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Learning for life

Principal Daniel Woolf presents a Teaching and Learning award to (from left to right) Sandra Halliday, Sheila Pinchin, Dr. Melanie Walker, Dr. Heather Murray, and Suzanne Maranda.

When the School of Medicine at Queen’s initiated a curriculum renewal process for the MD program in 2009, Heather Murray (Emergency Medicine) saw an opportunity to enhance the education of medical students in evidence-based medicine and research skills training.

The study and practice of medicine is constantly evolving, and there is an endless amount of information and new knowledge being created through research and then being shared through studies and journals. Long after they’ve graduated, Dr. Murray explains, doctors need to be able to access new information and understand it before they can apply it.

“As our knowledge and understanding of human disease and how we treat it changes, the management of these conditions change,” Dr. Murray says. “So our students must graduate with a framework for understanding what they don’t know and finding valid answers. We can’t teach them a static body of knowledge that will apply anymore. We have to teach them a series of steps they undertake to educate themselves as they go forward because the target is always moving.”

The plan, in short, was to teach students how to be continual learners while, at the same time, the School of Medicine reduced the amount of lecture-based learning in the program. This meant teaching students how to approach the vast body of information, critically analyze it, and then, if deemed viable, apply it.

The result was an innovative new curricular plan for each year of the four-year program, developed by Dr. Murray and a multidisciplinary team including fellow faculty members Melanie Walker (Division of Cancer Care and Epidemiology) and Linda Levesque (Centre for Health Services and Policy Research), Sheila Pinchin, Manager - Educational Development and Faculty Support, School of Medicine, as well as Suzanne Maranda and Sandra Halliday of the Bracken Library.

In 2015, the team received the Curriculum Development Award, one of six Principal’s Teaching and Learning Awards. The award recognizes excellence in curriculum or program development through collaborative efforts by committees, teams, units or departments.

As the curriculum renewal progressed, so did the introduction to evidence-based medicine and research.

The initial step in 2009 saw Dr. Murray and Dr. Levesque develop a first-year course in evidence-based medicine, MEDS 112, also referred to as CARL – Critical Appraisal, Research and Lifelong Learning.  Throughout first year, further sessions would be held in a variety of courses to entrench the connections.

“We slowly evolved this curriculum over the years where the students would do this foundational stuff in the CARL course: they would learn how to read papers and how to interpret results, and the basic skill set was to be a literate consumer of medical evidence,” Dr. Murray says. “Then the students would do these practical application sessions where I would team teach with a faculty member in a clinical course and we would do a deep dive and read a paper and apply it to some case scenarios.”

This is followed by a second newly designed course: the critical enquiry course (MEDS 232) in second year. In small groups of three students with one faculty mentor, the focus is on developing a research proposal longitudinally over the year, building upon the skills they gained in first year.

“In this course they conduct a literature search, they do a bit of critical appraisal, and then they build their own research proposal,” Dr. Murray explains. “And many of the students use that course as a launch pad to actually do research in the summer after their second year.”

The curriculum continues in third and fourth years, as the students conduct their clinical clerkships, where they complete a written exercise of asking questions, finding and appraising evidence and then writing up an actual patient case they have been involved with for each rotation.

The Principal’s Teaching and Learning Awards, created in 2015, recognize individuals and teams who have shown exceptional innovation and leadership in teaching and learning on campus. The awards are administered by the Centre for Teaching and Learning (CTL).

Nominations for the 2017 Curriculum Development Award are currently being accepted. All nominations should be sent electronically in PDF form to ctl@queensu.ca no later than Tuesday, Aug. 1, by 4 pm. For more information about the award and the nomination form and process, visit the CTL website

Five Queen’s students earn Vanier scholarships

Five Queen’s University doctoral students have earned Vanier Canada Graduate Scholarships designed to help Canadian institutions attract and retain highly qualified doctoral students. The five winners’ areas of study include breast and lung cancer, exercise training programs, pre-cancerous cells, emotions, and persistent genital arousal disorder.

The scholarships provide each student with $50,000 per year for three years during their doctoral studies.

“These are Canada’s most prestigious awards for doctoral students and they will put these young scholars on solid footing for future research success,” says Brenda Brouwer, Vice-Provost and Dean, School of Graduate Studies. “Our five new Vanier Scholars have shown their tremendous research potential. They are also role models for other students at Queen’s, and will mentor their colleagues and peers. We congratulate them on their success.”

This year's recipients include:

Taha Azad

Taha Azad - Mr. Azad has developed a light emission-based biosensor tool to detect interactions between proteins involved in Hippo signaling. The Hippo signaling pathway is involved in restraining cell proliferation. The tool allows the discovery of regulators, which are capable of promoting cancer cell proliferation and metastasis. Mr. Azad is funded by the Canadian Institutes of Health Research.

 

Elina Cook

Elina Cook - Ms. Cook’s work aims to enable earlier surveillance and treatment for blood cancer development in the elderly. For Canada’s aging population, this may facilitate a shift toward more targeted, preventative medicine. Additionally, this means that aggressive, often unsuccessful cancer therapies could be avoided in an already frail population, which would improve individuals’ quality of life and the healthcare burden overall. Ms. Cook is funded by the Canadian Institutes of Health Research.

 

Kalee De France

Kalee De France - Ms. De France is exploring emotions and how individuals learn to regulate emotions in order to operate in line with social norms and to prevent emotions from impeding social and academic functioning. She is exploring three questions: what are the differences in regulation across adolescence; what external mechanisms are responsible for this change; how do changes in adolescent emotion regulation relate to well-being. Ms. De France is funded by the Social Sciences and Humanities Research Council.

 

Jacob Bonafiglia

Jacob Bonafiglia - Mr. Bonafiglia and his supervisor Brendon Gurd (Kinesiology and Health Studies) are exploring genetic responses to acute exercise, skeletal muscle responses to training, and the use of progressive statistics to characterize individual exercise responses and better understand the potential of non-responders. Mr. Bonafiglia is funded by the Natural Sciences and Engineering Research Council of Canada.

 

Robyn Jackowich

Robyn Jackowich - The main goal of Ms. Jackowich’s study is to improve our understanding of the complex nature of persistent genital arousal disorder by examining psychosocial function, sensory characteristics (including sensitivity to touch and heat), and blood flow processes in a controlled study framed by the biopsychosocial perspective. She is funded by the Canadian Institutes of Health Research.

 

The Government of Canada awards up to 167 Vanier Canada Graduate Scholarships each year for highly qualified doctoral students who demonstrate academic excellence, research potential, and leadership. For more information on the awards and this year’s winners, visit the federal government’s website.

The evolution of medical education

The team behind competency-based medical education (CBME) at Queen's.

On a weekend when people across the country marked Canada’s 150th birthday, Queen’s University's School of Medicine celebrated the launch of something new in medical education. It’s called competency-based medical education (CBME) and Queen’s University is the first school in North America to implement it across all of its specialty programs for medical residents.

The CBME model was created in partnership with the Royal College of Physicians and Surgeons of Canada. Under this model, this year’s cohort of about 130 residents will be moved to their next rotation once they have demonstrated competency in the clinical tasks and activities expected of them at each stage. Previously, residents usually moved on once they had completed a certain amount of time in a set rotation.

“All the evidence points to using a competency-based approach as the fundamental and logical next step in medical education,” says Damon Dagnone, CBME Lead at Queen’s University. “Along the way, we will continuously study these changes, engage all stakeholders – including patients and families – and embrace co-production and a shared leadership model, use a systems-based approach, and commit to regular and gradual quality improvement. We’ve come so far in just two years, but this is really just the beginning.”

As an important next step, other hospital health care professionals will be able to share their feedback with every resident and their supervisors as part of CBME. The School of Medicine also aims to allow patients and families to contribute to the educational process in the future.

For the residents, this new model promises a rewarding learning experience as they will receive more timely feedback and mentorship from their faculty supervisors and academic advisors. This will help them identify their strengths and weaknesses at every stage. They will also have increased opportunities to pursue personal learning goals and desired areas of excellence.

While the Royal College of Physicians and Surgeons has asked all Canadian medical schools to transition their specialty residency training programs to the new model by 2022, Queen’s opted to transition all 29 residency programs at once. The move caps over two years of preparatory work, and was led by an executive team of eight faculty and staff members in the School of Medicine.

“At Queen’s, we are constantly striving to provide our students with the best possible education and so we have made it a fundamental component of our strategy to develop and trial new models of training,” says Richard Reznick, Dean of the Faculty of Health Sciences at Queen’s. “As such, we are very excited by the value of a system of competency-based education and are thrilled to take a national lead by transitioning all of our specialty medicine residency training programs at once; doing it this way gives us the ability to capture the hearts and minds of the entire medical school and I am very proud of what our team has achieved to get us to this point.”

The move to fully implement CBME at Queen’s has already attracted attention around the globe. Both Drs. Reznick and Dagnone have recently presented at multiple conferences, speaking of the mission at Queen’s to develop and test new models of training and to work closely with educational partners.

“On behalf of the Royal College of Physicians and Surgeons of Canada, congratulations to Queen’s University on their successful deployment of competency-based medical education,” says Ken Harris, executive director, Office of Specialty Education, RCPSC. “We believe CBME is the future of medical education. This outcomes-based approach incorporates more feedback and ongoing observation of how knowledge is being applied and will contribute to a practice environment where learning itself is integrated into the day-to-day.”

To learn more about CBME at Queen’s, please click here. You may also visit the Royal College’s “Competence by Design” project website here.

Want to meet a few of our new residents? Check out these short video interviews from their orientation day!

International research leader earns top honour

Queen’s Professor Paula James was recognized for her work with inherited bleeding disorders.

Queen’s University Professor Paula James, one of Canada’s leading researchers in inherited bleeding disorders, has been honoured with the Cecil Harris Award by the Canadian Hemophilia Society.

The award is presented to a physician in recognition of distinguished contributions in the areas of research or the advancement of the care of patients with inherited bleeding disorders. The award has not been presented in 10 years.

Dr. Paula James has earned the Cecil Harris Award.

“I’m proud and humbled to receive this national honour,” says Dr. James (Medicine and Pathology and Molecular Medicine, School of Medicine). “It was made even more special to receive the award from my mentor Dr. David Lillicrap.”

Drs. James and Lillicrap are principal investigators of the Clinical and Molecular Hemostasis Research Group located jointly between Queen’s and Kingston General Hospital. The focus of the lab is to utilize a variety of experimental approaches to understand the molecular basis of blood coagulation and to develop strategies to translate this knowledge into clinical benefits.

After completing her training in internal medicine at the University of Saskatchewan, Dr. James came to Queen’s to complete her clinical hematology fellowship. She then entered a 30-month training in basic laboratory research in the Department of Pathology and Molecular Medicine. During this time, she honed her talents as an accomplished clinician and researcher in the field of inherited bleeding disorders.

In her clinic, Dr. James directs the Southeastern Ontario Regional Inherited Bleeding Disorder Program and has established a Women’s Bleeding Disorder Clinic. Her expertise in the care of von Willebrand Disease (VWD) – a lifelong bleeding disorder which affects the blood’s ability to clot – has been recognized by the international bleeding disorder community. She also leads a research program with a focus on VWD along with hemophilia.

“For sure, an award like this is a recognition of a team effort,” says Dr. James.  “I’m fortunate to work with great people on a daily basis.”

Dr. James’ Let’s Talk Period website features a bleeding assessment tool to help women that may be suffering from bleeding disorders. More than 2,000 women have taken the test in 106 countries and the website has had more than 15,000 views.

“Receiving this award has given me even more motivation to work harder and help more people,” says Dr. James. “I’m committed to my patients and passionate about my work and I want to help. That’s always been my goal.”

For more information on the award please visit the Canadian Hemophilia Society website.

Making campus family friendly

Nursing students promote safe, child-friendly spaces.

Three Queen’s students are striving to make the local campus a more inclusive space for parents and caregivers attending the university.

Alina Leffler, Laura Kuikman and Andrew Ma (NSc’17), working under the supervision of Katie Goldie and Alicia Papanicolaou (Nursing) have developed the Queen’s University Child Friendly Campus (QUCFC) Initiative as part of their community health training.

[Inclusive Spaces]
Working on the Queen's University Child Friendly Campus Initiative are Andrew Ma, Laura Kuikman and Alina Leffler.

The project builds on the success of nursing students Kyrinne Lockhart (NSc’16) and Rachel Hannigan (NSc’16) who created a network of three breastfeeding spaces on campus last year.

“I heard a lot about the project from other students and wanted to get involved,” says Ms. Kuikman. “It was important for me to be a part of this. There is a concern that if no safe space is available parents could stop breastfeeding early. Pumping is also a challenge.”

The QUCFC features a number of new resources for parents on campus and the three students worked for months to conceptualize, build and deliver the initiative. They walked the entire campus and surveyed every washroom for access to change tables; they created a new website with a list of online resources for parents and caregivers, created a Facebook page to establish an online support system and created a survey which will help them and the next group of students to gather information to assess the needs of the campus community more efficiently.

“We explored campus for change tables and were surprised by what we found,” says Ms. Leffler.

Also included on the website is a map of all baby change tables and breastfeeding locations on campus. Each breastfeeding-friendly space has quiet, clean and sanitary spaces identified by common signage, comfortable seating, electrical outlets, and a nearby washroom.

“We have a number of people that need to bring children to campus for various reasons,” says Mr. Ma. “This effort will help bring a collective voice to support positive change for this group which has often gone unnoticed.”

With their part of the project completed, the three students are hoping to bring the information to the attention of university administration. A number of new buildings are being completed on campus and there are strict building code rules including the need for a universal washroom and adult-size change tables.

“These students did great work and have hopefully brought some change to campus,” says Dr. Goldie. “This fall, the next group will use the information from our survey and continue moving the project forward. We’d like parents on campus to rally together and join this initiative to have their voices heard and needs met.”

Gilbert Rosenberg: Jan. 12, 2017

Gilbert Rosenberg, a professor in the School of Medicine from 1980-1992 and a highly-respected member of the Queen’s community, passed away Jan. 12.  During his time at Queen’s Dr. Rosenberg was a professor in the Division of Geriatric and Continuing Care Medicine, and in the Department of Family Medicine, and was also the medical director of St. Mary’s of the Lake Hospital.  

Three students earn DAAD scholarships

For Parisa Abedi Khoozani (MSc’13), by receiving a scholarship from the German Academic Exchange Service (DAAD) she will be able to collaborate directly with her project partners at the University of Giessen while also gaining the opportunity to experience a new set of ideas and viewpoints.

[Parisa Abedy Khoozani]
Parisa Abedi Khoozani, a PhD student in the Centre for Neuroscience Studies, is one of three award applicants from Queen’s to receive a scholarship from the German Academic Exchange Service (DAAD). (Supplied Photo)

Ms. Abedi Khoozani, a PhD student in the Centre for Neuroscience Studies is one of three award applicants from Queen’s to earn a prestigious study scholarship along with Soren Mellerup, a PhD student in the Department of Chemistry, and Julia Kostin (Artsci’15), who applied after completing her undergraduate degree and is currently pursuing her master’s in sustainable development at Leipzig University.

“Having this level of success, with three Queen’s applicants receiving DAAD scholarships in one year – it’s fantastic, and reflects the excellent caliber of our students,” says Brenda Brouwer, Vice-Provost and Dean of Graduate Studies. “The competition is open to U.S. and Canadian citizens or permanent residents; in other words there’s a lot of competition. A successful applicant demonstrates not only academic excellence, but also leadership potential and a strong plan of study while in Germany. We’re thrilled with the outcome – it’s quite an achievement for these students and for Queen’s.” 

Through the 10-month scholarship Ms. Abedi Khoozani says she will be able to expand and strengthen her collaboration by being able to stay in Germany longer.

Her current research explores how the human brain combines information coming from different sources and how noise can affect this combination process. To expand her understanding, she is aiming to study the effect of noise during obstacle avoidance.

“For me I feel it’s a great opportunity to get more multidisciplinary ideas or different ways of looking at the data, as well as how to interpret it, how to make sense of the underlying mechanisms in the brain,” she says, adding that she will have access to leading researchers as well as various technologies that will allow her to do more advanced modelling. “Honestly, I am very excited because I have an opportunity that I have dreamed about, to have a chance to visit the university, further my research and collaborate with people.”

DAAD is a publicly funded independent organization of higher education institutions in Germany, offering research grants and study scholarships for students with at least a bachelor’s degree to either study or further their research in Germany.

Queen's earns two Banting Fellowships

Two postdoctoral fellows earn one of Canada’s top honours for young researchers.

Two young researchers at Queen’s University have been awarded Banting Postdoctoral Fellowships to continue their research. Nicolle Domnik (Medicine) and Sarah Yakimowski (Biology) received two of 70 fellowships awarded across Canada this year.

Dr. Domnik is funded by the Canadian Institutes of Health Research and Dr. Yakimowski is funded by the Natural Sciences and Engineering Research Council. The Fellowships are designed to attract and retain top-tier post-doctoral talent, both nationally and internationally. It also positions the winners as leaders of tomorrow.

Nicolle Domnik and Sarah Yakimowski have both earned Banting Postdoctoral Fellowships.

“The Fellowship recognizes our top post-doctoral trainees as future leaders in their respective fields,” says Brenda Brouwer, Vice-Provost and Dean, School of Graduate Studies. “For Queen’s to earn two this year is a testament to Queen’s being a place where early career researchers can refine their research focus and skills, as well as work alongside leading academics.”

Dr. Yakimowski is working with Robert Colautti (Biology) on a new research project focusing on an invasive species. Amaranthus palmeri is reducing the yield of soybean, corn and cotton across the United States. This crop weed is not yet in Canada but has moved north rapidly over the past 25 years and could have a huge impact on agriculture if it makes it north of the border.

“This weed has been fought with herbicides and, as a result, A. palmeri has evolved resistance. One of my primary goals is to understand how this weed’s reproductive strategies contribute to the origin and spread of herbicide resistance. This could provide insight into novel control strategies,” says Dr. Yakimowski.

A long term goal of this research is to understand whether herbicide resistance evolved once and spread, or whether resistance is evolving independently in many locations.

She adds the funding provides an opportunity to form the basis of her research for the next decade.

Dr. Domnik has always had an interest in respiratory physiology and the Banting Fellowship supports her research with Dr. Denis O’Donnell (Respirology). Her project at Queen’s and its affiliated teaching hospitals, Kingston General and Hotel Dieu, is focused on the impact of Chronic Obstructive Pulmonary Disease (COPD; a debilitating condition primarily caused by smoking) on breathing mechanics, lung function and respiratory symptoms at night.

“The intersection of breathing mechanics and sleep in COPD is a new and important area of research that I’m excited to explore,” she says. “This award allows me to dedicate myself fully to my research for the next two years, alleviating the stresses associated with funding that many postdocs experience. The Fellowships that Sarah and I have received also speak to the high level of research being done at Queen’s. It’s an honour to receive and I am very grateful for this opportunity.”

For more information on the Banting Fellowships, please visit the website.

Study compares cancer drug cost, benefit

Queen’s University researcher Christopher Booth reveals the price of new cancer therapies is not associated with treatment effectiveness.

A new study from Queen’s University professor Christopher Booth has revealed the pricing of cancer drugs appears to have no relationship to their effectiveness.

Through the review it was revealed that the most expensive drugs were not the most beneficial.

“Most members of the public (and many patients) may not understand that when they read about a new ‘breakthrough cancer therapy’ in the media it usually does not cure cancer but extends survival by a few weeks or perhaps a few months,” says Dr. Booth (Oncology). “Given that these drugs are very expensive and have important side effects, these small improvements may not lead to real improvements in the overall health and well-being of our patients or society as a whole.”

Using frameworks developed by the American Society of Clinical Oncology (ASCO) and the European Society of Medical Oncology (ESMO), Dr. Booth and his team studied all randomized controlled trials of new cancer drugs in non-small cell lung cancer, breast cancer, colorectal cancer and pancreatic cancer over a four-year period.

The study found that there was no relationship between the price of a cancer drug and the extent to which it improves patient survival and quality of life. The authors concluded that to deliver optimal cancer care in a sustainable health system will require oncologists and policy makers to reconcile the disconnect between drug cost and clinical benefit.

“Our data does not suggest the use of these agents is inappropriate. These treatments have been established based on well-conducted clinical trials,” explains Dr. Booth. “Our concern is that the very small magnitude of benefit associated with many new treatments may not be fully appreciated by the public and by some patients.”

Dr. Booth advocates moving towards a value-based system where treatments and interventions that have a greater benefit for patients and society receive more resources than treatments that offer little benefit. He says one model that is being considered is value-based pricing where cancer drugs that offer the largest treatment benefit are sold at a higher price than drugs with negligible benefit.

“In our current system the price of a new cancer drug has no relationship to its benefit but is largely driven by the maximum price the market will bear,” says Dr. Booth. “A value-based pricing system would encourage companies and researchers to focus on developing more effective medicines by offering greater financial returns for those therapies with substantial benefit and smaller financial returns for treatments with negligible benefits. If you think about it, this relationship between quality and cost is what drives most economic transactions and it has always seemed strange to me that it does not apply to new cancer medicines.

The study was published in The Lancet Oncology.

A major step in treating genetic diseases

Queen's researchers demonstrate proof-of-concept therapy for genetic disorders.

Researchers at Queen’s University have published new findings, providing a proof-of-concept use of genetic editing tools to treat genetic diseases. The study, published in Nature Scientific Reports, offers an important first step towards treatment for a rare liver disease, as well as other disorders caused by genetic mutations.

“Using the CRISPR-Cas9 system, we have demonstrated an important proof-of-concept in using gene editing to treat genetic disorders such as Arginase-1 deficiency,” says Angie Sin, a postdoctoral research fellow in the Department of Biomedical and Molecular Sciences at Queen’s.

Dr. Sin, working under the supervision of Queen’s researcher Colin Funk (Biomedical and Molecular Sciences) examined the use of the revolutionary CRISPR-Cas9 gene-editing tool, in combination with stem cell technology to repair Arginase-1 deficiency. The Arginase-1 enzyme plays an important role in the urea cycle – a key liver function that converts ammonia to urea for excretion in urine. Patients with a defective Arginase-1 coding gene are unable to convert ammonia, resulting in impaired ability to produce urea, as well as stunted growth, excess arginine in the blood, and progressive intellectual and neurological impairment.

The study offers an important first step towards treatment for a rare liver disease.

Like many genetic disorders, Arginase-1 deficiency is autosomal recessive – requiring two copies of the defective gene – and does not tend to result in symptoms before the age of three.

“Unlike many genetic disorders, there is a delay before symptoms present with Arginase-1 deficiency,” says Dr. Funk. “With this new gene editing technique, there might be a chance to cure the disease – as well as other similar disorders – much earlier.”

In testing the technique, Dr. Sin utilized a cell model with an induced genetic deletion, resulting in a defective Arginase-1 mimicking the disease in humans. Using the CRISPR system, Dr. Sin was able to reincorporate the repaired exons into the cell’s genetic structure and restore enzyme function.

While there are still many obstacles between the results of the cellular model and full-scale patient treatment, Dr. Sin explains that a new therapeutic strategy would offer tremendous benefits over current treatment methods. Current treatment for the disease is restricted to pharmacological agents, such as nitrogen-scavenging drugs, as well as protein-restricted diets. Demonstrating successful use of CRISPR gene editing technology for Arginase-1 deficiency would also offer clues as to treatment for other similar disorders.

”Using this approach may hold great promise for developing gene editing strategies to repair Arginase-1 and other similar genetic disorders,” she adds. “In current studies, we are using cells from Arginase-1-deficient patients to carry out a similar editing approach. The future goal is to transplant the corrected cells back to the patient and correct the disease. In addition, unlike the traditional gene therapy approach, there is no concern for loss of gene function over time or the potential for immune rejection.”

The full text of the study, titled Proof-of-Concept Gene Editing for the Murine Model of Inducible Arginase-1 Deficiency, is available online from Nature Science Reports.

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