Clinical

The 63-week Clinical program consists of three phases: Transition to Residency, Clerkship Foundations, and Transition to Residency.

The Transition to Clerkship period (3 weeks) was jointly developed and delivered through collaboration of the Pre-Clerkship, Clinical Skills, and Professional Competencies teams. This phase will focus on: (a) practical skills sessions; (b) opportunities for in-depth orientation/introduction to specific clinical environments such as the operating room (e.g., “scrubbing in”), clinic, and ward; (c) review and practice of common practical skills; (d) opportunities to learn and/or practice objectives and skills currently taught in specific rotations; (e) opportunities to revisit and transition concepts introduced through the Clinical Skills and Professional Competencies curricula that are important for Clerkship.

The Clerkship Foundations phase (44 weeks) begins immediately after the three-week Transition to Clerkship phase. This phase includes 9 core rotations and 12 weeks of electives. There will be 7 core rotations that are 4 weeks in duration (IM, OB/Gyn, Surgery, Psychiatry, Pediatrics, Family Medicine, and Emergency Medicine). There will be 2 rotations that are 2 weeks in duration (Anesthesia and Orthopedics).

The Transition to Residency phase (16 weeks) will consist of 6 rotations of 2 weeks duration in: Specialty Selectives, Internal Medicine, Pediatrics, Psychiatry, Surgery, and Family Medicine. Five of these rotations (all excluding SS) will be “Plus Two” rotations allowing students to revisit rotations they experienced in the Clerkship Foundations phase. There will be a total of 4 weeks of electives in this phase with 2 weeks occurring prior to the 3-week residency interview period.

The compulsory components of the Clinical program are carried out in teaching practices and in all the teaching hospitals in the regions of each campus: Waterloo, Niagara and Hamilton. As well, many clinical placements occur in the communities associated with the Rural Ontario Medical Program.

Because of the proposed changes to the pre-clinical portion of the renewed curriculum, students will be better positioned to call upon and consolidate knowledge and skills during their clinical rotations. During the national residency interview period, students will be able to focus on interviews and clinical responsibilities consecutively rather than concurrently.

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Anesthesia
This is a 2-week rotation during which students are exposed to many concepts of anesthetic practice in a combination of small group sessions, problem-based learning, part-task and full-body simulators and clinical environments.

The objectives are:
- To acquire an appreciation of the multifaceted discipline of Anesthesia
- To acquire an understanding of the clinical application of physiology and pharmacology to patients of all ages
- To acquire the basic practical skills of airway and circulatory management
Emergency Medicine
During this 4-week rotation, students will learn to:
- Demonstrate the ability to rapidly recognize and initiate basic management of acute life- or limb-threatening illness or injury
- Describe a basic differential diagnosis including the significant worst-case diagnosis for every patient assessed
- Demonstrate a basic systematic, prioritized approach to resuscitation and stabilization of emergencies
- Demonstrate a basic ability to distinguish seriously ill or injured patients from those with minor conditions
- Demonstrate a focused history and physical examination
- Distinguish which conditions are life-threatening or emergent from those that are less urgent
- Demonstrate the ability to evaluate and initiate treatment of the undifferentiated patient
- Describe the concept of triage and prioritization of care, including paraphrasing the use of CTAS. Recognize that certain groups of patients require a high index of suspicion for serious illness (e.g.,immunocompromised, chronic renal failure, transplant, extremes of age, intoxicated, and diabetes)
Family Medicine
The 4-week Family Medicine rotation revolves around a one-to-one experience pairing a student with a community-based family physician. The most significant component of the Family Medicine rotation is this time spent with the clinical preceptor in the office setting.

Family Medicine Clerkship can offer selective opportunities in Sports Medicine, Hospitalist Medicine, Women's Health and other area of special interests in Family Medicine.

The overall goals of the program are for all students to have:
- An understanding of the broad scope of family medicine
- An understanding of how virtual or same-site interprofessional teams function in the context of the primary care environment
- Appreciate the challenges in addressing complex, diverse patient care issues longitudinally
- Appreciate the nature of some of the specific challenges in the provision of primary care to patients, such as addressing undifferentiated illness, chronic illnesses and preventive care issues.
- Gain skills and experience in meeting patients’ needs for prevention, problem identification and management, and complex disease management through episodic care of patients and their families in the community practice setting
The cornerstone of the family medicine experience is the close relationship that learners develop with their preceptors when working together in the delivery of care to patients in the preceptor’s office, but also in other contexts such as long-term care, palliative care, and hospital settings.
Internal Medicine
Internal Medicine is a challenging and diverse specialty comprised of physicians who care for a broad range of adult patients with both acute and chronic conditions. They are also involved in health promotion and disease prevention. They treat a wide of conditions and provide compassionate care to a diverse group of patients. Internal Medicine physicians need to be experts in multiple domains including: history and physical exam skills, diagnostics, therapeutics, communication, team interaction, interdisciplinary collaboration, and patient advocacy.

The Internal Medicine rotation consists of a 4-week core rotation and a 2-week mandatory subspecialty selective rotation. The core rotation in Hamilton occurs at one of 3 hospital-based Clinical Teaching Units and there are also ward-based rotations at the hospitals associated with the Kitchener/Waterloo and Niagara campuses. The Internal Medicine clerkship objectives are a framework of basic competencies which are appropriate for mastery by clinical clerks during their rotation, and which include the content knowledge objectives.

Internal Medicine Clerkship Objectives are achieved in the following areas:
- History and Physical Examination
- Case Presentation
- Problem Formulation: Diagnosis
- Problem Formulation: Therapy
- Communication with patients
- Professionalism
- Bioethics of care
- Self-directed learning
- Basic Procedures
- Care of the Elderly
Obstetrics and Gynecology
The Obstetrics and Gynecology rotation is a dynamic 4-week clinical rotation where learners are assigned to a hospital site. Students will participate in their specific site call schedule and will spend a majority of their time in Triage on the Labour and Delivery Ward (Although each site will have some differences).

Students will mainly be participating in approximately 12-hour shifts focused on care in triage at L&D wards. In some sites additional time will be spent in clinics. This may differ depending on each individual site. Some of the learning you will obtain will be:
- labour assessments
- fundal heights
- fetal heart monitoring
- reviewing antenatal records
- dealing with pregnancy-related illnesses
- speculum exams (if ruptured membranes)
Orthopedic Surgery
The Orthopedic Surgery core is a 2-week rotation.

Students become familiar with the following areas (and when applicable with the signs, symptoms, relevant investigations, treatments and prognosis) of:
- Fractures and dislocations.
- Painful and/or swollen joints.
- Limb deformity (Paediatric/malunion)
- Inflammatory and non-inflammatory arthritis.
- Musculoskeletal tumors.
- Cervical/low back pain and sciatica
Pediatrics

The pediatrics clerkship rotation is a 4 week rotation during which students have exposure to both ambulatory and inpatient pediatrics care. The student inpatient experience often focuses on children with more severe or chronic diseases. Education about health maintenance, disease prevention, common illnesses, focused interviewing and clinical problem-solving as well as knowledge of community resources is provided by using community-based general pediatrics office experiences. Subspecialty clinics provide a unique experience to gain an intimate understanding of complex childhood conditions. Resource sessions consisting of 18 faculty lead teaching sessions will occur weekly. A series of 31 e-learning modules, which comprehensively cover the core objectives in pediatrics, will be completed during the 4 week rotation.
Psychiatry

The Psychiatry clerkship rotation is a full-time four-week rotation during which students are exposed to various psychiatric patients and settings. The rotation is comprised of several components including a clinical placement (which generally involves at least two different clinical settings), Psychiatry emergency room on-call experience, and a mandatory academic half day which includes teaching and tutorial sessions of various formats. Clinical placements may be in Hamilton, Waterloo, Brampton, Niagara region, or surrounding community settings (e.g. Burlington, Oakville).
Surgery

This is a 4-week rotation during which students are involved in a variety of clinical scenarios and learning opportunities designed to enhance their knowledge and skills. They interact with patients and their families in all aspects of surgical care (hospital wards, outpatient clinics, operating room, emergency department, intensive care unit, etc.). They are part of a team of highly qualified physicians and other health care professionals.

The aim of the surgical clerkship is for the students to achieve a defined body of knowledge, skills and attitudes necessary for the recognition and understanding of the management of patients with diseases which may be treated by surgeons. This clerkship will provide the foundation necessary for the student to enter into any field of medical practice.