Systems based or something else...

[Guest Jas001]

I read somewhere that UofT med school isn't systems based. Something about learning all the anatomy and then moving onto something else. Can somebody elaborate about the program (ie. if there is PBL and stuff like that)

 

Thanks

 

jas

[Guest cheech10]

Well, it's not systems based, but it's not a "traditional" curriculum either. In a systems based curriculum, you would do, for example, the heart, including anatomy, histology, physiology, biochemistry, pathology, and pharmacology together. Many schools have switched to this approach because thinking in an integrated systems based manner simplifies and organizes decision making. In a "traditional" curriculum, you would do all of anatomy together, then all of histology, etc. These subjects might be taught at the same time, but each is it's own course more or less and taught individually. One upside of this curriculum may be that it's easier to learn if you do all of, say, biochemistry at once. Few (if any) Canadian schools use this curriculum (as far as I know) but it is more popular in the US since the USMLE Step 1 questions are segregated in this way.

 

At UofT, we have somewhat of a combination of both styles. Our first year is divided into 3 courses: Structure and Function, Metabolism and Nutrition, and Brain and Behaviour. Structure and function starts off in a very traditional style, with only Anatomy and Embryology for 10 weeks. These subjects give us a bit of grounding for the future studies. Things become more integrated in the next 10 weeks, where we have cardiovascular physiology, respiratory physiology, biochemistry (except for metabolism), and histology. Unlike a traditional curriculum, we get 1 integrated test for these subjects. Throughout the year, we have a community health course, and a clinical skills course. In Metabolism and Nutrition (the course we're finishing now) we have a very integrated course which includes endocrinology, metabolism, renal, and GI in all their aspects (histo, physio, pharm, biochem, etc.) This is similar in some aspects to a systems based curriculum with respect to the renal and GI systems, while the metabolism and endocrine aspects are taught throughout the course. Our tests for this course are interesting since they are presented as clinical scenarios with questions relating to these scenarios. PBL runs in each of the 3 first year courses for 2 or 3 afternoons per week. It's more of a case based approach with learning objectives generated as the case proceeds through a clinical scenario with a patient presenting with certain symptoms, a differential being assembled, lab tests being ordered and results interpreted, and treatment and resolution of the case. Each week is devoted to a different case which integrates our learning for the week. Unfortunately, most of the learning objectives are covered in lecture, so this is not strict PBL. Finally, Brain and Behaviour is the closest we get to a systems based course, covering all things neuro. In addition to lectures and PBL, we get tutorials and seminars, guest lectures, patients that come in to discuss their diseases, ethics popping up from time to time, and field visits with community agencies as part of our community health course. Overall, it's really enjoyable, and the fact that we get (usually non-cumulative) tests every 4 weeks or so helps break the material up so that you're not as overwhelmed come test time. If you have any more questions, don't hesitate to ask.

[Guest Beth]

Thanks for your description of the program at UofT cheech! How much contact have you had with patients so far this year? Do you have a lot of opportunity to go into the hospitals, practice clinical skills, etc.? Are physicians in Toronto receptive to having med students follow them around (ie/ observe surgery, go on call with them, etc.). Thanks for the info

[Guest cheech10]

We get one half-day a week for clinical skills. These classes are based at the hospital, For the first hour or two we are taught a new interviewing or exam skill, and for the rest of the morning we are expected to go to the wards to practice these skills, then meet up and discuss our experiences. The first 3 or 4 weeks were done using standardized patients (actors), but since then it's been real patients almost every week. Also, during each semester your clinical skills group is assigned to one of the wards, so you get fairly familiar with a field and the diseases in that field.

 

Also, most physicians are very happy to let you follow them around. You can try to set this up through instructors or other people you know, the Medical Alumni Association, or in other ways. A friend of mine recently completed a few days of cardiac surgery observation, and scrubbed in on a coronary artety bypass graft as well as a mitral valve replacement.

 

As well, faculty are quite receptive to our input on curriculum matters. This year, my class lobbied for a required clinical elective to be completed in second year with protected time for it, and this will be implemented beginning with our class.

[Guest Koggetsu]

just wondering what is the significance of having this elective in 2nd year?

[Guest cheech10]

Well, it's a formal part of our curriculum that will let us experience a particular field that interests us. The fact that it is protected time that can't be scheduled for classes helps us organize these experiences. Also, unlike clerkship, I believe it will be done in smaller community hospitals. And finally, it was something that our class really pushed for and shows that the administration listened to us on curriculum matters.