McMaster University Undergraduate MD Program

Curriculum Management and Governance Structure ♦ The undergraduate MD program is one of several undergraduate health care professional programs within the Faculty of Health Sciences. ♦ The matrix organizational framework of basic and clinical departments interlinked with educational programs has remained basically unchanged over the past decade, although minor changes affecting the reporting relationship of the education program leaders to the Faculty Council are being introduced in 2000. ♦ The governance of the undergraduate MD program resides with the Medical Education Committee. ♦ In the past decade, a number of new working groups of the Medical Education Committee have become established as separate standing committees with clear mandates, faculty chairs, and widespread involvement of student representatives. ♦ There are student representatives on all committees related to the undergraduate MD program. ♦ These committees include the Curriculum Committee, the Evaluation Committee, the Student Affairs Committee, and the Protocol Review Committee. ♦ Admissions, Electives and Curriculum Unit Planning Committees have always existed at McMaster. ♦ In the past few years, many of these established committees have spawned standing or ad-hoc working groups (for example, the Curriculum Sub Committees for the Population, Behavioural and Biological Perspectives). A Computer-users Advisory Group has also been established in the past two years. Office of Education ♦ Support for educational development and research and faculty development is provided to the MD program through the Program for Educational Development and the Program for Faculty Development, respectively. ♦ Each of these educational resources within the school is currently being expanded in scope so that the individual educational programs can remain innovative and introduce curricular change. Budget to Support Educational Programs ♦ The operational budget of the educational program derives from the education services budget from the Faculty of Health Sciences. ♦ The education services budget receives funds from a variety of sources, including the Provincial Government of Ontario, but much of the educational activity within the school is funded by clinical earnings. CURRICULUM RENEWAL PROCESS ♦ The last major review of the curriculum of the medical student education program was carried out in 1983. ♦ The curriculum is reviewed annually at a Curriculum Retreat and minor modifications have been made since 1983. ♦ The curriculum is problem-based, and much of the educational activity is carried out in small-group tutorials, which are relatively faculty intense, given the requirement for tutors and clinical skills preceptors. ♦ New faculty interested in participating in the educational program are encouraged to attend the workshops in problem-based learning and the small-group tutorial run by the Program for Faculty Development, and also to act as co-tutors so that they can be mentored in the tutoring role. ♦ In 1997, the Curriculum Committee compiled data from a number of exit surveys of graduating students and it reviewed issues that had arisen at Curriculum Committee meetings over the preceding several years. ♦ These deliberations coincided with the appointment of a new chair of the undergraduate MD program. ♦ The Curriculum Committee and the Medical Education Committee determined that the pedagogic principles of the undergraduate MD program remained relevant and the principles that governed the educational objectives for the program that had been clearly enunciated in 1983 should continue to drive the curriculum. Learning Outcomes ♦ Learners must acquire the knowledge and skills to be lifelong, self-directed learners confront problems and seek solutions work effectively in groups integrate scientific principles into clinical care be effective communicators have a community perspective in addition to a sound biologic understanding be aware of personal qualities as they affect professional behavior self-evaluate and take part in responsible peer evaluation contribute to the solution of health care problems through innovative and fresh approaches ♦ Over the summer of 1997, the chair of the undergraduate MD program and a subgroup of the curriculum committee developed a number of curricular models or templates that might address the perceived problems with the current curriculum. The problems included the following: At 16 weeks, the introductory unit was felt by both students and faculty to be too long, and it appeared to cover too many topics in a relatively superficial manner. Several of the “content-laden” body-systems units (for example, cardiovascular, renal, and respiratory) required more time to allow students to integrate concepts. Clerkship rotations in pediatrics, obstetrics—gynecology, family medicine, and psychiatry were only four weeks long and felt to be too short. The curriculum calendar was arranged in such a way that students often missed core clerkship time when traveling to interviews for postgraduate training positions. In addition to curriculum renewal, the medical education committee felt that changes were needed in the clinical skills program to enhance integration of professional skills and allow for more direct supervision and evaluation of student learning. The medical education committee felt that many of the changes in evaluation in the undergraduate MD program that had been introduced in the previous five to seven years should be carried forward into the new curriculum without change. These evaluation methods included the personal progress index (PPI), clinical reasoning exercises, and OSCEs. Application of Computer Technology ♦ Access to faculty resource individuals is increasingly being obtained through the use of an intranet system at McMaster. ♦ Students make extensive use of electronic database searching, and an “electronic tutorial room” has been established in the school's Health Information Research Unit so that electronic information technology and computer-aided instruction in small-group tutorial learning can be adequately evaluated. Timeline for Revised Curriculum ♦ The curriculum committee resolved to introduce the revised curriculum for the undergraduate MD program by September 2000. ♦ The first of a number of faculty-wide retreats to plan the structure of the new curriculum was held in February 1998 (see Figure 1).FIGURE 1: Curriculum Renewal Timeline♦ At the first retreat, the curriculum committee was charged by the school to maintain the small-group tutorial PBL educational method, consider developing more of a life-cycle approach to the body-systems units in the pre-clerkship, and explore innovative ways of utilizing faculty for the didactic sessions that are held throughout the curriculum. ♦ Specific changes to the curriculum that were approved at this first retreat and directed further development of the new curriculum were as follows: The first curricular block, or unit one, was to be shortened from 16 weeks to 12 weeks and be divided into specific subunits with fewer but more clearly defined learning objectives. The three body-systems units would maintain their three-subunit structure but would incorporate life-cycle learning objectives and would each have one to two extra weeks of curricular time to allow for integration of concepts. The specific life-cycle—oriented unit would be taken out of the curriculum and its content placed both in the pre-clerkship body-systems units and also in the tutorial component of the clerkship, whose curriculum would be more closely allied to the pre-clerkship curriculum. Elective time would remain unchanged, since the faculty felt that the large amount of elective time in the McMaster curriculum was one of its strengths. Changes to the placement of elective time, however, allowed the overall length of the revised clerkship to be eight weeks longer. ♦ A new curriculum unit post-clerkship was to be established that would allow students to engage in interdisciplinary education with students from the other health science education programs as well as covering curriculum in health economics, pharmacoeconomics, community health, and the legal and organizational aspects of clinical practice. Curriculum Renewal Activities, Strategies, and Funding ♦ A number of working groups were established to develop specific goals and objectives within the mission of the curriculum renewal. ♦ Paradoxically, it has been relatively difficult for some faculty to engage enthusiastically in developing a revised curriculum whose pedagogic construct and overall outline and terminal objectives are not fundamentally different from those in the current curriculum. Despite this, however, the content-change issues described above have been embraced by the faculty. ♦ Curricular renewal has stimulated the development of innovative ideas about curriculum delivery in the following areas: Increasing use of an electronic curriculum database will aid curricular planning across the administrative structures of the different curriculum units and allow the Curriculum Committee to integrate the clerkship in the overall three-year curriculum. The Professional Skills Program concept has been developed, encompassing a three-year curriculum in clinical skills to include identifiable curriculum in verbal data gathering (i.e., communication skills, history taking, etc., physical examination, data gathering, and data interpretation and critical appraisal). Revision of the structure of the tutorial health care problem and, in particular, the Tutor Guide so that priority learning objectives will be more clearly identifiable for the tutors. Development of a program of professionalization and self-awareness. ♦ Unlike the major curriculum overhaul at McMaster that was undertaken in 1983, the current changes are not being made with the support of any major funding agency. ♦ Increased resources have been made available from education services within the faculty of health sciences for a number of retreats for faculty over the two years since planning for the revised curriculum was initiated. Challenges ♦ The two greatest challenges facing the implementation of a new curriculum are ensuring that the curriculum is truly coherent, particularly in the delivery of content related to the disciplines that track horizontally across the three years of the curriculum the development of a comprehensive but deliverable clinical skills curriculum with adequate preparation of faculty to deliver the objectives in the appropriate clinical settings. Plans for Evaluation of Change ♦ Overall curriculum coordination is being managed by the chair of the undergraduate MD program and a subgroup of the curriculum committee, with electronic interfacing between the individual curriculum unit planning groups. ♦ The success of curriculum integration will be evaluated by curriculum mapping of disciplines across the curriculum, particularly examining the integration of clerkship learning objectives with those developed for the preclerkship. ♦ Changes to the Professional Skills Program will be evaluated in the annual OSCE exams. ♦ In addition, the MD program will examine evaluations of students' clinical performances in the clerkships. ♦ Performances of the students will continue to be assessed on national licensing exams. ♦ Evaluation of individual curriculum units by the students will continue as is currently undertaken, and close attention will also be paid to the exit survey following curricular change. ♦ The major challenge for curriculum planners is to create a new and reinvigorated curriculum within a framework that continues to embody the educational principles that have governed this school since its inception. These educational principles are felt to be relevant in the year 2000 and represent the direction in which most other medical schools are heading in the new millennium.

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