Faculty Retreat – Sept. 20, 2004

1. Faculty Retreat – Sept. 20, 2004 Overview of Task Force Recommendations

2. An important definition: “Physicianship” - it refers to the dual roles of the physician: that of the professional and of the healer.

3. General Recommendations

4. 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”).

5. 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!

6. Specific Recommendations

7. 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.

8. Current CurriculumSchema

9. 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.

10. 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.

11. 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”.

12. 2. Introduce Physicianship Discussion Groups (PDGs) • will provide a forum to discuss the student’s transition from “laymanship” to “physicianship” • will demonstrate to the student body that the faculty acknowledges the enculturation that occurs in medical school

13. 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 student’s portfolio • student participation in the discussion groups and portfolio will “feed into” the Professionalism section of Dean’s letter

14. 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).

15. 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 Dean’s Letter will be modified to includea section on “physicianship”.

16. 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.

17. 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”).

18. 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.

19. 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)

20. 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.)

21. 7. Teach Communication Skills (CS) explicitly • adopt a previously validated model • an ad hoc committee was mandated to consider this recommendation in further detail

22. 8. Review the admissions process • admissions office to communicate the program’s 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

23. 9. Modify orientation activities for the program 10. Require that all BOM units contribute to the Physicianship curriculum

24. 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

25. 12. Introduce certain elements of the physical examination during BOM

26. 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

27. 14. Develop an MD,CM educational blueprint for physicianship issues

28. 15. Obtain formal legal advice on the physicianship evaluation structure • This is particularly important re: the issue of “forward feeding”.

29. Modify definitions of the Promotion Periods

30. Modify the “electronic” clinical case construct (being developed by MMI) • It should include “physicianship”. • It should reflect McGill’s approach to the clinical method (e.g. be congruent with the CS model to be adopted).

31. 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

32. In preparation for break-out groups

33. 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.

34. 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?

35. 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

36. 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.

37. 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.

38. 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.

39. 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.