Curriculum Management and Governance Structure
♢ The Undergraduate Medical Education Program Committee, chaired by the Director of Undergraduate Medical Education, has the overall responsibility for the design, planning, organization, implantation, evaluation, and management of the undergraduate medical program at Université Laval.
♢ There are separate subcommittees for the preclerkship and the clerkship components of the medical program. The preclerkship subcommittee is chaired by the Director of Undergraduate Medical Education and the clerkship subcommittee is chaired by the Assistant Director for Clinical Studies.
♢ There is a separate committee responsible for admissions to the undergraduate medical program. It is chaired by the President of the Undergraduate Medical Admissions Committee.
♢ The Undergraduate Medical Education Program Committee and the Undergraduate Medical Admissions Committee report to the faculty Vice Dean for Undergraduate Studies, who then reports to the Dean of the faculty and ultimately to the Faculty Council (see Figure 1).
♢ The office of the Vice Dean for Undergraduate Studies has overall responsibility for the organization and management of the resources required for the support of undergraduate medical admissions and curriculum. There is a staff of approximately 15 members.
♢ The role of the Vice Dean for Undergraduate Studies is to oversee all aspects concerning admission to and management of the undergraduate medical program, as well as to work with the Dean's Executive Committee, other faculties, the university, and other medical schools and organizations in matters concerning the undergraduate medical program.
Office of Education
♢ The Faculty of Medicine has a specific Vice Dean for Pedagogy and Continuing Professional Development.
♢ There are five divisions, each with a faculty member who is responsible for the activities. The divisions are: pedagogical development; evaluation; simulation; continuing professional development; research in health sciences education.
♢ The office of the Vice Dean for Pedagogy and Continuing Professional Development has a staff of approximately 25 members. In addition, there are numerous professors and clinical associates who participate very actively in the various areas.
♢ The role of the office of the Vice Dean for Pedagogy and Continuing Professional Development is to support all the medical faculty's programs in their educative missions and to advance research and scholarship in health sciences education.
Office of Student Affaires
♢ The Faculty of Medicine has an Office of Student Affaires with a Director who reports directly to the Dean.
♢ The role of the Office of Student Affaires is to support students of all the medical faculty's programs and to assist them in their adaptation during the various steps of their studies.
♢ There are four divisions, each with a faculty member who is responsible for the activities. The divisions are: prevention, identification, and intervention for students in difficulty; aid in career choice; support in situations of intimidation or harassment; financial aid.
♢ The Office of Student Affaires collaborates actively with the university Student Affaires Services.
Financial Management of Educational Programs
♢ Université Laval is a publicly funded university in Quebec, a Canadian province where the tuition fees are very strictly regulated by the provincial government. Annual tuition fees for a Quebec resident are approximately $5,000 Cdn.
♢ The Office of Student Affaires assists students in need in finding appropriate financial help.
♢ The medical faculty is funded by the provincial Ministry of Education, through the university, for its undergraduate medical program.
♢ The medical faculty also receives some financing from the provincial Ministry of Health and Social Services for certain clinical activities of the undergraduate program.
♢ For over 40 years the Faculty of Medicine has had various services for pedagogical support and development. In 2010, the faculty united all the activities in this area and created the office of the Vice Dean for Pedagogy and Continuing Professional Development. The mandate of this sector is to support the faculty's programs and educators and to promote excellence in teaching, scholarship, research, and leadership in health sciences education.
♢ Decisions taken for promotion and tenure at the Faculty of Medicine place considerable value on teaching and scholarly educational activities.
Curriculum Renewal Process
♢ In 2003, the Faculty of Medicine undertook a major curriculum renewal project for the undergraduate medical program, the first since 1982, when the program changed from a discipline-based approach to a system-based approach. The orientations of this recent revision were to have a program;
* based on the competencies deemed essential for all Canadian physicians and which should be acquired by the end of the program;
* that forms doctors centered on their community and on responding to the needs of all the Quebec society;
* including integration of fundamental and clinical sciences in system-based courses and in new longitudinal courses where students learn also history-taking, physical examination, and clinical reasoning and concentrate on the elements of an appropriate doctor–patient relationship;
* based on a variety of pedagogical approaches and methods;
* based on collaboration instead of competition;
* using a variety of clinical training sites, urban and regional, hospitals and clinics etc., and;
* continuing to offer a preclerkship phase of variable duration (two, two and a half, or three years), facilitating various program enrichments: international health, research, education in other fields etc.
♢ The revision process involved broad-based faculty and student participation during several years. The revised program was implemented in 2007, establishing a curriculum that fulfilled the initial objectives, and that is now greatly appreciated by both students and faculty.
♢ The educational objectives are structured around five core competencies: clinical expertise, communication, collaboration, erudition, and professionalism.
♢ For the list and descriptions of the competences and objectives, please visit http://www.fmed.ulaval.ca/site_fac/index.php?id=1,454.
New Topics in the Curriculum Since 2000
♢ Several areas have been included or expanded with the curriculum revision. These include the social and cultural determinants of health and sickness, professionalism, interprofessional team collaboration, patient safety, complementary and alternative medicine, palliative care, and acquisition of certain clinical skills in our well-equipped interprofessional simulation center.
Changes in Pedagogy
♢ With the curriculum revision, we have reduced the content delivered in the system-based, large-group courses and placed this material in four longitudinal courses that integrate it using a problem- or case-based approach. Three of these courses, Démarche Clinique 1–4, Intégration 1–3, and Médecin, médecine et société 1–4, are taken at each session during the preclerkship years. Another course sequence, Synthèse 1–2, brings clerks back to the faculty for several weeks during their junior (three weeks) and senior years (five weeks) to work in small teams on complex clinical situations that also require ethical, judicial, and resource-placement reflections. As has been so eloquently expressed in an old Spanish proverb, “The appearance of the bull changes when you enter the arena.”
♢ A series of courses, Collaboration interprofessionnelle 1–3, has been developed by an interprofessional team from the various health sciences' programs at Université Laval. In these courses our preclerkship students work in small groups with students from the other health professions on interprofessional collaboration.
♢ Numerous activities in the new interprofessional simulation center have been added throughout the program. Several of these activities also permit our students to interact collaboratively with students from the other health professions.
Changes in Assessment
♢ There has been an increase in the proportion of evaluation of clinical reasoning in the evaluation activities of the system-based courses. In the four longitudinal courses, evaluation is based predominately on written resolution of clinical problems and on reflections or argumentations touching clinical situations.
♢ In addition, there are practical evaluations using simulated patients in each of the courses Démarche Clinique 1–4, as well as a summative OSCE at the end of each preclerkship year.
♢ There is a formative OSCE at the end of the junior clerkship year, with a detailed retroaction for the clerk on his performance. At the end of the senior year, there is a summative OSCE.
♢ In addition, clerks must now pass the Medical Council of Canada Qualifying Examination, part I, as a requirement for graduation.
♢ We are presently developing a system for following the students longitudinally in their acquisitions in the five competencies areas of our program.
♢ The clinical education in core rotations is carried out principally in urban tertiary care hospitals, with the exception of the family medicine rotation that is carried out in regional community hospitals and includes ambulatory experiences.
♢ The principal challenge presently involves ensuring adequate clinical exposure for clerks at a time of increasing class sizes. We have an in-house, user friendly, web-based program and an online entry tool with which the clerks can record their clinical experiences. This permits the direction and the clerks to follow the achievement of objectives across the clerkship rotations and to make appropriate adjustments.
♢ Two semiintegrated clerkship programs, each for eight clerks, were opened in the last two years in regional hospitals in Joliette and in Rimouski, Quebec.
Highlights of the Program/School
♢ The newly revised, competency-based curriculum, that continues as well into clerkship, with considerable integration of subject matter via longitudinal courses.
♢ Flexibility in the duration of the preclerkship phase of the program, permitting students to pursue other interests simultaneously with their medical studies program during the early years of their formation (e.g., MSc or PhD programs, participation in a sport at a highly competitive level, working to finance studies, family obligations, etc.). Presently about 75% of our students take three years for their preclerkship phase.
♢ The very well-equipped interprofessional simulation center.
♢ Excellent support for educative innovations from the office of the Vice Dean for Pedagogy and Continuing Professional Development, as well as excellent support from the faculty informatics sector for implementing informatics technology to support and enhance our educational activities.
♢ Education at Université Laval is carried out in French, per the mandate of the university.