Faculty of Medicine, University of Montreal

Curriculum Management and Governance Structure (See Figure 1)FIGURE 1: Curriculum Management and Governance Structure ♦ Course and clerkship directors and their respective committees update the curriculum, detailed in a list of required cognitive objectives, every year. ♦ In addition, the Curriculum Committee conducted a thorough curricular review when the new program was implemented and continues to review the curriculum annually. Budget to Support Educational Programs ♦ From 1992–93 to 1998–99, cumulative budget cuts reached $11.4 M, or an approximate reduction of 30% of the faculty's budget. ♦ Fiscal balance was achieved in 1996–97 ($37.9 M budget). ♦ The school had a $1.6 M deficit in 1997–98 ($35.1 M budget), which was offset by the university. ♦ In 1998–99 the school succeeded in convincing the university that it could not attain its mission with a budget of less than $36.5 M. ♦ Recent discussions held with university administration confirmed that the school would receive the requested budget provided it increased its revenues. ♦ The school has therefore presented a plan for recruiting new clientele to the university. This project should ensure a budget increase for the faculty in two to three years. ♦ From 1999–00, the school's budget should remain stable, or even increase. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ Inspired by the GPEP Report Physicians for the Twenty-first Century, the faculty have adopted as objectives five basic competences that students should master following their medical studies and throughout their professional lives: The basic clinical management of patient care Application of scientific reasoning and critical appraisal Communication and teamwork skills Behaviors and attitudes appropriate to the practice of medicine Ability to carry out independent learning and updating ♦ The curriculum before renewal had the following characteristics: Pedagogy based on behavioral approach First-year enrollment: 170 students Basic sciences taught by basic science faculty only (lectures) No attempt to integrate content of clinical sciences determined by individual departments and no attempt to coordinate teaching programs across disciplines Humanities were taught through behavioral sciences courses Most preclinical and clinical courses were lecture-based Clinical teaching was inpatient-oriented ♦ The new curriculum has the following characteristics: Pedagogy based on the cognitive approach First-year enrollment: 138 students Basic sciences are taught by PBL approach and tutors are divided among basic science faculty (20%), clinicians (80%), (specialists, 80%, general practitioners, 20%); major efforts have been made to improve coordination and integration Clinical departments have made some efforts to adjust the contents of their teaching to be in line with basic population needs, but they still need improvement in coordination and integration A doctoring course has been set to develop the professionalism and competency of preclinical students Most preclinical and clinical courses use PBL and focus on teaching clinical reasoning. Clinical teaching is a balance between ambulatory and inpatient education (50%-50%) and sufficiency of experiences in primary and specialty care Curriculum Renewal Timeline ♦ GPEP Report 1987 ♦ Faculty Council meets December 1990, decision to undertake a complex and extensive process of curricular revision ♦ Task force for giving the new program its general orientation June 1991—publication of “Livre vert” ♦ September 1991-1993: new Curriculum Committee Curricular development and planning meetings—pedagogic training Support to faculty and students New program September 1993 Full implementation ♦ 1993-1999: Through the Curriculum Committee Each course was evaluated and modified by the input of faculty and students Basic sciences departments made special efforts to integrate the content of their teaching ♦ April 1998: self-study report ♦ April 1999: AAMC Evaluation ♦ October 1999: Seven-year accreditation Changes in Pedagogy ♦ The content of the curriculum and the learning activities are focused on teaching the objectives. ♦ The program includes both basic sciences and clinical sciences. ♦ Efforts are made to focus on the required curriculum on specific target groups, the pediatric/adult/geriatric population, the male/female population, the multiethnic population, in order to make the curriculum representative of various aspects of medical practice and sensitive to the needs of our society. ♦ The PBL method is used in two thirds of the learning activities for courses given on campus. This method allows students to develop teamwork and independent-learning abilities. ♦ In the first year of the program, students are already involved in clinical learning activities in hospitals one day a week, giving them an early exposure to clinical environments, teachers, and multidisciplinary hospital teams. ♦ The program offers students a wide range of courses and optional clerkships outside the Quebec urban areas and academic centers and abroad, affording them the opportunity to explore new fields. ♦ Because students with different backgrounds are admitted, the admission policy promotes the development of an all-round education rather than a strictly scientific one. ♦ All branches of medicine, i.e., family or specialized medicine, community medicine, research or university careers, are available to students. ♦ The program also provides the opportunities to do Master's or PhD work in other fields while completing the medical curriculum. ♦ Students must reconcile their choices of careers with hospital and university needs, since the numbers of family physicians and medical specialists are controlled by the government, limiting the areas and the fields of practice. Changes in Assessment ♦ During the two preclinical years, for every PBL-based course, 20% of the final score is the result of the evaluation by the tutor of the student's involvement, behavior, and attitude, and 80% is the evaluation of the students' knowledge, usually assessed through a mid-session and a final exam that are mostly made up of SAQs, SEQs and MCQs. ♦ So far as the Introduction to Clinical Medicine (ICM) courses are concerned, the evaluation is based on various methods (logbook record, case histories, making a video of a clinical exam, behavior during patient tours, personal assignment on an ethical question, mini-tests made up of SAQ questions related to directed readings) that account for 40% to 50% of the final score. ♦ At the end of each term, the evaluation is completed by an OSCE of ten stations for the first three terms and an OSCE of 16 stations for the last term in view of the final ICM exam, which covers the knowledge acquired over the two preclinical years. ♦ Students must answer a series of SAQ questions that represent 20% of the final score, in comparison with 80% in the case of the OSCE. ♦ The clerkship-sanctioning evaluation consists of an evaluation of the student's clinical behavior and abilities that accounts for 40% to 80% of the overall score depending on the clerkship, and of a final exam (20% to 60%). ♦ The exam includes OSCE stations in surgery, pediatrics, medicine, obstetrics—gynecology and radiology that account for 25% to 55% of the overall score. ♦ Varying numbers of problem-solving and clinical decision-making questions (Medical Council of Canada Q4 test) and of multiple-choice questions are also used, depending on the clerkship. ♦ For every written exam, an acceptable performance level (APL) is determined, using the Ebel scale. Curriculum Review Process ♦ The vice dean, the coordinators, the course and clerk-ship directors, and the Evaluation Office analyze the exam and evaluation results, which are also forwarded to the Curriculum Committee. ♦ Assessing student performance is based mainly on in-house exam results. ♦ The only outside indicator currently available is the Medical Council of Canada (MCC) licensing exam results. ♦ For 1997 and 1998, the first two groups of graduates who completed the new MD program ranked third in Canada. For 1994, 1995, and 1996 (old program), the Faculty of Medicine students from the Université de Montréal ranked first at the Medical Council of Canada exam (Part I). The first group of the new program (1997) ranked first for the part II of the MCC exam. We used to rank sixth to eighth in the old program. ♦ An examination of the results of the in-house exams of the clerkship I and II and the results of the MCC exam shows a strong correlation, with coefficients of .30 to .51 for the 1997 graduates and of .25 to .50 for the 1998 graduates, and a full accreditation from the LCME in 1999. ♦ The strengths and weaknesses identified during the LCME visit are summarized here: Strengths —The Faculty of Medicine at the Université de Montréal, under the leadership of the dean, is one of Canada's most prestigious faculties of medicine —A strong, dynamic Curriculum Committee, with an enthusiastic chair, supported by URDESS and the Bureau d'évaluation —A highly motivated, talented student body that is substantively involved in the curriculum —A creative and well-monitored curriculum in which the subject matter is well covered, with no significant gaps —Ongoing improvement of integration of basic and clinical sciences in the undergraduate medical curriculum —A well designed ICM/IDC program that highlights the early introduction of clinical material and principles of clinical medicine —A broad base of excellent and dynamic clinical teachers who are widely respected by students —The protection of the undergraduate curriculum budget in the face of severe across-the-board budget cuts in the school —A firm commitment to facilitating the learning of computer-based knowledge and evidence-based medicine Weaknesses —Very significant budget compressions that have hit the faculty/university and the hospital sector simultaneously —As in 1992, communication is problematic; this appears to be the case between the administration and departments, especially regarding financial planning and accountability—it also exists between departments and faculty —Clinical professors, who are carrying out most of the teaching responsibilities, feel vulnerable because of the lack of formal long-term career and financial security that recognizes and values academic contributions —There needs to be recognition of faculty members' contributions to undergraduate teaching through promotion and benefits —The development of plans to pool practice and other revenues to support the academic mission continues to be extraordinarily difficult to implement; it is essential that a fresh analysis of the situation be undertaken and that efforts in this direction be negotiated —The condition of student amenities, including the library, is deplorable Future Goals ♦ Despite the recent full accreditation, new problems emerge that need to be addressed. ♦ Because of government legislation an increase of 50 new students (over the next two years) will put a burden on faculty. ♦ Ambulatory services are on the rise, and new methods of teaching preclinical students will need innovations. ♦ Pressures on clinical faculty for clinical productivity may prevent them from performing their teaching tasks. ♦ Changes in society's needs and contingencies force a curriculum to adapt more and more rapidly.

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