Photo by 3TEN Photography
There was nothing stand-out about the University of Alberta lecture hall that Shaun Loewen found himself in seven years ago. One of nearly 160 second-year medical students, Loewen watched as Dr. Scott North – slight, bespectacled and younger than Loewen expected – entered the room. He’d be leading the oncology class for the next four weeks.
Typically dressed in a collared shirt and khakis, no lab coat or tie, North would occasionally lead students through PowerPoint presentations, sans notes. His lectures were concise and informative, so much so that one of Loewen’s colleagues still uses notes from North’s oncology class today. But it was the times when North wasn’t standing in front of the classroom that Loewen remembers the best.
In other medical school courses students may receive a piece of paper explaining a situation they must solve. For example, 50-year-old Mrs. Jones is complaining of feeling tired and fatigued and her husband says she looks pale. North’s class is different. “We bring in an actor, they put makeup on her to make her look pale and she says ‘Hi my name is Mrs. Jones and I’m really tired all the time,’” says 41-year-old North, an associate professor of oncology at the University of Alberta and medical oncologist at Edmonton’s Cross Cancer Institute.
At the conclusion of the four-week course, Loewen had learned an incredible amount, thanks to the guests that North often brought to class.“We learn throughout medical school but his course was definitely the most memorable,” says Loewen. North teaches his students lessons a textbook simply can’t by making use of actors and guest speakers and engaging students in practice situations. “If they realize once the patient leaves ‘Oh, we forgot to ask this question’, then they’ll never forget to ask this question again,” says North. Actors allow students to practice a variety of skills including giving bad news to a patient in a tactful and respectful way, time management and learning to work while being observed.
North’s teaching philosophy is one of enabling students to learn – setting up the optimal conditions – and it’s a philosophy that recently landed him a prestigious 3M National Teaching Fellowship award, Canada’s top award for university professors, in March. “It’s not about teaching so much as it is about learning,” says North. “Learning is an active thing that the individual has to do. I consider myself a facilitator, not necessarily the person who’s going to stand up there and say, ‘I need you to memorize these 10 things.’”
The oncology course also includes psycho-social teaching. For example, following a breast cancer lecture, North will talk about body image and how a woman’s sense of herself may be negatively impacted by a mastectomy. “The problem with traditional medical curriculum,” says North, “is it’s very heavy on the science and less on the art of medicine.”
North began instructing as a resident in 1997, under a program director who advocated to his residents the importance of teaching. North was inspired to get his master’s degree in health professions education and, in April 2002, he took over the spring oncology course, which introduces second-year medical students to the field of cancer care.
“You have to remember when you’re teaching in any area, but specifically in medicine, that there is no way that you can teach the learner everything that they need to know about a subject,” says North. He strives to teach students the fundamentals and necessary tools to understand the principles behind a concept. “You don’t teach somebody to memorize what kind of chemotherapy to give to treat breast cancer, rather you teach them about principles of staging and the type of cancer and the patient factors and then they can use that information to constantly update themselves about what’s going on in the field.”
North’s passion for the field of oncology was spurred by a simple comment that he would be good at the job in his 1996 exit interview, during his first clinical rotation as a second-year oncology resident at Edmonton’s Cross Cancer Institute. “Whether or not you’re a physician, an engineer or you dig ditches for a living, if somebody tells you you’d be good at this job, that matters so much more than whether or not you think you’d be good at the job,” says North. “You don’t really know what the job is, they do.”
The cancer care advocate is motivated by a desire to improve the patient experience. “I want the providers who are graduating with medical training nowadays to be comfortable dealing with cancer patients,” says North. He’s been teaching the oncology course for almost a decade and says of a typical class of 160 students, perhaps only three will become cancer specialists in medical or radiation oncology, but more than 60 will become family doctors.
“Part of my passion for (teaching) is knowing that I’ve got a good group of colleagues out there, who are going to take good care of patients when I can’t do all that work myself,” says North. North estimates that in Alberta there are more than 100,000 people who have or have had cancer and only 100 physicians who are radiation and medical oncologists. This disparity means all doctors must be comfortable dealing with cancer. It’s an idea that is echoed by Sandy Moser, a retired nurse, who has acted in North’s oncology class for several years. “Everybody who goes through his class, if they listen to him carefully, they’re going to be able to deal with oncology whether they go into the field or not,” says Moser.
Moser, who has seen her share of instructors while acting in medical school courses at the University of Alberta, was thrilled to hear North had won the 3M Fellowship. “Dr. North almost can’t be equalled,” says Moser. “You get to my age and you’ve seen a lot of instructors. He’s got to be the top of the heap. He’s got this magical ability to be kind to everyone, which is difficult. He’s exceedingly kind to the students, very kind to us actors and incredibly kind to the examiners. He has one mode and that is kindness.”
Former student Loewen says North’s memorable course inspired him to pursue oncology. “You could just tell he really loved what he was doing,” says Loewen, who is finishing his final year of residency in radiation oncology at the Cross Cancer Institute. “He’s a great teacher and he’s really a visionary.” Loewen says working with patients who have a terminal diagnosis can be a daunting concept for medical students to embrace, and one that North was able to make less intimidating by including actors and guest speakers in his classes.
North says there’s a huge sense of satisfaction when he sees students understand something they previously struggled with. “If you do a good job teaching somebody, they’re going to go out and teach the next person. You’re helping to keep the ball rolling and to keep everybody globally educated.”
And while students such as Loewen have chosen to pursue oncology, hundreds of others who have not specialized in the field of cancer have learned to be comfortable working with cancer patients. “I want (students) to look at oncology as a specialty that maybe they would consider,” says North. “But, even if they don’t want to consider it, at least I want them to walk away from the course feeling a little bit more confident, that they can deal with people who’ve got cancer.”
Abreast of Change
Some women dread breast examinations, but not Sandy Moser. The retired nurse works as a standardized patient in Dr. Scott North’s oncology class, helping to teach second-year medical students how to give a patient a breast examination. “You have to be an old broad who doesn’t get embarrassed anymore to go ahead and let the students learn how to do a proper breast exam on you,” says Moser.
Moser has worked as a standardized patient in University of Alberta classes for more than a decade. A standardized patient is a person who has been trained to realistically reproduce the history, physical findings and personality of an actual patient for the benefit of students.
In Dr. North’s oncology class she also acts as a patient who has cancer and is about to receive very bad news from her doctors. Moser is typically put in a room alongside an examiner, students then come into the room one at a time to give the bad news and Moser must show shock, grief, dismay and whatever other emotions feel natural. “Amazingly, I find I can burst into tears 20 times in a row,” says Moser.
While Moser says the exercise is difficult for all involved, she sees it as essential in preparing students to tell patients similar news, in a kind and caring matter, once they leave the classroom. Helping students learn, by acting as a standardized patient, is important to Moser. “When I graduated (from nursing) in 1963, we had no such thing. We had a plastic dummy that we could practice on,” says Moser. “I would have loved to had standardized patients to try out my skills on, before I actually got into the general population. I think it’s one of the most ingenious ideas yet.”