Clerkship Overview

Contact information for Clerkship Directors and Administrators:
http://www.md.utoronto.ca/clerkship-course-directors-and-administrators

Contact information for Academy Directors and Academy Staff: 
http://www.md.utoronto.ca/academies

 

Curriculum Design

The Clerkship is 76 weeks long, and is divided into year 3 (51 weeks) and year 4 (25 weeks).

Transition to Clerkship (TTC) occurs in the first two weeks of Clerkship. This curriculum provides students with the opportunity to gain knowledge and skills that will help them to successfully move from Foundations to Clerkship. TTC focuses on developing competency in teamwork, managing and applying evidence, quality improvement and patient safety. The course also includes sessions on medical-legal aspects of professionalism, public health, and gender and cultural diversity. Also included are two full days of instruction in Dermatology, involving: viewing a large number of patients with various skin findings; seminars; time to complete online learning modules; plus a written examination. Students also attend mandatory academy sessions which include an orientation to the academy, sessions on professionalism, infection control, crisis intervention and clinical skills training.

In year 3 of Clerkship curriculum, there are two 24-week blocks, one of which includes eight weeks each of Surgery and Medicine, four weeks of Emergency Medicine, two weeks of Anesthesia, and one week each of Ophthalmology and Otolaryngology. The other 24-week block includes six weeks each of Psychiatry, Paediatrics, Obstetrics & Gynecology, and Family & Community Medicine. Each rotation includes substantial time spent learning in the context of providing care to patients, often as part of a multidisciplinary team, in a variety of settings including ambulatory clinics, hospital wards, the emergency department, the operating room, the labour and delivery suite, among others. Rotations include a variety of assessments, including clinical performance evaluations, written tests and on several of the rotations, clinical skills assessments via oral or OSCE examinations.

During year 3, students participate in the Portfolio course which has been designed to facilitate students’ professional development through guided reflection, focused on all their activities in the clinical phase of their journey and how they relate to the six intrinsic CanMEDS roles of Collaborator, Communicator, Leader, Health Advocate, Scholar and Professional. The goal of the course is to promote greater professional self-awareness in each of these roles, as students enter the clinical world. Students attend one large group introductory session and seven mandatory small group meetings throughout the academic year. In the latter, students meet in small groups of up to eight, with one resident (Junior Academy Scholar) and one faculty member (Academy Scholar) to support them in reflecting on their experiences in the clinical setting, and the resulting effects on their professional development. Students will create portfolio submissions throughout the year for eventual inclusion in the final portfolio.

Student assessment includes an integrated OSCE (iOSCE) during year 3. The OSCE stations each consist of a simulated patient encounter during which students may be required to obtain a history, perform aspects of a physical examination, interpret diagnostic tests, provide patient counselling, suggest management or provide answers to questions related to the patient encounter. The first iteration, which provides principally formative evaluation, is held during week 24, and the second, which is a summative evaluation, is held during the penultimate week of year 3. Successful completion of the iOSCE is a requirement for graduation from the MD Program.

At the beginning of year 4, 13 weeks are allocated to elective experiences, where students are provided the opportunity to gain exposure to areas of expertise beyond the scope of the core Clerkship and to further enhance their training in sub-disciplines within the major specialties. Electives in Clerkship must be organized so that by the time of graduation, each student has had an elective experience in a minimum of three different disciplines, each of which takes place for a minimum of two weeks. Note that a discipline is any CaRMS direct-entry program.

Transition to Residency consists of the final 12 weeks of year 4. This course allows students to bring together many of the concepts they have learned about functioning as doctors and put them into practice in real world settings, where they get a chance to participate in the ‘real’ work of physicians, as preparation for postgraduate training. There are two campus weeks which contain classroom-based learning activities about concepts such as understanding chronic care, medical-legal and licensure issues, complementary medicine, fitness to drive, and a number of other topics. The two-week Fusion period brings the students back together for review of clinical material through lectures which help to prepare students for the Medical Council of Canada Part 1 Examination. The Selectives cover eight weeks and promote workplace-based learning, where students have increased (graded) responsibility under supervision, and allow the students to bring together many different areas of knowledge and skill in the care of patients or populations, as they get ready for the increased responsibility of their postgraduate programs. Selectives also serve as a resource for students to complete specific self-directed learning activities for course credit, and also include an evaluation performed by their supervisor(s). Students should experience how the competencies of Communication, Collaboration, Advocacy, Leader, Professionalism and Scholar all work together in ‘real’ clinical activity. Finally, students ideally should be able to interact with multiple disciplines (physician specialties, other health care professions) over patient care issues to develop a more holistic understanding of those issues.

Students are required to complete at least four weeks of the Selectives in a community setting, and at least one of the Selectives in either a Medicine or Surgery based area. It is possible that a single Selective can satisfy both requirements. Students may use one of their Selectives to satisfy the requirement for three CaRMS direct-entry electives.

 

Case Logs

All year 3 clinical clerks are required to log the required experiences defined in each core clerkship rotation using an online system called ‘Case Logs’. ‘Case Logs’ are entered and monitored in MedSIS. Each course has defined its required patient encounters (the patients’ presenting problems or diagnoses) and procedures that all students must log as part of the rotation. In order to achieve credit in any core clerkship rotation, students must complete, in full, all requirements on the encounter and procedure list. Details of the logging and review process are described in the policy Required clinical experiences in the core clerkship rotations: Responsibilities of students, faculty, and UME curriculum leaders (PDF).  An orientation to Case Logs is provided in the Transition to Clerkship (TTC310) course.  Additional information is available on Portal.

 

Clinical Responsibilities of Clerks

It is to be understood that a clinical clerk is an undergraduate medical student and not a physician registered under the Regulated Health Professions Act (RHPA). Clerks will wear name tags, clearly identifying them by name, and as a ‘senior medical student’, and they must not be addressed or introduced to patients as ‘Dr.’ to avoid any misrepresentation by patients or hospital staff.

Each student shall be under the supervision of a physician registered under the RHPA who is a member of a medical or resident staff of a hospital or who is a designated preceptor. Final responsibility for medical acts performed by clinical clerks rests with the clinical teacher or preceptor.

Recommendations for the scope of activities:

  • Documentation of a patient's history, physical examination and diagnosis. This must be reviewed and countersigned by either the attending physician, or another physician registered under the RHPA who is responsible for the care of the patient, if it is to become part of the official record in the patient's chart. Similarly, progress notes must also be countersigned.
  • Orders concerning the investigation or treatment of a patient may be written under the supervision or direction of a physician registered under the RHPA. Before these orders can be put into effect, the supervising registered physician must either 1) immediately countersign the order or 2) verbally confirm them with the healthcare personnel (usually nursing staff) responsible for their enactment. All orders must be countersigned within 24 hours.
  • Orders for medication or investigations are to be clearly and legibly signed with the signature of the clinical clerk followed by the annotation "cc". Students should make a practice of printing their name below their signature.
  • Guided by the principles of graded responsibility, medical students engaged in clinical activities may carry out controlled acts, according to the RHPA, under direct or remote supervision, depending on the student's level of competence. In the latter case, these acts must be restricted to previously agreed upon arrangements with the registered physician who is responsible for the care of the patient.
  • A clinical clerk is not permitted to submit prescriptions to a pharmacist unless they are countersigned by a registered physician.

For more information, please visit the College of Physicians & Surgeons of Ontario’s Policy on Professional Responsibilities in Undergraduate Medical Education.

http://www.cpso.on.ca/policies-publications/policy/professional-responsibilities-in-undergraduate-med