Our Curriculum

Communication is a basic clinical skill. There is evidence to support that:

• Effective Communication skills training can lead to improvement in patient and physician satisfaction and that it can significantly improve health care outcomes.
• The use of specific core skills make a difference in doctor-patient communication and its outcomes.
• An experiential skills-based training approach is an effective method to transform knowledge and attitudes into competent professional behaviour.
• Specific teaching methods are particularly effective in learning this skill, including observation, feedback, and reiteration.

Based on recent evidence on communication skills from the Kalamazoo Consensus, these competencies in communication and interpersonal skills would include the ability to:

• Build and sustain a trusting relationship
• Open the discussion
• Gather information
• Understand the patient's perspective
• Share information
• Reach agreement
• Provide closure

The competent graduate will have a sound knowledge of:

• Concepts, principles and research evidence that support the importance and efficacy of developing communication and interpersonal skills in medicine.
• Communication tasks and skills required to build a therapeutic relationship and to conduct an effective interview with the patient.
• Communication tasks and skills required to communicate effectively about the patient.
• Communication tasks and skills required to communicate effectively about medicine and science.

Skills in lifelong learning have been identified by both the College of Family Physicians of Canada and the Royal College of Physicians and Surgeons of Canada as requirements for competent practice. In a rapidly changing health care environment, physicians need to be information literate in order to keep up to date and to deliver best practice effectively and efficiently. The competent McMaster graduate should therefore:

• Recognize personal limits in knowledge and pursue the information necessary to understand and solve problems in a clinical setting
• Search for information in an effective and efficient manner
• Apply acquired knowledge effectively in the clinical setting
• Self assess and self correct
• Demonstrate an active commitment to the pursuit of knowledge
• Have started a plan for lifelong learning to maintain competency
• Display competence in basic clinical problem-solving and decision-making

Reflection and Evaluation provide the framework for all the component parts of the model.

• Reflection is the deliberate consideration of all the learning and experience you bring to the task and, very importantly, of what you take away from it. The outcome of the process will result in new perspectives on experience, a change in behaviour, or the commitment to action.
• Evaluation is the assessment of your progress towards your objectives or to the problem’s solution. It will be both informal (self-evaluation and evaluation by your peers) and formal (use of tools specified for the task).
• Problem and/or Patient is a description of a health care problem provided to you or an actual patient presenting to you. This step helps to identify your knowledge gap and drives the subsequent steps of the cycle. You will work to understand the simulated problem or to address the patient’s problem.
• Definition of Questions in considering the entire problem you will identify what issues are relevant to your purpose and prepare questions that are clear, addressable and will illuminate decisions related to the problem and/or patient.
• Information Seeking is the identification of appropriate sources and the information in them that you need to address your questions.
• Validation and Integration are the processes in which you will assess, with help if necessary, the adequacy and accuracy of the information you have collected. You will then integrate this information with what you already know in order to answer your questions and/or to resolve the problem or patient situation.
• Decision making can take place when you have determined that you have adequate information to permit subsequent action and that you have assessed the impact of the decision.
• Action will be depend on the extent to which you believe that you understand the problem. It may include asking new questions, seeking new investigations or undertaking patient care, i.e. it is taken only after a thorough reconsideration of the original problem. This completes the cycle.
  
  At any stage it may become apparent that some part of the cycle must be repeated because new insights were gathered that had not been considered before.
• Preparation and Application show the relative emphasis expected; the dividing line is arbitrary. Preparation indicates emphasis on appropriate knowledge collection and activation of stores of prior knowledge; Application includes decisions and actions that may include patient care.

Some topics that will be addressed include:

• Introduction to ethics in healthcare
• Ethics and professionalism
• Where autonomy ends and justice begins: rethinking the primacy of autonomy in health care
• Consent conundrums
• End of life issues
• Ethical issues in reproduction
• Genethics
• Resource allocation
• Uncertainty and expectation
• Ethical issues in mental health
• Confidentiality
• Medical research

Population health refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services.

Goals of Population Health

• To maintain and improve the health status of an entire population
• To reduce inequities in health status between population groups (The Population Health Template, Health Canada, 2001)

Topic areas to be covered:

• Determinants of health
• Health status assessment
• Interventions at the population level
• Health of special populations

The competent graduate:

• Recognizes the diverse factors that influence the health of the individual and the community
• Identifies the sociocultural, psychological, economic, occupational, environmental, legal, political and spiritual factors impacting health and health care delivery
• Responds to these factors by planning and advocating the appropriate course of action at both the individual and community level

Pre-Clerkship

• Values constructs foundational to the practice of medicine and the delivery of health care, including issues related to vulnerable and marginalized populations, and the recognition of cultural diversity using a broad definition and understanding of culture.
• Importance of personal and professional ethics
• Laws, legislations and professional codes relevant to medical practice
• Range and scope of contemporary medical practice and understanding of the role of the physician in emerging health care models
• Organizational structures applied within institutions and agencies accountable for the delivery of health care
• Different models related to team versus hierarchical structures and understanding strategies for successful team functioning
• Skills of negotiation and conflict resolution

Clerkship

• Management of practice environments including charting, public reporting expectations, and malpractice privileges
• Appropriate behaviours, habits and skills required for referral and consultation
• Standards of care, institutional policies and standard operating procedures.

Physicians who have an understanding of the social and cultural dimensions of health are able to analyzehealth issues more cogently and to interact with patients more effectively. In the McMaster medical education curriculum, we use the tools of social science to explore the concept of culture and its relevance to medical practice. Students will learn skills and attitudes that promote cultural competence and cultural safety, and they will have the opportunity to use these skills when they meet with immigrants and refugees from our local community. Aboriginal health is also an important area of focus in this domain, part of a national educational initiative across Canadian medical schools.

Much of medical training focuses on learning about disease processes and their treatment. Yet for the patient, the experience of the illness is often the most compelling. Making meaning out of serious illness is a key aspect of the healing process. Medical anthropologists have made valuable contributions to the understanding of illness experience, and these insights can help medical students and physicians respond to their patients with greater empathy.

There are many bridges between this domain and others within the Pro Comp curriculum. The social context of health is a key focus of the Population Health domain; cultural competence is linked closely with communication skills, and reflection about our response as physicians to the patient’s illness experience is part of self-awareness.

Topics addressed will include:

• A social science perspective on culture and health
• Cultural competency and cultural safety
• The effects of oppression on health (racism, classism, etc)
• Gender and health
• An introduction to aboriginal health
• Immigrant and refugee health
• Perspectives on the illness experience – suffering and healing
• Narrative and the creation of meaning

Prior to entering clerkship, students will be expected to:

• Gain an appreciation for the social science perspective on medical practice.
• Develop a critical understanding of various approaches to cultural competency.
• Develop a set of skills and attitudes that foster cultural safety.
• Recognize the influence of oppression in its various forms (racism, sexism, classism, etc) on health.
• Be able to view health through a “gender lens”.
• Understand historical perspectives on aboriginal health, as well as current challenges and new initiatives.
• Demonstrate an awareness of key health challenges faced by immigrants and refugees.
• Develop an appreciation for different “ways of knowing” about the body, and how this affects the
  clinical encounter.
• Recognize the difference between disease and illness, and have an approach to understanding the patient’s illness experience.
• Gain an appreciation for the use of narrative in the process of meaning-making, both for patients and for clinicians. 

The McMaster Faculty of Health Sciences is highly committed to interprofessional education. Under the leadership of the Program for Interprofessional Practice, Education and Research (PIPER), the Undergraduate MD Program supports students in interprofessional experiences throughout their training.

As such, medical students will demonstrate IPE competencies prior to graduation. Our goals with respect to IPE align with the Centre for the Advancement of IPE in Great Britain (CAIPE), who defines IPE as: "when two or more professionals learn with, from and about each other to improve collaboration and quality of care".

In 2010, the World Health Organization recognized Interprofessional Education / Interprofessional Collaboration (IPE/IPC) as an, "important strategy for strengthening healthcare systems worldwide". McMaster's Faculty of Health Sciences and the Undergraduate MD Program have embraced CAIPE's model of IPE outlined below:

IPE Competencies: Graduates will:

• Be able to describe their own professional roles and responsibilities and the scope of practice of other health professionals to colleagues as well as patients.
• Know when and how to involve other professions in patient care appropriate to their roles, responsibilities, and competence.
• Collaborate with other professions to establish common goals, provide care for individuals and their caregivers, facilitate shared decision making, problem solving, and conflict resolution.
• Contribute to team effectiveness by sharing information, listening attentively, respecting others opinions, demonstrating flexibility, using a common language, providing & responding to feedback from others