Michael G. DeGroote School of Medicine Waterloo Regional Campus Faculty Guide

Michael G. DeGroote School of Medicine Contents Waterloo regional campus Welcome Michael G. DeGroote School of Medicine...... 2 Curriculum Outline...... 3 Small Group PBL Tutor...... 4

Welcome to our guide for physicians and other health care Clinical Skills Preceptor...... 5 professionals interested in becoming involved with the Waterloo Clinical Clerkship Placement Preceptor...... 5 Regional Campus of the Michael G. DeGroote School of Medicine. Professional Competencies Longitudinal Facilitator...... 6 This is McMaster’s first fully distributed site for medical education, and the vision of a local distributed medical school campus is Student Advisor...... 7 being realized through a unique partnership between McMaster How else can you participate?...... 8 and the . Volunteer...... 9 The first students of the medical school campus, who graduate in Contact May 2010, have been warmly welcomed by the community, which sees Waterloo-Wellington as ideally suited to advance its long Michael G. DeGroote School of Medicine established interest and role in the training and preparation of Faculty of Health Sciences physician and residents. The long term success and sustainability of McMaster University this initiative is clearly due to the commitment of local physicians to Waterloo Regional Campus share their expertise and wisdom with our students. 50 Queen Street N., Suite 700 Kitchener, ON N2H 6P4 There are many valued educational roles described in this brochure n Phone: 519-885-5426 ext. 21104 that we hope will intrigue and interest you. Our students require n Fax: 519-584-0197 a vast array of preclinical and clinical experiences within a well n Email: [email protected] defined medical education program. Your willingness to assist in n Web: www.fhs.mcmaster.ca/wrc the training of our future physicians ensures their experiences and education in Waterloo – Wellington is first class! directory

Thank you for considering what role you can play in this exciting 519-885-5426 and extension: educational mandate. Through focused, accredited faculty Regional Assistant Dean: 21100 development sessions and individual support by our knowledgeable Director Student Affairs: 21122 regional education leaders, we trust you will feel comfortable and Regional Program Administrator: 21112 supported to participate as vital members of our teaching team. WRC Administrative Assistant: 21104 Curriculum Assistant: 21101 Education is our legacy and we all have much to share. Regional Administrative Leader: 21105 Regional Administrative Assistants: 21137 Educationally yours, links Cathy Morris, MHSc, MD, FRCP(C) Faculty Development website: Regional Assistant Dean www.fhs.mcmaster.ca /facdev Michael G. DeGroote School of Medicine MD Program website: McMaster University www.fhs.mcmaster.ca/main/medschool Waterloo Regional Campus Faculty of Health Sciences website: www.fhs.mcmaster.ca

1 Michael G. DeGroote School of Medicine

The Faculty of Health Sciences was formed in 1974, incorporating the School of Medicine and the School of Nursing. By 2000, building on its interprofessional character, the Faculty had expanded to include a School of Rehabilitation Science, a midwifery program, many post-professional diploma programs and graduate studies and a health sciences honours undergraduate program. In the past eight years, with Dr. John Kelton as the dean and vice-president of the Faculty of Health Sciences as well as dean of the medical school, enrolment of the medical school has increased from 100 first-year students to 183, and the research mandate with its academic Highlights: Since its founding in 1966, innovation hospital partners has soared to $240 has been the hallmark of McMaster million a year. n McMaster currently has 496 University’s Michael G. DeGroote School The medical school was named the undergraduate medical students and of Medicine and a major contributor to its Michael G. DeGroote School of Medicine 684 medical residents working in 46 international reputation for excellence. in 2003, in honour of the Hamilton specialties and sub-specialties at its philanthropist. His donation of $105 academic hospital partners throughout Innovation is the hallmark of million, to support the school’s research Hamilton, as well as through placements mission, was the largest-ever educational in more than 60 cities and rural McMaster University’s Michael donation to a Canadian institution. communities, in keeping with a move In 2005, the medical school moved into towards distributed education. G. DeGroote School of Medicine. the new Michael G. DeGroote Centre for Learning and Discovery, a $71-million, n The school regularly receives double Under the school’s first dean, Dr. John 300,000-square-foot facility, linked by the number of applications of any other Evans, a group of innovative educators pedestrian skyway to the Health Sciences Canadian medical school. Every year developed an undergraduate medical Centre. The building includes small group there are more than 4,500 applicants program that stirred controversy and classrooms equipped with the newest vying for the three-year program’s 183 defied convention by emphasizing self- technology suitable to the needs of its entry spots. directed learning. McMaster created a diverse educational programs as well revolution in health care training with the as state-of-the-art wet labs, including n In 2007 the inaugural class of 15 first-year establishment of a medical school that a human vector laboratory unique to students began at the new Waterloo pioneered a problem-based learning (PBL) Canadian . Regional Campus in December. curriculum, which has since influenced From its early days as the focus of health care education worldwide. controversy and scrutiny, McMaster’s n In 2008, the first class of 15 medical The inaugural in 1972 saw medical school has prospered, and students for the new Niagara campus of 19 students receive their MD degrees. That proven that its community-oriented, the medical school began. After the initial same year construction was completed of interdisciplinary, small group learning medical Foundation of four months the the McMaster University Health Sciences provides a fertile environment for class transferred to the Niagara Campus. Centre, a uniquely designed building educating physicians. In 2005, a revised housing a 370-bed tertiary care hospital undergraduate medical curriculum, together with teaching and research which is concept-based and electronically facilities for the medical school. enhanced, was launched.

2 Curriculum

Medical Foundations 1 (MF1) (16 weeks): Medical Foundations 3 (MF3) (9 weeks): The Clerkship (60 weeks): The first week of this block of This foundation covers the second part of Clerkship begins in December of the second curriculum addresses patterns of homeostasis, including the balance of acid year. While the clerkship is firmly linked to the determinants of health. The premise and base, blood pressure and renal function. pre-clerkship concept-based curriculum and will of this introductory component of the It goes on to address reproduction include continuing delivery of the professional curriculum is that health care systems do and pregnancy and a number of issues in competencies curriculum, this is now the time not account for much of the systematic genetics related to reproduction. for students to participate in the direct care of differences in health status within The professional competencies patients as they learn about the management or among populations in advanced curriculum in MF 3 will focus on an of health and illness. industrial economies. Health care introduction to the health care system The tutorial cases are now real patients or students need to understand why people and preventative medicine. populations. Students become self-sufficient get sick in the first place and why people in contemporary medicine, able to sense get well. Social epidemiologists see that Medical Foundations 4 (MF4) (9 weeks): when today’s medicine becomes out-of-date causes of ill health in populations are This foundation addresses host defence, by adopting good habits of learning and different from causes of ill health in which includes immunology and infectious assessment. individuals. disease, and then moves on to look at The clerkship program consists of rotations in After this introductory look at neoplasia and the genetics of neoplasia. medicine, surgery, family medicine, anesthesia, determinants of health, the curriculum The professional competencies moves on to address the first of the curriculum in MF 4 will focus on emergency medicine, psychiatry, pediatrics, major concept themes in the curriculum: professional practice and preparations obstetrics and gynecology and orthopedic oxygen supply and exchange. In for summer electives. surgery. There is also elective time, the majority addressing problems that arise from of which must be spent in clinical activity. inspired air right through to oxygen The compulsory components of the Clerkship at the cellular level, students will McMaster’s medical school will be conducted in the affiliated community learn much related to the respiratory, has prospered, and proven hospitals and physician offices in Waterloo/ hematologic and cardiovascular systems. Wellington Region. Students are expected The professional competencies that its community-oriented, to travel throughout the Region during their curriculum in MF 1 will focus clerkship. on communication skills, ethics, interdisciplinary, small group Students may choose elective experiences introduction to epidemiology and learning provides a fertile in various activities utilizing local, regional, or reflection on the students’ experiences distant resources. attending at a family medicine office. environment for educating In clerkship, the professional competencies physicians. weekly tutorial sessions will be discontinued Medical Foundations 2 (MF2) (8 weeks): and instead, there will be monthly professional This is the first of the two foundations competency activities focusing on specialized that address aspects of homeostasis, Medical Foundations 5 (MF5) (13 weeks): communication skills, critical incident particularly that of energy balance, This covers the concepts of movement debriefing, self care, clinical reasoning and the including issues related to the GI tract, control, interacting and communicating, role of the physician and interdisciplinary team. endocrine system and nutrition. and includes the locomotor system, the The program finishes up with a period of The professional competencies nervous system and behaviour. The concept integration and review. This includes curriculum in MF2 will focus on professional competencies curriculum faculty-led interactive sessions on difficult continued communication skills practice, in MF 5 will focus on preparation cases to integrate basic concepts with the introduction to self care, the role of for clerkship, self care and advanced clinical, and preparations for the licensing ethics in clinical decision-making, and communication skills. critical appraisal. An integration week between each examinations of the Medical Council of Canada. of these medical foundations allows students to review.

3 Small Group PBL Tutor in the Pre-Clerkship, Undergraduate MD Program

appear to be functioning well. At the first meeting the group should set the group norms and that includes a discussion of how evaluation is going to take place in tutorial. A tutorial evaluation at McMaster comprises self evaluation, peer evaluation and tutor evaluation. Some time needs to be set aside at the end of every tutorial to evaluate overall tutorial function for that particular day, and for individual feedback. Both giving and receiving feedback requires practice. Tutors need to keep brief informal notes about each tutorial so that at mid-foundation and also at the end of the medical foundation or curriculum The work The other half of each tutorial block, enough evaluation items or data Since the small group, problem-based- provides the time to revisit the points have been collected to provide a learning (PBL) tutorial is the central previously started cases armed with the meaningful evaluation. component of the Undergraduate MD information to understand and explain While students evaluate themselves Program curriculum, the tutor plays an all the concepts that were embedded and each other, it is the tutor who is extremely important role in facilitating in the tutorial case. Most of the work responsible for collecting and creating the learning of the students. in tutorial is done by the students the final student evaluations, including Although the tutor will be perceived themselves as they exchange hypotheses a narrative summary. This final by the group of seven or eight students and explanations, or simply brainstorm. evaluation at the end of the medical as their senior, their mentor and The role of the tutor is to ensure that foundation comprises evaluation of ultimately their evaluator, the tutor has the discussion stays on track. While the tutorial performance itself with input to become a functional member of the group might decide to appoint a student from the clinical skills preceptor for the small group and therefore needs to leader to keep time and another student student, and the performance on the end understand some of the basic principles to be responsible for recording the of foundation short answer exam, the of group formation and group dynamics. various themes and hypotheses that are “concept application exercise” (CAE). As such, the tutor is not necessarily generated during discussion, the tutor Tutors do not use the performance functioning as the group “leader” needs to be in touch with discussion on the CAE as an independent measure during the tutorial sessions. Some of closely enough to recognize when of whether the student passes or fails the important functions of the tutor are students seem to be going down blind the curriculum block, but it provides described below. alleys. There are guides that accompany additional or supportive information the tutors version of each of the tutorial in helping the tutor decide the extent The requirements cases and supply the tutor with probing to which the student has mastered the Typically tutorial groups meet for three questions to help bring the students learning objectives. hours twice a week, on Mondays and back on track. Tutors should be able Thursdays or Tuesdays and Fridays. Part to provide corrective feedback when of each tutorial session is spent tackling necessary during the discussion. Background requirements fresh cases and developing learning It is important that the tutorial process n Small group, PBL tutors are objectives which will guide the students’ be transparent to all members of the professional medical practitioners, reading to bring back information for the group. The MD program provides or PhD scientists, recruited for their next tutorial. support for tutorial groups which do not area of specialty or interest.

4 Pre-Clerkship Clinical Skills Preceptor in the Undergraduate MD Program

The work Since there are seven or eight students CLINICAL CLERKSHIP PLACEMENT The Undergraduate MD Program in each group, it is almost impossible to PRECEPTOR curriculum is designed to allow students observe each student in any great detail The Clinical Clerkship Placement Preceptor to learn the physical examination every single week, but the preceptor is an essential participant in the clerkship of the various body systems while does need to keep a regular record of training of the Waterloo Regional Students. covering the same systems in the each student’s performance, so that While the Clerkship will be firmly linked to Medical Foundations. History taking, at mid-foundation and at the final the pre-clerkship concept-based curriculum while taught by the clinical skills evaluation there is enough recorded and will include continuing mastery of preceptor and integrated into the body information on which to provide reliable Professional Competencies, this is now the system teaching, is aligned with the feedback and a summary of each time for students to participate in the direct communication skills training provided student’s performance. The clinical care of patients as they learn about the in the professional competencies skills evaluation of each student is management of health and illness. Clerkship curriculum, which runs during the returned to the student’s tutor, since highlights experiential, hands on practice same months. clinical skills forms part of the student’s under preceptor supervision. Clear objectives The clinical skills teaching sessions overall evaluation for each of the are defined for each rotation to guide the are held once per week throughout the preceptor in the cases and skills the clerk Medical Foundations. Each session is expected to last from 2 to 2.5 hours. The demonstration of the skill needs to see, acquire and demonstrate. These are the formative opportunities to turn There are a number of options in terms or competency by the preceptor of teaching location, and whether real, book knowledge into clinical practice under standardized or simulated patients are followed by directly observing the watchful guidance of the preceptor. used for the sessions. Some clinicians will have ready access to patients who student practice is important for are willing and able to interact with the students’ skill development. medical students. Where real patients are not available, standardized or simulated patients can be made available Medical Foundations, which is by the Undergraduate MD Program. The collated by the tutor. teaching setting may be a hospital ward, The Undergraduate MD Program a clinic, an office setting or the clinical publishes a professional skills skills laboratory. manual which outlines the expected competencies across the entire The requirements curriculum. It also includes a log for For both history taking and physical each of the Medical Foundations. examination, the demonstration of the Clinical skills preceptors for any of skill or competency by the preceptor the medical foundations can therefore followed by directly observing student identify the competencies expected of practice is important for the students’ the students at the time of entry to that skills development. During the course particular Foundation, as well as have of the first year of the pre-clerkship an understanding of what comes in the curriculum, students also learn how to following block of curriculum. record their observations, and several times during each of the medical foundations are required to write up Background requirements a patient case in an organized format n Clinical skills preceptors are to be reviewed by the clinical skills professional medical practitioners preceptor. or residents.

5 Longitudinal Facilitator Professional Competencies Curriculum, Undergraduate MD Program

in Waterloo until the end of MF5. The professional competencies issues are covered separately and with different facilitators in the clerkship. The longitudinal facilitators meet each week with their groups for part or all of the morning, usually Tuesdays, since there are also large and small group sessions throughout this longitudinal curriculum. The large group sessions will be conducted by videoconference so that students at all campuses can participate. The longitudinal facilitators take a direct hand in helping students master some of the competencies acquired during this curriculum, for example, communication skills. The work The professional competencies The longitudinal facilitators The professional competencies curriculum curriculum is made up of the maintain an ongoing evaluation of runs throughout the Undergraduate following six domains: the students in their group. Students MD Program three-year curriculum, but - effective communication maintain an electronic portfolio of particularly during the pre-clerkship. - lifelong learning evaluations throughout the professional The major components of this - ethics and moral reasoning competencies curriculum. professional competencies curriculum - professionalism Longitudinal facilitators provide include longitudinal small groups, - self-awareness and self-care formative feedback at the end of interdisciplinary facilitator pairs, large - social and community context MF2 and MF4 and then a summative group lectures combined with small of healthcare. evaluation narrative at the end of MF5. group sessions, experiential learning and These domains are integrated The latter summary appears in the skills practice, facilitated reflection and a across the medical foundations of student’s transcript. focus on competency attainment. the pre-clerkship curriculum and at The professional competencies manual strategic points are integrated into describes the various components of Longitudinal facilitators each of the clerkships. professional competencies curriculum, identifying the learning objectives as provide formative feedback. The requirements well as providing a schedule for each The longitudinal facilitator is recruited particular class. Unlike the medical foundation for a total period of 14 months of the tutorials, the professional competency pre-clerkship between orientation of the groups are co-facilitated by a pair of first year students and Christmas of their Background requirements expert facilitators. Each group has one second year. Each group of 10 students n Longitudinal facilitators are physician and one person from another and their longitudinal facilitator team professional practitioners in relevant discipline such as nursing, stays together for this period of MF1 medicine or are non-MD health rehabilitation sciences, public health or right through to the end of MF5. The professionals from areas such social work. Pairs are chosen to offer longitudinal facilitators of the Waterloo as nursing, physiotherapy, an optimal diversity of skills to each Regional Campus will be expected to occupational therapy or group. The complementary skills and travel to Hamilton for the initial four social work. experience within each facilitator pair months of the curriculum to conduct the help students learn how to work within MF1 unit with their group of students. interprofessional teams. The same group will continue thereafter

6 Student Advisor Waterloo Regional Campus

The Work - Discuss plans for upcoming electives - discussion of issues of common The student advisor is an important and sign elective forms; interest to all students, such as stress position in the undergraduate MD - Inquire about career plans and how management, career planning, and Program and has the primary roles of: electives will be used to further plans, staying healthy; - Guiding a group of two undergraduate or fill in knowledge gaps; - the advisor’s role is to facilitate peer MD students within each of the three - Inquire about personal difficulties which mentoring, discussion and support years of the MD program. The advisor may affect academic performance; and occasionally offer guidance and meets both individually and as a - Refer to services as needed to address perspective. group throughout their medical school academic, learning or personal experience, difficulties, or for further assistance - Monitoring academic progress, with career planning. Background requirements - Providing mentorship to students, - Review a recent learning plan at each n Student advisors are medical - Facilitating referrals to the Director meeting. physicians, from all specialties, and of Student Affairs for students who The advisor will facilitate two or currently practicing in the Waterloo experience academic difficulties as a more group meetings per year with Regional Campus area. They should result of learning problems or personal their group of student advisees. These be enthusiastic, pragmatic individuals stressors. meetings should be informal (perhaps who are keen to act in a mentorship/ including a meal) and it is hoped that advisee role to our undergraduate The Requirements peer mentoring will naturally occur medical students. The advisor will eventually follow in such a setting. The group meetings six undergraduate medical students might include: longitudinally through their time in the - discussion of where in the programme MD Program. Two new students will be the students are; The student advisor has the picked up every fall until the total of six - discussion of issues specific to each of students are being followed. the years, such as: first year issues important role of guiding, The advisor reviews all Medical - adjusting to PBL and horizontal Foundation, clerkship and elective electives, 2nd year issues- managing monitoring and providing evaluations in addition to reviewing all clerkship and thinking about specialties, mentorship to students in the examination results (such as the PPI and 3rd year issues- CARMs strategies and OSCE’s) for each of his/her students. moving on from medical school; undergraduate MD Program. The file is periodically reviewed in its entirety by the advisor to look for trends, strengths and weaknesses. The advisor maintains an ongoing confidential file of each of his/her student. The advisor meets alone with each of his/her students regularly. Meetings should occur one-two times per unit, and every few months through clerkship. These meetings are confidential. Although there is no formal agenda for the individual meetings, the advisor should: - Discuss current and recent rotations and inquire about any difficulties; - Review all recent evaluations received; - Assist student in looking at the ‘big picture’ by reflecting on major themes, strengths and weaknesses that come out of evaluations;

7 How else may I participate?

OSCE Observer Electives Preceptor in this lifelong learning and enriching OSCE stands for Objective Structured The elective program at McMaster experience called medicine. Clinical Examination. It is a method for covers 24 weeks, or 20%, of the time Let us know if you would be evaluating our medical students’ clinical spent in the program. Several concepts interested in providing an elective skills. McMaster medical students have were critical in assigning so much time experience for our students. We will one OSCE in each year of their medical to the elective program at McMaster. place your name, specialty and contact school training. Most important was the recognition of information on an electives list for The idea is that the students the enormous amount of knowledge the students. rotate through a series of 10 stations, directly relevant to the practice of performing a physical exam or taking a medicine. This knowledge far exceeds history from a simulated patient while the amount any student can possibly This is an excellent way to being evaluated on their performance by absorb in 33 months and as a result, a physician. In our OSCEs, the students many important topics must be become involved with our have nine minutes to perform the task omitted from the core curriculum. and then the faculty member gives them The students are therefore Waterloo Regional Campus. verbal feedback for four minutes and also encouraged to consider the elective gives them a score from one to ten. Over as a truly enriching experience to the course of the evening, the faculty enhance their appreciation of the ad hoc content resource member will observe and give feedback scientific and humanistic aspects Your name and contact information to about 20-22 medical students. of medicine. would be listed in the Medical The Waterloo Regional students We believe that McMaster is Foundations guide, students would participate in their OSCE in Hamilton fortunate in that we were, and know then that if they had a question in with the rest of their class. The are, able to attract students your specific field/specialty they could Program for Educational Research who are mature and independent contact you and ask it. This happens and Development (PERD) is collating learners. It is an essential component infrequently, but is an important part information and data with respect to of the process of medical education of the resources offered to our students, the distributed campuses and these at our school to instill a commitment it is also an excellent way to become students. Data to assure equivalency of to self-directed learning that can involved with our Waterloo Regional performance and outcomes for this group be carried throughout their future Campus without making a large time will be closely monitored, and reviewed. careers. Electives are the first step commitment.

8 Volunteer

Volunteer Patient Program We are developing a Volunteer Patient Program and are asking for your help to recruit some of your patients who have stable findings that would be interested in allowing our students to question and examine them. This program will enhance traditional opportunities for students to learn and develop their clinical and communication skills in a unique experiential setting. This experience mimics the “real world” where they will eventually be working.

Who are Volunteer Patients Volunteer patients provide the student with feedback on communication style or Patient Partners? Volunteer patients are people who allow medical students to interview them about their health, family and lifestyle; or to conduct a non-invasive physical examination. We are looking for people of any age (infants, youth, adolescents or older adults), that come from all walks of life, they may be healthy or living with an illness or disability. These important volunteers will give the learner real people to interact with and they will provide the student with feedback on his or her communication style and interaction. We will provide the volunteer patient with an orientation and tour ....in a unique experiential setting. of our facility. If the patient drives to our campus we will cover the cost of parking, if they do not drive we will provide taxi transportation or will reimburse them for using GRT.

Contact us n If you are interested in becoming involved in any of these programs please call or email our office at: 519-885-5426 ext. 21104 [email protected]

9 Michael G. DeGroote School of Medicine n Waterloo Regional Campus | 519.885.5426 | www.fhs.mcmaster.ca/wrc