Curriculum - MED 1 

Key features of a typical week in the first year include:

	tutorial groups meeting for 2-3 hours, 2 times a week;
	3-5 hours of lectures;
	a patient contact experience for 3-4 hours emphasizing patient-doctor relationships;
	an elective opportunity for 1/2 day;
	a 3-hour laboratory experience related to the cases under study.

Effective group learning requires active participation from everyone. The unit objectives in the first year place an emphasis on uncovering issues in a particular case, and understanding "why" and "how" they occur. Cases are used as a vehicle for students to learn in a clinical context and to apply the first steps of a clinical reasoning process which will be defined and further developed over the four years of undergraduate medical education. In later years, a shift in emphasis for the unit objectives will occur, which will center around "solving the mystery" and deciding upon a management plan.

See Typical Week Schedule for detailed weekly breakdown.

Unit Descriptions 

• Foundations of Medicine
• Host Defense
• Metabolism & Homeostasis
• Human Development
• Professional Competencies
• Clinical Skills I
• Electives
• Rural Week

Foundations of Medicine

The principal goal of the Foundations unit is to prepare students for successful completion of the systems based units of the curriculum, including foundations in biomedical, epidemiological, social and human sciences.  The two major components consist of a review of cell and molecular biology (weeks 1-3) and an introduction to evidence based practice (weeks 4-6).  The cell and molecular biology component will highlight medically-important concepts in genomes and gene expression, proteins and enzymes, cell structure and dynamics, and concepts in signal transduction. Cancer will be introduced in this context as a longitudinal disease theme.  The evidence based practice component will focus on finding, appraising and using evidence from the medical literature. The unit will also include an introduction to the basic biomedical science disciplines (e.g. anatomy, histology, pathology and pharmacology), a full day experience of shadowing a physician in his/her practice, and presentations by clinical and biomedical researchers.  

Objectives:   

1. Describe basic scientific principles at the molecular and cellular levels as a framework for understanding biomedical concepts. (SC2b, SC2c, SC2d SC3a, SC3c; LLL2)
   
2. Demonstrate the retrieval, appraisal and application of the best available evidence to address a clinical problem e.g., interpretation of a diagnostic test. (SC1b, SC2b, SC2d, SC3c, SC4c; LLL1, LLL2)
   
3. Construct a foundational framework for integration of human anatomical, histological, pathological and pharmacological concepts across the curriculum. (SC2a, SC2c,SC2d, SC3a, SC3c)
   
4. Discuss the contributions of biomedical, clinical and other types of research to improved health and the prevention and treatment of disease. (SC1b, SC3b, SC4c; LLL2; P2; CC1, CCC2,CCC3)

Host Defense
(Hematology, Infection, Immunity & Inflammation)

The Hematology, Immunology, Infection and Inflammation Unit is designed to engender an appreciation in the minds of medical students of the components of blood that are involved in fighting pathogens, the types of pathogens that affect the population locally and globally, the basics of infection and infectious disease, the structure function and development of the immune system, immune deviation and immunopathology, development and function of blood cells, normal hemostasis, and diseases of the blood systems including anemias and haemoglobinopathies, bleeding and clotting disorders and hematological neoplasms.

Objectives:   

1. Describe how the physical and cellular elements of the immune system are integrated and how the immune system operates to protect the body from infections. (SC2b, SC2c, SC2d, SC3a)
2. Describe the nature and impact of immune deficiency and autoimmunity on the health of the population. (SC3b)
3. Explain the cellular basis of the most common immunological deviations and immunopathologies and the impact these have on the community. (SC2a, SC3b; CC2)
4. Construct an integrated model that reflects the process of normal haematopoiesis, the structure and function of bone marrow, the development of the cells which make up the blood and the immune systems, and how these change with age and normal development . (SC2b, SC2c, SC2d)
5. Describe the normal function of blood cells and blood coagulation as well as deviations in blood development and function such as anaemia, congenital and acquired bleeding and clotting disorders, leukaemia’s, lymphomas and monoclonal gammopathy, together with a recognition of the global impact and importance of haematological diseases. (SC2b, SC2c, SC2d; CC3)
6. Describe the basic structure and growth characteristics of bacteria, parasites, viruses and fungi. (SC2b, SC2d, SC3a)
7. Explain how infections are acquired and how they spread within populations. (SC3a, SC3b; CC1, CC2)
8. Explain the strategies to prevent the spread of infections between individuals and within larger populations. (SC3a, SC3b; CC1, CC2)
9. Describe how specific aspects of individual pathogens determine the site of infection as well as influence disease expression, pathology, treatment and outcomes of common infections. (SC2c, SC2d)
10. Recognize the need for interprofessional and multidisciplinary teamwork in the diagnosis and management of haematological, immunological and infectious disease. (SC1d; CC4)
11. Understand the basis of laboratory medicine which supports all other disciplines in medicine. (SC2B)
12. Recognize the various therapeutic tools for the management of haematological, immunological and infectious disease. (SC3a, SC3c)

Metabolism & Homeostasis
(Gastroenterology, Endocrinology, Nutrition & Oral Medicine)

The Metabolism & Homeostasis unit will introduce two new modules to the undergraduate curriculum – oral medicine (approximately 1 week) and nutrition (which will run longitudinally through the 10 weeks). There is a close integration of basic and clinical science built around cases, with supporting labs and lectures.  There will also be lots of clinical backup so basic scientists, and clinicians who may not be expert in these areas, should be able to function very comfortably in tutorials.

Objectives:   

1. Describe the mechanisms underlying biochemical and physiologic processes related to oral medicine, gastrointestinal issues, nutrition and endocrinology. (SC2b, SC2c, SC2d; SC3a, SC3c)
   
2. Recognize normal and abnormal anatomic and histological structures of the gastrointestinal and endocrine systems. (SC2b, SC2c, SC2d)
   
3. Apply the clinical and basic science knowledge acquired to the understanding of pathophysiologic mechanisms relevant to oral medicine, gastrointestinal issues, nutrition and endocrinology. (SC2a, SC2b, SC2c, SC2d)
   
4. Recognize the pathophysiological signs that underlie the diagnosis of common clinical problems representative of oral medicine, gastrointestinal issues, nutrition and endocrinology. (SC2a, SC2b, SC2c, SC2d, SC3a, SC3b, SC3c, SC3d, SC3e, SC3f, SC3g)
   
5. Relate how societal factors influence health and disease relevant to oral medicine, gastrointestinal issues, nutrition and endocrinology. (SC1e, SC1f; P4)
   
6. Consider how physicians can influence community determinants of health (CC1, CC3; LLL5)

Human Development
(Genetics, Embryology, Genitourinary, Human Sexuality)

The Human Development Block will be an integrated review of all aspects of human reproduction, encompassing sexuality, the genitourinary system, embryology, genetics, labor and birth. Clinical cases will be used to illuminate and reinforce the acquisition of basic concepts of anatomy, physiology and pathology and demonstrate their linkage to high level themes of professionalism, patient centredness and community responsibility. The course will aim to provide a solid foundation for further development of these content areas in Med II, Clerkship and Residency.

Objectives:     

1. Relate the anatomy of the pelvis, and function of the male and female genital systems, bladder and urethra sufficient to competently make common differential diagnoses and to provide a foundation for further learning. (SC2a, SC2b, SC2c, SC2d)
   
2. Describe reproductive endocrinology, male and female gametogenesis, ovulation and menstrual physiology, pregnancy, and labour and delivery. (SC2a, SC2b, SC2c, SC2d)
   
3. Use understanding of embryology and cell differentiation to: explain the spatial relationship and shared developmental lineages of structures in the mature human body and to illustrate the normal process of human development, including the development of form and function. Be able to apply this knowledge to construct rationales to explain clinically significant perturbations in morphogenesis. (SC2a, SC2b, SC2c, SC2d, SC3a)
   
4. Use the principles of genetic transmission, molecular biology of the human genome, and population genetics to infer and calculate risk of disease, to institute an action plan to mitigate this risk, to obtain and interpret family history and ancestry data, to order genetic tests, to guide therapeutic decision making, and to assess patient risk. (SC1a, SC1b, SC2a, SC2b, SC2c, SC2d, SC3a, SC3c, SC3e)
   
5. Describe and interpret the broad range of human sexual behaviour, its change through life stages and its cultural contexts, in sufficient depth to appreciate common problems affecting patients in the communities we serve. (SC1a, SC1c, SC1e; CC2, CC3; P2, P4)

Professional Competencies

The Professional Competencies I Unit is the first year of a new two-year longitudinal Unit with a weekly two-hour tutorial followed by a one-hour large group session. This unit gives students the opportunity to integrate their biomedical and clinical learning with the context of patient care from professional, community, and life-long learner perspectives. Content includes public health and infectious disease management in the community, end of life decision-making and other ethical challenges, patient safety and other system and quality improvement approaches, social accountability and global health, physician wellness and career paths, and the Health Mentors program. Key concepts come from population health, epidemiology, ethics, law, informatics, health policy and the humanities. The Unit will be highly applied and case-based, and closely integrated with the block unit through shared cases and topics.

Objectives:       

1. Contextualize medical care within healthcare systems and practice environments (CC4 CC5; LLL5)
   
2. Interpret the ethical implications of situations you encounter in medicine and be able to approach these situations in systematic yet flexible ways that focus on the good of the patient and of communities (P1, P3; SC1c, SC1d)
   
3. Describe ways that law shapes medical practice, and how physicians work within legal standards in clinical care (P2 )
   
4. Describe patient experiences and perspectives, and integrate awareness of these into your approach to advocacy and care (Pr4; SC1e, SC1f)
   
5. Identify the health needs of communities you serve, and select appropriate approaches to prevention, management, and advocacy to meet those needs (CC1, CC2, CC3; SC1f)
   
6. Consistently search out and evaluate the best evidence, and describe approaches to integrating evidence with patient values and goals of care (P2; LLL1)
   
7. Maintain healthy skepticism, reconcile disparate sources of knowledge/evidence, and assist patients and families to do the same (LLL2; SC1b)
   
8. Reflect on your own learning processes and behaviours, and develop and implement your own learning plans (P6; LLL3 LLL4 LLL6)
   
9. Identify healthy boundaries in interactions with patients and colleagues, and maintain your own work-life balance (P7)
   
10. Contribute productively to learning communities through helping others learn and contributing to the knowledge base (LLL6)
    
11. Maintain good stewardship of patient data: from gathering; to securing; to employing for improvement of practice and care, and the empowerment of patients (SC4c)

Clinical Skills I

Clinical Skills I is the first year of the Clinical Skills Unit, which gives students the tools they will require in clinical electives and, later, in Clinical Clerkship.  In this Unit, students will learn Communication skills to perform a basic history and examination of a patient.        

One of the major goals for our committee is to ensure that the material being taught in the Clinical Skills Unit is closely linked to what the students are learning in their other blocks at the time. This integration may facilitate not only skills training, but also a greater understanding of the didactic content which students are being taught.

Objectives:      

1. Demonstrate with diverse patient populations, communication process skills of the Medical Interview (Calgary-Cambridge Guide) specifically related to: Initiating a medical interview; Gathering information; Building the relationship; Structuring the interview; and, Closing the interview.
2. Integrate communication process skills of the Medical Interview (Calgary Cambridge Guide) with basic content of the medical history.
3. Describe the components of a complete Medical History.
4. Demonstrate a patient-centered approach to the medical history that elicits the unique illness narrative and psychosocial and cultural context of each patient.
5. Communicate empathetically with patients who experience emotions such as sadness, fear, frustration and anger.
6. Analyze their own and their peers' communication skills and skill development needs and give and receive constructive feedback based on this analysis
7. Conduct a physical examination in a manner that is informative and respectful of patient dignity and culture.
8. Correctly drape and position patients during physical examination.
9. Demonstrate correct physical examination techniques for each system as outlined in the reference material for this Unit.
10. Verbally present a history and physical examination in an organized and concise fashion.
11. Record a history and physical examination in an organized, concise and legible format.

Electives

The Elective, which comprises 10% of the year's curriculum, provides an opportunity for students to pursue topics related to medicine which are of specific interest to them, and which are not considered part of the core curriculum. It is designed to complement the COPS program, and allows the student to plan, develop, and execute a personal project. This is expected to involve the cultivation of a socratic type of relationship between the student and a member of the faculty (the individual acting as preceptor) over a longer time period than other contacts during the year, and may extend over several years. Such projects may take many different forms, though in first year the emphasis will be laying a firm foundation for later work by acquiring fundamental skills in concisely defining a problem, searching the literature effectively to assess current knowledge, collecting reliable data where applicable, and reporting the whole process, with an analysis of results, and presentation of conclusions and speculations where appropriate, in a clear and lucid paper. At the end of the Elective, students will submit a written report for evaluation. Unique and out-of-the-ordinary projects are encouraged! While the Elective may turn out to be a demanding task, it is often an enjoyable and gratifying experience.

Rural Week

The last week of Med 1 will have students spending one week observing a rural physician in practice. During this week, the students will reflect on the unique characteristics of a rural lifestyle and clinical practice. The purpose of this unit is to identify characteristics of clinical practice in a rural setting as well as health care delivery and resource access/utilization in a rural setting and determinants of health unique to the community in which the student is located and reflect how health care delivery addresses or does not address these needs. Students will also focus on physician wellness and lifestyle in a rural setting and identify the physicians’ role in a rural setting including leadership responsibilities. 

Objectives:       

1. Describe clinical practice in a rural setting, including the unique characteristics of health care delivery and the issues related to resources
   
2. Apply a determinants of health lens both in relation to rural practice decisions and in considering the needs and context of the community
   
3. Relate rural lifestyle issues to personal interests and future career goals
   
4. Compare and contrast the physicians’ role in rural and urban settings, including leadership responsibilities
   
5. Demonstrate and apply the basic clinical skills (communication, history-taking and physical exam skills) learned in Med I
   
6. Demonstrate personal integrity, honesty, reliability, respect, compassion and commitment towards others