Faculty of Medicine, McGill University

Abstract

Curriculum Management and Governance Structure ♦ A traditional departmentally based governance was used at McGill prior to the implementation of the new curriculum. ♦ This was changed to a centrally governed curriculum under the direction of the Curriculum Implementation Committee (CIC) and standing faculty Curriculum Committee (CC) in 1994. ♦ The CIC was dissolved in 1998 once the full curriculum had been implemented, and its responsibilities were transferred to the CC. ♦ Each curricular unit has a committee that is responsible for the coordination of the unit. ♦ The chairs of the curricular units constitute a component committee that oversees and maintains horizontal and vertical integration. ♦ The component committees also provide a forum for discussion of quality control and any issues of common concern. ♦ The chairs of the unit and component committees report to the CC as indicated in the organizational chart (see Figure 1).FIGURE 1: Governance Structure Office of Education ♦ The McGill Center for Medical Education conducts research on the integration of biomedical and clinical knowledge, the evaluation of small-group interaction in relation to problem-solving skills, and student use of medical informatics. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ The Committee on Curricular Outcomes oversees graduate performances on national examinations (USMLE and Medical Council of Canada) residency match results (CaRMS and NRMP) studies in cognitive research performed by the Center for Medical Education changes in medical student values and attitudes throughout the four-year curriculum (Medical Education Assessment Project administered by Dartmouth College) alumni tracking of practice profiles practice outcomes utilizing provincial databases on prescription claim files and laboratory test requisitions (periodic assessment) ♦ A comprehensive database including 23 variables is maintained by the Student Records Office. ♦ These variables are used to correlate various performance measures (e.g., cumulative averages and USMLE scores). ♦ There was a comprehensive review of the curriculum and all aspects of undergraduate medical education teaching in the period 1991-93. The 1984 report by the Project Panel on the General Professional Education of the Physician (GPEP) and the 1992 presentation by the Commission on Medical Education (of The Robert Wood Johnson Foundation) provided guidelines and a context for this process. The main goals of the process were to shift the teaching venue from the lecture hall to the small-group setting to further emphasize problem solving to augment the integration of the basic and medical sciences to promote and nurture self-directed and lifelong learning to continue to develop the biopsychosocial model in understanding health and illness to respond to and reflect societal changes in health care delivery, such as making increased use of ambulatory care settings. to review and update methods for evaluating performance ♦ In response to these challenges, a revised curriculum was introduced in 1994. ♦ The CIC was constituted as a parallel structure to the standing CC. ♦ The CIC was mandated to apply the guiding principles, as outlined above, using a blueprint. This blueprint included the basic science component would retain a two-phase approach (normal followed by abnormal) the basic science component would follow an organ/system-based approach the clinical experience would continue to have two levels (pre-clerkship followed by clerkship) the curriculum would continue to provide for early patient exposure lectures would constitute a maximum of 50% of the total instructional time in each curricular unit the units would include small-group sessions, with the goals of providing clinical relevance to basic science material, promoting problem solving, and nurturing collaborative peer exchanges the student-evaluation system would accent a multifaceted approach and diminish the weights attributed to grades on final examinations and subjective clinical supervisor assessments Changes in Pedagogy ♦ The curriculum is comprised of four components: Basis of Medicine (BOM) follows a systems-based and integrated approach to normal and abnormal function. It includes a unit that introduces the behavioral sciences and communication skills. Introduction to Clinical Medicine (ICM) is a preclerkship clinical experience with rotations in hospital teaching units and ambulatory care settings. It replicates a clerkship experience, albeit with more direct supervision. Practice of Medicine (POM) provides for clerkship rotations in six core disciplines as well as electives. Back to Basics is the last component; it reinforces concepts in the fundamental sciences as they apply to clinical medicine. It also includes a longitudinal clinic experience and a course called Medicine and Society. ♦ McGill considers the teaching of professionalism to be an essential tenet of its mission. ♦ Current activities that promote professionalism include the annual commemorative service for the families of donors (cadaveric dissection program); the Standards of Behavior in the Learning Environment Committee; faculty development workshops on professionalism; lectures on professionalism in the core curriculum; and a small group program in professionalism being developed. Application of Computer Technology ♦ The BOM component of the curriculum is now available in electronic format on the Web. It includes over 8,000 pages and approximately 2,000 diagrams. ♦ The BOM is fully indexed and searchable. ♦ The incorporation of interactive components such as quizzes is under way. ♦ Students contribute to this process by developing Web-based instructional modules under faculty supervision and with faculty financial support. ♦ An Information Literacy course has been introduced; its main objective is to ensure that students have the skills needed to search the electronic medical literature. It is also a prerequisite to a course offered in the ICM component, Critical Appraisal and Informed Medical Practice. ♦ Computer-based testing and training are being developed and will contribute to evaluation of student performance. ♦ The program's Web site is: 〈http://www.med.mcgill.ca/ugme〉.