Amy Tan, assistant professor in the Department of Family Medicine, is finishing up a very busy and exciting year. When Tracey Hillier, associate dean of curriculum with Undergraduate Medical Education (UME) in Faculty of Medicine & Dentistry, asked her to take on a new project called the Year 1 Physicianship Course in the MD Program, Tan says she knew she was being offered a challenge of monumental proportions. But the vision of the program meshed with Tan's personal concept of what a progressive undergraduate medical student education looks like, and the opportunity to work towards this shared vision enticed her to accept the assignment.
Hillier realized that Tan's work with the Department of Family Medicine over the past 10 years created a near-perfect fit for both her and the department to help lead this inspiring initiative. In accordance with the Future of Medical Education in Canada (FMEC) recommendation, the MD Program curriculum is grounded in generalism, and the UME Program saw the new curricular changes as a way to further the generalist foundation through the department's involvement. Tan's master's thesis studied communication and ethics, and since 2005, she has taught many UME programs, including Gilbert's Scholars, Community-Based Experience, Patient-Centred Care and Discovery Learning. She was also the Department of Family Medicine's clerkship director from 2009 to 2013. Likewise, the department has long been on the leading edge of medical teaching innovation, being one of the first Canadian university departments to introduce Narrative Reflective Practice into its residency and clerkship curriculum, and competency-based assessment implementation.
What is Physicianship?
Building on the definition by Fuks et al. (2012) that Physicianship is the "development of the craft of a physician: scientific knowledge (knowing), skill and craftsmanship (practice and experience), and practical wisdom (knowing what to do in a given situation through the use of analysis) with the ethical and compassionate doctor-patient relationship as the basis for all actions," the Physicianship Course focuses on fully integrating all of the longitudinal components of the curriculum (ethics and law, clinical skills, professionalism, cultural competency, clinical reasoning, health systems, identity formation, evidence based medicine) to ensure medical students are developing academic knowledge and practical skills concurrently. This includes bringing components of previous discrete courses (such as Gilbert's Clinical Skills, Community-Based Experience and Patient-Centred Care) into a fully integrated and longitudinal year-long course. For example, family medicine preceptors ensure students are given the opportunity to do very specific physical examination maneuvers during their clinic sessions that are concurrent with what is being practiced in Physical Exam small groups during the relevant system blocks.
The UME priority on generalism expands on the experiential component of the Family Medicine Year I curriculum. DFM faculty, clinic preceptors and community preceptors have made Longitudinal Clinical Experience in Family Medicine (LCE-FM), formerly Community Based Experience, a success over the past few years. The Physicianship Course allows more curricular time for an increased number of LCE-FM sessions for each student, as well as set goals for the sessions which are integrated to the student's level of learning within the physicianship course and their core blocks. This longitudinal clinical experience is one of the core components of the physicianship course and, ideally, students would work with the same physician for all of their sessions in both years to develop a longitudinal relationship with their preceptor and preceptor's clinic.
The DFM is working to roll out the Year II portion of the LCE-FM as part of the new Physicianship Year II Course in September 2014. This is currently being developed by Sheny Khera, also a member of the Department of Family Medicine. Year II will build on components introduced in Year I with purposeful repetition appropriate to the student's stage of learning. Two other foundational components of this course are grounded in principles central to family medicine. The new Patient Immersion Experience (PIE) matches pairs of students to a patient with chronic illness over two years so that students can learn from these mentors about what it means to live with a chronic illness and how this is shaped by the doctor-patient relationship. The other is the Physicianship Discussion Groups, where the same group of students meets with their faculty facilitator over two years to discuss key concepts related to physician identity formation through the use of reflective practice and discussion of their experiences in LCE-FM and PIE, among others. In addition to this, the new course created an opportunity to develop an exciting Resident-as-Teacher initiative in our department through collaboration between the Department of Family Medicine's undergraduate, residency and faculty development programs. In this initiative, departmental faculty members coach family medicine residents who, in turn, directly facilitate Year 1 medical students in their physicianship communication, physical exam and consolidation case group sessions throughout the year.
Initial feedback from students, residents and faculty on Year 1 of the Physicianship Course and the Resident as Teacher initiative has been very positive. Students tell us they like experiential learning in LCE-FM, being mentored by patients in the PIE program, and learning how to manage experiences ethically through small group sessions with facilitators and standardized patients.
If you have chronic illness patients you think would be good patient mentors for our students as part of the Patient Immersion Program, please contact Jo-Ann Paul at jkpaul@ualberta.ca. More information on the goals of the Patient Immersion Program can be found in this article: Every patient is a person with a story. We are always looking for new preceptors for the LCE-FM sessions. Please contact Erika Siroski (erika.siroski@ualberta.ca) for information about how you can become part of this exciting initiative.