Fresh cases to better reflect patients in the clinic: Dalhousie University revises curriculum for pre-clerkship medical students

First-year medical students at Dalhousie University are discussing and examining new cases as part of a curriculum refresh at the school. “It’s a refresh; it’s not a revamp. It’s not changing the structure of how we deliver or structure knowledge,” said Dr. Evelyn Sutton, associate dean of undergraduate education at Dalhouse University medical school. The program remains case-based, with students discussing and researching fictious patient cases to learn essential concepts. The curriculum refresh means that the medical school is rewriting more than 200 cases students study in the first two years of medical school. The changes reflect a commitment to equity, diversity and inclusion, and to recognize “the new challenges of climate change and the effects on not only on individual health but health systems,” Dr. Sutton said. The case revision also ensures that students appreciate the role of the generalist in the healthcare system. Dr. Sutton said that the medical school continues to work with family medicine experts to ensure there’s not a hidden curriculum that suggests family physicians can only take treatment so far. Previously, there were cases which suggested that a family physician missed a diagnosis and a Royal College of Physicians and Surgeons specialist came to the rescue. This may have introduced bias against family medicine and portrayed medical practitioners working in a silo, instead of working as a team. “We’re focusing on a generalist lens and the importance of that,” Dr. Sutton said. There’s more of a focus on the need for physicians to have core abilities that can be applied across a range of settings. “One of the things we're giving more emphasis to is that patients don't come in with labels, in terms of ‘here's what's wrong with me,’” Dr. Sutton said in a Dalhousie University press release. “They come in with a headache and the student’s job is to start developing a differential diagnosis, and how challenging and how interesting that process is.” Read: Practicing pediatric medicine on the real thing: program lets medical students interact with kids and families The case refresh aims to remove other unconscious biases. Patients in the cases are presented as whole people, where aspects of their identity may affect their health. Now, cases include: a full name pronouns racialized identity sexual orientation sex/gender identity family structure socioeconomic status First-year students are already learning with the new cases, and the revised cases for second year of medical school will be completed by next school year. The case revisions were coordinated by Leanne Picketts from Dalhousie University’s Centre for Collaborative Clinical Learning and Research. The goal of the refresh isn’t to add information to cases, but to remove assumptions about the ‘standard’ patient, Picketts said in a Dalhousie University press release. There’s also a goal to better represent communities in the Maritimes. For example, the curriculum previously only included four cases with Indigenous patients, but the refresh will provide students with 20 cases featuring Indigenous patients. An advisory group on diversity in cases, led by Dr. Lynette Reid, oversaw the process to ensure diversity was presented in ways that are respectful, authentic and of value to students. “We are also paying particular attention to language use, to avoid perpetuating stigma, bias, and harm,” Picketts said. “We are using person-first language, eliminating pejorative terms, and aiming to make patient-centeredness a key component of every case.” The curriculum refresh includes a focus on student wellness. The office of student affairs developed a learning program that will be integrated into the undergraduate medical education curriculum. “In the past, a lot of the sessions would be after hours and that’s not appropriate, so we’re making time for that,” Dr. Sutton said. Dr. Sue Zinck, associate dean of student affairs at the medical school, and Dr. Lisa Sutherland, associate dean of student and resident affairs at Dalhousie Medicine New Brunswick are working on a curriculum that addresses physical, mental and financial wellness, as well as a healthy environments. Read: Canadian medical schools are out of this world Dalhousie University medical students also benefit from the Association of Medical Faculties of Canada curriculum about the opioid crisis, released in January 2021. There are some changes to the clerkship years. There’s a new clerkship objective of anti-oppressive practice and cultural safety, Dr. Sutton said. There will also be more attention to health system sciences, reducing inequities and being a responsible steward of health resources. While the curriculum is evaluated and modified on an ongoing basis, the last extensive revision was in 2009. The work on the revision began in 2020 and included consultations with faculty, residents, students and the community. Read: Saskatchewan medical students no longer need to move cities mid-degree

Fresh cases to better reflect patients in the clinic: Dalhousie University revises curriculum for pre-clerkship medical students

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