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Faculty Retreat – Sept. 20, 2004. Overview of Task Force Recommendations. An important definition:. “ Physicianship ” - it refers to the dual roles of the physician: that of the professional and of the healer. General Recommendations.

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faculty retreat sept 20 2004
Faculty Retreat – Sept. 20, 2004

Overview of

Task Force

Recommendations

an important definition
An important definition:

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

slide4
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”).

slide5
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!

1 introduce a series of courses on the physician as healer professional php
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.
php continued
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.
php continued1
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.

php continued2
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”.

2 introduce physicianship discussion groups pdgs
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
pdgs continued
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
3 physicianship portfolios pp
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).
4 physicianship will be evaluated in a longitudinal fashion
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”.
physicianship evaluation continued
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.
5 develop community based education projects
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”).
6 renew teaching of the clinical method cm
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.
the cm continued
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)
the cm continued1
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.)
7 teach communication skills cs explicitly
7. Teach Communication Skills (CS) explicitly
  • adopt a previously validated model
  • an ad hoc committee was mandated to consider this recommendation in further detail
8 review the admissions process
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
9 modify orientation activities for the program

9. Modify orientation activities for the program

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

11 reorganize the icm component
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
13 introduce an icm exit exam
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
15 obtain formal legal advice on the physicianship evaluation structure
15. Obtain formal legal advice on the physicianship evaluation structure
  • This is particularly important re: the issue of “forward feeding”.
modify the electronic clinical case construct being developed by mmi
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).
18 introduce mandatory clinical rotations in rural settings
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
class size
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.

the recommendations that we anticipate will be most controversial
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?
icm an alternative scheduling
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
schedule group 1
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.
schedule group 2
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.
schedule group 3
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.
schedule group 4
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.