2023 - 2024 MD Program Updates

As the population of Canada continues to age, the incorporation of Older Adult Medicine (OAM) into MD Program training has become increasingly important. The vertical integration of older adult medicine in our Foundations and core Year 3 Clerkship curriculum provides a solid foundation for meeting the specific needs of older adult patients. However, the gap in clinical experience must still be addressed. Beginning in 2024-25, MD students will now receive a mandatory 2-week clinical experience in Older Adult Medicine during the Year 4 as part of the Transition to Residency (TTR).  

This increased training is designed to better prepare students for residency and for the future care of older adults through:  

• Improved competence in essential skills and knowledge specific to older adults 

• A holistic approach to understanding the unique needs of older patients 

• Reducing age bias through direct exposure to aging populations 

• Increasing interest in older adult medicine as a career 

• Hands-on experience with age-related conditions, polypharmacy, and geriatric syndromes 

• Interdisciplinary collaboration with other healthcare professionals 

• A preventative approach centred on early detection and proactive management 

• Developing specialized approaches to geriatric syndromes like falls, delirium, mobility decline, cognitive decline, and frailty 

This new clinical experience is supported by Geriatric Medicine, Family Medicine-Care of the Elderly, and Geriatric Psychiatry. A small-scale optional “OAM pilot” is currently underway during the 3 clinical blocks during TTR. This pilot allows for the assessment of feasibility, identification of challenges, and program design refinement before full-scale implementation. 

As emerging technologies like artificial intelligence (AI) and virtual care continue to advance the field of medicine they will continue to unlock new and exciting possibilities in disease prevention, diagnostics, and personalized treatment all while aiding physicians to be more knowledgeable and more efficient in the delivery of care. In 2023, the MD Program began offering new curriculum to address the continued integration of new technologies into medicine. 

AI is now covered during lectures, workshops, and self-learning modules in Year 1 to provide students with a solid foundation for understanding its growing implications to medicine. These sessions explore the role of AI within healthcare, including its potential role in decision-making as well as its potential benefits and limitations. Ethical issues relating to AI are explored, including consent, data privacy, security, liability, responsibility, and unintended consequences or harms relating to health inequities. Future opportunities to explore AI will follow in both Foundations and Clerkship as the role of AI in health care evolves. 

The past several years of remote learning and work served to highlight the potential role of virtual medicine into the future. Virtual care is incorporated in several aspects of the curriculum, including Year 1 clinical skills and clerkship where students encounter patients virtually. A virtual clinical skills curriculum is now incorporated into the Year 2 Psychiatry block, including important topics such as privacy, security, confidentiality, limitations, and ethical situations. Students also practice interacting with simulated patients in a virtual, videoconference environment. 

Over the past year, the MD Program has implemented a system of entrustable professional activities (EPAs) in the form of a workplace-based assessment tool within and across courses to prepare medical students with the core skills they require to succeed in residency and beyond.  Consistent documentation of feedback and coaching received on observed skills allow students, and the program, to track students’ developmental progress over the course of Clerkship.  

EPAs have been incorporated as another key to the overall programmatic assessment framework in the MD Program with frequent, low stakes formative feedback to support student learning. While EPAs are mandatory, the focus is on providing actionable, high-quality feedback to students as they progress through the MD Program. 

EPA implementation in the MD Program is being evaluated using a rapid-cycle, continuous quality improvement approach with student, assessor, and administrative input. This has allowed the program to make real-time changes to the EPA tool to improve workflow, adjust course-specific EPA requirements, address orientation needs, and tailor faculty development efforts. Students have commented on feeling more comfortable seeking feedback and in the improved structure to their learning it provides. There is an ongoing analysis of the current assessment scale of narrative feedback provided to students to guide best practices as EPAs continue to be refined. 

The transition from Foundations to Clerkship is a major milestone in the journey of an MD student. The move from the classroom to clinical experiences can also be met with a great deal of uncertainty and anxiety. While the Foundations curriculum provides, as the name suggests, a solid foundation of medical knowledge, ensuring students feel properly supported and prepared for life in the clinical environment is also crucial. 

To give students a greater understanding of what to expect in Clerkship, we have developed the Transition to Clerkship – Clinician in Action (TTC-CIA) series of clinical scenarios which highlight common activities in clerkship, including patient handover, communication between health care providers, admission orders and discharge summaries, and approaches to clinical reasoning. 

Now past the pilot stage, TTC-CIA sessions were expanded in the 2023-2024 academic year to two full weeks of training at the end of Year 2 embedded within Complexity & Chronicity. Sessions are taught by specialists from different disciplines, including family medicine, surgery, psychiatry, obstetrics, and gynaecology.