elicited belly laughs from the entire room. He was a bit of a silly child and would always find himself getting injured through his shenanigans. Their mother would say, “All these accidents, but he always survives. This boy is protected by mala’ekah,’ which means ‘protected by the angels’”. Abdullah’s characteristics and charms were passed down to his little boy Alan. Alan, however, did not receive the same protection as his father did.

“When you saw the photograph of that little boy, my dear nephew Alan, dead on a faraway shore, you became part of our family” 20

book review

As the Syrian civil war garnered international attention, some European countries began opening their doors. Thousands of people left Syria for Turkey.

Unfortunately, the influx of refugees was not well-received and the capacity to hold them did not exist. It was difficult for refugees to find work and moreover, refugee camps were rampant with starvation and illness. These camps were not a feasible long-term solution. Countries such as Canada did not help. Fatima tried tirelessly to sponsor her family to Canada through refugee status, however, the government required a Turkish residence permit, which was not provided to citizens of non-EU countries. Their applications were at a standstill. Thus, refugees would tackle the fierce waves of the Kos river in hopes of seeking asylum in Greece. People would pay hundreds to thousands of Canadian dollars to smugglers offering flimsy plastic rafts in the face of tumultuous waves. As a result, many would drown on the journey to freedom and safety.

Kurdi reminds us of our responsibility to humanity. She came to Canada as a hairdresser who knew very little English in hopes of starting a new life. She missed her home in Syria dearly and would visit her family often. As the conditions in Syria worsened, she longed to help her family, and she sent little of what she made to support their journeys out of the conflict zone. “The Boy on the Beach� reminds us that we yearn for the same things in life: family, love, security, and safety. Reading this book only reminded me how much hurt there is in this world and the frustrating bureaucracy that intentionally prevents refugees from seeking safety. Through her emotional and ingenious storytelling, Fatima Kurdi reminds us that we should not need to a see a little boy dead on the beach to be angry, to be vocal, and to advocate for a better life for all.

Andrew Lee - Meds 2022

21

GREEN G.I. GOODNESS

Recipes provided by Sarenna Lalani, Meds 2023

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fun

What fuels the body feeds the soul amiright?

Here’s a collection oF GREEN-INSPIRED RECIPES to feed your soul this fall!

Grow Green or Go Home Smoothie Bowl Vegan, gluten-free, soy-free A breakfast of champions that will make you feel ready to take on the day and feel great about sneaking in your veggies so early in the day!

Prep time: 5 minutes Serving size: 1 serving Ingredients: ● For the bowl:

○ 1 banana

○ ½ cup frozen mango chunks

○ 3 generous handfuls of baby spinach or kale (depending on what you’re feelin!)

○ ¾ cup unsweetened vanilla almond milk (or any milk of your choice)

○ Optional: handful of ice ● For the toppings:

○ ½ teaspoon chia seeds

○ ½ banana, sliced

○ Fresh berries of your choice, washed Directions: 1. Place all of the bowl ingredients in a blender and blend until completely smooth (aka no visible spinach bitties). The consistency should be somewhere between a thick smoothie and slightly melted sorbet.

2. Spoon into a bowl and layer on the toppings.

3. Enjoy the most delectable serving of vegetables you’ve ever had!

Tips: ● If you prefer to consume your breakfast through a straw (reusable, of course), leave out the ice, cut the banana by half, and blend for a glassfriendly alternative!

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“Oh she grows” kale lentil soup (adapted from ohsheglows.com)

Vegan, gluten-free, nut-free, soy-free An effortless fall favourite perfect for days that need a little something green! Full of fibre and packed with protein, this is a flavourful recipe that is sure to make a recurring appearance each flu season!

Prep time: 45 mins Serving size: 5 servings Ingredients: • 1 tablespoon (15 mL) extra-virgin olive oil • 2 large garlic cloves, minced • 1 yellow onion, diced • 3-5 celery stalks, diced • 1 bay leaf • 1 1/2 teaspoons ground cumin • 2 teaspoons chili powder • 1/2 teaspoon ground coriander • 1/2 teaspoon smoked sweet paprika, to taste • 1/8 teaspoon cayenne pepper, or to taste • 1 (14-ounce/398 mL) can diced tomatoes, with juices • 5 to 6 cups low-sodium vegetable broth, as needed • 1 cup uncooked red lentils, rinsed and drained • Sea salt and pepper, to taste • 5 handfuls destemmed and chopped kale leaves or baby spinach (Food Basics sells a bag of chopped kale for a great price!)

Directions: 1. In a large pot, sauté the onion and garlic in the oil for about 4 to 5 minutes over medium heat. Add in the celery and sauté for a few minutes more.

2. Stir in the bay leaf and spices (cumin, chili powder, coriander, paprika, cayenne).

3. Stir in the can of tomatoes (including the juice), broth, and lentils. Bring to a boil, reduce heat, and then simmer uncovered for 20 to 25 minutes, until lentils are tender and fluffy.

4. Stir in kale or spinach and cook until just wilted. Serve and enjoy! The cooled soup can be stored in an air-tight container in the fridge for 3 to 5 days, or you can freeze it in a freezer-safe container (leave 1-inch at the top for expansion) for 1 to 2 months.

Tips: • This recipe can be adapted for an instant pot to make your life super duper easy! Use this instant pot on “Saute” mode to saute the vegetables then spices (as per the original instructions). Then, instead of simmering uncovered, cover the pot, place the valve on “Sealing” and set the pot to manual for 6 minutes.

• Tara Fine Foods is a great spot to buy spices in in quantities of your choosing (especially if you don’t want to invest in an entire jar of a spice!).

• Make sure you rinse the lentils well and not too far in advance. I learned this the hard way - if you leave them to drain for too long and they are not thoroughly washed, they will congeal. Trust me, it’s gross and super inconvenient so just wash them well (longer than 5 minutes, for sure).

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growin’ strong one-pan meal prep Gluten-free, nut-free, soy-free A multi-meal solution so easy, you’ll be tempted to repeat it two weeks in a row! Healthy and efficient, this recipe is about to turn your meal prep Sunday into a meal prep FUNday.

Prep time: 1 hour Servings: 3 servings Ingredients: • 2 chicken breasts, cubed • 1 bunch asparagus • 1 zucchini, cubed • 0.75 lbs baby potatoes, scrubbed, rinsed and halved/quartered • Olive oil • 2 + 3 cloves of garlic, separated and minced • 1 teaspoon thyme • 2 + 1 teaspoon oregano, separated • 1 squeeze of a fresh lemon • Sea salt and pepper, to taste Directions: 1. Place chicken breast cubes, 1 tablespoon of olive oil, 2 teaspoons of oregano, and 2 cloves of garlic into a bowl. Add salt and pepper.

2. Drizzle with lemon juice, toss together using tongs.

3. Cover and place in fridge for ½ an hour.

4. Preheat oven to 425 degrees Fahrenheit.

5. Using a silicone-lined baking sheet, place the chicken on one-third of the pan.

6. Place the asparagus down the middle to fill the middle-third of the pan.

7. Fill the last third with zucchini and potatoes, trying to keep them separated as much as possible.

8. Drizzle all the veggies with olive oil.

9. Add 1 clove of garlic to the zucchini and 2 cloves to the potatoes. Toss with your hands to ensure an even distribution.

10. Sprinkle the potatoes with the remaining oregano and thyme, then sprinkle salt and pepper to all vegetables.

11. Use your hands to toss potatoes together once more.

12. Roast in the oven for 30 minutes. Cut the chicken to ensure there’s no pink in the centres and that the juices run clear. The veggies are done when the asparagus and zucchini are softened and the potatoes have dark crispy bits on the edges and can easily be poked with a fork.

Tips: Cooking times will vary with oven strength - the most important thing is for the chicken to be cooked, so please cut open the biggest piece and check!

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Student-Run Clinics

QMED CAREs

Although Canadian healthcare is regarded as universal, major barriers to healthcare access exist for many Canadians. These barriers are a result of social, economical, and political disparities that consequently lead to increased hospital readmissions, higher rates of infectious and chronic disease, and ultimately, lower life expectancy (Pan-Canadian Health Inequalities Reporting Initiative, 2018). These challenges are exacerbated for those who do not have healthcare cards, guaranteed access to meals or shelters, or those who struggle to navigate the Canadian healthcare system. These include new immigrants, refugees, and those who struggle with home insecurity or substance use disorders.

Recent cuts to healthcare such as the elimination of more than 800 full-time healthcare positions, cuts to 6 overdose prevention sites, and future plans to cut up to half a billion dollars in OHIP services, just to name a few, have dug deep into many medical services leading to ongoing shortages of staff, equipment, and space.

Unfortunately, it is those that are most vulnerable with the least options that have the greatest to lose. As students and future Canadian healthcare leaders, we see an opportunity to use our time and energy to do something to help bridge this gap and address these unmet healthcare needs through the development of a student run clinic (SRC) here in Kingston.

SRCs are a model of healthcare delivery that places students in a leadership position to organize and facilitate care under the supervision of licensed healthcare professionals. With at least one hundred operating in the USA, these free clinics hold an important role in providing primary care services to the poor and uninsured while offering medical students an educational opportunity to practice both their empathy and clinical skills. Starting in 1989 with a group of first year medical students at UC Berkeley-UCSF Joint Medical Program who provided free blood draws and screenings at a local homeless drop-in center, this model arrived in Canada in 2000 when students from the University of British Columbia picked it up. Known as the Community Health Initiative by University Students (CHIUS), their clinic currently hosts an interdisciplinary student and resident-led team that partners with both the Vancouver Native Health Clinic and Three Bridge Clinic.

With now more than 8 SRCs around the country, some of these clinics have expanded beyond medical services provided by medical students to become hotspots for interprofessional partnership. In Toronto, Ontario, The Interprofessional Medical and Allied Groups for Improving Neighbourhood Environment (IMAGINE) clinic has medical students interacting with pharmacy and nursing students to provide comprehensive care. Moreover, some of them have

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become community centers where patients can access social work, tax filing services, and in Saskatoon, Saskatchewan, at the Student Wellness Initiative Toward Community Health (SWITCH), even pick up a hot meal for the day.

essay

Benefits of Student Run Clinics:

With having an SRC, adding in interprofessional care that these vulnerable populations are unable to afford or access in the community, is both holistic and cost-effective. It provides patients the ability to engage in more holistic care of their own health, allowing them to take ownership instead of being subjugated to their circumstances. It allows them to not only have access to medications, but they will be able to obtain care for physical pain or conditions, social/mental/occupational issues, and potentially be able to achieve goals and have access to opportunities that they would not have been able to before. SRC’s have been shown to increase patient compliance, patient satisfaction, and have fewer return visits, which marry the two ideas of patient-centered care and ideal outcomes for patients (Charon, 2001; Gross et al., 1998; Cepeda, et al., 2008; Arntfield et al., 2013)

Students will also benefit in that they will have the opportunity to interact with vulnerable populations almost exclusively in the SRC. They will better understand this population, be able

to form connections with them, refine their skills taught in practical classes, and be able to carry forward this experience to their future practice with a more empathetic approach. Furthermore, current healthcare professionals lack a strong sense of what their other colleagues scope of practice is, which potentially can lead to confusion and lack of proper referrals (Curren et al., 2008). As such, students from the various fields will be able to witness and discuss cases with each other, fostering positive attitudes to colleagues from these fields that will hopefully carry forward into their careers. Coincidentally, studentrun clinics also improve interest in primary care for medical students, where interdisciplinary care of patients is essentially required (Shabbir & Santos., 2015).

An already clogged and overworked healthcare system benefits from the SRC model as well, as this holistic approach could keep patients out of emergency departments and avoid preventable hospital admissions (Thakkar et al., 2019, Kramer et al., 2015; Stuhlmiller and Tolchard, 2015; Arenas et al., 2017; Trumbo et al., 2018). Especially with having the multidisciplinary function, SRC’s will improve the quality of care and allow the clinic to tackle multiple issues at once. The SRC at theUniversity of New England in Australia,for example, has managed to save the health system an estimated $430,000 in their first year of operation (Stuhlmiller and Tolchard, 2015). Another SRC situated in Philadelphia managed to save an estimated $850,000 with an operating budget of only $50,000 (Arenas et. al., 2017).

With strong evidence for the benefits of SRC’s, the primary focus moving forward, is to assess the need and feasibility for this multidisciplinary approach in Kingston, Ontario., to ensure that 27

patients indeed desire and will utilize these services for maximum benefit.

Updates regarding the first SRC in Kingston:

Despite the proven benefits of opening a SRC to the community, students and the system, our team was faced with numerous challenges when pioneering the first SRC in Kingston.

Firstly, finding the support of faculty and staff was challenging in the beginning phases of this initiative. As any novel idea, which is filled with uncertainty and more questions than answers, there was initial hesitation to support our proposal. However, throughout the past 6 months and many meetings, we were able to finally secure the support of the Office of Undergraduate Medical Education, and Interprofessional offices of Nursing, Occupational Therapy and Physical Therapy at Queen’s University. Following a landmark meeting in October of 2019, the leadership of these programs agreed on the value of opening such a clinic in Kingston. However, it was also agreed that numerous challenges have to be overcome first before QMedCare - Student Run Clinic can be launched.

One of the challenges outlined was defining the scope of responsibility of medical and allied health students. It was discussed at the meeting with faculty leaders that medical students would have the same scope of responsibility as during regular curricular

observerships, with the duty of care ultimately on the supervising physician. This is the same structure of operations of other Canadian and American SRCs, and it makes sense. Pre-clerkship students lack the necessary knowledge and training and should be supervised at all times. The case is similar for interprofessional students, where a licensed allied health professional will have to supervise students and the duty of care will be ultimately on him/her.

Another challenge discussed was establishing the continuity of the QMedCare SRC, not just at the intra-departmental level, but also at the interdepartmental. In medicine, QMedCare was recently approved by the Aesculapian Society as an official student interest group, which provides us with logistical support and financial backing of a larger organization necessary for the clinic to begin and continue its operations. Our team will soon begin the recruitment and training of next year’s executive council to further establish continuity. Recruiting students from the next cohort is essential, as they will be able to learn from the current council this year, and take over the leadership during the 2020/2021 school year. In terms of continuity in inter-professional departments, we were able to recruit two representatives from the schools of nursing, occupational therapy, and physiotherapy and we will be discussing with them how they see establishing continuity of operations in their departments.

Our team was very fortunate to find great support in our initiative from other Canadian SRCs. We had in-depth conversations with the IMAGINE clinic in Toronto and SWITCH clinic in Saskatchewan, who guided us throughout the startup process, answered our questions and shared their experiences with us. Recently, we have joined the Canadian Student Run Clinic Association (SRCA), which governs and provides logistical support to SRCs. QMedCare will be sending its delegates to the SRCA Summit in Toronto on November 30th, 2019.

Furthermore, we are very thankful to Dr. Meredith MacKenzie, Carol Lynch (NP), and the Street Health Centre (SHC, 115 Barack Street) who generously offered us training, supervision and clinic space. Without their ongoing support our initiative would not be possible. They have offered to host our clinic at SHC, under their supervision, every Tuesday from 5-9pm. We are so thankful for their generosity.

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As our team grew and became increasingly inter-professional, Valera - the founder and executive director of QMedCare, decided to rename the SRC to be more inclusive of our inter-professional colleagues. As this initiative was pioneered

by Queen’s Medicine students, QMedCare was a great initial name of the initiative.

However, as our team welcomed inter-professional members, it was an executive decision to rename the SRC for every team member to feel welcome and included.

The new name of the clinic has not been decided yet, as we want to make it a collaborative decision with the input of all inter-professional members - which will likely occur at an upcoming meeting in November.

Overall, our team was able to achieve great progress in a very short span of time and we are very proud of the work that we have done and continue to do.

From securing faculty approval and support, supervision, clinic space and interprofessional collaboration, we came a long way from just “Valera’s dream”.

Conclusion

Regardless of the challenges, as future healthcare leaders we are obliged to do what is best for our community, patients, and colleagues, and therefore, we will work hard and do what is in our capacity to establish the first SRC in Kingston.

Having talked to many other Canadian SRCs, every clinic had challenges when they first started. In many cases, it took years for their respective clinics to open. After all, Rome was not built in a day.

We have heard from our colleagues that medical students at the Schulich School of Medicine at Western University have also recently brought the proposal of opening a SRC to help their community. This is very inspiring to see, as in the background of ongoing cuts to healthcare, medical students across Canada are striving to open pro-bono health-clinics to help the underserved and marginalized populations.

Let’s contribute to healthcare growth together. Let's open the first student run clinic in Kingston!

By: Valera Castanov, Minnie Fu and Adam Gabara, Meds 2022 Illustrations by Amanda Mills

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References: Arenas, Daniel J, et al. "A Monte Carlo simulation approach for estimating the health and economic impact of interventions provided at a student-run clinic." PloS one 12.12 (2017): e0189718.

Arntfield SL, Slesar K, Dickson J, Charon R. “Narrative medicine as a means of training medical students toward residency competencies”. Patient education and counseling.

2013 Jun 30;91(3):280-6.

Cepeda M, Chapman R., Miranda N, Sanchez R., Rodriguez C, Restrepo A, ... Carr DB. “Emotional disclosure through patient narrative may improve pain and well-being: results of a randomized controlled trial in patients with cancer pain”. J. Pain Symptom Manage. 2008; 35(6), 623-631.

Charon R. “Narrative medicine: a model for empathy, reflection, profession, and trust”.

Jama. 2001 Oct 17;286(15):1897-902.

Curran, V. R., Sharpe, D., Forristall, J., & Flynn, K. (2008). “Attitudes of health sciences students towards interprofessional teamwork and education”. Learning in Health and Social Care, 7(3), 146-156.

Gross D, Zyzanski SB, Cebul R, Stange K. (1998). “Patient satisfaction with time spent with their physician”. J Fam Pract. 1998;47(2), 133 Kramer, Nick, Jaden Harris, and Roger Zoorob. “The Impact of a Student-Run Free Clinic on Reducing Excess Emergency Department Visits”. Journal of Student-Run Clinics 1.1 (2015).

Pan-Canadian Health Inequalities Reporting Initiative. “Key Health Inequalities in Canada: A National Portrait – Executive Summary”. Public Health Agency of Canada.

2018 May 28.

Shabbir SH, Santos MT. “The role of prehealth student volunteers at a student-run free clinic in New York, United States”. Journal of educational evaluation for health professions. 2015;12.

Stuhlmiller, Cynthia M., and Barry Tolchard. “Developing a student-led health and wellbeing clinic in an underserved community: collaborative learning, health outcomes and cost savings.” BMC nursing 14.1 (2015): 32.

Thakkar A , Chandrashekar P, Wang W, Blanchfield BB. “Impact of a Student-Run Clinic on Emergency Department Utilization”. Fam Med. 2019;51(5):420-423. https://doi. org/10.22454/FamMed.2019.477798.

Trumbo, Silas P., et al. "The Effect of a Student-Run Free Clinic on Hospital Utilization."

Journal of health care for the poor and underserved 29.2 (2018): 701-710.

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Thank you to all our contributors to this column.

All advice and opinions belong to our QMR contributors and do not reflect the opinions of the Queen’s Medical Review.

If you don’t see your question here, check out our website, or look for your question in our next issue.

Questions and answers may have been edited for length or clarity.

Dear QMR, Why is QMed so cliquey?

Sincerely, Cady Heron Dear Cady, Oh, the classic cliques. You would think after leaving high school people would collectively start to grow out of this habit. However, it is not necessarily ill-intended, as it is also human nature to feel secure in a select group of people you know you can be included with. As a wise second-year, I can tell you that the “cliques” will always have some framework in class, but the “cliquey-ness” starts to become more fluid. The more you are exposed to different small groups and participate in different events, the more opportunity you will have to meeting new people. Also, everyone will calm down from the initial first year hype and people will start to open up more.

That being said, be the change you want to see in QMed. If you want to see less cliquey-ness, host a social event that includes many people, such as a dinner party or a games night. Put yourself out there, don’t be worried to step out of your comfort zone to explore other friendships, and help advocate within your class to encourage the whole group to be more inclusive.

Good luck!

Tina Fey 31

fun

What do you do if you fall in love with a competitive speciality too late in four years?

Sincerely, Head over heels but not enough time Dear Head over heels, Ahh, every med student’s biggest fear: finding your “soulmate” specialty too late. I have two thoughts on this.

First, how late is “too late”? As avid planners and overachievers, I think most med students feel very uncomfortable jumping into something they didn’t prepare for. But that doesn’t mean discovering you love OB in Block 5 is actually “too late.” Most preceptors in your new chosen field are thrilled to help you discover their career and write letters, and you can reorganize your electives up until 16 weeks before they begin with ease or up to six weeks with some difficulty. You could actually argue that it makes your “story” (which you will write about ad nauseum for CaRMS applications) more interesting. The true “too late” is after CaRMS applications, which are due in November of your fourth year. But even then, many people switch in residency. You’ll hear of them a lot more in clerkship, but it happens all the time. So I don’t think you’re ever truly stuck, it just depends on what you’re willing to do to get to your “dream job.”

Which relates to my second thought: know yourself! Are you someone who struggles with risk? Does the thought of not matching make your literal skin crawl? If so, going through the process of a truly late switch might not make the most sense for you. You have to live through the journey, and it can’t all be about when you’re an attending in X number of years. This is about making a choice that is right for you, as a person and as a med student, and accepting that there are so many ways to be happy and find your niche in medicine.

I hope this helps!

Sincerely, All you need is love

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How do I get a medical school boyfriend/girlfriend?

Sincerely, Hopeless Romantic Dear Hopeless, The question isn’t, “How do I get a medical school partner?” but, “Do I even want a partner in medicine?” There are both advantages and disadvantages to this, and you need to think about what you want. If your partner is in medicine, you can share the highs and lows of your work life with someone who truly understands the nuance of the profession, and this can provide an incredible support. At the same time, you will both be working in demanding professions, and it can be challenging to co-ordinate working in the same location, child care, vacation, and others.

Below is a tried-and-true recipe for finding a medical school significant other. Proceed with caution, for with great power comes great responsibility: Step 1: Make the decision and tell all of your friends and classmates that you would never date someone in medicine.

Step 2: Create an online dating profile (Tinder, Bumble, Grindr, whatever floats your boat) that not-so-subtly indicate you are in medicine. A photo of in you with your stethoscope, or looking extra cute in your scrubs, is perfect.

Step 3: DO NOT swipe right on any QMed interests when using aforementioned dating apps. You want your crush to know you are single and available, but still play hard to get.

Step 4: When your crush mentions seeing you in an online dating app, joke about how hard it is to meet people outside of medicine.

Step 5: Try to get closer to your crush: Start an interest group, Join MedsHouse, bribe Dr. Sanfilippo to putting you in an SGL with your crush. Do whatever it takes.

Step 6: If somehow, the above steps don’t work, just go to the MedLaw mingler and settle for a lawyer.

Good luck, Here’s Looking At You, Kid

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Is research really necessary for CaRMS? Sincerely, P-Values get me down Dear P-Values, It’s never a bad idea to get involved in some research but don’t lose sleep over it. The name of the game for CaRMS applications is to make yourself stand out from other applicants and show your dedication to the field you’re applying to. That can be through unique electives, leadership in the field, volunteer work, research, or anything else. If you’re applying to a non-competitive specialty (based on supply-demand ratios released by CaRMS) and are flexible with location, then I would say don’t worry about research.

There’s no right answer to this because each individual’s pre-med experience, medical school involvement, and desired program/specialty is different. Participating in research will never hurt so if you have the time, interest, and a project available – do it. If you have a heavy research history prior to medical school, maybe that’s enough.

CaRMS has become more transparent over the years.

Each specialty and all programs now list components of the file review (leadership, research, publications, CV, electives, etc.) and how heavily they are weighted.

Go look at this. Some programs will want research experience. For example, orthopaedic surgery at the

University of Toronto evaluates “Success in publication [and] quality of work.”

Whether or not you need research will depend on what you want to do.

This being said, it’s ok if you don’t know to which programs you want to apply.

Research skills are transferrable regardless of the subject, so if you decide to do research you can likely apply it to any program or specialty.

If you are early in your QMed career, get involved doing research because you may have more free time. Opportunities pop up throughout clerkship as well if you don’t manage to get yourself involved in preclerskhip.

If you’re a 4th year and never did any research, include your Mini-Scholar assignments in the research section of your CV and hype them up. Include your Critical Enquiry Project. Include pre-med research even if it was just for a summer.

Don’t leave this section blank.

Good luck!

Sincerely, brokebuthappy

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Can introverts thrive in medicine?

Sincerely, Demure Doctor-To-Be Dear Demure, In a word – yes!

In my first week of Medical School, a faculty lecturer implied that introverts would have a tough time in medicine making friends and staying connected to the community. I left that class wondering the same thing as you – how would I make friends and succeed in a field that often demands direct leadership and meeting new people each day?

I think that being an introvert in medicine is actually a secret strength.

You will understand team dynamics through observation, make patients feel comfortable by giving them one-on-one time, and already have built resiliency skills for times in medical school when you’re inevitably more alone or isolated.

A few ways to put yourself out there: Try a lot of things, even just once. You may be able to find your community of people with whom you feel safe, and with whom spending time with is a pleasure. You may also find an activity or group that’s enjoyable regardless of who you’re doing it with.

Make friends with the extroverts 1-on-1. You’ll get passed the small talk and chaos of large groups, and always have a friend to pull you into the action (when you want to!).

Take time for yourself – there will always be more medicine, more opportunities, more things to see and do. Never feel guilty about focusing on what you need to feel good and prioritize what is most important to you.

Celebrate your accomplishments and don’t sell yourself short. You’ve achieved great things and will keep achieving more. Allow yourself to be the center of attention once in a while – you deserve it.

Best of luck – you’ve got this!

Cheers, A Perky Wallflower

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GROWTH CROSSWORD

Created by Sean Leung, Meds 2022 - so you know it’s gonna be a challenge!

Be the first to correctly finish this to win a prize!

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fun

ACROSS

2 A popular eponymous hub for metastatic abdominal cancers 8 This German’s ribs, margin, and axillary line hold hands to

non-sensitively identify a giant 10 A pathological pebble at the 2nd or 3rd of 3 kinks can produce this

condition that’s likened to an inflated 12 This cephalopod catching apparatus makes ST segments bloom 15 This vision defect can be treated by Cushing’s transsphenoidal hypophysectomy 19 Paul... you don’t want to drink the ‘chocolate milk’ that comes from

these cysts 20 What you call a bruise when you’re trying to impress your OSCE examiner 21 A curious intestine can take this path to find the XY orchids 22 Macrophage mosh pit 23 Testicular chaperone and also the name of a great Spotify playlist 24 Giants are born from the excess love of ________ 25 The name of the non-cardiac fetal shunt

DOWN

1 3

4 5 6

7 9 11 13 14 16 17 18

The task of the dam of the cornea 50% of children will lose faith in your ability to spontaneously vanish at this age The ancestral originator of the bone dissolving cell This type of injury can make you ipsilaterally taller You have 7 of these structures in your body but only 6 of them can be enlarged by fluid Rubor, calor, dolor...

A cream cheese brand shares a name with this leukemogenic muta The trees grow distant in Carl’s forest One of the dynamic duo that keeps J. Cole’s lil’ man up You don’t pop pimples in the danger triangle because of this structure McIsaac’s worst nightmare Large Japanese gland common in North America The disease of the king’s hallux

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fun

horoscopes

Sagittarius (Nov 23 - Dec 21)

(Created by Amanda Mills - Meds 2023, these are just for fun!)

This time is about connections. You’re making connections that will you with your ambitions and help you to move forward. Take it slowly though, and at the end of November you’ll have more clarity about which of these paths you want to follow.

Gemini (May 22 - June 21)

Your creative side will be rejuvenated Gemini.

You may finally achieve some movement forward on something that you felt was stalled. Pace yourself on this important project and you won’t burn out.

Capricorn (Dec 22 - Jan 20)

Cancer (June 22 - July 23)

This time is about choices Capricorn. You will be facing choices this month, and you may not know what to do. Follow your intuition. Some people may doubt you but you’ll surprise yourself with what you achieve this month.

Stay in the present right now Cancer. You’re supported by everyone around you and it’s important that you realize this. Enjoy everything you’ve worked so hard towards, and make sure to take some space for gratitude to those around you.

Aquarius (Jan 21 - Feb 19)

Leo (July 24 - Aug 23)

You may get a second chance at something you’ve been waiting for Aquarius. Take it! Just make sure you consider what you need to feel secure and confident. How can you make sure you succeed at this opportunity?

Dare to have honest conversations Leo. It’s the time for baring your heart to others, and expressing your emotions and creativity. Believe in yourself and share your vision with others.

Pisces (Feb 20 - Mar 29)

Virgo (Aug 24 - Sept 23)

You’ll be learning new information that may open new paths. Open you mind to things you may not have thought were possible. Look back at how far you’ve come already and get ready for new adventures!

It is time for release of resentment and perceptions. Open your mind to things you may have dismissed in the past, Virgo. Open channels of communication and you may see the other side of things that you disagreed with in the past.

Aries (Mar 21 - April 20)

Libra (Sept 24 - Oct 23)

Practice finding balance Aries. You need both freedom and security, and while Mars is in Libra it is a great time to work on figuring out the balance between these. If you work on determining what your values are, you’ll have great success.

You’ve recently learned how to use your voice for truth, Libra. Continue to grow into this role. You could soon have a breakthrough that you’ve been waiting for if you continue on your current path.

Don’t give up!

Scorpio (Oct 24 - Nov 22)

Taurus (April 21 - May 21)

This is a time of regrowth for you Scorpio!

Mercury is in retrograde in your sign and that will allow you to redefine who you are and what your focus is. Take this time to reassess your goals and what you spend your time on. Maybe it’s time to take on a new project!

You will have increased demands on your time and attention at this time of year Taurus.

Make sure you take time for yourself and meet your needs as well. It is a busy time, but a time that you need to make sure you are taken care of first.

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fun

We had an extra page to f ill, so here's a picture of a cat to get you through to the holidays.

- Cat hanging off tree meme from Google Images.

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