University of British Columbia Faculty of Medicine

Medical Education Program Highlights Publicly funded, 4-year program, admitting 288 learners annually; distributed across 4 locations in the province of British Columbia (BC) including 3 regional medical campuses: the Island Medical Program (Victoria), the Northern Medical Program (Prince George), and the Southern Medical Program (SMP) (Kelowna). The main medical campus is the Vancouver Fraser Medical Program (Vancouver and Fraser Valley). All graduates receive an MD from University of British Columbia (UBC). Social responsibility is central to the undergraduate curriculum as the Faculty of Medicine directs its education activities toward addressing the current and future needs of BC. Distributed medical education is fundamental to the Faculty of Medicine’s structure and culture. Learners are exposed to a range of communities and patient populations and taught in underserved areas including remote and rural areas of BC. There are now distributed residency training programs in family medicine, internal medicine, psychiatry, pediatrics, and emergency medicine that complement the undergraduate training program. Admissions criteria are competitive, but holistic in nature, allowing learners from a wide range of backgrounds to succeed in the application process. Special streams exist for Indigenous, rural/remote, and MD–PhD candidates. Curriculum Curriculum description Competency based and designed around the principles of horizontal and vertical (i.e., spiraled) integration. Integration occurs through a “body systems and themes” framework. More specifically, themes of medical sciences, diagnostic sciences, treatment, populations and diversity, care of patients, evidence-based medicine, and scholarship are integrated into relevant body system weeks across all courses. Systems and themes are revisited throughout all 4 years of the curriculum with increasing levels of difficulty (see https://mdprogram.med.ubc.ca/about/curriculum). Year 1 and 2 content is anchored through 56 core case-based learning (CBL) cases, with related content explored in weekly clinical decision-making, clinical skills, and family medicine sessions. A Curriculum Integration Advisory Council, informed by theme leads, monitors curricular content for sequencing, gap identification, redundancies, and opportunities for further integration. Other key features include Flexible and Enhanced Learning (FLEX) courses, transitions courses (into medical education, into clinical education, and into postgraduate education and practice), and support for professional identity formation through small-group and reflective portfolio review sessions led by a coach. Curriculum changes since 2010 In August 2015, a renewed undergraduate curriculum was launched. Guiding principles included social responsibility and accountability competency-based and programmatic assessment, flexibility, scholarship, integration, continuity, and preparation for active participation in the current and future health care system. A significant innovation is the FLEX course. It is a required curricular component that spans all 4 years and emphasizes a broad understanding of scholarship, engagement, and social accountability. Students are prepared through a Foundations of Scholarship component and engaged in community and/or research activities. Goals include fostering innovation, creativity, and critical thought as well as preparing graduates for roles as scholars, lifelong learners, and medical leaders. Indigenous health is a new theme (as part of Populations and Diversity) generated in collaboration with the central university’s academic units including the UBC Centre for Indigenous Health. Preclinical students participate in a foundational Indigenous cultural safety learning experience covering topics of Indigenous perspectives of history, the legacy of colonialism in Canada, Indigenous peoples’ health, and Canada’s health care system. Web-based modules and face-to-face interdisciplinary workshops are used with lectures, orientation to local Indigenous communities, CBL, and small-group teaching sessions with Indigenous simulated patients and elders/educators. For ongoing quality improvement, the Curriculum Review Working Group formally reviews the curriculum in light of internal and external feedback to ensure the curriculum is accomplishing its intended outcomes. The SMP, based in the interior of BC, became the fourth undergraduate campus in 2011 and graduated its first class in 2015. Assessment See Supplemental Digital Appendix 1—Medical Education Program Objectives (Exit Competencies)—at https://links.lww.com/ACADMED/A834. Exit competencies, developed during the curriculum renewal process, define the program’s objectives. They were developed based on: Association of Faculties of Medicine of Canada (AFMC) (2010): The Future of Medical Education in Canada College of Family Physicians of Canada’s Undergraduate Education Committee (2009): CanMEDS-FM competency framework for undergraduate medical education from a family medicine perspective Royal College of Physician and Surgeons of Canada (2005): The CanMEDS Physician Competency framework A programmatic assessment approach was implemented with the renewed curriculum. It includes 4 assessment modalities, each designed to assess specific content and competencies: Written tests (multiple-choice question exams), portfolios, OSCEs, and workplace-based assessments. Progress tests are provided regularly for students to enable them to assess their progression. The goal is to provide longitudinal and competency-based assessment that enables regular feedback and opportunities for coaching. An MD–PhD program is jointly administered by the Faculty of Medicine and Faculty of Graduate and Postdoctoral Studies. Its purpose is to provide qualified students the opportunity to combine medical school with intensive scientific training for careers as clinician–scientists. Students usually complete the program in 7 years, with 3 years of full-time PhD training occurring between preclerkship and clerkship. The MD curriculum for all students is delivered using several pedagogical approaches. Most prevalent in terms of curricular hours are lecture, CBL, small-group discussion, independent learning, large-group discussion, ambulatory and inpatient clinical experience, laboratories, reflection, service learning, and research activity. In addition, approximately 3,600 hours of teaching is scheduled in the context of patient care. All learners’ first encounter with clinical experiences occurs during clinical skills training and family medicine office placements, integrated throughout years 1 and 2. Both activities begin in the first term. Clinical skills involves exposure to a mix of volunteer patients, inpatients, and standardized patients. Clinical education takes place in urban, regional, and rural/remote settings in both academic and community centers across BC. Year 3 core clerkships and year 4 clinical electives are offered across the province at clinical academic campuses (larger, often highly specialized hospitals) and affiliated regional centers (medium-sized hospitals in urban or nonurban settings) that incorporate rotation-based and integrated community clerkships (ICCs). ICCs are currently delivered at 6 sites with 24 students in total, located in rural and remote communities. Year 2 students apply to ICCs for their third-year clerkships. Students are selected on the basis of merit and in accordance with regional quotas. For their entire clerkship year, ICC learners are assigned to a primary preceptor in family practice and work with patients whom they follow through various specialty clinics and other aspects of their care in the local community hospital. 24 weeks of clinical electives are offered in year 4, during which students can complete 2- or 4-week rotations in a variety of disciplines, in-province, out-of-province, and/or out-of-country. Curricular Governance The Undergraduate Medical Education Committee (UGMEC) is responsible for design, management, integration, evaluation, and enhancement of the curriculum. Several subcommittees report to the UGMEC. Operational responsibility for the development, monitoring, and review of learning objectives is delegated to the years 1 & 2 and years 3 & 4 Curriculum Subcommittees. These groups work across all sites. The Learning Environment Advisory Council is responsible for monitoring the learning environment, including mistreatment of students and promoting a culture of trust and respect among learners, faculty, and staff. It is advisory to the UGMEC, the regional associate deans, and the curriculum subcommittees. See Figure 1—Curricular governance.Figure 1: Curricular governance.Education Staff The Curriculum Management Unit tracks objectives across the curriculum and maps them to link the granular, session-level objectives with weekly objectives, course outcomes, yearly milestones, and exit competencies. The Educational Assessment Unit aligns objectives across assessment modalities to ensure what is taught is being assessed. They also monitor quality of assessment practices. The Evaluation Studies Unit conducts evaluations of courses and clinical rotations. They analyze and report to UGMEC on data arising from admissions, AFMC Graduation Questionnaires, learning environment surveys, Medical Council of Canada Qualifying Examinations, Canadian Residency Matching Services, and long-term outcomes. Student Affairs offices collaborate with UGMEC, but is purposefully separated from the undergraduate medical education structure. The Student Affairs Advisory Council advises the associate dean of medical student affairs, who reports directly to the executive associate dean of education, who is the chief academic officer of the Faculty of Medicine. Student Affairs offices, each with an assistant dean, exist at each regional campus. They are responsible for ensuring students have access to health services, personal counseling and well-being programs, and financial aid and debt management services. They also participate in electives advising and career counseling and can make referrals for academic advising and accommodations. The Centre for Health Education Scholarship (CHES) provides consultation regarding how modern understanding of educational practices can influence curriculum development. They also support faculty, staff, and trainees who wish to pursue educational scholarship of their own. The Faculty of Medicine’s Education Office, led by the executive associate dean of education, provides strategic support to advance the education mandate of the Faculty of Medicine, overseeing 95 health professions programs. See Supplemental Digital Appendix 2—Medical Education Leadership—at https://links.lww.com/ACADMED/A834. Faculty Development and Support in Education The Faculty Development Office empowers teachers to be successful by developing a model for educational support that takes into account the needs of all teaching sites and teachers at all career stages. It maintains a distributed structure involving regional teams delivering local, central, and online offerings. In this way, faculty development offers a consistent core program while accommodating the unique needs of faculty in their geographical/departmental areas across regional sites. The faculty development team organizes and supports a collaborative, interprofessional network of teachers and clinician–educators and facilitates the development and renewal of foundational and advanced teaching and learning competencies. Full-time (academic) faculty and clinical faculty appointments are governed by the UBC Faculty Association Collective Agreement and follow the same policies and procedures for initial appointment, renewal, promotion, granting of tenure, remediation, and dismissal. Promotion decisions are based on performance in both teaching and scholarly activity/educational leadership. Evidence is provided through teaching dossiers, examples of scholarly activity, and summative peer reviews of teaching. To support faculty and trainees interested in education scholarship, CHES was established to shape the theories and activities of learning in the health professions by creating new knowledge through research and informed innovation, building capacity through mentorship of individuals, and fostering a culture of collaboration and scholarly thinking in health professions education. CHES offers the Clinical Educator Fellowship Program aimed at training senior residents or junior faculty for roles as education leaders. It involves experiential teaching, a cohort-based academic program, and completion of a master’s degree. CHES also delivers the Educators Leadership Program to support the development of multiprofessional health professions educators. Regional Medical Campuses UBC has 3 geographically distributed campuses, each of which operate on a combined model (i.e., offering both preclerkship and clerkship training separate from the main campus). Regional associate deans are the principal academic officers for each campus. They are responsible for the delivery of undergraduate medical education as well as providing regional oversight of postgraduate residency and allied health professions programs. They are involved in all domains of activity at their geographically distributed campuses including research, faculty affairs, and engagement with partners (e.g., health authorities) and the community. To help maintain a consistent educational experience across sites, the Faculty of Medicine has a stable, sustainable, and renewable technology platform that facilitates collaborative education, research, and administration. Further, the UGMEC and other committees include representatives from all distributed campuses and ensure that policies and procedures define common processes and expectations. Faculty leaders travel between regional campuses regularly, and a clear delineation is offered to faculty and students regarding what is context-specific versus core material. Students at all campuses receive the same materials, are directed to the same learning resources, and are assessed in the same way. Teaching faculty across campuses also receive the same materials that include the exit competencies, objectives, assessment criteria, and so forth. Program objectives and achievement markers are consistent across regional campuses with UGMEC monitoring written exam and clinical marks, OSCE results, graduation rates, residency match rates, Medical Council of Canada Qualifying Examination scores, and the AAMC Graduation Questionnaire, to ensure regional campus comparability. See Table 1—Regional Medical Campuses.Table 1: Regional Medical CampusesAcknowledgments: Submitted on behalf of the countless people who contributed to the educational program outlined in this document, the authors would like to extend a particular thank you to Lua Lynch for her assistance in aggregating the materials that enabled this snapshot’s creation.

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