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SECTION 4: The Program for the M.D. Degree 4.1 Governance

The program and its curriculum are the responsibility of the Faculty Executive Council (FEC). The policies, regulations, implementation and modifications of the educational program for the M.D. degree are determined by the FEC on the recommendation of the Faculty of Medicine Undergraduate Medical Education Curriculum Executive Committee. The Curriculum Executive Committee is chaired by the Director, UGME Curriculum.  The Terms of Reference for this committee and committee membership can be viewed at the following link. The Curriculum Executive Committee is responsible for the curriculum, teaching, and evaluation in the educational program leading to the M.D. degree.

4.2 General Statement

The UGME program has undergone an exhaustive comprehensive curriculum renewal process which commenced in 2010. The new clerkship was introduced in August 2013, and the new preclerkship will be introduced in August 2014. The curriculum was created to be a fully integrated spiral scaffold curriculum throughout all 4 years that fulfills UGME global objectives, Future of Medical Education (FMEC) recommendations and LCME/CCME standards. It was fashioned to be a Person to Community Centered curriculum (as opposed to organ system or department base).

The program is a continuum over the four years but is divided into the Pre-Clerkship, Years 1 and 2, and the Clerkship, Years 3 and 4, for administrative purposes. The mission and objectives of the program can be found at the following link  

The Faculty of Medicine does not support students’ limitation of their studies to only fields and disciplines of personal interest. Nonetheless, students are encouraged to pursue areas of interest and to develop their own education through clerkship electives and summer clinical exposures or research experiences. Students learn to use information, skills and behaviour from multiple sources of teaching to prevent and solve the health care issues that face their patients and society. Students learn that physicians are part of an interdisciplinary team and health care system that provides accessible, continuous and comprehensive health care.

In order to modify and enhance the educational program, the opinions of students and their evaluation of the program and its teachers are formally sought and respected by faculty. This information is used by the Curriculum Executive Committee to improve the program.

4.3 The Plan of the Curriculum

4.3.1 Professionalism

Professionalism, behaviour and attitudes befitting medical professionals, are an important component of the Undergrad­uate Medical Education curriculum. The goal is to instill the attributes of professionalism and to emphasize to medical learners that professional charater­istics and attributes are necessary for the practice of medicine and for their identity as physicians.

The Faculty of Medicine has developed a professionalism charter that serves as a framework for defining and demonstrating medical professionalism.

In cases where lapses in the level of professionalism necessary to underpin medical education are recognized, the Facul­ty of Medicine uses a Professionalism Report by which single egregious or recurrent lapses in student professionalism can be brought to the school’s attention. A summary statement will be included on an individual’s Medi­cal Student Performance Record if two or more validated reports have been received. The Faculty of Medicine maintains the option to dismiss students on the basis of unprofessional behaviour, regardless of performance in the curric­ulum.

4.3.2 Pre-Clerkship Program:

The goals and objectives of the UGME Pre-Clerkship curriculum are based on the mission and objectives of the undergraduate program as outlined in the following link. The evaluation of student academic progress is based on achievement of the learning objectives provided to students on-line via a curriculum management system known as the Online Portal for Advanced Learning (OPAL).

The cur­riculum framework is based upon the principles of scaffolding and integration. The program comprises Human Biology, Health and Disease Modules  commencing with a four week module – Foundation of Medicine. This module provides a basic science foundation relevant to the study and practice of medicine with the focus on principles, themes and overarching framework- these normal structure and function of molecules, cells and tissues and how homeostasis is maintained at these levels; how cells respond to perturbations in homeostasis and some of the possible consequences; major mechanisms that underlie the development of disease, and exogenous factors that threaten health.

This is followed by 23 weeks of the Human Biology and Health Modules which in sequence are: Blood and Immunology 1, Cardiovascular 1, Respiratory 1, Neuroscience 1, Musculoskeletal 1, Endocrine 1, Woman’s Reproductive Health 1, GI and Nutrition 1 and Urinary Tract 1 courses. These courses cover the normal development, anatomy and processes for the various systems, predominantly basic sciences with clinical cases (normal or abnormal) to contrast or help illustrate normal. Each  course will include an overview of burden of illness or diseases related to that system. The courses will be presented in the mornings while the afternoons will consist of five Longitudinal Courses that will proceed throughout all four years. These include:

  • (1) Clinical Reasoning
  • (2) Professionalism
  • (3) Public Health, Prevention and Scholarship
  • (4) Clinical Skills
  • (5) Indigenous Health 

The content, where relevant will parallel the morning module courses.

Following completion of the Human Biology and Health Modules, the same course names will appear as Human Health and Disease Modules. This is 36 weeks in total with the first 9 weeks completing year 1 of study.  Health and Disease Modules starts with an Introduction to Infectious Disease and Therapeutics course followed by Cardiovascular 2 and Respiratory 2.  Year 2 of study commences with the remainder of the M2 courses in sequence: Blood and Immunology 2, Neuroscience 2, Endocrine 2, Woman’s Reproductive Health 2, GI and Nutrition 2, Urinary Tract 2 and Musculoskeletal 2. All the courses are presented as abnormal processes, predominantly clinical cases with review and application of basic sciences.  Earlier modules will be presented in the mornings while the afternoons will be five Longitudinal Courses again including:

  • (1) Clinical Reasoning
  • (2) Professionalism
  • (3) Public Health, Prevention and Scholarship
  • (4) Clinical Skills
  • (5) Indigenous Health

The content, where relevant will parallel the morning module courses. Each course provides an overview of burden of illness and societal impact of diseases, and for each specific abnormality or disease covers where relevant the epidemiology, scientific basis and anatomy review, prevention and screening, cultural, social and ethical issues, natural history and prognosis, diagnosis, therapeutics and disease management. These may be covered during the morning module course or the afternoon Longitudinal course. The impact of Translational Research, Evidence Based Medicine and Health Care Systems will be highlighted where appropriate.

Year 1 will conclude with a one week rural primary care exposure.

Year 2 will conclude with a 10 week Consolidation module. The module will ensure all the content  from the previous modules are assimilated, and includes single symptom presentations with broad differential diagnosis, multisystem disease such as complicated diabetes,  “Themes” or disciplines such as pediatrics, geriatrics and systemic diseases such HIV, SLE and multiple myeloma. The first week of the consolidation module will be the pain management and dermatology courses. The subsequent 9 weeks will be small group case based discussions to ensure all the 137 Composite Clinical Presentations have been covered at appropriate level. 

The two-year Pre-Clerkship curriculum brings together teachers and facilitators from across all Faculty Departments, other healthcare related faculties and disciplines as well as members of the public. All basic medical sci­ences, including anatomy, molecular biology, bio­chemistry, human genetics, immunology, microbiology, physiology contribute to the curriculum as do the clinically applied basic sciences of pathology, pharmacology and community health sciences. Clinical depart­ments including anaesthesia, clinical health psychology, family medicine, internal medicine, obstetrics, gynaecology, ophthalmology, otolaryngolo­gy, paediatrics, psychiatry, surgery are involved in all aspects of the curriculum.

An overview of the UGME Framework within the Pre-Clerkship component of the Undergraduate Medical Education program can be viewed at the following link  

Methods of Teaching

A variety of approaches are used to facilitate learning. These include self-directed learning, small group sessions, whole group sessions, lab practicals and simulation.

Methods of Assessment

Formative and summative assessments are provided throughout the Pre-Clerkship curriculum. These include self-reflection, learning portfolios, tutor feedback, instructional tests, multiple choice examinations, practical examinations, and short and long answer examinations.

Attendance

Certain learning sessions within the UGME program are designated as “mandatory attendance” sessions. These are generally sessions in which patients or their families are involved; clinical skills are being taught; or clinical care is being provided. Attendance at these sessions is recorded and reported to the UGME office, and contributes to the evaluation of the learner’s professionalism, The Attendance Policy can be viewed at the following link

The procedures outlined in this policy do not preclude course directors, session leaders and instructors from tracking student learner attendance in their sessions and discussing any concerns related to attendance with the learners.

4.3.3 Clerkship Program:

The Clerkship component of Curriculum Renewal introduced in 2013 was created to facilitate the integrated 4 year scaffold curriculum with central governance, supervised responsibility for pa­tient care and mandatory academic time with frequent feedback and evaluation. The program is governed by the Clerkship Curriculum Committee for which the terms of reference and membership can be viewed on the website

The Clerkship (Years 3 and 4)  consists of Transition to Clerkship (5 weeks), Core Clinical Rotations  (48 weeks), Electives and CaRMS interviews (17 weeks), and Transition to Residency (12 weeks)

Transition to Clerkship (TTC) (5 weeks): The goal of TTC is for the students to expand their focus from learning during preclerkship years to the actual provision of care in various health care settings. This will help the students translate the knowledge gained in pre-clerkship to the clinical setting and the actual provision of care. This includes the supervised responsibilities that accompany provision of preventative health and management of disease by use of simulation, patient assessments, small group sessions and shadowing experiences.  The Transition to Clerkship is launched with a prominent local keynote speaker and reciting of hippocratic oath, includes two weeks in various community settings and culminates in a transition to clinical service week shadowing the student’s first rotation. This includes buddy call without direct responsibility.  

Core Clerkship Rotations (48 weeks):  There are four 12 week blocks comprising 8 major clinical disci­plines combining 2 disciplines per block to facilitate delivery of joint academic time: Surgery and Anesthesia, Internal Medicine and Emergency Medicine, Pediatrics and Obstetrics/Gynecology and Psychiatry with Family Medicine/Public Health.  For more specific outline see http://umanitoba.ca/faculties/medicine/education/undergraduate/program_overview.html. The primary responsibility of the clerks in the program is the care of patients under the supervision of post­graduate students and faculty. Settings for the clerkship experience are varied, including wards and outpatient facilities of the hospitals, doctors' offices, rural settings and commu­nity-based hospitals. A formal Academic half day occurs weekly with mandatory attendance shared and created equally by the UGME office and Longitudinal Courses, and the respective core rotations. The Longitudinal Courses are those that proceed throughout all four years and include:

  • (1) Clinical Reasoning
  • (2) Professionalism
  • (3) Public Health, Prevention and Scholarship
  • (4) Clinical Skills
  • (5) Indigenous Health

The UGME academic time includes reflection exercises and assignments. A Scholarship in Medicine Project (SiMed3) is included during this time period. The core rotations have additional scheduled academic sessions.

Electives and CaRMS National Interview Period (17 weeks): There are 15 weeks of electives running into CaRMS National Interview Period. Throughout the elective periods, students must pur­sue education in a minimum of three different disciplines with a minimum duration of two weeks each. Electives may be pursued in a setting of the student’s own choice, but must be approved by the Director, Electives. Students are responsible for all costs associated with electives and CaRMS interviews, e.g. transportation, accommodation etc. During this time period students will be participating in A Scholarship in Medicine Capstone Project (SiMed4) on line.

Transition to Residency (12 weeks): Following  completion of the CaRMS interviews will be two 3 week elective periods selected from a catalogue of options sandwiching CaRMS match week .The CaRMS match week will include preparation for PGME  sessions including types of practise,  leadership, team work and medical legal/licensure  sessions, and  SiMed4  wrap up with the students presenting their capstone projects . Transition to Residency will conclude with a 4 week MCCQE preparation course and Advanced Cardiac Life Support (ACLS) course

4.3.4 Requests for Conscience-Based Objections

The Faculty of Medicine acknowledges that at times, learners may object to participating in educational activities. Learners who object to participation in educational activities may refer to the Conscience Based Exemptions Policy available online in order to seek a Conscience-Based Objection.

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