Foundations Overview

In This Section:

The MD Program at the University of Toronto is one of the largest undergraduate medical education programs in Canada. We are proud to support and promote the development of future academic health leaders who will contribute to our communities and improve the health of individuals and populations through the discovery, application and communication of knowledge.

The U of T MD Program, like most North American medical schools, is four years in length. The final two years are known as the Clerkship (which involves learning while working with physicians and other health care team members in the hospital and clinic). The first two years of the program - known as Foundations - take place in laboratory, classroom, clinical, and community settings and are designed to prepare students for the workplace learning that occurs in Clerkship.

 

Curriculum Structure

There are three major dimensions to the Foundations Curriculum: courses, components, and themes. An important feature of the Foundations Curriculum is that each week has the equivalent of a full day that is unscheduled, and available for self-study, and special activities such as clinical skill development.

Courses

  • Introduction to Medicine: An introduction to the basic and social sciences relevant to medicine, to cognitive science, to clinical skills and community health

  • Concepts, Patients and Communities 1: An instruction on health and the diagnosis and treatment of disease relevant to all of the body’s systems, including a consideration of all of the major curricular themes

  • Concepts, Patients and Communities 2: A continuation of Concepts, Patients and Communities 1

  • Concepts, Patients and Communities 3: A continuation of Concepts, Patients and Communities 1 and 2

  • Life Cycle: An instruction on health and disease from conception, antenatal development, birth, infancy, childhood, adolescence, aging, and for patients who are dying

  • Complexity and Chronicity: A consolidation of the program with emphasis on chronic disease management, and complex problems with preparation for Clerkship

Components

Toronto Patient-Centred Integrated Curriculum (TOPIC): In TOPIC, content is delivered through lectures, workshops, eLearning materials, anatomy labs as well as case-based learning (CBL) sessions. In CBL, students work through a patient case in small groups of 8 – 10 students in two sessions each week: the first one is on their own, the second is with a tutor who is a faculty member. The majority of the faculty tutors are practicing physicians based at one of the GTA teaching or community hospitals. Over the 72 weeks, the cases introduce students to all aspects of clinical medicine. Each case describes a medical problem in a patient (or occasionally a family) and offers students the opportunity to learn material in a clinically relevant way while introducing them to the scientific and humanistic foundation for the theory and practice of medicine.

Learning about the cases is supported through carefully selected eLearning materials. Each week is introduced by a half-day during which a small number of lectures provide context for the issues addressed during the week. Another half-day consists of expert-led seminars or workshops which serve to provide further context and content. Every few weeks, there is a multi-disciplinary summary lecture to help pull it all together for students.

Many of the weeks include specific instruction on the longitudinal thematic issues (described below), such as medical ethics, leadership and collaboration with other health professionals.

Integrated Clinical Experience (ICE): ICE occupies two half-days per week. One half-day provides students with instruction in groups of six on how to take a patient’s history and perform a physical examination (ICE: Clinical Skills).

The second half-day for ICE provides students with opportunities for early clinical exposure in a variety of settings, include doctors’ offices, hospitals, community health agencies and home care visits (ICE: Health in Community).  There are also simulated patient encounters which allow students to develop an understanding of the roles of other health care professionals and gain an appreciation of patients' experiences (ICE: Medical Psychiatry). Throughout the Foundations Curriculum, students will be able to prepare for Clerkship by spending time in clinical placement shadowing opportunities (ICE: Family Medicine Longitudinal Experience; ICE: Enriching Educational Experiences).

Portfolio: Students will spend a half-day every three to four weeks in a small group with a tutor in Portfolio. Portfolio focuses on two types of activities:

  • Students will reflect on their previous experiences and their experience as first- and second-year medical students and the resulting effects on their professional development.

  • Guided self-assessment: students will compile their formal assessments and the student’s reflections and develop an individualized learning plan related to these assessments to ensure students are staying on track, and receiving help where it is needed.

Health Science Research (HSR): HSR provides students with lecture, tutorial and eModule-based learning on two major topics:

  • How to participate in health research projects.

  • How to apply the findings of health research to patient care.

Themes

Curricular themes are embedded in the Foundations Curriculum.  For more on the MD Program's curricular themes: http://md.calendar.utoronto.ca/curricular-themes

 

Educational Learning Modalities

The students’ weekly teaching and learning experience will occur using a variety of learning modalities that are selected based on the desired learning outcomes and the integrated blended learning teaching model that is used in the MD Program Foundations Curriculum. Modalities that are used to meet the learning outcomes include: (a) Independent Learning; (b) Large Group Lectures; (c) Small Group Learning/Discussions (d) Anatomy Labs; and (e) Experiential Learning.  

Each of these learning modalities is described below with examples on how it is used in the MD Program Foundations Curriculum.

Independent Learning

Each week students are provided learning content that they are expected to learn on their own. This material has been specifically selected or designed to provide foundations content required to effectively engage in subsequent learning tasks during the week.

a) Pre-week preparation (PWP)

  • These are online foundational resources (e.g., readings, videos, e-learning Modules, etc.) that support basic learning objectives of the week.
  • Students are expected to study independently these materials and understand the content prior to the start of the weekly lectures.

b)   Self-learning modules

  • Certain learning outcomes that are not covered by one of the other face-to-face educational learning modality described in this document can be addressed by students on their own using any of the following predesigned self-learning modules in the form of: (a)  preselected or  predesigned reading; (b) e-learning Module; (c) education video; (d) or a practice exercise with answers.
  • Students are expected to study these materials independently during the week in preparation for small group discussions and mastery exercises.

Large Group Lectures

During the week teaching and learning also occurs in the form of large group lectures that are video-conferenced between Medical Sciences Building at the St. George Campus and the Terrance Donelly Health Sciences Building at Mississauga Campus.  Some, but not all, of these lectures are recorded for future viewing.

a) Foundational lectures for TOPIC

  • There are live lectures that are scheduled on the first day of each content week. These lectures may serve several purposes:
    • To build on material covered in the pre-week preparation
    • To serve as a broad introduction to material that will be covered in greater depth in the Case-based learning (CBL) and self-learning modules
    • To provide an opportunity to teach concepts best conveyed in a lecture format

These lectures are designed to be engaging and incorporate various active learning strategies (e.g. use of audience response system, questioning, small group dialogues, using patient or clinician panel) instead of the traditional didactic style. Lecturers may quiz the class on the PWP materials to identify learning gaps for further discussion during lectures. This is a form of “flipped-classroom” – the students are expected to be prepared by completing the pre-week learning (see Independent Learning description) before coming to lectures for a more engaging active learning experience. 

b) Component and Theme Lectures

  • These lectures, held centrally at the St. George and video-conferenced to the Mississauga campus, are led by faculty and/or content experts, including non-physicians. They will teach and interact with students on content and skills relevant to a particular component/ theme (e.g., ethics, leadership).

c) Integrated and application lectures (ISAL)

  • These lectures occur at the end of every sub-section of each course and provides an opportunity for faculty to summarize key concepts, to reinforce learning points, and to teach about any challenging/difficult concepts encountered by students (e.g., during CBL or weekly feedback quizzes). Some of this review will be directed by students’ questions that have arisen throughout the subsection, but there is also an opportunity for students to ask questions during the ISAL.
  • Sample multiple-choice questions and/or clinical cases are often used during ISAL to demonstrate the application of concepts. Patients may also be invited to discuss their lived experiences, which will help to bring the conditions taught to life and to provide students with a more comprehensive understanding of both the medical and psychosocial aspects of such conditions.
  • Attendance is mandatory when patients are present. From time to time, additional material (e.g., previously not discussed case examples or slides) may be introduced in order to reinforce or clarify concepts previously taught. This material will not be assessed per se, but the learning objectives relating to these materials will be highlighted by the faculty.

Small Group Learning

To support guided discovery learning a significant proportion of teaching and learning opportunities occur in small groups guided by a faculty member. Small groups may be run as tutorials, workshops, or seminars.

Tutorials

Tutorials include the following: (a) Case-based Learning (CBL) tutorials; (b) ICE: Health in the Community (HC) tutorials; (c) ICE: Clinical Skills tutorials; (d) Portfolio Tutorials; and (e) Health Sciences Research (HSR) tutorials.

a) CBL Tutorials

  • CBL tutorials focus learning around a weekly patient case that is presented as a virtual patient in an online module. Student learning occurs in a group of 8-10 students who go each week through the CBL module in two face-to-face small group sessions.  The first CBL tutorial is run by students on their own (student-led face-to face discussion) and the second is guided by a CBL tutor (faculty-led). Within each case, there are approximately 10-15 embedded questions that represent typical questions that a preceptor could ask during bed-side clerkship teaching and that require student learning that aligns with the weekly learning outcomes. Some of these assignment questions are to be responded to together by the group (group questions) during their first CBL session and the reset are to be prepared by each student on his or her own (independent  study questions) prior to the second CBL session.  The group assignment questions are designed to ensure students have grasped the fundamental building blocks of the clinical problem that is being discussed in the CBL module, and the group will have to answer and submit collaboratively developed answers to the faculty CBL tutor by the end of the student-led CBL session. The independent study questions required students to dig more deeply into specific aspects of the clinical problem. Answering of these questions may require completion of the mid-week self-learning modules and/or bringing in additional resources either from materials that have been provided for the week or new materials from the literature.
  • One of the important objectives of CBL is to support discovery learning, which encourages students to engage in active learning and  “productive struggle” and to learn the content more deeply through active participation in problem solving. The goal of discovery learning is to encourage understanding of concepts and deep learning, as opposed to just memorization and surface learning.  Learning for understanding of concepts and struggling in the process to learn how to apply the learning to patients require students to think innovatively and creatively and through this process lay down  the foundations  upon which students can develop abilities to  problem solve in clinical situations that fall outside of the usual and routine problems. This is known as adaptive expertise.
  • The CBL format aims to create an understanding-oriented learning environment that fosters exploration, explanations, and mechanisms behind clinical presentations. This is in contrast to a performance-oriented learning environment that simply focuses on completing the task by identifying the correct answer. Struggle, risk-taking, and productive failure are all encouraged and supported, and do not have to wait until the faculty-led CBL session. Together, they should constitute an important facet of student-led CBL as students work through the group assignment questions. This is very much like the experience students will have working with a team of colleagues during clerkship, residency and ultimately in clinical practice.
  • In addition, each CBL case will include “what if scenario” - questions posed by CBL tutors during faculty-led CBL. These are new questions students have not seen before. The goal of this activity is to expose students to meaningful contextual variation, as in, looking at the concepts in the CBL from a different context or angle. Asking students to apply their new knowledge to a slightly different context or scenario can consolidate their learning of the concept, and uncover any gaps in understanding, and help them transfer their learning to new contexts. Furthermore, being exposed to a new clinical scenario “on the spot” encourages the development of adaptive expertise. Sometimes these “what if” questions will be followed up with questions to help students appreciate the importance of the concept or reflect on why seeing the concept in a different context is important to their understanding.

b) ICE: Health in Community Tutorials

  • These tutorials are led by a team of two academy-based tutors including one physician and an allied health professional.  Tutorial groups contain 6-8 students. The ICE: HC tutorials provide an opportunity for small group discussion and reflection. Tutors will guide students through discussion of cases, videos, podcasts and articles focused on topics related to social determinants of health, health promotion, disease prevention and public health and population health. In addition, the tutorials also provide students with an opportunity to present and reflect on the field experiences

c) ICE: Clinical Skills Tutorials

  • During the Clinical Skills Tutorials, students learn the clinical skills of interviewing, history-taking, physical examination, and communication, as well as how to interpret the data in a diagnostic formulation, and then document and present it. Instruction takes place at the academies in groups of five to six students facilitated by one clinical skills tutor (or occasionally two tutors) per group.
  • The tutors are responsible for teaching the basic clinical skills to the students, who often initially practice the skills on each other or sometimes on ‘standardized patients' and subsequently on real patients. The students are assigned particular tasks in each tutorial, and the tutors are responsible for observing the students’ performance and correcting any deficits.
  • The key learning activity of each tutorial involves students interviewing and examining patients.
  • Students receive feedback from their tutors throughout the courses, based on both direct observation and submitted written work.

d) Portfolio Tutorials

  • There are six Portfolio sessions in each academic year to allow students reflect on, and discuss, key subjects relevant to their experiences as medical students and in developing their identity as future physicians
  • Focus of the sessions as linked to the educational content and activities of their other courses
  • The tutorials are facilitated by Senior Academy Scholars (faculty) and Junior Academic Scholars  (residents)
  • Twice a year students meet with their Senior Academy Scholars for a progress review and develop their own individualized learning plan

e) HSR Tutorials

  • There are several HSR tutorials in year 2 which occur in groups of 8-10 students guided by an HSR tutor.
  • Through discuss and opportunities to struggle and to apply research principles to relevant group activities students learn how to become effective consumers of research and to contribute to improving the health of patients and populations.
  • When possible examples are used in HSR tutorial of articles that align with content discussed in CBL cases of the week.

Workshops

a) Skill-based workshops

  • The focus of these workshops is to learn and practice a specific clinical skill within a clinical context including, when relevant, learn how to communicate about the situation to the patient and family (e.g., ECG workshops).

b) Clinical Decision Making Workshop

  • The purpose is to provide active learning opportunities for students to practice clinical decision making to variety of clinical cases, as a reinforcement to what was covered in the other modalities listed above, and to build their clinical decision making skills.
  • Students meet in groups of 15 or fewer at the academies or centrally with a faculty facilitator.

Seminars

  • Seminar occur in groups of 12-32 students and are held either centrally at the St. George and Mississauga campuses or at the academy sites.
  • Focus is on discussion of particular longitudinal theme.
  • Types of seminars may include theme related topics such as, but not limited to:  (a) Ethics; (b) Interprofessional Education (IPE); (c) Leader; (d) Medical Psychiatry; (e) Resilience; or f) Pharmacology.
  • Seminars are led by faculty and/or content experts, including non-physicians

Anatomy Labs

  • Scheduled throughout the two year curriculum, the Anatomy learning objectives are planned with the content experts of the specific weeks to fully integrate anatomy into the curriculum.
  • Students are expected to prepare for the Anatomy lab with digital anatomy apps and videos, and attend anatomy labs at the two campuses to explore dissections, prosections, and anatomical models.
  • Students meet in groups of 8-9 and learning session are guided by anatomy tutors
  • Anatomy is assessed after each learning block using the “bell-ringer” format.

Experiential Learning Opportunities

Throughout Integrated Clinical Experience (ICE), there will be opportunities for experiential learning. This will include interactions with standardized patients, real patients, and role-play (simulation of a health care provider encounter). Experiential learning will allow students to develop skills (i.e., communication), receive feedback in a safe environment, overcome anxiety related to speaking in front of others, inform future career decisions, enhance students’ learning of clinical medicine, and gain insight into the patient experience.

The different types of experiential learning opportunities that have been integrated in the curriculum include: (a) Standardized Patient Encounters in ICE: clinical skills; (b) Real patient encounters in ICE: Clinical Skills; (c) Enriched Education Experience (EEE); and (d) Community Site Visits in ICE: HC.

 

Global Observerships in Foundations

Foundations students interested in pursuing a global observership must do so on their own personal time and resources as an unsanctioned activity, without the MD Program or University’s authorization or formal support. Global observerships undertaken by Foundations students on their own initiative are not facilitated or sanctioned by the MD Program and form no part of curricular or co-curricular programming of any kind.