Memorial University of Newfoundland Faculty of Medicine

Medical Education Program Highlights The Faculty of Medicine (FOM) at Memorial University has recently celebrated 50 years since students first entered the classroom in 1969. The curriculum has seen many adaptations since its inception. Recent highlights include: Being the first Canadian medical school to implement Entrustable Professional Activities (EPAs) as the framework for learning and assessment in the final 2 years of clinical learning. EPAs are professional practice tasks or responsibilities that trainees must be able to perform without direct supervision at the time of graduation from the MD program. Each of the 13 adopted EPAs have been linked to CanMEDS1 competencies. The development of a Leadership in Medicine (LIM) Certificate option for learners of the MD program. In addition to the 8 physician competencies modules, learners wishing to pursue the LIM Certificate must complete an online capstone Leadership in Medicine module, which builds upon leadership concepts introduced in the MD program. A focus on rural medical education, requiring learners in the first 2 years of the MD program to complete, minimally, 2 rural clinical experiences. This allows learners to become familiar with the unique needs of rural populations of Newfoundland and Labrador. During the final 2 years, learners participate in an 8-week rural family medicine rotation and a 4-week rural selective in a core discipline. Memorial learners have hosted the Monte Carlo Charity Gala annually, since 1977, raising almost $2,000,000 in support of local charities. This event embodies our philanthropic spirit and provides opportunities to make meaningful contributions to our communities. Curriculum Curriculum description Our 4-year MD program is theme-based with both horizontal and vertical integration, whereby each phase builds on the knowledge acquired in the previous phase. Learners develop clinical skills, build on clinical knowledge, pursue a research project, and experience a variety of teaching and learning methods throughout the program. We strive to graduate well-rounded, generalist MDs. See Supplemental Digital Appendix 1—Curriculum Description—at https://links.lww.com/ACADMED/A841. Curriculum changes since 2010 Through the curriculum renewal process, we developed and implemented a spiral curriculum, which was introduced to first-year medical learners in 2013. The spiral curriculum featured “stories” which were developed to allow learners to follow a set of fictional patients through the progression of health and disease across learning experiences. A recent full review of the curriculum identified that it had not evolved into a purposeful spiral and the clinical skills sessions did not align with content delivered in learning sessions. From these recommendations, we began a reorganization to a theme-based curriculum, whereby basic and clinical sciences are integrated into clinical encounters and clinical skills sessions are better aligned with the delivery of learning sessions. The theme-based curriculum was introduced for Phase 1 learners in 2019. In 2013, we increased the incoming MD class size from 64 to 80 learners. In 2014, a new Medicine building was opened, complete with state-of-the-art classroom technology, seating accommodations for up to 120 learners in 2 designated lecture theatres, and many small learning rooms. Assessment Our MD program objectives are linked directly to the CanMEDS competency framework. All session and course objectives covered in the curriculum have been mapped using an in-house software, CBlue. See Supplemental Digital Appendix 2—Medical Education Program Objectives—at https://links.lww.com/ACADMED/A841. Since 2010, the MD program has implemented several changes in learner assessment, including increasing transparency through the development of assessment plans for each phase and course. Assessment plans detail formative and summative assessments, reassessment, and course success criteria. Assessment plans are approved by the Undergraduate Medical Studies (UGMS) Committee prior to the commencement of the phase. In 2013, the learning technology team introduced the use of QuestionMark, to create and deliver multiple-choice examinations and generate a cumulative question bank. Online multiple-choice examinations have now largely replaced paper-based assessments. In 2015, we became the first MD program at a Canadian medical school to introduce EPAs as the primary learning and assessment tool during Phase 4, the final 2 clinical learning years. We transitioned away from discipline-specific medical expert examinations and adopted comprehensive clinical sciences examinations, which we deliver in the form of progress testing. Learners complete a baseline formative comprehensive exam prior to the commencement of Phase 4, 2 additional formative comprehensive exams during the Core Experiences course, and a summative comprehensive exam at the end of the course. In addition to the assessment of clinical and medical expert knowledge, the development of the core competency professionalism is assessed throughout the entire program. Parallel curriculum or tracks Our Core Experiences course has traditionally been made up of block-based, discipline-specific core experiences. In 2018, a longitudinal integrated clerkship (LIC) was introduced at one teaching hospital in parallel with the 50-week block-based Core Experiences course. Learners in the final year of the MD program also have the opportunity to complete a 12-week integrated selective in a rural setting. Traditional selective experiences are arranged in 2- to 4-week blocks to meet criteria for clinical diversification. We refer to this mini-LIC as Progression to Postgraduate, and it runs in parallel with the traditional 12 weeks of selective time. Pedagogy In addition to common pedagogical approaches, in 2013, the MD program implemented integrated learning sessions (ILSs) throughout the first 2 years of the MD program. ILS is a blended teaching approach, which helps learners integrate new medical expert knowledge into realistic clinical scenarios. Learners lead small-group discussions, followed by a facilitator-led large-group debrief and discussion. Learners gradually take on increasingly responsible roles in the large-group facilitation as they progress through the first and second years of the program. Faculty remain involved to provide oversight and input, as needed. Clinical experiences Learners in the MD program participate in rotations at several types of clinical sites, including: Hospital wards Medical specialist clinics, hospital and community based Family medicine clinics, rural and urban Community health clinics, rural and urban Required and elective community-based rotations include: Phase 1 learners participate in weekly afternoon community placements, typically under the supervision of a family practitioner within an urban area. Phase 2 learners participate in a 2-week community visit at a rural site, during which 80% of the time is spent with community services and 20% of the time is spent under the supervision of a family practitioner. Phase 3 learners participate in a 2-week community visit, during which 80% of the time is spent under the supervision of a family practitioner and 20% of the time is spent with community services. During Phase 4, learners have many opportunities to participate in clinical learning experiences outside of the main teaching hospitals but are required to participate in an 8-week rural family medicine placement under the supervision of a family practitioner and a 4-week rural placement in 1 of the 8 core disciplines. Electives and selectives may be completed at other Memorial affiliated sites, as well as other Canadian and international medical schools and teaching hospitals. Service learning opportunities are also available outside of the hospital setting. The major challenges faced in designing and implementing clinical experiences for our medical learners are: Preceptor availability Housing accommodations at rural sites Inconsistent preceptor approaches to formative and summative feedback Curricular Governance The UGMS Committee, Curriculum Oversight Working Group (COWG), and Phase Management Teams are responsible for the planning, management, and monitoring of the MD curriculum. The COWG and the Phase Management Teams report to the UGMS Committee, which reports to Faculty Council and includes the curriculum lead; the four phase leads; representatives from the Student Assessment Subcommittee (SAS), Program Evaluation Subcommittee (PESC), and Informatics & Technology Advisory Committee (iTac); and other related professionals. The curriculum lead chairs the COWG, and the phase leads chair the respective management teams, all of which include representation from the instructional design team, as well as administrative personnel. See Figure 1—Curricular governance.Figure 1.: Curricular governance.Education Staff The Undergraduate Medical Education (UGME) team coordinates the implementation of the MD curriculum. Program evaluation, learner assessment, and educational technologies are overseen by subcommittees of the UGMS (PESC, SAS, and iTac) and are partially administered by units outside of the educational office. The UGME office is responsible for the delivery and assessment of the MD program and includes the faculty and administrative professionals who are responsible for the following elements of the MD program: Curriculum oversight Accreditation Preclinical administration Clinical skills administration Core clinical administration Elective/selective administration Research administration ILS administration Assessment administration Faculty and staff responsible for admissions, student affairs, and professional and educational development fall outside the auspices of the UGME office. There are several faculty appointments with the UGME office: The associate dean, undergraduate medical education, in collaboration with the UGMS, has major responsibility for the education of our learners. The curriculum lead oversees the undergraduate medical education curriculum and seeks direction of the undergraduate content leads for the objectives relating to their specific discipline or division. The Phase 1, 2, and 3 leads oversee faculty with designated responsibilities of assessment, research, ILSs, clinical skills, and coordinate matters relating to the respective phase. The Phase 4 lead oversees faculty clerkship discipline coordinators, selectives coordinator, electives coordinator, course chairs, research lead, assessment lead, and coordinates matters relating to Phase 4. See Figure 2—Medical education leadership.Figure 2.: Medical education leadership.The UGME office administers the budget for curricular matters that cannot be met by appointed faculty. The UGME office pays the prorated salaries for nonfaculty MDs and non-MDs who play instructional or facilitative roles in the curriculum, as well as assessment invigilators and assessment markers. Faculty Development and Support in Education Applications for promotion and tenure must illustrate the candidate’s excellence in scholarship of education, clinical excellence, excellence in scholarship of discovery, and excellence in leadership. Candidates must demonstrate meaningful contribution to the achievement of the FOM and Memorial’s educational missions, through curriculum development, innovation in instructional delivery methods and evaluation, and leading major program development, among other educational contributions. The learner-completed evaluations of faculty teaching must attest to the faculty member’s efficacy as an educator. The Office of Professional and Educational Development (OPED) is an accredited provider of university continuing professional development for health care professionals and other faculty members at the FOM as well as the physicians in the province of Newfoundland and Labrador. OPED offers a breadth of professional development programming which is accredited by the Committee on Accreditation of Continuing Medical Education of the Association of Faculties of Medicine of Canada. The programs, offered in a variety of formats, are designed to address the needs of health care professionals who practice in both urban and rural communities throughout the provinces we serve, nationally and internationally. Distributed Medical Education At Memorial, we do not have regional medical campuses; however, approximately 10–14 learners participate in clinical learning opportunities such as community visits and the Core Experiences course in New Brunswick or Prince Edward Island each year. All clinical learners must meet the same set of objectives irrespective of the clinical learning site. Each clinical discipline is overseen by one clerkship discipline coordinator, and in the case of the LIC, education is overseen by one site director. The site directors and clerkship discipline coordinators meet at the monthly Phase 4 Management Team meeting and discuss performance and assessment challenges, and unified approaches. All Phase 4 learners must meet success criteria for the phase. Learner performance issues are reviewed and addressed during the monthly Management Team meeting and as needed. Assessment profiles are presented at the Phase 4 Management Team meeting for learners who have not met the assessment criteria for the Core Experiences course at the 6-, 9-, and 12-month reviews. Remediation and reassessment are prescribed for learners, as required. See Table 1—Distributed Medical Education Learners.Table 1: Distributed Medical Education LearnersInitiatives in Progress In conjunction with the LIC we currently offer in Moncton, New Brunswick, we intend to introduce another LIC site for our learners in Fredericton, New Brunswick, by August of 2020. We are also currently exploring opportunities for rural LIC sites in the province of Newfoundland and Labrador. With the theme-based curriculum well underway for Phase 1 learners, we are looking forward to its full implementation by April of 2023. Acknowledgments: The authors wish to thank Alison Haynes, Brian Kerr, and David Stokes for Memorial University’s Doctor of Medicine Curriculum Infographic.

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