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Vaccines: what are we teaching our students in the Faculty of Health Sciences?

Vaccines: what are we teaching our students in the Faculty of Health Sciences?

In light of the media attention this week surrounding vaccines, I thought that this would be an opportune time to expand on what we, in the Faculty of Health Sciences, teach our students about immunization.

In FHS, we deliver education about immunization in our medical school, our nursing school, our school of rehabilitation therapy, our MPH program and in many of our residency programs, such as family medicine, paediatrics and public health & preventive medicine.

A guiding principle of our educational delivery is to provide current information to students, rooted in the scientific literature, and oriented towards informing evidence-based decision-making. We draw heavily on practice guidelines that emanate from recognized national organizations such as the Canadian Paediatric Society and the Centers for Disease Control and Prevention.

As I am not an expert in the area of vaccinations, I have reached out to faculty members who deal with these issues day in and day out. I have also reached out to our students.

Our head of the department of paediatrics, Dr. Robert Connelly, says that “vaccines are a safe, effective and important health measure for children; they are one of the most significant public health initiatives that we’ve had in the history of medicine. We reinforce this and teach this in our postgraduate pediatrics program. In our teaching, we focus on how to appropriately deal with vaccine-hesitant parents in order to address their concerns, and endorse the Canadian Paediatric Society’s approach to this issue.1”

Within the School of Nursing, Cheryl Pulling, Associate Director of Undergraduate Nursing Programs, informs me that vaccination is addressed across many courses within the curriculum: Microbiology, Care of the Elderly and Children’s Nursing, to name a few. Students in our nurse practitioner program encounter teaching on immunization in the Therapeutics and Diagnostic courses. The content ranges from covering risks and benefits to vaccination recommendations for various age groups to the administration of the vaccines themselves. The school ensures that the curriculum is aligned with current clinical guidelines, and liaises with Kingston, Frontenac and Lennox & Addington Public Health on a regular basis for updates.

Much like in the School of Nursing, the Family Medicine Residency Program provides both a knowledge-based perspective and practical perspective in providing care for patients. “At all four of our sites, our family medicine residents are given didactic sessions on the importance of vaccination, and they are taught about relative risks of vaccinating vs. of not being vaccinated, and how the risks of not being vaccinated far outweigh the risks presented by the vaccinations themselves,” says Dr. Karen Schultz, Postgraduate Program Director for the department of family medicine. “In practice, it is our nursing colleagues who work with our residents to teach good injection techniques in order to ensure the safe administration of vaccines.”

In Dr. Heidi Cramm’s RHBS 822 course in the School of Rehabilitation Therapy, students learn about the current vaccination evidence and discuss the anti-vaccination sentiment that remains residual in some of the broader community. “Public health continues to struggle with the reality that the scientific evidence for vaccination has not been fully disseminated and/or taken up across all community members,” says Dr. Cramm. “This is particularly important for clinicians who will work with children and families, especially when autism is present within families.”

In our undergraduate medical education program, we are guided by the Medical Council of Canada clinical presentations, which are distributed to courses within our curriculum. One such clinical presentation stresses that an important objective for our medical students is as follows: “Given an infant or child presenting to a physician, the candidate will be able to recommend an appropriate schedule of vaccinations, and discuss with parents the risks and benefits of vaccination.”

Our Associate Dean of Undergraduate Medical Education, Dr. Tony Sanfilippo, informed me that Dr. Lewis Tomalty teaches about how immunizations work in the Mechanisms of Disease course; Dr. Ian Gemmill teaches about vaccinations in a course on Population Health as does Dr. Richard Van Wylick in the undergraduate Paediatrics course. The issues in and around vaccinations are also brought up in our clinical skills course under the subsection of ‘difficult conversations’. Dr. Sanfilippo is confident that the Queen’s School of Medicine has a robust and evidence-based curriculum, taught by regional experts.

Our Aesculapian Society President Jonathan Cluett reported on behalf of a group of his student colleauges. “Our vaccination curriculum begins with the molecular science and expands to the epidemiological benefits and public health impacts. We are taught the process by which any new medication is meticulously tested to ensure safety before they are offered to the public. No medication is 100% safe, but vaccines – given that they will be provided to such a large population – are more rigorously tested than any other medication in Canada. Ultimately, Queen’s Medical students are taught that the recommendations for vaccinations are grounded in hard evidence and decades of highly scrutinized research.

Beyond these lectures, a significant portion of our curriculum is dedicated to learning the language of evidence-based medicine. We are taught how to critically analyze the information presented to us because it is essential that, as future physicians, we are able to use these skills in sifting through the noise to make the best choices for our patients. We must be able to look beyond singular pieces of research and instead, synthesize the results of one study in the context of other research on the same topic.”

Our medical students add, “when meeting with vaccine-hesitant families, we are taught that it is important to initiate discussions on vaccinations early in the newborn’s life and ascertain the parent’s major worries. It is crucial to engage in a thoughtful conversation, taking the time to address each concern. We are taught to educate the family on the rigorous process behind creating and testing vaccines, clearly review the risks and benefits, and provide them with real statistics to help put the risks in context. For example, whereas as many as 100 in 1,000,000 can die of a complication of a disease that is largely preventable through vaccination, only one in 1,000,000 will have a serious vaccine complication. The conversation about vaccinations is ultimately about doing what evidence shows is best for our patients’ health. Every part of our education is driven by this mission – to communicate clearly with our future patients, share accessible and reliable resources, and provide all the facts necessary for patients to be able to make the most informed choice.”

As Dean of the Faculty of Health Sciences, I believe that the issue of vaccination is serious business. For example, measles, which had been previously eradicated is now making a recurrence, and can have severe repercussions. In one in 10 cases measles can result in ear infections, in one in 20 it can result in pneumonia, and in one in 1000 it can result in encephalitis.2

Another important issue is that not every child in our population can be vaccinated; in a small number of paediatric conditions, vaccination is not advisable. This potentially puts those children, who for medical reasons cannot be vaccinated, at risk of contracting a disease that for the general population is preventable. Dr. Gerald Evans, Chair of the division of infectious disease, says “widespread immunization against vaccine preventable infections is arguably the greatest scientific and public health success of the last 100 years. A return to the dark ages of infection that existed before global vaccination through discredited and false beliefs about vaccine safety is in turn, our greatest public health threat.”

Our goal in the Faculty of Health Sciences is to equip our students with the skills, knowledge and attitudes they need to be competent practitioners and compassionate healthcare advocates.

If you have any thoughts on this issue, comment on the blog…or better yet please drop by the Macklem House. My door is always open.

 

  1. http://www.cps.ca/en/documents/position/working-with-vaccine-hesitant-parents
  2. http://www.cdc.gov/measles/about/complications.html

Tom Jones

Fri, 06/30/2017 - 12:35

-Vaccines are not safe, well partly. A common sense approach.

-The autism rate has sky rocketed to 1 in 68 kids now : see link http://www.cnn.com/2014/03/27/health/cdc-autism/

-There is a 10 fold increase in kids food allergies and asthma.

-Question? What are we dong different to babys that we never use to do 40 years ago?

Am open to answers, but multiple vaccinations at birth is the only thing I can think of that we are doing different.

It is widely known that big Pharma, the mostly profitable companies on earth will fight tooth and nail in every way imaginable to protect those profits. Google “drug companies corporate criminals”.

-So the chance of your baby having autism or food allergy or asthma is now about 50/50 (that is a guess). Would it be a good idea to wait until the child is 3 or 4 years old before giving him vacinations? And not give him so many of them. Remember it is a grand slam, every time big Pharma can get another vaccine into the group of shots given to every single child.



– VAERS The US gov vaccine side effect reporting site shows 122 deaths last year and thousands of bad reactions. Yes these reports are not verified but people don’t put the reaction into this system unless they believe the reaction was caused by vaccines. And the CDC figures only 1% of adverse reactions get reported into system.

Tom Jones

Michael Blennerhassett

Fri, 06/30/2017 - 12:36

We are encounter that uneasy interface between reality and “I wish it were so…” or “Could it be that…” with increasing frequency, from Gordie Howe’s stem cell therapy for stroke in Mexico on the news this morning, to the anti-vaccination activists.
I teach the erroneous (and saddening) lack of relationship between the GI hormone secretin and autism in my GI course. Yearly, I show the ever-better studies proving lack of effect and every year, the continuing interest from the general public.
Bottom line, it may be hard to prove that something works, scientifically, but it is much harder to prove lack of effect. This must be approached with understanding of scientific principles, and persistence.
Remember the furor over power lines causing cancer? If you enter “Do power lines” into Google, guess what the auto-complete is? Yep, still there. Let’s not do that again over vaccines – the toll will be much worse.

Michael Blennerhassett

Susan Phillips

Fri, 06/30/2017 - 12:36

Well put! For those who might want to read more about the science of vaccines and the anti-science of the anti-vaccine movement I recommend books by Paul Offit, an American MD (Infectious Diseases).

Susan Phillips

Donald Forsdyke

Fri, 06/30/2017 - 12:36

Chapter 2 of my book “Tomorrow’s Cures Today?” is entitled “The Slaughter of the Innocents. Diphtheria.” It details the infant mega-deaths due to delay in implementation of vaccination for diphtheria. Hamilton in Ontario was a pioneer in this field, and by 1930 the mortality had been reduced to near zero. But the words of anti-vaccinationists such as George Bernard Shaw were highly influential and it took ten years for such immunization to begin in the UK.

I remember to this day the nurses holding me down, kicking and screaming, when I was given the potentially life-saving jab in war-torn England in the early 1940s. A graph at the top of our John Austin Society webpage details the hundreds of thousands of unnecessary deaths in the 1930s (C:\Users\Donald\My Webs\Content\john_austin_society.htm).

For more see: http://www.taylorandfrancis.com/books/details/9789057026034/ or http://www.amazon.com/Tomorrows-Cures-Today-Donald-Forsdyke-ebook/dp/B000OT80S6/ref=sr_1_2?s=books&ie=UTF8&qid=1423239271&sr=1-2&keywords=%22Tomorrow%27s+cures+today%3F%22#reader_B000OT80S6

Donald Forsdyke

Mandy

Fri, 06/30/2017 - 12:36

Thank you. My 6 year old niece is receiving chemo treatment & relies on herd immunity to live a relatively regular senior kindergarter life – being able to attend school, go to birthday parties & public places is important for her well being. Thank you to those who immunize their children!!

Mandy

Kanji Nakatsu

Fri, 06/30/2017 - 12:37

We all have our thoughts re vaccination – – Personally I feel that the science of vaccination is well founded – – the problem – from my point of view – is [1] The frequency of injections – too close – thus not giving the immune system time to adjust – [2] the bundling of many together into one injection – thus putting a load on the immune system – [3] and the preservatives that have been added – – – – When people talk about their concerns with vaccination I wish that they would be more specific – for the above reasons – – – – JIM – –

Kanji Nakatsu

R – – Received an email from a fellow Queen’s meds grad. – – He pointed out the I had missed a very important item – – There was a 4th concern – that of the manufactures – There have been many failures in this area – They have been granted immunity – from both prosecution and $ liability – – It is the hall mark of an excellent school that they freely embrace even the most controversial subjects and do not try to sweep them under the table, as the CPS has done for many years with all aspects of vaccination – – This blog gives you the avenue to approach even the most distasteful of subjects and encourage people to think out side of the rigid walls imposed by conventional medical education and practice – – How else can we ever hope to learn – – JIM – –

JH Coyle [Queen's Meds]

reznickr

Fri, 06/30/2017 - 12:38

In reply to by student

Dear Dr. Coyle,

Thanks for your comments. I have tried, and will continue, to bring up challenging topics in my blog. I agree, we do learn through rigorous debate.

Richard

reznickr

Moira Browne

Fri, 06/30/2017 - 12:39

Richard. Thanks for such an elegant, well-researched and timely post. As a front line family physician, it’s crucial that families receive information about the proven effectiveness and safety of vaccines, in a respectful way. And yes it’s also crucial that information be disseminated to students at Queen’s in a factual evidence-based manner. I had no doubt that the Faculty of Health Sciences was doing precisely that.

Moira Browne

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