University of Manitoba Faculty of Medicine

Curriculum Management and Governance Structure ♦ The undergraduate program of the Faculty of Medicine consists of four years of education leading to the Doctorate of Medicine (MD) degree of the University of Manitoba. ♦ The dean and faculty members, represented by the faculty executive council, are responsible for the design, implementation, and evaluation of the program. ♦ Policies that govern the program are established by the faculty executive council, while the dean is responsible for the administration of the program. ♦ The dean acts through the associate dean (undergraduate education) and appoints the faculty curriculum coordinators, who are charged with the task of administering the program. ♦ The hierarchy of the undergraduate medical program is composed of (at the top) the faculty executive council, the dean of medicine, and the associate dean for undergraduate education the curriculum committee, composed of faculty curriculum coordinators, the chairs of the committees of evaluation, members at large elected by the faculty executive council, and selected students the preclerkship and clerkship committees, composed of the course and clerkship directors teachers of courses and clerkships Office of Education ♦ There is no office of education at this time. ♦ A new position, called Director of Educational Development, was created in August 1999. Currently, this is a three-year contingent position. ♦ The director envisions the creation of an educational development office that would serve all aspects of the medical faculty regarding curricular, evaluation, and faculty development issues. Budget to Support Educational Programs ♦ There is a discrete budget with funds provided by the dean to support the office and administrative expenses in the undergraduate program. ♦ The director of educational development is funded from the dean's office for start-up funding, and from the continuing medical education department for ongoing supplies and support-staff assistance. Valuing Teaching ♦ The vast majority of people involved in the medical education program have other duties such as research and/ or clinical practice. ♦ The Teaching Improvement Program(s) TIPS involves medical faculty members in developing and delivering instructional workshops. The Certification in Higher Education Teaching Program prepares residents and doctoral students for their first academic appointment. ♦ The workshops are given free of charge to medical faculty, including residents at the University of Manitoba. ♦ The medical students also recognize outstanding teachers through a teacher-recognition program. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ The faculty has developed performance objectives for students encompassing knowledge, skills, and attitudes. ♦ Students must demonstrate these objectives prior to graduation. Changes in Pedagogy ♦ The school was one of the first universities in Canada to utilize small-group learning and tutorials. ♦ The school has developed a strong problem-solving program that utilizes cases relevant to the areas students are currently studying. ♦ Communication and clinical skills are introduced early in the student's experience. There is a standardized patient program where students can practice those skills through a variety of activities. Application of Computer Technology ♦ There are two computer labs and a new open resource area in the Faculty of Medicine. Together they will house approximately 70 computers. ♦ Web-based courses are being developed. ♦ Formative assessments are now available on-line, and there is increased use of the medical school's Web site. Changes in Assessment ♦ Evaluation occurs at each level of the curriculum. ♦ There is a comprehensive exam at the end of each block in the first and second years; a GOSCE is administered at the end of first year, an OSCE is administered at the end of the second year, NBME exams are taken at the end of all major clerkships, and an OSCE is administered in the fourth year. ♦ Students are also evaluated based on attendance and participation in small-group sessions. ♦ In the clerkships preceptors evaluate clinical performance. ♦ Standardized patients are used in the assessment process in the OSCE in the second year and in a comprehensive clinical exam in the fourth year. ♦ Faculty observation, in-training evaluations, MCQ exams, problem-solving (PBL) exams, OSCEs with standardized patients, practical exams, and exams with mixtures of multiple-choice and short-answer questions are all used in student assessment. Clinical Experiences ♦ The Clinical Skills Program begins in the first year. ♦ Throughout the four years each student is placed, at different times, in the wards of the teaching hospitals, emergency wards, hospital clinics, physicians' offices, homes for the elderly, and rural hospitals. Curriculum Review Process ♦ The new director of educational development, in collaboration with the associate dean, has constructed a curriculum evaluation framework to guide curriculum review. ♦ The purpose of the curriculum review is to conduct an outcome and process evaluation. ♦ The review is divided into three parts. Part One of the review will consist of two “snapshots” of the medical faculty, one snapshot prior to the curricular change and one current snapshot. The snapshots will include the curriculum content being taught, the number of hours and the methods of instruction, and the primary assessment measures used to evaluate students. This information will be compared with that of other medical schools. This will serve as a reference or comparison point to assist in present and future decision making. ♦ Part Two involves the identification of a series of performance expectations for students. The performance expectations are the attributes, listed below, that the medical school will impart to its students to prepare them for professional lives. Thus, students must be able to make accurate diagnoses and institute appropriate treatment for patients with common illnesses and some critical illnesses; be able and willing to use scientific principles in evaluating information relating to patients; communicate sensitively and effectively with patients and colleagues—this communication is a two-way street, involving both sending and receiving; be firmly grounded in the ethics of medicine and relate to patients ethically—they must be accountable for their actions and words to patients, colleagues, and society; continue to educate themselves for their entire medical careers (without such activity they will become obsolescent as physicians) and recognize their own strengths and weaknesses and practice within those limitations; and try to understand the society within which they live and, in particular, the health care system within which they work. They must function as responsible members of the system. ♦ Part Two of the curriculum review will also assess how well the educational program is imparting these performance expectations. ♦ Questions on the issues below will be posed through surveys, focus groups, and/or interviews to a representative sample of staff and students. Are the performance expectations in line with LCME, CanMeds, and Cleo expectations? Based on your experience teaching the new curriculum, would you make any changes to our current performance expectations? If so, what and why? Are the current performance expectations being taught? In which block(s) were expectations addressed? How are the expectations being taught? How are the expectations being assessed? How well are students doing in meeting these expectations? What evidence exists to support the view that the expectations are or are not being met? ♦ Part Three of the curriculum evaluation will identify the other factors that affect the success of the new curriculum. The questions below will be posed in survey, focus group, and/or interview form to a representative sample of staff and students. Content —Are there content holes or over-emphases in the curriculum? If so, identify these areas. —Is there an appropriate balance between basic science and clinical content? —Does the content flow in a logical sequence that supports student learning, transference of knowledge, and the clinical skills components? Instruction —Do students receive clear statements about the goals and expectations for each block? —Do students receive information about what the essential learnings are? —Do we utilize teaching strategies that enhance the likelihood that students will learn and/or retain essential learnings? —Do students understand how to transfer knowledge, skills, and ethical values from one block to the next? Evaluation —Do students understand how and when they will be evaluated? —Do we have both formative and summative assessments? —Do our assessment tools fairly assess what we want students' knowledge and skill bases to be? —Do students feel they are being fairly assessed? —Do we have a process for remediation of students' deficiencies? Faculty —Do we value teaching as an integral activity of the medical faculty? —How do we demonstrate that we value teaching? —How do we evaluate teaching performance? —Are the assessment tools for evaluating teaching fair and/or appropriate? —Do we require additional faculty development in the areas of teaching and assessment? —Do we have the right numbers of people teaching in the faculty? —Do we reward good teaching and remediate those who lack certain skills? Outcomes —Is there consistency between the type of student we look for in the admission process and how we develop that student? —Does the undergraduate program adequately prepare the student for postgraduate training? —How are we seen external to our faculty? Are we competitive in the CARMS matches? —What external awards do we receive? —Can students identify excellent performance? Resources —Do we have the necessary resources to continue to implement the curriculum changes? If not, identify what we need and why? —Do we have the human resources to continue to implement the new curriculum changes? If not, what do we need and why? —Are there adequate supports for students? If not, which ones are missing? Governance —Are there appropriate and effective avenues to communicate information about students, curriculum, instruction, and assessment issues within the faculty, university, and country? —Do we have the appropriate committee structures? —Do we have support and leadership from the various deans' offices and the university administration? Outcomes to be tracked include —Results on examinations —Percentage of first matches on the CARMS —Number of external awards —Total faculty hours and commitment of resources ♦ The results of the curriculum review will be used to provide a clearer picture of where the University of Manitoba stands in relation to other medical faculties in regard to curriculum reform issues provide information about whether the school is meeting the undergraduate performance expectations provide information concerning what factors assist or impede progress provide information that can be used in the Faculty of Medicine to develop a set of principles that directly link teaching with instructor performance provide a framework for future decision making provide data to be used in the accreditation review provide information that can be used to develop curriculum packages and guidebooks provide information that can be used to develop a student-assessment strategy ♦ Implementation resources have included financial support from the dean's office to conduct this review. ♦ Part of the money will be used to design conduct and analyze surveys, focus groups, and interviews with faculty and students. ♦ The results will be distributed to the faculty and students as well as used at a retreat to develop and prioritize strategies to address the issues in the review. ♦ At this point it is anticipated that the major issues of the review will include support for teaching time in the faculty availability of space, especially for clinical teaching faculty development balance and sequencing of the basic and clinical sciences appropriate assessment ♦ A review of evaluation methods is currently under way. Some of the changes to be made include improving the OSCE and CCE exam process developing performance rubrics that run on a palm pilot; this will make rating of students in clinical settings easier and more consistent

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