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UGME CURRICULUM RENEWAL EDUCATION RETREAT ( ….Forum #5) February 11, 2013
AGENDA Review CuRe Process and Development Keevin Bernstein
Lunch 12:30 – 13:15 pm ...Includes meeting new colleagues Roundtable Introductions Keevin Bernstein Creating the New PreClerkship Joanne Hamilton
Break 14:30 – 15:00 pm ...Includes networking with new & old colleagues Development of Course Outlines and Joanne Hamilton
Faculty development process
UGME CURRICULUM RENEWAL EDUCATION RETREAT ( Forum #5) February 11, 2013
CuRe Process and Developments to date
1. Current Curriculum (1997) review process- Needs Assessment 2. Principles extracted from 11 CuRe Task Groups 3. Governance 4. Curriculum 21st century Framework
CP4 Normal Health & Disease Modules (Modules 0-3)
Foundation Module Normal Biology & Health Module Health & Disease Module Consolidation Module
Clerkship (Modules 4-7) 5. Evaluation: Student Assessment and CuRe Evaluation
Consistent Pedagogy Scholarship Outcome Based Objectives
Medical Informatics Integrated Continuous Quality Improvement
Inter-Professionalism Flexible Maximize Current strengths
New UGME Curriculum 2013 that fulfills FMEC recommendations & Accreditation Standards
Task Specific groups
External Consultation
Website Educational Experts
Site visits
Internal Review Surveys Retreats
Curriculum map Existing curriculum
Commitment to Patient, Family & Community ; Social Responsibility, Professionalism, Inclusivity; Scholarship, Excellence, Discovery, Innovation, Critical Thinking
UGME CURRICULUM RENEWAL MAP April 2011
OUTCOME>
Process
Principles
Curriculum Renewal
Goal
Mission
Stakeholder Consultations
Faculty Development
UGME CuRe NEEDS ASSESSMENT University of Manitoba UGME Review
CuRe UGME Faculty Survey - FMEC Dec 2010
CuRe Faculty Retreat and Report April 2011
CuRe UGME Course & Clerkship Director Survey June 2011
CuRe Department Representative Focus Group July 2011
LCME/CACMS Accreditation Oct 2011 • Student surveys • Report
CuRe Task Group (11) Reports Nov 2011
External Review; Genevieve Moineau MD June 2008 Associate Dean, UGME University of Ottawa
Internal Review; Oscar Casiro MD Associate Dean UGME 2002 Cheryl Kristjanson PhD Director Education Development
UGME CURRICULUM RENEWAL University of Manitoba UGME Review
CuRe UGME Faculty Survey Dec 2010
CuRe Faculty Retreat and Report April 2011
CuRe UGME Course & Clerkship Director Survey June 2011
CuRe Department Representative Focus Group July 2011
LCME/CACMS Accreditation Oct 2011 • Student surveys • Report
CuRe Task Group (11) Reports Nov 2011 External Review; Genevieve Moineau MD June 2008 Associate Dean, UGME University of Ottawa
Internal Review; Oscar Casiro MD Associate Dean UGME 2002 Cheryl Kristjanson PhD Director ED Development
CuRe UGME Faculty Survey Dec 2010
CuRe Faculty Retreat and Report April 2011
CuRe UGME Course & Clerkship Director Survey June 2011
CuRe Department Representative Focus Group July 2011
LCME/CACMS Accreditation Oct 2011 • Student surveys • Report
CuRe Task Group (11) Reports Nov 2011
Summary of issues with current curriculum: Not optimally integrated Limited scaffolding - each organ system taught once as a single unit, frequently in isolation Some major systems not covered until late Med 2. Problem Solving (PR) has not been the integrative tool for which it was originally intended. Blocks 1 and 2 are viewed by stakeholders as fragmented
In particular SF which attempts to provide a superficial overview of all the systems; is not seen to provide the foundational knowledge required for future learning.
Limited integration of preclerkship and clerkship No formal overall clerkship curriculum to provide structured review of the scientific basis of medicine or important clinical skills to provide both horizontal and vertical integration Doesn’t fulfill many of FMEC recommendations i.e. social accountability
UGME CURRICULUM RENEWAL 2011
UGME CURRICULUM RENEWAL CuRe Task Groups (11)
Created June 2011 following UGME Spring Retreat (post accreditation)
Collapsed 28 potential topics
2 co-chairs ( 1 from CuRe Steering Committee & 1 expert )
Generic mandate for all TG…….and Key principles identified for each TG
Report to CuRe Steering Committee then synopsis at Faculty Forum & CuRe Website Nov 2011
7
UGME CURRICULUM RENEWAL CURE TASK GROUP (11)
1. CURRICULAR FRAMEWORK
2. PEDAGOGICAL APPROACHES
3. INTEGRATION
4. INFORMATION LITERACY AND INFORMATICS (INFORMATION SCIENCES)
5. TEACHING CLINICAL SKILLS
6. SCIENTIFIC BASIS OF MEDICINE
7. HEALTH CARE SYSTEMS & QUALITY
8. SOCIAL ACCOUNTABILITY FRAMEWORK
9. EXPERIENTIAL & DIVERSIFIED LEARNING CONTEXTS
10. GENERALISM
11. PROFESSIONALISM
( Read handout for summary of each TG) 8
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
April 2011
Mar 2012
Feb 2012
Dec 2010
Forum #2
April 2012
June 2011
Sept 2010
Forum #1
Dec 2011
CuRe WG CuRe Ex/WG Environmental scanning – Seek best practices, conferring/visiting other medical schools or experts/websites Self examination – Solicit internal opinions; critique existing curriculum; Broad consultation - Smaller specific task to topic orientated groups; discuss novel ideas
Stakeholder Engagement : Faculty - Student - Post Graduate Government - RHAs - Public
Oct 2011
Evaluation – Processes & Outcomes
Feb, 2012
Principles:
Physicians for 21st century: Fulfills (or exceeds) UGME global objectives, FMEC recommendations
and LCME/CCME standards
Fully integrated spiral scaffold curriculum throughout 4 years
Patient to Community Centered not focused on organ system or department based
Build upon existing or potential strengths
Innovative – utilizing evolving technology
Iterative and Transparent process
UGME CURRICULUM RENEWAL
10
Governance: Modified to enhance & facilitate transparent communication
Maintain quality assurance and curricular stability Recognize faculty – remuneration or time
Faculty: Appointed Educational Leaders: oversee/ensure continuum for each:
Module or Unit within modules Longitudinal Course Discipline/Department or “Theme”
• With job description and appropriate recognition & reward
Each educational “unit” with leader will have a curriculum committee with relevant representation Fewer teachers…..participating in lectures Formal Faculty Development & Evaluation
11
UGME CURRICULUM RENEWAL Principles:
Year 1 2 3 4
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
12
Principle: “Fully integrated spiral scaffold curriculum through 4years”
MO: Foundation M2: Health and
Disease Abnormal Processes Clinical Integration
M1: Normal Biology and Health
Normal Processes Clinically Applied
M3: Consolidation
M2: Health & Disease Abnormal Processes
M4 TTC: Transition to Clerkship
M5:“Junior” Clerks (JC)
UGME
Academic Time
M6:“Senior”Clerks (SC)
UGME Academic Time
M7 TTR: Transition to Residency
Faculty Keevin Bernstein MD Director, CuRe
Ira Ripstein MD Associate Dean
Gary Harding MD Director, Curriculum
Rob Brown MD Director, CLSF
Don Smyth PhD Pharmacologist
Joanne Hamilton MEd Department Med Ed
Barry Cohen MD Director, Assessment
Merril Pauls MD Director, Preclerkship
Eunice Gill MD Director, Clerkship
Karen Klym MD Director, Clinical Skills
Bryan Payne MBA Program Manager
“Consumers” Amit Kaushal MD PGY3* Internal Medicine
Steven Promislow MD PGY3* Internal Medicine
Elizabeth Berg MD PGY3* Surgery
Steven Montague Med IV MMSA Senior Stick
Sarah Van Galen Med III Communication Rep
Eyal Kraut Med III Academic Rep
Pol Darras Med III Academic Rep
Jesse Marantz Med II Student
Harald Gjerde Med II Academic Rep
Anne Finlayson Med II Academic Rep
* All Task Group residents were invited to join executive
UGME CuREXecutive: ( Convened Nov 2011) UGME CuRe GOVERNANCE
CuRe Clinical Skills Committee Karen Klym & Rob Brown, Co-Chair Holly Harris Nancy Porhownik Susan Hauch Tom Klonisch TJ Grexton (Med III) Maggie Eade Greg Schmidt (Med III) (Stasa Veroukis Jeanette Edwards)
14
Cure Clerkship (M4-7) Committee Eunice Gill & Keevin Bernstein, Co- Chair Ira Ripstein Rob Brown Joanne Hamilton Catherine Moltzan Elizabeth Berg (PGY3) Tara Petrychko Peter Syntnik (Med IV) (Nicola Matthews) Current Department Clerkship Directors
UGME CuREXecutive ( convened Nov 2011) Keevin Bernstein , Chair
CuRe Progress (Student Assessment) Subcommittee Barry Cohen, Chair Ira Ripstein Brent Kvern, Director , Remediation Allen Kraut Steven Montague (Med IV) Pol Darras (Med III) (Maria Vrontakis , M0-3 Student Assessment Coordinator) (Nancy Porhownik, OSCE Coordinator)
ACTIVE Committees:
Convened June 2012
( later additions)
UGME CuRe GOVERNANCE
UGME CURRICULUM RENEWAL Committees
15
CuRe Preclerkship (M0-M3) Committee Merril Pauls & Keevin Bernstein Co-Chairs Appointed Dec 2012- Effective Jan 1, 2013:
Preclerkship Educational Leaders Longitudinal Course Leaders
UGME CuREXecutive Keevin Bernstein , Chair
Committee not yet convened awaiting new governance/appointments:
FACULTY LEADERSHIP POSITIONS All Positions appointed by UGME Associate Dean ……..….in
conjunction with relevant Department Head
• All non clinical positions are determined by Associate Dean • Clinical positions determined by Department Head
Equivalent transparent EFT grid for all positions with recognition formula:
• Protected Time • Remuneration
Detailed Job descriptions
3 year appointments with performance reviews and
reappointment strategies
UGME CuRe GOVERNANCE
17
FACULTY LEADERSHIP POSITIONS:
Directors will ensure curriculum is comprehensively managed and governed
Preclerkship Merril Pauls
Clerkship Clinical Eunice Gill
Clerkship Academic *(M4 & M7) (responsible spiral curriculum /coordinating nonclinical learning)
Nicola Matthews
Integration * (responsible spiralling throughout 4 years specifically CR course & Consolidation Module)
Catherine Moltzan
Simulation * Rob Brown
Clinical Skills Karen Klym
Student Assessment Barry Cohen
Education Development * Joanne Hamilton
Online learning * TBD
Electives ( Clerkship) John Lee * New positions
UGME CuRe GOVERNANCE
FACULTY LEADERSHIP POSITIONS Module Leaders : M0*(Foundation Module)
• Educational leader from a basic science department • Don Smyth (Pharmacology) & Cindy Ellison (Pathology) appointed as Co-Leaders • Create curriculum committee with single rep from each BS department
M1/2(Organ system modules)Single Educational leader; clinician • Responsible for coordinating all undergraduate activity pertaining to their
respective organ system (s) • Responsible for the cognitive content throughout 4 years • Supervising the clinical elective/selective pertaining to respective clinical area • Work collaboratively with all relevant department/discipline and longitudinal or
theme leaders • Each M1/2 should have a basic science lead
M3* ( Consolidation Module ) Leader; Clinician = Director, Integration • work closely with CR Leaders feeding into M3
UGME CuRe GOVERNANCE
* New positions
19
FACULTY LEADERSHIP POSITIONS
Longitudinal Course* Leaders: Develops and implements the specific LONGITUDINAL COURSE curriculum
including overall goals and educational objectives, types of sessions, and student material
Works with Preclerkship and Clerkship Academic Directors, M1-3 Leaders, and Clerkship Rotation Leaders to ensure appropriate longitudinal COURSE content is covered during the academic sessions
Develops student assessment in collaboration with Director
Longitudinal Theme* Leaders Works with preclerkship and clerkship academic directors, M1-3 Leaders, and
Clerkship rotation Leaders to ensure appropriate LONGITUDINAL THEME content is covered during the M1/2 courses, clinical exposure or academic sessions
No separate student assessment
UGME CuRe GOVERNANCE
* New positions
20
FACULTY LEADERSHIP POSITIONS
Discipline*Leaders(Clinical Departments or Sections without core rotations) Works with preclerkship and clerkship academic directors, M12 Leaders, and
Clerkship Rotation Leaders to ensure appropriate content is covered during M1/2 courses, clinical exposure or academic sessions
Supervises sub-rotation including creating objectives and academic content
Basic Science Department* Leader Each basic science department will have a single leader representing them
Participate in MO Appoint representation to M1/2 courses Determine if relevant content for Clerkship Academic Half Day
M1/2 Course Committees Chaired by M1/2 Leader Membership allocated by Longitudinal Theme Leader, Discipline Leaders , and /or
Basic Science Department Leader
UGME CuRe GOVERNANCE
* New positions
April 2011
Forum #4
Oct 2011
Forum #1
UGME CURRICULUM RENEWAL MILESTONES
Dec 2011
Stakeholder Engagement : Faculty - Student - Post Graduate Government - RHAs - Public
ACHIEVED:
April 2011
Oct 2011
June 2011
Dec 2011
Forum #2
21 Undergraduate Medical Education
21 ONE UNIVERSITY MANY FUTURES.
Forum #3
Mar 2013
Feb 2012
Jan 2013
Dec 2012
Mar 2012 June 2012
Created: April 2011
Modified : Oct 2012
Aug 2013
Aug 2013
Clerkship
Mar 2012
April 2012
Modified : Dec 2012
Dec 2012 Aug 2014
PreClerkship
April 2012 Oct 2012 Dec 2012
Feb 2013
Year 1 2 3 4
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
22
Principle: “Fully integrated spiral scaffold curriculum through 4years”
MO: Foundation M2: Health and
Disease Abnormal Processes Clinical Integration
M1: Normal Biology and Health
Normal Processes Clinically Applied
M3: Consolidation
M2: Health & Disease Abnormal Processes
M4 TTC: Transition to Clerkship
M5:“Junior” Clerks (JC)
UGME
Academic Time
M6:“Senior”Clerks (SC)
UGME Academic Time
M7 TTR: Transition to Residency
Provide a basic science foundation relevant to the study and practice of medicine
• Focus will be on the principles, themes and overarching framework
• Not contain sessions that are simply an overview or sample of things to come
• Not dwell on specifics from clinical examples but use only clinical vignettes for illustration
Appoint Foundation Leader and curriculum committee from basic science departments who will provide most of the teaching, then continue as Department “Leader”
4 weeks………sample schedule created (enclosure)
Foundation of Medicine (Module 0)
23 23
UGME CURRICULUM RENEWAL
Year 1 2 3 4
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
24
Principle: “Fully integrated spiral scaffold curriculum through 4years”
MO: Foundation M2: Health and
Disease Abnormal Processes Clinical Integration
M1: Normal Biology and Health
Normal Processes Clinically Applied
M3: Consolidation
M2: Health & Disease Abnormal Processes
M4 TTC: Transition to Clerkship
M5:“Junior” Clerks (JC)
UGME
Academic Time
M6:“Senior”Clerks (SC)
UGME Academic Time
M7 TTR: Transition to Residency
Composite Clinical Presentations (CP4)
Goals to be achieved upon graduation
Derived from combination : • MCC objectives • UBC modified MCC Objectives–clinical presentations (~130) • Suggestions from UGME PreClerkship and Clerkship
Directors survey ( June 2011) ……Then divided into 4 color coded groups…….
Spiral Curriculum Framework
“Composite” Clinical Presentations:
ONE UNIVERSITY. MANY FUTURES. Undergraduate Medical Education
25
• Symptoms or Signs • Lab abnormalities • Factors Affecting Health • Health Conditions
Clinical Presentations “must represent a common or important way in which a patient, group of patients, community or population actually presents to the physician and which a graduate would be expected to handle” UC 2009 http://www.ucalgary.ca/mdprogram/node/622
25
UGME CURRICULUM RENEWAL
26
Composite Clinical Presentations CP4* UGME Sept 2012 DRAFTV6 HEALTH CONDITIONS
SYMPTOMS & SIGNS 34 hemoptysis ABNORMAL LABS 99 ADHD spectrum 1 abdominal mass 35 hirsutism 66 acidosis 100 adrenal disorders 2 abd pain: acute & chronic 36 hoarse voice 67 alkalosis 101 arthritis 3 allergic reactions 37 impotence 68 hemoglobin disorders 102 CVD 4 anxiety 38 incontinence 69 calcium/phopshate/magnesium 103 cirrhosis 5 ascites 39 jaundice 70 cardiac markers/EKG 104 CNS infections 6 blunt trauma 40 joint pain-acute & chronic 71 coagulation abnormalities 105 diabetes
7 burns 41 low back pain 72 creatinine:acute & chronic 106 Drug OD 8 bleeding 42 lymphadenopathy 73 CXR abnormalities 107 eating disorders 9 cardiac murmurs 43 neck mass/thyroid 74 lipd abnormality 108 fungal infections
10 chest pain 44 pain syndrome 75 leukocyte disorders 109 HIV/AIDS 11 constipation 45 palpitations 76 liver enzymes/function 110 hypertension 12 cough- acute & chronic 46 pruritus 77 potassium abnormalities 111 infertiltiy 13 cyanosis 47 red eye 78 platelet disorders 112 kidney disease-chronic 14 delirium 48 paralysis 79 pulmonary function tests 113 lung disease-chronic 15 dementia 49 pelvic pain/mass 80 sodium abnormalities 114 malnutrition 16 diarrhea- acute & chronic 50 seizures 81 urinalysis abnormalities 115 menses/menopause 17 diplopia 51 skin growths FACTORS EFFECTING HEALTH 116 mood disorders 18 dysphagia 52 skin rashes 82 adverse drug reactions 117 multiple sclerosis 19 dyspnea-acute & chronic 53 sleep disorders 83 chronic disease 118 osteoprosis 20 dysuria/UTI 54 somnolence 84 Contraception 119 pediatric emergencies 21 ear pain 55 sore throat 85 Culture 120 palliative care 22 edema 56 syncope 86 WHO Determinants of Health 121 pituitary disorders 23 extremity pain-acute&chronic 57 tendon rupture 87 developmental pediatric delay 122 pregnancy/complications 24 eye trauma 58 testicular swelling/pain/mass 88 Disabilities 123 psychosis 25 fever 59 tinnitus 89 neglect/abusive relationship or behavior 124 suicidal behavior 26 fatigue 60 vomiting 90 educational level 125 shock/resuscitation 27 foot ulcers 61 vision loss acute&chronic 91 elderly/frail 126 sports injuries 28 fracture/dislocation 62 weakness 92 environmental health 127 STI 29 GI bleed 63 wheezing- acute & chronic 93 infectious epidemic/prevention 128 suicidal behavior 30 head injury 64 UT obstruction symptoms-lower 94 food and water security 129 systemic autoimmune disorders 31 headache 65 vertigo/dizziness 95 body weight disturbances 130 surgical infections 32 hearing loss 96 substance abuse/addiction/alcoholism 131 TB 33 hematuria 97 poverty 132 thyroid disorders
98 smoking 133 Venous thrombosis
*Complied from MCC objectives, UGME CD survey 2010 , UBC website
CP4: Composite Clinical Presentations Learning Outcomes or Goals to be achieved upon graduation
highlighted at different junctures at the relevant educational level (vs. Instructional objectives)
Derived from combination : • MCC objectives • UBC modified MCC Objectives–clinical presentations (~130) • Suggestions from UGME PreClerkship and Clerkship
Directors survey (June 2011) ……Then divided into 4 color coded groups……over 4 years.
Clinical Presentations “must represent a common or important way in which a patient, group of patients, community or population actually presents to the physician and which a graduate would be expected to handle” UC 2009
27
Composite Clinical Presentations CP4* UGME Sept 2012 DRAFTV6 HEALTH CONDITIONS
SYMPTOMS & SIGNS 34 hemoptysis ABNORMAL LABS 99 ADHD spectrum 1 abdominal mass 35 hirsutism 66 acidosis 100 adrenal disorders 2 abd pain: acute & chronic 36 hoarse voice 67 alkalosis 101 arthritis 3 allergic reactions 37 impotence 68 hemoglobin disorders 102 CVD 4 anxiety 38 incontinence 69 calcium/phopshate/magnesium 103 cirrhosis 5 ascites 39 jaundice 70 cardiac markers/EKG 104 CNS infections 6 blunt trauma 40 joint pain-acute & chronic 71 coagulation abnormalities 105 diabetes
7 burns 41 low back pain 72 creatinine:acute & chronic 106 Drug OD 8 bleeding 42 lymphadenopathy 73 CXR abnormalities 107 eating disorders 9 cardiac murmurs 43 neck mass/thyroid 74 lipd abnormality 108 fungal infections
10 chest pain 44 pain syndrome 75 leukocyte disorders 109 HIV/AIDS 11 constipation 45 palpitations 76 liver enzymes/function 110 hypertension 12 cough- acute & chronic 46 pruritus 77 potassium abnormalities 111 infertiltiy 13 cyanosis 47 red eye 78 platelet disorders 112 kidney disease-chronic 14 delirium 48 paralysis 79 pulmonary function tests 113 lung disease-chronic 15 dementia 49 pelvic pain/mass 80 sodium abnormalities 114 malnutrition 16 diarrhea- acute & chronic 50 seizures 81 urinalysis abnormalities 115 menses/menopause 17 diplopia 51 skin growths FACTORS EFFECTING HEALTH 116 mood disorders 18 dysphagia 52 skin rashes 82 adverse drug reactions 117 multiple sclerosis 19 dyspnea-acute & chronic 53 sleep disorders 83 chronic disease 118 osteoprosis 20 dysuria/UTI 54 somnolence 84 Contraception 119 pediatric emergencies 21 ear pain 55 sore throat 85 Culture 120 palliative care 22 edema 56 syncope 86 WHO Determinants of Health 121 pituitary disorders 23 extremity pain-acute&chronic 57 tendon rupture 87 developmental pediatric delay 122 pregnancy/complications 24 eye trauma 58 testicular swelling/pain/mass 88 Disabilities 123 psychosis 25 fever 59 tinnitus 89 neglect/abusive relationship or behavior 124 suicidal behavior 26 fatigue 60 vomiting 90 educational level 125 shock/resuscitation 27 foot ulcers 61 vision loss acute&chronic 91 elderly/frail 126 sports injuries 28 fracture/dislocation 62 weakness 92 environmental health 127 STI 29 GI bleed 63 wheezing- acute & chronic 93 infectious epidemic/prevention 128 suicidal behavior 30 head injury 64 UT obstruction symptoms-lower 94 food and water security 129 systemic autoimmune disorders 31 headache 65 vertigo/dizziness 95 body weight disturbances 130 surgical infections 32 hearing loss 96 substance abuse/addiction/alcoholism 131 TB 33 hematuria 97 poverty 132 thyroid disorders
98 smoking 133 Venous thrombosis
*Complied from MCC objectives, UGME CD survey 2010 , UBC website
Year 1 2 3 4
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
28
Principle: “Fully integrated spiral scaffold curriculum through 4years”
MO: Foundation M2: Health and
Disease Abnormal Processes Clinical Integration
M1: Normal Biology and Health
Normal Processes Clinically Applied
M3: Consolidation
M2: Health & Disease Abnormal Processes
M4 TTC: Transition to Clerkship
M5:“Junior” Clerks (JC)
UGME
Academic Time
M6:“Senior”Clerks (SC)
UGME Academic Time
M7 TTR: Transition to Residency
Normal Biology and Health Module (formerly Systems I ) Health and Disease Module (formerly Systems II)
Contrasting Systems I and Systems II I = Normal Biology and Health…Module 1 II = Health and Disease……………..Module 2
1: Normal development, anatomy and processes Provide overview of burden of illness / diseases related to system Predominantly basic sciences with clinical cases (normal or abnormal) to
contrast or help illustrate normal
2: Abnormal processes Provide overview of burden of illness & societal impact of diseases With each specific abnormality or disease cover all “9” elements Predominantly clinical cases with review of basic science
UGME CuRe 21st century: Normal Health & Disease Module formerly “System” Course Template
29
Normal Biology & Health…(“systems I”) 1 1. Introductory lecture (2hrs) Course objectives Overview of system/organ function Overview of anatomy and relevant structures Overview of Burden of illness Patient illustration
2. Normal Development & Embryology
3. Gross Anatomy & Imaging
4. Microanatomy
5. Normal Processes Physiology Biochemistry & Molecular biology Pharmacology
*All material ( where possible) will be presented as normal contrasting to illustrations of abnormal providing clinical relevance
Health & Disease….(“systems II” ) 2
1. Introductory lecture (2 hrs) • Course objectives • Review of Systems I • Burden of illness
Epidemiology and Social • Patient illustration
2. Clinical Genetics • Review of embryology if relevant
3. *Life Cycle impacts: • Development--> pediatrics --> geriatrics
4. Abnormal Processes: • Specific Abnormality or Disease pathophysiology
*With each entity : 1) Epidemiology 2) Scientific Basis and Anatomy review 3) Prevention and Screening1
4) Cultural, Social and Ethical issues 5) Natural History & Prognosis 6) Diagnosis 2 7) Therapeutics and Disease Management 8) Translational Research & Evidence Based Medicine 9) Health Care System
*Either as part of unit or parallel longitudinal course
1 Includes amongst others nutrition, life style, exercise
2 Includes history, physical, labs, imaging and pathology
UGME CuRe 21stCentury: Module 1 & 2 Course Template DRAFT Mar2012
30
1. Introduction to Infectious Diseases/ Intro to Oncology Blood, Lymph and Immunology II 2. CV II
3. Resp II 4. Endocrine II 5. Kidney II 6. Reproduction II 7. GI & Nutrition II 8. Musculoskeletal II & Skin II 9. Neurobiology II (Psychiatry, Clinical Psychology, Neurology, Opth & ENT)
1.Blood, Lymph, Immunology & Skin I 2.Musculoskeletal I 3.Neurobiology I(Psychology, Neurosciences, & ENT) 4.CV I & 5.Kidney I & GI/ Nutrition I 6.Endocrine I & Reproduction I
UGME CuRe Preclerkship Y1/Y2: M0-M3: Normal Health and Disease Modules Y1
M0 M1
Y2
Health and Disease
Dec. break
Dec. break
Reading Week
Reading Week
Rural Week
Consolidation
M2
M3
Normal Biology & Health
Foundation of Medicine
DRAFT Feb 14
31
1. Introduction to Infectious Diseases/ Intro to Oncology Blood, Lymph and Immunology II 2. CV II
3. Resp II 4. Endocrine II 5. Kidney II 6. Reproduction II 7. GI & Nutrition II 8. Musculoskeletal II & Skin II 9. Neurobiology II (Psychiatry, Clinical Psychology, Neurology, Opth & ENT)
1.Blood, Lymph, Immunology & Skin I 2.Musculoskeletal I 3.Neurobiology I(Psychology, Neurosciences, & ENT) 4.CV I & 5.Kidney I & GI/ Nutrition I 6.Endocrine I & Reproduction I
UGME CuRe Preclerkship Y1/Y2: M0-M3: Normal Health and Disease Modules Y1
M0 M1
Y2
Health and Disease
Dec. break
Dec. break
Reading Week
Reading Week
Rural Week
Consolidation
M2
M3
Normal Biology & Health
Foundation of Medicine CREATION of M1 and M2 course sequencing & allocation 1. Logical sequencing of systems
2. Commence with Immunology and Blood
3. Logical anatomy instruction – dissection and student comprehension
4. Ensure all systems completed before spring year 1
5. Separated current topics into M1 and M2 equivalents & allocated 90 %
6. Ensure M1 course schedule doesn’t overlap with respective M2 schedule. 7. Accommodate student assessment and remediation Accommodate remediation of M1 Y1 courses before M2Y1 i.e. CV 2 days for Student assessment per course All courses end on Fridays with final course/unit exams that day
7. Accommodate natural holidays ( eg Dec break, Reading week and summer)
8. Accommodate national scientific meetings
……………….Numerous iterations >>>>> 32
Normal Biology and Health wks.days ( w. 2 days eval ) Approximate dates
UGME CuRe Preclerkship M1/2: Health & Disease Modules Y1
M1
Y2
Health and Disease
• FOUNDATION 1.Blood & Immunology I (+ Skin I) 2.CV I & Resp (+ ET) I 3.Neurobiology I(Psych, Neuro + Opth) 4.Musculoskeletal I 5.Endocrine I & Reproduction I 6.GI/ Nutrition I & Renal I
M2
M3
JULY 23 2012
4 ---- 2013 Aug 26 - Sept 20 3------------ Sept 23 - Oct 11
5 ------------ Oct 14 - Nov 15 4.6 --------- Nov 18 - Dec 18… Dec break 2------2014 Jan 6 - Jan 17 4------------- Jan 20 - Feb 14
4------------- Feb 17 - Mar 14 TOTAL 26.6 ……………….Mar 17 - 21 ………Reading week
2-------------Mar 24 - April 4 3-------------Apri 7 - April 25 4-------------Apri 28 - May 23 -----------May 26 - 30 …………. Rural week 4--------------Aug 25 - Sept 19 3--------------Sept 22 - Oct 10 3--------------Oct 13 - Oct 31 3 -------------Nov 3 - Nov 21 3 +3d------- -Nov 24 - Dec 18…… Dec break 6 -----2015- Jan 5 - Feb 13 4--------------Feb 16 - Mar13 ----------------Mar 16 - 20 ……. Reading week
1. Intro to ID/Intro Oncology 2. Blood & Immunology (+ autoimmune diseases) II 3. CV II
4. Resp + ET II 5. Endocrine II 6. Reproduction II 7. GI & Nutrition II 8. Renal II 9. Neurobiology II (Psych, Neuro, Opth) 10. Musculoskeletal II & Skin II 33 Consolidation 10-------------Mar 23 - May 29
5
PROPOSED /DRAFT
Year 1 2 3 4
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
34
Principle: “Fully integrated spiral scaffold curriculum through 4years”
MO: Foundation M2: Health and
Disease Abnormal Processes Clinical Integration
M1: Normal Biology and Health
Normal Processes Clinically Applied
M3: Consolidation
M2: Health & Disease Abnormal Processes
M4 TTC: Transition to Clerkship
M5:“Junior” Clerks (JC)
UGME
Academic Time
M6:“Senior”Clerks (SC)
UGME Academic Time
M7 TTR: Transition to Residency
Purpose: Ensure all the content from the previous modules are assimilated Applied to patient care in a complex health care environment Ensure ~130 Composite Clinical Presentations have been covered
(if not covered elsewhere) at appropriate level.
Include: Single symptom presentations with broad differential diagnosis Multisystem Disease – eg complicated diabetes “Themes” or Disciplines such as pediatrics, geriatrics Systemic diseases – eg HIV, SLE ,etc. Health Care Issues- pain, addictions, etc.
Format: small group problem solving and clinical reasoning sessions.
Duration: 10 weeks
Consolidation Module (Module 3)
35
UGME CURRICULUM RENEWAL FRAMEWORK
Foundation of Medicine
Year 1 2 3 4
Health & Disease Abnormal Processes- Clinical Integration
Normal Biology & Health Normal Processes- Clinically Applied
Consolidation
Health & Disease Abnormal Processes
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4) 36
Year 1 2 3 4 Year 1 2 3 4
Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”
TTC: Transition to Clerkship
“Junior” Clerks (JC) UGME Academic time
“Senior”Clerks (SC) UGME Academic time TTR: Transition to Residency
UGME CURRICULUM RENEWAL FRAMEWORK
Longitudinal Courses: Names TBA
Clinical Reasoning CR (formerly Problem Solving) Information Sciences* Integration* strategies - eg Case of the week Critical Thinking Pathology (eg mini hospitals) CP4
Community Health Epidemiology Public health Health care systems * (includes Law & Med) Global Health Occupational Environmental
Clinical Skills * Communication skills Physical exam skills/diagnosis Community Clinics & Distributed Learning
contexts* Procedural skills Self reflection
Professionalism*/Doctoring Social accountability/equity* Cultural safety/diversity Humanities/Ethics/History Life Skills (formerly Survival Tactics) Narrative or Arts and Medicine Decorum Interprofessional Leadership/Health advocacy
Indigenous Health*
Scholarly Activity Basic or clinical science research Educational research Health Care system or Leadership Community research
UGME CURRICULUM RENEWAL *CuRe TG
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Not developed for 2013 -2014 ?CHS Academic project for Clerkship
Longitudinal Themes: Themes: Not individual courses but thread throughout curriculum with a designated leader:
Generalism * Information Science* Diagnostic Imaging Leadership* Geriatrics Genetics Pediatrics Palliative Care Health Care Systems/Safety* Interprofessional Education*
UGME CURRICULUM RENEWAL *CuRe TG
38
CURRICULUM RENEWAL: Community Engagement
Social Responsibility and Accountability • Population health and determinants of health framework • Health Advocacy • Interprofessional education and care • Contextualize health issues – quality, equity and cost effectiveness
Curriculum needs to be based upon priority health needs of community and province : We need to engage government, agencies and public
Longitudinal Courses: • Clinical Skills • Professionalism • Community Health/Public Health • Indigenous Health • Scholarly activity with community
39
Person to Community Centered :
UGME CURRICULUM RENEWAL –CLINICAL SKILLS
Service Learning ( Currently Co-Curricular ) • WISH clinic • Winnipeg Harvest • Jacob Penner Park • Global Health Concentration Program
Learning in the Community ( Curricular):
•Urban ( eg WRHA Access or others) •Emergency departments •Rural Health care clinics •First Nation Communities •Health Care Agencies •Personal Care Homes
Foster Interest or Careers: -Urban primary care
- Rural primary care - Indigenous /global health - Public Health/Equity - Geriatrics
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New Clinical Skills Course: Following introduction to communication skills (early Module 1)….
Longitudinal clinics follow assigned families: Address community needs Range of engagement:
• Appreciate social diversity>>> manage chronic disease • Interprofessional care and /or education
Self reflection Commenced engagement with WRHA Primary Care Network
• Intended for communication skills • provide student exposure to various chronic diseases, and their
impact on both individual and family, • utilization of other care professionals, and how they navigation
through community services and resources
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Service Learning ( Currently Co-Curricular or becomes curricular) Learning in the Community ( Curricular)
UGME CURRICULUM RENEWAL: Clinical Skills
Normal Health & Disease Modules : 17 hrs /week- AMs Lectures: Introductions; interdisciplinary ; summaries
Proportion & Number of lecturers TBD Independent learning: role
Assigned studies – Directed Self Learning Small group learning:
Tutorials: o cases or questions o apply content o apply critical thinking o evidence based with references
Case Base Learning Team Based Learning
Online learning Peer teaching Link to Clinical skills/simulation/early exposure Student Assessment- formative & summative
Longitudinal Courses : 11hrs /week- PMs Clinical Skills - 3 hrs ( 4 hrs in Year 2) Clinical Reasoning - 3 hrs Others - 5 hrs 42
UGME CuRe 21st : Pedagogical Template DRAFT DRAFT April 2012
Year 1 2 3 4
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4) 43
Year 1 2 3 4 Year 1 2 3 4
Boxes are not scaled Principle: “Fully integrated spiral scaffold curriculum through 4 years”
MO: Foundation M2: Health &
Disease Abnormal Processes- Clinical Integration
M1: Normal Biology & Health Normal Processes- Clinically Applied
M3: Consolidation
M2: Health & Disease Abnormal Processes
M4 TTC: Transition to Clerkship
M5:“Junior” Clerks (JC)
UGME Academic time
M6:“Senior”Clerks (SC)
UGME Academic time
M7 TTR: Transition to Residency
UGME CURRICULUM RENEWAL FRAMEWORK
CLERKSHIP plans to date 2013:Year 3(M4&M5)
ECP and CP4 Don’t need to be rotation specific - tracked electronically
Transition to Clerkship (TTC) 5 weeks
Block 1 Surgery /Anesthesia
Block 2 Peds and OG
Block 3 Int /Emerg Med
Block 4 FM and Psych
12 weeks 6 weeks each 12 weeks 6 weeks each 3 groups 9 2 groups 14 2 groups 14 2 groups 14
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Academic time: UGME qThursday PM- once developed determine if time required or qoThursday
Mandatory attendance Policy no “call” past 2300
Block specific academic time Maintain central oversight Developed jointly by 2 departments Commence each block 1-2 days academic time
Longitudinal Courses: Community Health Sciences (Public health & Health care system), Professionalism & Social Equity, Indigenous Health & Clinical Reasoning Incorporated into clinical rotation or UGME Academic half day
HIGHLIGHTS: Preparation for clerkship with enhanced simulation and shadowing opportunities
Final week : Shadowing on 1st rotation • TCS: “Transition to Clinical Service”
“Grace” Day – utilize new Grace Simulation lab ; • Each student spends 1 full day at Grace with 12-14 /group split into 2 • Create 3-4 IM simulation cases in half day ; Other half day shadowing • Sim. AM and Shadow PM ; other half vice versa • Other students not at Grace divided into groups of 7 ; combo of Small Group
Sessions (SGS), Brodie SIM ( 10 in total), CPA and Consolidation
Create 10 other “shadowing “ experiences • Chosen from a catalogue of options to include ones created by LC or theme
ie aboriginal services, lab, etc.
“Consolidation” – truncated version of 10 week M3 planned for med 2 ; • Allocate 3 sessions per week
Transition to Clerkship (TTC): 5 weeks
Block 1: Surgery /Anesthesia: 3 groups- 9 students /group Segment A Segment B Segment C
# Weeks 2 2 2 2 2 2 Group A General Surgery Subspecialty
Surgery Orthopedic /MSK Med
Anesthesia Perioperative Care
General Surgery : 4 weeks all students do GS; include community hospitals
Surgery subspecialty: 2 weeks limited to Urology or Plastics
Orthopedic medicine: 2 weeks
• Called MSK include joint & soft tissue management w. Sports & Physical Med
Anesthesia: 2 weeks Perioperative care: 2 weeks
• Follow a patient through perioperative experience in PAC & in surgery clinics • Non-operative ENT ( may change to LC) and ophthalmology ( and include in EM ) • Pain management curriculum: to include Non-pharmacologic pain management-
psychology, acupuncture and complimentary med Miscellaneous: Incorporate public health into surgery in collaboration with CHS,
and some component of pediatrics in collaboration with Peds 46
CLERKSHIP plans to date 2013:Year 3 (M5) Block 1: Surgery /Anesthesia: 3 groups- 9 students /group
Segment A Segment B Segment C
# Weeks 2 2 2 2 2 2 Group A General Surgery Subspecialty
Surgery Orthopedic /MSK Med
Anesthesia Perioperative Care
Group B Subspecialty Surgery
Orthopedic /MSK Med
Anesthesia Perioperative Care
General Surgery
Group C Anesthesia Perioperative Care
General Surgery Subspecialty Surgery
Orthopedic /MSK Med
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Block 2: Obstetrics & Gynecology and Pediatrics #
Weeks 6 6
2 2 2 3 3
Group2
Peds Emergency & Outpatient
Peds Inpatients
Obstretrics Gyne Clincs
Obs/Gyn: Jenna MacNaught Pediatrics: Jeff Hyman Create shared academic time where possible
Integrate longitudinal Courses and Themes
Group1 Obstretrics Gyne Clincs Peds Emergency & Outpatient
Peds Inpatients
CLERKSHIP plans to date 2013:Year 3(M5)
12 week overall rotation called Block IM–EM – ACUTE MEDICINE 4 weeks Emergency Medicine
• ~ 15 emergency medicine shifts, plus optional EMS ride along • Incorporate internal medicine ambulatory care exposure (number of and type of clinics
are TBD; aim for 2 per week 1 GIM and 1 specialty ) • Develop continuity between ER and IM (ex. fast track clinic, urgent consult/follow up). 6 weeks general Internal Medicine (CTU)
2 weeks of Internal Medicine selective
Create shared academic time where possible
Integrate longitudinal Courses and Themes
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Block 3: Internal & Emergency Medicine: 2 grps- 14 students / grp #
Weeks 6 6
4 2 4 2 Group1
CTU Emergency Medicine Outpatient Internal
Subspecialty Medicine
Group2
Emergency Medicine Outpatient Internal
Subspecialty Medicine
CTU
Emergency: Mona Hegdekar Internal Med: Mike Semus
CLERKSHIP plans to date 2013:Year 3(M5)
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Block 4: Family Medicine and Psychiatry # Weeks 6 6
Group1 Family Medicine Psychiatry Group2 Psychiatry Family Medicine
Family Med: Susan Hauch Psychiatry: Eunice Gil
Psychiatry • More ambulatory care - Shared care model with Family Med
Family Medicine
• Rural Family med – incorporate rural Public health officer
Create Create shared academic time where possible
Integrate longitudinal Courses and Themes
CLERKSHIP plans to date 2013:Year 3(M5)
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Develop Year 4 ( M6 & M7) M6 – Electives pre CaRMS ( 17 weeks including interviews)
ie no Change Need to Develop M7 :
• With academic time, LMCC review and concept of senior clerk
• Mandatory additional Core rotations: ie selective IM/ surgery / Community care
• Selectives – palliative care, care of elderly, indigenous health, etc
• Program tailored to specific residencies
CLERKSHIP plans 2014:Year 4(M6 & M7)
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CuRe EVALUATION
1. UGME : STUDENT ASSESSMENT Maria Vrontakis , M0-3 (Preclerkship)Student Assessment Coordinator
Nancy Porhownik, OSCE Coordinator
Barry Cohen, M4-7 (Clerkship)Student Assessment Coordinator
2. UGME CuRe EVALUATION Department of Medical Education led Joanne Hamilton
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Longitudinal Courses: Separate assessments Clinical Reasoning: Integrated cases; based upon on both prior and
concurrent CR and Modular material; short answer questions Year 1 : 6 exams for year 1 with proportional increase in value: Percent: 5% / 5% / 20% / 20% / 20% / 30%
PRECLERKSHIP: Module (M0-M3) Courses:
• Each M1 and M2 course evaluated and passed separately i.e. No cumulative single block exam
Proposed: • 30% MCQ midterm, with strugglers flagged and assisted ;
• 70% MCQ final
• Faculty Development from M.C.C. for exam questions
• Do not have to pass M0 to proceed to M1 but must pass M1 course to proceed to its respective M2 course
• Remediation may occur during other mandatory curricular time i.e Wed + Fri aft if unscheduled
CuRe: STUDENT ASSESSMENT PLAN – Barry Cohen
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UGME CuRe EVALUATION
Quantitative: 1. Class surveys with Demographic information : post admission, post
preclerkship and post clerkship 2. LMCC scores: pre and post 3. NBME scores: pre and post 4. Course and Rotation Evaluations: pre and post 5. Canadian Graduate Survey: comparison pre and post implementation 6. Faculty Evaluation results: pre and post implementation
Qualitative: 7. Faculty Focus groups, interviews (and surveys) 8. Staff focus groups, interviews (and surveys) 9. Student focus groups, interviews
Administrative data 10. Changes in instructional strategies 11. Administrative workload
Two Questions: Is the new curriculum an improvement over the old? Does the new curriculum achieve its objectives?
UGME CURRICULUM RENEWAL GOVERNANCE UGME CuREXecutive ( Directors) Preclerkship Keevin Bernstein Chair Clerkship Merril Pauls Ira Ripstein Associate Dean Eunice Gill Nicola Matthews Gary Harding Curriculum Clinical Academic Rob Brown Simulation (Transition:TTC) Catherine Moltzan Integration Karen Klym Clinical Skills Barry Cohen Assessment Joanne Hamilton Educ. Development
Preclerkship M0 & M1/2
Leaders
Longitudinal Courses Leaders
Clerkship Core Rotation
Leaders
Longitudinal Theme Leaders
UGME CURRICULUM RENEWAL Committees
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Proposed Reporting GOVERNANCE
Preclerkship (M0-3) Committee Content relevant to preclerkship only Chaired by Preclerkship Director Meets Q3m or call of chair
Scheduling Student assessment Faculty evaluation
Clerkship (M4-7) Committee Content relevant to clerkship only Chaired by Clerkship Directors Meets Q3m or call of chair
Scheduling Student assessment Faculty evaluation
Curriculum Integration (M0-M7) Committee Content relevant to all 4 years Chaired by Curriculum Director All UGME Directors and Leaders Meets Q3m or call of chair
Course or rotation review
Year 1 2 3 4
UGME CURRICULUM RENEWAL FRAMEWORK
Incorporated into Academic time • Longitudinal Courses I. Clinical Reasoning II. Professionalism/Doctoring III.Clinical Skills ->Community Clinics IV.Community Health/Epidemiology V. Indigenous Health VI.Scholarly Activity
• Themes/Disciplines Composite Clinical Presentations (CP4)
Boxes are not scaled
56
Principle: “Fully integrated spiral scaffold curriculum through 4 years”
MO: Foundation M2: Health &
Disease Abnormal Processes- Clinical Integration
M1: Normal Biology & Health Normal Processes- Clinically Applied
M3: Consolidation
M2: Health & Disease Abnormal Processes
M4 TTC: Transition to Clerkship
M5:“Junior” Clerks (JC)
UGME Academic time
M6:“Senior”Clerks (SC)
UGME Academic time
M7 TTR: Transition to Residency
FD Module 1 PRECLERKSHIP LAUNCH EDUCATION RETREAT Feb 11 2013
FD Module 2&3 ASSESS NEEDS & DEVELOP COURSE OUTLINE April early 2013 All courses to present outline; 4 hrs Tina will survey FD Module 4&5 UNDERSTANDING LEARNING Online
WRITING GOALS AND OBJECTIVES
FD Module 6&7* WRITING MCQ QUESTIONS with MCC 1/2day May early 2013 ASSESSMENT: MORE THAN MCQ (*OPTIONAL)
FD Module 8&9 CHOOSING LEARNING STRATEGIES ; 2 hrs June early 2013
FD Module 10 PRESENT OBJECTIVES & DETAILED OUTLINE Sept. late 2013 two half days vs one full day ? Tina will survey
FD Module 11 MAPPING AND BLUEPRINTING Online
FD Module 12 COURSE EVALUATION Oct. late 2013
FD Module 13 SYLLABUS Nov. late 2013
DEADLINE : FINAL OUTLINE/SYLLABUS/OBJECTIVES Jan. 30 2014 OPAL ready for schedule
SENATE SUBMISSION Feb. 14 2014
Preclerkship CuRe Timelines & Faculty Development Plan
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