University of Ottawa Faculty of Medicine

Curriculum Management and Governance Structure (See Figure 1)FIGURE 1: Governance of the Curriculum ♦ The overall coordination and monitoring of the MD program is the responsibility of the Undergraduate Curriculum Committee (UCC). ♦ The organization of the new curriculum introduced in 1992 is illustrated in Figure 2.FIGURE 2: Organization of the New Curriculum♦ The UCC has substantial student representation from the student body association (Aesculapian Society), and student representatives to the two major curriculum committees (Stage I and Stage II Committees). ♦ There are student representatives on all of the committees that report to the UCC. ♦ Each curricular component as well as themes that run through the program are represented on the UCC. ♦ The University of Ottawa is the only bilingual (French and English) university in Canada and has been selected as the National Center for the Education of Health Care Professionals in French in the provinces outside Quebec and Ontario. ♦ The MD program is currently delivered in both English and French. ♦ To ensure that there is one program with the same goals and objectives delivered in two languages, the director of the Office of the Francophone Program (Bureau des Affaires Francophone) is a member of the UCC. ♦ To ensure that clinical skills and disease prevention and health promotion issues are addressed and well integrated in the program, representatives from these committees are members of the UCC. ♦ The co-chairs of the Evaluation Committee and the director of electives are also members. ♦ There is also one representative each from the clinical and basic sciences. ♦ The directors of the library and the computer laboratory (Teaching/Learning Center) as well as the director of faculty development, the assistant dean of admissions, the vice dean of education and the dean of the Faculty of Medicine are ex officio members of the committee. ♦ The composition of the committee ensures that problems/issues are brought to the attention of faculty and students soon after they arise and that there is effective communication regarding proposed changes as the curriculum evolves. ♦ The committee is chaired by the assistant dean of undergraduate medical education; it meets monthly and members communicate via e-mail frequently, which is the case with all of the UCC subcommittees. ♦ The committee structure of the UCC can determine whether the program is able to address problems, improve functionality, and introduce new initiatives (e.g., evidence-based medicine, technology-assisted learning, addiction curriculum, CanMeds 2000) as it continues to evolve. ♦ By consensus of the UCC and the UCC subcommittees, representatives from newly formed committees can have representation on the UCC. ♦ Proposals regarding curricular change can come from students, faculty, and organizations outside the university (e.g., the Medical Council of Canada, the Ministry of Health, the AAMC, and the ACMC, and community health organizations). For example, the Medical Council of Canada (MCC) has recently incorporated objectives (LEO) on the law, ethics, and the organization of the health care system on the licensing exam. ♦ In order to ensure the curriculum provides the resources required to allow the students to meet the LEO objectives, a committee is being formed to determine the required contents and propose the level and method of integrating them into the program. This committee will be a subcommittee of the UCC. ♦ Proposals are approved at the appropriate UCC subcommittee level, then by the UCC, the Faculty Council, the University Senate Subcommittee on Undergraduate Studies, and finally the University Senate. Office of Education ♦ In 1992, subsequent to implementation of the first year of the new curriculum that fully integrated clinical and basic sciences into multidisciplinary blocks, it became increasingly clear that responsibility no longer fell under the governance of the traditional basic and clinical departments. ♦ The Medical Education Office initially consisted of two assistants to the assistant dean of undergraduate medical education and gradually expanded to its present size of six staff persons. ♦ There is one academic administrator who coordinates the undergraduate education staff. ♦ There are four academic assistants with responsibility for the blocks in Stage I (both languages), one academic assistant who coordinates the activities in Stage II as well as registering all outside students for electives; and one academic assistant who is responsible for room bookings, faculty and course evaluations, and attestations of credentials for graduates of the MD program. ♦ In addition to the Stage II coordinator, although not directly funded by the Faculty of Medicine, there are one or two hospital-based coordinators for each rotation who deal with student placements in the core rotations, selectives, and electives. ♦ There will be one individual funded half-time to assist in the coordination of the Physician Skills Development (PSD) program. ♦ There is one secretary shared by the assistant dean and the vice dean, who also contributes to the team effort. ♦ There is another assistant partially funded (75%) in the Department of Epidemiology and Community Medicine to coordinate the Individual and Population Health (IPH) component of the curriculum. ♦ Plans are under discussion to bring in at least one more academic assistant for Stage II and to coordinate the activities associated with the French-language program, and to obtain a full time coordinator for the PSD course and the link block that precedes the core rotations. This individual will also coordinate the use of standardized patients in clinical teaching. ♦ The Bureau des Affaires Francophone provides invaluable administrative support for the recruitment and development of French-speaking PBL tutors and teachers, and timely translation of learning materials. Budget to Support Educational Programs ♦ Funding for education has come from the Faculty of Medicine to provide the infrastructure of the undergraduate and postgraduate staff (salaries) as well as modest stipends for the undergraduate and postgraduate deans; the admissions deans and the CME and faculty development directors. ♦ Hardware and software requirements and office supplies are funded from the school budget. ♦ No discretionary funds were previously available that permitted planning for long-term or short-term initiatives. ♦ A discrete education budget is to be established this academic year. ♦ Funds have been identified from increased student tuition fees, and special foreign trainees at the undergraduate and postgraduate level. ♦ The school, like so many others, relies on individually funded faculty members to provide basic support for a sizable fraction of teaching and its administration. Valuing Teaching ♦ The school has a prestigious teaching award, “Excellence in Medical Education,” the recipient of which is chosen by the students (in all four years of the program). ♦ The school is presently establishing other awards for outstanding tutors, preceptors, and innovators in medical education. Work is under way with students regarding the mechanism and type of award. ♦ There is a plan to have separate awards to identify excellent preceptors from the community who participate in medical education. ♦ Faculty recognition deserves significant attention if any medical school is to be successful in maintaining enthusiasm for teaching. ♦ It is critically important that teaching undergraduate medical students be recognized at the level of promotion and tenure. ♦ The school is considering the identification of separate tracks for faculty whose predominant contribution is in the area of teaching. ♦ Likewise, it is important to recognize innovations in medical education and research in medical education as valid academic activities worthy of consideration for promotion and tenure. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ A list of learning outcomes for the MD program is available from the authors. ♦ The outcomes were developed in the mid-late 1980s by a task force of the faculty. ♦ Perhaps because of the interest of the faculty in going through this critically important exercise, the substantial task of curriculum renewal that followed in the wake of this process was undertaken. ♦ The Curriculum 2000 committee was established to outline reasons for change and the desired direction of change. ♦ A task force was created to develop the new curriculum. ♦ The task force consisted of basic science and clinical faculty from several disciplines who through several faculty-wide retreats came to the decision to dismantle the traditional curriculum and design a new learner-centered education program with problem-based learning and full integration of clinical and basic sciences. ♦ Task force members outlined what a week in the first two years of the curriculum should resemble. ♦ An evaluation committee outlined principles of evaluation for PBL and examination format. ♦ Four large committees were created: The Multidisciplinary Steering Committee (MDSC), which worked on the first two years (biomedical and clinical sciences); the SCRIBS Committee (Structured Clinical Rotations Integrating Basic Sciences); The PSD Committee (for interviewing skills and physical diagnosis); and the IPH Committee (which addresses health promotion, disease prevention, and psychosocial aspects, for example, ethics, legal, epidemiology). ♦ The MDSC and the SCRIBS Committees were each cochaired by a clinical scientist and a basic scientist and consisted of members of basic and clinical science disciplines. This was in large part the key to the success of this endeavor. ♦ The committees identified the learning objectives for each discipline for the level of training. ♦ After this exercise was completed, the Stage I and Stage II committees were formed to organize the objectives into blocks and determine which learning modalities would be used to achieve their objectives, e.g., PBL, independent learning, laboratory, or case-discussion group. ♦ The overall organization of the first two years of the program, which ensured integration of PSD and IPH into the blocks, was achieved by an executive committee consisting of the co-chairs of the MDSC (a physiologist and a cardiologist), the chair of PSD (a family physician), and the chair of IPH (a community MD involved in public health). Changes in Pedagogy ♦ The traditional curriculum was over 60% lecture-based, the remainder consisting of laboratory teaching. ♦ Students spent over 29 hours per week in classes. ♦ There was essentially no small-group teaching. ♦ In the new curriculum there are 33% fewer scheduled learning activities. ♦ Students spend five hours per week in PBL, approximately five to seven hours in lecture, two to five hours per week in multidisciplinary laboratory learning, and two to three hours per week in tutorials/workshops. ♦ All of the learning activities are structured around the PBL of the week. Group sizes are seven to eight students in PBL and about 15-20 in tutorials. ♦ There was no clinical education in the first years of our old curriculum. ♦ Students now have patient contact within the first four weeks of the first year in an interviewing skills course. ♦ Clinical education continues through the first two years of the program. ♦ An outline of a week in the multidisciplinary block is available from the authors. ♦ There have been major changes in clinical teaching during the core rotations. ♦ All core rotations have three hours per week of PBL; most rotations have four to eight lectures per week, some of which are on basic science topics. ♦ One day per week in the eight-week surgery rotation is devoted to laboratory-based surgical anatomy. This is a prime example of integration of basic science into clinical education. Application of Computer Technology ♦ The entering class of 2000 will be required to have PCs with specified performance capability and Web access. ♦ Plans are to have in place by September 2001 a PC-lease program in which students will pay to lease a fully-loaded laptop that is configured to allow direct and easy access to all curricular material. ♦ Presently, the education program uses technology in a conservative fashion to enhance or facilitate education. ♦ All students are given e-mail accounts and are expected to be on-line. ♦ All communications with students regarding announcements and requests to meet with the staff or the undergraduate dean are transmitted via e-mail. ♦ The assistant dean maintains rapid communication with students who have academic or other problems and can usually work with the faculty within hours or days to resolve such problems or fill requests. ♦ The majority of teachers are giving lectures using Power Point and provide copies of the slides electronically to the students. ♦ A faculty member is developing a Web-based histology resource that has been well received. ♦ The University of Ottawa is committed to using technology to facilitate learning and to that end established an Office of Technology-assisted Learning and appointed a director. ♦ Retreats and workshops have been held and others are planned to dialog extensively with students and faculty as how best to utilize technology in learning. ♦ The most important component in the curriculum is PBL, and plans are to use technology to enhance this experience, not to replace it. ♦ The plan is to replace many traditional lectures with learning modules and use faculty to hold interactive, problem-solving small-group sessions as the main way of supporting student learning. This will free up the time of our English- and French-speaking professors to become engaged in more interactive teaching as lectures are replaced. ♦ Each block also has hands-on learning in laboratory settings where gross anatomy and pathology as well as tissue histology and pathology are learned. Plans are to enhance this learning with computers, although some materials may be so well-learned virtually that some microscopy learning may no longer be necessary. ♦ Presently the faculty and students believe that hands-on learning of morphologic sciences must remain. The laboratories are being wired to bring technology to the site to assist in this process. Changes in Assessment ♦ Standardized patients are gradually being introduced into the PSD course. ♦ Standardized patients are used for the OSCE exams. ♦ Four of six core rotations have an OSCE component at the end of rotation evaluation. ♦ Students take a written exam and/or an MCQ exam and receive a mark for PBL, and from their preceptors. ♦ Two compulsory OSCEs are held in the program, one at the completion of the link block that precedes the start of core rotations. The second one is in February of the fourth year. Both use standardized patients or trained actors. The exam is based on the Part II of the MCC Licensing Exam. ♦ The school has standardized the evaluation system across the program and has a peer-refereed honors category that is defined as the 80th percentile on objective assessments and meets or exceed performance expectations in PBL (Stage I) or on the clinical preceptor evaluation (Stage II). ♦ Students merit a Pass with Distinction for a mark of 80% and having also met the same level of achievement in PBL (Stage I) or preceptor (Stage II) evaluation as required for honors. ♦ Attendance and participation in PBL are mandatory at the school. ♦ An objective assessment method for PBL evaluation is currently under development. Clinical Experiences ♦ Clinical exposure begins in the first month of the first year, usually in a community MD office in the Interviewing Skills Course. ♦ Most physical diagnosis is learned in the teaching hospitals for the remainder of year two. ♦ A clinical skills enhancement week has been added to the spring term of second year. This is usually community based and may take place in a rural, underserviced, or northern location. ♦ The pediatrics, psychiatry, and family medicine component of the ambulatory rotation has four weeks of community-based learning. Students can do this portion in a rural, underserviced, or northern area. There is much interest in outplacements during these rotations. ♦ Obstetrics–Gynecology has a community component or a primary care component conducted in the hospital setting. ♦ Medicine has not moved from tertiary care in the core rotation, nor has surgery. ♦ Students have 14 weeks of elective time in the fourth year that can be spent at any level of medical care in the hospital or community setting. ♦ The four-week ambulatory selective is exclusively out-patient-based, and students are encouraged to undertake this training in rural, underserviced, or northern locations.

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