Northern Ontario School of Medicine

Curriculum Management and Governance Structure ♦ The Office of Undergraduate Medical Education (UME), under the direction of the Associate Dean, is responsible for the development, management, and evaluation of the four-year undergraduate medical education curriculum. ♦ The Undergraduate Medical Education Committee (UMEC) serves as the curriculum committee of NOSM and is the standing committee of the NOSM Academic Council. UMEC develops overall program policy and plans and evaluates the four-year course of study leading to the MD degree. ♦ The UMEC ensures that decisions made involving the development and management of the undergraduate medical education program are framed by NOSM vision, mission, goals, and the six key academic principles of NOSM. They are interprofessional, integration, community oriented, distributed community engaged learning, generalism, and diversity (for an overview of the curriculum approval process, see http://www.nosm.ca/documents/Overview.pdf). ♦ NOSM functions as the Faculty of Medicine of Lakehead University (Thunder Bay, Ontario) and Laurentian University (Sudbury, Ontario). ♦ The Senates of Lakehead and Laurentian provide academic governance for NOSM through a joint standing committee, the Joint Senate Committee for NOSM. ♦ The Joint Senate Committee receives recommendations from the Academic Council and passes them on to the Senates, which accept, reject, or return items for further consideration. ♦ The UMEC functions through a series of standing committees and work groups to develop learning objectives for the educational program to assess student performance and to evaluate program effectiveness. ♦ The standing committees include Phase 1–3 Committees, Theme 1–5 Committees, module and Phase working groups, and Phase 1 Coordinators Committee. Phase 1 represents the first two years of the four-year program, Phase 2 is Year 3, and Phase 3 is Year 4 of the program. ♦ These committees are responsible for the development, management, assessment, evaluation, and coordination of the curriculum. In order to ensure a coherent and coordinated curriculum, the standing committees of UME meet on a regular basis. Membership on all committees to date has remained constant. Vacated seats are replaced on all committees (see Figure 1).FIGURE 1:: Curriculum Approval Process♦ The review of the individual curriculum elements occurs at a variety of levels within NOSM. ♦ At the module level, the module working groups, Phase-working groups, and Theme committees review the outcomes of their respective modules following the completion of each module. ♦ This review includes student performance, faculty and student workload issues, delivery of objective-based materials, and feedback from the Module Coordinator. Recommendations and observations are provided to the Theme committees by Theme representatives on the module working groups. Information is then moved forward to the appropriate Phase committee and then to the UMEC. ♦ The UMEC is responsible for preparing the regulations required for the degree program for approval by the Academic Council and the University Senates. This includes course descriptions, calendar contents, and course requirements for the MD degree. Office of Education ♦ The Office of Undergraduate Medical Education (UME) is the educational arm of NOSM responsible for the design, development, implementation, assessment, and management of the four-year undergraduate medical education program for students leading to the MD degree. ♦ The Office of UME comprises individuals and groups responsible for providing a CACMS/LCME accredited MD degree program that is innovative and responsive to the needs of the students and the health care needs of the people of Northern Ontario. ♦ While this medical school does not have an Office of Medical Education, it should be noted that the organizational structure, which has all faculty members of this school reporting through the division heads to the chief academic officer, allows an integration of effort and focus on undergraduate medical education that is not the norm in other medical schools. Financial Management of Educational Programs ♦ NOSM is funded by Ontario provincial government through the Ministry of Training Colleges and Universities and the Ministry of Health and Long-Term Care. Detailed budgets are prepared by each portfolio within the established budget framework estimating the expenditures required for the fiscal year. ♦ A budget committee composed of senior executives of the School is established to review the budget request for each portfolio and approve the allocation of the resources in accordance with NOSM's objectives and priorities. Value Teaching ♦ NOSM does not at the present time have an academy or institute for educators. However, effective July 1, 2010, a Center for Research in Education of Health Professions (CREHP) will be established at the School. An experienced senior administrator and medical educator has been appointed as Director of the Center. ♦ The Center's mission will be to provide a catalyst across all educational portfolios and a focus for the collaboration of individuals committed to conducting scholarly endeavors and exploring all dimensions of health professions education. Funding for the position has been established as have initial operating funds. ♦ NOSM places a high value on teaching and broadly defines teaching to include giving courses, seminars, tutorials, laboratories, and supervising field work as well as individual study projects. ♦ It also defines teaching as guiding the work of teaching assistants, evaluating the learners' individual work on theses and papers, providing individual consultation outside of class and laboratory time, participating in the development of teaching and assessment methods, programs, or course content, the preparation of all instructional materials, writing textbooks, and the coordination of educational modules and phases in the curriculum. ♦ Faculty members who are exceptional teachers and make this contribution have that exceptional performance as a teacher taken into consideration, which can compensate for lesser performance in other areas. ♦ In order to ensure that teaching as broadly construed by NOSM is appropriately recognized in the promotion of faculty members, the Associate Dean for Undergraduate Medical Education serves as a voting member by position on the Faculty Promotion Committee of the Northern Ontario School of Medicine. Curriculum Renewal Process ♦ It is the responsibility of the Phase and Theme Committees to examine ways in which to implement the short and long-term curriculum revision goals identified at the committee level. ♦ At NOSM, the process of curriculum revision remains an ongoing quality improvement activity that is overseen by the Associate Dean, UME. ♦ Suggestions for curriculum revision are received through ongoing program evaluation. These suggestions are vetted through the curriculum committees, and recommendations for change are then brought forward to the UMEC and, once approved, Academic Council. Learning Outcomes ♦ Theme committees are responsible for the review of related learning objectives across all four years of the program. These learning objectives are detailed in each of the Phase 1–3 syllabi. As such, each learning objective is identified by one of five Themes and is related to an item(s) of knowledge, skills, behaviors, and attitudes that students are expected to exhibit as evidence of their achievement. ♦ The learning objectives identified for each Theme are enhanced by a focus on the seven competencies outlined in CanMEDS 2005, which are medical expert, collaborator, manager, health advocate, scholar, professional, and communicator. New Topics in the Curriculum Since 2000 ♦ With the establishment of NOSM in 2002 and its explicit social accountability mandate, the four year undergraduate curriculum was carefully developed with input from a variety of stakeholders to specifically address the health care needs of all people of Northern Ontario, including Aboriginal and Francophone populations. ♦ In 2003, the first of a series of workshops was held. Participants, representing the various populations and social sectors of Northern Ontario, were asked to provide input into what type of doctor they wanted the medical school to graduate. It was established that the people of Northern Ontario wanted doctors that had an affinity for living and working in Northern Ontario, had an understanding of the various cultures represented in Northern Ontario, and had good communication skills. With that in mind, five Theme/courses were identified. Each Theme/course was designed to span the entire four years of the program. ♦ The five Themes are Northern and Rural Health, Personal and Professional Aspects of Medical Practice, Social and Population Health, Foundations of Medicine, and Clinical Skills in Health Care. ♦ The five Themes are enhanced in the curriculum by a focus on the seven competencies described in CanMEDS 2005. They are medical expert, collaborator, manager, health advocate, scholar, professional, and communicator. ♦ A series of curricular threads run through the five Themes. They are Aboriginal health, interprofessional education, health effects of social problems, patient safety (occupational health and safety concepts/curriculum), dementia project, gender issues, and Canadian Medical Protective Association. ♦ At NOSM, team-based learning is referred to as interprofessional education. Interprofessional is one of the six key academic principles that frame all teaching and learning activities of the school. ♦ In November, 2009, under the direction of the Office of the Dean, an Integrated Clinical Learning (ICL) Project was conducted that examined models of integration in clinical education in Northern Ontario. A total of 43 communities where NOSM's undergraduate and postgraduate learning occurs were visited by school faculty and administration. A series of interviews were conducted in order to gather information about existing clinical learning practices. ♦ In the report generated from the project, recommendations were made that would serve to assist NOSM in moving forward with the principles and concepts of ICL as the preferred model of clinical education for all NOSM teaching and learning sites (see http://www.nosm.ca/documents/ICLReport.pdf). Changes in Pedagogy ♦ Through continual program evaluation, UME monitors the effectiveness of the established pedagogical methods. ♦ To date, the original blueprint of self-directed learning in small groups has been upheld. NOSM continues to employ a distributed community engaged learning (DCEL) model involving over 70 community partners where students are provided with opportunities to meet their learning objectives. To date, there are no plans to change the curricular blueprint or the DCEL model. ♦ NOSM is exploring the possibility of Interprofessional learning experiences for Year 2 of the NOSM program involving the medical students and Year 4 nursing students. Changes in Assessment ♦ In 2008, a Phase 1 Assessment Working Group was established by the Associate Dean, UME to oversee the review of the processes of assessment of student performance in Phase 1. This group was tasked with making recommendations for improvement of the processes to the UMEC. ♦ The pass grade for all Phases of the program was established at 60% beginning September, 2009. Previously, a pass grade of 75% was established for Phase 1 of the program. ♦ Initially, a mandatory formative midmodule assessment (MMA) was required of all Phase 1 students. In September, the MMA was replaced with a voluntary Formative Module Assessment presented (with the answer key) to the students at the beginning of each module. ♦ Initially, a summative end-module assessment (EMA) was delivered at the end of each Case-based module (CBM) in Phase 1. Since September, 2009, the EMA is now delivered at the end of every second CBM. ♦ The Offices of UME and Learner Affairs review student academic progress at the end of every second CBM in an effort to facilitate early identification of students in academic difficulty. Remediation is provided for all students below the pass mark. ♦ Over the past four years, there has been no change in the assessment of student performance in Phase 2 of the program. ♦ In Phase 3 of the program, a summative examination is given to students at the end of each required clinical rotation rather than the previous plan, which included two summative examinations presented over the entire clerkship. ♦ Remediation is provided for all students below the pass mark. The more frequent summative examinations have served to facilitate early identification of students in academic difficulty. Clinical Experiences ♦ Clinical learning experiences begin in the first month of Year 1 of the program. Students are placed in pairs once a week in Community Learning Sessions (CLS) in a variety of allied health, physician offices, and community and social service agencies. These experiences continue throughout Phase 1 and Phase 2 of the program. ♦ Also in Phase 1, students have weekly Structured Clinical Skills sessions in which they are required to develop patient interview and physical assessment skills on standardized patients. ♦ At the end of Year 1, students are assigned in pairs to a mandatory four-week immersion experience in one of 28 Aboriginal communities located throughout Northern Ontario. During these immersion experiences, students are provided with opportunities to shadow all health care providers that visit or reside in these communities. ♦ In Year 2, students are assigned in pairs to two mandatory four-week immersion experiences in one of 28 rural/remote communities located throughout Northern Ontario. During these immersion experiences, students are provided with an opportunity to shadow a primary care physician for five half-day sessions/week. In addition, CLS continue, thus providing students with opportunities to discover various health care providers in each community. ♦ In Year 3 (Phase 2), students are assigned to 1 of 12 small urban/large rural communities outside of Sudbury and Thunder Bay, for a mandatory eight-month Comprehensive Community Clerkship, which is a longitudinal integrated community clerkship. Each student is assigned to a primary care physician's practice. ♦ Students are provided with opportunities to meet all clinical learning objectives in the six core clinical disciplines through primary care sessions, on-call sessions, and hospital round sessions. ♦ Phase 3 is a 52-week educational program consisting of seven required rotations (i.e., four weeks each in Internal Medicine, Surgery, Women's Health, Children's Health, Mental Health, and Emergency Medicine). The seventh required rotation is a two-week experience in Family Medicine. Students are also required to successfully complete 12 weeks of elective time during Phase 3. ♦ Challenges of this model of clinical education involve its sustainability in relation to physician burn-out, community engagement and reengagement, and the fiscal resources required to maintain the teaching and learning activities. ♦ NOSM plans to increase yearly enrollment by eight students beginning in September 2010. This increase presents a challenge in relation to the recruitment of new communities, Aboriginal, remote/rural, small urban and large rural, to accommodate the placement of students for Phase-1 and Phase-2 immersion experiences. Regional Campus ♦ NOSM functions as the Faculty of Medicine of Lakehead University (Thunder Bay, Ontario) and Laurentian University (Sudbury, Ontario). The medical students are enrolled with one or other of the universities and graduate with a joint MD degree of both universities. The terms regional or main campus are not appropriate for NOSM as it has 70 partner communities and 2 host universities. Highlights of the Program ♦ NOSM was created with a social accountability mandate to provide innovative undergraduate and postgraduate medical education programs that meet the needs of the students as well as the health care needs of all populations of Northern Ontario. ♦ This social accountability mandate is clearly written into the Letters Patent (2002), which provides the legal basis for the establishment of the school. As such, all academic activities are framed around this mandate and the six key academic principles defined by the NOSM Academic Council. ♦ The NOSM undergraduate curriculum was carefully developed (beginning January 2003) with input from a variety of stakeholders as to the type of physician NOSM should train and the type of medical training the school should offer. ♦ In keeping with the curriculum blueprint, NOSM has established three mandatory four-week immersion experiences in Aboriginal and in rural/remote communities located throughout Northern Ontario. The Distributed Community Engaged Learning model of medical education allows widely distributed human and instructional resources to be utilized among community partner locations across Northern Ontario. ♦ Phase 2 (Year 3) of the NOSM program involves a mandatory eight-month longitudinal integrated clerkship in one of 12 small urban or large remote northern Ontario communities. ♦ In Phase 1 of the program, the case-based learning sessions are designed around actual physician cases seen in rural and remote communities in Northern Ontario. ♦ In Phase 1, students learn anatomy through the use of plastinated and prosected specimens and 3-D virtual anatomy programs. No cadavers are used. ♦ NOSM is a medical school without departments. This was an intentional design component of NOSM based primarily on the fact that the interdisciplinary nature of the curriculum required the ability of faculty members to be able to function in an interdisciplinary and collegial manner. ♦ The interdisciplinary approach mirrors the interdisciplinary nature of medical practice across Northern Ontario and provides the context in which undergraduate and postgraduate learners could eventually practice medicine. ♦ The lack of departments has led to significant cooperation across a variety of disciplines (Medical Sciences, Human Sciences, and Clinical Sciences) and has reduced the potential for conflict arising from institutional political issues.

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