Laval University

Thanks to pioneers in medical education—Gilles Cormier, Jean-Jacques Ferland, Georges Bordage, and Hélène Leclère —the Laval University MD program underwent a major curriculum reform in the seventies and the early eighties. It is now a flexible, mature, renewed MD program. ♦ In 1982, the school moved from a traditional two-year basic sciences and two-year clinical sciences curriculum to 15 weeks of introduction to the basic sciences in the first semester, 52 weeks of integrated courses by systems and organs, and “transversal” courses, aimed at the integration of biologic concepts and fostering the ethical, psychological, social, and economic aspects of medicine. ♦ The clerkship is 86 weeks long: 14 mandatory clinical rotations and five electives. ♦ The program is very flexible. The first 67 weeks can be done in two, two and a half, or three calendar years, permitting each student to plan the duration of his or her program according to background and personnal interests. Curriculum Management and Governance Structure ♦ The Faculty of Medicine is responsible for undergraduate programs in medicine, kinesiology, occupational therapy, and physiotherapy, and for granting certificates in human sexuality and in palliative care. ♦ Each program has a program director and a curriculum committee. ♦ Each course or rotation is under the responsibility of a course coordinator, who chairs the course committee and reports to the curriculum committee. ♦ The vice-dean of education's role is to help program directors in their tasks, to promote better teaching methods and evaluation procedures, and to work with the dean's office, other faculties, the university, and other medical schools and organizations. Office of Education ♦ In 1975, Laval University created the Office of Health Sciences Education. ♦ The members were instrumental in the major undergraduate curriculum reform, the creation of a learning center, the reorganization of the family medicine residency program, the establishment of a master's degree program, and the creation of many courses offered to teachers and clinical instructors. ♦ For the last few years, certain course directors have had the impression that the office was a tool for surveillance and criticism rather than a source of help, advice, and inspiration. This perception may have been accentuated by the “surveillance” role asked of the members of the office by the Faculty of Medicine's administration. ♦ Confronted with declines in student numbers and professional resources, the Faculty of Graduate Education chose to suspend admissions to the master's program in university pedagogy of health sciences in accordance with the program director's recommendation. ♦ The school is now involving experienced and interested professors in contributing to the training of new course directors and other teachers. ♦ There is an evaluation center for health sciences that is doing very well. ♦ The staff—one full-time professor, two half-time professors, and administrative staff—contribute to evaluation activities (OSCEs, written exams) in the different programs of the Faculty, in addition to being very active nationally and internationally. Budget to Support Educational Programs ♦ Faculty are separated into the teaching faculty and the program faculty from the various departments. ♦ Negotiations for resources take place with the departments. ♦ The evaluation process is funded with more than $500,000 per year from grants and contracts. Valuing Teaching ♦ In the 1970s and early 1980s many clinicians were hired into the tenure track. The majority of them will retire within the next three to seven years. ♦ In the last ten years, fiscal constraints and a major increase in research funds have limited hiring to researchers and non-MD experts and decreased dramatically the funding for small-group learning (non-tenured) MD course coordinators. CURRICULUM RENEWAL PROCESS Learning Objectives ♦ The objectives of the undergraduate program have been reviewed and were adopted by the faculty council in 1991-92. ♦ The objectives focus on acquiring general competence, including mastering the knowledge and the reasoning specific to the practice of medicine displaying evidence of scientific rigor and intellectual autonomy being able to communicate effectively and establish harmonious interpersonal relationships considering the ethical dimension of the practice of medicine and respecting the Code of Ethics Changes in Pedagogy ♦ During the first 67 weeks the medicine curriculum consists of approximately 700 hours (46%) of lectures, 308 hours (20%) of small- and medium-sized-group discussions, 54 hours (4%) of laboratory work, and 458 hours of individual work: self-instruction modules, and interviews with a seriously ill patient or an elderly person, for example. ♦ There has been a slight decrease in small-group discussions due to fiscal constraints. ♦ Cases are used, and patients are interviewed, in large class settings. ♦ The clerkship is still based on inpatient experiences under the supervision of experienced and devoted clinicians who know well the objectives of the clinical rotations. ♦ The rotations in family medicine and emergency medicine are ambulatory. ♦ The opportunities for learning in an ambulatory care setting have increased in surgery and gynecology. ♦ Some interesting but limited experiences take place in psychiatry and pediatrics. ♦ It is hoped there will be an increase in ambulatory care settings; however, this is presently limited by the scarcity of rooms, lack of availability of supervisors, and infrequently, fortunately, by the prioritizing of floor work for the clerk. Application of Computer Technology ♦ Students are not required to have computers, but almost all of them have access to computers. ♦ There has been a computer learning center since 1975. ♦ There is a computer laboratory with 40 PCs, funded in large part by a student investment fund. ♦ The school is in the process of transferring audiovisual and paper learning modules to CD-ROMs and Web pages, with the help of students. ♦ Faculty are increasing their use of computer-assisted presentations, and a few have Web pages for their courses. Changes in Assessment ♦ Every course has a mid-term evaluation and a terminal evaluation. ♦ Various types of evaluations are used, the most frequent being multiple-choice questions and short, open-ended questions. ♦ Other evaluation instruments used include essays, problem-solving sessions, case studies, and observation of students' behavior in small groups. ♦ At the end of each clerkship rotation, student performance is evaluated by the supervisor, who completes a narrative report and provides individual feedback. ♦ Supervisors are invited to give a mid-rotation formative evaluation, at least to students who do not perform adequately. ♦ There are comprehensive simulated-patient OSCEs after eight weeks, after 52 weeks, and at the end of the clerk-ship. The OSCEs are prepared by the evaluation bureau of the faculty, CESSUL, which evaluates physicians, nurses, midwifes, and lawyers. Curriculum Review Process ♦ The program was reviewed by the LCME in May 1999 and was granted a continued full accreditation for a seven-year term in October 1999. ♦ Between LCME visits, courses are evaluated at least every two years and mandatory clerkship rotations every year. ♦ The contributions of the students to the curriculum committee and the courses committees are excellent. ♦ Prior to the last LCME visit, the quality of the student analysis of the Faculty of Medicine evaluation report was found exceptional, in the opinion of LCME authorities. ♦ The visitors qualified the study body as “creative, energetic, accepting the responsibility for its education, supportive, and appreciative of its teachers and its school.” ♦ In April 99, following the self-study, the Curriculum Committee identified these themes for improvement: Increase students' clinical exposure in the first years of the curriculum Improve evaluation of learning; increase formative evaluation and improve quality of final evaluation Plan the contribution of teaching faculty: —Ensure continuity in the transfer of course coordinator duties. —Ensure the involvement of other faculty members —Ensure adequate resources and enhance the value of teaching in the undergraduate curriculum Organize pedagogic activities: —Conduct a needs assessment and inventory resources —Implement a pedagogic activities program —Offer the faculty pedagogic consultants' services Increase students' exposures to ambulatory medicine and to primary care during clerkship Ensure greater uniformity of teaching sites (supervision, clinical exposure, evaluation), allowing for local specificities and innovations

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