Progress tracking: Undergraduate Medical …...Last revised December 11, 2016 *CACMS refers to the Committee on the Accreditation of Canadian Medical Schools. Progress tracking: Undergraduate

Last revised December 11, 2016

*CACMS refers to the Committee on the Accreditation of Canadian Medical Schools.

Progress tracking: Undergraduate Medical Education CACMS* accreditation elements currently under review

Element

Finding

Structural Change

Actions Completed/Status

Next Steps

Next Steps Timeline

1.1 Strategic Planning & Continuous Quality Improvement

Non-compliance; The strategic plan should include a timetable for achieving the various milestones, and have clear outcome markers. This is a recurrent issue.

Deanery Executive Committee is responsible for annual reviews of each Faculty of Medicine strategic plan. Reports on progress on strategic plans to be made annually to the Faculty Council by the Dean of Medicine Additional Resources added to Accreditation/CQI: Director of Accreditation, UGME/IRC is appointed (November 2015) Associate Director, Faculty of Medicine Accreditation is appointed (October 2015) Accreditation Implementation Committee (AIC) terms of reference are revised to reflect oversight of CACMS elements

Each strategic plan that grew out of Thinking Dangerously has timetables and outcome markers. The Faculty Life Cycle Strategic Plan and the Strategic Research Plan were reviewed by Deanery Executive on June 13, 2016. New strategic planning process for The Faculty of Medicine, Project Renaissance, with specific component for the MDCM Program, Physicians of Tomorrow, initiated by Dean of Medicine (presented to Deanery Executive June 13, 2016; to Faculty Council December 6, 2016). Resources and mechanisms in place to enable ongoing monitoring of compliance with the CACMS Standards and Elements. Schedule to review all CACMS elements presented to AIC by Director of Accreditation, UGME/IRC (May 26, 2016).

Begin program evaluation of new MDCM curriculum. Ratification of strategic framework. Establishment of working group and consultation process for each theme. Working groups present to Faculty Council. Implementation of recommendations. Constitute Quality Assurance Committee for MDCM Program to be chaired by Director of Accreditation, UGME/IRC. Initiate review of CACMS elements according to review schedule.

July 2017, continuous Winter 2017 Spring 2017 December 2017 2018, continuous March 2017 Winter 2017


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currently under review (December 2015) UGME committees’ terms of reference are revised to denote responsibility for specific CACMS elements (approved by Deanery Executive August 22, 2016)

1.3 Mechanism for faculty participation

Compliance with a need for monitoring; A new faculty council has just been created, as part of governance reform, but its effectiveness remains to be determined.

Faculty Council is established and functional: https://www.mcgill.ca/medicine/about/governance/faculty-council Nominations Committee is established (October 18, 2016) https://www.mcgill.ca/medicine/files/medicine/faculty_council_nominating_committee_termsofref_october2016.pdf

Four Faculty Council meetings held since the 2015 CACMS full survey. https://www.mcgill.ca/medicine/about/governance/faculty-council/meetings-minutes

Faculty Council meetings to be held four times per academic year. Additional subcommittees will be struck as needed. Nominations Committee to propose potential individuals to fill vacancies on various Faculty of Medicine committees.

Continuous Continuous Winter 2017, continuous

1.4 Affiliation Agreements

Non-compliance; Affiliation agreements with some institutions do not contain all of the required components, and some are unsigned.

As part of the Quebec Government’s recent health care reform, several institutions have merged and are now grouped into larger entities called either a Centre intégré universitaire de santé et de services sociaux (CIUSSS), or a Centre intégré de santé et de services sociaux (CISSS). Our primary clinical affiliate, the McGill University Healthcare Centre is called a Centre hospitalier universitaire (CHU). Contracts of affiliation will no longer be between individual hospitals and the University but between these larger

The MSSS is developing a template contract of affiliation that is suited to the reformed health care organizations. A draft contract of affiliation template was received by the Dean of Medicine on September 7, 2016. This draft is currently being reviewed by the Deans of the four Faculties of Medicine in Quebec.

Once finalized and approved by the MSSS and the Ministère de l’Éducation et de l’Enseignement supérieur, new contracts of affiliation will apply to all public health care organizations in Quebec.

TBD

https://www.mcgill.ca/medicine/about/governance/faculty-council



https://www.mcgill.ca/medicine/files/medicine/faculty_council_nominating_committee_termsofref_october2016.pdf




https://www.mcgill.ca/medicine/about/governance/faculty-council/meetings-minutes




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entities and the University and must be approved by the Ministère de la Santé et des Services sociaux (MSSS).

2.6 Functional integration of the faculty

Non-compliance; Very few chairs/course directors have visited Gatineau in the last year. While the survey team noted substantial heterogeneity in levels of administrative attention and support, teaching time, and clinical exposure across all teaching sites, the noted issues at the Gatineau site were particularly acute. The program will need to undertake a comprehensive review of the program in Gatineau.

Confirmation from the CACMS that Gatineau is not a geographically-distributed campus.

Review of the Gatineau Integrated Clerkship conducted March 2016. Special efforts made to include faculty members from Gatineau. The Terms of Reference of the Faculty Council, MDCM Admissions Committee, MDCM Program Committee, and Clerkship Component Subcommittee all include at least one faculty member based at the Gatineau site. Inaugural Annual Outaouais Retreat held on May 10, 2016.

Annual Outaouais Retreat scheduled to take place on May 16, 2017.

Continuous/ Annual


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3.3 Diversity/ Pipeline and partnership programs

Compliance with a need for monitoring; The school has a new definition of diversity and has developed interventions to improve the diversity of medical students and faculty. However the school’s definition of low- socio- economic status is not in keeping with demographic data for the region. In addition, there remains significant under-representation in the student and faculty body of identified groups, including women in leadership positions, and aboriginal faculty. The commitment to diversity is variable across departments.

New Office of Social Accountability & Community Engagement (SACE) with mandate to examine Faculty diversity, including leadership & promotional diversity (September 2015) Interim Director of SACE appointed (September 2015) Director of SACE appointed (July 2016) Diversity and Engagement Officer appointed (December 2016)

Definition of low SES clarified. Since 2015, search committees receive mandatory equity training. Faculty development workshop series for Chairs: Workshop #1 Building an Inclusive Learning and Work Environment (held November 30, 2016). MEE Survey: More than 80% of respondents (Class of 2017 and Class of 2018) believed that faculty demonstrated ethical behavior, compassion for patients, pride in their work and respect for diversity.

Create Faculty Equity Committee with a mandate to review and revise diversity target groups for faculty members and the educational and academic leadership. Faculty development workshop series for Chairs: Workshop #2 Building inclusive Leadership within the Faculty of Medicine. Faculty development workshop series for Chairs: Workshop #3 Building a Socially Accountable Faculty of Medicine. Implement equity reporting accountability in annual reports.

Jan 2017 May 2017 Oct 2017 2017, continuous

3.5 Learning environment / Professionalism

Non-compliance; Several of the major teaching hospitals are just starting to implement

ADUGME is a member of the DPS Committee.

Clarification made to the process used by the AAO in addressing breaches of professionalism by academic faculty members. https://www.mcgill.ca/medicine-academic/learning-

First meeting of Learning Environment Advisory Panel to be held.

Jan 2017

https://www.mcgill.ca/medicine-academic/learning-environment/monitoring-and-protecting-learning-environment



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processes to identify and fix systemic problems in the learning environment. Some Directors of Professional Services identify a culture in the hospitals that makes this challenging. The Dean or one of his delegates is not a member of the joint Hospital-University Directors of Professional Services committee.

Creation of the Learning Environment Advisory Panel (LEAP), chaired by the Vice-Dean, Education to provide a venue for formal discussions about issues affecting the learning environment.

environment/monitoring-and-protecting-learning-environment MEE Survey: The data indicated that more than 80% of respondents (Class of 2017 and Class of 2018) believed that faculty demonstrated ethical behavior, compassion for patients, pride in their work and respect for diversity.

3.6 Mistreatment

Non-compliance; The school has engaged in a comprehensive plan to address mistreatment of students and progress is being made. Nevertheless, students continue to report a lack of confidence to report mistreatment due to fear of reprisals and fear of lack of

Assistant Dean, Student Affairs no longer reports to the Associate Dean, UGME but rather to the Vice Dean, Education to remove perceived conflict of interest. Additional resources added to the WELL Office (the Faculty of Medicine’s Office of Student Affairs): Wellness Consultant appointed (May 2016) Project Manager position created and posted (posted September 30, 2016, recruitment ongoing)

Existing processes for reporting mistreatment have been reviewed. Processes for investigating and addressing reports of learner mistreatment by faculty members have been formalized by Academic Affairs: (http://www.mcgill.ca/medicine-academic/learning-environment/monitoring-and-protecting-learning-environment). Processes for investigating and addressing reports of student mistreatment by residents/fellows have been formalized by PGME: (http://www.mcgill.ca/pgme/files/pgme/learner_mistreatment_complaint_process_november2016.pdf)

Appoint Project Manager.

Dec 2016



http://www.mcgill.ca/medicine-academic/learning-environment/monitoring-and-protecting-learning-environment




http://www.mcgill.ca/pgme/files/pgme/learner_mistreatment_complaint_process_november2016.pdf




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anonymity /confidentiality. Students cite examples of breaches of anonymity. Students are not informed systematically about outcomes of their complaints.

AFMC GQ: The percentage of respondents that personally experienced mistreatment (according to the definition provided) decreased from 59.9% in 2015 to 56% in 2016. AFMC GQ: Of those respondents who reported a mistreatment incident, 40% were dissatisfied/very dissatisfied with the outcome of reporting. Additionally, fear of reprisal as a reason for not reporting mistreatment increased from 28.7% (2015) to 35.5% (2016). 2015 AGMC GQ and 2016 MEE Survey data reviewed by PECO and presented with recommendations to the MDCM Program Committee on September 19,

2016. All recommendations were adopted including the following: “In collaboration with Faculty Development, the Office of Academic Affairs, the UGME Office, and the Directors of Professional Services, interdisciplinary educational programs on student mistreatment be developed and deployed (behaviours that constitute mistreatment and fear of reprisal for reporting must be addressed).”

4.5 Faculty professional development

Non-compliance; The Gatineau campus does not have comparable faculty development opportunities for preceptors to the central

Confirmation from the CACMS that Gatineau is not a geographically-distributed campus. As such, Gatineau faculty must have comparable, though not identical, faculty development opportunities to those offered to faculty

Initiated the Annual Outaouais Retreat for chairs, clinical chiefs, UGME course directors, Faculty leadership, and local faculty members. A strategic planning exercise exploring the scope of, and approach to, faculty development in the Outaouais was undertaken by the Associate Dean of

Annual Outaouais Retreat scheduled to take place on May 16, 2017. Faculty development workshop scheduled to be held in Gatineau: Enseigner lorsque le temps nous manqué et mieux gérer son temps.

May 2017 Mar 2017


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(Montreal) campus offerings.

members who are based in Montreal.

Faculty Development in collaboration with the Faculty Development Program Director in Family Medicine, the Assistant Dean Rural Education, and the Assistant Dean, Medical Education, McGill University, Outaouais Region on June 21, 2016. The results of a recent faculty development needs assessment distributed to all faculty members in the Outaouais Region (spring 2016) was reviewed and based on the needs assessment, a faculty development plan for the 2016-17 academic year was developed. A half-day teaching skills workshop was held on June 17, 2016. Faculty development workshops on formative and summative assessment was held in Gatineau (November 4, 2016).

5.6 Clinical Instructional Facilities/Information Resources 5.11 Study/Lounge/Storage Space/Call Rooms

Non-compliance; Some of the hospitals affiliated with the medical school have inadequate infrastructure resources such as locker facilities, general Wi-Fi access and call rooms.

New Clinical Facilities and Resources Policy and Checklist developed: https://www.mcgill.ca/ugme/academic-policies/clinical-facilities-and-resources-policy

Increase in the number of student-assigned lockers installed at the Glen (October 2016) New Clinical Facilities and Resources Checklist completed by DPS offices. (May 2016) 2015 AGMC GQ and 2016 MEE Survey data reviewed by PECO and presented with recommendations to the MDCM Program Committee on September 19, 2016. The MDCM Program Committee was concerned about the student perception that facilities are inadequate at some training sites, and decided to conduct site visits to

First meeting of Learning Environment Advisory Panel to be held.

Reports from site visits completed in 2016 will be reviewed by the Undergraduate Operating Committee.

Site visit scheduled at LaSalle Hospital.

Jan 2017

Jan 2017 Feb 2017

https://www.mcgill.ca/ugme/academic-policies/clinical-facilities-and-resources-policy




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examine facilities at our partner institutions. Further, it was decided that these site visits would be a joint effort between students, the UGME Office and DOE/DPS Offices. To date, site visits have occurred at

MGH (October 17, 2016)

Glen Site (November 25, 2016)

Lakeshore General Hospital (June

1, 2016)

SMH (November 18, 2016)

JHG (November 29, 2016)

Douglas Mental Health University

Institute (December 6, 2016)

5.8 Library Resources/Staff

Non-compliance; Access to libraries at some of the affiliated hospitals is problematic (limited hours) and Wi-Fi is not available.

New Clinical Facilities and Resources Policy https://www.mcgill.ca/ugme/academic-policies/clinical-facilities-and-resources-policy

2016 GQ: the percentage of respondents that were satisfied/very satisfied (aggregated) with the library decreased from 90.6% (2015) to 68.3% (2016). Renovations of the McIntyre library completed to increase and enhance study space for medical students (September 2016).2015 AGMC GQ and 2016 MEE Survey data reviewed by PECO and presented with recommendations to the MDCM Program Committee on September 19, 2016. All recommendations were adopted, including the following: “Deficiencies in infrastructure support at the different hospitals, and the discordance between DPS Office belief and student perception be urgency investigated and quickly corrected, the hospital directors of education (where they exist) or a representative from





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the undergraduate Dean’s office being charged with this responsibility.

6.1 Format/ Dissemination of medical education program objectives and learning objectives

Non-compliance; At the site visit, the majority of medical students interviewed were not aware of the overall education program objectives.

The MDCM Program Objectives were revised for clarity and approved by the MDCM Program Committee (October 26, 2015).

As of 2016-17, students enrolled in the MDCM Program must view the MDCM Program Objectives in myCourses before they are able to access curricular content for the FMD Courses. Component Objectives for each of the curricular components are structured like the MDCM Objectives with objectives that are not relevant to that component minimized in grayed out font. Course objectives include reference to the component objectives.

Completed Sept 2016

6.2 Required clinical learning experiences

Non-compliance; The school has established specific criteria for the types of patients that students must encounter and the appropriate clinical settings needed for students to meet the learning objectives for clinical education. However, level of student responsibility is unclear for the majority of patient encounters. This is a recurrent issue.

The level of student responsibility for required clinical learning experiences has been revised and clarified for LFME, TCP, and Clerkship.

Completed Summer 2016


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6.6 Service-learning

Compliance with a need for monitoring; The new curriculum has just recently instituted a mandatory service-learning component for students, and made sufficient opportunities available. Effectiveness data are not yet available.

In the first iteration of CHAP in 2014-15, aggregate course evaluation data indicated that 88% of students rated their placement experience positively, and four students from that cohort remained active in their service-learning placements into Year 3 of the MDCM Program. In the second iteration in 2015-16, aggregate course evaluation data indicated that 86% of students rated their placement experience positively and 91% of students indicated they would recommend their community organization to future medical students.

MDCM Program Committee will continue to monitor the effectiveness of CHAP.

Continuous

7.1 Biomedical, behavioral, social sciences

Non-compliance; Over the past 5 years, on the CGQ, students have reported inadequate instruction in pain management (42.7% in 2014), health care system and policy (50.0 and 47.1% respectively in 2014), behavioral sciences (35.5% in 2014), human sexuality (47.4% in 2014) and complementary medicine (39.5% in 2014).

Implementation of new MDCM curriculum.

AFMC GQ: 2016 data show no sustained improvement in student satisfaction with instruction of biomedical behavioural, and social science sciences in the former curriculum. MEE Survey was administered in the spring of 2016 to the first two cohorts in the new curriculum. Findings show marked improvement in satisfaction with instruction in Pain Management, Health Care System, Health Policy, Behavioural Sciences, and Human Sexuality. Additional instruction of these topics, and most instruction in Complementary and Alternative Medicine, is offered in Year 4 of the MDCM Program.

PECO will review the existing curricular content of the following topics and report back to the MDCM Program Committee separately: nutrition, biochemistry, hematology, complementary and alternative medicine, anesthesia, imaging, population health. MEE Survey 2017: survey students on perceived adequacy of curricular content.

Spring 2017


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7.5 Common societal problems

Non-compliance; Over the past 5 years, on the CGQ, students have reported inadequate instruction in women’s health (range 23.9% to 24.5%) and family and domestic violence (range 51.5% to 59.1%). There has been no discussion on this particular topic at the new curriculum executive level.


AFMC GQ: 2016 data found that 55.6% of respondents rated instruction in Family/Domestic Violence in the former curriculum as appropriate or excessive. MEE Survey: 77% of respondents in the Class of 2017 (i.e., first cohort to complete the new curriculum) rated the instruction and time devoted to Family/Domestic Violence, as appropriate or excessive. AFMC GQ: 2014 data found that 75.8% of respondents rated instruction of Women’s Health in the former curriculum as appropriate or excessive. MEE Survey: 82% of respondents in the Class of 2017 (i.e., first cohort to complete the new curriculum) rated the quality of instruction of Women’s Health in the former curriculum as appropriate or excessive. MDCM Program Committee tasked the Chair of the Social Accountability and Health Advocacy Theme Subcommittee with defining common societal problems for the MDCM Program.

Define “common societal problems” for the MDCM Program. MEE Survey 2017: survey students on perceived adequacy of curricular content, including newly defined “common societal problems.”

Jan 2017 Spring 2017

7.7 Medical ethics

Compliance with a need for monitoring; Over the past 5 years, on the CGQ, students have reported inadequate instruction in ethics (range


The rate of student satisfaction with the instruction of Ethics/Humanism and Health Law is higher in the new curriculum compared to the former curriculum. MEE Survey: 91% of Med-3 respondents (Class of 2017) and 92% of Med-2 respondents (Class of 2018) rated instruction of Ethics/Humanism

MEE Survey 2017: survey students on perceived adequacy of curricular content.

Spring 2017


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15.7% to 29.9%), and law and medicine (range 69.3% to 82.1%). The school has responded with the development of a new course in law and ethics, but effectiveness/evaluation data for this course are not yet available.

as appropriate or excessive; and 87% of Med-3 respondents (Class od 2017) and 82% of Med-2 respondents (Class of 2018) rated instruction of Health Law as appropriate or excessive.

8.1 Curricular management

Non-compliance; The Curriculum Committee has not managed the curriculum effectively with respect to implementation of workload policy, and ensuring comparability of student experience across sites. There continue to be significant delays in finalizing clinical grades. The committee has also not effectively addressed multiple curricular topics which McGill students have

MDCM Program Committee replaced the Curriculum and the New Curriculum Implementation Committees.

MDCM Program Committee and its subcommittees are responsible for specific CACMS elements (per each committee’s terms of reference) to ensure oversight and accountability for the program (August 22, 2016).

Aug 2016


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persistently reported are inadequately covered in the curriculum.

8.2 Use of medical education program objectives

Non-compliance; A set of educational program objectives and outcomes is in place for each competency. However, many of the objectives are not explicitly mapped to specific courses or to outcome measures. Existing clerkship rotation objectives are not fully mapped to program objectives or outcomes. The school indicates it is planning to link their new curriculum clerkship rotation objectives to the overall objectives, but this is not yet complete.

Acquisition and implementation of ENTRADA.

Component Directors develop component objectives based on the MDCM Program Objectives. These are subject to the approval of the MDCM Program Committee. Course Directors are required to develop course objectives that link to the component objectives. These are then brought by the Component Director to the MDCM Program Committee for approval. Session objectives must link to course objectives and component objectives. MDCM Program adopted the MCC Clinical Presentations as the backbone of the medical expert objectives for the curriculum. Each course has been assigned specific MCC Clinical Presentations that must be addressed by that specific course, and these are referenced in the course objectives and session objectives.

Implement Entrada. Once implemented, Entrada will ensure that all learning sessions and courses are explicitly tagged to curricular objectives and that students are aware of these linkages. This will facilitate curricular mapping in the future.

2017

8.3 Curricular Design, Review,

Non-compliance; The school lacks a well-functioning

Acquisition and implementation of ENTRADA.

Currently, curricular mapping is a manual process, whereby the curriculum management administrator

Implement Entrada. 2017


14

Revision/Content Monitoring

curriculum mapping system. A new internet based mapping system has just been purchased, but its effectiveness and utility remain to be determined. This is a recurrent issue.

interrogates the learning management system, myCourses. myCourses uses the Desire2Learn (D2L) Brightspace platform and curricular information in myCourses is available to both students and faculty. As myCourses does not have a native search engine feature, the MDCM Program acquired iSeek software to facilitate curricular mapping by being able to search for keywords and using synonyms to identify related concepts to map the curricular objectives throughout the curriculum to specific courses and learning sessions. In addition to using iSeek to map the implemented curriculum as available on myCourses, an Excel-based database is used to track major themes throughout the curriculum. This helps identify differences between the intended curriculum (i.e., what was planned) and the implemented curriculum (i.e., what is accessible to students and teachers in the learning management system). The MDCM Program is in the process of implementing a new software solution, Entrada, which will require that courses and learning sessions be tagged to curricular objectives at the time of session development within the learning management system. Once fully implemented, this will facilitate curricular mapping, as all sessions will be tagged using a uniform system. The tagging system that will be used in Entrada is already being used to tag items in our examination item bank. A taxonomy was completed (February 2016), and to-


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date, the Program has meta-tagged over 25% of the question bank (approximately 1,550 items). Also, all course objectives and most session objectives are tagged with the MDCM Program Objectives and MCC clinical presentations. Therefore, current curricular mapping is able to consider the alignment of assessment with curricular objectives. Finally, component objectives include reference, in parentheses, to the program objectives as do course objectives and session objectives. This makes the mapping of teaching-and-learning moments to curricular objectives more explicit to the students and teachers.

8.7 Comparability of education/ assessment

Non-compliance; There is significant heterogeneity across multiple teaching sites and hospitals in levels of administrative support provided to the program, amount of dedicated teaching time and content, clinical exposure, and overall student satisfaction with clerkship rotations. This is a recurrent issue.

New UGME Policy on Continuous Quality Improvement for Educational Experiences (http://www.mcgill.ca/ugme/academic-policies/policy-continuous-quality-improvement-educational-experiences)

Focus groups with graduates of the MDCM Program held to better understand variation in student satisfaction across sites (2015-16) Learning sessions in TCP and Clerkship are now centralized through academic half-days that regroup students from all training sites. All written and OSCE examinations are administered centrally, ensuring equivalence of assessment for those formats. Implementation of UGME Policy on Continuous Quality Improvement for Educational Experiences (2016-17) To help reduce discrepancies in administrative support across training sites, new job descriptions for Course Directors, Site Directors, and the new

Ongoing evaluation of data related to educational experiences across sites.

Continuous

http://www.mcgill.ca/ugme/academic-policies/policy-continuous-quality-improvement-educational-experiences






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position of Site Physician Leads were approved by the MDCM Program Committee. These job descriptions will ensure that the academic administrative leadership at each site has the same expectations and remuneration.

8.8 Monitoring time spent in educational and clinical activities

Non-compliance; Although the school has a well-developed workload policy, there are frequent violations of the policy in all rotations except psychiatry and family medicine, coupled with reluctance by students to report violations. This is a recurrent issue.

Revised Workload Policy https://www.mcgill.ca/ugme/academic-policies/workload-policy

Targeted interventions have been used to foster respect for the Workload Policy, including course-by-course interventions aimed at sensitizing faculty and residents to the Workload Policy. The MDCM Program uses an anonymous system to protect students and maximize reporting of policy violations. Review of the workload data is a twice-yearly item on the MDCM Program Committee agenda (presented on August 15, 2016 and on November 14, 2016) and a three times yearly item on the Clerkship Component Subcommittee (presented on November 9, 2016) MEE Survey: 13% of respondents (Class of 2017) reported that the UGME Workload Policy was not respected during their internal medicine clerkship; 20% of respondents (Class of 2017) reported that the UGME Workload Policy was not respected during their surgical clerkship. 2015 AFMC GQ and 2016 MEE Survey data reviewed by PECO and presented

Review of workload data at the MDCM Program Committee level. Review of workload data at the Clerkship Component Subcommittee level.

Continuous/ Annual Continuous/ Annual

https://www.mcgill.ca/ugme/academic-policies/workload-policy




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with recommendations to the MDCM Program Committee on September 19, 2016. All recommendations were adopted, including the following: “Team function on the clinical teaching units be discussed. Given the current work flow on most hospital wards, it is difficult to imagine how a clerk on the one hand can have specific work hour restrictions and on the other be a full member of the CTU team, participating in all clinical decisions that concern their assigned patients. Although work hour restrictions may be respected, a cultural change in hospital (ward) function would be required to eliminate resulting tensions between house staff, attending staff and the student. Collaboration between UGME, PGME, Academic Affairs and the hospital partners will be necessary.”

9.1 Preparation of residents and other non-faculty instructors

Non-compliance; Teaching skills training is not mandatory for residents or graduate students, and they are not uniformly aware of program objectives. Residents do not consistently receive feedback about their teaching.

Mandatory training for residents via the development and implementation of the Teaching Residents to Teach course.

The Teaching Residents to Teach course was rolled out in September 2016. This centrally-monitored course is mandatory for all McGill residents.

Monitor residents’ completion of Parts 1 and 2 of the Teaching Residents to Teach course. All McGill residents to complete the Teaching Residents to Teach course.

Dec 2016 2017, continuous


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9.2 Faculty appointments

Non-compliance; Efforts are being made in Gatineau to provide faculty appointments, but 29% of supervisors remain without McGill faculty appointments.

New McGill University Faculty of Medicine Policy on Clinical Faculty Appointments https://www.mcgill.ca/medicine-academic/files/medicine-academic/20160714_policy_on_clinical_faculty_appointments.pdf

Assistant Dean, Medical Education, McGill University, Outaouais Region, with the Academic Affairs Office have facilitated the appointments of all preceptors in Gatineau.

Process outstanding appointment. In progress

9.3 Clinical supervision of medical students

Non-compliance; At times in the surgery clerkship, supervision of clinical clerks is not adequate. Despite 79.3% of students in the ISA indicating they were well supported while on call, at the site visit, multiple students reported an inability to reach residents or staff when needed for a variety of acute patient care issues in the surgery clerkship.

New McGill Supervision Policy for Trainees in the Clinical Team https://www.mcgill.ca/ugme/academic-policies/mcgill-supervision-policy-trainees-clinical-team

AFMC GQ: 2016 data corroborate suspicions that supervision in the Surgery Clerkship was problematic. However, these data relate to surgical rotations that occurred in 2014-15, prior to remedial action being taken by the Department of Surgery. MEE Survey: The data reflect an improvement in supervision following the measures implemented in fall 2015; 80% of respondents (Year-3 students) were satisfied with the level of supervision in the Surgery Clerkship, while 15% were neutral and 5% were dissatisfied. It also found that 90% of respondents (Year-3 students) were satisfied with the level of responsibility for patient care in the Surgery Clerkship. The Dean of Medicine, Associate Dean of UGME, Clerkship Component Director, Chair of the Department of Surgery, and Surgery Clerkship Course Director met on October 7, 2016 and agreed to a number of remedial measures: (1) discuss trainee supervision with surgical division chiefs, (2) review potential factors impacting the supervision of trainees,

https://www.mcgill.ca/medicine-academic/files/medicine-academic/20160714_policy_on_clinical_faculty_appointments.pdf





https://www.mcgill.ca/ugme/academic-policies/mcgill-supervision-policy-trainees-clinical-team





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and (3) develop a multifaceted action plan - led the Chair of the Department of Surgery, clinical chiefs, and the Course Director. The Dean of Medicine held a follow-up meeting with the Surgical Executive Committee at the end of November to reinforce with the division chiefs the importance of supervision.

9.4 Assessment system

Compliance with a need for monitoring; Direct observation of history and physical examinations has not been consistent across all core clerkship rotations. The CGQ identified significant deficiencies in Emergency Medicine, Surgery, and Obstetrics and Gynaecology. However, the school has recently mandated observation, and data tracked this academic year for the class of 2016 suggests improvement.

New Student Assessment Policy https://www.mcgill.ca/ugme/academic-policies/ugme-student-assessment-policy

There are discrepancies between data sources regarding direct observation during required clinical experiences in Clerkship. Directly observed encounters are mandatory in all required clinical courses in Clerkship, and 100% of students complete their requirements in myMED Portfolio. Course evaluations surveys indicate that approximately 95% students are observed at least once taking a history and performing a physical examination. However, far fewer respondents to the AFMC GQ and the MEE Survey report having been observed. The MDCM Program Committee has not been successful in determining whether this is due to students entering inaccurate information in their myMED Portfolio logs or, for example, to students answering the AFMC GQ based on their perception of the frequency of direct observation in a specific course. However, focus groups with residents from the Class of 2015, and Clerkship students during 2015-16 and 2016-17 have suggested that both of these factors may be at play.

Clerkship Component Subcommittee to determine ways to demonstrate that direct observation is occurring in all Clerkship courses, and present recommendations to the MDCM Program Committee.

July 2017

https://www.mcgill.ca/ugme/academic-policies/ugme-student-assessment-policy




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On September 19, 2016, the MDCM Program Committee tasked the Clerkship Component Subcommittee with reviewing the issue and returning to the MDCM Program Committee with a recommendation for how to clearly demonstrate that direct observation is occurring in all Clerkship courses. 2015 AFMC GQ and 2016 MEE Survey data reviewed by PECO and presented with recommendations to the MDCM Program Committee on September 19, 2016. All recommendations were adopted, including the following: “Different strategies be developed to ensure that clerks are observed at least once while performing a history or physical exam for all clerkships. The problem is particularly acute in Emergency Medicine.”

9.5 Narrative assessment

Non-compliance; The school uses narrative feedback in most course and clerkship settings, however a significant number of blocks that include small group learning (permitting narrative assessment), in the new Fundamentals of Medicine and Dentistry (FMD) 18-month course


FMD courses with sufficient teacher-student interaction (when the same teacher meets the same student for a minimum of 4 sessions within the same course) and of sufficient depth (when the teacher: student ratio is no greater than 1:20) provide narrative feedback to students. In 2015-16, a pilot project introduced narrative assessment in three FMD courses: Molecules to Global Health, Circulation, and Human Behaviour. The feasibility of providing narrative feedback and the quality of narrative comments were examined. The FMD Component Director presented the MDCM Program Committee with an analysis of the narrative feedback in

MDCM Program Committee will continue to monitor the effectiveness of the current policy.

Continuous





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Component do not include a narrative assessment.

the selected courses. The MDCM Program Committee determined that it was possible to provide meaningful feedback in the Human Behaviour course, and to pilot the narrative feedback in the Movement course starting in 2016-17. The tutor-student interactions were judged to be insufficient in the Molecules to Global Health and Circulation courses to make narrative assessment mandatory. In response to tutor feedback, the narrative assessment form for FMD was modified to include some examples of well-constructed feedback.

9.8 Fair and timely summative assessment

Non-compliance; Provision of final grades in the family medicine, pediatrics, obstetrics and gynaecology, general surgery, and surgical subspecialty clerkship rotations at one or both campuses (Montreal and Gatineau) is beyond six weeks. This is a recurrent issue.


In all Courses: Closer follow up by the UGME Office; notification to the Dean and Department Chair when assessments are delinquent; intervention by Department Chair with delinquent faculty In some Courses: Changes to the way assessment is done. As a result of program-wide and course-specific interventions, improvements have been seen during the 2016-17 academic year (from Block 1 to Block 3) in both TCP and Clerkship MEE Survey: The data showed an unacceptable delay in the posting results of examinations and evaluations for a large number of clerks. MDCM Program and the UGME Office made several changes during 2015-16 to address delays program-wide:

UGME Student Assessment Policy

UGME to monitor submission of grades.

Continuous





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Active follow-up and tracking by Student Records; and

Re-centralizing the release of grades to students and the ability to modify previously submitted assessment forms in the UGME Office.

10.2 Final authority of Admission Committee

Non-compliance; The admissions committee does not have a majority of voting faculty members.

Terms of reference for the MDCM Committee denotes the scope of power and autonomy of the MDCM Admissions Committee (August 2016) Revised terms of reference for the MDCM Admissions Committee (August 2016).

Majority of members on the MDCM Admissions Committee are faculty members.

Fill vacant committee positions. Winter 2017

11.1 Academic Advising

Non-compliance; Osler fellows provide both academic advising and student assessment concurrently. In addition, students at the Gatineau campus do not have comparable access to academic counselling.

Osler fellows no longer provide academic counseling to students. Osler Fellows may provide advice to students related to career decisions and receive instructions by the Course Director for the Physician Apprenticeship courses regarding how to refer students who are in difficulty.

Review of the Gatineau Integrated Clerkship (March 2016) Report: With respect to ‘aide pédagogique’ there is no structured system in place in Gatineau (although there is informal support for students experiencing academic difficulties). This is no different than the current situation in Montreal. There is an individual that has been identified as a mentor for the Gatineau students, and this person has no involvement in student assessment. The UGME Office and the WELL Office created the Academic Advising Flow Chart to help guide students in academic difficulty to seek out appropriate help, depending on

The UGME Office is developing a tracking mechanism that will allow for rapid identification of students whose grades begin to slide, even if they have not yet failed a course requirement. This would allow for earlier intervention and may prevent students from failing course requirements or courses and having to complete remedial or supplemental activities.

Winter 2017


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his/her situation ((http://mcgill.ca/thewelloffice/files/thewelloffice/academic_difficulty_flowchart_aug_17_2016_edit.pdf). The MDCM Program recognizes that academic difficulty is often multifactorial. While a student’s difficulties may appear academic, there are often wellness concerns at play. Therefore, academic advising is handled through Student Affairs, housed in the WELL Office. All academic advising and counseling resources that students access through the WELL Office are at arm’s length from medical student assessment and promotion. The WELL Office will help the student determine the need for a referral to University resources (i.e., the Office for Students with Disabilities for exam or course accommodations; Student Health Service; the Counselling and Mental Health Service; Scholarships and Student Aid for financial problems; or the Tutorial Service.) The University offers tutoring in study skills, and the WELL Office has worked with campus services to develop a list of tutors with MDCM Program content expertise. AFMC GQ: The percentage of respondents that were satisfied/very satisfied with academic advising/counseling decreased from 90.2% (2015) to 78.1% (2016).

12.3 Personal Counseling /

Non-compliance; The school is

Revised Absences and Leaves Policy

Based on feedback from students, the policy was rewritten to include 10 Flex

Appoint Project Manager. Dec 2016


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Well-Being Programs

beginning to integrate health and wellness into the curriculum, but most students remain uncomfortable taking absences for health related matters and note insufficient time for basic wellness activities. The school has recently instituted a flex day policy that permits five (5) flex days per year to deal with these concerns, but this has been poorly communicated to students.

http://www.mcgill.ca/ugme/academic-policies/absences-and-leaves Additional resources have been added to the WELL Office (the Faculty of Medicine’s Office of Student Affairs): Wellness Consultant (full-time) appointed (May 2016) Project Manager position created and posted (posted September 30, 2016, recruitment in process)

Days (or 20 half-days) for students’ academic or personal purposes instead of the 5 Academic Days and 5 Flex Days that were previously allowed (May 2016). A full-time Wellness Consultant was hired for the WELL Office (May 2016) with a mandate to support medical students through individual counselling, outreach and program innovation. The Wellness Consultant provides confidential short-term counselling to students across the four years of the MDCM Program, including students completing the Longitudinal Integrated Clerkship (LIC) at the Gatineau site, with whom she visits every twelve weeks to offer group wellness activities and individual counselling. The Wellness Consultant also works to further develop the Longitudinal Wellness and Resilience Curriculum with her Postgraduate counterpart. AFMC GQ: The percentage of respondents that were satisfied/very satisfied with programs/activities that promote effective stress management, a balanced lifestyle and overall wellbeing increased from 69.4% in 2015 to 79.7% in 2016.

12.4 Student access to health care services

Non-compliance; Students at the Gatineau campus reported not having comparable access to health and other

Revised Absences and Leaves Policy http://www.mcgill.ca/ugme/academic-policies/absences-and-leaves

Review of the Gatineau Integrated Clerkship (March 2016) Report: LIC students in the Class of 2017 were found to be very satisfied with the health care services, including mental health services, provided for them:

Students know how to access the MedWell Office and are

http://www.mcgill.ca/ugme/academic-policies/absences-and-leaves







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preventative and therapeutic health services, including mental health services, despite having a dedicated family physician and psychologist

comfortable doing so. Dr. Gupta has also traveled to Gatineau to meet with the students.

They are provided with the names of family doctors who have no role in their assessment and access has been timely and easy (when needed).

They are provided with a psychologist or other mental health professional who has no role in their assessment and access has been timely and easy (when needed).

The WELL Office offers counselling services for students who require immediate or short-term support. Students make appointments with the Assistant Dean Student Affairs or the Undergraduate Medical Education (UGME) Wellness Consultant via a booking service and appointments are offered in-person, as well as by phone or Skype. LIC students have preferential access to appointments when they return to Montreal for Recall Days and they can schedule appointments with the UGME Wellness Consultant in Gatineau, as she is on site every 12 weeks. The WELL Office facilitates health and mental health appointments for Clerkship students. Monthly email notices are sent to remind students that appointments with McGill Student Health Services and/or McGill Mental Health Services can be made through the WELL Office. LIC students


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have preferential access to appointments during Recall Days, but also have access to health care in Gatineau through local resources. The Absences and Leaves Policy allows for Flex Days to enable students to take time off to access health services. In the event of a more urgent request, upon explanation to the Assistant Dean Student Affairs absences are permitted even if the posted deadline for requesting the absence was not respected. Students are also permitted sick days in the event of illness, and in the case of a more prolonged illness, leaves of absence up to one year may be granted.

Documents

Progress tracking: Undergraduate Medical …...Last revised December 11, 2016 *CACMS refers to the Committee on the Accreditation of Canadian Medical Schools. Progress tracking: Undergraduate