- What is it like to be at the U of T Medical School?
- What are the first two years of the MD program like currently?
- How successful is the current program?
- So why change the curriculum?
- Who planned the new Foundations Curriculum?
- What will the new Foundations curriculum look like?
- Have you piloted any of these activities, and if so how did it go?
- Who has approved the new Foundations Curriculum?
- How will this new Foundations Curriculum effect the accreditation of the U of T Medical School?
- Other FAQs about the Foundations Curriculum
There are many outstanding features of the medical education experience at U of T.
- First, the city of Toronto is one of the most vibrant and ethnically diverse cities in North America. The people of this city are the patients whom our students meet, learn from and help to look after.
- Second, the Faculty of Medicine in Toronto is fully affiliated with nine outstanding teaching hospitals, has associate affiliations with four hospitals, and has community affiliations with 11 others. In addition, there are multiple community-based agencies with connections to the medical school. This makes for an amazingly rich clinical and community environment in which to learn, and this is matched by an incredible array of research institutes that tackle every imaginable issue related to health. This includes the Wilson Centre for Research in Education. The learning of our students is organized in four academies, which are groupings of several of these teaching sites.
- Third, the there is a vast number of exceptionally capable teachers who are dedicated to providing the best possible program for our students, in both the first two years and the clerkship.
- Fourth, we have wonderful facilities, ranging from state-of-the-art lecture halls at the Medical Sciences Building to outstanding simulation centres at multiple sites. We have recently opened the Mississauga Academy of Medicine, housed principally in the brand new Terrence Donnelly Health Sciences Complex.
- Fifth, we have explicitly organized the program around helping students develop competence in the many roles required of a modern physician. These are organized around the “CanMEDS roles  ”, each of which is supported by several “competencies” (essentially things physicians are able to do to help patients and populations).
- Finally, we have an unwavering commitment to making sure our students have an excellent and supportive curriculum, and strong support in each of the academic, career counseling, financial counseling and personal counseling domains.
 The CanMEDS roles are: medical expert, communicator, collaborator, leader, health advocate, scholar and professional. For more information, see: http://md.utoronto.ca/program/goals.htm.
The current first two years of the MD program uses two kinds of courses. There are “block courses” (three in first year, and one in second year) that occupy most of the time each week, and through lectures, seminars, small-group problem-based learning sessions and laboratory exercises, provides students with learning about the basic science and clinical topics that are the content of medicine. Two “continuity” courses each occupy one half-day per week: one teaches students about history-taking and physical examination (Art and Science of Clinical Medicine) and the other about community, population and public health issues.
The MD program at U of T has been very successful. It is fully accredited by the Committee on Accreditation of Canadian Medical Schools and the (US) Liaison Committee on Medical Education. We have had an excellent record of placing students in postgraduate training positions, and in success on the Canadian licensing examinations. Every year, our graduates when surveyed report a strong level of satisfaction with the program.
Despite the successes we have enjoyed, we feel it is time to introduce significant changes into the first two years of the MD program, for a variety of reasons:
- For graduates to practice medicine optimally in the 21st century, substantial changes are needed in how medical education should be delivered. The health care knowledge base is constantly growing, technology is becoming more and more important in health care, patient safety and quality improvement are emerging priorities, just to name three major forces for change. Numerous reports in the recent medical education literature have made this clear, including the 2010 Carnegie Report , the Lancet Commission , and the Future of Medical Education in Canada Project . Multiple medical schools in Canada and around the world are pursuing substantial curricular revisions in keeping with these recommendations.
- Priorities in curriculum planning in the 21st century need to include:
- A competency-based approach, which is one that focuses on ensuring medical students’ learning is based on what doctors need to be able to do
- Flexibility for students to pursue special interests, such as public health or research during medical school
- Integration of basic sciences with clinical learning, to enhance its relevance
- Early clinical immersion
- Curriculum delivery has been found to be more effective if:
- A more active learning approach is taken, with fewer passive lectures
- There is carefully planned and increased use of technology
- More community-based learning
- Interprofessional education, in which medical students spend part of their time learning with, from and about health professional students
- Curriculum content needs to include:
- Explicit teaching of cognitive sciences
- Teaching to support the development of one’s identity as a professional
- Learning to reflect on one’s experiences
- Enhanced attention to prevention, public health and the health care system
- Explicit teaching about patient safety and quality improvement
- Assessment of what students have learned should involve:
- Using assessment to support learning with emphasis on feedback
- Multiple lower-stakes assessments, rather than infrequent extremely high stakes examinations
- Preparation of teachers (“faculty development”) is critical to success.
- A comprehensive faculty development program is needed for the new curriculum of the 21st century.
 Cooke, M. Irby, D. O’Brien, B. Educating Physicians: A Call for Reform of Medical School and Residency. Jossey-Bass. 2010: San Francisco.
 Frenk, J., Chen, L., Bhutta, Z. et al. Health professionals for a new century: Transforming education to strengthen health systems in an interdependent world. Lancet 2010;376:1923-1958.
 Association of Faculties of Medicine of Canada. (2010). The Future of Medical Education in Canada (FMEC): A Collective Vision for MD Education. Ottawa, ON: Author. Retrieved from http://www.afmc.ca/future-of-medical-education-in-canada/medical-doctor-project/index.php
The Foundations Curriculum is the result of more than two years of collaborative planning involving the Preclerkship and Deputy Preclerkship Director, the Curriculum Director and Vice Dean of the MD program, the Preclerkship Committee with its course directors, Academy Directors, administrative staff and a great many students.
The evidence-based changes we are making are supported by the latest medical education literature, and developed through broad engagement with curriculum developers, assessments specialists, faculty developers, department and hospital leaders, our teachers, recent graduates, current students, as well as the education research community.
The Foundations Curriculum runs throughout the first two years of the program. There are 36 weeks in Year 1, and then 36 weeks in Year 2. There is a 12-week summer holiday after each of the two years.
The Foundations Curriculum is comprised of: courses, components and themes. An important feature of the Foundations Curriculum is that each week has the equivalent of one day per week that is unscheduled, and available for self-study, for special activities such as shadowing.
What will the schedule look like in the Foundations Curriculum?
Year one schedule - Foundations Curriculum
Year two schedule - Foundations Curriculum
Can you provide an example of a student timetable in the new curriculum?
Timetables will vary from week to week. This timetable is an illustrative example of a typical week in year one:
During the 2014-15 and the 2015-2016 academic years, three weeks of the first year Structure and Function course (dealing with the respiratory and cardiovascular systems) were transferred to the Foundations Curriculum format, with case-based learning, integrated anatomy teaching, integrated population health and community-based learning, a small number of introductory and summary lectures, and coordinated teaching of history-taking and physical examination.
Students and teachers provided detailed feedback, which was overall extremely positive, and included many useful suggestions for improvement. In addition, a preview of the new curriculum occurred the second year course Mechanisms, Manifestations and Management of Disease in Fall 2015. See an what students and faculty had to say in the aritcle: A preview of the new Foundations Curriculum: an integrated and engaging learning experience.
The Foundations Curriculum has undergone a rigorous review by each of the following: the medical school’s Preclerkship Committee and its Curriculum Committee, the Faculty Council (which is the governing body of the Faculty of Medicine), and ultimately by the Committee on Accreditation of Canadian Medical Schools and the (US) Liaison Committee on Medical Education, which are the bodies that grant accreditation to Canadian medical schools. All of these groups have approved the Foundations Curriculum. For key documents, please click here.
The U of T Medical School was recently fully accredited by the Committee on Accreditation of Canadian Medical Schools (CACMS) and the Liaison Committee on Medical Education (LCME) for the maximum allowable eight year term, until May 2020. We are confident that our new curriculum meets the high standards expected by CACMS and LCME, who have reviewed and approved our proposal regarding the Foundations curriculum. Additional information on accreditation can be found here.
How many weekly hours of mandatory instructional and preparation time are there in the Foundations curriculum?
On average, there are approximately 22 hours each week of instructional time. In addition, there is a student-led case-based learning session each week. Pre-week preparation time should take approximately three hours. And course work throughout the week should take approximately three hours. Time devoted to studying is dependent on the needs and goals of the individual student.
How does the Foundations Curriculum connect with what makes Toronto special in the medical world?
Students will have an excellent opportunity to meet with and learn about patients from the diverse communities that make up Toronto. They will be able to learn in the many outstanding clinical and research facilities in Toronto. They will have contact with dozens of outstanding teachers from every possible clinical discipline. The program is planned by a great diversity of education leaders, including experts in medical education from the internationally famous Wilson Centre for Research in Education. Students will have abundant opportunities to learn in depth about all of the roles they need to master as they become physicians. All of these opportunities are supported by an outstanding network of leaders in curriculum, student affairs, and all areas of counseling.
Will there still be lectures?
Large-group lectures will continue to be important, for purposes of providing orientation and context, and in order to summarize key learning issues. Lectures will have a much smaller role to play with respect to simply transmitting information. This will be done through other means, including online resources, short recorded videos and podcasts, and carefully selected readings.
How much contact with patients will there be?
This will occur in the ICE program both during the Art and Science of Clinical Medicine sessions; and, during the various other ICE activities including longitudinal clinical experiences and community-based activities. The other major place for contact with patients will be on the unscheduled time each week, when students will be able to pursue individualized clinical “shadowing” activities, which involve observing the work of physicians in various settings.
What about group learning?
Students will learn in groups in multiple settings: during the case-based learning sessions in TOPIC, during bedside sessions in the ICE program; during portfolio sessions; during community visits in ICE; among others. This represents an important increase form the current curriculum, and provides students with a greater opportunity to learn to work with others, to give and receive feedback from peers, which are all essential abilities for the team-based health care system of the future. Students will also work closely with faculty members during these sessions, which will give faculty a better sense of how students are doing.
What about anatomic dissection?
Dissection of cadavers has long been a centerpiece of medical education at U of T, and such dissection will continue to be used in the Foundations Curriculum. It will be more integrated, focused, and supplemented to a greater degree by already-dissected specimens, and online and other digital resources.
What about free time?
As described above, there is the equivalent of an unscheduled day each week across the two years of the Foundations Curriculum. This is available for self-study, for students to pursue shadowing opportunities (observing physicians doing clinical and other work in various settings), taking part in research or community activities, among many other opportunities.
Do I have to do research? Can I do research?
All students will learn about research during the Health Science Research course, with an emphasis on learning skills needed to participate effectively in a research project, and to interpret the findings of research studies to help with patient care.
In addition, students have many opportunities to actually participate in research projects, although this is not a requirement of the program. This includes several programs that take place in the summers after first and second year, and also some opportunities to pursue projects in various settings during the course of the school year. There are several programs that provide funding support to many medical students for summertime research work. The range of projects available for students to engage in is simply enormous, covering every imaginable area of health research.
What about examinations?
Examinations will be used in two ways: first, they will be used to provide students with feedback about their progress in learning, and areas where they need to particularly focus to ensure they are on the right track. Second, information from various assessments, will be used in the aggregate to ensure students are meeting minimum standards to continue to progress in the program, and to provide a basis for remediation for those who have some struggles. These assessments will include written examination questions, clinical skills assessments, measures of individual contributions to group learning, of community-based activities, of learning from online modules, of laboratory-based skills exercises, among others.
How will students from different backgrounds manage this new curriculum?
We think the Foundations Curriculum is ideally suited for students from various backgrounds. We know students come to medical school with some basic knowledge of life sciences, and we will ensure through their exposure to Unit 1 that all students have reached the required level of basic biomedical and social science knowledge required to do well in the rest of the program. We will provide students with early assessments of their progress and sufficient unscheduled time ensure they are prepared to move on.
The diversity of subject areas covered in the Foundations Curriculum – which reflects the complex skill set required of today’s physicians – should also appeal to students from many backgrounds. This should allow students to share their strengths with one another as they support their colleagues.
Are there going to be changes to the Clerkship curriculum as well?
The Clerkship program is constantly evolving.