McGill University Faculty of Medicine

Abstract

Curriculum Management and Governance Structure ♦ The departmentally based management structure was changed to a centrally governed curriculum in 1994. ♦ In 2005, the structure of the Curriculum Committee (CC) was modified such that each curricular component [Basis of Medicine, Introduction to Clinical Medicine (ICM), Clerkship, and Physicianship] had its own component committee (see Figure 1).FIGURE 1:: Curriculum Management Structure♦ The CC, which is a standing committee that meets once a month, is responsible for the objectives, content, and pedagogy of the MDCM curriculum. ♦ The CC ensures integration and coherence of content across the curriculum and oversees and maintains horizontal and vertical integration. ♦ The component committees report to the Curriculum Committee, which in turn advises the Associate Dean. ♦ The component committees provide a forum for discussion of quality control and are responsible for ensuring their component objectives are congruent with the overall educational program objectives, reviewing and ensuring use of appropriate teaching and assessment methods, monitoring the quality of teaching by reviewing course evaluations and assessing results. ♦ The departmental Undergraduate Medical Education committees have a role in ensuring integration by considering their discipline throughout the clinical curriculum. Office of Education ♦ The Office of Medical Education and Student Affairs (OMESA) consists of approximately 30 staff. Admissions and Physicianship Curriculum Development are included in this group. Administrative support for the medical student education program is provided by this office. ♦ The Faculty of Medicine also includes the Center for Medical Education (CME), housed outside OMESA and providing support to both undergraduate and postgraduate programs. ♦ The Center includes 2 educational researchers, 13 core faculty members, and approximately 50 associated members. Medical student electives offered by the CME are well subscribed. ♦ The Center carries out educational training and research that informs new course and program development, evaluation of new forms of teaching, novel methodologies for evaluation of trainees and teachers, the development of teachers for our programs. ♦ The Office for Faculty Development also supports OMESA by ensuring that Faculty Development programs develop skills in our faculty members that are congruent with our educational objectives. Financial Management of Educational Programs ♦ McGill University is a publicly funded university in a Canadian province, where tuition fees are strictly regulated (and kept low) by the provincial government. ♦ Although tuition fees vary by the residency status of the student, students who are Quebec residents (92% of our student body) pay only $4,000–$5,000 Cdn. per year. ♦ The university receives approximately $27,000 Cdn. per undergraduate medical student per year from the provincial Ministry of Education. ♦ All students have access to our Student Aid office, which seeks to provide needy students with scholarships or loans as required. ♦ The university also channels some Ministry of Education funds to clinical institutions, which receive our students for training. ♦ The total budget of the Faculty of Medicine (including research grants and infrastructure grants) is in the order of $320 million Cdn. per year. ♦ Due to an active capital campaign, the Faculty has been able to maintain a stable income in spite of losses on income from endowments. Valuing Teaching ♦ The CME functions as our institute for educators in medical education. A teaching scholars program within this center provides a one-year intensive educational methodology training to selected faculty members. ♦ Faculty members who have made a significant and noteworthy contribution to health sciences education are eligible for nomination to the Faculty Honor List. ♦ The tenure and promotion process is based on three criteria: teaching, research, and other contributions. Teaching dossiers are used for promotion not only for tenure track faculty but for our numerous nontenure track clinical teachers. ♦ In spite of these three points, the need to better value teaching has been identified as a priority in our current strategic planning process. Curriculum Renewal Process ♦ In 2003, a formal review of the entire curriculum was undertaken with broad-based faculty representation. It was stimulated by the creation of a Task Force on “professionalism,” on “healing and the medical mandate,” and on the “evaluation of Physicianship.” ♦ The review resulted in the Physicianship program being implemented in 2005. This consists of courses that run as “ribbon courses” throughout the four years, including a mentorship program, and emphasizes the professional and healer aspects of the practice of medicine. ♦ In 2006, the clerkship was restructured to two years (core clerkship and senior clerkship), the family medicine clerkship was expanded, a mandatory rural family medicine experience was implemented, and a four week emergency medicine clerkship was begun. ♦ In 2008, a faculty strategic planning process was begun and is still underway. ♦ The Education Design Group, a subgroup of the strategic planning exercise, has reviewed the educational program and has developed goals and strategies for the future. ♦ The priority areas identified by the Educational Design Group are (1) determining which basic sciences are the “must know” basic sciences for current physicians, (2) promotion of family medicine, public health, and an understanding of the effect of health systems on health, and (3) the identification of best pedagogical practices in medical education. ♦ Key objectives for the curricular renewal include an increased proportion of our students choosing family medicine as a career, better scores on public health, ethics, and health systems sections of the Canadian licensing examinations, and developing evidence that our students have successfully acquired lifelong learning skills. ♦ The strategic planning and formal reviews described above are in addition to the ongoing course reviews by the curriculum committee (nine courses reviewed annually) and reviews of all course evaluations by component committees. Learning Outcomes/Competencies ♦ Our educational program objectives are organized by competencies deemed essential for Canadian physicians. These competencies have been elucidated by the Royal College of Physicians and Surgeons of Canada (see CanMEDS 2005, http://rcpsc.medical.org/canmeds/index.php) and by the College of Family Physicians of Canada (Four Principles of Family Medicine): For the Medical Expert Competency, the medical graduate will be able to demonstrate: In the traditional basic sciences, a knowledge of the normal human body, abnormal structure and function, the causes of disease, normal psychological development over the life cycle, normal growth, maturation and aging from fetus to old age, and human sexuality. In the clinical sciences, knowledge of the manifestations of common diseases, family structure, infertility and fertility control, normal and abnormal pregnancy, the differences between disease and illness, the prevention and treatment of common diseases, and the role of alternative and complementary medicine. In the area of epidemiology, biostatistics, and population health, knowledge of the determinants of health, the distribution of diseases, research techniques, and health care delivery systems. Effective observational skills, to obtain an accurate and complete medical history, perform a complete physical examination including the mental status examination, and perform an assessment of the newborn and frail elderly. Appropriate, skilled medical reasoning, the ability to prioritize clinical problems clearly, and to interpret diagnostic tests. The ability to perform basic procedures under supervision and to resuscitate following the standards of ACLS. For the Professional Competency, the medical graduate will demonstrate: In the areas of humanities, history of medicine, and ethics and law, a knowledge of the role of a physician as a professional and healer, the nature of professionalism, the major ethical and legal dilemmas that physicians encounter, the role of culture in clinical decision making, the history of medicine, the main determinants of the healing process, and the concept of self-care. The ability to self-reflect, particularly in relation to professional attributes and reactions to suffering. An ability to distinguish between personal and professional obligations and to respect boundaries. Behaviors that are guided by the fundamental values of altruism, commitment, equanimity, integrity, respect, tolerance, trustworthiness, and receptivity to feedback and criticism. For the Communicator/Doctor–Patient Relationship Competency, the medical graduate will listen and communicate effectively, convey presence, and understand the importance of information as a therapeutic tool. demonstrate the ability to provide accurate and appropriate information to the patient. For the Health Advocate Competency, the medical graduate will incorporate the patient/family-centered model of care. be able to identify and utilize appropriate resources in the community that can provide support to patients, their families, and other caregivers. recognize the conditions in individual patients that present a risk to population health. For the Scholar Competency, the medical graduate will demonstrate an ability to use evidence as one of the anchors of clinical decision making. conduct a skilled critical appraisal of the medical literature and practice guidelines and use information technology to search, retrieve, and organize biomedical information. participate effectively in self-directed learning. For the Collaborator Competency, the medical graduate will collaborate in an interdisciplinary approach based on a knowledge of and respect for the roles of other health care professionals. For the Manager Competency, the medical graduate will manage clinical responsibilities and health care resources in an efficient and effective manner. demonstrate an understanding of the health care system and its impact on the care of patients. ♦ Upon completion of the program, the graduate will be able to function responsibly, in a supervised clinical setting, at the level of an “undifferentiated” physician. New Topics in the Curriculum Since 2000 ♦ Patient safety: Patient safety is covered in one half-day session on inter and intraprofessional communication skills as a patient safety issue. ♦ Interprofessional education: A half-day interprofessionalism session given jointly by the schools of Medicine, Nursing, Physical and Occupational Therapy, and Communication Sciences explores roles of various health professionals. Changes in Pedagogy ♦ Basis of Medicine Educational Methods: There has been a decrease in lecture time in the Basis of Medicine Unit. Some physical examination skills have also been integrated into the Basis of Medicine component. ♦ Several simulation sessions have been added. ♦ Student Response System (clickers): The student response system (SRS or clickers) technology allows instructors to ask questions and collect and display student responses in real time and enables interaction and feedback even in large class environments. ♦ All students are provided with a “clicker” at the time of registration. ♦ ICM: Shadowing Experience. The shadowing experience has been introduced during ICM in a number of courses. ♦ The aims are to enable students to feel more confident when they begin their clerkship and help them identify the clinical and educational challenges that they will meet as a clinical clerk. ♦ Simulation based sessions have also been added to the ICM component of the curriculum. ♦ Simulation Training: With the opening of a new Simulation Center in 2006, simulation has been introduced in many parts of the curriculum. These include communication skills using standardized patients, minor procedures (capillary blood glucose testing, phlebotomy, stool for occult blood testing) during Basis of Medicine, physical examination techniques (sensitive pelvic examination, rectal examination, joint examinations, etc.) during ICM, and procedures (intubation, intravenous cannulation, foley catheter insertion) during clerkship. OSCE examinations in psychiatry, obstetrics and gynecology, and Introduction to Clinical Sciences are conducted there as well. ♦ The above changes have been evaluated positively by student satisfaction surveys. Changes in Assessment ♦ The admissions office now conducts multiple mini-interviews (MMI) to assess applicants. They complete a circuit of 10 10-MMI stations, rotating from station to station. ♦ In January 2010, an OSCE examination was introduced during the Introduction to Clinical Sciences course. ♦ Online Quizzes: Many clerkship rotations are using online quizzes in our WebCT e-curriculum as an assessment tool (Surgery, Obs–Gyn and Geriatrics). ♦ There is an increased use of NBME shelf examinations among clinical clerkship rotations. ♦ There is increased use of simulation center and testing of specific procedural skills. ♦ A new clerkship evaluation form was implemented that also assess professionalism behaviors. ♦ A physicianship portfolio is used throughout the four-year program to assess reflective skills among students. Clinical Experiences ♦ The McGill University Health Center (MUHC) is a merger of five teaching hospitals affiliated with the Faculty of Medicine at McGill University. ♦ The activities of the MUHC are carried out at the following locations: the Royal Victoria Hospital, the Montreal General Hospital, the Montreal Children's Hospital, the Montreal Neurological Hospital, and the Montreal Chest Institute. ♦ There are three other teaching hospitals, Sir Mortimer B. Davis-Jewish General Hospital, St. Mary's Hospital Center, and Douglas Hospital, as well as four affiliated institutions, Hôpital de LaSalle, Lakeshore General Hospital, Centre Hospitalier de Val D'Or, and Shriner's Hospital for Children—Canada. ♦ Students are all required to do at least one month of rural family medicine, and they go to various communities for this; some more than 2,000 km away. ♦ Challenges in our students' clinical education are as follows: Ensuring that there are not too many students on a clinical rotation at a time. This is particularly an issue in pediatrics and obstetrics/gynecology. This is due to our increased class size. Related to this is the challenge in developing new sites for clinical rotations, sometimes in hospitals where there has not been a “teaching culture” and where French is the language of work. One unanticipated (but positive) outcome has been the use of shifts in obstetrics and gynecology. This was instituted originally to accommodate the large numbers of trainees but is very popular with students as they feel the workload is more manageable. Tracking comparability in clinical exposure and teaching is more difficult as clinical sites are added. A new software program (One45) in place since July 2009 has been a significant help in tracking clinical exposures and evaluations of both students and faculty. ♦ Regional Campus: An opportunity for nine selected students to participate in an integrated clerkship in Gatineau, Quebec (200 km from Montreal) will begin in August 2010. Highlights of the Program/School ♦ Physicianship Program: The Physicianship Program focuses on teaching the professional and healer aspects of the practice of medicine. It consists of two series of courses: Physicianship, and Physician Apprenticeship. ♦ The Physicianship Courses (1–4) are taught in each of the four years and include lectures, small groups, simulation-based training in communication skills, as well as required reading and essays. ♦ The Physician Apprenticeship (PA) Courses (1–4) are also taught in each of the four years, led by a faculty mentor known as the Osler Fellow. ♦ Students are assigned in the first week of medical school in groups of six students to one Osler Fellow, and they meet on average six times yearly for four years. ♦ Activities within the PA course include small group discussion on specified topics, maintenance of a learning portfolio, clinical visits, longitudinal follow-up of patients (my first-year patient), and, in some cases, structured participation in community groups. ♦ Simulation Center: The Arnold and Blema Steinberg Simulation Center is used in multiple ways during the four years of the curriculum, some of which are described in the “Changes in Pedagogy” section above. The Simulation Center has become essential to our curriculum throughout the four-year program. ♦ Community Health Alliance Program (CHAP): CHAP is a program that offers students the opportunity to work with community organizations, usually those serving disadvantaged or marginalized populations. Examples include needle exchange programs, programs for dietary support for disadvantaged pregnant women, and aboriginal health groups. ♦ The CHAP initiative introduces medical students to local organizations and was conceived by medical students but incorporated as an option within Physician Apprenticeship in 2008. ♦ ICM: ICM forms the second half of the second year. This phase is relatively unique to McGill University. ♦ During this time, students have completed their basic sciences courses and focus for six months on learning clinical skills in a supervised clinical environment. They are exposed to many different disciplines and shadow residents or clerks to experience an evening on call. This is excellent preparation for their clerkship, which begins in third year, and enables McGill clinical clerks to function much more independently than would otherwise be the case. ♦ Bilingual Students: Although the university and medical faculty function in English, we are located in province that is 90% French speaking. Patients that students will care for will often be primarily French speaking, and a number of institutions that train our students also have French as a working language. As a result, all our students must be functional in both French and English by the time they begin their clinical rotations. We offer French workshops on weekends to help students who require formal instruction to achieve this.