Phase 4- INTEGRATION INTO PRACTICE
MED 8740: Advanced Practice integration (Selectives/P2P)
Academic Year 2024-2025
Class of 2025

Assessment Plan

Description
Enables learners to be assigned to a physician, physician group or discipline for experiences that focus on following patients as they interact with the health care system.

Entrustable Professional Activities (EPAs)
EPA 1: Obtain a history and perform a physical examination adapted to the patient’s clinical situation.
EPA 2: Formulate and justify a prioritized differential diagnosis.
EPA 3: Formulate an initial plan of investigation based on the diagnostic hypotheses.
EPA 4: Interpret and communicate results of common diagnostic and screening tests.
EPA 5: Formulate, communicate and implement management plans.
EPA 6: Present oral and written reports that document a clinical encounter.
EPA 7: Provide and receive the handover in transitions of care.
EPA 8: Recognize a patient requiring urgent or emergent care, provide initial management and seek help.
EPA 9: Communicate in difficult situations.
EPA 10: Contribute to a culture of safety and improvement.
EPA 11: Perform general procedures of a physician.
EPA 12: Educate patients on disease management, health promotion and preventative medicine.
EPA 13: Collaborate as a member of an interprofessional team.
EPA 14: Incorporate the relevant social determinants of health (SDoH) and cultural safety in relation to patient’s illness and management planning.

Course Structure
A summary of requirements for Selectives is available here. The requirements for P2P are listed here.

Option 1:
12 weeks as follows
4 consecutive weeks in a rural site* in one of the core disciplines for the Rural Core Selective (Family Medicine, Pediatrics, Internal Medicine, Obstetrics and Gynecology, Psychiatry, General or Orthopedic Surgery, Emergency Medicine, Anesthesia, Anesthesia/Emergency Medicine)
4 weeks Surgery (two 2 week selectives or one 4 week selective)
4 weeks Non-core (two different 2 week selectives) in lab medicine, radiology, or a discipline of the learner’s choice.

* Definition of rural site

For the province of Newfoundland and Labrador, a rural site is defined as having a population of less than 50,000 people and not within a one hour commute of a population centre exceeding 100,000. For the province of New Brunswick, rural includes any location outside the main centers of New Brunswick (Moncton, Saint John, Fredericton).

Option 2:
Progression to Postgraduate (P2P)
12 weeks integrated selectives based with a rural preceptor or other preceptor appropriate to the learner’s needs.

Objectives
The course objectives are listed on C-blue and have been mapped to the EPAs.

Objectives/Learning Plan
Each learner required to submit personal objectives/learning plan linked to EPAs and in response to their progress to date.

Learners identified as requiring remediation will require objectives/learning plan to be developed in conjunction with UGME (Phase 4 Lead) and approved by the Phase 4 Management Team. These learners will be required to complete these electives in NL/NB/PEI with a Memorial Faculty member as a preceptor.

Teaching and Learning Methods
Clinical teaching

Assessment plan
Learners will be assessed using the In Training Assessment Report (ITAR). EPAs will be selected based on the customized objectives above.

Option 1:
Summative ITAR at the end of the rotation for all selectives.

Option 2:
Formative: Mid rotation ITAR at 6 weeks and electronic field notes.
Electronic field notes must be regularly completed throughout the P2P rotation, minimum two field notes per week. This ensures frequent narrative feedback and enables learners to identify learning needs. Learners or preceptors can complete the electronic field note using the T-res app.

Summative:  ITAR at the end of the rotation.

Remediation
Customized to the identified performance concerns after completion of the 12 weeks and designed by Phase 4 Management Team. 

Course Success Criteria

To pass the course, a learner must:

• Obtain an overall rating of performance as appropriate for this level of training in the ITAR for all selective/P2P rotations
• Have no outstanding concerns with professionalism

As outlined in the MD program objectives, the Faculty of Medicine at Memorial University values professionalism as a core competency and a requirement of the MD program. Recognizing that medical learners are developing their professional identity, professionalism lapses will be remediated where possible and appropriate. Unsuccessful remediation will result in failure of the Phase.  Professionalism lapses may render a learner incompatible with continuation in the MD program (as outlined in the Memorial University Calendar Regulation 10.5 Promotion).

Learners will receive their grades from the Undergraduate Medical Education (UGME) office via One45.

Original work, completed wholly by the learner, is expected to be submitted in this course. The use of an artificial intelligence tool like chatGPT is not permitted.

As outlined in Section 10.5.2 and 10.5.3 of the Regulations for the Degree of Doctor of Medicine in the University calendar, learners with a Fail grade in any course cannot be promoted to graduation. Even in the absence of any Fail grades, a learner for whom substantial concerns about performance have been expressed may either be required to repeat the Phase or required to withdraw conditionally or unconditionally.

 

Version date: March 13, 2023
Reviewed by SAS: April 26, 2023
Approved by UGMS: May 17, 2023