Faculty Retreat Sept' 20, 2004

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Faculty Retreat Sept. 20, 2004

• Overview of
• Task Force
• Recommendations

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An important definition

• Physicianship - it refers to the dual roles
  of the physician that of the professional and of
  the healer.

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General Recommendations
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• Adopt Physicianship as the organizing theme (a
  leitmotif) for the M.D.,C.M. curriculum.
• Prioritize and update the teaching of the
  clinical method. (This is based on the premise
  that physicianship is enacted primarily through
  the clinical method).

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• Develop on-going evaluation and monitoring of
  the curriculum.
• Allocate sufficient resources (e.g. salary
  support for tutors, additional funds for faculty
  development, access to a skills centre, external
  consultants) to make it happen!

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Specific Recommendations
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1. Introduce a series of courses on the
Physician as Healer Professional (PHP)

• There will be 5 courses in the series
  PHP-A,B,C,D,E.
• They will replace ITP, ITPM, Professional Skills
  (formerly ICM-A), Introduction to POM (formerly
  ICM-E), and Communications Plus.

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Current Curriculum Schema
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PHP (continued)

• The five courses will be integrated
  professionalism, healing and ethics will be
  constant threads.
• They will be the primary home for the teaching
  of the clinical method, including communications
  skills.

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PHP (continued)

• Many details concerning the PHP courses have yet
  to be finalized, for example, how to integrate
  topics in ethics and the history of medicine?
  how to make use of the skills center? whether to
  introduce interdisciplinary teaching? etc.
• One important issue concerns scheduling -
  scheduling of PHP-D.

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PHP (continued)

• PHP-D can be offered via two radically different
  schedules
• as a 4-week block at the start of 3rd year (i.e.
  mid-August to mid-Sept), just before the start of
  clerkships, or
• 2. interspersed throughout clerkships (e.g. every
  8 weeks, on the last Friday of each clerkship)
  this model has been referred to as
  intersessions.

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2. Introduce Physicianship Discussion Groups
(PDGs)

• will provide a forum to discuss the students
  transition from laymanship to physicianship
• will demonstrate to the student body that the
  faculty acknowledges the enculturation that
  occurs in medical school

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PDGs (continued)

• The discussion groups will be linked to the
  Physicianship Portfolio as follows
• entries in the portfolio may serve as triggers
  for group discussions
• group leaders will review each students
  portfolio
• student participation in the discussion groups
  and portfolio will feed into the
  Professionalism section of Deans letter

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3. Physicianship Portfolios (PP)

• Each student will be required to maintain a
  portfolio.
• It will be used as a stimulus for discussion (in
  the PDGs) and self-reflection (i.e. formative
  purposes). It will not be used for assessment
  (i.e. summative purposes).

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4. Physicianship will be evaluated in a
longitudinal fashion.

• The evaluation will be formative and summative.
• Clinical evaluation forms will be modified to
  include a section on physicianship.
• The Deans Letter will be modified to include a
  section on physicianship.

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Physicianship evaluation (continued)

• Pilot project (P-MEX) has already been
  undertaken.
• A system to permit on-going student evaluation of
  teacher faculty performance in physicianship
  and professionalism domains will need to be
  implemented.

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5. Develop Community-based education projects

• The faculty commits to securing funds to provide
  financial assistance to students (i.e. summer
  bursaries or studentships).
• Increase visibility for these projects (e.g.
  Presentation Day for Student Extracurricular
  Projects).

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6. Renew teaching of the Clinical Method
(CM)

• develop a unique McGill approach
• make this a priority for the program
• Note Drs. Cassell and Boudreau have started this
  a work in progress it has been distributed.

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The CM (continued)

• focus on function
• teach the foundations of the CM in an explicit
  fashion these include teaching observation,
  fundamentals of spoken language, narrative
  competence and introducing topics in the logic of
  medicine (e.g. reasoning, probability)

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The CM (continued)

• teach communication skills
• improve teaching of the Neuro MSK portions of
  the Physical Examination
• decide on which procedural skills will be
  required (e.g. use of microscope?)
• modify the template for the written case report
  (e.g. emphasize justification reasoning
  underlying diagnosis introduce section on
  prognosis, etc.)

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7. Teach Communication Skills (CS) explicitly

• adopt a previously validated model
• an ad hoc committee was mandated to consider this
  recommendation in further detail

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8. Review the admissions process

• admissions office to communicate the programs
  emphasis on physicianship to new applicants
• encourage students with non-science backgrounds
  to apply
• reaffirm the importance of altruism in
  prospective applicants, but underline that this
  can be demonstrated by a variety of means

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9. Modify orientation activities for the program

• 10. Require that all BOM units contribute to the
  Physicianship curriculum

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11. Reorganize the ICM component

• Considered necessary in order to
• teach the clinical method more effectively
• make better use of the skills center
• (perhaps) accommodate increased student
  enrollment more effectively
• (perhaps) deal with current tensions more
  effectively

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12. Introduce certain elements of the physical
examination during BOM
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13. Introduce an ICM Exit Exam

• make this a skills-based (e.g. OSCE) assessment
  tool
• include communication skills
• all disciplines participating in ICM would be
  expected to contribute to this examination

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14. Develop an MD,CM educational blueprint for
physicianship issues
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15. Obtain formal legal advice on the
physicianship evaluation structure

• This is particularly important re the issue of
  forward feeding.

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Modify definitions of the Promotion Periods
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Modify the electronic clinical case construct
(being developed by MMI)

• It should include physicianship.
• It should reflect McGills approach to the
  clinical method (e.g. be congruent with the CS
  model to be adopted).

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18. Introduce mandatory clinical rotations in
rural settings

• Three models have been explored
• introduce a 3-week rotation during BtB
• introduce a 4-week rotation in the summer between
  2nd and 3rd years
• require that one of the clerkships be completed
  in a rural setting and leave it up to the student
  to select which clerkship

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In preparation for break-out groups
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Class size

• In 2004 we accepted 172 medical students. We
  assume that we have reached steady state, but
  we should probably plan for approx. 200.

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The recommendations that we anticipate will be
most controversial

• the Physicianship discussion groups
• the Physicianship portfolios
• modifications to ICM (particularly scheduling
  issues)
• scheduling of PHP-D (especially the
  intersessions model)
• how to introduce mandatory rural rotations in the
  curriculum?

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ICM an alternative scheduling

• scheduling is based on days of the week, (for a
  period of 20 weeks)
• class is divided in ¼ (approx. 43 students)
• Group 1 complete Medicine on Mondays Group 2 on
  Tuesdays Group 3 on Thursdays Group 4 on
  Fridays
• all students are scheduled in the McGill Skills
  Center on the Wednesdays

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Schedule Group 1

• Half of the group (i.e. approx. 21 students)
  complete ER and Neurology in the am while Fam Med
  and Oncology are in the pm.
• Half of the group (i.e. approx. 21 students)
  complete Fam Med and Oncology in the am while ER
  and Neurology are in the pm.

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Schedule Group 2

• Half of the group (i.e. approx. 21 students)
  complete ER and Neurology in the am while Fam Med
  and Oncology are in the pm.
• Half of the group (i.e. approx. 21 students)
  complete Fam Med and Oncology in the am while ER
  and Neurology are in the pm.

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Schedule Group 3

• Half of the group (i.e. approx. 21 students)
  complete ER and Neurology in the am while Fam Med
  and Oncology are in the pm.
• Half of the group (i.e. approx. 21 students)
  complete Fam Med and Oncology in the am while ER
  and Neurology are in the pm.

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Schedule Group 4

• Half of the group (i.e. approx. 21 students)
  complete ER and Neurology in the am while Fam Med
  and Oncology are in the pm.
• Half of the group (i.e. approx. 21 students)
  complete Fam Med and Oncology in the am while ER
  and Neurology are in the pm.

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