Curriculum Leading to MD Degree

The curriculum of the Faculty of Medicine is under continuous review, to respond to changes in patterns of health and disease treatment, the health care system, and in methods of effective teaching and learning. The Dalhousie University Faculty of Medicine’s undergraduate program was awarded accreditation effective June, 2017 by the Liaison Committee on Medical Education (LCME), the American based certifier of Medical Schools in Canada and the United States and the Committee on Accreditation of Canadian Medical Schools (CACMS) in Canada.

Objectives of the Undergraduate Program

Basic Assumptions

Graduates of Dalhousie Medical School are caring, resourceful physicians, able to work with patients, families, and colleagues to provide excellent care in many different contexts and in complex and uncertain situations. They are able to work as agents of creative change in healthcare institutions and communities.

Educational Goals for the Medical Student

Our graduates will integrate their knowledge, skills and attitudes for competence in four principal and interdependent areas of achievement: as professionals, as community contributors, as life-long learners, and as skilled clinicians.

Professional:
As professionals, our graduates are able to join and enhance the medical profession, through their commitment to excellence in patient care, high ethical standards, and accountability to society for the responsibilities entrusted to them.

Community Contributor:
As community contributors, our graduates understand a community’s health needs and respond to promote health. They contribute constructively to communities of practice and the institutions and healthcare systems to which they belong.

Lifelong Learner:
As lifelong learners, our graduates engage in self-assessment and reflective practice to integrate clinical experience, and scientific evidence for the improvement of patient care, safety, and outcomes.

Skilled Clinician:
As skilled clinicians, our graduates are able to apply scientific understanding, clinical skills, professional attitudes, and reflective practice in their provision of safe, patient-centered care, in collaboration with patients, families, colleagues, and communities.

Policy Statement on Interprofessional Health Education

Students in the Faculties of Dentistry, Health Professions and Medicine are required to participate in interprofessional health education activities. These activities, together with specific program requirements, are currently evolving and in transition and are integrated into the curricula of individual programs. Participation is mandatory. The objective of interprofessional education include developing:

• knowledge and understanding of, and respect for, the expertise, roles and values of other health and human service professionals
• understanding the concept and practice of patient/client/family-centred care.
• effective communication, teamwork and leadership skills applied in interprofessional contexts.
• positive attitudes related to the value of collaboration and teamwork in health and human service contexts.
• an understanding, from a multi-disciplinary perspective, of the Canadian health and social systems, the legal send regulatory foundation of professional practice, how health and human service institutions are organized and operate, and how different health and human service professions contribute to the systems and institutions.

During each year of the four-year undergraduate medical education program, learners will be required to participate in IPE activities.  In years 1 and 2, some activities will be embedded in their curriculum, and others will be elective.  In year 3 there are multiple embedded interprofessional learning activities during several clerkship rotations.  During the final year of the medical program, all students are required to participate in an interprofessional educational elective, in a collaborative setting.

The Four Year Program

Pre-clerkship Years (Years One and Two)

Beginning in late August/early September with duration of 35 weeks, the pre-clerkship program is designed around patient-centered clinical cases. Students work in groups of seven to 10 with a faculty tutor, meeting for approximately six hours weekly. Laboratory experience and a small number of lectures (three to five weekly) are included. An important component of learning is participation in the small group tutorials. Students are expected to participate, and assessment will reflect this expectation. Self-directed study is an integral part of the curriculum. Introduction to patients and clinical medicine occurs early in Year One with volunteer patients and in Year Two includes more advanced clinical findings with ‘real’ or simulated patients. There is also opportunity for students to work clinically during electives.

Year One

Unit 1: Foundations I (6-weeks)
Unit 2: Host Defence (9-weeks)
Unit 3: Metabolism I (10-weeks)
Unit 4: Human Development (8-weeks)
Unit 5: Rural Week (1-week)
Unit 6: Skilled Clinician I (33-weeks)
Unit 7: Professional Competencies I (33-weeks)
Unit 8: Electives (24-weeks - includes 6-week Family Medicine Experience)
Unit 9: Research in Medicine (33-weeks)

The units run consecutively as follows:
Units 1-5 run consecutively throughout the year
Units 6-9 run longitudinally

Year Two

Unit 1: Neuroscience (12-weeks)
Unit 2: Metabolism II (14-weeks)
Unit 3: Musculoskeletal and Dermatology (5-weeks)
Unit 4: Palliative Care, Oncology and Geriatrics (4-weeks)
Unit 5: Skilled Clinician II (35-weeks)
Unit 6: Professional Competencies II (35-weeks)
Unit 7: Electives (25-weeks)

Unit 8: Research in Medicine (33-weeks)

The units run consecutively as follows:
Units 1-4 run consecutively throughout the year
Units 5-8 run longitudinally

Clinical Years (Years Three and Four)

The clinical years are a continuum of 76 weeks’ clinical experience. Year Three begins in September and runs for 52 weeks. Core rotations in the clerkship years are completed throughout the Maritime Provinces. Med 4 is 26 weeks long and will complete the clerkship experience. Med 4 Electives are approved for placements locally, nationally and internationally. Clerkship includes the following units:

Year Three

• Positioning, Integration, Evaluation, Research, and Review (PIER) 1 (2-weeks)
• Emergency Medicine (3-weeks)
• Family Medicine (6-weeks)
• Internal Medicine (12-weeks)
• Obstetrics and Gynecology (6-weeks)
• Pediatrics (6-weeks)
• Psychiatry (6-weeks)
• Surgery (9-weeks)
• Positioning, Integration, Evaluation, Research, and Review (PIER) 2 (2-weeks)
• Research in Medicine (26 weeks)

OR

• Longitudinal Integrated Clerkship (LIC) Track (includes Research in Medicine and PIERs)

Year Four

• Electives (12-weeks)
• Non-Tertiary/Community Based (2-4 weeks)
• Interprofessional (2-4 weeks)
• Positioning, Integration, Evaluation, Research, and Review (PIER) 3 (2-weeks)
• Positioning, Integration, Evaluation, Research, and Review (PIER) 4 (6-weeks)

Courses Offered

The units in the curricula are listed alphabetically. Each unit is described briefly. Unit Heads and Clerkship Directors are subject to change.

Community-Engaged Service Learning Program (CESL) 

Faculty Leads: Dr. Marc Nicholson, DMNB; Dr. Dan Boudreau, DMNS

Through our social accountability mandate, Dalhousie Medicine offers the Community-Engaged Service Learning Program (CESL) during the first two years of Undergraduate Medical Education (UGME). CESL is a learning enrichment program integrated into the established curriculum and facilitated in partnership through the Office of Community Partnerships and Global Health. The program integrates health advocacy preparatory content into classroom-based learning (Professional Competencies 1) in first year with an optional community-engaged experience in second year. Students who opt to take part in the community-engaged “for credit” program component complete a minimum of 20 hours during the academic year. The experience includes critical reflection, participation in community-based settings, and the completion of a small project deliverable that is reciprocal in both learning and benefits driven by community-identified priorities. The projects are designed in collaboration with community partners, students and the CESL program. Students apply for the program and are either matched with community-based not-for-profit organizations or develop their own experiences (in consultation with the program’s leadership) based upon their own existing partnerships or interests. 

Electives (Years One and Two)

Unit Head: Dr. M. Rashid

The longitudinal Elective unit provides an opportunity for students to pursue an area of personal interest, have exposure to clinical medicine early in training, and supplement basic science learning with clinical medicine. It can also be a means of interprofessional education which is a process of developing and maintaining effective interprofessional working relationships with learners, practitioners, patients and communities to enable optimal health outcomes. The Elective unit comprises of 48 hours (12 sessions x 4 hrs) in one of the semesters for Med-1 and each of the two semesters for Med-2 students. The students can do an Elective in a variety of disciplines including traditional areas of medicine, basic sciences, and allied health. They develop their own specific learning objectives in consultation with their preceptors.  Students complete an Assignment during the Elective which could be a portfolio of purposeful collection of learning experiences, a case report, patient information material, etc. Elective is often an enjoyable and gratifying experience, both for the students and the preceptors.

Electives (Clerkship)

Assistant Dean, Clerkship: Dr. S. Field
Assistant Dean, Clinical Education DMNB: Dr. D. Smyth

The objective of the program is to provide flexibility and opportunities in order to: gain experience in aspects of medicine not offered in the regular curriculum; study particular areas of the curriculum in greater depth; and explore career opportunities. The clinical elective period consists of 18 weeks in Phase 2 (Med 4). Students will be expected to identify objectives centered on the CanMeds competencies.

Students will complete three two-week rotations with a focus on non-tertiary/community based care, and interdisciplinary clinical care. The goal of the non-tertiary/community based rotation is for students to learn about the differences in healthcare delivery in a smaller community versus tertiary care setting. Additionally, students are expected to broaden their clinical skills through their application in non-acute care settings, and community settings. The goal of the interdisciplinary rotation is to learn about the interdisciplinary management of patient care. Students must work with an interdisciplinary team and participate in decision-making and medical education of patients and their families. The rotation should have a focus on outpatient ambulatory care and further their knowledge, skills and attitudes related to interdisciplinary teamwork.

Emergency Medicine

Clerkship Director: Dr. L. Patrick
Clerkship Director, DMNB: Dr. M. Greer

All clerks are required to complete a three week core rotation in Emergency Medicine. All students will be required to attend weekly mandatory teaching seminars and departmental grand rounds.

Family Medicine

Clerkship Director: Dr. E. Davies
Clerkship Director, DMNB: Dr. S. Caines

During this unit clerks will complete six weeks in Family Medicine. Of the six weeks in Family Medicine clerks have the choice to complete either two, three-week rotations or one, six-week rotation. Family Medicine rotations are completed throughout the Maritimes, with a limited number of rotations within the Halifax/Saint John Metro areas.

Family Medicine Experience (FMEX)

Unit Head, DMNS: Dr. J. Hernandez-Lee
Unit Head, DMNB: Dr. S. Caines

One of the primary responsibilities of family physicians is to provide front-line health care that is accessible, of high-quality, comprehensive and continuous. The Family Medicine Experience (FMEX) provides early exposure to the discipline of Family Medicine, which will provide important context to medical students as they approach their learning. Medical students will engage in a formal reflection with their preceptor on the Principles of Family Medicine. Additionally, the Family Medicine Experience will provide opportunity for students to enhance their communication and physical examination skill development learned in Skilled Clinician; by observing and participating in components of the patient encounter.

Med 1 students will complete a 6-week longitudinal Family Medicine rotation (one half-day session per week). Rotations will be completed within the Halifax/Saint John Metro areas.

Foundations of Medicine I

Unit Head: Dr. T. Pulinilkunnil

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 major components in Med 1 Foundations consist of a review of cellular biochemistry and molecular biology (weeks one), biomedical and clinical concepts in anatomy, histology, pathology and pharmacology (weeks two to four), and an introduction to evidence-based practice (weeks four to six).

The cellular biochemistry and molecular biology component will highlight medically relevant and applicable concepts in genomes and gene expression, proteins and enzymes, cell structure and dynamics, metabolism and concepts in signal transduction.

The anatomy and histology component will cover concepts in macroscopic, microscopic, developmental and radiological anatomy and their importance in medical practice.

Pharmacology will focus on fundamental pharmacodynamics and pharmacokinetics concepts to understand the therapeutic nuances of clinically relevant drugs.

The pathology component will illustrate fundamental concepts in the detection of disease and nomenclature of distinguishing clinical features. As a longitudinal disease theme, cancer pathology and therapeutics will be introduced across these components.

This unit will also include a full day experience of shadowing a physician in his/her practice and presentations by clinical and biomedical researchers.

The evidence-based practice component will focus on finding, appraising, and using evidence from the medical literature.

Host Defence (Hematology, Infection, Immunity and Inflammation)

Unit Head: Dr. R. Davidson

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.

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

Unit Head: Dr. A. Williams

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 centeredness and community responsibility. The course will aim to provide a solid foundation for further development of these content areas in Med 2.

Internal Medicine

Clerkship Director: Dr. N. Forward
Clerkship Director, DMNB: Dr. J. LeBlanc

This 12 week unit will incorporate objectives of internal medicine and the medical sub-specialties. Clerks will complete a four week rotation on a medical teaching unit (MTU), and eight weeks on selective medical rotations. Of these eight weeks, students will be given choice from a selected menu for one month and can choose to complete one four week rotation at an out of town location provided that the pre-set criteria have been met.

Metabolism I (Gastroenterology, Endocrinology, Nutrition and Oral Medicine)

Unit Head: Dr. M. Irwin

The Metabolism and Homeostasis unit will introduce two new modules to the undergraduate curriculum - oral medicine (approximately one 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.

Metabolism II

Unit Head: Dr. A. Smith

This unit will present the major diseases of the cardiovascular, renal and respiratory systems. All three components of the unit will include pediatric and adult conditions. Cases will deal with the pathophysiology and clinical presentation of the major types of cardiovascular, renal and respiratory disease with appropriate coverage of physiology. Lectures and laboratory sessions will cover normal human physiology, anatomy and histology as well as the pathophysiology and principles of management of diseases affecting these three systems. Relevant radiology, including images, will be integrated throughout the three components. 

Musculoskeletal and Dermatology

Unit Head: Dr. A. Trenholm

This block addresses patient mobility and function in the performance of work, recreation and activities of daily living. It will focus on the unique elements of the clinical assessment required by the skilled-clinician for effective diagnosis and management of musculoskeletal and dermatologic conditions. S/he will learn the collaborative competencies of an effective team based professional while working with, from and about other health care providers in assessing the patient's environment for most effective management. Through application of skills of life-long learning concerning the impact of musculoskeletal and dermatologic conditions on the health care system and knowledge of effective preventive measures, the student will learn how they can positively affect patient outcomes for significant benefit to the community.

Neuroscience

Unit Head: Dr. K. Mukhida

The Neurosciences Unit focuses on the structure and function of the nervous system. Students are taught basic neuroanatomy and neurophysiology which serves as a foundation for the clinical component of the unit which focuses on neurologic and psychiatric disorders. The course also includes content related to the special senses of vision and cochlear/vestibular function as they relate to clinical neurosciences.

Obstetrics and Gynecology

Clerkship Director: Dr. R. Findley
Clerkship Director, DMNB: Dr. K. Howatt

The Obstetrics and Gynecology rotation will provide students with exposure to the care of patients during pregnancy, labour, and the puerperium. As well, students will have the opportunity to learn about a broad range of conditions and diseases relating to the female reproductive system. Students will learn through direct involvement in patient care, as well as seminar teaching and self study. 

Palliative Care, Oncology and Geriatrics

Unit Head: Dr. T. Daigle-Maloney

By the end of the unit, the student will be able to use a patient-centered approach to take into account the whole person (culture and context, illness experience, feelings and expectations) with respect to diagnosis and management while synthesizing relevant information from history, physical examination and investigations to develop an appropriate care plan. This includes incorporating evidence-based practice and clinical practice guidelines into the assessment, education and care of patients using a patient centered approach, and recognizing the limitations of clinical evidence.

Pediatrics

Clerkship Director: Dr. J. Holland
Clerkship Director, DMNB: Dr. A. Newman

Core pediatric clerkships for Dalhousie take place at sites in Nova Scotia, New Brunswick, and Prince Edward Island.  The number of students at any given site and the organization of experiences across sites varies, however for all clerks the goal is to provide an exposure to a blend of urgent/emergency, ambulatory clinic, inpatient, and newborn care.  There are regularly scheduled seminars for clerks at all sites.  Being on call is part of the educational experience.  All clerks complete an Adolescent Interview with accompanying patient feedback, write-up and reflection. The clerks are required to complete the Clinical Encounter Logs on the One45 system. The In-Training Evaluation Reports (ITERS) are available on the One45 system. The end-of rotation multiple choice question examination and OSCE are derived from the pediatric clerkship objectives.  The objectives and some practice questions are available for review on Brightspace, as well as all pertinent pediatric content for this 6-week rotation.

PIER 1

Unit Head, DMNS: Dr. A. Harris
Unit Head, DMNB: Dr. C. Rouse

This is the first of four PIER (Positioning, Integration, Evaluation, Research & Review) units that span the third and fourth years of medical school. The unit picks up on several of the longitudinal courses offered during Med 1 and 2 such as Communication Skills, Skilled Clinician, and Critical Thinking, and builds on content that prepares the student’s transition to the clinical setting. Collaborative learning workshops that incorporate discussions, procedural skills practice, and simulation sessions, PIER 1 facilitates the transition of medical students into the clinical setting as contributing members of the healthcare team.

PIER 2

Unit Head, DMNS: Dr. A. Harris
Unit Head, DMNB: Dr. C. Rouse

This is the second of four PIER (Positioning, Integration, Evaluation, Research & Review) units that span the third and fourth years of medical school. The unitcarries on with several of the longitudinal sessions from the previous PIER unit, including the Bootcamp Cases, Diagnostic Imaging and ECG workshops, communications sessions, and critical thinking curriculum. The unit contains workshops and clinical skills sessions designed to help students participate actively in patient care. The unit also includes sessions on preparing for theCaRMS application process.

PIER 3

Unit Head, DMNS: Dr. T. Dahn
Unit Head, DMNB: Dr. P. Frankish

This is the third of four PIER (Positioning, Integration, Evaluation, Research & Review) units that span the third and fourth years of medical school. The Unit carries on with several of the longitudinal sessions from the previous PIER units, including the Diagnostic Imaging and ECG workshops, communications sessions, and critical thinking curriculum.To prepare clerks for their fourth-yearelectives,studentswillhave the opportunity to practic eprocedural skills on clinical grade cadavers and will participate in a simulation day to prepare for on-call time during electives. The Unit also includes sessions on preparing the students’ CaRMS application.

PIER 4

Unit Head, DMNS: Dr. T. Dahn
Unit Head, DMNB: Dr. P. Frankish

Professional Competencies I

Unit Head: Dr. T. O'Donnell

The Professional Competencies I Unit is the first year of a two-year longitudinal Unit with weekly, three hour case-based sessions.  It is a clinically applied, integrated & longitudinal programme on the social aspects of medicine that imparts the knowledge and skills to: practice ethically and not just think ethically; practice within the law, and understand your legal duties; practice collaboratively; and practice patient-centered care.  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 the ethical and legal aspects of public health; end of life decision-making and other bioethical, clinical ethics, and legal challenges; patient safety and other health technology assessment, system and quality improvement approaches; social accountability and global health; physician wellness; and community and interprofessional collaboration to address challenges in health care equality and equity for priority communities. The Unit is taught from perspective in community health and epidemiology, bioethics, medical law, health policy, and medical humanities.

Professional Competencies II

Units Head: TBD

At the end of the Professional Competencies Unit, you will have the foundations to see yourself as a professional, and have the background understanding and skill exposure you need to take responsibility for diverse physician roles in healthcare and in the community. You will be prepared to work with in partnership with patients, caregivers, and communities in all dimensions - biological, emotional, cultural, and social - with a focus on improving the health of populations, keeping patients safe, shaping care to patients' needs and contexts, and working to sustain and improve the healthcare systems in which you work. This will set the groundwork for a life of 'meaningful work' in medicine.

Psychiatry

Clerkship Director: Dr. K. Black
Clerkship Director, DMNB: Dr. A. Faridi

During the Psychiatry Unit, clerks will be exposed to a variety of psychiatric disorders. Clerks will complete a six week rotation, which may include inpatient, outpatient, community, short stay, and consultation liaison psychiatry. Rotations will be completed in the Halifax/Saint John Metro Areas as well as other sites throughout the Maritimes.

Research in Medicine (RIM) Unit

Research in Medicine Unit Head & Char, RIM Committee: Dr. Anna MacLeod
Research in Medicine Unit Co-chair, DMNB: Dr. Colleen O'Connell

Starting in September of 2013 the Dalhousie Faculty of Medicine initiated an innovative enhancement in the undergraduate medical curriculum. A mandatory component, Research in Medicine (RIM) was implemented for all medical students starting in their first year of study. To practice medicine in the future, all students need to graduate from medical school with the knowledge, skills and attitudes that RIM can provide. Furthermore, the RIM program provides a solid base for clinicians of the future who will be capable of utilizing and contributing to evidence-based advances for improved health care and health outcomes.

The RIM Unit is a 3-year longitudinal program, beginning in September of first year with completion in September of fourth year. Research is built around an intensive summer studentship, typically in students’ first year and conducted under the supervision of a faculty mentor. RIM is designed to instill a high level of critical thinking and create a culture of inquiry among our learners. At the end of their undergraduate medical training, students should see themselves no longer as consumers of knowledge but as professionals with responsibility to generate knowledge to advance their profession.

Rural Week

Unit Heads: Dr. D. MacDonald (DMNS), Dr. A. Dysart (DMNB)

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, including collaborative multidiscipline care, 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.

Skilled Clinician (Years One and Two)

Assistant Dean, Skilled Clinician Program and IPE: Dr. A. Mishra
Skilled Clinician Course Director Med 1 & Med 2 DMNB: Dr. R. Morton
Unit Head - Med 1: Dr. M. Keating
Unit Head - Med 2: Dr. S. Workman

The Skilled Clinician Unit provides students with the skills to take a thorough history and perform a physical examination of a patient. These skills are essential to providing appropriate clinical care, and will prepare students for clinical electives and, later, in Clinical Clerkship. The material being taught in the Skilled Clinician Unit is closely linked to what 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.

Surgery

Clerkship Director: Dr. J. Rasmussen
Clerkship Director, DMNB: Dr. S. Smith

The nine weeks of the Surgical Unit are intended to provide the clerk with the broad principles of surgery and the basics in the individual surgical specialties as a foundation for postgraduate training. The clinical rotations are organized into three segments of three-weeks each.

All clerks will complete a mandatory three-week General Surgery rotation. There are two three-week selective rotations that can be chosen from the following nine specialties: Cardiac, Neurosurgery, Otolaryngology, Pediatric General Surgery, Plastic Surgery, Orthopedics, Thoracic Surgery, Vascular Surgery and Urology. Clerks will be scheduled for call duty, as these are important surgical experiences.

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