There’s no such thing as being too old to run through the sprinkler.
Dr. Alison Dugan
Division of general internal medicine
Dr. Alison Dugan has a long and passionate history with medical education. Her philosophy about teaching has developed over the years through a variety of educational exposures like revising the entire Undergrad Medicine curriculum, running the International Medical Graduate Program, developing feedback workshops and guiding small groups of learners through her CBL teaching. Today she is putting a big emphasis on a part of the curriculum that she feels is vital, but not always acknowledged or evaluated, and that is the importance of communication.
I CHOSE Internal Medicine as my subspecialty because I liked all of it so well and really didn’t have to memorize the coagulation cascade.
WHEN I WAS SIXTEEN or seventeen I wanted to be an astronaut.
I PROBABLY WOULDN’T have been a physician if it had required 2nd year university physics.
LAST SATURDAY, I went for walk around downtown Boston before going to school for a week. I went to do the Harvard intensive internal Medicine Review Course because sometimes I think, ’am I on top of all this stuff?’. You work from seven in the morning until seven at night for eight days in a row. So, I arrived a day early and snuck in a bit of down time before the craziness started.
I DID AN ENGLISH lit degree before I went to medical school. I knew I wanted to study medicine but while I was sitting there in life sciences I thought, I don’t really want to study this. So, I changed and did Victorian literature…restoration literature… Chaucer… Shakespeare. Typically, we teach our medical students in the science track and don’t necessarily get them to think so much about the humanities. Reading books makes you understand things about people. I think we may be missing something there.
HISTORICALLY, medicine’s curriculum has been heavily weighted to facts with not so much focus on communication and emotions. People are emotional and they care about feeling connected.
GOOD COMMUNICATION is such an important part of what we do in so many jobs and yet we don’t really acknowledge that it’s important…or talk to people about how to do it well —especially in groups. Yet when I look at my colleagues and residents on the wards who do it well, it’s just such an obvious asset — to be able to listen to other people, to recognize when they have an emotional response to something and to be sympathetic.
MY IDEA OF MISERY is being stuck on parliament Hill during a celebration.
MY GREATEST JOY in life is a canoe trip with my kids.
MY PRINCIPLE FAULT is my irrepressible desire to question authority, and challenging doing things just because of “rules”, when sometimes the rules are just wrong.
YOU DON’T KNOW what people are really like until you see them tired and hungry.
THE BEST ADVICE I was ever given was listen more, talk less.
IF I COULD ONLY pack 3 things in my suitcases to travel to an unknown destination, they would-be a Kobo reader with unlimited battery power, my mouth guard and a light sabre.
CHRISTCHURCH, NEW ZEALAND is my favourite city in the world. I spent 2 years working there. It was a great job, I had great friends, tons of adventures and the most beautiful country right out my front door. It was just a wonderful place to live but it was on the other side of the world and my family was all here. It was not a simple decision… we, my ex-husband and I, spent evenings making pros and cons lists for both places to determine whether we would come back or not. Jeff Turnbull was Head of our Department at the time and I can say quite frankly that he was one of the strong reasons for me coming back.
RIGHT FROM THE MOMENT I arrived in Ottawa I was involved in medical education — when Alan Karovitch and I took over as co-chairs of the Medicine Clerkship. We basically revised the entire curriculum, including the exam, and introduced the initial version of Problem Assisted Learning Sessions (PALs). Back when we were training, Alan and I would round and do physical exams daily, but our medical students didn’t always get that same opportunity so we also introduced physical exam teaching which, as far as I was concerned, was extremely important.
IT WAS ALSO important to teach the students about the role physio, occ health and social work played so we started sessions called ’Who Else Are on the Team’ to help them understand and navigate the barriers to a person being able to get home. Medical students are eager learners. If you teach them right they can learn to be doctors who really understand that it’s not just about the 17 causes of heart failure. It’s also about the wife who, when she gets home must pick up medications, which might be difficult if she can’t leave the house because the patient has other issues. That’s where I started in medical education. I did that job for 10 to 15 years.
I REALLY LIKE working with the medical students because of their enthusiasm — that combination of happiness they have when they get into medical school and the fact that they are very open and respectful and you feel like they are waiting on every word you say. I see this all the time as part of the CBL teaching I do.
I WAS IN A MEDICAL SCHOOL with 85 students and got 8 hours of lectures a day. As part of CBL, my guys sit in groups of eight and discuss how to solve a problem. This format allows the students to be more fluent, and consider scenarios like ’what if this was a different gender or age?’ In fact, it was the students who said, “when we do it the same way all the time we don’t really feel like we’re really getting our chops”. In this setting they each have to contribute to the conversation but not take too much air time and squeeze other people out.
I WAS ALSO responsible for running the International Medical Graduate Program for 7 or 8 years and was involved with the group in Toronto that reviewed the results of the screening exam and the Objective Structured Clinical Examination (OSCE) and then there would be a match. Three to eight people would be deployed to Ottawa and I’d develop curriculum specifically designed to meet their needs in order for them to transition into applying for residency here in Canada.
MY SENSE of humour is never disrespectful. I use humour a lot in my teaching because medicine is a very heavy duty topic and it helps take the edge off how difficult it can be. I think it’s a way to bond the team and make it through a long day.
MAYBE I’M WRONG, but I think the world would work much better if instead of trying to find jobs that earned the most money, we tried to find a job that made us REALLY want to get out of bed in the morning and validated uses people.
I DON’T UNDERSTAND how people would rather watch a sport than play one.
WORDS OR PHRASES I should use more often are: Don’t make me wave my wooden spoon at you!
I DON’T LIKE IT when people say, ’what are you having?’ at a restaurant. Are you asking me that so you can decide what you’re having? It’s a funny question, I don’t know why people ask that.
I AM MOTIVATED by chocolate in most forms.
I HAVE A RULE in life: leave room for dessert.
AS YOU GET OLDER, you get more comfortable looking silly while having fun, rather than looking good and having no fun.
I THINK you do your best when you like yourself.
THE THREE GREATEST WORDS in the English language are: honesty, kindness and empathy…or supercalifragilisticexpialidocious, onomatopoeia and slither.
CLEAN SHEETS (especially flannel) are one of life’s greatest luxuries.
THE AFTERNOON of my dreams would include a bike ride, a swim and a nap!
ONE PRESENT I will always be happy to receive is a new book I haven’t read or wool for knitting… but there isn’t room on my bookshelves or in my closets for any more of either.
MY FATHER was a Physics student and later a University Professor and my mother was a California dreamer — born in California and raised in San Diego. She studied social work and had a very strong sense of what she thought was the right thing to do. We lived in Boston when my Dad was getting his PhD and my parents had five kids before he got a real job in Canada as a professor — talk about stressful. My Mom had never seen snow. I was eight.
I’VE BEEN SHAPED by growing up with four siblings and not much money, and lots of tasks to do.
WHAT I GOT from my father was an understanding of the importance of civility and good manners.
MY GREATEST professional achievement was convincing my colleagues to recruit Alan Karovitch! I think he’s a Mensch: he’s honest, ethical, smart… he’s just a superstar. I have a huge amount of respect for him. He’s just a really excellent role model. There was a point in a conversation when it could have gone either way and I’m like, “you cannot let this guy go.” He absolutely should be here, he’s like a rock star.
I DON’T FEEL super comfortable blowing my own horn but what I’ll say is that what patients tell me almost all the time when I give them an explanation about something is “nobody‘s ever explained it like that before, and I really appreciate you taking the time and helping me to understand it”. I think that when patients understand, they can manage much better. I would say my biggest educational accomplishment is conveying that to the residents that come and work with me on an ongoing basis.
I ALWAYS wanted a horse. All four girls in my family are horse crazy. As kids, all our games were imaginary where we’d scoop up the leaves in the fall and make stables, then we’d pretend to sleep in the trees while the horses were sleeping.
I’D LIKE TO BE transported into the movie avatar because like I said, I wanted to be an astronaut. Touching the plants that would disappear and riding the winged creatures would be so cool. And the message of respect for the environment and for other living creatures — I thought there were a lot of really nice themes in that movie.
CHARLTON HESTON would portray me in movie about my life. You’ve got to watch the ten Commandments or Ben Hur and then you’ll understand. I’m kidding of course.
IF I HAD TO WRITE my autobiography using only 6 words it would be “MUM and doctor, best jobs ever!”. My Dad and I were out walking —probably 10 years ago or so — and he asked something having to do with my life and I replied, ’you do know that having and bringing my kids up has been the most amazing thing I’ve ever done’. And he was completely shocked because he thought I would be most proud of my career in medicine. I feel so lucky to have had the opportunity to raise my kids and have job like being a doctor.