Page created by Donald Carrillo

         AT THE


                      May 2, 2007

Learning Medicine at the
                Northern Ontario School of Medicine

A Curriculum for Northern Ontario
The curriculum of the Northern Ontario School of Medicine is grounded in its social
accountability mandate by “… providing undergraduate and postgraduate medical
education programs that are innovative and responsive to the individual needs of
students and to the health care needs of the people of Northern Ontario”. * This is the
foundation of the school and the reason for its creation.

The curriculum content is centered on the five Themes. They are:
   • Theme 1 – Northern and Rural Health
   • Theme 2 – Personal and Professional Aspects of Medical Practice
   • Theme 3 – Social and Population Health
   • Theme 4 – Foundations of Medicine
   • Theme 5 – Clinical Skills in Health Care

These Themes are enhanced by a focus on the seven competencies described in
CanMed 2005, which are:
   • Medical expert
   • Collaborator
   • Manager
   • Health advocate
   • Scholar
   • Professional
   • Communicator

In addition, a series of curricular “threads” run through the four-year curriculum. They
    • Aboriginal health
    • Interprofessional education and work
    • Health effects of social problems
    • WSIB concepts/curriculum
    • Dementia project
    • Gender issues
    • CMDA patient safety curriculum


       *       Principles and Framework for Working Arrangements Involving
               Lakehead University, Laurentian University and the Northern Ontario
               School of Medicine

Our Curriculum: A Philosophy and an Approach
The curriculum at the Northern Ontario School of Medicine (NOSM) employs a case-
based approach to focus student learning. The emphasis is on self-directed learning
and the role of faculty tutors is to facilitate learning. In years 1 and 2, this model is
employed with the Case Based Learning Sessions (CBLs) and the Topic Oriented
Sessions (TOSs). In year 3, Virtual Academic rounds are utilized to bring small groups
of learners together to discuss cases from their personal clinical experiences.
Objectives and learning tasks are provided to guide study and to indicate the depth of
understanding required for successful completion of the module. However, the
curriculum demands significant self-directed work and study by the individual student.

                  The Phase 1 (Years 1 and 2) Curriculum
The curriculum is divided into eleven Case-Based Modules (CBM), in Phase 1 (Years 1
and 2). Six of these occur in Year 1 and five occur in Year 2 of the program. CBM 101
is four weeks in duration, while the remaining Modules are six weeks in length. All
information about the CBM is available on-line and provided in increments to the
students as needed for their learning activities. This material, along with other
scheduled learning activities and content information, will guide student learning
throughout Phase 1. Each CBM has a body system emphasis as outlined in the figure

              Module                                           System Focus
CBM 101                                Review/Introduction
CBM 102                                Cardiovascular/Respiratory System
CBM 103            Phase 1             Gastrointestinal System
CBM 104             Year 1             Central Nervous System /Peripheral Nervous System
CBM 105                                Endocrine System
CBM 106                                Musculo Skeletal System
CBM 107                                Reproductive System
CBM 108                                Renal System
CBM 109            Phase 1             Hematology/Immunology
CBM 110             Year 2             Neurological/Behavior
CBM 111                                End of life issues

       *Yellow denotes an integrated community experience (ICE) away from the
                    Lakehead and Laurentian Campuses.

In years 1 and 2 there are five distinct types of learning opportunities at the School of
Medicine; large group sessions, small group facilitated sessions, structured clinical skills
sessions, laboratory sessions and Community Learning Sessions.

Large Group Sessions
       Module Coordination Sessions (MCS)
       Each week begins with a one-hour facilitated session during which students are
       encouraged to raise any concerns about the instructional content of the learning
       process. The session provides an opportunity for dialogue between students and

Whole Group Sessions (WGS)
      These sessions are usually three hours in length and are scheduled once per
      week as determined by the instructional demands of the curriculum. In a Whole
      Group Session, the class is instructed as a whole by faculty of the School. The
      instructional format includes traditional lectures, demonstrations, and large group
      tutorial activities. These sessions are simultaneously video-conferenced
      between campus locations.

Small Group Sessions
      Case-Based Learning (CBL)
      Each week students meet with a facilitator in groups of no more than eight for a
      two-hour session. Through a model of guided discovery, which is designed to
      support self-directed research, students consider a complex case that directs the
      learning for the module. Each module reflects six weeks of study and explores
      instructional content related to the five themes. Prepared objectives guide
      student learning during CBL sessions.

      Topic-Oriented Sessions (TOS)
      These two-hour facilitated sessions occur two or three times each week. The
      TOS focus is on an individual patient, which students have met through the
      module case. Using a problem-based learning format, students identify learning
      issues, develop a strategy to acquire the necessary knowledge and share the
      knowledge gained through independent research. As the week progresses,
      information is revealed about the patient until the objectives related to these
      sessions have been fully explored by the students.

Structured Clinical Skills (SCS) Sessions
      These weekly three-hour sessions focus on instruction and practice in
      patient/doctor communication and physical examination skills. Students meet in
      small groups with a clinical instructor and practice their interviewing and
      examination skills with simulated and standardized patients. The objective for
      these sessions is to explore the knowledge, skills and attitudes defined by
      Theme 5 of the curriculum.

Laboratory Sessions (LAB)
      These three-hour sessions occur four times in every six-week module. Each
      LAB session, students initially meet as an entire group for a WGS session.
      Students are then required to meet in small groups to focus and work through
      case studies based on learning objectives outlined and explained in the WGS
      session. For each module, the LAB sessions focus on four sets of learning
      objectives related to basic anatomy and histology, pathology, diagnostic imaging
      and clinical/diagnostic skills.

Community Learning Sessions (CLS)
      Each week there is one three-hour session dedicated to providing students with a
      wide range of community-based clinical experiences. Observing and interacting
      with patients under the guidance of a preceptor, students visit patients in their
      homes, in hospitals, long-term care centers, doctors’ offices, pharmacies, rehab
      centers, nursing homes, or other health service providers or organizations.
      These experiences involve the content of all of the five themes and provide a
      focus for interprofessional learning.

Distributed Tutorial Sessions (DTS)
           A Distributed Tutorial Session (DTS) is a session developed by a faculty member
           related to specific learning objectives. It is conducted via electronic means either
           synchronously or asynchronously. A DTS is analogous to the weekly Whole
           Group Session (WGS) for on campus modules but incorporates instructional
           methods appropriate to distributed or distance education models. The DTS is
           usually implemented in the Integrated Community Experience Modules CBM
           106, 108 and 110.

   Self-directed Learning Cycle

   The following diagram and accompanying narrative describe the cycle of self-directed
   learning by students as a part of the TOS and CBL sessions. The diagram of the tent is
   a visual analogy for the integration of the various student-learning activities in the NOSM

                                                         The students’ own investigation is supported by
                                                         weekly whole group sessions. The students at
                                                         both campuses are linked by videoconference
                                                         during these sessions. Facilitators are faculty
                                                         who are content experts.

                                                         During clinical skills sessions, students will
                                                         receive instruction in communication skills,
                                                         interviewing and history-taking and a range of
                                                         other clinical skills. Students will work with
                                                         standardized and volunteer patients. Many
                                                         clinical skills are further supported by labs.
                                                         Community learning experiences are provided
                                                         to augment the learning in each module.

   Typical week schedule in Phase 1 (Years 1 and 2)

  Week X         Monday            Tuesday             Wednesday         Thursday              Friday
9 – 10         Module           Community          Whole Group         Structured        Lab
               Coordination     Learning Session   Session (WGS)       Clinical
               Session (MCS)    (CLS)                                  Session (SCS)
10 – 11        Case Based
11 – 12        Learning                            Personal Study
12 – 1         Lunch            Lunch with         Lunch               Lunch             Lunch
                                Student Affairs
1–2            Topic Oriented   Student Affairs    Personal Study      Topic Oriented    Personal Study
2–3            Session (TOS)    Opportunity                            Session (TOS)
                                (1 - 2:30)
3–4            Personal Study                                          Personal Study

NOSM Phase 1 Sessions at a Glance

         CBL = Case Based Learning
         TOS = Topic Oriented Session
         WGS = Whole Group Session
         SCS = Structured Clinical Session
         CLS = Community Learning Session
         LAB = Laboratory
         SAS = Student Assessment Session
         ICE = Integrated Community Experience
         MCS = Module Coordination Session
         DTS = Distributed Tutorial Session

Integrated Community Experiences (ICE) in Phase 1

In addition to the modules on the Laurentian Campus and Lakehead Campus, there are
three six-week Integrated Community Experiences in Phase 1 modules. They are CBM
106 in year 1 (Aboriginal), and modules 108 and 110 (Remote / Rural). It is important to
note that learning experiences in all five Themes continue during these ICEs. In many
important ways the ICE modules 106, 108 and 110 are similar to the other Phase 1
modules. They also differ in several important ways. The first two weeks are spent on
the home campus with a concentrated orientation, whole group and laboratory sessions,
which are difficult to deliver in the various community settings. This also allows time for
students to focus on their respective community and clinical activities. A typical ICE
week is shown in the figure below.

ICE Week for Year 2
              Monday           Tuesday            Wednesday         Thursday           Friday

9 -10
             FLEXIBLE             TOS             FLEXIBLE                           FLEXIBLE

11-12                                                DTS
12 – 1         Lunch             Lunch              Lunch             Lunch             Lunch
                               FLEXIBLE           FLEXIBLE          FLEXIBLE         FLEXIBLE
3–4             MCS

4–6             CBL

□ Fixed Session
The only sessions that are fixed are the TOS, CBL, MCS and DTS, as they will involve students
and faculty at different sites facilitated by telecommunication.

□ Flexible Session
Clinical – Five ½-day sessions per week
Community Learning Sessions – One ½-day per week
Structured Clinical Skills - One ½-day per week
Personal Study – 7 hours per week

The Phase 2 (Year 3) Curriculum
The Phase 2 (year 3) Comprehensive Community Clerkship (CCC) at NOSM provides
students with clinical experiences away from the main campuses of Sudbury and
Thunder Bay. Students assigned in pairs to primary care practice settings, live and learn
as small groups of up to eight learners in one Northern Ontario community for an eight-
month period. The communities of Kenora, Sioux Lookout, Fort Frances, Timmins,
North Bay, Sault Ste. Marie, Parry Sound, Bracebridge, Huntsville, and Temiskaming
Shores will host CCC learners.
The aim of the Phase 2 curriculum is to provide academic and professionally relevant
learning opportunities that, through small group sessions and clinical practice, exemplify
reflective learning and comprehensive interprofessional care. Furthermore,
opportunities to care for patients in a safe and efficient manner are enhanced by the
clerkship’s prolonged duration, which promotes continuity of care. The student will
increase their knowledge of medical care through clinical encounters and through the
socio-cultural context in which the patient and their family cope and adapt to their health
care needs. This social and intellectual process will be encouraged through continuous
interaction with community-based faculty members.
The CCC experience will enhance the NOSM learner’s personal and professional
development. Additionally, the nature of the course work and the learner-centered
environment will promote critical thinking and life long learning skills. The CCC will
provide an opportunity to enhance knowledge, skills, and attitudes conducive to an
understanding of medical practice in remote, rural, and/or underserved communities and
contrast that with urban practice. The learner will observe the skills and attributes of
health professionals in stimulating environments, furthering their consideration of career
choices including clinical practice and research.
As in the first two years, the five Themes (courses) continue through the Phase 2 (year
3) clerkship. Additionally, Theme 5 (Clinical Skills) is subdivided in to the disciplines of:
           •   Child Health
           •   Women’s Health
           •   Internal Medicine
           •   Mental Health
           •   Family Medicine
           •   Surgery

Rather than specific sequential rotations in each of the disciplines, students will engage
in parallel exposure to these areas of medicine.
Although the community-based faculty member provides direction for the student in
achieving their learning goals, ultimately it is the responsibility of the learner to maintain
a high level of motivation and a self-directed approach to their learning. Much of this
learning will be opportunistic and they are encouraged to engage in, and navigate
through, specific learning objectives wherever possible.
As the learning is family focused, the students are to identify families early in the year
and through informed consent processes, follow them through an illness/wellness
continuum. Under the community preceptor’s guidance, students will examine a range
of psychosocial and multicultural contexts in which the family interacts with other
members of the health care team and health related organizations and services.

This experience will form the basis of personal research and reflection exercises rich in
experiential data that extends beyond the boundaries of clinical medicine. Some of
these experiences will enhance the students’ clinical practice and may influence their
values and beliefs about the way they behave as a physician.
Students are encouraged to take ownership of their learning as they begin to think and
act as critically reflective practitioners, an attribute central to safe, and rewarding medical
practice. Students are given opportunities to work in partnership with patients and their
families, with appropriate supervision and support. To this end, it is anticipated that they
will develop, and practice patient and family centered care.

                    Activity                                     Duration
Orientation                                         1 Week
Comprehensive Community Clerkship                   14 Weeks
Holiday Break                                       3 Weeks
Comprehensive Community Clerkship                   16 Weeks
Review and OSCE                                     2 Weeks

Description of Phase 2 Instructional Sessions

In year 3, Phase 2, there are two distinct types of learning opportunities during the
Comprehensive Community Clerkship (CCC): explanatory sessions, which provide
didactic instruction specific to the core clinical disciplines; and experiential sessions,
which provide clinical experiences in a variety of settings.

Explanatory Sessions

Discipline-Focused Sessions (DFS)
These sessions are three hours in length and are scheduled as determined by the
instructional demands of the curriculum. In a Discipline-Focused Session, the class is
instructed as a whole by faculty of the School. The instructional format will include
traditional lectures in order to review key concepts and issues related to the objectives
that are mapped to the cases that will be discussed and presented in small group

Virtual Academic Rounds (VAR)
Students meet twice weekly with a facilitator in groups of eight for two 3-hour sessions.
Through a model of guided discovery, students identify learning issues, develop a
strategy to acquire the necessary knowledge and share the knowledge gained through
independent research by considering cases identified from their clinical experiences in
the community. Each case discussion will be divided in two 1½ hour segments. Early in
the week, in the first 1½ hour segment, the case is presented and the objectives are
reviewed. The objectives are then discussed and presented in a subsequent 1½ hour
session later in the week. The sessions explore specific objectives which have been
selected to guide discussions related to the student’s case presentations. The
objectives of the discussion are related to all five Themes.
Experiential Sessions

Primary Care Sessions (PCS)
On a weekly basis, five half-day sessions provide opportunities to develop and refine the
students’ communication and physical examination skills and management approaches
under the supervision of experienced clinicians. Students participate in the care of 2 to 4
patients per half day session. Using available resources, including electronic texts and
evidence-based materials, students are to conduct independent research regarding their
patients and utilize their findings as part of the clinical encounter reviews they will be
discussing with their faculty members. Supervising faculty members will also review the
students’ findings and suggested management plans.

Specialty Enhancement Sessions (SES)
Each week’s schedule includes two three-hour sessions dedicated to providing students
with a wide range of clinical experiences related to the six core disciplines of Family
Medicine, Surgery, Internal Medicine, Mental Health, Child Health, and Women’s Health.
Students will examine patients and assist with the management of their illnesses or
conditions under the guidance of health care professionals. These sessions will include
participating in surgical assisting, specialty clinics, physician’s offices and a variety of
hospital and community-based programs related to the core clinical disciplines. These
experiences will explore the content of all of the five Themes and provide an opportunity
for interprofessional learning.

In-patient rounds, ER and Obstetrical Care Sessions
Students are to participate in the daily care of in-patients as directed by their site
coordinating teacher. Emphasis will be given to continuity of care. It is anticipated that
the student will have participated in the patient’s admission and will subsequently follow
the patient in the continuity of care within the community. Emergency Room and
Obstetrical Care Sessions will be assigned by the site coordinating teacher and
student’s participation in the care of patients will be supervised by a supervising faculty

Logging Clinical Encounters
While not all the specialist services may be present at each individual CCC site, students
will nevertheless have the advantage of encountering patients over time and in different
stages of care, therefore experiencing the realities of continuity of care. Students will
observe and record their learning opportunities, which arise from personal interaction
with patients, families, and communities, in an electronic log. Benchmarks for specific
numbers and types of clinical encounters and clinical procedures have been established
by the Phase 2 Committee. The electronic logs of individual students will be reviewed
on a regular basis to assist students in achieving their objectives.

Year 3 CCC Weekly Schedule

TIME        Monday          Tuesday        Wednesday             Thursday             Friday              W/E
8–9       In-patient      In-patient      In-patient           In-patient         In-patient      OB/ER

9 – 12    Virtual         Primary Care    Primary Care         Virtual Academic   Specialty       OB/ER
          Academic        Session (PCS)   Session (PCS)        Rounds (VAR)       Enhancement
          Rounds (VAR)                                                            Session (SES)

12 – 1                                                    Lunch Break
1–5       Primary Care    Primary Care    Specialty            Primary Care       Self Study      OB/ER
          Session (PCS)   Session (PCS)   Enhancement          Session (PCS)
                                          Session (SES)
7 – 11                    OB/ER                                                                   OB/ER

         NOSM Phase 2 Sessions at a Glance

                  VAR = Virtual Academic Rounds
                  PCS = Primary Care Session
                  SES = Specialty Enhancement Session
                  OB/ER = Obstetrics and Emergency Room consultations

         Orientation to the Comprehensive Community Clerkship (CCC)
         The Year 3 academic year includes an initial one-week orientation period to ensure that
         students are familiar with particular skills, roles, and procedures prior to entering the
         clinical environment. The Clerkship orientation will also provide outlines of the roles,
         responsibilities, and expectations of students during the clerkship period. While many of
         the hands-on aspects of the orientation will be conducted at the clinical sites,
         supplemental material will be provided by means of Discipline-Focused Sessions.

         Once students are at their sites, they will be oriented to the clinics and hospitals in which
         they will be learning in order to facilitate their integration into the work environment.
         Introductions will be made to the faculty members with whom they will work, and to the
         health care and administrative staff, to help make them feel like part of the team. It is felt
         that the social aspects of this experience are important because the learning
         environment encompasses much more than readings and formal instruction. Students
         make career and practice location decisions based upon the relationships they develop
         with physicians and other health professionals while learning in clinical environments.
         Students learn to care for patients from observing patient-physician interactions and
         from informal interactions with staff and community members.

Phase 3 Program Description (March 2007)

Phase 3 is a progression of the clerkship from the smaller distributed community
hospitals throughout northern Ontario experienced in Phase 2. It provides an exposure
to secondary and tertiary care of patients in the larger communities of Sudbury and
Thunder Bay.

The overall purpose of this last phase of the undergraduate curriculum is to expose
students to the various specialties and the subspecialties, which will lead to fulfilling of
the graduation requirements of the LCME/CaCMS. It will allow students to observe,
participate, and care for patients with problems addressed by specialists in various
disciplines. It will allow students an opportunity to experience a continuum of care which
seriously ill patients receive in the north.

It will also provide students with an opportunity to experience through core and elective
experiences various specialties which they may choose to pursue as career choices in
their postgraduate years. Through core rotations in seven broad specialties, students will
be provided with a thorough background in medicine and surgery. Through electives,
students will experience medicine in different settings outside the traditional geographic
area taught by NOSM. Finally it will provide an important background of knowledgewhich
will allow students to graduate and transition into the PGY 1.

The development, implementation and curriculum for Phase 3 must be consistent with
the academic principles which are the foundation of the Northern Ontario School of
Medicine. These principles are:

       An important feature of the school is partnership, participation, collaboration,
       coordination and shared a decision making with other members of the Healthcare
       team. A team approach is essential in the complex world of health care.

       This involves coordination, partnership and interaction to create a meaningful
       learning experience for students, residence, faculty, and staff.

       Community Oriented
       NOSM students will integrate into and learn in most communities throughout
       northern Ontario. This will lead to a pragmatic understanding of the dynamics of
       the north and create meaningful partnerships between northern communities and

       Distributed Community Engaged Learning
       This is an instructional model that allows widely distributed human and
       instructional resources to be utilized independent of time and place in community
       partners with NOSM across the north.

       This is a broad, holistic view and approach to activities, values and knowledge in
       education, organization, and patient care activities.

       Is a valuing and recognition of the richness and diversity of all cultures of
       Northern Ontario. It recognizes the importance of this diversity to our lives, and
       our learning.


Learning objectives will continue to be the cornerstone upon which the NOSM curriculum
is built. The five NOSM themes will continue to have emphasis in Phase 3. These are:

   •   Northern and Rural Health
   •   Personal and Professional Development
   •   Population Health
   •   Foundations of Medicine
   •   Clinical Skills in Medicine

Specific learning objectives for all of these themes will be clearly spelled out to students
as the curriculum progresses. Further details will be elaborated on later in this

Moreover, there are many important general objectives which are important in the
clerkship training of physicians in any medical program. NOSM clerkship objectives will
also include the following:

   •   Demonstrate the abilities and take a focused patient history and complete a
       physical examination. This includes a psycho-social history, family history and
       psychiatric examination.

   •   Provide a complete and accurate case presentation.

   •   Complete and maintain an organized medical record.

   •   Gain and expand knowledge of common acute and chronic problems across age,
       gender and disciplines.

   •   Gain and expand knowledge of preventative health issues.

   •   Further develop interpersonal skills to enhance patient rapport and

   •   Continue to develop the skills of using Evidence Based Medicine to solve clinical

   •   Formulate a patient centered management plan including diagnosis,
       investigations, treatment, and prevention.
•   Demonstrate an awareness of cost effective care when formulating patient
       management plans.

   •   Continue to develop knowledge and sensitivity to the unique problems of
       Northern Ontario.

   •   Continue to develop skills and attitudes for lifelong learning.

   •   Demonstrate respect for and appropriate use of other healthcare disciplines.

   •   Continue to develop and deepen awareness and understanding of the
       CANMEDS roles. These include:

               - Medical expert
               - Communicator, educator, humanist
               - Health advocate
               - Learner/scholar
               - Collaborator
               - Resource manager
               - Scientist
               - Person

Program Design and Content
Students will be based primarily in Thunder Bay and Sudbury for the Phase 3 program.
Students are expected to rotate through seven core general specialties. These are
Surgery, Internal Medicine, Children’s Health, Women’s Health, Mental Health,
Emergency Medicine, and Family Medicine. Students will spend four weeks on each of
these core rotations with the exception of Family Medicine. Family Medicine will be a half
day longitudinal experience during rotations in children’s health, mental health, and
internal medicine. The alternative is for students to acquire the family medicine
requirement during a four-week elective experience.

The program will begin for E2005, after the third weekend in May, 2008. It will conclude
with LMCC review the last week of April 2009. With 24 students in Thunder Bay and 32
students in Sudbury, students will be divided into six streams which will run through the
year. Hence there will be four students per stream in Thunder Bay and six students per
stream in Sudbury. Two of the streams in Sudbury will have four students.

The intent of the core rotations is to expose students to inpatient and outpatient care
pertinent to these specialties. A number of important considerations are being taken into
account for these core rotations. These include the following:

   •   The focus will be on exposing students to complex care both in and out of
       hospital for the core disciplines.

   •   For the core rotations, time will be spent on the hospital wards, physicians’
       offices, specialty clinics, the emergency department, didactic academic half days,
       and in clinical services i.e. fracture clinic/endoscopy etc.

•   It is expected that students will be part of Clinical Teaching Units. These will be
       composed of a staff physician or physicians, residents, and clinical clerks. The
       specific makeup of these clinical teaching units may vary depending on the
       specialty involved, capacity of the specialty and organization which works best in
       the core specialty for that particular Clinical Teaching Unit. Students’ time will be
       portioned according to the functioning of the clinical teaching unit and student’s

   •   Exposure to residents and resident teaching is important to clinical clerks and is
       mandated by the MCC. This will occur.

Students will also spend session time during the week in academic/didactic learning.
The form this takes will be dependent on the particular specialty. However learning
objectives will be clearly outlined for those specialties and these objectives must be
adhered to and will form the basis for learning and assessment. The time spent in
academic learning will be approximately ½ day per week.

Students are expected to take call with residents in the core specialties.

Students will be expected to track their learning experiences in a similar fashion to what
they have done in Phase 2. This will involve the use of PDAs or online. Specific types of
encounters for Phase 3 students and numbers are currently being developed.

Electives will comprise a major component of student’s time in Phase 3.The objective of
electives is to further develop, enhance and broaden students’ knowledge and
experience in medicine. It will allow them to explore an area of knowledge in more depth
than they otherwise might have received. It will allow students to explore specialties they
may want to pursue in a residency. Electives also allow students to spend time on
academic pursuits which might otherwise not be possible during the core rotations, ie/
publications etc. It also allows students to showcase themselves in other academic
centers where they might consider postgraduate learning. Electives may be done
anywhere that students so choose, provided they receive approval from the
undergraduate medical education office. It is important that students have a supervisor
for these electives. Furthermore a report will be required from students following their
elective experience. The guidelines which have been developed for Phase 2 electives
will continue to be applied to Phase 3, ie/ Types A, B, C and D electives.

There are a total of 16 weeks of elective time in Phase 3 with 12 of those weeks
occurring in all streams before the second week of November. This provides sufficient
time for students to explore various specialties prior to the CaRMS match so they can
make career decisions. It also allows students the opportunity to obtain references for
the CaRMS match in a timely fashion.

Potential electives in Sudbury/Thunder Bay can be divided into medical or surgical.
Potential medical electives include:

       Neurology                        Nephrology                   Anesthesiology
       Cardiology                       Oncology                     ER
       Respiratory Medicine             Endocrinology                General Medicine
       GI                               Infectious Disease           Family Medicine
       Rheumatology                     Geriatrics/Palliative Care   Mental Health
       Dermatology                      Intensive Care               Children’s Health
       Public Health

Potential surgical electives include:

       General surgery                            Orthopedics
       Urology                                    ENT
       Neurosurgery                               Cardiothoracic surgery
       Plastic Surgery

The following large table outlines the yearly schedule for Phase 3 as of March 2007.

WEEK       DATE       Stream      Stream      Stream     Stream     Stream     Stream
                      1           2           3          4          5          6
           May 5-9

1 2008     19-23      SX          MH          EL         MED        WH         ER
2                     SX          MH          EL         MED        WH         ER
3          June 2-6   SX          MH          EL         MED        WH         ER
4                     SX          MH          EL         MED        WH         ER
5                     EL          SX          ER         EL         MED        EL
6                     EL          SX          ER         EL         MED        EL
7                     EL          SX          ER         EL         MED        EL
8          July7-11   EL          SX          ER         EL         MED        EL
9                     ER          EL          SX         EL         EL         EL
10                    ER          EL          SX         EL         EL         EL
11                    ER          EL          SX         EL         EL         EL
12         Aug4-8     ER          EL          SX         EL         EL         EL
13                    EL          EL          EL         EL         EL         MED
14                    EL          EL          EL         EL         EL         MED
15                    EL          EL          EL         EL         EL         MED
16         Sept1-5    EL          EL          EL         EL         EL         MED
17                    EL          ER          EL         MH         EL         CH
18                    EL          ER          EL         MH         EL         CH
19                    EL          ER          EL         MH         EL         CH
20                    EL          ER          EL         MH         EL         CH
21         Oct6-10    WH          EL          MH         EL         CH         EL
22                    WH          EL          MH         EL         CH         EL
23                    WH          EL          MH         EL         CH         EL
24                    WH          EL          MH         EL         CH         EL
25         Nov3-7     MH          CH          MED        ER         SX         WH
26                    MH          CH          MED        ER         SX         WH
27                    MH          CH          MED        ER         SX         WH
28                    MH          CH          MED        ER         SX         WH
29         Dec1-5     Is/Acad     Is/Acad     Is/Acad    Is/Acad    Is/Acad    Is/Acad
30                    EL          WH          CH         SX         ER         EL
31                    EL          WH          CH         SX         ER         EL
32                    WB          WB          WB         WB         WB         WB
33                    WB          WB          WB         WB         WB         WB
34         Jan5-9     EL          WH          CH         SX         ER         EL
35                    EL          WH          CH         SX         ER         EL
36                    Is/Acad     Is/Acad     Is/Acad    Is/Acad    Is/Acad    Is/Acad
37                    Intervws    Intervws    Intervws   Intervws   Intervws   Intervws
38         Feb2-6     Intervws    Intervws    Intervws   Intervws   Intervws   Intervws
39                    Intervws    Intervws    Intervws   Intervws   Intervws   Intervws

40                     MED        EL          WH          CH          EL         MH
41                     MED        EL          WH          CH          EL         MH
42         Mar2-6      MED        EL          WH          CH          EL         MH
43                     MED        EL          WH          CH          EL         MH
44                     CH         MED         EL          WH          MH         SX
45                     CH         MED         EL          WH          MH         SX
46                     CH         MED         EL          WH          MH         SX
47         Apr6-10     CH         MED         EL          WH          MH         SX
48                     Review     Review      Review      Review      Review     Review
49                     Review     Review      Review      Review      Review     Review
50                     Review     Review      Review      Review      Review     Review
51         May4-8      LMCC       LMCC        LMCC        LMCC        LMCC       LMCC
52                     LMCC       LMCC        LMCC        LMCC        LMCC       LMCC

Several explanatory notes are required for interpretation of the above.

       SX= surgery                                     CH= children’s health [paediatrics]
       MH= mental health [psychiatry]                  ER= emergency medicine
       MED= internal medicine                          WH= women's health
       EL= elective                                    WB= winter break
       Interviews= CaRMS interviews
       Is/Acad= independent study/academic week

There are six streams in which there will be 4 students per stream in Thunder Bay and 6
students per stream in Sudbury. Two streams in Sudbury will have four students.
Students will have four-week rotations in the above core subjects. There will be an eight
week elective block occurring before the students submit their Ca RMS letter.

Because of the two-week winter break, rotations at that time are divided. Students may
also choose to work at their core rotations over this week winter break. It is not
designated officially as “time off”. Is/Acad refers to an independent study/academic
week. The Is/Acad blocks of time are scheduled around the CaRMS interviews. There is
the potential to provide ACLS training or other academic sessions during this time. The
schedule is designed so that no core specialties are being duplicated by more than one
stream at a time. Students also will have an opportunity to experience some elective
time in most streams after the winter break.

The clerkship concludes on April 10, 2009 for E 2005. Following the clerkship there will
be a three-week period before the LMCC examinations. Review sessions will be
provided for students but attendance will be optional. The review sessions will be a
combination of didactic learning provided by faculty, LMCC review questions and a
question and answer format.

Year 4 Weekly Schedule

The sample weekly schedule provided here is a sample week that could occur during a
children’s health, internal medicine, and mental health rotation. The family medicine
session included in the weekly schedule is only relevant to those students who chose
not to participate in a family medicine elective. The family medicine elective is not
mandatory. During surgery, women’s health, and E.R., the family medicine session will
not be included.

    MON            TUES           WED           THURS            FRI
Ward Rounds & Ward Rounds & Ward Rounds & Ward Rounds & Ward Rounds &
    Duties         Duties         Duties         Duties         Duties
Spec Clinic/OR Spec Clinic/OR Spec Clinic/OR Spec clinic/OR Spec Clinic/OR

   LUNCH               LUNCH           LUNCH              LUNCH              LUNCH
Spec Clinic/OR    Fam Med           Spec Clinic/OR    Academic Half      Personal Study
                  Office                              Day                Longitudnl Elec
   DINNER             DINNER           DINNER            DINNER             DINNER
ER/ On Call       ER/On Call        ER/On Call        ER/ On Call        ER/On Call

Phase 3 as designed follows the original blueprint for NOSM, by providing a bridge to
postgraduate medical education and specialty training. During the weekly schedule,
students will have in-patient ward responsibilities and duties. Potentially these may be
done in the morning or whenever the clinical teaching unit decides. Time then will be
spent in offices/clinics or in the operating room depending on the specialty. Evenings
may potentially be an ER shift or spent on call in the hospital. It should be emphasized
that the weekly schedule will be completely flexible depending on the particular
specialty, needs of the clinical teaching unit, or the needs of the student. For example
students may not necessarily need to do ward rounds early in the morning. Furthermore
personal study time for example may be on a different day than Friday etc. The only
exception will be the academic half day which will be rigidly set depending on the
location ie/ Thursday afternoons.

Student Guides and Online Resources
           and the Health Information Resource Centre (HIRC)

In order to assist students in the case based learning sessions (CBLs) and task oriented
sessions (TOSs) during Phase 1 and the Virtual Academic rounds of Phase 2, student
guides containing learning objectives, cases, focus statements, learning tasks and
resources are available online.

Through the affiliation with Lakehead University and Laurentian University, all students
of the Northern Ontario School of Medicine have access to library services and
resources on both university campuses. These services and resources include:

       •    Print resources in a variety of formats may be checked out; library card
            applications are available in the libraries, or on our website, at
       •    Pint / photocopying cards are available for purchase in the main university
       •    On-campus, access to print, and networked computer access to e-resources.
       •    Off-campus, remote access to licensed e-resources
       •    Database instruction and on-going user support: a schedule of library-related
            training sessions will be posted on our website.
       •    Other services include: document delivery/interlibrary loan; reference and
            research assistance.

E-Resource Access
       •    While on-campus, all NOSM students have IP access to the HIRC’s
            collections of electronic databases, journals and texts, and other biomedical
            resources, and to the e-resources of our affiliated university libraries.
       •    Whether on-campus or off-campus, for access to the HIRC’s e-resources,
            registered students may go to our website, at www.normed.ca/library, and
            click on their choice under the Resources heading, or browse our iLink online
            Catalogue. For access to the resources of our affiliated university libraries,
            from the Resources heading, select the link to the Lakehead Resources, or to
            the Laurentian Resources. Students are then prompted to enter their
            NormedNet username/password.

During Phase 2, resources will be further augmented by community faculty members,
local health care facilities, specialists, and other health care individuals and resources in
the community.

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