Farrell, Gerard J. MD; Peters, Sharon D. MD; Rourke, James T. MD
Curriculum Management and Governance Structure
♢ The Undergraduate Medical Studies (UGMS) Committee is a standing committee of the Faculty Council, designated with the responsibility of governance of and policies related to the curriculum. This committee is chaired by one of its members, elected by it. Members are both elected and ex-officio faculty and students.
♢ Through policy, the UGMS Committee determines the objectives of the curriculum and its method of delivery. Through subcommittees the UGMS Committee determines the effectiveness of the delivery and quality of the outcomes.
♢ The UGMS Committee also approves any change to the curriculum (new course/clerkships, amendments to courses/clerkships).
♢ The UGMS Committee brings to the Faculty Council any policy change that requires change in the university calendar.
♢ Subcommittees of the UGMS Committee are
* Programme Evaluation Subcommittee,
* Student Assessment Subcommittee, and
* Information Technology Subcommittee.
Office of Education
♢ The Undergraduate Medical Education (UGME) Office is responsible for curriculum delivery and management.
♢ The Associate Dean for Undergraduate Studies leads the office, reports to the Dean, and is responsible for day-to-day and strategic administrative decisions on curriculum delivery.
♢ The Associate Dean for Undergraduate Studies is supported in his/her role by the Undergraduate Management Team.
♢ The Team consists of the Associate Dean Undergraduate Studies, Preclerkship and Clerkship Coordinators, and the UGME Office Coordinator.
♢ The Preclerkship and Clerkship Committees oversee the implementation of the curriculum.
♢ The Preclerkship committee is chaired by the Pre-Clerkship Coordinator and consists of the chairs of the courses offered.
♢ The Clerkship Committee is chaired by the Clerkship Coordinator and consists of the discipline clerkship coordinators and the electives coordinator.
♢ The UGME Office is staffed by 11 full-time positions to support curriculum delivery.
♢ Memorial University Faculty of Medicine makes extensive use of rural and remote sites for clerkship teaching. To facilitate this, the Assistant Dean for Rural Clinical School Medical Education Network has been tasked with ensuring adequate infrastructure is in place in each of our rural sites to permit a complete education experience regardless of the geographic location of the clerkship.
♢ The Rural Clinical School Medical Education Network office is staffed by two full-time positions to accomplish its work, and four rural/regional positions are being added.
♢ The Health Sciences Information & Media Service assists curriculum delivery by providing instructional design, multimedia, and information technology support to the Faculty of Medicine.
♢ The Medical Education Scholarship Centre (MESC) was created to enhance the development of medical education scholarship throughout the faculty.
Financial Management of Educational Programs
♢ Newfoundland and Labrador's overall economy has become more centered on the oil found off our coast. The economy has performed better than the rest of Canada during the global economic downturn. Canada's economy, in turn, has been more robust than that of the United States.
♢ We have had increasing funding since 2007 for:
* Expansion of the Medical School, its faculty and staff, and its rural and regional network.
* A new medical education and research building that will include a state-of-the-art simulation centre, a standardized patient area, and small-group teaching rooms, as well as educational support offices and advanced information technology services. This will enable medical class size to increase from the current 64 to 80 or more once construction is completed.
♢ Leading rural teaching physicians now have full-time faculty appointments in a clinical educators career path.
♢ The Medical Education Scholarship Centre has research assistants to help faculty take their innovations beyond delivery.
♢ The establishment of a teaching scholar program is being investigated.
♢ Awards for outstanding teaching as determined by students are presented to those recognized in the first-, second-, and third-year curricula.
♢ The graduating class each year chooses a member of the faculty for, respectively, the Silver Orator award, the D.W. Ingram Award (for excellence in clinical teaching), and the Killick Award (for an outstanding contribution to a graduating class by a member of the faculty or staff).
♢ HSIMs and MESC are providing more support in the development and better delivery of curricular elements for those both interested in and involved in medical education.
♢ In April 2009, the promotion and tenure guidelines for physician faculty were revised to reflect a new “Four Pillars” model:
Clinical Excellence, as demonstrated by outstanding clinical care, and effective teamwork that enhances patient care management and outcomes.
* Faculty are expected to excel in collaboration, communication and professionalism.
* Examples of clinical excellence may be demonstrated by such activities as the creation and introduction of clinical guidelines, development and evaluation of new diagnostic or therapeutic techniques, and design and implementation of new delivery models of care.
Excellence in Scholarship of Education, as demonstrated by the spectrum from direct teaching to involvement in the development of learning objects to contribution to overall curriculum design and implementation locally, nationally and internationally.
* Examples of these activities include curriculum development, innovation in instructional delivery methods, and evaluation.
* Educational scholarship and its dissemination are encouraged and valued.
* Faculty are encouraged to develop learning objects such as DVDs/CDs, course syllabi, Web sites, and other products beyond the traditional publications and presentations.
* Teaching dossiers should include objective evaluations of new objects. Teaching honours and awards are a traditional and important recognition of educational instructional excellence. These are by no means meant to be limiting or exclusive in scope;
Excellence in Scholarship of Discovery, as demonstrated by research impact that includes every phase of the cycle of knowledge generation, exchange, translation, and implementation.
* Peer-review publications and research awards, as well as local, national or international presentations are considered.
Excellence in Leadership, as demonstrated in local, provincial, national or international leadership positions in clinical, research, educational or public service positions.
♢ The adoption of these guidelines recognizes the heterogeneity of the contributions of clinical faculty to the process of medical education, research, and leadership and attempts to reward such contributions fairly. They have been seen as a better fit for physician faculty than the standard university criteria that were previously used.
Curriculum Renewal Process
♢ A strategic planning exercise in 2007 identified curriculum renewal as a priority. As a result, the Medical Education Leadership Team (MELT) was formed to facilitate the renewal process.
♢ MELT has completed a literature review in the areas of governance and design, pedagogy, and student assessment.
♢ MELT has completed a needs assessment to fully document needs, gaps, and redundancies in the current curriculum within the framework of CanMeds roles.
♢ Work is underway in mapping the undergraduate learning objectives to the CanMeds competencies and to specific areas of the proposed curriculum design.
♢ Cases are being designed that will be used as the backbone for the spiral format of the curriculum helping to link the phases within the curriculum in the context of the population of Newfoundland and Labrador.
♢ A blended learning approach to teaching and learning methods with link to the overall objectives and competencies is planned.
♢ The learning objectives for the current curriculum were the Medical School Objectives Project (MSOP) as our overarching objectives and Medical Council of Canada examination objectives as our specific outcomes objectives.
♢ As part of the curriculum renewal process, it has been decided that CanMEDS competencies replace the MSOP objectives as our overarching curriculum objectives in the future.
New Topics in the Curriculum Since 2000
♢ The Black Bag, a two-week rural clinical placement at the end of the second year
♢ Humanities Ethics and the Law in Medicine (including Professionalism), now part of Clinical Skills
♢ Complementary and Alternative Medicine
♢ Expansion of Family Medicine Clerkship from four to eight weeks
♢ Interprofessional Health Education
♢ Initiatives are under way to emphasize the following health issues in the curriculum:
* Lesbian, Gay, Bisexual and Transgendered;
* Aboriginal, First Nations, and Metis;
* Patient Safety (already started with the preclerkship module done by CCHPE in year one); and
* Anaesthesia and Emergency Medicine, to be included as core clerkship rotations.
Changes in Pedagogy
♢ As a result of decreased availability of patients suitable for Clinical Skills teaching, standardized patients and simulation are being enhanced as ways of teaching students clinically important skills.
♢ Memorial University has led the development of telemedicine and teleconferencing for medical education.
♢ Students are involved in telemedicine as an integral part of health care delivery to patients in Newfoundland's and Labrador's many distant rural communities.
♢ A member of the faculty has recently been charged with continuing this work by doing an inventory of our current practices and technologies and strategizing how we might use emerging methods in delivering medical curricula.
♢ The interprofessional education modules at many universities are optional activities.
♢ At Memorial, we have developed a compulsory modular program in conjunction with the Nursing, Pharmacy, Social Work, Human Kinetics, Education, and Counselling Centre.
♢ In response to feedback from students, compulsory IPE modules have been modified in terms of volume and content to achieve an effective balance.
♢ At the end of every subject/course, students are given the opportunity to provide feedback about the subject/course. This information is reviewed by the Programme Evaluation Subcommittee.
♢ The scores received by the subject/course in areas of identified curriculum delivery are compared to acceptable benchmarks that have been determined by the committee. Subjects/courses that do not meet these benchmarks are required to outline for the committee in writing how they plan to rectify the deficiencies. If the committee does not find the written response to be sufficient, they can require the subject/course chair to appear before the committee to answer in person. If still not satisfied with the response, the committee will inform the UGMS Committee of the situation.
Changes in Assessment
♢ Standardizing methods of examination, determination of failing grades, and work to move the examination process online for increased efficiency of grading is all work of the Student Assessment Subcommittee.
♢ It was recognized that some of our students who failed a subject or course had declining marks recorded prior to the failing grade. In the hope of identifying such students before they recorded a failure, a system for identifying borderline performance was instituted.
Highlights of the Program/School
♢ The smaller class size (64 learners per year) fosters cohesion and collaboration and provides students and faculty with more individual attention, support, and flexibility.
♢ From the beginning, students have an exceptional opportunity for close interaction with faculty. This becomes a core ingredient in their clinical rotations.
♢ The Gateway Project, while not part of the curriculum, is supported by the Faculty of Medicine and sees participation by large numbers of first- and second-year students. This project involves student volunteers meeting with newly-arrived refugee clients of the Association for New Canadians (ANC), in the presence of a translator. The student takes and records the medical history, which can be sent to a doctor recruited to take on refugee clients. This information facilitates the client being accepted as a new patient by the family physician.
♢ Rural physicians and general specialists are in high demand not only in Newfoundland and Labrador but across Canada. In Canada, about 20% of the population lives in an area classified as rural. However, only 11% of Canadian medical students have rural backgrounds.
* 30–50% of our medical students come from a rural setting.
* Memorial received the 2008 award from the Society of Rural Physicians of Canada (SRPC) for having the highest percentage of medical school graduates to do specific rural family medicine training programmes (Canadian average, 8%; Memorial, 26%). More than 40% of doctors who did their family medicine training at Memorial establish practice in rural communities.
* The Memorial family medicine training programme was awarded the 2010 SRPC award for having the highest percentage of graduates practicing in rural areas ten years after graduation (Canadian average, 20.9%, Memorial, 52%; Rourke J. How can medical schools contribute to the education, recruitment and retention of rural physicians in their region? Bulletin World Health Org. 2010;88:395–396).
* Much of the teaching and learning happens in a rural setting. This is not just on an elective basis but for core rotations as well. This approach, in part, is in support of producing a more generalist physician at the end of our training. This leads to a more individualized and a very hands-on experience, especially in clerkship.
* We encourage rural experience in postgraduate training as well. One example is the NorFam (Northern Family Medicine Education) Program. This approach to family medicine postgraduate training heavily emphasizes rural rotations and is designed to train physicians for rural practice.
♢ Hosted at Memorial, MDcme is an association of 17 Canadian medical schools, in partnership with the Canadian Medical Association and the College of Family Physicians of Canada, to provide the highest quality online continuing professional development for physicians.