Dalhousie University Faculty of Medicine

A student-centered, problem-based, small-group-learning curriculum was introduced in September 1992. Implementation was very successful, and the next comprehensive review started in 1998 with an in-depth evaluation of the two clerkship years. Several changes were suggested to faculty and implemented in late 1999. At the same time, review of the first two years' units was undertaken to identify necessary changes to promote better horizontal and vertical integration. Changes to the two longitudinal units (patient—doctor/clinical epidemiology, and population health) were implemented in the first year of the curriculum in 1999-00, and their introduction into the second year was scheduled for August 2000. Curriculum Management and Governance Structure ♦ The associate dean's portfolio includes the Undergraduate Medical Education and Student Affairs Division (UMESA), the Learning Resource Center, and the curriculum committees described below. ♦ The associate dean chairs the COPS Curriculum Committee and the year committees (e.g., the year one committee, etc.). Progress committees are chaired by chief evaluators. ♦ The COPS Curriculum Committee is a faculty committee with membership of non-departmental basic science faculty, clinical and education faculty, and student representatives. It has major responsibilities to develop the overall curriculum, including both content and methods of teaching and learning develop policy regarding the curriculum review the curriculum for integrity and adherence to the curriculum goals evaluate each program assist year committees in their functions, when necessary ♦ The year committees (preclinical/clinical) are composed of unit heads of each unit in the curriculum year and student representatives. These committees have responsibilities to discuss issues relating to all units implement the learning experiences most appropriate for the learning objectives of each unit manage implementation issues, with support from the COPS Curriculum Committee, as needed develop and implement student assessment for each unit review students' academic progress ♦ The progress committees (preclinical/clinical) are composed of the associate dean of UMESA, the director of admissions, unit heads, and student representatives. Major responsibilities are to review the progress of each student with respect to all evaluations review students' fitness for the study and practice of medicine make recommendations to the faculty review and approve the results of end-of-unit evaluations recommend to the COPS Curriculum Committee matters that relate to evaluation policies of the MD curriculum CURRICULAR RENEWAL PROCESS Learning Outcomes ♦ The COPS Curriculum Committee throughly reviewed the clerkship curriculum in 1998 and proposed a set of learning outcomes that had to be demonstrated by graduating students. ♦ The learning outcomes were approved by the faculty in January 1999 and implemented as some of the terminal goals of the clerkship, starting in August 1999. ♦ At the end of the clerkship, students should be able to demonstrate attitudes and qualities, and proficiencies in skills and tasks necessary for the development of their future role as medical expert/clinical decision maker through acquiring initial competencies in the roles of scholar, communicator, collaborator, professional, manager, and health advocate. ♦ Levels of competency were described in essential roles of graduating students and standards of performance suggested to unit chairs in areas of professionalism, self-assessment skills, humanistic medical care abilities (in clinical ethics and health advocacy), communication and collaboration (including interpersonal skills, communication skills, and team skills), medical expertise (including problem-solving, life support, and technical skills), and the intellectual tools and abilities to use basic science in the practice of medicine (including knowledge of the medical sciences; knowledge of pathophysiology; skills in diagnosis, management, and assessment; organization skills, ability to synthesize information, and clinical judgment), and scholarly activity (including critical assessment skills and independent learning skills). Principles of Ongoing Curriculum Renewal ♦ Self-directed, lifelong learners ♦ Student-centered curriculum ♦ Small-group learning ♦ Case-oriented problem-stimulated curriculum (COPS) ♦ Problem-based learning with selective, substantive mastery of foundation knowledge ♦ Integration of basic, clinical, and social sciences ♦ Evaluation of student performance based on curriculum goals ♦ Adaptation of learning to new realities of health care and patients' needs Timeline for Curricular Change ♦ September 1992: First COPS class ♦ May 1996: First class graduation ♦ January 1999: Revised clerkship approved by faculty and review of patient—doctor units ♦ August 1999: Start of revised clerkship, phase I Start of revised patient—doctor units Start of revised clinical epidemiology and critical thinking courses in medicine I unit Review of medicine I and II units Increased responsibilities of the Learning Resource Center (LRC) ♦ April 2000: Appointment of medical director, LRC ♦ August 2000: Start of clerkship, phase II ♦ September 2000: Start of revised critical thinking and population health courses in medicine II ♦ August 2001: Start of revised medicine I and II units Changes in Pedagogy ♦ In the clerkship years the following changes have been implemented: Move to ambulatory care settings Move to non-tertiary care settings, including community experiences Move to integrated units: —Medicine Principles of Practice —Behavioral Medicine and Primary care —Women, Children, and Youth —Surgical Principles of Practice —Electives and remedial unit —Continuing and preventive care, including a mandatory rotation in care of the elderly Introduction of a longitudinal emergency medicine unit Students' objective- and criteria-based assessments of attitudes, skills, and knowledge in each unit ♦ The Patient—Doctor Units (see Figure 1, top panel) includeFIGURE 1: Curriculum Overview use of Learning Resource Center Simulated Patients program revision of the human sexuality component increase in communication skills opportunities introduction of interprofessional learning modules simulated-patients workshops in specific areas of the clinical examination use of simulated patients for complete history and clinical examination training integrated with themes of COPS units learning of focused history and examination skills six-week unit on integration of clinical skills at the end of the second year objective and criteria-based assessment of clinical skills skills and procedures modules integrated into other medicine I and II units ♦ The clinical epidemiology and the critical thinking courses (see Figure 1, bottom panel) foster mastery of learning principles of evidence-based medicine team skills application of population health principles in community skills Changes in Assessment Methods ♦ There has been an increase in the use of standardized patients in summative assessment at the end of patient—doctor units and at the end of unit evaluation during clerkship. ♦ There has been an increased use of COPS cases for communication skills learning and assessment. ♦ Computers are used in COPS units for testing heart sounds. ♦ Computers are used in the Licentiate of the Medical Council of Canada (LMCC) examination. ♦ Computers are used in the development of multimedia applications for the curriculum. ♦ OSCEs are used in assessment at the end of patient—doctor units and the end of units during clerkship. ♦ Faculty observation is used to assess students in-training evaluation forms. ♦ Preceptor tutorial evaluations include faculty observation. ♦ MCQs are used in the assessment of knowledge at the end of units during the clerkship. Curriculum Review Process ♦ Evaluation of changes in the curriculum will be a constant process. ♦ A variety of measures have been in place since the start of the COPS curriculum, and data on student, preceptor, and program performances are available for comparison with the next cohorts of students who are going through curricular reform starting with the new clerkship in 1999. These measures include student evaluations of introduction to clerkship using standardized forms student evaluations of clerkship experiences using standardized forms and focus groups unit evaluations of clerkship experiences using focus groups student readiness for next clinical experience using questions added to regular rating forms student self-assessments using standardized forms student evaluations of end-of-unit examinations using standardized forms and focus groups assessment of student performances at unit end with MCQ examination and OSCE examination of LMCC performances development of instruments to measure faculty performance Future Goals ♦ To increase integration at all levels of the curriculum ♦ To continue to improve assessment tools ♦ To centralize assessment functions under the umbrella of a new evaluation committee ♦ To re-energize the tutorial process and the development and use of cases ♦ To improve the evaluation of faculty performance and reward faculty for their educational activities related to the curriculum ♦ To continue the ongoing development of multimedia resources for learning ♦ To develop distributed learning modules for outside metro clinical settings

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