Osler Fellows: The joy of…working with students

April 2014
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Sir William Osler

What does it mean to be an Osler Fellow? For some, it’s about the building of community. For others, it’s about the process of reflection and renewal. For yet others, it’s about the desire for making a difference.

And then there are those who do it for the joy of working with students.

“Joining the group felt a lot like jumping in the water, in the dark, from a cliff,” says Dr. Richard Fraser (MDCM’76), a pathologist at the McGill University Health Centre who really didn’t know what to expect when he signed on as an Osler Fellow, “but it was a pleasure to be a mentor to bright, young people who lack a certain amount of confidence when they start.”

The Osler Fellows are a group of practicing physicians and faculty members who are recruited to teach a four-year medicine course called Physician Apprenticeship (PA). Unique to McGill, the program focuses on the dual role of the physician as healer and professional and explores issues like professionalism and the need to promote a patient-centered approach to learning.

“There is an activity that covers professionalism and narrative medicine that is really powerful,” says Dr. Shannon Fraser, Chief of General Surgery at the Jewish General Hospital and Interim Chief of Surgery at Lakeshore General Hospital. “We get the students to write a narrative about getting into medical school that shows just how differently people experience things. The activity teaches them the importance of just being quiet and listening to your patients.”

The course uses a variety of techniques, including reflective writing, structured reading exercises, debriefing, vignettes or role plays that relate to the symptoms, diagnosis and treatment of an individual patient, and parallel charting, a narrative medicine method developed by Rita Charon that focuses on patients’ parallel charts, to help students on their journeys of discovery.

As the students learn and reflect, so do the Osler Fellows. In fact, the experience of being an Osler Fellow is itself a form of apprenticeship. “I was able to explore subjects and themes that I would not have otherwise experienced,” says Dr. Richard Fraser. “As Osler Fellows we learn different teaching strategies. This is something that goes on in the group independent of the students.”

Dr. Shannon Fraser agrees. “Being in close contact with students gives me a fresh perspective and helps keep me up-to-date with new applications and programs,” she says. “Sometimes I start looking at the trees instead of the forest. The students help me remember the forest and provide me with a more innocent perspective.”

And the benefits are just as numerous for the students, if not more so. “I got a lot out of the visit to the Arnold and Blema Steinberg Medical Simulation Centre, where we had the opportunity to interact with standardized patients and then debrief,” says Samantha Balass, a fourth year medical student who participated in the program both as a junior student and as a PA Leader or senior student. “It was great for teaching us about how to interact with patients. I also enjoyed watching clips from Scrubs and ER and talking about how they handled various situations and what we would have done differently.”

“I really liked discussing hard cases. Just being able to talk about them with other students and an Osler Fellow, to bounce ideas off each other, it’s very helpful,” says Robin Nathanson, also in his fourth and final year and now a PA leader. “Sometimes we experience things that people in our personal lives won’t understand and it’s important for us to be able to be able to get them off our chest.”

“For students, this is a chance to learn about professionalism in a formal way, as opposed to by osmosis. To have that opportunity is excellent,” says Dr. Richard Fraser. “This type of program did not exist when I was a student, in the ‘70s. Back then, we learned everything from books, not people. It’s a real advance in terms of how medicine is taught.”

Balass concurs. “When I was doing my interviews for residencies, people were really impressed by this program,” she says. “It helps you appreciate the amazing patient encounters you have as well as understand the difficult experiences.”

An increasing emphasis on professionalism in medicine and the need to promote a patient-centered approach to teaching and learning inspired the Faculty of Medicine to introduce the new curricular component in 2005. Students in each undergraduate class are divided into groups of six that meet regularly with two senior students, or PA Leaders, and an Osler Fellow.

The Osler Fellowship consists of two key components: regular meetings with students across the four years of their undergraduate education and a longitudinal faculty development program specifically designed to prepare and support the Fellows in their role.

When Nathanson was asked to be a PA two years ago leader, he still remembered his first day as a student. “That transition of going from one role to the other really showed me how far I’d come. It was a very proud moment for me.”

The Fellowship, though started in 2005, is very reflective of the new MDCM curriculum that was launched in 2013.  Patient at heart, Science in hand – the name of the new program – focuses on our aging population and other demographic shifts, technological advances and emerging global issues. In it, students are exposed to primary care from their first year of studies, basic science and clinical material are interwoven more closely, and, because health care is now delivered in teams of doctors, nurses and other allied health specialists, students learn similarly, in inter-professional groups.

For more information on the Osler Fellows: http://www.mcgill.ca/physicianship/

For more information on the new MDCM: http://www.mcgill.ca/new-mdcm/

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