UGME Curriculum
The curriculum underwent an extensive renewal process following a needs assessment commencing in 2010. The new Pre-Clerkship curriculum was introduced in 2014 following the introduction of a revised Clerkship in 2013. The curriculum is separated into 8 Modules (M0-M7) with Pre-Clerkship and Clerkship each having 4 modules.
The overarching principles of the curriculum entail a fully integrated spiral scaffold curriculum throughout the four years emphasizing Person to Community Centered approach. The Pre-Clerkship modules, the Human Biology, Health & Disease Modules are based upon organ systems, and are not departmentally based. The educational strategies involve a progressive increase in interactive and self-directing learning with continued development beyond the initial introduction.
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PRE-CLERKSHIP (Modules 0 – 3)
Human Biology, Health & Disease Modules
After the first 4 weeks of basic science foundation relevant to the study of medicine (M0), the following 62 weeks ( separated by breaks) provides a system-based, spiral, scaffold, integrated approach to normal (M1) and abnormal function (M2).
There are 9 system based units each with 2 separate courses per system scaffolding from the application of basic science to normal function (M1) evolving to clinical practice (M2). M2 starts with an introduction to Infectious Disease and Therapeutics.
Year 2 concludes with a 9 week Consolidation Module (M3) to ensure all the content from the previous modules and Longitudinal courses is assimilated.
All individual courses will have a separate evaluation each requiring a minimum mastery with scaffold content.
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Module Zero Foundation of Medicine (M0) +
Provides basic science foundation relevant to the study & practice of medicine. The course is intended to provide foundational knowledge in cell biology, cell adaptation/response to insult, importance of genetics in disease, exogenous factors that impact health (pathogens, toxins), and a brief introduction to how these cellular mechanisms relate to regulating and/or maintaining whole body function; presented mostly with WGS (Whole Group Sessions) with relevant illustrative clinical scenarios if applicable.
Module One Human Biology & Health (M1) +
The M1 courses will cover normal processes specific to the individual system including normal development and embryology, gross anatomy & Imaging, histology, physiology, biochemistry & molecular biology and general pharmacology where relevant. Included for each system is an overview of burden of illness and diseases, and impact of life cycle and aging related to the system. Anatomy sessions will integrate normal radiology and cross sectional imaging. Content is predominantly basic sciences with clinical cases (normal or abnormal) to contrast or help illustrate normal. The M1 courses will provide the foundation to begin to build a clinical approach to assessment and management of diseases within that system covered in M2. Format will be combination of WGS (Whole Group Sessions), AS (directed assigned studies) and Small Group Sessions (SGS) tailored to the system.
Module Two Health and Disease (M2) +
The M2 courses will each build upon the basic processes established in their respective M1 course to develop clinical approaches to the relevant disease states. Abnormal processes and pathophysiology for disease related to the specific system are covered. This will include the scientific basis and anatomy review (i.e. M1) then for each entity epidemiology, prevention and screening, natural history & prognosis, diagnosis , therapeutics and disease management, and impact of cultural, social, ethical issues and health care system where relevant. Format will be predominantly clinical cases with review of basic science presented as combination of WGS (Whole Group Sessions), AS (directed assigned studies)and Small Group Sessions (SGS) tailored to the system.
Module Three Consolidation (M3) +
As the final Pre-Clerkship module, Consolidation ensures that all the content from the previous modules, and the CP4s (one hundred thirty (137) Composite Clinical Presentations) are fully integrated and applied to patient care in a complex health care environment at a defined level of competence. Sessions will include approaches to single symptom conditions with broad differential diagnosis (e.g. management of a patient presenting with shortness of breath), multisystem diseases such as complicated diabetes within a complex patient context, and systemic diseases such as HIV or SLE. Consolidation will also include topics that cross system boundaries, such as pain management, and dermatology, and address diseases and conditions across the life cycle specifically pediatrics and geriatrics. Format will be mostly AS (directed assigned studies) and Small Group Sessions (SGS) tailored to the system.
Pre-clerkship Course Descriptions
Blood and Immunology (BI) +
BI1 course covers the normal Immune system, Hematopoiesis, and Hemostasis and Coagulation. B12 course covers abnormalities of the above including anemias, bleeding and thrombotic abnormalities, and malignancies of the Hematopoietic system.
Cardiovascular (CV) +
CV1 covers basic Cardiovascular Anatomy, Physiology, Pathophysiology, and Pharmacology, including the burden of Cardiovascular disease in our community highlighting the importance of primary prevention. CV2 covers various common cardiovascular diseases, including the clinical presentations, investigative tools, and treatment options, and an approach to the cardiovascular patient including obtaining a pertinent history and physical examination.
Respiratory (RS) +
RS1 covers the anatomy, histology and physiology of the respiratory system including nose and throat. RS2 covers the pathophysiology, clinical presentation, diagnosis, management, follow up and prognosis of various diseases of the upper and lower respiratory tract.
Neuroscience (NS) +
NS1 covers the normal anatomy and physiology of the nervous system including the eye, and the normal human behavior. NS2 covers the spectrum and treatment of neurological and psychiatric illnesses from infancy to old age.
Musculoskeletal (MSK) +
MSK1 covers development, function and diagnostic imaging separated into three regions: Upper extremity, Lower extremity and Spine. MSK2 covers common conditions of the MSK system including traumatic and chronic injuries of muscle, ligament and tendon; development and remodeling of bone, metabolic bone disease, bone tumors, fractures; and muscle and connective tissue diseases. The rheumatology component of this course includes arthritis, autoimmune disorders, genetic influences on joint disease, septic arthritis and the basic science of joint inflammation. Management will provide both a medical and surgical perspective.
Endocrine and Metabolism (EM) +
EM1 covers basic science foundation of the endocrine system and introduces students to glucose metabolism and metabolic disorders. EM2 will expose students to clinical aspects of endocrinology, diabetes, and lipids. The first half of the course will focus on the pituitary, adrenal, and thyroid glands and reproductive endocrinology. The second half will focus on bone/calcium, diabetes and lipids.
Women’s Reproductive Health (WRH) +
WRH1 covers the anatomy, histology, pharmacology, embryology, genetics, and physiology of the female reproductive system followed by a clinical introduction to Women’s Health preventative care, family planning and prenatal care. WRH2 will cover clinical problems that women may encounter during their life cycle, including both benign and malignant diseases.
Gastroenterology, Hepatology, and Nutrition (GHN) +
GHN1 covers normal gastrointestinal anatomy and physiology in the context of common gastrointestinal symptoms and disorders. The focus will be on integrating normal anatomy and concepts of basic science with clinical relevant topics in gastroenterology and nutrition. Anatomy sessions will integrate normal radiology, cross sectional imaging with endoscopic images. Gastrointestinal physiology will be taught in the context of testing GI function and pathophysiology of common GI disorders. An introduction to clinical nutrition will focus on the diets and normal digestion and absorption of macro and micronutrients. GN2 covers the presentation, investigation and management of common gastrointestinal disorders integrating important aspects of pathology, clinical health psychology, genetics, pain management and ethics relevant to gastrointestinal and nutritional disorders.
Urinary Tract (UT) +
UT1 covers the normal urinary tract and male sexual anatomy and function including clinically applied renal physiology. Included are the clinical application renal physiology, genetic and cystic disease, and male sexual dysfunction.UT2 covers abnormalities that are either urology (anatomical abnormalities of the urinary tract and male genitalia) or nephrology (abnormalities of kidney parenchymal function, and more complex renal physiological based cases.
Infectious Diseases and Therapeutics (IDT) +
IDT2 is one of two courses that are only M2. It covers the common bacteria, fungi, viruses and parasites causing infectious diseases, and the principles of antimicrobial stewardship. It will also cover the practice of infection control and prevention in medical settings, immunization practices, and the principles and practice of therapeutics.
Introduction to Oncology (ONC) +
The intent of the Introduction to Oncology course is to offer students insight into the basic principles and practice of clinical oncology. A primary goal is to ensure that students understand the Generalists role in the multidisciplinary, team-based, approach to cancer.
LONGITUDINAL COURSES
The focus will be a Person to Community Centered curriculum highlighting principles of professionalism, social accountability & responsibility helping to contextualize health issues and maximizing community exposures.
Longitudinal Course Descriptions:
Clinical Reasoning (CR) +
Using case-based learning with a focus on common clinical problems; students will develop their clinical reasoning, information science and integration skills in preparation for clinical care. The cases will progress from an illustration of clinical reasoning principles alone, to including relevant anatomy, physiology and laboratory/radiological investigations as the student acquires that knowledge in the M1 courses, then pathophysiology as the course parallels M2 courses. As the course progresses into M2 and throughout Year 2, the cases will become increasingly more integrated and complex. Case-based learning through small group work will be the primary tool to help integrate the spiral Pre-Clerkship content of the modular courses and other Longitudinal Courses and Themes. These strategies will include generating and narrowing a differential diagnosis using: pattern recognition; likelihood ratios; knowledge of disease prevalence; clinical decision rules; physiologic and anatomic reasoning; semantic qualifiers; red flags and algorithms. Students will identify a focused approach to history taking and physical examination, and document and communicate both their observations and their reasoning. Students will analyze and apply evidence to specific cases. The focus of the sessions will fall under one of three formats: 1) Faculty guided learning – In these faculty guided diagnosis tutorials, the questions will be about how to analyze a clinical presentation, gather information and form a diagnosis based upon the principles of CR with limited knowledge acquired for the case. 2) Student led diagnosis- In these student-led identification, analysis and synthesis tutorials, students will apply the principles of CR to the student’s content knowledge to address clinical cases. 3) Applying Translational Research – these faculty guided evidence analysis tutorials will be about finding primary source evidence, analyzing its strengths and weaknesses, and applying it to clinical practice.
Clinical Skills (CS) +
CS course teaches all of the clinical skills found in the clinical skill inventory spanning years one and two of the M.D. program. Individual sessions will be designed and taught by various physician and non-physician groups, as appropriate to the skills taught in the session. Clinical skills learning is experiential and involves several teaching methodologies, including standardized patient, high fidelity simulation, full and partial task trainers and actual clinical exposure. There are additional clinical skills sessions in M5 during UGME academic time with Clinical Health Psychology, reinforcing communicating (verbal & non-verbal) with patients during their sessions on Motivational Interviewing, Grief & Sorrow, Trauma and Conflict Management.
Professionalism (PF) +
PR spanning all fours of the MD program will cover and demonstrate the need for professionalism in the practice of medicine, and how to act as professionals throughout their medical careers.
Population Health (PH) +
PH course spanning all four years provides a broad framework of knowledge on measuring and improving the health of individuals and populations as an integral part of all fields of Medicine. The course will cover societal and structural factors that impact health and wellness and help balance interventions at the individual level with the population level. As a longitudinal course, it is built into other components of the scaffolded curriculum. Throughout the Pre-Clerkship years, the Population Health course will integrate with relevant module courses to broaden your learning of the practice of medicine, demonstrate how population health is applied to clinical practice and promote scholarship throughout medical school and your medical careers. Special attention is focused on preventing illness at both the individual and population level, including health topics that are unique to certain populations. The goal is to articulate a wide spread of concepts including: health systems programs, biostatistics and statistical models, research design, epidemiology, health promotion, disease prevention, health protection, determinants of health, health policy and administration, global health, environmental and occupational health, applied public health, quality improvement, critical appraisal and health of specific populations.
Indigenous Health (IH) +
The goal of the IH course spanning all four years is to train physicians who will contribute to the improvement of health outcomes for Manitoba’s First Nations, Metis and Inuit communities. Through teaching methods that incorporate facilitated dialogue, community engagement and critical self-reflection, undergraduate medical students are guided through content and issues of increasing complexity in the realm of Indigenous health.
Consolidation Module 3 (CM) +
As the final module in Pre-Clerkship, Consolidation ensures that all the content from the previous modules are fully integrated and applied to patient care in a complex health care environment at a defined level of competence.
One hundred thirty (137) Composite Clinical Presentations will be covered at appropriate level to support the students transition to Clerkship and will include approaches to single symptom conditions with broad differential diagnosis (e.g. management of a patient presenting with shortness of breath), Multisystem Diseases such as complicated diabetes within a complex patient context, Systemic diseases such as HIV or SLE. Consolidation will also include topics that cross system boundaries, such as pain management, and dermatology, and address diseases and conditions across the lifespan.
THEMES
The Themes in the context of this curriculum are content areas or disciplines integrated into other courses each with a designated leader but no separate student assessment:
CLERKSHIP (Modules 4 – 7):
Clerkship was redeveloped to facilitate the integrated 4 year scaffold curriculum ensuring the clerkship curriculum is connected with the principles of the new Pre-Clerkship curriculum.
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Module Four: Transition to Clerkship (M4) +
The goals of TTC are to help the students expand their focus from learning during the Pre Clerkship years to the actual provision of care in various health care settings. This includes supervised responsibilities that accompany the provision of health and the management of disease. The format includes the use of simulation, patient assessments, small group sessions and shadowing experiences to teach students to translate the knowledge gained in pre-clerkship to the clinical setting and the actual provision of care. This will enable students to further facilitate achievement of UGME global objectives transitioning from the predominantly medical expert, scholar and communicator domains to include collaborator, manager, health advocate and professionalism domains. The students spend the last week of TTC shadowing their first core rotation.
Module Five: Core Clinical Rotations and UGME Academic Half Days (M5) +
M5 consists of the 8 core clinical rotations and a centrally organized weekly UGME academic half day separated into four, 12 week blocks. Students move through each block in a cascading pattern of eight tracks to complete all 8 core clinical rotations. Block 1: Surgery and Anesthesia provides clinical teaching in; general surgery (3 wks) musculoskeletal medicine (2 wks), urology (1 wk), plastic surgery (1 wk), neurosurgery (1 wk), anesthesia (2 wks), and perioperative care (2 wks). Block 2: Pediatrics and Obstetrics & Gynecology provides clinical teaching in; pediatrics inpatient care (3 wks), pediatric outpatient care (3 wks), obstetrics (2 wks), gynecology (2 wks) and obstetrics & gynecology outpatient clinics (2 wks). Block 3: Internal Medicine and Emergency Medicine provides clinical teaching in; internal medicine inpatient care (6 wks), internal medicine selective (2 wks), and emergency medicine (4 wks). During emergency medicine students will also spend one morning a week attending an internal medicine outpatient clinic. Block 4: Psychiatry and Family Medicine/Public Health provides clinical teaching in; psychiatry inpatient, outpatient and consultations (6 wks), family medicine clinics – majority in a rural community with public health teaching interlaced within the community placement (6 wks). The UGME academic time occurs the first half of Thursday afternoons and incorporates the Longitudinal courses of Clinical Skills, Professionalism, Indigenous Health and Population Health. The sessions also incorporates many of the Themes specifically Clinical Health Psychology, Information Sciences, Health care systems and safety, and Social accountability amongst others. Each of the core rotations have scheduled academic time with the majority in the second half of Thursday afternoons but additional time may also be scheduled during the week. Surgery & Anesthesia, as well as, Internal Medicine & Emergency Medicine organize their Thursday afternoon sessions conjointly.
Module Six: Electives and CaRMS (M6) +
M6: 14 weeks of electives followed by the CaRMS national interview period of 3 weeks. The module is completed with the Comprehensive Clinical Examination (CCE) a formal skills based exam that takes place in the Clinical Learning and Simulation Facility over a 3 day period.
Module Seven: Transition to Residency (M7) +
M7 is the last 11 weeks of the UGME program and commences after the completion of the CaRMS interviews. The goal of TTR is to provide opportunities to enhance ambulatory and community care exposures for students, provide a platform to transition skills, experience and knowledge acquired during UGME to the entry point of the PGME program. TTR consists of the following: Selectives – two, 3 week blocks of selectives intended to be non-traditional emphasizing community and outpatient activities. Sandwiched between the two selective blocks is Match week. Match Week – With the CaRMS match released on a Wednesday, the students have that day free to celebrate and spend with family & friends. The two preceding days consist of a team building & leadership program; with the two days following devoted to presentations from PGME, PARIM and Financial management. Evidence Based Medicine Capstone Course & Project (EBM) – the course has 6 weeks of formal teaching sessions each Friday afternoon throughout the selective blocks. The course concludes with a written paper and presentation in the seventh week. CCR/CP4R – The comprehensive course review and advanced cardiac life support (ACLS) course occurs during the last four weeks of year four to provide a review of the items from CP4s and aid the students in preparing for the Medical Council of Canada Qualifying Examination Part I (MCCQE Pt I).
