Michael G. DeGroote School of Medicine Faculty of Health Sciences, McMaster University

Curriculum Management and Governance Structure ♦ The integrated curriculum in the medical school at McMaster is divided into preclerkship and clerkship, and there are standing committees for each of these two components of the curriculum. ♦ The preclerkship committee membership comprises the directors of each of the five preclerkship medical foundations as well as representatives from the clinical skills program and the longitudinally arranged professional competencies curriculum. ♦ The clerkship committee comprises the Chairs of each of the clinical clerkships as well representatives from the professional competencies curriculum. ♦ The Chairs of these two curriculum committees sit on the MD Program Executive Committee, which has oversight over the entire curriculum. Office of Education ♦ Within the Faculty of Health Sciences at McMaster University, the Program for Educational Research and Development (PERD) provides expert advice and support for innovation and renewal in the areas of curriculum and evaluation for the Undergraduate MD Program. ♦ The PERD office has two full-time education PhDs and a number of part-time staff. Both of the full-time PhD Faculty in the PERD have been intimately involved in supporting research and development in the development of new admissions tools, evaluation tools, and the COMPASS curriculum, which was introduced in 2005. ♦ PERD is involved in continuous quality improvement for the Undergraduate MD Program curriculum. Financial Management of Educational Programs ♦ As a provincially funded Canadian Institution, the medical school at McMaster receives funding from the Ministry of Health and Long-Term Care and Ministry of Training Colleges and Universities. ♦ In addition, most but not all of the University Departments whose members participate in research and education involving the Undergraduate MD Program are enrolled in a faculty alternate funding plan, which is funded by the Ministry of Health. ♦ This alternative funding mechanism acknowledges a given amount of clinical activity by the participating clinicians but provides compensation for academic activities. This has reduced the dependence on clinical earnings to support the medical education mission of the faculty. ♦ Despite the current economic climate, funding of medical education has actually increased over the past five years, and while the number of medical students admitted to medical school has increased, the funding per student provided by the Province has also increased. ♦ Over the past three years, the MD Program at McMaster has expanded to include two Regional campuses. ♦ There has been significant capital expenditure at both campuses, resulting in adequate educational resources at each academic site, although Provincial Ministry funds for capital expansions at many of the regional community hospitals associated with these campuses have not yet been disbursed. ♦ Additionally, the stipends for community clinical preceptors have not increased in over a decade, and this is certainly having an impact on recruitment and retention of community based preceptors. Valuing Teaching ♦ The Faculty of Health Sciences has a very active faculty development program, which offers training and development in all aspects of the educational and research mission of the faculty. ♦ There is an expectation that all new faculty participate in the faculty development offerings relevant to their academic role in the faculty. ♦ Faculty who are destined to have a large educational role as part of their academic portfolio can participate in faculty development offerings at different levels of complexity. ♦ The faculty development office coordinates an educators' collegium for those faculty who are most involved in educational activities within the medical school. ♦ The increased sophistication and course offerings of the faculty development office reflect a significant increase in the recognition of education as an academic and scholarly pursuit of the faculty. ♦ Within the promotion and tenure process, the clinician scholar stream comprises a significant number of faculty. Along with the development of this academic stream within the promotion and tenure process has come increased rigor in the evaluation of faculty and their scholarly educational activities in addition to a rigorous portfolio process within the faculty development organization. Curriculum Renewal Process ♦ In 2002, the Undergraduate MD Program embarked on a complete revision of the curriculum. The concept-oriented COMPASS curriculum was inaugurated in August of 2005, and two classes have graduated from this curriculum. ♦ The major goal of this curriculum renewal was to maintain the integrated PBL curriculum philosophy, which had been the educational foundation of the program since its inception in 1969, but to inject a more coherent and thorough coverage of basic fundamental concepts of both biomedical and behavioral domains. ♦ The new COMPASS curriculum was developed on an electronic learning management system that allowed access to all of the curricular educational resources online. This was obviously a requirement for a medical school that at this time was expanding and developing two new regional campuses. ♦ A description of the new curriculum and a comparison with the two previous curricula at McMaster was published in Academic Medicine (Neville AJ, Norman SR. PBL in the Undergraduate MD Program of McMaster University: Three Iterations in Three Decades. Acad. Med. 2007; 82: 370–374). ♦ While the vision for the COMPASS curriculum was created by a small group of individuals, the curriculum planning detail resulted from multiple facultywide retreats that included many medical students. ♦ Curriculum development was preceded by major literature reviews, qualitative studies, and preferencing focus groups of current students as well as graduates of the program and a series of referencing studies to decide on curriculum structure and presentation. Learning Outcomes/Competencies ♦ The COMPASS curriculum had been designed to allow McMaster medical students to attain the competencies laid out in the competency framework in Table 1.TABLE 1: Representation of Graduating Competencies New Topics in the Curriculum Since 2000 ♦ In the past 10 years, the MD Program curriculum has implemented curriculum in the area of gender and health, palliative care and end of life management, complementary and alternative medicine, patient safety curriculum with an emphasis on interprofessional collaboration, curriculum on physician self-care, and curriculum on health care systems. ♦ The development of the Center for Simulation Based Learning in the Faculty of Health Sciences has allowed the introduction of simulation based learning in the core clerkships of Anesthesia and Obstetrics and Gynecology and also for surgical skills training. Changes in Pedagogy ♦ Although the new COMPASS curriculum emphasizes the importance of conceptual understanding, the application of analogous transfer of concepts from one context to another, and the use of repeated examples to improve mastery of concept learning, the fundamental philosophy of the program remains small group, tutorial based, problem-based learning. ♦ The curriculum changes have had an impact on how tutorial cases are written and presented to students, and the embedded electronic web based resources have increased the opportunities for small group learning in the curriculum. Changes in Assessment ♦ The evaluation tools used in the Undergraduate MD Program to assess student performance have not changed since 2000. ♦ Students are evaluated in tutorial in those domains that can be validly evaluated by the tutor and peers, but knowledge attainment and application are assessed using a short answer based concept application exercise, which is given to students every two weeks throughout each of the preclerkship blocks. ♦ A norm referenced progress test is used to assess knowledge acquisition throughout the course of the three-year MD Program curriculum. ♦ Each of the three classes has an OSCE. Evaluation in the clerkship takes multiple forms, including encounter card assessment, tutorial assessment, clinical preceptor assessment, and end of rotation examination, which may be multiple choice or clinical decision-making key feature format. Clinical Experiences ♦ The Undergraduate MD Program at McMaster has undergone a doubling in enrollment over the past 12 years. The greatest challenge in accommodating and delivering the curriculum to this increased number has come in the clerkship component of the curriculum. ♦ Even before the development of the two regional campuses, several of the clerkship specialties were sending students to communities outside of Hamilton for core rotations. This was in part deliberate to allow students more opportunities to have community based educational clerkship experiences, but it also reduced the burden on clinical teaching within the two major teaching hospital corporations affiliated with the medical school. ♦ Two regional communities became the main sites of clinical teaching expansion for the medical school, and it was within these two communities that the resources were developed for creating the two new regional campuses. Thus, when the regional campuses based in Kitchener/Waterloo and St. Catharines respectively opened, there was already a cadre of relatively experienced clinical teachers developed at each site. Regional Campus ♦ The medical school at McMaster has opened two regional campuses. The first, the Waterloo Regional Campus based in Kitchener/Waterloo, first admitted students in 2007, and the Niagara Regional Campus based in St. Catharines followed one year later. ♦ While each campus initially admitted 15 students, the enrollment starting in 2010 will be 28 students at each campus. ♦ The regional campuses follow exactly the same COMPASS curriculum, and videoconferencing and web conferencing allow for integrated communication across the three campus network in both the preclerkship and the clerkship. ♦ There have been substantial resources applied for faculty development in order to recruit and retain motivated physicians in the community to become clinical teachers. ♦ Because of the integrated nature of the preclerkship curriculum, much of which is available on the electronic learning management system, there has not been the pressure to recruit basic science faculty to the same extent as would be required in a medical school with a traditional basic science curriculum. However, anatomy and pathology education faculty are available at each of the regional campuses. ♦ Although each of the two regional campuses has been up and running for a relatively short time, comparative assessments of student performance both from progress testing and clinical performance in the OSCE have already been made. ♦ Academic progression as assessed by the progress testing shows no difference across three campuses. OSCE performance data actually show that one of the regional campuses has for the past two years outperformed both the central campus in Hamilton and the other regional campus, although the differences are small. Highlights of the Program/School ♦ National licensing examination data from the Medical Council of Canada show that the graduates from the first two cohorts of medical students who experienced the new COMPASS curriculum have outperformed their predecessors and indeed in the clinical decision-making component of this examination are at the top of the 17 Canadian Medical Schools. ♦ An increase in the comparative performance in medicine and surgery components of these examinations has been an encouraging development and reflects one of the goals of the development of the new COMPASS curriculum. ♦ The Undergraduate MD Program at McMaster continues to graduate about 40% of its class to train in family medicine. This reflects the high visibility and overall teaching contributions from the Department of Family Medicine to the Undergraduate MD Program curriculum at McMaster. ♦ One of the major innovations of the new COMPASS curriculum was the development of the longitudinal professional competencies curriculum that runs continuously throughout the entire preclerkship and further to each of the individual clinical clerkships. ♦ The professional competencies curriculum covers the domains of professionalization, physician self-awareness and reflection, moral and ethical reasoning, medicine and the law, social and community context of health, the arts in medicine, and humanism. One half day of each week of the preclerkship is given over to this curriculum. ♦ The Faculty of Health Sciences at McMaster University has devoted increasing resources over the past few years to the development of Interprofessional Education. ♦ A Program for Interprofessional Practice, Education and Research has been established, and through this a menu of Interprofessional Educational Experiences has been developed for students across all the Health Science Programs within the Faculty of Health Sciences of the University. These experiences or curriculum offerings are graded into one of three of levels of complexity and involvement for the learner. ♦ All students in the Undergraduate MD Program require an evaluated Interprofessional Educational experience in each of three levels of IPE curriculum prior to graduation.

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