Fishing for a Longitudinal Integrated Clerkship

at McMaster

Jonel Miklea, MD CCFPAsst Prof, Undergraduate Program Director

Dept of Family MedicineMcMaster University

Hamilton, ON, Canada

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Ice Fishing

• Locations• Shelters• Fishing equipment• Modern ice fishing• Dangers• Contests• Current Fishing Conditions• References

Location

• Canada• Finland• Estonia• Latvia• Norway • Russia• Sweden• Ukraine• Germany• USA

Flinders Minnesota USF Harvard UBC Calgary Edmonton NOSM …and soon McMaster

Shelters

• Shelter = ice shanty, ice shack, fish house, bobhouse, or ice hut.

LIC will be sheltered in our 2 distant campuses; Niagara campus and Kitchener/Waterloo

Fishing Equipment

• Ice saw• Skimmer• Heater• Fishing rod• Lures

Buy in from faculty, deans and community

Interest among students

Budget

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Modern Ice Fishing

• Power drills• Flashers (sonar)• Snowmobiles

• Evidence: students perform as well or better

than colleagues in traditional clerkship programs

graduates overwhelmingly choose primary care specialties

in rurally based programs, at least 50% of grads choose rural practice locations

Dangers

• Walking - 10cm (6cm)• Sleds, Snowmobiles -

12cm• Light cars - 25cm • Frostbites, CO

poisoning from fish-house heaters

Student’s anxiety re exam performance, Exam structure

Administration - central

Equitable experiences

Program evaluation

Contests

• Catching a big fish, no matter what the species, is always a thrill, and it usually requires exceptional fishing skill.

Improved resiliency

Comfort with uncertainty

Patient-centred care

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Current fishing conditions

COMPASS

• Concept-oriented• Multidisciplinary• Problem-based• Practice for transfer• Simulations in clerkship• Streaming

Pre-Clerkship FM Experience

• STUDENTS: Mandatory 6 week at the beginning of Med School or optional 12 weeks

• FACULTY: teaching Clinical Skills, Precepting 6 week Mandatory FM, strong presence in Professional Competencies

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Professional Competencies Domains

• Effective Communication• Professionalism and Role Recognition• Self Awareness and Self Care• Lifelong Learning • Social and Community Context of Health Care• Moral Reasoning and Ethical Judgment• Clinical Examination

Family Medicine Clerkship

• FM Clerkship = 6 week rotation

• 6-7 half days/week with FM clinical preceptor integrated with other teaching activities

• Total # students 182: Local 108 & Rural 76

• 1 tutorial per week

• Daily evaluations & Key Feature Exam

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Integration

4 half days of Palliative Care3 half days of Early years2 half days of Global Health 1 half day of Care of the Elderly2 half days FM Selective2 half days of Complementary/Alternative

Medicine

Our Success

• 50% of our students choose FM as a career choice

• National average 32.5%

LIC Pilot at Mac

• November 2011 • distant campuses Niagara and Kitchener

Waterloo• 8 mo in FM, 1.5 month ward based Peds, 1.5

month ward based IM and 2 month elective• More to share at the 2010 Global Community

Engaged Medical Education Conference, Barossa Valley

References

• Fishing:Gruenwald, Tom and Genz, Dave (1999) Modern

Methods of Ice Fishing

LIC literature:Paul WorleyGwen HalaasLucie WaltersMolly Cook

Conclusions• If students have their clinical training mainly in hospitals,

especially tertiary care hospitals, they will get the message: ‘this is what disease is and this method for investigating it, is the method of medicine.’ If they never care for a patient at home, the message will be ‘the home is no place for a physician.’ If they are taught mainly by specialists, they will get the message: ‘this is where authority, prestige, and power lie.’

Ian McWhinney

• Many men go fishing all of their lives without knowing that it is not fish they are after.

Henry David Thoreau

Thank You!