QMR - Volume 13, Issue 3 (2020)

SPRING 2020

ISSUE 13.3

CONVERSATION

QMR

Conversation in medicine BE IT RESOLVED

DEAR QMR

COVID-19

That in-person lecture should be discontinued as a delivery method for undergraduate medical education

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

A special time capsule feature of the COVID-19 pandemic, including reflections, poems, and more

REAL TALK

6

#MEDTWITTER

8

K-HEALTH INITIATIVES

12

KIND EXCHANGES IN CAMBODIA

13

THE OTHER "F" WORD

16

TO ME, MEDICINE IS...

Content Contributors Andrew Lee Christine Moon Emily Wilkerson Emma Spence Iku Nwosu Jennifer Ma Jessica Nguyen Kassandra McFarlane Kimberley Yuen Michael Scaffidi Mike Christie Nicole Krysa Sarenna Lalani Sean Leung Stephanie Jiang Valera Castanov Dear QMR Team

18

DEBATE: IN PERSON LECTURES

22

DIFFICULT CONVERSATIONS

24

DIVERSITY IN PLASTIC SURGERY

26

CAMELS & NEW FRIENDS

28

ART OF EFFECTIVE COMMUNICATION

30

CONVERSATIONS WITH ANNA

32

TALES OF A YOUNG REFUGEE

34

CONVERSATIONS ON SEXUAL VIOLENCE

36

DEAR QMR

Design Jessica Nguyen Andrew Lee Doan-Nghi Dam-Le Amanda Mills Kimberley Yuen Editors Jessica Nguyen Grace Yin Zoe Hu Sarenna Lalani Mike Christie Managing Editors Christine Moon Grace Yin Editors in Chief Nicole Krysa, Content Kimberley Yuen, Design

COVID-19

In This Issue

4

Cover photo: Doan-Nghi Dam-Le

2

QMED COVID COLLAGE

42

SPREAD TOO THIN

43

WOMEN ON THE FRONT LINES

44

WHEN RUNNING WENT VIRAL

46

ISOLATION POEMS

50

COPING WITH UPHEAVAL

52

COVID-19 CROSSWORD

54

THE CURE

56

CONVERSATION

From the Editors Dear lovely readers, We are pleased to present to you our third (and final!) issue as Editors-in-Chief of the QMR. It has been such a privilege to have been a part of the longstanding QMR community, and we have loved every minute of it. Although the QMR tradition has been a constant for many years in QMed, we have found ourselves releasing our final issue in truly unprecedented times. COVID-19 has had widespread impacts on Queen’s students, as well as the medical community. Students have been displaced from their usual learning environments as their preceptors bravely face the virus head on.

As such, we felt that we could not launch this issue without devoting a significant portion of it to this once-in-a-lifetime event. We invited contributors to submit pieces under either our initial theme of Conversation in Medicine or the theme of COVID-19. The outpouring of responses that we received were wide-ranging, inspiring, and thought-provoking. We hope that they serve as a reprieve from the stress that accompanies these difficult times.

As always, an emphatic thank you goes out to our devoted Managing Editors, Grace Yin and Christine Moon. They have been working diligently behind-the-scenes for the past year to ensure that all trains run on time. An additional acknowledgement goes out to our Editorial team; Mike Christie, Zoe Hu, Sarenna Lalani, Grace Yin, and Jessica Nguyen, who have meticulously ironed out our wrinkles to ensure that all our articles read in the best way possible. Finally, our design team, who have collectively revolutionized the aesthetic of the QMR over this past year; Amanda Mills, Andrew Lee, Doan-Nghi Dam-Le, and Jessica Nguyen. You have each dedicated so much time and effort, and added your personal touches to make the QMR look amazing. We couldn't have done it without you! A special shoutout also goes out Kiera Liblik for coming onboard this issue and providing us with some beautiful graphics.

Thank you again for supporting us through your readership and enthusiasm over the past year. From the bottom of our hearts, we are so grateful. We wish you all health and safety during these times. As a collective QMed family, we will get through this.

Your Editors-in-Chief, Nicole & Kim

Mike Christie, Meds ‘21

Real-talk: What every clerk needs to know about conversation in medicine.

After a few months of clinical, I’ve come to the realization that effective conversation in medicine is its own art form. The physician has the role of immediately building trust and rapport with complete strangers, albeit while conversing with a wide diversity of people who present in a swirling myriad of contexts. Situations can change rapidly from patient to patient. Sometimes the circumstance surrounding a conversation is turbulent, emergent, panicked, or tragic. Other times, it’s jubilant, relieving, or routine.

Combining the variety of situational dynamics with various personalities, at times I’ve found it both equally intriguing and challenging to communicate with the patient, or person, sitting across from me.

From watching experienced physicians do their thing, it’s clear that effective medical conversation takes tremendous focus, tact, and humility. All of these docs admit that mastering the Art of Medical Conversation takes a career to learn. However, through their own examples, they’ve passed along some insights that have built a solid foundation off of which I’ve been able to learn. I think the basic - yet overwhelmingly human essence of these principles make them something that every medical student should know.

First off, you can’t have a conversation with a patient if they can’t hear you, you can’t hear them, or even worse – both! It’s okay to turn down the blaring TV in a patient’s room or close the door if there’s a commotion out in the hallway. You may have to raise your voice to what feels like an incredibly loud volume – we’re talking rock concert levels – when conversing with a hearing-impaired patient. Sitting down when at the bedside can help with hearing, and it erases perceived power dynamics at the same time.

I have even seen a patient put in the earpiece of their doctor’s stethoscope while the clinician spoke through the bell. (Don’t worry, there were disinfectant wipes involved before and after). Regardless, setting the stage for conversation with something as simple as making sure you can hear one another is a critical, but often overlooked, first step.

“Patients don’t read the textbooks on how their disease presents!” It’s a line we’ve all heard at one point or another in our training, and it’s true. Patients typically don’t describe symptomology or progression of illness in a clear-cut timeline that perfectly matches classic clinical presentations. Obviously, part of the Art of Medical Conversation is carefully reconstructing the sequence of events in a medical history – that’s what we’re there for. The reality is, though, that it can be quite puzzling. Add in the pressure of limited time 4

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and it can quickly become overwhelming. It’s key to remember that it’s okay to pause, backtrack, and ask for clarification on timing of symptoms or events. Initially I was worried that patients would (incorrectly) view this as a result of inattention, however over time it became clear that they instead appreciated that I was being thorough. It’s more efficient to invest a few moments up front to avoid having to go back again at a later time. On a pertinent practical note, when patients struggle with remembering timelines or frequencies, using generalizations of timelines “days, weeks, months, or years” has proven highly effective at helping quantify a timeline.

Reflection

“ If there was one thing that at first put me a tad off-kilter, it was experiencing firsthand that medical conversation is not sterile. ”

Part of collecting information from patients involves asking them a certain list of questions to ascertain critical details about their condition or clinical presentation. The challenge with this when first starting out is that it can be exceptionally difficult to focus on a patient’s answer to a question while at the same time considering what to ask them next. One helpful strategy for managing this is simply taking notes as you go along to more easily follow the conversation and have a quick summary available for review if you feel lost. Another key point is knowing that you are, in fact, allowed to pause and think for a few seconds! The interaction doesn’t have to be a rapid fire of back and forth.

Pauses can feel tremendously awkward, however patients understand if you need a moment to consider which routes to explore with your next question.

energy reserves. Acknowledging that you are in one of these conversations is helpful for regulating your reaction and keeping a level head in the remainder of the interaction. Debriefing with the team can be beneficial to learn what other strategies team members use for challenging interactions. Lastly, recognizing that from a mental standpoint you may take some of your work home with you is also a valuable insight. It may be necessary for you to unwind a bit afterwards, and it’s okay to take time to do so.

If there was one thing that at first put me a tad off-kilter, it was experiencing first-hand that medical conversation is not sterile. What I mean is that it’s not always exactly like attending a formal Sunday tea party. This isn’t something that can truly be simulated in pre-clinical training. When we go to work, we deal with real, live human beings, and usually when they come to see us it’s not under the easiest of circumstances. Part of the job is speaking with patients who are anxious, angry, or frustrated.

The reasons behind their attitudes, behaviours, and language choices are complex and multifactorial.

It’s not our role to judge, and it’s key to understand that if a patient is upset, it’s usually not about you. To be clear, there is zero room for abuse of any sort, and although it can feel scary to do, you are never in the wrong for addressing it with your resident, preceptor, or the supports in place via the medical school. Having said that, there will be other situations that can challenge your patience, require great diplomacy, and drain your emotional

Finally, it’s helpful to appreciate that as medical students our job is not to have all of the answers (at least not yet). The one thing we can do, though, is to make sure that in every single encounter the person sitting across from us knows that we’re there to take good care of them. An empathy-based conversation recognizes and respects the humanity of our patients. By dedicating ourselves to this axiom, we can always put the wellbeing of our patients first, and no matter what our discipline, that’s a part of the Art of Medical Conversation worth talking about.

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Gone are the days when you tweeted about how boring second period calculus was, or showed the world your cafeteria lunch - #blessed. Twitter has gone through a revival since we last knew it, now becoming a forum for academic discussion, debate and trolling. #MedTwitter has taken the chirpy website by storm, amassing hundreds and thousands of tweets per day from all corners of the globe.

Whether it be tweetorials or people straight meme-ing it, twitter has truly changed the way people in medicine interact with research, colleagues and the public.

Bite-sized information in real-time Twitter is not for the faint of heart, it is a constant barrage of information. However, in 140 characters people are forced to be concise. The only atrocity is verbosity. One can receive up to date information from reputable sources at their fingertips. With trending hashtags and the opportunity to go “live” twitter has built an ecosystem conducive to digestible information. To optimize your twitter experience you can set up lists, follow certain hashtags and obviously follow your favourite influencers. Twitter is the Costco sampler of the internet.

Breaking down barriers with mentors and idols Academia has always been inaccessible, the coveted “cool kids table” in the cafeteria. However, twitter has been able to bridge the gap between the nerds and jocks. Liking, replying and retweeting your idol’s tweets is an opportunity to be seen. There is a low threshold to echoing the voices of others on this platform and if you appear in someone’s feed enough, they might just send a follow your way. It’s like having your professors and heroes on Facebook, but in a more professional manner. This is a great way to connect with people you find interesting or inspiring and it breaks down the intimidation of sending a formal email. Not to mention, this humanizes your idols. You learn about their quirks and interests and you can see their “likes”. Why yes, professors also enjoy the occasional meme.

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OPINION

Subcultures

Like any good social media platform, subcultures exist. From #gaymedtwitter to #medhumchat you can explore niche areas of medicine that might not be prominent at your home institution. This allows you to connect with people around the world who share marginalized identities or specific interests tangential to medicine! There is so much to offer and medicine is so much more than‌ well medicine. Look hard enough and you will find the #HotDogIsASandwichDoctorsClub, even though that opinion is straight up wrong.

Being vulnerable Although Twitter has become a professional forum, it has still retained some of the personal nature of what we once knew. From your tough days to angry rants, many physicians can be quite vulnerable on the platform. Especially in the era of COVID-19, we see across the board an unprecedented vulnerability displayed by colleagues. I for one, believe that this is healthy for medical culture. It is important to show our colleagues, learners and society at large that physicians are prone to similar stressors (if not more) as everyone else and sometimes, life is just plain ol’ hard.

Thank you for all the doctors out there who have shown us that being vulnerable is not a weakness, but a strength.

Meme-ing it From Dr. Glaucomflecken our resident eyeball enthusiast and tiktoker, to sassy memes by accounts by the selfproclaimed monikers such as HotGirlMed or BlondeBoy3000MDToBe. The anonymity that Twitter provides can be an outlet for disgruntled medical students around the globe. Dark humour has always been a part of medicine - this is just the modern form.

ph Gra iera

by K ics eds ik, M

Libl '23

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KHealth – Kingston’s Comm

Written by Valera Castanov, Founder of KHealth, Meds '22

An inspiring story of how Queen’s medical, nursing, physical therapy and occupation therapy s united to help Kingston’s vulnerable populations.

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PROFILE

munity Health Initiative

students

Introduction to KHealth

W

hen the COVID-19 pandemic first began, KHealth was among the few student organizations at Queen’s University that was able to rapidly respond and launch several initiatives to help Kingston’s vulnerable populations. KHealth started the Student-run Community Support Program, hosted “Call Your First Patient” Day, and launched an emergency fundraiser for the Lionhearts Inc, a group that helps feed those in need in our community — raising over $2.4 thousand dollars.

How did KHealth start and how did this organization end up at the forefront of helping our community during these difficult times?

I

t all started with the author’s original idea of launching a student-run clinic in Kingston to help improve healthcare access to all residents of the greater Kingston area, particularly to the marginalized populations, and those without OHIP cards, permanent place of residence, official immigration status, or with other limitations. Please see Queens Medical Review’s Issue 13.1 - Growth for a more detailed discussion. However, due to several logistical, financial, and legal concerns, launching this clinic was not possible.

When one door closes, another opens While working towards establishing a student-run clinic, the author was able to assemble executive and volunteer teams of interprofessional health students, gather community support and build close relationships with the administration. When the original idea did not work out, the author worked with all parties to develop a new vision and find a way forward to help Kingston’s vulnerable and underserved populations. This is when the idea of KHealth – Kingston’s Community Health Initiative was born.

KHealth is the first student-led interprofessional community health initiative in Kingston, Ontario, where students from programs in medicine, nursing, physical, and occupational therapy work together to improve the health and wellbeing of the local community. It is also the class project of Queen’s Medicine class of 2022! KHealth is actively developing educational and service-learning components, which are aimed to introduce students to working with vulnerable and underserved populations in an interprofessional community health setting. The organization also strives to combine theory and experiential learning to provide an enriching, immersive, and interactive experience to students.

Core values of KHealth are equity, diversity, and inclusivity. The organization aims to familiarize students to concepts of equity in healthcare and emphasize the crucial role of the social determinants on health and wellbeing. A large focus of KHealth is also on diversity and inclusivity. To date, KHealth has 14 executive team members and over 40 volunteers, each from diverse health programs, with diverse socioeconomic and sociocultural backgrounds – with a common aim to serve and be inclusive of everyone in the community regardless of their gender, age, race, sexual orientation, socioeconomic status, or overall health status.

Overall, KHealth is positioned in a unique and fortunate position to be able to act as a liaison between the students in the Faculty of Health Sciences and the community and can leverage its volunteers and resources in the time of need. Consequently, when the COVID-19 pandemic first began, KHealth was able to respond quickly and launch several initiatives to help Kingston’s vulnerable populations.

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Emergency Services and Food/Meal Programs Available in Kingston and Frontenac April 2020 KHealth’s Student-run Community Support Program: Offering check-ins via phone/video call, grocery/pharmacy/ foodbank delivery, and minor errands.

Leave message at 613-817-7787 or email khealth.community@gmail.com

Lionhearts: 263 Weller Ave. Take-home meals.

Monday – Sunday, 5 – 6 p.m.

30 Alma Street. Take-home meals.

Lunch by George: 129 Wellington St. Hot take-home meals or bag lunches.

Monday – Sunday, 6 – 7 p.m.

Monday – Friday, 11 – 11:30 a.m.

Martha’s Table: 629 Princess St. Providing take away hot meals.

Monday – Sunday, 11 a.m. – 1 p.m.

Mutual Aid Katarokwi: Offering check-ins, grocery/pharmacy/foodbank box delivery.

Leave message at 613-665-2959 or email mutualaidkatarokwi@gmail.com

North Frontenac Food Bank: 14152 Road 38, Sharbot Lake Call 613-532-8855 for appointment.

Partners in Mission Food Bank: 140 Hickson Ave. Call 613-384-4534 for appointment. No walk-in service.

Monday – Friday

8:30 a.m. – 12 p.m., 1 – 4 p.m.

Salvation Army: 342 Patrick St. Take-away prepared food baskets.

Monday – Friday, 11 a.m. – 4 p.m.

South Frontenac Community Services/Sydenham Food Bank: Frozen meals available for delivery daily. Hot meals delivered Tuesday and Thursday. Delivery only to South Frontenac/rural Kingston. 613-376-6477

St. Mary’s Cathedral: 260 Brock St. Providing takeaway light food/snacks.

St. Vincent de Paul: 85 Stephen St. Providing bag lunches.

Monday – Friday, 1 p.m. – 4 p.m.

Food Pantry available by appointment

Monday – Friday, 10:30 a.m. – 12 p.m.

Please take a moment to read about some of KHealth’s COVID-19 initiatives.

Shortly after the beginning of the COVID-19, the KHealth’s Student-run Community Support Program (SCSP) was spearheaded by Queen’s medical students: Jenn Campbell, Vanessa Giuliano, Nia King, Ruchit Patel, Daniel Shi, and the author, in partnership with students of the schools of Nursing (Michaela Patterson and Cici Siju), Physical Therapy (Kathryn McGuire and Justin Achat), Occupational Therapy (Grace Manalili and Theresa Fraser), and Medicine (Adam Gabara and Minnie Fu).

The program involves partnering a Since the inception of the program, student from the Faculty of Health there have been 43 volunteer sign-ups Sciences,with an elderly person and/or a and numerous requests for services member of a vulnerable population from the community. The program to assist them during the COVID-19 was advertised in retirement homes, pandemic and beyond. The SCSP community groups, community offers the following two services: KHealth’s Student-run Community health clinics and throughout the 1. weekly check-ins via phone or Faculty of Health Sciences. To date, Support Program video calls for social comfort; and SCSP volunteers have completed 2. assistance with grocery shopping numerous grocery deliveries, phone and delivery, medication pickcalls, and laundry pick-ups and dropups, and/or minor tasks (e.g. pickingoffs! The Kingston community has up laundry). All of KHealth’s volunteers been overwhelmingly receptive to this have been instructed to follow strict program.

COVID-19 precautions.

Furthermore, KHealth was invited to present this initiative at the Ontario Medical Students Association’s COVID-19 Forum on Saturday, April 11th to partake in knowledge sharing with other medical schools in Ontario. It is projected that SCSP will continue its operations beyond COVID-19.

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“Call Your First Patient” Day

COVID19 is an especially challenging time for seniors and vulnerable populations, and our First Patients, for the most part, belong to one or both of these groups.

Consequently, KHealth hosted an inaugural “Call Your First Patient” Day on Saturday, April 4th, to encourage medical students to call their First Patients to inquire about their health and wellbeing, and ask whether they required any help or assistance of any kind.

Final words

KHealth is an inspiring story of how interprofessional collaboration can do a lot of good for the community. It provides an impetus to develop and support interprofessional education programs across all four schools in the Faculty of Health Sciences.

KHealth proposes to collaborate with the Interprofessional Education Committee (IPEC) on the development of such programs.

KHealth received a lot of positive feedback from both the participants and the First Patients. Some First Patients received numerous phone calls from different cohorts of medical students, one quoting that “[he] did not feel this popular in a while, it feels great”. Several First Patients also signed up for KHealth’s SCSP services.

Overall, after having received a lot of positive feedback, KHealth will be suggesting to the Undergraduate Medical Education (UGME) to make “Call Your First Patient” Day a yearly event.

Supporting Lionhearts Inc.

During the COVID-19 pandemic, the most vulnerable members of our Kingston community are disproportionately impacted. Several community organizations have significantly reduced their hours of operation or have been forced to close. In particular, this state of emergency severely exacerbated the food insecurity issues vulnerable populations already face.

Among the organizations that are still operating during this difficult time is Lionhearts Inc. Every day, Lionhearts sets-up two mobile command centres, one in the McBurney Park (30 Alma St) and the other at the Weller Clinic (263 Weller Ave), and distributes nutritious meals and beverages to Kingston’s marginalized populations. Lionhearts also supplies warm clothing, personal toiletries, and fresh socks/towels. Most importantly, they provide a point of entry for those in need to access other emergency services. Lionhearts’ volunteers are some of the many heroes at the frontlines of the COVID-19 pandemic. However, due to the increased demand (over 240 people per day), as a result of closures in the Kingston community, Lionhearts needed help to continue their ground-breaking work.

As KHealth believes in Lionhearts’ courageous efforts, a fundraiser was launched to provide financial contributions to support their ongoing projects. Within the first 4 days, KHealth was able to raise a total of $2,464! The fundraiser is ongoing, so please consider making a donation to support the Lionhearts’ COVID-19 initiative.

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Acknowledgements

The author would like to thank Canadian Federation of Medical Students (CFMS) for providing KHealth with the CommunityCare Initiative Grant. Also, the author would like to extend sincere gratitude to the Ontario Medical Students Association (OMSA) for their COVID-19 Initiative Fund.

Lastly, a huge thank you to the Aesculapian Society (AS) at Queen’s School of Medicine for their continuous logistical and monetary support. Without the help from all of these organizations, KHealth’s efforts would not have been possible.

For more information: General information: khealth.info@gmail.com KHealth’s SCP: khealth.community@gmail.com

Poem Kind Exchanges in Cambodia We started uneasy, adjusting Yet, every interaction came easy All kindness From every single person.

“She wants to take us out to dinner.”

Our instinct was to be scared We were advised to worry Yet, each person we spoke to Generous, overly generous Nothing we had seen before.

“The laundromat fixed the hole in my pants without me asking.”

Conversations were so different, The stories they shared Our normalcy, so dreamlike Their normalcy, hard to fathom Yet, all they spoke of was giving.

Selflessly, regardless of circumstance.

“She said ‘there is always someone who needs help.’ ” Finally, in moments of our gratitude They met us with confusion These kind exchanges, these are just their usual “He insisted on driving us everywhere.”

“She hand-wove us gift baskets.”

“He opened his house to us.”

We the weary on the West, We have a lot to learn.

- Iku Nwosu, Meds ‘22

Graphic by Kiera Liblik, Meds '23

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The Other “F” Word Aware that many would not be eager to dive into an article about Feedback, I knew that I would need to do something to captivate your attention. I hope to entice you to stay tuned at least long enough for me to share my view on feedback. Come my third year of medical school, I now realize that feedback is one of the most significant contributors to my growth and development as a burgeoning clinician. How uniquely valuable it is that I get to glean opportunities to see myself through expert eyes, to get practical insight from MDs with decades of experience, and to get an honest rating of my performance. Since I have come to value its importance so highly, I have invested significant thought into breaking down my approach to feedback, some aspects of which I hope to share here.

Reflection

By Emma Spence, Meds '21

my training. Rather, I mean feedback that was poor in that it did not help me to assess my performance in a way that would be useful to my development as a learner. Some assessors would clearly have intentional, organized, pertinent and thoughtful methods of giving feedback. Contrastingly, others would simply employ the “things are fine” approach. The latter would sometimes make me mourn the wasted breath – my words in eliciting the feedback would seem futile, and I felt almost guilty having them expend their breath on an unconstructive answer. Both of these types of experiences have prompted me to appreciate that creating valuable feedback is in fact a skill –a skill that not everyone has been explicitly taught. I would like to emphasize here that I have yet to even mention the content of any feedback. This discussion has little to do with whether the feedback received is positive, constructive, or otherwise. Rather, it has to do with how effectively feedback can be elicited, delivered and received by students – the performance quality of the skill of feedback itself.

Feedback in medical training comes in many forms.

It can look very different based on the individuals involved, the level of training, the setting in which it was evaluated and received, etc. While a sitdown meeting can be conducive to communication, sometimes a telling gaze across a room can send alltoo-clear a message. Feedback can be an expressive process through exchanges with others. However, it can equally be an introspective and reflective practice carried out within one’s own consciousness. While many of these may be simultaneous and ongoing, various individuals tend to weigh differently the value of spontaneous versus elicited feedback, external versus internal feedback, and verbal versus non-verbal feedback. I believe that it is crucial to tune into all of these forms of feedback in order to optimize one’s development as a medical learner. For the purposes of this article, I will focus on elicited verbal external feedback.

Once I established that feedback was a key component of my learning, I decided that it was a worthwhile investment of my time. The trouble was, external feedback inherently involved individuals and elements beyond my own locus of influence. So, came the understanding that in order to acquire the caliber of feedback I sought, I would have to make the most of those things that I could in fact control.

Below are a series of questions I now tend to ask myself each time I seek out verbal external feedback.

As with most things, there is certainly more than one good way to approach feedback. I hope to share just one such method that I have personally found to be constructive in case a colleague might derive benefit.

I recall learning about giving and receiving feedback during the Clinical Skills course in my first year of medical school. While this learning did effectively prompt me to shift away from my previously employed “compliment sandwich” method of receiving and delivering feedback, the content felt fairly intuitive and conceptual, and I did not think too much it. It was not until clerkship that I really experienced what it was like to receive poor quality feedback. I don’t mean feedback telling me my performance was poor - I have gratefully received constructive feedback throughout 13

Why do I want this feedback?

There are instances where we collect feedback simply because we have to, or because we feel we should. For example, at the end of a Clinical Skills encounter during pre-clerkship or to fill out one of the tens of clerkship evaluations we are all unavoidably required to submit. Beyond the program requirements, however, I find it valuable to take a moment to consider why ‘I’ want this feedback. There are occasions when we seek others’ thoughts as a means of forcing ourselves to reflect on our own performance. Alternatively, asking for a performance evaluation can force an assessor to reflect critically on our functioning, which may be valuable to get their wheels turning with regard to a reference letter, to reflect our investment as a learner, or to somehow implant ourselves in their memory before getting lost as yet another clerk rotating through their service. Sometimes we ask for feedback simply to ensure that we aren’t doing a terrible job! Often, opening a feedback discussion carries the intent of debriefing – whether about an isolated difficult encounter or a longitudinal clinical experience. Other times, admittedly, we are looking for some reassurance or a pat on the back. Evidently there is a wide variety of reasons we might seek out feedback.

Program requirements and reassurance aside, if I can truthfully say that my motivation to receive this particular feedback is due to a genuine desire to improve, then I can move forward to these following questions.

What am I willing to put in to receive high quality feedback?

As is frequently the case, “you often get out what you put in.” External feedback is a conversation, which inherently involves at least two people. As such, if we are expecting meaningful output from them, it is only fair that we input a similar amount of thought and effort.

The timing of a request for feedback is important. In my opinion, if I catch a preceptor with one foot out the door on a Friday afternoon to ask for feedback, it would not be fair of me to be frustrated with a low-volume, generic response. While there is only so much control we can exert over the ever-unpredictable schedules of clinicians, one thing I do to help myself is to foreshadow my desire for a discussion. This typically helps us to later find a time and place that feels more private and less rushed.

It is equally important to make sure you have provided the assessor with the information they require in order to give valuable feedback. After pre-clerkship, oftentimes it is challenging for staff to keep track of your level of training – did that clerk say they were in third or fourth year? Does their school have a fourth year?

Does that mean they have only done core blocks or elective placements? Why do they need this feedback?

Is it simply to review whether the course objectives were satisfied or is it because this particular rotation is important regarding career choices? You know your own training, experiences and goals better than anybody else. So, I have found it really helpful to voice what my own objectives and focus-points are, which provides specific things for my assessor to comment on that are actually valuable to me and appropriate to my level of training.

A final, very valuable, input of effort prior to seeking feedback is self-reflection. This reflective process can be quite brief. For instance, if you only worked with a staff for one day, there is not a lot to review. However, if you have worked with someone over a longer period

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of time, it can be a deeper dive into how you feel you have developed over recent days, weeks, blocks, etc.

I have found that going in with my own assessment of my learning and performance adds meaning and calibrates whatever is subsequently shared with me. I have often found it helpful to voice these reflections (negative, positive or otherwise) to my assessor prior to them sharing their thoughts as it provides a framework as to the scope, depth and topics of commentary I am hoping for.

“Are there considerations I need to make from the other person’s point of view?” to not listen to what your evaluator has to share.

Once the encounter has passed, you are then able to select what information you would like to carry forward with you versus what information you might leave behind. Yes, you are allowed to leave some comments behind. However, I would caution that comments which I have found myself feeling defensive about in the moment, have turned out to be some of the greatest motivators or contributors to my growth.

Are there considerations I need to make from the other person’s point of view?

Most teachers do in fact want to stimulate and contribute to the growth of their learners, and many see feedback as a key component of this process.

However, it is important for us students to consider that while we are there to learn and grow – other than in controlled setting such as clinical skills or a classroom – our superiors are there to care for and keep patients alive. As such, we must be cognizant of the setting, timing and emotions surrounding our desire to learn.

Ultimately, how you respond to the feedback ties in extremely closely with my first question – Why do I want this feedback? If I did genuinely seek this feedback in order to grow, then I will want to jot down the information that has been shared with me and apply the feedback that has been given.

Also, when it comes to viewing things from another’s perspective, I would like to openly admit that my assessment from others’ points of view with regard to feedback has more than once been quite inaccurate – thinking a week was going terribly but finding out at the end this staff was impressed by how much he pushed me. This to say, while it is courteous and important to consider things from another’s viewpoint, avoid losing learning opportunities by shying away from seeking feedback from individuals when you think you already know their opinions.

You will often be surprised how differently they see things.

---As mentioned throughout, these questions are by no means strict choreography to successful exchanges of feedback. These are simply some thoughts to consider as we go through our medical training that undoubtedly will be inundated with feedback (sometimes to the point of “feedback fatigue”).

Ultimately, despite our best efforts, there will still be occasions where all we get back is, “things are fine” – and that is ok. I feel that if I have carried out this exercise and asked myself these questions, I have done my part in the dance of feedback. While the dance may have turned into a solo, I will have, nonetheless, invested truly meaningful reflection that contributes to my ultimate goal of growth.

How am I going to respond to this feedback?

Responding to feedback is often a two-part process involving both an immediate and longer-term response. In the moment, feedback can spark any number of emotions from flattery, to embarrassment, to frustration or disappointment. This aspect of feedback likely is the most disparate in terms of how individuals handle themselves. One approach is to allow yourself to feel whatever emotion is stirred up in that instant, while still allowing yourself to listen to all the feedback being offered. It would be a wasted effort to go through this whole process only

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16

ART

to me, Description of piece: This is an abstract mixed media piece that represents what medicine means to me: connection, communication, and community. Under the theme of connection, the hands symbolize the physical aspect of medicine and how important human touch is.

All of the hands are connected with the red thread via their “heart lines”, symbolizing how our actions affect one another, but also how we are interconnected and can support each other. The middle hand is the American Sign Language sign for “I love you” which represents the importance of communication, advocacy and accessibility. The first and third hand pay homage to “the Creation of Adam” by Michelangelo, which symbolizes humanity. The mixed media aspects were created to resemble different communities coming together to form something bigger. All of the components of this piece embody how medicine is comprised of many unique and working parts, which all come together to create a unified whole.

medicine is...

kimberley yuen meds ‘22

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Be it resolved that:

NAY!

YAY!

Mi ke C h

Mike Christie, Meds ‘21 (YAY) Sarenna Lalani, Meds ‘23 (NAY)

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rist i e,

ed M

aL

Saren n

s ‘2 3 ed

ala ni ,M

in-person lecture should be discontinued as a delivery method for undergraduate medicAL education

DEBATE

YAY

D

oes it make sense to continue doing something a certain way simply because that’s how it’s always been done?

Lecture requiring in-person attendance has undeniably been the longstanding workhorse of medical education, however in modern times its utility has faced increasing criticism. A brief consideration of its pitfalls makes it clear that in-person lecture should be discontinued as a delivery method for undergraduate medical education.

While the average attention span is a source of debate among academics, it is generally accepted to be between 10 and 20 minutes. This means that during a standard 50-minute lecture, the average student is likely only paying attention forty percent of the time! Extrapolating this forward, the retention of the knowledge and concepts covered suffers because they are not learned in the first place. The driver behind these limitations is the reality that lecture does not engage students in critical thought.

The reason? There simply is no time for it. The voluminous nature of medical education does not permit time for more effective lecture styles where questioning of the audience to spur critical thought can occur simultaneously with the dissemination of information. From the student’s perspective, the goal of lecture is to somehow pay attention to the continuous relay of information, rather than to interpret, apply, or question it. Consequently, while lecture may claim to disseminate information, it is woefully ineffective for having students actually learn it.

Medical students, however, are only part of the equation.

A critical component of medical education is the presence of passionate, experienced, highly qualified experts to organize and deliver it. It is important to consider that having these individuals provide in-person teaching removes them from clinical activity. Although this is necessary to facilitate certain sessions, it is unreasonable to pull physicians from patient care to teach didactically what students could otherwise learn themselves. It would be sensible to instead have content sessions be self-taught and then followed by interactive, engaging, case-based sessions facilitated by these physicians.

Further considerations with this model include increased ease of scheduling for all parties involved, as well as a decreased need for a physical space to host lectures, thereby freeing up this resource for other learners.

With a lack of student engagement, the didactic relay of content makes lecture attendance akin to data-mining.

In a world where distribution of educational content is possible through online modalities, attending lectures to collect information is completely unnecessary.

“during a standard 50-minute lecture, the average student is likely only paying attention forty percent of the time!”

d

s‘

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Furthermore, this teaching method forces a universal learning pace and style upon students with a wide variety of individual knowledge bases and learning preferences.

Consider that in comparison to a recorded session, a student seated in a lecture hall cannot rewind or fast forward a presentation. If a point is missed, or a quick read up on a topic is necessary to contextualize content, keeping up with the relay of information becomes impossible. Having the option to select which lectures to spend more or less time on would optimize individual learning. Students spending self-determined time on a recorded session as opposed to re-teaching themselves a lecture means that overall less time is spent on the subject and there is more time to cover additional material.

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In summary, the fundamental problem with didactic in-person lecture is that it is an ineffective method of education. Lecture, in and of itself, does not teach students. The reasons for this are that it disregards limitations of attention span, results in poor retention of content, and lacks engagement via critical thought.

Supporters of lecture must come to acknowledge both the constraints on lecture style inherent in medical school and that the dissemination of information is not synonymous with quality, functional learning. Building upon this argument, because the learning method of didactic inperson lecture is ineffective, it is also intrinsically an inefficient use of both students’ and educators’ time.

Compounding this inefficiency is that other easily accessible alternatives exist that would optimize learning.

In a system without in-person lectures, the medical school still exists. Fears surrounding loss of community or a trend towards completely removing in person attendance from schooling are hyperbolic and discount the continued need for attendance at both case-based and clinical skills sessions. Indeed, constructing delivery of medical school curriculum around practical, modern, and effective educational methods has the capacity to help the physicians of today more optimally train the physicians of tomorrow. School is in session, and lecture is cancelled!

NAY

W

ith the past month’s unprecedented circumstances, #ZoomUniversity has become all-the-rage. As it stands, it is our best option to fill our brains with something beyond the murder, mayhem and madness of Netflix and YouTube’s seemingly endless depths. In a world where most of our lives have been reduced to containment within four walls, (which I admit, we are very privileged to have) I find myself wondering about the pros and cons of this avant-garde style of teaching. For me, video-conferenced learning doesn’t quite hit the spot, at least not in the same way inclass lectures do, but let’s unpack that a little more…

From people, for people:

Fundamentally, e-learning methods lack the humanity that defines our educational experience. Your peers are reduced to abstract concepts, nothing more than their initials (or if you’re lucky, their photo) in an icon on your screen. Funnily enough though, if you ask most of your colleagues “why medicine?”, I am certain that human interaction owns some prime real estate in those top slots. Human interaction in medicine is far from restricted to patients; medicine is a team sport – you work with other physicians and healthcare professionals, seek inspiration from those who came before you and provide mentorship for those to follow.

Our profession is a social and personal one, but those facets of our education are lost with the ousting of inperson lectures. As far as I’m concerned, good social skills are not inherent in a medical school admission.

Sure, we’d all like to think that our EQ is above-average – maybe it is, but that doesn’t mean we have nothing more to learn in the realm of teamwork. The non-verbal language in SGL, the process of forming a differential with your tutor, being able to both observe a patient and generate ideas synchronously – these are all skills that flourish as we interact with others. We are always told that our patients will remember us for how we make them feel, but if we haven’t had the chance to hone our interpersonal skills, there is no reason to believe that we will be good at it once residency comes around the corner.

Log-in, check out

I buy that learning online forces people to manage their time well and practice exceptional self-discipline. With the availability of recordings, one can work at their own pace, work from the couch and in their pj’s and channel major #WFH vibes. While this is an A+ in comfort, I would argue that this doesn’t necessarily enrich the educational process. There’s an article in the Harvard Business Review on the daily routines of geniuses; the piece references many successful writers – Austen, Twain, and Hemingway to name a few – and how their cultivated daily routines ultimately resulted in their success. Through notions as simple as a clean workspace with minimal distractions (nudge nudge, 032A) to accountability metrics, these extraordinary minds were able to unlock their potential. I would argue that this is much easier to do in a classroom, which is designed explicitly for your learning success and tailored to make your experience one of ease. With a schedule parsed out to maximize your hours in a day, you are inherently given a routine – all you have to do is show up! Coming to class is a system of checks and balances in itself. The sheer setting and the added bonus of your partners-in-knowledge hold you accountable and keep you honest, because goodness knows we are phenomenal at making excuses for ourselves.

The temptation to pull out your phone, open a new tab, or just excuse yourself for a mid-lecture snack is much stronger when no one else is watching, making online learning that much more dangerous than its in-person counterparts.

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“

Our profession is a social and personal one, but those facets of our education are lost with the ousting of in-person lectures.

”

It takes two to tango!

Let us appreciate that there is a whole other population besides ourselves affected by the advent of online lecturing – our professors. Intelligent, wise, generous with their time, and confident, they are now thrown into Zoom University alongside us, unsettled by lectures delivered into the abyss. Gone are the times when profs could appreciate the moment of satisfaction when realization washed over students’ faces as they finally grasped that complex concept. Gone is their ability to read the room and explain things when 216 (or so) befuddled eyes stared blankly back at them. Gone are the experiences of genetic escape rooms, class jeopardy, randomizer-induced palm sweat and red blood cell piñatas, as teaching is reduced to a mere video call… or worse, an online module. In removing in-person lectures from our curricula, we effectively suck dry the joy of teaching (and potentially the joy of learning too… I mean who didn’t love hemolyzing the RBC?). We risk putting our lecturers in uncomfortable positions and depriving them of the delight of influencing students. More, we miss out on the wealth of knowledge and personalities of our profs outside of lecture; be it a discussion in the ten minute break, a walk to the SMB entrance after class or a run-in in the atrium. A loss of lecture is a loss of the valuable little moments that inspire us too.

In an era where technology is not the future but the present, we are at risk of losing the mortality of medicine more than ever before. We are fortunately given access to a fountain of knowledge through our medical education, but a transition to online or alternate delivery methods jeopardizes our ability to absorb and process that knowledge. Without human context, we risk reverting to the memorization tactics of undergraduate education – the rote learning that we so greatly despised in our past lives. We aren’t learning for a test; we are learning for our patients. By not refining our social skills and optimizing our educational experiences, we not only cheat ourselves, but risk harming our patients.

Zoom University is the best solution we have for now, but I cannot wait to be back in class with 107 diverse, intelligent, eager and similarly caffeinated classmates by my side.

Sources: Carmichael, S. G. (2014, March 19). The Daily Routines of Geniuses.

Retrieved from https://hbr.org/2014/03/the-daily-routines-of-geniuses

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D i f f i c u l t Conversations Emily Wilkerson, Meds ‘21

It’s very hard to ask a question when you’re afraid of the answer.

I

can remember sitting there like it was yesterday. It wasn’t a private room, but my grandfather was the only occupant. My grandmother, mother, and I sat in a row on a bench against the wall, facing the end of the bed. The doctor sat in a chair that she brought in with her, and the nurse stood next to her keeping one eye on my grandfather, and the other on my grandmother. It wasn’t the first family meeting we had, and it wouldn’t be the last. It was, however, the first meeting in this new room, with this new doctor, who was now my grandfather’s palliative care physician. My grandfather had just been moved to palliative care after a series of unfortunate events leading to a decline in his health. He had poor shortness of breath and pain control, and we were hoping that making him more comfortable would give us more time. Now that things were a bit calmer, we had to ask the impossible question – how long do we have?

During this conversation, the question never came out quite as bluntly as that. We danced around it, as if to avoid getting burnt by a campfire. Slowly chipping away at our concerns, we finally mustered the courage to say, “Are we being dramatic by having our family fly in to see him by the end of the week?” Taking a deep breath, the physician responded while gently shaking her head, “No. You’re not being dramatic. Everyone who would like to come, should come now.”

It took a significant amount of courage for us to ask this question. We wanted to have all the answers and to know what was coming so we could be prepared. At the same time, we wanted to be blissfully in denial. It wasn’t our intention to step into a world where our timeline was cut down from two months to two weeks, but so we did. We had to be brave so that we could make the most of the time we had left and so we could stop fighting against the clock, and start working with it.

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REFLECTION Those two weeks were the slowest two weeks of my life. The days blended together into one. It was as if time stood still. And finally when it was all over, it went by too fast. Even now, some days it feels like it never happened.

In our clinical skills practice in medical school, we have sessions to prepare ourselves for difficult conversations in medicine. Using the SPIKES framework, published in The Oncologist in 2000 by Baile et. al., medical students are placed in simulation environments to practice delivering “bad news.” These simulations are designed to help the medical learner set up a space with a patient and their family in order to communicate key pieces of information, while remaining mindful and empathetic towards the patient (1). These simulations are surprisingly difficult in the beginning. With my first scenario, I felt clumsy, trying to lessen the blow by avoiding harsh words. However, this only confuses the truth. During feedback from the patient actor, they explained that what they really needed was for me to just be honest. While these simulations are extremely valuable, nothing quite prepares you for the day when you must actually deliver bad news, no matter how small, to a real person, with real consequences. Then perhaps your training serves you well, and you get through the first conversation without much difficulty. Soon you realize that in reality it’s not just a single conversation.

Rather, it’s a series of difficult conversations, difficult questions, and difficult answers.

I always imagined that to the outside world, physicians, being used to deal with these hard conversations over time with their patients, would somehow be better at receiving it. One would think that since they’ve been on one side of the conversation, they may know all the right questions to ask. They might be eased by their intricate medical knowledge and by the understanding of the progression of chronic disease. They can see it coming, so it doesn’t come as quite a shock. In my experience, this couldn’t be farther from the truth.

When it came to having this conversation, it was impossibly hard. I had been in this situation before on the other side of the table, but instead I felt like I was in the passenger seat of a speeding car and had no control over where we were going.

It is always interesting to reflect back on the reversal of the role of patient and physician – and when you think about it, it is a privilege. How can we sit on the physician side of the table and truly understand what goes through the patient or their family’s minds when they are receiving bad news? This is not to say that we as medical professionals cannot be empathetic, conscientious, and mindful communicators. It might just mean that until you experience it yourself, you can’t truly understand the patient’s experience.

In the future, I hope that I will never take for granted having a difficult conversation with a patient. These conversations are moments that last in the minds of our patients and their loved ones forever. They are implanted like art work framed on a wall. These moments are opportunities for connection, for empathy, and for offering peace of mind. I am grateful for the palliative care physician who chose to be honest with us. There are no certainties in the prediction of when death will come. You can only be patient and be quiet. To a mere medical student, this might feel like forever in the moment, but for the patient, there is never enough time.

References: 1. Baile, W.F., Buckman, R., Lenzi, R., Glober, G., Beale, E.A. and Kudelka, A.P. (2000), SPIKES—A Six‐Step Protocol for Delivering Bad News: Application to the Patient with Cancer. The Oncologist, 5: 302-311.

Images by Evie S from Unsplash

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The Diversity in Plastic & Reconstructive Surgery: AN OVERVIEW OF SUBSPECIALTIES VALERA CASTANOV, MEDS '22

Aesthetic surgery Aesthetic (cosmetic) surgery is a subspecialty of plastic and reconstructive surgery, which focuses on enhancing a patient’s appearance. It is an elective surgery, with the goals of improving appeal, symmetry, and proportion of a part or a region of the body. There are numerous aesthetic procedures that can be performed, which focus on facial and body contouring and rejuvenation.

Discussion of individual procedures will be the topic of a separate article.

Craniofacial surgery Craniofacial surgery is a surgical subspecialty that deals with the cranium and the facial skeleton, along with the overlying soft tissue. This subspecialty is further divided into adult and pediatric surgery. Adult subdivision focuses primarily on trauma and post-traumatic craniomaxillofacial deformities, orthognathic surgery, orbital defects, and a variety of other craniofacial bony and soft tissue pathologies. Pediatric craniofacial surgery deals mostly with congenital malformations of the craniomaxillofacial skeleton and soft tissue, which include craniosynostosis, cleft lip, cleft palate, craniofacial cleft, micrognathia and many others.

Hand surgery Hand surgery deals with the management of acute, chronic and congenital conditions of the hand and wrist. It involves the treatment of different regional body tissues, including skin, ligaments, tendons, vessels, nerves, and bony structures. Plastic surgeons perform tendon repairs/transfers/releases, fracture repairs, reconstruction of injuries and other deformities. Hand surgery involves the management of conditions such as the carpal tunnel syndrome, trigger finger, dupuytren’s contracture and many others. Microsurgical techniques are used in many procedures, e.g., replantation surgeries of the traumatic hand and digit amputations, for nerve and soft tissue reconstruction and blood vessel reconnection.

Photo by JC Gellidon from Unsplash 24

INFORMATIVE Plastic and reconstructive surgery is a versatile specialty with a great diversity of subspecialties, surgical techniques, conditions treated, and the ability to transcend multiple anatomical boundaries which restricts other surgical disciplines [1-4]. However, due to its versatility, the exact scope of plastic and reconstructive surgery is often not well understood by the public and other healthcare providers [2-4]. The media further exacerbates the misunderstanding by portraying plastic surgeons as primarily aesthetic (cosmetic) surgeons, while neglecting other subspecialties within the field [1,4]. This article will discuss some subspecialties within plastic surgery to shed light on non-aesthetic procedures and showcase the great diversity available in plastic and reconstructive surgery.

Reconstructive surgery includes breast reconstruction, burn, craniofacial, hand, and oncology surgery.

Breast reconstruction

Oncology surgery

Breast reconstruction is a surgical procedure aimed to restore the appearance of a breast, most often after a mastectomy, lumpectomy, or trauma. For patients undergoing a mastectomy or lumpectomy, breast reconstruction can be performed at the same time (immediate reconstruction) as the surgery to remove the affected breast tissue, or at a later time (delayed reconstruction). Different techniques of breast reconstruction exist, which include alloplastic and autologous reconstructions.

Alloplastic breast reconstruction involves using an implant, whereas, autologous technique uses the patient’s own tissues to restore the breast. Autologous reconstruction is also called “flap” reconstruction, as a “flap” refers to the transfer of tissue from one area of the body to another e.g., abdomen to breast.

Plastic surgeons can also decide to do combined techniques, using both the patient’s own tissues and an implant.

Plastic surgeons treat different types of skin cancer, including basal cell carcinoma, squamous cell carcinoma and melanoma. Surgical approach depends on the type, extent, and location of the skin cancer, along with other factors. Some procedures may require flaps or skin grafts.

One of the most sophisticated skin cancer surgeries is Mohs surgery. It involves removing the visible portion of the cancerous skin lesion, along with the thin layer of tissue deep to it. The excised deeper tissue layer is then mapped, and a histological analysis is performed.

If cancerous cells are detected, the next layer of skin is excised from the affected area and analyzed. The procedure is repeated until cancerous cells are no longer present on microscopic examination of the biopsied tissue.

Conclusion

Burn surgery Plastic surgeons are involved in the treatment of burns and perform acute and reconstructive surgeries. Acute burn surgery occurs immediately after the injury and includes surgical excision and skin grafting of deeper burn wounds.

Reconstructive burn surgery takes place following the healing of burn wounds, with the goal of improving function, comfort, and appearance.

References [1] Agarwal JP, Mendenhall SD, Moran LA, Hopkins PN. Medical student perceptions of the scope of plastic and reconstructive surgery. Ann Plast Surg. 2013;70(3):343-349. doi:10.1097/SAP.0b013e31823b6c19 [2] Kim DC, Kim S, Mitra A. Perceptions and misconceptions of the plastic and reconstructive surgeon. Ann Plast Surg. 1997;38(4):426-430. doi:10.1097/00000637-199704000-00020 [3] Fraser SJ, Al Youha S, Rasmussen PJ, Williams JG. Medical Student Perception of Plastic Surgery and the Impact of Mainstream Media. Plast Surg (Oakv). 2017;25(1):48-53. doi:10.1177/2292550317694844 [4] Dunkin CSJ, Pleat JM, Jones SAM, Goodacre TEE. Perception and reality-a study of public and professional perceptions of plastic surgery. Br J Plast Surg.

2003;56(5):437-443. doi:10.1016/s0007-1226(03)00188-7

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Plastic and reconstructive surgery is one of the most diverse surgical fields that medical students can pursue.

Despite the media focusing primarily on aesthetic surgery, it is just one of the many subspecialties of plastic and reconstructive surgery. Plastic surgeons operate on different parts of the body, use versatile approaches from macro- to microscopic techniques, treat diverse patient populations - from pediatric to geriatric patients - and work within interdisciplinary teams to deliver comprehensive patient care. The diversity within this surgical field is truly fascinating!

Disclaimer: The list of subspecialties mentioned in this article is not all-inclusive, and highlights only a few of the many surgical techniques and approaches used by plastic surgeons. Some of the surgical techniques specified for individual subspecialties, e.g. microsurgery for hand and/ or digit replantation, can be used across many different subspecialties. Of note, plastic surgeons often work in large interdisciplinary health teams when treating many of the above-mentioned conditions. For the purposes of this introductory overview article, many things were simplified.

Ajda

Camels and New Friends B a c k s t o r y :

B

efore I started medical school, my partner and I decided to do a backpacking trip for five months, which started in September 2017. Our first stop was India — we both had never been, and we were ready to explore this culturally rich, colourful and culinarilyexquisite country. We were three weeks into our time in India and we had just hopped off a train in Jaisalmer.

Nicknamed the “Golden City”, Jaisalmer is situated in the Thar Desert, which boasts touristy things like: “overnight desert getaway” and “camel desert adventure.”

Being the first-timers we were, we obviously had to try it out (but on a budget of course!). Naturally, we quickly booked one of the awesome-sounding overnight camel tours for the next day.

The following morning, we were whisked up in a mid-2000s Jeep and were told we would be picking up another group. We didn’t know that another group would be

joining us, but this also wasn’t the first time something like this happened to us.

Turns out the group was a couple from Slovenia and coincidentally, a medical student and business person (like a Slovenian version of my partner and I).

After 2 nights of sleeping on a blanket in the sand, with dung beetles crawling all over us and harsh winds blowing sand in our faces all night, an unforgettable and comical friendship was born.

Side note: I would not recommend a budget overnight camel tour, no matter how extravagant it sounds.

You definitely get what you pay for.

At the time I met Ajda, she was a medical student in her last year in Slovenia. I asked her a few questions about what medical school is like halfway around the world.

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Dung beetles

INTERVIEW

What is your current role?

Currently I’m on maternity leave after which I will start rotating for an internship in Paediatrics.

Why did you choose to go into medicine?

Since I could remember, I was interested in science, biology and the human body, especially genetics. So going to medical school seemed a perfect decision to me. Honestly, I was more interested in medicine in terms of science and not so much in becoming a doctor. I’m a doctor now but I would gladly go back to med school. I loved it.

What is the process like in Slovenia?

After finishing medical school, which is six years, you have to rotate for six months. Rotation is mostly in emergency departments. After that, you can apply for a professional exam. If you pass, you are permitted to apply for a specialisation. Public tender for specialisations is twice a year. Internships are given to candidates with the best score. Scores are composed of an interview, average grades, recommendation [letters] and extra points like published papers etc. The length of your internship depends on the specialty and can take from four to six years. At the end you have a specialty exam after which you finally become a licensed doctor and can practice medicine independently.

What is the medical system like in Slovenia?

We have a public health care system. We have mandatory insurance, however not all medical costs are covered by this programme, thus the majority [of people] also have additional insurance that covers full medical costs.

What do you love most about medicine?

That it’s alive. It can be unpredictable and challenging. And nothing is straightforward. Straightforward is easy and boring. But I was drawn to it because the physiology of the human body fascinates me.

What is one piece of advice you have for those currently on their medical journey?

Be confident, you know more than you think you do... But still doubt yourself, you don’t know everything.

What do you think could be improved in the medical system in Slovenia?

Firstly, there should be more doctors. On an everyday basis it is often impossible to take time for your patients, to answer all their questions or to simply give them encouraging or kind words… you are just too worn out. A big problem is also the waiting periods to get [in] to [see] specialists. So, I guess the capacity on all levels is a big issue in Slovenia.

Kimberley Yuen, Meds '22 27

AR T Effect

The

f o

Communication

A

s medical students, one of the first skill sets that we are taught in the curriculum is communication. We are instructed on how best to interview patients using DISCLO TRAAAP A SOUL, PQSRT, or the Sacred Seven. We’re also taught to listen and to enter into a dialogue with patients. Sir William Osler said it best: “Listen to the patient. He [or she] is telling you the diagnosis”. While communication with patients is important, it is not the only important type of communication in medicine. We also need to be cognizant of how we communicate with each other.

There is a growing evidence base – which, and this is a shameless plug, my lab has happily contributed to, showing that “non-technical skills” have an appreciable impact on patient care. One non-technical skill is that of interpersonal

Michael Scaffidi, Meds '22 communication. Intuitively, this relationship makes sense, as better communication amongst colleagues leads to better collaboration and delivery of care. After all, medicine is a team effort.

And yet, how many of us many of us strive to use “effective communication” in our day-to-day interactions with one another? I know that I certainly struggle with it. By “effective communication”, I’m referring to the act of expressing oneself genuinely with one another without pretense or façade. This concept seems like common sense – after all, we all got to medical school by knowing how to behave and act in a professional manner. Nevertheless, it can be easy to fall into the trap of mincing our words or not speaking directly to our peers.

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REFLECTION I’ll give an example from my own experience. Before medical school, I used to work in a lab. One of the constant sources of unease was discussions surrounding authorship.

In particular, there was a project in which the medical student with whom I was doing the study — let’s call him Josh, approached me about authorship surrounding the paper. Josh was rather direct about it, asking me for first authorship. Josh had certainly done a great deal of work — he collected data from a number of participants and had spent hours organizing the data. At the same time, I had also done a considerable amount of work with data collection, in addition to designing the study, writing the protocol, and submitting the ethics approval.

I remember being initially taken aback by Josh’s candor. In fact, it would not be a stretch to say I was more than a little irritated with his approach. He had only been involved in the lab for two months and here he was asking for first authorship. My initial instinct was to defer the conversation indefinitely. We both had compelling reasons to vie for first authorship, but I felt that I had done the lion’s share of the work, including both the leg work of data collection and the intellectual development. So I asked Josh for time to think about it. And in that time, I wrote out a list of arguments for both sides. In the end, I decided my work had merited first authorship, but I also realized that Josh had put in a huge effort and had significantly helped advance the project. In the end, I told him directly that I thought that I should be first author, while proposing that we share authorship as joint co-first authors. Josh agreed and we completed the study together smoothly.

tive

Looking back, however, I am thankful for Josh’s direct approach. Although I was not used to his candor, I learned that it was for the best — not only did we finish the study without a hiccup, but we became fast friends.

In fact, Josh and I are close friends and colleagues to this day. Effective communication, though sometimes initially uncomfortable initially, can serve as a powerful forge for strong relationships. After all, diamonds are made under pressure!

What did I learn from this interaction? First and foremost, it’s important to be direct when expressing your needs and concerns. It would have been easy for Josh to sweep the issue under the rug and not ask in the first place. Yet, he recognized that his argument had merit and was worth bringing up. Moreover, we had our conversation in person, which minimized any possibility of misinterpretation. While 29

email and online messaging present expedient ways to communicate, they can often unnecessarily introduce ambiguity into a conversation. Alternatively, talking with someone in person allows fidelity of discussion, as we can physically see how the other reacts to what we say.

Second, Josh approached the situation in a way that was firm while remaining respectful. Sometimes, we can fall prey to the idea that we’ll only be taken seriously if we are aggressive. While there are times when we need to take a hard-line stance, it is often the case that respectful assertiveness will go a long way in ensuring receptivity.

Josh and I were extremely polite through our discussions, which ensured that we both gave the other space to hear and listen to each other.

Finally, and perhaps most importantly, there is a need for dialogue. Yes, we each have our own wants and needs. “Of course, everyone does, Michael”, you say in your head, “Are you saying that I don’t think of others?”. No, not at all, dear reader. What I am saying, however, is that it can be easy to gloss over what would best serve others for what we would like for ourselves, especially if we’re angry, tired, or stressed. And yet, putting in even a little effort to empathize with the other person can make a difficult interaction into a bearable one. In the example above, it didn’t come easy but I forced myself to see Josh’s perspective by literally writing it out. Talking with colleagues or friends for their opinion is another approach.

As I come to the end of this article, I want to end with a reflection on my ongoing journey with effective communication. As I mentioned earlier, I have done work with my lab in the area of effective communication and medicine. Although useful, this work led primarily to theoretical knowledge. I provided the example of Josh to illustrate a milestone in my practical understanding of effective communication. This understanding has only grown from having experienced effective communication among the interactions with many of my fellow classmates and friends in QMed. I am fortunate to be surrounded by many effective communicators. There were many times where misunderstandings could have easily been blown out of proportion. Yet, we were able to resolve the issues amicably because we were direct, respectful, and empathetic with one another. In other words, we used effective communication. As we move throughout our training, especially in these strange, uncertain times of the COVID-19 era and beyond, I know that we’ll need to rely on effective communication more than ever. It’s easy for tensions to run high on the wards, when life is hectic and fast-paced. However, I am confident that effective communication will help us see it through.

Conversati Written by Sarenna Lalani, Meds '23

F

ull disclosure: I never thought I would be someone who went to see a shrink. Therapy was for people who had something wrong with them, and I was hell-bent on the fact that there was nothing wrong with me. Sure, I can be a little bit of a perfectionist at times and sure, I probably operate at a higher basal level of stress than the average person, but that’s normal… right? That’s just part of your regularly scheduled med school programming, isn’t it?

Over the past couple of years, I’ve toyed with the idea of seeing someone. I paid lipservice to the benefits of therapy, especially when friends needed help beyond what my words could offer them. I’ve casually referred friends to resources on campus, and whenever I was met with hesitation, I would always throw in the fact that I’d been considering making an appointment too. I didn’t feel the stigma – the cloud of judgement never lurked over my head – and I wasn’t ashamed to share my truth – I had indeed considered making an appointment – but when push came to shove, something would prevent me from taking that first step. I was too busy to call or didn’t have time that week or had other things outside of school that were taking up my time. I was nothing if not consistent at making excuses.

contained, were certainly higher than usual. I can recall a handful of weeks where I really didn’t think I would make it through – there was too much on my plate for me to even begin to tackle, and I had absolutely no idea where to start. I became reliant on my schedule to get me through, but my set-up was

these are some of the findings Anna and I came through after sifting through my psyche. I just knew something was off, and come December, I knew that I needed to make an appointment to preserve my well-being. I was ready to admit that I might need a teensyweensy bit of outside help.

I recall sitting nervously in the little waiting corridor (it really does not have the structure to be considered a room) of Student Wellness Services, eagerly awaiting Anna’s arrival. I remember wondering what would she look like: was she tall or short? Young or old? Would she be a nice person? How would I know that I could trust her? Anna, a small-statured and peppy woman with a soothing voice eventually appeared in the waiting corridor and guided me down the hallway towards her office. It was dimly lit with a warm-shaded lamp, had a desk in the corner and one sofa and one armchair. It was small, but cozy. She beckoned towards the sofa, and as I sat down,

So, this was therapy, eh? Not so scary after all.

When this year started, I could sense that I was struggling with striking a balance. My stress levels, while still

unstable at best. If I didn’t check off one of today’s boxes, the rest of my week and weekend would be thrown off, and feelings of guilt would wash over me. I began cutting myself less and less slack; I was less forgiving if I worked slowly because I was tired.

While I wasn’t a ruthless dictator of my own life, I certainly wasn’t being kind to myself either. Of course, I didn’t realize this on my own – 30

I could feel the tension dissolve across my shoulders. So, this was therapy, eh?

Not so scary after all.

An hour later we had talked about all kinds of things. We shared funny stories from our lives, talked about the stress of med school, shared our favorite spots in Kingston and so much more. Anna, more than a therapist, was a friend. She didn’t judge and she certainly normalized and validated everything I was feeling. She

ions Anna

REFLECTION

with

gave me some homework, which was really more of a mantra to use when I felt myself spiraling. Instead of feeling guilt when I couldn’t get everything on my to-do list done in a day, I needed to accept that I was doing my best and that that was enough. I only have a certain bandwidth, all of us do, and we can only do so much. She said not making it to the gym one day, or not finishing all of

the notes I had hoped to do was “fact, not failure.”

Fact, not failure – three simple words that have, in many ways, changed my life. Every one of us could probably benefit from being a little kinder to ourselves, and thanks to Anna I was able to see that. Med school can be hard, life can be hard, and you’re doing yourself dirty if you pretend otherwise. Some days, you will be your own superhero; you will dot every “i” and cross every “t” that you intend to, but if one day you don’t, remember it’s fact, not

failure.

Graphic by Amanda Mills, Meds '23

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Tales of a Young R

I

Written by Jessica Nguyen, Meds '23 grew up hearing that “I’m very lucky”. As a first-gen Canadian and a daughter of two refugees, I knew that I would never know adversity like my parents do. Yes, I heard stories of about their life-altering journeys from war-torn Vietnam to Canada, but I don’t think I ever really took a minute to marvel at the strength, courage, and sheer luck that it took for my parents to make it to this country. That is, until a simple conversation we shared while on a drive to Kingston.

In the midst of the COVID-19 pandemic, my dad and I were on the road to pack up some things so I could move back home. We ate snacks in the car, listened to music, and talked about how lucky we are to have a house to socially distance inside, full of cupboards of food and closets of board games to distract ourselves. My brother had just turned thirteen that week. Curious about what my father’s life was like at thirteen, I asked him about his upbringing and journey to Canada, something he rarely talks about. During my father’s childhood, Vietnam was still recovering from a war that still has grips on the country today. My grandfather was a

soldier for the side that lost the war and was branded a ‘traitor’ after it ended.

He was imprisoned and my father’s family was forced to move to the southernmost province of the country.

“It was riddled with malaria and waterborne diseases,” he told me. “They made us live somewhere that was basically a jungle, and we survived there for five years. Essentially, the government oppressed anyone who had stood in its way during the war.” He was three years old when the government moved them.

Five years later, his family moved back to the city, where they survived on the streets. At least there was opportunity to find work there. Back then, living on the streets was the norm for families that had fought for the “wrong side” during the war. After all, they lost everything. “We were so poor,” my dad told me. “We had this wooden fish that we would put on a plate to make it seem like we were eating more than just a bowl of stolen rice for dinner”.

Living in the city, my father made a friend who eventually presented my father with an opportunity to flee the country by boat. In the years after the war, millions of Vietnamese citizens fled the country this way in hopes of finding 32

a better life, and at the age of fourteen, my dad became one of them. Not only did he face the dangers of the sea, he also faced death – escaping was a crime that the government persecuted many people for, with countless dying these journeys.

When my father told his parents that he was planning on escaping, my grandmother insisted that his older brother take his place on the boat instead. My uncle was almost at the age of conscription and she didn’t want him being taken away by the government.

My dad begrudgingly agreed. The night of the planned escape, my dad stayed awake all night, until he heard his brother leave quietly to go to the meeting point.

“I decided last minute that I was going on that journey no matter what, so I jumped out of the window and followed your uncle in his xích lô to the meeting point”. He ran after my uncle for 15 km through the night to the first meeting point, where they would meet others that were headed onto the same boat.

When my uncle realized that my father had been following him, he demanded that he return home. “I was getting on that boat no matter what,” my father said.

When their small fishing boat left the dock, the police had caught wind of the escape. “They shot at us until we crossed into international waters,” he recounted.

And then when they were just barely safe, they realized that their motor had fallen off in the commotion. “All fortyfour of us thought we were going to die.

During the day all you saw was water and during the night, you couldn’t see anything. How was anyone going to find us?” he said. “It was so cold I went to sleep in the boiler room one night and had some oil spill on me. It would keep me warm during the night, but I didn’t realize how terrible of an idea it was until the morning, when the sun would burn my skin”. Not only that, they suffered from dehydration, starvation, and seasickness. I don’t know how he held onto hope after being at sea for seven days.

On the seventh day, a terrible storm was headed straight to them. My father looked up at the sky wondering how his life could end this way. “I regretted everything. Being a troublemaker to your grandma, leaving home without telling anyone, not trying harder to help around at home”. Everyone cried and prayed. It seemed that they were just going to be another failed attempt at escape, a shipwreck containing bodies of passengers that never made it to freedom. But out of sheer luck, an American ship found this tiny fishing boat in the middle of the ocean and brought them to the shores of Singapore.

They were saved.

REFLECTION back, telling him she was heartbroken that my father was lost and had run away from home. Imagine her surprise when she found out he was with my uncle all along! After a couple months at the camp, my father and uncle arrived in Canada. (Fun fact: they chose Canada because the snow looked so beautiful – ironically, they are both the biggest grouches during Canadian winters nowadays). Two young men, fourteen and twenty-one, starting their lives in a country whose language they didn’t speak and customs they didn’t know.

It amazes me how refugees like my From the Singaporean refugee camp, my father manage to build a life in Canada uncle sent letters back home and told despite all odds. While other teenagers my grandmother he was safe. She wrote spent their time playing video games,

Refugee

“I was getting on that boat no matter what” my father spent his years learning English and trying to sponsor the rest of his family to Canada. While others lived their lives oblivious to what was happening in Vietnam, my father and countless others rebuilt their lives in countries they had never heard of before.

So, there I was. Listening to this insane story, in disbelief at how the man driving the car, who I call ‘dad’, had risked everything in hopes of a life he would have never dreamed of. I couldn’t believe that this man eating a whole bag of mini eggs with me, was also a man who was able to journey to another country, learn its language, and thrive in its society at the age of fourteen. I don’t know why I had never had this conversation with my dad before, but I knew that this would forever change how I see the world.

When I hear “I am lucky”, I know that it is true. After all, it was only one generation ago that my family had to risk their lives for the hopes of a brighter future.

Photo source: www.sbyfproject.com/post_card/14089 commons.wikimedia.org

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S t a r t i n g Conversations A b o u t S e x u a l V i o l e n c e Nicole Krysa, Meds ‘22

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INFORMATIVE

Current data suggests that in Canada,

1 in 3 women and 1 in 8 men

will be subject to unwanted sexual behaviour at some point in their adult lives.

It is thought that this population might be even larger than is currently estimated, as the nature of the psychological sequelae following sexual trauma, as well as the stigma associated with being a “victim� means that many are reluctant to report or even acknowledge what they have endured. The implication of these striking figures for us as oneday physicians is that nearly all of us will encounter individuals who have suffered sexual violence in our medical practices. While many of these patients might want to discuss their current or historic trauma, they may perceive a barrier, assuming that their physician will not be understanding or receptive to what they have to say.

In recognizing all of this, a universal symbol was created for physicians to display which signals to those who have been subject to sexual violence that they can make disclosures in a safe, traumainformed environment. The current plan is to print this symbol on window stickers and pins, and to distribute it to physicians across Canada. In the meantime, we encourage physicians and other healthcare workers to employ it at their leisure, and to make others aware of it as well. Our hope is that it will be adopted and utilized universally.

Thank you in advance for being an advocate against sexual violence and for supporting those in need.

References: Cotter, A., & Savage, L. (2019, December 5). Gender-based violence and unwanted sexual behaviour in Canada, 2018: Initial findings from the Survey of Safety in Public and Private Spaces. Retrieved from https://www150. statcan.gc.ca/n1/pub/85-002-x/2019001/article/00017-eng.htm Logo Design Credit: Olivia Kotarba (www.okkdesign.com)

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r a e D

M R , Q How do you stay focused/motivated for #ZoomUniversity during this time?

SINCERELY, ZOOMED OUT Dear Zoomed Out, It's not easy, but I find that sticking to a schedule works, and taking breaks is as necessary as ever. I try my best to attend all Zoom classes and sit far from my bed. Staying away from my bedroom and wearing real clothes (not PJs) for classes and when doing work has been surprisingly helpful. Even more so, I've prioritized my wellness and physical health and make sure that I do something everyday, whether it's a quick yoga sequence, going for a run, or a virtual workout. These breaks help me feel refreshed and refocused. Another productivity tip is virtual studying with friends! Just having someone to virtually keep you accountable works!

The QMed social distancing group has been fun to keep up with, and the QMed Run Squad has been really uplifting and motivating, no matter if you're a beginner or avid runner. I've also spent more time doing hobbies like drawing and baking (yes, I've made it to the bread stage).

I'm usually a busy body so I enjoy doing things, but during this strange time I've definitely felt deflated and have had a lot of do nothing days.

This pandemic is tough and I definitely have not been as focused/motivated/productive as I thought I would be and that is totally OKAY. Stay well, #muteyourcamera 36

FUN

Does a summer job exist that’s good for my resume, soul and wallet?

Sincerely, Summer Bummer Dear Summer, This question sounds a lot like the Queen’s housing conundrum where you want a cute dig that is close to campus and downtown, plus wallet-friendly. Oftentimes, you have to shoot for the best two out of three - the trifecta is very hard to find!

Definitely consider using summers for career exploration; if you are undecided or want to explore a specialty more, clinical experience is valuable and will help you speak to the specialty you end up selecting in your CaRMS interviews (I mean, that’s what we are all thinking about, right?). While there is a tendency to discount observerships beyond helping us figure out what we want to do, having clinical experiences that you can draw on and speak to is definitely an asset in interviews (and potentially feeds the soul, too). While it may not be so advantageous from a financial standpoint, the flexibility of the situation could allow for a part-time gig too! In addition to this, I’d encourage you to expand your frame of mind from thinking solely about research to other scholarly activities. Wet labs are not the only options when it comes to research. Doing quality improvement projects, literature reviews, or even being involved in activities that allow you to highlight your interests will all augment your resume! I would highly encourage you to seek out a career counsellor if you are fretting - they often have fantastic advice and are readily available to meet (even over Zoom)! I'm not sure how relevant my response is considering the pandemic, but if you still have a summer job that's great! If not, hopefully this will help for future summer plans, or maybe you could ask to do something remotely.

Good luck!

Fun in the Sun

Thank you to all of 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, look out for your question in our next issue. Questions and answers may have been edited for length or clarity.

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I feel way behind on clinical reasoning compared to my peers. What are some ways to improve?

Sincerely, Egophoney Dear Egophoney, Feelings of inadequacy are all too commonplace in the world of medicine. Where’s the surprise? We’re surrounded by the aces of the aces. There’s always someone who’s more involved, someone who’s more athletic, someone who’s more artistic, someone who seems to have their life more put together, someone who can bake better bread. But chances are, you’re also one of those “someone”s. We’re not here because we’re particularly good at medicine. That’s what we came to learn. We’re all here because we’ve demonstrated that we can excel diversely and consistently. So, before we move on, please just remember that.

When it comes to clinical reasoning, it really is all about the learning. No one was born knowing that pleuritic chest pain makes pericarditis more likely than GERD. Some people may make the connection to the anatomical basis before others. But that too relates to their prior experiences in learning and working with that material. There has probably been a unit or topic where you’ve felt like you had a bit better of a grasp than your peers too.

Clinical reasoning should be seen as a skill and not a gift. It’s not something that you magically acquire after one clin skills session. In fact, part of the reason that physicians have to train so long is to hone their ability to reason clinically – it’s an incredibly multifaceted skill that demands the integration and synthesis of everything from anatomy, to pathophysiology, to histories and physicals, to investigations and imaging. The ability to even start reasoning clinically represents the summit of an ever-growing mountain. Be proud of that!

Because of what it is, there really only is one answer to your question. Practice. Wherever you can, practice. As a medical student you will inevitably have people ask you about their problems. You’re not fit to give advice yet, but you certainly can reason! Painful toe?

Maybe it’s gout. Or a bunion. Metatarsalgia? Tendinopathy? You can’t know for sure, but you certainly can write it out, explore your ideas, and read up on it. You ever have some mysterious chest pain? Try and figure it out! Rinse and repeat.

It may be hard to hear, but the key to improving is to immerse yourself. It’s to open your mind to the gruelling task of thinking hard and perpetually learning. It’s to expose yourself to the point at which you become fluent. It’s to stoke your relentless curiosity and to absorb your experiences. But truly, in the end, the key is to work hard and be patient. You’ll get there, eventually, one differential diagnosis at a time.

Sincerely, Trust the Process

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What are good strategies to pay off debt after medical school?

Sincerely, Financial Fury Dear Financial Fury,

For people thinking about family development, at what point in your career is it easier to have children?

Sincerely, Planning Parenthood Dear Planning Parenthood, This is a tricky one - the short answer is that it depends. I don’t think there is an “easy” time for family development at any point in your medical career (I mean, raising kids is hard at any point in your life!). I think more than ease, it is a matter of deciding what time is right for you and working your life around it. I know people who were pregnant starting med school, had kids during med and took a year off or took no time off at all, had kids in residency (and were even due around the time of licensing exams) or waited until afterwards. At the end of the day, I think you have to decide what will work best for you and your family and, unfortunately, that means there is no easy answer.

Cheers, No Kids and Counting (Yet)

1. Try not to accumulate debt! This seems simple but it’s very easy to start thinking “it's just another drop in the bucket at this point” especially during summer vacation, clerkship, and electives. It’s important to live your life and do things that will help your wellness but think about what your financial situation is before you start balling out on Michelin star restaurants.

2. Find a financial advisor that you trust. This may be through MD Financial, your bank, or a third party company that a friend or upper-year recommends. Ideally, this advisor will have worked with medical students, residents, or doctors in the past.

3. If you don’t already, keep a budget. Start by taking your past credit card bill and approximating how much money you spent on food, clothes, travel, rent, wellness, whatever your big categories are. This can be eye-opening and enough of a wake up call to help budget.

4. For those of you going into Family Medicine look up the “Canada Student Loan Forgiveness for Family Doctors”. You can get up to $40,000 knocked OFF your national student loan for doing 400 hours of rotations in rural areas (during residency) or working in an underserved community as a staff. Note: this forgiveness is on national student loans, not provincial loans and not your LOC – in order to use this program, do NOT pay off all your Canadian student loans with your LOC at graduation even though there’s a temptation to do this because of the interest rate differences. Note: Don’t go into Family Medicine solely for this reason, there are ways to pay off debt in every specialty.

5. In residency, try to stay at-debt instead of getting deeper in. The PGY-1 salary in Ontario is approximately $60,000 per year. If you can afford to set aside a few hundred dollars per month into the debt-payment piggy bank that’s great! If you really can’t, budget yourself so you’re not accumulating more.

6. There is a program for residents training in Ontario that can have loan forgiveness (any specialty not just family med) if they promise to work 5 years in Ontario after graduating.

Sincerely, Living off the LOC

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Conversation in medicine:

COVID-19 S pe c i al Fe at ure

"Masked Caution" Photo by Fraser Allen Best 100% of proceeds from the purchase of this photo go to the University Health Network’s Emergency COVID-19 fund, to support healthcare workers, patients, and research as they work to overcome this pandemic.

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41

Lungs graphic by Kiera Liblik, Meds '23

COLLAGE

42

Reflection

Spread Too Thin: A COVID-19 Reflection

By Iku Nwosu, Meds ‘22 We start off the year full speed ahead, spirits ablaze. Whether it is orientation week, meeting 100+ new faces as first year students and group leaders, or even just coming straight into class (the infamous, well-loved Cardio-Resp block), suddenly you cannot catch a break. You may have a plan at the start of the term; there is always a plan. You want to be disciplined, eat healthy food, work out often, have some nights out with your friends, and even keep up with the DILs. You also want to be involved “just enough” to keep your CV on edge.

Two weeks into second year for me, I was already starting to burn out.

I am the first to admit I probably do too many things. And no, this is not a humble flex or subtle brag. Being busy is not cute. Overworking yourself is far from a “vibe” when you are actually living in it.

It is easy to judge someone who suddenly chooses to drop a commitment or group, but when I see it happen, I have started trying to understand.

Dedication is an important skill to develop but not at the expense of your wellbeing. The whirlwind of everything we “balance” can start to make you feel suffocated.

Now, you might already see where I am going with how this relates to COVID19. In the last couple of weeks, all the commitments we have had look completely different or are off our plates altogether. The kind of free time I have now is honestly baffling. If you are someone who makes to-do lists like me, you have probably laughed to yourself about how short it can be these days. It is in some ways relieving if I am being completely honest. The Spring Formal I no longer have to plan and promote, the interest group meetings

I do not have to squeeze into my schedule, the lunch talks I can attend comfortably from my bedroom, amongst everything else academic that has shifted.

I do not want to downplay the severity of this pandemic or disregard the immense privilege I and many others have. We are very fortunate to be able to go through this with some semblance of normal or feeling of safety. However, if there is one simple notion that I can take away from this time (and there is no pressure to have to “take away” anything during a pandemic), it is this: I was spread astonishingly too thin. Perhaps when we re-enter life as we knew it, as joyous as this prospective occasion will be, I will try to do so not as full speed ahead.

“Dedication is an important skill to develop but not at the expense of your wellbeing.”

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Women on the F Written and illustrated by Christine Moon, Meds '23

S

ince December 2019, the global viral pandemic of SARS-CoV2, has been assaulting the health of people all over the world. Here at home: in our nation, in our province, and in our own school, we rely on leaders to mobilize resources, communicate important scientific information, and protect the population. Here are the profiles of four women who are doing just that.

Sharon Yeung As co-chair of the Ontario Medical Students’ Association, Sharon supports medical students province-wide in their efforts to aid with the COVID-19 pandemic. She works with the Ministry of Health to find opportunities for students to be involved in contact tracing and public education. She has developed a central online hub through the OMSA for volunteer opportunities and medical student initiatives across Ontario, and has been instrumental in connecting medical student initiatives (for example, initiatives to gather donations of PPE), encouraging collaboration and idea-sharing. Sharon is not only a leader at Queen’s but also for medical students province-wide.

Role: Co-chair of the Ontario Medical Students’ Association (OMSA) Training: MD-MSc (Epidemiology, Queen’s University)

Dr. Michelle Gibson You know her as a beloved professor of geriatrics, but in recent weeks she has been the voice of support for students as we navigate a move to online learning. Her cheery update emails (and reassurances on Zoom), filled with concern for our wellbeing, make these scary and unpredictable times a little less so.

We appreciate her efforts behind the scenes to make our online transition as smooth as possible and we all can feel a little more comfortable, knowing that she is doing everything in her power to support us.

Role: Assistant Dean, Curriculum for UGME at Queen’s Training: MD (Memorial University of Newfoundland), Residency in Family Medicine & Care of the Elderly (Queen’s University), MEd (Queen’s University) 44

Front Lines

PROFILE

Dr. Eileen de Villa As the leader of Toronto Public Health in the province’s capital, Dr. de Villa has been a leader in Ontario’s public health since her appointment in 2017. Her harm-reduction approach for personal use drugs, as well as her outspoken advocacy against the Ford government’s cuts to the health budget, has made her a household name in the last three years. Her continuing voice of reason (sometimes in the face of political crosswinds) makes her a great advocate for the health of all during this uncertain time.

Role: Medical Officer of Health for City of Toronto Training: MD (University of Toronto), Residency in Public Health and Preventative Medicine (University of Toronto), MHS – Health Promotion (University of Toronto), MBA (York University)

Dr. Theresa Tam As head of the Public Health Agency of Canada, Dr. Tam is responsible for leading her organization and indeed the nation, in times of crisis. In the past, she has been a leader during the SARS, H1N1, and Ebola outbreaks. Now, her daily updates, informed by clinical science and epidemiology, help inform both the public and health professionals across the country.

Role: Chief Public Health Officer of Canada Training: BMBS (University of Nottingham), Residency in Pediatrics (University of Alberta), Fellowship in Pediatrics Infectious Diseases (University of British Columbia)

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When Runni Written by Sean Leung, 2022

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went

ing

Unwilling Beginnings

L

reflection

VIRAL

et’s see… how did this all start? It was March 2018 – about two years from me writing this right now. I didn’t even like running. Cardio sucked. I never did it. All I needed were protein shakes and the iron temple. But then one day my best friend Darren messaged me asking me if I wanted to run a 10K. “Bro, I don’t do cardio LOL”, I said. He said “Come on, man”, and told me I’d be getting a Lululemon shirt – and the cost of registration was less than the value of the shirt itself. Well, I mean… sounded like a pretty good deal to me!

Fig 2. Max and Sean tackle Lulu10K 2018.

So, I signed up.

but I began to find solace in the warm company, the refreshing nature, and the burst of endorphins waiting for me at every finish line. I ran the race, and I beat my target time by 4 minutes. It was a thrilling experience to run in the middle of the highways of downtown Toronto, surrounded by several thousands of people, and breaking personal records in a legitimate race (Fig 2.). It was equally awesome getting my shirt.

with me. Kim said she was down, and all of a sudden, I was much less anxious about making new friends (Fig 3.). The familiar feelings of companionship flooded my brain, and I realized that day: I actually liked running.

Come December, a classmate and former varsity track star named Clare McGrath asked if she could run with me and Kim. I said “Of course!”, not knowing that this

Birth of the QMed Run Squad (QRS) Fig 1. Sean’s first run. Note the elapsed time.

The next day, I started training with my housemate, Max. That still sucked. I couldn’t even run 500 meters without slowing, stopping, gasping for air (Fig 1.).

Honestly, if it weren’t for him dragging me out for workouts, I probably would have quit. I’m a social exerciser and I easily lose motivation when training alone. So, trailing behind Max on every run, I endured it. I won’t lie – I still hated running. The air was cold and harsh, I was tired, and it was hard to breathe;

I thought that was it. Another bucket list item ticked off. Great start to the summer. Back to the no cardio life. Little did I know, running would soon become an integral component to my life, and a gateway to a community that would grow to inspire and motivate me every day.

Fast forward to the end of August 2018.

I’d just moved in to my new house in Kingston, ready to start up my new life at QMed. I didn’t really know my housemates at the time, so I shot my Fig 3. Kim joins Sean for some housemate shot and asked if anyone wanted to run bonding.

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woman would, in the following months, completely destroy and rebuild me as an athlete. As our little squadron continued our workouts to keep cozy through the frigid grips of the winter, March crept back around – a year from when I first began running. I thought “maybe it’s time to do a race again”. We started up a group chat called “Run Squad” on Facebook Messenger, excited whenever someone new eagerly joined in. With blossoming membership, Clare and I started to design a training plan for the Sporting Life 10K and Lululemon 10K. Our philosophy was to create a training group that was fun and accessible to people of all levels. So, we planned workouts with defined training sites so that everyone could stick together; and we implemented a “satellite” rule for longer runs, where more seasoned athletes could orbit around more novice runners. We got started, and quickly ramped up the mileage (Fig 4.). The training was brutal, but exhilarating.

New friends joined here and there. I even managed to convince this cute girl named Jessica Nguyen to run with me.

And all together, the QRS got better, faster, and stronger.

Then came September anew, and a whole new class came to QMed. A fresh new cohort of people to lure into my kilometer crushing frenzy.

Our membership shot up to 33. We

Fig 4. Training begins for SL10K 2019.

had people from 2021-2023 join in. It was an amazing community, everyone ready to get sweaty and tired together.

It spurred my inner social athlete on, having a group to rely on. Catching sunrises and boosting our VO2max became my escape. I loved the sense of purpose, rising before the sun, going out to meet my fellow crusaders, ready to combat any terrain or weather. QRS truly became part of my enormous pride in QMed. I was ecstatic. It was February

2020, I created a new 10K training plan, and had just started convincing people to sign up for races. Then, suddenly, we were met by our greatest adversary: the COVID-19 Pandemic.

The COVID-19 Era Everyone had to go home. To fight the virus, we couldn’t see each other. It was a complete 180. We couldn’t run together anymore. All our plans to run races and train together – gone. I tried going on runs by myself. It felt like crap.

My motivation was shot. Where before I could run any distance with QRS by my side, I could hardly finish 5km by myself.

It felt like I regressed to that first run in 2018. I was crushed…but I wouldn’t be defeated. And I wanted to keep the group alive.

We started to post updates of our workouts in the group chat. A quick selfie and Strava post here and there. It soon started to feel like I was running with everyone again. I guess that’s the great thing about running: it’s portable.

It didn’t matter that we were all pushed to our own little corners of the Earth.

We were as connected as ever – and the loneliness of social distancing began to fade.

Eventually, we had the idea of seeing how many kilometers we could run cumulatively. And thus, the Run Bank

Fig 5. The QRS Run Bank Competition. Join here: bit.lyRUNBANK 48

Fig 6. The QRS Run Bank statistics after 2 weeks.

was born. It started initially as a group effort to rack up distance. But leave it to Queen’s medical students to turn it into a fierce (but fun!) competition (Fig 5.).

Our membership almost immediately doubled to 62, with athletes diligently updating their spreadsheets with every workout conquered. People who had never run before started to join. Others set new goals, drew up plans, inspired their families, and broke through past limits. I can’t express how bizarre of an experience it is to look teary-eyed at a spreadsheet, bubbling in pride and joy.

In just 2 weeks, the Run Bank demolished

2506.6 kilometers. The average runner contributed 40.4km (Fig 6.). I’d created a monster, and I’m determined to keep feeding it. Harnessing our invincible inertia, we decided to take it to the next level. Set near the end of April, QRS is hosting a virtual 5K and 10K race. I can’t wait to see what our athletes can accomplish.

simply staying home to curb the virus.

It’s hard, and it’s taxing. Amidst all this, we can’t forget to take care of ourselves and each other. Maybe we all run for different reasons. Maybe we’re all at different fitness levels. Maybe we’re all in different places. But hopefully, by running, we can escape the weight of the dread. We can welcome the surge of This pandemic has sunk its teeth into endorphins. We can embrace the crisp the very way we as humans live our fresh air of the outdoors. We can bathe lives. Each and every one of us is making in the warmth of each others’ company. sacrifices in our own way, whether it be All together. All apart. by serving on the front lines, volunteering to help those in our communities, or

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isolation poems

isolation poems let’s get through the quarantine haikus, made for you

staring at my screen so many hours to pass why would I start now?

isolated days Tiktok, Twitter, Zoom Zoom Zoom scrolling all the news

watching numbers climb existence now statistic human beings’ lives

50

POETRY

no friendly hellos as if making eye contact or smiling infects

viral droplets, ew speaking moistly right on you cough, hold breath, achoo

toilet paper rolls never thought twice about you panicked empty shelves

lectures in PJs sipping coffee, protected in my childhood bed jen ma, meds ‘23

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CCooppiinngg wwiitthh UUpphheeaavvaall

A Reflection on Creativity By: Kassandra McFarlane, Meds' '23 Photography Credits: Tyler Skode Layout: Doan-Nghi Dam-Le 52

Reflection

Like many others in the past few weeks I find myself in unfamiliar territory. The upheaval in my life in light of this global pandemic has been a creeping escalation. Naturally, as the severity of this new virus became more apparent and government-initiated social distancing came into effect, I felt less secure in the routines I had grown accustomed to because they were no longer available to me. I feel disjointed – half of my life in Kingston and half of it in Vancouver. I am living out of a suitcase; I left Kingston with the intent to be absent for one week. It has been nearly four. I haven’t seen my parents or my friends for months and I am uncertain of how the next months of my life will unfold. My future is anything but certain.

From this upheaval, though, has arisen a new motivation and inspiration for creativity. I have written more short stories than I ever have and have also started cowriting a novel. I feel more in tune with my penchant for expression and notice that I am more willing to engage my creative urges. Most recently, after exploring a local park nearby, I noticed a large cherry tree in bloom with full blossoms erupting from every branch. I was struck with inspiration for a photoshoot (the result of which is the adjoining image to this brief reflection).

There is a stillness of thought in the flow of a creative endeavour; fully engaging allows us freedom to relegate the tough parts of life for a moment. Though the current global situation is tumultuous and at times frightening, I have found resilience by following my intuition and spontaneous drive to delve into creative projects. Art allows us to pause and reconnect with our inner worlds and find comfort in our own self-expression. My life is confusing right now, as is true for all of us, but we have control over the allocation of our attention and the things we choose to focus on. By returning to ourselves and finding ways to stay present-focused, we will weather this storm and emerge with deeper selfknowledge, both individually and collectively.

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COVID-19 CROSSWORD

Created by Sean Leung, Meds ‘22 - so you know it’s gonna be a challenge!

Be the first to finish this crossword and win a prize! Send a photo of your crossword to qmreditors@gmail.com.

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FUN ACROSS

1. It was clear President Trump hadn’t ever met CARL when he recommended using this to treat COVID-19 2. The first infectious disease to have been eradicated off the face of the Earth by human intervention 3. The Latin animal that is the namesake for the most effective way to prevent infectious disease 4. The first item removed during appropriate PPE doffing 5. We use this term to describe a group of the animals in 3 Across, and also to describe the immunity that is key to ending infectious disease outbreaks 6. You could be talking about the sun, the cumulus oophorus, the internal capsule, or a pale lager 7. The pathognomonic sign for the disease caused by one of the pathogens addressed by 12 Across 8. An activity that furry pets and viruses both have in common 9. The language that the instructions to build a coronavirus is written in 10. We thought it only presented in Kallman syndrome 11. The first line treatment for 8 Down, which acts by inhibiting 13 Across 12. The name of the combination vaccine that helps to take down pathogens with extremely high R0s 13. The N in H5N9 14. If you go up instead of straight in a nasopharyngeal swab, you risk poking the brain through this structure 15. Now that the 2023s know what this is: if elevated, it could mean you have ankylosing spondylitis, obstructive sleep apnea, COVID-19, or all three 16. The species name of the bacterium causing the Bubonic Plague 17. I say ground, you say ________, and we both still don’t really know what this means on a chest CT. But it happens with 33 Down infection 18. Your phone is a really good example of this 19. In 2020, many of the world’s medical schools congregated into a singular entity, known as _______ School of Medicine 20. The “S” in the name of the sticky substance granulocytes and monocytes use to climb to the site of an infection 21. The other (non-viral) microorganism that’s infiltrated a devastating number of isolating households during this pandemic 22. The doorknob to type II pneumocytes for multiple strains of coronavirus 23. You know it’s an email about COVID-19 when this word is in the first line 24. The group of animals responsible for transmitting MERS to humans 25. The historic name for the leading cause of death from a single infectious agent, but also what most of us are probably doing a little too much of while isolating

DOWN

6. An effect of COVID-19 and a predictor of mortality that makes taking a D-dimer useful 7. The American state theorized to be the origin of the Spanish Flu 8. The weaker twin of the 1918 Spanish Flu 9. Impress your attending by knowing the most likely pathogen behind the common cold 13. The unit used to measure the size of a virus 14. If you’re lagging, Queen’s Video Conferencing will probably tell you to mute this 26. A patient presents with frequent watery stools, a fever, abdo pain, anorexia, and nausea a few days after taking antibiotics. What level of transmission-based precautions do you take?

27. The mighty N95 is not resistant to this type of substance 28. A fateful seafood market selling everything from wolf puppies to emmental cheese 29. The period of time that ships and their passengers were required to be isolated during the Black Death 30. The Spanish corruption of the Swahili description of “a cramp-like seizure caused by evil spirits” 31. The original target for the drug currently running through clinical trials for the treatment of COVID-19 32. The reason the father of epidemiology was born 33. How you snobbily correct your non-medicine friends when they talk about COVID virus 34. Causing a disease with an R0 that rivals that of measles, this pathogen can reactivate to produce painful blisters in a dermatomal distribution 35. Instagram baddies certainly want to grow their curves, but it’s in public health’s best interests to flatten this kind of curve 36. In the dating world, we call this having a “type”. In virology, it’s what it’s called when HIV likes CD4+ T-cells and 33 Down likes type II pneumocytes

55

ART

"The Cure" Stephanie Jiang, Meds '22

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Thank you all for another awesome year.

To the 2023s, you made it through first year, and a pandemic!

To the 2022s, the white coat is within reach!

To the 2021s, hang in there - you've survived the brunt of it.

To the 2020s, congratulations and good luck! You will all be fantastic doctors and we wish you all the best.

To the 2024s, welcome to QMed!

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SPRING 2020

ISSUE 13.3

COVID-19

QMR

COVID-19 SPREAD TOO THIN A reflection on the current pandemic situation and its impact on dedication and personal wellbeing

WOMEN ON THE FRONTLINES A spotlight on some women from the community to national level leading change on the global pandemic

ISOLATION POEMS A series of haikus reflecting on isolation and COVID-19 from passing time to toilet paper

WHEN RUNNING WENT VIRAL How one student's running journey became a movement for health, fun, and bringing the QMed community together

in medicine