April 2011 Mar 2012 Feb 2012 Dec 2010 Forum #2 April 2012 Oct 2011 June 2011 Sept 2010 Forum #1 Dec 2011 Stakeholder Engagement : Faculty - Student - Post Graduate Government - RHAs - Public ACHIEVED: CuReS Committee Environmental scanning – Seek best practices, conferring/visiting other medical schools or experts/websites Self examination – Solicit internal opinions; review existing curriculum; Broad consultation - Smaller specific task to topic orientated groups; discuss novel ideas Evaluation – Processes & Outcomes April 2011 Dec 2010 Oct 2011 June 2011 Sept 2010 Dec 2011 Forum #2A Feb 2012 Undergraduate Medical Education 1 ONE UNIVERSITY MANY FUTURES. Forum #2 Feb 28, 2012
Transcript
April 2011
Mar 2012
Feb 2012
Dec 2010
Forum #2
April 2012
Oct 2011
June 2011
Sept 2010
Forum #1
Dec 2011
Stakeholder Engagement : Faculty - Student - Post Graduate Government - RHAs - Public
ACHIEVED:
CuReS Committee
Environmental scanning – Seek best practices, conferring/visiting other medical schools or experts/websites
Broad consultation - Smaller specific task to topic orientated groups; discuss novel ideas
Evaluation – Processes & Outcomes
April 2011
Dec 2010
Oct 2011
June 2011
Sept 2010
Dec 2011
Forum #2A
1
Feb 2012
Undergraduate Medical Education
1
ONE UNIVERSITY MANY FUTURES.
Forum #2 Feb 28, 2012
Faculty of Medicine UGME CURRICULUM RENEWAL STEERING COMMITTEE
CuREX REPORT
2
OUTLINE
1. CuRe Current Curriculum (1997) review process
2. Principles extracted from 11 CuRe Task Groups (Faculty Forum 2A)
3. Curriculum “21st century” Framework
4. Description of the Components: CP4 – Composite Clinical Presentations Normal Health & Disease Modules (Modules 0-3)
Foundation Module Normal Biology & Health Module Health & Disease Module Consolidation Module
Clerkship vision (Modules 4-7)
5. Faculty Impact
6. Next Steps
Undergraduate Medical Education
2
ONE UNIVERSITY MANY FUTURES.
UGME CURRICULUM RENEWAL
University of Manitoba UGME CuRe Review
CuRe UGME Faculty Survey Nov 2010
CuRe Faculty Retreat and Report April 2011
CuRe UGME Course & Clerkship Director Surveys June 2011
CuRe Department Representative Focus Groups July 2011
CuRe Task Group (11) Reports Nov 2011
LCME/CACMS Accreditation Oct 2011
• Student surveys • Reports
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 Educ. Development
Undergraduate Medical Education
3
ONE UNIVERSITY MANY FUTURES.
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
4
Summary of issues with current curriculum: Not optimally integrated
Problem Solving (PR) has not been the integrative tool for which it was originally intended.
Limited scaffolding - each organ system taught once as a single unit, frequently in isolation
Some major systems not covered until late Med 2.
Blocks 1 and 2 are viewed by stakeholders as fragmented…. In particular SF –while providing a very superficial overview of all the
systems, it is not viewed as providing the foundational knowledge.
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
UGME CuREXecutive:
Faculty Keevin Bernstein MD Director, CuRe
Ira Ripstein MD Associate Dean,
Gary Harding MD Director, Curriculum
Rob Brown MD Director, CLSF
Don Smyth PhD Basic Scientist
Joanne Hamilton MEd Department Med Ed
Karen Howell MBA Project Manager
Carol Anne Northcott MEd Program Manager
“Consumers” Amit Kaushal MD PGY2* Internal Medicine
Steven Promislow MD PGY2* Internal Medicine
Elizabeth Berg MD PGY2* Surgery
Mark Lipson Med IV MMSA Senior Stick
Steven Montague Med III MMSA Vice Stick
Konstantin Jilkine Med III Communication Rep
Eyal Kraut Med II Academic Rep
Pol Gomez Med II Academic Rep
Jesse Marantz Med I Academic Rep
Harald Gjerde Med I Academic Rep
* All Task Group residents were invited to join executive
Process: Nov 30, 2011 Weekly Monday 2 hour meetings 12-2 Invited guests or presentations
UGME CURRICULUM RENEWAL EXECUTIVE
Undergraduate Medical Education
5
ONE UNIVERSITY MANY FUTURES.
Principles: Physicians for 21st century: Fulfills (or exceeds) UGME global objectives, FMEC recommendations
and LCME/CACME standards
Fully integrated spiral scaffold curriculum throughout 4 years
Person/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
Faculty: More Educational leaders but fewer teachers
More Faculty Development, Evaluation, Reward and Recognition
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
6
UGME CURRICULUM RENEWAL
Foundation MO of Medicine
“Preclerkship” “Clerkship” Year 1 2 3 4
Health & Disease Abnormal Processes: Clinical Integration M2
TTC: Transition to Clerkship M4
Normal Biology & Health M1
Normal Processes: Clinically Applied
Consolidation M3
Junior Clerks (JC) Intersessions JC
M5
Senior Clerks (SC)
Intersessions SC
M6
TTR: Transition to Residency M7
Health & Disease M2
Abnormal Processes
UGME CURRICULUM RENEWAL FRAMEWORK DRAFT Feb 2012
Incorporated into Intersessions • 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
: Modules 0 -3 : Modules 4-7
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:
8
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
8
UGME CURRICULUM RENEWAL
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
9
• Symptoms or Signs • Lab abnormalities • Determinants of Health • States of Health
Provide a basic science foundation relevant to the study and practice of medicine
• Focus 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 ( and relevant clinical) departments who will provide most of the teaching, then continue as respective Department “Leader's”.
Estimated ~ 4 weeks
Foundation of Medicine (Module 0)
10 ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
10
UGME CURRICULUM RENEWAL
1/31/2012
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
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
Introduction to Infectious Diseases/Intro to Oncology Blood, Lymph and Immunology II CV II
Resp II Endocrine II Kidney II Reproduction II GI & Nutrition II Musculoskeletal II & Skin II Neurobiology II (Psychiatry, Clinical Psychology, Neurology, Opth & ENT)
Blood, Lymph, Immunology & Skin I Musculoskeletal I Neurobiology I(Psychology, Neurosciences, Ophth & ENT) CV I & Resp I Kidney I & GI/ Nutrition I 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
Proposed sequencing
Proposed sequencing
DRAFT Feb 2012
UGME CuRe 21st century: Pedagogical Template
Normal Health & Disease Modules : 17 hrs /week- AMs Lectures: Introductions; interdisciplinary; summaries
Proportion & Number of lecturers TBD
Independent learning: role
Assigned studies
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
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 or SLE
Format: Small group Problem solving and clinical reasoning sessions.
Duration: ~ 10 weeks
UGME CURRICULUM RENEWAL
Consolidation Module (Module 3)
Longitudinal Courses: Names TBA
Clinical Reasoning CR (formerly Problem Solving)
Information Sciences* Integration* strategies - eg Case of the week
Pathology ( eg mini hospitals)
CP4
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
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
Scholarly Activity Basic or clinical science research Educational research Community research
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
Vision: Brief introduction: Transition to Clerkship (TTC: M4)- ? 2 weeks Junior clerk: year 3 (M5) and Senior clerk: year 4 (M6) Splitting major rotations into senior and junior rotations. Scheduled “intersessions”:
• Delivery of a formal curriculum • Review and integration of both basic science and clinical concepts • Introduction to the student’s next rotation. • Duration: TBA ? 2 weeks
Increase the ambulatory care experiences in all rotations.
Transition to Residency Module (M7) Following the CARMS match Review for LMCC Ensure all the CP4 have been met at the desired level Provide separate introduction for the graduate’s residency Duration and format: TBA
UGME CURRICULUM RENEWAL
Clerkship Modules (Module 4 - 7)
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
Faculty: Appointed Educational leaders to 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, more involved/committed teachers…..in particular lectures
Formal Faculty Development & Evaluation …equals more support from Department of Medical Education
18
UGME CURRICULUM RENEWAL
1. Foundation of Medicine Module Faculty appointed Module Leader and Committee Taught by basic science (and some clinical) members - mostly lectures
2. Normal Biology, Health and Disease Modules Each Organ System will have a basic science lead:
• Unique to that system eg. Neuro- neurophysiologist; Kidney – pharmacologist; MS – anatomist, etc. • Active participant with Faculty appointed System Leader planning both Normal Biology
& Health (Module 1) and Health and Disease (Module 2) units Each Basic Science Department may have a representative on all the organ systems Normal Biology & Health (Module 1) units will be taught by basic scientists if relevant Role in Health and Disease (Module 2) units Medical Sciences I as proposed by TG
3. Clerkship “Intersessions” Provide opportunity to incorporate review of scientific basic principles applied to clinical
medicine e.g. pharmacology, anatomy, physiology, molecular biology etc. Medical Sciences II as proposed by TG
4. Role in Longitudinal Courses Course Leaders Mentors for scholarly activity projects (… will require as many as 220)
UGME CURRICULUM RENEWAL: BASIC SCIENCE DEPARTMENT ROLE
UGME CURRICULUM RENEWAL
NEXT STEPS:
Approval: Department Heads Council Faculty Executive Council Revised governance to appoint new educational unit leaders
Creation of pedagogical template for Health and Disease Module Units
Development of revised student assessment
Formalizing the Longitudinal Courses, and Theme threads and begin to create linkage with Community.
Appointment of new educational leaders who will then develop their committees and course content
Development of clerkship modules
UGME CURRICULUM RENEWAL FRAMEWORK DRAFT Feb 2012
Module 0: BioFoundation of Medicine Module 1: Normal Biology & Health
Module 2: Health & Disease Module 3: Consolidation
