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University of Calgary Faculty of Medicine

Coderre, Sylvain MD, MSc; Woloschuk, Wayne PhD; Tworek, Janet MSc; Veale, Pamela MD, MSc; McIlwrick, Joann MD, MSc; Wright, Bruce MD; McLaughlin, Kevin MB ChB, PhD

doi: 10.1097/ACM.0b013e3181eaae7a
The Reports: Canada: Alberta
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Curriculum Management and Governance Structure

  • ♦ The governance structure for the MD Undergraduate Program has been reviewed and modified in the past five years.
  • ♦ Responsibility for curricular overview and policy development lies with the Undergraduate Medical Education Committee (UMEC).
  • ♦ The responsibility of curricular implementation and management lies with UMEC's three subcommittees: Preclerkship Committee, Clerkship Committee, and the Student Evaluation Committee.
  • ♦ Day-to-day management of the preclerkship program is fully centrally coordinated by the Undergraduate Dean's Office.
  • ♦ The clerkship is managed centrally by the Undergraduate Dean's office, in conjunction with support from the respective Departments.
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Office of Education

  • ♦ The Department of Community Health Sciences houses the Medical Education Research Unit (MERU), which provides educational and research expertise support to the Undergraduate Dean's office.
  • ♦ Director of Program Evaluation, housed within the Undergraduate Dean's office, provides support in the area of curriculum evaluation and research to the Undergraduate Dean.
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Financial Management of Educational Programs

  • ♦ The Faculty of Medicine has applied various budgetary restrictions to address the current financial crises, without noticeably affecting the delivery of the MD Undergraduate Program.
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Valuing Teaching

  • ♦ The Faculty of Medicine has created an Office of Faculty Development, which has achieved a high profile in the academic community.
  • ♦ Teaching faculty members are routinely honored by both students and faculty, given the variety of teaching awards available at the course, clerkship, and facultywide levels.
  • ♦ Teaching accomplishments occupy a major role (alongside with research) in determining faculty promotion and tenure.
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Curriculum Renewal Process

  • ♦ The University of Calgary, a three-year medical school curriculum since its inception, modified its medical school curriculum in the mid 1990s to what is called a “Clinical Presentation” curriculum.
  • ♦ In 2005, after 10 years of experience and several positive outcomes with the Clinical Presentation curriculum, an exhaustive consultative renewal process occurred, which lead to the “Integrated Clinical Presentation Curriculum” inaugurated in August 2006.
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Learning Outcomes/Competencies

  • ♦ The 10 institutional “exit objectives” of our school are listed here. These objectives were approved in October 2004. A student at the time of graduation will be able to
    1. demonstrate the basic science and clinical science knowledge and skills necessary for the supervised practice of medicine and be able to use the knowledge efficiently in the analysis and solution of the most common clinical presentations.
    2. evaluate patients and properly manage their medical problems by
      1. conducting a comprehensive medical history and thorough physical examination; reliably eliciting appropriate information in the history and detecting abnormal findings on the physical examination.
      2. correctly identifying the patient's medical problems.
      3. formulating accurate hypotheses as to the causes and solutions of the problems.
      4. developing appropriate strategies for exploring these hypotheses.
      5. formulating and implementing a management plan to deal effectively with these problems.
    3. apply a comprehensive bio-psychosocial approach in the evaluation and care of patients while sensitive to cultural and spiritual beliefs, attitudes, and behaviors.
    4. demonstrate knowledge of the fundamental concepts of disease prevention and health promotion for individual patients and populations and incorporate them into treatment plans as appropriate.
    5. communicate and interact effectively with patients, families, medical staff, and others involved in the delivery of health services.
    6. develop and apply high ethical principles and standards in all aspects of medical practice.
    7. exhibit appropriate personal and interpersonal professional behaviors.
    8. demonstrate effective and appropriate use of technology and critically analyze and interpret biomedical data in the evaluation and selection of optimal care for patients.
    9. demonstrate self-directed life-long learning skills.
    10. identify and investigate diversified opportunities for research experience and training.
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Changes in Pedagogy

  • ♦ A major highlight of the above-mentioned curricular modification was the creation of 7 (from 12) “linked” preclerkship courses.
  • ♦ The preclerkship courses are the Blood-GI, MSK-Dermatology, Cardio-Respiratory. Renal-Endocrine, Neurosciences-Aging, Women and Child Health, and Mind-Family courses.
  • ♦ The creation of longer, linked preclerkship courses addressed a number of practical concerns, in addition to providing pedagogical advantages such as dispersed learning, heightened attention to diagnostic classification schemes, reduced frequency of certifying examinations, increased formative evaluations, and creation of a review week before certifying examinations.
  • ♦ The modified curriculum also impacted clerkship, with the addition of an “Introduction to Clerkship” course and the addition of a formal two-week break for CaRMS (residency) interviews.
  • ♦ Several outcomes measures (MCC Examination scores, student surveys, Canadian Graduate Questionnaire results, local examination scores, residency program directors' assessment of our graduates) have been followed and generally yield favorable results regarding our current curriculum.
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Changes in Assessment

  • ♦ In 2004, the Student Evaluation Committee was established with the mandate to develop policies and procedures to ensure a reliable, valid, fair, and feasible student assessment program.
  • ♦ In 2005, student evaluation policies were formally established, outlining the purpose, frequency, components, preparation, and psychometric monitoring of student evaluations.
  • ♦ In 2006, the “Examination Standards of Practice” was established by the Student Evaluation Committee.
  • ♦ Included in the Standards of Practice were the four Stages of Test Development and Administration, which introduced the requirement that all student evaluations meet basic psychometric standards. Alongside this process, Examination Blueprinting was introduced to all course and clerkship examinations.
  • ♦ In 2008, the Student Self-Evaluation System, an internally developed on-line evaluation platform, became available for the delivery of electronic formative evaluations.
  • ♦ In 2009, the Peer Feedback and Self-Assessment Student Program was launched on-line for the purpose of providing narrative descriptions of student performance and of noncognitive achievements (such as professionalism).
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New Topics in the Curriculum Since 2000

  • ♦ In addition to the curricular changes noted above, the preclerkship has seen the addition of a scheduled half-day per month Family Medicine experience for all students in first year.
  • ♦ The clerkship has seen the addition of a mandatory Emergency Medicine rotation for all clerks and a Rural Integrated Community Clerkship stream for 10–12 students per year.
  • ♦ Effective March 2010, a formal UME half-day back experience will be introduced in clerkship. This course will use virtual and simulated patients to cover such topics as key basic science concepts, clinical skills, pharmacology, patient safety, conflict resolution, and chronic disease management.
  • ♦ Since 2007, the clerkship administers a single overarching OSCE, which examines content/skills across all Departmental clerkships.
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Clinical Experiences

  • ♦ The City of Calgary has four major teaching hospitals (Foothills Hospital, Peter Lougheed Center, Rockyview Hospital, Alberta Children's Hospital).
  • ♦ Additional sites outside of Calgary are utilized for Family Medicine, Pediatrics, and Obstetrics/Gynecology.
  • ♦ Despite an increase in class size (180 students starting August 2009), we have been able to maintain clinical education sites of sufficient quality for our students.
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Regional Campus

  • ♦ While we do not have a regional campus, one recent innovation was the creation of the Rural Integrated Community Clerkship (RICC) for 10 to 12 clerks per year.
  • ♦ The RICC provides a preceptor-based, longitudinal (36 weeks) experience in a rural setting, with exposure to both primary and specialist care. The remaining clerkship weeks occur as electives (6 weeks) and tertiary hospital rotations (12 weeks).
  • ♦ Outcome measures for our first cohort in the RICC program were very positive.
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Application of Computer Technology

  • ♦ The school has introduced “OSLER” (On-line Schemes, Learning and Education Resources) for a variety of curricular uses such as schedules, logbooks, notices, lecture notes, learning resources, course evaluations, interactive forums, and student polling.
  • ♦ Podcasts and an audience response system (“Clickers”) have been introduced for all preclerkship courses and most clerkship teaching sessions.
  • ♦ The school has four simulators (Harvey and SimMan3G) and 97 virtual patients, primarily used in the Cardio-Respiratory course, and the UME clerkship half-day back teaching sessions.
  • ♦ Various Telehealth modalities are available for all clerkship teaching sessions.
  • ♦ For examination purposes, the school has capacity for on-line examinations (currently applied to formative examinations only) and OSCE on-line scoring sheets.
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Highlights of the Program/School

  • ♦ A three-year program, organized around Clinical Presentations, the 120 ± 5 ways patients present to physicians.
  • ♦ Diagnostic possibilities for a given Clinical Presentation are organized in structures called “schemes,” which have been compiled in the University of Calgary “Black Book,” available free of charge to all students.
  • ♦ The processes of examination creation, blueprinting, review, and standard setting are viewed as strengths of our school.
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