UNDERGRADUATE MEDICAL IMAGING EDUCATION AT THE UNIVERSITY OF TORONTO
The Foundations Curriculum runs throughout the first two years of the MD program (pre-clerkship curriculum). There are three major dimensions to the Foundations Curriculum: courses, units, and themes.
There are four courses in the Foundations Curriculum that run throughout the first two years.
The Toronto Patient-Centred Integrated Curriculum (TOPIC)
TOPIC makes use of case-based learning (CBL). The course is structured in four sequential units. CBL is the core activity in each of the 72 weeks of the curriculum and involves students working in a group, supervised by a faculty tutor, and going through a simulated clinical case and curated learning material. Case topics are carefully selected to cover the wide spectrum of clinical medicine. Case exercises are designed to promote integrated learning of the relevant foundational sciences (e.g., anatomy, pharmacology, sociology) combined with specific clinical medicine concepts; all of which is put into a larger psychosocial and community health context. Longitudinal themes are woven into these CBL cases across the 72 weeks.
The Integrated Clinical Experience (ICE)
ICE focuses on teaching clinical skills and community health. Clinical skills instruction builds on the strengths of our current Art and Science of Clinical Medicine (ASCM) courses. The weekly clinical skills sessions are highly integrated with the clinical content also being taught in any given week. Students will have extensive opportunities to experience the social context of health and illness through various activities, including visits to schools, community health agencies and patients’ homes, together with a community-based scholarship and service-learning project. Ultrasound teaching is often used to enhance learning of physical examination skills within ICE.
The Portfolio Course
This course offers an opportunity for guided reflection on what students are learning and incorporates frequent assessment exercises such as written tests, clinical skills observations and clinical application exercises. Students may receive mentorship and support from faculty and peers as they are able to discuss their concerns in a non-judgmental environment. Assessments are gathered by students in a dossier throughout the course, and are regularly reviewed with faculty mentors to ensure that students are progressing well and receiving help where needed. The goal is to ensure that students have a solid foundation upon which to build the remainder of their medical studies and receiving the support they need to excel.
Health Science Research (HSR) Course
This course is designed to help students learn how to appraise health science literature. It provides students with tutorial and e-module-based learning on two major topics: how to participate in health research projects and how to translate and apply the findings of health research to patient care.
Courses are layered on top of a structure that involves four sequential units:
UnIT 1 (Introduction to Medicine; 11 weeks) provides an introduction to clinically relevant foundational medical sciences and humanities. Considered through all the levels of organization – from the gene to the cell to the individual and to society, including a consideration of normal health at each stage of life – the course provides a focus on how cognitive sciences help in medical decision-making. It is also the start of a longitudinal consideration of professional identity formation. Here, medical imaging is introduced in the form of an introductory lecture on the use of chest radiographs and introduction to their interpretation. Ultrasound workshops are incorporated here to aid students’ understanding of anatomy.
UnIT 2 (Concepts, Patients and Communities; the last 25 weeks of year 1 and the first 16 weeks of year 2) focuses on an integrated body-systems based approach to medicine. Within this part of the curriculum, year 1 medical students learn how to interpret chest radiographs and have an opportunity to review unknown chest radiographs with expert readers. Common entities such as pneumothorax, pleural effusion, pulmonary edema and pneumonia are covered. They also have imaging workshops introducing them to abdominal imaging (ultrasound, computed tomography and magnetic resonance imaging) and specifically, genitourinary imaging. An ultrasound based workshop is also incorporated to aid in the understanding of chest, abdominal and pelvic imaging.
The goal is to achieve an understanding of: each system’s normal structure and function
- how these are deranged by disease and social determinants of health
- how physicians can intervene to improve health UnIT 3 (Life Cycle; 9 weeks in the middle of year 2) addresses health and illness at different stages of the life cycle, including reproductive health, neonate, infant, child, adolescent, aging person and care at the end of life. Medical Imaging cases are embedded in the life cycle cases.
- UnIT 4 (Complexity and Chronicity; 11 weeks - end of year 2) provides a synthesis of the Foundations curriculum, within the context of chronic and complex illnesses, in preparation for Clerkship. In this section, there is a Trauma Imaging 2 hour workshop that teaches students about the role of imaging in the management of trauma patients.
- Medical Imaging is not a dedicated course or unit in the pre-clerkship curriculum and is considered a longitudinal theme. Longitudinal themes run throughout each unit. Content related to themes are delivered during Case-based learning (CBL) and are integrated with other issues addressed in the cases, as well as dedicated sessions at other times to explore the themes in more depth. Medical Imaging as a Theme is widely integrated throughout the pre-clerkship curriculum. Medical Imaging is considered an important theme that does not necessarily fit well with the systems-based or the life-cycle frameworks. Therefore, it requires added emphasis in the form of dedicated workshops and embedded learning content within the other courses and units.
I. Transition to Clerkship (TTC) is a course that helps to prepare medical students as they enter their clerkship training within hospitals. Medical imaging has a specific course delivered over a half-day that is divided into:
1. Essentials of Medical Imaging (how to consult with a radiologist resident or staff, basic concepts of radiation dose associated with certain medical imaging studies and intravenous contrast safety etc.)
2. Essentials of neurologic, chest, abdominal and musculoskeletal imaging
3. CXR Bootcamp: A high-yield review of approach to chest radiographic interpretation and case review.
II. During clerkship, medical imaging makes it appearance during the surgery rotation in the form of an imaging workshop entitled, “Imaging of the Acute Surgical Patient” This workshop reviews the common indications and imaging findings relevant to imaging surgical patients, with focus on acute abdominal conditions. The medical imaging relevant for the internal medicine rotation has been converted to an electronic learning module for self-study.
III. Towards the end of clerkship, medical imaging is revisited again in Transition to Residency (TTR) with a fusion lecture reviewing important medical imaging concepts in preparation for the LMCC parts I and II examinations.