Faculty of Medicine UGME CURRICULUM RENEWAL Faculty Forum #4 Oct .11, 2012
1
OUTLINE
1. Update Milestone map/ progress
2. Curriculum 21st century Framework
Description of components
3. Faculty Impact
4. Next Steps
Undergraduate Medical Education
1
April 2011
Forum #3
Oct 2011
Forum #1
UGME CURRICULUM RENEWAL MILESTONES
Dec 2011
Stakeholder Engagement : Faculty - Student - Post Graduate Government - RHAs - Public
ACHIEVED:
April 2011
Oct 2011
June 2011
Dec 2011
Forum #2A
2 Undergraduate Medical Education
2 ONE UNIVERSITY MANY FUTURES.
Forum #2
Mar 2013
Feb 2012
Jan 2013
Dec 2012
Mar 2012 June 2012
April 2012 Oct 2012
Created: April 2011
Nov 2012
Modified : Oct 2012
Aug 2013 Aug
2013
Mar 2012
April 2012
Faculty Keevin Bernstein MD Director, CuRe
Ira Ripstein MD Associate Dean
Gary Harding MD Director, Curriculum
Rob Brown MD Director, CLSF
Don Smyth PhD Pharmacologist
Joanne Hamilton MEd Department Med Ed
Barry Cohen MD Director, Assessment
Merril Pauls MD Director, Preclerkship
Eunice Gill MD Director, Clerkship
Karen Klym MD Director, Clinical Skills
Karen Howell MBA Project Manager
Bryan Payne MBA Program Manager
“Consumers” Amit Kaushal MD PGY3* Internal Medicine
Steven Promislow MD PGY3* Internal Medicine
Elizabeth Berg MD PGY3* Surgery
Steven Montague Med IV MMSA Senior Stick
Sarah Van Galen Med III Communication Rep
Eyal Kraut Med III Academic Rep
Pol Gomez Med III Academic Rep
Jesse Marantz Med II Student
Harald Gjerde Med II Academic Rep
Anne Finlayson Med II Academic Rep
* All Task Group residents were invited to join executive
UGME CURRICULUM RENEWAL EXECUTIVE
Undergraduate Medical Education
3 ONE UNIVERSITY MANY FUTURES.
UGME CuREXecutive:
CuRe Clinical Skills Committee Karen Klym & Rob Brown , Co-Chair Holly Hamilton Nancy Porhownik Susan Hauch Tom Klonisch TJ Grexton (Med III) Maggie Eade Greg Schmidt (Med III) (Stasa Veroukis Jeanette Edwards)
UGME CURRICULUM RENEWAL Committees
Undergraduate Medical Education
4 ONE UNIVERSITY MANY FUTURES.
Cure Clerkship (M4-7) Committee Eunice Gill & Keevin Bernstein , Co- Chair Ira Ripstein Rob Brown Joanne Hamilton Catherine Moltzan Elizabeth Berg (PGY3) Tara Petrychko Peter Syntnik (Med IV) Current Department Clerkship Directors
UGME CuREXecutive Keevin Bernstein , Chair
CuRe Progress (Student Assessment) Subcommittee Barry Cohen, Chair Ira Ripstein Allen Kraut Brent Kvern Steven Montague (Med IV) Pol Gomez (Med III)
ACTIVE Committees:
UGME CURRICULUM RENEWAL Committees
Undergraduate Medical Education
5 .
CuRe Preclerkship (M0-M3) Committee Merril Pauls & Keevin Bernstein Co-Chairs TBD:
Preclerkship Educational Leaders Longitudinal Course Leaders
UGME CuREXecutive Keevin Bernstein , Chair
CuRe Longitudinal Course Committee Gary Harding & Keevin Bernstein Co-Chairs TBD:
Longitudinal Course Leaders
Committees not yet convened:
Principles: Physicians for 21st century: Fulfills (or exceeds) UGME global objectives, FMEC recommendations
and LCME/CCME standards
Fully integrated spiral scaffold curriculum throughout 4 years Person to Community Centered not focused on organ system or department based
Build upon existing and potential strengths
Innovative – utilizing evolving technology
Iterative and Transparent process
Faculty: More Educational leaders but fewer teachers More Faculty Development, Evaluation, Reward and Recognition
UGME CURRICULUM RENEWAL
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
6
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
Health & Disease Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
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Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTR: Transition to Residency
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Intersessions/ Academic time
“Senior”Clerks (SC) UGME Intersessions/ Academic time TTR: Transition to Residency
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
Health & Disease Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
8
Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTR: Transition to Residency
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Intersessions/ Academic time
“Senior”Clerks (SC) UGME Intersessions/ Academic time TTR: Transition to Residency
Provide a basic science foundation relevant to the study and practice of medicine
• Focus will be on the principles, themes and overarching framework
• Not contain sessions that are simply an overview or sample of things to come
• Not dwell on specifics from clinical examples but use only clinical vignettes for illustration
Appoint Foundation Leader and curriculum committee from basic science departments who will provide most of the teaching, then continue as Department “Leader”
4 weeks
Foundation of Medicine (Module 0)
9 ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
9
UGME CURRICULUM RENEWAL
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
TTR: Transition to Residency
Health & Disease Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4) 10
Year 1 2 3 4
Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Intersessions/ Academic time
“Senior”Clerks (SC) UGME Intersessions/ Academic time TTR: Transition to Residency
Composite Clinical Presentations (CP4)
Goals to be achieved upon graduation
Derived from combination : • MCC objectives • UBC modified MCC Objectives–clinical presentations (~130) • Suggestions from UGME PreClerkship and Clerkship
Directors survey ( June 2011) ……Then divided into 4 color coded groups…….
Spiral Curriculum Framework
“Composite” Clinical Presentations:
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
11
UGME CURRICULUM RENEWAL
• Symptoms or Signs • Lab abnormalities • Factors Affecting Health • Health Conditions
Clinical Presentations “must represent a common or important way in which a patient, group of patients, community or population actually presents to the physician and which a graduate would be expected to handle” UC 2009 http://www.ucalgary.ca/mdprogram/node/622
11
Goals to be achieved upon graduation
“Composite” Clinical Presentations:
Spiral Curriculum Framework Clinical Presentations “must represent a common or important way in which a patient, group of patients, community or population actually presents to the physician and which a graduate would be expected to handle” UC 2009 http://www.ucalgary.ca/mdprogram/node/622
Composite Clinical Presentations (CP4)
• Symptoms or Signs • Lab abnormalities • Determinants of Health • States of Health
CCOMPOSITE CLINICAL PRESENTATIONS CP4* UGME Sept 2012 DRAFT V6 SYMPTOMS & SIGNS 34 hemoptysis ABNORMAL LABS HEALTH CONDITIONS
1 abdominal mass 35 hirsutism 67 acidosis 99 ADHD spectrum 2 abd pain: acute & chronic 36 hoarse voice 68 alkalosis 100 adrenal disorders 3 allergic reactions 37 impotence 69 hemoglobin disorders 101 arthritis 4 Anxiety 38 incontinence 70 calcium/phosphate/magnesium 102 CVD 5 Ascites 39 jaundice 71 cardiac markers/EKG 103 cirrhosis 6 blunt trauma 40 joint pain-acute & chronic 72 coagulation abnormalities 104 CNS infections 7 Burns 41 low back pain 73 creatinine: acute & chronic 105 Diabetes 8 Bleeding 42 lymphadenopathy 74 CXR abnormalities 106 Drug OD 9 cardiac murmurs 43 neck mass/thyroid 75 lipid abnormality 107 eating disorders
10 Chest pain 44 pain syndrome 76 leukocyte disorders 108 fungal infections 11 constipation 45 palpitations 77 liver enzymes/function 109 HIV/AIDS 12 cough- acute & chronic 46 prostatism 78 potassium abnormalities 110 hypertension 13 cyanosis 47 pruritus 79 platelet disorders 111 infertility 14 delirium 48 red eye 80 pulmonary function tests 112 kidney disease-chronic 15 dementia 49 paralysis 81 sodium abnormalities 113 lung disease-chronic 16 diarrhea- acute & chronic 50 pelvic pain/mass 82 urinalysis abnormalities 114 malnutrition
17 diplopia 51 seizures FACTORS AFFECTING HEALTH 115 menses/menopause 18 dysphagia 52 skin growths 83 Adverse drug reactions 116 mood disorders 19 dyspnea-acute & chronic 53 skin rashes 84 Chronic disease 117 multiple sclerosis 20 dysuria/UTI 54 sleep disorders 85 Contraception 118 osteoporosis 21 ear pain 55 somnolence 86 Culture 119 pediatric emergencies 22 edema 56 sore throat 87 WHO Determinants of Health 120 palliative care 23 extremity pain-acute & chronic 57 syncope 88 developmental pediatric delay 121 pituitary disorders 24 eye trauma 58 tendon rupture 89 Disabilities 122 pregnancy/ complications 25 fever 59 testicular swelling/pain/mass 90 neglect/abusive relationship or behavior 123 psychosis 26 fatigue 60 tinnitus 91 educational level 124 suicidal behavior 27 foot ulcers 61 vomiting 92 elderly/frail 125 shock/resuscitation 28 fracture/dislocation 62 vision loss acute & chronic 93 environmental health 126 sports injuries 29 GI bleed 63 weakness 94 infectious epidemic/prevention 127 STI 30 head injury 64 wheezing- acute & chronic 95 food and water security 128 suicidal behavior 31 headache 65 UT obstruction symptoms-lower 96 Body weight disorder 129 systemic autoimmune disorders 32 hearing loss 66 vertigo/dizziness 97 substance abuse/addiction/alcoholism 130 surgical infections 33 hematuria 98 Poverty 131 TB
Smoking 132 thyroid disorders 133 Venous thrombosis *Compiled from MCC website, UGME CD survey 2010, and UBC website
CP4: Composite Clinical Presentations Learning Outcomes or Goals to be achieved upon graduation
highlighted at different junctures at the relevant educational level ( vs Instructional objectives)
Derived from combination : • MCC objectives • UBC modified MCC Objectives–clinical presentations (~130) • Suggestions from UGME PreClerkship and Clerkship
Directors survey ( June 2011) ……Then divided into 4 color coded groups……over 4 years.
Clinical Presentations “must represent a common or important way in which a patient, group of patients, community or population actually presents to the physician and which a graduate would be expected to handle” UC 2009
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Goals to be achieved upon graduation
“Composite” Clinical Presentations:
Spiral Curriculum Framework Clinical Presentations “must represent a common or important way in which a patient, group of patients, community or population actually presents to the physician and which a graduate would be expected to handle” UC 2009 http://www.ucalgary.ca/mdprogram/node/622
Composite Clinical Presentations (CP4)
• Symptoms or Signs • Lab abnormalities • Determinants of Health • States of Health
CCOMPOSITE CLINICAL PRESENTATIONS CP4* UGME Sept 2012 DRAFT V6 SYMPTOMS & SIGNS 34 hemoptysis ABNORMAL LABS HEALTH CONDITIONS
1 abdominal mass 35 hirsutism 67 acidosis 99 ADHD spectrum 2 abd pain: acute & chronic 36 hoarse voice 68 alkalosis 100 adrenal disorders 3 allergic reactions 37 impotence 69 hemoglobin disorders 101 arthritis 4 Anxiety 38 incontinence 70 calcium/phosphate/magnesium 102 CVD 5 Ascites 39 jaundice 71 cardiac markers/EKG 103 cirrhosis 6 blunt trauma 40 joint pain-acute & chronic 72 coagulation abnormalities 104 CNS infections 7 Burns 41 low back pain 73 creatinine: acute & chronic 105 Diabetes 8 Bleeding 42 lymphadenopathy 74 CXR abnormalities 106 Drug OD 9 cardiac murmurs 43 neck mass/thyroid 75 lipid abnormality 107 eating disorders
10 Chest pain 44 pain syndrome 76 leukocyte disorders 108 fungal infections 11 constipation 45 palpitations 77 liver enzymes/function 109 HIV/AIDS 12 cough- acute & chronic 46 prostatism 78 potassium abnormalities 110 hypertension 13 cyanosis 47 pruritus 79 platelet disorders 111 infertility 14 delirium 48 red eye 80 pulmonary function tests 112 kidney disease-chronic 15 dementia 49 paralysis 81 sodium abnormalities 113 lung disease-chronic 16 diarrhea- acute & chronic 50 pelvic pain/mass 82 urinalysis abnormalities 114 malnutrition
17 diplopia 51 seizures FACTORS AFFECTING HEALTH 115 menses/menopause 18 dysphagia 52 skin growths 83 Adverse drug reactions 116 mood disorders 19 dyspnea-acute & chronic 53 skin rashes 84 Chronic disease 117 multiple sclerosis 20 dysuria/UTI 54 sleep disorders 85 Contraception 118 osteoporosis 21 ear pain 55 somnolence 86 Culture 119 pediatric emergencies 22 edema 56 sore throat 87 WHO Determinants of Health 120 palliative care 23 extremity pain-acute & chronic 57 syncope 88 developmental pediatric delay 121 pituitary disorders 24 eye trauma 58 tendon rupture 89 Disabilities 122 pregnancy/ complications 25 fever 59 testicular swelling/pain/mass 90 neglect/abusive relationship or behavior 123 psychosis 26 fatigue 60 tinnitus 91 educational level 124 suicidal behavior 27 foot ulcers 61 vomiting 92 elderly/frail 125 shock/resuscitation 28 fracture/dislocation 62 vision loss acute & chronic 93 environmental health 126 sports injuries 29 GI bleed 63 weakness 94 infectious epidemic/prevention 127 STI 30 head injury 64 wheezing- acute & chronic 95 food and water security 128 suicidal behavior 31 headache 65 UT obstruction symptoms-lower 96 Body weight disorder 129 systemic autoimmune disorders 32 hearing loss 66 vertigo/dizziness 97 substance abuse/addiction/alcoholism 130 surgical infections 33 hematuria 98 Poverty 131 TB
Smoking 132 thyroid disorders 133 Venous thrombosis *Compiled from MCC website, UGME CD survey 2010, and UBC website
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CP4: Composite Clinical Presentations Reviewed /Finalized with all UGME leaders once courses developed
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
Health & Disease Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4) 14
Year 1 2 3 4 Year 1 2 3 4
Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Intersessions/ Academic time
“Senior”Clerks (SC) UGME Intersessions/ Academic time TTR: Transition to Residency
Normal Biology and Health Module (formerly Systems I ) Health and Disease Module (formerly Systems II)
Contrasting Systems I and Systems II I = Normal Biology and Health Module II = Health and Disease Module
I: Normal development, anatomy and processes Provide overview of burden of illness / diseases related to system Predominantly basic sciences with clinical cases (normal or abnormal) to
contrast or help illustrate normal
II: Abnormal processes Provide overview of burden of illness & societal impact of diseases With each specific abnormality or disease cover all “9” elements Predominantly clinical cases with review of basic science
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
UGME CuRe 21st century: Normal Health & Disease Module …formerly “System” Course Template
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Normal Biology & Health… (“systems”) I 1. Introductory lecture (2hrs) Course objectives Overview of system/organ function Overview of anatomy and relevant structures Overview of Burden of illness Patient illustration
2. Normal Development & Embryology
3. Gross Anatomy & Imaging
4. Microanatomy
5. Normal Processes Physiology Biochemistry & Molecular biology Pharmacology
*All material ( where possible) will be presented as normal contrasting to illustrations of abnormal providing clinical relevance
Health & Disease….(“systems” ) II
1. Introductory lecture (2 hrs) • Course objectives • Review of Systems I • Burden of illness
Epidemiology and Social • Patient illustration
2. Clinical Genetics • Review of embryology if relevant
3. *Life Cycle impacts: • Development--> pediatrics --> geriatrics
4. Abnormal Processes: • Specific Abnormality or Disease pathophysiology
*With each entity : 1) Epidemiology 2) Scientific Basis and Anatomy review 3) Prevention and Screening1
4) Cultural, Social and Ethical issues 5) Natural History & Prognosis 6) Diagnosis 2 7) Therapeutics and Disease Management 8) Translational Research & Evidence Based Medicine 9) Health Care System
*Either as part of unit or parallel longitudinal course
1 Includes amongst others nutrition, life style, exercise
2 Includes history, physical, labs, imaging and pathology
UGME CuRe 21stCentury: Module 1 & 2 Course Template DRAFT Mar2012
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1. Introduction to Infectious Diseases/ Intro to Oncology Blood, Lymph and Immunology II 2. CV II
3. Resp II 4. Endocrine II 5. Kidney II 6. Reproduction II 7. GI & Nutrition II 8. Musculoskeletal II & Skin II 9. Neurobiology II (Psychiatry, Clinical Psychology, Neurology, Opth & ENT)
1.Blood, Lymph, Immunology & Skin I 2.Musculoskeletal I 3.Neurobiology I(Psychology, Neurosciences, & ENT) 4.CV I & 5.Kidney I & GI/ Nutrition I 6.Endocrine I & Reproduction I
UGME CuRe Preclerkship Y1/Y2: M0-M3: Normal Health and Disease Modules Y1
M0 M1
Y2
Health and Disease
Dec. break
Dec. break
Reading Week
Reading Week
Rural Week
Consolidation
M2
M3
Normal Biology & Health
Foundation of Medicine
DRAFT Feb 14
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1. Introduction to Infectious Diseases/ Intro to Oncology Blood, Lymph and Immunology II 2. CV II
3. Resp II 4. Endocrine II 5. Kidney II 6. Reproduction II 7. GI & Nutrition II 8. Musculoskeletal II & Skin II 9. Neurobiology II (Psychiatry, Clinical Psychology, Neurology, Opth & ENT)
1.Blood, Lymph, Immunology & Skin I 2.Musculoskeletal I 3.Neurobiology I(Psychology, Neurosciences, & ENT) 4.CV I & 5.Kidney I & GI/ Nutrition I 6.Endocrine I & Reproduction I
UGME CuRe Preclerkship Y1/Y2: M0-M3: Normal Health and Disease Modules Y1
M0 M1
Y2
Health and Disease
Dec. break
Dec. break
Reading Week
Reading Week
Rural Week
Consolidation
M2
M3
Normal Biology & Health
Foundation of Medicine CREATION of M1 and M2 course sequencing & allocation 1. Logical sequencing of systems
2. Commence with Immunology and Blood
3. Logical anatomy instruction – dissection and student comprehension
4. Ensure all systems completed before spring year 1
5. Separated current topics into M1 and M2 equivalents & allocated 90 %
6. Ensure M1 course schedule doesn’t overlap with respective M2 schedule. 7. Accommodate student assessment and remediation Accommodate remediation of M1 Y1 courses before M2Y1 i.e. CV 2 days for Student assessment per course All courses end on Fridays with final course/unit exams that day
7. Accommodate natural holidays ( eg Dec break, Reading week and summer)
8. Accommodate national scientific meetings
……………….Numerous iterations >>>>> 18
Normal Biology and Health wks.days ( w. 2 days eval ) Approximate dates
UGME CuRe Preclerkship M1/2: Health and Disease Modules Y1
M1
Y2
Health and Disease
• FOUNDATION 1.Blood & Immunology I (+ Skin I) 2.CV I & Resp (+ ET) I 3.Neurobiology I(Psych, Neuro + Opth) 4.Musculoskeletal I 5.Endocrine I & Reproduction I 6.GI/ Nutrition I & Renal I
M2
M3
JULY 23 2012
4 ---- 2013 Aug 26 - Sept 20 3------------ Sept 23 - Oct 11
5 ------------ Oct 14 - Nov 15 4.6 --------- Nov 18 - Dec 18… Dec break 2------2014 Jan 6 - Jan 17 4------------- Jan 20 - Feb 14
4------------- Feb 17 - Mar 14 TOTAL 26.6 ……………….Mar 17 - 21 ………Reading week
2-------------Mar 24 - April 4 3-------------Apri 7 - April 25 4-------------Apri 28 - May 23 -----------May 26 - 30 …………. Rural week 4--------------Aug 25 - Sept 19 3--------------Sept 22 - Oct 10 3--------------Oct 13 - Oct 31 3 -------------Nov 3 - Nov 21 3 +3d------- -Nov 24 - Dec 18…… Dec break 6 -----2015- Jan 5 - Feb 13 4--------------Feb 16 - Mar13 ----------------Mar 16 - 20 ……. Reading week
1. Intro to ID/Intro Oncology 2. Blood & Immunology (+ autoimmune diseases) II 3. CV II
4. Resp + ET II 5. Endocrine II 6. Reproduction II 7. GI & Nutrition II 8. Renal II 9. Neurobiology II (Psych, Neuro, Opth) 10. Musculoskeletal II & Skin II 19 Consolidation 10-------------Mar 23 - May 29
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UGME CuRe 21st century: Pedagogical Approach
Pedagogical approach and weekly template Ensure consistency amongst courses CuRex debated based upon Task Groups recommendation
However….. Needed buy in from all course leaders
……………Awaiting governance reorganization and Appointment of educational leaders :
Commence Faculty Development Organized by Joanne Hamilton (MEd) In person and online ; 13 modules 1st module: Pedagogical approach &
weekly template Course structure and organization Creation of objectives Creation of exam questions with MCC
Appointed Course leaders : Create curriculum committees
Membership to reflect requirements for course from all relevant departments
Submit course outline to CuRex /CuRe Preclerkship cte for approval
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UGME CuRe 21st century: Pedagogical Template DRAFT Normal Health & Disease Modules : 17 hrs /week- AMs Lectures: Introductions; interdisciplinary ; summaries
Proportion & Number of lecturers TBD
Independent learning: role Assigned studies – Directed Self Learning
Small group learning: Tutorials:
o cases or questions o apply content o apply critical thinking o evidence based with references
Case Base Learning Team Based Learning
Online learning Peer teaching Link to Clinical skills/simulation/early exposure Student Assessment- formative & summative
Longitudinal Courses : 11hrs /week- PMs Clinical Skills - 3 hrs ( 4 hrs in Year 2) Clinical Reasoning - 3 hrs Others - 5 hrs
DRAFT Feb 2012
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9-10
10-11
UGME MODULE 2 or Year 2 AM Labs: anatomy
or Sim. Small group 180 minutes divided by 2, 3 or 4
Monday Tuesday Wednesday Thursday Friday
Whole group sessions: 160 minutes divided by 2, 3 or 4
Didactic, TBL, T1 with Iclickers
11-12
12-13
Break
Break
Whole group sessions
Unit specific Activity ( 2hrs)
Whole group sessions
Course specific Activity
Small group sessions: ( 2hrs)
Whole group sessions
Course specific Activity
Small group sessions: ( 2hrs)
9-10
10-11
Labs: anatomy or Sim.
Small group 180 minutes divided by 2, 3 or 4
Whole group sessions:
Whole group sessions: 160 minutes divided by 2, 3 or 4
Didactic, TBL, T1 with Iclickers
11-12
12-13
Small group sessions: ( 2hrs)
Course specific Activity
Break
Whole group sessions:
Small group sessions: ( 2hrs)
Course specific Activity
Break
Whole group sessions:
Course specific Activity ( 2hrs)
UGME MODULE 1 & MODULE 2 Year 1 AM
Year 1 & 2 : Noon hours for joint sessions: Tues & Thursday; 1300 Wed
Break
Break
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SAMPLE UGME WEEKLY TEMPLATE AM: Module 1 and 2
Longitudinal courses:
3 hrs (<1 hr didactic
lecture)
UGME PM/Longitudinal Courses Year 1 and 2
Monday Tuesday Wednesday Thursday Friday
Clinical Reasoning (1hr)
Clinical Reasoning (2 hrs) Longitudinal
courses 2hrs
13-14
14-15
15-16
16-17
Break
Break
Break
Break
Clinical Skills (3 hrs)
Break
12-13
Year 1
Clinical Skills (4 hrs)
Clinical Reasoning (2 hrs)
Longitudinal
courses 2hrs
Break
Break
Break
Break
Break
Longitudinal courses:
3 hrs (<1 hr didactic
lecture)
13-14
14-15
15-16
16-17
12-13
Clinical Reasoning (1hr)
Year 2
UGME M 1
UGME M 1
UGME M 2
UGME M 2
Monday Tuesday Wednesday Thursday Friday
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Year 1 & 2 unscheduled : Monday and Friday PM
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
Health & Disease Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4) 24
Year 1 2 3 4 Year 1 2 3 4
Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Intersessions/ Academic time
“Senior”Clerks (SC) UGME Intersessions/ Academic time TTR: Transition to Residency
Purpose: Ensure all the content from the previous modules are assimilated Applied to patient care in a complex health care environment Ensure ~130 Composite Clinical Presentations have been covered
(if not covered elsewhere) at appropriate level.
Include: Single symptom presentations with broad differential diagnosis Multisystem Disease – eg complicated diabetes “Themes” or Disciplines such as pediatrics, geriatrics Systemic diseases – eg HIV, SLE ,etc. Health Care Issues- pain, addictions, etc.
Format: small group problem solving and clinical reasoning sessions.
Duration: 10 weeks
UGME CURRICULUM RENEWAL
Consolidation Module (Module 3)
25
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
Health & Disease Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4) 26
Year 1 2 3 4 Year 1 2 3 4
Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Intersessions/ Academic time
“Senior”Clerks (SC) UGME Intersessions/ Academic time TTR: Transition to Residency
Longitudinal Courses: Names TBA
Clinical Reasoning CR ( formerly Problem Solving) Information Sciences* Integration* strategies - eg Case of the week Pathology ( eg mini hospitals) CP4
Community Health Epidemiology Public health Health care systems * (includes Law & Med) Global Health Occupational Environmental
Clinical Skills * Communication skills Physical exam skills/diagnosis Community Clinics & Distributed Learning
contexts* Procedural skills Self reflection
Professionalism*/Doctoring Social accountability/equity* Cultural safety/diversity Humanities/Ethics/History Life Skills ( formerly Survival tactics) Narrative or Arts and Medicine Decorum Interprofessional Leadership/Health advocacy
Indigenous Health*
Scholarly Activity Basic or clinical science research Educational research Health Care system or Leadership Community research
UGME CURRICULUM RENEWAL *CuRe TG
27
Longitudinal Themes: Themes: Not individual courses but thread throughout curriculum with a designated leader:
Generalism * Information Science* Leadership Geriatrics Pediatrics Palliative Care Health Care Systems/Safety* Interprofessional Education
UGME CURRICULUM RENEWAL *CuRe TG
28
CuRe: STUDENT ASSESSMENT PLAN – Barry Cohen
29
PRECLERKSHIP: Module (M0-M3) Courses:
• Each M1 and M2 course evaluated and passed separately i.e. No cumulative single block exam
• 30% MCQ midterm, with strugglers flagged and assisted ;
• 70% MCQ final • Faculty Development from M.C.C. for exam questions • Do not have to pass M0 to proceed to M1 but must pass M1 course to
proceed to its respective M2 course • Remediation may occur during other mandatory curricular time
i.e Wed + Fri aft if unscheduled
Longitudinal Courses: Separate assessments • Clinical Reasoning: Integrated cases; based upon on both prior and
concurrent CR and Modular material; short answer questions • Year 1 : 6 exams for year 1 with proportional increase in value:
Percent: 5% / 5% / 20% / 20% / 20% / 30%
CURRICULUM RENEWAL: Community Engagement
Social Responsibility and Accountability • Population health and determinants of health framework • Health Advocacy • Interprofessional education and care • Contextualize health issues – quality, equity and cost effectiveness
Curriculum needs to be based upon priority health needs of community and province : We need to engage government, agencies and public
Longitudinal Courses: • Clinical Skills • Professionalism • Community Health • Indigenous Health • Scholarly activity with community
30
Person to Community Centered :
UGME CURRICULUM RENEWAL –CLINICAL SKILLS
Service Learning ( Currently Co-Curricular ) • WISH clinic • Jacob Penner Park • Global Health Concentration Program
Learning in the Community ( Curricular):
•Urban ( eg WRHA Access or others) •Emergency departments •Rural Health care clinics •First Nation Communities •Health Care Agencies •Personal Care Homes
Foster Interest or Careers: - Urban primary care - Rural primary care - Indigenous /global health - Public Health/Equity - Geriatrics
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UGME CURRICULUM RENEWAL –Clinical skills
New Clinical Skills Course: Following introduction to communication skills (early Module 1)….
Longitudinal clinics follow assigned families: Address community needs Range of engagement:
• Appreciate social diversity>>> manage chronic disease • Interprofessional care and /or education
Self reflection Commenced engagement with WRHA Primary Care Network
• Intended for communication skills • provide student exposure to various chronic diseases, and their
impact on both individual and family, • utilization of other care professionals, and how they navigation
through community services and resources
32
Service Learning ( Currently Co-Curricular or becomes curricular) Learning in the Community ( Curricular)
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
Health & Disease Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4) 33
Year 1 2 3 4 Year 1 2 3 4
Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Intersessions/ Academic time
“Senior”Clerks (SC) UGME Intersessions/ Academic time TTR: Transition to Residency
CLERKSHIP >2015: Year 3 ( M4 & M5)
ECP and CP4 Don’t need to be rotation specific - tracked electronically
TTC
9 days
Block 1 Surgery /Anesthesia
Block 2 Peds and OG
Block 3 Adult Medicine
Block 4 FM and Psych
12 weeks 6 weeks each 12 weeks 6 weeks each 3 groups 9 2 groups 14 2 groups 14 2 groups 14
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???
3 weeks
Academic time: UGME qThursday PM- once developed determine if time required or qoThursday
Mandatory attendance Policy no “call” past 2300
Block specific academic time Maintain central oversight Developed jointly by 2 departments Commence each block 1-2 days academic time
Longitudinal Courses: Community Health Sciences (Public health & Health care system), Professionalism & Social Equity and Indigenous Health Incorporated into clinical rotation or UGME Academic half day
Block 1 Surgery /Anesthesia: 3 groups- NO overlaps- 9 students /group Segment 1 Segment 2 Segment 3
# Weeks 2 2 2 2 2 2 Group 1 General Surgery Subspecialty
Surgery Orthopedic /MSK Med
Anesthesia Perioperative Care
General Surgery : 4 weeks all students do GS; include community hospitals
Surgery subspecialty: 2 weeks limited to Urology or Plastics
Orthopedic medicine: 2 weeks
• Called MSK include joint & soft tissue management w. Sports & Physical Med
Anesthesia: 2 weeks Perioperative care: 2 weeks
• Follow a patient through perioperative experience in PAC & in surgery clinics • Non-operative ENT ( may change to LC) and ophthalmology ( and include in EM ) • Pain management curriculum: to include Non-pharmacologic pain management-
psychology, acupuncture and complimentary med Miscellaneous: Incorporate public health into surgery in collaboration with CHS,
and some component of pediatrics in collaboration with Peds
CLERKSHIP >2015: Year 3 ( M4 & M5)
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Block 1 Surgery /Anesthesia: 3 groups- NO overlaps- 9 students /group Segment 1 Segment 2 Segment 3
# Weeks 2 2 2 2 2 2 Group 1 General Surgery Subspecialty
Surgery Orthopedic /MSK Med
Anesthesia Perioperative Care
Group 2 Subspecialty Surgery
Orthopedic /MSK Med
Anesthesia Perioperative Care
General Surgery
Group 3 Anesthesia Perioperative Care
General Surgery Subspecialty Surgery
Orthopedic /MSK Med
12 week overall rotation called Block IM–EM – ACUTE MEDICINE 4 weeks Emergency Medicine
• ~ 15 emergency medicine shifts, plus optional EMS ride along • Incorporate internal medicine ambulatory care exposure (number of and type of clinics
are TBD; aim for 2 per week 1 GIM and 1 specialty ); • Develop continuity between ER and IM (ex. fast track clinic, urgent consult/follow up). • Incorporate General Internal Med Consult service if possible 6 weeks general internal medicine (CTU)
2 weeks of internal medicine selective
Miscellaneous: • Incorporate public health into block in collaboration with CHS
CLERKSHIP >2015: Year 3 ( M4 & M5)
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Block 2 Internal & Emergency Medicine: 2 grps- 14 students / grp #
Weeks 6 6
4 2 4 2 Group1
CTU Emergency Medicine Outpatient Internal
Subspecialty Medicine
Group2
Emergency Medicine Outpatient Internal
Subspecialty Medicine
CTU
TO DO LIST: Appointment of Academic Clerkship Director
Redevelop TTC Develop overview for UGME academic half time Develop TTR M7
Develop Four M5 ( core or junior )Blocks Family Med & Psych and Peds & Obs/gyn…….. add something novel Each block to develop objectives and work out academic time Appoint Block Coordinators
Develop 3 weeks “post TTC” ….Options: • Selectives ….different than traditional (s)electives- create catalogue of Selectives
which could to include anatomy, health care systems, leadership, palliative care, etc • 1- 2 weeks of Community clinics- urban..as continuation of preclerkship Clinical skills
Develop Year 4 ( M6 & M7) M6 – Electives pre CaRMS ( 17 weeks including interviews) ie no Change Develop M7 with academic time, LMCC review and concept of senior clerk:
Mandatory additional Core rotations ie selective IM/ surgery / Community care Selectives – palliative care, care of elderly, indigenous health, etc Program tailored to specific residencies
CLERKSHIP >2015: Year 3 (M4/M5) and Year 4 (M6/M7)
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Governance: Modified to enhance & facilitate transparent communication
Maintain quality assurance and curricular stability Recognize faculty – remuneration or time
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
Appointed Educational leaders to oversee/ensure continuum for each: • Module or Course within modules (“unit”) • Longitudinal Course • Discipline/Department or “Theme”
With job description and appropriate recognition & reward
Formal Faculty Development & Evaluation All Educational leaders understand the curriculum framework Each educational “unit” with leader will have a curriculum
committee with relevant representation
Fewer teachers…..in particular lectures
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UGME CURRICULUM RENEWAL: Faculty
UGME CURRICULUM RENEWAL NEXT STEPS:
1. Finalize Governance: Attaching remuneration and source
2. Appointment of new educational unit leaders Who will then develop their committees and course content
3. Commence Faculty Development
4. Revised overarching UGME objective – Gary Harding
Mission statement
5. Formalizing the Longitudinal Courses, and Theme threads
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QUESTIONS
Thank you.
UGME CURRICULUM RENEWAL
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