To achieve the objectives of the Undergraduate Medical Education program, students are introduced to patients within the first foundation of the curriculum. In this way, students understand the relevance of what they are learning, maintain a high degree of motivation and begin to understand the importance of responsible professional attitudes. The students are presented with a series of tutorial problems, requiring for their solution the understanding of underlying biological, population and behavioural principles, the appropriate collection of data and the critical appraisal of evidence. The faculty function as learning resources or guides. Learning by a process of inquiry is stressed.
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In 1969, the medical school at McMaster University introduced a unique, hands-on approach to learning medicine called Problem-based Learning. Problem-based Learning is quite different from “problem-solving”, and the goal of the learning is not to solve the problem which has been presented. Rather, the problem is used to help students identify their own learning needs as they attempt to understand the problem, pull together, synthesize and apply information to the problem, and begin to work effectively to learn from group members as well as tutors. Below are the cornerstones of problem-based learning:
SMALL GROUP LEARNING
Problem-based learning occurs in a tutorial-style setting and includes 7-8 student participants. A student is assigned to a different tutorial group and facilitator in each of the five pre-clerkship Medical Foundation. Tutorials occur twice a week.
FACULTY FACILITATION
Each Problem-based Learning tutorial is led by a physician tutor. The tutor aims to strike a balance between directing the tutorial’s conversation, while actively soliciting student feedback to ensure that a student’s gap in knowledge is addressed and remedied.
USE OF PATIENT-BASED CASES
Students are presented with a realistic clinical case during their first tutorial of the week. Students are expected to study and research the case and present their findings during that week’s second tutorial. Please find an example of a tutorial case here.
LEARNING OBJECTIVES
Simply providing students with a patient case does not ensure that they will grasp the appropriate concepts. Each tutorial case is paired with a well-defined set of learning objectives, which are essential in ensuring that students address the correct content and identify their strengths and weaknesses in that particular content area.
MD students are introduced to patients within the first foundation of the curriculum. This early exposure allows students to understand the relevance of what they are learning, maintain a high degree of motivation and begin to understand the importance of responsible professional attitudes.
CLINICAL SKILLS
The Clinical Skills Program of the UGME Program is designed to allow students to develop an integrated approach to the doctor-patient encounter. The Program has three components: first, verbal data-gathering, which includes communication skills and history-taking; a second component of physical examination skills; and a third component, data interpretation, which rounds out the doctor-patient encounter. This component includes the interpretation of verbal and physical findings from the patient as well as diagnostic tests.
In most Medical Foundations (MFs), each MF tutorial group works with a clinical skills preceptor in weekly sessions focused on the clinical skills appropriate to the topics being covered in the MF. From the first MF, students begin meeting patients. There are also sessions with Standardized Patients, which allow students to master basic skills before they begin to use these skills with real patients.
The Clinical Skills curriculum and the Professional Competencies curriculum are closely linked in teaching students the basic communication skills so vital to good clinical practice.
As students progress, more specialized clinical skills such as those relating to psychiatric interviewing and ophthalmology are taught using varied formats.
FAMILY MEDICINE EXPERIENCE
The 6-week Family Medicine rotation revolves around a one-to-one experience pairing a student with a community-based family physician. The most significant component of the Family Medicine rotation is the time spent with the clinical preceptor in the office setting.
The overall goals of the program are for all students to have:
- An understanding of the broad scope of family medicine
- An understanding of how virtual or same-site inter-professional teams function in the context of the primary care environment
- Appreciate the challenges in addressing complex, diverse patient care issues longitudinally
- Appreciate the nature of some of the specific challenges in the provision of primary care to patients, such as addressing undifferentiated illness, chronic illnesses, and preventive care issues.
- Gain skills and experience in meeting patients’ needs for prevention, problem identification and management, and complex disease management through episodic care of patients and their families in the community practice setting
HORIZONTAL ELECTIVES
Horizontal electives, unlike block electives, are done on a part-time basis while students are in full-time studies, either during the medical foundations (1-5) or clerkship rotations. Horizontal electives are completely optional and do not appear on the transcript. Many students find them a clear complement to their core studies or areas they feel interested in exploring in more detail than has occurred in their tutorials.
Attendance at the annual Introduction to Horizontal Electives Session is mandatory before arranging any horizontal elective (October). It is recommended that students not make any firm plans for horizontal electives until they have a clear idea of the time demands within a specific medical foundation or clerkship rotation.
McMaster’s focus on self-directed learning encourages medical students to take an active approach to their education. Furthermore, McMaster’s approach to self-directed learning allows students to explore their interests.
UNSCHEDULED TIME
Relatively more unscheduled learning time allows students to address any identified gaps in their knowledge. Unscheduled time also allows students to explore various avenues of medicine through horizontal elective placements.
ELECTIVE OPPORTUNITIES
McMaster medical students are given relatively more scheduled elective time which provides them with the opportunity to gain experience in their field of interest.
Student assessment in the UGME program documents the student’s emerging identity as a medical professional. In each component of the program, several different tools are used to assess the student’s achievement of the learning objectives and to provide the student with regular and timely feedback to facilitate improvement. In all phases of the program, students are assessed on professionalism in practice.
Medical Foundation Assessment
Assessment in the Medical Foundations (MF) includes both tutorial and clinical skills assessments.
In tutorial, students are assessed in three domains by their tutors: Professional Behaviours, Contribution to Group Process, and Contribution to Group Content. As well as tutorial performance, tutors assess knowledge acquisition through Concept Application Exercises (CAEs). CAE questions are focused on applying scientific concepts covered in tutorials to the clinical situations presented in the test problems.
The student’s clinical skills preceptor provides an assessment of history taking, physical examination skills, and professional behaviour, which the tutor integrates into the final MF student assessment.
Professional Competencies
Students are assessed on their achievement of the learning objectives in Professional Competencies in several ways. Tutorial performance is an important factor. In addition, the student’s developing communication skills are assessed through the observation of interviews with Standardized Patients. Development in the area of reflective practice is documented by entries in the student’s Reflective Physician Portfolio.
Students are explicitly assessed on the concepts covered in Professional Competencies through the Professional Competencies Integrative Exercises (PIEs). As with the CAEs above, the PIE questions are focused on applying the concepts to a patient or societal situation.
Clerkship
Students receive regular feedback throughout the Clerkship with respect to their critical appraisal and medical problem-solving skills, as well as their understanding of societal needs and healthcare demands. In the course of normal patient care, students will be required to demonstrate these skills and incorporate this knowledge into their care decisions.
Students are formally assessed on these skills and this knowledge throughout their clerkship in written, oral, and clinical examinations. Patient encounter cards and mid- and end-of-rotation assessments require specific assessments of “Knowledge Integration” and “Clinical Management” which also address these domains.
Objective Structured Clinical Examination (OSCE)
The development of clinical skills is assessed by program OSCEs. Students participate in one OSCE each year of the program. Each 12-minute OSCE station presents the student with a unique clinical case that will test particular skills such as history-taking, physical examination, communication skills, test interpretation, medical decision-making, and responses to ethical dilemmas. Each student receives feedback from the assessor as well as overall scores for the stations.
Personal Progress Index (PPI)
Formative assessment is provided to students through the Personal Progress Index which all students in the program complete three times each year.
This is a 180-question multiple-choice online test that allows students and the program to assess progressive knowledge acquisition. The questions test a broad range of basic and clinical science and fundamental principles of medicine.