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TEACHER HANDBOOK

2011/2012

Acknowledgements: The Undergraduate Medical Education program is grateful to Jennifer Anderson, Joanie Fong, Martin Schreiber, and Anita Rachlis for their development of this handbook. This publication represents the efforts of many individuals in UME who contributed and verified the content, and also provided feedback on the design of the publication. Please direct any questions or comments about the handbook to jen.anderson@utoronto.ca.

2012 Undergraduate Medical Education, Faculty of Medicine, University of Toronto This version published: 16 February 2012

Introduction from the Vice-Dean Undergraduate Medical Education


Dear teaching colleagues: We in the Undergraduate Medical Education program are delighted to be providing this handbook to all teachers in our program. We have gathered in this one package much of the core information which we believe you may need to refer to while participating in the education of our medical students. The handbook begins with the Undergraduate Medical Education (UME) programs overall Goals and Objectives. These learning objectives underpin our entire curriculum, and are organized along the lines of the CanMEDS competencies and the Four Principles of Family Medicine, with which many of you are already familiar. Each of our individual courses has developed its own set of objectives which are aligned with the overall objectives and correspond to the same seven CanMEDS roles. All teachers should be aware of this basic structure, given the central role it plays in everything we do in UME. The next sections of the handbook provide an overview of the Administration and Leadership of the UME portfolio and some context on the Student Experience, followed by a description of the Program, both at a high level and then with details about the individual courses and themes. We also provide important information on types of teaching (learning modalities), grading and assessment, and student professionalism. UME offers a rich diversity of teaching opportunities, and, regardless of when and how you contribute to our students education, you will find information pertinent to your role in the section devoted to the Teaching Experience. Of particular interest are the subsections on the variety of electronic resources used in the UME program and on faculty development. One of the most important features of the handbook is the reference section on Key Policies that govern how UME conducts its program and its expectations for students and teachers. Many of these policies are new for the 2011-12 academic year, so please do take a few minutes to familiarize yourself with what is here. They are organized by theme for ease of use. At the back of the handbook, we have provided a Directory of contact information for the key individuals and offices in UME. Lastly, for a handy reference whenever a question or concern arises, flip to the back page for a troubleshooting guide entitled If you encounter a problem. On behalf of the entire medical school leadership and our student body, I would like to express my gratitude to all of our UME teachers for the outstanding learning environment you create for our students, and my hope that this handbook will assist you in your teaching efforts.

Jay Rosenfield, MD, MEd, FRCPC Vice-Dean Undergraduate Medical Education Professor of Paediatrics

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Table of Contents
INTRODUCTION FROM THE VICE-DEAN ........................................................................................................................ 3 GOALS & OBJECTIVES ............................................................................................................................................................... 6 ADMINISTRATION & LEADERSHIP....................................................................................................................................14 Undergraduate Medical Education Organizational Chart .............................................................................................15 Overview of the Faculty of Medicine & UME ...................................................................................................................16 Governance And Management: Separate But Linked..................................................................................................16 Faculty Council .....................................................................................................................................................................16 Management Of The Undergraduate Medical Education Portfolio.........................................................................17 Management Committees Of The Dean..........................................................................................................................18 THE STUDENT EXPERIENCE .................................................................................................................................................19 The Continuum Of Medical Education ..............................................................................................................................20 Admission To Medical School ..........................................................................................................................................20 Application To Postgraduate Training Programs.........................................................................................................21 Student Affairs ..........................................................................................................................................................................22 The Academies ..........................................................................................................................................................................24 THE PROGRAM........................................................................................................................................................................... 25 Program Overview....................................................................................................................................................................26 2011-12 Key Dates And Holidays...........................................................................................................................................29 Preclerkship (Years 1 & 2) ..................................................................................................................................................... 30 Organizational Chart.......................................................................................................................................................... 30 Preclerkship Contacts .........................................................................................................................................................31 Diagram Of The Preclerkship Schedule ......................................................................................................................... 34 Course Descriptions............................................................................................................................................................ 35 Themes & Competencies (Years 1-4).................................................................................................................................. 57 Theme & Competency Descriptions .............................................................................................................................. 57 Clerkship (Years 3 & 4).......................................................................................................................................................... 63 Organizational Chart.......................................................................................................................................................... 63 Clerkship Contacts .............................................................................................................................................................64 Diagram Of The Clerkship Schedule .............................................................................................................................. 66 Course Descriptions............................................................................................................................................................ 67 Learning Modalities............................................................................................................................................................... 125 Lectures ................................................................................................................................................................................ 125 Seminars (Preclerkship & Clerkship).......................................................................................................................... 125 Clinical Supervision In The Clerkship ......................................................................................................................... 126 Clinical Skills Instruction In The Preclerkship (ASCM) ........................................................................................ 126 Family Medicine Clinical Experiences In FMLE....................................................................................................... 126 Simulation............................................................................................................................................................................ 126 Problem-Based Learning (PBL).......................................................................................................................................127 Gross Anatomy Laboratories ...........................................................................................................................................127 Portfolio Tutorials ..............................................................................................................................................................127 Field Visits During DOCH-1 & DOCH-2.................................................................................................................... 128 Independent Learning ...................................................................................................................................................... 128

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TABLE OF CONTENTS
(THE PROGRAM, continued)

Grading System & Assessment of Students .................................................................................................................... 129 Transcripting Practice...................................................................................................................................................... 129 Grading Regulations In UME......................................................................................................................................... 130 Assessment Modalities...................................................................................................................................................... 131 Professionalism Of UME Students .....................................................................................................................................137 Professionalism Overview ................................................................................................................................................137 Frequently Asked Questions About Professionalism For UME Students ...........................................................138 Sample Professionalism Form..........................................................................................................................................141 THE TEACHING EXPERIENCE ........................................................................................................................................... 143 Getting More Involved.......................................................................................................................................................... 144 Teaching............................................................................................................................................................................... 144 Enriching Educational Experiences (EEE) Preceptorships .................................................................................... 145 Course Committees........................................................................................................................................................... 145 Leadership Roles................................................................................................................................................................ 145 Admissions File Review And Interviews..................................................................................................................... 145 Research Supervision........................................................................................................................................................ 146 E-Resources Used In UME .................................................................................................................................................. 148 UME Website..................................................................................................................................................................... 148 UTORid................................................................................................................................................................................ 148 Portal..................................................................................................................................................................................... 149 T-Res..................................................................................................................................................................................... 149 University Of Toronto Libraries .................................................................................................................................... 149 Medical Student Information System (MedSIS) ....................................................................................................... 150 UME Curriculum Map (CMAP) .................................................................................................................................... 151 Information On Videoconferencing In The Classroom................................................................................................. 152 Lecture Presentation Guidelines For Videoconferencing........................................................................................ 152 Lecturer Support For Videoconferencing.....................................................................................................................153 Seminar Presentation Guidelines For Videoconferencing........................................................................................153 Opportunities & Resources For Faculty Development................................................................................................ 154 Centre For Faculty Development (CFD)..................................................................................................................... 154 Faculty Development Organized By Individual Departments ............................................................................... 155 Faculty Development Provided By Individual UME Courses ................................................................................ 155 Faculty Development At The Mississauga Academy Of Medicine ....................................................................... 155 Teaching Awards.................................................................................................................................................................... 155 KEY POLICIES, STATEMENTS, & GUIDELINES ........................................................................................................... 156 On Teaching & Assessing Students ...................................................................................................................................157 On Student Responsibilities, Behaviour, & Professionalism ...................................................................................... 186 On Teacher Behaviour & Student Well-Being ...............................................................................................................209 On Support & Feedback for Teachers ............................................................................................................................. 244 DIRECTORY & LIST OF OFFICES ..................................................................................................................................... 249 IF YOU ENCOUNTER A PROBLEM.................................................................................................................................255

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Undergraduate Medical Education

GOALS & OBJECTIVES

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UME GOALS & OBJECTIVES

Introduction to the UME Goals and Objectives


The Undergraduate Medical Education program is governed by a set of Goals and Objectives that were adopted in February 2003 following extensive development and consultation. CanMEDS The Objectives, which are found on the following pages, are based on the seven Royal College of Physicians and Surgeons of Canada CanMEDS roles and on the College of Family Physicians of Canadas Four Principles of Family Medicine. Each of the courses in both the Preclerkship and Clerkship have adopted objectives that are explicitly aligned with these overall UME objectives, ensuring continuity throughout the program. The seven categories Medical Expert, Communicator, Collaborator, Health Advocate, Manager, Scholar, and Professional each contain three to ten objectives that describe what abilities our students are expected to have achieved by the end of their medical school education. In total, there are 40 program objectives across all the categories. For convenience, the full text of each objective is accompanied by a summary a brief phrase that captures the essence of the expected outcome.

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UME GOALS & OBJECTIVES

Goals
Recognizing 1. the continuum of medical education, and the compelling logic of linking medical student education to subsequent post-graduate training and continuing education, and 2. the scientific and humanistic foundations of Medicine*, the University of Toronto, Faculty of Medicine has adopted the following goals for the undergraduate curriculum: 1. Graduates of the Undergraduate Medical Program will demonstrate the foundation of knowledge, skills and attitudes necessary to achieve the CanMeds 2000 competencies and the four principles of Family Medicine. 2. In keeping with the Faculty of Medicines vision of International Leadership in Health Research and Education, the Undergraduate Medical Curriculum will encourage, support and promote the development of future academic health leaders, who will contribute to our communities, and improve the health of individuals and populations through the discovery, application and communication of knowledge.

Background
The competencies from CanMEDS 2000 and the four principles of Family Medicine have been merged for the purpose of defining the specific objectives that follow. The principle of The Family Physician as a Skilled Clinician is associated with the Medical Expert/Skilled Clinical Decision Maker CanMEDS competency. The second and third Family Medicine principles a resource to a defined practice population and communitybased expands the CanMEDS Health Advocate competency. Similarly, the CanMEDS Communicator competency adds depth to the Doctor-Patient Relationship Family Medicine principle. Based on this, curriculum objectives are organized into the following categories: 1. 2. 3. 4. 5. 6. 7. Medical Expert / Skilled Clinical Decision Maker Communicator / Doctor-Patient Relationship Collaborator Manager Health Advocate Scholar Professional

The competency descriptors are modified to acknowledge that graduates of the MD program are about to start their post-graduate residency programs.
* An example of this concept is contained in Dr. Edmund Pellegrino's definition of medicine as the most "humane of the sciences, the most scientific of the humanities and most empiric of the arts."

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UME GOALS & OBJECTIVES

Objectives
Role Medical expert / skilled clinical decision-maker No. 1.1 1.2 Summary Understand the scientific and humanistic foundations of medicine Know about all aspects of common and lifethreatening illness and all MCC clinical presentations Full objective
Demonstrate a knowledge of the scientific* and humanistic foundations of medicine and be able to apply that knowledge to the practice of medicine. Demonstrate a thorough knowledge of the etiology, pathogenesis, clinical features, complications, principles of prevention and management of common and life-threatening illnesses presenting throughout the age spectrum, including all of the core clinical presentations outlined by the Medical Council of Canada. Demonstrate the ability to obtain and document both a complete and a focused medical history, as the situation requires. Demonstrate the ability to perform and document both a complete and focused physical and mental status examination, as the situation requires. Demonstrate the ability to interpret commonlyemployed laboratory tests, including tests of blood and other body fluids, various imaging modalities, and other specific tests such as electrocardiography. Demonstrate the ability to integrate the above history, physical and laboratory test findings into a meaningful diagnostic formulation. Demonstrate therapeutic and on-going management skills with respect to health and disease. Retrieve, analyze, and synthesize relevant and current data and literature, using information technologies and library resources, in order to help solve a clinical problem. Propose clinical decisions utilizing methods which integrate the best research evidence with clinical expertise and patient values.

1.3a 1.3b 1.3c

Obtain and document a complete and focused history Perform and document a physical examination Interpret tests

1.3d 1.3e 1.4

Integrate clinical data into a diagnostic formulation Demonstrate therapeutic and management skills Retrieve and apply best evidence Integrate best evidence with patient values and clinical expertise

1.5

*Scientific foundations include among others, the contemporary content of those disciplines that have been traditionally titled anatomy, behavioural science, biochemistry, genetics, immunology, microbiology, pathology, pharmacology and therapeutics, physiology, and preventive medicine.

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UME GOALS & OBJECTIVES


(Objectives, continued)

Role Communicator / Doctor-Patient Relationship

No. 2.1

Summary Communicate effectively in multiple ways with patients and families Establish professional relationships with patients and others Deliver information effectively

Full objective
Communicate effectively with patients, their families and the community through verbal, written and other non-verbal means of communication, respecting the differences in beliefs and backgrounds among patients and students. Establish professional relationships with patients, their families (when appropriate) and community that are characterized by understanding, trust, respect, empathy and confidentiality. Deliver information to the patient and family (as appropriate) in a humane manner, and in such a way that it is easily understood, encourages discussion and promotes the patients participation in decisionmaking. Gather information, negotiate a common agenda, and develop and interpret a treatment plan, while considering the influence of factors such as the patients age, gender, ethnicity, cultural and spiritual values, socioeconomic background, medical conditions, and communication challenges. Demonstrate the importance of cooperation and communication among health professionals so as to maximize the benefits to patient care and outcomes, and minimize the risk of errors.

2.2

2.3

2.4

Gather information and be cognizant of factors which influence this process

2.5

Cooperate and communicate with team members

Role Collaborator

No. 3.1

Summary Understand the roles of interdisciplinary team members Develop a collaborative multidisciplinary care plan Participate effectively in team discussions

Full objective
Describe the roles and expertise of all members of an interdisciplinary team that are required to optimally achieve a goal related to patient care, a research problem, an educational task, or an administrative responsibility. Develop a care plan for a patient he/she has assessed, including investigation, treatment and continuing care, in collaboration with the members of the interdisciplinary team. Participate in interdisciplinary team discussions, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing an appropriate level of expertise to patient care.

3.2

3.3

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UME GOALS & OBJECTIVES


(Objectives, continued)

Role Manager

No. 4.1

Summary Participate in health-care organizations

Full objective
Participate effectively in health care organizations, ranging from individual clinical practices to Academic Health Sciences Centres, exerting a positive influence on clinical practice and policy-making in ones professional community. Describe the governance, structure, financing, and operation of the health care system and its facilities and how this influences patient care, research and educational activities at a local, provincial, regional, and national level. Apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings. Describe the rationale for wise stewardship of available resources, appreciating the overall framework for resource allocation, and the absolute and relative levels of resources in various components of the health care system. Help to build better teams. Describe how population-based approaches to health care services can improve medical practice. Participate in planning, budgeting, evaluation and outcome of a patient care program. Participate in innovative approaches to clinical care.

4.2

Understand the health care system

4.3 4.4

Apply a broad base of information Use health care resources wisely

4.5 4.6 4.7 4.8

Build better teams Understand populationbased health care services Participate in developing a patient care program Help with innovation in clinical care Summary Understand determinants of health and principles of disease prevention Understand population health

Role Health Advocate / Community Resources

No. 5.1

Full objective
Describe the determinants of health and principles of disease prevention and behaviour change appropriate for specific patient populations within a community and internationally, and apply these to patient care responsibilities and broader patient care initiatives. Define and describe a population, its demography, cultural and socioeconomic constitution, circumstances of living, and health status; and understand how to gather health information about this population in order to better serve its needs. Respect diversity, be willing to work through systems, collaborate with other members of the health care team, and accept appropriate responsibility for the health of populations Participate in community activities directed at improving health, utilizing the best evidence, effective teamwork and communication skills. Describe the importance of the individual physician/patient relationship, and develop it appropriately, as a means to identify and implement individual health and disease management strategies on an individual basis. Be prepared to challenge clinical orthodoxy, or identify threats to population health and advocate for their amelioration.

5.2

5.3

Respect diversity, collaboration, and population health Participate in communitybased interventions Understand the physicianpatient relationship in the service of care Advocate for population health, challenge orthodoxy

5.4 5.5

5.6

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UME GOALS & OBJECTIVES


(Objectives, continued)

Role Scholar

No. 6.1

Summary Contribute to research

Full objective
Contribute to Research: The medical graduate will be able to pose a research question, help develop a protocol, assist in carrying out the research, and disseminate the results. The medical graduate will demonstrate an understanding of ethics as it relates to medical research. Contribute to Education: The medical graduate will a) demonstrate the ability to engage in life-long, selfdirected learning and critical inquiry. b) compare and contrast the diverse learning approaches of peers, patients and others, in order to effectively interact and collaborate. c) assist in teaching others and facilitating learning where appropriate d) understand the importance of being mentors to those less experienced members of the health care teams. Contribute to Creative Professional Activity: The medical graduate will be able to describe the importance of, and contribute to professional innovations, creative excellence, and exemplary professional practice. The graduate will also demonstrate leadership potential by participating in the development of professional practices, such as practice guidelines or health policy development, and participation in professional organizations.

6.2

Engage in lifelong learning, teaching, mentoring

6.3

Participate in creative professional activity innovations, leadership, organizations

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UME GOALS & OBJECTIVES


(Objectives, continued)

Role Professional

No. 7.1 7.2

Summary Demonstrate self-care, personal development Demonstrate altruism, honesty, integrity Demonstrate compassion and respect for patients Be reliable and responsible Recognize ones limitations, strive for improvement Abide by regulations Understand conflicts of interest Use principles of medical ethics Understand law as applied to medicine Manage medical error

Full objective
Recognize and accept the need for self-care and personal development as necessary to fulfilling ones professional obligations and leadership role. Demonstrate altruism, honesty and integrity and respect in all interactions with patients, families, colleagues, and others with whom physicians must interact in their professional lives Demonstrate compassionate treatment of patients and respect for their privacy and dignity and beliefs Be reliable and responsible in fulfilling obligations. Recognize and accept the limitations in his/her knowledge and clinical skills, and demonstrate a commitment to continuously improve his/her knowledge, ability and skills and leadership, always striving for excellence. Describe and abide by the University/Faculty codes of professional conduct, and the relevant professional regulatory requirements concerning medical practice. Describe the threats to medical professionalism posed by the conflicts of interest which can occur in the practice of medicine. Demonstrate a sound grasp of the theories and principles governing ethical decision-making, the major ethical dilemmas in medicine, and an approach to resolving these. Demonstrates an understanding of the principles and practice of law as they apply to the practice of medicine. Develop the capacity to recognize common medical errors, report them to the required bodies, and discuss them appropriately with patients.

7.3 7.4 7.5

7.6 7.7 7.8

7.9 7.10

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Undergraduate Medical Education

ADMINISTRATION & LEADERSHIP

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UME ADMINISTRATION & LEADERSHIP

Undergraduate Medical Education Organizational Chart

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UME ADMINISTRATION & LEADERSHIP

Overview of the Faculty of Medicine & UME


GOVERNANCE AND MANAGEMENT: SEPARATE BUT LINKED The Faculty of Medicine like the University of Toronto as a whole is directed through paired governance and management structures. Understanding the roles of these structures and how they intersect can help teachers make sense of how decisions are made and how changes are implemented. In general terms, governance can be understood as the authority and responsibility to set appropriate principles and policies for an institution in order to establish the direction of its activities. By contrast, management is the authority and responsibility to run the day-to-day operations of an institution in accordance with the principles and policies that have been established by governance. For example, in corporations, including hospitals, the governance structure is represented by the Board of Directors or Trustees, and the management structure is the Senior Leadership Team. In the Faculty of Medicine, governance is the purview of the Council of the Faculty of Medicine (commonly referred to as Faculty Council), while management is the purview of Dean of Medicine Dr. Catharine Whiteside, the Vice-Deans and Associate Deans (which together are referred to as the Decanal Team), the CAO, and the Senior Managers. Both the governance and management structures work closely with the Facultys Departments (via the Chairs), the Extradepartmental Units (via the Directors), and programs (via the Vice-Deans Education).

FACULTY COUNCIL Faculty Council is a large body consisting of approximately 100 members drawn from faculty, students, staff, and the leadership of the Faculty of Medicine, other Faculties, and the University. Some of the faculty seats are appointed, while others are elected by the faculty at large. The Dean and entire Decanal Team serve on Faculty Council to ensure cohesion with the management structure. Faculty Council is led by a Speaker, which is an annual appointment drawn from among the faculty members of the Council. Meetings of Faculty Council are held three times a year and are announced in advance in the MedEMail newsletter. They are open to the general public, and the minutes are posted online at www.facmed.utoronto.ca under Leadership. The Faculty Council has a number of standing committees, the memberships of which are drawn from a combination of Council members and other individuals from the Faculty of Medicine. The standing committees are the Boards of Examiners for the health professional programs, an Education and Continuing Education Committee, a Research Committee, and two procedural bodies: an Agenda Committee and Striking Committee. Some items approved by Faculty Council are then submitted to the Governing Council of the University of Toronto for final approval. The Governing Council is the senior governing body of the university that oversees the academic, business, and student affairs of the University (www.governingcouncil.utoronto.ca).

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UME ADMINISTRATION & LEADERSHIP: Overview


MANAGEMENT OF THE UNDERGRADUATE MEDICAL EDUCATION PORTFOLIO The UME program is led by the Vice-Dean Undergraduate Medical Education, Dr. Jay Rosenfield. As described above, as a Vice-Dean, Dr. Rosenfield contributes to both the management and governance of the Faculty of Medicine. The Vice-Dean chairs the UME Executive Committee, which consists of the Associate Deans Health Professions Student Affairs (HPSA), Admissions & Student Finance, and Physician Scientist Training, the Preclerkship and Clerkship Directors, the four Academy Directors, the Faculty Registrar, the Administrative Managers for the St. George and UTM campuses of UME, and the Special Projects Manager. This group addresses high-level management issues, many of which are brought forward by the committees chaired by the members, including the Preclerkship and Clerkship Committees (see below), the Admissions Committee, and the Academy Directors Committee. In his capacity as Curriculum Director, the Vice-Dean also chairs the Undergraduate Medical Education Curriculum Committee (UMECC). This Committee straddles management and governance functions, and has responsibility both for setting the direction of the curriculum and for making management decisions related to the curriculum. Updates from UMECC are reported to the Faculty-level Education Committee and occasionally to Faculty Council by the Vice-Dean. The membership of UMECC consists of the Preclerkship and Clerkship Directors, the Academy Directors, the Faculty Registrar, the Associate Deans HPSA and Admissions & Student Finance, one clinical and one basic science sector Chair, the Director of Evaluations, two student representatives, and a recent graduate of the program. Two operational committees the UME Curriculum Evaluation Committee (UMECEC) and the Examination and Student Assessment Committee (ESAC) are responsible for evaluating all aspects of the design, delivery, and outcomes of the curriculum, and delivering their findings and recommendations to UMECC. Both of these committees are chaired by the Director of UME Evaluations, and include a mixture of course directors, teachers, students, and evaluation research scientists The Preclerkship Committee and Clerkship Committee consist primarily of course directors, as well as student representatives, Academy Directors, the Associate Dean HPSA, the Director of Evaluations, the thematic faculty leads, and several other members. These committees report to UMECC and are charged with proposing, deliberating, and implementing broad curriculum decisions. Like UMECC, their mandates meld governance and management aspects of their periods of the curriculum. Each course also has a course committee (sometimes known as a course planning committee, or CPC). Course committees bring together students and teachers from the course, particularly those who are heavily involved as site directors, week managers, block coordinators, etc. Course committees are often a teachers first introduction to UME curriculum management.

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UME ADMINISTRATION & LEADERSHIP: Overview


MANAGEMENT COMMITTEES OF THE DEAN Several management committees are chaired by the Dean or report to her. Chief among these is the Deans Executive, which consists of the entire Decanal Team, CAO, CFO, Senior Managers (administrative directors), and four Department Chairs representing the clinical, basic science, rehabilitation, and community health sectors. A Budget Committee representing the four sectors advises the Dean on faculty budget issues. In addition, there are four committees of Department Chairs: the All Chairs Committee, Basic Science Chairs Committee, Clinical Science Chairs Committee, and Rehabilitation Science Chairs Committee. Together, the management committees serve as a forum for discussion and receive updates about procedural issues in the Faculty, and at the University. The committees ensure consistent operations among the portfolios. Outside of the committees, members of the Faculty management structure work together on a daily basis in a variety of capacities, for instance with regard to finances, human resources, inter-departmental initiatives, space and infrastructure, etc.

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Undergraduate Medical Education

THE STUDENT EXPERIENCE

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THE STUDENT EXPERIENCE

The Continuum of Medical Education


The following is a brief description of the admissions process to enter medical school and the procedures students follow when they apply to postgraduate training. Although these aspects of a medical students life are not directly related to teaching, teachers may find it helpful to have a perspective on where our students have come from and where they are headed. ADMISSION TO MEDICAL SCHOOL Each year, approximately 3,000 people apply to the University of Toronto Faculty of Medicine Undergraduate Medical Education (or MD) program, for one of 259 spots; this number has grown by more than 30% in recent years, thanks to government expansion of medical student positions. Application submissions include a transcript of grades, letters of reference, a sketch describing activities since age 16, and a personal statement; applicants are also required to write the MCAT, a standardized test used by many schools across North America, to confirm a minimum standard of knowledge, writing ability, and verbal reasoning. Based on a file review conducted by teams of trained faculty and students, along with staff of the Office of Admissions, approximately 520 applicants are granted an interview. The interviewees participate in highly engaging Interview Weekends, which enable the applicants to learn more about our school at the same time as we learn more about them. The interview itself is carried out and scored by both a faculty member and a student. The applicants are then ranked using combined scores derived from the file review and their interview performance. Offers of admission are made in late spring of each year. The acceptance rate for offers of admission is very high, generally around 75-80%. Beginning in 2011-2012, students were admitted to either the St. George Campus (downtown Toronto) or the Mississauga Academy of Medicine (MAM). The St. George students are then further distributed among one of the three downtown Academies. These Academy assignments last for all four years of the program. In addition to the regular MD program, the University of Toronto offers a combined MD/PhD degree. Of the 259 students admitted each year, a maximum of 10 are admitted into this special stream. To be admitted, applicants are reviewed separately by the MD admissions committee and a MD-PhD selection committee, and must be acceptable to both. Their program consists of the same curriculum described in this handbook, with extra research-preparation sessions during Year 1 and a hiatus of typically four years from MD studies after Year 1 in order to complete the PhD.

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THE STUDENT EXPERIENCE: The Continuum of Medical Education


APPLICATION TO POSTGRADUATE TRAINING PROGRAMS The process of application to postgraduate training is managed nationally by the Canadian Residency Matching Service (CaRMS). In the autumn of their fourth year, students submit to CaRMS a list of the postgraduate training programs for which they wish to be considered. The programs review the applications, and then offer interviews to their preferred candidates. The UME program provides a three-week break in January of fourth year to enable students to attend these interviews. In contrast to a typical application process such as those used for academic programs, the residency match is intended to ensure that graduates are placed in a program that meets their needs as much as the graduate meets those of the program. Therefore, following the interview period, both students and residency programs submit rankings to CaRMS, and these lists are both used to determine the optimal placement or match of every student across the country. CaRMS then notifies applicants of the results in March of fourth year. Typically, the vast majority of University of Toronto students do match, but any unmatched candidates are able to enter a second round of matching, which is completed in April. University of Toronto graduates historically perform very strongly in the CaRMS match for Canadian residency programs. In each of the last five years, we have met or exceeded the national average of graduates matching to their first choice of discipline. In this period, 92.3% of University of Toronto MD graduates have matched to their first choice of discipline, compared to 90.9% across Canada. Our graduates enter the full spectrum of postgraduate training. In the last three years, for example, the graduating classes have matched to programs in specialties including family medicine (approximately 30%), internal medicine (approximately 20%), general surgery and surgical sub-specialties (approximately 15%), and smaller proportions to a wide variety of programs, including paediatrics, obstetrics and gynaecology, anesthesia, diagnostic radiology, psychiatry, ophthalmology, otolaryngology, laboratory medicine, pathology, radiation oncology, emergency medicine, dermatology, neurology, community medicine, medical genetics, and physical medicine and rehabilitation.

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THE STUDENT EXPERIENCE

Student Affairs
The Faculty of Medicine, Office of Health Professions Student Affairs (OHPSA) has personal counsellors specifically to assist students with any personal concerns/issues. These services are available to all students in the Doctor of Medicine, Medical Radiation Sciences, Occupational Therapy, and Physician Assistant Programs and serve both the St. George and MAM campuses. They provide daytime and evening appointment times. These services are confidential; counsellor offices are privately located at both campuses. Students may arrange an appointment in the following ways: 1. Telephone: 416-978-2764 2. Email: ohpsa.reception@utoronto.ca 3. Directly with the counsellors. Their contact information can be found on the OHPSA website, www.ohpsa.utoronto.ca 4. They can also drop-in to arrange an appointment: At St. George campus, the OHPSA office is at MSB, 1 Kings College Circle, Room 2171B the receptionist can book an appointment for you. At MAM, the Student Support Administrator is located at the HSC at UTM, and she can arrange appointments for you at MAM. The Associate Dean and staff of the Office of Health Professions Student Affairs are dedicated to helping students adjust to Faculty of Medicine programs and achieve their full academic and personal potential. They have expertise in a variety of areas, and access to extensive resources and networks within the University and surrounding community. Teachers who are approached by students who are dealing with a personal problem of any nature are encouraged to contact the Office of Health Professions Student Affairs for advice, or to suggest that the students contact the Office directly. SERVICES OFFERED Wellness Program and Personal Counsellors The OHPSA has three experienced personal counsellors with a wide range of expertise to assist students in addressing these challenges through private, confidential, short-term counselling. Career Counselling and Advising Medical students must make many decisions during their four years of study that will have an impact on their ultimate career path, including electives, residency, service-learning activities and CaRMS. To assist in this process, the OHPSA Career Counsellors provide a full range of individual and group career services dedicated to medical students. Guidance for faculty career advising is also available. Academic Enrichment and Learning Skills Counselling The OHPSA Learning Skills Counsellor provides one-on-one counselling and resources to help Faculty of Medicine students understand the various aspects of learning and learning skills. Activities include facilitation of small and large group seminars/workshops and other events to promote educational development and academic success. The Learning Skills Counsellor also offers individual evaluation of learning/study challenges for students who have particular concerns, and works with such students to develop personal strategies and coaching to achieve optimal academic performance. Students must have authorization through accessibility services to receive accommodation related to a physical or other impairment, and are required to bring their needs to the attention of their course directors, or Associate Dean, OHPSA. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 22

THE STUDENT EXPERIENCE: Student Affairs


EXTRACURRICULAR AND SERVICE-LEARNING ACTIVITIES The OHPSA recognizes the value of a well-rounded program for student development, and the role of social responsibility in medicine. The OHPSA encourages students to participate in campus and Faculty activities. A number of social, charitable, and personal development and wellbeing events are facilitated by the OHPSA. These encourage awareness of social issues, and professional responsibilities to support those in need both locally and globally. Collaboration and participation by students from all interdisciplinary groups in the Faculty of Medicine wherever possible is encouraged. In addition, the OHPSA assists the Community Affairs Portfolio of the students Medical Society (MedSoc) in its service learning activities. MedSoc operates approximately twenty community programs to benefit underprivileged and marginalized groups through promotion of health, education, and well-being.

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THE STUDENT EXPERIENCE

The Academies
In a medical school of close to 1,000 MD students and almost 30 affiliated hospitals, the program appreciates that students benefit from a clinical home where they get to know the teachers, staff, and other students around them. In addition, the Preclerkship curriculum is heavily based on small group learning opportunities which require appropriate resources, rooms and clinical teaching facilities. The Academies of the Undergraduate Medical Education program were created in 1992 for these reasons and have responded to the evolving needs of the undergraduate curriculum. The four Academies, which consist of clusters of both fully-affiliated and community-affiliated hospitals, provide the hospital-based portions of the curriculum in a supportive, student-focused learning environment. Each Academy offers unique and diverse strengths of their constituent hospitals and clinical sites, while maintaining a consistent standard of excellence in their educational role.
FitzGerald Academy St. George (Toronto) Anchor hospital: St. Michaels Associated hospitals: Bridgepoint Health Providence Healthcare St. Josephs Dr. Molly Zirkle zirklem@smh.ca ~54/year Mississauga Academy of Medicine UTM (Mississauga) Anchor hospitals: Credit Valley Trillium Health Centre Peters-Boyd Academy St. George (Toronto) Anchor hospitals: Sunnybrook Health Sciences Centre Womens College North York General Associated hospital: Markham-Stouffville Dr. Mary Anne Cooper maryanne.cooper@ sunnybrook.ca ~60/year Wightman-Berris Academy St. George (Toronto) Anchor hospitals: Mount Sinai UHN Associated hospitals: Toronto East General Humber River Regional Baycrest Dr. Jackie James jjames@mtsinai.on.ca ~91/year

Campus Hospitals

Director E-mail # students in 2011-12

Dr. Pamela Coates pcoates@cvh.on.ca 54/year

For more information, see the Partners section of the UME website (www.md.utoronto.ca). The Mississauga Academy of Medicine (MAM), based at the University of Toronto Mississauga (UTM) campus and its affiliated clinical sites, opened in August 2011. The MAM joins the University of Torontos three existing Academies in providing all elements of the undergraduate curriculum. Teaching has been building steadily at Credit Valley Hospital and Trillium Health Centre since 2006 in preparation for the launch of the Academy. Each year an additional cohort of students will be placed at MAM so that by 2014, all four years of the curriculum will be fully implemented in Mississauga. Academy assignment is integrated into the admission process and takes applicant preference into consideration. Detailed information regarding the medical schools campuses and the Academy structure is provided to interviewees who are asked to indicate a campus preference. Offers of admission are then made for either the Mississauga Academy of Medicine or the St. George campus. Students admitted to the St. George campus are subsequently assigned to one of its three Academies FitzGerald, Peters-Boyd, and WightmanBerris again based as much as possible on their stated preferences. All campus and Academy assignments last for the entire four years of medical school, although students have ample opportunities to participate in clinical learning experiences outside of their Academies. The Academy Directors and their staff work together to coordinate the provision of core curriculum as determined by the University and clinical departments. In many courses, the role of the Academy Director includes recruitment of local faculty for teaching activities. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 24

Undergraduate Medical Education

THE PROGRAM

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THE PROGRAM

Program Overview
The program consists of two years of Preclerkship education followed by two years of Clerkship. Throughout the curriculum, individual courses are enriched through longitudinal learning about key themes, some of which correspond to specific CanMEDS roles (see UME Goals and Objectives, p. 7). The overall scheme of the program is diagrammed below, followed by a brief description of the major components. (Note that in the Clerkship, students rotate through the clinical courses in different orders.) Greater detail is provided in the sections that follow.

Every course has one ore more course directors, who are responsible for the design and implementation of their course with support from their course committee, administrative staff, and often Academy Medical Education Offices.

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THE PROGRAM
PRECLERKSHIP The Preclerkship is comprised of two kinds of courses: Block courses, which occupy most of the time during each week of the Preclerkship, and include a mixture of lectures, case-based seminars, and laboratory sessions and/or problem-based learning (PBL) tutorials. The aim of these courses is to provide a clinically relevant scientific foundation for the theory and practice of medicine, together with a comprehensive introduction to all aspects of clinical medicine. o Year 1: Structure & Function (STF, 16 weeks) Metabolism & Nutrition (MNU, 10 weeks) Brain & Behaviour (BRB, 10 weeks), including a two-week general Pharmacology unit o Year 2 Mechanisms, Manifestations & Management of Disease (MMMD, 36 weeks) Continuity courses, which are each assigned a number of half-day blocks and feature a variety of instructional methods. o Years 1 and 2 The Art and Science of Clinical Medicine (ASCM-1 and ASCM-2) is scheduled for one half-day per week throughout both years, and covers history-taking and physical examination mainly through small group teaching in the hospital. Determinants of Community Health (DOCH-1 and DOCH-2) is scheduled for one halfday throughout both years and addresses community health through field visits, tutorials, lectures, independent research, etc. o Year 2 only Family Medicine Longitudinal Experience (FMLE) is flexibly scheduled for six half-day clinics during second year, and provides students with a community-based experience with family physicians.

For more details on each Preclerkship course, turn to the descriptions beginning on p. 35.

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THE PROGRAM
CLERKSHIP The beginning of the Clerkship is a three-week Transition to Clerkship course during which students have orientation to the hospital setting in their new role as clinical clerks, further exposure to community health and ethical issues, instruction in evidence-based medicine, medical imaging and pharmacology review lectures, and teaching on their future role as managers in patient care. The Clerkship itself was revamped beginning in 2010-11 and now consists primarily of a series of core clinical courses in the third year, covering all of the major disciplines of medicine, followed by a fourth year intended to consolidate and deepen students learning through electives, selectives, and central teaching. For the third-year core rotations, students are divided into groups and sites, and rotate through each of the courses in different orders as illustrated in the diagram on p. 26. They assume supervised responsibility for patient care, and supplement this learning with didactic experiences at their local sites and through central teaching. In addition, students take part in a Portfolio course for seven sessions of two hours each, during which they have the opportunity to reflect with peers and supervisors (a faculty member and a resident) on their clinical learning in each of the CanMEDS roles (see UME Goals & Objectives, p. 7). The new fourth-year curriculum consists of twelve weeks of electives, which can be taken at the University of Toronto or other institutions in Canada or around the world, three weeks off for CaRMS interviews (see The Continuum of Medical Education, p. 20), and the new fourteen-week Transition to Residency course, which consists of centralized teaching, including further experiences in community health and review sessions for the Medical Council examination, and three selective periods, at least four weeks of which must be spent on a community-based experience. In addition, the final year of the program features a continuation of the Portfolio course from Year 3, with sessions taking place during the TTR central teaching blocks. For more details on each Clerkship course, turn to the descriptions beginning on p. 67. THEMES & COMPETENCIES There are several cross-cutting themes and competencies which have representation in many of the courses, during both the Preclerkship and the Clerkship. Teaching is carried out by a variety of teachers from medicine, as well as other health professions and professions outside of healthcare, via lectures, case-based seminars, and various team-based activities. Themes and competencies are coordinated by designated faculty leads. The UME themes and competencies include: Ethics and Professionalism Collaborator role and interprofessional education Manager role Pharmacology Medical imaging Note that several of the themes and competencies are directly tied to the same CanMEDS roles that underpin the program objectives. For more details on each, turn to the descriptions beginning on p. 57.

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THE PROGRAM

Undergraduate Medical Education 2011-12 Key Dates and Holidays


Key program dates are indicated in bold and indented. Statutory holidays are marked with an asterisk (*). Other holidays are indicated for information only. Students who observe these or other holidays may request permission for absence.
Ramadan Year 3 Begins Preclerkship Courses Begin Eid-Al-Fitr *Labour Day Year 4 Begins Rosh Hashanah Yom Kippur *Thanksgiving Sukkot Shemini Atzeret/Simhat Torah Diwali Eid-Al-Adha Winter Break (All Years) Hanukkah Feast Of The Nativity Christmas (Orthodox) CaRMS Interview Break (Year 4) Lunar New Year *Family Day March Break (Years 1, 2, 3) *Good Friday First 2 Days of Passover Easter Sunday (Western) Easter Monday Holy Friday (Orthodox) Last 2 Days of Passover Easter Sunday (Orthodox) Year 4 Ends *Victoria Day Shavuot Preclerkship Courses End Aboriginal Day of Prayer Canada Day Canada Day (Observed) Ramadan Civic Holiday Eid-Al-Fitr Year 3 Ends Sunday, July 31 (p.m.) Tuesday, August 30, 2011 Monday, August 22, 2011 Monday, August 29, 2011 Tuesday, August 30 Wednesday, August 31, 2011 Monday September 5, 2011 Tuesday, September 6, 2011 Wednesday, Sept. 28 (p.m.) Friday, Sept. 30, 2011 Friday, October 7 (p.m.) Saturday, October 8, 2011 Monday October 10, 2011 Wednesday, October 12 (p.m.) - Friday, October 14, 2011 Wed., October 19 (p.m.) Friday, October 21, 2011 Wednesday, October 26, 2011 Sunday, November 6 (p.m.) Monday, November 7, 2011 Saturday, December 17, 2011 Sunday, January 1, 2012 Tuesday, Dec. 20 (p.m.) Wed., December 28, 2011 Friday, January 6, 2012 Saturday, January 7, 2012 Saturday, January 21 Sunday, February 12, 2012 Monday, January 23, 2012 Monday, February 20, 2012 Saturday, March 10 Sunday, March 18, 2012 Friday, April 6, 2012 Friday, April 6 (p.m.) Sunday, April 8, 2012 Sunday, April 8, 2012 Monday, April 9, 2012 Friday, April 13, 2012 Friday, April 13 (p.m.) Saturday, April 14, 2012 Sunday, April 15, 2012 Friday, April 20, 2012 Monday, May 21, 2012 Saturday, May 26 (p.m.) Monday, May 28, 2012 Tuesday, May 29, 2012 Thursday, June 21, 2012 Sunday, July 1, 2012 Monday, July 2, 2012 Friday, July 20 (p.m.) Saturday, August 18, 2012 Monday, August 6, 2012 Sunday, August 19 Monday, August 20, 2012 Friday, August 31, 2012

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THE PROGRAM

Preclerkship (Years 1 & 2)


ORGANIZATIONAL CHART

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THE PROGRAM: Preclerkship (Years 1 & 2)


PRECLERKSHIP CONTACTS Preclerkship Director Dr. Martin Schreiber m.schreiber@utoronto.ca YEAR 1 Course Structure & Function (STF) Preclerkship Administrative Coordinator Saimah Baig s.baig@utoronto.ca

Course Director Dr. Mike Wiley mike.wiley@utoronto.ca Dr. Roy Baker roy.baker@utoronto.ca Dr. Louis Liu louis.liu@uhn.ca Dr. David K. Chan chandav@smh.ca Dr. Dee Ballyk d.ballyk@utoronto.ca Dr. Cindy Woodland (Pharmacology) cindy.woodland@utoronto.ca Dr. Fran Scott fran.scott@utoronto.ca Dr. Ingrid Tyler (Associate Course Director) ingrid.tyler@utoronto.ca Dr. Fok-Han Leung (Associate Course Director) leungf@smh.ca Dr. Rajesh Gupta raj.gupta@utoronto.ca Dr. Jean Hudson (Deputy Course Director) jhudson@cvh.on.ca

Metabolism & Nutrition (MNU) Brain & Behaviour (BRB) and Clinical Pharmacology & Therapeutics (CPT)

Course Administrator Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca

Determinants of Community Health-1 (DOCH-1)

Yasmin Shariff yasmin.shariff@utoronto.ca Sylvia Jao sylvia.jao@utoronto.ca Frances Rankin (MAM) frances.rankin@utoronto.ca Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca

Art of Science of Clinical Medicine-1 (ASCM-1)

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Preclerkship Contacts, continued)

YEAR 2 Course Art and Science of Clinical Medicine-2 (ASCM-2) Mechanisms, Manifestations & Management of Disease (MMMD)

Determinants of Community Health-2 (DOCH-2)

Course Director Dr. David Wong wongdav@smh.ca Dr. Lori Albert lori.albert@uhn.on.ca Dr. Darlene Fenech darlene.fenech@sunnybrook.ca Dr. Eleanor Latta lattae@smh.ca Dr. Fran Scott fran.scott@utoronto.ca

Course Administrator Lina Marino lina.marino@utoronto.ca Lina Marino lina.marino@utoronto.ca Sue Sarju (Mechanisms block) s.sarju@utoronto.ca Yasmin Shariff yasmin.shariff@utoronto.ca Sylvia Jao sylvia.jao@utoronto.ca Susan Rice s.rice@utoronto.ca

Family Medicine Longitudinal Experience (FMLE)

Dr. Susan Goldstein susan.goldstein@utoronto.ca

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Preclerkship Contacts, continued)

ACADEMIES Academy FitzGerald

Mississauga Academy of Medicine

Peters-Boyd

Wightman-Berris

Medical Education Coordinators Dragana Markovic markovicd@smh.ca Sonya Surbek surbeks@smh.ca Dr. Pamela Coates Kristen Harshman-Best pcoates@cvh.on.ca kristen-harshmanbest@utoronto.ca Arlene Newland (Trillium) anewland@thc.on.ca Julie Burtch (Credit Valley) jburtch@cvh.on.ca Arlene Newland (Trillium) anewland@thc.on.ca Dr. Mary Anne Cooper Esther Williams (Sunnybrook) maryanne.cooper@sunnybrook.ca esther.williams@sunnybrook.ca Jenna Pariselli (Sunnybrook) jenna.pariselli@sunnybrook.ca Jennifer Alexander (Women's College) jennifer.alexander@wchospital.ca Libanos Getachew (North York General) libanos.getachew@nygh.on.ca Dr. Jacqueline James Anne Marie Holmes (Manager, UHN) jjames@mtsinai.on.ca annemarie.holmes@uhn.ca Shamim Ladak (Mount Sinai) sladak@mtsinai.on.ca Lina Turco (Mount Sinai) lturco@mtsinai.on.ca Babita Jadobeer (Toronto General) babita.jadobeer@uhn.ca Maureen Appleton (Toronto Western) maureen.appleton@uhn.ca Brian Davidson (Clerkship/DOCH) brian.davidson@uhn.ca

Academy Director Dr. Molly Zirkle zirklem@smh.ca

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THE PROGRAM: Preclerkship (Years 1 & 2)


DIAGRAM OF THE PRECLERKSHIP SCHEDULE

Year 1 Schedule 2011/2012


Sept Oct Nov Dec Structure & Function 16 weeks Aug. 29, 2011 to Dec. 16, 2011 Jan Feb Metabolism & Nutrition 10 weeks Jan. 2, 2012 to Mar. 8, 2012 Mar Apr May Brain & Behaviour 10 weeks Mar. 19, 2012 to May 29, 2012

Art & Science of Clinical Medicine-1 (ASCM-1) - Hospital (4 hours/week) Sept. 9, 2011 to May 18, 2012 Determinants of Community Health-1 (DOCH-1) - MSB/Community (4 hours/week) Aug. 31, 2011 to May 22, 2012

Year 2 Schedule 2011/2012


Sept Oct Nov Dec Jan Feb Mar Apr May Mechanisms, Manifestations, & Management of Disease 36 weeks Aug. 29, 2011 to May 29, 2012 Art & Science of Clinical Medicine-2 (ASCM-2) - Academy/Hospital (4 hours/week) Sept. 1, 2011 to May 23, 2012 Determinants of Community Health-2 (DOCH-2) - Community (4 hours/week) Aug. 30, 2011 to May 15, 2012 Family Medicine Longitudinal Experience (FMLE) (6 sessions, 4 hours/session) Sept. 2011 to May 2012

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 1 Block Course:STRUCTURE & FUNCTION (STF)


Course Director Dr. Mike Wiley mike.wiley@utoronto.ca Course Administrators Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca

Section Leads: Section Gross Anatomy, Histology, Embryology Ethics and Professionalism Manager Respiratory Physiology Cardiovascular Physiology Blood Physiology Biochemistry Pharmacology

Lead Dr. Mike Wiley mike.wiley@utoronto.ca Dr. Pier Bryden pier.bryden@sickkids.ca Dr. Dante Morra dante.morra@uhn.on.ca Dr. David Hall hallda@smh.ca Dr. Scott Heximer scott.heximer@utoronto.ca Dr. Anne McLeod anne.mcleod@sunnybrook.ca Dr. Roy Baker roy.baker@utoronto.ca Dr. Cindy Woodland cindy.woodland@utoronto.ca

This 16-week first-year block course runs at the start of medical school, from the end of August to the end of December, and provides students with instruction in: Gross anatomy, histology, and cell biology Embryology Radiological anatomy and an introduction to medical imaging Biochemistry Physiology (cardiovascular, respiratory, and blood) Pharmacology Ethics and the Professional role The Manager role This is accomplished via: Lectures (165 hours) Seminars and other small-group teaching (32 hours) Anatomy laboratory sessions (95 hours) Clinical relevance is emphasized throughout. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 35

THE PROGRAM: Preclerkship (Years 1 & 2)


(Structure & Function, continued)

ASSESSMENT Cardio-respiratory physiology and pharmacology examination: (25%) Gross anatomy and radiology examination #1: (25%) Embryology examination: (5%) Histology and Hematology examination: (15%) Gross anatomy and radiology examination #2: (30%) Exercises for the Ethics and Manager roles (Credit/No Credit) Professionalism evaluation: Credit / No credit For details, including grading regulations, see the STF webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year1/STF_111Y.htm COURSE OBJECTIVES (The numbers in parentheses refer to the UME objectives supported by each terminal learning objective.) By the end of STF, students are expected to be able to: [Medical Expert / Skilled Clinical Decision-Maker] 1. Describe the structure of the human body, at both the gross and microscopic levels, relevant to a future physician. (1.1, 1.2) 2. Describe the embryologic development of all organ systems, with an emphasis on developmental abnormalities relevant to a future physician. (1.1, 1.2) 3. Describe the functions of the following systems, explain how these functions may be deranged by disease, and develop a general understanding of interventions designed to treat these derangements. (1.1, 1.2) Respiratory, Cardiovascular, Blood and blood cells 4. Describe the basic principles of pharmacokinetics and pharmacodynamics and their application to clinical pharmacology and therapeutics, and begin to appreciate the role of pharmacology and therapeutics in patient care. (1.1, 1.2, 1.3e ) 5. Interpret radiologic images of normal human structures, and begin to appreciate the role of medical imaging in diagnosis of disease. (1.1, 1.2, 1.3d) [Manager] Develop a deeper understanding of the physicians role as a manager, of how to work effectively in teams, of how teams sometimes do not work well, and of the phenomenon of leadership. (4.5, 6.3) [Scholar] Demonstrate appropriate self-directed learning skills. (6.2a, 6.2b) Assist in teaching others and facilitating learning where appropriate (6.2c) [Professional] 1. Explain the major concepts of bioethics, professionalism and law in medicine and demonstrate the beginning of a sense of how to apply these to clinical practice when approaching ethical and professional dilemmas. (7.8) 2. Demonstrate a growing sense of the role of the physician as a professional (7)

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 1 Block Course: METABOLISM & NUTRITION (MNU)


Course Director Dr. Roy Baker roy.baker@utoronto.ca Dr. Louis Liu louis.liu@uhn.ca Course Administrators Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca

This ten-week first-year block course follows STF, running from January until the March Break. It focuses on the physiology and biochemistry of several body systems: reproductive renal endocrine cardiovascular gastrointestinal There is an important emphasis on nutrition, molecular biology, metabolism, and clinical biochemistry, and further instruction in pharmacology. Clinical relevance is emphasized throughout. MNU features a mixture of teaching modalities: lectures (66 hours) clinical conferences (15 hours) seminars (38 hours) problem-based learning (PBL) sessions, including an introduction to this learning modality (18 hours) ASSESSMENT Mid-term examination (30%) Histology examination (10%) Final examination (60%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the MNU webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year1/MNU_111Y.htm

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Metabolism & Nutrition, continued)

COURSE OBJECTIVES By the end of MNU, students are expected to be able to: [Medical Expert / Skilled Clinical Decision-Maker] Demonstrate knowledge of the scientific foundations of medicine in the following domains: Biochemistry Molecular Biology Nutrition The physiology, histology and pharmacology of the following systems o Endocrine o Reproductive o Renal o Cardiovascular o Gastrointestinal Describe basic principles of pathophysiology, diagnosis, and management of common clinical problems in the following domains: Nutrition Clinical biochemistry Endocrinology Nephrology Gastroenterology Reproduction Metabolsim [Communicator / Doctor-Patient Relationship] Demonstrate an increased ability to communicate effectively with colleagues [Manager] Demonstrate an increased understanding of the role of the primary care physician and consultant in the care of patients [Health Advocate / Community Resources] Increase ones understanding of the determinants of health and principles of disease prevention for patient populations internationally. [Scholar] Demonstrate appropriate self-directed learning skills. [Professional] Demonstrate a growing sense of the role of the physician as a professional. Demonstrate a sound grasp of the theories and principles governing ethical decision-making in relation to truth-telling.

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 1 Block Course: BRAIN & BEHAVIOUR (BRB) and CLINICAL PHARMACOLOGY & THERAPEUTICS (CPT)
This ten-week course marks the conclusion of the first year of the program, running through April and May. It consists of two distinct, independent parts: the Clinical Pharmacology and Therapeutics block and the Brain & Behaviour block.

Clinical Pharmacology Block


Course Director Dr. Cindy Woodland cindy.woodland@utoronto.ca Course Administrators Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca

The first two weeks of the last phase of Year 1 consists of a block on pharmacology, during which there are 20 hours of lectures and 10 hours of seminars. The goal of this two-week block is to consolidate the learning of pharmacology that students encountered in the systems-based teaching at various points earlier in the year, and to provide further instruction in both special topics in pharmacology and in the practical use of medications for various conditions. ASSESSMENT Written examination (100% of the CPT block; 20% of the combined BRB/CPT course) For details, including grading regulations, see the BRB webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year1/BRB_111Y.htm COURSE OBJECTIVES By the end of the two-week Clinical Pharmacology & Therapeutics block, students should be able to fulfill the following terminal objectives: [Medical Expert / Skilled Clinical Decision-Maker] Describe major principles of pharmacokinetics Describe major principles of pharmacodynamics Describe adverse drug reactions Describe the use of medications in specific practical settings

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Brain & Behaviour and Clinical Pharmacology & Therapeutics, continued)

Brain & Behaviour


Course Directors Dr. David K. Chan chandav@smh.ca Dr. Dee Ballyk d.ballyk@utoronto.ca Course Administrators Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca

The remaining eight weeks provide a comprehensive introduction to neurosciences, including neuroanatomy, neurophysiology, and an introduction to topics in clinical neurology, neurosurgery, and psychiatry. This is accomplished via lectures (86 hours), seminars (4 hours), PBL tutorials (24 hours covering six cases), and laboratory time (18 hours). ASSESSMENT Mid-term written examination (20%) Neuroanatomy bell-ringer examination (20%) Final examination (60%) Professionalism evaluation (Credit/No Credit) Note: The final BRB course mark is derived 80% from the assessments above and 20% from the students performance in the CPT block. For details, including grading regulations, see the BRB webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year1/BRB_111Y.htm

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Brain & Behaviour and Clinical Pharmacology & Therapeutics, Brain & Behaviour, continued)

COURSE OBJECTIVES By the end of BRB, students are expected to have accomplished the following terminal objectives: [Medical Expert / Skilled Clinical Decision-Maker] Describe the structure and function of the major components of the nervous system, at the gross, microscopic and biochemical levels. Describe how the nervous system achieves each of its major functions and begin to appreciate how these may be deranged in disease states. Apply their understanding of the structure and function of the nervous system to the localization and diagnosis of nervous system disorders.. Identify anatomical structures and common disease processes from radiological images utilizing axial, coronal, and sagittal planes. Integrate information from their understanding of nervous system structure and function, a patients symptoms and signs (including clinical localization), and imaging abnormalities, to propose an etiological diagnosis of a patients disease. Use their understanding of nervous system function, particularly at the subcellular level, to understand the pharmacological management of major neurological and psychiatric disorders. [Communicator / Doctor-Patient Relationship] Demonstrate an increased ability to communicate effectively with colleagues [Scholar] Demonstrate appropriate self-directed learning skills. [Professional] Demonstrate a growing sense of the role of the physician as a professional.

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 1 Continuity Course: THE ART & SCIENCE OF CLINICAL MEDICINE-1 (ASCM-1)
Course Directors Dr. Rajesh Gupta raj.gupta@utoronto.ca Dr. Jean Hudson (Deputy C.D.) jhudson@cvh.on.ca Site Directors: Academy FitzGerald Mississauga Mississauga Peters-Boyd Peters-Boyd Peters-Boyd Wightman Berris Wightman Berris Wightman-Berris Wightman-Berris Course Administrators Saimah Baig s.baig@utoronto.ca Elizabeth Day (MAM) elizabeth.day@utoronto.ca

Site SMH CVH THC SHSC WCH NYGH MSH TGH TWH TEGH

Site Directors Dr. Samir Grover grovers@smh.ca Dr. Jean Hudson jhudson@cvh.on.ca Dr. Darren Sukerman mailtoyoo@yahoo.com Dr. Michael Varenbut mvarenbut@toxpro.ca Dr. Pamela Lenkov pamela.lenkov@sunnybrook.ca Dr. Meeta Patel meetapatel.md@gmail.com Dr. Susan Goldstein susan.goldstein@utoronto.ca Dr. Douglas Ing douglas.ing@uhn.on.ca Dr. Bohdan Laluck bohdan.laluck@uhn.on.ca Dr. Michelle Lockyer michelle.lockyer@utoronto.ca

ASCM-1 occupies one half-day per week (Friday mornings) throughout Year 1. It provides an introduction to interviewing skills, history-taking, and physical examination, via 30 half-day sessions. Students interact with real and standardized patients. Students are divided into groups of six at their Academies, with each group typically led by one, two, or three core tutors, each of whom is with the students for seven to eleven sessions. At some sites, sessions are co-led by two tutors at a time. Several sessions are presented by specialists (neurologists, rheumatologists, ophthalmologists) assigned to each group, and there is one large-group lecture.

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THE PROGRAM: Preclerkship (Years 1 & 2)


(The Art & Science of Clinical Medicine-1, continued)

ASSESSMENT In-course narrative evaluation (30%) Written case reports (15%) Mid-year clinical examination (25%) Final OSCE (30%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the ASCM-1 webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year1/ASC_111Y.htm COURSE OBJECTIVES The overall or terminal objectives for ASCM-1 are as follows: [Medical Expert / Skilled Clinical Decision-Maker] Obtain a patients medical history Perform a complete physical examination. Present the findings from the history and physical examination orally and in writing Understand the goal and principles of infection control [Communicator / Doctor-Patient Relationship] Communicate effectively with patients during an interview, both verbally and non-verbally, so as to obtain accurate information that the patient is comfortable providing. Use an electronic medical record system effectively without detracting from the interaction during the interview. Exhibit a non-judgmental, patient-centred approach to the doctor/patient interaction, in order to promote the physical, emotional and social well-being of patients. [Manager and Scholar] Work effectively with colleagues [Scholar] Demonstrate appropriate self-directed learning skills. [Professional] Maintain confidentiality of patient data. Exhibit honesty, fairness and compassion towards patients, peers, and other members of the health care professions. Manage time and workload effectively.

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 1 Continuity Course: DETERMINANTS OF COMMUNITY HEALTH-1 (DOCH-1)


Course Directors Dr. Fran Scott fran.scott@utoronto.ca Dr. Ingrid Tyler (Associate Course Director) ingrid.tyler@utoronto.ca Dr. Fok-han Leung (Associate Course Director) leungf@smh.ca Course Administrators Yasmin Shariff (MSB DOCH coordinator) yasmin.shariff@utoronto.ca Sylvia Jao (MSB DOCH assistant) sylvia.jao@utoronto.ca Frances Rankin (MAM DOCH Coordinator) frances.rankin@utoronto.ca

The Determinants of Community Health (DOCH) course in first year introduces students to a population and community health perspective on medical practice, an important subject that receives considerable attention throughout the program, including in DOCH-2, the Year 3 Transition to Clerkship course, and the Year 4 Transition to Residency course. DOCH-1 integrates the academic material of population health with community based field experiences. The overall goals of the course are for students to become familiar with the social and physical determinants of health for both individual patients and for communities as a whole, the Canadian healthcare system, and health promotion and protection strategies. The course is scheduled for one half-day per week on Wednesday afternoons for all of first year. There is a mixture of teaching modalities including: full-class lectures at both the downtown and Mississauga campuses Academy-based large-group seminars small-group tutorials in groups of eight to ten students at the academies field visits to Community Care Access Centre clients, schools, and community health agencies. ASSESSMENT Semester 1 written examination (25%) Presentations on school and CCAC field visits in Semester 1 (20%) Semester 2 written examination (25%) End-of-year written essay integrating knowledge on health promotion and the community agency, (30%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the DOCH-1 webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year1/DOC_111Y.htm

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Determinants of Community Health-1, continued)

COURSE OBJECTIVES The terminal objectives for DOCH-1 are for students to be able to: [Medical Expert / Skilled Clinical Decision-Maker] - Determinants of Health interpret social/physical/economic context and apply this to the patient and the community identify and interpret risk factors as they affect patients and the community - Health Promotion, health protection, disease prevention understand health promotion, health protection and disease prevention strategies be able to identify how these strategies are applied in the community - Occupational and environmental health describe the importance of occupation and environment on health recognize the different roles of physicians in addressing occupational and environmental health issues [Communicator / Doctor-Patient Relationship (Multiprofessionalism)] Communicate effectively in essay writing and in oral presentations [Collaborator (Multiprofessionalism)] Appreciate the concept of healthcare team and be able to collaborate effectively with other professionals [Manager (Healthcare System)] recognize the changing nature of the healthcare system; assess and discuss patient and community needs in the face of changes to the healthcare system; appreciate the need to use resources efficiently. [Health Advocate (Community diversity)] describe diversity as it relates to community health; apply the principles of social justice; have self-awareness of diversity and its implications for the health of a community [Scholar (Epidemiologic methods)] interpret epidemiological findings in terms of the population and patients; identify community risks and needs. [Professional] learn and practice professional codes and ethics; recognize when to seek advice and assistance; recognize the complexity of various physician roles (e.g. listener, advocate, healer, etc.) and the correct application of each.

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 2 Block Course: MECHANISMS, MANIFESTATIONS, & MANAGEMENT OF DISEASE (MMMD)


Course Directors Dr. Lori Albert lori.albert@uhn.on.ca Dr. Darlene Fenech darlene.fenech@sunnybrook.ca Dr. Eleanor Latta lattae@smh.ca Course Administrators Lina Marino lina.marino@utoronto.ca Sue Sarju (Mechanisms block) s.sarju@utoronto.ca

This is a 36-week course which runs throughout the second year of medical school. The first nine weeks of the course concentrate on the mechanisms of disease: the pathogenesis and the changes in disease that occur at the tissue, cellular and molecular levels and how these correlate clinically. A comprehensive understanding of the mechanisms and structural alterations produced by disease is a necessary framework with which one can plan strategies for prevention, diagnosis and treatment. The mechanisms section covers the major categories of human disease, and is divided into four major topics: genetics and genetic diseases, immunology and disorders of the immune system, microbiology (including bacteriology, virology, mycology, and parasitology), and pathology (including cellular and molecular responses to injury, inflammatory disorders, and neoplasia). The remaining 27 weeks deliver a systems-based program that covers the manifestations and management of most diseases across the age spectrum. The major disease categories addressed are: obstetrical/gynaecological paediatric and adolescent surgical internal medicine, and psychiatric A primary care perspective is prominent throughout, and considerations of laboratory medicine are integrated into the systems portion. The themes of ethics and professionalism, manager, collaborator, medical imaging, and pharmacology all receive attention throughout the course. The MMMD course incorporates lectures, seminars, and problem-based learning (PBL) tutorials. ASSESSMENT Five written examinations (20% each) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the MMMD webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year2/mmmd.htm UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 46

THE PROGRAM: Preclerkship (Years 1 & 2)


(Mechanisms, Manifestations, & Management of Disease, continued)

COURSE OBJECTIVES The overall (or terminal) MMMD course objectives are for students to be able to: (numbers in parentheses refer to overall UME Program Objectives) [Medical Expert / Skilled Clinical Decision-Maker] 1. Describe current concepts of the mechanisms of disease, including etiology and pathogenesis, in relation to (1.1, 1.2): Cell pathology Environmental pathology Immunology Microbiology Neoplasia Genetic disease Paediatric disease Cardiovascular disorders. 2. Describe how structural alterations of disease correlate with clinical manifestations. (1.1, 1.2) 3. Describe common and/or life-threatening diseases in terms of their (1.2): Etiology, Pathogenesis, Clinical manifestations, Complications, Treatment, Prevention 4. Provide an approach to the differential diagnosis of the major presenting problems in clinical medicine, and how to manage the problem pending the identification of the underlying cause. (1.2) 5. Demonstrate growing competence in the gathering and interpretation of clinical data, including (1.3a, 1.3b, 1.3c, 1.3d): Taking a history, performing a physical examination Selecting and interpreting laboratory and imaging tests Creating a problem list, generating a differential diagnosis and a provisional diagnosis 6. Retrieve, analyze and synthesize current data and literature in order to help solve a patient problem. (1.4) 7. Integrate best research evidence with clinical expertise and patient values in making clinical decisions. (1.5) 8. Describe how physicians provide assistance to patients with managing normal life events including during pregnancy, childhood and adolescence, menopause, advice about lifestyle issues such as exercise, and diet, and the dying process. (1.2) 9. Describe the following treatments of disease and illness in terms of their rationale, the mechanism of their effects, indications for each, and side effects (1.3e): Management plan Pharmacotherapeutics Psychotherapy Surgery (including management of trauma), Transfusion and Intravenous fluid therapy Organ donation and transplantation Radiation therapy Rehabilitation Therapy of genetic disorders Palliative care

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Mechanisms, Manifestations, & Management of Disease, Course Objectives, continued)

10. Make appropriate use of medical imaging in the diagnosis of fractures, cancer, trauma and disorders of the heart and lungs. (1.3c) [Communicator / Doctor-Patient Relationship] 1. Further develop the ability to communicate effectively with patients, clinical colleagues and other allied health professionals. (2.1, 2.2, 2.4, 2.5) 2. Deliver information to patients humanely and effectively (2.3) 3. Contribute to a cumulative patient profile. (2.5) [Collaborator] 1. Describe in general terms the roles of other members of the healthcare team. (3.1) 2. Contribute to the development of a multidisciplinary care plan. (3.2, 3.3) [Manager] 1. Further develop a general understanding of the resource costs of healthcare interventions. (4.4) 2. Understand the optimal use of laboratory testing in relation to cost issues (4.4) 3. Help to build better teams. (4.5) 4. Describe aspects of the organization of the healthcare system (4.2) [Health Advocate / Community Resources] 1. Propose health promotion and disease prevention strategies for individuals and populations based on an understanding of disease mechanisms (5.1) 2. Demonstrate respect for diversity (5.3) 3. Demonstrate a deepening understanding of the doctor-patient relationship and the legal and ethical issues pertaining to it (5.5) [Scholar] 1. Demonstrate increasing self-directed lifelong learning skills (6.2) 2. Demonstrate a growing capacity to teach others (peers and patients) about clinical issues (6.2) [Professional] 1. Manage their time effectively. (7.4) 2. Demonstrate responsibility and reliability in the learning and performance of tasks. (7.4) 3. Demonstrate respect for instructors and peers within the educational environment. (7.2, 7.6) 4. Demonstrate a basic understanding of major concepts in bioethics and law as applied to medicine, and apply this understanding to challenges in clinical medicine. (7.8, 7.9) 5. Recognize and accept the limitations in his/her knowledge and clinical skills, and demonstrate a commitment to continuously improve his/her knowledge, ability and skills and leadership, always striving for excellence. (7.5) 6. Develop the capacity to recognize common medical errors, report them to the required bodies, and discuss them appropriately with patients. (7.10)

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 2 Continuity Course: THE ART & SCIENCE OF CLINICAL MEDICINE2 (ASCM-2)
Course Director Dr. David MC Wong wongdav@smh.ca Site Directors: Academy Fitzgerald Fitzgerald Peters-Boyd Peters-Boyd Peters-Boyd Wightman-Berris Wightman-Berris Wightman-Berris Wightman-Berris Block Coordinators: Block Paediatrics Psychiatry Ophthalmology Geriatrics Course Administrator Lina Marino lina.marino@utoronto.ca Site SMH THC SHSC WCH NYGH MSH UHN TEGH CVH Site Director Dr. David M.C. Wong wongdav@smh.ca Dr. Stephen McKenzie s.w.mckenzie@rogers.com Dr. Michael Bernstein michael.bernstein@sunnybrook.ca Dr. Tara OBrien tara.obrien@wchospital.ca Dr. Meeta Patel meetapatel.md@gmail.com Dr. Jacqueline James jjames@mtsinai.on.ca Dr. Diane Donat dianne.donat@uhn.ca Dr. Michelle Lockyer michelle.lockyer@utoronto.ca Dr. Jeff Myers jmyers@cvh.on.ca

MSK ENT

Coordinator Dr. Sheila Jacobson sheilajacobson@rogers.com Dr. Adrian Grek Agrek@mtsinai.on.ca Dr. Ken Eng k.eng@utoronto.ca Dr. Thirumagal Yogaparan tyogaparan@baycrest.org Dr. Mireille Norris mireille.norris@sunnybrook.ca Dr. Lori Albert lori.albert@uhn.ca Dr. Paolo Campisi paolo.campisi@sickkids.ca 49

UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca

THE PROGRAM: Preclerkship (Years 1 & 2)


(The Art & Science of Clinical Medicine-2, continued)

This course continues clinical skills instruction in the second year via 36 half-day sessions (scheduled on Thursday mornings). Students further develop their clinical abilities in performing a focused history and physical examination with respect to general medical practice as well as the specialized areas of geriatrics, paediatrics, psychiatry, and several other focal areas: vascular surgery, urology, general surgery (acute abdomen), orthopaedics, and rheumatology. Students rotate through these topics in varying orders in groups of six. Each group generally has two core teachers who teach approximately a third of the sessions, with the remainder delivered by various specialist tutors. ASSESSMENT Observed history and physical examination (20%) Written case reports (2 x 7.5%) Oral case presentations (2 x 7.5%) Final OSCE examination (50%) Professionalism evaluation (Credit/No Credit For details, including grading regulations, see the ASCM-2 webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year2/ASC_211Y.htm

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THE PROGRAM: Preclerkship (Years 1 & 2)


(The Art & Science of Clinical Medicine-2, continued)

COURSE OBJECTIVES The overall (or terminal) objectives of ASCM-2 are for students to be able to: [Medical Expert / Skilled Clinical Decision-Maker] Obtain a complete and focused medical history Perform a complete physical examination. Present the findings from the history and physical examination Know about all aspects of common and life-threatening illness and all Medical Council of Canada clinical presentations Interpret laboratory and imaging tests Integrate clinical data into a diagnostic formulation Demonstrate therapeutic and management skills (in specific contexts) Retrieve best evidence Understand the goals and principles of infection control [Communicator / Doctor-Patient Relationship and Health Advocate / Community Resources] Communicate effectively in multiple ways with patients and families [Collaborator] Exhibit honesty, fairness and compassion towards patients, peers and other members of the heath care professions [Health Advocate / Community Resources and Scholar] Work effectively with colleagues [Scholar] Demonstrate appropriate self-directed learning skills [Professional] Exhibit honesty, fairness and compassion towards patients, peers and other members of the healthcare professions. Maintain confidentiality of patient data. Manage time and workload effectively

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 2 Continuity Course: DETERMINANTS OF COMMUNITY HEALTH-2 (DOCH-2)


Course Director Dr. Fran Scott fran.scott@utoronto.ca Course Administrators Yasmin Shariff yasmin.shariff@utoronto.ca Sylvia Jao sylvia.jao@utoronto.ca

Research Coordinators Academy FitzGerald Peters-Boyd Wightman-Berris

Research Coordinator Dr. Gwen Jansz (Research Lead) janszg@smh.toronto.on.ca Katja Lutte (Research Coordinator) klutte@cpso.on.ca Dr. Joyce Nyhof-Young (Research Lead) joyce.nyhof-young@uhn.on.ca

The focus of this course, which occupies one half-day per week (Tuesday mornings) throughout the second year, is Researching Health in the Community. Students build upon the knowledge and skills acquired in DOCH-1 by completing an independent community-based research project in partnership with a health agency with the aim of addressing specific health problems and determinants of health affecting the agencys target population group(s). The students identify a research question, create a work plan, experience research processes such as obtaining ethics approval, and then carry out the study. The course culminates in a written paper and an oral presentation to classmates and teachers. Core research methodology curriculum is provided through the Academy-based sessions as well as on-line resources. The course time consists of: work at agencies carrying out the research, scheduled by students, representing the bulk of the course independent study for background research and preparation one half-day of lectures and six seminars on research methodology ASSESSMENT Library search strategy (10%) Individual Learning Plan (ILP) (20%) Written examination on research methodology (15%) ILP Progress report (10%) Oral presentation of research project (20%) Written research project report (20%) Participation (5%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the DOCH-2 webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year2/DOC_211Y.htm UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 52

THE PROGRAM: Preclerkship (Years 1 & 2)


(Determinants of Community Health-2, continued)

COURSE OBJECTIVES The terminal objectives for DOCH-2 are for students to be able to: [Medical Expert / Skilled Clinical Decision-Maker] Analyze the relationship between a health problem and a determinant of health Interpret social/physical/economic data in the context of the community and the sponsoring agency Identify and interpret factors as they affect the health of the community [Communicator / Doctor-Patient Relationship] Communicate effectively in written essays and oral presentations Communicate effectively as a member of a team in team-based learning sessions Communicate effectively with the individuals and organizations necessary for successful completion of the DOCH-2 project (agency, faculty, REB, research participants) [Collaborator] Continue to develop the capacity to work collaboratively with community agencies Appreciate the concept of the healthcare team and be able to collaborate effectively with other professionals [Manager] Project management: develop the skills required to design, execute and report a community-based research study of a health issue [Health Advocate / Community Resources] Analyze the relationship between a health problem and a determinant of health Interpret social/physical/economic data in the context of the community and the sponsoring agency Identify and interpret factors as they affect the health of the community Appreciate and describe diversity as it relates to community health Apply the principles of social justice Have an awareness of diversity and its implications for the health of a community

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Determinants of Community Health 2, Course Objectives, continued)

[Scholar] Evaluate the scientific literature in order to assess critically the research methods and findings presented Be able to describe and apply the ethical principles associated with research Become familiar with the characteristics of different quantitative and qualitative research methodologies (RCTs, cohort studies, case-control, cross-sectional, focus groups, surveys, interviews) Be familiar with issues related to: o Measurement (error, reliability, distributions, measurement, terminology), measures of central tendency, validity, sensitivity, specificity, positive predictive value, and measures of health and disease (incidence rates, prevalence rates, odds ratios, relative risk and attributable risk.) o Sampling for surveys o Concepts of efficacy, effectiveness, and efficiency Demonstrate the use of the computer for appropriate data retrieval and function Interpret epidemiological/research findings in terms of the population and patients [Professional] Adhere to standards of professional codes and ethics Recognize when to seek advice and assistance Recognize the complexity of various physician roles (e.g. researcher, listener, advocate, healer, etc.) and the appropriate application of each

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THE PROGRAM: Preclerkship (Years 1 & 2)


COURSE DESCRIPTIONS

Year 2 Continuity Course: FAMILY MEDICINE LONGITUDINAL EXPERIENCE (FMLE)


Course Director Dr. Susan Goldstein susan.goldstein@utoronto.ca Course Administrator Susan Rice s.rice@utoronto.ca

During FMLE, students participate in community-based family medicine clinics on six Monday and/or Wednesday afternoons spread out through the second year of the program. Students are assigned preceptors through a match process, after which the six clinic dates are arranged and agreed on jointly by the student and preceptor from a list of possible dates supplied by the University. The goal of FMLE is for students to develop an appreciation of the importance of generalist specialties and of family medicine in particular, including an understanding of the role family physicians play within the health care system. In addition, students will have some exposure to important issues in our healthcare environment such as physician distribution, physician remuneration, primary care reform, and social accountability. During FMLE, students also practise some of the history-taking and physical examination skills learned in ASCM-1 and ASCM-2. They also learn about the family medicine-based clinical S.O.A.P. (Subjective, Objective, Assessment, Plan) note and practice documentation using an Electronic Medical Record (EMR)type document. ASSESSMENT Midterm case report (50%) Final case report (50%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the FMLE webpage on the MD website: http://www.md.utoronto.ca/program/preclerkship/year2/FMLE.htm

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THE PROGRAM: Preclerkship (Years 1 & 2)


(Family Medicine Longitudinal Experience, continued)

COURSE OBJECTIVES Upon successful completion of the FMLE, the student should be able to: [Medical Expert / Skilled Clinical Decision-Maker and Communicator / Doctor-Patient Relationship] Use the patient-centered clinical method (including a patient-centered interview) to conduct a supervised office visit. Use patient-centered record keeping when caring for patients. [Medical Expert / Skilled Clinical Decision-Maker and Health Advocate / Community Resources] Demonstrate some ability to identify the health needs of an individual patient and how to work with this patient to improve their health. [Health Advocate / Community Resources and Professional] Identify that the patient-physician relationship is central to the practice of family medicine in allowing therapeutic relationships with patients to develop. [Health Advocate / Community Resources] Demonstrate an appreciation of the value of continuity of care for developing a deep knowledge of patients. [Manager] Demonstrate an understanding of the role of the family physician, family medicine, and primary healthcare in the overall function of the healthcare system, including family physician roles in officebased care. [Communicator / Doctor-Patient Relationship and Professional] Create and maintain a positive working environment by demonstrating a respectful attitude towards other colleagues, other healthcare professionals and/or members of the health team and patients and their families. [Collaborator and Professional] Create and maintain a positive working environment by demonstrating professionalism in all aspects of care. [Scholar] Engage in self-directed learning based on reflective practice (e.g. read around cases)

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THE PROGRAM

Themes & Competencies (Years 1-4)


In addition to the courses in the Preclerkship and the Clerkship, UME includes several themes and competencies: Ethics & Professionalism Manager Collaborator/Interprofessional Education Pharmacology Medical Imaging The first three of these correspond very closely to three of the CanMEDS roles that form the basis of the UME program objectives. Theme & Competencies Ethics & Professionalism Manager Faculty Lead Dr. Pier Bryden pier.bryden@utoronto.ca Dr. Geoff Anderson geoff.anderson@utoronto.ca Dr. Dante Morra dante.morra@uhn.on.ca Dr. Cynthia Whitehead cynthia.whitehead@utoronto.ca Dr. Cindy Woodland (Preclerkship) cindy.woodland@utoronto.ca Dr. Lisa Thurgur (Clerkship) lthurgur@sympatico.ca Dr. Nasir Jaffer njaffer@mtsinai.on.ca Dr. Rachel Spitzer rspitzer@mtsinai.on.ca Administrator Joan McKnight joan.mcknight@utoronto.ca Lindsey Fechtig lindsey.fechtig@utoronto.ca Lindsey Fechtig lindsey.fechtig@utoronto.ca

Collaborator / Interprofessional Education Pharmacology

Medical Imaging Global Health

THEME & COMPETENCY DESCRIPTIONS Teaching in these thematic areas is given during both the Preclerkship and Clerkship and serves to provide students with an integrated exposure to these very important issues. Each of them has a faculty lead, as indicated in the table above. The themes and competencies are described on the following pages.

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THE PROGRAM: Themes & Competencies (Years 1-4)


THEME & COMPETENCY DESCRIPTIONS

ETHICS & PROFESSIONALISM


Faculty Lead Dr. Pier Bryden pier.bryden@utoronto.ca Theme Administrator Joan McKnight joan.mcknight@utoronto.ca

Teaching in professional ethics in the core curriculum includes a mix of large-group (lecture) sessions and seminars/workshops. The large-group sessions give students familiarity with the central concepts of medical ethics, professionalism and medical jurisprudence. Some of these sessions are given by single lecturers, others are team-taught, and some involve multidisciplinary panels and patients. Ethics seminars are expert-led and case-based, and sometimes involve the participation of standardized patients. The Ethics & Professionalism Preclerkship curriculum consists of 52 hours, woven into almost all of the Preclerkship courses. Ethics teaching addresses topics pertaining to the individual doctor-patient encounter (e.g., confidentiality, truth-telling, obstetrical and paediatric ethics, informed consent, euthanasia and assisted suicide, and breaking bad news). There is also teaching on issues such as public and private rights, social justice, research ethics, and professionalism. In the Clerkship, there are 18 hours of scheduled sessions for didactic ethics teaching, in addition to the education about ethics and professionalism that arises in the course of students patient care experience. These sessions include several lectures in the Transition to Clerkship, and seminars in the Medicine, Surgery, and Paediatrics rotations. Also see: The Program Professionalism of UME students (p. 137)

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THE PROGRAM: Themes & Competencies (Years 1-4)


THEME & COMPETENCY DESCRIPTIONS

MANAGER
Faculty Lead Dr. Geoff Anderson geoff.anderson@utoronto.ca Dante Morra dante.morra@uhn.on.ca Theme Administrator Lindsey Fechtig lindsey.fechtig@utoronto.ca

The Manager theme curriculum spans the four years of the UME program, and so provides an opportunity for students to learn in progressively greater depth about the various aspects of the role of the physician as a manager in the healthcare system. The objectives for the Manager role are contained within the overall UME program objectives (p. 7). Manager theme activities are woven into the block courses during the Preclerkship and also play a major role in the Transition to Clerkship that marks the beginning of the third year, and the Transition to Residency that occurs at the conclusion of fourth year. Assessment involves the completion of required assignments, and also questions on the course examinations. Year 1: This year includes a lecture on the Manager role as part of a series on the CanMEDs roles, as well as lectures on the Canadian health care system and on career planning. Students complete a group assignment that focuses on management and team-building skills. They also complete a Canadian Medical Association leadership module on personal leadership and emotional intelligence. Year 2: Students have more formal instruction about the Manager role via several half-day exercises that address the following topics, the first three of which are CMA modules: team-building and leadership managing conflict health and personal growth patient-centred care diversity and advocacy Year 3 (Transition to Clerkship (TTC)) Several activities at the beginning of the Clerkship further develop students grasp of the Manager role and teamwork, and in particular the phenomenon of change management, via a complex healthcare planning simulation activity. A major topic during the TTC is learning about quality of care, quality improvement, patient safety and management of medical error, and this is accomplished through both classroom sessions and Institute for Healthcare Improvement (IHI) open school online modules. Year 4 (Transition to Residency (TTR)) As part of the first running of the Transition to Residency course in Year 4, students will have the opportunity to learn about transfer of care, getting involved in the healthcare system, managing interprofessional conflict, and physician supply.

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THE PROGRAM: Themes & Competencies (Years 1-4)


THEME & COMPETENCY DESCRIPTIONS

COLLABORATOR / INTERPROFESSIONAL EDUCATION


Faculty Lead Dr. Cynthia Whitehead cynthia.whitehead@utoronto.ca Theme Administrator Lindsey Fechtig lindsey.fechtig@utoronto.ca

Collaborative practice enables the optimal provision of high quality health care. New collaborative models of care are particularly important given the complex nature of health systems, providing care for aging populations and persons with multiple chronic diseases. Internationally, there is consensus that models of education need to change in order to train health professions learners to be collaborative-practice ready. Governments and health professions faculties worldwide, including the University of Toronto, have endorsed the move to greater interprofessional training. According to the World Health Organization (WHO, 2010), interprofessional education occurs when two or more professions learn about, from and with each other to enable effective collaboration and improve health outcomes. The goal of the Collaborator role curriculum is to encourage the development of the Collaborator objectives, which are found in the overall UME program objectives (p. 7). Achievement of these objectives is accomplished through participation in a variety of sessions across the four years of the curriculum. One of the chief ways in which this educational content is delivered is via interprofessional education (IPE). Interprofessional Education (IPE) The IPE curriculum has been developed for students from 11 health professions University of Toronto Departments and Faculties (Dentistry, Medical Radiation Sciences, Nursing, Occupational Therapy, Pharmacy, Physical Education & Health, Physical Therapy, Physician Assistant, Social Work, and Speech-Language Pathology, as well as the MD program), and is delivered under the auspices of the Centre for IPE. To complete the IPE curriculum, students take part in both core and elective learning activities throughout the four-year UME program. The core activities include a large-group session with all first-year health professionals that introduces the concept of the healthcare team in Year 1, a week on the management of pain and the role of the multidisciplinary team during Year 2, IPE in a clinical placement (through DOCH in Year 1 and the Collaborator role sessions in the portfolio project in clerkship), and a session on conflict resolution in Year 4. Students also have many other opportunities for learning about different aspects of their role as collaborators, including a lecture on medication safety in Year 3, various lectures from non-physicians, panel presentations, and interaction with other health professionals during clinical training in the Clerkship. Other important collaborator learning occurs throughout the curriculum in teamwork sessions, shadowing experiences, and educational sessions delivered by educators from other health professions and in clinical rotations.

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THE PROGRAM: Themes & Competencies (Years 1-4)


THEME & COMPETENCY DESCRIPTIONS

CLINICAL PHARMACOLOGY & THERAPEUTICS


Theme Coordinators Dr. Cindy Woodland (Preclerkship) cindy.woodland@utoronto.ca Dr. Lisa Thurgur (Clerkship) lthurgur@sympatico.ca Formal teaching in pharmacology occurs throughout the two years of the Preclerkship and in the Transition to Clerkship: Structure & Function o There are ten hours of introductory lectures on pharmacokinetics and pharmacodynamics. Metabolism & Nutrition o Students learn about medications relevant to the systems being addressed (endocrine, gastrointestinal and renal) and also about relevant aspects of pharmacokinetics. The instruction is via lectures and a seminar, and is also incorporated into problem-based learning (PBL) cases. Brain & Behaviour o During the dedicated two-week Pharmacology block of this course (see BRB course description, p. 39), students learn in greater depth about pharmacokinetics, pharmacodynamics, autonomic and cardiovascular drugs, and also receive instruction in toxicology and adverse drug reactions, drug dependence, herbal medicines and cost effectiveness of drug therapy, while they begin to develop an understanding of the practical use of medications. The teaching is via lectures and seminars. o In the rest of BRB, Pharmacology is discussed during problem-based learning (PBL) cases and relevant lectures. Mechanisms, Manifestations, & Management of Disease o Learning about the appropriate use of medications in the treatment of disease is a principal goal of the MMMD course, and medications are addressed in virtually every week of the course. In addition, there is specific teaching of several key pharmacological topics such as teratogens, drug use in pregnancy, and drug interactions, via lectures. Transition to Clerkship o There is a two-hour review lecture during the Transition to Clerkship to prepare students for practical application of their CPT knowledge in patient care.

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THE PROGRAM: Themes & Competencies (Years 1-4)


THEME & COMPETENCY DESCRIPTIONS

MEDICAL IMAGING / DIAGNOSTIC RADIOLOGY


Theme Coordinator Dr. Nasir Jaffer njaffer@mtsinai.on.ca Medical imaging instruction occurs in a number of courses in the Preclerkship and Clerkship: Structure & Function: o There is a major introduction to this topic including seven introductory lectures on radiologic anatomy of the major parts of the body, with clinical correlations provided. Also, post-graduate trainees in medical imaging provide instruction to students in the context of their gross anatomy dissection laboratories. Brain & Behaviour: o There is instruction on neuroradiology during Brain and Behaviour via lectures and also during problem-based learning (PBL) tutorials. Mechanisms, Manifestations, & Management of Disease: o Teaching in medical imaging is delivered through dedicated sessions that address chest X-ray interpretation, imaging in the context of trauma and cancer, and obstetrical ultrasound, and is also integrated into the discussion of many of the clinical problem presented in the course. Transition to Clerkship o There is a total of three hours, including an introductory lecture on medical imaging, a review of the American College of Radiology Guidelines for appropriate medical imaging, and a review of chest imaging. Medicine o There are four one-hour small group seminars conducted at each Academy for Year 3 clinical clerks during their Medicine rotation: two sessions on chest imaging, a second one on abdominal imaging, and a fourth on neuroimaging. Surgery o A two-hour interactive, case-based seminar is conducted during each rotation, on the subject of surgical issues and the role of medical imaging in addressing them.

GLOBAL HEALTH
Theme Coordinator Dr. Rachel Spitzer rspitzer@mtsinai.on.ca The newest theme in the UME curriculum, global health, will focus on integration and coordination of existing teaching in this subject area and on expanding it across the entire program. Global health is a major focus of the Faculty of Medicines 2011-2016 strategic plan, and an important facet of social responsibility.

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THE PROGRAM

Clerkship (Years 3 & 4)


ORGANIZATIONAL CHART

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THE PROGRAM: Clerkship (Years 3 & 4)


CLERKSHIP CONTACTS Clerkship Director Dr. Anita Rachlis a.rachlis@utoronto.ca YEAR 3 Course Transition to Clerkship Clerkship Administrative Coordinator Tim Flannery tim.flannery@utoronto.ca

Anesthesia Dermatology Emergency Medicine Family Medicine Medicine Obstetrics & Gynaecology Ophthalmology Otolaryngology Paediatrics Psychiatry Surgery Portfolio Integrated OSCE

Course Director Dr. Geoff Anderson geoff.anderson@utoronto.ca Dr. Dante Morra dante.morra@uhn.on.ca Cynthia Whitehead cynthia.whitehead@utoronto.ca Dr. Isabella Devito isabella.devito@uhn.on.ca Dr. Perla Lansang perlalansang@gmail.com Dr. Laura Hans hansl@smh.ca Dr. Azadeh Moaveni azadeh.moaveni@uhn.on.ca Dr. Danny Panisko danny.panisko@uhn.on.ca Dr. Filomena Meffe filomena.meffe@utoronto.ca Dr. Kenneth Eng k.eng@utoronto.ca Dr. Paolo Campisi paolo.campisi@sickkids.ca Dr. Stacey Bernstein stacey.bernstein@sickkids.ca Dr. Raed Hawa raed.hawa@uhn.on.ca Dr. George Christakis george.christakis@sunnybrook.ca Dr. Ken Locke ken.locke@utoronto.ca Anita Rachlis a.rachlis@utoronto.ca

Course Admin Coordinator Lindsey Fechtig lindsey.fechtig@utoronto.ca

Gary Cronin gary.cronin@utoronto.ca Michelle Mooney michelle.mooney@sunnybrook.ca Nancy Medeiros em.undergrad@utoronto.ca Samantha Fortunato family.undergrad@utoronto.ca Sumitra Robertson med.undergrad@utoronto.ca Maria Wowk maria.wowk@utoronto.ca Francesca Di Leo francesca.dileo@utoronto.ca Alice Forbes alice.forbes@sickkids.ca Mary Antonopoulos mary.antonopoulos@sickkids.ca Rachel MacKenzie rachel.mackenzie@utoronto.ca Shibu Thomas shibu.thomas@utoronto.ca Rosalind Armstrong portfolio.ume@utoronto.ca Tim Flannery tim.flannery@utoronto.ca

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THE PROGRAM: Clerkship (Years 3 & 4)


(Clerkship Contacts, continued)

YEAR 4 Course Electives Portfolio Transition to Residency ACADEMIES Academy FitzGerald

Course Director Dr. Mara Goldstein mara.goldstein@utoronto.ca Dr. Ken Locke Ken.locke@utoronto.ca Dr. Ken Locke Ken.locke@utoronto.ca

Course Admin Coordinator Eva Lagan Eva.lagan@utoronto.ca Rosalind Armstrong Portfolio.ume@utoronto.ca Nima Heirat ttr.ume@utoronto.ca

Academy Director Molly Zirkle zirklem@smh.ca Dr. Pamela Coates pcoates@cvh.on.ca

Mississauga Academy of Medicine

Peters-Boyd

Dr. Mary Anne Cooper maryanne.cooper@sunnybrook.ca

Wightman-Berris

Dr. Jacqueline James jjames@mtsinai.on.ca

Medical Education Coordinator Dragana Markovic markovicd@smh.ca Sonya Surbek surbeks@smh.ca Kristen Harshman-Best kristen-harshmanbest@utoronto.ca Julie Burtch (Credit Valley) jburtch@cvh.on.ca Arlene Newland (Trillium) anewland@thc.on.ca Esther Williams (Sunnybrook) esther.williams@sunnybrook.ca Jenna Pariselli (Sunnybrook) jenna.pariselli@sunnybrook.ca Jennifer Alexander (Women's College) jennifer.alexander@wchospital.ca Libanos Getachew (North York General) libanos.getachew@nygh.on.ca Anne Marie Holmes (Manager) annemarie.holmes@uhn.on.ca Shamim Ladak (Mount Sinai) sladak@mtsinai.on.ca Babita Jadobeer (Toronto General) babita.jadobeer@uhn.on.ca Maureen Appleton (Toronto Western) maureen.appleton@uhn.on.ca

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THE PROGRAM: Clerkship (Years 3 & 4)


DIAGRAM OF THE CLERKSHIP SCHEDULE YEAR 3: YEAR 4:

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3 transition course: TRANSITION TO CLERKSHIP (TTC 3 weeks)


Course Director Dr. Geoff Anderson geoff.anderson@utoronto.ca Dr. Dante Morra dante.morra@uhn.on.ca Dr. Cynthia Whitehead cynthia.whitehead@utoronto.ca Course Administrator Lindsey Fechtig lindsey.fechtig@utoronto.ca

The Transition to Clerkship builds on material covered in the Preclerkship, and introduces new concepts and skills to assist students in their preparation for Clerkship. The course includes large group lectures, online courses, and smaller group seminars, as well as Academy-based sessions on hospital protocol that are intended to prepare students for their role as clinical clerks. The major topics addressed include: Teamwork skills (via a health care simulation exercise with reflection and lectures) Issues related to managing knowledge and information (evidence-based medicine, clinical practice guidelines, systematic reviews, library resources , and shared decision-making) Issues related broadly to the healthcare system (patient safety, public and population health, and quality improvement) Review of medical imaging and clinical pharmacology (see Program Themes & Competencies pg. Error! Bookmark not defined.) Preparation for clinical duties (Academy-based sessions addressing professionalism, infection control, procedural skills, managing crisis situations, order-writing, and the healthcare team) Special topics (complementary and alternative medicine, medico-legal issues, and diversity and cultural sensitivity) In addition, the large group lectures include an Interprofessional Education (IPE) session on medication safety. The students also complete five online courses from the Institute for Healthcare Improvement (IHI) Open School as part of TTC. The students are assigned to groups of eight students, which are assessed on their ability to complete certain tasks together. ASSESSMENT EBM-RCT appraisal (5%) EBM Diagnostic Test Appraisal (10%) EBM CAT Assignment 1 (10%) EBM CAT Assignment 2 (15%) Multiple-choice examination (60%) Online CQI course 5 modules (Credit/No Credit) Teamwork Group Assignment 1 & 2 (Credit/No Credit) Diversity PBL and Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the TTC webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/TTC_310Y.htm UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 67

THE PROGRAM: Clerkship (Years 3 & 4)


(Transition to Clerkship, continued)

COURSE OBJECTIVES By the conclusion of the Transition to Clerkship, students should be able to: [Manager] Participate effectively in health care organizations, ranging from individual clinical practices to Academic Health Sciences Centres, exerting a positive influence on clinical practice and policy-making in ones professional community Apply a broad base of information to the care of patients in ambulatory care, hospitals and other health care settings Help to build better teams Participate in innovative approaches to clinical care Participate in planning, budgeting, evaluation and outcome of a patient care program [Collaborator] Participate in interdisciplinary team discussions, demonstrating the ability to accept, consider and respect the opinions of other team members, while contributing an appropriate level of expertise to patient care. [Health Advocate / Community Resources] Respect diversity, be willing to work through systems, collaborate with other members of the health care team, and accept appropriate responsibility for the health of populations. Describe the importance of the individual physician/patient relationship, and develop it appropriately, as a means to identify and implement individual health and disease management strategies on an individual basis. [Communicator / Doctor-Patient Relationship] Gather information, negotiate a common agenda, and develop and interpret a treatment plan, while considering the influence of factors such as the patients age, gender, ethnicity, cultural and spiritual values, socioeconomic background, medical conditions, and communication challenges. Demonstrate the importance of cooperation and communication among health professionals so as to maximize the benefits to patient care and outcomes, and minimize the risk of errors. [Professional] Demonstrate an understanding of the principles and practice of law as they apply to the practice of medicine Develop the capacity to recognize common medical errors, report them to the required bodies, and discuss them appropriately with patients [Medical Expert / Skilled Clinical Decision Maker] Retrieve, analyze, and synthesize relevant and current data and literature, using information technologies and library resources, in order to help solve a clinical problem, Propose clinical decisions utilizing methods which integrate the best research evidence with clinical expertise and patient values.

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: ANESTHESIA (2 weeks)


Course Director Dr. Isabella Devito isabella.devito@uhn.ca Site Directors/Assistants Site HSC MSH Course Administrator Gary Cronin gary.cronin@utoronto.ca Director (Faculty) Dr. Jamie Robertson james.robertson@sickkids.ca Dr. Darryl Irwin darryl.irwin@uhn.ca Dr. Mital Joshi mital.joshi@utoronto.ca Dr. Suzanne Lilker slilker@rogers.com Dr. Carol Loffelmann loffelmannc@smh.toronto.on.ca Dr. Ryan Mai mai.ryan@gmail.com Dr. Anita Sarmah anita.sarmah@sunnybrook.ca Dr. Mabel Choi mabel.choi@sunnybrook.ca Dr. Larry Panos drlpanos@sympatico.ca Dr. Alan Tallmeister tallmeister9818@rogers.com Dr. Hossam El Beheiry helbeheiry@thc.on.ca Dr. Patrick Mark patrick.mark@utoronto.ca Dr Desmond Lam delam@tegh.on.ca Dr. Lisa Bahrey lisa.bahrey@uhn.ca Dr. Diana Tamir diana.tamir@uhn.ca Dr. Ahtsham Niazi ahtsham.niazi@uhn.ca Dr. Vinod Chinnappa drvinodc@yahoo.com Dr. Christopher Flynn cflynn@cvh.on.ca Assistant Shue Lin Loo shuelin.loo@sickkids.ca Josephine Sham josephine.sham@uhn..ca Megan Marshall marshme@stjoe.on.ca Anna Salter saltera@smh.toronto.on.ca Holly Mae Mendoza holly.mendoza@sunnybrook.ca Madeline Wimbs mwimbs@tsh.to Heather Huckfield hhuckfield@tsh.to Paty Callaghan pcallaghan@thc.on.ca

SJHC SMH

SHSC

TSH General TSH Birchmount THC TEGH

TGH

Eva Bowman eva.bowman@uhn.ca

TWH WCH CVH

Christine Drane christine.drane@uhn.ca Cyra Elva cyra.elva@wchospital.ca Laura Champagne lchampagne@cvh.on.ca 69

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THE PROGRAM: Clerkship (Years 3 & 4)


(Anesthesia, continued)

The Anaesthesia rotation is a two-week course in the eight-week Otolaryngology/Ophthalmology/ Anaesthesia/Emergency Medicine rotation. Clinical Schedule Students are assigned for each shift to a faculty staff member in the operating room, labour floor, pre-admission clinic, or pain service. They are provided with a Topics for Discussion form which serves as a guideline for discussion of core objectives with their faculty member. Students complete a preoperative assessment on all patients assigned, and assist in all aspects of anesthetic care. There are evening shifts but no overnight call. Seminars and Simulation Day Four seminars are held once during each rotation. The topics include preoperative assessment, airway management and acute resuscitation, obstetrical and regional anaesthesia, and pain management The rotation includes one day at the Simulation Centre at Sunnybrook Health Sciences Centre for all students, with training on monitoring, IV skills, and airway management, and case scenarios using simulation to learn ACLS protocols, communication, and collaboration skills during critical events in a simulated operating room. ASSESSMENT Written examination (60%) Clinical performance evaluation (assessment of the students clinical work during the rotation (40%)) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Anesthesia webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/ANS_310Y.htm COURSE OBJECTIVES Upon completion of the Anesthesia Clerkship Rotation, third year medical students will understand the implications of pre-existing disease for patients undergoing anesthesia. They will demonstrate competency in basic airway management and acute resuscitation, and will be able to discuss pain management in the perioperative period. The third-year medical student will be able to: [Medical Expert / Skilled Clinical Decision Maker] Demonstrate the ability to assess a patient in the preoperative period and formulate a basic management plan Demonstrate the ability to take a focused history and physical examination, including anesthetic history and airway exam Develop a plan for preoperative investigations and interpret these investigations Understand and explain the risks and benefits associated with regional versus general anesthesia Develop an approach to acute resuscitation Develop an approach to perioperative pain management Demonstrate competency in airway management and other procedural skills relevant to the perioperative period UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 70

A. GENERAL COMPETENCIES

THE PROGRAM: Clerkship (Years 3 & 4)


(Anesthesia, Course Objectives, continued)

[Communicator / Doctor-Patient Relationship] Communicate effectively and empathetically with patients and their families, and recognize their high level of anxiety. Communicate their level of training and involvement in the patients care Communicate risk with high risk patients and their families. Communicate effectively with the perioperative team noting anesthetic related concerns Present the preoperative assessment in a clear, concise and complete format in a timely manner [Collaborator] Establish and maintain effective working relationships with colleagues and health care professionals. Consult effectively with physicians and other health care professionals Participate effectively on health care teams, namely the Anesthesia Care Team (ACT), Acute Pain Service (APS) and Cardiac Arrest and/or Trauma Teams Understand the high level of collaboration (anesthesia, surgery, nursing, pharmacy, anesthesia assistants, and respiratory therapists) required for the effective management of the patient in the perioperative period [Manager] Demonstrate appropriate and cost-effective use of investigations in an evidence based manner. Understand the prioritization of the surgical emergency patient to minimize risk of negative outcome. Develop an understanding of the factors contributing to resource issues in the perioperative period. Understand the role of physicians in developing the health care system and promoting access to care. (Anesthesia Care Team) [Health Advocate/ Community Resources] Understand the risk factors that lead to increased perioperative risk and how anesthesiologists can assist in modifying these risks in the perioperative period: Smoking cessation, Weight loss, Alcohol use, Recreational drug use [Scholar] Retrieve information from appropriate sources related to the anesthesia curriculum. Assess the quality of information found, using principles of critical appraisal Develop an approach to self-directed learning [Professional] Interact with patients in a compassionate, empathetic and altruistic manner. Recognize his or her limitations and seek appropriate help when necessary. Maintain patient confidentiality. Understand the current legal and ethical aspects of consent for surgery, anesthesia, and blood transfusion. Understand full and honest disclosure of error or adverse events Understand initiatives, such as the Operating Room Checklist which have been undertaken to ensure patient safety and to minimize medical error in the perioperative period. Fulfill all obligations undertaken, including educational obligations. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 71

THE PROGRAM: Clerkship (Years 3 & 4)


(Anesthesia, Course Objectives, continued)

B. EDUCATIONAL CORE OBJECTIVES


I. SKILLS At the completion of the Anesthesia Clerkship rotation, the third year medical student should be able to demonstrate basic proficiency in the following skills. These skills may be acquired during the clinical rotation, seminars or simulation day. Technical Skills: One of each must be attempted or completed. 1. Airway insertion 2. Cardiac monitor lead placement 3. Endotrachael intubation 4. Laryngeal mask insertion 5. Mask ventilation 6. Peripheral IV insertion Interpretive Skills: One of each must be completed. 1. Capnography 2. Cardiac Monitor 3. Pulse Oximetry 4. Airway assessment II. PROBLEM-BASED Upon completion of the Anesthesia Clerkship rotation, the third year medical student should be able to demonstrate an approach, including differential diagnosis and management, for the following patient encounters. These may be based on either real or simulated encounters. Required: One encounter of each is required: 1. Hypotension/Shock (Observe and manage with faculty or resident) 2. Hypoxia/Apnea (Observe and manage with faculty or resident) 3. Pain Management (Observe and discuss management with faculty) 4. Preoperative Assessment (Complete independently and discuss with faculty) Other encounters: 1. Altered Consciousness/Coma 2. Anaphylaxis 3. Anemia 4. Arrhythmia 5. Cholinesterase Deficiency 6. Complex regional pain syndrome 7. Cyanosis 8. Delirium 9. Difficult Airway 10. 11. 12. 13. 14. 15. 16. 17. Hypercarbia Hypothermia Malignant Hyperthermia Nausea/ Vomiting Obstetrical Pain Management Pediatric Resuscitation Regional Anesthesia Trauma

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: DERMATOLOGY (3 days + self-study)


Course Director Dr. Perla Lansang perlalansang@gmail.com Site Directors/Assistants Site Director (Faculty) SMH Dr. Dave Adam dnadam@gmail.com SHSC Dr. Perla Lansang perlalansang@gmail.com TWH Dr. Sanjay Siddha siddhasanjay@hotmail.com WCH Dr. Jensen Yeung jensen.yeung@utoronto.ca Course Administrator Michelle Mooney michelle.mooney@sunnybrook.ca

Assistant Michelle Mooney michelle.mooney@sunnybrook.ca Michelle Mooney michelle.mooney@sunnybrook.ca Tina Meilach tina.meilach@uhn.ca Tania Hibbs tania.hibbs@wchospital.ca

The Dermatology course consists of three elements: 1. Three half-day clinics 2. Eight online cases (individual work) 3. Written Exam The clinics are held within the Family Medicine rotation. By the end of the six-week Family Medicine block, the clerks are expected to have completed the eight online cases and to have submitted their answers electronically to the course coordinator for marking. The course concludes with a computer-based exam. In addition to the aforementioned course work, course materials in the form of a syllabus and online atlas are provided to students, covering all the topics that they are expected to learn during their Dermatology course. ASSESSMENT Clinic assessment (3 x 10%) Online cases (8 x 5%) Final written examination (50%) For details, including grading regulations, see the Dermatology webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/DER_310Y.htm

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THE PROGRAM: Clerkship (Years 3 & 4)


(Dermatology, continued)

COURSE OBJECTIVES At the conclusion of the clerkship in dermatology, the student will be able to: [Medical Expert / Skilled Clinical Decision Maker] Obtain and document a complete and focused medical history. Perform and document a complete and focused dermatological and related physical examination. Accurately apply dermatological terms to normal and abnormal features on physical exam. Identify and demonstrate normal and abnormal features on general skin exam. Recognize dermatological manifestations of internal disease. Demonstrate an understanding of the role of the immune system in the pathogenesis of skin disease. Formulate a basic practical approach to the investigation of dermatological conditions. Integrate history, physical and laboratory test findings into a meaningful diagnostic formulation. Demonstrate an understanding of basic pathophysiology and treatment of common skin conditions. [Communicator / Doctor-Patient Relationship] Communicate effectively with patients and family through verbal, written and other non-verbal means of communication. Demonstrate the importance of cooperation and communication among health professionals. [Collaborator] Recognize the importance of collaboration with other health care professionals in achieving optimal dermatological patient care. Describe the roles and expertise of all interdisciplinary team members that are required to achieve optimal dermatological patient care. Demonstrate the ability to accept, consider, and respect the opinions of other interdisciplinary team members. [Manager] Demonstrate an understanding of the appropriate use of health care resources in the dermatological context. [Health Advocate / Community Resources] Describe the determinants of health and principles of disease prevention and behaviour change pertinent to dermatological disease, including but not limited to skin cancer and occupational skin disease. [Scholar] Demonstrate the ability to engage in self-directed learning and critical inquiry. Assist in teaching others and facilitating learning where appropriate

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THE PROGRAM: Clerkship (Years 3 & 4)


(Dermatology, Course Objectives, continued)

[Professional] Recognize and accept the need for self-care and personal development as necessary to fulfilling ones professional obligations and leadership role. Demonstrate altruism, honesty and integrity and respect in all interactions with patients, families, colleagues, and others with whom physicians must interact in their professional lives. Demonstrate compassionate treatment of patients and respect for their privacy and dignity and beliefs. Be reliable and responsible in fulfilling obligations. Recognize and accept the limitations in his/her knowledge and clinical skills Abide by the University/Faculty codes of professional conduct. Describe the threats to medical professionalism posed by the conflicts of interest which can occur in the practice of medicine. Demonstrate a sound grasp of the theories and principles governing ethical decision-making, the major ethical dilemmas in medicine, and an approach to resolving these.

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: EMERGENCY MEDICINE (4 weeks)


Course Director Dr. Laura Hans hansl@smh.ca Site Directors/Assistants Site Director (Faculty) CVH Dr. Mike Cohen mike.cohen@utoronto.ca MSH Dr. Laura Hans hansl@smh.ca NYGH Dr. John King jking@nygh.on.ca SJHC Dr. Richard Kim richardskim7@gmail.com SMH Dr. Laura Hans hansl@smh.ca SHSC Dr. Lisa Thurgur lthurgur@sympatico.ca TEGH Dr. George Porfiris gporfiris@rogers.com TGH Dr. Peter Switakowski pswitakowski@rogers.com TSH Dr. Caroline Thompson cjthomps@rogers.com THC Dr. Catherine Grenier mmcgrenier@yahoo.ca Course Administrator Nancy Medeiros em.undergrad@utoronto.ca

Assistant Christine Hall chall@cvh.on.ca Nancy Medeiros nancy.medeiros@utoronto.ca Virginia Fletcher vfletche@nygh.on.ca Lina Lorzano emergadmin@smh.toronto.on.ca Paola Tiveron paola.tiveron@sunnybrook.ca Vivian Bryan vbrya@tegh.on.ca Julie Johnston julie.johnston@uhn.on.ca Madelaine Wimbs mwimbs@tsh.to Paty Callaghan pcallaghan@thc.on.ca

The Emergency Medicine Clerkship is a four-week experience that integrates core didactic teaching in Emergency Medicine and a clinical placement in one of ten Emergency Departments throughout the Greater Toronto Area. Students complete 15 shifts, including up to two weekends and three overnight shifts. The course includes didactic teaching in the form of three days of hands-on workshops and seminars utilizing simulation, skills-based teaching, and case-based interactive sessions. These sessions provide opportunities to acquire important knowledge and skills in preparation for the clinical experience, and cover topics such as airway management, cardiac dysrhythmias, trauma, toxicology, chest pain, wound management, and splinting. During the clinical experience in the Emergency Department, the clerk functions as a member of an interprofessional team working closely with the Attending Emergency Physicians and managing the spectrum of patients that present to the Emergency Department. Each clerk is assigned one or two preceptors with whom at least half their shifts occur. This preceptor will meet with the clerk at mid-rotation to provide feedback and again at the end of the rotation. The preceptor will complete the formal clinical evaluation at the end of the rotation. This evaluation is based on shift evaluation cards completed by staff physicians who have worked with the student and the preceptors own experience with the student.

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THE PROGRAM: Clerkship (Years 3 & 4)


(Emergency Medicine, continued)

Each clerk will spend half a shift with the nursing staff, performing basic procedures (intravenous insertion, venipuncture, foley catheter insertion, NG insertion, ECG) and observing the triage process. This procedure shift is meant to allow students enhanced interprofessional experience while learning important skills. ASSESSMENT Written examination (50%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (50%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Emergency Medicine webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/EMR_310Y.htm COURSE OBJECTIVES By the end of Emergency Medicine Clerkship, the clinical clerk will demonstrate the foundation of knowledge, skills and attitudes necessary for the practice of Emergency Medicine. The clinical clerk will be able to:

A. GENERAL COMPETENCIES

[Medical Expert / Skilled Clinical Decision Maker] Demonstrate the ability to initially assess and manage common problems presenting to the Emergency Department (ED) (see B.II below) Demonstrate the ability to distinguish seriously ill or injured patients from those with minor conditions. Demonstrate a focused history and physical examination. Develop a working differential diagnosis and management plan. Develop plans for investigations and interpret these investigations. Understand and explain the risks and benefits of investigations and treatments. Demonstrate competency in basic procedural skills relevant to the ED (see B.I below) Demonstrate skills in time management. [Communicator / Doctor-Patient Relationship] Communicate effectively and empathetically with patients and their families. Demonstrate thorough and clear documentation and charting, with concise recording of pertinent positive and negative findings. Demonstrate the ability to council and educate patients and families in the ED. Provide clear discharge instructions for patients and ensure appropriate follow-up care. Demonstrate the ability to present a patient case in a clear, concise and complete manner.

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[Collaborator] Establish and maintain effective working relationships with colleagues and other healthcare professionals. Demonstrate an understanding of the concept of triage and prioritization of care in management of multiple patients simultaneously. Discuss the roles of the various providers of prehospital care and the role of the Emergency Physician in prehospital care. Demonstrate knowledge of community resources available to the ED. Respect the role of the patients primary care physician by soliciting input in the assessment, in the development of the care plan, and in follow-up. [Manager] Demonstrate appropriate and cost-effective use of investigations and treatments. Develop organizational skills and efficiency in managing patients and maintaining patient flow. Develop an understanding of the factors contributing to resource issues in the ED. [Health Advocate / Community Resources] Demonstrate an awareness of the underlying psychosocial and socioeconomic problems that may precipitate an ED visit. Discuss the role of the ED in the health care system and how it relates to other hospital and community health services. Demonstrate an understanding of legal and ethical issues surrounding emergency care. Identify opportunities for primary prevention in the ED and council patients accordingly. [Scholar] Access and critically appraise the literature relevant to ED care. Understand the many unique learning and teaching opportunities available in Emergency Medicine. [Professional] Attend scheduled and assigned teaching and clinical responsibilities in a timely fashion. Communicate with educational administrators and clinicians when not able to attend scheduled assignments in a timely fashion. Recognize and accept his or her limitations and know when to ask for help. Protect information provided by or about patients, keeping it confidential, and divulge it only with the patient's permission except when otherwise required by law. Be reliable and responsible when fulfilling obligations. Recognize situations where common medical errors may occur in the ED.

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B. EDUCATIONAL CORE OBJECTIVES


I. SKILLS By the end of the EM Clerkship rotation, the student should be able to demonstrate basic proficiency in the following skills. Competencies to complete these skills may be acquired during clinical shifts, seminars, workshops or on other rotations. Technical Skills: 1. airway assessment/management 2. Casting/splinting 3. wound care (including local anesthetic, simple suturing, dressing) Interpretive Skills: 1. cardiac monitor (rhythm interpretation) 2. electrocardiograms (MI & rhythm) 3. plain radiographs (extremity, chest) II. PROBLEM-BASED By the end of the EM Clerkship rotation, the student should be able to demonstrate an approach to patients presenting to the Emergency Department (based on real or simulated encounters) with the following problems (including differential diagnosis, investigations, and initial treatments): 1. 2. 3. 4. 5. 6. 7. Abdominal pain Altered level of consciousness Anaphylaxis/severe allergic reaction Arrhythmia Chest pain First trimester bleeding Fracture/Sprain 8. 9. 10. 11. 12. 13. Headache Hypotension/Shock Overdose/Toxicology Seizure Shortness of Breath Trauma

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COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: FAMILY MEDICINE (6 weeks)


Course Director Dr. Azadeh Moaveni a.moaveni@utoronto.ca Site Directors/Assistants Site Director (Faculty) CVH Dr. Jean Hudson jhudson@cvh.on.ca MSH Dr. Melissa Nutik mnutik@mtsinai.on.ca NYGH Dr. Jordana Sacks jordana.sacks@gmail.com Dr. Sharonie Valin sharonie.valin@utoronto.ca SJHC Dr. Nadine Laraya larayn@stjoe.on.ca Dr. Priya Sood soodpr@stjoe.on.ca SMH Dr. Karen Weyman k.weyman@utoronto.ca SHSC Dr. Sherylan Young sherylan.young@sunnybrook.ca TSH Dr. Dave Wheler dave.wheler@rogers.com TEGH Dr. Lisa Ilk lisa.ilk@utoronto.ca TWH Dr. Sarah Fleming sarah.fleming@uhn.on.ca Dr. Sabrina Akhtar sabrina.akhtar@uhn.on.ca THC Dr. Ruby Alvi ralvi@summervillefht.com WCH Dr. Dara Maker dara.maker@utoronto.ca ROMP Dr. Leslie Hutchings la_hutchings@hotmail.com Course Administrator Samantha Fortunato family.undergrad@utoronto.ca

Assistant Laura Champagne lchampagne@cvh.on.ca Paula Darocha pdarocha@mtsinai.on.ca Michelle Madhoo michelle.madhoo@nygh.on.ca Helen Flynn flynnh@stjoe.on.ca Ed Ang ange@smh.ca Erin Tigchelaar erin.tigchelaar@sunnybrook.ca Janet Singh jsingh@fhc-chc.com Lydia Lamberti lydia.lamberti@uhn.on.ca Paty Callaghan pcallaghan@thc.on.ca Donna Feeney donna.feeney@wchospital.ca Kristin Earles kearles@romponline.com

Students experience family medicine at a Family Medicine Teaching Unit or a community family physicians office or a combination of both teaching environments over the course of 40 or more clinical half-days. The sixweek rotation exposes students to different models of practice including various components of primary care reform and strives to have students learn in an interprofessional environment.

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(Family Medicine, continued)

Clerks are responsible for taking complete histories and performing physical examinations, as well as formulating differential diagnoses and management plans. All patients seen by clerks are reviewed by a staff physician. Students are expected to research patients health promotion, disease prevention, and diagnoses through the use of appropriate texts and journals. The initial week of the family medicine rotation includes mandatory central core seminars which are undertaken by students from all sites (including the Rural Ontario Medical Program). Core seminars cover topics including common infections, office emergencies, pelvic exam training, family violence, global and resource poor health, palliative care, and geriatrics. Students also have three half days of Dermatology within their family medicine rotation. Other seminars are site-based and are also mandatory. These include well-baby care, obstetrics, and others at each sites discretion. Clinical elective half-days may also be available depending on the site and may include family medicine obstetrics, home visits, inpatient (hospitalist) care, sexual health, environmental medicine, etc. ASSESSMENT Written examination (32%) Written project on a clinical problem o Abstract (4%) o Presentation (8%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (40%) Clinical evaluation exercises (CEXs) (16%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Family Medicine webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/FCM_310Y.htm

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COURSE OBJECTIVES By the end of Family Medicine Clerkship, the clinical clerk will demonstrate the foundation of knowledge, skills and attitudes necessary for the practice of Family Medicine. Family medicine is now recognized as a specialty based on a body of knowledge and an approach to care unique to its discipline. Because family physicians commitment is to the person and not to a particular organ system, age group, or technique, they must be skilled in accepting responsibility for the full scope of care of patients in health and illness at all stages of the life cycle. While facets of this comprehensive patient-centred approach are present in the care provided by others, no other discipline has all of these tenets as its core raison dtre. This approach is described according to the four principles of family medicine: 1. The family physician is a skilled clinician 2. The patient-physician relationship is central to the family physicians role 3. The family physician is a resource to a defined population 4. Family medicine is community-based

BACKGROUND

A. GENERAL COMPETENCIES

Adapted from CanMEDS-FMU: Undergraduate Competences from a Family Medicine Perspective, The College of Family Physicians of Canada. The learner will: [The Family Medicine Expert] Be able to describe how illness presents differently in the family medicine setting compared to other specialist settings and demonstrate an approach to the diagnosis and management of undifferentiated patient problems that present to family physicians. Demonstrate an approach to the diagnosis and management of common patient problems that present to family physicians. Use patient-centred record-keeping when caring for patients. Be able to obtain informed consent appropriate to their level of care. Use the patient-centred clinical method to conduct a supervised office visit for common presentations. Be able to describe common sources of error in the assessment and management of patients. Be able to identify what health-promotion and disease-prevention activities are appropriate to particular populations using evidence-based guidelines. Demonstrate an approach to health promotion and disease prevention during patient encounters that reflect best evidence and patient preferences and values. Identify pharmacotherapeutic approaches to primary care conditions based upon the patients context and issues such as pharmacodynamics, pharmacokinetics, adverse effects and important drug interactions. Have an approach to polypharmacy. Demonstrate the correct technique in common office procedural skills. Understand the family physicians role in maternity care, palliative care and other settings in which family physicians work. Appreciate the value of continuity of care for developing a deep knowledge of patients. Demonstrate application of an ethical framework in the clinical decision-making process.

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[The Family Medicine Communicator] Recognize that the patient-physician relationship is central to the practice of family medicine in allowing therapeutic relationships with patients to developthe insights gained from the family medicine perspective will support learners in developing and understanding these relationships. Demonstrate a willingness to become involved in the full range of difficulties which patients bring to their physicians and not just their biomedical problems. Be able to carry out a patient-centred interview. Demonstrate skills in finding common ground with patients. Encourage patients to take as active a role as they are comfortable with in collaborating in deciding on a treatment plan. Demonstrate respect for patient confidentiality, privacy and autonomy. Demonstrate sensitivity to cultural differences between physicians and patients and encourages patients to help their physician to understand these. Recognize the importance of doctor-patient boundaries and can describe common situations that create a risk for boundary violation. Present verbal reports of clinical encounters that summarize the key findings in a succinct, wellorganised manner that highlights the clinical reasoning process and provides a clear rationale for investigation and management. [The Family Medicine Collaborator] Experience working in a collaborative team-based model as well as consult other health care professionals in the care and the continuity of care of their patients. Demonstrate an understanding of the principles of maintaining a positive working environment with consulting health professionals, health care team members and community agencies. Demonstrate an understanding of how to engage patients or specific groups of patients (population) as active participants in their care (empowerment). [The Family Medicine Manager] Demonstrate an understanding of the role of the family physician, family medicine and primary health care in the overall function of the health care system. including family physician roles in office based care, emergency care, inpatient and ambulatory hospital care, primary obstetrical care, continuing and long term care, and public health. Describe the key elements of a family practice. Describe the supports and resources that enable family physicians to maintain a healthy work-life balance.

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[The Family Medicine Health Advocate] Be able to identify the health needs of an individual patient and how to work with this patient to improve their health. Demonstrate an understanding of that fact that the patient is part of a network that can be drawn upon (e.g. family, community, workplace) but also be able to identify that stressors related to these networks can limit advocacy and care. Be able to describe the attributes of a population they have worked with or are working with and will be able to identify the initial steps on how to work with this population to improve its health. Be able to take a history that includes the non-biological determinants of health. Demonstrate application of an ethical framework in the clinical decision-making process and be able to identify that there can be competing demands in their role as an advocate for both patients and populations. Demonstrate an understanding of the range of organizations that promote the well-being of his or her patients (e.g., community agencies, self-help groups) and how to identify and work with these groups when appropriate. Be able to identify evidence based health promotion and disease prevention recommendations appropriate for populations. [Family Medicine Scholar] Demonstrate self-directed learning based on reflective practice. Be able to demonstrate an evidence-based approach to decision making within a patient centered clinical method. Prepare a learner-centered educational presentation or activity for peer colleagues and/or patients and families. Provide constructive feedback for a peer presentation or learning activity. [The Family Medicine Professional] Demonstrate an understanding of the key components of a professional relationship. Be seen to be altruistic, behaving in a manner consistent with putting a patients best interests first. Be respectful to patients, their families, colleagues and other members of the health care team. Be known as being honest, and will disclose areas of uncertainty, and promptly and voluntarily identify any errors of omission or commission. Be seen to be responsible, by completing required tasks , meeting timelines on schedule, and promptly bringing to their preceptors attention when task completion is delayed or not possible. Show evidence of striving towards personal balance (health, family, social, etc) as this will improve their ability to maintain professional standards of practice. Understand the patient, personal, and professional impact of medical error.

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B. EDUCATIONAL CORE OBJECTIVES:


I. SKILLS By the end of the Family Medicine Clerkship rotation, the student should be able to demonstrate basic proficiency in at least the following skills. Competencies to complete these skills may be acquired during clinical hours, seminars, workshops or on other rotations. 1. Pap Smear 2. Throat Swab II. PROBLEM-BASED By the end of the Family Medicine Clerkship rotation, the student should be able to demonstrate an approach to patients presenting to the Family Physicians Office (based on real or simulated encounters) with the following problems (including differential diagnosis, investigations and initial treatments): 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Abdominal pain Anxiety Asthma Chest Pain Contraception Cough/Dyspnea Depression Diabetes Type II Dizziness Fatigue 11. Fever 12. Headache 13. Hypertension 14. Ischemic Heart Disease 15. Low Back Pain 16. Palliative Care 17. Prenatal Care 18. Well Adult Female 19. Well Adult Male 20. Well Baby/Child

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COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: MEDICINE (8 weeks)


Course Director Dr. Danny Panisko danny.panisko@uhn.on.ca Site Directors/Assistants Site Director (Faculty) MSH Dr. Luke Devine ldevine@mtsinai.on.ca Dr. Ken Locke ken.locke@utoronto.ca TGH Dr. Katina Tzanetos katina.tzanetos@uhn.ca Dr. Cheryl Jaigobin cheryl.jaigobin@uhn.ca TWH Dr. Nadine Abdullah nadine.abdullah@uhn.ca Dr. Caroline Chessex caroline.chessex@uhn.ca SHSC Dr. Lynfa Stroud lynfa.stroud@sunnybrook.ca Dr. Gregory Choy gregory.choy@sunnybrook.ca WCH Dr. Jeff Stal jeff.stal@wchospital.ca SMH Dr. Yuna Lee leeyuna@smh.ca Course Administrator Sumitra Robertson med.undergrad@utoronto.ca

Assistant Jeannette Moniz jmoniz@mtsinai.on.ca Daisy Troiano daisy.troiano@uhn.ca Stephanie Ferguson stephanie.ferguson@uhn.ca Sally Ganesh sally.ganesh@sunnybrook.ca Vaughn Gillson vaughn.gillson@wchospital.ca Betty-Ann Lemieux lemieuxb@smh.ca

The Medicine Clerkship is eight weeks in duration, and each clerk is assigned to a single Internal Medicine Team for the entire rotation. The course begins in the first week with a seminar series over several half-days. Over the entire length of the course, there is a graduated experience with increasing responsibility as the rotation progresses. Students have the opportunity to perform the admitting history and physical examinations on patients who present to the Emergency Room, and are asked to provide a provisional diagnosis and differential diagnosis, and to construct an investigation and management plan. They also provide direct patient care for their assigned patients. Later in the rotation, students carry more patients (up to six per student) and have enhanced responsibilities for patients while on call. Support is provided by other members of the team, including the attending physician and supervising residents. Students are also assigned to six half-days in ambulatory clinics so that they have an opportunity to learn about how care is delivered to medical patients in this setting.

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(Medicine, continued)

ASSESSMENT Written examination (35%) Clinical oral examination (20%) Self-directed EBM learning project (5%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation o Ward (30%) o Ambulatory clinics (10%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Medicine webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/MED_310Y.htm COURSE OBJECTIVES At the conclusion of the clerkship in Internal Medicine, the medical student will be able to: [Medical Expert / Skilled Clinical Decision-Maker] Demonstrate knowledge of the scientific and humanistic foundations of medicine in order to more rationally diagnose and manage the various factors contributing to a patients illness. Demonstrate a thorough knowledge of internal medicine. This has three dimensions: a. Relevant aspects of common and life-threatening illnesses affecting adults in terms of: i. Definition ii. Epidemiology iii. Etiology - biological, psychological, social, economic, legal, ethical, and cultural iv. Pathogenesis and pathophysiology v. Clinical features vi. Complications vii. Investigations required to confirm a diagnosis viii. Principles of prevention ix. Principles of management - medical, surgical, involvement of allied health professionals, nutritional x. Prognosis b. An approach to the diagnosis of the major presenting problems encountered in internal medicine. In order to do this, the student needs to be able to: i. List in an organized fashion the major causes of each of these problems ii. List the most important or life-threatening causes of each problem iii. Explain how data that may be obtained from the history and physical examination will affect the likelihood of these diagnostic possibilities for each problem iv. Understand the appropriate use and interpretation of diagnostic tests (see below) c. The properties of medical therapies, in terms of their indications, contraindications, mechanisms of action, side effects, and monitoring.

A. GENERAL COMPETENCIES

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[Medical Expert / Skilled Clinical Decision-Maker] Demonstrate clinical skills: a. Students should be able to obtain and document both a complete and a focused medical history, as the situation requires. b. Students should be able to perform and document both a complete and a focused physical examination, as the situation requires. In order to do this, students must be able to demonstrate: i. An understanding of the physiologic basis of clinical findings ii. A logical, comprehensive, organized approach to the physical examination that is adaptable to specific circumstances iii. Proper techniques of physical examination iv. Appropriate attention to patient comfort, hygiene, and privacy v. An understanding of the significance of, and the ability to detect the presence of, the most important physical examination abnormalities pertinent to internal medicine. c. Students should be able to interpret commonly-employed diagnostic tests, knowing their indications, contraindications, risks, and in general terms their test characteristics (sensitivity and specificity). d. Students should be able to integrate the above history, physical findings, and diagnostic test results into a meaningful diagnostic formulation by: i. Generating a problem list ii. Generating a differential diagnosis for each of the problems, and suggest a tentative or provisional diagnosis e. Students should be able to demonstrate therapeutic and management skills. In order to do this, the student needs to be able to: i. Suggest appropriate additional investigations for each problem ii. Propose a management strategy for each of the problems based on a knowledge of efficacy, risk and cost. By the end of the Clerkship, students should be able to write admitting orders for each of the common diagnoses encountered in internal medicine. f. Students should be able to demonstrate the technical skills necessary to perform several of the common procedures used in internal medicine, as well as show that they understand the indications, risks and benefits of these procedures. Make use of evidence-based medicine so that they can better diagnose and manage patient problems. [Communicator / Doctor-Patient Relationship] Communicate effectively with patients, their families and the community through verbal, written, and other non-verbal means of communication. Establish professional relationships with patients, their families (when appropriate), and community that are characterized by understanding, trust, respect, empathy, and confidentiality. Deliver information to the patient and family (as appropriate) in such a way that it is easily understood, encourages discussion, and promotes the patients participation in decision-making. Gather information, negotiate a common agenda, and develop and interpret a treatment plan, while considering the influence of factors such as the patients age, gender, ethnicity, cultural and spiritual values, socioeconomic background, medical conditions, and communication challenges. Present a case summary orally in a clear, logical, and focused manner. Document in writing all aspects of the patient encounter in the patient chart.

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[Collaborator] Describe the roles and expertise of all members of the interdisciplinary team that are involved in the care of patients with an internal medicine problem. Develop a care plan for a patient he/she has assessed, including investigation, treatment and continuing care, in collaboration with the members of the interdisciplinary team. Participate in interdisciplinary team discussions, demonstrating the ability to accept, consider, and respect the opinions of other team members, while contributing an appropriate level of expertise to patient care. [Manager] During the clerkship in internal medicine, the medical student will deepen his/her understanding of the appropriate use of health care resources in the internal medicine context. Students are also expected to manage their own time in an efficient manner. [Health Advocate / Community Resources] Accept appropriate responsibility for the health of patients assigned to their care. Recognize important determinants of health and principles of disease prevention pertinent to internal medicine. Act as an advocate on behalf of patients assigned to their care, when interacting with other members of the health care team. [Scholar] Demonstrate the ability to engage in self-directed learning. Assist in teaching others and in the facilitation of their learning where appropriate. Demonstrate the ability to search the evidence-based medicine literature for evidence to support the diagnostic and therapeutic management of their patients. [Professional] Behave in an altruistic manner. Demonstrate reliability and a strong sense of responsibility. Demonstrate a commitment to excellence via self-improvement and adaptability. Demonstrate respect for others, as in the course of relationships with students, faculty and staff. Demonstrate honour and integrity by upholding student and professional code of conduct.

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B. EDUCATIONAL CORE OBJECTIVES


I. SKILLS By the end of this internal medicine clerkship rotation, the student should be able to demonstrate basic proficiency in the following procedural and interpretive skills. Competence to complete these skills may be acquired during clinical shifts, seminars, bedside teaching or on other rotations. 1. Arterial blood gases 2. Diagnostic imaging (chest, abdomen, and brain) 3. Electrocardiograms (MI, rhythm, conduction blocks, etc.) 4. Diagnostic Laboratory Results (biochemistry, haematology, microbiology) II. PROBLEM-BASED By the end of this internal medicine clerkship rotation, the student should be able to demonstrate an approach to patients presenting with the following problems (including differential diagnosis, investigations and appropriate further investigations and management plans for each of the identified problems): Cardiorespiratory Cardiac arrest / respiratory arrest Chest discomfort Cough Cyanosis / hypoxemia / hypoxia Dyspnea Edema Hemoptysis Hypercarbia Hypoxemia and hypoxia Insomnia / sleep-apnea syndrome Murmurs / extra heart sounds Palpitations (abnormal ECG, arrhythmias) Shock, hypotension Syncope, presyncope, loss of consciousness Wheezing Gastrointestinal / hepatobiliary Abdominal pain Ascites Abnormal liver enzyme levels Blood in stool (hematochezia and melena) Constipation Diarrhea Dysphagia Hematemesis Abnormalities of liver synthetic function Jaundice Vomiting, nausea Hematologic/oncologic Leukocytosis Leukopenia Anemia Bleeding tendency/bruising Lymphadenopathy, Splenomegaly Polycythemia Febrile neutropenia Rheumatologic Joint pain (mono-articular and poly-articular) Painful limb Back pain Neurological Coma / impaired consciousness Confusion / delirium Dementia / memory disturbances Diplopia Dizziness / vertigo Gait disturbances /Ataxia Headache Numbness and tingling Pupil abnormalities Seizures Speech and language abnormalities Tremor Visual disturbance / loss Weakness / paralysis

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Renal / fluid-electrolyte Metabolic acidosis and alkalosis Respiratory acidosis and alkalosis Hypo- and hyperkalemia Hypo- and hypernatremia Hematuria Hypertension Proteinuria Urinary frequency (associated with dysuria; associated with polyuria) Oliguria Endocrine Hyperglycemia Hypo- and hypercalcemia Hypo- and hyperphosphatemia Hirsutism and virilisation

Geriatrics Falls Failure to thrive (elderly) Urinary incontinence (elderly) Polypharmacy Capacity assessment Other topics Allergic reactions Dying patient Fatigue Fever and chills Pain Overdose Pruritus Substance abuse / addiction, withdrawal Weight gain / loss, obesity / malnutrition

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COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: OBSTETRICS & GYNAECOLOGY (6 weeks)


Course Director Dr. Filomena Meffe filomena.meffe@utoronto.ca Site Directors/Assistants Site Director (Faculty) SMH Dr. Sari Kives kivess@smh.ca SHSC Dr. Dini Hui dini.hui@sunnybrook.ca MSH Dr. Michael Sved michaelsved@bellnet.ca NYGH Dr. Sabrina Lee sabrina.lee@utoronto.ca SJHC Dr. Suzanne Wong wongsu@stjoe.on.ca TEGH Dr. Maja Gans majagans@sympatico.ca THC Dr. Dalip Bhangu dbhangu@thc.on.ca CVH Dr. Scott Tigert scott.tigert@gmail.com Course Administrator Maria Wowk maria.wowk@utoronto.ca

Assistant Angela LaCroix lacroixa@smh.ca Gregor Campbell obgyn@sunnybrook.ca Sylvia Muir smuir@mtsinai.on.ca Arlyne Gumangi Arlyne.gumangi@nygh.on.ca Megan Marshall marshme@stjoe.on.ca Joanne Mount j.mount@utoronto.ca Paty Callaghan pcallaghan@thc.on.ca Tammy Ramnarace tramnarace@cvh.on.ca

In this course, each student spends six weeks participating in a variety of clinical activities related to womens healthcare, including rotations in labour and delivery, inpatient antenatal and postpartum units, antenatal clinics, gynaecologic ambulatory care, and inpatient gynaecology units. In addition to clinical activities, the students attend small-group teaching seminars on a range of obstetrical and gynaecological topics. In all clinical settings, the student is responsible for taking complete obstetrical and gynaecological histories. Students also have the opportunity to develop their pelvic examination skills under the supervision of their clinical teacher and with the consent of the patient. Students are expected to formulate differential diagnoses and management plans. All patients seen by the student are reviewed by the obstetrics and gynaecology resident or by a staff physician. A comprehensive orientation is provided on the first day of the clerkship rotation. The approach to the pelvic examination is initially taught through the use of pelvic exam videos and practice on pelvic models with supervision by a faculty member and/or resident. This initial instruction is further consolidated when students have an opportunity to perform the pelvic examination in the clinical setting. A standardized seminar series designed for the Clerkship level and characterized by active participation, problem-solving, and reflection is conducted by staff physicians at each of the main teaching hospital sites. In addition to the seminar series, each hospital site conducts its own set of teaching and/or grand rounds meant for the hospital staff, which students are also expected to attend.

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(Obstetrics & Gynaecology, continued)

ASSESSMENT Written examination (33.3%) Clinical oral examination (33.3%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (33.3%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Obstetrics & Gynaecology webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/OBS_310Y.htm COURSE OBJECTIVES The Obstetrics & Gynaecology Clerkship rotation is designed to further develop and consolidate the knowledge, skills and attitudes acquired in Preclerkship and to achieve clinical competence in managing common and important clinical problems that women may present with in the discipline of obstetrics and gynecology. The Obstetrics & Gynaecology Clerkship objectives are based on the CanMEDS competencies and meet the ED-2 standard of the LCME. With respect to all the general competencies, the medical student should achieve the following: [Medical Expert / Skilled Clinical Decision-Maker] Demonstrate the ability to assess and manage common and important problems which women will present within the discipline of Obstetrics & Gynaecology. Demonstrate the ability to take an obstetrical, gynaecological and sexual history. Develop a working differential diagnosis and management plan. Develop plans for investigation and interpret these investigations Understand and explain the risks and benefits of investigations and treatments. Demonstrate competency in pelvic examination and other basic procedural skills relevant to the discipline of obstetrics and gynaecology [Communicator / Doctor-Patient Relationship] Communicate effectively and empathetically with patients and their families. Ensure that women have given informed consent before conducting and/or being present for examinations or procedures. Communicate effectively, respectfully and empathetically with women while performing and/or assisting at examinations and/or procedures. Demonstrate thorough and clear documentation and charting with concise recording of pertinent positive and negative findings. Demonstrate the ability to council and educate patients and families. Provide clear discharge instructions for patients and ensure appropriate follow-up care. Demonstrate the ability to present a patient case in a clear, concise, and complete manner.

A. GENERAL COMPETENCIES

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(Obstetrics & Gynaecology, Course Objectives, continued)

[Collaborator] Establish and maintain effective working relationship with colleagues and other health care professionals. Demonstrate an understanding of the concept of triage and prioritization of care in management of multiple patients simultaneously in the labour and birth unit. Demonstrate knowledge of other resources available to women when providing prenatal, intrapartum, postpartum, and gynaecological outpatient and inpatient care. Maintain respect for the role of the patients primary care provider by ensuring that the provider is informed about the patients care plan. [Manager] Demonstrate appropriate and cost-effective use of investigations and treatments. Develop an understanding of the organizational skills and efficiency required in managing patients and maintaining patient flow. Develop an understanding of the factors contributing to resource issues in outpatient prenatal and gynaecology clinics, in-hospital labour and birth and postpartum units, and inpatient gynaecologic and peri-operative services. [Health Advocate / Community Resources] Respond to the individual womans health care needs and issues as part of patient care. Understand the health needs of the community of women served by the health care unit. Identify the determinants of health of the population of women that are served by the health care unit. Understand methods to promote the health of individual women, communities, and populations. [Scholar] Access and critically appraise the literature relevant to obstetrics and gynecology care. Understand the many unique learning and teaching opportunities available in obstetrics and gynaecology. [Professional] Attend scheduled and assigned teaching and clinical responsibilities in a timely fashion. Communicate with educational administrators and clinicians when not able to attend scheduled assignments in a timely fashion. Recognize and accept his or her limitations and know when to ask for help. Protect information provided by or about patients, keeping it confidential, and divulge it only with the patients permission except when otherwise required by law. Be reliable and responsible in fulfilling obligations. Recognize situations where common medical errors may occur.

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(Obstetrics & Gynaecology, Course Objectives, continued)

B. EDUCATIONAL CORE OBJECTIVES


I. SKILLS By the end of the Obstetrics and Gynaecology Clerkship rotation, the medical student should be able to perform the skills/procedures listed below. Competency to complete these skills may be acquired during clinical shifts, seminars, workshops, or simulations. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Bimanual pelvic examination Vaginal speculum insertion Cultures of vagina and cervix Pap test Fetal heart rate tracing interpretation normal and abnormal tracings Fetal heart auscultation with doptone Leopold manoeuvres Symphysis fundal height measurement GBS (group B streptococcus) culture for antenatal screening Nitrazine test for SROM Fern testing for SROM (spontaneous rupture of membranes) Cervical examination during labour Spontaneous vaginal birth Delivery and examination of placenta Obtaining cord blood

II. PROBLEM-BASED By the end of the Obstetrics & Gynaecology Clerkship rotation, the student should be able to demonstrate an approach (including differential diagnosis, investigation and initial treatment) to women presenting for antenatal care, intrapartum care, gynaecological consultation (outpatient, inpatient, emergency room), and gynaecologic surgery, based on real or simulated encounters listed with the following issues: Gynaecological: 1. Abnormal vaginal bleeding (pre and postmenopausal) 2. Adnexal mass and/or ovarian cyst 3. Amenorrhea/oligomenorrhea 4. Contraceptive methods 5. First trimester or early second trimester complications: a. Spontaneous abortion b. Unwanted pregnancy and therapeutic abortion c. Ectopic pregnancy d. Recurrent pregnancy loss 6. Dysmenorrhea 7. Dyspareunia 8. Endometriosis 9. Fibroids 10. Genital tract infections 11. Incontinence 12. Infertility 13. Irregular periods 14. Menopausal counselling 15. Pap test counselling 16. Pelvic pain acute and chronic 17. Post-gynaecologic surgery complications 18. Sexual disorders 19. Urogenital prolapse/disorder 20. Vaginal discharge 21. Vulvar lesion or pruritis

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(Obstetrics & Gynaecology, Course Objectives, Problem-Based Objectives, continued)

Obstetrical: 1. Antepartum haemorrhage 2. Assisted birth (vacuum, forceps, Caesarean delivery) 3. Fetal well-being issues: a. Genetic screening and prenatal diagnosis b. Small/large for gestation age fetus c. Management of Rh negative status d. Fetal demise 4. Diabetes in pregnancy 5. Hypertension in pregnancy 6. Induction of labour

7. 8. 9. 10. 11. 12.

Labour progression normal and abnormal Pain management in labour Preterm labour Preterm premature rupture of membranes Nausea and vomiting in pregnancy Postpartum care and complications: a. Postpartum hemorrhage b. Postpartum fever c. Postpartum mood disorder 13. Obstetrical emergencies 14. Obstetrical ultrasound

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COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: OPHTHALMOLOGY (1 week)


Course Director Dr. Kenneth Eng k.eng@utoronto.ca Site Directors/Assistants: Site TWH SHSC SMH MSH HSC Director (Faculty) Dr. Michael Brent mh.brent@utoronto.ca Dr. John Lloyd john.lloyd@sunnybrook.ca Dr. Filberto Altomare altomaref@smh.toronto.on.ca Dr. Baseer Khan baseer.khan@mac.com Dr. Nasrin Tehrani nasrin.tehrani@sickkids.ca Assistant Mirella Marcantonio mirella.marcantonio@uhn.on.ca Charlene Muller charlene.muller@sunnybrook.ca Helen Son sonh@smh.toronto.on.ca Rebecca Scott rscott@mtsinai.on.ca Karen Martin karen.martin@sickkids.ca Course Administrator Francesca Di Leo francesca.dileo@utoronto.ca

The one-week Ophthalmology block is part of the Anesthesia / Emergency Medicine / Ophthalmology / Otolaryngology rotation. During the Ophthalmology portion, students are exposed to a variety of ambulatory ophthalmology patients by attending the eye clinics of their Academy or in the offices of attending ophthalmologists during the first four days. On the fifth day (Friday morning), all students attend seminars at the Hospital for Sick Children (HSC) on paediatric ophthalmology. This paediatric teaching half-day is shared with Otolaryngology. On the fourth Friday of the combined rotation, students take separate written examinations in Ophthalmology, Otolaryngology, and Anesthesia. Students are expected to review the lectures on the Red Eye, Glaucoma, Retina, Neuroophthalmology, Geriatrics, Trauma, and Systemic Diseases independently with lecture notes provided on the course portal. In clinic, students are responsible for taking complete ophthalmic histories and performing relevant ocular examinations on patients, as well as formulating differential diagnoses and plans of management. All patients seen in the clinics/offices are reviewed by an ophthalmology resident/fellow or staff ophthalmologist. Students are expected to research each assigned patient's disease by the use of appropriate texts and journals. Attendance in the operating room is also available to students and may be arranged at their Academy and/or with a supervisor at the beginning of their rotation. Students are not expected to take call, but if interested, they may request to do so through the ophthalmology residents at their hospital or Academy.

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(Ophthalmology, continued)

ASSESSMENT Written examination (65%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (35%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Ophthalmology webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/OPT_310Y.htm COURSE OBJECTIVES By the end of Ophthalmology Clerkship, the clinical clerk will demonstrate the foundation of knowledge, skills and attitudes necessary for the practice of Ophthalmology from the perspective of the primary care physician. The clinical clerk will be able to:

A. GENERAL COMPETENCIES

[Medical Expert / Skilled Clinical Decision-Maker] Demonstrate the ability to initially assess and manage common ophthalmic problems presenting to the primary care physician (see B.II below) Demonstrate: The ability to rapidly recognize and initiate management of ocular emergencies and trauma. A systematic, prioritized approach diagnosing common ophthalmic presentations. The ability to distinguish those ophthalmic conditions requiring immediate referral to an ophthalmologist. Demonstrate a focused history and physical examination for patients presenting with common ocular symptoms. Develop a working differential diagnosis and management plan. Develop plans for investigations and interpret these investigations. Understand and explain the risks and benefits of investigations and treatments. Demonstrate competency in basic diagnostic and procedural skills relevant to the ophthalmic conditions (see B.I below) [Communicator / Doctor-Patient Relationship] Communicate effectively and empathetically with patients and their families. Demonstrate thorough and clear documentation and charting, with concise recording of pertinent positive and negative findings. Demonstrate the ability to manage difficult or violent patients in the eye clinic. Demonstrate the ability to council and educate patients and families in the eye clinic. Provide clear discharge instructions for patients and ensure appropriate follow-up care. Demonstrate the ability to present a patient case in a clear, concise, and complete manner.

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(Ophthalmology, Course Objectives, continued)

[Collaborator] Establish and maintain effective working relationships with colleagues and other health care professionals. Discuss the roles of the various providers of hospital care and the role of the ophthalmologist in triaging consults from the emergency department, operating room, and in-patient units. Demonstrate knowledge of community resources available to the ophthalmologist. Respect the role of the patients primary care physician by soliciting input in the assessment, in the development of the care plan, and in follow-up. [Manager] Demonstrate appropriate and cost-effective use of investigations and treatments. Develop organizational skills and efficiency in managing patients and maintaining patient flow. Develop an understanding of the factors contributing to resource issues in the eye clinic. [Health Advocate / Community Resources] Demonstrate an awareness of the underlying psychosocial and socioeconomic problems that may precipitate an eye clinic visit. Discuss the role of the ophthalmologist in the healthcare system and how it relates to other hospital and community health services. Demonstrate an understanding of legal and ethical issues surrounding ophthalmic care. Identify opportunities for primary and secondary prevention in the eye clinic and council patients accordingly. [Scholar] Access and critically appraise the literature relevant to ophthalmic care. Understand the many unique learning and teaching opportunities available in ophthalmology. [Professional] Recognize and accept his or her limitations and know when to ask for help. Protect information provided by or about patients, keeping it confidential, and divulge it only with the patient's permission except when otherwise required by law. Be reliable and responsible in fulfilling obligations. Recognize situations where common medical errors may occur in the eye clinic.

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(Ophthalmology, Course Objectives, continued)

B. EDUCATIONAL CORE OBJECTIVES


I. SKILLS By the end of the Ophthalmology Clerkship rotation, the student should be able to demonstrate basic proficiency in the following skills. Clinical Examination Skills: 1. Visual acuity measurement 2. Confrontation visual fields 3. Pupil examination 4. Extraocular motility/strabismus examination 5. External/adnexal examination 6. Slit lamp examination 7. Direct funduscopy Technical Skills: 1. Application of eye patch 2. Eversion of eyelid II. PROBLEM BASED By the end of the Ophthalmology Clerkship rotation, the student should understand the following concepts and/or be able to demonstrate an approach to patients presenting to the Emergency Department (based on real or simulated encounters) with the following problems or conditions (including differential diagnosis, investigations and initial treatments): 1. Structure and Basic physiology of the eye (from Brain and Behaviour course) (Aqueous dynamics and glaucoma, Retinal vasculature and function, Extraocular muscle function and innervation, Neuroanatomy of the eye and visual pathways) 2. Refractive Error (Myopica, hyperopia, astigmatism, Presbyopia) 3. Pediatric Ophthalmology (Amblyopia, Congenital cataracts, Strabismus, Orbital cellulitis, Leukocoria) 4. Red Eye (Foreign bodies, Corneal disorders, Conjunctivitis (viral, bacterial, allergic), Uveitis, Acute glaucoma, Complications of contact lenses, Ocular emergencies (see below)) 5. Geriatric ophthalmology (Glaucoma, Cataracts, Macular degeneration, Dry eye) 6. Chorioretinal disorders (Retinal detachment, Diabetic retinopathy, Retinal vascular occlusions, Macular degeneration, Inflammatory conditions) 7. Ocular manifestations of systemic diseases (Diabetes, Hypertension, HIV/AIDS, Thyroid Disease, Oculocutaneous disorders, Autoimmune diseases) 8. Neuroophthalmology (Anisocoria, Swollen optic nerve (papilledema, optic neuritis, anterior ischemic optic neuropathy), Optic atrophy, Diplopia and cranial neuropathies, Visual field defects, Headache and ocular pain) 9. Ocular Emergencies and Trauma (Blunt trauma (including hyphema), Penetrating injuries, Foreign bodies, Alkali injuries) 10. Ocular pharmacology (Diagnostic agents, Therapeutic agents (i. Glaucoma, ii. Antiinfectives, iii. Steroids)

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COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: OTOLARYNGOLOGY (1 week)


Course Director Dr. Paolo Campisi paolo.campisi@sickkids.ca Site Directors/Assistants Site Director (Faculty) HSC Dr. Paolo Campisi paolo.campisi@sickkids.ca MSH Dr. Al Vescan Avescan@mtsinai.on.ca SHSC Dr. Jean Davidson jean.davidson@sunnybrook.ca SMH Dr. Al Chiodo achiodo@rogers.com UHN - PMH Dr. Dale Brown dale.brown@uhn.on.ca Course Administrator Alice Forbes alice.forbes@sickkids.ca

Assistant Alice Forbes alice.forbes@sickkids.ca Caroline Prato cprato@mtsinai.on.ca Lyn Snelling lyn.snelling@sunnybrook.ca Julia Chapman chapmanj@smh.ca Sonia Costantino sonia.costantino@uhn.on.ca

The one-week Otolaryngology block is part of the Anesthesia/ Emergency Medicine / Ophthalmology /Otolaryngology rotation. The Otolaryngology portion takes place at the otolaryngology clinics at the University Health Network, Sunnybrook Health Sciences Centre, St. Michaels Hospital, and Mount Sinai Hospital. Each hospital develops and distributes a site-specific schedule of teaching sessions and clinical experience in the outpatient clinics. The remainder of the time is spent on the wards, in the operating room, on seminars, and in self-directed learning with otoscopy and nasal-packing simulators and online cases. The rotation incorporates a series of on-line seminars, covering common and important topics in otolaryngology including hearing loss, vertigo, epistaxis, rhinosinusitis, emergencies, and head and neck malignancies. Students are also given a paediatric otolaryngology and audiology lecture at the Hospital for Sick Children in conjunction with the Paediatric teaching in Ophthalmology. ASSESSMENT Written examination (80%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (20%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Otolaryngology webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/OTL_310Y.htm

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(Otolaryngology, continued)

COURSE OBJECTIVES By the end of the Otolaryngology Clerkship rotation, the clinical clerk will demonstrate the foundation of knowledge of medical conditions involving the ears, nose, neck and upper aerodigestive tract necessary for the practice of otolaryngology from the perspective of the primary care physician. In addition, the clinical clerk will demonstrate the skills necessary to perform a thorough head and neck examination. The Otolarygology clerkship course follows the CanMEDS Guidelines through both didactic and clinical teaching. The course also provides an opportunity to develop Collaborator and Manager skills through interprofessional collaboration with nursing, audiology and speech-language pathology services. The clinical clerk will be able to:

A. GENERAL COMPETENCIES
[Medical Expert / Skilled Clinical Decision-Maker] Demonstrate the ability to evaluate and manage common ear, nose and throat problems presenting to the primary care physician Demonstrate the ability to rapidly recognize airway and head and neck oncologic emergencies that require immediate referral to an otolaryngologist Demonstrate a focused history and physical examination for patients presenting with common ear, nose and throat symptoms. Develop plans for investigations (diagnostic imaging and audiometry) and interpret those investigations. Develop a differential diagnosis and management plan. [Communicator / Doctor-Patient Relationship] Communicate effectively and empathetically with patients and their families. Demonstrate thorough and clear documentation and charting, with concise recording of pertinent positive and negative findings. Demonstrate the ability to counsel and educate patients and families. Demonstrate the ability to present a patient case in a clear, concise and complete manner. [Collaborator] Establish and maintain effective working relationships with colleagues and other healthcare professionals commonly treating otolaryngology patients (nursing, audiology, speech language pathology). Demonstrate knowledge of community resources available to the otolaryngologist. [Manager] Demonstrate appropriate and cost-effective use of investigations and treatments. Develop organizational skills and efficiency in managing patients and maintaining patient flow. Develop an understanding of the factors contributing to resource issues in the otolaryngology clinic. [Health Advocate / Community Resources] Demonstrate an awareness of the underlying psychosocial and socioeconomic problems that contribute to otolaryngologic problems. Identify opportunities for primary and secondary prevention strategies (smoking cessation, alcohol intake, etc.).
(Otolaryngology, Course Objectives, continued)

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[Scholar] Access and critically appraise the literature relevant to otolaryngology. Understand the many unique learning and teaching opportunities available in otolaryngology. [Professional] Recognize and accept his or her limitations and know when to ask for help. Protect information provided by or about patients, keeping it confidential, and divulge it only with the patient's permission except when otherwise required by law. Be reliable and responsible in fulfilling obligations. Recognize situations where common medical errors may occur in the otolaryngology clinic.

B. EDUCATIONAL CORE OBJECTIVES


I. SKILLS By the end of the Otolaryngology Clerkship rotation, the student should be able to demonstrate basic proficiency in the following skills. Clinical Examination Skills: 1. Head and neck examination 2. Thyroid examination 3. Oral examination 4. Cranial nerve examination 5. Balance testing Technical Skills: 1. Otoscopy 2. Nasal packing (simulation) II. PROBLEM-BASED By the end of the Otolaryngology Clerkship rotation, the student should understand the following concepts and/or be able to demonstrate an approach to patients presenting to the Emergency Department (based on real or simulated encounters) with the following problems or conditions: 1. 2. 3. 4. 5. 6. Hearing Loss Vertigo Nasal Obstruction Epistaxis Neck Mass Stridor

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COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: PAEDIATRICS (6 weeks)


Course Director Dr. Stacey Bernstein stacey.bernstein@sickkids.ca Site Directors/Assistants Site Director (Faculty) CVH Dr. Dror Koltin dkoltin@cvh.on.ca HSC Dr. Stacey Bernstein Stacey.Bernstein@sickkids.ca HRRH Dr. Joseph Porepa j.porepa@rogers.com NYGH Dr. Glen Berall gberall@nygh.on.ca Dr. Steven Moss steven.moss@utoronto.ca RVCH Dr. Yehuda Mozes mozes@rogers.com TSH Dr. Raymond Shu Birchmount raymond.shu@Rogers.com TSH General Dr. Peter Azzopardi petera@idirect.com SJHC Dr. Nirit Bernhard nirit.bernhard@utoronto.ca Dr. Sharon Naymark snaymark@yahoo.ca SMH Dr. Sohail Cheema mrcheema@hotmail.com TEGH Dr. Janet Saunderson janet.saunderson@sympatico.ca WOHC Dr. Gaugan Saund Brampton gagan30@gmail.com Dr. Anna Sellah prasanna.Selliah@williamoslerhs.ca YCH Dr. Jeff Weisbrot jfweisbrot@rogers.com Course Administrator Mary Antonopoulos mary.antonopoulos@sickkids.ca

Assistant Tammy Ramnance tramnance@cvh.on.ca Mary Antonopoulos mary.antonopoulos@sickkids.ca Mary Latter mlatter@hrrh.on.ca Neysa Berall nberall@nygh.on.ca Kim Zetazate kzetazate@rougevalley.ca

Brenda McCormick coachnine@yahoo.ca Meghan Marshall marshme@stjoe.on.ca Sharmilaa Kandasamy kandasamy@smh.ca Joanne Mount family.tegh@utoronto.ca Janice Flynn janice_flynn@oslerhc.org

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(Paediatrics, continued)

Four different variations are offered for each six-week Paediatrics rotation, exposing students to a combination of ambulatory and hospital based paediatrics: 1. All six weeks in a Community Hospital paediatric setting 2. Three weeks at The Hospital for Sick Children on the paediatric wards, and three weeks in a community paediatricians private office. 3. Three weeks at The Hospital for Sick Children in the Paediatric Emergency Department, and three weeks in a community paediatricians private office. 4. Three weeks at The Hospital for Sick Children in the Adolescent Medicine Department, and three weeks in a community Paediatricians private office. In all four variations, three full days are devoted to an academic teaching program at The Hospital for Sick Children. In addition, a half-day session is allocated to Neonatology Teaching. ASSESSMENT Student assessment includes: Written examination (50%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (50%) Observed history and physical examination (Credit/No Credit) Completion of 10 online modules (Credit/No Credit) Professionalism evaluation (Credit/No Credit)

For details, including grading regulations, see the Paediatrics webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/PAE_310Y.htm

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(Paediatrics, continued)

COURSE OBJECTIVES The medical graduate will be able to: [Medical Expert / Skilled Clinical Decision-Maker] Apply a science-based approach to the diagnosis and management of common clinical problems in childhood and adolescence and demonstrate an empathic approach appropriate to clinical paediatric practice, in relation to children, parents, health professionals, peers, others and self. *See content list

after Course Objectives


Demonstrate a thorough knowledge of normal growth and development of infants, children and adolescents; their interaction with common paediatric clinical problems and their management, including the immunizations and anticipatory guidance necessary for the promotion of well-being and optimal development, and the prevention of infections and unintentional injury; as well as the recognition and management of life-threatening illness in these age groups. Demonstrate: The ability to obtain and document a comprehensive and focused medical and psychosocial history from a caregiver and a child/adolescent regarding the health and illness of infants, children and adolescents. The ability to perform and document an opportunistic, comprehensive and focused physical and developmental examinations of infants, children and adolescent, as the situation requires. The ability to select and interpret commonly-employed laboratory tests, including tests of blood and other body fluids, various imaging modalities, and other specific tests in infants, children and adolescents. The ability to synthesize the data derived from the history, physical and laboratory assessments and formulate a problem-oriented approach to the infants, childs or adolescents health problems. An approach to the common health problems of infants, children and adolescents including their treatment and ongoing management Retrieve, analyze, and synthesize relevant and current data and literature, using information technologies and library resources, to supplement information provided in syllabus and seminars in order to address clinical paediatric problems. Apply an approach based on evidence and clinical expertise integrated with family values to the diagnosis and management of common paediatric clinical problems.

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(Paediatrics, Course Objectives, continued)

[Communicator / Doctor-Patient Relationship] Communicate effectively with infants, children and adolescents, their families and the community, through verbal, written and other non-verbal means of communication, demonstrating an understanding of the influence of family, community, society and their values on the infants/ childs/ adolescents health and respecting the differences in developmental stages, beliefs and backgrounds among patients and students. Establish professional relationships with infants, children and adolescents, their families (when appropriate) and community that demonstrate the attitudes, professional behaviours and ethics appropriate for clinical paediatric practice, in relation to children, parents, health professionals, peers, others and self and respecting the confidentiality inherent in these relationships. Deliver information to the child and adolescent and his/her family (as appropriate) in a humane manner, and in such a way that it is easily understood, encourages discussion and promotes the young persons and familys participation in decision-making keeping in mind the developmental evolution of young persons capacity to consent. Gather information, negotiate a common agenda, and develop and interpret a treatment plan, while considering the influence of factors such as the infants/ childs /adolescents age and gender, and the familys and communitys ethnicity, cultural and spiritual values, socioeconomic background, medical conditions, and communication challenges. Demonstrate the importance of cooperation and communication among health professionals in the care of the infant, child and adolescent so as to maximize the benefits to patient care and outcomes, and minimize the risk of errors. [Collaborator] Demonstrate an understanding of the role of others in providing optimal interdisciplinary care to infants, children, adolescents and their families in research and educational tasks. Synthesize the data derived from the history, physical and laboratory assessments and formulate a problem-oriented approach to the infants, childs or adolescents presenting problems, in collaboration with the youth, family and members of the interdisciplinary team. Participate in interdisciplinary team discussions, demonstrating the ability to accept, consider and respect the opinions of the youth, the family and other team members, while contributing an appropriate level of expertise to the care of infants, children and adolescents. [Manager] Participate effectively in health care organizations, ranging from individual clinical practices to academic health sciences centres and the child health network, exerting a positive influence on clinical practice and policy-making in ones professional community. Describe the governance, structure, financing, and operation of the health care system, its facilities and networks and how these influences patient care, research and educational activities at a local, provincial, regional, and national level. Apply a broad base of information to the care of infants, children, adolescents and their families in ambulatory care, hospitals and other health care settings. Demonstrate an awareness of the need for wise stewardship of available resources for child health care with a focus on preventive health care. Participate actively in team building function by demonstrating the necessary attitudes, professional behaviours and ethics. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 107

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(Paediatrics, Course Objectives, continued)

[Manager, continued] Apply population-based approaches to child health care and illness prevention as appropriate. Participate in evaluation and outcome of patient care and educational programs. Participate in innovative approaches to clinical child health care at an appropriate level of expertise. [Health Advocate / Community Resources] Apply the determinants of health and principles of disease prevention and behaviour change to child health care responsibilities and broader patient care initiatives based on an understanding of the normal growth and development of infants, children and adolescents and their common health problems. Be aware of diverse characteristics and needs of different cultural groups and specific populations, i.e., immigrants and minority or marginalized groups Respect diversity, be willing to work through systems, such as child welfare, collaborate with other members of the health care team, and accept appropriate responsibility for the health of infants, children, adolescents and their families. Participate at the appropriate level of expertise in community activities directed at improving health of infants, children, adolescents and their families, utilizing the best evidence, effective teamwork and communication skills. Demonstrate an understanding of infants, children and adolescents and their families and apply that understanding to achieve a physician/ patient relationship that is likely to identify and implement individual health and disease management strategies on an individual basis. Achieve a sufficient fund of knowledge and an ability to appraise the available knowledge critically so as to challenge the limitations of clinical orthodoxy or identify threats to population health and advocate for their amelioration in a reasoned manner. [Scholar] Research: Develop an awareness of how research questions are formulated and how protocols are elaborated to address them. Understand the unique aspects of research with infants, children and adolescents and the ethical issues it raises. Education: demonstrate the ability to engage in life-long, self-directed learning and critical inquiry. compare and contrast the diverse learning approaches of peers, patients and others, in order to interact and collaborate effectively. assist in teaching others and facilitating learning where appropriate understand the importance of being mentors to those less experienced members of the health care teams Creative Professional Activity: The medical graduate will be able to describe the importance of, and contribute to professional innovations, creative excellence, and exemplary professional practice. The graduate will also demonstrate leadership potential by participating in the development of professional practices in child health, such as practice guidelines or health policy development, and participation in professional organizations at the appropriate level of expertise.

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(Paediatrics, Course Objectives, continued)

[Professional] Recognize and accept the need for self-care and personal development as necessary to fulfilling ones professional obligations and leadership role. Demonstrate altruism, honesty and integrity and respect in all interactions with infants, children, adolescents and their families, colleagues, and others with whom physicians must interact in their professional lives. Demonstrate compassionate treatment of infants, children and adolescents and their families and respect for their privacy and dignity and beliefs Be reliable and responsible in fulfilling obligations. Recognize and accept the limitations in his/her knowledge and clinical skills, and demonstrate a commitment to continuously improve his/her knowledge, ability and skills and leadership, always striving for excellence. Describe and abide by the University/Faculty codes of professional conduct, and the relevant professional regulatory requirements concerning medical practice. Describe the threats to medical professionalism posed by the conflicts of interest which can occur in the practice of medicine. Demonstrate a sound grasp of the theories and principles governing ethical decision-making, the major ethical dilemmas in the care of infants, children and adolescents, and an approach to resolving these. Demonstrates an understanding of the principles and practice of law as they apply to the practice of paediatrics. Develop the capacity to recognize common medical errors, report them to the required bodies, and discuss them appropriately with infants, children and adolescents and their families. The following is a comprehensive list, divided by sub-specialty, for student learning. Students are expected to know the approach, signs and symptoms, differential diagnosis, and management of the following common paediatric issues: Health Supervision Care of the Well Baby, Child, Adolescent Anticipatory Guidance-Injury Prevention Normal Growth Parameters Nutrition from Newborn to Adolescence Growth Problems-Failure to Thrive, Short Stature, Obesity Development-Normal, Delayed Autism Learning Disabilities, School Problems Attention Deficit Hyperactivity Disorder Impact of Chronic Disease Immunizations Sudden Infant Death Syndrome Behaviour-colic, toilet training, temper tantrums, enuresis, encoporesis Neonatology Jaundice Respiratory Distress Newborn Screening Problems of the Premature Infant Hypoglycemia Seizures Sepsis Causes of Infant Born Small- or Large-forGestational Age

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(Paediatrics, Course Objectives, continued)

Adolescent Medicine Sexually Transmitted Infections Contraceptive Counseling, Emergency Contraception Teen Pregnancy Substance Misuse Eating Disorders Bioethics Cardiology Innocent Heart Murmurs Common Congenital Heart Defects Child Abuse Dermatology Pediatric Exanthems Atopic Dermatitis Endocrinology Puberty-Normal, Early, Late Diabetes Type 1 and 2 Gastroenterology Chronic Diarrhea Vomiting-Gastroesophageal Reflux Disease, Pyloric Stenosis Constipation Abdominal Pain-acute, recurrent Abdominal Masses Genetics Approach to the Dysmorphic child Common Syndromes (Down, Turner, Fragile X) Hematology/Oncology Lymphadenopathy Anemia Immune Thrombocytopenic Purpura Sickle Cell Disease Leukemia Neuroblastoma Wilms Tumour

Infectious Diseases Approach to Fever in Different Age Groups Gastroenteritis Otitis Media Urinary Tract Infection Meningitis Pharyngitis/Tonsillitis Pneumonia Skin and soft tissue infections Nephrology Dehydration and Shock Fluid Management Hematuria/Proteinuria Hypertension Neurology Febrile Seizures Seizures Cerebral Palsy Headache Respirology Common Cold Croup Asthma Bronchiolitis Cystic Fibrosis Rheumatology Limb and Joint Pain Henoch Schonlein Purpura Kawasaki Disease

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: PSYCHIATRY (6 weeks)


Course Director Dr. Raed Hawa raed.hawa@uhn.on.ca Site Directors/Assistants Site Director (Faculty) CAMH Dr. Mark Pearce (acting) mark_pearce@camh.net SHSC UHN MSH Dr. Gayla Tennen gayla.tennen@sunnybrook.ca Dr. Pat Colton patricia.colton@uhn.ca Dr. Ellen Margolese emargolese@mtsinai.on.ca Dr. Edred Flak (Assistant Coordinator) eflak@mtsinai.on.ca Dr. Kien Dang dangk@smh.ca Dr. Karen Petruccelli k.petruccelli@utoronto.ca Dr. Rose Geist rgeist@thc.on.ca Course Administrator Rachel MacKenzie rachel.mackenzie@utoronto.ca

Assistant Sarah Barrett sarah_barrett@camh.net Nancy Gribben nancy.gribben@sunnybrook.ca Elizabeth Quashie elizabeth.Quashie@uhn.ca Jeanette Villapando jvillapando@mtsinai.on.ca Jeff Loudermilk loudermilkj@smh.ca Tammy Ramnarace tramnance@cvh.on.ca Paty Callaghan pcallaghan@thc.on.ca

SMH CVH THC

The six-week Psychiatry Clerkship is designed to consolidate the knowledge, skills, and attitudes acquired in the Preclerkship and, relying heavily on clinical experience, develop clinical competence in approaching common and important presenting problems in psychiatry. Introductory didactic teaching occurs during the first three days of Week 1 of the rotation and the first day of Week 4. For these sessions, all students gather at a central location. The integral components of the central teaching are interviewing patients and/or standardized patients with anxiety, mood, psychosis, cognitive and substance disorders, with a focus on symptomatology, diagnosis and basic treatment principles. In addition, each hospital site holds two weekly seminar series: an Interviewing Skills seminar series designed to meet the interviewing skills objectives through practice with feedback, and a personality disorders course generally consisting of five sessions in which clerks have a chance to practice interviewing standardized patients. The personality disorders course, which is usually conducted by psychiatry residents, introduces diagnostic and interviewing skills related to difficult patients. The basic clinical experience with direct patient care responsibility takes place in a variety of settings including inpatient units, the clerk supportive psychotherapy clinic, ambulatory clinics, consultation liaison teams, emergency settings, and psychotherapy clinic. Each clerk is assigned a supervisor who ensures that the clerk obtains the suitable clinical experiences necessary to fulfill the objectives.

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(Psychiatry, continued)

All clerks gain exposure to psychiatric emergencies by taking night and weekend on-call one-in-six, until 12 midnight. Clinical experience with children and families takes place during two half-days (per rotation) at each Academy or in a child psychiatry setting under the direct supervision of a child psychiatrist. The following seminars will be held weekly at each hospital site: a) An Interviewing Skills seminar designed to meet the interviewing skills objectives through practice with feedback. b) A Personality Disorders course generally consisting of five sessions in which clerks have a chance to practice interviewing standardized patients. The course introduces diagnostic and interviewing skills related to difficult patients. Most sessions are conducted by residents in psychiatry. ASSESSMENT Written examination (25%) OSCE (25%) Continuous Patient Profile written assignment (10%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (40%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Psychiatry webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/PSS_310Y.htm COURSE OBJECTIVES

A. GENERAL COMPETENCIES:
The clinical clerk will be able to: [Medical Expert / Skilled Clinical Decision-Maker] Demonstrate the ability to assess and manage common psychiatric presentations, including assessment of suicidal and homicidal risk. (The relevant disorders are listed below under Educational Objectives/Problem-based.) Conduct a focused, relevant, empathic and accurate clinical history. (Further details related to this are found below under Educational Core Objectives/Skills.) Conduct a relevant mental status examination including cognitive testing. Establish a working differential diagnosis. Outline a management plan that incorporates biological, psychological, and social investigations and interventions where appropriate.

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(Psychiatry, Course Objectives, continued)

[Communicator / Doctor-Patient Relationship] Communicate effectively and empathetically with patients and their families. Demonstrate thorough and clear documentation and charting, concise recording of pertinent findings. Demonstrate the ability to communicate and educate patients with mental illness and their families. Demonstrate the ability to present a clinical case in a clear, concise and complete manner. [Collaborator] Establish and maintain effective working relationships with colleagues, other healthcare professionals. Discuss the roles of the various providers of care and the role of allied health professionals. Demonstrate knowledge of community resources available to help patients with mental illness and their families if outpatient supports are needed. Respect the role of the patients primary care physician by soliciting input in the assessment, in the development of the care plan, and in follow-up. [Manager] Demonstrate appropriate and cost-effective use of investigations and treatments. Develop organizational skills and efficiency in managing patients. Develop understanding of factors contributing to resource issues in care of patients with mental illness. [Health Advocate / Community Resources] Demonstrate an awareness of the underlying psychosocial and socioeconomic problems that may precipitate a mental health contact. Discuss the role of the psychiatrist in the healthcare system and how it relates to other hospital and community health services. Demonstrate an understanding of legal and ethical issues surrounding the care of patients with mental illness. [Scholar] Access and critically appraise the literature relevant to psychiatric care, management and treatment. Understand the many unique learning and teaching opportunities available in Psychiatry. [Professional] Be respectful of interactions with patients and their families Recognize the legal and ethical issues inherent in interactions with patients Appreciate the cultural and social stigma towards psychiatric patients Demonstrate professionalism as per professionalism form Respect confidentiality in emergency and non-emergency settings. Be aware of deficiencies in knowledge or skills and implement the necessary steps to improve in these areas

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(Psychiatry, Course Objectives, continued)

B. EDUCATIONAL CORE OBJECTIVES:


I. Skills: By the end of the Psychiatry Clerkship rotation, the clinical clerk should be able to demonstrate basic proficiency in the following skills. Competencies to complete these skills may be acquired during clinical encounters, core lectures, interviewing skills seminar, personality disorders sessions, being on call or on other rotations. Interviewing Skills: As the psychiatric interview is the foremost diagnostic and therapeutic tool, special emphasis will be placed on this skill. A clerk should be able to: 1. Assess the danger of a clinical situation and respond to reduce the danger to an acceptable level 2. Understand and use a variety of questioning techniques to elicit information (open-ended, closed ended) in an interview 3. Practice awareness of one's own emotional responses to patients to further one's understanding of a patient 4. Conduct an interview with a child and a family with the above goals 5. Conduct a brief focused interview in an interval of 10-15 minutes, characteristic of an assessment in family practice Psychiatric Skills: 1. Assessment of capacity 2. Assessment of violence/agitation 3. Assessment of suicide risk 4. Legal certification forms 5. Mini mental status examination II. Problem-based By the end of the Psychiatry Clerkship rotation, the clinical clerk should be able to demonstrate an approach to patients presenting with the following problems: (including differential diagnosis, investigations and initial management) Eating Disorders Mood Disorders Somatoform Disorders Psychotic Disorders Suicidal and/or homicidal risk Personality Disorders Anxiety Disorders Consideration for psychotherapy treatment Consideration for psychopharmacological Cognitive Disorders treatment Substance Use Disorders

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3 Core Clinical Rotation: SURGERY (8 weeks)


Course Director Dr. George Christakis george.christakis@sunnybrook.ca Site Directors/Assistants Site Director (Faculty) UHN Dr. Fred Gentili fred.gentili@uhn.on.ca SMH SHSC MSH HSC HRRH Dr. Robert Stewart rob.stewart@utoronto.ca Course Administrator Shibu Thomas shibu.thomas@utoronto.ca

Assistant Liz Doherty elizabeth.doherty@uhn.on.ca Michelle Dominey domineym@smh.ca

Dr. George Christakis Renita Yap george.christakis@sunnybrook.ca renita.yap@sunnybrook.ca Dr. Helen MacRae hmacrae@mtsinai.on.ca Dr. J. Theodore Gerstle theodore.gerstle@sickkids.ca Firdeza Mustafovski-Vujaklija fmustafovski@mtsinai.on.ca

SJHC TEGH WCH

Shannon Hannah shannon.hannah@sickkids.on.ca Francesca Settino (AA Church) fsettino@hrrh.on.ca Vania Bucci (HRRH Adm Finch Site) vbucci@hrrh.on.ca Dr. Christopher Compeau Megan Marshall compec@stjoe.on.ca marshme@stjoe.on.ca Joanne Mount Dr. Paul Bernick (Med. Director) j.mount@utoronto.ca bernickp@sympatico.ca Dr. George Christakis Renita Yap george.christakis@sunnybrook.ca renita.yap@sunnybrook.ca

The Surgical Clerkship is an eight-week rotation, which is sub-divided into four sections. All students commence the rotation with a one-week centralized seminar and surgical skills program called A Crash Course in Surgery. Held at the University of Toronto Surgical Skills Centre at Mount Sinai Hospital, this week provides an excellent opportunity for orientation and introduction to fundamental skills and concepts. Following the Crash Course, students then complete a pair of two-week sub-rotations and one three-week sub-rotation in various surgical specialties. General Surgery is a mandatory sub-rotation for all students (for either two or three weeks), but the others are selected. Students work with the site directors and support staff to determine the experiences to which they are assigned.

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(Surgery, continued)

Each student is assigned to a surgeon preceptor for each of their three sub-rotations. The student is expected to contribute to the admissions and daily patient care, and to attend the operating room, and the clinic/office of their preceptor or team. On Call: The on-call schedule for students is one night in four. This provides them the opportunity to see patients in the emergency room, as well as in the ward and operating room, where appropriate. ASSESSMENT NBME Shelf Examination (33.3%) Performance-based Structured Oral Examination 4 stations (33.3%) Clinical performance evaluation, based on an assessment of the students clinical work during the rotation (33.3%) Professionalism evaluation (Credit/No Credit) T-Res documentation (Credit/ No Credit) For details, including grading regulations, see the Surgery webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/SRG_310Y.htm COURSE OBJECTIVES

A. GENERAL COMPETENCIES:

At the conclusion of the Surgical clerkship, students should be able to: [Medical Expert / Skilled Clinical Decision-Maker] Describe the relevant aspects of common and/or life-threatening surgical illnesses. Provide an approach to the diagnosis of the major presenting problems encountered in surgery. Understand the appropriate use and interpretation of diagnostic tests relevant to surgical decisionmaking. Make use of evidence-based medicine (EBM) so that they can better diagnose and manage patient problems. Make use of the basic science principles relevant to surgery, as learned during the Preclerkship and expanded on during clerkship, in order to more rationally diagnose and manage the various factors contributing to the patients illness. Describe the properties of medical and surgical therapies, in terms of their indications, contraindications, mechanisms of action, side effects and monitoring. [Communicator / Doctor-Patient Relationship] Communicate effectively and empathetically with patients and their families. Demonstrate thorough and clear documentation and charting, with concise recording of pertinent positive and negative findings. Demonstrate the ability to obtain informed consent for surgical procedures Demonstrate the ability to council and educate patients and families in the inpatient as well as out patient environments. Provide clear discharge instructions for patients and ensures appropriate follow-up care. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 116

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(Surgery, Course Objectives, continued)

[Collaborator] Establish and maintain effective working relationships with colleagues and other healthcare professionals including nurses, physiotherapists, social workers and other allied healthcare workers. Demonstrate an understanding of the concept of triage and prioritization of care in management of multiple patients simultaneously. Demonstrate knowledge of community resources available to surgical patients on an outpatient basis. Understand the critical role of the patients primary care physician. [Manager] Demonstrate appropriate and cost-effective use of investigations including medical imaging and laboratory studies. Develop understanding of factors contributing to resource issues in operating room and outpatient environments. [Health Advocate / Community Resources] Demonstrate an awareness of the underlying psychosocial and socioeconomic problems that may complicate discharge from hospital following elective or emergent surgery. Discuss the role of the surgeon in the healthcare system and how it relates to other hospital and community health services. Demonstrate an understanding of legal and ethical issues surrounding surgical care. Identify opportunities for primary prevention in the outpatient environment and council patients accordingly. [Scholar] Access and critically appraise the literature relevant to surgical care. Understand the many unique learning and teaching opportunities available on the outpatient and inpatient surgical service. [Professional] Recognize and accept his or her limitations and know when to ask for help. Protect information provided by or about patients, keeping it confidential, and divulge it only with the patient's permission except when otherwise required by law. Be reliable and responsible in fulfilling obligations. Recognize situations where common medical errors may occur in outpatient/inpatient environment.

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THE PROGRAM: Clerkship (Years 3 & 4)


(Surgery, Course Objectives, continued)

B. EDUCATIONAL CORE OBJECTIVES At the conclusion of the Surgical clerkship, students are expected to have the following experiences: Encounters 1. Acute abdomen 2. Post-op fever 3. Post-op electrolyte management 4. Post-op urine output management 5. Trauma 6. Tumour/ malignancy 7. Wound care Procedures 1. Casting/ splinting (perform individually) 2. Chest tube insertion (observe procedure) 3. Laparotomy (perform with assistance/ assist) 4. Suturing/ knot tying (perform with assistance/ assist) 5. Wound closure/ dressing (perform with assistance/ assist)

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3: PORTFOLIO
Director Dr. Ken Locke ken.locke@utoronto.ca Administrator Rosalind Armstrong portfolio.ume@utoronto.ca

The Portfolio Year 3 course is designed to consolidate students knowledge and experiences about each of the non-Medical Expert CanMEDS roles through reflective discussions and assignments. The Process Component of the course consists of one large-group introductory session, and seven mandatory small group meetings throughout the academic year. The students are given protected time away from their rotations to attend the small group meetings. Students meet in small groups of up to eight, with one resident (Junior Academy Scholar) and one faculty member (Academy Scholar) to support them in reflecting on their experiences in the clinical setting, and the resulting effects on their professional development. Each of the small group meetings is assigned to one of the non-Medical Expert CanMEDS roles. During the year, the students work on portfolio submissions, which capture their thoughts from the meetings, and which are submitted for formative feedback during the course. An electronic tool linked to the Blackboard pages for the Portfolio Course facilitates students production of portfolio submissions. Final versions of the portfolio submissions are assessed summatively at the end of the year in the Final Portfolio. Attendance at the small group meetings is mandatory. Meetings take place in facilities provided by the Academies, with the capability for a limited number of students to connect from remote sites either by telephone or web connection. ASSESSMENT Process component assessment of preparedness and participation in sessions (50%) Final portfolio submission (50%) Professionalism evaluation (Credit/No Credit) For details, including grading regulations, see the Portfolio Year 3 webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/PFL_310Y.htm

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(Portfolio Year 3, continued)

OBJECTIVES The goal of the course is to promote greater professional self-awareness, as students enter the clinical world, specifically related to the 6 non-Medical Expert CanMEDS roles of Collaborator, Communicator, Manager, Health Advocate, Scholar and Professional.

A. GENERAL OBJECTIVES:

At the end of this course, each student will: 1. Be able to reflect on the personal meaning of a clinical experience, in terms of how it illustrates the student's developing professional identity; 2. Demonstrate understanding of the CanMEDS roles, and how they relate to each other in clinical examples; 3. Be able to describe their own development in each of the CanMEDS roles, as illustrated by their own experiences; 4. Be able to create reflective writing or other materials to demonstrate/document their professional development to peers; 5. Provide appreciative and developmental feedback to peers on their reflections; 6. Be able to analyze their own learning needs as they look ahead to further training, e.g. Residency.

B. COMPETENCIES:
The student will: [Professional] Display respectful and supportive behaviour towards the stories, and feelings, of their classmates within the Portfolio Group meetings. Safeguard the confidentiality of all discussions within Portfolio Groups, meaning that no information divulged there may be discussed or disclosed outside the meeting, except when creating a Final Portfolio, which shall itself be confidential (see below). [Communicator / Doctor-Patient Relationship] Be able to convey a story of themselves in a clinical situation, related to the CanMEDS Role under discussion, clearly and with appropriate emphasis on its meaning. This story will be conveyed both in verbal form and in written (or otherwise recorded) form. Be able to provide appreciative feedback to peers about their stories within the Portfolio Groups. [Collaborator] Work within their Portfolio group to enable the participation of all members, and to enhance the climate for learning for the entire group. [Scholar] The student will develop and use critical reflection skills in the analysis of the importance of the stories described, while creating their Portfolio Sections (see below). The student will act on feedback to improve their Portfolio as required.

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 3: INTEGRATED OSCE


Director Dr. Anita Rachlis a.rachlis@utoronto.ca Administrator Tim Flannery tim.flannery@utoronto.ca

Year 3 clinical clerks take part in two OSCEs that each integrate content from multiple rotations. The first of these Integrated OSCEs (iOSCEs) takes place after 24 weeks of the core third-year clerkship, and consists of six stations covering the courses that the student has taken to date. The second OSCE takes place after the full 48 weeks and consists of ten stations, six of which cover the courses taken in the second half of the course while the remaining four integrate the entire Year 3 curriculum. These examinations provide an opportunity for a summary judgement of students mastery of integrated clinical skills, to identify deficits not related to specific clinical domains, e.g. communication skills, and also provide a rich source of feedback to students. ASSESSMENT Interim iOSCE (20%) Final iOSCE (80%) For details, including grading regulations, see the iOSCE webpage on the MD website: http://www.md.utoronto.ca/program/clerkship/year3/Integrated_OSCE.htm Note: Students will be evaluated according to the following CanMEDS competencies: 1. [Medical Expert / Skilled Clinical Decision-Maker]- history taking and data collection: acquires chronologic, medically logical description of pertinent events; acquires information in sufficient breadth and depth to permit a clear definition of the patients problem(s) 2. [Medical Expert / Skilled Clinical Decision-Maker] - physical examination: elicits physical findings in efficient logical sequence and demonstrates appropriate technique, sensitive to patients comfort and modesty, explains actions to the patient 3. [Medical Expert / Skilled Clinical Decision-Maker] - information synthesis and problem formulation: organizes pertinent data in a logical manner and synthesizes the data into an integrated concept that defines the problem; discriminates important from unimportant information and reaches a reasonable diagnosis based on sound clinical knowledge 4. [Medical Expert / Skilled Clinical Decision-Maker] - diagnostic and management plan: able to generate diagnostic and therapeutic management plan 5. [Collaborator] - allied health professionals: understands and utilizes expertise of other health care professionals 6. [Communicator / Doctor-Patient Relationship] - counselling: explains rationale for test/treatment approach; counsels regarding management; considers risks and benefits; establishes rapport 7. [Communicator / Doctor-Patient Relationship] - verbal expression: demonstrates fluency in verbal communications e.g. grammar, vocabulary, tone, volume 8. [Communicator / Doctor-Patient Relationship] - non-verbal expression: demonstrates responsiveness; demonstrates appropriate non-verbal communications e.g. eye contact, gesture, posture, use of silence 9. [Professional / Ethical Behaviour] - responds to patients needs in a timely and respectful manner, demonstrating attitudes and professional behaviours appropriate to the clinical situation. Lack of professionalism may include inappropriate draping, inappropriate touching, abusive communication UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 121

THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 4: ELECTIVES
Director Dr. Mara Goldstein mara.goldstein@utoronto.ca Administrator (Electives Officer) Eva Lagan eva.lagan@utoronto.ca

The goals of the Electives program are to provide students with flexibility and opportunities to explore career possibilities, to gain experience in aspects of medicine beyond the core curriculum, and to study subjects in greater depth. Knowledge, skills and attitudes are further developed in a clinical context selected by students. Individualized experiences may occur within UofT or at other recognized sites of practice such as other medical schools across Canada and in northern and non-urban practices. Students may also undertake Global Health Electives in accordance with University of Toronto regulations. The student and the supervisor are responsible for ensuring a clear, mutual understanding of the learning activities designed to meet the objectives of the Elective. Students are responsible for arranging and completing a total of 12 weeks of electives during their designated fourth year Elective period. Each Elective must be at least two weeks in duration. Students must complete Electives from three different disciplines, with a discipline defined as being any one of the CaRMS directentry programs.

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THE PROGRAM: Clerkship (Years 3 & 4)


COURSE DESCRIPTIONS

Year 4: TRANSITION TO RESIDENCY (TTR) and PORTFOLIO


Director Dr. Ken Locke ken.locke@utoronto.ca Administrator Nima Heirat For TTR: ttr.ume@utoronto.ca Rosalind Armstrong For Portfolio: portfolio.ume@utoronto.ca

As of 2011-12, medical students devote the final 14 weeks of the four-year MD program to bringing together many of the concepts they have learned about functioning as doctors, and putting them into practice in real world settings, as preparation for PGY1. The majority of TTR consists of ten weeks assigned for selectives (two of which are three weeks in duration and the final one is four weeks long). In addition, there are four weeks for centralized teaching, divided into two blocks of one week each and a third block of two weeks. The first two central week blocks contain classroom-based learning activities about concepts such as understanding chronic care, medical-legal and licensure issues, complementary medicine, fitness to drive, and a number of other topics. The Fusion period (the two weeks just prior to the end of the school year in April) bring the students back together for review of clinical material through the Tovee lectures. The selectives promote workplace-based learning, where students have increased (graded) responsibility under supervision. These experiences allow the students to bring together many different areas of knowledge and skill in the care of patients or populations, as they get ready for the increased responsibility of their PGY1 programs. Students are required to complete at least one of the selectives in a community setting, and at least one of the selectives in either a medicine or surgery-based area. Students may use one of their selectives to satisfy the requirement for three different direct-entry program electives in their UME program. The Year 4 Portfolio course is run during the central teaching weeks of TTR. In this continuation of the Year 3 Portfolio experience, students and their faculty scholar meet for three sessions and jointly reflect on the progress the students have made towards becoming physicians in their final year of the program.

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(Transition to Residency and Portfolio Year 4, continued)

ASSESSMENT Clinical performance evaluation, based on an assessment of the students clinical work during the rotation Written assignment on health equity Written assignment on health systems OBJECTIVES At the end of the Transition to Residency course, students will be able to: Demonstrate competence in each of the Communicator, Collaborator, Manager, Health Advocate, Scholar, and Professional roles in the specific setting of each selective, such that they can undertake these roles at the PGY1 level. (This will primarily be assessed by the supervisors using rating scales.) The precise requirements for each competency are found in the UME Goals and Objectives, found at http://www.md.utoronto.ca/program/goals.htm. Demonstrate an understanding of a significant health equity issue as it pertains to the experience of ONE selective, through the production of a written assignment. (This will be assessed centrally through the course.) Demonstrate an understanding of a significant health systems issue as it pertains to the experience of ONE selective, through the production of a written assignment. (This will be assessed centrally through the course.) Demonstrate appropriate command of the medical knowledge or other factual content of the Central Weeks and Selectives. (This will primarily be assessed by knowledge tests in the Central Weeks, and by the supervisors using rating scales.)

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THE PROGRAM

Learning Modalities
The following descriptions capture the major types of learning modality employed in the UME curriculum. LECTURES Lectures delivered to the entire class are a core activity in the Preclerkship curriculum. There are generally between ten and twelve hours of lectures per week during both Year 1 and Year 2. Each lecture is scheduled for 50 minutes, beginning at ten minutes after the hour and concluding on the hour. Outside of the Preclerkship, lectures are also included in some clinical clerkship rotations. In this case, the lecture is given multiple times throughout the year to each group of students on a given rotation. Typically, the individual responsible for delivering a lecture is also responsible for preparing the lecture materials. The course director or other faculty leader in the course should provide direction to the lecturer on the general content and expectations of the session. Most lecturers use Powerpoint to present their lecture materials. In the Preclerkship lecture theatres, a digital document camera is also available, and can be used in the same way as an overhead projector. Lecture materials must be submitted to the course director or administrator at least ten business days beforehand to allow time for technical testing, online posting, and printing (if applicable). Every lecturer must include a declaration of potential conflicts of interest due to commercial or professional interests. Declarations of no conflict should also be made. UME requests that these declarations be included as the second slide in any Powerpoint presentation. All lectures are digitally recorded and posted online on the secure portal for later review by students. In the first-year class, lectures are now video-captured. In the second-year class, the digital capture consists of an audio recording of the lecturers speech paired with the projected slides. Videoconferencing has now been introduced into the first-year class to coincide with the opening of the Mississauga Academy of Medicine. Students at both the St. George (Toronto) and UTM (Mississauga) campuses view and participate interactively in lectures. Beginning this year, approximately 20% of lectures will feature a live lecturer in Mississauga, linked by video to the Medical Sciences Building (MSB) on the St. George campus, while in the remainder, the lecturer will be located at the MSB. SEMINARS (PRECLERKSHIP & CLERKSHIP) These are case-based sessions delivered by content experts to groups varying in size from ten to thirty students in the Preclerkship, or as low as two or three students in the Clerkship. Seminars are characterized by a significant emphasis on the approach to clinical problems. During seminars, students are encouraged to answer questions about the problems. They are also given the opportunity to ask questions about material covered in other parts of the specific course. Seminar materials for the students and additional information in the form of a confidential tutor guide are typically prepared by the course committee or an appropriate teacher, and provided to all seminar leaders to ensure a consistent student experience.

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CLINICAL SUPERVISION IN THE CLERKSHIP Students in Years 3 and 4 spend the majority of their time in clinical settings, under the supervision of experienced physicians from a variety of disciplines. Supervision of clerks entails a number of activities, including observing their interactions with patients, demonstrating new skills to them, discussing all issues related to patient care, hearing reports from the student, appraising his/her level of knowledge and clinical abilities, and serving as an example and mentor in the provision of care. Individual rotations will naturally focus on teaching skills that are particularly relevant to their specific domain. Constant formative feedback to the student is paramount at this stage of their training, to ensure that they progress as expected. All seven CanMEDS roles (see p. 7) take on new meaning for the student who is assuming clinical responsibilities for the first time, and supervisors should ensure that they are familiar with the expectations in this framework for the program as a whole and for the specific course in which they are teaching. In cases where residents, allied health professionals, or others are also involved in clinical clerk supervision, the primary faculty supervisor holds overall responsibility for the education and well-being of the student, and should ensure that the other team members understand all expectations related to the student. CLINICAL SKILLS INSTRUCTION IN THE PRECLERKSHIP (ASCM) For one half-day per week throughout the first and second years of the program, in the ASCM-1 and ASCM-2 courses, students learn clinical skills of history-taking and physical examination, as well as how to interpret the data in a diagnostic formulation, and then document and present it. Instruction takes place in groups of five to six students, with one tutor (or occasionally two tutors) per group. The tutors are responsible for teaching the basic clinical skills to the students, who often initially practice the skills on each other or sometimes on standardized patients. The students are assigned particular tasks in each tutorial, and the tutors are responsible for observing the students performance and correcting any problems. The key learning activity of each tutorial involves students interviewing and examining patients. They receive feedback from their tutors throughout the courses, based on both direct observation and submitted written work. For more details, please see the course descriptions under Program Preclerkship (beginning p. 35) FAMILY MEDICINE CLINICAL EXPERIENCES IN FMLE In the second-year Family Medicine Longitudinal Experience (FMLE) course, students attend six half-day family medicine clinics in the community, observe the family doctor, and practice the history-taking and physical examination skills that they have acquired in ASCM. Placements are one-on-one, which enables students to spend time with their preceptors patients during clinic and to receive focused feedback. For details, please see the course description under Program Preclerkship FMLE (p. 55). SIMULATION Simulation is employed in several settings during the undergraduate program, and includes a variety of technologies including computer models, mannequins, online cases, standardized patients, etc. Simulation allows students to effectively learn a variety of skills and receive structured feedback prior to patient contact. Simulation also provides opportunities for students to tackle clinical tasks that they would not otherwise see.

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PROBLEM-BASED LEARNING (PBL) PBL tutorials are a significant part of the Metabolism and Nutrition (MNU) and Brain and Behaviour (BRB) courses in Year 1, and the Mechanisms, Manifestations and Management of Disease (MMMD) course in Year 2. PBL tutorials are delivered in groups of six to nine students, and are facilitated by a faculty tutor. Each PBL tutorial centres around a fictional clinical case designed to stimulate student learning on the topic of the week in the course. Groups meet twice for each case. The purpose of the first session is to introduce the case and define the learning issues. At this first tutorial, the case is distributed to the students one page at a time in order to simulate the process of real-life data-gathering. As each page is distributed, the students define what they understand about the case, their hypotheses about diagnosis and management, and their learning requirements to better understand the case. In so doing, they generate a set of learning objectives in the form of questions. The homework after the first session is then to research these questions on their own (or in groups). At the second tutorial, the students share with their peers and their tutor what they have learned since the first session, and in particular how they went about trying to answer the questions: what sources they used, how they found them, and the strengths and drawbacks of each. Throughout the PBL tutorial process, emphasis is placed on both the Medical Expert and other categories of objectives, in order to encourage students to appreciate the variety of roles physicians need to play and the range of psychosocial contributors to illness. They also consider ethical and organizational aspects of clinical practice. PBL cases are developed and refined centrally, and all tutors are provided with both the learning materials to be given to the students and a confidential set of tutor materials that should be used to prompt discussion and ensure that there is general uniformity among the groups with regard to the learning objectives that are attained by the end of the second tutorial. Where possible, PBL tutors are assigned to cases whose content is relatively close to their clinical domain of interest. GROSS ANATOMY LABORATORIES Gross anatomy instruction is a core component of the first-year curriculum. Students take part in approximately 46 gross anatomy dissection laboratories in the Structure & Function course, in groups of eight. Four groups of eight at a time are taught by a demonstrator from the Division of Anatomy. In addition to teaching anatomy, the dissection component of STF provides students with an early opportunity for peerteaching, since students are frequently expected to divide the dissection tasks and then present their findings to the other members of their group. PORTFOLIO TUTORIALS These take place on seven occasions during the third year Clerkship and three times in fourth year. They are led by a faculty member (Academy Scholar) and a senior resident (Junior Academy Scholar), and involve students in groups of approximately eight sharing accounts of their experiences during their Clerkship in relation to the non-Medical Expert CanMEDS roles.

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DOCH-1 TUTORIALS In the DOCH-1 course, these sessions address a variety of issues related to community health, and are co-led by a physician and an allied health professional. In the Portfolio courses, each session involves student reflection on their insight into a particular CanMEDS role, with facilitation by a faculty member and a resident. FIELD VISITS DURING DOCH-1 & DOCH-2 A major learning opportunity in DOCH-1 involves students taking part in field visits to inner-city schools, on accompanied home care visits to the clients of Community Care Access Centres (CCACs), and to a variety of community-based health service agencies. These visits allow students to observe and reflect on population health, on the social and physical determinants of health, and to gain a perspective on how community-based initiatives can improve the health of populations. In the second-year course, students select a single agency and collaborate with them to conduct a research project aimed at improving some aspect of the agencys work. INDEPENDENT LEARNING An essential category of educational modalities is independent learning or self-study. Time is reserved for this each week during the Preclerkship. Students often use these timeslots to arrange shadowing opportunities (see Teaching Experience Getting More Involved Enriching Educational Experiences, p. 145), participate in service learning, or pursue other interests. Otherwise, this time can be used to study their course material, complete written assignments, and prepare for upcoming sessions. A variety of resources in print and online are provided to students for study, including recorded lectures, and they receive instruction in the use of these resources during each of the first three years of the program. During the Clerkship, the amount of independent learning time varies from rotation to rotation, but UME policy places restrictions on the number of hours students can be assigned to clinical and didactic activities, in order to ensure that they have adequate time for study and personal matters.

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Grading System & Assessment of Students


Many teachers have assessment responsibilities, and it is important to understand both the purpose of the assessment and the expectations for student competence. If you are assigned to assess one or more students and have any questions about the requirements, please contact the course director. TRANSCRIPTING PRACTICE All courses in all four years of the MD program at the University of Toronto are transcripted Credit/No Credit (CR/NC), which is commonly referred to as Pass/Fail at other institutions. This policy was introduced beginning with the 2009-10 academic year. Up to 2008-09, all courses with the exception of the first-year clinical skills course, ASCM-1, had been transcripted as Honours/Pass/Fail (H/P/F). This change is congruent with our competency-based curriculum and approaches to student assessment. It is also in line with the trend in grading policy across Canada. Our shift from an Honours/Pass/Fail system to Credit/No Credit came about thanks in large part to a concerted student effort facilitated by the Faculty. In response to feedback about the H/P/F system, the leadership of Undergraduate Medical Education (UME) invited the student body to conduct a formal dialogue on grading policy. Following a public debate, student townhall meetings, position papers, podcasts, and other strategies, students voted overwhelmingly in a referendum in 2008 to replace H/P/F with CR/NC. The Undergraduate Medical Education Curriculum Committee (UMECC) unanimously agreed to support the students stance, and after review and acceptance by the Facultys Education Committee, the policy change was granted final approval by Faculty Council in March 2009. A note about numerical results: Individual assessment components (e.g. exams) may be given a numerical mark, which is shared with the student. As component marks, these results will never appear on transcripts or other documentation provided by UME to external individuals or organizations. Furthermore, UME will calculate numerical grades for each course for the purpose of determining the recipients of academic awards and identifying students whose performance is below expected standards and who may therefore require either extra work, remediation, or repetition of a course or year. These confidential numerical final grades will never appear on transcripts or other documentation, but will be reserved exclusively for internal use. According to UME policy, individual teachers are also prohibited from disclosing students numerical marks or evaluation results in reference letters or other documentation. What information about student grades is sent to CARMS when students apply for postgraduate training programs? UME sends three kinds of information: 1. The transcript of course grades, indicating whether the student received Credit or No credit for each course in the first three years of the MD program. Individual components are not listed. 2. The Medical Student Performance Record (MSPR, also known as the Deans Letter), which provides a summary of the students ratings in each of the competencies for each of the clerkship rotations, based on their final clinical evaluation form. (See Clinical Performance Evaluations below on p. 133 for details.) 3. A statement that the student has met the medical schools expectations regarding professional behaviour.

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GRADING REGULATIONS IN UME Each UME course assesses students on at least two occasions, as required by University policy. The methods of assessment used in the various courses are described below under Assessment Modalities. Course directors are responsible for selecting both appropriate assessment modalities to best measure how students perform in relation to the program and course objectives, and appropriate criteria for students at this level of training. As described in the Transcripting section above, many assessments receive a numerical mark while others are simply denoted Credit or Non-Credit. For numerical assessments, 60% is generally a passing grade. In most courses, all assessments must be passed in order to receive credit in the course. Details and exceptions are provided in the official course descriptions on the UME website (www.md.utoronto.ca/program). Furthermore, students must demonstrate satisfactory professional behaviours, as described under Program Professionalism of UME Students (p. 137). In the clinical clerkships, they must also achieve satisfactory performance in each competency on the clinical evaluation and must complete all required encounters and procedures. Outcomes of Course Assessments: A summary of the Guidelines for the Assessment of Undergraduate Medical Trainees in Academic Difficulty is available under Key Policies, Statements, & Guidelines On Teaching & Assessing Students (p. 157). Briefly, there are three possible outcomes in relation to a students status at the conclusion of a course: A clear pass: the student demonstrates satisfactory performance on every assessment, scores at least 60% in the course as a whole (calculated based on the numeric assessments), and meets all other specific requirements of the course. o Credit is obtained in the course. Borderline performance: the student demonstrates performance on one or more components that does not meet the standards of the course, and/or is generally weak (typically 60-70% overall) o Credit is temporarily withheld. o Course director assigns the student extra work (additional study and a written assignment or new exam) in the area(s) of weakness. o If the extra work is completed satisfactorily, the original marks are permitted to stand and credit is obtained in the course. A clear failure: the students performance on one or more assessments is sufficiently low that the students calculated grade in the course is below 60% and/or other specific requirements of the course are not met. o Credit is temporarily withheld. o Student is brought forward to the Board of Examiners, who will typically require the student to complete formal remediation. o If the remediation is completed satisfactorily, the course mark is raised to 60% and credit is obtained in the course. Board of Examiners: All academic programs in the Faculty of Medicine have a Board of Examiners, a standing committee of Faculty Council. The UME Board of Examiners consists of 13 members, including two students. The Board of Examiners is responsible for approving all course grades, and makes the ultimate decisions about student promotion, requirements to do remedial work, and dismissal from the program, e.g. for repeated failures of an entire year or egregious lapses in professionalism. Students have the right to appeal decisions made against them by the Board of Examiners.

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(Grading Regulations in UME, continued)

Criteria for graduation: In order to graduate from the program, students must achieve a standing of Credit in every course, based on the requirements of the course. They must also have satisfactory professionalism evaluations. ASSESSMENT MODALITIES The following descriptions capture the major types of assessment employed in the UME curriculum. Multiple-choice examinations: Examinations featuring multiple-choice questions are used extensively throughout the program, most prominently in the Preclerkship block courses to verify students knowledge of the course content, but also in the Clerkship and other Preclerkship courses. These questions are typically written by a group of teachers with content expertise, and marked by computer. Short-answer questions: These are generally used in combination with multiple-choice questions on written examinations. They require the student to demonstrate a thorough understanding of the topic at hand and an ability to reason through a problem. These questions are used in many Preclerkship and Clerkship courses; they are usually composed and marked by teachers with specific content expertise. Written assignments: Written assignments range in scope and purpose across the program, from an original research paper developed over the course of an entire year (DOCH-2) to case reports (ASCM-1 and ASCM-2), a team-based problem-solving assignment (Manager theme), a continuous patient profile (Psychiatry rotation), reflections on the students personal experiences in clinical settings (Portfolio), and a number of others. While the specific objectives of these assignments vary, they generally do involve an assessment of the students ability to communicate effectively in writing, including presenting their findings or argument in a logical, well-organized manner. Creation of the assignments usually rests with the course committees. Responsibility for marking is determined on a course-by-course basis. Clinical oral examinations: Oral exams are a component of many clinical clerkships. Generally, the student will interact with a selected patient (or Standardized Patient, i.e. an actor) for a period of time, obtaining the history and physical examination, and present this to the examiner(s). The student is then asked questions about the case and other pertinent details, based on the course or assessment objectives. Clinical oral examinations are designed as a summative assessment of a students acquisition of the required skills of the rotation. The specific expectations are set by the course committees, and marking is conducted by the students tutor or supervising faculty member (not residents). UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 131

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(Assessment Modalities, continued)

Oral presentations: These are a key component of small-group learning in the Preclerkship, in particular in the ASCM courses (as case reports) and in the DOCH courses, in which they relate to the students experiences in community field visits (DOCH-1) or their research projects (DOCH-2). Students also make presentations to their teachers and classmates in other settings such as Portfolio sessions and PBL (problem-based learning) tutorials in the Preclerkship block courses, although these activities are not always graded. Oral presentations are generally marked by the students tutor, using criteria established by the course committee. OSCEs (Objective Structured Clinical Examinations): OSCEs are station-based clinical skills examinations in which students rotate through a series of rooms, and in each one are required to simulate a real clinical encounter with a Standardized Patient (an actor playing a patient) who is assigned a particular case, while being observed by a faculty examiner. The student is expected to complete specific tasks and, towards the end of each station, may be asked a small number of questions by the examiner. Students are given a global rating on each OSCE station, and examiners may also be asked to complete a checklist documenting the students performance on all aspects of the station (for instance, their skills on certain manoeuvres, their communication with the patient, etc.). OSCEs are considered to be more reliable than simple clinical oral examinations because they present each student with identical cases, and because the number of stations translates into assessment of a broader array of tasks and scenarios. NB: OSCEs are conducted in the ASCM courses in the Preclerkship. In the Clerkship, an Integrated OSCE is conducted for all clinical rotations at the midpoint and end of Year 3. (See Program Clerkship Course Descriptions Integrated OSCE, p. 121.) The Psychiatry rotation also runs a separate OSCE. In all cases, stations are carefully developed by committee. Examiners may be recruited from the existing teaching pool in a course and/or at the Departmental level, and are given orientation prior to each exam. Professionalism evaluations: Student professionalism is assessed in all small-group and clinical activities. In each course, students are required to demonstrate satisfactory professionalism in order to receive credit. The evaluation forms are completed on MedSIS, and prompt the tutor or supervisor to record any lapses in professionalism that the student has made. A small number of minor lapses is considered a normal part of a students development, but a larger number of laspses, patterns of repeated lapses across courses, or more serious incidents are carefully reviewed by the UME program. Teachers who are assigned to complete a professionalism evaluation will receive an automated e-mail at the appropriate time from medsis.server@utoronto.ca with instructions to log in and fill out the evaluation. See Program Professionalism of UME Students (p. 137) for details.

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(Assessment Modalities, continued)

Clinical performance evaluations: These are one of the principal methods of assessment in every clinical clerkship. The assessment is captured in all the courses using a secure online form known as the Clinical Skills Evaluation or ward form. The ward forms in all clinical clerkships feature a standard set of competencies under the seven CanMEDS categories. Each competency is assessed on a scale from Unsatisfactory to Outstanding. In some courses, particularly those in which students will encounter a number of different supervisors, the students preceptor each day is responsible for completing a daily encounter card on paper, and these are then submitted to the site director and summarized at the middle or end of the rotation using the ward form. In other courses in which a student has a more continuous experience with a single supervisor, the daily encounter cards are not used, and the supervisor himself/herself is typically responsible for completing the online ward form. Anyone who is assigned to complete a ward form will receive an automated e-mail at the appropriate time from medsis.server@utoronto.ca with instructions to log in and fill out the evaluation. See the next pages for a sample ward form. NB: In all rotations of two weeks or more, students receive a mid-rotation evaluation for formative feedback only, i.e. to give them a sense of how they are performing, so that adjustments can be made in the second half of the rotation. Although this mid-rotation evaluation does not contribute to the students grade, it is a mandatory aspect of these courses and any teacher who is assigned to complete a mid-rotation form (online or on paper) is expected to do so promptly. A mid-rotation meeting is also generally scheduled for supervisors or site-directors to review with each student their progress towards completion of the mandatory clinical encounters and procedures for that course.

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SAMPLE WARD FORM

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Professionalism of UME Students


PROFESSIONALISM OVERVIEW Being a professional is of course one of the key attributes of being a physician, and this is reflected by the prominence in the UME goals and objectives of the role of professional (see UME Goals and Objectives, p. 7). In order to assist students in their development as future professionals, UME provides students with abundant instruction and feedback, both formal and informal, about professionalism. Formal professionalism instruction is described earlier in this handbook under Program Themes & Competencies Ethics & Professionalism (p. 58). This section deals with expectations for students professional behaviour. In all teaching and learning settings where teachers are in a position to make meaningful observations about students professional behaviour (including all small group settings such as ASCM tutorials, PBL tutorials, and DOCH-1 tutorials, and all clerkship rotations), supervising faculty members complete professionalism evaluation forms. This assessment exercise provides an opportunity for teachers to point out to students, occasions when they fell short of expectations in their professional behaviour and also to indicate when they performed exceptionally well. Instances of suboptimal behaviour are recorded as either: minor lapses, where students fall short of expectations to only a minor degree, major lapses, where the deficit is quite significant, or critical incidents, which occur rarely, but are very important as they signify a situation where a student has put a patient or someone else at significant risk because of their behaviour

These terms are described in greater detail below, under Frequently Asked Questions About Professionalism for UME Students, questions 8 and 9. Ongoing professionalism assessment is useful to students for formative reasons (i.e., to provide them with feedback about areas for them to work on in order to ensure they meet expectations in future). It is also crucial to UME, since it allows the programs leadership to monitor whether individual students are exhibiting a pattern of unprofessional behaviour, possibly across multiple courses or multiple learning contexts. In such a case, intervention such as remediation in professional behaviour may be required.

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FREQUENTLY ASKED QUESTIONS ABOUT PROFESSIONALISM FOR UME STUDENTS 1. How is professionalism evaluated in the Undergraduate Medical Education program at the Faculty of Medicine, University of Toronto? a) Who completes the forms? Professionalism evaluation forms are completed online by faculty. In the Preclerkship, professionalism forms are completed by teachers who have had significant contact with students in small group settings. This includes tutors in the ASCM-1 and ASCM-2 courses, gross anatomy demonstrators, problem-based learning tutors, and tutors in Determinants of Community Health. In the Clerkship, forms are generally completed by the site supervisor for each rotation. b) How are the professionalism forms completed? Copies of the actual forms used are found elsewhere in this handbook. They evaluate several elements that contribute to professionalism. For each element, the faculty member can indicate that there were no lapses identified, that one or two minor lapses occurred, or that there were three or more minor lapses or a major lapse. Faculty members must provide comments that describe the lapses, if they indicate a minor or major lapse has occurred. At the bottom of the form, there is space for faculty members to indicate if there are any areas of praise and/or areas of concern. c) Are the professionalism forms monitored? By having the evaluations online, the UME program has the opportunity to monitor students professionalism over time. This gives us the ability to identify a pattern of minor lapses and allows us to respond promptly, in the hope of preventing a more significant problem. d) What happens if a student has several lapses noted? When three or more evaluations with minor lapses are recorded, and the evaluations are approved and locked by course directors, a graded educational response begins: First response: E-mail from the Preclerkship or Clerkship Director to acknowledge identification of professionalism learning issues and offer of assistance Second response: With continued minor lapses, students must attend a mandatory appointment with the Preclerkship or Clerkship Director Third Response: With continued minor lapses OR with a first major lapse, a formal coaching program in professionalism is instituted Fourth response: With continued lapses, a meeting with the Vice-Dean Undergraduate Education, and consideration of referral to the Board of Examiners Fifth response: Referral to Board of Examiners and consideration of a permanent note on transcript or Deans letter (Medical Student Performance Record), and other potential consequence.

2. Can anyone other than faculty members fill in a professionalism evaluation form? Because students have significant contact with medical education administrative staff, these staff members may also fill in a form if they feel a student has significant learning issues related to professional behaviour. Forms can also be completed on behalf of community preceptors such as CCAC staff.

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(Frequently Asked Questions, continued)

3. When the professionalism evaluation forms are completed and there is a tick for a lapse in an area, does that tick box show up on a students transcript or "Dean's Letter"? No. The evaluation forms are mainly to be used for education and thus faculty will indicate lapses in order to identify areas that require improvement. All lapses will first be reviewed by the course director. The course director will ensure that clear comments are present for minor lapses, that sufficient evidence is presented for major lapses, and that the student has been notified. The course director when satisfied will approve and lock the evaluations. When a consistent pattern of minor lapse occurs over courses, the Preclerkship and Clerkship Directors are notified. They too have the ability to change the record if they have any concerns. If students persist with learning issues that do not respond to coaching, this eventually will lead to an assessment by the Vice-Dean Undergraduate Medical Education. The Vice-Dean will present to the Board of Examiners for advice on what to record on the students transcript. Information on professional misconduct appears on the student's transcript only if designated by the Board of Examiners and a comment on professionalism will only be put on the Dean's letter (Medical Student Performance Record) by the Vice-Dean. Hence evidence of lapses will be reviewed at least four times before any recordings can be put on the Dean's letter or transcript and students have multiple opportunities to state their version of events before any such recording would occur. 4. What support is available to students with professionalism lapses? Students who have had professionalism learning issues identified find this a stressful experience. As future professionals, they may feel quite threatened as if this is an attack on their character. The professionalism evaluation is intended to be educational AND to identify serious concerns. The Associate Dean, Health Professions Student Affairs is available to help students to identify potential mitigating factors with their behaviour: illness, stress, family concerns among others, and can help to develop a plan to deal with these issues. The Associate Dean, Health Professions Student Affairs or their designate will be involved for students support and will not be involved in any further evaluation process. Students will also be invited to submit their version of events to be considered. When the students case is reviewed, consideration will be made to any systemic issues that may have influenced the students behaviour and any such factors will then be addressed by the UME program. If deemed necessary, a formal coaching program in professionalism will be offered so that the student is able to learn from the experience. 5. When the professionalism evaluation forms are completed, where are they stored and who has access to them? The completed professionalism forms are considered confidential academic material and are thus handled in the same way as records of other academic marks. They only appear on the academic transcript or Deans letter after the process outlined in question 3. 6. Why are professionalism forms filled out on all students, and not just on those who have lapses? Would it not be more efficient to complete forms only when a lapse occurs? The forms are primarily meant to be for educating students on proper professional conduct. Completing the forms provides an opportunity for faculty and students to discuss the student's behaviour and make recommendations for improvement. Completing the forms on an "exception" basis would lose this educational process and focus solely on the punitive aspects of this process.

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(Frequently Asked Questions, continued)

7. Why do the forms use negative language? The Professionalism Committee struggled with the question of negative language as the Committee did want to foster a positive environment. It is administratively easier to detect lapses and the public is demanding that physicians have no lapses, or that the lapses be dealt with appropriately. Hence lapses in professional conduct became the focus. There is an opportunity on the forms for supervisors to note excellent professional behaviour also. 8. What is the difference between a major and a minor lapse? The differentiation is context-specific and may vary from situation to situation. The main contextual issues are the students underlying intention and motivation, and the resulting impact on others, including the patient, the students colleagues, the community of practice and the student themselves. A minor lapse is one that was committed inadvertently and/or did not cause any substantial harm. The Professionalism Committee recognizes that we are all human and do make mistakes. The vast majority of mistakes are minor and if addressed properly can lead to improved professional conduct. A confirmed pattern of repeated minor lapses will trigger a staged educational response. A major lapse is one when there is evidence of full knowledge that this action was not right and/or the lapse does cause harm. In such a case, the course director will follow up with the faculty member and student involved. They will be responsible for approving and locking the evaluation form, which may include changes if appropriate. A confirmed major lapse will trigger a staged educational response. Faculty should initially classify the lapse as being "major" or "minor" based on that person's perception of the event. Comments to direct learning or document major lapses must be provided. Decisions on major versus minor may change over time (be evolutionary) as the faculty reach consensus on these finer definitions of major versus minor. 9. What is a critical incident? Critical events, as defined by the Task Force on Professionalism, are listed below. Any of these events require that faculty take immediate action in reporting these breaches to the course director as soon as possible. Faculty should also ensure patient and student safety at all times. Critical incidents of unprofessional behaviour Referring to oneself as, or holding oneself to be, more qualified than one is Participating in a conflict of interest Theft of drugs Violation of the criminal code Failure to be available while on call Failure to respect a patient's rights Breach of confidentiality Failure to provide transfer of responsibility for patient care Failure to keep proper medical records Being disrespectful to patients and other professional staff Falsification of medical records Assaulting a patient Sexual impropriety with a patient Being under the influence of alcohol or drugs while participating in patient care or on call Any other conduct unbecoming of a practicing physician UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 140

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SAMPLE PROFESSIONALISM FORM Click the title for information on professionalism.

When using this form, you can click on these links for useful information.

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Click here to go to professionalism FAQs.

http://www.md.utoronto.ca/Assets/FacMed+Digital+Assets/ume/registrar/Clerkship+Professionalism+Form.pdf

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Undergraduate Medical Education

THE TEACHING EXPERIENCE

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Getting More Involved


There are a number of ways to become more active in the UME program, whatever your current level of participation. Several of these opportunities are described below. TEACHING The major types of teaching opportunities for prospective UME teachers are outlined under Program Learning Modalities (p. 125). Faculty members who are interested in teaching medical students are invited to contact the following individuals, depending on the kind of teaching they are interested in: Type of teaching role PRECLERKSHIP TEACHING Preclerkship small group leader (ASCM-1 tutor, ASCM-2 tutor, problem-based learning tutor, DOCH-1 tutorial group leader) DOCH-2 research project supervisor DOCH -2 research methods tutor or UoT research ethics panel member Preclerkship seminar leader or lecturer in teachers specific area of basic science or clinical expertise Preclerkship Day of the Doctor. Physician Shadowing in Year 1 and 2 Family physician supervisor for individual (1:1) Preclerkship student placements (FMLE) Who to contact Academy Director associated with teachers hospital/community (p. 24) Academy Director associated with teachers hospital/community (p. 24) DOCH-2 course director (p. 52) Preclerkship course director (p. 31) Academy Director associated with teachers hospital/community (p. 24) FMLE course director (p. 55)

CLERKSHIP TEACHING Seminar leader or lecturer during clinical clerkship Clerkship course director (p. 64) rotation Clinical clerk supervisor (in ambulatory clinic Clerkship site director for specific clinical and/or in-patient setting) clerkship rotations (see Program Clerkship Course Descriptions, beginning p. 67) Portfolio group facilitator Portfolio Coordinator (p. 119) Clerkship elective supervisor Clerkship Electives Officer (p. 122) Transition to Residency (TTR) selective TTR Coordinator (p. 123) supervisor

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ENRICHING EDUCATIONAL EXPERIENCES (EEE) PRECEPTORSHIPS The EEE Program refers to a clinical experience that is not part of the medical students formal core curriculum. This includes, but is not limited to, shadowing and observerships undertaken by first- and second-year students. The goal of the EEE Program is to help students with career exploration as well as to bring relevance to their Preclerkship learning. Students are required to log these experiences online via the Portal. The online system allows for logging of the EEE event and includes a section for reflections as well as a supervisory database. Participation in the EEE program is an excellent option for faculty members who are unable to commit to core teaching but would like to be involved in the growth, development and education of our future physicians. Supervisors wishing to join the database are welcome to contact Dr. Mara Goldstein, Electives Director, at mara.goldstein@utoronto.ca For more information, see: http://www.md.utoronto.ca/teachersandstaff/Undergraduate_Medical_Electives.htm COURSE COMMITTEES Every course in the UME program has a course committee which is responsible for the design, implementation, and evaluation of the course. The committee generally consists of the course director, administrative staff, student representatives, and several faculty members. The faculty members on the committee are usually those responsible for a significant teaching unit in the course and/or for one of the sites where learning takes place during the course. Teachers who are already involved in a course and wish to explore the possibility of contributing further to the courses organization are encouraged to contact the course director (see Program Preclerkship, p. 31, or Program Clerkship, p. 64,for contact information). LEADERSHIP ROLES There are many leadership roles in the UME program, including being a course director, a site director within a course, or an organizer of a major segment or unit of a course. Teachers, particularly those already involved in a course, are encouraged to discuss leadership opportunities with either the relevant course director or the Preclerkship or Clerkship director (see Program Preclerkship, p. 31, or Program Clerkship, p. 64, for contact information). ADMISSIONS FILE REVIEW AND INTERVIEWS Every year, large numbers of faculty members contribute their time and experience to the MD admissions process, helping to determine which of the thousands of applicants will be granted an interview and, of those, who will be offered a seat in the next first-year class. Faculty members who are interested in participating in admissions are encouraged to contact the Administrative Coordinator, Admissions & Awards, Deborah Coombs, at deborah.coombs@utoronto.ca.

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RESEARCH SUPERVISION University of Toronto medical students have many different research opportunities both during the regular curriculum and at other times, notably the two summers of the Preclerkship Research undertaken as part of the curriculum: DOCH-2 research project: In the Determinants of Community Health-2 (DOCH-2) course, which is described in more detail on p. 52, each student develops a research project addressing a community health issue over the course of the entire school year. These projects are generally conducted under the supervision of a community public health agency or a faculty member with a research interest in a community health topic, with further research assistance provided by experts arranged by each Academy. Faculty members interested in finding out more about this teaching opportunity should contact the DOCH-2 course director (Dr. Fran Scott, fran.scott@utoronto.ca) and/or the Academy director associated with their hospital (see p. 24). Clerkship research electives: Students in the Clerkship have 12 weeks scheduled for elective time. This time is primarily used to gain clinical experience in areas of interest, but many students use a portion of this elective time (two to six weeks) to get exposure to research under the supervision of faculty members. Students may select electives from the catalogue maintained by the UME program or make arrangements on their own. Teachers who would like to appear in the catalogue for a research elective are invited to contact the Electives Officer (see p. 122). Research outside the curriculum: The major UME program that supports funded research activity for medical students is called the Comprehensive Research Experience for Medical Students (CREMS). CREMS is meant to be a unique research program in Canada that allows interested U of T medical students to gain extracurricular research experience in any field in various structured programs without interrupting their medical studies. There are four main programs: 1. CREMS Research Scholar Program, a 20-month longitudinal program that runs from January of the students first year in the MD program to the end of August in the summer between second and third year, with full-time research during the summers. Student funding is divided equally between the CREMS program and the research supervisor. 2. CREMS Summer Program, a full-time 12-week summer research program between first- and second-year or second- and third-year. Student funding is divided equally between the CREMS program and the research supervisor. 3. CREMS International Health Summer Research Program, a 10- to 12-week international summer research program in which students participate in research related to important health issues in developing nations, conducted under the auspices of the on-going international work of a U of T faculty member. Partial funding is provided by the Medical Alumni Association. 4. CREMS-UofT-Technion (Israel) Medical Student Summer Research Exchange Program, a 10-12-week exchange summer research program with the Ruth & Bruce Rappaport Faculty of Medicine at the Technion-Israel Institute of Technology to provide summer research experience for UofT medical students in Israel and, in exchange, have an Israeli student come to the UofT for research experience.

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(Research Supervision, continued)

The objectives of these programs are to allow medical students to explore and gain valuable research experiences, to prepare medical students for a career as a physician with a good research foundation and understanding of biomedical research, and to engage and encourage students to consider a career as a clinical scientist. In addition to CREMS, many faculty members supervise medical student research organized through their hospital research institutes or similar organizations. Interested faculty members should contact their research institute administration for information on any programs that they support. Faculty who are interested in either supervising medical student research through the CREMS program or in publicizing a non-CREMS research opportunity to medical students should contact the program director Dr. Don Branch at crems.programs@utoronto.ca.

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E-Resources Used in UME


The UME program employs a number of different online resources. Each plays an important role in the program, for both teachers and students. Please take a few minutes to familiarize yourself with all of them. UME WEBSITE http://www.md.utoronto.ca This is the public website for the UME program. It was redesigned in the summer of 2011 with a new focus on specific user groups: students, teachers, course directors, and applicants. Full descriptions of all aspects of the program and the resources that are available to students and teachers are described on the site. In addition, all UME policies are posted, as well as links to other important information maintained by the Faculty of Medicine, the University of Toronto, and outside organizations. The website also has several new features including a Red Button to provide advice to students in emergency or crisis situations, an incident report form for students to report distressing events that they experience or witness, and an interactive absence tool for students (and interested teachers). This teacher handbook is also posted on the website. UTORID All University of Toronto faculty members and trainees (including residents) are entitled to have a UTORid, the unique username for a variety of online services including the Portal, the University of Toronto Library system, University of Toronto e-mail, and wireless access across the campus on the utorwin network. UTORids are typically eight characters long and take the first part (or all) of your last name, usually followed by the first letters of your first name and/or random numbers. E.g., singh516, leungden, etc. Most faculty members are assigned a UTORid upon appointment, but may not have activated it. Trainees are assigned a UTORid at the time of registration. If you do not know your UTORid or do not believe you have one, please contact: The business officer of your University Department, if you are a faculty member The administrator of your program, if you are a postgraduate trainee or graduate student The Help Desk of the Discovery Commons, the IT department of the Faculty of Medicine (416-978-8504 or discovery.commons@utoronto.ca), if you are either a faculty member, trainee, or student The course administrator of the course in which you teach (if you are not a faculty member, postgraduate trainee, or graduate student)

A note about security: Once you have logged into your UTORid for one online service (e.g. the Portal), you will remain logged in for other services as long as you keep at least one browser window open on your computer. To end your secure session (i.e. to log out), you must close all browser windows.

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PORTAL http://portal.utoronto.ca (login: UTORid and password)

The Portal (powered by an application called Blackboard) is a secure website used across the University as a hub for course websites, including those in UME courses. Login is via UTORID (see above). Unlike the UME website (see above), the Portal is designed for internal use only. At a minimum, all UME courses post their materials on the Portal, and many courses use other features such as announcements as well. Every UME teacher is expected to have access to the Portal websites of the courses in which they participate. This access should be given to you automatically, but you may need to provide your UTORID to the course administrator. If you log into the Portal (http://portal.utoronto.ca) and do not find that a given course in which you teach is listed, please contact the course administrator Please make full use of your Portal access to retrieve course information, lecture materials, seminar notes, etc. T-RES All clinical clerks are required to log the required encounters and procedures defined in each rotation, using an online system called T-Res. Completion of the list of requirements is necessary to obtain credit in each course. Individual clinical preceptors or supervisors are not required to use T-Res directly, but do make use of student logs to identify and remedy gaps in each students experiences. Be aware that students may be keeping track of their encounters and procedures using handheld devices, a computer on the ward, or even on paper for later entry into T-Res. They may also request particular experiences in order to fulfill their requirements. Supervisors who are assigned to complete mid-rotation feedback and evaluations of students have a particular responsibility with regard to clinical logs. As part of mid-rotation feedback, these supervisors must meet with the student, who will present their T-Res Report 062 (Trainee Encounters and Procedures Count Summary). The supervisor and the student are expected to discuss the encounters and procedures logged to date, and the plan for completion of any that are still outstanding in the second half of the rotation. At the end of the rotation, students submit a final T-Res Report 064 (Encounter and Procedure Goal Completion Summary) to either their site director or course director. It is expected that all required experiences will be complete by this point, but if gaps remain, the course director will facilitate completion by providing appropriate clinical experiences or virtual cases for the student. UNIVERSITY OF TORONTO LIBRARIES http://www.library.utoronto.ca (login: UTORid and password, or library card barcode and password)

The U of T library system has one of the most comprehensive collections of both print and online resources in the world. The Gerstein Science Information Centre is of particular importance in health sciences education. Online resources for Gerstein and the other U of T libraries are accessible to all members of the University of Toronto via their UTORid.

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MEDICAL STUDENT INFORMATION SYSTEM (MedSIS) http://medsis.utoronto.ca (login: unique 4 or 5-digit user ID and password)

MedSIS is the secure online system that UME uses to record and calculate student assessments by teachers in all courses, obtain student feedback on their teachers and courses, maintain student registration information, and perform course scheduling in all Preclerkship and some Clerkship courses. Teachers who are assigned to complete an online student evaluation form on MedSIS will receive an automated e-mail at the appropriate time from medsis.server@utoronto.ca with instructions on logging in and completing the form. Follow-up reminder e-mails will be sent if the form(s) remain incomplete. If you receive a prompt to use MedSIS and have never logged in before, go to the MedSIS website (http://medsis.utoronto.ca), click Login to MedSIS, and then click Forgot your password? Enter the same email address at which you received the prompt, and your userid and temporary password will be sent to you by e-mail. For security, when you next log into the system, please change your password. In addition to completing student evaluations on MedSIS, teachers can also: update their contact and appointment information see their teaching schedule (all Preclerkship courses and didactic sessions in some Clerkship courses), and sync this schedule to other electronic calendars review their TES reports (select courses check with your course administrator for details)

If you need assistance with any of the functionality within MedSIS, you can contact: MedSIS Help Desk: Support by Knowledge4You, the company that developed MedSIS; can assist with all aspects of the software UME Evaluations Project Coordinator / Data Analyst: In-house UME MedSIS support can provide orientation and training medsis@knowledge4you.com 905-947-9924 x223

medsis.ume@utoronto.ca 416-946-7040

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UME CURRICULUM MAP (CMAP) http://cmap.med.utoronto.ca (login: UTORid and password)

All didactic teaching sessions in the entire UME curriculum have been mapped in an online system known as CMAP. This reference tool is accessible to UME teachers, students, and curriculum planners, and is intended to support all aspects of the design and implementation of the curriculum. Each session (lecture, seminar, PBL case, etc.) is captured and categorized according to the following dimensions: Location in the program (year, course, week) Keywords (at various levels of coverage) UME program objectives supported by the activity Medical Council of Canada clinical presentations Considerations of legal, ethical and organizational (CLEO) aspects of practice objectives LCME hot topics (traditionally under-represented topics, often outside of traditional domains)

The map can be searched either by keyword, or by one of the learning parameters listed above. For example, a user may perform a keyword search on the term asthma, a UME objective search for Objective 5.1 (describing the determinants of community health), an MCC presentation search on chest pain, etc. An eight-minute tutorial (entitled How to use CMAP) is provided on the website. To access CMAP, users must login using their UTORid. This tool is available only to members of the Faculty of Medicine community.

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Information on Videoconferencing in the Classroom


With the opening of the Mississauga Academy of Medicine (MAM) in August 2011, first-year lectures in the University of Toronto's MD program are being videoconferenced between the Medical Sciences building on the St. George campus and the Health Sciences Complex on the University of Toronto Mississauga campus. (In 2011-12, both years of the Preclerkship will be in operation at MAM, and so both first and second-year lectures will be videoconferenced.) In addition, recordings are made of every lecture in the Preclerkship (both video and presentation materials), and are then posted online on the secure portal site for student access. Videoconferencing is also being used increasingly for seminars in both the Preclerkship and Clerkship. Full support is provided by the Discovery Commons in the Faculty of Medicine. See http://lecturesupport.med.utoronto.ca for more information. LECTURE PRESENTATION GUIDELINES FOR VIDEOCONFERENCING With the opening of the Mississauga Academy of Medicine and the program to videoconference lectures between the St. George and the Mississauga campuses, new standards for presentations have now been implemented in order to provide an equivalent education to all students, regardless of their location. Below are some guidelines for creating presentations for videoconferenced lectures, as well as established best practices for presenting. Rules about Laptops and Software Ensure that your presentation file is sent or uploaded 10 business days before the lecture takes place to allow adequate time for necessary testing and formatting. Use UTMedfiles.ca, a new file upload application for U of T Medicine, to upload your presentations and any associated files. You must use the teaching station PC or the document camera to present your lecture. Use of laptops or other devices during the videoconferenced lecture is not supported. If you use a Mac, you may create your presentation in Powerpoint for the Mac or in Keynote; if you create in Keynote, technicians will convert it to a Powerpoint file and test it on the presentation computer in the lecture room before your lecture. Content standards All lecturers must disclose any potential conflicts of interest that they may have with commercial products, research findings, etc. mentioned in their presentation, on their second slide (after the title slide). See Procedure for Disclosure of Potential Commercial or Professional Conflicts of Interest by UME Teachers under Key Policies, Statements & Guidelines On Teaching & Assessing Students, p. 157. Videoconferencing reduces the amount of material that can be covered in lecture, so plan for 40-45 minutes of material instead of 50 minutes. Do not change the content of your presentation after submitting it for publication and posting. Intellectual Property It is the responsibility of lecturers to ensure that their presentations follow the guidelines set by the University and the Canadian government regarding intellectual property. Go to www.teaching.utoronto.ca Essential Information for details on the regulations.

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(Lecture Presentation Guidelines for Videoconferencing, continued)

Formatting standards: Use a 24-28 point for text. Use basic fonts like Arial, Tahoma or Verdana. Avoid cursive fonts. Avoid animations and page transitions beyond straight cuts. Dont reduce font size to fit information in; start a new slide instead. Rule of thumb: max 6 lines of text per slide, max 6 words per line of text Make sure your text doesn't run to the edge of the slide as it may get cut off during projection. For more details on each standard, information on interactive lecturing through the use of clickers, and to download Powerpoint templates, conflict of interest slides, and more, please see Presentation Standards at: http://lecturesupport.med.utoronto.ca LECTURER SUPPORT FOR VIDEOCONFERENCING The technical support team provides technical assistance and training in advance of each lecture, and also schedules, configures, and monitors every lecture from a nearby control room, allowing lecturers and students to focus on teaching and learning. Contact discovery.commons@utoronto.ca to schedule a training session on the equipment. BEFORE the Lecture: Contact the Discovery Commons Service Desk, Monday to Friday, 8am to 5pm. 416-978-8504 Email: discovery.commons@utoronto.ca DURING the Lecture: All lectures will be monitored by two professional videoconferencing technicians, and most technical problems will be addressed before you even notice them. For immediate assistance just before or during a lecture, either: use the support intercom on the Teaching Station call the Discovery Commons Videoconferencing Hotline: 416-978-0007 If you contact technical support during a lecture, you will be talking to a live technician, and a technical support person can be in the room within one minute, if required. AFTER the Lecture: To provide feedback on your experience with lecture videoconferencing, contact the Facultys Director of Information Technology, Wes Robertson (416-946-8625 / wes.robertson@utoronto.ca). SEMINAR PRESENTATION GUIDELINES FOR VIDEOCONFERENCING A videoconferenced seminar is much like any other seminar that you would conduct: students gather and you lead the seminar in a focused discussion with or without a presentation, such as PowerPoint. The main differences with a videoconferenced seminar are that your students are in multiple locations and you have a layer of technology between yourself and some of the students. There are a number of things that you can do in preparation for and during the seminar to ensure a successful experience for all participants. Go to http://lecturesupport.med.utoronto.ca/seminars for more information. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 153

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Opportunities & Resources for Faculty Development


Faculty development refers to activities aimed at enhancing teachers abilities to provide high quality teaching, assessment, and feedback to learners. Faculty development can include large-group, lecture-type presentations, small-group workshops with opportunities to practice, and printed and web-based materials that teachers study at their own pace, among other formats. There are four major ways in which UME teachers can access faculty development: CENTRE FOR FACULTY DEVELOPMENT (CFD) The CFD is an extra-departmental unit of the Faculty of Medicine, based at St. Michaels Hospital. For more information, please see: http://www.cfd.med.utoronto.ca. The CFD provides a range of faculty development programs: (a) Best Practice in Education Rounds (B.P.E.R.) These are accredited group learning activities as defined by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons of Canada. They are also accredited group learning activities as defined by the College of Family Physicians of Canada. Rounds are open to all that are interested. Registration IS NOT required. The sessions are also recorded and posted on the BPER website. For details see: http://www.cfd.med.utoronto.ca/programs/rounds.html#bper (b) Individual workshops on a variety of topics are offered throughout the academic year. These workshops are devoted to the enhancement of teaching skills with a view to career development and scholarship in education. Each workshop is free to faculty in the Faculty of Medicine, University of Toronto. Registration is required. Workshops meet the accreditation criteria of the College of Family Physicians of Canada and are also an Accredited Group Learning Activity under the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada. For details see http://www.cfd.med.utoronto.ca/programs/workshops.html (c) Stepping Stones. This is a certificate program for those faculty interested in an in depth immersion in teacher training and a look at educational roles. The program fee is $600 for faculty in the Faculty of Medicine, and registration is required. Some University Departments may subsidize participation in this program. The Stepping Stones program is intended to provide participants with the knowledge of evidencebased strategies and the theoretical basis for clinical teaching, new skills in teaching and in critical appraisal of health professional education literature, an interest in implementing change in clinical teaching, ideas for introducing scholarship into teaching, and the ability to develop a strategy for their own career development plan. The program consists of a minimum of 26 hours of CFD workshops over the course of two years, and participation in at least seven out of nine monthly Stepping Stones journal club sessions on teaching and learning theory. For details see http://www.cfd.med.utoronto.ca/programs/stepping-stones.html

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(Centre for Faculty Development, continued)

(d) Education scholars Program (ESP): This is a two-year leadership development program for educators of health professional students, and consists of weekly in-class work, as well as independent work. The core themes are scholarship and curriculum design, education leadership, teaching excellence, and faculty development. The goal of the ESP is to support and enable the success of health professional and health science faculty in their many roles as educators. Individuals in the clinical, community health, basic science, and rehabilitation departments in the Faculty of Medicine and a select number of individuals in other health disciplines eg. Nursing, Psychology, Social Work, Pharmacy, Dentistry, Theology, etc. are eligible to participate. Tuition fees and protected time are approximately $6000 per year for two years. Some University Departments may subsidize participation in this program. For further information about the ESP, see: http://www.cfd.med.utoronto.ca/programs/educationscholars.html. FACULTY DEVELOPMENT ORGANIZED BY INDIVIDUAL DEPARTMENTS Individual departments offer a spectrum of faculty development programs, ranging from workshops to longerterm programs. For details, please contact your Departments Vice-Chair Education or equivalent. FACULTY DEVELOPMENT PROVIDED BY INDIVIDUAL UME COURSES Some individual courses offer various faculty development activities. For the clinical clerkship rotations, these may be combined with Departmental offerings, while in the Preclerkship, these activities may be organized separately: Workshop for ASCM-1 and ASCM-2 tutors, offered at the Academies Workshops on tutoring Problem-Based Learning (PBL), offered twice per year Workshops on being a DOCH-2 research advisor, offered twice per year For details about these and other opportunities, please contact the relevant course director. FACULTY DEVELOPMENT AT THE MISSISSAUGA ACADEMY OF MEDICINE The Mississauga Academy of Medicine is spearheading major efforts to provide faculty development for the many new teachers in Mississauga. Workshops are being offered both to advance individuals generic teaching skills and also to target more specific skills development, such as problem-based learning and bedside teaching. For details, please contact the Director of Faculty Development, Mississauga Academy of Medicine: Jana Bajcar, EdD (jbajcar@thc.on.ca).

Teaching Awards
Teaching awards are given each year in recognition of individual teachers excellent contributions to the UME program. Awards are given both at the Academies and also for the program as a whole. For details about the awards at each Academy, please visit each academys website. (Go to www.md.utoronto.ca Our Partners Academies). For details about the program-wide UME awards, please see http://www.facmed.utoronto.ca/staff/teach.htm. UNDERGRADUATE MEDICAL EDUCATION TEACHER HANDBOOK 2011/2012 Updates and details available at www.md.utoronto.ca 155

Undergraduate Medical Education

KEY POLICIES, STATEMENTS, & GUIDELINES

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On Teaching & Assessing Students


General Responsibilities of UME Teachers, Statement on the ......................................................................158 Disclosure of Potential Commercial or Professional Conflicts of Interest by UME Teachers, Procedure for ...................................................................................................................................................................160 Conflicts of Clinical and Educational Roles, Procedure For .......................................................................... 161 Call Duty and Student Workload in the Clerkship, Standards for............................................................. 164 Course Hours and Student Self-Study Time in the Preclerkship, Standards for ....................................165 Required Clinical Experiences in the Core Clerkship Rotations: Responsibilities of Students, Faculty, and UME Curriculum Leaders ..................................................................................................................167 Mid-Rotation Feedback in Core Clinical Clerkship Courses, Standards for ........................................ 170 Timely Completion of Student Assessment and Release of Marks, Standards for..................................171 Provision of Narrative Feedback to Students, Expectations for the............................................................172 Grading and Promotion of Undergraduate Medical Students, Standards for ......................................... 173 Assessment of Undergraduate Medical Trainees in Academic Difficulty Preclerkship and Clerkship, Guidelines for the (Summary).................................................................................................................179 Essential Skills and Abilities Required for the Study of Medicine, Council of Ontario Faculties of Medicine (COFM) Policy Document.................................................................................................183

For more information on this topic, see The Program Grading System & Assessment of Students (p. 129)

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StatementonthegeneralresponsibilitiesofUMEteachers
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:12September2011 Dateoflastreview:12September2011 Dateofnextscheduledreview:12September2015

TheUndergraduateMedicalEducationprogramanditsstudentsbenefittremendouslyfromthemanyteacherswho contributetoitscoursesinavarietyofcapacities.ThisStatementseekstoarticulatethegeneralexpectations placeduponteacherstoensureanoptimalteachingandlearningexperience. GENERALPREPARATION TeachersareexpectedtopreparefortheirdutiesinUMEbyreviewingallmaterials(includingcoursecontent, courseandprogramobjectives,relevantpolicies,etc.)thattheyaresentordirectedtoreadbythecoursedirector orthecoursedirectorsdelegate. KNOWLEDGEOFTHECURRICULARCONTEXT Allteachers,butespeciallythosewhocreatecoursecontent,areexpectedtofamiliarizethemselveswiththe curricularcontextinwhichtheirteachingissituated.Todoso,teachershaveaccesstotwokeytools: 1. Forincoursecontent,teachersshouldaccessthecoursewebsiteontheUniversityofTorontoportal,at http://portal.utoronto.ca.* 2. Forprogramwidecontentrelevanttothesubjectoftheirteaching,teachersshouldaccesstheonline CurriculumMap(CMAP)athttp://cmap.med.utoronto.ca. *TheCurriculumMapcanbesearchedbyavarietyofparametersincludingkeyword,MedicalCouncilof CanadaPresentation,UMEobjective,etc. *Note:Toaccessbothofthesesites,teachersmustbeenrolledbyprovidingtheirUTORID(Universityof Torontouniqueidentifier)tothecourseadministrativestaff.Allfacultymembersandlearners(e.g.residents) attheUniversityofTorontoareentitledtohaveaUTORID;forclarity,thisisthesameusernamethatisusedto logontoUniversityofTorontoemail.TeacherswhodonothaveaUTORIDshouldcontacttheirdepartmental businessofficerorthecourseadministrativestafffordirectiononhowtoproceed.Arrangementsforguest accountscanalsobemadeforinstructorswhodonotholdanappointmentattheUniversity. DEVELOPMENTOFCOURSECONTENT Teacherswhoareresponsibleforcreatingcontent(e.g.lecturenotes,examinationquestions,etc.)arerequiredto submittheirslidesorothermaterialsinelectronicformattothecoursedirectorand/orcourseadministrativestaff (asrequested)nofewerthantenworkingdaysbeforethescheduleddateofthesession(orthefirstdate,ifthe Page1of2 sessionistobeofferedonmultipleoccasions);coursedirectorsmayimposeanearlierdeadlineastheydeem

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appropriate.Thetendaydeadlineisenforcedtoensurethatthereisadequatetimetoarrangefor videoconferencing,printing,andonlinepostingofthematerials.Failuretomeetthisdeadlinemayseriouslyimpact thesuccessfuldeliveryoftheteachingsession. APPROPRIATESUPERVISIONANDROLEMODELLING TeachersofalltypesinUMEdonotmerelytransmitknowledgetostudents.Rather,andequallyimportantly,they alsoguidestudentsontheirpathtowardsprofessionalpractice.Itisthereforeessentialforteacherstorecognize theresponsibilitiesincumbentuponthemassupervisorsandrolemodelsinallsettingsandeducationalsituations. Forclinicalfaculty,manyoftheseresponsibilitiesaresetoutintheFacultyofMedicinesStandardsofProfessional BehaviourforMedicalClinicalFacultyandintheCollegeofPhysiciansandSurgeonsofOntariosProfessional ResponsibilitiesinUndergraduateMedicalEducation,amongotherguidingdocuments. STUDENTASSESSMENT TheUMEprogramplacesgreatvalueonprovidingstudentswithreliableandvalidassessmentsforpurposesof bothfeedbacktothestudentanddecisionsaboutwhetherstudentshaveachievedcompetency.UMEteachersplay acriticalroleintheseassessmentactivities.Forclarity,theseactivitiesinclude: completingevaluationformsordailyencountercards, markingwrittenassignmentsororalreports, markingexaminationpapersorportionsthereof, providingformalmidrotationfeedback(includingreviewofstudentsloggingreports), participatinginOSCEsorotherclinicalexaminations,and anyothersuchactivities. Insomecircumstances,adhocassessmentsmayalsoberequestedbythecoursedirector,forinstance,incasesof concernaboutastudent. Allteacherswhoareassignedassessmentresponsibilitiesareexpectedtodischargethesedutiespromptly, conscientiously,andintheformatrequested.UMEpolicyrequiresthatallassessmentoutcomesbesharedwith studentswithinamaximumoffourweeks1,butamuchshortertimeframeisgenerallyexpected.Coursedirectors mayimposeanearlierdeadlinedependingonthenatureoftheassessmentorotherfactors. RECORDINGSTUDENTABSENCES Teacherswholeadsessionsthathavebeendeemedmandatorybytheprogramorthecoursemustmaintaina completerecordofstudentabsences,andsubmitthisrecordtothecoursedirectorattheconclusionofthecourse orblockofteaching.2 TIMELYCOMMUNICATIONREGARDINGCONCERNSABOUTSTUDENTSOROTHERISSUES Individualteachers,particularlythoseinvolvedinoneononeorsmallgroupeducationalactivities,aregenerally bestplacedtoidentifyconcernsaboutstudentperformanceandconduct;theyarealsowellplacedtoevaluate otheraspectsoftheeducationalexperience,suchastheappropriatenessofthecontentordeliverymethod,the learningenvironment,etc.Consequently,timelycommunicationfromteacherstocoursedirectorsorsitedirectors isessentialtothedeliveryoftheUMEcurriculumwhenconcernsofanykindarise.
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SeeStandardsfortimelycompletionofstudentassessmentandreleaseofmarks. SeetheRegulationsforstudentattendanceandguidelinesforapprovedabsencesfrommandatoryactivitiesinUME.

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Procedurefordisclosureofpotentialcommercialorprofessionalconflictsof interestbyUMEteachers
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:3August2011 Dateoflastreview:3August2011 Dateofnextscheduledreview:3August2015
Procedure: AllteachersintheUMEProgrammustdiscloseanyactual,perceived,orpotentialconflictsofinterest. 1. Thisincludes: thosedeliveringcontentinlectures,symposia,seminars,andPBLtutorials. thosepreparingordeterminingcontentsuchascoursedirectors,planners,andmembersofcurriculum committees.

2. Thedisclosurebyteachersmustbeincludedinprintoronlinematerialsandmentionedatthebeginningof eachsession. Ifslidesareused,thesecondslideshouldcontainthedisclosureinformation.

3. Potentialconflictsofcoursedirectorsorplannersshouldbedeclaredintheoverallcoursedescriptionand publicallyavailable. 4. Inlessformalsettingssuchasclinicalteachingatthebedside,intheoperatingroomorprocedureroom,orin ambulatorysettings,itisnotpracticaltodisclosepotentialconflictsattheoutsetofeveryencounter.However, teachersshouldbemindfulofsituationsinwhichtheimpartialityoftheirstatementscouldbequestionedand discloseanypotentialconflictofinterestinsuchcasestothestudentsundertheirsupervision. 5. Foradviceonhowtoapproachthesesituations,teachersareencouragedtospeakwiththecoursedirector(s) ofthecoursesinwhichtheyparticipate. ThisprocedureisconsistentwiththeguidelinesarticulatedintheReportoftheTaskForceonRelationswith IndustryandthePrivateSector(TRIPS,January2011),1butalsorecognizesthepotentialfornonindustryrelated conflictsofinterest. Itistheresponsibilityofcoursedirectorsorotherfacultymemberswhocoordinateteacherrecruitment(e.g.week managersorsitedirectors)tomakethisprocedureknowntoallteachers.
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TheTRIPSreportidentifiesrelevantconflictsofinterestasincludingbutnotbeinglimitedto:partnerships,shareholdings,receiptof consultationfees,membershiponadvisoryboardsorspeakersbureaus,andfundingforresearch.

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Procedureforconflictsofclinicalandeducationalroles
Approvedby:UndergraduateMedicalEducationExecutiveCommittee Dateoforiginaladoption:17May2011 Dateoflastreview:17May2011 Dateofnextscheduledreview:17May2015
PREAMBLE: ManyteachersintheFacultyofMedicinearealsopractisingclinicians,creatingthepotentialforaconflictof professionalrolestoarise: o o First,aFacultyofMedicineteachermaybeassignedtoteachorassessamedicalstudentpreviouslycared fororcurrentlybeingseenasapatient. Second,aFacultyofMedicineteachermaybeaskedtoprovidecaretoacurrentorformerstudent.

Bothkindsofsituationsmustbecarefullymanaged,particularlyifthecareisofasensitivenatureasdefined below,orifthecareisprovidedinthecontextofanongoingclinicalrelationship. (1)Ifamedicalstudentcomesunderthesupervisionofateacherwhoiscurrentlytreatingorhaspreviouslytreated thatstudentforasensitivehealthconcern,orwhoistheirprimarycarephysicianorspecialistconsultantfor ongoingregularcare,aconflictofprofessionalrolesbetweentheteachersclinicalandeducationalresponsibilities arises. (NB:Supervisionisdefinedheretoincludeanysmallgroupdidacticteachingorteachingofclerksina clinicalsetting,butdoesnotincludelargegrouplectures. Sensitivehealthconcernsincludebutarenotlimitedtomentalhealthconditionsandconditionsthatare sexualinnature;thethresholdforsensitivityisrecognizedtobeanindividualdecision,whichshouldfully considerreasonableexpectationsofthepatient.) Insuchasituation,theteachermustnotparticipateintheassessmentofthestudentinquestion,eitherdirectlyor indirectly(e.g.,byprovidingfeedbacktothesitedirectorofaclinicalrotation).Itisalsopreferablethatthestudent bescheduledforalternativesupervision,ifpossiblewithoutdisruptingtheeducationalexperienceofthestudentin questionandotherstudentsinthecourse,andwithoutdrawinganyunnecessaryattentiontoeitherthestudentor teacher. Responsibilityandprocedure: Boththeteacherandthestudentareindividuallyresponsibleforreportingthepotentialconflictof professionalrolestotheappropriateUMEleaderoftheirchoosing;thismayincludethecoursedirector, thestudentsAcademyDirector,thePreclerkshiporClerkshipDirector,and/ortheAssociateDean,Health ProfessionsStudentAffairs.Onceeitherpartycontactsanyoftheaboveindividuals,thatindividualwill makearrangementstoremovethestudentfromtheteacherssupervisionorataminimumtoensurethat assessmentisconductedexclusivelybyotherfacultymemberswithnoinputfromthatteacher.

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notberequiredtodisclosethenatureofthehealthcaretheyreceived.Teacherswhomakeareportneed discloseonlythataconflictofinteresthasarisenwithoutmakingexplicitthatitpertainstotheirclinical role;thisprovisionhasbeenincludedinrecognitionofphysicianteachersprimaryresponsibilitytouphold patientconfidentiality. Ifitisthestudentwhoreportstheconflict,theteacherinquestionwillnotbeinformedofthereasonfor thechangeunlessitprovesnecessary,andonlythenafterstudentconsentisprovided.Ifitistheteacher whoreportstheconflict,thestudentwillbeinformedofinstitutionalpoliciesaroundconflictsofinterest andthereasonforthetransferofsupervision. Ifadditionalfacultyorstaffneedtobeinvolvedinordertotransferthestudenttoanothersupervisor, explanationsaretobeprovidedtothemonaneedtoknowbasisonly,withtheminimumamountof informationrequired. Specialprovisionregardingseniorteachers/leadersincurriculum: Whenthefacultymemberinquestionisinauniqueseniorposition,as,forexample,acoursedirector, PreclerkshipDirector,orClerkshipDirector,itwillgenerallynotbepossibletoremovethatindividual entirelyfromtheoversightandinvolvementofastudentwhoisaformerorcurrentpatient.1Instead,itis expectedthattheseniorteacher/leaderincurriculumreporttheirpotentialconflictofprofessionalrolesto theViceDeanUMEassoonastheybecomeawarethataformerorcurrentpatientisenrolledinacourse undertheirjurisdiction. Uponsuchnotification,theViceDeanUMEwilltakemeasurestoensurethatanyextraattentionthat maysubsequentlyneedtobepaidtothestudentinquestion(e.g.,foracademicdifficulty,professionalism concerns,orpetitionsforconsideration)ishandledbyasuitablealternate.Thecurriculumleaderinconflict maybeinvolvedonlyinsofarasthisisdeemednecessarytoensureconsistenttreatmentofallstudents. Theinvolvementofthealternatewillbedulydocumented.Itisnotrequiredthatthestudentbeadvised thatanalternatehasbeenputinplaceunlesstheirperformanceorbehaviournecessitatesextra attentionasdefinedabove;nevertheless,dependingonthecircumstances,theViceDeanathis/her discretionmaynotifythestudentofthearrangementfromtheoutset. (2)Ifastudentissupervised,tutored,ormentoredinaformalorinformalcapacitybyateacher,thenan educationalrelationshipisestablished.Consequently,aconflictofprofessionalroleswouldariseifateacher acceptedarequesttoprovidehealthcareservicesorclinicaladvicetosuchstudentsduringtheperiodofthe educationalrelationship.Ifastudentrequestssuchadviceorassistance,heorsheshouldbeadvisedtoseekcare fromtheirfamilyphysicianorotherappropriatehealthcareprovider(exceptincasesofanemergent/urgent nature).
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Itshouldbenotedthatsuchseniorteachersorleadersincurriculumdonotgenerallyparticipateindirectassessmentofstudents; rather,theytypicallymakejudgementsabouttheoverallperformanceandbehaviourofstudentsbasedonfeedbackfromothers,andthese decisionsarenormallymadebyagroupratherthanbytheseniorteacheralone.Consequently,thesituationsinwhichariskofunequal treatmentwouldarisearemorelimitedthantheywouldbeforapersoninvolvedindirectteachingandassessment.


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Alternatively,ifateacherwishestoaccepttherequesttoprovidecaretoastudent,theteachermustinformthe appropriateUMEleader2priortocommencingcare.TheprovisionsandprocedureinSection1ofthispolicywill thenapply.Forclarity,teachersshouldneverencouragestudentstoconfidepersonalhealthrelatedconcernsto

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them.3 Withregardtotheprovisionofmedicalservicesoradviceaftertheeducationalrelationshiphascometoanend, teachersarestronglyurgedtoexercisecautionandfamiliarizethemselveswiththerelevantprofessional regulations;theyshouldalsobearinmindthepossibilitythattheeducationalrelationshipmayberenewedata laterdate.
2

AnappropriateUMEleadermayincludethecoursedirector,thestudentsAcademyDirector,thePreclerkshiporClerkship Director,and/ortheAssociateDean,HealthProfessionsStudentAffairs. StudentsmaybereferredtotheAssociateDean,HealthProfessionsStudentAffairs,ortheirAcademyDirectorforassistanceinaccessing appropriateresources.OnlineinformationonhealthcareresourcesismaintainedbytheOfficeofHealthProfessionsStudentAffairs.

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StandardsforcalldutyandstudentworkloadintheClerkship
Approvedby:UndergraduateMedicalEducationExecutiveCommittee Dateoforiginaladoption:17May2011 Dateoflastreview:17May2011 Dateofnextscheduledreview:17May2015
Themaximumoncallfrequencyinallclinicalclerkshipcoursesisonenightinfouraveragedacrosstheentire rotationduration.Clerksmustnotbescheduledforcalldutytheeveningbeforeanexaminationoronthelastday ofasixoreightweekblock(usuallyaSunday),norontheFridaysbefore(a)theDecemberholidayperiod,(b)the CaRMSinterviewperiod,(c)theMarchBreak,and(d)thelastrotationoftheacademicsession. Afterbeingavailableforserviceinhospitalfortwentyfourconsecutivehours,clerksmustberelievedofallservice andeducationaldutiesuntilthecommencementofthenextworkingday,afterensuringadequatehandoverof patientcareresponsibilities.Suchhandovershallnotexceedtwohours,foratotaloftwentysixconsecutivehours inthehospital. Studentsshallnotbeaskedorexpectedtoexceedthelimitsspecifiedaboveunderanycircumstances. IfacourseortheClerkshipasawholehasdesignatedcertaineducationalactivitiesasmandatory,thenstudents mustberelievedoftheirdutiesatmidnightoftheprecedingday.Alternatively,suchmandatoryeducational activitiescanbescheduledfirstthinginthemorningtoenablepostcallstudentstoattendwithintheirtwentysix hourlimit. Ifastudentisnotoncalloronshift,he/sheshallnotworkonaweekendday. Acrossthedurationofarotation,theaveragenumberofhoursperdaythatastudentspendsintotalinrequired clinicalanddidacticexperiencesshallnotexceed10,excludingdaysonwhichthestudentisoncallorpostcall. Itistheresponsibilityofeverysitedirectorforeachclerkshipcoursetoactivelymonitoradherencetoallaspectsof thispolicyandtointerveneimmediatelyifanyarebreached. Concernsfromstudents,teachers,oradministrativestaffmembersregardingbreachesofthepolicyshouldbe broughttotheattentionofthesitedirectorinthefirstinstance.Iftheresponseisunsatisfactoryorifapatternof breachesemerges,themattershouldnextberaisedwiththecoursedirectorforreviewandpossibleredress.If continuednoncomplianceoccursatoneormultiplesitesafterthecoursedirectorhasintervened,theissueshould bereportedtotheClerkshipDirectorandrelevantUniversityDepartmentChairforimmediateresponse.

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StandardsforcoursehoursandstudentselfstudytimeinthePreclerkship
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:[21June2011] Dateoflastreview:[21June2011] Dateofnextscheduledreview:[21June2015]
TheUndergraduateMedicalEducationprogramrespectstheimportanceofenablingstudentstoachievean appropriatebalancebetweentheiracademicresponsibilities,independentlearningtime,andpersonallives.Tothis end,thefollowingstandardshavebeenadopted. Thenumberofscheduledteachinghours(lectures,seminars,laboratorysessions,andsmallgrouplearning activities)bytheFacultyinaweekofthePreclerkshipisnottoexceed32.AweekisdefinedasMondaythrough Friday,excludingholidays;therearenorequirededucationalactivitiesonSaturdaysandSundays. Inaddition,acrosseachentireyearofthePreclerkshiptherewillbeamaximumof30hoursofmandatorybut flexiblyscheduledcurriculumexperiences.MandatorybutflexiblyscheduledcurriculumexperiencesincludeFamily MedicineLongitudinalExperienceencounters,InterProfessionalEducationelectives,etc. OverthecourseofeachyearofthePreclerkship,thereshallbeaminimumtotalof36unscheduledhalfday blocks1,i.e.,anaverageofonehalfdayblockofunscheduledtimeperweek.Inaddition,thesehalfdayblocksshall becomplementedbyotherperiodsofunscheduledtimetoensureanaverageofatleasteighthoursintotalper week.Thedailylunchhour(whichisusuallyheldfrom12to1PM)isnotincludedinthisunscheduledtime. Moreover: Themaximumnumberofscheduledteachinghoursinadayshallbeseven,andthismaximumshallbe attainednomorethantwodaysperweek.Onallotherdays,themaximumnumberofscheduledteaching hoursshallbesix. Theremustbenomorethanthreehoursoflecturesscheduledconsecutively. Thereshouldbenomorethanfourhoursoflecturesinaday. Incircumstanceswherethecurricularframeworkrequiresadditionallecturetime,amaximumoffour consecutivehoursoflectureorsixhoursoflecturesinonedaymaybepermittedonlywithpriorapproval fromthePreclerkshipDirector.Extraconsiderationshouldbegivenonsuchoccasionstoemploying engagingandinteractivelargegroupformats.
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Anunscheduledhalfdayblockisaperiodoftimethatwilltypicallyextenduntil12PM(allmorning)orbeginat1PM(allafternoon)on agivenday.Lengthyunscheduledperiodsthatfallbetweenscheduledteachingactivitiesdonotconstituteunscheduledhalfdayblocks.For example,ifthereisscheduledteachingfrom9AMto11AMandthenmorescheduledteachingfrom4PMto5PM,theunscheduledperiod between11AMand4PMwillnotbeconsideredanunscheduledhalfdayblockforthepurposesoftheseStandards,butwillberecognized asfourhoursofunscheduledtime(withafifthhourforlunch)

Page1of2 Exceptionscanbemadeforunusualcircumstances(e.g.,torecoverasessionthatwascancelledonshortnotice

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duetoUniversityclosure,unforeseenlecturerunavailability,etc.),butstrictadherencetothispolicyisotherwise expected. Coursedirectors,insofarastheyareresponsiblefordesigningandimplementingtheircourses,holdprimary responsibilityforensuringcompliancewiththeseStandards.Coursedirectorsofcoursesthatrunsynchronouslyare expectedtoworkcollaborativelytoensurethattotalscheduledteachinghoursdonotexceedthelimitsspecified above. Coursedirectorsareencouragedtobemindfulofstudentsincreasedneedforselfstudytimeimmediatelypriorto examinations,andtoarrangethescheduleofsessionsintheircoursesaccordingly. Concernsfromstudents,teachers,oradministrativestaffmembersregardingbreachesoftheseStandardsshould bebroughttotheattentionofthecoursedirectorinthefirstinstance.Iftheresponseisunsatisfactoryorifa patternofbreachesemerges,themattershouldberaisedwiththePreclerkshipDirectorforreviewandredress.

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Required clinical experiences in the core clerkship rotations: Responsibilities ofstudents,faculty,andUMEcurriculumleaders


Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:12September2011 Dateoflastreview:12September2011 Dateofnextscheduledreview:12September2015

A. Principles 1. Educationalvalue a. Theloggingofclinicalproceduresandencountersincoreclerkshiprotationshasimportant educationalvalueforstudents,teachers,andcoursedirectors: b. Studentsbenefitfromloggingbecauseitallowsthemtoconfirmthattheyhaveinfact encounteredallofthecoreproblemsandperformedallofthecoreproceduresthatthe programhasdeemedessentialforcompletionoftheMDdegree. c. EveryparticipantintheClerkshipeducationprocessbenefitsfromloggingbecauseitallowsthe programtoconfirmthatallclinicalsitesprovideequivalentexperiencesandthatallstudents meettheminimumexpectationswithregardtopatientsseenandproceduresperformed. 2. Realpatients UndergraduateMedicalEducationemphasizestheimportanceofstudentinteractionwithrealpatients aspartoftheiracquisitionofallcategoriesofprogramcompetencies(i.e.theCanMEDSroles).Forthis reason,therequiredencountersandprocedureslistsaredesignedtobeachievableexclusivelythrough experienceswithrealpatients.However,simulatedexperiencesmaybepermittedinsomecasesto remedygaps,asdescribedbelow. 3. Coursecomponent Loggingofclinicalencountersandproceduresisamandatory,Credit/Noncreditcomponentofevery coreclerkshiprotation.Astudentwillnotreceivecreditinacourseuntilsuchtimeasthelistis completed. 4. Academicintegrityandprofessionalism Theprincipleofacademicintegrityappliestologgingjustasitappliestoallothercoursecomponents. Therefore,anyfalsificationofdatawillbeconsideredamajorlapseofprofessionalismandmayalsobe subjecttootherdisciplinaryactionaccordingtoUniversitypolicy. B. Descriptionofthecourselistsofrequiredencountersandprocedures Everycoreclerkshipcoursemaintainsandpublishesalistofrequiredencountersandprocedures.These listsarereviewedannuallybyeachcourseandupdatedasrequired,withcentraloversightbytheClerkship Director. Page1of3

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ThelistsarepublicizedonthecoursewebsitesonthePortal,ontheonlineloggingsoftwareTRes (www.tres.net),andontheTResPocketCarddistributedtostudents.Atthestartofeachrotation, studentsareexpectedtofamiliarizethemselveswiththelistofrequiredencountersandproceduresfor thatcourse,includingtherequirednumberofeachencounterandprocedureandthelevelofstudent involvementrequired,asdescribedbelow. 1. Encounters Encountersaredefinedasmeaningfulinvolvementinapatientscare.Forexample,takingahistory, performingrelevantphysicalexaminationmanoeuvres,andtakingpartindiscussionofinvestigation andmanagementwouldbeconsideredanencounter.

2. Procedures Procedureshaveaprespecifiedlevelofminimuminvolvementthatmustbeachievedinordertobe logged.Theseexpectationsareclearlyarticulatedaspartofthelistofrequiredprocedures.Thelevels are: a. Thestudentobservedtheprocedure. b. Thestudentperformedtheprocedurewithassistanceorassistedsomeoneelse. c. Thestudentperformedtheprocedureindependently.

3. Number Inmostbutnotallcases,onlyoneencounterorprocedureperitemlistedisrequired. Studentsarenotexpectedtologeverypatient,butmustmeettherequirementsforlogging(including quantity)specifiedbyeachcourse.

4. Settings Theexpectedsettingforeachprocedureandencounterisgenerallyimplicit,giventhatthelistsare coursebasedandcoursestypicallyhavespecificsettings.Incaseswheremorespecificityisrequired,it isincludedinthenameoftheprocedureorencounter. C. Processforreportingandreview 1. Midrotation Aspartoftheformalmidrotationfeedbackconversation,itismandatoryforstudentstoreviewTRes Report062(TraineeEncountersandProceduresCountSummary)withtheirpreceptor/sitesupervisor, exceptinthecaseofcourseswithdurationofoneweekorless.(Coursesofoneweekorlessare deemedtooshorttorequiremidrotationmeetings.)Itisthestudentsresponsibilitytopresentthe reporttotheirpreceptor/sitesupervisor. Studentsareexpectedtohaveadialoguewiththeirpreceptor/supervisorregardingthereport.This portionofthemidrotationfeedbackconversationhastwomainpurposes: todiscussthekeylearningpointsoftheexperiencesthathavebeenloggedbythestudentsto date toestablishaplanforsubsequentclinicalexperiencestoremedyanygapsinordertocomplete alltherequiredencountersandproceduresbytheendoftherotation. Note:Insomecourses,aformwillbecompletedjointlybythestudentandpreceptordocumentingthis discussion.
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2. Endofrotation Attheendoftherotation,itismandatoryforthestudenttosubmitacompletedTResReport064 (EncounterandProcedureGoalCompletionSummary)tothecoursedirectorordesignate(e.g.thesite supervisor)inordertoreceiveCreditfortheloggingcomponentofthecourse.Acheckmarkatthe bottomofthecolumnofencountersandproceduresindicatescompletion. 3. Reminders StudentswillreceivecentrallygeneratedemailreminderstoreviewReport062(midrotationreport) andtohandinReport064(endofrotationreport). 4. Incompleterequirements AsstatedinthePrinciples,theexpectationisthattherequiredclinicalencountersandproceduresare preferentiallyexperiencedthroughinteractionwithrealpatients.Someencountersandprocedureswill beidentifiedineachcourseasMustberealbecausetheyarecriticalcommonpatientencounters thatcannotbeadequatelyreplacedbysimulation.Evenforotherrequiredencountersandprocedures, simulationsshouldonlybeusedtoremedygaps,suchaswhenagivenexperiencewitharealpatientis unavailable(e.g.,inthecaseofseasonalillnessorcertainlesscommonpresentations). IntheeventofanincompleteReport064,studentswillberequiredtoworkwiththecoursedirector expeditiouslytomakeanactionplan,withfollowupfromthecoursedirector,toremedyanyremaining gaps.UponcompletionofReport064,Creditforthecomponentwillbeawarded.Note:Allgapsinall coursesmustbecompletedwithinsixweeksoftheendoftheYearIIIclerkshipinorderforallclerkship coursestobeconsideredcompletewithcreditearned. 5. Centralmonitoring TheClerkshipDirectorwillmonitoroverallcompletionratesineverycourseatregularintervalsto identifyanytrendsofconcernrequiringaction. Individualstudentswhoarepersistentlyunabletocompletetherequiredlistsinmultiplecoursesmay beconsideredtoexhibitacademicdifficulty,inwhichcasetheappropriateinterventionswillbe applied.(SeetheGuidelinesfortheAssessmentofUndergraduateMedicalTraineesinAcademic DifficultyClerkship.)

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Standardsformidrotationfeedbackincoreclinicalclerkshipcourses
Approvedby:UndergraduateMedicalEducationExecutiveCommittee Dateoforiginaladoption:[15November2011] Dateoflastreview:[15November2011] Dateofnextscheduledreview:[15November2015]
Inallcoreclinicalclerkshipcoursesoffourweeksorlonger,everystudentmustreceivebothverbalandwrittenformal, formativemidrotationfeedbackfromafacultysupervisor.Coursesshorterthanfourweeksareencouragedtoprovidesuch feedbackwherefeasible.Courseswithdistinctsubrotationsofdifferentsitesand/ordifferentservicesshouldpreferably providemidrotationfeedbackatthemidpointofeachsubrotation,butmayinsteadprovidethisfeedbackatthemidpointof therotationasawhole. Formativemidrotationfeedbackreferstoadescriptionoftheskillsandknowledgeastudenthasdemonstratedtodate,with anemphasisonthestudentsstrengthsandareasrequiringfurtherimprovementbeforetheendoftherotation(orsub rotation).Midrotationfeedbackincludesareviewofthestudentslogofclinicalexperiences1,i.e.thequantityandbreadthof theirexperiences,butitmustalsoincorporateconsiderationofthequalityofthestudentsexperiencesandperformancewith regardtoallsevencategoriesofcompetency(MedicalExpert,Communicator,Collaborator,Manager,HealthAdvocate, Scholar,andProfessional).Narrativeassessmentisanessentialcomponentofmidrotationfeedback2,althoughaquantitative assessment(e.g.throughansweringquestionsonaratingscale)mayalsobeemployedatthediscretionofacoursedirector. Aboveall,inpreparingtheirfeedback,supervisorsshouldbearinmindthattheprimaryaudienceisthestudenthimself/herself andthattheprimarypurposeofthefeedbackistoassistthestudentinachievingtheobjectivesofthecourse;itisnotusedin anywaytodeterminethestudentsoutcomeinthecourseorprogram. Formalmidrotationfeedbackmeansthatthefeedbackencountershouldbeconductedprivatelyandatatimemutually agreeduponinadvancebythestudentandsupervisor.Asummaryofthefeedbackmustberecordedonaformsuppliedby thecourseadministration,andsubmittedtoboththestudentandthecoursedirector;thisprocessmaybeperformedonpaper orelectronically(throughMedSIS). Coursedirectorsareresponsibleforactivelymonitoringthatmidrotationfeedbackisprovidedtoeverystudentoneach rotationandateachsite,andfortakingimmediateactionshouldtheybecomeawarethatthishasnotoccurred.Course directorsarealsoexpectedtoseekinformationfromstudentsonthequalityofthefeedbacktheyreceiveatmidrotation,to ensurethatthefeedbackisfulfillingitsaim.

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SeetheRequiredclinicalexperiencesinthecoreclerkshiprotations:Responsibilitiesofstudents,faculty,andUMEcurriculumleaders. 2 SeetheExpectationsfortheprovisionofnarrativefeedbacktostudentsinUME.

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Standardsfortimelycompletionofstudentassessmentandreleaseofmarks
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:19April2011 Dateoflastreview:19April2011 Dateofnextscheduledreview:19April2015
IneverycourseintheUMEprogram,eachstudentcomponentassessment(evaluationforms,examinationresults, etc.)mustbereleasedtothestudentswithinfourweeksofthecompletionoftheactivitytobeassessed.Individual adherencetothisdeadlineistobemonitoredbythecoursedirector.Regardlessofwhetherthecoursedirector electstodelegatethistasktoanadministrativeassistant,theoverallresponsibilityforcomplianceremainswiththe coursedirector. ThefinalgradeineachcourseistoberecordedwithinMedSISandmustbemadeavailabletostudentsnolater thansixweeksfollowingtheendofthecourse/rotation.Earliernotificationisencouraged.Inexceptional circumstances,anindividualstudentsassessmentsand/orfinalcoursegrademaybedelayed;inthissituation,the studentmustbenotifiedofthereasonsfordelay.Undernocircumstancesshouldthereleaseofassessmentsor gradestoanentireclassorgroupofstudentsbedelayedbeyondthetimeframesnamedabove. Studentsmustbeadvisedofsubstandardperformanceassoonasthisinformationisavailable,andwellinadvance ofthedeadlinesnotedabove. Teachersorcoursedirectorswhopersistentlyfailtomeetthefourweekassessmentdeadlineand/orsixweekfinal gradedeadlinewillbebroughttotheattentionoftheirDepartmentChairand/ortheViceDeanUMEbythe Registrar,thePreclerkshipDirector,and/ortheClerkshipDirector.

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ExpectationsfortheprovisionofnarrativefeedbacktostudentsinUME
Approvedby:UndergraduateMedicalEducationExecutiveCommittee Dateoforiginaladoption:3August2011 Dateoflastreview:3August2011 Dateofnextscheduledreview:3August2015
TheUMEprogramplacesgreatemphasisontheprovisionoffeedbacktostudentstosupporttheirlearning.This includesnumericalfeedback(seeStandardsforthedisclosureofcomponentmarksandfinalgradestostudents) andalsonarrativefeedback,inbothwrittenandverbalforms. Anarrativedescriptionofastudentsperformanceshouldbeincludedineverycourseorcurriculartheme.In particular,anyseriesofsmallgrouporoneononelearningexperiencesshouldculminateinnarrativefeedback fromtheteacher(s).Suchfeedbackmayormaynotbeaccompaniedbyaformalassessment,asdeemedmost appropriateforthecourse. Coursedirectorsandthematicfacultyleadsareexpectedtoreviewwrittendescriptionsandcommentstheyreceive abouteachstudentsperformance.Theyarealsoexpectedtotakeeveryopportunitytosharewrittennarrative feedbackwithstudentsincaseswherethisdoesnotoccurautomatically(i.e.whenitisnotprovidedverballyoron anevaluationformthatthestudentisabletoaccess).

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Standardsforgradingandpromotionofundergraduatemedicalstudents
Approvedby:UndergraduateMedicalEducationExecutiveCommittee Dateoforiginaladoption:[10February2012] Dateoflastreview:[10February2012] Dateofnextscheduledreview:[10February2016]
TheseStandardsserveasanadjuncttotheUniversityofTorontoGradingPracticesPolicyanddescribethepractices oftheUndergraduateMedicalEducationprogramwithregardtodeterminingthestandingofeveryenrolled student.TheyareinfullaccordancewiththeTermsofReferenceoftheBoardofExaminersoftheUndergraduate MedicalProgram,andarecomplementedbytheUMEprogramsGuidelinesfortheAssessmentofUndergraduate MedicalTraineesinAcademicDifficulty(PreclerkshipandClerkshipversions). 1. AuthorityoftheBoardofExaminers:Alldecisionsrelatedtoanundergraduatemedicalstudentsstanding areultimatelymadebytheBoardofExaminersoftheUndergraduateMedicalEducationprogram,a standingcommitteeoftheCounciloftheFacultyofMedicine.Toinformthesedecisions,theBoardof ExaminersreceivesrecommendationsfromthePreclerkshipandClerkshipDirectorand/orindividualcourse directors. 2. Componentmarksandcoursegrades:Componentmarksandcoursegradesarenormallyreleasedthrough theMedicalStudentInformationSystem(MedSIS),butmayalsobereleasedthroughothermeans(e.g.,e mail). a. Componentmarks:Componentmarksarenotsubjecttoanyformalapproval,butratherserveas thebasisfordecisionsaboutoverallcoursestanding. b. Provisional(unofficial)coursegrades:CoursegradescommunicatedthroughMedSISoremail constituteanunofficialrecord.ProvisionalcoursegradesinMedSISaresubsequently recommendedtotheBoardofExaminers.(SeeSections7and8.) c. Officialcoursegrades:UponapprovaloftheBoardofExaminers,coursegradesareloadedintothe RepositoryofStudentInformation(ROSI),whichistheofficialrecordandisusedbytheUniversity togenerateofficialtranscripts.IntheeventthattheBoardofExaminersmakesachangetoa studentsfinalstandinginacourse,thechangewillbemadeinMedSISaswell.
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3. Standardsofachievementonindividualcomponents,otherthanprofessionalism:Withtheexceptionof professionalism,itistheresponsibilityofeachcoursecommitteetodefinesatisfactorycompletionofeach componentoftheircourse.Specifically: a. Assessmenttoolsandmethods:Withtheexceptionofprofessionalismevaluations,course committeesareresponsibleforestablishingtheassessmenttools(examinations,assessments,etc.) tobeusedinthecourse,subjecttoperiodicreviewbytheExamination&StudentAssessment Committee(ESAC)and/ortheUMECurriculumEvaluationCommittee(UMECEC).Changesto assessmentmethodsmustbebroughttotheattentionofthePreclerkshiporClerkshipDirector,as pertheGuidelinesandprotocolformakingcurricularchanges. b. Definitionofaclearpass:Foreverymarkedcomponentinacourse,coursecommitteesare responsiblefordefiningthenumericalthresholdabovewhichastudentsperformanceonthat componentwillbeconsideredunequivocallysatisfactory(aclearpass)andforestablishing assessmenttoolstomeasureachievementofthisthreshold.Inmanycourses,thisthresholdis70%. ComponentsonwhichaclearpassisachievedwillberecordedasCR(Credit)inMedSIS. c. Definitionofaclearfailure:Onnumericallymarked(scored)componentsofeverycourseinthe UMEprogram,60%istheuniversalthresholdbelowwhichastudentsperformanceisdeemed unsatisfactory(aclearfailure).Coursecommitteesareresponsiblefordefiningwhatconstitutes performanceaboveandbelowthisthresholdandestablishingsuitableassessmenttools accordingly.ComponentsonwhichaclearfailureisachievedwillberecordedasNC(No Credit)inMedSIS,unlessextraworkisassigned,inwhichcaseaninterimstandingofCON (Conditioned)onthecomponentwillberecorded.(SeeSection7cfordetails.) d. Definitionofborderlineperformance:Numericalmarksforindividualcomponentsthatfallator above60%andbelowtheclearpassthresholdestablishedbythecoursearedeemedborderline. BorderlinecomponentswillberecordedasCR(Credit)inMedSIS,unlessextraworkisassigned, inwhichcaseaninterimstandingofCON(Conditioned)onthecomponentwillberecorded. (SeeSection7cfordetails.) e. Definitionofanincompletecomponent:Coursecommitteesareresponsibleforselectingany mandatorynonmarkedcomponentstheydeemappropriateforthecourse,subjecttoperiodic reviewbyESACand/ortheUMECEC.(Theseinclude,forexample,requiredencountersand proceduresinthecoreclinicalclerkshipcourses.)AninterimstandingofINC(Incomplete)will berecordedinMedSISforanysuchcomponentthatisnotsubmittedorcompletedtotheminimum standardestablishedbythecoursecommittee.(SeeSection7dfordetails.) f.
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Communicationtostudents:Coursecommitteesareresponsibleforarticulatingalloftheelements aboveinacourseoutlineprovidedtostudentsnolaterthanthefirstdayofthecourse.

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4. Definitionandapplicationofextrawork:Borderlineperformanceonacomponentorinacourse,aswellas marginalfailureofacomponent,mayleadtotheassignmentofextrawork,whichisashortprogramof additionalstudy,assignments,and/orclinicalexperiencetoensurethatthestudenthasmetthestandards ofthecourse.Coursecommitteesareresponsibleforestablishingstandardsofextrawork.Extraworkis assignedtoastudentatthediscretionofthecoursedirector,inconsultationwiththe Preclerkship/ClerkshipDirector;ifthestudentsdeficitissignificant,afurtherassessment(e.g.arepeat examination)mayberequiredbythecoursedirectorandPreclerkship/ClerkshipDirectoraspartofthe extraworktoconfirmthestudentsimprovement.Ifaprogramofextraworkissuccessfullycompleted,the originalmarkachievedonthecomponent/inthecoursewillbeallowedtostand.Intheeventthata programofextraworkisnotsuccessfullycompleted,seeSection8bbelow. 5. Standardsofconductinprofessionalism:Satisfactoryprofessionalbehaviourisarequirementtoachieve creditineverycourse,andassessmentofprofessionalismisincludedineverycourse. a. Standardsofachievementandassessmenttools:Incontrasttoothercomponents,boththe standardsofachievementinprofessionalismandthetoolstoassessstudentsprofessional performancearenottheresponsibilityofcoursecommittees,butareinsteadestablishedbythe ProfessionalismCommittee,subjecttoperiodicreviewbytheUMECEC.Thestandardsare describedintheGuidelinesforAssessmentofUndergraduateMedicalTrainees(Preclerkshipand Clerkshipversions). b. Responsibilitiesrelatedtostudentswithidentifiedweaknessinprofessionalism:Astudentwhois identifiedasexhibitingsignificantweaknessinthisarea,eitherthroughroutineprofessionalism evaluationsorthroughotherreportsofconcerningconduct,mayberaisedbeforetheBoardof ExaminersbythePreclerkship/ClerkshipDirector,thecoursedirectorofthecourseduringwhich theincidentoccurred,theFacultyLeadforEthics&Professionalism,and/ortheAssociateDean Equity&Professionalism.Extraworkandremediationinprofessionalismarenormallyassignedand conductedunderthesupervisionoftheFacultyLeadforEthics&Professionalismand/orthe AssociateDeanEquity&Professionalism. 6. Standardsofachievementinacourseasawhole: a. Determinationofachievement:Itistheresponsibilityofeachcoursecommitteetodefine satisfactorycompletionoftheircourseasawhole.Specifically: i. Relativeweightofcomponents:Coursecommitteesareresponsibleforassigningthe relativeweightofeachnumericallymarkedcomponentthatcontributestothecalculation ofthefinalcoursegrade.AspertheUniversityGradingPracticesPolicy,nosingle componentmaybeassignedaweightofmorethan80%oftheoverallcoursegrade. ii. Additionalexpectationsformarkedcomponents:Acomponentsweightnotwithstanding, coursecommitteesmayestablishadditionalexpectationsformarkedcomponents.For example,inagivencourse,theremaybearequirementtoachieve60%oneachwritten exam,inadditiontoanaverageoverallgradeof60%inthecourse. iii. Mandatorynonmarkedcomponents:Bytheirnature,mandatorynonmarkedcomponents arerequiredinordertocompletethecourse. iv. Professionalism:SeeSection5above. b. Communicationtostudents:Coursecommitteesareresponsibleforarticulatingalloftheelements aboveinacourseoutlineprovidedtostudentsnolaterthanthefirstdayofthecourse.
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7. MeaningofprovisionalcoursegradesinMedSIS:Provisionalcoursegradesdifferinsomerespectsfromthe finalgradesawardedbytheBoardofExaminers.Specifically: a. CR(Credit)isusedtodenotethatallrequirementsinthecoursehavebeenmet.Thisisthegrade thatwillberecommendedtotheBoardofExaminers,barringtheavailabilityofnewinformation thatcallsintoquestionthestudentssuccessfulperformanceinthecourse.(SeeSection8.) b. NC(NoCredit)isusedtodenotethatastudenthasnotbeensuccessfulincompletingthecourse duetoanyofthereasonsinSection6a.TherecommendationtotheBoardofExaminerswill dependonthestudentshistoryofacademicdifficulty1,asdescribedinSection8below.Ifformal remediationisassignedbytheBoardofExaminers,aninterimnotationofCONwillthenreplaceNC (seebelow). c. CON(Conditioned)isusedtodenotethatastudenthasbeenassignedextraworkorformal remediationthatispendingcompletion.CONisaninterim,internalnotationthatdoesnotappear onofficialdocumentation.TherecommendationtotheBoardofExaminerswilldependonthe successfulcompletionoftheextraworkorformalremediation,andonthestudentshistoryof academicdifficultyError!Bookmarknotdefined.,asdescribedinSection8below. d. INC(Incomplete)isusedtodenotethatastudenthasnotcompleted/submittedcertain requirementsofthecourse(markedornonmarked)withoutmakingarrangementswiththecourse director.Dependingontheextentofthedelay,evenifthestudenteventuallycompletesthe missingrequirements,theymaystillbebroughttotheBoardofExaminersforprofessionalism concernsinthecourse.INCisprimarilyaninterim,internalnotationthatdoesnottypicallyappear onofficialdocumentation.TherecommendationtotheBoardofExaminerswilldependonthe studentshistoryofacademicdifficultyError!Bookmarknotdefined.,asdescribedinSection8 below. e. IPR(InProgress)isusedtodenotethatastudenthasnotcompleted/submittedcertain requirementsinthecourse,asarrangedwiththecoursedirector.Asanexample,thismayincludea deferredexaminationorassignmentduetoillness.Uponcompletionoftherequirements,the componentmark(s)willberecordedinMedSISandthe(unofficial)coursegradewillbecalculated andrecorded,subjecttoapprovalbytheBoardofExaminers.IPRisprimarilyaninterim,internal notationthatdoesnottypicallyappearonofficialdocumentation,asdeferredcomponentsmust generallybecompletedbeforethestartofthenextacademicyear. f. NGA(NoGradeAvailable)isusedtodenotethatamarkorassessmenthasnotbeenreceivedfora studentforreasonsunrelatedtothestudenthimself/herself.Asanexample,thismayinclude delayedsubmissionofanevaluationformbythestudentssupervisor.TheUMEprogramtakes suchsituationsveryseriously,andthecoursedirectorisresponsibleforremedyingthematteras quicklyaspossible.Uponreceiptofthemissingmarkorassessment,thecomponentmarkwillbe recordedandthe(unofficial)coursegradewillbecalculatedandrecorded,subjecttoapprovalof theBoardofExaminers.Astudentwillneverbepenalizedforincompletecourseresultsdueto factorsoutsidetheircontrol.

Clearfailureofacomponent,clearfailureofacourse,borderlineperformanceonacomponent,borderline performanceinacourse,andfailuretoperformsatisfactorilyonanunmarkedcomponent(including professionalism)allconstituteacademicdifficulty.Thisisacomprehensivetermusedtorefertoallstudentswho demonstrateweaknessinsomeaspectoftheprogram.Itmustbenoted,however,thateachofthesituationsthat compriseacademicdifficultyishandleddifferentlyandmayleadtodifferentoutcomes,asdescribedinSection8 and,inmoredetail,intheGuidelinesforAssessmentofUndergraduateMedicalTrainees(PreclerkshipandClerkship versions).

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8. PrinciplesgoverningrecommendationstotheBoardofExaminers:ThePreclerkshipandClerkshipdirector, individualcoursedirectors,theFacultyLeadforEthics&Professionalism,andtheAssociateDeanEquity& ProfessionalismwillbeguidedbythefollowingprinciplesinmakingtheirrecommendationstotheBoardof Examiners: a. Successfulcompletionofacourse:AgradeofCredit(CR)inacoursewillberecommendedtothe BoardofExaminersifastudent: i. hasachievedanoverallnumericalgradeof70%orhigherinthecourse,AND ii. hasperformedsatisfactorilyonanynonmarkedcomponentsinthatcourse(includingbut notlimitedtoprofessionalismandloggingofclinicalexperiencesincourseswherethisis relevant),AND iii. hasmetalladditionalexpectationsformarkedcomponentsthatareestablishedbythe course,asdescribedinSection6a(ii). b. Remediation:AprogramofformalremediationwillnormallyberecommendedtotheBoardof Examinersifastudent: i. hasnotachievedanumericalgradeof60%inacourse,OR ii. hasnotperformedsatisfactorilyonanynonmarkedcomponentsofthecourse(including butnotlimitedtoprofessionalismandloggingofclinicalexperiencesincourseswherethis isrelevant)bythetimeoftheBoardsmeeting,OR iii. hasnotachievedasatisfactoryscore(asestablishedinadvance)onanyextrawork assignedatthediscretionofthecoursedirectorinresponsetoborderlineperformance,as describedinSection4. Forfurtherdetailsaboutremediation,pleaseseetheGuidelinesforAssessmentofUndergraduate MedicalTraineesinAcademicDifficulty(PreclerkshipandClerkshipversions).Ifaremedialprogram isimposedbytheBoardofExaminers,creditinthecoursewillnotbeassignedunlessanduntilthe remedialprogramissuccessfullycompleted.Iftheremedialprogramissuccessfullycompleted,the studentwillbeassignedanewgradeof60%andCRinthecourse,subjecttotheapprovalofthe Board. c. Borderlineperformanceinacourse:EitheragradeofCredit(CR)inacourseoraprogramof formalremediationmayberecommendedtotheBoardofExaminers,atthediscretionandinthe bestjudgementofthePreclerkship/ClerkshipDirectororcoursedirector,ifastudent i. hasachievedanoverallnumericalgradeinthecoursethatisgreaterthanorequalto60% butlessthan70%,OR ii. hasachievedanoverallnumericalgradeof70%orhigherBUThasnotmetalladditional expectationsformarkedcomponentsestablishedbythecourseasdescribedinSection 6a(ii),bythetimeoftheBoardsmeeting. ThePreclerkship/ClerkshipDirectororcoursedirectorshouldbeguidedintheirrecommendation byaconsiderationofallassessmentsofthestudentsperformanceinthecourse(includingany trendovertime),thestudentsperformanceonanyextraworkassigned,anyavailableevidenceof specificareasofweaknessinskillsorknowledge,andtheirexperienceregardingtherelative importanceofvariousaspectsofthecourse.
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d. Failureofayearandrepetitionofoneormorecourses:Reregistrationinthesamelevelofthe programandrepetitionofoneormorecoursesinthatlevelwillnormallyberecommendedtothe BoardofExaminersifastudenthasfailedtheyear,meaningthathe/she: i. hasnotachievedasatisfactoryscore(asestablishedinadvance)onashorterprogramof formalremediationpreviouslyimposedbytheBoardofExaminers,OR ii. hasnotachievedcreditintwoormorecoursesinthesameleveloftheprogram,as confirmedbytheBoardofExaminers. AtthediscretionofthePreclerkship/ClerkshipDirectorand/orcoursedirector(s),a recommendationmaybemadeforastudenttorepeatallofthecoursesintheacademicyearin questionoronlythecourse(s)inwhichhe/sheexperiencedacademicdifficulty.Error!Bookmark notdefined. e. Dismissal:DismissalfromtheprogramwillnormallyberecommendedtotheBoardofExaminersif astudent: i. hasnotachievedcreditinoneormorecoursesonhis/hersecondattempt(failed repetition),asconfirmedbytheBoardofExaminers,OR ii. hasfailedayear(asdefinedabove)ontwoseparateoccasionsoverthecourseofthe program,asconfirmedbytheBoardofExaminers. f. Promotion:PromotiontothenextleveloftheprogramwillberecommendedtotheBoardof Examinersifastudenthasbeendeemedtohavesuccessfullyachievedcreditineverycoursein Year1,2,or3oftheprogram,asconfirmedbytheBoardofExaminers.

g. Graduation:GraduationatthenextConvocationoftheUMEprogramwillberecommendedtothe BoardofExaminersifastudenthasbeendeemedtohavesuccessfullyachievedcreditinevery courseinYear4oftheprogram,includingaminimumof12weeksofapprovedandassessed electivetime,asconfirmedbytheBoardofExaminers. 9. Deviationsfromnormalpractice:ThroughouttheseStandards,wherethewordnormallyisusedin relationtorecommendationstotheBoardofExaminers,thePreclerkshipandClerkshipDirector,individual coursedirectors,theFacultyLeadforEthics&Professionalism,andtheAssociateDeanEquity& Professionalismmaychoosetodeviatefromtherecommendationthatisindicated.Insuchacase,the personmakingtherecommendationmustproviderationaletotheBoardofExaminersforthisdeviation, andtheBoardofExaminerswilltakeboththerecommendationandtherationaleunderconsideration. 10. Appeals:StudentshaverecoursetotheAppealsCommittee,astandingcommitteeoftheCouncilofthe FacultyofMedicine,tocontestanyadversedecisionmadebytheBoardofExaminers.

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SUMMARY(seewww.md.utoronto.ca/policiesforfulltextversion)

GuidelinesForTheAssessmentOfUndergraduateMedicalTraineesIn AcademicDifficultyPreclerkshipandClerkship
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:10December2010 Dateoflastreview:10December2010 Dateofnextscheduledreview:10December2014
PERFORMANCEBELOWEXPECTATIONS Categoriesofweakperformancethatmaybegroundsforfailingtoachievecreditinacourse,rotationor integratedOSCE,and/oraneedforextraworkandremediation:

Inordertoachievecreditinacourse,arotationoranintegratedOSCE,astudentmustdemonstrate satisfactoryperformanceineachofthreeseparate,thoughrelated,domains: 1. Theymustachieveasatisfactoryminimumoverallgradeinthecourse(60%orhigher). 2. Theymustalsosatisfactorilycompletethoseparticularcomponentsthatarespecifiedbyeachindividual courseasbeingrequiredforcreditinthecourse 3. Theymustalsodemonstrateappropriateprofessionalbehaviour. Whileasmallnumberofminorlapsesof professionalbehaviourisacceptable,alargenumberofminorlapsesoramajorlapsewilltriggeraprocess thatcanleadtothestudentfailingtoachievecreditinthecourse. Ifastudentfallssignificantlyshortoftheexpectedstandardsinoneorbothofthesedomains,theywillbereported totheBoardofExaminersbythePreclerkship/ClerkshipDirector. Remediation AstudentwillautomaticallybereportedtotheBoardofExaminersiftheyreceiveagradebelow60%overallinany courseoriftheyarenotsuccessfulincompletingarequiredprogramofextraworkinacourse(asdescribedbelow). AstudentmayalsobereportedtotheBoardofExaminersbecauseofweaknessinmultiplecoursesorbecauseof majorlapsesorasignificantnumberofminorlapsesinprofessionalism. TheBoardmaydeterminethatthestudentshouldinfactreceivecreditforthecourseafterreviewof comprehensiveinformationaboutthestudentsperformance.InthissituationthereferraltotheBoardofExaminers willremainonthestudentsfile. Page1of4ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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IftheBoarddeterminesthatthestudentshouldreceiveagradeof"Nocredit"(failure)inthecourseduetothe reportedconcernswiththeirperformance,thestudentwillnormallyberequiredtocompleteremediationand reexamination. IftheBoardofExaminersdeterminesthatremediationisappropriate,thecoursedirectorinconsultationwiththe appropriatecoursecommittee/faculty/academydirector,andsubjecttotheapprovaloftheBoardofExaminers, willdesignacourseofremedialworkanddeterminethelevelofperformanceexpectedinsupplemental evaluation(s)suchthatstudentsmaymeetthestandardforsuccessfulcompletionofthecourse.Specificactivities deemedlikelytobehelpfultothestudent,e.g.educationaltesting,examtakingskillsclasses,andfurtherworkin areasofweakness,mayberequiredatthediscretionoftheBoardofExaminers. ThestudentwillberequiredtomeetwiththePreclerkship/ClerkshipDirector.Thestudentmustbefully informedoftheirrights,includingtheirrighttoprovideawrittensubmissiontotheBoardofExaminersinthe eventthattheirperformanceisbeingreviewedbytheBoard.Thestudentmayberequiredtomeetwiththe AssociateDean,HealthProfessionsStudentAffairs,forthepurposeofexploringreasonsforperformancebelow expectationsandpotentialsupportsneeded. Thetimingoftheremediationwillbedeterminedinconsultationwiththecoursedirector,coursecommittee, AcademyDirector,Preclerkship/ClerkshipDirector,andstudent.Thedurationoftheremediationwillbe dependentonthespecificcourseinwhichthefailuretoachievecreditoccurred.IntheClerkship,electivetimeis usuallyrequiredforremediation.Ifso,theremediationmustoccurwithinthefirstsixweeksoftheelective periodandthestudentmustmakeupanyoutstandingelectivetimepriortograduation. Ifthestudentsuccessfullycompletestheremedialprogram,thecoursedirectorwillrecommendtotheBoardof ExaminersthatthestudentbegrantedCreditforthecourseandthatthemarkberaisedto60%.TheBoardof Examinerswillmakethefinaldeterminationregardingsuccessfulcompletionoftheremediation. Extrawork Forborderlineperformance,e.g.amarklessthan70%oramarkthatistwostandarddeviationsormore belowtheclassmeaninoneormoreofthecomponentsofacourse,rotationorintegratedOSCE,oras determinedforthespecificcourse,rotationorOSCE Evenifastudentachievesagradeof60%orhigherinacourseasawholeandhashadsatisfactoryprofessional behaviour,theymaystillberequiredtocarryoutextraworkinthatcourse,rotation,orskillsetrelevanttothe OSCE,whichmayincludeassessment.Thisdecisionwillbebasedoncriteriaspecifiedfortheparticularcourse, rotation,orOSCE.Thesestudentsareconsideredborderline. Thecoursedirectorandrelevantfacultywillberesponsibleforthedesignandcontentofextraworkandthelevel ofperformancewhichwillbeexpectedofthestudentsothattheycanmeetthestandardforsuccessfulcompletion ofthecourse.ThePreclerkship/ClerkshipDirectorandPreclerkship/ClerkshipCommitteewillbeinformedofany proposedadditionaleducationalexperienceandassessment.Thestudentmayberequiredtomeetwiththe Preclerkship/ClerkshipDirectoratthediscretionortherequestofthecoursedirector. Thiseducationalexperienceandassessmentmustbesuccessfullycompletedpriortothestudentbeingpermitted tostartthenextyearoftheirundergraduatemedicaleducationprogram,orbeingpermittedtograduate.Upon successfulcompletionoftheeducationalexperienceandassessment,theoriginalgradewillbeallowedtostand. Page2of4ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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ThecoursedirectorwillnotnormallyinformtheBoardofExaminersofsuchstudentsunlessthestudentdoesnot achieveanacceptablelevelofperformanceintheextraworkandassessmentthatisimplementedbythecourse director.Ifthatisthecase,thecoursedirectorwillinformthePreclerkship/ClerkshipCommittee,andthestudent willberequiredtomeetwiththePreclerkship/ClerkshipDirectorand,ifnecessary,withtheAssociateDean,Health ProfessionsStudentAffairs.Insuchacase,theBoardofExaminerswillbeinformedofthesituationandwillmake thefinaldeterminationregardingtheneedforformalremediation. Forborderlineacademicperformanceintwoormorecourses Weaknessesintwoormorecourses,rotations,ortheOSCE,thatbythemselvesmightnotbedeemedtomerita gradeofnocreditinanyoneofthem,maystillleadtoastudentbeingrequiredtocarryoutextraworkand/or beingreportedtotheBoardofExaminersundertheproceduresspecifiedbelow. ThePreclerkship/ClerkshipDirectorwillidentifysuchstudentsandrequestameetingtodeterminewhetherthe studentshouldmeetwiththeAssociateDean,HealthProfessionsStudentAffairs,andifspecificeducational activitiesandevaluationarerequiredbeyondorinplaceoftheextraworkassignedbytherelevantcourse directors. ThecoursedirectorwillinformtheBoardofExaminersofsuchstudents.Ifthestudentdoesnotachievean acceptablelevelofperformanceontheextraworkandassessmentassignedbythecoursedirectorsofthecourses inquestionand/orbythePreclerkship/ClerkshipCommittee,theBoardofExaminerswillmakethefinal determinationregardingaformalremediationprogram. Thestudentwillbeinformedthattheyhavethe opportunitytorespondtoallegationsofacademicdifficulty,especiallyifrelatedtoprofessionalism.Thestudent mustbefullyinformedoftheirrights,includingtheirrighttoprovideawrittensubmissiontotheBoardof ExaminersintheeventthattheirperformanceisbeingreviewedbytheBoard. Foramajorlapseinprofessionalism Thecoursedirectorwillmeetwithanystudentwhoexhibitsamajorlapseandconfirmthatsuchlapseshave occurred.ThestudentwillthenberequiredtomeetwiththePreclerkship/ClerkshipDirectortodiscussissues identifiedandthestudentviewpoint,withinputfromfacultymembersandcoursedirector(s)asappropriate.If themajorlapseisconfirmed,thestudentwillalsoberequiredtomeetwiththeAssociateDean,Health ProfessionsStudentAffairs. ThestudentwillbediscussedatthePreclerkship/ClerkshipCommitteeincamera discussionofStudentsinAcademicDifficulty. Aplanforextraworkinprofessionalismwillbedetermined. IfthePreclerkship/ClerkshipDirectorhasdeterminedthattheViceDean,UndergraduateMedicalEducation,should beinformedofthesituation,theViceDeanwillthendeterminewhethertoinformtheBoardofExaminers,which willmakethefinaldeterminationregardingtheneedforformalremediation Formultipleminorlapsesinprofessionalism Thecoursedirectorwillmeetwithanystudentwhoexhibitsthreeormoreminorlapsesinprofessionalismand confirmthatsuchlapseshaveoccurred. Thestudentwillthenbeinvitedtomeetwiththe Preclerkship/ClerkshipDirectortodiscussissuesidentifiedandthestudentviewpoint. Thepurposeofthe meetingiseducational. ReferraltotheAssociateDeanforHealthProfessionsStudentAffairswillbeoffered. Page3of4ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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Iftherearefurtherminorlapsesofprofessionalismbeyondtheinitialthreelapses,thenthestudentwillberequired tomeetwiththePreclerkship/ClerkshipDirector.ReferraltotheAssociateDeanforHealthProfessionsStudent Affairswillagainbeoffered,andthestudentwillbediscussedatthePreclerkship/ClerkshipCommitteeincamera discussionofStudentsinAcademicDifficulty. Aplanforextraworkinprofessionalismwillbedetermined. Ifminorlapsescontinuetobeidentified,andareconfirmedbythecoursedirector,thenthestudentwillbe consideredtohavetheequivalentofaMajorLapseinprofessionalism,andtheproceduresdescribedabove regardingamajorlapseinprofessionalismwillbefollowed. COMMUNICATIONREGARDINGSTUDENTPERFORMANCE a)CommunicationtothePreclerkship/ClerkshipDirectorfromthecoursedirectorregardingstudentperformance shouldtakeplaceinatimelyfashion,withintwoweeksofthetimeofanassessmentthattriggerstheconcernor withintwoweeksoftheendofthecourse,whicheverisearlier. b)Communicationbetweencoursedirectors,courseofficials,andAcademydirectorsregardingastudents performance,includingconcernsaboutprofessionalism,maytakeplaceatUME leadershipmeetings(e.g.Preclerkship/ClerkshipCommittee,AcademyDirectorsmeeting,etc.)atthediscretionof thePreclerkship/ClerkshipDirectororuponinstructionfromtheBoardofExaminers. c)Thestudentshouldbeinformedofsuchcommunicationsinatimelymanner. d)Thestudentshouldhavetheopportunitytorespondtoallegationsofacademicdifficulty,especiallyifrelatedto professionalism.Thestudentmustbefullyinformedoftheirrights,includingtheirrighttoprovideawritten submissiontotheBoardofExaminersintheeventthattheirperformanceisbeingreviewedbytheBoard. e)Intheeventthatprogrammodificationsareproposed: i. Everyeffortmustbemadebycoursedirectors,Academydirectors,andotherfacultytoensurea confidentialprocessandanenvironmentofpositiveexpectationamongthoseresponsibleforthe supplementalsupervision,teaching,andevaluation. ii. Ifappropriate,thestudentshouldbeinvolvedinplanningprogrammodifications.

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Essential Skills and Abilities Required for the Study of Medicine


Approved by the Council of Ontario Faculties of Medicine (COFM) November 2003

The Ontario Faculties of Medicine are responsible to society to provide a program of study so that graduates have the knowledge, skills, professional behaviours and attitudes necessary to enter the supervised practice of medicine in Canada. Graduates must be able to diagnose and manage health problems and provide comprehensive, compassionate care to their patients. For this reason, students in the MD program must possess the cognitive, communication, sensory, motor, and social skills necessary to interview, examine, and counsel patients, and competently complete certain technical procedures in a reasonable time while ensuring patient safety. In addition to obtaining an MD degree, and completing an accredited residency training program, an individual must pass the licensure examinations of the Medical Council of Canada (MCC) in order to practice medicine. Prospective candidates should be aware that, cognitive, physical examination, management skills, communication skills, and professional behaviours are all evaluated in timed simulations of patient encounters. All students must have the required skills and abilities described in the Section on Technical Standards. All individuals are expected to review this document to assess their ability to meet these standards. This policy does not preclude individuals with disabilities. Students who anticipate requiring disability-related accommodation are responsible for notifying the medical school. Because of the comprehensive, additive and integrative nature of the curriculum, students are expected to complete the MD degree within three or four years. Students with a disability may be granted an extension of time within which to complete the MD program. These requests are considered on a case-by-case basis. All other requests for a leave of absence are discussed in a separate policy.

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Technical Standards for Students in the MD Program A candidate for the MD degree must demonstrate the following abilities: Observation A student must be able to participate in learning situations that require skills in observation. In particular, a student must be able to accurately observe a patient and acquire visual, auditory and tactile information. Communication A student must be able to speak, to hear and to observe patients in order to effectively and efficiently elicit information, describe mood, activity and posture and perceive non-verbal communication. A student must be able to communicate effectively and sensitively with patients, families and any member of the health care team. A student must also be able to summarize coherently a patients condition and management plan verbally and in writing. Motor A student must demonstrate sufficient motor function to safely perform a physical examination on a patient, including palpation, auscultation and percussion. The examination must be done independently and in a timely fashion. A student must be able to use common diagnostic aids or instruments either directly or in an adaptive form (e.g. sphygmomanometer, stethoscope, otoscope and ophthalmoscope). A student must be able to execute motor movements reasonably required to provide general and emergency medical care to patients Intellectual-Conceptual, Integrative and Quantitative Abilities A student must demonstrate the cognitive skills and memory necessary to measure, calculate, and reason in order to analyze, integrate and synthesize information. In addition, the student must be able to comprehend dimensional and spatial relationships. All of these problem-solving activities must be done in a timely fashion.

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Behavioural and Social Attributes A student must consistently demonstrate the emotional health required for full utilization of her/his intellectual abilities. The application of good judgment, and the prompt completion of all responsibilities attendant to the diagnosis and care of patients is necessary. The development of mature, sensitive and effective relationships with patients, families and other members of the health care team are also required. The student must be able to tolerate the physical, emotional, and mental demands of the program and function effectively under stress. Adaptability to changing environments and the ability to function in the face of uncertainties that are inherent in the care of patients are both necessary. Compassion, integrity, concern for others, interpersonal skills, interest and motivation are all personal qualities that physicians must demonstrate and are expected qualities of students. Students with Disabilities Disability is defined by Section 10 (1) of the Ontario Human Rights Code. The Ontario Faculties of Medicine (COFM) are committed to facilitating the integration of students with disabilities into the University community. Each student with a disability is entitled to reasonable accommodation that will assist her/him to meet the standards. Reasonable accommodation will be made to facilitate students progress. However, such accommodation cannot compromise patient safety and well-being. Reasonable accommodation may require members of the University community to exercise creativity and flexibility in responding to the needs of students with disabilities while maintaining the academic and technical standards. The student with a disability must be able to demonstrate the knowledge and perform the necessary skills independently. There are a few circumstances in which an intermediary may be appropriate. However, no disability can be accommodated if the intermediary has to provide cognitive support, substitute for cognitive skills, perform a physical examination and/or in any way supplement clinical judgment. The appropriateness of an intermediary will be assessed on a case-by-case basis. This policy acknowledges that central to the success of a student with a disability in completing the MD program is her/his responsibility to demonstrate self-reliance and to identify needs requiring accommodation in a timely fashion.

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On Student Responsibilities, Behaviour, & Professionalism


NOTE: See the last page of this handbook for information on what to do in case of a concern about student conduct.
Student Attendance and Guidelines for Approved Absences from Mandatory Activities in UME, Regulations for (Summary)..........................................................................................................................187 o Appendix A: Petition for Consideration for Absence................................................................................................................................ 195 o Appendix B: Record of Absences............................................................................................................................................................................ 196 Professional Practice Behaviour for All Health Professional Students, Standards of............................197 Ethics & Professionalism in Healthcare Professional Clinical Training and Teaching, Guidelines For................................................................................................................................................................ 201 Code of Behaviour on Academic Matters (Summary) .......................................................................................204

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Summary(seewww.md.utoronto.ca/policiesforfulltextversion)

Regulationsforstudentattendanceandguidelinesforapprovedabsences frommandatoryactivitiesinUME
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:20September2011 Dateoflastreview:20September2011 Dateofnextscheduledreview:20September2015 TABLEOFCONTENTS A.ATTENDANCE B.REASONSFORABSENCES C.LEAVESOFABSENCE D.NOTIFICATIONSANDAPPROVALS APPENDIXA:PETITIONFORCONSIDERATIONFORABSENCEFORM APPENDIXB:RECORDOFABSENCES

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A.Attendance Ahighrateofattendanceiskeytothesuccessofmedicalstudents,giventhecompetencybased,experiential natureofmedicaltrainingandthecentralroleplayedbyhighlyinteractivesmallgroupmodesofinstructionatthe UniversityofToronto.Atthesametime,theUndergraduateMedicalEducationprogramrecognizesthatmedical studentsareadultlearnerswhoshouldbegiventheflexibilityandfreedomtomakejudgementsregardingtheir ownlearningneeds. Tobalancethesecompetinginterests,UMEhasadoptedthefollowingregulationsonattendance: Preclerkship: - Alllecturesandotherlargegroup(wholeclass)sessionsareoptionalexceptwhenotherwisespecifiedby thecoursedirectororthematicfacultylead - Allseminarsareoptionalexceptwhenotherwisespecifiedbythecoursedirectororthematicfacultylead - AllPBLtutorials,ASCMtutorials,andDOCHtutorialsaremandatory - AllDOCHcommunityvisits(toschools,CCACs,andagencies)aremandatory - AllFMLEsessionsaremandatory - AllcoreIPEsessionsaremandatory - Certaingrossanatomyandneuroanatomylaboratorysessionsaremandatory,asspecifiedbythecourse director - Allscheduledassessments1aremandatory - Attendanceatothertypesofsessionislefttothediscretionofthecoursedirectororthematicfacultylead. Studentsshouldassumethatsessionsnotincludedinthislistaremandatoryunlesstheyareadvised otherwise. Clerkship: - Allclinicalactivitiesaremandatory - AllcoreIPEsessionsaremandatory - AllPortfoliosessionsaremandatory - Alllocal(sitespecific)didacticteachingsessionsaremandatoryexceptwhenotherwisespecifiedbythe coursedirector - Allcentraldidacticteachingsessionsareoptionalexceptwhenotherwisespecifiedbythecoursedirector - NonUMEspecificsessions(suchasGrandRounds)maybemandatoryoroptional,atthediscretionofthe coursedirector - Allscheduledassessments1aremandatory - Attendanceatothertypesofsessionmaybemandatoryoroptional,atthediscretionofthecourse director.Studentsshouldassumethatsessionsnotincludedinthislistaremandatoryunlesstheyare advisedotherwise.
Scheduledassessmentsincludebutarenotlimitedtowrittenandoralexaminations,presentations,OSCEs,andsessions duringwhichstudentsareexpectedtosubmitworkforassessment.
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Studentswhofailtoattendamandatorysessionforaforeseeablereasonmaybedeemedtohavecommitteda lapseinprofessionalism,unlesspriorapprovalisgrantedbythesupervisingteacher,coursedirector,or Preclerkship/ClerkshipDirectorasappropriate(seesectionD).Studentswhofailtoattendamandatorysessionfor anurgent/emergentreasonanddonotsubsequentlyprovideadequatenotificationandexplanationtotheprogram withinareasonabletimeframemayalsobedeemedtohavecommittedalapseinprofessionalism.Finally,students whochoosetodisregardthedecisionofaUMEleaderorteacherregardingarequestforabsencefromamandatory sessionmayalsobedeemedtohavecommittedalapseinprofessionalism. AsdescribedinsectionsBEbelow,inadditiontocorrespondencewiththeappropriateUMEleader,studentsmay berequiredtosubmitaPetitionforConsiderationforAbsencetotheOfficeoftheRegistrarbeforeaplanned absenceorwithinfivebusinessdaysofanunplannedabsence;supportingdocumentationmayalsoberequested. Mandatorysessionsaresodesignatedbecauseoftheinherentvalueintheirmodalityofinstruction.Itistherefore considereddetrimentaltoastudentseducationtomissanexcessivenumberofsuchsessions.Forthisreason, wheneveranabsencefromamandatorysessionoccurs,whetheritwaspreapprovedornot,thestudentstutor orothersupervisorisrequiredtorecordtheabsence.Alistofallabsencesmustbesubmittedbyeachteacherto thecoursedirector/thematicfacultyleadattheendofthecourseorrotation(orearlier,uponrequest).(See AppendixforsampleRecordofAbsencesform.)Teacherswhoareuncertainwhethertoapprovearequestfor absenceatanypointareencouragedtocontactthecoursedirectorforadvice. Inallcasesofbothmandatoryandnonmandatorysessions,studentsareresponsibleforknowingthecontent coveredinasession,regardlessofwhethertheyattendornot.Toenhancestudentlearning,UMEproducesvideo oraudiorecordingsofthemajorityoflargegroupsessionsandmakestheserecordingsavailableonline.However, studentsareadvisedthatthisfeatureoftheprogramisaprivilegeandnotaright;hence,thenonrecordingofa sessionduetotechnicaloranyotherreasonswillnotalterstudentsresponsibilityfordemonstratingknowledgeof thecontentfromthatsession. Furthermore,foranyabsences,butespeciallythoseaffectingexperientiallearningsuchasclinicalplacements, studentsmayberequiredbythecoursedirector,sitedirector,and/orPreclerkship/ClerkshipDirectortomakeup thetimethatwasmissed,whethertheabsencewaspreapprovedornot. B.ReasonsforAbsences UMErecognizesthatspecialcircumstancesmaywarrantastudentsabsencefromamandatoryactivity,andwill accommodatereasonablerequestsfromstudentsthatdemonstraterespectforthefollowingprinciples: - equitabletreatmentofoneselfinrelationtootherstudents - recognitionandfulfillmentofonesacademicresponsibilities - awarenessofthefactorscontributingtooneswellbeing - soundjudgementwithregardtoonesabilitiesandlimitations - respectforallaspectsoftheUMEprogramandallmembersoftheUMEcommunity Theseprinciplesdonotapplysolelytorequestsforabsence;rather,theyunderpinahealthy,productive,and professionalmedicalstudentexperience,andstudentsarethereforeencouragedtobemindfulofallofthemonan ongoingbasisthroughouttheprogram. Page3of10ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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PlannedAbsences Whenaspecialcircumstancethatmaywarrantanabsenceisanticipated,UMErequiresthatstudentsnotifythe relevantindividualassoonastheybecomeawareofit(seesectionD).Inaddition,dependingonthetypeor durationoftheabsenceorthenumberofpriorabsences,studentsmayalsoberequiredtofileaPetitionfor ConsiderationforAbsencewiththeOfficeoftheRegistrar,possiblyaccompaniedbysupportingdocumentation,as describedinsectionD. Studentsshouldnotassumethatapprovalwillbegrantedforanabsence,andarestronglyadvisednottocommit toanyplansbeforereceivingconfirmationofapprovalfromtheprogram.UMEwilltakeintoconsiderationall relevantfactorsindeterminingwhethertograntapprovalforanabsence,includingbutnotlimitedto: - thereasonfortheabsence, - thetypeofmandatorysessionstobemissed,andtheirrelativeimportanceoruniquenessinthecourse(s) - thenumberofmandatorysessionstobemissed,andtheirrelativeimportanceoruniquenessinthe course(s) - thestudentsacademicperformancetodateandtheanticipatedimpactoftheabsenceonhis/herstudies, and - thestudentsprofessionalperformancetodate. PetitionsforConsiderationforAbsencebecomepartofthestudentspermanentrecord,andmaybereferredtoin makingfuturedecisionsregardingrequestedabsencesorotherrelevantmatters.Inthecaseofhighlysensitive reasonsfortheabsence(forexample,medicalorfamilymatters),studentsarenotrequiredtoprovidefulldetailsof thesituationonthePetitionforConsiderationforAbsence,butmayberequestedtoprovideinformationand/or supportingdocumentationtotheAssociateDeanHealthProfessionsStudentAffairsinorderforthepetitiontobe appropriatelyadjudicated. Thefollowinginformationservesasaguidelinetostudents,administrators,andfacultyinUMEregardingreasons forplannedabsences.UMEreservestherighttodeviatefromtheseguidelinesasitdeemsappropriateinindividual cases. Thefullpolicydescribesthehandlingandtypicaloutcomeofthefollowingtypesofplannedabsence.Pleasesee www.md.utoronto.ca/policiesfordetails. 1. Observanceofaholidayinthestudentsfaith 2. Healthcareappointment 3. Attendanceatthefuneralormemorialserviceofalovedone 4. Presentationatanacademicconference 5. Invitedparticipationinanorganizedathleticseventorothercompetition 6. Activeparticipationinamajorpersonalcelebrationorevent 7. AttendanceataUMEcommitteemeeting(asamemberorasaguest) 8. AppointmentwithanothercoursedirectororUMEleader 9. Attendance(withoutpresentation)atanacademicconference 10. Attendance(withoutparticipationasacompetitor,coach,orreferee/judge/etc.)atacompetition 11. Vacation 12. Otherreasons Page4of10ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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UnplannedAbsences Whilesomeabsencesfrommandatorysessionsmaybeanticipated,inothercases,theabsencearisesdueto unforeseenandoftenemergentcircumstances. Insuchasituation,UMErecognizestherightofeachstudenttodeterminethebestcourseofactionbasedon his/heruniqueknowledgeofandperspectiveonthesituation.Thiscourseofactionmayincludeadecisiontomiss oneormoremandatorysessions. UMEiscommittedtofosteringasupportive,compassionateenvironmentattheheartofwhichistheconviction thatstudentwellbeingisintimatelyconnectedtostudentsuccess.Nevertheless,itmustberecognizedthata studentsrighttodecidetomissmandatorysessionsisinherentlyaccompaniedbyhis/herresponsibilitytoaccept andaddressanyconsequencesofthedecisionwithregardtohis/herstudies. Ifthestudentchoosestobeabsentfromoneormoremandatorysessions,heorsheshouldendeavourtocontact theappropriateindividual(s)inUME(seepartD,above)assoonaspossibleafterattendingtotheimmediateneeds arisingfromthesituation;studentsarealsoexpectedtosendanemailinsuchsituationsto urgentcommunication.ume@utoronto.ca,anemailaddresswhichismonitoredbytheOfficeoftheRegistrar.The notifiedUMEleaderorteacherwilladvisethestudentoftheoptionsthatareavailableandonwhetherany documentationand/oraPetitionforConsiderationforAbsencearerequired.Intheeventthatthestudentbelieves thatanextendedabsenceofthreeormoredaysmayberequired,he/sheshouldconveythistothe Preclerkship/ClerkshipDirectorand/ortheAssociateDeanHealthProfessionsStudentAffairs,sothatappropriate optionscanbeexplored. Asnotedabove,PetitionsforConsiderationforAbsencebecomepartofthestudentspermanentrecord,andmay bereferredtoinmakingfuturedecisionsregardingrequestedabsencesorotherrelevantmatters.Inthecaseof highlysensitivereasonsfortheabsence(forexample,healthorfamilymatters),studentsarenotrequiredto providefulldetailsofthesituationonthePetitionforConsiderationforAbsence,butmayberequestedtoprovide informationand/orsupportingdocumentationtotheAssociateDeanHealthProfessionsStudentAffairsinorderfor thepetitiontobeappropriatelyadjudicated. Thefollowinginformationservesasaguidelinetostudents,administrators,andfacultyinUMEregardingreasons forunplannedabsences: Thefullpolicydescribesthehandlingandtypicaloutcomeofthefollowingtypesofunplannedabsence.Pleasesee www.md.utoronto.ca/policiesfordetails. 1. Illnessorinjuryofthestudent 2. Seriousproblemaffectingaclosefamilymemberorotherlovedone 3. Personalcrisis 4. Travelortransportationproblems 5. Otherreasons Page5of10ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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C.Leavesofabsence

Aleaveofabsenceconstitutesanofficial,temporarywithdrawalfromstudies,andisrecordedonthestudents transcript.

Note:LeavesofabsencefromtheDoctorofMedicineProgramarenotnormallygranted.Giventhehighlystructured natureoftheUMEcurriculum,leavesofabsencecanhaveasignificanteffectonastudentsacademicprogress,and shouldnotbecontemplatedlightly.

Therearetwotypesofleave:(1)forpersonalreasonsand(2)foracademicenrichment.

Personalleavesofabsence Leavesofabsencerequestedforextraordinaryandseriouspersonalreasonswillbeconsideredonacasebycase basisbytheAssociateDeanHPSA,possiblyinconsultationwithotherUMEleaders.Fulldisclosureofthereasons fortherequestisexpected,andsupportingdocumentationwillberequired.

Leavesofabsenceforacademicenrichment Underexceptionalcircumstances,aleaveofabsencemaybegrantedforanacademicyeartoastudentwithan excellentacademicrecordwithnoidentifiedweaknesses.

Suchaleavewillbegrantedforeitheroneortwofullacademicyears.Oncealeaveisgranted,noextensionwillbe permitted.

Studentswhoareconsideringanapplicationforleaveofabsenceforacademicenrichmentmustmeetwiththe AssociateDeanHPSAtodiscussacademicandcareerimplications.TheymustalsomeetwiththeRegistrarto discussmattersrelatingtoaccesstofinancialassistanceandtranscriptingoftheiracademicrecord. StudentsmustsubmitanapplicationforaleaveofabsenceforacademicenrichmenttotheViceDeanUMEnolater thanFebruary1oftheyeartheywishtheirleavetobegin.Aspartoftheirapplication,studentsmustincludea clearlysetoutplanandarticulatedobjectivesfortheproposedleave.

IftherequestedleaveofabsenceforacademicenrichmentisgrantedbytheViceDeanUME,theAssociateDean HPSAwillwriteaLetterofApprovalwhichsummarizestheconditionsunderwhichtheleavewasgrantedandthe expectedreentrydate.Thisletterwillbecopiedtothestudentsrecord,thePreclerkship/ClerkshipDirector(as appropriate),andtherelevantAcademyDirector..

StudentswhoaregrantedaleaveofabsenceforacademicenrichmentmustmeetwiththeAssociateDeanHPSA priortotheirleaveinordertodiscusstheirreentry.

ReentryintotheUMEprogramfollowingaleaveofabsence Studentswhoaregrantedaleavearenotregisteredasmedicalstudentsforthedurationoftheleave.Whenthey reentertheprogram,theywillbesubjecttothecurrentfeeschedule.

Creditisretainedforallcoursesthathadbeenfullycompletedpriortotheleave.Studentsreturningfromaleave aregenerallysubjecttothecurrentcurriculum,althoughcertainmodificationsmaybemadetoreflectanymajor curricularchangesintroducedduringtheirabsence. Page6of10ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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Studentswhoareonleave,whetherforpersonalreasonsoracademicenrichment,areexpectedtocontactthe AssociateDeanHPSAatleasttwomonthsbeforetheirintendedreturntotheUMEprogramsothatpreparations fortheirreentrycancommence. Allstudentswhoarepreparingtoreturnfromaleaveofabsencearerequiredtoundergoaclinicalskills assessment,andmayalsoberequiredtoparticipateinsupplementalclinicalskillstrainingtoensuretheiracademic successandthewellbeingofpatients. D.Notificationsandapprovals Inthecaseofanyabsencefromamandatorysession,UMEmustbenotified.Plannedabsencesrequireprior approval;unplannedabsencesrequiretimelyandsatisfactoryexplanation.Theindividualwhomthestudentis expectedtoconsultregardingtheirabsencevariesdependingonthetypeandnumberofsessionsmissedas indicatedbelow.

Note:Asessionisdefinedasaunitofteachingactivity,suchasasinglePBLtutorial,ahalfdayclinicinthe Clerkship,anFMLEsession,aPortfoliosession,alocalClerkshipseminar,awrittenexam,anOSCE,etc.

Toreiterate:Wheneveranabsencefromamandatorysessionoccurs,whetheritwaspreapprovedornot,the studentstutororothersupervisorisrequiredtorecordtheabsence.Alistofallabsencesmustbesubmittedby eachteachertothecoursedirector/thematicfacultyleadattheendofthecourseorrotation(orearlier,upon request).(SeeAppendixforsampleRecordofAbsences.)Teacherswhoareuncertainwhethertoapprovearequest forabsenceatanypointareencouragedtocontactthecoursedirectorforadvice.

Furthermore,alistofallabsencesfromscheduledassessmentsmustbesubmittedbyeachcoursedirectortothe Preclerkship/ClerkshipDirectorattheendofthecourseorrotation(orearlier,uponrequest).Coursedirectorswho areuncertainwhethertoapprovearequestforanabsenceatanypointareencouragedtocontactthe Preclerkship/ClerkshipDirectorforadvice.

Inaddition,forallabsencesfromscheduledassessmentsandcertainotherabsences,aPetitionforConsideration forAbsencemustbesubmittedbythestudentasearlyaspossible.AllsubmittedPetitionsforConsiderationfor Absenceareretainedinthestudentspermanentrecord,whethertheabsencewasgrantedornot.

Theguidelinesonthefollowingpagesindicatewhoshouldbenotifiedinthecaseofplannedandunplanned absences.Inadditiontothoseindividualswhoarespecified,othersincludingthestudentsAcademyDirector,the AssociateDeanHealthProfessionsStudentAffairs,theFacultyRegistrar,etc.maybeinvolvedinthenotification anddecisionmakingprocess. Followinganynecessaryconsultation,therelevantcoursedirector(s),sitedirector(s),and/orthe Preclerkship/ClerkshipDirectorwilldeterminetheappropriateresponsetotherequestornotification.Theywill alsospecifyattheirdiscretionanyextrameasuresthatthestudentwillberequiredtotakeasaresult,suchas makingupmissededucationalactivities,etc. Thefullpolicydescribeshowstudentsmayreceiveapprovalforabsences,dependingonthekindofactivitythey havemissedorwillmiss(i.e.anassessmentornot),thedurationoftheabsence,andtheirpastrecordofabsences. Thedetailsareprovidedinthefullpolicyatwww.md.utoronto.ca/policies. Page7of10ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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Asummaryisprovidedbelow: Absencesaffectingscheduledassessments(e.g.,exams,OSCEs,presentations,etc.) o 1stabsencefromanassessmentworthlessthan15%:Approvedbythecoursedirector (Preclerkship)orsitedirector(Clerkship) o 1stabsencefromanassessmentworth15%ormore:ApprovedbythePreclerkship/Clerkship Directorandthecoursedirector o 2ndorsubsequentabsencefromanassessment(inoneormorecourses):Approvedbythe Preclerkship/ClerkshipDirectorandthecoursedirector(s) Absencesaffectingmandatorynonassessmentactivities(e.g.clinics,PBLtutorials,etc.) o 1stabsence:Approvedbysupervisor o 2ndabsence:Approvedbythecoursedirector(Preclerkship)orsitedirector(Clerkship),plusthe supervisor o 3rdorsubsequentabsence:Approvedbythecoursedirector,plusthesupervisor o Continuousabsenceof3ormoredays:ApprovedbythePreclerkship/ClerkshipDirectorinthecase ofconferencesorcompetitions;approvedbytheAssociateDeanHealthProfessionsStudentAffairs inallothercases

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Regulations for student attendance and guidelines for approved absences from mandatory activities in UME Appendix A: PETITION FOR CONSIDERATION FOR ABSENCE FORM

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Regulations for student attendance and guidelines for approved absences from mandatory activities in UME Appendix B: RECORD OF ABSENCES
Course: ________________________________________ Supervisor/Tutor/Teacher: __________________________________ Type of session: __________________________________________ First date of instructional period: ________________________ Last date of instructional period: ________________________________

Absences (Please record in chronological order. Add rows as required) Date of absence Name of student Type of session that was missed (in particular, indicate whether there was an assessment component) Choose one of the following: o Approval sought beforehand (APPROVED) o Notification provided afterwards (NOTIFIED) o No explanation, approval, or notification provided (NONE) Reason given by student (if any) Comments (if any)

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Governing Council UNIVERSITY OF TORONTO

Standards of Professional Practice Behaviour for All Health Professional Students


Approved by Governing Council 17 June 2008 www.governingcouncil.utoronto.ca/policies

Preamble Health professional students engage in a variety of activities with patients/clients under supervision and as part of their academic programs. During this training, the University, training sites, and society more generally expect our health professional students to adhere to appropriate standards of behaviour and ethical values. All health profession students accept that their profession demands integrity, exemplary behaviour, dedication to the search for truth, and service to humanity in the pursuit of their education and the exercise of their profession. These Standards express professional practice and ethical performance expected of students registered in undergraduate, graduate and postgraduate programs, courses, or training (for the purposes of this policy, students includes undergraduate/graduate students, trainees including post doctoral fellows, interns, residents, clinical and research fellows or the equivalents) in the: (a) Faculty of Dentistry; (b) Faculty of Medicine; (c) Lawrence S. Bloomberg Faculty of Nursing; (d) Leslie Dan Faculty of Pharmacy; (e) Faculty of Physical Education and Health; (f) Factor-Inwentash Faculty of Social Work: (g) Ontario Institute for Studies in Education (OISE Programs in School and Clinical Child Psychology; Counselling Psychology for Psychology Specialists; Counselling Psychology for Community and Educational Settings). By registering at the University of Toronto in one of these Faculties or in courses they offer, a student accepts that he/she shall adhere to these Standards. These Standards apply to students in practice- related settings such as fieldwork, practicum, rotations, and other such activities arranged through the Faculty, program of study, or teaching staff. Other Faculties that have students engaged in such activities in health settings may also adopt these standards. These Standards do not replace legal or ethical standards defined by professional or regulatory bodies or by a practice or field setting, nor by other academic standards or expectations existing at the University of Toronto. Action respecting these Standards by the Faculty responsible for the program or course does not preclude any other action under other applicable University policies or procedures, action by program regulatory bodies, professional bodies, or practice/field settings, or action under applicable law including the Criminal Code of Canada.

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Breach of any of these Standards may, after appropriate evaluation of a student, and in accordance with applicable procedures, be cause for dismissal from a course or program or for failure to promote. Standards of Professional Behaviour and Ethical Performance All students will strive to pursue excellence in their acquisition of knowledge, skills, and attitudes in their profession and will uphold the relevant behavioural and ethical standards of his or her health profession or Faculty, including: 1. Keeping proper patient/client records 2. Where patient/client informed consent to an action is required, the student will act only after valid informed consent has been obtained from the patient/client (or from an appropriate substitute decision-maker) 3. Providing appropriate transfer of responsibility for patient/client care 4. Being skilful at communicating and interacting appropriately with patients/clients, families, faculty/instructors, peers, colleagues, and other health care personnel 5. Not exploiting the patient/client relationship for personal benefit, gain, or gratification 6. Attending all mandatory educational sessions and clinical placements or provide appropriate notification of absence 7. Demonstrating the following qualities in the provision of care: a. empathy and compassion for patients/clients and their families and caregivers; b. concern for the needs of the patient/client and their families to understand the nature of the illness/problem and the goals and possible complications of investigations and treatment; c. (c) concern for the psycho-social aspects of the patients/clients illness/problem; d. assessment and consideration of a patients/clients motivation and physical and mental capacity when arranging for appropriate services; e. respect for, and ability to work harmoniously with, instructors, peers, and other health professionals; f. respect for, and ability to work harmoniously with, the patient/client and all those involved in the promotion of his/her wellbeing; g. recognition of the importance of self-assessment and of continuing education; h. willingness to teach others in the same speciality and in other health professionals; i. understanding of the appropriate requirements for involvement of patients/clients and their families in research; j. awareness of the effects that differences in gender, sexual orientation, cultural and social background may have on the maintenance of health and the development and treatment of illness/problems; k. awareness of the effects that differences in gender, sexual orientation, and cultural and social background may have on the care we provide; l. respect for confidentiality of all patient/client information; and, m. ability to establish appropriate boundaries in relationships with patients/clients and with health professionals being supervised;

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These Standards articulate the minimum expected behaviour and ethical performance; however, a student should always strive for exemplary ethical and professional behaviour. A student will refrain from taking any action which is inconsistent with the appropriate standards of professional behaviour and ethical performance, including refraining from the following conduct: 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. Misrepresenting or misleading anyone as to his or her qualifications or role Providing treatment without supervision or authorization Misusing or misrepresenting his/her institutional or professional affiliation Stealing or misappropriating or misusing drugs, equipment, or other property Contravention of the Ontario Human Rights Code Unlawfully breaching confidentiality, including but not limited to accessing electronic records of patients/clients for whom s/he is not on the care team Being under the influence of alcohol or recreational drugs while participating in patient/client care or on call or otherwise where professional behaviour is expected Being unavailable while on call or on duty Failing to respect patients/clients rights and dignity Falsifying patient/client records Committing sexual impropriety with a patient/client1 Committing any act that could reasonably be construed as mental or physical abuse Behaving in a way that is unbecoming of a practising professional in his or her respective health profession or that is in violation of relevant and applicable Canadian law, including violation of the Canadian Criminal Code.

Assessment of Professional Behaviour and Ethical Performance The Faculties value the professional behaviour and ethical performance of their students and assessment of that behaviour and performance will form part of the academic assessment of health professions students in accordance with the Grading Practices Policy of the University of Toronto. Professional behaviour and ethical performance will be assessed in all rotations/fieldwork/practicum placements. These assessments will be timely in relation to the end of rotation/fieldwork placement/practicum and will be communicated to the student. Each Health Science Faculty will have specific guidelines related to these Standards that provide further elaboration with respect to their Faculty-specific behavioural standards and ethical performance, assessment of such standards and relevant procedures.

Students who have (or have had) a close personal relationship with a colleague, junior colleague, member of administrative staff or other hospital staff should be aware that obligations outlined in the Provosts Memorandum on Conflict of Interest and Close Personal Relations pertain to these Standards. http://www.provost.utoronto.ca/policy/relations.htm

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Breaches of these Standards or of Faculty-specific guidelines related to these Standards are serious academic matters and represent failure to meet the academic standards of the relevant health profession program. Poor performance with respect to professional or ethical behaviour may result in a performance assessment which includes a formal written reprimand, remedial work, denial of promotion, suspension, or dismissal from a program or a combination of these. In the case of suspension or dismissal from a program, the suspension or dismissal may be recorded on the students academic record and transcript with a statement that these Standards have been breached. With respect to undergraduate students, appeals against decisions under this policy may be made according to the guidelines for such appeals within the relevant Faculty. In the case of graduate students, the procedures for academic appeals established in the School of Graduate Studies shall apply. Recommendation to terminate registration in a graduate program must be approved by the School of Graduate Studies. Decisions to terminate registration in a graduate program may be appealed directly to the School of Graduate Studies Graduate Academic Appeals Board (GAAB) in accordance with its practises and procedures. In cases where the allegations of behaviour are serious, and if proven, could constitute a significant disruption to the program or the training site or a health and safety risk to other students, members of the University community, or patient/clients, the Dean of the Faculty responsible for the program or course is authorized to impose such interim conditions upon the student, including removal from the training site, as the Dean may consider appropriate. In urgent situations, such as those involving serious threats or violent behaviour, a student may be removed from the University in accordance with the procedures set out in the Student Code of Conduct.

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GuidelinesforEthics&ProfessionalismInHealthcareProfessional ClinicalTrainingandTeaching

FacultyofMedicine/HospitalEducationUniversityCommittee(HUEC) 8August2003
Preamble AllaffiliatedinstitutionsoftheUniversityofTorontohaveintheirmissionstatementsthefacilitatingofeducationof healthcareprofessionaltrainees.Students,atalllevelsofexperience,encounterlearningopportunitiesinawide varietyofclinicalsettings.ItistheaimoftheUniversityanditsteachinginstitutionstoprovidehealthcare professionaltraineesandclinicalfacultyorsupervisingclinicianswithawelcominglearningenvironmentand strongpositiverolemodelsforprofessionalbehaviourandprofessionalpractice.Indoingso,thefollowing guidelinesfortheconductofclinicalteachingintheclinicalenvironmentsaresuggestedforuseacrosstheaffiliated teachinginstitutions.Teachingisnotonlydefinedasspecificactsbutincludesallactivitieswhensomeonein trainingisprovidingcaretopatientsonadaytodaybasis. Purpose Thisdocumentisintendedtoprovideguidanceforallhealthcareprofessionaltraineesandtheclinicalfacultyor supervisingcliniciansindeterminingtheirrightsandresponsibilitieswhenparticipatinginclinicaleducation. Universityhealthcareprofessionaltraineesandclinicalfacultyorsupervisingcliniciansparticipatinginclinical teachingatdesignatedaffiliatedteachinglocations(e.g.hospitalsandcommunitysettings)mustadheretothe RegulatedHealthProfessionsAct(RHPA)andtheHealthCareConsentAct(HCCA),thepoliciesandprocedures outlinedbythehostinstitutionsandthepoliciesandproceduresoftheUniversity.Inaddition,eachtraineeand clinicalfacultyorsupervisingcliniciansshouldmakeuseofanyethicalguidelinesprovidedbytheirprofessional collegeororganization. TheUniversity,theAffiliatedTeachingInstitutions,theClinicalfacultyorsupervisingcliniciansandtheHealthcare ProfessionalTraineesarecommittedtotheirrolesin: A.TeachingandLearningand: 1. Totheeducationandtrainingofallhealthcareprofessionaltrainees. 2. Toexcellenceinpatientcare,teachingandresearch. 3. Agreethatclinicalteachingisanessentialcomponentinthedevelopmentofhealthcareprofessionaltrainees. Page1of3

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4. Agreetoattempttoclearly,effectivelyandappropriatelycommunicatetopatientsthattheaffiliatedteaching institution(s)isalearningenvironment(s)andthereforehealthcareprofessionaltraineesareconcurrently involvedinbothpatientcareandlearning. Agreethatitistheresponsibilityoftheclinicalfacultyorsupervisingcliniciantoprovidenotonly instructioninclinicalreasoningandtechnicalskills,butalsotoexemplifyethicalbehaviourandtoactasa rolemodeltotraineesforethicalpractice.Thisincludesmaintainingconfidentialityandaffordingpatient dignityandrespect,beingopentoquestionstraineesmayhavepertainingtowhatconstitutesethical practiceandacommitmenttothehigheststandardsofethicalconductinteachingactivities,including integrityandhonesty.

5.

B.SupervisionandCommunication: 1. Agreethattheinformationregardingtheroleandtrainingofhealthcareprofessionalsisavitalpartofthe missionoftheaffiliatedteachinginstitutionsandthatthisfactshouldbesharedwithpatientsbymeansof appropriatesignageandbycommunicationwithprofessionalhealthcareprovidersand/oradministrative staff.Patientconsentforcareandexchangeofinformationshouldbesoughtatthefirstappropriate opportunity. 2. Agreethatpatientsconsenttotreatmentinaclinicalteachingsettingshouldbeobtainedassoonas appropriatelypossibleafteranexplanationofthissettinganddiscussionofthepatientsconcernshavetaken place.Patientsmustbeinformedastowhoisresponsiblefortheircare.Thepatientsrighttorefuse treatmentundersuchcircumstancesmustberespected. 3. Agreethattheresponsibilityforthesupervisionofhealthcareprofessionaltraineeslieswiththeclinical facultyorsupervisingclinician.Detailsoftheresponsibilityanddisputeresolutionproceduresaretobe foundinthedocumentsspecificforeachclinicalgroup.Relevantdocumentsareappendedtothese guidelines. 4. Agreethattheclinicalfacultyorsupervisingclinicianisresponsiblefortheongoingevaluationofthe healthcareprofessionaltraineescompetenceinordertodeterminethedegreeofsupervisionthatthe healthcareprofessionaltraineerequiresandthedegreeofdelegationofcontrolledactsthatthehealthcare professionaltraineeisabletoaccept. 5. Agreethatregularandappropriateexchangeofinformationbetweenahealthcareprofessionaltraineeand clinicalfacultyorsupervisingclinicianisessentialforthehealthcareprofessionaltraineeslearning experienceandfortheoptimumcareofthepatient. 6. Agreethathealthcareprofessionaltraineesarerequiredtodocumentpatientcareinformationand interventionsandarerequiredtonotifytheclinicalfacultyorsupervisingclinicianofhis/heractionsina timelyfashion. 7. Agreethattheclinicalfacultyorsupervisingclinicianisresponsibleforreceivinghealthcareprofessional traineescommunicationsonpatientcareactivities,validatingthetraineesfindingsinanappropriate fashion. C.InformedConsent: 1. Agreethatpatientinformationisinvaluablefortheeducationofhealthcareprofessionaltrainees. 2. Agreethathealthcareprofessionaltraineeswillhaveaccesstopatientinformationandthatpatientswillbe informedthattraineeshaveaccesstothepatientsinformation. 3. Agreethatpatientconsentshouldbeobtainedforparticipationinteachingactivitiesthatarepurely educationalinnature(e.g.teachingsessionswithhealthcareprofessionaltrainees,bringingpatientsinto seminars,lectures,etc.)andthatpatientshavetherighttorefusetoparticipateinsuchactivities. Page2of3

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4. 5. Agreethatpatientshavetherighttorefusetheuseoftheirinformationforeducationalconferencesand seminarswhentheidentityofthepatientisprovided. Agreetoensurethattherelevantfaculties,programs,teachinginstitutionsandtherelevantgoverningbodies willdefinetheprofessionspecificinvasiveproceduresthatrequireapatientswrittenconsentpriortoa healthcareprofessionaltraineesparticipationinthedefinedinvasiveprocedure.

D.ProtectingPatientConfidentiality: 1. Agreethatclinicalfacultyorsupervisingcliniciansandhealthcareprofessionaltraineesarerequiredto maintaintheconfidentialityofpatientinformationincludingwritten,verbalandelectronicinformationatall times. E.ManagingEthicalConcerns: 1. Agreethattheexpectationisthatmostethicalordifficultsituationsintheteachinginstitutionswillbe discussedinacollegialatmospherethatnormallyexistsinhealthcareprofessionalinteractionsandbe satisfactorilyresolvedattheteachingorclinicalinterface. 2. Agreethattheclinicalfacultyorsupervisingclinicianmustprovidethehealthcareprofessionaltraineewith anopportunitytodiscussanethicalordifficultsituationandthatallhealthcareprofessionaltraineesandthe clinicalfacultyorsupervisingclinicianswillhaveaccesstoalternativeavenuestoresolvemisunderstandings anddifferencesofopinion. 3. Agreethatahealthcareprofessionaltraineehastherighttorefusetoparticipateinpatientcareorclinical teachingifthetraineehasethicalconcernsabouttheactivities,isconcernedregardingtheirown competency,lackofknowledge,lackofunderstandingoftheduties/tasks/responsibilitiesorbelievesthere isalackofexplanationorsupervision. 4. Agreethattheclinicalfacultyorsupervisingclinicianisresponsibletoacceptthetraineesrefusalto participateinpatientcareactivitiesorclinicalteaching,forethicalreasons. 5. Agreethatinsituationswhenahealthcareprofessionaltraineeexpressesconcernaboutethicalissues, refusestoparticipateinpatientcareactivitiesorclinicalteachingbasedonreasonableethicalgrounds,or seeksconsultationonanethicalissue,therewillbenorepercussionstothetrainee. 6. Agreethathealthcareprofessionaltraineesandclinicalfacultyorsupervisingclinicianshavetherightto consultationwithabioethicist,clinicalethicsconsultantorotherindividualsspecificallytrainedinthe managementofethicalissues.Eachinstitutionshouldhavepoliciesandprocedurestofacilitatethese consultations. 7. Agreethatprocedureswillbeimplementedforhealthcareprofessionaltraineesandclinicalfaculty/ supervisingclinicianstoreportethicalconcerns.Theseproceduresmayproceedthroughusualacademicor hospitalserviceroutesfordisputeresolutionorthroughtheinstitutionalcommittee(describedinE8). 8. Agreethateachaffiliatedinstitutionwillidentifyacommitteetoreceiveunresolvedethicalissues,adjudicate themasnecessaryandreporttoallpartiesinvolved.Committeeswillconsistofaninstitutionalbioethicistor his/herdelegate,andinstitutionalVPEducationorhis/herdelegateandatleastoneothermember. 9. Agreethatinformationwillbeavailabletoensurethathealthcareprofessionaltraineesandclinicalfacultyor supervisingcliniciansareawareoftheproceduresavailabletothemtoaddressethicalconcernsand/orother issuesbyperformingperiodicauditsofethicalissuesbroughtforwardfordisputeresolutionasinE8.

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Governing Council UNIVERSITY OF TORONTO

Summary(seewww.governingcouncil.utoronto.ca/policiesforfulltextversion)

Code of Behaviour on Academic Matters


Approved by Governing Council 1 June 1995 www.governingcouncil.utoronto.ca/policies

The concern of the Code of Behaviour on Academic Matters is with the responsibilities of all parties to the integrity of the teaching and learning relationship. Offences The University and its members have a responsibility to ensure that a climate which might encourage, or conditions which might enable, cheating, misrepresentation or unfairness not be tolerated. Wherever in this Code an offence is described as depending on "knowing", the offence shall likewise be deemed to have been committed if the person ought reasonably to have known. 1. It shall be an offence for a student knowingly: (a) to forge or in any other way alter or falsify any document or evidence required by the University, or to utter, circulate or make use of any such forged, altered or falsified document, whether the record be in print or electronic form; (b) to use or possess an unauthorized aid or aids or obtain unauthorized assistance in any academic examination or term test or in connection with any other form of academic work; (c) to personate another person, or to have another person personate, at any academic examination or term test or in connection with any other form of academic work; (d) to represent as ones own any idea or expression of an idea or work of another in any academic examination or term test or in connection with any other form of academic work, i.e. to commit plagiarism (e) to submit, without the knowledge and approval of the instructor to whom it is submitted, any academic work for which credit has previously been obtained or is being sought in another course or program of study in the University or elsewhere; (f) to submit any academic work containing a purported statement of fact or reference to a source which has been concocted. 2. It shall be an offence for a faculty member knowingly: (a) to approve any of the previously described offences; (b) to evaluate an application for admission or transfer to a course or program of study by reference to any criterion that is not academically justified; (c) to evaluate academic work by a student by reference to any criterion that does not relate to its merit, (d) to the time within which it is to be submitted or to the manner in which it is to be performed.

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3. It shall be an offence for a faculty member and student alike knowingly: (a) to forge or in any other way alter or falsify any academic record, or to utter, circulate or make use of any such forged, altered or falsified record, whether the record be in print or electronic form; (b) to engage in any form of cheating, academic dishonesty or misconduct, fraud or misrepresentation not herein otherwise described, in order to obtain academic credit or other academic advantage of any kind. 4. A graduate of the University may be charged with any of the above offences committed knowingly while he or she was an active student, when, in the opinion of the Provost, the offence, if detected, would have resulted in a sanction sufficiently severe that the degree would not have been granted at the time that it was. Parties to Offences Every member is a party to an offence under this Code who knowingly actually commits it; does or omits to do anything for the purpose of aiding or assisting another member to commit the offence; abets, counsels, procures or conspires with another member to commit or be a party to an offence.

Procedures in Cases Involving Students The procedures for handling charges of academic offences involving students reflect the gravity with which the University views such offences. Students are ensured the right of appeal which represent the University's commitment to fairness and the cause of justice. Divisional Procedures 1. Instructor's duties: Where an instructor has reasonable grounds to believe that an academic offence has been committed by a student, the instructor shall inform the student immediately, and invite the student to discuss the matter. 2. Instructor's report to the department chair: If after such discussion, the instructor believes that an academic offence has been committed, the instructor shall make a report of the matter to the department chair or through the department chair to the dean. The dean or the department chair shall notify the student in writing accordingly, and afford the student an opportunity for discussion of the matter. 3. Imposition of sanction: If the student admits the alleged offence, the dean or the department chair may either impose the sanction(s) that he or she considers appropriate or refer the matter to the dean or Provost. 4. Student may refer matter: If the student is dissatisfied with a sanction imposed, the student may refer the matter to the dean or Provost, for consideration. 5. Referral of matter to Tribunal: If the student does not admit the alleged offence, the dean may request that the Provost lay a charge against the student. If the Provost agrees to lay a charge, the case shall then proceed to the Trial Division of the Tribunal. Divisional Sanctions One or more of the following sanctions may be imposed by the dean where a student admits to the commission of an alleged offence:
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(a) an oral and/or written reprimand; (b) an oral and/or written reprimand and, with the permission of the instructor, the resubmission of the piece of academic work in respect of which the offence was committed, for evaluation. Such a sanction shall be imposed only for minor offences and where the student has committed no previous offence; (c) assignment of a grade of zero or a failure for the piece of academic work in respect of which the offence was committed; (d) assignment of a penalty in the form of a reduction of the final grade in the course in respect of which the offence was committed; (e) denial of privileges to use any facility of the University, including library and computer facilities; (f) a monetary fine to cover the costs of replacing damaged property or misused supplies in respect of which the offence was committed; (g) assignment of a grade of zero or a failure for the course in respect of which the offence was committed; (h) suspension from attendance in a course or courses, a program, an academic division or unit, or the University for a period of not more than twelve months. Where a student has not completed a course or courses in respect of which an offence has not been committed, withdrawal from the course or courses without academic penalty shall be allowed. The dean shall have the power to record any sanction imposed on the student's academic record and transcript for such length of time as he or she considers appropriate. However, the sanctions of suspension or a notation specifying academic misconduct as the reason for a grade of zero for a course shall normally be recorded for a period of five years.

Tribunal Procedures 1. Laying of charge: A prosecution for an alleged academic offence shall be instituted by the laying of a charge by the Provost against the accused. This is done when the student does not admit guilt; when the sanction desired is beyond the power of the dean to impose; when the student has been found guilty of a previous offence; or when the student is being accused simultaneously of two or more different offences involving more than one incident. 2. Consultation: No charge shall be laid except with the agreement of the dean concerned and of the Provost, after consultation between the Provost and the Discipline Counsel. 3. Onus and standard of proof: The onus of proof shall be on the prosecutor, who must show on clear and convincing evidence that the accused has committed the alleged offence. 4. Not compellable to testify: The accused shall not be compelled to testify at his or her hearing.

Tribunal Sanctions One or more of the following sanctions may be imposed by the Tribunal upon the conviction of any student: (a) an oral and/or written reprimand; (b) an oral and/or written reprimand and, with the permission of the instructor, the resubmission of the piece of academic work in respect of which the offence was committed, for evaluation. Such a sanction shall be imposed only for minor offences and where the student has committed no previous offence;
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(c) assignment of a grade of zero or a failure for the piece of academic work in respect of which the offence was committed; (d) assignment of a penalty in the form of a reduction of the final grade in the course in respect of which the offence was committed; (e) denial of privileges to use any facility of the University, including library and computer facilities; (f) a monetary fine to cover the costs of replacing damaged property or misused supplies in respect of which the offence was committed; (g) assignment of a grade of zero or a failure for any completed or uncompleted course or courses in respect of which any offence was committed; (h) suspension from attendance in a course or courses, a program, an academic unit or division, or the University for such a period of time up to five years as may be determined by the Tribunal. Where a student has not completed a course or courses in respect of which an offence has not been committed, withdrawal from the course or courses without academic penalty shall be allowed; (i) recommendation of expulsion from the University. The Tribunal has power only to recommend that such a penalty be imposed. In any such case, the recommendation shall be made by the Tribunal to the President for a recommendation by him or her to the Governing Council. Expulsion shall mean that the student shall be denied any further registration at the University in any program, and his or her academic record and transcript shall record this sanction permanently. Where a student has not completed a course or courses in respect of which an offence has not been committed, withdrawal from the course or courses without academic penalty shall be allowed. If a recommendation for expulsion is not adopted, the Governing Council shall have the power to impose such lesser penalty as it sees fit. (j) Recommendation to the Governing Council for i. cancellation, recall or suspension of one or more degrees, diplomas or certificates obtained by any graduate; or ii. cancellation of academic standing or academic credits obtained by any former student who, while enrolled, committed any offence which if detected before the granting of the degree, diploma, certificate, standing or credits would, in the judgement of the Tribunal, have resulted in a conviction and the application of a sanction sufficiently severe that the degree, diploma, certificate, standing, credits or marks would not have been granted.

Recording sanction: The hearing panel shall have the power to order that any sanction imposed by the Tribunal be recorded on the students academic record and transcript for such length of time as the panel considers appropriate.

Procedures in Cases involving Faculty Members Divisional Procedures Divisional and Tribunal procedures for faculty members charged with academic offences, and the sanctions and appeal procedures for those convicted, resemble - with appropriate modifications - procedures and sanctions in force for students, with this signal exception: grounds and procedures for terminating employment of tenured faculty are those set forth in the Policy and Procedures on Academic Appointments, as amended from time to time.

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1. Department chairs duties: Where a student or a faculty member or a member of the administrative staff has reason to believe that an academic offence has been committed by a faculty member, he or she shall so inform the chair of the department or academic unit in which the faculty member holds a primary appointment. The department chair shall inform the faculty member immediately and invite the faculty member to discuss the matter.. 2. Department chairs report to dean: If after such discussion the department chair believes that an academic offence has been committed, the department chair shall make a report of the matter in writing to the dean. 3. Deans meeting with faculty member: The dean shall immediately notify the faculty member in writing accordingly, and afford the faculty member an opportunity for discussion of the matter. 4. Imposition of sanction: If the faculty member admits the alleged offence, the dean may impose sanctions that are within the power and authority of the dean. 5. Faculty member may refer matter and complainant may refer matter: If the faculty member is dissatisfied with a sanction imposed, the faculty member may refer the matter to the dean or the Provost for consideration. If the complainant is dissatisfied with a decision of the department chair or the dean, the complainant may refer the matter to the dean or Provost for consideration.

Divisional Sanctions One or more of the following sanctions may be imposed by the dean where a faculty member admits the commission of an alleged offence: (a) an oral and/or written reprimand (b) assignment by the dean of administrative sanctions.

Tribunal Sanctions One or more of the following sanctions may be imposed by the Tribunal upon the conviction of any faculty member: (a) an oral and/or written reprimand; (b) recommendation to the President for the application of administrative sanctions; (c) recommendation to the President for dismissal, or, in the case of a tenured faculty member, for the appointment of a committee under the Policy and Procedures on Academic Appointments, as amended from time to time, to consider dismissal. The Tribunal has power only to recommend that such a penalty be imposed. If a recommendation for dismissal is not adopted, the Governing Council or the President, as the case may be, shall have power to impose such lesser penalty as is deemed fit.

Appeals An appeal to the Discipline Appeals Board may be taken in the following cases, only: (a) by the accused, from a conviction at trial, upon a question which is not one of fact alone; (b) by the Provost, from an acquittal at trial, upon a question which is not one of fact alone; (c) by the accused or the Provost, from a sanction imposed at trial.

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On Teacher Behaviour & Student Well-Being


Medical Student Workplace Injury and Exposure to Infectious Disease in Clinical Settings, Protocol for Incidents of (Summary).......................................................................................................................... 210 Mistreatment and Other Kinds of Unprofessional Behaviour, Protocol for UME Students to Report (Summary) ......................................................................................................................................................216 Professional Behaviour for Medical Clinical Faculty, Standards of ............................................................224 Professional Responsibilities in Undergraduate Medical Education, College of Physicians & Surgeons Of Ontario (CPSO) Policy on ...................................................................................................................231 Prohibited Discrimination and Discriminatory Harassment, Statement on ........................................... 235 Sexual Harassment, Policy and Procedures (Summary)......................................................................................240

Also see: Ethics & Professionalism in Healthcare Professional Clinical Training and Teaching, Guidelines for................................................................................................................................................................. 201 NB: Applies to both teachers and students Code of Behaviour on Academic Matters (Summary) .......................................................................................204 NB: Applies to both teachers and students

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SUMMARY(seewww.md.utoronto.ca/policiesforfulltextversion)

Protocol for incidents of medical student workplace injury and exposure to infectiousdiseaseinclinicalsettings
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:22September2011 Dateoflastrevision:17January2012 Dateofnextscheduledreview:22September2015
Overview TheUniversityofTorontoUndergraduateMedicalEducationprogramiscommittedtopromotingmedicalstudent safetyandtofacilitatingappropriatesupportforstudentswhobecomeinjuredorpotentiallyexposedtoinfectious diseaseinthecourseoftheirstudiesortraining.TheclinicalsitesaffiliatedwiththeUniversityofTorontoare likewisecommittedtoriskreductionamongmedicalstudentsandtothetimelyandeffectivemanagementof incidentsofmedicalstudentinjuryorpotentialexposurethatoccurontheirpremises.TheAcademybasehospitals playaspecialroleinprovidingfollowupcaretostudentsofthatAcademywhoincursuchaninjuryorpotential exposureatanothersite.Together,theUMEprogram,theAcademies,andalltheclinicalaffiliatesensurethat medicalstudentsreceivetheassistancetheyrequireintheaftermathofaninjuryorpotentialexposureto infectiousdisease. ThisProtocoldefinestherolesandresponsibilitiesofeverypartyinvolvedinthehandlingofincidentsofinjuryand potentialexposure,andisdividedintothreeparts: PartA:Financialresponsibility PartB:Administrativeresponsibilities(notincludedinthissummaryseefulltextversionfordetails) PartC:Detailedprotocol a. Flowchart b. Responsibilitiesofstudents c. Responsibilitiesofsupervisingphysicians d. Responsibilitiesofhealthprofessionalswhoprovideinitialcare(notincludedinthissummary) e. Responsibilitiesoffollowuphealthcareproviders(notincludedinthissummary) f. ResponsibilitiesofAcademyDirectors(notincludedinthissummary) g. ResponsibilitiesofUofTWSIBAdministrator(notincludedinthissummary) h. ResponsibilitiesofAssociateDeanHealthProfessionsStudentAffairs(notincludedinthissummary) Page1of6ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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PartA:Financialresponsibility TheMinistryofTraining,CollegesandUniversitiesensuresthatanyUMEstudentswhoareinjuredorexposedtoan environmentalorinfectioushazardwhileparticipatinginrequiredclinicaltrainingaspartoftheprogram(including transcriptedelectives)areeligibleforcoverageofclaimsatnocosttothestudents.Thiscoverageisprovidedby eithertheWorkplaceSafetyandInsuranceBoard(WSIB)orACEINA(aprivateinsurer),dependingonwhetherthe siteoftheincidentisaparticipantinaWSIBprogramornot.Studentswhoincuraninjuryorexposurewhile participatinginanactivitythatisnotpartoftherequiredclinicaltrainingoftheUMEprogramarenoteligibleto submitaclaimtotheWSIBorACEINA. Inaddition,allUMEstudentsattheUniversityofTorontoarestronglyencouragedtopurchasedisabilityinsurance ineveryyearoftheprogram.Throughthisinsurance,coststhatareincurredduetoincidentsthatoccurduring activitiesotherthanrequiredclinicaltrainingmaybecovered.Furthermore,privatedisabilityinsurancemayin somecasesprovideadditionaland/orbroaderfinancialsupportforincidentsthatarealsocoveredbytheWSIB. Studentsareencouragedtoeducatethemselvesabouttheirdisabilityinsuranceoptionstodeterminetheplanand providerthatbestmeettheirneeds.

AllcostsstemmingfrominjuryorexposuretoinfectiousdiseasethatarenotbornebytheWSIBorprivate insuranceshallbebornebythestudent. PartB:Administrativeresponsibilities AclaimtotheWorkplaceSafetyandInsuranceBoard(WSIB)orACEINAshouldbemadeinallcasesinwhichpost exposureprophylaxis(PEP)hasbeeninitiatedorwheneverothercostsareincurredbythesiteofinitialtreatment, thesiteoffollowuptreatment,and/orthestudent,followinganincidentthatoccurredinthecourseofrequired clinicaltraining.

Aclaimmayalsobewarrantedinothersituationswheremedicaltreatmentormodifieddutiesarerequired.The WSIBAdministratorattheUniversityofTorontocanprovideadviceifthereisuncertaintyastowhethertoproceed withpaperwork.

Note:TheMinistryofTraining,Colleges,andUniversitiesmayincurafineforclaimssubmittedtotheWSIBlater thanthreebusinessdaysaftertheincident.Timelinessisthereforeessential.

Theresponsibilitytocompletedocumentationinsupportofaclaimrestswithavarietyofparties.Thestudents AcademyDirectorisresponsibleforliaisingwithallpartiestoensuretimelycompletionofthedocumentationand tofacilitatecommunicationamongthepartiesasnecessary.

Forclarity,thefollowingdocumentationistypicallyrequiredfromeachparty:

Thestudent: a. Afterreceivingtreatmentandensuringanappropriateincidentreportformorequivalent(asper Sectiond(1))hasbeencompleted,thestudentshouldinformhis/herAcademyDirectorofthe incident. b. DocumentationmayberequesteddirectlybytheWSIBaftertheclaim(ifany)hasbeensubmitted bytheUniversityofTorontoWSIBAdministrator;thereisnotgenerallyanydocumentationforthe studenttocompletebeforehand Page2of6ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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FacultyRegistrar: a. Writtenconfirmationthatthestudentsinjuryorexposureoccurredduringthecourseofa legitimate,unpaidplacementthatrepresentedpartofthestudentsacademicprogram1 b. AcopyoftheaffectedstudentssignedStudentDeclarationofUnderstandingregardingWSIBand privateinsurancecoveragethroughtheMTCU c. AcopyoftheMTCULetterofAuthorizationtoRepresentEmployer,withthetopportioncompleted bytheRegistraronbehalfoftheUniversity Representativeatthesiteoftheincident:2 a. ThebottomhalfoftheMTCULetterofAuthorizationtoRepresentEmployerobtainedfromthe FacultyRegistrar(seeabove). b. ForsiteswithWSIBcoverage:aUofTAccidentReportForm,ifnonewascompletedatthetimeof theincident.TheUniversitywillmakethisformavailabletoallaffiliatedsites. c. ForsiteswithoutWSIBcoverage:anACEINAAccidentReportForm.TheUniversitywillmakethis formavailabletoallaffiliatedsites. OccupationalHealthstafforotherrepresentativeatthesite(s)oftreatment: a. Allrecordsrelatedtotheincidentandthetreatmentprovidedtothestudent WSIBAdministratorattheUniversityofToronto a. Consolidatedsubmission

PartC:Detailedprotocol a. Flowchart(onnextpage)
IftheincidentdidnotoccurduringrequiredclinicaltrainingaspartoftheUMEprogram,thenthestudentisnoteligibleto makeaclaimtotheWSIBorACEINA.However,compensationmaybesoughtthroughthestudentsdisabilityinsurance provider. 2 IfanincidentoccursatanAcademyhospital,theAcademyDirectorhimself/herselfmayactastherepresentativeofthe hospitalforthepurposesofincidentdocumentation,ifthisisdeemedappropriatebythehospitalleadership.
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b.ResponsibilitiesofSTUDENTSwhoareinjuredorpotentiallyexposedtoinfectiousdiseaseinaclinicalsetting i.Immediatelyfollowingtheincident,thestudentisexpectedto: (1) (2) (3) Informhis/hersupervisingphysicianorotherteacheroftheincidenttoensurethatpatientcarecanbe transferredasappropriate. Requestthatstepsbetakentoseekconsentfromthepatienttodrawasample,inthecaseofpotential exposuretoinfectiousdisease(e.g.aneedlestickinjury) Seekimmediatetreatment(withinamaximumoftwohours)fromoneofthefollowing: a. TheOccupationalHealthUnit(orsitespecificequivalent3)ifoneispresentwheretheincident occurred,anditisduringofficehours. b. ThesitesoffhourssubstitutefortheOccupationalHealthUnit(orequivalent)iftheincident occurredoutsideofofficehours. c. ThelocalEmergencyDepartmentiftheincidentoccurredsomewhereinthecommunity. (4) Informthehealthcareproviderwhoattendstotheincidentofhis/herstatusasamedicalstudentatthe UniversityofToronto.Iftheincidenthasoccurredinahospitalsetting,thestudentshouldpresenthis/her identificationbadge. Requestthataworkplaceincidentreportbefilled.Iftheincidenthasoccurredinthecommunityandcareis soughtatalocalEmergencyDepartmentwhereaworkplaceincidentreportmaynotbeavailable,an alternativedocumentindicatingthenatureoftheincidentandthemedicaltreatmentthatwas administeredshouldbecompleted Obtainacopyofallincidentreportsandotherpaperwork.

(5)

(6)

ii.Subsequenttoreceivinginitialtreatment,thestudentisexpectedto: (1) (2) (3) (4) (5) Reportanyincidentofinjuryorexposuretohis/herAcademyDirectorassoonaspossible,regardlessof wheretheincidenttookplace. Followthecourseoftreatmentprescribedbythesiteofinitialcare,ifany. Obtainfollowupcareand/orsupport,asarrangedbyAcademyDirector. Followthecourseoftreatment(ifany)prescribedbythedesignatedtreatmentsitesOccupationalHealth Unit. Complyinatimelymannerwithanyrequeststofilloutpaperworkrelatedtotheincidentfromthe AcademyDirector,theOccupationalHealthUnit,theUofTWSIBAdministrator,theWSIBorACEINA(the privateinsurerusedforcertainclinicaltrainingsites),theMTCU,orothers. Ifnecessary,makeappropriatearrangementswithcoursedirectors,thePreclerkship/ClerkshipDirector, and/ortheAssociateDeanHPSAforspecialaccommodations,absences,orothermattersarisingfromthe incident.

(6)

Studentsshouldbeinformedofthisatthecommencementofeachrotation.Insomecases,thiswillbedefinedastheEmergency Department.

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iii.Intheeventthattreatmentisunsuccessfulandthestudentcontractsaninfectiousdisease,he/sheisexpectedto: (1) Sharethisinformationconfidentiallywitheitherhis/herAcademyDirectorortheAssociateDeanHealth ProfessionsStudentAffairs,whowillarrangefortheExpertPanelonInfectionControltoconvene.The Panelwilldeterminewhatmeasuresmustbeenactedtosafeguardpatientswellbeing,asperthePolicyon InfectiousDiseasesandOccupationalHealthforApplicantstoandTraineesoftheFacultyofMedicine AcademicPrograms. Note:Informationonthestudentsstatusandhealthwillbesharedstrictlyonaneedtoknowbasis. c.ResponsibilitiesofSUPERVISINGPHYSICIANSorotherteacherswhenastudentundertheirsupervisionis injuredorpotentiallyexposedtoinfectiousdiseaseinaclinicalsetting. Immediatelyfollowingtheincident,thesupervisingphysicianisexpectedto: (1) (2) (3) Assistthestudentinaccessingimmediatecareasnecessary.Thesitespecificworkplaceinjuryprotocol shouldbeapplied. Facilitatetheobtainingofconsentforsamplestobedrawnfromthepatient,incasesofpotentialexposure toinfectiousdisease. (Ifthestudentisunabletospeakforhimself/herself) a. Describetheincidenttothehealthprofessionalswhoprovideinitialcaretothestudent. b. Informthehealthprofessionalswhoprovideinitialcaretothestudentthathe/sheisamedical studentfromtheUniversityofToronto. c. ContactatleastoneofthestudentsAcademyDirector,coursedirector,orsitedirectortoinform themoftheincident.

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SUMMARY(seewww.md.utoronto.ca/policiesforfulltextversion)

ProtocolforUMEstudentstoreportmistreatmentandotherkindsof unprofessionalbehaviour
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:21September2011 Dateoflastreview:21September2011 Dateofnextscheduledreview:21September2015 Important: ThisprotocolisNOTforemergencyuse.
Studentsconcernedaboutimpendingharmtothemselvesorothersshouldcall911orseekimmediateassistance fromonsitesecurityorotherauthorities.Thestudentisaskedtomakeasubsequentreportasdescribedinthis protocol,onlyaftersafetyisensured. UndergraduateMedicalEducation(UME)placestheutmostimportanceonthesafetyandwellbeingofstudents, andtheirabilitytolearninanenvironmentofprofessionalism,collegiality,andrespect. AllmembersoftheUMEcommunityhaveajointresponsibilitytoprotecttheintegrityofthelearningenvironment andarighttoappropriatetreatmentandtoappropriateresponsewhentheenvironmentiscompromised.This protocolspecificallyaddressesmechanismsforstudentstoreportharmtothemselvesorotherstudents,andto reportotherunprofessionalbehaviourthattheybelievehashadanegativeeffectonthelearningenvironment. Note:TheUniversityofTorontohassetoutanumberofpoliciesandproceduresthatdetailtherecourseavailable forspecificbreachesoftheexpectedstandardsofthelearningenvironment.Thepurposeofthisprotocolisto supplementtheUniversitysdocumentswheregapsexist,andtomakeexplicithowharmfulincidentsshouldbe reportedbystudentsandhowtheywillbetracked.Thisprotocoldoesnotsupersedepowersandproceduresset outinotherpoliciesoftheUniversity,theFacultyofMedicine,orhospitals.WhereanexistingUniversityor Facultypolicyapplies,theproceduredescribedinthatdocumentwillbefollowed.Likewise,ifaUniversityor Facultyofficeoraclinicalinstitutionhasjurisdictioninagivensituation,itsauthoritywillberespected. A.DEFINITIONS i. Harmfulincident UMEdefinesaharmfulincidentbroadlyasanincidentinwhichonepersonsbehaviouroractionscauseharmto UMEstudentsortheUMEcommunity.Harmfulincidentsfallintotwocategories: Page1of8ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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Incidentsofstudentmistreatment areincidentsinwhichsomeoneintheUMElearningenvironmentharmsastudentinsomemanner,including physically,sexually,oremotionally.Anyincidentsinvolvingharmtoanotherpersonnecessarilyentailharmto thelearningenvironmentaswell. Otherincidentsofunprofessionalism areincidentsinwhichtheinappropriateconductofamemberoftheUMEcommunitycompromisesthe learningenvironment.(Thismayincludemistreatmentofsomeoneotherthanastudent.)Astudentwho witnessesorexperiencesanincidentofunprofessionalbehaviourandisconsideringmakingareportshould firstdeterminewhetherheorsheconsiderstheincidenttobeminorormajor: o Minorincidentsofunprofessionalismaresingle,apparentlyisolatedeventsthataretroublingtothe studentwhowitnessesorexperiencesthem,butforwhichaformalreportmayseemunwarranted. o Majorincidentsofunprofessionalismarethosebehavioursandactionsthatareeitherrepeatedorso severeastohaveasignificantnegativeeffectonthelearningenvironment.Majorincidentsare sufficientlytroublingtothestudentwhowitnessesorexperiencesthemthattheywarrantformal reporting.

Itisrecognizedthatinterpretationsofharmwilldiffer.Studentsunsureaboutwhetherareportiswarrantedshould seekadviceasdescribedbelow. ii. Unacceptableconductleadingtoharmfulincidents Forthepurposesofthisprotocol,UMErecognizesasharmfulallofthebehavioursandactionsthataredeemed unacceptableunderoneormoreof: - theOntarioHumanRightsCode, - theCanadianCharterofRightsandFreedoms, - policiesoftheUniversityofToronto o CodeofBehaviouronAcademicMatters(appliestostudentsandteachers) o CodeofStudentConduct(appliestostudents) o HumanResourcesGuidelineonCivilConduct(appliestofacultyandstaff) o PolicywithRespecttoWorkplaceHarassment(appliestofacultyandstaff) o PolicywithRespecttoWorkplaceViolence(appliestofacultyandstaff) o SexualHarassment:PolicyandProcedures(appliestostudents,faculty,andstaff) o StandardsofProfessionalPracticeBehaviourforallHealthProfessionalStudents(appliestostudents) o StatementonProhibitedDiscriminationandDiscriminatoryHarassment(appliestostudents,faculty, andstaff) - policiesoftheFacultyofMedicine o GuidelinesforEthics&ProfessionalisminHealthcareProfessionalClinicalTrainingandTeaching (appliestostudentsandteachers) o StandardsofProfessionalBehaviourforMedicalClinicalFaculty(appliestoclinicalfaculty) - policiesoftheCollegeofPhysiciansandSurgeonsofOntario, o PhysicianBehaviourintheProfessionalEnvironment(appliestoregisteredMDs) o ProfessionalResponsibilitiesinPostgraduateMedicalEducation(appliestoregisteredMDs) o ProfessionalResponsibilitiesinUndergraduateMedicalEducation(appliestoregisteredMDs) - policiesofhospitalsandresearchinstitutesaffiliatedwiththeUniversityofToronto. o Consultthepoliciesonconductoftheappropriateaffiliatedhospitalorresearchinstitute. Page2of8ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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Whereversuchbehavioursoractionsdeemedunacceptablebyoneormoreofthesourceslistedabovetakeplace inthecontextoftheUMElearningenvironmentorbetweenmembersoftheUMEcommunity,areportshouldbe madeasdescribedinthisprotocol. Note:Areportofanyofthebehavioursnamedinthedocumentsaboveisaseriousaccusationagainstanother individualoragroupofindividuals,andUMEwillgiveseriousweighttoanysuchaccusation.Makingafalse, frivolous,vexatious,ormaliciousreportwillbeconsideredasaprofessionallapseandtheusualproceduresused byUMEforlapsesinprofessionalismwillbepursued. iii. DesignatedUMELeaders ThetermDesignatedUMELeaderisusedinthisprotocoltorefertoindividualswhoareofficiallydesignatedto receivereportsofharmfulincidentsfromstudents.Theyareasfollows: - Forincidentsofstudentmistreatment:theAssociateDeanHealthProfessionsStudentsAffairs - Forotherincidentsofmajorunprofessionalbehaviour:theAcademyDirectors,PreclerkshipDirector, ClerkshipDirector,FacultyLeadforEthics&Professionalism,coursedirectors,counsellorsoftheOffice ofHealthProfessionsStudentAffairs,AssociateDeanHealthProfessionsStudentAffairs,andAssociate DeanEquity&Professionalism B.PRINCIPLES Thisprotocolisgovernedbytwoprinciplesasfollows: Principle1multiplereportingoptions Studentsshouldhavemultipleoptionstoreportinformationaboutharmfulincidentsinthelearning environmenttoindividualswiththeauthoritytoassistthestudentand/ortakecorrectiveaction.Such reportingneednotbedirectinallinstances.(Forexample,astudentmayreportanincidenttoanindividual whodoesnothavetheauthoritytotakecorrectiveaction,butwhocanconveytheinformationtoanother individualwhodoeshavesuchauthority.) However,studentsshouldrecognizethatnotallsuchoptionsareequallyeffective.Forthisreason,thisprotocol clearlyidentifiesthepreferredreportingmechanismsadoptedbyUME. Principle2confidentiality Confidentialitywillbeupheldregardlessofhowortowhomthereportismade. ExceptasmayberequiredbylaworUniversitypolicy,anydetailedcommunicationaboutthereport(including thereportingstudentsidentity)willonlybemadewiththeexpressconsentofthestudentandonlyas necessarytoprovideassistanceorcaretothestudent,ortopursueaninvestigationorremedialaction. Studentsmustrecognizethatinmostinstances,atleastsomecommunicationwithanotherindividualwillbe necessarytoallowappropriatestepstobetaken. Althoughthereisanoptionforanonymousreportingofharmfulincidents,anonymousreportscannotusually beinvestigatedoractedupon.Studentsarestronglyencouragedtomakereportsthatarenotanonymous. Page3of8ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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Allreportsmaybeincludedinstatisticalanalysesofaggregatedata,andtheseanalysesmaybesharedatthe discretionoftheUMEleadership.Allidentifyinginformationwillbepurgedfromtheanalysesfortheprotectionof thereportingstudentandanyotherindividualsinvolvedintheincident. C.UMELEADERSWHOAREDESIGNATEDTORECEIVEREPORTSOFHARMFULINCIDENTSFROMSTUDENTS i. Incidentsofstudentmistreatment Ifanypersonharmsastudent,includingphysically,sexually,oremotionally,studentshavetheoptiontomakea reportoftheincidenttoanyUMEteacher,leader,1oradministrativestaffmemberoftheirchoice. However,toensurethatsuchreportsaredealtwitheffectively,particularlyifsafetyorwellbeingareatrisk,UME recommendsthatstudentsreportincidentsofharmtothemselvesorotherstudentstotheAssociateDean, HealthProfessionsStudentAffairs(HPSA). Note:Ifastudentdoeschoosetoreportstudentmistreatmenttoateacher,leader,orstaffmemberinsteadofto theAssociateDeanHPSA,thenthatindividualisstronglyadvisedtoobtainthestudentspermissiontosharethe informationwiththeAssociateDeanHPSA. ii. Incidentsofmajorunprofessionalism(otherthanstudentmistreatment) Thissectiondescribeswhomtocontactwhenastudentwitnessesunprofessionalbehaviourcommittedbya memberoftheUMEcommunitythatdoesnotconstitutestudentmistreatment,butdoescompromisethelearning environment.(Forclarity,thiscategoryofunprofessionalbehaviourincludesmistreatmentofindividualsotherthan students,includingresidents,facultymembers,patients,administrativestaff,otherhealthprofessionals,etc.) Majorincidentsofunprofessionalbehaviouraretypicallyverysevereorrepeated,andhaveasignificantnegative effectonthelearningenvironment.Majorincidentsaresufficientlytroublingtothestudentwhowitnessesor experiencesthemthattheywarrantformalreporting. Aswithincidentsofstudentmistreatment,astudenthastheoptiontomakeareportofanincidentof unprofessionalbehaviourtoanyUMEteacher,leader,2oradministrativestaffmember,accordingtopersonal comfortandpreference. However,studentsshouldrecognizethatnotallUMEteachers,leaders,orstaffmembersareequallywellplacedto provideassistanceorothersupportinresponsetoanincidentofunprofessionalbehaviour,noraretheyallequally capableofactingonthereporttoeffectivelyaddresstheparticularincidentorthesystemasawhole. Studentsshouldreportamajorincidentofunprofessionalismtoanindividualwithasuitablelevelofauthorityand knowledgeofthecontexttoaddressthesituationappropriately.UMEthereforerecommendsthatmajorincidents ofunprofessionalismbereportedtoONEofthefollowingindividuals.AlloftheseDesignatedUMELeadersmay assistwithreportsofunprofessionalbehaviourinanycontext,butsuggestedreasonsforchoosingoneindividual overanotherareindicated:
UMEleadersincludetheViceDean,theAssociateDeans,theAcademyDirectors,thePreclerkshipandClerkshipDirectors,the coursedirectors,thethematicfacultyleads,andtheFacultyRegistrar. 2 UMEleadersincludetheViceDean,theAssociateDeans,theAcademyDirectors,thePreclerkshipandClerkshipDirectors,the coursedirectors,thethematicfacultyleads,andtheFacultyRegistrar. Page4of8ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies
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ThestudentsAcademyDirectorortheAcademyDirectoratthesiteoftheincident (especiallyiftheincidentoccursinahospitalenvironment) Thecoursedirector (especiallyiftheincidentoccursinanonhospitalenvironment) ThePreclerkshiporClerkshipDirector,asappropriate (especiallyiftheincidentinvolvesacoursedirectororanunresolvedpatternofconduct) TheFacultyLeadforEthics&Professionalism CounsellorsintheOfficeofHealthProfessionsStudentAffairs TheAssociateDeanHealthProfessionsStudentAffairs TheAssociateDeanEquity&Professionalism

Note:Ifastudentchoosestoreportanincidentofunprofessionalismtoanindividualnotlistedabove,thenthat individualisstronglyadvisedtoobtainpermissionfromthestudentwhomadethereporttosharetheinformation withoneormoreoftheUMEleadersinthelistasdictatedbythesituation. iii. Incidentsofminorunprofessionalism Minorincidentsofunprofessionalismaretypicallysingle,apparentlyisolatedeventsthataretroublingtothe studentwhowitnessesorexperiencesthem,butforwhichaformalreportmayseemunwarranted. Wheneverpossible,thestudentisinsteadencouragedtodiscussthesituationdirectlywiththepersonwhose behaviourseemedunprofessional.ThisapproachrecognizestheroleofcollegialconversationintheUME community,andemphasizestheprincipleofaddressingproblemslocallywhereverpossible.Inaddition,students maywishtoapproachanothertrustedUMEteacher,leader,oradministrativestaffmemberforadvice. Ifforanyreasonthestudentdoesnotfeelcomfortableengaginginsuchadiscussion,oriftheresultofsucha discussionisnotsatisfactory,thenthestudentcanfollowthereportingproceduredescribedunderIncidentsof majorunprofessionalism. Studentmayalwaysreportincidentsonateachersevaluationformoracourseevaluationform.Note:Whileevery effortismadetoreviewevaluationformsinatimelymanner,studentsshouldnotassumethatactionwillbetaken quicklyonthebasisofacourseevaluation. [SECTIONSDandEareomittedfromthissummarypleaseseethefullpolicyatwww.md.utoronto.ca/policies fordetailsonreportsmadetoaDesignatedUMELeader] F.PROCEDUREFORANYOTHERINDIVIDUALSWHORECEIVEAREPORTOFAHARMFULINCIDENTFROMA STUDENT IfastudentchoosestoreportanincidentofmistreatmentormajorunprofessionalismtoanindividualinUME otherthanaDesignatedUMELeader(seeDefinitionssection),theindividualreceivingthereport(thereport recipient)hascertainresponsibilities: Page5of8ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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(1) Theymustmakethestudentawareofthisprotocol. (2) Theymustclearlyinformthestudentofanylimitationsontheirauthorityorabilitytorespond. (3) Theymustinformthestudentthatthepreferredapproachtodealingwithincidentsofstudentmistreatmentis tocontactaDesignatedUMELeader.Thisapproachhelpsensurethatthestudenthasaccesstosuitable support,thattheapplicableUniversity,Faculty,andhospitalpoliciesarefollowed,thatinvestigationsorother actionscanbeundertaken,andthatUMEisabletomonitorthelearningenvironmenteffectively. IfthestudentagreestotheinvolvementofaDesignatedUMELeader,therearethreeoptions: Preferably,thestudentcanfilloutanIncidentReportFormonline. ThestudentcancontactaDesignatedUMELeaderdirectlyasdescribedabove. ThereportrecipientcancontactaDesignatedUMELeaderonbehalfofthestudent.Inthissituation, thereportrecipientmustbeabsolutelyclearontheinformationthatheorsheispermittedtoshare withDesignatedUMELeader,andonthestudentsexpectationswithregardtodirectfollowupfrom thatindividual (4) Fortheprotectionofallinvolved,includingthereportrecipienthimselforherself,thereportrecipientmust obtainthestudentspermissionregardingthesharingofanypotentiallyidentifyinginformation. Anindividualwhoreceivesareportofstudentmistreatmentisexpectedtomakeasecure,personalrecordof thereport,regardlessofwhetherthereportingstudentwishestopursueanyactionornot.Thisrecordisfor personalreferenceonlyandmustbekeptstrictlyconfidential,unlessthestudentinquestionprovidesexpress permissionforitscontentstobeshared,orunlessrequiredbylaw. Note:UMEteachers,administrativestaffmembers,andleadersshouldbeawarethatalthoughastudentmay makeareporttotheminanapparentlyinformaloroffhandmanner(e.g.,inthecourseofregular conversation),bytheverynatureoftheseindividualsstatusvisvistheUniversityanditsmedicalstudents,it isgenerallysafesttoassumethatinfactthereportwasintendedtobeaformalnotification.Incaseofdoubt, anindividualwhoismadeawareofanincidentbyastudentshouldclarifythestudentsintentionsinraisingthe issuewiththem. (5) Ingeneral,individualswhoreceiveareportregardingsignificantincidentsofunprofessionalbehaviourand especiallystudentmistreatmentareadvisednottoattemptoragreetoprovideassistancetothatstudent, ortointercedeinsuchanincidentbymakingcontactwithanyone,withouttheassistanceofaDesignated UMELeader. Specialnoteregardingreportsmadeinthecontextofaneducationalexperience TherearecertainoccasionsintheUMEcurriculum,suchasthePortfoliogroupsessions,duringwhichstudents sharepersonalexperiencesrelatedtotheirtraining,withtheexpectationthattheinformationthatissharedwillbe keptconfidential. Page6of8ofthissummaryversionforfulltext,pleaseseewww.md.utoronto.ca/policies

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Teacherswholearnofanincidentofinappropriatetreatmentinthecourseofacurricularsessionofthistypeare encouragedtoprivatelyanddiscreetlyapproachthestudentwhodescribedtheincident,tomakesurethestudent hasreceivedappropriatesupportandisawareofoptionsavailabletothemtoreportsuchanincident.Students shouldbeinformedthatdescribingtheincidentinaconfidentialclassroomsettingcannotbeconsideredareport, andnoactioncanbetakenbasedonwhatwassaidinclass.Ifthestudentwishestopursuethematter,thenthe proceduredescribedaboveshouldbefollowed. G.TRACKING,ANALYZING,ANDADDRESSINGTRENDSINHARMFULINCIDENTS i. Individualresponsibility AllUMEleaders,whetherdesignatedorotherwise,areexpectedtomonitorthenumberandcontentofthe reportsthattheyreceive,andtolookforemergingtrends.Suchtrendsshouldbebroughttotheimmediate confidentialattentionoftheAssociateDeanEquity&Professionalism(E&P)andtheViceDeanUME.TheAssociate DeanE&Pand/ortheViceDeanUMEwillthendeterminewhatstepsmayberequiredandwillimplement measuresasappropriate(seebelow). Inparticular,theAssociateDeanHealthProfessionsStudentAffairs,asthesoledesignatedrecipientofreportson mistreatmentofstudents,willregularlyreviewthestatisticalreportsavailablethroughtheIncidentReportForm (IRF)system,andprovidearegularupdatetotheAssociateDeanE&PandtheViceDeanUME. Atleastonceperyear,orasdirectedbytheAssociateDeanE&P,everyUMEleadershallsubmitasummaryofthe harmfulincidentreportsthattheyhavereceivedduringthattimeframetotheAssociateDeanE&P(seeInstitutional Responsibility,below). ii. Institutionalresponsibility TheAssociateDeanEquity&Professionalism(E&P)holdsprimaryresponsibilityforthetrackingofreportsofall typesofharmfulincidentsinthemedicalstudentlearningenvironment.TheViceDeanUMEandtheAssociate DeanE&Parejointlyresponsibleforactivelyaddressingconcerningratesortrendsofharmfulincidentsthroughthe UMEportfolioandincollaborationwithpartnerssuchastheclinicalaffiliates,theUniversityDepartments,the decanalteam,andothers. Atleastonceperyear,theAssociateDeanE&PwillproduceareportfortheattentionoftheViceDeanUME summarizingtheharmfulincidentsthathavebeenrecordedintheUMElearningenvironment.Thedatawillbe conveyedinaggregateonlyandinsuchawaythatnoindividualsinvolvedintheincidentsareidentifiable.The reportshouldindicatethenumberandvarietyofincidentsreported,identifysitesorgroupsofsitesofconcern, summarizethestatus(student,faculty,residents,administrativestaff)ofbothpersonsmakingcomplaintsand thoseaboutwhomcomplaintsweremade,andsummarizeoveralldispositionofreports TheViceDeanUMEisresponsiblefordeterminingtheappropriatebreadthofdisseminationoftheAssociate Deansreportsofharmfulincidents.
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StandardsofProfessionalBehaviourforMedicalClinicalFaculty
ApprovedbytheCounciloftheFacultyofMedicine(FacultyCouncil) 22June2009
Introduction Patients,colleagues,andthepublicatlargehavelonghadhighexpectationsfortheprofessionalbehaviourof physicians.Toassistlearnerstomeetthisexpectationinourundergraduateandpostgraduatemedicaleducation programs,in1995theFacultyofMedicineestablishedstandardsofprofessionalbehaviourforstudentsand residents.ThesehaverecentlybeenreplacedbythenewUniversityofTorontoStandardsofProfessionalPractice BehaviourforHealthProfessionalStudents.(2008)1 Asstudentsandresidentslearnwhatitistobeaprofessional,theexamplessetbytheirteachers,theclinicalfaculty withwhomtheyworkindailypatientcare,areimportantinfluences.Whattheyseeintheirrolemodels,partofthe socalledinformalorhiddencurriculum,isjustasorevenmoreimportantthantheformalcurricularsessionson professionalism. Thesestandardsarticulateoursharedexpectationsforthehighstandardofbehaviourthatisalreadyexemplifiedby themajorityofourclinicalfaculty.TheyapplytoMedicalClinicalFacultyappointedundertheUniversityof TorontosPolicyforClinicalFaculty.2 Nothinginthesestandardslimitstheacademicfreedomofclinicalfaculty.ThePolicyforClinicalFacultydefines academicfreedomas: thefreedomtoexamine,question,teachandlearn,andtherighttoinvestigate,speculateandcommentwithoutreferenceto prescribeddoctrine,aswellastherighttocriticizetheUniversityandsocietyatlarge..Academicfreedomdoesnotrequire neutralityonthepartoftheindividualnordoesitprecludecommitmentonthepartoftheindividual.Rather,academicfreedom makessuchcommitmentpossible3 Allclinicalfacultyremainsubjecttotheapplicableethicalandclinicalguidelinesorstandards,lawsandregulationsgoverning thepracticeofmedicineandthesitespecificrelevantsitespoliciesorbylaws4
UniversityofTorontoStandardsofProfessionalPracticeBehaviourforHealthProfessionalStudents. http://www.pgme.utoronto.ca/Assets/Policies/Professional+Practice+Behaviour.pdf 2UniversityofTorontoPolicyforClinicalFaculty http://www.governingcouncil.utoronto.ca/Assets/Policies/PDF/Policy+for+Clinical+Faculty.pdf 3UniversityofTorontoGoverningCouncil:PolicyforClinicalFacultyat7. 4UniversityofTorontoGoverningCouncil:PolicyforClinicalFacultyat8.
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Thesestandardsdonotreplaceorlimitthelegalandethicalstandardsestablishedbyprofessionalorregulatory bodies,byrelevantclinicalsettings,orbyotherapplicableUniversitystandards,policiesandprocedures. Thesestandardsmaybeusedasonerelevantfactorintheassessmentandevaluationofclinicalfaculty. SECTION1 Clinicalfacultyshoulddemonstrateandeffectivelymodelhighstandardsofprofessionalism,includinga commitmenttoexcellenceandfairandethicaldealingswithothersincarryingouttheirprofessionalduties.The followingillustratesomeofthebehavioursandcharacteristicsthatclinicalfacultystrivetoachieve: 1. Maintainahighstandardofpractice&seekexcellence(selfassessment,lifelonglearning) 2. Demonstratehonesty,integrity,empathy,humility,andcompassion 3. Showconcernforpatientsandtheirphysicalandpsychosocialwellbeing;exhibitaltruism 4. Bearolemodelforrelationshipswithpatientsandtheirfamiliesintheclinicalandcommunitysetting,with participantsandtheirfamiliesintheresearchsetting,andwithlearners. 4.1 Actwithcourtesyandrespect 4.2 Recognize&observeboundaries 4.3 Communicateeffectively,provideappropriateinformation,andendeavourtoanswerquestions. 4.4 Respectprivacyandmaintainconfidentiality 4.5 Maintainanacceptablestandardofappearanceandhygiene 5. Becollegialinrelationswithothers:physicians;otherhealthcareprofessionalsandstaff;andstudents& residents 6. Besensitivetoandacceptingofdiversityinpatients,teammembers,andlearners.Diversityincludes,butis notlimitedto:age;disability;sexandgender;sexualorientation;race,colour,ethnicity,nationalityor ancestry;culture&religion;familyormaritalstatus;socioeconomicstatus;andpoliticalaffiliation. 7. Recognize,disclose,andmanagecompetinginterests(ConflictsofInterest)suchasfinancialinterest; researchinterest;careeradvancement,andotherpersonalinterests. 8. Bearolemodelinmaintainingpersonallifebalance,health,andwellbeing 9. Contributetomeetingthecollectiveresponsibilitiesoftheprofession. 9.1 Practiseinasociallyresponsiblemanner,consideringandadvocatingfortheneedsofthepatient,the communityandanyvulnerablepopulationsinthephysicianspractice. 9.2 Besupportiveofcolleaguesinachievingandmaintaininggoodstandardsofpracticeandappropriate professionalbehaviour. 10. Demonstrateinsightintoownbehaviourandseektoimprovewhennotmeetingstandardsofbehaviour, includingacknowledgingerror. Facultymemberswillrecognizethattheirconductbeyondtheclinicalandeducationalsettingandafterhours,such asininterviews,schoolvisits,andcommunitygroups,mayalsoreflectontheirroleintheuniversity. Professionalconductextendstouseoftheinternetandelectroniccommunicationinallsettings.Usefulguidance maybefoundinthepostgraduatedocumentGuidelinesforAppropriateUseoftheInternet,ElectronicNetworking andOtherMedia,2008http://www.pgme.utoronto.ca/Assets/Policies/Guidelines+Internet.pdf Page2of7

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SECTION2

Clinicalfacultymemberswillnotengageinactionsinconsistentwiththeappropriatestandardsofprofessional behaviourandethicalperformance,includingbutnotlimitedtothefollowingconduct:

1.

Creationofahostileenvironment5 1.1 Failuretoworkcollaborativelyinpatientcare 1.2 Intemperatelanguage:rudeness,profanity,insults,demeaningremarks,verbalabuseorintimidation 1.3 Inappropriateremarksorjokesaboutrace,gender,sexualorientation,physicalappearance,disabilities, oreconomicandeducationalstatus. 1.4 Bullying 1.5 Recurringoutburstsofanger:shouting;throwingorbreakingobjects 1.6 Violence&threatsofviolence 1.7 Inhibitingothersfromcarryingouttheirappropriateduties 1.8 Disparagingpublicremarksaboutthecharacterorpatientcareofanotherphysicianorhealth professional. Intimidation&Harassment: 2.1 Useofridiculeintheworkenvironmentorasaninstructionaltechnique 2.2 Inappropriateassignmentofdutiestoinfluencebehaviourorasapunishment 2.3 Denyingappropriateopportunitiesforlearningandexperience 2.4 Inhibitinglearnersfromprovidingappropriatefeedbackandevaluationofteachersandexperiences 2.5 Interferingwiththereportingofimproperconduct 2.6 Sexualharassmentorimpropriety6

2.

3.

Discrimination: 3.1 Makingdistinctionsbasedoncriteriairrelevanttothedecisioninquestion,particularlythoseprotected undertheOntarioHumanRightsCode:race,ancestry,placeoforigin,colour,ethnicorigin,citizenship, creed,sex,sexualorientation,age,maritalstatus,familystatus,ordisability. Failuretoidentify,disclose,andmanageconflictsofinterest 4.1 Conflictsarecommonlyrecognizedinfinancialmattersbutmayalsoariseoverresearchinterests,and careeradvancement7 4.2 Conflictsmayalsoariseandmustbedeclaredwhenthereisorhasbeenaclosepersonalrelationship includingafamily,romanticorsexualrelationship 4.2.1betweenteachersandlearners 4.2.1.1 Universitypolicydoesnotprohibitromanticorsexualrelationshipsbetweenteachers andlearnersbutdoesregulatetheconflictofinterestthatinevitablyresultsfromsuch arelationship8

4.

SeetheCollegeofPhysiciansandSurgeonsofOntario(CPSO)documentPhysicianBehaviourintheProfessionalEnvironment. http://www.cpso.on.ca/Policies/behaviour.htm 6UniversityofTorontoPolicyandProcedures:SexualHarassment http://www.governingcouncil.utoronto.ca/Assets/Policies/PDF/sexual.pdf 7seeUniversityofTorontoPolicies:ConflictofInterestandClosePersonalRelations http://www.provost.utoronto.ca/policy/relations.htm 8ibid


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4.2.1.2 Thefacultymembermustdisclosetheconflicttothepersontowhomthefaculty memberreports(DepartmentHead,Chair,orDean.)Thedeclarationisconfidential andneedonlybethataconflictexists,notthedetailsoftherelationship.The appropriateadministratorwilltakestepsnecessarytoseparatetheinterestsofthe facultymemberandthelearner. Boththefacultymemberandthelearnerareprohibitedfromevaluatingeachother bothduringandafterthetermoftherelationship.Thefacultymemberisprohibited fromexercisingdirectorindirectinfluenceoverdecisionswhichaffectthelearner. betweenfacultymembersorfacultymembersandstaff,forexample,whenpromotion andtenureorsalariesareconsidered. 4.2.1.4.1 Closepersonalrelationshipsbetweenfacultymembersorbetweenfaculty andstaffmayalsoraiseconflictsofinterestandrequiredisclosureand separationofinterests.Bothpersonsinthepersonalrelationshipshould declaretheexistenceofaconflictasdescribedabove.

4.2.1.3

4.2.1.4

5. Inappropriaterelationshipswithindustry 5.1 allowingcommercialorselfintereststo 5.1.1compromiseprofessionalautonomyandindependence,or 5.1.2haveanundueinfluenceonpatientcare,theteaching/learningenvironment,orresearch integrity Violationofboundaries 6.1.Inappropriaterelationshipswithpatients(e.g.,sexualorfinancial) 6.2.Inappropriatetouchingintheworkplace 6.3.Failuretorespectappropriateboundarieswithlearners Repeatedfailuretobeavailableforscheduledduty,includingteaching Chroniclateness Reportingforworkwhenunabletoperformrequiredduties,forexample: 9.1.impairedfunctionduetotheuseorabuseofsubstancessuchasalcoholordrugs. 9.2.whenphysicianillnesspreventssafepatientcare

6.

7. 8. 9.

10. Failuretofulfillacademicobligations(e.g.,inadequatesupervision,beingunavailabletolearners,orfailure tohandinevaluationsinatimelyfashion) 11. Failuretocompleteprofessionalobligationssuchasrequiredclinicalrecordsandreportsinatimelyfashion. 12. Failuretocooperatewithinvestigationandmanagementofallegedbreachesofprofessionalconduct. RESEARCHMISCONDUCT Standardsofbehaviourinresearcharedescribedinthefollowinguniversitydocuments: PolicyonEthicalConductinResearch(1991) http://www.governingcouncil.utoronto.ca/Assets/Policies/PDF/Policy+on+Ethical+Conduct+in+Research.pdf FrameworktoAddressAllegationsofResearchMisconduct(27Nov2006) http://www.research.utoronto.ca/ethics/pdf/conduct/framework.pdf Page4of7

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SECTION3 REPORTINGOFPROBLEMSANDINITIALRESPONSE TheFacultyofMedicinewillemphasizedevelopmentofbehaviourconsistentwiththesestandards.Eachmemberof theClinicalFacultyshouldstrivetodemonstratethepositivebehavioursandencouragethemincolleagues. Collectively,physicianshaveanobligationtopatientsandsocietytostriveforalevelofbehaviourconsistentwith thesestandards;thisisthebasisofselfregulation. Whenbreachesofthesestandardsareobservedinthebehaviourofacolleague,thefirststepshouldbetoapproach thatcolleagueanddiscussthesituationwiththegoalofendingtheinappropriatebehaviour.Ifsuchaconversationis inappropriate,inthecircumstances,orcannottakeplaceorisineffective,theproblemshouldbereportedtothe hospitaldepartment/divisionchiefortheuniversitydepartmentchair,dependingonthenatureoftheissue., Studentsorresidentswithconcernsaboutthebehaviourofaclinicalfacultymembershouldbringthemtothecourse orprogramdirectoror,inaclinicalinstitution,tothesitedirector,VPEducationorequivalent.Studentsorresidents shouldbeassuredprotectionfromretributionorreprisals. Confidentialitymustbemaintained,includingbythecomplainant,totheextentpossibleconsistentwiththorough andfairinvestigationofallallegationsofbreachesofthesestandardsandinthemanagementofprovenbreaches. Onlythosewhoneedtobeinvolvedtoinvestigateorgiveinformationshouldbeinformed.Thisdoesnotmean anonymityforthosewhobringcomplaints:fairnessdemandsthataphysicianaskedtorespondmustknowthe identityofthecomplainant.Anexceptionwillbeforinformationfoundinregularanonymousteacherandrotation evaluations. Reportsofbreachesofthesestandardsmustbemadeingoodfaith.Bringingafrivolousorvexatiouscomplaintis itselfabreachofprofessionalconduct. Whereconcernsarereported,thephysiciantowhomtheconcernsrelatemustbegivenanappropriateopportunity bytheDepartmentChieforChairtorespondbeforeactionistaken.Atthislevelthegoalshouldremaininternal resolutionoftheproblem;useofconflictresolutionstrategiesasappropriateisrecommended. Incaseswheretheallegationsofbehaviourareserious,andifproven,couldconstituteasignificantdisruptionora healthandsafetyrisktopatients,students,ormembersoftheUniversityorhospitalcommunity,theDeanhas authoritytoimposesuchinterimconditionsuponthefacultymemberastheDeanconsidersappropriate.Similar authorityresideswiththeChiefofStafforequivalentinclinicalinstitutions. Clinicalfacultyshouldbeawareofcircumstanceswhentheyhaveanobligationtoreportundertheregulationsof theCollegeofPhysiciansandSurgeonsofOntario(CPSO.)9

SeetheCPSOGuidebookforManagingDisruptivePhysicianBehaviour http://www.cpso.on.ca/uploadedFiles/downloads/cpsodocuments/policies/positions/CPSO%20DPBI%20Guidebook(1).pdfSee particularlypage9DealingwiththeConcern;page32,AppendixCSampleComplaintsProcedure;andpage43,AppendixG, BehaviourManagementFlowChart SeeAlsoPolicyonMandatoryReporting(notethisPolicymaychangein2009) http://www.cpso.on.ca/uploadedFiles/policies/policies/policyitems/mandatoryreporting.pdf


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SECTION4 BREACHESOFTHESESTANDARDS: Remediation Ifnootherauthoritywithjurisdictioncompelsotherwise(e.g.,thelaw,aregulatorybodyorUniversitypolicyor regulation),theinitialapproachtoallbutthemostseriousbreacheswillbeefforttoremediatethebehaviourofthe clinicalfacultymember Jurisdiction Theuniversityandthehospitalsjointlyholdresponsibilityregardingthesestandards.10 Eachinstitutionwillfollowitsowndetailedprotocolsfortheinvestigationandmanagementof behaviouralmisconduct.11 Ifbreachesareallegedtohaveoccurredintheclinicalsettingorapplytoactionsinthejurisdictionofhospitals, suchasclinicalcareorrecordkeeping,thehospitalshouldtaketheleadinrespondingtotheproblem,usually throughhospitaldepartmentalchiefs.Ifallegationsrelatedtoahospitalcometotheattentionofauniversityofficial, thehospitaladministrationmustbenotifiedthroughtheVPMedicalAffairs,ChiefofStaff,orequivalentofficer. Theuniversityshouldtaketheleadinrespondingifthebreachisintheclassroomoruniversity researchlaboratoryorconcernsprimarilytherelationoffacultytolearners. Respectingtheconfidentialityofthefacultymember,theuniversityandthehospitalwillinformtheother jurisdictionasappropriate.Thiswillincludeinformationthattherehasbeenacomplaint,itsmanagementandthe outcomeorresolutionofthematter. Whenthereisdoubtaboutjurisdiction,adviceshouldbesoughtfromtheofficeoftheViceDean,ClinicalAffairs ortheAssociateDean,EquityandProfessionalism.12 Discipline Ifabreachisdeterminedtohaveoccurred,remedialresponsesmayincludesuchdisciplineasiswithinthepowers ofthehospitalandtheUniversity,whicheverhasjurisdiction. ThePolicyforClinicalFacultyanditsProceduresManualstatethatFullTimeClinicalFacultyappointmentsmay onlybeterminatedforcause.Professionalmisconductislistedamongtheexamplesofcausethatmayleadto termination.Conductdescribedinsection2ofthesestandardsmaybeinterpretedasprofessionalmisconduct. (SeeUniversityofTorontoFacultyofMedicineProceduresManualforPolicyforClinicalFaculty, 23July2008,Section2.X.Section3dealswithProceduresfordealingwithdisputes. http://www.facmed.utoronto.ca/Assets/staff/Procedures+Manual+for+Policy+for+clinical+Faculty.pdf?metho d=1)
ParallelswillbefoundinSexualHarassmentComplaintsinvolvingFacultyandStudentsoftheUniversityofTorontoarisingin IndependentResearchInstitutions,HealthCareInstitutionsandTeachingAgencies http://www.utoronto.ca/sho/healthcareprotocols.html 11AnexamplecomplaintsprocedureisalsogiveninAppendixC,page32,oftheCPSOGuidebookforthe ManagingDisruptivePhysicianBehaviour,citedabove. 12Thefollowingquestions,modifiedfromthesexualharassmentprotocolabove,maybehelpful: 1.Whichinstitution(s)havetheauthority,capacityandresponsibilityforsupervisionandmanagementoftheperson(s)accusedof abreachofprofessionalbehaviour? 2.Whichinstitution(s)haveobligationstoorliabilitiesinrespectoftheperson(s)complainingofthebreachofprofessional behaviour?
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ConfirmedbreachesbyclinicalfacultywhoarenotsubjecttothePolicyforClinicalFaculty,suchasthose whodonotholdanappointmentinanaffiliatedinstitution,mayleadtotheseveranceoftheteachingrelationship. SECTION5 ASSOCIATEDANDINCORPORATEDPOLICIES,CODES,ANDGUIDELINES Nothinginthisdocumentshouldbeinterpretedtomeanthatitreplacesanyexistingpolicyorregulationsof theUniversityofToronto. Existenceofthispolicydoesnotprovideprotectionfromcriminalprosecutionorcivilaction. ClinicalfacultymustalsocomplywithUniversityandFacultypoliciesandregulations.Inparticular,the readerisdirectedto: o CodeofBehaviouronAcademicMatters(June1,1995) http://www.utoronto.ca/govcncl/pap/policies/behaveac.html o PolicyonConflictofInterestAcademicStaff http://www.utoronto.ca/govcncl/pap/policies/conacad.pdf o ConflictofInterestandClosePersonalRelations http://www.provost.utoronto.ca/policy/relations.htm o PolicyandProcedures:SexualHarassment http://www.governingcouncil.utoronto.ca/Assets/Policies/PDF/sexual.pdf ClinicalfacultyshouldrefertoUniversityapprovedguidelinessuchas o Faculty/AffiliatedInstitutionsGuidelinesforEthicsandProfessionalisminHealthcare o ProfessionalClinicalTrainingandTeaching. http://www.facmed.utoronto.ca/Assets/about/guidelines.pdf?method=1 o PostgraduateMedicineGuidelinesAddressingIntimidationandHarassment[in]The o EducationandLearningEnvironmentatUTPGMEApril21,2006 http://www.pgme.utoronto.ca/policies/iah.htm o SexualHarassmentComplaintsinvolvingFacultyandStudentsoftheUniversityofTorontoarising inUniversityAffiliatedHealthInstitutions http://www.facmed.utoronto.ca/Research/ethicspolicy/harass.htm AllClinicalFacultymustmeettheexpectationsoftheirregulatorybodyandprofessionalcollege(s)and abidebylawandbytheirhospitalbylaws,regulationsandpolicies. o CollegeofPhysiciansandSurgeonsofOntario(CPSO)PhysicianBehaviourintheProfessional Environment.http://www.cpso.on.ca/policies/policies/default.aspx?ID=1602 ClinicalFacultyshouldcomplywiththeCanadianMedicalAssociation(CMA)CodeofEthicsandother relatedCMApolicies.http://policybase.cma.ca/PolicyPDF/PD0406.pdf

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COLLEGE OF PHYSICIANS AND SURGEONS OF ONTARIO


Professional Responsibilities in Undergraduate Medical Education
CPSOPolicyStatement#203 ApprovedbyCouncil:September2003 Published:November/December2003 www.cpso.on.ca
PURPOSE The purpose of this policy is to clarify the roles and responsibilities of most responsible physicians and supervisors engaged in undergraduate medical education programs, thereby ensuring the safety and proper care of patients in situations where undergraduate medical students are being educated. SCOPE This policy applies to all physicians who are involved in the education, observation, assessment, and supervision of undergraduate medical students. DEFINITIONS Undergraduate Medical Students1 ("medical students") are university students enrolled in an undergraduate medical education program. They do not hold any special status or membership with the College of Physicians and Surgeons of Ontario. Most Responsible Physician is the physician who has final responsibility and is accountable for the medical care of the patient. Supervisors are clinical teachers who are delegated by their respective training programs to educate, observe, assess, and supervise the educational activities of medical students. They may also be the most responsible physicians for the patients receiving care in the educational setting.2 PRINCIPLES The College policy is based on the following principles: 1. Appropriate care of the patient is central to the educational endeavour. 2. Proper education, which respects the autonomy and personal dignity of both patient and medical student, optimizes patient care as well as the educational experience. 3. In order to obtain the best results from the educational experience, there should be joint decision-making and exchange of information between supervisor and medical student.

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4. In order for medical students to prepare for future practice, they must have the opportunity to participate actively in the provision of health care; that is, they must have hands-on experience in a system of delegated and graded responsibility. By doing, as well as observing, medical students learn how to question, examine, diagnose, manage, and treat patients, and adopt the necessary attitudes towards patients and their relatives, colleagues and other members of the health care team. COLLEGE POLICY This policy focuses on professional and supervisory responsibilities in the following aspects of the education of medical students: 1. Identification of Medical Students 2. Observation of Medical Students 3. Designation of Most Responsible Physician 4. Supervision of Medical Students 5. Professional Relationships 6. Reporting Responsibilities 7. Respecting Patient Rights and Consent to Treatment 1. Identification of Medical Students Medical students will be involved in observation and interaction with patients from the start of their medical education. It is the responsibility of the supervisor/most responsible physician to ensure that the status of medical students is clear, and that they are introduced to patients and hospital staff as medical students and not as physicians. 2. Observation of Medical Students Initially, supervisors should closely observe interactions between medical students and patients. When the supervisor is satisfied with the level of education and demonstrated expertise of the medical student, the medical student may be permitted to see patients alone. 3. Designation of Most Responsible Physician One physician must always be designated the most responsible physician for the patient's care. In a teaching environment, the most responsible physician may or may not also be the supervisor of the medical student. 4. Supervision of Medical Students When a medical student becomes a member of a health care team or is in a rotation where he or she is expected to participate in the delivery of health care, the supervisor and/or most responsible physician must provide appropriate supervision. This includes: a. evaluating the medical student's level of expertise through direct observation, and ensuring ongoing evaluation to determine the medical student's clinical competence and educational requirements; b. ensuring that the medical student to whom they are delegating has the appropriate knowledge, skills and judgement to perform the delegated act such that the patient is not put in jeopardy;3 c. meeting regularly with the medical student to discuss his or her assessment, management and documentation of patient care.
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d. providing direct or remote supervision to medical students while they engage in clinical activities. According to the RHPA and guided by the principles of graded responsibility, students may carry out controlled acts, under direct or remote supervision, depending on their level of competence. In cases of remote supervision, these acts should be restricted to previously agreed-upon arrangements with the most responsible physician. e. reviewing and countersigning documentation by a medical student of a patient's history, physical examination, and diagnosis, within a fixed time period, as well as progress notes. f. countersigning all orders concerning investigation or treatment of a patient, written under the supervision or direction of a physician. Prescriptions, telephone or other transmitted orders of a physician may be transcribed by the medical student, but must be countersigned at a later date. g. Educational institutions are expected to ensure that medical students engaged in clinical activities are covered by liability insurance carried by the hospital, the university, or the student. 5. Professional Relationships It is expected that physicians involved in the education of medical students will: a. provide a model of appropriate and compassionate care; b. maintain an ethical approach to the care of patients; c. maintain a professional relationship with medical students at all times, which includes: not exploiting the power differential that is inherent in the relationship; not becoming involved in situations involving potential conflicts of interest; not intimidating or harassing medical students emotionally, physically or sexually; d. maintain a professional relationship with all other colleagues, which includes not intimidating or harassing them emotionally, physically or sexually. 6. Reporting Responsibilities It is expected that physicians involved in the education of medical students will report to the educational institution when a medical student exhibits behaviours that would suggest incompetence or incapacity, fails to behave professionally and ethically in interactions with patients, supervisors, and/or colleagues, or otherwise engages in inappropriate behaviour. Similarly, educational institutions are expected to provide a supportive environment that allows medical students to make a report if they believe their supervisor and/or the most responsible physician exhibits behaviours that would suggest incompetence or incapacity, is engaging in or has engaged in sexual abuse of patients or colleagues, or is engaging in or has engaged in harassment of patients or colleagues. 7. Respecting Patient Rights and Consent to Treatment Patients have the right to be fully informed about, and to refuse to participate in, medical education; however, alternative care arrangements may be required if a patient refuses treatment in a clinical teaching setting. The most responsible physician and/or supervisor is responsible for trying to ensure that patients are aware of their rights in this context, and that such rights are respected. Consent: Patients must consent to treatment.4 It is understood that patients entering teaching facilities will be notified of the educational nature of the patient care to be provided and will give informed consent.
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Special Situations Incapable Patients: When the patient is incapable of consenting to treatment (e.g., due to age or other reason), consent should be obtained from the appropriate substitute decision-maker. Significant Component of Procedure Performed Independently by Medical Student: When a significant component of a diagnostic or therapeutic procedure is to be performed independently by a medical student without direct supervision by the most responsible physician/supervisor, a patient must be specifically informed. Examination and Clinical Demonstration Solely for Educational Purposes: When patient participation is purely for educational reasons, the patient must be notified and must provide consent. The most responsible physician and/or supervisor should ensure that the proposed examination or clinical demonstration is not detrimental to the patient, either physically or psychologically. An explanation of the educational purpose behind the proposed examination or clinical demonstration must be provided to the patient when obtaining the patient's informed consent. ENDNOTES are able to participate in the delivery of health care through a provision in the Regulated Health Professions Act, which permits them to carry out controlled acts "under the supervision or direction of a member of the profession," i.e., a clinical teacher or supervisor. Medical students are not independent practitioners or specialists. They are pursuing both program and individual objectives in a graded fashion under the supervision of the undergraduate medical education program. Supervisors, however, may be senior residents or fellows (sometimes holding certificates of registration authorizing independent practice) who are acting as clinical teachers, but are not ultimately responsible for the patient's care in the educational setting.
2 3 4 1 Students

For more information, please refer to the CPSO Policy, Delegation of Controlled Acts.

For more information, please refer to CPSO Policy, Consent to Medical Treatment and also the Health Care Consent Act.

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Governing Council UNIVERSITY OF TORONTO

Statement on Prohibited Discrimination and Discriminatory Harassment


Approved by Governing Council 31 March 1994 www.governingcouncil.utoronto.ca/policies
Purpose 1. The University aspires to achieve an environment free of prohibited discrimination and harassment and to ensure respect for the core values of freedom of speech, academic freedom and freedom of research. The purpose of this Statement is to promote a greater awareness of the rights and responsibilities entailed by these aspirations and to describe the manner in which the University deals with prohibited physical and verbal harassment (apart from harassment based on sex or on sexual orientation, which are dealt with in Policy and Procedures: Sexual Harassment). The approach taken in the Statement is to reiterate the University's commitment to the rights of freedom from prohibited discrimination and harassment and to the rights of freedom of expression and inquiry, to recognize that the task of implementing and respecting those values within the unique environment of the University is a delicate one that precludes the use of blunt instruments, and to describe the responsibilities of various members of the University community and the institutional arrangements available to fulfill the commitment to a working and learning environment free from prohibited discrimination and harassment. Foundation Documents 2. The University of Toronto Statement on Prohibited Discrimination and Discriminatory Harassment is based upon the principles set out in the following foundation documents: a. The University of Toronto Statement of Institutional Purpose b. The University of Toronto Statement on Human Rights c. The Ontario Human Rights Code d. The University of Toronto Statement on Freedom of Speech e. The University of Toronto Employment Equity Policy Discrimination and Harassment 3. In its Statement of Institutional Purpose the University affirms its dedication "to fostering an academic community in which the learning and scholarship of every member may flourish, with vigilant protection for individual human rights, and a resolute commitment to the principle of equal opportunity, equity and justice." This principle is further explained in the University's Statement on Human Rights which states that the University acts within its purview to prevent or remedy discrimination or harassment on the basis of race, gender, sexual orientation, age, disability, ancestry, place of origin, colour, ethnic origin, citizenship, creed, marital status, family status, receipt of public assistance or record of offence.
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4. The Ontario Human Rights Code provides that employees have a right to freedom from harassment in the workplace by the employer or agent of the employer or by another employee because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, age, record of offences, marital status, family status or handicap. The Human Rights Code further provides that occupants of accommodation have a right to freedom from harassment by the landlord or agent of the landlord or by an occupant of the same building because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, age, marital status, family status, handicap or the receipt of public assistance. 5. Under the Human Rights Code, harassment is defined as "engaging in a course of vexatious comment or conduct that is known or ought reasonably to be known to be unwelcome." As well as being expressly prohibited as indicated above, such conduct may constitute discrimination when based on prohibited grounds. 6. In addition, the Human Rights Code provides that: Every person has a right to equal treatment with respect to services, goods and facilities, without discrimination because of race, ancestry, place of origin, colour, ethnic origin, citizenship, creed, sex, sexual orientation, age, marital status, family status, or handicap. This provision has been interpreted to include the provision of education to students. The Human Rights Code further requires that employees of the University be accorded equal treatment without discrimination on prohibited grounds, as well as according the right to equal treatment with respect to the occupancy of accommodation without such discrimination. Discrimination against employees on the basis of record of offences, and in respect of accommodation on the basis of receipt of public assistance is also prohibited. 7. According to the Human Rights Commission, offensive or threatening comments or behaviour which create a "poisoned environment" in the workplace or in the provision of services or accommodation, whether or not amounting to harassment, may violate the right to equal treatment without discrimination. 8. Accordingly, the University of Toronto and all members of its community are both morally and legally bound to foster a learning and working environment free from prohibited discrimination and harassment.

Freedom of Speech Academic, Freedom and Freedom of Research 9. The University's commitment to a learning and working environment free from prohibited discrimination and harassment must take account of what the University of Toronto's Statement of Institutional Purpose has defined as "the most crucial of all human rights" within the unique context of the university, "the rights of freedom of speech, academic freedom and freedom of research". The Statement of Institutional Purpose also affirms that
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these rights (of freedom of speech, academic freedom and freedom of research) are meaningless unless they entail the right to raise deeply disturbing questions and provocative challenges to the cherished beliefs of society at large and of the university itself. 10. These rights are further explained in the University's Statement on Freedom of Speech. Reconciling Competing Rights 11. The task of respecting the rights of freedom from prohibited discrimination and harassment together with freedom of expression and inquiry is difficult and complex, and raises issues which lie at the very core of the University's purpose and mission. Attempts to formulate a comprehensive code of conduct which defines precisely what is permitted and what is forbidden are impractical because of the difficulty of anticipating the range of possible conflicts and determining in advance the proper balance. 12. The University aspires to achieve an appropriate balance between these rights in order to maximize the capacity of every individual to flourish to the fullest extent possible. A detailed code or policy runs the serious risk of giving one right or value undue emphasis or priority, and thereby inhibiting and interfering with the ability of the University to live up to its highest aspirations. Responsibilities of Individuals 13. It is the responsibility of every member of the University community, including visitors and persons on campus in the conduct of University business to adhere to University policies and to support and promote its aim of creating a climate of understanding and mutual respect for the dignity and rights of each individual. It is the responsibility of every member of the University community to respect both the rights of freedom of expression, academic freedom and freedom of research, and the University's institutional commitment and obligation to provide a learning and working environment free from prohibited discrimination and harassment. Responsibilities of Academic and Non-academic Administrators and Supervisors 14. The University confers particular responsibilities upon its administrators and supervisors to implement University policies and to work diligently within their departments or divisions towards fulfilling the University's institutional commitment to provide a learning and working environment free of prohibited discrimination and harassment. This includes the responsibility to foster a non-discriminatory environment, to inform those under their authority of their responsibilities to avoid prohibited behaviour, to monitor activities within their jurisdiction, and to deal effectively with reports of prohibited conduct. The Race Relations Office 15. In furtherance of its commitment to a learning and working environment free from prohibited discrimination and harassment, the University has established a Race Relations Office. The mandate of the Race Relations Officer is to provide the President and other members of the University community with advice and assistance in fostering the principles of equal opportunity and equity. Responsibilities of Student Leaders and Organizations 16. While student leaders and organizations are not given specific institutional powers with respect to the implementation of University policies, they are encouraged to adopt policies and practices which will enhance the capacity of the University to provide a learning and working environment free of prohibited discrimination and harassment. In particular, a. newspapers publishing on the campuses of the University of Toronto are encouraged to develop a voluntary University of Toronto press council similar to the Ontario Press Council
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b. college and residence student organizations are encouraged to promote an awareness of antidiscrimination and harassment policies and to review their activities in light of University policy. Information and Education 17. The University, through the offices of the Provost, the Race Relations Office, the Sexual Harassment Office, the Office of the Vice-President Human Resources, the Equity Issues Advisory Group and the Student Affairs Office, has a responsibility actively to foster a learning and working environment free of prohibited discrimination and harassment by providing all members of the University community with access to appropriate information regarding the University's policies in this regard. In particular, the University has the responsibility to: a. inform and remind administrators and supervisors of their responsibilities, provide supervisors and academic administrators with appropriate training, advice and information to fulfill their responsibilities, and b. make available appropriate written materials to all members of the University community describing the University's policies regarding prohibited discrimination and harassment and the University's institutional arrangements for ensuring respect for such policies. Complaints 18. Complaints of harassment based on sex or sexual orientation should in all cases be referred to the Sexual Harassment Office in accordance with the Policy and Procedures: Sexual Harassment. As with any violation of University policy, complaints of discriminatory or harassing behaviour should, in the first instance, be directed to the administrative officer or supervisor responsible for the department or division in which the incident is alleged to have occurred. Complainants may also seek the advice and assistance of the Sexual Harassment Office in the case of harassment on the grounds of family or marital status, or the Race Relations Office in the case of harassment on the grounds of race, ancestry, place of origin, colour, ethnic origin, citizenship or creed. General advice about dealing with complaints of harassment may be sought from the Equity Issues Advisory Group, who may refer them to the appropriate office or assist directly in dealing with complaints of harassment based on age, handicap, receipt of public assistance or other grounds. Administrative officers to whom concerns of harassment based on sex or sexual orientation are addressed should refer the complainant to the Sexual Harassment Officer. In the case of concerns based on other grounds, they are encouraged to seek the advice of the Convenor of the Equity Issues Advisory Group, the Sexual Harassment (for concerns based on family or marital status) or Race Relations office as the case may be and to make appropriate but discrete inquiries, take appropriate action if warranted, and report as appropriate on the disposition of the matter to the person who has referred the matter to her or him. The Sexual Harassment Office, the Race Relations Office and the Convenor of the Equity Issues Advisory Group may also be asked to mediate any dispute should the complainant so wish. In dealing with incidents raised under this policy, administrative officers or supervisors shall act in accordance with the existing and applicable academic, administrative or disciplinary policies or procedures. Should a complaint result in adverse consequences for the person complained of, existing channels for questioning that decision will be available to that person. A complainant who is not satisfied with the handling of a complaint by the administrative officer responsible may pursue the matter with the person to whom that administrative officer reports or pursue the matter in accordance with the existing and applicable academic, administrative or disciplinary policies or procedures.
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Members of the University community retain the right to bring a complaint directly to the Ontario Human Rights Commission in accordance with the provisions of the Ontario Human Rights Code.

19. Persons may seek enforcement of this policy without reprisal or threat of reprisal by any person acting on
behalf of the University for so doing.

20. To better enable the University community, including the University's officers, to fulfill effectively its
commitment to a learning and working environment free from prohibited discrimination and harassment, the Equity Issues Advisory Group shall make annual reports, through the President, to Governing Council assessing the efficacy of these policies.

April 1, 1994

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Governing Council UNIVERSITY OF TORONTO

SUMMARY(seewww.governingcouncil.utoronto.ca/policiesforfulltextversion)

Policy and Procedures: Sexual Harassment


Approved by Governing Council 25 November 1997 www.governingcouncil.utoronto.ca/policies

University policy Sexual harassment jeopardises the rights of staff, students and faculty and will not be tolerated in the University of Toronto. University policy is based on the Ontario Human Rights Code. It provides a definition of unacceptable conduct; a procedure for making formal complaints; and a range of remedial and disciplinary measures, up to and including expulsion or dismissal. What is sexual harassment? Sexual harassment is unwanted sexual attention, or an undue focus on a person's sex or sexual orientation. Under the Human Rights Code it is a form of unlawful discrimination. University Policy defines sexual harassment as any unwanted emphasis on the sex or sexual orientation of another person, or any unwelcome pressure for sex. It is conduct which creates an intimidating, hostile or offensive working or learning environment, and which a reasonable person would realise was unacceptable. It may include: suggestive comments or gestures sexual innuendo or banter leering remarks about looks, dress or lifestyle pressure for dates homophobic insult verbal abuse intrusive physical behaviour or contact

where any of these conducts is unwelcome. Some instances of sexual harassment are very clear, and are intentionally demeaning or discriminatory; others are ambiguous, and may result from thoughtlessness or incomprehension. The Policy requires people to treat one another courteously, fairly, and with respect for individual values and preferences.

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Homophobia The Sexual Harassment Policy covers harassment directed at people because of their sexual orientation, actual or perceived. For example, if you are harassed because you are a lesbian or a gay man, you can use the Policy to seek a remedy. Sexual harassment is not: consensual sexual interaction physical affection between friends mutual flirtation, joking or teasing general statements of opinion or belief

Teacher/student relationships Faculty members are sometimes accused of sexual harassment by their students. The following comments address some of the issues that arise. Conflict of interest Faculty members who become romantically or sexually involved with a student they teach are in a conflict of interest. University policy on conflict of interest requires that in any circumstance where your personal and professional interests overlap you must declare the conflict to your own supervisor, who will arrange for someone else to evaluate that student's work. This is to safeguard the right of all your students to fair and unbiased treatment. Faculty members should also be aware that sexual invitations or suggestions to their students leave them open to allegations of sexual harassment. Members of faculty have authority over students, and thus any intimate overture can readily be interpreted as coercive. Professional conduct A faculty member's relation with students is a professional one and as such many personal comments or questions (about looks, personal life, sex life, etc.) are improper and potentially damaging. Remarks which focus on the sex or sexual orientation of individuals can constitute sexual harassment. If you are unsure of the appropriateness of your comments, or your audience reacts negatively, you should probably desist. Similarly, you should give careful consideration to your physical conduct with students. Many of us touch one another in conversation, or greet friends and colleagues with a hug. This is fine when the recipient is familiar to us and we are peers, but it may not be fine with your students. Because of the possible overtones of such gestures, you should ask yourself how they might be understood. Is my conduct acceptable to this student? How do I know? Am I certain the student would tell me otherwise? Academic freedom The University protects the freedom of staff and students to engage in critical thinking, writing, speech and research. University members are entitled to espouse and express controversial views without penalty. Verbal conduct is actionable under the Sexual Harassment Policy only if it exceeds the bounds of academic freedom and freedom of expression as these are understood in the University.
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Responsibilities of supervisors & managers People in positions of supervisory authority have particular responsibilities under the Sexual Harassment Policy: to communicate the requirements of the law; to prevent harassment in the working or learning environment; to intervene and stop harassing conduct if it occurs; and to refer concerns to the Sexual Harassment Office. If you supervise Teaching Assistants or other non-academic staff you must be familiar with the University policies which govern labour relations. TAs are represented by CUPE 3902, and their collective agreement contains a specific clause on sexual harassment. This means a TA can use the grievance procedure to make a complaint about sexual harassment at work. Many other University staff are covered by other collective agreements, or by administrative staff policies. The Sexual Harassment Office can provide you with detailed information about the pertinent procedures. If you know that a colleague is involved in a sexual harassment case you should be careful not to discuss the matter or interfere. The complaint process is confidential and you are bound by this. The Sexual Harassment Office at the University of Toronto The role of this office is to provide information and assistance to all members of the University of Toronto community - staff, students, and faculty. The Sexual Harassment Officer offers counsel to both people involved in a complaint, makes referrals to appropriate University or community resources, explains the detail of the formal complaint process, provides mediation, and administers formal complaints. If you decide not to make a formal complaint, the Sexual Harassment Officer can suggest other ways to resolve a situation. When you contact the office: You can make an appointment to meet the Officer, or you can discuss the matter on the phone. You can bring a support person or representative to any meetings. You can obtain a copy of the Policy and other resource materials. You can get information about how the complaint process works. Contact with the office is confidential, and the Officer is non-partisan. The complaint process is also confidential, and if you want to make a formal complaint you must maintain confidentiality. This requirement covers all those involved in a formal complaint. The complainant decides whether to go forward with a complaint, not the Officer.

Making a formal complaint All formal complaints under the University of Toronto Sexual Harassment Policy are made through the Sexual Harassment Officer, and they must be made within six months of the events, or in exceptional circumstances twelve months. The complaint must be made in writing, and signed. The person whose conduct is being complained about, the respondent, is contacted by the Officer, and will receive a copy of the complaint. If a student whom you teach or supervise makes a complaint about you, either you or the student can request that the Office make arrangements for someone else to evaluate the student's work.

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The Policy lays out three stages for resolving complaints: Stage 1: Both parties take part in individual discussions with the Sexual Harassment Officer. They may also meet, in the Office, to discuss the matter with each other and the Officer. They may agree on a resolution at this stage. Stage 2: A mediator is appointed in consultation with the parties. The mediator assists the parties in further discussion and in formulating terms and agreements. If there is no resolution at this stage, the complainant may request a Formal Hearing. The complaint is referred to the Vice-President, who may then refer it to the University Hearing Board. Stage 3: The complaint is heard by the University Hearing Board, which is composed of student, staff and faculty members. The Board hears evidence, rules on the complaint, and, where appropriate, imposes sanctions. The decision of this Board may be appealed to the Appeals Board, whose decision is final. Complainants may opt for a mediation-only procedure if they prefer a more informal approach. Reprisals: The Policy prohibits any form of retaliation against people who use its complaint procedures or who are witnesses to a complaint. Retaliation can form the basis of a further complaint and will attract additional sanctions. Other proceedings: In some circumstances you may decide to pursue a complaint through the Human Rights Commission or other legal action. The Office can provide information about alternative procedures. You cannot use the University Policy and another procedure at the same time. A complete copy of the Sexual Harassment Policy and Procedures can be obtained from the Sexual Harassment Office, at 40 Sussex Avenue. The office is open during business hours and at other times by arrangement. The Officer visits the Scarborough and Mississauga campuses on a regular basis and by appointment.

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On Support & Feedback for Teachers


Responsibility of Course Directors in the Orientation of UME Teachers, Statement on the ............245 Importance of Faculty Development for UME Teachers, Statement on the ............................................246 Value and Use of Student Feedback in UME, Statement on the..................................................................247 Timely Release of Feedback to Teachers and their Department Chairs in UME Courses, Standards for ..................................................................................................................................................................248

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StatementontheresponsibilityofcoursedirectorsintheorientationofUME teachers
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:[21June2011] Dateoflastreview:[21June2011] Dateofnextscheduledreview:[21June2015]
Coursedirectorsortheirrecruitmentdesignates(e.g.sitecoordinators,AcademyDirectors,weekmanagers,etc.) areresponsibleforensuringregularcommunicationwithallteachersintheirrespectivecourses,includingresidents andalliedhealthprofessionalsifapplicable. Atleastonceperacademicyear,theleadershipofeverycoursemust: makeknowntoeachteacher: o theoverallUMEprogramobjectives, o thespecificcourseobjectives,and o theobjectivespertinenttothespecificteachingsessionsoractivitiesdeliveredbythatteacher; providetoeachteachertherelevantcoursecontentorsyllabusexcerptthatistobecoveredinthat teacherssession,unlessresponsibilityforpreparingthecontenttobedeliveredlieswiththeteacher himself/herself(e.g.asalecturer); facilitateallteachersaccesstorelatedcoursecontent,e.g.,bydrawingtheirattentiontothecourse websiteontheportal,informingthemofhowtousethecurriculummap,etc.; clearlyarticulateexpectationswithregardtostudentsupervision describeeachteachersroleinassessmentandthestandardsofcompetencythatapplyinthecourse; provideteacherswiththeessentialpoliciesandproceduresrelevanttothecourseand/ortheirteaching role,andinformthemofwheretoaccessotherpoliciesapplicabletoUME; providecontactinformationincaseofquestions,concerns,oremergencies; provideinformationonaccessingfacultydevelopmentopportunities;and otherwiseensurethatteachersarefunctionallyintegratedintothedeliveryoftheacademicprogram. Coursedirectorsmustalsomaintainacompleteanduptodaterosterofteachers,includingresidentsandallied healthprofessionalsifapplicable.Thisrosteranditsamendmentsshouldbeprovidedtotheindividual(s) responsibleformaintaininguseraccesstocoursewebsitesontheportal.TherostermayalsobeusedbyUMEfor purposesincludingpreceptorpayment,reportingoncourseoutcomes,etc. TheUMEleadershipwillassistcoursedirectorsinupholdingtheprinciplesinthisStatementbymaintainingand disseminatinglistsofpolicies,facilitatingMedSIStrainingandimprovementinrelevantareas,andsupportingother reasonablemeasuressuggestedbycoursedirectorsthemselvesorothers.

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StatementontheimportanceoffacultydevelopmentforUMEteachers
Approvedby:UndergraduateMedicalEducationExecutiveCommittee Dateoforiginaladoption:[21June2011] Dateoflastreview:[21June2011] Dateofnextscheduledreview:[21June2015]
Facultydevelopmentcanbedefinedasabroadrangeofactivitiesthatinstitutionsusetoreneworassistfaculty, supervisors,preceptors,fieldinstructors,clinicaleducators,andstatusappointeesintheirroles.Theseactivitiesare designedtoimproveanindividualsknowledgeandskillsinareasconsideredessentialtotheirperformanceas teachers,educators,administrators,leaders,and/orresearchers. ItisoftheutmostimportancetotheUMEprogramtohaveteacherswhoarewellpreparedfortheirteachingtasks, acrossthewholespectrumofteachingandassessmentactivities.Theprogramthereforestronglyencouragesallits teacherstoavailthemselvesofopportunitiestohonetheirteachingandassessmentskillsandacquirenewones,to refreshtheirknowledgeandexpanditfurther. ThisincludesfacultydevelopmentbothforteacherswhoarenewtotheFacultyandforthosewhohavebeen involvedinteachingforsometime.Facultydevelopmentactivitiesservetoenhancegenericteachingand assessmentskillssuchaseffectivequestioningtechniquesandhowtogivefeedback,aswellasenablingteachersto teachandassessstudentsmosteffectivelyinaparticularcourseviaaparticularteachingmodalityormethodof assessment. Inordertomeettheseneeds,theUniversityofTorontoUMEprogramiscommittedtoprovidinghighquality,highly relevantfacultydevelopmentforallteachers.ThisoccursviatheCentreforFacultyDevelopment;throughthe effortsofindividualdepartmentsorAcademies;and,aspartofthemanagementofindividualcoursesunderthe directionofthecourseleadership.

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StatementonthevalueanduseofstudentfeedbackinUME
Approvedby:UndergraduateMedicalEducationExecutiveCommittee Dateoforiginaladoption:[21June2011] Dateoflastreview:[21June2011] Dateofnextscheduledreview:[21June2015]
TheUMEprogramreliesonvarioussourcesofinformationtoprovidefeedbackonthequalityoftheprogramasa whole,onindividualcomponentsincludingcourses,andonindividualteachers.Thisfeedbackenablesevidence basedcontinuousqualityimprovementoftheprogramandstudentexperience.Itisalsoacoreelementofafaculty membersteachingdossier,whichisusedforpromotionandrelatedpurposes. Oneofthechiefsourcesofsuchfeedbackisdataobtainedfromstudentsviaevaluationformsdistributedbycourse directorsonlineoronpaper. Coursedirectorsareresponsiblefordeterminingtheoptimalapproachtoevaluationwithintheircourses,and shouldcommunicatetheirexpectationstostudentsatthebeginningofthecourseandatsubsequentpointsas necessary.Coursedirectorsshouldworkwithstudentcourserepresentativestoensurethattheimportanceof timelyevaluationcompletioniswellunderstoodandthattheoutcomesofpreviousstudentfeedbackare highlighted. Foritspart,theUMEleadership(ViceDeanUME,PreclerkshipDirector,andClerkshipDirector)commitstosupport theongoingimprovementandcoordinationofevaluationstrategiesforthebenefitofstudents,coursedirectors, andfacultyatlargewhoaretherecipientsofevaluationdata;inparticular,strategiesshouldbesoughtthat promotesufficientresponseratestoallowmeaningfulinterpretation,whilerespectingthechallengesstudentsmay faceinaddressinglargenumbersofevaluationrequests.CoursedirectorshaveaccesstotheUMEDirectorof EvaluationsandthestaffundertheEvaluationsportfoliotoachieveoptimalresultsintheirapproachesto evaluation. Fortheirpart,studentsshouldrecognizetheimportantrolethatprovidingevaluationsandconstructivefeedback playsintheirdevelopmentasfuturemembersofhealthcareteams,asmanagers,collaborators,andprofessionals. Whilestudentsarenotexplicitlyrequiredtoevaluatevariousaspectsoftheprogram,theyshouldnevertheless appreciatetheircollectiveresponsibilityforthequalityandimprovementoftheirlearningexperience.

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Standards for timely release of feedback to teachers and their Department ChairsinUMEcourses
Approvedby:UndergraduateMedicalEducationCurriculumCommittee Dateoforiginaladoption:[21June2011] Dateoflastreview:[21June2011] Dateofnextscheduledreview:[21June2015]
TheUMEprogramplacesgreatvalueonthecommitmentofthemanyteacherswhocontributetotheeducationof ourstudents.Inrecognitionoftheirefforts,theUMEprogramrequiresthatteachersreceiveTeachingEffectiveness Scores(TES)andotherformalfeedbackwithinthreemonthsoftheendofthecourse(inPreclerkship)andwithin threemonthsoftheendoftheacademicyear(inClerkship);theUMEprogramshallalsoprovideeachteachersTES resultstotherelevantUniversityDepartmentChair(s). Teacherevaluationdatawill,however,onlybereleasedwhenthreeevaluationshavebeenreceivedforagiven teacherinordertoprotecttheanonymityofthestudentswhoprovidedthefeedback. Coursesthatrunforaprolongedperiodoftime(particularlytheentirelengthoftheacademicyear)andcourses withmultiplerotationsareencouragedtoshareinterimorinformalfeedbackearlierwhenthiscanbedonewithout compromisingstudentanonymity. FailuretomeetthethreemonthdeadlinewillbebroughttotheattentionofthePreclerkshipDirectororClerkship Directorasappropriate,andifnecessarytheViceDeanUMEand/ortherelevantDepartmentChair.

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Undergraduate Medical Education

DIRECTORY & LIST OF OFFICES

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UME DIRECTORY & LIST OF OFFICES


OFFICE/POSITION FIRST NAME LAST NAME PHONE OFFICE OF THE VICE-DEAN UNDERGRADUATE MEDICAL EDUCATION (UME) VICE-DEAN Jay Rosenfield (416) 978-4934 Executive Assistant Dorothy Hou (416) 978-4934 Manager, Business & Administration Riet van Lieshout (416) 978-8544 Business Officer Minda Nessia (416) 978-7807 Special Projects Manager TBD (416) 978-1831 Senior Academic Coordinator, Accreditation Martin Schreiber (416) 867-7454 Accreditation Coordinator Jennifer Anderson (416) 978-4543 Accreditation Administrative Assistant Joanie Fong (416) 978-0282 ACADEMIES FitzGerald Academy Director Education Assistant Other Fitz staff: See listings on p. 33 Mississauga Academy of Medicine Director Executive Assistant Director Faculty Development Operations Manager Other MAM staff: See listings on p. 33 Peters-Boyd Academy Director Administrative Assistant Other P-B staff: See listings on p. 33 Wightman-Berris Academy Director Manager Other W-B staff: See listings on p. 33 EMAIL jay.rosenfield@utoronto.ca dorothy.hou@utoronto.ca r.vanlieshout@utoronto.ca minda.nessia@utoronto.ca m.schreiber@utoronto.ca jen.anderson@utoronto.ca joanie.fong@utoronto.ca

Molly Hollie

Zirkle Mullins

(416) 864-5187 (416) 864-6060 x 77405

zirklem@smh.ca mullinsh@smh.ca

Pamela Kristen Jana Tamara

Coates Harshman-Best Bajcar Breukelman

(905) 569-4617 (905) 569-4619 (905) 569-4769 (905) 569-4428

pcoates@cvh.on.ca kristen.harshmanbest@utoronto.ca jana.bajcar@utoronto.ca t.breukelman@utoronto.ca

Mary Anne Jenna

Cooper Pariselli

(416) 480-4274 (416) 480-6100 x 4274

maryanne.cooper@sunnybrook.ca jenna.pariselli@sunnybrook.ca

Jacqueline Anne Marie

James Holmes

(416) 586-8369 (416) 340-4832

jjames@mtsinai.on.ca annemarie.holmes@uhn.on.ca

UME DIRECTORY & LIST OF OFFICES


OFFICE/POSITION FIRST NAME LAST NAME UNDERGRADUATE MEDICINE ADMISSIONS AND STUDENT FINANCE ASSOCIATE DEAN Mark Hanson Associate Registrar, Student Finances Bill Gregg Financial Assistant / Counsellor Renuka Kapur Administrative Coordinator, Admissions and Deborah Coombs Awards Admissions Officer Leslie Taylor Office Administrator TBD REGISTRARIAL AFFAIRS Faculty Registrar Coordinator Registrarial Affairs Office Administrator CURRICULUM Curriculum Director Preclerkship Director Clerkship Director Director, UME Evaluations Central curriculum staff Preclerkship Administrative Coordinator (and first-year courses) Preclerkship Course Assistant (second-year courses) Preclerkship Course Assistant (MAM) Clerkship Administrative Coordinator Evaluation Research Scientist & Coordinator Curriculum Evaluation Coordinator Project Coord. MedSIS & Evaluations and Data Analyst Programmer Analyst Professional Educator Electives Officer, U of T Students PHONE (416) 946-7978 (416) 946-0739 (416) 978-5216 (416) 978-2715 (416) 978-2729 (416) 978-7928 EMAIL mark.hanson@utoronto.ca bill.gregg@utoronto.ca r.kapur@utoronto.ca deborah.coombs@utoronto.ca ld.taylor@utoronto.ca

Judy Dana Diane

Irvine Rose Ford

(416) 978-7570 (416) 946-8236 (416) 946-8720

judy.irvine@utoronto.ca dana.rose@utoronto.ca reception.registrar@utoronto.ca

Jay Martin Anita Richard

Rosenfield Schreiber Rachlis Pittini

(416) 978-4934 (416) 867-7454 (416) 946-5251 (416) 978-8543

jay.rosenfield@utoronto.ca m.schreiber@utoronto.ca a.rachlis@utoronto.ca richard.pittini@sunnybrook.ca

Saimah Lina Elizabeth Tim Jodi Joyce Frazer Alan Katherine Eva

Baig Marino Day Flannery Herold Nyhof-Young Howard Pike MacRury Lagan

(416) 978-1186 (416) 946-7009 (905) 569-4618 (416) 978-6941 (416) 340-3202 (416) 946-7040 (416) 978-6941 (416) 978-8543 (416) 978-0416

s.baig@utoronto.ca lina.marino@utoronto.ca elizabeth.day@utoronto.ca tim.flannery@utoronto.ca jodi.herold@utoronto.ca joyce.nyhof-young@uhn.on.ca fraz.howard@utoronto.ca a.pike@utoronto.ca k.macrury@utoronto.ca eva.lagan@utoronto.ca

UME DIRECTORY & LIST OF OFFICES


OFFICE/POSITION CURRICULUM, continued Electives Officer, Visiting Students DOCH Administrative Coordinator DOCH Assistant Portfolio Administrative Coordinator TTR Administrative Coordinator Ethics & Professionalism Admin. Coordinator Coordinator, Manager & Collaborator Competencies Course Directors and Thematic Faculty Leads o Themes & Competencies Ethics & Professionalism Faculty Lead CPT / BRB Pharmacology block Faculty Lead Medical Imaging Faculty Lead Global Health Faculty Lead Interprofessional Education / Collaborator Role faculty lead Manager Role Co-Lead Manager Role Co-Lead o Preclerkship STF Course Director MNU Co-Course Director MNU Co-Course Director BRB Course Co-Director BRB Course Co-Director DOCH-1 and DOCH-2 Course Director DOCH-1 Course Director (Associate) DOCH-1 Course Director (Associate) ASCM-1 Course Director ASCM-1 Deputy Course Director FIRST NAME Sheila Yasmin Sylvia Rosalind Nima Joan Lindsey LAST NAME Binns Shariff Jao Armstrong Heirat McKnight Fechtig PHONE (416) 978-2691 (416) 978-8213 (416) 978-6860 (416) 978-7327 (416) 978-2763 (416) 946-8719 (416) 946-5879 EMAIL sheila.binns@utoronto.ca yasmin.shariff@utoronto.ca sylvia.jao@utoronto.ca portfolio.ume@utoronto.ca ttr.ume@utoronto.ca joan.mcknight@utoronto.ca lindsey.fechtig@utoronto.ca

Pier Cindy Nasir Rachel Cynthia Geoff Dante Mike Roy Louis David Dee Fran Ingrid Fok-Han Rajesh Jean

Bryden Woodland Jaffer Spitzer Whitehead Anderson Morra Wiley Baker Liu Chan Ballyk Scott Tyler Leung Gupta Hudson

(416) 978-0655 (416) 978-3102

pier.bryden@utoronto.ca cindy.woodland@utoronto.ca njaffer@mtsinai.on.ca rspitzer@mtsinai.on.ca cynthia.whitehead@utoronto.ca geoff.anderson@utoronto.ca dmorra@uhn.on.ca mike.wiley@utoronto.ca roy.baker@utoronto.ca chandav@smh.toronto.on.ca d.ballyk@utoronto.ca fran.scott@utoronto.ca ingrid.tyler@utoronto.ca leungf@smh.ca raj.gupta@utoronto.ca jhudson@cvh.on.ca

(416) 978-2763

UME DIRECTORY & LIST OF OFFICES


OFFICE/POSITION CURRICULUM, continued ASCM-2 Course Director MMMD Course Co-Director MMMD Course Co-Director MMMD Course Co-Director FMLE Course Director o Clerkship Transition to Clerkship Co-Director Transition to Clerkship Co-Director Transition to Clerkship Co-Director Anesthesia Course Director Dermatology Course Director Emergency Medicine Course Director Family Medicine Course Director Director Undergraduate Education, Family Medicine Medicine Course Director Obstetrics & Gynaecology Course Director Ophthalmology Course Director Otolaryngology Course Director Paediatrics Course Director Portfolio Course Director Psychiatry Course Director Surgery Course Director Integrated OSCE Director Electives Director Transition to Residency Director MD/PHD PROGRAM ASSOCIATE DEAN, Physician Scientist Training, and Director, MD/PhD Program Administrative Director FIRST NAME David Lori Darlene Eleanor Susan Geoff Dante Cynthia Isabella Perla Laura Azadeh Kymm Danny Filomena Kenneth Paolo Stacey Kenneth Raed George Anita Mara Kenneth LAST NAME Wong Albert Fenech Latta Goldstein Anderson Morra Whitehead Devito Lansang Hans Moaveni Feldman Panisko Meffe Eng Campisi Bernstein Locke Hawa Christakis Rachlis Goldstein Locke PHONE EMAIL wongdav@smh.ca lori.albert@uhn.on.ca darlene.fenech@sunnybrook.ca lattae@smh.ca susan.goldstein@utoronto.ca geoff.anderson@utoronto.ca dante.morra@uhn.on.ca cynthia.whitehead@utoronto.ca isabella.devito@uhn.on.ca perlalansang@gmail.com hansl@smh.ca a.moaveni@utoronto.ca kymm.feldman@utoronto.ca danny.panisko@uhn.on.ca filomena.meffe@utoronto.ca k.eng@utoronto.ca paolo.campisi@sickkids.ca stacey.bernstein@sickkids.ca ken.locke@utoronto.ca raed.hawa@uhn.on.ca george.christakis@sunnybrook.ca a.rachlis@utoronto.ca mara.goldstein@utoronto.ca ken.locke@utoronto.ca

(416) 978-1896

(416) 978-8156 (416) 978-1896 (416) 946-5249 (416) 946-0638 (416) 946-0305 (416) 813-2192 (416) 978-4561 (416) 978-1662 (416) 978-4561

Norman Sandy

Rosenblum McGugan (416) 978-8885

norman.rosenblum@sickkids.ca sandra.mcgugan@utoronto.ca

UME DIRECTORY & LIST OF OFFICES


OFFICE/POSITION FIRST NAME LAST NAME PHONE EMAIL CREMS (COMPREHENSIVE RESEARCH EXPERIENCE FOR MEDICAL STUDENTS) PROGRAM Director Donald Branch don.branch@utoronto.ca Administrative Coordinator Vanessa Shaffie (416) 946-7866 crems.program@utoronto.ca HEALTH PROFESSIONS STUDENT AFFAIRS ASSOCIATE DEAN Leslie Administrative Coordinator Kelly Sr. Officer, Service Learning/ Community Diana Partnership / Student Life Operations Manager Nancy Office Administrator and Outreach Assistant Teresa Receptionist and Office Assistant Hannah Counsellor Manager Shayna Personal Counsellor Christiane Career Counsellor / Coach Carol Learning Skills Counsellor Reza Career Counsellor Nancy Personal Counsellor Shannon

Nickell Geddes Alli Fortin Biderman Slaughter Kulman-Lipsey Martin Bisnath Noori Dunlop Collins

(416) 978-2713 (416) 978-2713 (416) 978-2684 (416) 978-4651 (416) 978-2764 (416) 978-2764 (416) 946-0809 (416) 978-6092 (416) 9780810 (416) 946-0810 (416) 978-3956 (416) 978-3957

leslie.nickell@sunnybrook.ca kelly.geddes@utoronto.ca diana.alli@utoronto.ca nancy.fortin@utoronto.ca teresa.biderman@utoronto.ca reception.osa@utoronto.ca shaynak.lipsey@utoronto.ca christiane.martin@utoronto.ca carol.bisnath@utoronto.ca reza.noori@utoronto.ca nancy.dunlop@utoronto.ca shannon.collins@utoronto.ca

If you encounter a problem


related to the curriculum overall:
[Specifically the Preclerkship, i.e. Years 1 and 2] [Specifically the Clerkship, i.e. Years 3 and 4] Contact the Preclerkship Director Contact the Clerkship Director Write to: Dr. Martin Schreiber, m.schreiber@utoronto.ca Write to: Dr. Anita Rachlis, a.rachlis@utoronto.ca

related to your teaching responsibilities in a particular course:


[For central teaching in the Preclerkship or Clerkship)] [For hospital teaching in the Preclerkship] [For hospital teaching in the Clerkship] Contact the course director Contact the Academy Director Contact the site director See: Program Preclerkship or Clerkship Course Descriptions See: Program Preclerkship Contacts See: Program Clerkship Course Descriptions

related to information technology or audiovisual technology:


[For an MSB lecture theatre videoconferencing or lecture recording problem] [For other AV problems in MSB lecture theatres] [For a MAM/UTM lecture theatre videoconferencing or lecture recording problem] [For other types of problems in MAM/UTM lecture theatres] [For problems in a hospital/Academy Med Ed Centre] [For problems in another area of the hospital] [For MedSIS-related problems] [For all other IT-related inquiries] Contact the Discovery Commons Contact the Office of Space Management Contact Technology Resource Centre Contact Technology Resource Centre Contact Academy Med Ed staff Contact your local IT department Contact Knowledge4You Contact Discovery Commons Contact: Intercom button on podium (immediate) or 416-978-8504 (non-emergency) or discovery.commons@utoronto.ca Contact: Intercom button on podium (immediate) or 416-978-6544 (non-emergency) or go to www.osm.utoronto.ca Contact: 905 569-4300 or crt@utm.utoronto.ca Contact: 905-569-4300 or crt@utm.utoronto.ca See: UME Directory & List of Offices Academies Consult: your hospitals directory for contact information Contact: 905-947-9924 ext. 253 or medsis@knowledge4you.com Contact: 416-978-8504 or discovery.commons@utoronto.ca or http://dc.med.utoronto.ca

related to a teaching evaluation you have received:


Contact the course director of your course See: Program Preclerkship or Clerkship Course Descriptions

related to student academic performance:


Contact the course director of your course See: Program Preclerkship or Clerkship Course Descriptions

related to student behaviour (professionalism):


Refer to professionalism protocols to determine how to proceed. See: Program Professionalism of UME students and: Key Policies, Statements, & Guidelines On Student Responsibilities, Behaviour, & Professionalism

related to an incident of student injury or exposure to infectious disease:


Refer to flowchart on student injury in clinical settings. See: Key Policies, Statements, & Guidelines On Teacher Behaviour & Student Well-being Protocol for incidents of medical student injury and exposure to infectious disease in clinical settings

related to an incident of mistreatment or harmful behaviour towards a student:


Contact the Associate Dean HPSA Contact: Dr. Leslie Nickell, leslie.nickell@sunnybrook.ca or 416-978-2713