Annual Review 2014 Represents the Opinions of the Authors and Not Necessarily Those of the CanAdian Federation of Medical Students (CFMS)

Annual

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CFMS letters 17 Is our approach to patient care questionable? 5 Letter from the editor 18 Advocating for access to adequate and 6 Letter from the president affordable housing 19 Searching for research in Siberia CFMS activities 20 Research in the Global Health Program 7 Québec update 21 The CFMS Global Health Program: 8 Uniting the West advancing health equity at home and abroad 9 Ontario update 10 Governmental affairs 11 Big questions Initiatives 23 IREACH — improving access to care for 12 Bringing medical student mental health to refugee and new Immigrant Populations light 24 IHI Open School, Manitoba Chapter: 13 Keeping up with social media student-led initiatives 26 Need for improved eye care among In memory of homeless Canadians 14 Amanda Kelsall 27 Medical humanities at the Schulich School of Medicine and Dentistry Global health 15 Vaccinations in 2013 — a global student Experiences perspective 28 The best-kept secret

Cover art All editorial matter in CFMS Annual Review Description 2014 represents the opinions of the authors Fear of the unknown, and not necessarily those of the Canadian the disease that Federation of Medical Students (CFMS). abandons logic and The CFMS assumes no responsibility or makes man inhuman. liability for damages arising from any error Artist or omission or from the use of any informa- Haley Augustine tion or advice herein. Dalhousie University, Class of 2015

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33 46 51

29 These first times Travel award winners 30 Appreciation 43 A date in the rain 31 Summer woes: child malnutrition in Nepal 43 Reconnecting with my peers, passion and 32 Good kaRMSa purpose 33 Medical student elective experience in 44 Reflections from a first timer: CFMS Seoul, South Korea: gangnam style annual general meeting 34 Say it like you mean it 44 Exposure and awareness at the CFMS AGM 45 Connecting across Canada Opinions 35 The truth – a physician’s most powerful Featured interview weapon? 46 An interview with province of Alberta 36 Temples chief medical officer, Dr. James Talbot 37 What it means to be a medical student: a reflection Creative works 49 Once upon a September Alumni affairs 49 Anatomy cupcakes 38 Top 10 things to know before starting 50 Day in the life of Mary: a short story residency 51 The ruins of Ta Prohm Cambodia 40 Challenges of life as a military medical 51 Kulen Mountain Cambodia officer

52 Photo album 42 Fibromyalgia–Chronic Fatigue Syndrome Canada essay 55 Executives and representatives winners

April 2014 CFMS Annual Review 3 Lifestyle Checklist short commutes diverse diverse practices communities room to play financial security great schools

Visit us at: www.saskdocs.ca or send us an email at [email protected]

Physician Recruitment Agency of Saskatchewan CFMS Letters

Letter from the editors

Dear readers

It is with great pleasure that we present to you the 2014 issue of the CFMS Annual Review. Since its creation, the Annual Review has served as a venue for Canadian medical students to keep up-to-date with the CFMS team. As well, it has also served as a medium for Canadian medical students (and often practicing physicians) to show case their experiences and activities. This issue is no exception.

From the CFMS executive team comes activities and initiatives ongoing throughout the year to improve our members’ academic experience and wellness, as well as advocacy efforts in support of Yin Hui the health and well-being of our patients. This year, our members far and wide and found experi- Annual Review Editor ences that enriched their education and expanded their horizons. Initiatives continue to demonstrate University of that patient advocacy begins the moment we enter medical school. You’ll find thoughtful reflections Western Ontario from students in this issue. In the Alumni Affairs section, you’ll find valuable insight and advice Class of 2015 offered by our alumni on the great unknown beyond medical school. As usual, we have a section dedicated to recent marriages and births in the medical student and alumni community.

This year, we had the pleasure of inviting Dr. James Talbot, Alberta’s Chief Medical Officer of Health, for our featured interview. He expresses the importance of strong public health and a focus on prevention as significant components required for our patients’ good health. Make sure to read this insightful piece and think about all the non-medical factors that impact on one’s health.

Once again, this year we were happily overwhelmed by the large number of quality submissions. Due to space limitations, we unfortunately had the difficult task of selecting only a portion of the submissions we received for publication. Our sincerest thanks to those who submitted to the Annual Review. We would also like to encourage all of our members to share your experiences in the future! Mimi Lermer VP Communications The Annual Reivew 2014 editors University of British Columbia Class of 2014

Yin Hui Mimi Lermer

All editorial matter in CFMS Annual Review 2014 represents the opinions of the authors and not necessarily those of the Canadian Federation of Medical Students (CFMS). The CFMS assumes no responsibility or liability for damages arising from any error or omission or from the use of any information or advice herein.

April 2014 CFMS Annual Review 5 CFMS Letters

A letter from your CFMS president

Dear CFMS members, colleagues and friends The Canadian Federation of Medical Students (CFMS) is proud once again to offer you our Annual Review. It has been a busy year for our organization as you will see from the various executive reports and articles that share the stories and activities of medical students from across our country. From my perspective, I have had the privilege of working with an executive that has demonstrated passion for their various responsibilities and, most importantly, for ensuring that the needs of medical students are met and that our voices are heard at many different levels. Ultimately, we want to be an organization that serves its members and ameliorates the Canadian medical student experience while simultaneously translating these outcomes into better patient and population health. These aims are met by focusing on the three pillars of the CFMS: representation, Jesse Kancir, BSc, services and communication. MSc President On the front of representation, the CFMS has been particularly active this year being involved with University of Toronto the ongoing development of the Association of Faculties of Medicine of Canada’s Student Portal Class of 2014 that is looking to streamline the way in which Canadian medical students secure elective experiences. We’ve also been an active participant in the Physician Resource Planning Task Force, the national steering committee funded by Health Canada and composed of representatives from federal/provincial/territorial governments and from national medical organizations. This group has the aim of providing a pan-Canadian understanding of population physician needs (demand), working toward understanding and matching supply, and creating the resources to guide decision-making for medical trainees throughout their education. In terms of services, not only has the CFMS been concerned with the quantity of physicians but also the quality. We were thrilled to learn in December 2013 that we had been awarded a grant from the Canadian Physician Health Institute to survey Canadian medical students and determine their relative levels of wellness. More of this is described in our VP Services report to which I refer you. In addition to the host of educational products and services available to CFMS members, we have taken the concept of “services” to mean ways in which we can help ameliorate student experience. Finally, our communications have flourished this year with increased engagement through social media and progress on translating our website into French. Our aim is to reach every Canadian medical student with a variety of relevant information and opportunities in both of our official languages. The CFMS is on track to complete these changes throughout the year ahead and we are proud of these efforts. The past few months have been incredibly busy ones for the many students who dedicate themselves to the CFMS and to their medical training. My sincere thanks to everyone who contributes to the work of this organization and to the production of this Annual Review. As always, please feel free to get in touch with any of the executive should you have any questions. Sincerely

Jesse Kancir

6 CFMS Annual Review April 2014 CFMS Activities

Quebec update

Bryce Durafourt (McGill) Quebec Regional Representative and Executive Vice-President CFMS

was thrilled to have been Among my responsibilities as an “This initiative re-elected as Quebec regional repre- executive member, I oversee the CFMS Isentative this year at our 2013 annual travel funding, offered to support non- will allow our general meeting (AGM) in Vancouver elected CFMS members attending a and honoured to have been named the CFMS general meeting. Modifications information and executive vice-president of the organiza- I have made to the program include tion. I have spent the first half of my streamlining the process for applicants term continuing a number of projects and reviewers by revamping the applica- services to be and picking up new ones as well. One tion form and introducing clear criteria of my key roles as Quebec representative for evaluation, as well as providing accessible to more is to act as liaison with the Fédération earlier decisions to applicants. We con- médicale étudiante du Quebec (FMEQ), tinue to receive an increasing number of students across and strengthen the relationship between applications for each meeting, demon- our two organizations. In my capacity as strating a growing interest in the CFMS! the country…” Quebec representative, I regularly attend I also assisted with the recent review of meetings of the FMEQ. Once again our organizational bylaws, carried out translation of the website as the number this year, the FMEQ sent a delegation to comply with the new Canada Not- one priority in our strategic financial plan to our AGM 2013, allowing for con- for-profit Corporations Act. The updated last year. Given the large volume of text tinued discussions and sharing of ideas, bylaws will be submitted to our mem- available, funds were allocated in order especially on the topic of student well- bership for approval at our next general to use professional services for the initial ness. We have continued to collaborate meeting. Finally, I continue to act as website translation. In order to reduce since that meeting, and the CFMS and external representative to the Canadian our costs, it was decided that once this FMEQ submitted a joint proposal to Association of Internes and Residents initial translation was complete, we would the Canadian Physician Health Institute (CAIR), attending their meetings and ask our task force members to assist with to fund a pan-Canadian medical stu- offering opinions on issues relevant to ongoing translation of new items posted dent wellness survey. We were pleased medical students as they arise. to the website. The most relevant and to recently find out that we had been One of the largest projects I have up-to-date sections of our website were awarded the funding, and planning been involved with over the past year is compiled and have now been translated, of the survey is now underway. This one that involves offering our services to and should be posted to our new French- project exemplifies the results that can all of our members in both official lan- language section of our website shortly. come from collaboration between our guages. To this end, I created the CFMS This initiative will allow the information organizations. As another example of our Bilingualism Task Force, comprised of and services to be accessible to more collaborative efforts, we were happy to bilingual medical student volunteers from students across the country and should again invite a delegation from the FMEQ across the country, to assist with docu- encourage increased interest in individual to the CFMS Lobby Day on Feb. 3 in ment translation. As much of our interac- membership in the CFMS by students at Ottawa, which was deemed a success by tion with our membership occurs through the three non-CFMS member medical both our organizations. our website, the CFMS executive ranked schools in Quebec. n

April 2014 CFMS Annual Review 7 CFMS Activities

Uniting the West

Irfan Kherani Western Regional Representative University of Alberta, Class of 2015 Kimberly Williams Western Regional Representative University of Calgary, Class of 2014

estern Canada, although diverse, is in many “Over the next six months ways connected. We are excited to be the team working on uniting Wmedical students from western Canada. Our role has been to meet we will be laying the with medical student society presidents frequently in order to better understand some of the strengths and concerns of our region. We are excited to keep work- foundation of how CFMs ing with medical students from western Canada and are trying to discover any cross-cutting factors that unite us. We both love research and are excited to be tasked with setting up the can conduct research first research arm of the CFMS. Over the next six months we will be laying the foundation of how CFMS can conduct research moving forward moving forward in in order to best represent you — our members — to various external stakeholders. Our hope with this project is that we will not only create a order to best represent solid foundation for how CFMS conducts its research but also open up new opportunities for you, our members, to get involved with some of the you — our members CFMS research projects. We need you! If you have ideas on how to unite the West or want to get more — to various external involved in research please contact us ([email protected]). Happy to be working with you this year! n stakeholders.”

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8 CFMS Annual Review April 2014 CFMS Activities

Ontario update

David Linton Ontario Regional Representative University of Western Ontario, Class of 2016

his year I have had the out in any special way. It wasn’t until that we not only received a historic high great privilege to serve as an I was selected as a Lobby Day delegate number of applications, but we were also TOntario regional representative and went to Ottawa and met with so able to expand the funding available by for the CFMS. As a new member of the many other people from the CFMS that 50% to fund more of the many excellent CFMS executive, the year so far has been I first saw the CFMS activities first hand. applications we would have otherwise had both enlightening and humbling. The Later, I was fortunate enough to be one to reject. depth of experience and skills that medi- of the Political Advocacy Committee As a member of the Nominations cal students across Canada have to offer representatives to be awarded travel Committee I have also been exposed to continue to amaze me, and I am proud funding to the CFMS Annual General the number of highly qualified medical to be representing such a fantastic group Meeting in Ottawa. When I reflect on students eager to help their colleagues of people this year. this it really emphasizes for me how across the country. Together with my As I reflect on my experience so far, important it is to have as many oppor- experience working on the student ini- I realize how important it is to me to tunities as possible for students to get tiative grants, I realize that it is essential ensure that opportunities are open to all involved with the CFMS. that we not only continue to work to members of the CFMS, that the selec- Without all these chances to apply to ensure that as many opportunities as tion process is fair and transparent, and so many different opportunities, I would possible are open to medical students that we encourage people not to get dis- not be in the position I am now. In my across the country but also to encour- couraged if they are unsuccessful in an work for the CFMS this year I’ve seen age all medical students who have application. first hand how many people are trying to applied to continue to be active with I first became involved with the seize these opportunities. Together with the CFMS. CFMS as a delegate from the University Laura Butler, our Atlantic regional repre- During the rest of my term as a of Western Ontario to the federal Lobby sentative, I’ve had the chance to take the CFMS regional representative, I hope to Day in February last year. As a first- lead on the student initiative grants. The reaffirm these values and work to make year medical student I had some idea of depth and variety of applications from sure that we continue to reach medical the role of the CFMS, but in the mix across the country are truly remarkable, students across the country, and that of acronymic organizations to which I and it was a challenge selecting a small medical students continue to see the had been introduced as a new medical number of projects to fund from so many value in playing an active role in our student, the CFMS didn’t initially stand excellent applicants. We were thrilled organization. n

April 2014 CFMS Annual Review 9 CFMS Activities

Governmental affairs

Melanie Bechard Vice-President Government Affairs University of Toronto, Class of 2015

hat is the ultimate Upon reflection, it strikes me that this “Everyone enters the goal of our CFMS advocacy debate is a scaled-up version of one that Wefforts? As is often the case with- medical students face within our daily medical profession in medicine, this seemingly simple ques- lives. We constantly find ourselves balanc- tion requires a complex answer. This year, ing the sometimes competing priorities of for different the Government Affairs and Advocacy providing service to others and taking care Committee, which consists of student of ourselves. We ask ourselves whether we representatives from each of the 14 should visit the gym after clinic or spend reasons, but I do CFMS member schools, found ourselves the evening reading about the conditions grappling with this question. we encountered. We wonder whether our believe that we all Each year, the CFMS organizes a federal little sister would mind if we attended a Lobby Day where approximately 70 del- conference instead of her birthday party. have an underlying egates from across Canada gather in Ottawa As medical students know, there is no to meet with members of Parliament and single answer telling us where to devote desire to serve present a proposal relating to medical edu- our energies. The balance is constantly in cation or health policy. Selecting the specific flux. Providing excellent and compassion- those in need.” “Ask” we bring to Parliament Hill is a task ate care depends upon a commitment to that demands much research, attention and the health of both patients and ourselves. discussion in order to maximize this exceed- Perhaps our advocacy efforts can be housing facilities, and the other advo- ingly rare opportunity. most effective if we look toward adopting cated for federal Canada Student Loan This past autumn, selecting the Lobby this balance. Sometimes, policy changes deferral during residency with the pur- Day topic triggered an intriguing internal may place a group of patients at risk, pose of both relieving financial burden debate. The group had a sense that we and we need to leverage our resources to during medical training and enabling should create an Ask that benefits our col- respond appropriately. At other times, residents to participate in rural recruit- leagues. After all, the three pillars of the there may be issues creating inequities in ment programs that provide federal loan CFMS include service, representation and medical education that have a negative forgiveness. It was intended to represent communication. If we do not advocate impact on medical students and require the needs of both medical students and for medical students, who will? Yet there attention. It is very rare that the priorities vulnerable populations. Thankfully, we was an equally strong sense of duty to our of patients and medical students are not received an overwhelmingly positive patients. As a whole, medical students closely aligned — after all, happy patients response from the 65 policy-makers on tend to be a fairly privileged group. It is make happy doctors, and vice versa. Parliament Hill who agreed to meet with difficult to justify devoting our unique This year, the Government Affairs us. We look forward to building on these Ask opportunity to ourselves when there and Advocacy Committee had the relationships over the next few months are much more vulnerable groups who privilege of working with the National with the hopes of impacting policy. struggle to access shelter or basic medi- Officer ofH uman Rights and Peace As anticipated, defining the goal of cal services. Everyone enters the medical as well as the global health advocates our CFMS advocacy efforts has required a profession for different reasons, but I do in the creation of the Lobby Day Ask. complicated answer. While this question believe that we all have an underlying The global health team has extensive continues to be discussed, it is hoped that desire to serve those in need. By choosing experience working with vulnerable this focus on balance and collaboration to focus on issues specific to medical edu- populations and addressing the social with Global Health can continue to pro- cation, rather than the social determinants determinants of health. Together, we duce successful Asks that create wellness of health, would we eschew our commit- decided upon a two-part Ask: one for both medical students and the patients ment to our future patients? asked for continuing funding for social we are privileged to serve. n

10 CFMS Annual Review April 2014 CFMS Activities

Big questions

Ian Brasg Vice-President Education University of Toronto, Class of 2014

his year I’ve had the plea- education sites? Even more fundamentally, “What is the benefit of sure of holding the education port- how can our faculties keep curricula rel- Tfolio on the national CFMS execu- evant in the era of Google, social media pursuing bachelor’s tive for the second consecutive year. My and point-of-care tools? work to date continues to touch on all Which specialties should be offered as coursework before three of the central pillars of the CFMS: core-clerkship rotations? How much elec- representation, communication and ser- tive time should students have and where vice. Much of my role involves collabo- in the curriculum should it occur? What starting medical ration with our sister national medical are longitudinal clerkships and how do education stakeholders on projects that they affect the learning of students? Should training? ” seek to innovate and reform our collective clerkship students experience overnight call enterprise. Instead of summarizing my or would they benefit more from consis- activity to date, I’d like for you to content daily experiences? Should duty hours and demand in the future? How can we sider the Big Questions that this portfolio be restricted? How can medical student make these projections, anyway? Under regularly tackles. wellness be engendered and supported? what circumstances, if any, should return- How do we select the best possible can- Can we do a better job at helping students of-service agreements be used? Can cur- didates for admission to medical school? balance dua degrees and transition into ricular time that occurs after the Match Are successful candidates demonstrably and out of leaves of absence? be better used? Is the timing of the Match better than those who get bad news? Is the What means should be used to evalu- and licensing exam even optimized in the Medical College Admission Test a useful ate medical students during pre-clerkship first place? tool for differentiation, or does it select and clerkship? Have pass–fail policies Finally, some bigger questions: What is for homogenous thinkers of similar back- improved the well-being of students? Has the benefit of pursuing bachelor’s course- ground? How can we create institutional competition for grades been replaced by work before starting medical training? levers that promote the matriculation of competition for extracurricular activities, What is the optimal length of medical students of underserviced backgrounds? electives and letters of reference? What are training for the flexible production of com- Should class sizes increase, decrease or stay best practices for the selection of medical petent physicians who are prepared to meet the same? students for residency? Which compo- societal expectations and needs? Should all What is the right balance of lectures nents of the application have the most medical students receive the same curricu- and small-group sessions for optimal predictive value for future residency and lum, or is there a role for streaming based learning? How can early clinical teaching licensing performance? Is there a hidden on interest and/or aptitude? Similarly, how and observership experiences be woven component to residency selection? How would our education system look if we into curricula? Should pre-clerkship years transparent should programs be regarding pared down the 30 or so direct-entry spe- focus on providing grounding in Medical their selection criteria? cialties? How do you balance a desire for Expert and Scholar teaching, or should How can we help medical students generalism, flexibility and wellness with the pre-clerkship students also learn how to make informed choices regarding resi- necessity of producing fully licensed physi- advocate, communicate, collaborate, man- dency and careers? Is the R1 postgraduate cians in a timely fashion? age and be professional? How can material match becoming more competitive for I’d like to thank you for your interest from the social sciences and humanities Canadian medical graduates? If so, what in medical education and my portfolio, be incorporated? Should it? Are emerg- are some possible reasons? Should our and hope that these questions have you ing subjects — like leadership, handover system guarantee all Canadian medical thinking! Please contact me at ian.brasg of care and patient safety — emphasized graduates a postgraduate position? Should @mail.utoronto.ca if you have any ques- enough in our coursework? What are best postgraduate positions be redistributed tions or concerns or would like to get practices for integrating distributed medical to reflect the projected balance of supply involved! n

April 2014 CFMS Annual Review 11 CFMS Activities

Bringing medical student mental health to light

Brandon Maser Vice-President Services Queen’s University, Class of 2016

“Mental pain is less dramatic than be successful and resilient. This fear of medical student well-being. This cam- physical pain, but it is more common and weakness is compounded by the stigma paign will also include the publication of also more difficult to bear.T he frequent that exists towards those who suffer from a medical student wellness book, which attempt to conceal mental pain increases mental health disorders, making seeking will be a compilation of stories of medi- the burden: it is easier to say ‘My tooth is help even more challenging. It takes cour- cal students’ and professionals’ personal aching’ than to say ‘My heart is broken.’” age to confide in another that one’s heart struggles and/or triumphs with mental — C.S. Lewis, The Problem of Pain is broken, and even more courage to seek health and wellness; creative pieces, such the help of others in fixing it. as art, poetry, short stories; data from the n the winter of 2009, I was However, despite how isolating burn- national wellness survey; information on diagnosed with major depressive disor- out and depression are, we are not alone in wellness resources; and recommendations Ider. Despite the illness being well behind our struggles and weaknesses. This is espe- for the improvement of medical student me, this is not a fact about me that I often cially true for medical students. A recent well-being. Our hope is that both the share with others and something that I study released in the US shows that medi- survey and wellness book will serve as attempted even harder to conceal during cal students have higher rates of depression advocacy tools for the implementation my depression. I suffered in the silence of (58%) and burnout (50%) than their age- of new medical learner wellness resources my own choosing, secretly hoping someone matched, college-graduate counterparts.1 and curricula across the country. would decipher my cryptic stares; thank- The frequency of suicidal ideation among The solution to this problem begins fully someone did and encouraged me to medical students, although no different with us, with the advocacy we demon- finally reach out for help. than the general population of the same strate, with the supportive environment The reason I share this with you age, is also alarmingly high (9%–11%).1,2 we foster. I encourage those who are strug- now is because when I read the statistics Medical learner burnout and depression gling to reach out to the supports around evidencing the struggles that medical stu- are not uncommon, nor are they new phe- you and to share your story. The courage dents face with burnout and depression, nomena; they are systemic problems that you demonstrate in doing so will motivate when I see those cryptic stares in the faces require a systemic solution and a change in others to do the same and will contribute of some of my colleagues, I can relate first attitudes. to an environment free from stigma and hand to the silent burdens that are weigh- In an effort to catalyze this systemic full of openness and support. n ing them down. These burdens are not change, the CFMS, in partnership with easily suffered through alone, yet so much the Fédération médicale étudiante du If you or anyone you know is struggling effort is put into hiding our struggles and Quebec (FMEQ), is currently develop- with suicidal ideation, please visit http:// weaknesses as medical students. ing a national wellness survey to be www.suicideprevention.ca/in-crisis-now/ I often reflect on my reasons for suf- implemented in all 17 Canadian medical find-a-crisis-centre-now/ for information fering silently during my depression and schools over the next year. Along with on a crisis centre in your province. wonder if I had been in medical school this survey, we have plans to develop a when my depression first manifested, national multimedia wellness campaign, in References 1. dyrbye LN, West CP, Satele D, et al. Burnout among would I have still sought help? To accept which we hope to highlight results from U.S. medical students, residents, and early career physi- that we are at the mercy of something our survey, raise awareness for medical cians relative to the general U.S. population. Acad Med 2014;89(3):443-51. we cannot conquer alone is frightening student mental health issues and resources, 2. dyrbye LN, Thomas MR, Massie FS, et al. Burnout and humbling, especially when there are and advocate for changes within medical and suicidal ideation among U.S. medical students. Ann expectations on us, real or perceived, to education that will be aimed at improving Intern Med 2008;149(5):334-41.

12 CFMS Annual Review April 2014 CFMS Activities

Keeping up with social media

Mimi Lermer VP Communications University of British Columbia, Class of 2014

t has been an incredible disseminate the information from our bi- outlining their role going forward, to privilege working with the executive weekly newsletters. Without this team we proactively engage stakeholders with the Iand members of the CFMS over the would be lost! CFMS. The Social Media Committee past several years. What I have enjoyed Social media has erupted over the is working on a branding project, along most is collaborating with students across past half decade and this year the CFMS with several executive members, to cre- the country on incredible projects aimed has been working hard to keep pace. ate a cohesive image moving forward. to better the experiences of the medical Our social media committee expanded Communications is actively involved with student body. and has worked incredibly hard to keep the government affairs, regional represen- The most challenging aspect of the students up to date about opportunities tative and services portfolios on new and communications portfolio is effectively to get involved, to get published, to win exciting projects. The student-led CMAJ reaching out to all of our student mem- scholarships, to get internships and more. Humanities Blog is a new initiative that bers. In many cases we lack exposure and Not only that, but they post and tweet we are very excited to share with our students spend their three or four years of about exciting medical advances and con- members, the medical community and medical school wondering what it is that troversial medical news to keep followers the public! the CFMS is or does for them. Every year engaged and interested. Now medical stu- Thank you to all those students (and the communications team, comprised of dents can contribute content to be posted now residents) who have contributed so representatives and committee members on Facebook and Twitter by the social much time to supporting others through across the country, works hard to convey media team. Let us know what you’d like collaborative leadership and advocacy. to students the opportunities available to read about! It has been my pleasure working with to them through the CFMS, often in The communications portfolio is ever all of you! I look forward to the rest innovative ways. At the University of evolving and several projects are on the of this year and to further teamwork Manitoba, student reps are creating funny go at any time. Currently our new Media efforts as I complete my term as VP news reports posted through YouTube to Engagement Committee is working on Communications. n

April 2014 CFMS Annual Review 13 In Memory

Amanda Kelsall

manda Lee Kelsall (Feb.16, 1991–Jan. 5, 2014), Afrom Horseshoe Valley, Ontario, was a second-year medical student (MD2016) at the University of Ottawa. She was distinguished throughout her high school and undergraduate studies for her academic and athletic excel- lence and known for her warmth and generosity. Entering medical school at the University of Ottawa, she brought a brightness and enthusiasm to the MD Class of 2016. She had a joy for life that was contagious, sharing with others her passion for service through her involvement with the Refugee Health Initiative and as a leader of the Christian Medical and Dental Society, Ottawa chapter. Amanda loved to run and was often out training for her next half marathon — well before her classmates had hit their snooze buttons. Despite her dedication to these early morning runs, Amanda could always be found in the front row of lectures, engaged in her medical training and impeccably dressed. On Jan. 5, Amanda passed away in a tragic accident returning to Ottawa following the holiday break. The MD Class of 2016 will forever feel the loss of one of its purest and humblest. Amanda represented all of the good in medicine and embodied the spirit of someone who would change the medical field. Amanda will be remembered by her family and friends as a woman of compassion, courage and faith. Her honest spirit will live on through all of the lives we will touch as future physicians. In conjunction with the Kelsall family’s wishes and to honour her memory as well as for the outpouring of condo- Alternatively, donations can be made and pay tribute to Amanda, a fund lences and warm wishes from the national by calling 613-562-5800 x3417. n was created in her name. The Amanda medical student community. Kelsall Fund will be used to financially Anyone wishing to make a donation support undergraduate MD students at can do so by visiting the website below the University of Ottawa. (the drop-down menu will bring up the Written with contributions from Elise The University of Ottawa Class of Amanda Kelsall Fund name): alumni. Azzi, Alexa Clark, Lindy Buzikievich, 2016 thanks the CFMS for their gener- uottawa.ca/medicine (note: there is no Amelia Wilkinson, Kayla Simms, Anthea ous support of the Amanda Kelsall Fund www. before alumni). Girdwood and the Kelsall family.

14 CFMS Annual Review April 2014 Global Health

Vaccinations in 2013 — a global student perspective

Anthea Girdwood Ontario Representative for the CFMS University of Ottawa, Class of 2017 Benjamin Veness Past President of the Australian Medical Students’ Association University of Sydney, Class of 2014

his week, 450 medical about whether misinformation is also an students from around the world are issue in Central America. “Are we, in places Tmeeting in Santiago, Chile, to dis- After an awkward explanation of what cuss global health. All would agree that, Playboy was, and how on earth a nudie like Canada and along with public sanitation, mass vacci- magazine was connected to public health, nation has undoubtedly been one of the his response was refreshing. Australia, giving most important factors behind reduced “Why would anyone connect autism infant mortality and increased life expec- to vaccines? They’re not at all related,” our citizens too tancy. Nonetheless, the World Health Martin queried, genuinely perplexed. Organization (WHO) still attributes 1.5 “You know, your country should much freedom million deaths among children under really put out a public education cam- five years of age (2008) to vaccine-pre- paign to explain why vaccines are good.” when it comes to ventable illnesses, like measles, for which According to the WHO, Canada had American John Enders developed and 759 cases of measles in 2011. Panama, a released a vaccine in 1963. developing nation, had four. Even if you important matters Fifty years on, why are children still gross up Panama’s population to compare dying of this disease? In the developing like with like, the equivalent number of of public health? world, access to essential medicines has cases is only 37. Maybe he’s right. been the greatest impediment. Canada, Australian medical students had heard Does the danger meanwhile, has a publicly funded of Ms. McCarthy but attributed any mis- immunization program that, along with information Down Under to a “crackpot” posed by those the program in the United States, has group duplicitously calling themselves the included the measles vaccine since the Australian Vaccination Network, a name left unvaccinated 1960s. Despite the apparent interrup- that the New South Wales Office of Fair tion of endemic transmission in the late Trading recently demanded they change necessitate 1990s, the 2000s have seen a number as it is “misleading.” Australia had 190 of Canadian measles outbreaks, most cases of measles in 2011. notably that of 2011 in Quebec. No one “The Australian Vaccination Network mandatory would consider Quebec a developing does not present a balanced case for vaccina- nation and yet still we had hundreds of tion, does not present medical evidence to immunization?” Canadian children suffering needlessly. back up its claims and therefore poses a seri- We may have averted any deaths, but ous risk of misleading the community,” the vaccines, seemingly attributing autism children infected with measles may still New South Wales minister for fair trading to unnecessary “toxins.” This type of experience fever, diarrhea, pneumonia said in December last year. Sound familiar? lame pseudo-science has been thoroughly and infections of the brain. In an interview with TIME magazine debunked and is widely criticized by the Given the extensive debate over for- in 2009, Ms. McCarthy is quoted as say- scientific and medical corps, yet somehow mer centrefold Jenny McCarthy’s partici- ing, “If you ask a parent of an autistic child still persists. All vaccines are reviewed and pation on The View and her dangerous if they want the measles or the autism, approved by the Biologics and Genetic opposition to childhood vaccination, we will stand in line for the [expletive] Therapies Directorate of Health Canada. it was interesting to speak to a medical measles.” She claimed that it was not vac- “Educate before you vaccinate” is student, Martin Alpirez, from Panama, cines that they were against, just “unsafe” the imploration on Ms. McCarthy’s

April 2014 CFMS Annual Review 15 Global Health

Generation Rescue website. Good idea. measles, there are no exemptions. There of their people, commending groups Mike Kalmus-Eliasz, a medical student is less freedom when it comes to public such as GAVI — the Global Alliance for from London, reported that in his school, health.” Chinese students Alex Wang Vaccines and Immunisation. a common examination involves trying and Nate Du agreed, but described the Are their patients concerned about the to convince a sceptical parent to vacci- challenges facing health care providers safety of vaccinations? No. nate their child. “The scary thing is that when it comes to vaccinating a popula- “It is an achievement to bring your sometimes you can’t convince the actor,” tion of 1 billion people, especially those child to be vaccinated. Mothers are proud he says. The United Kingdom had 1,112 in remote regions. Despite this, China, to take care of their children this way.” cases of measles infection in 2011. a country with 40 times the population These students will practise medicine The picture seems brighter in the of Canada, had a per capita measles rate in areas of the world where infectious Middle East. Lebanese student Joe Cherabie in 2011 that was only three times that disease kills millions of children every claimed not to know of any local equiva- of our own. year. They will see patients every day lents to “what’s her name” (McCarthy). Interestingly, it was discovered that suffering without access to existing pre- The WHO reports that Lebanon had nine you can, in fact, refuse vaccinations in ventative care. In Canada, Australia and cases of measles in 2011. China — but in a paternalistic society the UK, it would seem that we have for- Are we, in places like Canada and where the distribution of information gotten what that looks like. n Australia, giving our citizens too much is highly controlled, it seems that even freedom when it comes to important mat- its medical students aren’t privy to that Anthea Girdwood is a second-year medi- ters of public health? Does the danger information. It’s doubtful that Canadians cal student at The University of Ottawa posed by those left unvaccinated neces- would appreciate such an approach. and Ontario representative for the CFMS. sitate mandatory immunization? Near the end of this conference, a Benjamin Veness is the past president of the Making sweeping assumptions about number of students from African nations Australian Medical Students’ Association. which countries just might have man- gathered to offer their thoughts on vac- This piece was co-authored from the gener- datory immunization, we sought out cination. Students from Kenya, Namibia al assembly of the International Federation Calvin Liu of Hong Kong. “When it and Ghana alike applauded the incred- of Medical Students’ Associations in comes to vaccination for diseases such as ible efforts to support the vaccination Santiago, Chile.

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16 CFMS Annual Review April 2014 Global Health

Is our approach to patient care questionable?

Danielle Chard National Officer of Reproductive and Sexual Health McGill University, Class of 2016

r more importantly, share information and contextualize a are you an Askable Doctor? Why treatment with an understanding of the “It is much more Odo we wait until the end of an person as a whole. If you begin by lis- appointment to ask “Do you you have tening, a patient’s questions crystallize important to any questions?” What if, instead, we important information for you. They can started our appointments with the patient help you understand what your patient know what sort asking the questions instead of the physi- needs from you, their knowledge level cian? and, importantly, what motivates them. of a patient has a I can already hear the cynics. “What’s Letting a patient take the driver seat the point in a patient asking question I reaffirms that they are in control and disease than what won’t have time to answer?” “I’m a spe- you are simply a guide. By acting as their cialist. I want to keep things focused on navigator you can point out which routes what I do best.” A quiet voice from the are the safest, places they might want to sort of disease a back row might ask, “What if they ask a explore, while all the while allowing them question I don’t know the answer to?” to choose the direction they want to take. patient has.” – Sir Consider this statement from Sir This trip is time limited, and perhaps you William Osler: “It is much more impor- can’t explore everything this time around, William Osler tant to know what sort of a patient has a but a navigator can only lay out your disease than what sort of disease a patient options; you make the decisions. outside your comfort zone, you give your has.” When the patient is asking the ques- patient the opportunity to be vulnerable. I had to read it twice myself; it tions, you are able to customize the So be brave and let let your patients seemed like a phrase that simply information you provide. Instead of get- help you to help them — that is, after all, repeated itself. Go ahead, read it again. ting an overwhelming information bomb why we’re here. Begin by listening to the We are all familiar with protocols based we are so infamous for, your patient will parts of the story your patient wants you on what “sort of disease” a patient has. receive a personalized package, tailored to hear. Create an openness that will leave What kind of training do we receive to to their needs, appropriate to their level patients knowing they are important and figure out what “sort of a patient” has a of knowledge. that you are committed to helping them disease? We’re taught to listen to what Perhaps most importantly, an Askable find wellness.W e don’t need to know all our patient has to say, but I feel like this Doctor approach allows you to create the answers and we don’t need to answer generally only happens after we’ve asked an open and safe space for all questions. all the questions all at once, we’re just a question, after we’ve delineated what When your patient feels safe and in con- opening up the conversation, our minds “kind of thing” we want to hear. trol they are more likely to ask questions and our patients to a lasting and trusting The opportunity to make our interac- about topics that can leave one feeling relationship with both their doctor and tions with patients less like transactions exposed; questions about sexual health or the health care system in general. n and more meaningful is in the way we mental health come to mind. By stepping

April 2014 CFMS Annual Review 17 Global Health

Advocating for access to adequate and affordable housing

Ben Langer National Officer for Human Rights and Peace University of Western Ontario, Class of 2015

he Global Health we were able to narrow in on the issue of terms of both human and health care costs. Advocacy Program (GHAP) has expiring federal social housing agreements. Recognizing that calls for federal leadership Tgone through some major change In Ottawa in February we made a strong in housing are coming from municipal and this year, taking part in the CFMS Lobby case for reinvesting federal social housing provincial governments, as well as many Day for the first time and bringing our subsidies back into programs that address prominent civil society groups, we’re going focus on health equity to the event. Our the large and growing crisis in adequate to be joining these voices in pushing for advocacy theme this year is Access to and affordable housing in Canada and a national housing strategy that would Adequate and Affordable Housing, and it had many productive conversations with address both current and future housing was a whirlwind journey from November policy-makers around the issue. We look needs, as well as continuing to push for to February getting to know the political forward to being part of this crucial CFMS reinvestment of federal housing subsidies. landscape around housing issues in time initiative in the future. Look out in a few months for a CFMS to bring a housing ask to Parliament Hill. This spring the GHAP is going to be housing advocacy video, as well as a clini- With the help of incredible global health working on a few different aspects of hous- cal tool to help med students and other advocates, a savvy research team, strong ing nationally. Housing and health are health professionals put housing on their partners in the CFMS Government Affairs inextricably linked, and we recognize that radar. And before we know it, it will be and Advocacy Committee, and support focusing upstream on this social determi- time to head back to Ottawa for our new from some great civil society partners, nant of health will help down the line in November Lobby Day! n

Recrutons psychiatres bilingues

Le département de psychiatrie est à la recherche de psychiatres pour son unité d’hospitalisation d’une capacité de 60 lits (40-44 lits ouverts présentement), ses services ambulatoires et ses services de consultation-liaison.

Montfort a reçu récemment sa désignation provinciale de centre hospitalier universitaire des sciences de la santé et s’implique activement dans l’enseignement.

La langue de travail et d’enseignement à Montfort est le français. Les soins et les services de l’Hôpital sont offerts dans les deux langues officielles. Tout médecin voulant œuvrer à l’hôpital doit démontrer une volonté d’apprendre à s’exprimer en français. La rémunération est excellente.

Ottawa, 20 mars 2012, Ottawa encore une fois première au palmarès des meilleures villes canadiennes – Pour une troisième année consécutive, Ottawa a reçu l’insigne honneur d’être désignée ville canadienne où la qualité de vie est la meilleure par le magazine MoneySense1.

Pour plus d’information, veuillez contacter le Dr Guy Moreau, médecin-chef et chef intérimaire de psychiatrie au 613.746.4621 poste 6201 ou par courriel à [email protected]. Montfort. Mon choix. Mon avenir.

1 http://www.jimwatsonottawa.ca/fr/nouvelles/ottawa-encore-une-fois-premi%C3%A8re-au-palmar%C3%A8s-des-meilleures-villes-canadiennes Ottawa, Ontario

18 CFMS Annual Review April 2014 Global Health

Searching for research in Siberia

Kayla Simms MD Candidate University of Ottawa, Class of 2016

t started on the plane. Flying to Russia in the summer of I2013, an overwhelming excitement began to surface as I thought about matryoshka dolls and ushankas. I imagined the gourmet food new to my palate and the pristine facilities I would soon call my workplace in Yekaterinburg. Through the International Federation of Medical Students’ Associations lottery selection, I had been chosen to participate in a month-long ophthalmology research project 4,931 miles away. It didn’t take long before I realized how little I understood of the Russian culture or language. This weighty fact became apparent when ordering my in-flight meal Shrieking, I frantically ducked and lectures on appropriate hygiene. Gone by means of embarrassingly flapping my looked to Dr. B, who appeared surpris- were the scrub nurses demanding students arms and chirping loudly. Needless to ingly composed. to step away from the surgical field. say, the stewardess served me beef. To my “Kyla, dis hospital bird. Make patients But then it happened. They ran out of absolute pleasure, however, I was seated calm. Ve also have room of bunnies.” And anesthetics. next to a curious young boy. just like that, he opened a door to his left, And with their final operation to go, “Vy you go to Siberia,” he asked. revealing a room chock-full of live, frolick- I watched as a physician whipped a bed At the word “Siberia,” the nerves in ing bunnies. sheet taut like a child playing with a home- my stomach threatened to send me search- By early afternoon, after being exposed made lasso. Except this wasn’t playtime. ing for the nearest parachute; I could feel to a series of obscenities and inexplicable This was for tying the patient down. my heartbeat resonating the entire plane. mayhems, nothing fazed me. So when Dr. And perhaps my interpretation of the Suddenly, just as I thought I would hurl, I B asked if I would like to observe the after- exact events was misperceived by the over- felt a tap on my shoulder. noon’s surgeries, I delightedly followed whelming cultural and language barriers, “Velcome,” the boy said, beaming him through a big blue door. but this is where a parachute on that flight from ear to ear. Right before my eyes, in a tiny room seemed like a sweet alternative. Smiling at this small but meaningful ges- with a window wide open (not to mention But I stayed for the month, and I ture, I removed the Canadian flag from my Russia’s pigeon problem), three operations loved it. I met fathers who smiled from knapsack and pinned it on the boy’s jacket. were being performed simultaneously. toothless grins and mothers who touched It was then that the magnitude of this Three patients. Twelve doctors. No gloves, my red hair in awe. I was greeted with an exchange began to sink in. surgical masks, or even so much as a shoe- admiration that defied the bounds of ver- Upon arriving in Yekaterinburg and cover in sight. bal communication, all the while exploring meeting my supervisor, Dr. B, he told me he I looked to my right and glared at a a most intriguing medical community was only made aware of my coming “vone group of patients awaiting their turns. To through the privilege of a lifetime. veek ago. So zere is no project for you, Kyla.” my left, I found more patients, post-op. And although my in-flight “research- Before I even had time to react, a para- I began to feel claustrophobic, over- project fantasy” never came to fruition, I keet swooped over our heads right in the come by practices incomparable to any- am certain Russia enriched my life with hospital lobby. thing I knew. Gone were the countless more than any test tube ever could. n

April 2014 CFMS Annual Review 19 Global Health

Research in the Global Health Program

Stephanie Brown National Officer of Global Health Education University of Calgary, Class of 2015 Irfan Kherani National Officer of Global Health Education University of Alberta, Class of 2015

n 2013, a major focus of the adapting back into their settings and low-resource settings and should be able global health program (GHP) was applying their knowledge. Despite recog- to identify sources of information con- Iglobal health education research; the nizing the importance of PRD, students cerning global health topics. Medical stu- 2014 GHP looks forward to building across the country requested a more dents also ought to appreciate the role of on the excellent work carried out by five systematic and evidence-based approach physicians as advocates for improving the working groups and their student chairs. to the debrief program. The GHP looks health of patients and populations in their forward to developing a plan to deliver communities and globally. Since 2011, Pre-departure training better post-return debriefing toC anadian the Global Health Education Consortium (Ali Manning) medical students! competencies have been transposed into In 2007, the CFMS established the pre- to the CanMEDS roles to make the com- departure training (PDT) program. This Global health concentrations petencies more applicable to Canadian project was created in order to ensure Recognizing that many schools do not medical school curricula. The competencies that Canadian medical students were sufficiently address global health within are currently in for peer-review and will adequately prepared when participating their core curricula, several schools have be made available after their presentation in medical electives in low-resource set- developed extracurricular programs to at Canadian Conference on Medical tings. In 2008, the CFMS and the Global promote comprehensive global health Education 2014 in Ottawa! Health Interest Group of the Associations education. These often take the form of of Faculties of Medicine of Canada a global health concentration program, Global health experiences (AFMC-GHIG) co-published a set of though they lack consistent structure. A database (Robynn Geier) guidelines for PDT programming. As set of minimum national standards for The evolving role of physicians in the PDT is further developed and incorpo- these programs has been developed and domains of international development rated into medical education, it is impor- will be made available in order to provide and advocacy has prompted Canadian tant to solicit feedback to ensure current a template for schools wishing to expand medical students to report unprecedented programming is meeting the needs of their global health education offerings. demand for experiences in global health. students who wish to travel overseas to Global health opportunities vary in scope, low-resource settings. Global health core quality and availability, with many stu- competencies in medical school dents expressing difficulty accessing the Post-return debrief curricula (Rabia Bana) appropriate information to guide their (Scott Hodgson) Based on the expectation that all medical pursuit of elective, volunteer and research In 2013, the CFMS global health pro- graduates should understand the major experiences both locally and abroad. gram developed a study aimed at clarify- factors that influence the health of indi- The current database includes detailed ing and recording qualitative information viduals and populations worldwide, a information on volunteer opportuni- on existing post-return debrief programs set of core competencies in global health ties, exchanges, courses, summer schools, (PRD) at medical schools across Canada. was developed by the Global Health internships, conferences, assemblies, PRD is present in most medical schools Education Consortium in 2008-2009. journals, newsletters and international across the country, though the method In conclusion it was agreed that students electives, both in Canada and abroad. We and timing vary considerably. Students should have a basic understanding of will be posting a link to the database on who received debriefing were better at the complexity of global health issues in the CFMS website in 2014! n

20 CFMS Annual Review April 2014 Global Health

The CFMS Global Health Program: advancing health equity at home and abroad

Andrew Bresnahan Vice-President, Global Health McMaster University, Class of 2015

ach year, the CFMS from each other’s work. In February global health program (GHP) 2014, Emily Stewart (Toronto) and “... a commitment Eunites medical students from every Scott Hodgeson (Manitoba) led the corner of Canada working to advance first Canadian delegation in many years to ensuring that all health equity at home and abroad. We to attend the Pan-American Medical are always looking for ways to welcome Students’ Association (PAMSA) meet- people, regardless more medical students to the program ings in Panama, where they led more and improve our communications, ser- than 36 hours of workshops on sexual of where they are vices and representation in Canada and health and Indigenous health. In March around the world. This year, we have 2014, Danielle Chard (McGill), Zia born or who they made great steps in this direction, thanks Saleh (Alberta), Siqi Xue (Toronto) and to a brilliant team from across Canada I will be leading Canada’s delegation to are born to, have working to bring our program to life. the IFMSA March Meeting in Tunisia, where we will be continue working with Connecting across Canada our international neighbours to shape a fair shot at a Supporting a team spread from coast to the post-2015 sustainable development coast to coast is an inspiring challenge. agenda to include measureable and healthy life.” This year we have continued using effective action on the social determi- the CFMS website, Twitter account, nants of health. The GHP is also leading efforts Facebook pages, email lists and confer- to improve CFMS’s capacity to work ence calls to communicate with students Global health services — a alongside Aboriginal peoples to promote and colleagues at medical schools across focus on health equity First Nations, Metis and Inuit health. Canada, sharing news, opportunities and This year the GHP designed our first Our 2014 Annual General Meeting will reports to make our work as transparent strategic plan, bringing a focus on health be the first to include representatives and accessible as possible. Blog posts on equity to each of our areas of service from Aboriginal health interest groups housing and health, intimate partner delivery, including our programs in global from medical schools across Canada, violence and Indigenous health have health education, reproductive and sexual creating an opportunity to build last- helped build our organizing momen- health, international exchanges, partner- ing partnerships at a local level. At a tum, while reports from international ships, Aboriginal health and advocacy. national level, we are also in dialogue meetings of medical students in Central For the first time this year, our global with Inuit Tapiriit Kanatami, the Métis America and North Africa helped high- health advocates (GHAs) worked with National Council, the Assembly of First light the strengths we bring to interna- the CFMS Government Affairs portfolio Nations and the Indigenous Physicians tional efforts to build a more just and from day one to design and implement Association of Canada as we develop healthy world. our national Lobby Day, bringing a new CFMS policy papers on First focus on social determinants of health Nations, Metis and Inuit health. Global leadership to Parliament Hill. Over 80 students, To highlight our shared commitment CFMS is a member of the International representing every medical school in to health equity, medical students from the Federation of Medical Students’ Canada, joined us for advocacy training global health program have partnered with Associations (IFMSA). Each year, we at CMA House in Ottawa and met with Upstream (www.thinkupstream.ca) to write participate in bi-annual meetings of nearly 70 MPs, senators and cabinet a book celebrating Canadian physicians the IFMSA, meeting with medical stu- ministers to call for improved access to whose work offers practical examples of dents from over 100 countries around physicians in rural Canada, and better action to improve the social determinants the world to share projects and learn investment in social housing. of health. Like 12 Stories, our book on

April 2014 CFMS Annual Review 21 Global Health

migrant and refugee health, we hope this Through pity, we respond to the new collection of student writing will be other as a kind of object, and can “Our GHAs worked an inspiring tool for Canadian medical assume a kind of apolitical stance students working to build a more just and on the causes of and the condi- with the CFMS healthy society. tions that create such suffering, as though these lie somehow outside Government Affairs Health for all the responsibility of politics, and as As I write, I am watching the snow fall on though charity and philanthropy the town where I was born, an Inuit com- are adequate responses. In being portfolio from day munity on Labrador’s north coast. Listening with the victim, one refuses to to my friends share stories of everyday life in accept what is an unacceptable one to design and the north, and thinking of our CFMS del- assault on the dignity of the other, egation to the IFMSA meetings in Tunisia, and thus on the self...Solidarity implement our I am reminded that what links these areas of implies a willingness to confront the practice is our shared commitment to health causes and conditions of suffering equity — a commitment to ensuring that that persist in destroying dignity, national Lobby Day, all people, regardless of where they are born and to demand a minimum respect or who they are born to, have a fair shot at for human life. Solidarity also bringing a focus on a healthy life. means recognizing the dignity and Beyond the busy pace of clinical autonomy of others, and assert- social determinants work, early morning rounds and late ing the rights of others to make night call, it’s good to take time to choices about their own destiny. remember what we are working toward. Humanitarianism is about the of health to We can find these reminders every time struggle to create the space to be we listen to our patients, accompany fully human. Parliament Hill.” them through their suffering, and learn about the everyday conditions that shape What better work to share? Thanks their lives. Canadian physician and to each of you who work to bring the humanitarian James Orbinksi reminds GHP to life, and who bring it closer us of this when he writes: to contributing in practical ways to from other Canadian medical students the struggle to ensure that all people, involved in the GHP. Please feel free In our choice to be with those wherever they are born, have the space to contact us anytime with questions who suffer, compassion leads not to be fully human. Over the next few or ideas about we can work together to simply to pity but to solidarity. pages, you will have the chance to hear advance global health. n

22 CFMS Annual Review April 2014 Initiatives

IREACH — improving access to care for refugee and new immigrant populations

Danny Chan University of Toronto, Class of 2016 Leora Branfield Day University of Toronto, Class of 2016 Ayan Dey, MD, PhD University of Toronto

mmigrant and Refugee including St. Stephen’s House, a commu- To create these cards, first and Equitable Access to Community nity-based social service agency in down- second year medical students gather a IHealthcare (IREACH) began in 2012 town Toronto. This enables us to reach detailed medical history from clients, as an initiative of University of Toronto out to immigrant and refugee clients in with or without an interpreter. In doing medical students driven to make a the community. One of IREACH’s main so, students are able to practise and positive difference in the community. initiatives is the development of a wallet- improve their history-taking skills and Through their own academic fieldwork sized medical history card for each client, learn how best to communicate with in the community, personal experiences created from a medical history taken by patients who speak limited English. and volunteer work, they realized that a volunteer medical student. Clients are Importantly, through this process, stu- many new immigrants and refugees face then able to use this card when they are dents gain exposure to working with several barriers to accessing care. This visiting a health care provider for the first vulnerable populations and learn first- includes language, cultural, educational time, in the emergency room or in an hand about the clients’ varied cultural and social barriers, in addition to a lack emergency scenario. This helps to over- backgrounds, beliefs and needs. As such, of familiarity with social and health care come language barriers and facilitates the IREACH serves an important role not services available to them. Recognizing transmission of these individuals’ most only in assisting immigrant and refugee this issue and motivated to help improve important health record information to populations, but also in providing valu- accessibility and empower refugees and health care providers, assisting in their able, hands-on opportunities for students new immigrants, medical students at the treatment and management. to work with diverse and marginalized University of Toronto began IREACH Over the past two years, the card- populations. — an initiative to connect new immi- making clinics have received very posi- Overall IREACH’s mandate is to grants/refugees with community resourc- tive feedback. Specifically, clients have oversee initiatives that improve access es and facilitate communication with described feelings of empowerment and to health care for immigrant and refu- medical professionals through interpreta- confidence in seeking out health care ser- gee populations, while giving medical tion services. vices with the use of the card, as the cards students the opportunity to work with Since its inception in early 2012, act as an important resource to help facili- unique populations and develop their IREACH has won a project grant to sup- tate communication with health care pro- communication skills. By sharing our port its operations and was recognized viders. Other clients have expressed that story, we hope similar programs can as an official student group within the this initiative has reinforced their faith in become established at other universities Faculty of Medicine. Today, IREACH the health care system as a whole, as they across Canada. works in partnership with a number have been moved by the respect and care Please contact us at ireachuoft@gmail of community centres and services, shown by medical student volunteers. .com for more information. n

April 2014 CFMS Annual Review 23 Initiatives

IHI Open School, Manitoba chapter: student-led initiatives

Kristina Joyal University of Manitoba, Class of 2015 Cara Katz University of Manitoba, Class of 2015

n health care, the con- cepts of interprofessional teamwork, Ipatient-centred care and quality improvement are fundamental for an optimal system. The Institute for Healthcare Improvement (IHI) is an international non-profit organization that works towards these goals, and at the University of Manitoba we have a chapter of IHI that functions under the Manitoba Health Sciences Students’ Association (MaHSSA). We want to highlight recent chapter activities, as well as our challenges and future directions, in hopes to inspire others to engage in activities related to health care improvement and interprofessional education and foster national dialogue in these regards.

Activities of note Nightmare Night Care (2011–2013) Nightmare Night Care (NMNC) is an overnight simulation shift that includes nursing, medicine and pharmacy. First- year nursing and medical students play the role of patients on a hospital ward while fourth-year nursing and pharmacy students, and second year medical students play their respective roles. Approximately 45 students are involved annually, including medical residents throughout the evenings as “attendings”. This simulation allows for insight into what our colleagues do and an appreciation of their skills and knowledge, as well as teamwork. “Patients” are given roles that they are expected to act out (e.g., requiring a wheelchair, trying to attract a nurse’s attention for help to the bathroom, etc). Students reported learning what it can feel like to be a patient, as well as some new insights into other

24 CFMS Annual Review April 2014 Initiatives

professional roles. We have since initiated and we plan to expand this opportunity a loss of momentum with the handover a daytime simulation, and are looking to for recognition to other health care stu- of leadership each year. include occupational therapy and physio- dents outside of medicine. therapy students in the future. Future directions In 2013, an ethics-approved survey Other past activities include: IHI is working with MaHSSA to improve evaluated the ability of the NMNC event Interprofessional Competition: Patient inter-professional communication and to improve inter-professional attitudes. Safety Project (2006), Assessment of representation. We have also changed the From this, it was clear that, for some stu- the Adoption of the World Health chapter leadership to two two-year posi- dents, this was their first chance to work Organization Surgical Safety Checklist tions, to reduce the loss of momentum with other health care professionals. (2009), a case study (2013), poster presen- from year to year. Ideally, the two posi- tation at Canadian Conference on Medical tions would be held by students from dif- IHI Open School Workshop (2011–2013) Education (CCME, 2013) and Student ferent programs. This annual workshop introduces stu- Quality Leadership Academy (2013) Finally, we are hoping to promote dents to (and reminds them about) quality improvement projects by engaging the IHI, the Open School, orientation Challenges with hospital and faculty quality improve- regarding the certificate, and other ways There are numerous challenges to main- ment committees. to get involved. Approximately 40 stu- taining an active, inter-professional We hope that you have enjoyed read- dents attend annually, with a few from student group. The most glaring of our ing about the University of Manitoba’s outside of medicine. Students can receive challenges is scheduling of events due to IHI activities, and that it is helpful and recognition on their medical student the physical separation between the two inspiring for your own inter-professional, performance record (MSPR or dean’s campuses and differing exam and holi- patient-centred or quality-improvement letter) for completion of the IHI Basic day schedules. Additionally, we currently activities. Feel free to email us (IHI. Certificate.T his acts as further motiva- lack representatives from each program [email protected]) with any com- tion to complete the IHI Open School, to coordinate with. Finally, there can be ments or questions! n

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CMY

April 2014 CFMS Annual Review 25 Initiatives

Need for improved eye care among homeless Canadians

Christopher W. Noel University of Toronto, Class of 2016

omelessness impacts The hope is that our study will help not thousands of Canadians, and it has only to identify those with visual disabilities, “The belief among Hbeen linked to many important but also to elucidate any access issues within health implications, including greatly our current eye care delivery system. all members of our increased rates of morbidity and mortality.1 The project is well underway, and our While there has been a significant preliminary data suggest that the major- team is that vision is amount of research conducted to identify ity of homeless individuals are dissatisfied the prevalence of some diseases within the with their vision. What I find particularly not luxury for those homeless population, little is known about distressing is that over three-quarters of their ocular health. Given that the Ontario our participants have decreased visual who can afford it, government does not cover the costs of acuity that could easily be corrected with primary eye care, the cost associated with prescription glasses. While many of our receiving eye exams and prescription glasses study participants qualify for Ontario but rather a right to is believed to be a major barrier for many Works, which helps subsidize prescription people with limited financial resources, drugs, dental care and eye examinations, which all Canadians including those living on the street. the cost of glasses is only partially funded Our team’s extensive literature search and very few receive regular eye exams. In should be entitled.” generated fewer than half a dozen articles addition, despite our small sample size, our related to the ocular status among home- team has uncovered a number of sight- homeless community’s response to this ini- less persons. Results from these papers threatening findings, such as homonymous tiative has been overwhelmingly positive, are quite striking: one study conducted hemianopsia, elevated intraocular pressure, and the vast majority of our study partici- in Vancouver’s inner city found that herpetic keratitis and retinopathy. In most pants have expressed interest in accessing the prevalence of visual disability was cases, these eye problems were not being these services. While the development of a approximately nine times more than the medically managed; Dr. Lichter has sub- free eye clinic is still in its early stages, our estimated Canadian rate.2 sequently offered to provide ongoing eye hope is that it will assist the disadvantaged Under the supervision of Dr. Myrna care for these individuals. in overcoming the hurdles they face when Lichter, a staff ophthalmologist at St. Our preliminary results have moti- accessing eye care. Michael’s Hospital, a student-led research vated a group of ophthalmologists at St. For more information about the team from the University of Toronto has Michael’s Hospital to consider establishing study please contact Christopher Noel launched an initiative to determine the a free eye clinic within Toronto’s Central ([email protected]). prevalence of eye disease within Toronto’s Local Health Integration Network. The homeless community. This initiative belief among all members of our team is References 1. Hwang SW. Homelessness and health. CMAJ involves administering surveys and vision that vision is not luxury for those who 2001:164(2):229-33. screens to 100 homeless individuals across can afford it, but rather a right to which 2. maberley DA, Hollands H, Chuo J, et al. The 10 randomly selected shelters in the city. all Canadians should be entitled. The prevalence of low vision and blindness in Canada. Eye 2005:20(3):341-6.

26 CFMS Annual Review April 2014 Initiatives

Medical humanities at the Schulich School of Medicine and Dentistry: integrated extracurricular pre-clerkship modules in narrative medicine, visual arts and history of medicine

Thomas Fear University of Western Ontario, Class of 2015 Joshua Tobe University of Western Ontario, Class of 2015 Jessica Truong University of Western Ontario, Class of 2015

he study of humanities direction it’s moving and how it can be offers medical trainees both the refined. “These courses Topportunity to fortify their com- The program is now in its second year. munication skills and a means to grow To date, we have run several sessions in have succeeded in into reflective and introspective physicians. each of the three streams and the informal However, over the course of Schulich feedback we have received from our fellow making studies in School of Medicine and Dentistry’s students has been tremendously positive. To (SSMD) pre-clerkship educational years, formalize and characterize some of this feed- the humanities more there is a lack of arts- and humanities- back, we asked the students who attended based learning offered to students. one or more of a series of three visual art accessible to medical Considering both the rich academic milieu sessions to provide constructive criticism in at Western University and the varying the form of a questionnaire that followed students, and they interests of SSMD medical students, there each session. The majority of students felt is an opportunity and demand for cross- that, although they had the desire to engage faculty programs to be developed. in artistic endeavours, their medical educa- have proven to A small group of us have established tion did not provide the infrastructure, nor a student-driven and faculty-facilitated the encouragement, to do so. At the outset, be well-liked by subset of courses. These short courses we thought the chief impediment to stu- function as a complement to the current dent attendance and participation would be participants.” pre-clerkship training; they include courses the workload of pre-clerkship education. As in the disciplines of visual art, narrative it turned out, many of the 40 first- and sec- medicine/philosophy, and the history of ond-year medical students who attended felt medicine, each with distinct goals. The that they could benefit from pre-readings for students, it is the long-term goal of the narrative medicine course aspires to impart and post-sessions assignments. program organizers to confer a certificate a broader sense of oneself and others — These courses have succeeded in mak- of completion for full participation, which what is often referred to as sensibility — ing studies in the humanities more acces- would be recognized on students’ tran- while building moral insight and empathy. sible to medical students, and they have scripts. Furthermore, we hope to create a The visual arts stream strives to develop proven to be well-liked by participants. website to publish student work derived one’s visual acuity and interpretation However, varying levels of attendance sug- from these courses in order to increase proficiency, skills essential to the art and gest the programs are not as appealing as awareness of fellow students and faculty. practice of medicine. Finally, the history of other extracurricular activities. One reason We are very proud of this initiative and are medicine module assumes a more public we have hypothesized for this is the lack of excited to finally see SSMD join the ranks health approach: a critical study of the his- transcript recognition. To improve atten- of other Canadian medical schools on the tory and modern practice of medicine, the dance and increase the value of the course medical humanities forefront. n

April 2014 CFMS Annual Review 27 Experiences

The best-kept secret: an unforgettable summer clinical studentship in radiation oncology

Wei Ning (Will) Jiang University of British Columbia, Class of 2015

he best half-hour I spent radiation oncologist primary investigator aimlessly browsing the internet were so supportive that I did not hesitate “A handmade card Tlast year was when I chanced upon to continue my work into my third year! the Canadian Association of Radiation Throughout the six weeks, Dr. landed on my desk. Oncology/Canadian Radiation Oncology Carolan and the coordinator accom- Foundation clinical summer studentship modated my every request. For instance, In it, with large, in radiation oncology. I had high hopes when I reflected that I lacked exposure about experiencing all aspects of radiation to pediatric and gynecological cancers, rough handwriting, oncology to inform my career decision, they scheduled more sessions for me in high hopes of verifying that the patient these areas. The radiation oncologists was ‘To the student interaction speaks to my heart, and high and residents were consistently helpful hopes for developing clinical skills for and patient to answer my questions. The doc: Thank you.’ ” all the years to come. It exceeded all my environment at BC Cancer Agency was expectations and gifted me with an unfor- collegial and supportive. gettable summer. By far the most memorable experi- For the clinical component, the expe- ences, though, were the interactions with gnawed at me: Did we do this to her? Is rience is similar to a third-year radiation patients. I fondly remember one patient this the neurocognitive sequelae of pedi- oncology elective: I was assigned to a dif- who came into the clinic angry, repeat- atric whole brain radiation? In another ferent radiation oncologist and resident edly complaining about the wait time to instance, I can still taste the profound each day, so I was exposed to all treat- see his cardiologist and frustrated about sadness when I heard about the death ment sites, from pediatric to gynecologi- his painful bloody diarrhea after his of a patient I saw in clinic just a day cal, from head and neck to sarcoma. As I prostate radiotherapy. What remained ago, but I can also reminisce about the have an interest in palliative radiotherapy, with me, though, is not his radiation satisfaction blooming in my heart when I spent each Friday at the rapid access pal- colitis, or the long discussion we had — I realized that the changes we made to liative lung clinic. I saw patients through it was his son’s comment that his father his pain medication helped him to be the whole spectrum of care, from new had not looked so relieved or so under- comfortable during his last hours. From patient consultation, to patient review stood in weeks. Two days later, a hand- the highs and the lows, I found working during treatment, to follow-up after treat- made card landed on my desk. In it, with the patient population fulfilling. ment. On top of that, I had a chance with large, rough handwriting, was “To In these six weeks, there were times to attempt contouring and treatment the student doc: Thank you.” That card of joy, times of empathy, times of curios- planning. Reflecting on the experience, it now has a permanent home on my win- ity and times of learning. Whether in painted a realistic picture of life as a radia- dow sill. Certainly, not all experiences the clinical or the research component, tion oncologist. ended well. I recall a pediatric follow-up with the support of residents and radia- For the optional research component, patient who confessed that she always tion oncologists, I was blessed with this I had six half days set aside to assist in an feels one step behind in her classes, at opportunity. It was the best first clinical ongoing research project. The resident and her work, or with friends. My worries rotation I could ever ask for. n

28 CFMS Annual Review April 2014 Experiences

These first times

Nina Nguyen Université de Sherbrooke, Class of 2016

he four boxes were final- The faint hum of the coffee machine for listening to him, for writing down ly lying in the middle of the empty pouring into my stained cup and the his regrets. He thanked me for study- Troom after spending so many hours spring rain gently knocking on the ing medicine while the monitor faintly in the car. After endless days spent day- library’s windows were stopped by a shy beeped, reminding me that his face will dreaming about medical school, I finally cough. A classmate was waiting in line not feel the autumn’s winds. got to unpack my ambitions. I plastered for the coffee machine, but his gaze was the walls of my new home with nostalgia directed at me. It was the first time that I felt like I and stared at pictures of old friendships. “Nina, do you still have these pills? belonged here. Medical school marked the start of some- For anxiety. I’ve heard you had some. thing new, and expectations kept me For depression. Anything will do.” “I think I know you. I’ve seen you awake before the first day of class. I remembered speaking to him once somewhere.” or twice, but I did not know his full I did not expect anyone to talk to It was the first time I moved away. name. During the past few months, me when I exited the press box. I should I thought that I was the only one have remembered someone with such a Memories blinded me when I sat down for whom the sun never rose. For a radiant smile, but months of cramming in the lecture hall. Butterflies, again, were moment, I mourned these classmates muddled my memory. flying in my stomach, just like when I had who were also trapped in the dusk. She knew who I was, despite my stepped into the kindergarten’s schoolyard “I don’t know where I can get help.” business attire, despite the steno pad I years ago, not knowing even one word of was holding, despite the masquerade. French. I smiled quietly, wondering how It was the first time that I suffered. “You’re a medical student.” great all my classmates must also be if I I stopped walking. She knew. myself made it so far. As soon as the resident slit the uterus “And you write. A lot. And well. It was the first time I attended univer- I was on my tiptoes, trying to catch a Thanks for showing me how medical sity. I felt a little naïve to be so proud to be glimpse of that baby girl, but streams school is incredible. I’m applying soon.” sitting there. It was just school, after all. of blood blurred my view. The attending pulled a wailing baby out of this It was the first time that I was proud to Wrong — it was the first time I mess, and then nurses quickly wrapped be a medical student. attended medical school. her and laid her in the incubator. I was adjusting her knitted cap when the baby Medical school feels like growing up, The warmth of the freshly ironed seized my pinky finger.H er lips, still once again. Dreams bruised my idealism white coat on my shoulders did not stop blue, curled up. and stained my white coat while silently me from shivering. It seemed that the watering the physician-in-training spotless linen, embracing every curve It was the first time that I made some- sprouting in me. Next time you meet me of the body lying on the hospital bed, one smile, her very first smile. at the hospital, you will recognize my as white as the season’s first snow, was genuine smile, but my darkened eyes will mocking my uniform. Maybe this is why His strained breathing was slicing betray who I have become. superheroes never wear white. his sentences in half. His bony hand on Don’t be afraid. my left shoulder felt as heavy as hope It was the first time I witnessed a Code despite the ravages of disease in his body. It will be the first time that I will truly Blue fail. He took a deep breath to thank me feel like a doctor. n

April 2014 CFMS Annual Review 29 Experiences

Appreciation

Kevin Dueck University of Western Ontario, Class of 2016

Have a successful career.

he came into the clinic struggling Achieve balance in your life. to carry all she had brought. A purse over one shoulder, Sa plastic bag slung at the crook of her arm and both Choose New Brunswick! hands holding something delicately covered in foil. The nurse greeted her and checked her in, and she was directed www.gnb.ca/health into one of the small consultation rooms. When we entered the room the object in foil was sitting on the counter, the plastic bag beside it. She lit up seeing the surgeon. Through her thick accent she thanked the doctor for what he had done and proudly removed the foil. It was a Ayez du succès dans cake, made from scratch. She had baked it for the doctor and the staff. From the plastic bag came paper plates and cutlery. votre carrière et un I had seen patients express gratitude before, but this was équilibre dans votre vie. something more. What had the surgeon done? I expected it to be emergency surgery saving her life. No, her diabetic foot had Choisissez le been amputated. Nouveau-Brunswick! Removing a part of someone’s body and having them thank you for it, this is where I start to struggle. Receiving not only thanks, but a cake for cutting off a part of this www.gnb.ca/santé woman’s body, it was hard to wrap my head around. Despite easily being able to list benefits of such a surgery (no further foot ulcers, worry of infection, wound care, etc.) it still does not feel quite right. Removing a cancer is like dealing with an invader, something foreign, and thus different than removing a still functional part of the body. This part of medicine is going to take some getting used to. n

30 CFMS Annual Review April 2014 Experiences

Summer woes: child malnutrition in Nepal

Laura Stratton University of Toronto, Class of 2016

NE OF THE MANY THINGS severely malnourished children, as well as my classmates and I worried about education for their families. “There simply Oduring our first year of medicine was My role was to identify evidence- what to do during the summer. Should the based ways for BABU to help improve were not enough summer be spent doing something “pro- the nutrition program offered by IFCH. ductive,” such as research or work? Or do Despite the extraordinary dedication and human and material you escape from the whirlwind that is first passion of the interdisciplinary team of year and travel to exotic destinations? Or dietitians, nurses and physicians at the resources available perhaps it should be left empty, so as to centre, its future was uncertain due to enjoy the luxuries of an unscheduled day? lack of sustained funding. There simply to care for all the On a break from making Excel were not enough human and material charts analyzing the pros and cons of resources available to care for all the mal- malnourished these options, I stumbled across an nourished children admitted to IFCH. information session for the non-profit Although I helped implement prac- organization Bringing About Better tice improvements to the Nutrition children admitted to Understanding (BABU; www.thebabu Centre, I left Nepal feeling as though project.com). I learned that BABU was the real issue of resource scarcity fac- IFCH.” co-founded by University of Toronto ing the centre had not been addressed. medicine graduate Hamid Izadi in Coincidently, shortly after returning I 2009, with the mission to improve child received a call for charity nominations of different food supplementation health through preventative and curative for EarthTones — an annual benefit options available at the centre, as well medicine in Nepal. Since then, more concert put on by University of Toronto as the impact of existing education than 50 Canadian medical students have students to raise money for child health and outreach programs. We hope that volunteered with BABU in programs around the world. I applied on behalf of through this work, we will lay a foun- that combine clinical experience, public the Nutrition Centre and was overjoyed dation for long-term success of the health initiatives, research and adventure to learn that it had been selected as a Nutrition Centre. in Nepal. I was sold. Gone were my recipient of donations from the 2013 I am immensely grateful for the Excel files, replaced with a plane ticket concert. I know these funds will make opportunity I had to learn and work to Kathmandu. an immense difference for children at alongside the clinicians I met at IFCH. Having recently completed a mas- the Nutrition Centre; however, this is Continuing this work since returning to ter’s in nutrition, I was thrilled to be the first of many steps needed to ensure Canada has been an unexpected addi- assigned to the Nutrition Centre at the long-term sustainability. tional bonus, which wouldn’t have been International Friendship Children’s Research to evaluate the treatment possible without the dedicated staff at Hospital (IFCH). Nepal has some of the program at IFCH is critical. To achieve BABU. I encourage anyone looking for highest rates of malnutrition in the world these goals, I am collaborating with the an adventurous and rewarding summer and the Nutrition Centre was recently BABU research director, University of to consider volunteering with BABU, or opened in response to the overwhelming Toronto MD/PhD student Natasha any international program that exposes need in Nepal’s most densely populated Lane, to plan a series of research projects you to novel clinical settings. Delete that city, Kathmandu. The Centre functions for future students. These projects will Excel sheet! Buy a plane ticket! You will to provide nutritional rehabilitation to focus on examining the cost-effectiveness be grateful you did! n

April 2014 CFMS Annual Review 31 Experiences

Good kaRMSa

Ameer Farooq University of Alberta, Class of 2014

have just finished putting Throughout the process of preparing in all my CaRMS applications. For my CaRMS applications, I was focused “You have to Iany first years reading who don’t yet on my future prospects, as I have been know, CaRMS stands for Canadian my whole life. I have always focused somehow convince Resident Matching Service, and it is the on the road ahead, the next challenge. central online system through which There is always the sense that if I can residency directors applications for residency are submitted. just clear this hurdle, it will be smooth It has also been the bane of my existence sailing and clear skies. Yet there is always that you are different for the last few months. a fresh anxiety at the next hurdle and the CaRMS applications are no fun. You familiar manoeuvre of ignoring family, than the dozens have to somehow convince residency friends, and cheesecake to concentrate directors that you are different than the on hustling. of other smart, dozens of other smart, organized, well- What I often fail to do is appreciate qualified applicants. You have to convince where I have been and how I have gone them that you are 100% committed to about navigating the journey. I don’t mean organized, well- program X at location Y. This is despite that I fail to do this in the very obvious the fact that you are not entirely sure that “reflective” style we are asked to use in qualified applicants.” you are making a wise move by commit- medical school assignments, but to really ting five years of your life in a somewhat be grateful for all the things that had to unknown city and even less sure about go right for me to get here. I have never It always used to annoy me when my (finally) choosing a career for the rest of been in a major accident. I wasn’t born in father, a general surgeon, would come your life. You scrutinize the inner recesses a wartorn country and and haven’t had to home and regale us with tales of woe of your mind for anything to put on your flee as a refugee, as the millions ofS yrian and sadness. My siblings and I would resume (what was that volunteer activity I children are doing right now. I wasn’t born get irritated — why would he always tell did in first year?). You write and re-write into a poor family that couldn’t afford to us these sad stories of good people get- your personal letters, and each version send me to taekwondo or needed someone ting sick? Now, I begin to understand sounds more and more like a Rob Ford to finish high school and go out and get what my father was getting at. I have rant, minus the hilarity. a job. I was born — perhaps the greatest realized medicine is often not a series of The application deadlines coincided miracle of all. serendipitous, transcendental experiences with my two-week elective in general sur- For all of us medical students, we have and profound achievements, but a hard gery. On a particularly busy night of call, had incredibly good karma, though prob- slogging, a disciplined effort to measure we had a major trauma come into the ER. ably not through any action of our own. twice, cut once. For me, CaRMS was a It was a young man who had sustained This is not to diminish the struggle many hard process, but I have at least realized horrible injuries through a motor vehicle medical students have gone through to that in spite of everything, in spite of all accident. In the ICU, I looked at the get here. What I can say is that a lot of the other roads I could have traveled, here man’s fractured face and realized that he people who struggle their whole lives I am at the crossroads. And for that, I am was not so different from me. never succeed in making headway. grateful. n

32 CFMS Annual Review April 2014 Experiences

Medical student elective experience in Seoul, South Korea: gangnam style

Loretta Cheung MD Candidate University of Ottawa, Class of 2016

amsung Medical Center (SMC) is one of the largest hospitals Sin South Korea, with the latest medical equipment and one of the best patient- centred medical services. Located in the Gangnam region within Seoul, the capital of South Korea, the centre includes the main hospital and the cancer centre, with over 40 medical departments, 10 specialist centres, and 120 special clinics. With SMC being one of the best hospitals in Asia, I chose to go on a two-week elective in the department of dermatology during the summer of 2013. While I had visited Korea before and understood some spoken and written language, this was my first “busi- very kind to explain the cases in English. I In addition, I met many other foreign ness” trip to Korea and I was excited to had the opportunity to practise my Korean doctors and medical students training at experience the medical work environment. with the nurses and patients and I certainly SMC from many countries, including From the start, I was warmly wel- improved upon my knowledge of the lan- China, Germany, Myanmar, Ecuador and comed by everyone in the department. I guage for both conversational and medical India. I often had insightful conversations was placed in the outpatient dermatology terms. Additionally, it was interesting to with many of them about the differences clinic and the laser clinic at the hospital discuss the similarities in medical educa- in our health care system and patient care. and observed many treatment procedures tion, including the incorporation of the The hospital environment and performed by the residents. problem-based learning (PBL) system. resources provided for the doctors and Seeing over 50 patients in the morning There were many cultural differences in patients were excellent. Patients were often alone, I was able to see a variety of cases patient care between Korea and Canada. In entertained well in the waiting rooms with presented in a fairly homogeneous popula- Korea, the doctors are more reserved and new television shows and evening concerts tion, including atopic dermatitis, alopecia, efficient when taking care of patients, with performed by musicians. Also, I enjoyed vitiligo, skin tumours, onychomycosis, some departments seeing over 90 patients the Korean meals in the staff cafeteria that pityriasis alba and prurigo. Foreign patients per day. Patients always show their respect I ate together with the doctors and resi- from many countries, including Russia, toward their doctors by bowing and thank- dents, as it is within Korean culture for the Iran, Germany and the United States, were ing them. Similarly, the residents and senior residents and doctors to buy meals seen in the afternoon clinics. I learned medical staff show great courtesy toward for their junior colleagues and to make about many skin diseases that are more their professors. I found the more open sure my stay at SMC was pleasant and prevalent in Asia than North America, and liberal student–teacher relationships in memorable. such as Behçet’s disease and non-HIV North America was not seen in the Asian Having a more multicultural and associated Kaposi’s sarcoma. It was fasci- culture, as there were strict and clear divi- global view of medicine has allowed me to nating to see the different skin manifesta- sions between students and professors. The understand patients from different coun- tions among various ethnicities. Although doctors were often very rigorous in teach- tries better. I highly recommend doing an the patients mainly conversed in Korean ing the residents, who worked hard and elective at SMC for a global view of health with the doctors and residents, they were were on call every other night. care. n

April 2014 CFMS Annual Review 33 Experiences

Say it like you mean it

James Yan University of Western Ontario, Class of 2015

...“Exactly so,” said Alice. the slip, but my attending immedi- or delayed diagnoses. Unfortunately, “Then you should say what you ately noticed. Before my next word, he the hospital has many opportunities mean,” the March Hare went on. interjected, with a small smirk, “Well, for such breakdowns, ranging from “I do,” Alice hastily replied; “at COPD cases can feel exasperating but I unclear orders, vague charting and least — at least I mean what I think you should try again.” illegible writing, to overly casual hando- say — that’s the same thing, you Embarrassed, I fumbled for a vers. A common motif behind these is know.” response. “Sorry, exacerbation. You know the assumption that the receiver will ‘“Not the same thing a bit!” said what I meant, right?” intuitively be able to interpret what the the Hatter. “You might just as well The third, and most cringe-worthy, sender meant. Alice’s conversation with say that ‘I see what I eat’ is the mistake. the March Hare highlights that the same thing as ‘I eat what I see!” “That’s beside the point. You have to “simple” act of interpreting meaning — Lewis Carroll’s, Alice’s be careful with the words you choose,” from another’s remarks is not a clear Adventures in Wonderland he snapped, shaking his head, “The lines and easy process in the slightest. of communication are so fragile.” It was a sobering realization that nother Thursday after- And that should have been the end I was an example of the problem. noon on my clinical teaching unit of it. Medical student screws up, doc Yet, I am still grateful for having this A(CTU) rotation. Afternoons all a corrects him. Roll the credits. But my encounter, in particular toward my similar routine: see patients, teaching ses- attending’s last line really stuck with me. attending who was willing to bring sions, team rounds, and then finish up I remembered a game in elementary this deficiency to my attention, and leftover tasks. Aside from Fridays which school, Broken Telephone, in which that it was done at a time in clerkship had an extra clerk teaching sessions, there a sentence was spoken down a line of where I was still relatively fresh and was not too much of a variation. Thus, children and then recalled, often errone- able to address this issue sooner rather when we met for rounds that afternoon, ously, by the last person. Simple misun- than later. Reflecting on the whole I was not expecting anything unusual to derstandings were funny; however, errors event also brought a deeper apprecia- occur as I began to report on my patients. due to misinterpretations in medicine tion of the CanMEDS Communicator This was to be my first, but not my are not humorous at all. competency. Like Alice, I had initially last, mistake. There are no “simple misunder- thought communication was natu- I had reached my last patient, Mr. standings” to ignore regarding patient ral and straightforward. But delving W. Casually, as I had done dozens of care. Communication breakdowns beyond the surface revealed it to be a times over my five weeks of TUC , I have the potential for very seri- complex and inconsistent process. As began. ous consequences. A 2006 Annals of medicine becomes increasingly inter- “Mr. W. A 60-year-old male presenting to Internal Medicine article by Gandhi professional, communication is a skill our ER with shortness of breath from a COPD et al. revealed that communication “that it is essential that we develop exasperation …” Mistake number two. factors were a major reason behind properly. Honestly, I did not even realize process breakdowns leading to missed And I do truly mean that. n

34 CFMS Annual Review April 2014 Opinions

The truth — a physician’s most powerful weapon?

Mark Hewitt, BMSc Memorial University of Newfoundland, Class of 2017

physician may possess for an entire family and within this fam- enormous amounts of medical ily the parents may not want to tell their “The patient has put A knowledge; they may have the tech- young child that they are dying. nical skills to suture a heart back together One could argue that it would be their absolute trust or to excise a pancreatic tumour or a world- easier to tell the elderly patient that all renowned reputation. However, the truth the tests were normal, reasoning a non- in us to help.” of the matter is that a physician’s profession essential diagnosis could potentially exac- is rooted in their ability to connect to each erbate current conditions and reduce the and every patient as an individual, to show quality of their remaining life. In the care just legality. The physician, no matter compassion and concern. Every detail the of the child it would be easily justifiable how “well” they know the patient, cannot patient tells us is a clue to their diagnosis. to believe they don’t understand the mag- fully understand how the patient would Without those clues, the physical symptoms nitude of the situation. However, usually want their information or what they are useless. It is this dialogue that allows us it is the parents’ disbelief and inability would want to do with this information to truly help individuals and it is this com- to face reality that drives this request. unless explicitly told beforehand. The munication upon which the foundations of Despite the personal turmoil, the upset patient has put their absolute trust in us patient-doctor trust are built. families, it remains that the biggest con- to help, and even if it is easing concern At some point within our careers as sideration of truth telling has to lie with with a fatal diagnosis, that is a small mea- physicians, we will be faced with a situa- the best interest of the patient. Lies only sure of help we can offer. tion in which disclosing the full truth of perpetuate lies; if one test is lied about, Overall, the act of truth telling is far a diagnosis may be earth shattering. One the next one will have to be. Once this from black and white. Pros and cons could certainly think of many situations trust is gone, the connection between a can be created for not fully disclosing where the whole truth may not be rel- patient and the physician is severed, leav- the extent of a diagnosis. However, evant to the patient’s needs, and certainly ing the physician in the dark. above all, we as physicians owe it to our where it may cause more harm than good A physician has a moral obligation patients to allow them autonomy over — a principle that contradicts our train- to tell their patients the truth, barring their health care, to provide guidance ing and oaths as physicians. The patient any deemed incompetency. From a legal and beneficence yet not paternalism, and may be a terminally ill elderly individual standpoint, withholding information to give them the same trust and respect and be found to have a slow-growing regarding a diagnosis can lead to lawsuits; for their own decisions that they give to cancer. You may be the family physician however, this belief is built on more than us by stepping into our clinics. n

April 2014 CFMS Annual Review 35 Opinions

Temples

Kyra Harris, BHSc McGill University, Class of 2016

ost days in the gross gross anatomy lab once inspired in me “In the practice of anatomy lab, I stand next to the quickly vanished. I was now innately Msame cadaver. He has no name, aware that our bodies are flesh. The medicine, I am not just a number: Slab 20, Body 1719. I moment I saw the body broken into watch as my colleagues delve deeply into parts I was unable to continue to see it only responsible for him. I have tried to make peace with this as a temple. I began to ask: does a tem- practice of mining the dead for knowl- ple still hold the same spiritual mean- edge. For most, it offers the chance to ing when the candles have been blown the maintenance of colonize the human body in the name of out? When the scriptures have all been medicine. For me, it has become the most read? Or when all the chants have been the temple, but also spiritual aspect of my medical education, recited? When believers have vacated masquerading as a simple anatomy lesson. the holiest of all holy places, then is it the health of the Most days, when I stand before my still holy? Or does it just become bricks cadaver, I want to clean his body, wash and mortar, holding up the roof of a soul that resides his feet and comb his hair; my instinct is place where people once found god? to take care of him. I stare at his hands: This is what I wondered when I looked within it.” hands that once pressed into the palms into that bucket of prosections. How of loved ones, I now find balled in cold, simple it is to distill a body that once rigid fists. I want to unfurl them the way held so much life into unrecognizable wholeness that makes each and every my mother unfurled my own hands while remnants. one of us alive. reminding me that the only things kept in Today, the will I once had to make Today, I will leave the gross anatomy the tiny cages of closed fists are the things my cadaver whole again has vanished. lab with a crucial lesson: in the practice that haunt us. With my fearful hands, I I have no desire to piece together of medicine, I am not only responsible want to suture up the signs of our explo- these prosections because I would have for the maintenance of the temple, but ration. More than anything, I desperately nowhere to begin. There is no way to also the health of the soul that resides want to make my cadaver whole again. draw life back into these abandoned within it. If I am only to treat the parts, Instead, at the end of each lab, I tenderly bodies. I now realize that a human then I am but a carpenter. Only when I replace each of his organs and lay him to being is much more than just the sum treat the patient as a whole, will I truly rest under his green shroud. of their parts. It is not just the beating be able to practice the sacred art of heal- But today, we did not pull back his heart or breathing lungs that constitute ing. For this invaluable lesson, I kneel green shroud. Instead, we learned from our existence. It is each person’s story, beside Slab 20 and whisper “thank you” prosections: bodies dissembled and echoing within their bodily temple, to Body 1719, hoping that wherever his sorted into labelled buckets. As I looked which makes them uniquely human; it spirit may be he knows the depths of my into the buckets, the spirituality the is our physical, emotional and spiritual gratitude. n

36 CFMS Annual Review April 2014 Opinions

What it means to be a medical student: a reflection

Alyssa Lip Queen’s University, Class of 2017

t was about seven months What I now know is that it was naïve ago when I was an undergraduate stu- to think that being a medical student “It’s no coincidence Ident, eagerly anticipating the moment simply meant changing schools, and that I would get into medical school, not being one step closer to my final goal of that a big part of knowing exactly what it meant. becoming a doctor. Getting into medical And then it happened. Luck, hard school meant so much more. It’s more the emphasis in the work, and other mysterious (but evidently than being one step closer — it’s a giant important) elements all contributed to that leap, it’s crossing that invisible threshold. medical curriculum, one life-changing email from the Queen’s Here, in Canada, the selection pro- School of Medicine Admissions Office. cess for incoming medical students is right from the very One of the first things I recall doing meticulous, demanding and highly criti- was setting up my line of credit. I went cal. What results is a trust in our coun- beginning, focuses to my bank’s local branch and explained try’s medical professionals. my new situation. Immediately, I was From my perspective, it makes being set up with my own financial advisor a medical student a privilege. on professionalism. and a credit of $250,000. Absolutely Time and time again, it amazes me nothing about me had changed — I had just how much of a privilege it is. It’s here and it’s not grown any older, more responsible, With a simple email, we can attend or added a dime of worth to my name surgeries, clinics and rounds. Patients now. ” — and yet here was the bank, treating confide in us, knowing we’re medical me with much more deference than any students. We have a voice, and people normal 20-year-old would receive. I was actually listen. We, ourselves, can change suddenly someone you could entrust a our curriculum. We have a say in the medical curriculum, right from the very loan of a quarter of a million dollars to. future of medical classes. We have beginning, focuses on professionalism. All this was because I added two little countless opportunities that I don’t It’s here and it’s now. words to my name — medical student. think there’s quite an equivalent to in Upon receiving and accepting that I’d been working in a research labo- many other faculties and levels of study. admissions letter, you gain a certain ratory at the time. Even there, I felt my For example, in a few weeks time, my respect. In my personal experience, I felt co-workers’ shift in recognition of my colleagues will be meeting with members it instantaneously and it is a wonder- education. It wasn’t just about how oth- of Parliament to discuss issues of impor- ful feeling. But with that respect comes ers perceived me though — I reacted tance to medical students. responsibility. Herein lies the proverbial the same way. I felt different, now as a There is no far-off reality, where it’s double-edged sword: there is an assumed medical student. And yet, I hadn’t actu- years before you’re a licensed doctor trust in you, paired with an expected ally been educated as a medical student. with all the responsibilities. It all started accountability. This inherent trust, from That wouldn’t come for at least another from when you clicked “accept” on that colleagues, superiors and especially the three months, and it wouldn’t be com- offer of admission. It’s no coincidence public, is a privilege that we, as medical pleted for another four years. that a big part of the emphasis in the students, cannot take for granted. n

April 2014 CFMS Annual Review 37 Alumni Affairs

Top 10 things to know before starting residency

Robin Clouston Past President Dalhousie Family Medicine Integrated Emergency Medicine, PGY1

ow that I’ve graduated the circumstance. You can figure out medical school and started my what works for you. “Getting that medical Nresidency, there is so much that I 3) At first, your clerks may know wish I had known beforehand! I started in more than you know. As residency degree was one of Family Medicine integrated Emergency is starting, third year of clerkship is Medicine at Dalhousie at Saint John, NB, still going and you will have seasoned the best feelings on July 1, 2013, and I’m now over half- clerks. In many ways, this is great way through my PGY1 year — a busy, (i.e., if they save your behind) but ever, but I still educational, daunting but very fun year. also a reality check! It’s important Now that Match Day 2014 has come and in these circumstances to recognize stumbled how to gone (congratulations Class of 2014!), your knowledge gaps and work to fix there is plenty that I’ve reflected on — them, and also recognize that there introduce myself to here are the top 10 things I wish I had is still plenty of knowledge you can known before starting residency: share with your clerk colleagues. 4) At first, you will feel like you are patients. Was I really 1) The level of responsibility is in transition. Because you will be. daunting at first. I really thought You will feel more experienced than going to call myself I knew what I was getting into; I a medical student, but not quite like passed the Licentiate of the Medical a resident — for me this transition ‘Doctor?’ ” Council of Canada exams and did felt about three months long. More advanced cardiac life support train- and more, medical educators are ing, right? But the first time you acknowledging the existence of this This is normal. Remember that all write a prescription and no one transition1 and implementing steps of your residency colleagues are in cosigns it, you realize how impor- to ease the transition from medical the same boat. Reach out and talk to tant it is to check and recheck, and school to residency. them, even when you are knees deep look it up again that your treatment 5) Residency can be socially isolat- in that tough rotation, because you is correct (amoxicillin is 500 mg ing. Often, we move away from our will get each other through the low- TID, right?). The code pager is a friends and families, into a place est and highest points of residency. whole other level of unease. But where our new job can consume us. 7) Time is short. There are rounds to once you’ve been through the code Unlike medical school, we aren’t get through, consults waiting and your and written those first few orders, a surrounded by our classmates all pager is ringing again. Sometimes new sense of confidence will bloom. day. It’s easy to lose touch with old your ability to see each patient and get 2) You will wonder what to call your- friends and difficult to make new to know his or her full story may feel self. Getting that medical degree ones. It will take more effort, but it is compromised. However, it is at these was one of the best feelings ever, but more important than ever to actively times that it is most important to I still stumbled how to introduce make time for both medical and remember that the patient comes first myself to patients. Was I really going non-medical friends and family. — and this may mean staying late. I to call myself “Doctor?” The answer is 6) All the other residents will feel just have found that organization is key at yes — mostly. I’ve settled into a pat- like you do — sometimes confident, these busy times. Particularly, you can tern of “Dr. Clouston,” or “Robin” sometimes overwhelmed, sometimes strive for efficiency in the aspects of or even “Dr. Robin,” depending on really smart and sometimes idiotic. your day that are not spent in front of

38 CFMS Annual Review April 2014 Alumni Affairs

the patient — writing notes, entering you can actually take care of patients. — but you need to work really hard at orders, etc. But I’m noticing even for practising it. (My favorite saying: Respect your 8) Listen to your patients. We all know physicians, the need for continu- bedtime.) I even cook — and healthy — at least cognitively — how impor- ing medical education in order to stuff. I’m still working on getting to tant it is to listen to our patients on stay current never goes away, but the gym, but the point is, wellness is their medical care — that is patient- perhaps balloons. So for all of us, within reach. You can do it! centred care, after all. But further, for the rest of our careers, there will I’ve found that particularly some of always be something medical that we My medical school experience is filled my older patients have been some of could be reading right now. Once I with wonderful memories with wonderful the wisest people I’ve ever met. At accepted the above, it was also pos- people. I always get excited when I see an the times when I’ve taken the time to sible to accept that it is unreasonable old classmate in the halls of my hospital. really listen, I’ve learned a lot about life to study at all hours, and the best But now I also have a new group of resi- and this has really enriched my year. approach was to create goals for my dency colleagues with whom to share this 9) Learning is self-directed. You know learning. I continue to struggle to journey of medicine, and patients that that feeling you have in medical meet all those goals, but I think the enrich the experience. So, Class of 2014, school, like you should probably be exercise of planning one’s learning is (and 2015, 2016 and 2017), as you com- studying right now? I have come invaluable for a medical career. plete medical school, get that MD and to the conclusion that this feeling 10) Residency is the perfect time to prepare for residency, believe me when I might never go away. Definitely in figure out your wellness routine. say: the best is yet to come. residency there is plenty of read- Finally, I’m in one city, and the nomad ing and studying to be done — for life of clerkship is behind. Never Reference 1. The future of medical education in Canada: postgraduate that far-away College of Family has my own wellness seemed more project. Ottawa: Association of Faculties of Medicine Physicians or Royal College exam, important. Particularly, never has sleep of Canada; 2012. Available: www.afmc.ca/future-of- so that you don’t sound like a fool seemed more important. It is possible medical-education-in-canada/postgraduate-project/pdf /FMEC_PG_Final-Report_EN.pdf (accessed 2014 on rounds, and most importantly so to get enough sleep during residency Mar 6)

Recruiting bilingual psychiatrists

The Department of Psychiatry is currently recruiting psychiatrists for its 60-bed capacity inpatient services (currently 40-44 active beds), its outpatient services and consultation-liaison services.

Montfort recently obtained its provincial designation as an Academic Health Science Centre and is actively involved in teaching medical students, family medicine and psychiatry residents.

The working and teaching language at Montfort is French. Health care and services are provided in both official languages. Any physician interested in practicing at the Montfort Hospital will have to demonstrate a willingness to learn and work in both French and English. There is an excellent earning potential at the Montfort Hospital.

Ottawa, March 20, 2012 – Ottawa again tops list of Best Places to Live in Canada For the third year in a row, Ottawa has taken top honours as the best city to live in Canada by MoneySense magazine’s annual Best Places to Live survey1.

For more information, please contact Dr. Guy Moreau, Chief of Staff and Interim Head of Psychiatry at 613.746.4621 ext. 6201 or by email at [email protected].

Montfort. Mon choix. Mon avenir.

1 http://www.jimwatsonottawa.ca/en/news/ottawa-again-tops-list-best-places-live-canada Ottawa, Ontario

April 2014 CFMS Annual Review 39 Alumni Affairs

Challenges of life as a military medical officer

Lieutenant-Colonel Nick Withers, MD, CCFP(EM), FCFP CFMS President, 1995–96

ebruary 28, 2014, 2:45 am — phone rings: “Sir, the Admiral Fneeds you to come. The PROTECTEUR is on fire with 298 personnel on board.” I would like to say that interesting calls like these have been rare during my 20+ year career in the Canadian Armed Forces but I would be lying. Having lived and worked around the world, I have many memories of unique challenges that I had never dreamed of when I started medical school some 22 years ago. Whether it be planning medical care for Her Majesty, Queen Elizabeth II on her 2010 Canadian tour or planning the closing of the Canadian medical facilities in Kandahar, there have been a plethora of interesting experiences during my career. While opportunities to deliver health care in unique and often austere places are plentiful in uniform, there are many aspects of the job that are very challenging.

Clinical competence Maintenance of clinical skills is a significant challenge for uniformed physi- Taken outside of the medical clinic at the Airbase in Kandahar, Afghanistan. Lieutenant-Colonel cians (called medical officers (MOs)). Withers had just returned from donating medical material to a local military hospital. I often remind new MOs that it takes 10 years to gain 10 years experience … unless you are in the Forces — then “Work–life balance is a catch phrase it takes 30 years as we see fewer patients and they are generally healthy. Opportunities for provision of urgent bandied around loosely in many circles. or emergent care are limited except on operations or remote training locations. Whereas we all recognize its importance, The Canadian Forces Health Services sponsors a program to allow its doc- very few of us are able to achieve it tors to work in an acute care setting four weeks per year but this needs to be effectively.”

40 CFMS Annual Review April 2014 Alumni Affairs

supplemented by “moonlighting” if one graphically dislocated from family, mak- strongly supports physical fitness. Our has any hope to maintain clinical coming the absence from home more like Special Operations Forces demand petence. I have taken this as a personal nine or more months. Throw in a few that even their physicians maintain the challenge and continued a rural ER ER shifts a month and regular reloca- same fitness standards as the operators. practice throughout my career, success- tions to new places and you need a really Although you may end your career with fully challenging the CCFP(EM) last supportive family! That said, I am able an additional ache or pain, generally year. These extra hours have been at the to retire with a sizeable pension at age your body thanks you for decades of cost of family time, leading me to the 42, which does a whole lot for work–life activity. This has certainly been a posi- next point. balance! tive challenge from my perspective and has helped ward off those extra pounds. Maintaining work–life balance Physical fitness These represent just a few of Work–life balance is a catch phrase While the day-to-day humdrum of the challenges of life in uniform. bandied around loosely in many circles. seeing patients is not terribly demand- Representing both the patient and the Whereas we all recognize its impor- ing on the body, a military career can employer is another unique aspect that tance, very few of us are able to achieve provide a significant physical fitness requires you to ensure all your patients it effectively. Although routine days challenge if you embrace it. For some, are actually fit enough to safely do their are 7:30 am to 4 pm, there are times fitness testing and standards can be jobs anywhere in the world. I have when you may be sent away on short discouraging but for those who rec- embraced these challenges and with notice. Deployments can last six or more ognize the health benefits of activity, the support of an amazing family have months and are often accompanied by this is a welcome addition to the daily enjoyed immensely my years serving in an intense training cycle that is geo- routine. The Canadian Armed Forces the Canadian Armed Forces. n

Employment Opportunities! • Specialists and General Practitioners • Fee For Service and Salaried vacancies

Contact Sarah at [email protected] or visit www.westernhealth.nl.ca/physicians for details.

April 2014 CFMS Annual Review 41 FM-CFS Essay Winners

Fibromyalgia–Chronic Fatigue Syndrome Canada essay winners

stablished in the spring of 2011, the FM-CFS Canada Essay Competition has been organized collaboratively between the board of directors of Fibromyalgia–Chronic Fatigue Syndrome Canada and the CFMS Egeneral manager, Rosemary Conliffe. This year, Canadian medical students were asked to answer the question “If a diagnosis is made (fibromyalgia, chronic fatique syndrome or myalgic encephalomyelitis), what can we learn from patients?” Congratulations to this year’s award winners, listed below:

First Prize Chelsea Wharfasky Queen’s University $1000.00 Second prize Paula Tchen University of Ottawa $500.00 Second prize Sheila Wang University of Toronto $500.00 Second prize Natalie Lidster McMaster University $500.00 Three other entrants will Haley Augustine Dalhousie University receive a prize of $250 Joanne Reid Dalhousie University Kelly Fenn Dalhousie University

Together, we create great workplaces. We welcome new graduates to join the largest health authority in BC! Apply online: physicians.fraserhealth.ca Toll-Free: 1-866-837-7099 Email: [email protected] Twitter: @FHCareer

42 CFMS Annual Review April 2014 Travel Award Winners

A date in the rain

Nina Nguyen Université de Sherbrooke, Class of 2016

hen I interrupted the The pouring rain washed my worries plane bound somewhere West, I shiv- buzz in the hotel lobby with the away, and the sky remained blue. ered at the immensity of the world of Wclicking of my heels, I felt uneasy. — medicine. You showed me how united I was usually comfortable around strangers Only a few hours later, two bowls of we, the Canadian medical students, are but this time, I felt like I was out of place. steamy ramen were already framing our in front of pressing issues such as health “So you’re from Sherbrooke, right?” conversations about refugee health and human resources management and wait I turned around to find a pair of eyes medical humanities. times in the emergency room. locked on my nametag. Medicine never tasted so good. But, most of all, you showed me how “Bonjour.” Medicine never felt so warm. we, twentysomething students, can shape Your eyebrows greeted me with their — the world of medicine. surprise. I untied the knot in my stomach, You spoke a lot. Between sips of black — and then introduced myself. “Yes. Nina. coffee, you moved motions, you proposed When I sat down on the Canada From Quebec. Yes, I speak French. You position papers, and you debated on Line carrying my new knowledge and too? I’m impressed!” Everyone wanted to issues that were important to us. I was my new, unexpected friendships toward know why I was here, and the answer is surprised that we shared so many inter- the East Coast, I was not sad to leave still probably somewhere between the sea ests: medicine, of course, but also that you; I was hopeful because it was not and the mountains of the West Coast. same desire to break down borders. an adieu, but rather an au revoir. On my way to downtown Vancouver, Medical education, global health, mental It was a pleasure meeting you, I worried about fitting in, about making health: these topics, not often discussed by CFMS. Let us have a date over a bowl friends, about deserving to be there. At the our mentors, occupied our minds for three of hot chocolate in Ottawa this spring, crossroads of success and happiness. The days. I, too, forgot that there was another shall we? doors of the SkyTrain swung open, and I world beyond the walls of my classroom. See you again. À bientôt. n mindlessly wandered to Coal Harbour. From the moment I stepped on the

Reconnecting with my peers, passion and purpose

Danielle Chard McGill University, Class of 2016

am grateful to have had I was delighted to see that there was rec- sexual health officers at medical schools the opportunity to attend the CFMS ognition that this work is a continuation across Canada. IA GM this fall through travel funding. of work often already being done and that I spent my first year of medical Being able to share ideas, resources and there was active sharing of resources. school consumed by books and lectures. goals has impacted the work I want to as On an advocacy level I was encour- Attending this meeting has reminded me I finish my medical degree and beyond. I aged to see a focus on sexual health. of why I want to be a doctor and that feel excited to pursue involvement with my This often-forgotten aspect of health was knowledge is an important, but small, tool community outside my studies and my pas- addressed from the perspective of improv- of my trade. I want to look back on my sion for advocacy has, again, been sparked. ing medical school curricula, providing last years of medical school as a time when On a professional level I left this meet- support to members through position I grew as an advocate for better education, ing feeling connected and supported. papers (sexual health education and better patient care and better health care Realizing that many medical students are induced abortion), and work being done policy. Being at the CFMS AGM has pro- facing the same challenges brought us by the national officer of reproductive and vided me with the inspiration, connections together with common goals for the future. sexual health (Joshua Dias) along with the and tools to start this work. n

April 2014 CFMS Annual Review 43 Travel Award Winners

Reflections from a first timer: CFMS annual general meeting

Emily Milko McMaster University, Class of 2016

s a very new medical national and international level, and I which made me quite excited to follow student, having only been in kept having to remind myself that on the actions of the CMA this year. I was Amedical school for a couple of top of all the work each individual was very pleased to see that in addition to the weeks, I learned an incredible amount contributing towards the CFMS, they CFMS’ very strong global health pro- at this year’s CFMS AGM. The meeting were also working to complete their gram, they are placing more emphasis on was incredibly well organized and rarely medical education! It was incredible to national health policy than in the past, strayed from the agenda, an impressive witness the passion that every member and I look forward to seeing this arm of feat in itself, but what was even more had for the CFMS and how this passion the CFMS develop. impressive, and evident throughout the fueled their actions. To sum up my experience at the meeting, was the level of dedication In addition to leaving the meeting CFMS AGM in a few words, I would say: shown by all the individuals in atten- feeling absolutely inspired by these indi- inspiring, promising and exciting. It was dance, particularly the CFMS executive viduals, a personal highlight included a privilege to sit among so many health members. As a new medical student it hearing the interesting thoughts and leaders for the weekend, and I cannot was both intimidating and inspiring opinions of Dr. Louis Francescutti, wait to continue to follow, and hopefully to witness a room full of young lead- current CMA president, during his pre- in some way contribute to, the incredible ers who positively impact health at a sentation to the global health program, work of the CFMS. n

Exposure and awareness at the CFMS AGM

Krystyna Ediger University of Calgary, Class of 2015

consider myself to be very from some of the best and brightest clinics. It is my hope that this group will fortunate to have been a recipient of medical students in the nation. One serve to benefit schools that want to start Ia travel award to attend this year’s theme that seemed to arise from the these types of initiatives, as well as those CFMS AGM. I had never attended a global health program was national stu- who are seeking to foster and improve CFMS event before, and the weekend dent interest in the development of stu- active clinics. provided me with great insight into the dent-led clinics. As a clinic manager at In addition to this new role, my workings and processes of our national the University of Calgary’s student-run attendance at the meeting will allow me student body. clinic, one of the few functioning stu- to bring knowledge and information Since June 2013, I have been work- dent clinics in Canada, I was approached about medical education, student well- ing with the CFMS vice-president to chair a working group on student-run ness, advocacy and global health back global health and the national officer of clinic development under the national to my colleagues at the University of partnerships as a member of a number officer of global heath education. It is Calgary. Being part of my school’s dele- of global health small working groups. an honor to be able to work with this gation to the AGM will allow me to help Because of this involvement, I attended portfolio and representatives from mem- increase University of Calgary student the global health portion of the CFMS ber schools to develop and foster infor- awareness about the important work of meeting, where I got to meet and learn mation sharing regarding student-led CFMS. n

44 CFMS Annual Review April 2014 Travel Award Winners

Connecting across Canada

Ryan Chard University of Manitoba, Class of 2015

would like to thank the forth a unique perspective and fully every student’s education. Most schools CFMS for the opportunity to attend engaged the topic. The respect and have some framework to be involved Ithe AGM in Vancouver, BC. The instant partnerships formed between stu- with wellness as a student and I would conference really emphasized how many dents coming from very different places encourage everyone to take that opportu- student leaders across Canada come was exciting. nity and ensure that wellness is a part of together to advocate for health and One big message I took from this your curriculum. rights of people worldwide, Canadians conference is that student wellness is a On the whole, this conference really and medical students. The highlight of rapidly growing concern across Canada. highlights the power of medical students the conference for me was seeing rapid All Canadian students have the opportu- when we share ideas and unite nation- exchange of ideas shared in small work- nity to engage with this topic and a lot ally. I would also like to thank UBC for ing group sessions on topics ranging of what can be accomplished through hosting this event in beautiful British from use of electronic tablets/phones in the CFMS can be anticipated from the Columbia and the many speakers that clinic to wellness and many, many oth- trailblazing work the FMEQ has done came from far and wide to help provide ers. Every person at the table brought in establishing this as a necessary part of students and the CFMS with direction. n

Society of Rural Physicians of Canada

Ask not what the country can do for you; Ask what you can do in the country! WWW.SRPC.CA

April 2014 CFMS Annual Review 45 Featured Interview

“We need to change society” — an interview with the province of Alberta’s chief medical officer, Dr. James Talbot

Kimberly Williams University of Calgary, Class of 2014 Western Canadian representative

r. James Talbot is the Chief Medical Officer of Health for the province of Alberta. He is tasked on behalf Dof the minister of health to monitor the health of all Albertans. In this role, he offers recommendations to the minister of health and Alberta Health Services on how to protect and promote the health of the public through disease and injury prevention. Prior to his appointment, Dr. Talbot served as the senior provincial medical officer of health for Alberta and was responsible for strategic planning surveillance, health assessment and other special projects. Dr. Talbot has a BSc, a PhD in biochemistry from the University of Alberta, and as an MD from the University of Toronto. He is Royal College certified as a medical microbiologist.H e has worked in public health since 1991 as director of the Provincial Laboratory for Northern Alberta, chief medical officer for Nunavut and associate medical officer of health forA lberta Health Services. He most recently served as Medical Director for the Alberta Real- Time Syndromic Surveillance Net, a system he developed to monitor and act on emerging infections and injuries. Dr. Talbot is also an associate professor cross appointed in the School of Public Health and the Faculty of Medicine at the University of Alberta.

46 CFMS Annual Review April 2014 Featured Interview

What were your reasons for developers, landscape architects and You have been highly involved going into public health? politicians. These coalitions will be key in surveillance including During my training and work, I came to to creating a health system that results in developing the Alberta Real- realize that you can help more people if you wellness and healthy society. Time Syndromic Surveillance help more than one person at a time. I am In major cities across Canada, we are Net. Do you think that infectious lucky to work with wonderful family physi- building suburban neighborhoods that disease outbreaks such as cians and specialists who help individual do not catalyze healthy living. Rather, the case of avian flu seen in patients and families on a daily basis. As a they facilitate obesity, hypertension and Alberta this year is something medical officer of health,I can help to pre- diabetes. We need to change society. We we should worry about as future vent suffering in those that I have not even need the cooperation of large groups of physicians? met; this concept to me is profound. people including academics, business When it came to infectious disease out- owners and faith-based organizations breaks, 20 years ago we had more gaps Why is public health so to design communities that will result in Canada than plans. We did not have important to the health in health, not disease. Access to healthy access to creating vaccines rapidly; we care system? foods from local farms, reducing vending did not have a method to relay mes- Public health has an unbroken track machines in schools and convincing the sages to the public and we did not have record of decreasing disease, improv- public that fresh food prepared by you an antiretroviral stock. Today, all of ing health and prolonging life. It really for you are the types of changes that will those concerns have been rectified. We has the longest record of success within help us move upstream. have a global reporting system sending medicine measured by hard outcomes Acute care, based on diagnosis, treat- us information from even the remotest like decreasing disease incidence and ment and cure, is an ever-growing part parts of China. We have contracts in increasing life expectancy. Public health of health care. Unfortunately, it has and Canada that ensure the expedited pro- recognizes the difference between well- will continue to eat away the budget of duction of vaccines for Canadians. We ness or true health and health care. It governments, thereby minimizing the have antiretroviral medications stock acknowledges that in the past few decades budget available for targeting the social piled, those that have been proven to the balance in society has changed — determinants of health. In Alberta, 45% work in specific situations such as out- there are many more things that conspire of the budget currently goes to illness. breaks within continuing care facilities. against people’s health than promote it. As a result, less money is allotted to We have clear lines of communication Public health, however, understands that other ministries in charge of the social and coordination. We have improved there are real factors that help or hinder determinants of health, ministries such our techniques — the public is more both individuals and society from being as parks and recreation. If we build fewer aware of respiratory hygiene and hand healthy; we appreciate that not all of these parks, people have less space to be well hygiene than ever before. That being factors are under the control of the health and survive in our complicated world. said, if a mutation to a current virus care system. They are less mentally fit and more likely occurred resulting in a high infection obese leading to an increased need for rate and high mortality, all of our plans What do you see as challenges acute care in turn reducing the budget would be put to the test. to the health care system that available for prevention. we, las medical students, will The solution: to recognize that well- What role do you believe face during our career? ness is not just about the absence of medical students play in regards The short-term problem is that our illness; to recognize that those outside to public health? health care system is always struggling the health system are those who really Medical students should recognize that to move upstream. We are not focusing contribute to everyday wellness. It’s not the future belongs to them. They need enough on chronic disease prevention, just physicians, but people like minor the insight to realize that it takes lots of and this is causing our health system to league hockey coaches who cause com- people to create health outside of the be overwhelmed by disease. We need to munities to be well. Farmers’ markets health care system. The factors that you create the right coalitions to deliver and are engines for health, they help to learn about in medical school — the build health in our communities. We increase the income of local farmers, social determinants of health — are need a health approach that emphasizes while at the same time supplying the important! chronic disease prevention and not just community with healthy foods. Benefit A family physician I know recently acute care. These coalitions must bring comes from a recognition of the impor- told me a story about a diabetic patient together not just those in the health care tance of what goes on outside hospitals she saw in clinic to whom she described system; they must be supported by city and then using that momentum to act the importance of exercise and eating planners, architects, farmers, dieticians, and incite change. healthy foods.

April 2014 CFMS Annual Review 47 Featured Interview

The patient subsequently replied, my friend realized that so many of her to be role models of wellness. They need to “How do I do that?” The physician patients were simply unable to adopt speak out for the creation of healthy cities explained more specifically the cardiovas- healthier lifestyles due to systemic chal- made for pedestrians and cyclists. They can cular exercise one needs in a week includ- lenges out of their control. The physician donate their time or money to charitable ing other options such as yoga or walking realized that she was wasting her breath. organizations that bring these ideas to frui- to work. She discussed how to shop the It was the social determinants of health tion. Physicians are respected and people outer edge of the grocery store where they that were affecting her patients and no will listen. stock the fresh fruits and vegetables and amount of education was going to help After all, what was Hippocrates talk- to stay away from the high fat, high salt them to achieve the interventions that ing about? He is the father of medicine for and high sugar food-like products in the she described. Medical students need to a reason. He was talking about an ideal interior of the store. When she finished be aware of these type of situations; they where healthy relationships create real the patient once again asked, “But how need to remember that they work as part health: relationships between individu- do I do that?” The patient described her of a wellness system in addition to the ill- als, between individuals and society and community, an environment where there ness treatment system. between society and their environment. were no stores offering healthy foods and As Spider-Man’s Uncle Ben once said, Medical students have a responsibility where her work limited any purpose- “With great power comes great responsibil- to society and this responsibility is more ful exercise. It was at this moment that ity.” Medical students have a responsibility important right now than ever before. n

48 CFMS Annual Review April 2014 Creative Works

Once upon a September

Noor Amily University of Ottawa, Class of 2014

Once upon a September ... I became a real hospital member My Ob/Gyne rotation started ... and I knew inside that this is what I hearted The nurse called my pager ... as that woman in room two was in labour Everyone rushed and I was pushed to find myself in room two all squished I heard that baby’s first cry ... as another nurse came rushing by As I wiped my tears of joy ... I saw that it was a baby boy Blood covering my scrubs ... nothing helped even with all my rubs I smiled and wanted to hold ... that bloody placenta that sure wasn’t cold I moved closer as the resident stitched ... that tear which with blood was enriched I wanted to do that hand tie I knew ... but I wasn’t sure what to do I knew then that all along ... this is the place where I belong A speciality that filled me with joy ... and I would, till the last of my days enjoy

3Anatomy cupcakes

Karen Willoughby McGill University, Class of 2015

In my first year of medical school for my 30th birthday I made anatomy lab-inspired cupcakes depict- ing different organs using gum paste. In order from top-->bottom, Left --> right: the kidney and adrenal gland (in yellow) with ves- sels, an eyeball with the four rectus muscles, the heart, the liver and gallbladder (in green), the small and large intestines with mesentery (in yellow), the cortex/brain, the knee joint (between the femur and tibia) with the fibula bone, patella and patellar ligament on top, the lungs, trachea and bronchi, and half of a breast showing the mam- mary glands.

April 2014 CFMS Annual Review 49 Creative Works

Day in the life of Mary: a short story

Esther Kitai Rosenthal University of Toronto, Class of 2015

It takes me a minute to realize what is waking me: the screaming lady is at it again. “Go to sleep,” my daughter’s voice says. Can’t she hear the screaming lady? How does she expect me to sleep? I know, somehow, that there is no-one with me, and that the voices are not real. “Get up. You are so dirty. Go and wash.” He is always criticizing me and telling me what to do. I oblige, go to the wash- room, lie back down, and wonder what the voices will let me do today. Why did the voices come? They were not with me in China, or for the first years in Canada.

The loudspeaker announces breakfast, and I sit up, waiting for the voices’ reaction. I hear ... nothing. For the first time in three days they are letting me go to breakfast. I walk to the dining hall and stand in line; as always, I feel bad for the other patients, and scared of some of them. They all seem so bizarre. It is hard to believe that, until three years ago, I had barely heard of “psychiatry”— but here I am surrounded by “crazy people.” I guess that my voices make me one of them.

I get my food tray and bring it back to my room. My sister says, “You cannot eat. They are poisoning you.” I pick up the bagel and bring it toward my lips. “DO NOT EAT.” I put it back down. Silence, so I pick it up again. “STOP TRYING TO EAT”. I give up, put it back and lie down. I listen to my stomach grumble and my roommate scream.

I spend hours listening to the loud voices, while my roommate yells. I should probably do something, but cannot think what. I pull up the covers and hope that sleep will take away the noisy emptiness. Finally, the doctors come. The questioning begins: How are you today? How did you sleep? Did you take your medications? How are the voices? Are they better, worse or the same? Why have you not eaten anything? Is it the voices? Can you try to eat with us here? I perform the same routine for them as I did alone, moving food toward and away from my mouth, paralyzed by the voices. I can tell they are not happy with my inability to eat. Neither am I. Neither is anyone (except maybe the voices).

The ending of my meeting with the doctors is the same as always: “We are worried about you, Mary.” I am worried too.

Over the next few hours, the voices become quiet and I can take my medications and even eat lunch. The rest of the day is the same as always. Nurses come and go, encouraging me to attend group activities. The voices do not let me, so I stay in bed. Pretty soon, through the window of my room, I can see the sun setting. I think about my husband and children and wonder what they are doing and if they think about me. Are they ashamed of me? Saliva builds up inside my mouth, and I hear the common “Do not swallow that saliva. Do not swallow. You may not swallow.” I must have fallen asleep before deciding whether to swallow, because the next thing I remember is waking up to the screaming lady. Another day is here ...

50 CFMS Annual Review April 2014 Creative Works

3The ruins of Ta Prohm Cambodia

Elaine Tang University of Western Ontario, Class of 2015

The temple of Ta Prohm shows the force of nature against the power of mankind. Amongst solid rock temples built by man, ancient trees dig their roots deep into the walls, climb over roofs and undermine the foundations.

Kulen Mountain 3 Cambodia

Elaine Tang University of Western Ontario Class of 2015

Cambodia is a country that has been torn apart by civil unrest and political upheaval in recent times.

Due to widespread poverty, many adults utilize children as part of begging rings to get money from travellers and wealthier locals. Despite this, many of the children retain their innocence and are content with remarkable little in their lives. They always have a smile for you.

April 2014 CFMS Annual Review 51 Photo Album

Weddings

3Daria Zajac and Robert Peeters August 24, 2013

Windsor, Ont. Allison Meiwald and 3 Rob Davis August 10, 2013 Corner Brook, NL

52 CFMS Annual Review April 2014 Photo Album

3Christopher Proctor and Sarah Lefley July 6, 2013

Grosse Isle, Man. Angela Bell and Rory Cavanagh 3 July 21, 2012 Lucknow, Ont.

April 2014 CFMS Annual Review 53 Photo Album

Babies

3Erin Aurora Cavanagh Born June 1, 2013 Parents Angela and

Rory Cavanagh Arya Taylor Graham 3 Born January 30, 2014 Parents Geeta Yadav and Andrew Graham

3Layan Sabalbal Born August 2, 2013 Parents Maher Sabalbal and Samah Rafehi

54 CFMS Annual Review April 2014 Your CFMS Executive and Representatives

CFMS executive and representatives 2013–2014

EXECUTIVE

Jesse Kancir Robin Clouston Bryce Durafourt Ian Brasg Ben Frid President Past President Executive VP (Quebec VP Education VP Finance [email protected] [email protected] Regional Representative) [email protected] [email protected] [email protected]

Mimi Lermer Melanie Bechard Brandon Maser Andrew Bresnahan Kimberly Williams VP Communications VP Government Affairs VP Services VP Global Health Western Regional [email protected] melanie.bechard@mail. [email protected] [email protected] Representative utoronto.ca [email protected]

Irfan Kherani Anthea Girdwood David Linton Laura Butler Rosemary Conliffe Western Regional Ontario Regional Ontario Regional Atlantic Regional General Manager Representative Representative Representative Representative [email protected] [email protected] [email protected] [email protected] [email protected]

April 2014 CFMS Annual Review 55 Your CFMS Executive and Representatives

NATIONAL OFFICERS VP EXTERNALS/CFMS REPRESENTATIVES

Zachery Information [email protected] Connor Forbes UBC Sr. [email protected] Hynes (Sr) technology Wendy Ming UBC Jr. [email protected] Franco Information [email protected] Iyswarya Mani UofA Sr. [email protected] Dattilo (Jr) technology Bhaskar Justin Neves Health policy [email protected] Madura UofA Jr. [email protected] Kayla Berst Wellness [email protected] Sundareswaran Maegan Blood drive [email protected] Megan Blades UofC Sr. [email protected] Springman Verlyn Leopatra UofC Jr. [email protected] Cait Champion Alumni affairs [email protected] John Schulte UofS Sr. [email protected] Lindsey Anderson UofS Jr. [email protected] Jordyn Lerner UofM Sr. [email protected] NATIONAL OFFICERS OF GLOBAL HEALTH Chris Proctor UofM Jr. [email protected] Kayla Berst NOSM Sr. [email protected] Nadine Qureshi Partnerships [email protected] Heather Smith NOSM Jr. [email protected] Josephine Chow Exchange [email protected] Jimmy Yan UWO Sr. [email protected] Stephen Cashman Exchange [email protected] James Ahlin UWO Jr. [email protected] Irfan Kherani Education [email protected] Nicole Archer McMaster [email protected] Stephanie Brown Education [email protected] Gord Locke McMaster [email protected] Danielle Chard Reproductive [email protected] and sexual Latif Murji UofT Sr. [email protected] health Ali Damji UofT Jr. [email protected] Benjamin Langer Human rights [email protected] Branden Queen’s [email protected] and peace Deschambault Sr. Adam Mildenberger Aboriginal [email protected] Alana Fleet Queen’s Jr. [email protected] health liaison Ambika Gupta UofO Sr. [email protected] Anthea Girdwood UofO Jr. [email protected] Kenjey Chan McGill [email protected] MEDICAL SOCIETY PRESIDENTS Haley Augustine Dal Sr. [email protected]

Gurinder Grewal UBC [email protected] Peter Bettle Dal Jr. [email protected] Robert Schultz UofC [email protected] Leanne Murphy MUN Sr. [email protected] Chris Novak UofA [email protected] Loni Slade MUN Jr. [email protected] Lena Xiao UofS [email protected] Terry Colbourne UofM [email protected] Kendra Komsa NOSM [email protected] Daniela Kwiatkowski UWO [email protected] Erica Hoe (Windsor) UWO [email protected] Perry Guo McMaster [email protected] Kim Blakely UofT [email protected] Carl Chauvin Queen’s [email protected] Chloe Corbeil UofO [email protected] Carl White Ulysse McGill [email protected] Leo Fares Dal [email protected] Alison Howley MUN [email protected]

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Annual Review 2014 Represents the Opinions of the Authors and Not Necessarily Those of the Can­Adian Federation of Medical Students (CFMS)

Annual Review 2014 Represents the Opinions of the Authors and Not Necessarily Those of the CanAdian Federation of Medical Students (CFMS)