A new study from The Institute for Education Research (TIER) has revealed that medical school orientation can be a source of lasting tension and uncertainty for students, particularly those of diverse backgrounds.
Students entering medical school are quickly introduced to many of the social and professional aspects of the medical profession. Orientation is meant to be an informative period that welcomes students and sets the stage for a positive medical school experience. Unfortunately, if inclusion is not a priority in its design, orientation can cause students stress and uncertainty as they begin to develop their professional identity.
To understand the source of this stress and uncertainty, a research team led by Dr. Marcus Law, an Education Investigator at TIER, explored student experiences during medical school orientation.
The research team interviewed 16 students from five Canadian medical schools. From these interviews, several issues emerged that were related to students’ personal identity and feelings toward their medical school orientation.
Students described being indirectly introduced to the identity of the dominant medical professional (e.g., white, heterosexual, high socioeconomic status and a science-based education background). Students felt tensions when they were introduced to this identity, particularly if it differed from their own. These tensions were especially distressing and long-lasting for students from underrepresented groups.
According to Dr. Law, “Students from underrepresented groups were welcomed into medical school, but once they arrived, they felt pressures to hide their unique qualities and backgrounds in order to match what they thought a doctor looks like.”
Students also described sensing a gap between their school’s investment in diversity and the way that it approached inclusion. Some students felt that their faculty voiced the importance of including students of all backgrounds, but their words were not backed by actions.
This study indicates that medical schools can achieve diversity, but still fall short when it comes to ensuring that everyone feels like they belong.
“We encourage medical schools to take a second look at their orientation programs to ensure that they are inclusive of students with diverse backgrounds and experiences, particularly those from marginalized groups,” says Dr. Law. “Increasing diversity is not enough. Schools need to safeguard inclusion from the moment that students walk through the doors.”
This work was supported by The Institute for Education Research and the UHN Foundation.
van Buuren A, Yaseen W, Veinot P, Mylopoulos M, Law M. Later is too late: Exploring student experiences of diversity and inclusion in medical school orientation. Med Teach. 2021 Feb 2:1-15. doi: 10.1080/0142159X.2021.1874326.
As the weather gets warmer and the days longer, it is a great time to bike to UHN. Biking is sustainable, provides much needed exercise and allows you to avoid overcrowded public transit.
UHN is home to extensive bicycle infrastructure that continues to expand in response to growing demand during the pandemic. While UHN builds the capacity for more bicycle parking, new policies are being implemented to ensure that users can access spots when they arrive to work.
Bicycle Parking Dos and Don’ts
Given the high demand for this resource, it is important that it is shared equitably among all staff. Long-term storage of your bike is not permitted because it hinders the ability of UHN to accommodate all cyclists in our research community. To guard against this, periodic patrols will identify and tag bicycles that appear to be abandoned or stored on-site for an extended period of time. Owners of these bicycles will have two weeks grace before they are removed and donated to community organizations. New signage will be installed shortly to remind users of this policy.
Bike Share Toronto UHN Discount
If you are interested in cycling to work but don’t have access to a bicycle, Bike Share Toronto offers 24/7 access to 5,000 bikes and 465 stations across the city. Bike Share Toronto is kindly offering UHN employees a $40 discount off annual memberships. See here for details on how to easily request your discount code.
Expanded Biking Infrastructure in Toronto
The City of Toronto is also increasing cycling infrastructure by installing over 25 km of a planned 40 km of new protected bike lanes. Some of the most recent bike lane additions are on University Avenue, Bloor Street, Dundas Street and Danforth Avenue. See here for updated information on bike lanes near you.
Join the UHN Bicycle User Group
If you are choosing to bike to work this summer, be sure to take safety precautions such as completing regular bike maintenance, using lights and wearing a helmet at all times. For up-to-date cycling information, join the UHN Bicycle User Group by contacting UHNcycling@uhn.ca.
A recent study led by researchers at UHN and SickKids has revealed a potential treatment for glioblastoma, which is the most aggressive and most common brain cancer in adults.
The research team identified a drug-like chemical compound that slows the growth of glioblastoma stem cells—these cells contribute to initiating or 'seeding' the cancer and its ability to resist treatment. The study was co-led by Dr. Cheryl Arrowsmith, Senior Scientist at Princess Margaret Cancer Centre and Chief Scientist at The Structural Genomics Consortium (SGC), Dr. Peter Dirks, neurosurgeon at SickKids and Dr. Panagiotis Prinos, senior research associate at the SGC and the University of Toronto.
Cancer stem cells, first discovered at UHN in the 1990s, are now recognized to be responsible for the growth and recurrence of many cancers.
“Glioblastoma presents further challenges to treatment because the tumours comprise diverse types of cells. As well, not many drugs can reach the brain because of a physiological 'filter' known as the blood-brain barrier,” says Dr. Arrowsmith.
Elevated levels of a protein called PRMT5 have recently been linked with the severity of brain tumours. PRMT5 belongs to a class of proteins called epigenetic regulators, which have been the focus of intense drug discovery efforts in recent years, including 50 novel drug-like candidates developed by the SGC in a program led by Dr. Arrowsmith.
Recognizing the potential for a treatment strategy, the research team tested 39 epigenetic drug-like candidates on glioblastoma stem cells isolated from 26 patients. Two of these molecules were found to be highly promising. Further testing revealed that they were effective at reducing PRMT5 in glioblastoma stem cells and prevented those cells from growing. One of the molecules, LLY-283, was able to efficiently cross the blood-brain barrier and prevent tumour growth in experimental models.
“These results show that targeting PRMT5 may be an effective therapeutic strategy for patients,” says Dr. Arrowsmith. “We now have a better understanding of how these potential drug candidates halt glioblastoma stem cells from growing and multiplying.”
Currently, no effective chemotherapies exist for children with glioblastoma. The team’s work with pediatric glioblastoma stem cells suggests that targeting PRMT5 may also be an effective strategy for treating glioblastoma in children.
This work was supported by Stand Up To Cancer Canada, Genome Canada, Canadian Institutes of Health Research, Ontario Institute for Cancer Research, The Structural Genomics Consortium and The Princess Margaret Cancer Foundation. T Pugh holds a Tier 2 Canada Research Chair in Translational Genomics. M Tyers holds a Tier 1 Canada Research Chair in Systems and Synthetic Biology. B Haibe-Kains holds a Tier 2 Canada Research Chair in Computational Pharmacogenomics.
Sachamitr P, Ho JC, Ciamponi FE, Ba-Alawi W, Coutinho FJ, Guilhamon P, Kushida MM, Cavalli FMG, Lee L, Rastegar N, Vu V, Sánchez-Osuna M, Coulombe-Huntington J, Kanshin E, Whetstone H, Durand M, Thibault P, Hart K, Mangos M, Veyhl J, Chen W, Tran N, Duong BC, Aman AM, Che X, Lan X, Whitley O, Zaslaver O, Barsyte-Lovejoy D, Richards LM, Restall I, Caudy A, Röst HL, Bonday ZQ, Bernstein M, Das S, Cusimano MD, Spears J, Bader GD, Pugh TJ, Tyers M, Lupien M, Haibe-Kains B, Artee Luchman H, Weiss S, Massirer KB, Prinos P, Arrowsmith CH, Dirks PB. PRMT5 inhibition disrupts splicing and stemness in glioblastoma. Nat Commun. 2021 Feb 12. doi: 10.1038/s41467-021-21204-5.
Deep brain stimulation (DBS) is being explored as a treatment for individuals with Alzheimer disease. Researchers have previously shown that stimulation applied to the fornix—a memory-related structure located deep in the brain—can cause vivid flashbacks of old memories and events in some, but not all, individuals with Alzheimer disease. The occurrence of flashbacks suggests that the stimulation is activating brain circuits involved in memory recall.
“It is a mystery why only certain individuals experience these flashbacks—especially considering that the fornix is stimulated in everyone who undergoes the procedure,” says Krembil Senior Scientist Dr. Andres Lozano, who led a recent study that has shed new light on how DBS causes flashbacks.
DBS involves the use of surgically implanted electrodes to stimulate specific regions of the brain. DBS has been successfully used to reduce the symptoms of certain neurological conditions, including tremors in Parkinson disease. In this study of DBS for Alzheimer disease, DBS electrodes are implanted to stimulate the fornix.
Although the fornix is the main target in this type of DBS, other brain structures are likely activated at the same time due to the placement of the electrodes. Lozano’s team suspected that this effect, which would vary between patients, may be the key to why only certain patients experience flashbacks.
The researchers examined scans from 39 individuals with mild Alzheimer disease who previously participated in a clinical trial of fornix DBS to reduce memory impairment. Using computer modeling of the connections between different brain regions, the team identified three structures involved in flashbacks. They found that flashbacks were associated with stimulation of the fornix, the anterior commissure (a collection of nerve fibres that connects the two halves of the brain), and the bed nucleus of the stria terminalis (a part of the brain’s emotion and memory circuits).
Patients were more likely to experience flashbacks when electrodes were placed in such a way that they stimulated these three regions. This finding provides further evidence that these deep brain structures make up an important memory-related circuit.
“Our findings reveal the areas of the brain where electrical stimulation produces DBS-induced memory recall, in approximately half the patients,” says Dr. Lozano. “By demonstrating the importance of stimulating different, yet connected brain regions with DBS, these results improve our understanding of the brain circuits involved in memory. This information will help us to refine the DBS procedure so it has the greatest therapeutic impact for people with Alzheimer disease, and perhaps other forms of dementia.”
This work was supported by the Canadian Institutes of Health Research, the German Research Foundation and the Toronto General & Western Hospital Foundation. A Lozano is the RR Tasker Chair in Functional Neurosurgery.
Germann J, Elias GJB, Boutet A, Narang K, Neudorfer C, Horn A, Loh A, Deeb W, Salvato B, Almeida L, Foote KD, Rosenberg PB, Tang-Wai DF, Wolk DA, Burke AD, Salloway S, Sabbagh MN, Chakravarty MM, Smith GS, Lyketsos CG, Okun MS, Lozano AM. Brain structures and networks responsible for stimulation-induced memory flashbacks during forniceal deep brain stimulation for Alzheimer's disease. Alzheimers Dement. 2021 Jan 21. doi: 10.1002/alz.12238.
Princess Margaret (PM) Cancer Centre addresses over 200,000 visits each year. When the COVID-19 pandemic was declared, the Centre quickly devised a solution to minimize the disruption of care. Within just 12 days, a novel platform was launched that enabled providers and their care teams to co-ordinate virtual care visits so patients could be seamlessly assessed from the safety of their own home using a computer, tablet or phone.
Prior to the pandemic, only 1% of visits at PM Cancer Centre were conducted virtually, making it challenging to rapidly scale its use in response to the pressing needs imposed by COVID-19, and also difficult to study its impact on patients and health care providers.
Because virtual care has now become the norm, vast amount of data are available and have been used by a multidisciplinary team at UHN to explore the benefits of virtual care. The team, led by Techna Affiliate Scientist Dr. Alejandro Berlin and PM Clinician Investigator Dr. Monika Krzyzanowska, revealed how virtual appointments affect quality of care, patient and practitioner experience, and health care costs.
“Patients with cancer often have a weaker immune system due to their disease and/or treatments. It was imperative to find a solution that would protect our patients, allowing them to physically distance and stay home if possible,” says Dr. Berlin. “Additionally, moving eligible appointments to a virtual setting makes it safer for those coming to the hospital to receive essential cancer treatments like chemotherapy and radiotherapy.”
Designed by the Health Informatics Research Team (Techna) and PM’s Smart Cancer Care Program with the help of UHN Digital and Healthcare Human Factors, the custom virtual care platform seamlessly integrates with pre-existing booking systems and electronic medical records. The quality of care enabled by this system was evaluated using indicators of effectiveness, safety, timeliness, patient-centredness, equitability and efficiency.
Within one month, PM Cancer Centre returned to pre-COVID visit volumes (about 3,900 weekly visits) and in the first two months, the system facilitated 22,085 virtual appointments, accounting for over half of all visits.
The study found that switching to virtual appointments had no negative effect on the safety or timeliness of cancer care compared to standard in-person care.
Out of 284 practitioners and 2,738 patients, 72% and 82% respectively were satisfied with their remote appointment. Moreover, 64% of health care providers and 85% of patients indicated that the quality of care was comparable or better than in-person visits. Around two-thirds of patients also said that they would likely request virtual appointments in the future.
Using Canadian census data and Google application programming interfaces (APIs), the researchers also determined that patients saved a combined $3M on transportation costs accounting for the current fees for public transit and parking around PM.
“While the team is continuing to monitor and investigate whether virtual care has any impact on long-term disease outcomes, this study supports using virtual care in our post-pandemic world,” says Dr. Berlin. “Our findings suggest that telemedicine provides substantial benefits to patients and health care providers—both now and in the future.”
This work was supported by The Princess Margaret Cancer Foundation.
Berlin A, Lovas M, Truong T, Melwani S, Liu J, Liu ZA, Badzynski A, Carpenter MB, Virtanen C, Morley L, Bhattacharyya O, Escaf M, Moody L, Goldfarb A, Brzozowski L, Cafazzo J, Chua MLK, Stewart AK, Krzyzanowska MK. Implementation and Outcomes of Virtual Care Across a Tertiary Cancer Center During COVID-19. JAMA Oncol. 2021 Jan 7:e206982. doi: 10.1001/jamaoncol.2020.6982.
Welcome to the latest issue of The Krembil.
The Krembil is the official newsletter of the Krembil Research Institute (formerly the Toronto Western Research Institute). Research at Krembil is focused on finding innovative treatments and cures for chronic debilitating disorders, including arthritis and diseases of the brain and eyes.
Stories in this month’s issue include:
● 2020 KREMBIL ANNUAL REPORT IS HERE: Read the latest annual report to learn how Krembil is making progress from promise.
● ALZHEIMER’S GAIRDNER SYMPOSIUM: Krembil to host Gairdner Symposium on Alzheimer’s disease for scientists and the public.
● CHOLESTEROL & NERVOUS SYSTEM: Drugs used to lower cholesterol levels can help nerve fibres regenerate following injury.
● PREDICTING LUPUS FLARE-UPS: Scientists identify a new way to predict the severity of systemic lupus erythematosus symptoms.
● WIRED DIFFERENTLY: Brain circuitry features may explain why men and women experience chronic pain differently.
● JUMP-STARTING MEMORY: Scientists learn how deep brain stimulation causes memory recall in patients with dementia.
Read these stories here. To read previous issues, see the newsletter archive.
Krembil is pushing forward.
The year 2020 witnessed tremendous global challenges. The COVID-19 pandemic changed lives around the world and transformed the way we work, learn and interact. Daily activities came to an abrupt halt for many. Science was thrust into the spotlight.
While research was forced to change dramatically, Krembil scientists continued to work with utmost dedication to pursue treatments for diseases of the brain, eyes, bones and joints. We have many exciting stories of progress to share.
This year’s Krembil Annual Report highlights a selection of our greatest achievements over the past year, including:
● identifying a marker of brain degeneration following repeated concussions
● revealing how a protein contributes to the development of brain networks
● discovering how immune cells in the joints differ between healthy individuals and those with arthritis
● advancing our understanding of COVID-19 and developing strategies and therapies to beat the disease
To read the report, click here (PDF will automatically download).
Research conducted at UHN's research institutes spans the full spectrum of diseases and disciplines, including cancer, cardiovascular sciences, transplantation, neural and sensory sciences, musculoskeletal health, rehabilitation sciences, and community and population health.
Learn more about our institutes by clicking below:
