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Undergraduate Medical Education Faculty of Medicine
Clerkship Manual Med 4
2014-2015
Please do not save a copy of this manual. The UGME website now provides much of the information referenced in this manual, including frequently used forms, policies, and manuals. The original is always available on the website. http://undergraduate.medicine.dal.ca/
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GENERAL STRUCTURE OF THE CLERKSHIP In Phase 2, there is a scheduled block that is designed for clerks to participate in 18 weeks of elective time, as well as two PIER blocks, specifically designed to assist in preparing students for CaRMS, Medical Council examinations, and entry into postgraduate training. Vacation time and CaRMS interviewing time can be scheduled around the clinical rotations. PIER III – 2 weeks Electives* – 12 weeks Non-Tertiary/Community* – 3 (consecutive) weeks Interdisciplinary* – 3 (consecutive) weeks PIER IV – 6 weeks *THESE UNITS HAVE PASS/FAIL CRITERIA. For all rotations, students must develop individualized learning objectives, structured around the CanMEDS format. For a detailed outline of the CanMEDS framework, please review the website: http://rcpsc.medical.org/canmeds/bestpractices/framework_e.pdf DEFERRED OR SUPPLEMENTAL EXAMS Clerkship deferred exams and Clerkship Supplemental MCQ and OSCE exams are scheduled to occur during Phase II Clerkship. If you are required to write a deferral or supplemental exam, you will need to pre-arrange to be in Halifax or Saint John during the scheduled exam dates. ITERS (IN-TRAINING EVALUATION REPORT) Elective (Med 4) – successful completion of a Formative ITER for each Elective, as well as successful completion of a Summary ITER encompassing all Electives. Interdisciplinary (Med 4) - successful completion of a Summative ITER. Non-Tertiary/Community (Med 4) - successful completion of a Summative ITER.
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CLERKSHIP - PHASE II PIER III PIER III is designed to facilitate the transition from third year to fourth year, while both reviewing and building on key clinical components. There will be opportunities to engage with Program Directors on an informal basis, allowing students to explore potential career opportunities in advance of submitting their CaRMS application. PIER IV This Unit is scheduled as the last six weeks in fourth year and is intended to help transition students from Undergrad into Postgrad. Sessions will be offered to assist students with preparing for their Medical Council of Canada Part 1 exams and their first year in Residency. A focus will be on the basic science and clinical correlations of common clinical presentations. An Advanced Cardiac Life Support (ACLS) course is required for all PGY1 programs and will be offered to all 4th year students. ELECTIVES The objective of the electives to provide flexibility and opportunities in order to:
Gain experience in aspects of medicine not offered in the regular curriculum
Study particular areas of the curriculum in greater depth
Explore career opportunities Students are encouraged to be creative in their selection of electives. Electives in basic science, medical education, Bioethics, and Health Law are encouraged. Additionally, students should choose areas that are complimentary to the specialty of major interest (i.e. for an interest in Orthopedic Surgery, an experience in Radiology and/or Anaesthesia would provide excellent complimentary experiences). CRITERIA FOR ELECTIVES 1. Each rotation must be a minimum of two consecutive weeks in one specialty with the same
preceptor(s). 2. For Canadian sites each proposal must be submitted through one45 at least four weeks prior
to the start of the rotation. 3. For International sites each proposal must be submitted through one45 at least eight weeks
prior to the start of the rotation. If you are applying for an International rotation please below for further instructions.
4. The Formative ITER must be completed through one45 within four weeks of completion of the rotation.
INTERDISCIPLINARY
The goal of this rotation is to learn about the interdisciplinary management of patient care.
Students must work with an interdisciplinary team (i.e. PT, OT, dieticians, nurses, etc.) and participate in decision-making and medical education of patients and their families.
The rotation should have a focus on outpatient ambulatory care.
Further their knowledge, skills and attitudes related to interdisciplinary teamwork.
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NON-TERTIARY/COMMUNITY
The goal of this rotation is for students to learn about the differences in healthcare delivery in a smaller community versus a tertiary-care setting.
Broaden their clinical skills through their application in non-acute care settings, and community settings.
The rotation must be based in a community setting. Rotations at the Victoria General, Halifax Infirmary, IWK, Dartmouth General, Nova Scotia Hospital, or Saint John Regional Hospital WILL NOT meet the criteria of a Non-Tertiary/Community Rotation. CRITERIA FOR INTERDISCIPLINARY AND NON-TERTIARY/COMMUNITY ROTATIONS Students must complete a single rotation in both disciplines, each for a minimum of three consecutive weeks. These rotations must include active student participation in patient care. Each experience must have sufficient clinical density to ensure good learning and minimize unproductive time. During these rotations students will be able to access a broad range of experiences in order to accomplish the global goals of the rotations. Overall, the experiences should allow a student to reinforce self-assessment, independent and lifelong learning skills. 1. Each rotation must be three (3) consecutive weeks in one specialty with the same
preceptor(s). 2. For Canadian sites each proposal must be submitted through one45 at least four weeks prior
to the start of the rotation. 3. For International sites each proposal must be submitted through one45 at least eight weeks
prior to the start of the rotation. If you are applying for an International rotation please below for further instructions.
4. The evaluation form must be completed through one45 within four weeks of completion of the rotation.
Additionally, as one of the goals of these rotations is to learn about different health care systems, international electives tend to qualify for both the Interdisciplinary and Non-Tertiary/Community rotations. ARRANGING ROTATIONS IN MED 4 When arranging your rotations, please be specific on the requirements of the rotation (i.e. Interdisciplinary vs. Elective). If you set up rotations that do not meet the requirements, you may be required to cancel them, as they may not fit the objectives. WITHIN THE DALHOUSIE SYSTEM Please contact the appropriate Administrator in the Department or Medical Education Office that you are interested in – do not contact the preceptor directly. As a 4th year student you have more to contribute to the overall management of patients, and are much more useful on the clinics and wards as a contributing member of the health care team.
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Electives, Non-Tertiary/Community, and Interdisciplinary/Multidisciplinary – to arrange rotations within the Maritimes, please contact the appropriate Administrator (see Contacts on pages 11-15). INTERNATIONAL ROTATIONS An international health rotation is an option for Med 4 students who may wish to build on their international experience, or work internationally. In order to comply with the University Policy governing students travelling outside Canada, the International Clerkship Rotation form must be completed and submitted to GHO at least eight (8) weeks prior to commencing the elective. Funding is available for rotations organized in a developing country, through the International Health Education Program Fund (IHEP), and through the Study/Work International Fund (SWIF). Students applying for funding from the IHEP Committee must submit their application to the Global Health Office at least eight (8) weeks before their departure. Whether or not you are applying for funding, you must submit the International Clerkship Rotation form and the Clerkship Elective Proposal (with learning objectives) to the Undergraduate Medical Education Office at least eight (8) weeks prior to commencing the elective. Please Note: Electives may not be undertaken in countries where Foreign Affairs Canada has issued a travel advisory stating that non-essential or all travel should be avoided. Please visit the Foreign Affairs Canada website for up-to-date travel information and country reports: http://www.voyage.gc.ca/index-eng.asp For further information regarding International Electives, please contact: Brie Rehbein Global Health Office Room C-240, Clinical Research Centre Halifax, NS B3H 4H7 Phone: (902) 494-8054 Fax: (902) 494-2799 Email: [email protected] Website: http://gho.medicine.dal.ca/
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LETTER OF RECOMMENDATION/SUPPORT If you require a letter of recommendation to accompany an application, please submit to the Electives Coordinator, the name and address of the individual to whom the letter should be addressed, the dates of your rotation, the Department/Division, and name of preceptor (if known), and this will be prepared. Please ensure that application forms requiring the signature of the Dean (or Designate) are completed before making this request. CERTIFICATE OF INSURANCE If you require a Certificate of Insurance (proof of malpractice insurance) for an elective, please submit the following information to the Electives Coordinator. A Certificate of Insurance (COI) will be prepared and sent directly to the requesting institution. Student Name Dates of Elective Type/Title of Elective (Dept/Div) Preceptor Name (if known) Preceptor Mailing Address (if known) Preceptor Phone Number (if known) Preceptor Fax Number (if known) Preceptor Email Address (if known) ***** Name of Institution Name of Contact Person Title of Contact Person Contact’s Mailing Address Contact’s Phone Number Contact’s Fax Number Contact’s Email Address
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SUBMITTING PROPOSAL FORMS (I.E. OBJECTIVES) Once you have made arrangements and been accepted for a placement, you must complete all information required on the proposal form, which is accessed through the one45 system. Proposal forms with objectives are due four (4) weeks before your proposed start date (eight (8) weeks for International electives). Step-by-step instructions are available in a separate document titled “Med 4 Student Responsibilities”. You are responsible for ensuring your proposals have been approved in a timely fashion. For assistance on what we are looking for in your objectives, please refer to Dr. Watson’s handout on Writing Learning Objectives, which can be found on the following page, or the PowerPoint presentation, Writing Objectives for Electives. You are not required to write an objective for each of the CanMEDS categories (Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional); however, you should have a minimum of 2-3 objectives in at least three of the categories (Medical Expert will almost always be used). If you have followed the guidelines, your proposal will be approved and you may proceed with your plans. If there is information missing on the proposal form, or your objectives are either too vague or too ambitious, it will be rejected and will not be approved until it is completed properly. Approval of the elective must be completed to ensure malpractice coverage. Please Note: If you commence any rotation without approval from the UGME office (i.e. the
proposal form approved by the Clerkship Director, Electives), you will not receive credit for the elective time.
You must submit one proposal for each rotation that you are completing.
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WRITING LEARNING OBJECTIVES WADE WATSON, MD, FRCPC, MED
As an adult learner, physicians need to be effective in writing learning objectives. This helps the physician to establish learning needs, set up appropriate learning encounters and to measure success. Your electives are not only to explore your potential future careers, but are planned learning activities. Objectives can assist your supervisors in establishing an effective educational experience. Your objectives can also establish an important initial interaction with your supervisor as a dialogue to discuss, expand or refine these objectives. You are expected to meet with your electives supervisor on the first day to discuss your objectives. Effective communication around these objectives should enhance your learning experience. Some aspects of learning objectives:
1) Specific 2) Achievable in the time available 3) Relevant and important for the learner
It is important to distinguish between goals versus objectives. A goal is a general statement that describes a major purpose of a program, course or unit of instruction. Goals help to provide direction for selection of content. A learning objective is a statement that describes what the learner will be able to do after a prescribed unit of instruction. It may be relevant for some of your experiences to write goals rather than objectives since you may not be familiar enough with the topic to write effective objectives. There are four elements of an instructional objective:
1) Audience. This is to whom the objective is intended. Since you will be writing your own objectives, obviously, this will be you.
2) Behaviour. This is specific, observable action or behaviour the learner is to perform. 3) Condition. The condition is the relevant factors affecting the performance. 4) Degree. This is the level of acceptable performance.
Objectives need to be relevant to the learner, understandable, measurable and achievable. Educational objectives can be used to in different learning domains, including cognitive domains (facts), psychomotor domain (skills), and effective domains (attitudes). An example of a goal would be that, by the end of the elective in Radiology, the student would be able to be more effective in interpreting radiographs. An objective would be that the student would be able to describe five steps in a logical approach to evaluating a chest radiograph. As you can see, a goal is a very general statement while an objective gives some idea of how successful you would like to be. Try to be as specific as possible if you can. Please give this some thought in your generating of your goals and objectives for your electives. Hopefully, this will increase your satisfaction and decrease the stress around your electives.
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CANCELLING ELECTIVES If you commit to doing an elective, changes can be accommodated up until the effective cancellation policy of the University affected. For Dalhousie-arranged electives there is a four week cancellation policy, and for Non-Dalhousie electives the policy is generally six weeks (please refer to the specific cancellation policy of each University). Only under exceptional circumstances will this change. A detailed letter outlining your reason for changing the elective with short notice will be required before a change will be considered; however, this will not guarantee that the change will be allowed. Many Departments receive numerous requests for electives and there are limited spots available in each of these Departments. Usually, they are approved on a first-come, first-serve basis. If an elective spot is approved for one student, there may be several other students who have been turned down for that spot because of sheer numbers and an inability to accommodate them. Should a student then cancel their elective at the last minute, an open spot is left that could have been filled by other students who truly wanted to do that specialty. It is impossible to give this spot to another student. This leaves a rather uncomfortable and unpleasant feeling within the Department affected. We realize that agreeing to an elective is not a binding contract; however it does speak towards the issue of professionalism. Sometimes, we are unable to have our first choice in life and so we pursue our second or third choice. Once we decide on the second or third choice, it really becomes our first choice. SUBMITTING ASSESSMENT FORMS ITERs will be distributed by the student, via one45, to be completed electronically. We recommend you send the ITER to your preceptor on the Monday of the last week of your rotation and sit down together to complete it before you leave; however, if you must leave the elective site without your preceptor having completed the form, it is your responsibility to follow-up with your preceptor to ensure the form has been submitted by the deadline. Evaluations for all rotations are due four weeks after completion.
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MED 4 ELECTIVE CONTACTS
Department Contacts - Halifax Metro (updated October 2014) (Contact Information can also be found by searching DalMedix)
It is your responsibility to schedule your own rotations in consultation with the appropriate department contact. A list of departmental contacts for Dalhousie is included to assist you in making your choice. Anaesthesia Jessie Dowell-Gullison 473-2325 [email protected] Laura Harris-Buffett 473-8883 [email protected]
Emergency Medicine Sheila Srinivasan-Thomas 473-8921 [email protected]
Emergency Dept, HI Site Dr. Albert Williams 465-8300 [email protected]
Emergency Dept, DGH Dr. Emma Burns 470-3725 [email protected] Emergency Dept, IWK (the only possible availability is over Christmas) Dr. Michael Clory 869-6141 [email protected] Dawn Maxwell 869-6101 [email protected]
Emergency Dept, Cobequid Family Medicine* Cindy Bergeron** 473-4748 [email protected] *Includes Family Medicine electives anywhere in the Maritime Provinces (NS, NB, PEI) **Note: Pamela Decker ([email protected]) is the regular contact for Family Medicine requests; however, she is on maternity leave until September 2015) Internal Medicine** Catriona Talbot 473-7722 [email protected] **Includes all inquiries for the Divisions of Medicine: Cardiology, Critical Care (ICU), Dermatology, Endocrinology, Gastroenterology, General Internal, General Internal Intermediate Care Unit, Geriatric Medicine, Haematology, Infectious Diseases (mandates 4 weeks), Medical Oncology, Nephrology, Neurology, Palliative Care, Physical Medicine & Rehabilitation, Respirology, and Rheumatology. **Please note that Internal Medicine limits students to a combined maximum of eight (8) weeks.** Obstetrics & Gynaecology Mary Boudreau 470-6675 [email protected] Ophthalmology Melissa Bonn 473-2517 [email protected] Otolaryngology Brenda Oake 473-2737 [email protected] Pathology Andrena Brown 473-7706 [email protected] Dr. M. Castonguay 473-7826 [email protected]
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Pediatrics Bernice MacLellan 470-8115 [email protected] Allergy & Immunology Helene Whitford 470-6554 [email protected]
Cardiology Debbie Clarke 470-8407 [email protected]
Developmental Cathy Johnson 470-8483 [email protected]
Emergency Medicine Dr. Emma Burns 470-3725 [email protected]
Endocrinology Mary Hill 470-6955 [email protected]
Gastroenterology Karen Eyking 470-8784 [email protected]
General Pediatrics Rodena Mignault 470-6499 [email protected]
General Pediatrics Tracy Sainsbury 470-8534 [email protected]
General Surgery Sheila Reid 473-5570 [email protected]
Medical Genetics Britney Borden 470-8641 [email protected]
Hematology/Oncology Alicia MacDonald 470-6839 [email protected]
Immunology Anne Woolaver 470-8491 [email protected]
Immunology (Dr. T. Issekutz) Allison Proudfoot [email protected]
Infectious Diseases Allison Young 471-6968 [email protected]
Intensive Care Unit (PICU) Lisa DeWolfe 470-7515 [email protected]
Neonatology (NICU) Wendy Mitchell 470-6466 [email protected]
Nephrology Mary Young 470-8195 [email protected]
Neurology Janet Avery 470-8475 [email protected]
Orthopedic Surgery Sheila Reid 473-5570 [email protected]
Palliative Care Schoel Strang 470-7262 [email protected]
Radiology Elizabeth Johnson 470-8060 [email protected]
Respirology Kelly Purcell 470-8218 [email protected]
Rheumatology Peggy Brinton 470-8827 [email protected]
Urology Laila Rockman 473-5469 [email protected]
Psychiatry Mandy Esliger 473-4883 [email protected]
Radiation Oncology Karen Watts 473-6068 [email protected] Radiology (Diagnostic) Heather Langer 473-5453 [email protected] Margaret Garnier 473-5476 [email protected] Sports Medicine @ Fenwick Niki Power 421-7525 [email protected]
Surgery Sheila Reid 473-5570 [email protected] Urology Laila Rockman 473-5469 [email protected]
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Department Contacts - Outside Metro (Contact Information can also be found by searching DalMedix)
To arrange an elective in Family Medicine in the Maritime Provinces please contact: Cindy Bergeron Tel: 473-4748 Dept of Family Medicine Fax: 473-4760 Room 8424, Abbie Lane [email protected] *Note: Pamela Decker ([email protected]) is the regular contact for Family Medicine requests; however, she is on maternity leave until September 2015) Nova Scotia – South Shore District Health Authority You must forward a completed Medical Student Approval form and a letter of good standing to ensure you will be properly registered as required by their Board of Directors. Melissa Hiltz, Tel: (902) 527-5057 Assistant to the VP Medicine Fax: (902) 527-5269 90 Glen Allan Drive [email protected] Bridgewater, NS B4V 3S6 www.ssdha.nshealth.ca Nova Scotia – South West Nova District Health Authority You must forward a completed privilege application form to make sure you will be properly registered as required by their Board of Directors. Shirley Watson-Poole, Tel: (902) 742-3542, ext. 1451 Physician Resource Manager Fax: (902) 742-0369 60 Vancouver Street [email protected] Yarmouth, NS B5A 2P5 [email protected] *Copy Heather Blackler on all correspondence* www.swndha.nshealth.ca Nova Scotia – Annapolis Valley District Health Authority You must forward a completed privilege application form to make sure you will be properly registered as required by their Board of Directors. Angie Davidson, Office of VP Medicine Tel: (902) 538-3424 121 Orchard Street Fax: (902) 538-3432 PO Box 490 [email protected] Berwick, NS B0P 1E0 www.avdha.nshealth.ca
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Nova Scotia – Colchester East Hants Health Authority You must forward a completed privilege application form and a letter of good standing to make sure you will be properly registered as required by their Board of Directors. Judy MacKay Tel: (902) 893-5539 207 Willow Street Fax: (902) 893-7653 Truro, NS B2N 5A1 [email protected] www.cehha.nshealth.ca Nova Scotia – Cumberland Health Authority Shirley Symes Tel: (902) 661-1090 Ext. 22 34 Prince Arthur Street Fax: (902) 667-1125 Amherst, NS B4H 1V6 [email protected] www.cha.nshealth.ca Nova Scotia – Pictou County Health Authority Nancy MacConnell-Maxner Tel: (902) 752-7600 Ext. 4560 835 East River Road Fax: (902) 752-6231 New Glasgow, NS B2H 3S6 [email protected]
www.pcha.nshealth.ca Nova Scotia – Guysborough Antigonish Strait Health Authority Donalda MacGillivary Tel: (902) 867-4273 25 Bay Street Fax: (902) 863-1176 Antigonish, NS B2G 2G5 [email protected] www.gasha.nshealth.ca Nova Scotia – Cape Breton District Health Authority You must forward a completed privilege application form to make sure you will be properly registered as required by their Board of Directors. Kathleen Williams, Administrative Assistant Tel: (902) 567-7741 Undergraduate Program Fax: (902) 567-7992 1482 George Street [email protected] Sydney, NS B1P 1P3 www.cbdha.nshealth.ca
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Prince Edward Island Verna McInnis Tel: (902) 894-2537 PEI Medical Education Program Fax: (902) 620-3072 Department of Health and Social Services [email protected] Charlottetown, PE C1A 7N8 www.gov.pe.ca/health/index.php3 *Note: Carrie Barlow ([email protected]) is the regular contact for PEI requests; however, she is on maternity leave until January 2015) New Brunswick – Moncton Martine McKay, Clerkship Coordinator Tel: (506) 860-2331 Dalhousie Medicine New Brunswick Fax: (506) 857-5660 South-East Health Care Corporation [email protected] Moncton, NB E1C 6Z8 www.serha.ca New Brunswick – Saint John Rebecca Comeau, Clerkship Coordinator Tel: (506) 648-6595 Dalhousie Medicine New Brunswick Fax: (506) 648-6833 400 University Avenue, 3D South [email protected] Saint John, NB E2L 3L6 http://www.ahscmeded.ca New Brunswick – Fredericton Mallory Flowers, Clerkship Coordinator Tel: (506) 447-4487 Dalhousie Medicine New Brunswick Fax: Dr. Everett Chalmers Regional Hospital [email protected] Fredericton, NB E3B 5N5 http://en.horizonnb.ca/ New Brunswick – Miramichi Dr. Robert Boulay, Clerkship Director Tel: (506) 778-8994 (Dr. Boulay) Rachel Cameron-Dubé, Clerkship Coordinator Tel: (506) 623-3341 (Rachel) Dalhousie Medicine New Brunswick Fax: (506) 623-3347 Miramichi Regional Hospital [email protected] 500 Water Street [email protected] Miramichi, NB, E1V 3G5 http://en.horizonnb.ca/