UGME CURRICULUM RENEWAL EDUCATION RETREAT ( ….Forum …proxycheck.lib.umanitoba.ca/faculties/health_sciences/medicine/... · UGME CURRICULUM RENEWAL EDUCATION RETREAT ( Forum #5)

UGME CURRICULUM RENEWAL EDUCATION RETREAT ( ….Forum #5) February 11, 2013

AGENDA Review CuRe Process and Development Keevin Bernstein

Lunch 12:30 – 13:15 pm ...Includes meeting new colleagues Roundtable Introductions Keevin Bernstein Creating the New PreClerkship Joanne Hamilton

Break 14:30 – 15:00 pm ...Includes networking with new & old colleagues Development of Course Outlines and Joanne Hamilton

Faculty development process

UGME CURRICULUM RENEWAL EDUCATION RETREAT ( Forum #5) February 11, 2013

CuRe Process and Developments to date

1. Current Curriculum (1997) review process- Needs Assessment 2. Principles extracted from 11 CuRe Task Groups 3. Governance 4. Curriculum 21st century Framework

CP4 Normal Health & Disease Modules (Modules 0-3)

Foundation Module Normal Biology & Health Module Health & Disease Module Consolidation Module

Clerkship (Modules 4-7) 5. Evaluation: Student Assessment and CuRe Evaluation

Consistent Pedagogy Scholarship Outcome Based Objectives

Medical Informatics Integrated Continuous Quality Improvement

Inter-Professionalism Flexible Maximize Current strengths

New UGME Curriculum 2013 that fulfills FMEC recommendations & Accreditation Standards

Task Specific groups

External Consultation

Website Educational Experts

Site visits

Internal Review Surveys Retreats

Curriculum map Existing curriculum

Commitment to Patient, Family & Community ; Social Responsibility, Professionalism, Inclusivity; Scholarship, Excellence, Discovery, Innovation, Critical Thinking

UGME CURRICULUM RENEWAL MAP April 2011

OUTCOME>

Process

Principles

Curriculum Renewal

Goal

Mission

Stakeholder Consultations

Faculty Development

UGME CuRe NEEDS ASSESSMENT University of Manitoba UGME Review

CuRe UGME Faculty Survey - FMEC Dec 2010

CuRe Faculty Retreat and Report April 2011

CuRe UGME Course & Clerkship Director Survey June 2011

CuRe Department Representative Focus Group July 2011

LCME/CACMS Accreditation Oct 2011 • Student surveys • Report

CuRe Task Group (11) Reports Nov 2011

External Review; Genevieve Moineau MD June 2008 Associate Dean, UGME University of Ottawa

Internal Review; Oscar Casiro MD Associate Dean UGME 2002 Cheryl Kristjanson PhD Director Education Development

UGME CURRICULUM RENEWAL University of Manitoba UGME Review

CuRe UGME Faculty Survey Dec 2010





CuRe Task Group (11) Reports Nov 2011 External Review; Genevieve Moineau MD June 2008 Associate Dean, UGME University of Ottawa

Internal Review; Oscar Casiro MD Associate Dean UGME 2002 Cheryl Kristjanson PhD Director ED Development

CuRe UGME Faculty Survey Dec 2010





CuRe Task Group (11) Reports Nov 2011

Summary of issues with current curriculum: Not optimally integrated Limited scaffolding - each organ system taught once as a single unit, frequently in isolation Some major systems not covered until late Med 2. Problem Solving (PR) has not been the integrative tool for which it was originally intended. Blocks 1 and 2 are viewed by stakeholders as fragmented

In particular SF which attempts to provide a superficial overview of all the systems; is not seen to provide the foundational knowledge required for future learning.

Limited integration of preclerkship and clerkship No formal overall clerkship curriculum to provide structured review of the scientific basis of medicine or important clinical skills to provide both horizontal and vertical integration Doesn’t fulfill many of FMEC recommendations i.e. social accountability

UGME CURRICULUM RENEWAL 2011

UGME CURRICULUM RENEWAL CuRe Task Groups (11)

Created June 2011 following UGME Spring Retreat (post accreditation)

Collapsed 28 potential topics

2 co-chairs ( 1 from CuRe Steering Committee & 1 expert )

Generic mandate for all TG…….and Key principles identified for each TG

Report to CuRe Steering Committee then synopsis at Faculty Forum & CuRe Website Nov 2011

7

UGME CURRICULUM RENEWAL CURE TASK GROUP (11)

1. CURRICULAR FRAMEWORK

2. PEDAGOGICAL APPROACHES

3. INTEGRATION

4. INFORMATION LITERACY AND INFORMATICS (INFORMATION SCIENCES)

5. TEACHING CLINICAL SKILLS

6. SCIENTIFIC BASIS OF MEDICINE

7. HEALTH CARE SYSTEMS & QUALITY

8. SOCIAL ACCOUNTABILITY FRAMEWORK

9. EXPERIENTIAL & DIVERSIFIED LEARNING CONTEXTS

10. GENERALISM

11. PROFESSIONALISM

( Read handout for summary of each TG) 8

ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education

April 2011

Mar 2012

Feb 2012

Dec 2010

Forum #2

April 2012

June 2011

Sept 2010

Forum #1

Dec 2011

CuRe WG CuRe Ex/WG Environmental scanning – Seek best practices, conferring/visiting other medical schools or experts/websites Self examination – Solicit internal opinions; critique existing curriculum; Broad consultation - Smaller specific task to topic orientated groups; discuss novel ideas

Stakeholder Engagement : Faculty - Student - Post Graduate Government - RHAs - Public

Oct 2011

Evaluation – Processes & Outcomes

Feb, 2012

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

Patient to Community Centered not focused on organ system or department based

Build upon existing or potential strengths

Innovative – utilizing evolving technology

Iterative and Transparent process

UGME CURRICULUM RENEWAL

10

Governance: Modified to enhance & facilitate transparent communication

Maintain quality assurance and curricular stability Recognize faculty – remuneration or time

Faculty: Appointed Educational Leaders: oversee/ensure continuum for each:

Module or Unit within modules Longitudinal Course Discipline/Department or “Theme”

• With job description and appropriate recognition & reward

Each educational “unit” with leader will have a curriculum committee with relevant representation Fewer teachers…..participating in lectures Formal Faculty Development & Evaluation

11

UGME CURRICULUM RENEWAL Principles:

Year 1 2 3 4

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

12

Principle: “Fully integrated spiral scaffold curriculum through 4years”

MO: Foundation M2: Health and

Disease Abnormal Processes Clinical Integration

M1: Normal Biology and Health

Normal Processes Clinically Applied

M3: Consolidation

M2: Health & Disease Abnormal Processes

M4 TTC: Transition to Clerkship

M5:“Junior” Clerks (JC)

UGME

Academic Time

M6:“Senior”Clerks (SC)

UGME Academic Time

M7 TTR: Transition to Residency

Presenter

Presentation Notes

“Titles” of preclerkship, clerkship, systems, year etc may not be maintained Applied Contextualized Linked Relevance

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

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 Darras 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 CuREXecutive: ( Convened Nov 2011) UGME CuRe GOVERNANCE

CuRe Clinical Skills Committee Karen Klym & Rob Brown, Co-Chair Holly Harris Nancy Porhownik Susan Hauch Tom Klonisch TJ Grexton (Med III) Maggie Eade Greg Schmidt (Med III) (Stasa Veroukis Jeanette Edwards)

14

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) (Nicola Matthews) Current Department Clerkship Directors

UGME CuREXecutive ( convened Nov 2011) Keevin Bernstein , Chair

CuRe Progress (Student Assessment) Subcommittee Barry Cohen, Chair Ira Ripstein Brent Kvern, Director , Remediation Allen Kraut Steven Montague (Med IV) Pol Darras (Med III) (Maria Vrontakis , M0-3 Student Assessment Coordinator) (Nancy Porhownik, OSCE Coordinator)

ACTIVE Committees:

Convened June 2012

( later additions)

UGME CuRe GOVERNANCE

UGME CURRICULUM RENEWAL Committees

15

CuRe Preclerkship (M0-M3) Committee Merril Pauls & Keevin Bernstein Co-Chairs Appointed Dec 2012- Effective Jan 1, 2013:

Preclerkship Educational Leaders Longitudinal Course Leaders

UGME CuREXecutive Keevin Bernstein , Chair

Committee not yet convened awaiting new governance/appointments:

FACULTY LEADERSHIP POSITIONS All Positions appointed by UGME Associate Dean ……..….in

conjunction with relevant Department Head

• All non clinical positions are determined by Associate Dean • Clinical positions determined by Department Head

Equivalent transparent EFT grid for all positions with recognition formula:

• Protected Time • Remuneration

Detailed Job descriptions

3 year appointments with performance reviews and

reappointment strategies


17

FACULTY LEADERSHIP POSITIONS:

Directors will ensure curriculum is comprehensively managed and governed

Preclerkship Merril Pauls

Clerkship Clinical Eunice Gill

Clerkship Academic *(M4 & M7) (responsible spiral curriculum /coordinating nonclinical learning)

Nicola Matthews

Integration * (responsible spiralling throughout 4 years specifically CR course & Consolidation Module)

Catherine Moltzan

Simulation * Rob Brown

Clinical Skills Karen Klym

Student Assessment Barry Cohen

Education Development * Joanne Hamilton

Online learning * TBD

Electives ( Clerkship) John Lee * New positions


FACULTY LEADERSHIP POSITIONS Module Leaders : M0*(Foundation Module)

• Educational leader from a basic science department • Don Smyth (Pharmacology) & Cindy Ellison (Pathology) appointed as Co-Leaders • Create curriculum committee with single rep from each BS department

M1/2(Organ system modules)Single Educational leader; clinician • Responsible for coordinating all undergraduate activity pertaining to their

respective organ system (s) • Responsible for the cognitive content throughout 4 years • Supervising the clinical elective/selective pertaining to respective clinical area • Work collaboratively with all relevant department/discipline and longitudinal or

theme leaders • Each M1/2 should have a basic science lead

M3* ( Consolidation Module ) Leader; Clinician = Director, Integration • work closely with CR Leaders feeding into M3


* New positions

19

FACULTY LEADERSHIP POSITIONS

Longitudinal Course* Leaders: Develops and implements the specific LONGITUDINAL COURSE curriculum

including overall goals and educational objectives, types of sessions, and student material

Works with Preclerkship and Clerkship Academic Directors, M1-3 Leaders, and Clerkship Rotation Leaders to ensure appropriate longitudinal COURSE content is covered during the academic sessions

Develops student assessment in collaboration with Director

Longitudinal Theme* Leaders Works with preclerkship and clerkship academic directors, M1-3 Leaders, and

Clerkship rotation Leaders to ensure appropriate LONGITUDINAL THEME content is covered during the M1/2 courses, clinical exposure or academic sessions

No separate student assessment


* New positions

20

FACULTY LEADERSHIP POSITIONS

Discipline*Leaders(Clinical Departments or Sections without core rotations) Works with preclerkship and clerkship academic directors, M12 Leaders, and

Clerkship Rotation Leaders to ensure appropriate content is covered during M1/2 courses, clinical exposure or academic sessions

Supervises sub-rotation including creating objectives and academic content

Basic Science Department* Leader Each basic science department will have a single leader representing them

Participate in MO Appoint representation to M1/2 courses Determine if relevant content for Clerkship Academic Half Day

M1/2 Course Committees Chaired by M1/2 Leader Membership allocated by Longitudinal Theme Leader, Discipline Leaders , and /or

Basic Science Department Leader


* New positions

April 2011

Forum #4

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 #2

21 Undergraduate Medical Education

21 ONE UNIVERSITY MANY FUTURES.

Forum #3

Mar 2013

Feb 2012

Jan 2013

Dec 2012

Mar 2012 June 2012

Created: April 2011

Modified : Oct 2012

Aug 2013

Aug 2013

Clerkship

Mar 2012

April 2012

Modified : Dec 2012

Dec 2012 Aug 2014

PreClerkship

April 2012 Oct 2012 Dec 2012

Feb 2013

Year 1 2 3 4





22






M3: Consolidation




UGME

Academic Time


UGME Academic Time


Presenter

Presentation Notes


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………sample schedule created (enclosure)

Foundation of Medicine (Module 0)

23 23


Year 1 2 3 4





24






M3: Consolidation




UGME

Academic Time


UGME Academic Time


Presenter

Presentation Notes


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

25

• 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

25


http://www.ucalgary.ca/mdprogram/node/622

26

Composite Clinical Presentations CP4* UGME Sept 2012 DRAFTV6 HEALTH CONDITIONS

SYMPTOMS & SIGNS 34 hemoptysis ABNORMAL LABS 99 ADHD spectrum 1 abdominal mass 35 hirsutism 66 acidosis 100 adrenal disorders 2 abd pain: acute & chronic 36 hoarse voice 67 alkalosis 101 arthritis 3 allergic reactions 37 impotence 68 hemoglobin disorders 102 CVD 4 anxiety 38 incontinence 69 calcium/phopshate/magnesium 103 cirrhosis 5 ascites 39 jaundice 70 cardiac markers/EKG 104 CNS infections 6 blunt trauma 40 joint pain-acute & chronic 71 coagulation abnormalities 105 diabetes

7 burns 41 low back pain 72 creatinine:acute & chronic 106 Drug OD 8 bleeding 42 lymphadenopathy 73 CXR abnormalities 107 eating disorders 9 cardiac murmurs 43 neck mass/thyroid 74 lipd abnormality 108 fungal infections

10 chest pain 44 pain syndrome 75 leukocyte disorders 109 HIV/AIDS 11 constipation 45 palpitations 76 liver enzymes/function 110 hypertension 12 cough- acute & chronic 46 pruritus 77 potassium abnormalities 111 infertiltiy 13 cyanosis 47 red eye 78 platelet disorders 112 kidney disease-chronic 14 delirium 48 paralysis 79 pulmonary function tests 113 lung disease-chronic 15 dementia 49 pelvic pain/mass 80 sodium abnormalities 114 malnutrition 16 diarrhea- acute & chronic 50 seizures 81 urinalysis abnormalities 115 menses/menopause 17 diplopia 51 skin growths FACTORS EFFECTING HEALTH 116 mood disorders 18 dysphagia 52 skin rashes 82 adverse drug reactions 117 multiple sclerosis 19 dyspnea-acute & chronic 53 sleep disorders 83 chronic disease 118 osteoprosis 20 dysuria/UTI 54 somnolence 84 Contraception 119 pediatric emergencies 21 ear pain 55 sore throat 85 Culture 120 palliative care 22 edema 56 syncope 86 WHO Determinants of Health 121 pituitary disorders 23 extremity pain-acute&chronic 57 tendon rupture 87 developmental pediatric delay 122 pregnancy/complications 24 eye trauma 58 testicular swelling/pain/mass 88 Disabilities 123 psychosis 25 fever 59 tinnitus 89 neglect/abusive relationship or behavior 124 suicidal behavior 26 fatigue 60 vomiting 90 educational level 125 shock/resuscitation 27 foot ulcers 61 vision loss acute&chronic 91 elderly/frail 126 sports injuries 28 fracture/dislocation 62 weakness 92 environmental health 127 STI 29 GI bleed 63 wheezing- acute & chronic 93 infectious epidemic/prevention 128 suicidal behavior 30 head injury 64 UT obstruction symptoms-lower 94 food and water security 129 systemic autoimmune disorders 31 headache 65 vertigo/dizziness 95 body weight disturbances 130 surgical infections 32 hearing loss 96 substance abuse/addiction/alcoholism 131 TB 33 hematuria 97 poverty 132 thyroid disorders

98 smoking 133 Venous thrombosis

*Complied from MCC objectives, UGME CD survey 2010 , 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

27

Composite Clinical Presentations CP4* UGME Sept 2012 DRAFTV6 HEALTH CONDITIONS

SYMPTOMS & SIGNS 34 hemoptysis ABNORMAL LABS 99 ADHD spectrum 1 abdominal mass 35 hirsutism 66 acidosis 100 adrenal disorders 2 abd pain: acute & chronic 36 hoarse voice 67 alkalosis 101 arthritis 3 allergic reactions 37 impotence 68 hemoglobin disorders 102 CVD 4 anxiety 38 incontinence 69 calcium/phopshate/magnesium 103 cirrhosis 5 ascites 39 jaundice 70 cardiac markers/EKG 104 CNS infections 6 blunt trauma 40 joint pain-acute & chronic 71 coagulation abnormalities 105 diabetes

7 burns 41 low back pain 72 creatinine:acute & chronic 106 Drug OD 8 bleeding 42 lymphadenopathy 73 CXR abnormalities 107 eating disorders 9 cardiac murmurs 43 neck mass/thyroid 74 lipd abnormality 108 fungal infections

10 chest pain 44 pain syndrome 75 leukocyte disorders 109 HIV/AIDS 11 constipation 45 palpitations 76 liver enzymes/function 110 hypertension 12 cough- acute & chronic 46 pruritus 77 potassium abnormalities 111 infertiltiy 13 cyanosis 47 red eye 78 platelet disorders 112 kidney disease-chronic 14 delirium 48 paralysis 79 pulmonary function tests 113 lung disease-chronic 15 dementia 49 pelvic pain/mass 80 sodium abnormalities 114 malnutrition 16 diarrhea- acute & chronic 50 seizures 81 urinalysis abnormalities 115 menses/menopause 17 diplopia 51 skin growths FACTORS EFFECTING HEALTH 116 mood disorders 18 dysphagia 52 skin rashes 82 adverse drug reactions 117 multiple sclerosis 19 dyspnea-acute & chronic 53 sleep disorders 83 chronic disease 118 osteoprosis 20 dysuria/UTI 54 somnolence 84 Contraception 119 pediatric emergencies 21 ear pain 55 sore throat 85 Culture 120 palliative care 22 edema 56 syncope 86 WHO Determinants of Health 121 pituitary disorders 23 extremity pain-acute&chronic 57 tendon rupture 87 developmental pediatric delay 122 pregnancy/complications 24 eye trauma 58 testicular swelling/pain/mass 88 Disabilities 123 psychosis 25 fever 59 tinnitus 89 neglect/abusive relationship or behavior 124 suicidal behavior 26 fatigue 60 vomiting 90 educational level 125 shock/resuscitation 27 foot ulcers 61 vision loss acute&chronic 91 elderly/frail 126 sports injuries 28 fracture/dislocation 62 weakness 92 environmental health 127 STI 29 GI bleed 63 wheezing- acute & chronic 93 infectious epidemic/prevention 128 suicidal behavior 30 head injury 64 UT obstruction symptoms-lower 94 food and water security 129 systemic autoimmune disorders 31 headache 65 vertigo/dizziness 95 body weight disturbances 130 surgical infections 32 hearing loss 96 substance abuse/addiction/alcoholism 131 TB 33 hematuria 97 poverty 132 thyroid disorders

98 smoking 133 Venous thrombosis

*Complied from MCC objectives, UGME CD survey 2010 , UBC website

Year 1 2 3 4





28






M3: Consolidation




UGME

Academic Time


UGME Academic Time


Presenter

Presentation Notes


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 1 II = Health and Disease……………..Module 2

1: 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

2: 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

UGME CuRe 21st century: Normal Health & Disease Module formerly “System” Course Template

29

Normal Biology & Health…(“systems I”) 1 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” ) 2

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

30

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

31

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 >>>>> 32

Normal Biology and Health wks.days ( w. 2 days eval ) Approximate dates

UGME CuRe Preclerkship M1/2: Health & 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 33 Consolidation 10-------------Mar 23 - May 29

5

PROPOSED /DRAFT

Year 1 2 3 4





34






M3: Consolidation




UGME

Academic Time


UGME Academic Time


Presenter

Presentation Notes


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

Consolidation Module (Module 3)

35


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


• Themes/Disciplines Composite Clinical Presentations (CP4) 36

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 Academic time

“Senior”Clerks (SC) UGME Academic time TTR: Transition to Residency


Presenter

Presentation Notes


Longitudinal Courses: Names TBA

Clinical Reasoning CR (formerly Problem Solving) Information Sciences* Integration* strategies - eg Case of the week Critical Thinking 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

37

Not developed for 2013 -2014 ?CHS Academic project for Clerkship

Longitudinal Themes: Themes: Not individual courses but thread throughout curriculum with a designated leader:

Generalism * Information Science* Diagnostic Imaging Leadership* Geriatrics Genetics Pediatrics Palliative Care Health Care Systems/Safety* Interprofessional Education*

UGME CURRICULUM RENEWAL *CuRe TG

38

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/Public Health • Indigenous Health • Scholarly activity with community

39

Person to Community Centered :

UGME CURRICULUM RENEWAL –CLINICAL SKILLS

Service Learning ( Currently Co-Curricular ) • WISH clinic • Winnipeg Harvest • 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

40

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

41

Service Learning ( Currently Co-Curricular or becomes curricular) Learning in the Community ( Curricular)

UGME CURRICULUM RENEWAL: Clinical Skills

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 42

UGME CuRe 21st : Pedagogical Template DRAFT DRAFT April 2012

Year 1 2 3 4


• Themes/Disciplines Composite Clinical Presentations (CP4) 43

Year 1 2 3 4 Year 1 2 3 4

Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”

MO: Foundation M2: Health &

Disease Abnormal Processes- Clinical Integration

M1: Normal Biology & Health Normal Processes- Clinically Applied

M3: Consolidation




UGME Academic time


UGME Academic time



Presenter

Presentation Notes


CLERKSHIP plans to date 2013:Year 3(M4&M5)

ECP and CP4 Don’t need to be rotation specific - tracked electronically

Transition to Clerkship (TTC) 5 weeks

Block 1 Surgery /Anesthesia

Block 2 Peds and OG

Block 3 Int /Emerg Med

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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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, Indigenous Health & Clinical Reasoning Incorporated into clinical rotation or UGME Academic half day

HIGHLIGHTS: Preparation for clerkship with enhanced simulation and shadowing opportunities

Final week : Shadowing on 1st rotation • TCS: “Transition to Clinical Service”

“Grace” Day – utilize new Grace Simulation lab ; • Each student spends 1 full day at Grace with 12-14 /group split into 2 • Create 3-4 IM simulation cases in half day ; Other half day shadowing • Sim. AM and Shadow PM ; other half vice versa • Other students not at Grace divided into groups of 7 ; combo of Small Group

Sessions (SGS), Brodie SIM ( 10 in total), CPA and Consolidation

Create 10 other “shadowing “ experiences • Chosen from a catalogue of options to include ones created by LC or theme

ie aboriginal services, lab, etc.

“Consolidation” – truncated version of 10 week M3 planned for med 2 ; • Allocate 3 sessions per week

Transition to Clerkship (TTC): 5 weeks

Block 1: Surgery /Anesthesia: 3 groups- 9 students /group Segment A Segment B Segment C

# Weeks 2 2 2 2 2 2 Group A 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 46

CLERKSHIP plans to date 2013:Year 3 (M5) Block 1: Surgery /Anesthesia: 3 groups- 9 students /group

Segment A Segment B Segment C

# Weeks 2 2 2 2 2 2 Group A General Surgery Subspecialty

Surgery Orthopedic /MSK Med


Group B Subspecialty Surgery

Orthopedic /MSK Med


General Surgery

Group C Anesthesia Perioperative Care

General Surgery Subspecialty Surgery

Orthopedic /MSK Med

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Block 2: Obstetrics & Gynecology and Pediatrics #

Weeks 6 6

2 2 2 3 3

Group2

Peds Emergency & Outpatient

Peds Inpatients

Obstretrics Gyne Clincs

Obs/Gyn: Jenna MacNaught Pediatrics: Jeff Hyman Create shared academic time where possible

Integrate longitudinal Courses and Themes

Group1 Obstretrics Gyne Clincs Peds Emergency & Outpatient

Peds Inpatients

CLERKSHIP plans to date 2013:Year 3(M5)

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). 6 weeks general Internal Medicine (CTU)

2 weeks of Internal Medicine selective

Create shared academic time where possible


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Block 3: 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

Emergency: Mona Hegdekar Internal Med: Mike Semus


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Block 4: Family Medicine and Psychiatry # Weeks 6 6

Group1 Family Medicine Psychiatry Group2 Psychiatry Family Medicine

Family Med: Susan Hauch Psychiatry: Eunice Gil

Psychiatry • More ambulatory care - Shared care model with Family Med

Family Medicine

• Rural Family med – incorporate rural Public health officer

Create Create shared academic time where possible



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Develop Year 4 ( M6 & M7) M6 – Electives pre CaRMS ( 17 weeks including interviews)

ie no Change Need to 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 plans 2014:Year 4(M6 & M7)

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CuRe EVALUATION

1. UGME : STUDENT ASSESSMENT Maria Vrontakis , M0-3 (Preclerkship)Student Assessment Coordinator

Nancy Porhownik, OSCE Coordinator

Barry Cohen, M4-7 (Clerkship)Student Assessment Coordinator

2. UGME CuRe EVALUATION Department of Medical Education led Joanne Hamilton

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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%

PRECLERKSHIP: Module (M0-M3) Courses:

• Each M1 and M2 course evaluated and passed separately i.e. No cumulative single block exam

Proposed: • 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

CuRe: STUDENT ASSESSMENT PLAN – Barry Cohen

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UGME CuRe EVALUATION

Quantitative: 1. Class surveys with Demographic information : post admission, post

preclerkship and post clerkship 2. LMCC scores: pre and post 3. NBME scores: pre and post 4. Course and Rotation Evaluations: pre and post 5. Canadian Graduate Survey: comparison pre and post implementation 6. Faculty Evaluation results: pre and post implementation

Qualitative: 7. Faculty Focus groups, interviews (and surveys) 8. Staff focus groups, interviews (and surveys) 9. Student focus groups, interviews

Administrative data 10. Changes in instructional strategies 11. Administrative workload

Two Questions: Is the new curriculum an improvement over the old? Does the new curriculum achieve its objectives?

UGME CURRICULUM RENEWAL GOVERNANCE UGME CuREXecutive ( Directors) Preclerkship Keevin Bernstein Chair Clerkship Merril Pauls Ira Ripstein Associate Dean Eunice Gill Nicola Matthews Gary Harding Curriculum Clinical Academic Rob Brown Simulation (Transition:TTC) Catherine Moltzan Integration Karen Klym Clinical Skills Barry Cohen Assessment Joanne Hamilton Educ. Development

Preclerkship M0 & M1/2

Leaders

Longitudinal Courses Leaders

Clerkship Core Rotation

Leaders

Longitudinal Theme Leaders

Presenter

Presentation Notes


UGME CURRICULUM RENEWAL Committees

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Proposed Reporting GOVERNANCE

Preclerkship (M0-3) Committee Content relevant to preclerkship only Chaired by Preclerkship Director Meets Q3m or call of chair

Scheduling Student assessment Faculty evaluation

Clerkship (M4-7) Committee Content relevant to clerkship only Chaired by Clerkship Directors Meets Q3m or call of chair

Scheduling Student assessment Faculty evaluation

Curriculum Integration (M0-M7) Committee Content relevant to all 4 years Chaired by Curriculum Director All UGME Directors and Leaders Meets Q3m or call of chair

Course or rotation review

Year 1 2 3 4





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Principle: “Fully integrated spiral scaffold curriculum through 4 years”

MO: Foundation M2: Health &

Disease Abnormal Processes- Clinical Integration

M1: Normal Biology & Health Normal Processes- Clinically Applied

M3: Consolidation




UGME Academic time


UGME Academic time


Presenter

Presentation Notes


FD Module 1 PRECLERKSHIP LAUNCH EDUCATION RETREAT Feb 11 2013

FD Module 2&3 ASSESS NEEDS & DEVELOP COURSE OUTLINE April early 2013 All courses to present outline; 4 hrs Tina will survey FD Module 4&5 UNDERSTANDING LEARNING Online

WRITING GOALS AND OBJECTIVES

FD Module 6&7* WRITING MCQ QUESTIONS with MCC 1/2day May early 2013 ASSESSMENT: MORE THAN MCQ (*OPTIONAL)

FD Module 8&9 CHOOSING LEARNING STRATEGIES ; 2 hrs June early 2013

FD Module 10 PRESENT OBJECTIVES & DETAILED OUTLINE Sept. late 2013 two half days vs one full day ? Tina will survey

FD Module 11 MAPPING AND BLUEPRINTING Online

FD Module 12 COURSE EVALUATION Oct. late 2013

FD Module 13 SYLLABUS Nov. late 2013

DEADLINE : FINAL OUTLINE/SYLLABUS/OBJECTIVES Jan. 30 2014 OPAL ready for schedule

SENATE SUBMISSION Feb. 14 2014

Preclerkship CuRe Timelines & Faculty Development Plan

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