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, 2011 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 (CCMS) 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 (12-weeks)
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: Integration (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)

Research in Medicine (RIM) Program

RIM Unit Head & Char, RIM Governance Committee: Dr. Anna MacLeod
Associate Unit Head, DMNB - Dr. Amanda Caissie

The Research in Medicine (RIM) Program is designed for all medical students enrolled in the Dalhousie Medical School and is meant to develop skills of critical thinking and creativity through a mentored research project conducted longitudinally throughout the four-year curriculum. Our graduates will be able to advance knowledge in their profession and will be equipped for 21st century medical practice. During the first term of Med 1, didactic courses will expose all students to essential research skills. Completion of this program, including presentation of research findings, takes place in fourth year and is a requirement for graduation. An innovative system of web-based supports will facilitate learner-mentor communication. The Research in Medicine Program represents the first of its kind in Canada. For more information, contact the unit coordinator email rim@dal.ca. 

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

• 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)
• PIER 2 (2-weeks)
• RIM (26 weeks)

OR

• LIC Track (includes RIM and PIERs)

Year Four

• Electives (12-weeks)
• Non-Tertiary/Community Based (2-4 weeks)
• Interprofessional (2-4 weeks)
• PIER 3 (2-weeks)
• 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.

Skilled Clinician (Years One and Two)

Assistant Dean of Clinical Skills: Dr. A. Mishra
DMNB Clincial Skills Director: Dr. R. Morton
Unit Head - Med 1: Dr. M. Keating
Unit Head - Med 2: Dr. O. Loubani

The Clinical Skills Unit gives students the tools they will require in clinical electives and, later, in Clinical Clerkship. In this Unit, students will learn Communication skills to take a thorough history and perform a physical examination of a patient. One of the major goals 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.

Electives (Years One and Two)

Unit Head: Dr. M. Rashid

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 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.

Electives (Clerkship)

Assistant Dean, Clerkship: Dr. S. Field
Assistant Dean, Clinical Education DMNB: Dr. R. Boulay

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. C. Cox
Clerkship Director, DMNB - Dr. C. Vaillancourt

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. K. Horrey
Clerkship Director, DMNB - Dr. M. Simon

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: Dr. K. Horrey

The Family Medicine Experience (FMEX) provides an opportunity for medical students to gain early exposure to the discipline of Family Medicine, One of the primary responsibilities of family physicians is to provide front-line health care that is accessible, of high-quality, comprehensive and continuous and it’s introduction to medical students early in their training will providing important context as they approach their learning. 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, in some cases, participating in components of the patient encounter.

Med 1 students will complete a 6-week longitudinal Family Medicine rotation.  During this rotation they will engaged in a formal reflection with their preceptor on the Principles of Family Medicine.

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 two major components consist of a review of cell and molecular biology (weeks one to three) and an introduction to evidence based practice (weeks four to six). 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.  

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. C. Adams

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.

Integration

Unit Head: Dr. J. Gordon/Dr. L. Wood/Dr. D. Carver

By the end of the Integration 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.

Internal Medicine

Clerkship Director: Dr. B. Kidwai

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.

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. H. Rigby

The Neurosciences Unit focuses on the structure and function of the nervous system. In addition to basic anatomical and physiological content, this unit includes material relevant to the Clinical Neurosciences, focusing on the nervous system as it relates to neurological disorders and psychiatric conditions. This course will also include the special senses of vision and cochlear/vestibular dysfunction as they relate to clinical neurosciences.

Obstetrics and Gynecology

Clerkship Director - Dr. J. Coolen

The Obstetrics and Gynecology rotation will be structured to provide a broad view of reproductive health as it pertains to women, covering the full spectrum from birth to climacteric. The aim of the rotation is to provide opportunity for good clinical exposure.

Pediatrics

Clerkship Director - Dr. J. Holland
Clerkship Director, DMNB - Dr. S. Gander

The six-week rotation in Pediatrics will have students located throughout the Maritimes. Regular tutorials are held at noon and all are conducted from the IWK and connected to the sites by video conferencing. Selected tutorials also include the students in Saint John by videoconference. A community project or clinical case and an adolescent interview are included in this rotation. Students will be expected to present their projects and submit a write-up of the adolescent interview. All students will have in-patient experience and follow their own patients from admission to discharge. The ambulatory portion of the rotation includes the Emergency Department, General Pediatrics and, where applicable, subspecialty clinics.

Psychiatry

Clerkship Director - Dr. C. Murphy
Clerkship Director, DMNB  - Dr. E. Maxan

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.

Professional Competencies I

Unit Head: Dr. B. Capps

The Professional Competencies I Unit is the first year of a 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.

Professional Competencies II

Units Head: Dr. J. Adelson

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.

Rural Week

Unit Head: Dr. D. Field/Dr. M. McQuaid

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.

Surgery

Clerkship Director: Dr. C. Coles
Clerkship Director, DMNB: Dr. T. Whalen

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.