College of Medicine, University of Saskatchewan

Medical Education Program Highlights The College of Medicine at the University of Saskatchewan offers an undergraduate 4-year MD degree. One hundred students matriculate each year. There are 2 main campuses and 3 distributed clinical training sites. Of the 100 seats available each year, 10 are reserved for qualified, self-identified First Nations, Métis, and Inuit students and 6 for diversity and social-accountability applicants (based on family income and rural location). Unique course offerings: Success in Medical School courses: Focused curricular time supports students to successfully transition into medicine (topics include professionalism, wellness, career advising, and study strategies). Clinical Integration courses: A series of preclerkship courses use a competency-based approach with focus on developing the clinical reasoning process through undifferentiated case-based problems. Medicine and Society courses: Patient- and family-centered care modules provide students with authentic patient perspectives on health care experiences. This course contains a longitudinal theme for both research/evidence-based medicine and arts and humanities experience. Finally, students engage in a community agency–based learning experience. Principles of Biomedical Sciences course: Integration of anatomy/pathology and point of care ultrasound/medical imaging helps students understand and visualize structures and pathologies. Unique student activities: Making the Links and Global Health Certificate: In this unique service-learning opportunity, students gain experience in traditionally underserved/ disadvantaged contexts, working in interprofessional teams, and cultural safety/health advocacy. MD–MBA dual degree: Students offered admission to the college can defer entry to complete an MBA. Unique curricular oversight: The Curriculum Quality Review Subcommittee of the Curriculum Committee provides an internal peer-audit and course review to ensure alignment with program goals and objectives. Curriculum The undergraduate medical education program consists of 2 years of preclerkship study and 2 years of clerkship. Horizontal and vertical integration of curricular themes are effected within this curricular structure. See Supplemental Digital Appendix 1—Curriculum Overview—at https://links.lww.com/ACADMED/A965. Curriculum changes since 2010 The medical school class size increased from 84 to 100 in AY 2011–2012 academic year. All students are based at the Saskatoon campus for year 1. In year 2, a cohort of students (40%) transfer to the Regina campus. This distributed model supports optimal access for clinical experience opportunities. In year 3, there are 6 clerkship positions available at a regional site in Prince Albert and 4 positions available for students to engage in the rural Saskatchewan longitudinal integrated clerkship (SLIC), in Estevan and Meadow Lake, Saskatchewan. In AY 2014–2015, the undergraduate medical program at University of Saskatchewan instituted the 2 + 2 curriculum. Assessment At the University of Saskatchewan, the medical education program learning objectives and all subordinate course/module/rotation/session-level objectives are aligned with the CanMEDS framework that identifies and describes the abilities physicians require to effectively meet the health care needs of the people they serve. A competent physician seamlessly integrates the competencies of all 7 CanMEDS roles. See Supplemental Digital Appendix 2—Competencies, Program Objectives, and Outcome Measures—at https://links.lww.com/ACADMED/A965. Medical education program objectives are described in outcome-based terms that allow assessment of medical students’ progress in developing competencies that the profession and the public expect of a physician (2020–2021 CACMS Standards 6.1). The University of Saskatchewan implemented several changes around student assessment in the last several years. These changes include: Introduction of computer-based exams for examination administration Development of consistent standard-setting process for assessments that contribute > 20% to student grades Assessment mapping and monitoring Robust examination quality review processes Regular faculty development for exam construction Processes for individual student performance feedback linked to specific learning objectives Rigorous OSCE station development and review processes Required narrative feedback to students from specific educational experiences At present, the University of Saskatchewan has no plans to reduce our undergraduate medical program from the current duration of 4 years. Pedagogy University of Saskatchewan undergraduate medical program courses use a variety of pedagogical approaches to medical education. Each course has developed an individual strategy for employment of pedagogical methods. Approaches used in various courses include: Case-based learning Clinical experience: ambulatory Clinical experience: inpatient Discussion: large group (> 12) (e.g., flipped classroom) Discussion: small group (≤ 12) Laboratory Lecture Peer teaching Preceptorship Problem-based learning Role play/dramatization Self-directed learning/tutorial Simulation Standardized/simulated patients Team-based learning Video/podcast Workshop/skills days Other: Experiential learning through service learning in the community In the last decade, the medical school has increased diversity of teaching methodologies. We have introduced team-based learning within preclerkship and clerkship courses. Webinars have been used supporting teaching and learning for clerkship students in distributed geographic sites. Opportunities for clinically relevant exercises in application of learning have been expanded, with many faculty using a flipped classroom approach and assistive technologies to support active learning. There is increased emphasis on preclerkship experiential and service learning. Clinical experiences Hospital and outpatient clinic sites are primarily accessed for required educational experiences. These sites include urban major teaching hospitals and clinics through small rural community-based hospitals and clinics. A subset of year 3 students participate in a 42-week longitudinal integrated clerkship in rural setting within Saskatchewan. Students begin their patient clinical experiences and learn interviewing and physical examination skills in the first term of year 1. Students complete a 1-week community hospital/clinic placement in the summer of year 1. In year 2, students from both campuses participate in service-learning experiences engaging with different community agencies. Year 2 students have the option to engage in community clinical placements during the summer before clerkship. In year 3, students participating in the Core Clinical Rotations course rotate through a rural family medicine rotation in a rural/remote community. Students also have opportunities within some clinical rotations to have outpatient clinic experiences outside the teaching hospital in practitioner private offices. For students in the longitudinal integrated clerkship, their clinical experiences in year 3 are hosted within a community hospital and clinics. In year 4, students have opportunities to select community-based rotations for a variety of disciplines including rural family medicine and indigenous health rotations. Designing and implementing optimal experiences for medical students presents challenges in the real-world environment of clinical medicine. Competing needs with postgraduate programs have been somewhat of an obstacle for our undergraduate learners in some more specialized areas such as palliative care. Curricular Governance The preclerkship phase is managed from the centralized Office of Undergraduate Medical Education. The majority of clerkship administrative staff are employees of the undergraduate medical education office, but may be geographically located in clinical department offices. The undergraduate medical program provides funding for teaching, assessment, and academic support. See Figure 1—Curriculum Committee.Figure 1: Curriculum Committee.Education Staff Preclerkship: Preclerkship administrative coordinators work with faculty course/module leads to ensure effective planning, implementation, and day-to-day oversight of the curriculum. Year 1 and year 2 administrative assistants work with administrative coordinators to carry out planning, implementation, and day-to-day oversight of the curriculum. Additional administrative assistants support Regina campus for students in year 2. Clerkship: Two clerkship administrative coordinators (1 at each main campus) work with faculty course/rotation leads to ensure effective planning, implementation, and day-to-day oversight of the clerkship. Year 3 and year 4 administrative assistants work with administrative coordinators to carry out planning, implementation, and day-to-day oversight of the clerkship. Administrative assistants located at all campuses and distributed sites support learners and faculty. The College of Medicine has created 5 specialist positions for the major areas of undergraduate medical education program management: Curriculum specialist, who focuses on objective creation and alignment Assessment specialist, who focuses on methods of assessment, alignment with objectives, standard setting, and multiple choice question (MCQ) and OSCE development Indigenous curriculum specialist, with focus on curriculum integration of indigenous health and ways of knowing Program evaluation specialist, with focus on ensuring timely course and instructor evaluations, including loop closure, as well as longitudinal student performance outcome data Academic support specialist, with focus on identifying students in academic difficulty and coordinating academic support for students The College of Medicine has a dedicated team of IT specialists to provide support for curriculum management, curriculum delivery (in-class assistive technology for active learning, asynchronous online learning technology, electronic exam software, recorded lectures), classroom videoconferencing for distributed large-group sessions, and computer troubleshooting and support. See Figure 2—Organizational chart.Figure 2: Organizational chart.The undergraduate medical education program is responsible for the education delivery of the MD program. Student affairs reports directly to vice dean of education. Faculty Development and Support in Education The Office of Faculty Development provides a number of centrally located and developed professional development activities for faculty. Faculty development offers regularly scheduled monthly events (Teaching and Learning Tuesdays, Webinar Wednesdays, medical education grand rounds, book club). They offer extensive website-based resources, peer-teaching mentorship, and both regularly scheduled and customized workshops and teaching sessions for faculty. All faculty have expectations for demonstration of teaching ability and performance. We have specific evaluation criteria for faculty who have a focus in teaching and the scholarship of medical education, called practice of professional skills. This category evaluates for a scholarly approach to teaching, learning, and mentorship in the area of education. It also evaluates for excellence in teaching and engagement in translation and dissemination of effective and/or innovative teaching practices, as well as research and scholarship engagement, dissemination, translation, and leadership. Regional Medical Campuses A regional medical campus is a site distinct from the main campus where at least 1 student spends at least 6 consecutive months. The campus may offer the basic science portion of the curriculum, the clinical portion of the curriculum, or both. Excluded are affiliated clinical sites at a distance from the main campus where a given student would only take 1 or 2 clerkships. See Table 1—Regional Medical Campuses.Table 1: Regional Medical CampusesThe Prince Albert site has rotation site coordinators that work in tandem with the rotations site coordinators at the 2 main campus sites of Saskatoon and Regina to ensure consistency of curriculum delivery at the rotation level. All rotation coordinators have membership on, and report to, the Clerkship Subcommittee, where all curricular activities of clerkship are planned, implemented, evaluated, and monitored. The Clerkship Subcommittee then reports any recommendations for decision to the Curriculum Committee. The 2 regional distributed clinical teaching sites for the SLIC have a committee that meets regularly to coordinate delivery of the SLIC. This committee includes representation from the year 3 co-chairs, academic director, and assistant dean for curriculum. The SLIC lead also has membership on the Clerkship Subcommittee. The Curriculum Quality Review Subcommittee, in reviewing the delivery and organization of the clerkship courses, may also identify opportunities or deficiencies in consistency across sites, which would be reported back to the regional site leads, SLIC and Prince Albert coordinators, and Curriculum Committee.

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