School of Medicine, Faculty of Health Sciences, Queenʼs University

Curriculum Management and Governance Structure ♦ In 1996, the Faculty of Medicine and Rehabilitation Therapy joined with the Faculty of Nursing to form the Faculty of Health Sciences. Each discipline then became a school within the faculty. The hope is that the new structure will facilitate the development of multi-professional education. ♦ The Undergraduate Medical Education Committee, a subcommittee of Faculty Board, centrally governs the undergraduate medical curriculum. ♦ This policy committee is chaired by the associate dean for undergraduate medical education and has representatives from the core system committees, clinical skills, clinical and basic science, information technology, and the student body. ♦ The associate dean and the systems committees direct the administration of the curriculum (see Figure 1).FIGURE 1: Undergraduate Medical Education Organizational Chart Office of Education ♦ Office of Undergraduate Medical Education coordinates the organization and day-to-day running of the undergraduate curriculum. ♦ The school is in the process of developing an Office of Medical Education. ♦ A director, with a PhD in education, has been hired. ♦ The director's task will be to foster curriculum development in the health sciences and education research. Budget to Support Educational Programs ♦ The funding of the faculty in the School of Medicine is unique. ♦ In 1994, the faculty adopted an Alternate Funding Plan (AFP) for clinical service. ♦ The AFP (a global “envelope” negotiated with the Ministry of Health of Ontario that provides funds to cover all clinical service) replaced fee-for-service for clinical work. ♦ The AFP has decreased the dependence on clinical work to fund the educational mission of the faculty and allows for more time for faculty teaching and research. ♦ There is a budget to support the undergraduate program that primarily pays for support staff in the undergraduate office. ♦ Also included in the budget are funds to pay stipends to faculty members who have major administrative responsibilities for curriculum. ♦ Support for teaching or curriculum development or innovation is not part of this budget. Valuing Teaching ♦ Faculty members are recognized in a variety of ways for their teaching contributions (apart from the stipends paid to faculty members who have major administrative roles). ♦ Many departments have financial rewards for teaching as part of an activity-based compensation formula. ♦ Community preceptors are paid for their teaching contributions, provided with faculty appointments, and given access to library and gym facilities at the university. ♦ There are a number of teaching excellence awards to recognize superb educators within the faculty. Both students and peers are involved in the selection projcess. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ The school had a major curriculum revision starting in 1987, and a new curriculum was implemented in 1991. ♦ The curriculum focuses on three major curricular objectives: the development of problem-solving skills, knowledge, and professional behavior. Within each framework objective, there are learning outcomes as follows: The major goal of the undergraduate program is the education of students as critical thinkers and problem solvers, skilled in sensing, formulating, and managing common health problems. By so doing, students at graduation will be prepared to expand their competencies either in breadth for careers in family practice, or in depth for careers in particular disciplines, and in either case for continuation of their own education throughout their working lives. ♦ The essential competencies of students at the time of graduation are in the form of three major instructional objectives of equal importance: Problem-solving skills Knowledge Professional characteristics Changes in Pedagogy ♦ With the curriculum reform in 1991, the school moved from a very traditional department-based curriculum to a “hybrid” system-based model. ♦ The curriculum has undergone several minor revisions since that time. ♦ The format is a mixture of lecture, small-group sessions, and problem-based learning. ♦ Basic science and clinical sciences for each system are fully integrated. ♦ The curriculum has several unique aspects. ♦ There is an eight-week block at the end of the second year called the Critical Inquiry Elective in which every student must develop and research some scholarly question of interest. This usually involves some data collection and can vary from doing basic bench research to addressing some clinical question. The student must write up the results in a format suitable for publication in a peer-reviewed journal. A number of these have been published. ♦ One of the most important parts of the curriculum is the clinical skills program. ♦ The clinical skills program runs out of the Clinical Learning Center that is the setting in which all health science students learn clinical skills. ♦ Medical students can learn interviewing, communication, and physical examination skills with either patient volunteers or standardized patients specifically recruited to the center for this purpose. ♦ All rooms are equipped with videocameras so that the student-patient encounters can be viewed remotely by teachers or reviewed at a later date. ♦ In the Medicine in Society phase of the curriculum, students have longitudinal courses in medical ethics and law, which use case discussion and small-group interaction as the main methods of learning. ♦ Evaluation for this component is by written essay. Application of Computer Technology ♦ All students are strongly encouraged to have personal computers. A recent survey suggests that about 80% of students have computers at home. ♦ All course syllabi are mounted on the school's Web site, and several system blocks (e.g., neuroscience) have Web sites where lecture materials, problems, and question-and-answer pages are posted. ♦ The school's Multimedia Learning Center is currently planning for expansion. ♦ A course on information literacy is integrated into years one to three. Clinical Experiences ♦ Students participate in a wide range of clinical activities. ♦ Students from week one of medical school see patients at the Clinical Learning Center and in hospitals, clinics, physicians' offices, and chronic care institutions. Curriculum Review Process ♦ The faculty reviewed the undergraduate curriculum for LCME accreditation in 1999. ♦ Prior to that, focused reviews had been undertaken as shown below: Clerkship review, 1995 Review of student assessment, 1998 Review of clinical skills teaching, 1999 Review of basic science, planned Review of “hybrid” curriculum format, planned ♦ A task group with specific terms of reference does the reviews. ♦ The task group will include a member external to the faculty. ♦ A faculty retreat is planned to provide specific input for the planned review. Process for Ongoing Review of the Educational Program ♦ Student assessment is changing as a result of the task group report and the accreditation process. The changes are: Increase in the amount of formative testing. This included the development of a new cumulative MCQ examination that students take twice yearly. It tests important knowledge objectives from the beginning to the current point of study. This exam is currently written, but we are planning to develop it as a computer-based examination. Improved remediation for students with academic difficulty. Introduction of logbooks for students to document clinical experiences in clinical skills and clerkship rotations. Yearly OSCE for clinical skills assessment. Future Goals ♦ The major issues that the School of Medicine will be addressing in undergraduate education over the next five years will be: increased use of ambulatory environments for clinical education expansion of the involvement of regional health institutions and physicians in medical education increased education of health professionals (medicine, nursing, physio- and occupational therapy) together in appropriate settings development of computer and Web applications in education and assessment

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