University of Alberta

Curriculum Management and Governance Structure ♦ The curriculum changed over to a completely new format in 1998, necessitating a revision of the governance structure, particularly for the two preclinical years of the program, which now includes dental students. ♦ Originally the first year consisted of separate courses in basic science, followed by second- and early-third-year courses devoted to pathophysiology. The clinical rotations were scheduled from late third year to end of fourth year. ♦ Each course was departmentally or divisionally based and directed by a coordinator selected by the department chair. ♦ Each phase had an overall director. ♦ There was some clinical skills teaching in the first two years of the curriculum. ♦ With the introduction of an integrated first two years, organized primarily around different systems, each sequential course has one or two coordinators supported by a course committee. (See Figure 1.)FIGURE 1: Organizational Chart♦ None of these courses is departmentally based. ♦ In a longitudinal course that runs throughout the year, public health, clinical skills, the function of the health care team, complementary medicine, sexuality, death and dying, substance use disorder, and similar issues are discussed. This course is taught primarily in small groups and makes considerable use of role plays and standardized patients. ♦ The program for the first two years is directed by a preclinical coordinator, who chairs the preclinical committee, which consists of the course coordinators. ♦ The clinical years are organized in a similar manner. ♦ The Undergraduate Education Committee chaired by the associate deans for Undergraduate Medical Education (UGME) and for Dentistry, oversees all the educational programs for medicine and dentistry. Office of Education ♦ The Division of Studies in Medical Education was established in 1987. ♦ The UGME Office led the recent development of the new curriculum and, among its other roles, is currently providing support for faculty development and the writing and scoring of examinations. Budget to Support Educational Programs ♦ There is a budget for medical student education that covers the operation of the UGME Office and support for the first two years of the program. ♦ The budget was developed by the UGME Office and approved by the Faculty Budget Committee. Valuing Teaching ♦ Faculty job descriptions, including the teaching role, are defined by the department chairs in consultation with the dean and the faculty members involved, and these are reviewed periodically. Performance is assessed in relation to the job description. ♦ Undergraduate medical teaching responsibilities are assigned jointly by the UGME Office and the department chairs. ♦ All teaching performance is assessed anonymously by students, and this information and other relevant material are used at the end-of-year performance appraisal. ♦ All faculty making application for promotion are required to provide the Faculty Evaluation Committee with teaching dossiers, using an approved format. ♦ Students also recognize instructors for their individual teaching performances in both conventional lectures and small groups, through an annual award system. ♦ Students choose a course of the year for each year of the program. ♦ The awards are recognized by the faculty at their Spotlight on Achievement ceremony. CURRICULUM RENEWAL PROCESS Learning Outcomes ♦ Part of the curricular redesign process involved the development of a common set of learning objectives. ♦ Now that the curriculum is in place, these objectives are being revisited to see whether they are still appropriate and whether there are gaps in the information provided and the topics covered. ♦ The objectives are not yet faculty-approved and are still in the hands of the course committees. Changes in Pedagogy ♦ Each of the new courses now uses small groups as an integral part of the learning process, using either a casebased approach or PBL. ♦ The number of lectures has been significantly reduced. ♦ Clinical skills are taught in the first two years using a combination of role-playing and standardized patients. Application of Computer Technology ♦ Students are not required to have their own computers. ♦ The students have access to computers through a faculty-sponsored, university-supported computer laboratory and a recently built separate faculty facility. Informatics is a formal part of the early curriculum. ♦ The traditional histology teaching using microscopes is being replaced by a series of faculty-developed, interactive, computer-based units. ♦ Transmission of information to students is done largely through computer usage; e-mail, the Web for course information, schedules, and exam results. Changes in Assessment ♦ There have been several major changes in the assessment of students' performances: Each course is now pass/fail rather than having a numerical grade assigned. The pass/fail cutoff point is determined by the Angoff method. The students are provided with much more individual feedback. Performance in the small-group setting is evaluated to assess the ability of the student to function as part of a team. The use of OSCEs has increased. Computer-based assessment is about to become standardized by the Medical Council of Canada, and internal exams will be developed using similar methods. Clinical Experiences ♦ Students take a series of mandated core clinical rotations in medicine, surgery, obstetrics, pediatrics, geriatrics, psychiatry, anesthesia, emergency medicine, and family medicine. ♦ The clinical rotations are primarily hospital-based except for family medicine, which occurs in rural family doctors' offices. ♦ Each student is assigned to a rural physician and spends four weeks working in the physician's community. ♦ In the other core areas office experiences vary, but plans are under way to substantially increase this component of the students' education. Curriculum Review Process ♦ A new curriculum was implemented two years ago with the goal of reducing lecture-oriented teaching and greatly increasing self-directed learning by the students. ♦ A curriculum committee was established that then developed a series of theme committees responsible for designing individual new components of the curriculum. ♦ The curriculum committee established the basic order of the courses and the time allotted to each. ♦ The course committees put forward proposals for content and teaching methods based on pedagogic principles and on available resources. ♦ Resources The Division of Studies in Medical Education led the effort. A new support person was hired to coordinate the committee efforts, about one year into the process. When implementation started, a second individual was also assigned to planning and support. For ease in planning meetings, most were scheduled for noon hours and lunches were provided. New small-group classrooms had to be built to accommodate the new style of teaching. The major challenge was to find the time for faculty to undertake this task at the same time as the delivery of medical services was being reorganized in the health care area. One excellent outcome has been the increased collaboration between basic scientists and clinicians as they team-teach in the new curriculum. The outcomes are being assessed in several ways. —Students' preferred learning styles are measured, using a validated questionnaire, throughout their program, and the results are compared with data collected during the last years of the old curriculum. —There are course-based examinations from the old curriculum, and some questions are used as “marker questions” to assess the learning of key facts. —There are plans to measure performances on the wards to see whether the students are better at integrating clinical concepts and have better clinical skills than students from the old curriculum. —A research project currently in progress seeks to define learning objectives for the clinical clerkships and compare the objectives with student experiences. ♦ Curricular development is very much a work in progress. Each course committee, and the Preclinical, Clinical, Medical Curriculum, and Undergraduate Education Committees meet regularly to assess, discuss, and modify the curriculum. ♦ There is no formal internal process beyond this, but each year has seen highly significant changes as a result of the inputs of the students and the teaching staff.

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