No abstract

Context: Since its inception more than 150 years ago, the School of Medicine at Queen’s University has aspired ‘to advance the tradition of preparing excellent physicians and leaders in health care by embracing a spirit of inquiry and innovation in education and research’. As part of this continuing commitment, Queen’s School of Medicine developed the Queen’s University Accelerated Route to Medical School (QuARMS). As Canada’s only 2-year accelerated-entry premedical programme, QuARMS was designed to reduce training time, the associated expense of medical training, and to encourage a collaborative premedical experience. Students enter QuARMS directly from high school and then spend 2 years enrolled in an undergraduate degree programme. They then are eligible to enter the first-year MD curriculum. The 2-year QuARMS academic curriculum includes traditional undergraduate coursework, small group sessions, and independent activities. The QuARMS curriculum is built on 4 pillars: communication skills, critical thinking, the role of physician (including community service learning [CSL]), and scientific foundations. Self-regulated learning (SRL) is explicitly developed throughout all aspects of the curriculum. Medical educators have defined SRL as the cyclical control of academic and clinical performance through several key processes that include goal-directed behaviour, use of specific strategies to attain goals, and the adaptation and modification to behaviours or strategies that optimize learning and performance. Based on Zimmerman’s social cognitive framework, this definition includes relationships among the individual, his or her behaviour, and the environment, with the expectation that individuals will monitor and adjust their behaviours to influence future outcomes. Objectives: This study evaluated the students’ learning as perceived by them at the conclusion of their first 2 academic years. Methods: At the end of the QuARMS learning stream, the first and second cohorts of students completed a 26-item, 4-point Likert-type instrument with space for optional narrative details for each question. A focus group with each group explored emergent issues. Consent was obtained from 9 out of 10 and 7 out of 8 participants to report the 2015 survey and focus group data, respectively, and from 10 out of 10 and 9 out of 10 participants to report the 2016 survey and focus group data, respectively. Thematic analysis and a constructivist interpretive paradigm were used. A distanced facilitator, standard protocols, and a dual approach assured consistency and trustworthiness of data. Results: Both analyses were congruent. Students described experiences consistent with curricular goals including critical thinking, communication, role of a physician, CSL, and SRL. Needs included additional mentorship, more structure for CSL, more feedback, explicit continuity between in-class sessions, and more clinical experience. Expectations of ...

Innovation: We developed two new rubrics with explicit behavioural anchors to assess students in the Queen's undergraduate medical education (UGME) surgery clerkship rotation. These rotation rubrics, complemented by a new ambulatory clinic encounter card, improved the quality, consistency, and timeliness of feedback for clerks from faculty preceptors. This innovation was introduced during a comprehensive workplace-based assessment redesign being undertaken in the Department of Surgery as part of the transition to a postgraduate competency-based medical education (CBME) system for postgraduate education (PGME). The core UGME working group, comprised of a faculty surgeon, assessment consultant, and a surgical resident, selected terminology and designed the tool visual structure to be similar to the new postgraduate assessment tools, since most preceptors supervise learners in both programs. This consistency enhanced buy-in from faculty and ensured a smooth transition to the use of the new UGME tools. Development: The new assessment process was developed and piloted in three phases: (1) development of an assessment system based on rubrics with explicit behavioural descriptors as the key assessment tools; (2) implementation of a pilot study to establish the acceptability and feasibility of the use of these rubrics, with iterative revisions based on stakeholder feedback; and (3) development of a validity argument for the use of these assessment tools. The latter is scheduled for 2018. Outcomes: The use of these rotation behaviour-anchored rubrics and corresponding ambulatory clinic encounter card has greatly improved the mid-and final-rotation feedback provided to students on the Surgery Clerkship. The concrete, descriptive information provided by the rubrics allows the course director to provide specific feedback during rotation exit meetings. The course director has the ability to clearly articulate to students the areas where they have met (or exceeded) the expected level of competency, as well as areas which require additional attention.

No abstract