Background: 

WHO’s concept of Social accountability has been embraced by the Association of Faculties of Medicine of Canada, and the social accountability accreditation standards for Canadian medical schools include the degree to which schools employ a variety of educational strategies to produce physicians who are not just technically but also socially and culturally capable of addressing the health and social needs of the Canadian population. 

Current context: Case Based Learning 

UGME at uOttawa has a series of Case Based Learning (CBL) sessions that extend throughout the first two years of medical school. CBL is an evidence-based teaching method to assist students to translate theory into practice and to develop the skill set to approach to real-life situations. The cases in CBL2 are intended to be or strongly resemble real-world scenarios, however, the learning objectives for uOttawa’s sessions are almost exclusively related to basic and clinical sciences. In order to ensure the cases reflect the patients students will care for in practice, as well as to assist in fulfilling uOttawa’s social accountability mandate, it is essential that we modify the current cases to reflect the population of our region, their priority health needs, and essential social medicine concepts. Before such modifications can be undertaken, we require a roadmap for this work that includes regional sociodemographic and health profiles, the content of the existing cases, where the CBLs currently fit into the curriculum, and recommendations for a logical sequence and reinforcement of essential social medicine concepts. 

Objective: 

Create a roadmap for CBL sessions that ensures social accountability principles are reflected in a logical sequence and align with the rest of the curriculum. 

Methodological Approach: 

The student will assist with the following: 

• Work with the Ottawa Neighbourhood Study to produce a picture of our region’s residents, including gender, race/ethnicity, language, neighbourhood of residence, and priority health concerns 
• Create a document detailing the current CBL learning objectives, schedules, and course content. 
• Using the above data as well as our social medicine definition and content areas, identify gaps and misalignment in the current CBL cases 
• Develop a roadmap for the inclusion of social medicine principles across the CBL sessions 

The student will use environmental scanning, document review, and narrative synthesis to complete this project. They will be supported by the Director, Social Medicine, the SIM co-Leads, and the Office of Social Accountability (Associate Dean and Team). Aside from receiving required information about the current CBL cases and other curricular information, the student will not require assistance from staff or Med Tech. They will have the opportunity to contribute to presentations and a publication of their work. 

Outcomes: 

The work from this project is essential to integrate social medicine concepts into case-based learning in order to: 

• provide evidence to guide short- and long-term curricular refresh 
• ensure our graduates are well positioned to meet the needs of our community. 
• strengthen our accreditation standard for social accountability.

Background: 

Our medical school has a social accountability mandate to educate future physicians to meet the needs of Canadians. Rural communities are underserved by the Canadian medical system. The literature tells us that early and frequent rural experiences during training improves the likelihood of a physician choosing rural practice. Even urban-based physicians will treat patients from rural communities and must be aware of important considerations that affect the health outcomes of their rural patients.

Medical students at our University participate in a clerkship lottery to determine their assignment to one or more rural rotations in 3rd year, among many other things. At minimum, each student is assigned to a mandatory 1-month rural placement in a core discipline such as family medicine, general surgery, obstetrics/gynecology, psychiatry, or emergency medicine. Offerings vary by language stream and period. While each student indicates their personal preferences, there may be challenges in matching due to logistics, capacity, or other issues.

Project Aim: 

We wish to explore factors that promote or hinder students in their decisions around selection of rural rotations in clerkship. We hope to learn from the students’ first-hand experience with the lottery and curriculum. Study results will inform priority setting and further development of the curriculum in Distributed Medical Education (DME). We hope to enact practical changes within the plans for curriculum reform. Changes may enable students to have more rural opportunities and improve the matching of students with rural disciplines and communities. 

Intervention and Outcomes: 

We will develop an online survey questionnaire to explore these issues. The draft questionnaire will be shared with the Assistant Dean, Curriculum and the Assistant Dean, Curriculum Implementation to invite their input on aspects relevant to curriculum reform. The study will be submitted for Ethics approval. We propose to distribute the survey to 2nd year medical students at the University of Ottawa, soon after their lottery experience. Responses will be collected anonymously.

Survey questions are divided into four areas:

1. Demographics – including Franco/Anglo stream, rural background, participation in Rural Medicine Interest Group information-sharing activities. 
2. Reasons for choosing rural experiences – including connection to a community, previous positive experiences (e.g. Community Week in Year 1), clinical opportunities that differ from urban practice, plans to practice in a rural setting.
3. Barriers to choosing rural experiences - including distance from personal support systems, financial, logistics, poor fit with career plans.
4. Factors that would encourage the student to choose more rural rotations – ways to address barriers, possibly a new dedicated rural medicine area of concentration.

Results will be analyzed and will inform further development of the DME clerkship curriculum. 

An abstract will be submitted to the national conference of the Society of Rural Physicians of Canada.  

The internal medicine clerkship rotation includes established learning objectives covering a breadth of topics. High yield topics are taught in 1 hour lunchtime teaching sessions led by clinician tutors. There are currently 14 topics covered: Acute Kidney Injury, Acute Monoarthritis, Anemia, Antibiotics, Bugs and Drugs, Asthma/COPD, CHF/Edema, Diabetes, Palliative care, EKG/Chest Pain, Abnormal liver enzymes, PFT/Pleural Fluid Interpretation, Radiology and Substance use disorders. When initially created, these sessions were designed as Problem-assisted learning sessions (PALS) where material is delivered through discussion of clinical case and content is presented on PowerPoint and handouts. The format and content of these sessions are due for a renewal. 

This is an opportunity to update the in-person teaching sessions delivered during the core Internal Medicine Clerkship Rotation.

Expectations of the student:

• Perform a brief review of the literature of effective teaching strategies and principles in medical education.
• Apply strategies and principles of effective teaching in medical education to renew the formal teaching sessions for the Internal Medicine Clerkship Rotation.
• Ensure content of teaching session is updated and in line with current learning objectives/curriculum. 
• Update handouts/written material for each teaching session.

The Elentra Exam Management system contains an item bank module for UGME Summative Exams. This item bank currently contains questions from the last three years of Preclerkship exams. The Exam Management System also contains a module for creating exams by pulling Unit specific questions from the Item bank. Starting in September 2024, the Elentra Exam Management System will be used to create specific exams for each Preclerkship unit. 

Each question on an exam is linked to a learning event objective.  It is not currently known how many objectives in each unit are actually tested on the exams or where the gaps are that could inform question development.

We propose hiring a student to conduct a gap analysis of the Preclerkship Summative Exam questions and the learning objectives. Using the gap analysis, Assessment, Evaluation and Curriculum (AEC) staff could then better inform unit leaders and content experts as to what is covered and where attention should be given to create new questions. The student will receive a copy of the objectives that are currently linked to questions in the item bank (note they will not receive the actual questions) along with a copy of the Learning objectives that are to be covered within a unit. They will be expected to generate a report for each Preclerkship Unit.

Key deliverables:

• Conduct a gap analysis of objectives that are linked to questions in the item bank and learning objectives that are taught in each Preclerkship unit.
• Prepare a report that summarizes both the coverage (i.e., number of questions / objective and content area) as well as the gaps in each unit. 

AI has garnered immense notoriety and discourse among the public in recent years, largely due to ChatGPT, a chatbot that receives over 1.6 billion website visits per month. ChatGPT has demonstrated unprecedented ability to gather information and synthesize intelligible outputs based on user prompts. It is clear due to the potential and ubiquity of AI, that it will play a substantial role in shaping future physicians and healthcare. Although, the nature of this impact is uncertain as medical schools currently lack standardized, formal training for the use of AI in medicine. 

There is a clear need for curricular adaptations based on a 2021 study by Mehta et. Al which studied the knowledge and perceptions of AI in undergraduate medical students across Ontario. 79% of students believed their medical education has not adequately prepared them to work alongside AI tools. Further, 72% of respondents believed that medical training should include AI competencies, with 68% of students indicating AI competency training should begin in medical school. 

However, in the literature there is a lack of data for how AI is currently used in undergraduate medical education. This poses a significant challenge for medical education programs to develop robust policies and educational frameworks to establish ethical, appropriate use of AI. The purpose of this study is to anonymously survey how medical students use and perceive AI in medical education to guide pragmatic curricular development. 

The attached questionnaire will be delivered on Microsoft Forms to medical students. The questionnaire is divided into 4 sections: 

1. use of AI, 
2. perceptions and attitudes of AI,
3. participant characteristics, and 
4. open forum. 

Section 1 explores how often AI is used, the specific AI tools used, and the precise ways in which students utilize AI in academic, clinical, and personal settings. The results of this survey will be used to select relevant educational content, with an emphasis on popular AI tools, and AI’s advisable applications in certain settings. Due to the powerful functionality and versatility of AI, it is critical to clearly identify what tasks AI is used for in medicine. This is to ensure medical students are well educated on the different ethical implications and risks for patients, healthcare providers and society based on the applications of AI. Section 2 investigates the enablers and barriers to the use of AI, and how medical students may anticipate u sing AI in their future practice. These responses are also crucial in addressing common misconceptions, potential biases, and suitability of AI in medicine. Lastly, the open forum allows students to provide their own insight and recommendations for how AI can be implemented into medical education curriculums. 

The objective of this study is to provide data on the usage and beliefs of AI to inform and justify the design of pertinent, topical curricular adaptions for AI. Due to the evolving presence of AI in workplace and educational structures, it is up to medical institutions to ensure future physicians maintain integrity and are competent in the face of rapidly advancing technology.