Dalhousie University, Faculty of Medicine

Curriculum Management and Governance Structure ♦ See Figure 1.FIGURE 1:: Curriculum Committee Structure♦ The curriculum committee is responsible for the curriculum, and the preclerkship (Med 1,2) and clerkship (Med 3,4) committees report to this committee. Office of Education ♦ The Division of Medical Education, http://dme.medicine.dal.ca/index.cfm, supports the continuum of medical education including the undergraduate program. ♦ This office includes the division head, 5 program directors, 1 coordinator, 9 support staff, a research assistant, 17 faculty appointments, and 29 cross appointments. In addition, there are a number of emeritus professors. The Head of the Division is the chair of the Med 1,2 committee. The director of communication skills is responsible for the undergraduate program in communication skills and chairs the committee. Other directors are responsible for Faculty Development, Medical Humanities, Medical Informatics, and Interprofessional Education. In addition, the division is heavily involved in our curriculum renewal project. Financial Management of Educational Programs ♦ This is the responsibility of the Dean in consultation with the university and our Government partners. We are currently opening a branch campus in New Brunswick, and the provincial government in this province has provided additional support. Valuing Teaching ♦ We do not have an academy of educators, but many are cross-appointed to the Division of Medical Education. ♦ There is a track for promotion as a Teacher. All faculty must meet a certain level of teaching standard, and the promotion with focus on teaching requires, in addition, reaching a certain level in either research or clinical care. Curriculum Renewal Process ♦ Current process was launched in September 2009. ♦ Goals of the process are as follows: The curriculum will be patient centered in content and student-centered in approach. The curriculum design recommendations were endorsed at the curriculum retreat; these include that the curriculum will be patient centered, support life-long learning, provide integrated learning experiences, be clearly linked to objectives and outcomes, and be student/learner-centered. ♦ The curriculum will be delivered using a menu of learning formats: Lectures Case-based learning Self-directed learning E-learning Game learning Experiential learning Inter and intraprofessional learning Process of Renewal ♦ A retreat was held in September 2009 with students, interested colleagues, community stakeholders, and faculty (>100 participants) to define direction for the undergraduate curriculum with a focus on educational outcomes. ♦ Powerful themes emerging from the retreat included navigation and integration, across health care systems and among scientific disciplines foundational to the practice of medicine; the importance of trust and trustworthiness; maintaining curiosity while managing complexity and uncertainty; and a connection between good citizenship for physicians and work-life balance. ♦ Participants noted traditional strengths in clinical preparation and community connection and raised questions about how we might advance in scientific preparation, leadership, and interprofessional, and evidence-based practice. ♦ A small writing group articulated educational goals and outcomes for the curriculum, using the themes emerging from the retreat, frameworks from the medical community (e.g., CanMEDS), and further consultation with the relevant committees. ♦ The writing group has designed and refined a schematic concept map of the curriculum outcomes through an iterative process. These outcomes and associated concept map formed the basis of a series of Community Conversations across the Maritime provinces we serve, an important social accountability aspect of our curriculum renewal. ♦ At the same time, 20 groups were formed to perform environmental scans on a wide range of educational topics including curriculum design, the scientific basis of medicine, the art of medicine, e-learning, and so on. These may be accessed at: http://symposium.medicine.dal.ca/material.htm. ♦ Following this, a symposium, Vision 2020: Renewal of the Undergraduate Curriculum, was held November 2009 with five experts on medical education and curriculum renewal, including Dr. Karen Mann, Emeritus Professor at Dalhousie, and Dr. Hilliard Jason. The symposium, as all our deliberations, included presentations by our medical students. ♦ Finally, a retreat was held in December 2009 to review all the material collected and make decisions on curriculum renewal. The renewal teams redefined the curriculum for March 2010. ♦ A major change is the introduction of case-based learning and the integration of the scientific foundations of medicine with clinical medicine and clinical and professional skills. ♦ We are including a dedicated professional competencies curriculum longitudinally and two blocks for integration. We intend to include a Therapeutics stream throughout the curriculum with a consolidation month in the fourth year. Learning Outcomes/Competencies ♦ Our new program-level Educational Outcomes and associated concept map provide a common reference point and standard for the new curriculum (see Figure 2).FIGURE 2:: Curriculum Concept Map♦ Our approach was to integrate the CanMEDS roles into four domains of professional engagement (Skilled Clinician, Life-long Learner, Community Contributor, and Professional) and to bring out the process of laying a foundation in knowledge, skills, and attitudes that students will integrate over the course of UME in order to be prepared to perform as competent professionals in these spheres. ♦ A key organizing concept was “entrustable professional activities,” described by ten Cate (Academic Medicine, 2007, 82(6), 542). These are the actions students can be entrusted to perform successfully on graduation from our program. ♦ These function as a useful intermediary between full professional competencies for the physician in practice (e.g., “manage patient care”) and the level of achievement relevant to the end of UME (e.g., “can be entrusted to perform a good history and physical”). They are highly concrete action statements and, at the same time, powerful indicators (through the notion of “trust”) of high levels of achievement in underlying knowledge, skills, and attitudes. ♦ For each domain, we have a set of brief, action-oriented goal statements that provide touchstones for that domain's outcome-oriented learning objectives; these, in turn, describe the knowledge, skills, and attitudes that students will develop and integrate in the course of our program. ♦ The full set of goals, entrustable professional activities, and outcomes can be accessed at: http://undergraduate.medicine.dal.ca/. ♦ Our concept map provides everyone involved in the curriculum with a reference point that frames discussions about location and coverage across the curriculum. Does a given unit “hit all four sides of the square”? Is a student accomplished in one corner but needing to strengthen another? Will their path to strengthening in that domain take them back through one of the scientific bases? Or into a cross-cutting skill? New Topics in the Curriculum Since 2000 ♦ The new Professional Competencies curriculum will introduce students to practice-level issues, such as patient safety and quality improvement. ♦ Team-based learning: Team skills will be enhanced as part of the small group learning and through the professional competencies. Team-based learning in large groups may be introduced in the future. ♦ At the undergraduate level, simulation will be used in standardized patient encounters, in the skills laboratory, and through on-line modules. Surgical training for new surgical techniques is considered a postgraduate level skill. ♦ Interprofessional learning is proposed as part of a chronic illness curriculum in the preclinical years, through following a patient over two years. ♦ Leadership will be delivered using activities adapted from the Canadian Medical Association curriculum. ♦ E-learning is expected to play a role in the new curriculum. ♦ We will be using distance techniques as we open the distributed campus, and there is a plan to assess the comparability across sites on a number of outcome measures. Changes in Pedagogy ♦ Our previous case-oriented, problem-stimulated curriculum had in essence been a hybrid between case-based and problem-based learning, and the perception had developed over time that our paper patients were in fact “problems” rather than “people.” ♦ Our new curriculum is patient centered and case based. As a case-based curriculum, it will take advantage of efficiencies in learning to be gained by sharing objectives and expectations in advance, with expert tutors to guide the process. As patient centered, it will connect students to patients as situated in their social and physical environments. ♦ Vertical integration with the clinical skills and professional competencies curriculum will ensure that students develop knowledge and skills around all aspects of the patient's situation relevant to their health. ♦ Student outcomes are largely above the national average and lead the country in a number of areas such as the CLEO objectives. We will continue to monitor outcomes through the graduate questionnaires, national examinations, success on the resident match, and surveys of postgraduate program directors. Changes in Assessment ♦ We have implemented a more robust system of formative assessment across all units and in the clerkship. ♦ The tutorial assessment includes assessment of professional attributes and deficiencies are reviewed by the Associate Dean UME. ♦ All formative assessments in the clerkship force either pass or a remediation plan required. ♦ The third year OSCE is now formative at midpoint, and the final OSCE will be a comprehensive examination. ♦ We are embarking on using on-line examinations, and we are hiring an assessment specialist. ♦ We are considering the use of portfolio assessment that includes attention to the educational goals of the curriculum. Clinical Experiences ♦ Clinical education takes place throughout the Maritimes, with major sites in Halifax, Nova Scotia, and Saint John, New Brunswick. ♦ A high percentage of our graduates choose family medicine as a career, and many remain to serve the Maritime communities. ♦ The major challenges in a distributed program are financial support for travel and accommodation. ♦ Recently, a new position, Senior Associate Dean Rural and Regional Medicine, was appointed to ensure we have appropriate clinical placements for our students and to ensure comparable learning experiences. Although students often do not appreciate the disruption to their lives with this program, they appreciate the clinical learning opportunities in the communities. Regional Campus ♦ The Dalhousie Medicine New Brunswick program is slated to open with 30 students in September 2010. Currently, clerkship students are placed in this program. This will be the first time that we will be distributing the preclerkship program. Highlights of the Program/School In the most recent accreditation survey, the strengths outlined below reflect this program: ♦ A high number of students entering family medicine fulfilling the social responsibility for the Maritime Provinces. ♦ Leadership of Dean to expand Dalhousie Medical School as the center for physician training in the Maritime provinces in a complex political and financial environment. ♦ Strong working relationships in developing the New Brunswick campus. ♦ Depth and strength of the bonds between the students and the faculty. ♦ Medical Humanities program. ♦ Electives program in Med 1, 2 with opportunities for diverse research or clinical experiences. ♦ Current strengths include the engagement, energy, and creativity of the faculty and students to renew the curriculum at the same time as we open the distributed campus.

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