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Canada: Quebec

McGill University Faculty of Medicine

Cummings, Beth-Ann MD, MSc (HPE); Koch, Marion MD; Mondou, Melanie MD, MSc (HPE); Millar, Catherine MA; Elizov, Michelle MD, MSc (HPE)

Author Information
doi: 10.1097/ACM.0000000000003309

Medical Education Program Highlights

“Patient at heart, Science in hand” is at the core of the 4-year MD, CM program at McGill University. The Longitudinal Family Medicine Experience (LFME) immerses first-year medical students in early clinical exposure in the specialty of family medicine, while learning the basic and social sciences that underpin medicine. In year 2 of the program, students benefit from 6 months of the Transition to Clinical Practice (TCP) course, learning at the bedside without responsibility for patient care in preparation for taking an active role in caring for patients in clerkship. During clerkship, students complete their third-year rotations in 3 semi-integrated blocks that allow them to learn 2 disciplines hand in hand (e.g., medicine and surgery, pediatrics and obstetrics–gynecology, family medicine and psychiatry). Throughout the 4-year program, groups of 6 students meet with a mentor (Osler Fellow) as part of the Physician Apprenticeship program.

Curriculum

Curriculum description

The mission of the MD, CM program is “to prepare students for careers as key members of the medical community, whether in clinical practice, in medical education, in research or as leaders of the health care system.” Three longitudinal themes run throughout the curriculum: basic science, critical thinking, and knowledge translation (BSCTKT), emphasizing the basic sciences that underpin medical practice; social accountability, population health, and health advocacy (SAPHHA), emphasizing that medical practice is in service to society; and professional identity and practice, emphasizing professional identity formation and the dual role of the physician as professional and healer (i.e., physicianship). The MD, CM program includes 4 curricular components: Fundamentals of Medicine and Dentistry (FMD, first 1.5 years), TCP (second half of year 2), clerkship (years 3 and 4), and physicianship (longitudinal across all 4 years).

See Supplemental Digital Appendix 1—Curriculum Schema—at https://links.lww.com/ACADMED/A842.

Curriculum changes since 2010

The strategic planning process that concluded in 2010 led to the rollout of a revised MD, CM curriculum. The class of 2017 was the first to graduate from the new curriculum. The curriculum features an increased focus on public health, social accountability, and primary care while maintaining traditional strengths in basic sciences and clinical training. The revised program also includes a longitudinal curriculum in point-of-care ultrasound, the Mindful Medical Practice course, and interprofessional education sessions with students from other professional programs in the Faculty of Medicine (nursing, physical therapy, occupational therapy, and speech language pathology). Aligned with the Future of Medical Education in Canada recommendations emphasizing the transitions between educational phases, the new curriculum includes the TCP (between FMD and clerkship), Transition to Clerkship (at the end of TCP), and Transition to Residency (at the end of clerkship). The assistant dean, student affairs, and the team at the Wellness Enhanced Lifelong Learning (WELL) Office (i.e., student affairs) oversee longitudinal curricula related to wellness and career advising that are integrated into the MD, CM program.

Since the implementation of the new curriculum, curricular changes have been on an annual basis in response to student and faculty feedback, student performance on licensing exams, and evolving societal problems. Upcoming changes already planned for 2020–2021 and beyond include the replacement of TCP Anesthesia in second year with an anesthesia clerkship in third year and enhancing teaching by family physicians during FMD. The MDCM Program Committee (curriculum committee) is also working on the integration of all 12 Association of Faculties of Medicine of Canada (AFMC) Entrustable Professional Activities (EPAs) into the curriculum, enhancing teaching related to the opioid crisis, and evolving the way human sexuality is taught in recognition of evolution in our understanding of gender and sexuality.

The size of the incoming class is increasing in 2020, coincident with the opening of our distributed medical campus in Gatineau, in the Outaouais Region of Quebec.

Assessment

The objectives of the MD, CM program follow the CanMEDS framework and incorporate the Medical Council of Canada list of clinical presentations, with the AFMC EPAs informing our assessment approach.

See Supplemental Digital Appendix 2—Medical Education Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A842.

The assessment program relies on a variety of assessment methods and incorporates assessment that is purely formative, low-stakes summative, and high-stakes summative. Since the curricular renewal begun with the class of 2017, the MD, CM program uses progress tests in addition to other methods of assessment such as anatomy lab exams, final written examinations, written assignments, oral presentations, and objective structured clinical examinations. Some small-group sessions in FMD include peer assessment. In the clinical setting, the student assessment forms in TCP and clinical assessment forms in clerkship rate students across the CanMEDS competencies and emphasize the provision of formative feedback for ongoing development and summative feedback for Pass/Fail decisions. Beginning in 2020–2021, in addition to the existing progress tests used in clerkship, discipline-based clerkship exams are being reintroduced to favor discipline-based knowledge acquisition.

Teaching and learning methods include case-based learning in small groups of 12–18 students, large-group interactive sessions with up to 60 students, whole-class lectures, anatomy laboratory sessions with both prosection and dissection, simulation with standardized patients and with technical models, online virtual patient cases, online modules and podcasts, workshops and clinical experiences in ambulatory, ER, OR, birthing center, and inpatient settings. The curricular renewal was associated with an increase in interactive learning sessions, simulation, and online cases. Clerkship student integration into health care teams has been maintained in the revised curriculum, with students actively participating in the care of patients, including documenting consultations, admissions, progress notes, and discharge summaries and writing medical orders for revision and co-signature.

Clinical experiences occur in a variety of settings ranging from independent family doctor’s offices, to group practices, community hospitals, and large tertiary and quaternary care academic health centers. Students have meaningful exposure to both acute and chronic presentations of common and serious diseases. All students participate in the LFME in outpatient family medicine in the first year of the program, and all students complete 4 weeks of regional family medicine outside of the major teaching hospitals in Montreal during the third year (clerkship).

Curricular Governance

The MDCM Program Committee is the curriculum committee for the program, with central oversight of the entire curriculum. The Program Committee is assisted by component subcommittees, theme subcommittees, the Program Evaluation and Curricular Outcomes subcommittee and the Wellness and Learning Environment subcommittee. While the curriculum is managed centrally, the clinical departments have an important role in clinical courses and input into the selection of course leadership for TCP and clerkship.

See Figure 1—Curriculum governance structure.

F1
Figure 1:
Curriculum governance structure.

Education Staff

The Faculty of Medicine is in the process of being renamed the Faculty of Medicine and Health Sciences. The Faculty includes cross-cutting offices that serve all of the health sciences schools within its mandate, such as the Office of the Vice-Dean, Education, the Office of Accreditation and Education Quality Improvement, the WELL Office (student affairs office), and the Faculty Development Office. The Faculty is also in the process of establishing a formal School of Medicine, which will include undergraduate medical education (UME), postgraduate medical education (PGME), and continuing professional development (CPD). Currently, Medical Education Administration and Operations administratively includes UME, PGME, and educational systems. UME benefits from an administrative team of 28 people supporting the planning, implementation, and oversight of the curriculum, UME student records, interprofessional education, and distributed medical education. The UME Office works closely with the Medical Education Systems team (7 people, including 2 data analysts) for the development and maintenance of the tools to support curriculum delivery, monitoring, and management. An estimated 20 administrators will support the Outaouais campus opening in August 2020, including UME; student affairs and faculty development; and other dossiers such as PGME, finance, and academic affairs.

The associate dean, UME heads a 16-person academic team responsible for curriculum planning, implementation, and oversight:

  • Assistant dean, UME
  • Program director—Outaouais campus
  • Chair, program evaluation, and curricular outcomes (PECO)
  • Academic lead, curriculum design, and implementation
  • Academic lead, assessment design, and implementation
  • Two theme leaders (BSCTKT and SAPHHA)
  • Eight component directors (4 at each campus: FMD, TCP, clerkship, physicianship)

See Figure 2—Organizational chart of deans.

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Figure 2:
Organizational chart of deans.

The Institute of Health Sciences Education (IHSE; https://www.mcgill.ca/ihse) was established in 2019, building on the previous Centre for Medical Education in the Faculty of Medicine. The institute is a home for scholarship and innovation in health sciences education, and there are full-time PhD faculty as well as health care professionals with full-time or part-time appointments.

Faculty Development and Support in Education

The associate dean, faculty development (FacDev) works with the assistant dean, FacDev; assistant dean, FacDev—Outaouais campus; director of FacDev, UME; and others members of the FacDev Committee and the Faculty Development Office (https://www.mcgill.ca/medicinefacdev) to offer activities and programs geared toward both new and experienced faculty. Programs range from short 15-minute targeted “capsules” for UME leaders at the beginning of committee meetings, to targeted workshops for clinical departments or the Outaouais campus based on needs identified by UME or PGME and to half day, full day, and multiday workshops open to all faculty in the Faculty of Medicine. FacDev is in the process of developing a longitudinal series of blended (online and face-to-face) modules to facilitate access to important activities.

Key topics relevant to UME offered by FacDev include:

  • Orientation for new faculty
  • Assessment in the clinical setting
  • Assessment in the classroom setting
  • Giving effective feedback
  • Interactive lecturing skills
  • Improving the learning environment
  • Teaching culturally diverse learners
  • Role modeling
  • Assessing and teaching clinical reasoning
  • The learner in “difficulty”
  • Teaching when there’s no time to teach
  • Teaching in the ambulatory setting
  • Small-group teaching skills
  • Leadership development

FacDev has partnered with the Faculty’s Academic Affairs Office (https://mcgill.ca/medicine-academic) and the University’s Teaching and Learning Services (https://www.mcgill.ca/tls) to support faculty in academic promotion. This includes:

  • Understanding how to maximally benefit from annual review/performance dialogues
  • Overview of promotions timelines and processes
  • How teaching is recognized through the promotions process
  • How to prepare the promotions dossier

Excellence in teaching and/or education activities is central to the promotions process. All faculty members are required to submit a teaching portfolio when applying for promotion. The teaching portfolio includes:

  • Teaching approach: rationale for particular teaching methods; learning goals for students; how student learning is evaluated and why; how research and the “process of inquiry” is integrated into teaching; directions and plans for future development of teaching, in the light of teaching experiences
  • Teaching responsibilities
  • Evidence of teaching effectiveness
  • Summary of activities undertaken to develop and enhance teaching: development and sharing of teaching innovations, materials, or strategies; advising and mentoring colleagues about teaching-related issues; mentoring; contributions through teaching support units, teaching committees, associations; organizing or facilitating seminars, workshops, or conferences on teaching and learning; contributions to the development of policies on teaching and learning; teaching-related publications

Educational scholarship is recognized and weighted on its own merits—the value of grants and impact factors of publications are rated compared with standards expected in the realm of educational scholarship, not clinical research. For faculty members in the clinician–teacher and clinician–educators tracks, teaching excellence and educational innovation, scholarship and research, and educational administration are weighted appropriately in the promotions process and these achievements can serve as the backbone for successful promotion. The Faculty Honour List for Educational Excellence also provides an opportunity for public recognition of excellence in teaching.

Regional Medical Campuses

The MD, CM program has an integrated clerkship in the city of Gatineau, in the Outaouais region of Quebec, which has been welcoming students for the core clerkship year since 2010. In August 2020, the Outaouais campus will officially open, welcoming 24 students into the first year of the medical program. The language of instruction at the Outaouais campus will be French, whereas the primary language of instruction at the main Montreal Campus is English.

Supplemental Digital Content

Copyright © 2020 by the Association of American Medical Colleges