Last Revision: Friday, January 10th

, 2014

POLICIES AND PROCEDURES MANUAL FOR STUDENTS IN YEAR 4

ACADEMIC YEAR 2014-2015

This document contains information for Faculty & Students in Year 4 of the Medical Curriculum on Assessment and Key

Policies & Procedures.

Note: Updates to the Policies and Procedures manual may be made during the academic year. The most recent version of this document is the one found on the MEDICOL website.

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Table of Contents YEAR 4 PROGRAM & SITE LIST ........................................................................................................... 4 I.POLICIES AND PRINCIPLES GUIDING THE DESIGN AND IMPLEMENTATION OF ASSESSMENT IN YEAR 4 5

A. Preamble B. Types of Assessments 5 C. Purposes of Assessment 5 D. Policies 6 E. Principles 6

II.YEAR 4 CURRICULUM AND ASSESSMENT POLICIES .......................................................................... 7

A. Goals of the Year 4 Curriculum 7 B. Preparation for Medical Practice (PMP) Course 7 C. Assessment of Preparation for Medical Practice Course 8 D. Electives: Principles and Guidelines 9 E. Comprehensive OSCE Assessment 11 F. First Point of Contact 11

III.PROMOTIONS POLICIES ............................................................................................................... 12

A. Student Promotions Committee Years 3 & 4 12 B. Advancement in Year 4 12 C. Year 4 Grading Practices 12 D. Release of Grades and Promotions Committee Decisions 13 E. Special Recognition and Awarding of Scholarships and Prizes 14 F. Academic Probation 15 G. Problems related to Unprofessional Behaviour 15 H. Information Sharing 15 I. Withdrawal from the Program 15 J. Appeals Policy and Process 16 K. Appeal of Promotions Decisions 16

IV.ADMINISTRATIVE POLICIES .......................................................................................................... 16

A. Year 4 Scheduling Policies 16 B. Policies Relating to Insurance during Year 4 Electives 16 C. Pagers 17 D. Dress code 17 E. Absence Policy & Procedures 17 F. Parental Leave of Absence Policy 20 G. Parental Leave in Year 4 20 H. Academic Concessions 21 I. Accommodation for Examinations 22 J. Policy and Procedure for Missed Examinations 22 K. Student Movement between Sites of the UBC MD Undergraduate Program 22 L. Transfer requests 22

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APPENDIX 1: Defined Competencies: Learning Goals and Objectives ................................................ 24 APPENDIX 2: Students Engaging in Clinical Activities........................................................................ 27 APPENDIX 3: End of Elective / Mid-Rotation Assessment Forms ....................................................... 30 APPENDIX 4: Case Report Guidelines............................................................................................... 32 APPENDIX 5: Elective Cancellation Policy ........................................................................................ 33 APPENDIX 6: Liability Insurance & Informal Elective Opportnities .................................................... 34 APPENDIX 7: OSCE Exam Guidelines ................................................................................................ 35 APPENDIX 8: First Point of Contact .................................................................................................. 36 APPENDIX 9: MSPR ......................................................................................................................... 39 APPENDIX 10: Disruption of Teaching and Learning Activities .......................................................... 39 APPENDIX 11: Unmatched Students from the CaRMs First or Second Iteration ................................. 42 APPENDIX 12: International Elective Guidelines & Application Form ................................................ 43 APPENDIX 13: Year 4 Committee TERMS OF REFERENCE .................................................................. 53 APPENDIX 14: Student Support and Development Committee (SSDC) & Complaints Received by the College of Physicians & Surgeons of BC .................................................................. 55 APPENDIX 15: Anti Plagiarism Guide.................................. .................................... 64 APPENDIX 16: Blood & Body Fluid (BBF) Exposure Policy. ......... 65 APPENDIX 17: Appeals Process . 70 APPENDIX 18: CaRMS Entry Disciplines and Medical, Surgical/Procedural and Primary Care elective75 APPENDIX 19: Class of 2015 Academic Schedule .77

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Year 4 Programme & Site List

Vancouver Fraser Medical Program (VFMP) Regional Associate Dean: Dr. Dawn DeWitt Assistant Dean Vancouver: Dr. Amil Shah Associate Dean Student Affairs: Dr. Janette McMillan Assistant Dean, Student Affairs: Dr. Carol Ann Courneya Assistant Dean, Student Affairs: Dr. Christina Roston Assistant Dean Fraser: Dr. Jill McEwen Clinical Education Leader Fraser: Dr. Dan Beegan VFMP Site Director: Dr. Jill McEwen Year 4 Electives Director: Dr. Michael Curry Island Medical Program (IMP) Regional Associate Dean: Dr. Oscar Casiro Assistant Dean Student Affairs: Dr. Darlene Hammell Year 4 Electives & Site Director: Dr. Amita Modi Northern Medical Program (NMP) Regional Associate Dean: Dr. Paul Winwood Assistant Dean Student Affairs: Dr. Leigh Hunsinger Year 4 Electives & Site Director: Dr. Tony Preston Southern Medical Program (SMP) Regional Associate Dean: Dr. Allan Jones Assistant Dean Student Affairs: Dr. Connie Hull PMP & Year 4 Electives Course Lead: Dr. Katharine Smart Year 4 Departmental/Site Representatives Anaesthesia, Pharmacology & Therapeutics: Dr. James Price Dermatology: Dr. Simon Wong Emergency Medicine: Dr. Shahin Shirzad Family Medicine: Dr. Barra OBriain Internal Medicine: Dr. Jennifer Yao Obstetrics & Gynaecology: Dr. Francine Tessier Ophthalmology: Dr. Noa Mallek Orthopaedics: Dr. Nelson Greidanus Paediatrics: Dr. Victoria Atkinson Pathology: Dr. Jason Ford Psychiatry: Dr. Peter Chan Radiology: Dr. Savvas Nicoloau Surgery: Dr. David Taylor Urological Sciences: Dr. Ercole Leone Public Health & Preventative Medicine: Dr. David Moore Year 4 OSCE Director: Dr. Amil Shah Chilliwack: Dr. Mark Mackenzie Lions Gate Hospital: Dr. Dean Brown Richmond General Hospital: Dr. Nancy Austin Royal Columbian Hospital: Dr. Dale Stogryn Surrey Memorial Hospital: Dr. John Diggle Course Directors, Preparation for Medical Practice (PMP) VFMP Course Director: Dr. Linlea Armstrong IMP Course Director: Dr. Fraser Black NMP Course Director: Dr. Keri Closson Program Administrative Managers Year 4 Program Manager, VFMP: Deborah Phillips Year 3 & 4 Program Manager & Assessment Manager, IMP: Lynne Fisher Year 3 & 4 Curriculum and Assessment Manager, NMP: Jennifer Young Year 3 & 4 Curriculum and Assessment Manager, SMP: Elaine Thomas

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I. POLICIES AND PRINCIPLES GUIDING THE DESIGN AND IMPLEMENTATION OF ASSESSMENT IN YEAR 4

A. Preamble

This Policy and Procedures Manual is intended to provide faculty and students with the guidelines used for developing Year 4 assessment plans. Please note that each Course or Elective is responsible for providing students with an overview describing learning objectives, faculty contact information, and specific assessment procedures. While the policies and procedures below are the ideal standards that every experience should endeavour to meet, due to existing resource limitations (e.g., the availability of clinical teaching units, human resources, patient populations), it may be difficult for all Electives to meet all standards, however, all clinical departments have agreed to attempt to fulfill these policies and procedures to the best of their abilities.

B. Types of Assessments

Central tenets of the assessment process are that ongoing and detailed dialogue with students on their progress is an integral part of the learning process, and that early detection of problems will enable more effective help to be provided. Both formative and summative assessments will be provided to each student. The following lists the types of assessments that may be included in each category: Formative (To provide students with information about their skills and achievements and how to improve them, and to enable students to practice self-assessment skills):

Preceptor feedback ongoing Mid Rotation Clinical Assessment Clinical supervisor - resident, fellow, clinical faculty feedback; including Mini-CEXs, & Case Reports Formal feedback about performance levels on the components of the summative assessments (OSCE, written

examinations) Summative (To record formal judgments about student progress):

End-of-rotation clinical assessment Comprehensive Exit Year 4 Objective Structured Clinical Exam (OSCE) Preparation for Medical Practice (PMP)

student project participation in large and small group sessions on-line written examination

C. Purposes of Assessment

Assessments are critical to the learning process and significantly determine what, when and how students learn. The primary purposes of assessments are to assist student learning, to measure the learning results and to predict practicing performance. To ensure that assessments complement learning, the instruments and process used will measure attainment of the required competencies for the MD undergraduate program at the University of British Columbia and must provide feedback to students and faculty. Assessments will measure the critical components of learning: what we know; what we do; how we think; and how we act. A list of the defined competencies for the UBC MD Undergraduate Program is attached in Appendix 1. These competencies include:

Knowledge Integration and Analytical Skills Communication Skills Professional Behaviours

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Clinical Skills including Clinical Reasoning Practical and Technical Skills Personal Management Skills Health Policy Skills

All competencies are considered essential to the practice of Medicine. The Faculty of Medicines assessment procedures will ensure that these competencies are adequately learned and satisfactorily performed upon completion of the MD Undergraduate Program. Faculty assessment of student performance as potential colleagues and future practicing physicians is an important professional responsibility. Identification of students who require improvement in any aspect of their learning initiates a positive and constructive process of assistance and remediation.

D. Policies

Assessment policies and procedures will be consistent with the Principles identified by the Council of Undergraduate Associate Deans UBC Taskforce on Student Assessment Report May 2006.

There must be a single standard for promotion and graduation of students across geographically separate campuses.

Comprehensive assessment policies will be adopted which are consistent throughout all components of the entire MD undergraduate curriculum.

Assessment policies will be developed, reviewed and revised by the MD Student Assessment Committee (SAC). The SAC along with the Curriculum Committee reports to MDUEX. SAChas the responsibility to establish policy, develop and/or approve procedures and instruments, and monitor the effectiveness of the system for assessing students. The MD Student Assessment Committee is tasked with the implementation of assessment in the UBC integrated and distributed program.

The Promotions Committee will use the criteria and policies as set out in this Policies and Procedures Manual in making decisions on student advancement, the need for remediation and supplemental work or assessment.

The development of assessment instruments will be based on the domains of competence (e.g., professional behaviours, knowledge, clinical, psychomotor and technical skills, reasoning and decision-making skills).

Standards will be established and all stakeholders will be informed of Promotion requirements. Specific consequence of failure will be made clear:

A structured process of appeal will be available. The development, administrations, scoring of assessments and remedial instruction for students will be the

responsibility of the Deans Office and/or faculty members as well as rotation and course directors. The assessment of course content and competencies will be cumulative across the MD Undergraduate

Program. Students will be responsible for ensuring the submission and maintenance of their assessments to enable

follow-up discussion with student advisors. The Deans Office will retain the original copies of all summative assessment data.

Students must satisfactorily pass all required assessments prior to the granting of the MD undergraduate degree.

E. Principles

Assessment measures will be positive learning experiences. All assessments will be directly linked to competencies and specific course objectives. Assessments across Courses will provide a balanced representation of the biological, behavioral, social, and

population domains.

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Assessments of basic knowledge will focus on the application and integration of knowledge as applied to relevant clinical phenomena.

A variety of assessment methods will be used to provide reliable, valid and realistic evaluation of specific content and competencies. These could include written and oral examinations, standardized patient examinations, tutor ratings and narratives, clinical preceptor ratings and narratives, and any other procedures that effectively assess the achievement of program objectives.

Assessment of students will be comprehensive, cumulative, and frequent in order to guide and facilitate student learning.

The assessment process will include effective measures to provide feedback to students on their strengths and weaknesses (formative assessment) and to judge students achievements (summative assessment).

Summative assessments will include carefully determined criterion referenced passing standards. Grades will be designated as follows: (Note, however, that only an F, or a P will appear on student

transcripts.) Fail (F): Does not Meet Requirements Pass (P-): Requires Improvement Pass (P): Meets Requirements

All students must obtain a passing grade on both Course and formal examination components of the

assessment system. The timing of summative assessments will be scheduled to allow for remediation measures should they be

necessary. Faculty will be assisted with the provision of quality assessments. The system of student assessment will evolve with the ongoing development, review and evaluation of

program effectiveness.

II. YEAR 4 CURRICULUM AND ASSESSMENT POLICIES

A. Goals of the Year 4 Curriculum

The Faculty of Medicine has a responsibility to ensure that students meet the goals of the MD Undergraduate Program through a high quality and rigorous four- year educational program. In Canada, the final year of medical school is influenced by two powerful external events that dominate the students lives: the CaRMS Match and Part 1 of the Licensure examination of the Medical Council of Canada (MCCQEI). The challenge is to provide a coherent and meaningful educational experience in year 4 while recognizing the external realities and the needs of students to be successful in both the Match and the examination (since these affect not only a students future but also act as benchmarks by which the success of the undergraduate program is judged). Year 4 is composed of four curriculum elements: 1. Clinical Block 1: Electives 1, 2, 3 & 4 is September 2nd - December 21st 2014 (a total of 15 weeks) 2. Clinical Block 2: Electives 5 & 6 is February 9th April 5th 2015 (a total of 8 weeks) 3. The Preparation for Medical Practice Course (PMP): 2 weeks in January and 4 Weeks in April, 2015 4. The Year 4 Objective Structured Clinical Examination (OSCE) held November 29th and 30th 2014 Please refer to Medicol or ONE 45 Handouts & Links for the current schedule of Year 4.

B. Preparation for Medical Practice (PMP) course

The PMP Course is protected academic time, and content is designed to complement and augment what students learn during their clinical rotations. Much of the Course content is case- based which ensures that the

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clinical relevance of the teaching components are explicitly demonstrated. Learning formats include large group learning, small group sessions, online assignments, and a student project. Small group sessions are of various formats, including a number with standardized patient encounters. Please refer to MEDICOL for the current schedule of the PMP Block. Large and small group sessions: Students must attend all large and small groups sessions. These are set up to be interactive, and allow students to apply their learning and practice their skills. Online Assignments: The PMP Course requirements include completion of a series of online assignments. With clearly specified objectives, students are guided through various tasks. Formative guidance is provided as embedded feedback within the assignment wherever possible. Most assignments have multiple choice post tests to be completed on MEDICOL for the purpose of formative assessment. The assignments complement the face to face learning within the Course. These assignments are not formally graded, and do not contribute to the final numeric grade in the Course however, students must satisfactorily complete the assignments to pass the Course. The quizzes are set up so students can repeat them until they achieve a Passgrade. Each assignment can take up to three hours. The Student Project: Students work with peers to address a clinical question of their choice. Students must present their work to Faculty and their peers. Assessment by faculty will provide 15% of the course mark, and assessment by a selection of peers will provide 10% of the PMP mark. The project allows students to work with peers, research an interest of their choice and develop a more indepth understanding and reasonable conclusions to articulate and educate the rest of the Class.

C. Assessment of The Preparation for Medical Practice course

Student Assessment: There will be formative and summative assessments provided to students. The formative assessments provided to students over time will help guide student learning. Formative assessments include: feedback from peers and tutors during student projects, , and the small and large group sessions . Answers to the multiple choice post tests in the online assignments will be provided, including why certain

answers were right/wrong to ensure students have a full understanding of the correct answer. Assignments will also direct students having difficulty with related concepts to specific resources. Some of the assignment EBM concepts will be reviewed with students during an EBM Lecture and small group

sessions. The Palliative Care on-line assignments will be reviewed in a small group setting. The On-line Written Examination will be followed by an exam-review opportunity for formative purposes. Summative assessments are those that judge and rank the students for the purpose of promotion and award determination. The following components compromise the final numeric mark for the PMP Course: Team Project 25% Completion of the Online Assignments and participation during large and small group sessions 25% Online written examination on April, 2015 50%

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Final standing is determined as follows: *Pass A PMP numeric mark of at least 60%. *Fail Failure to meet any of the passing requirements. Failure of the PMP course will result in a detailed review of performance to identify the problematic areas, and the requirement to successfully complete an appropriately designed remedial program, and may also require a passing grade in supplemental assignments written, or OSCE, as per the nature of the identified weaknesses.

D. Elective Principles and Guidelines

Students will continue to be connected with and supported by the Program to which they were admitted for the duration of their undergraduate degree, irrespective of the location(s) of their Electives. The UBC Clinical Departments will continue to have overall responsibility for quality assurance with respect to Elective offerings, however the Programs and Sites are, in accordance with the geographic model approved by Year 4 Committee, are responsible for approving their Electives, confirming directly with applicants (irrespective of home program), scheduling, and orientation if necessary. The UBC MD Programme includes includes 24 weeks of Elective time during Year 4. Carry-over work from Year 3 or academic remedial work during Year 4 will reduce Elective time. When selecting electives, students will follow these guidelines:

1. No more than 8 weeks in any one CaRMS entry position (see * Exception below) 2. Core Electives:

a) At least 4 weeks must be surgical / procedural based b) At least 4 weeks must be medical based c) At least 4 weeks must be in a primary care setting (eg: Family Medicine, Emergency Medicine,

Community Medicine) d) Must be taken at LCME accredited schools in the USA and Canada

3. No more than 12 weeks in any one Elective Category: Medical, Primary, Surgical / Procedural (see **Exception below)

4. Students are allocated 8 Change Credits per Clinical Block with a total of 16 Change Credits to make changes to Electives in the One45 system.

5. Students must complete 12 weeks of UBC Year 4 Electives. 6. Students may spend up to 12 weeks Out-of-Province (OOP) with no more than 8 weeks at Non-LCME

medical schools 7. A maximum of 4 two-week electives 8. An elective cannot be done more than once in the same discipline at the same site..

Students who have failed a clerkship or the Year 4 OSCE or who have had professionalism concerns raised on Evaluations may be required to stay in-province. Please see appendix number 18 for lists of CaRMS Entry Disciplines and Medical, Surgical/Procedural and Primary Care elective. Appendix 19 for Academic Schedule (with exceptions* & **) Students with special requests or circumstances outside these guidelines MUST have approval from the Year 4 SITE Director before proceeding. 1. Electives Assessment Assessment of performance is critical to the growth of student physicians.

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There will be formal assessments of the students for all Electives during Year 4. Students are advised to ensure that these are done. It is hoped that excellence is the norm and that most students will meet requirements. Preceptors will be encouraged to do a Mid-Rotation Assessment to provide realistic feedback to students to address any concerns and make any necessary changes to improve his/her performance before the Final/End-of-Rotation assessment. Some students may be required to have Mid-Rotation assessments sent to the Deans Office. Students will also be required to complete two to four Mini-CEXs during one selected 4 week UBC Elective in the first clinical block. Students will also be required to complete one Case Report for one selected 4 week UBC Elective in the first clinical block. See Appendix 4 for Case Report Template. Categories are graded on an Exceeds Requirements (H), Meets Requirements (P), Borderline (P-), or Does Not Meet Requirements (F) basis. Overall, Electives are graded on a Pass/Fail basis. 2. Failure of Electives Students must successfully complete, i.e. receive at a minimum, a Pass grade, for each Year 4 Elective. If a student fails an Elective, a supplemental Elective must be successfully "passed" (in the same category and discipline, whenever possible), in order to adequately remediate the failure. If an Elective is failed close to the end of Year 4 and the supplemental Elective cannot be successfully completed before the scheduled end of Year 4, it may jeopardize the ability of the student to graduate with his/her Class in May. Students are advised to be particularly wary about leaving core Electives until the end of their schedule. Mid-Rotation Assessments must be completed. In extenuating circumstances, primarily unavoidable medical issues, the Promotions Committee may consider waiving only one non-core Elective. The Promotions Committee will take into consideration both the circumstances and the previous academic as well as professional record of the student in making the decision. 3. Supervision All Electives require a designated supervisor who is responsible for all aspects of the Elective. 4. Learning Objectives Each Elective must provide the educational objectives of the rotation. Students are required to prepare a list of five or more personal objectives for their Electives and to obtain the consent of the supervisor for these objectives. See Appendix 1 & 2. 5. Educational Activities Each Elective must outline the academic activities developed to facilitate student learning, i.e., Rounds seminars, tutorials, etc. Most Electives provide an opportunity for increasing responsibility with direct patient care under appropriate supervision in both inpatient and ambulatory care settings, however, some Electives may focus on non-patient care activities such as Pathology, Laboratory Medicine, Radiology, and Clinical Epidemiology. The Elective will describe any special features which provide further educational opportunities for the student. In addition, there may be a written report required for the Elective. This report may take the format of a case report, critical appraisal of a topic or a topic review. If a case report, it will include a history and management plan for a patient to illustrate the students clinical reasoning skills and to develop clinical judgment skills 6. Research Electives - Scholarship in Medical Education Year 4 supports scholarship in medical education and with this in mind, will review student requests for approval to pursue Research Electives. There are eligibility criteria:

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a. The student must not have had academic difficulty prerformance or competency issues, in the preceding years. b. The student must have a balanced Year 4 schedule that fully meets the stated Year 4 core curriculum requirements. c. The elective will be classified as miscellaneous and cannot count toward Year 4 core curriculum requirements. d. There must be a specific scholarly deliverable from the Elective, clearly laid out in writing in the form of an application using the Elective description template form. e. The Research Elective must be affiliated with a recognized university, and a well-established graduate degree programme in health care research. f. The application to pursue this Elective must be submitted a minimum of three months in advance of the proposed start date to the students home site Year 4 Site Director, so it can be reviewed by the Year 4 Director or Site Directors with enough time should another Elective need to be chosen prior to the 6-week cancellation deadline. g. The allowable duration for this Elective experience is 4 weeks. h. If the deliverables are not met during the allotted 4-week time frame, the student will have to address a remediation plan as determined by the home site Year 4 Director. 7. Evaluations by the Student Students may be required to submit an evaluation of the Elective and its preceptor. 8. Elective-related Policies See Appendix: Assessment forms Appendix 3 Cancellation of Electives Appendix 5 Malpractice and Liability during outside formal Electives Appendix 6 Unmatched Students from CARMS First or Second Iteration Appendix 11 International Electives Guidelines Appendix 12

9. Comprehensive OSCE Assessment

A comprehensive objective structured clinical examination (OSCE) based on the MD Undergraduate Program outcome objectives will be administered as an exit examination for the MD Undergraduate Program. All students must pass the OSCE in order to graduate. The OSCE for the Class of 2014 will take place at each students home sites, IMP,NMP, SMP & VFMP on both Saturday, November 29 and Sunday, November 30, 2014. Each student will participate in 16 stations total; 8 stations on Saturday and 8 stations on Sunday. Students are required to attend both examination dates. Students will receive specific details of the OSCE (e.g. number of stations, mix of cases, the required number of stations to be passed, etc.) as soon as the examination is set. Please refer to the section below Year 4 Grading Practices on page 13 for further OSCE details. 10. First Point of Contact

Please see Appendix 8

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III. PROMOTIONS POLICIES

A. Student Promotions Committee, Year 3 & 4

The Years 3 and 4 Student Promotions Committee makes decisions on student advancement, and the need for remediation and supplemental assessment or other requirements based on the academic standards and policies of the Faculty of Medicine. Promotion decisions are based on a detailed review of student performance both within the PMP Course blocks and across clinical sites for the respective academic term. The detailed Terms of Reference for this Committee is available from the Deans Office, Undergraduate Education. Medical Student Performance Record (MSPR) A Medical Student Performance Record (MSPR) is composed for each student in the Fall term of fourth year in preparation for the Canadian Residency Matching Service (CaRMS) application process. Please refer to the Year 3 P & P Manual for additional information.

B. Advancement in Year 4

Supplemental Clinical Rotations Supplemental rotations as part of remedial work from Year 3 may require the utilization of six weeks of Year 4 Elective time. It is the responsibility of the student to consult the Clerkship Program Director concerning details of the schedule. Students who may be using the month of August 2014 to complete Year 3 requirements need to be aware that these requirements may not be completed with results known for the Promotions Committee Meeting, in time for the beginning of Year 4. Therefore, such students are advised to not apply for or confirm an OOP Elective during the first 6 weeks of the first clinical block of Year 4. All supplemental clinical work must be completed by the end of the first 6 weeks of Year 4. The consequences of not successfully completing the supplemental program will be decided by the Student Promotions Committee - Years 3 & 4 and may result in the repetition of the clerkship year (Year 3) or dismissal from the Program. Some students may have possible stipulations and requirements for Year 4 schedules. The Year 4 Director, as well as the Home Site Directors for Year 4 will be advised of such supplemental work. Students involved in supplemental work will be asked to discuss their Elective schedule in Year 4 and may be required to provide mid-rotation assessments as well as additional Mini-CEXs, reflective essays and case reports.

C. Year 4 Grading Practices

The PMP Course component is graded on a Pass/Fail basis, according to the guidelines outlined in section II. B. While the assessment categories of the Electives Assessment Form are graded on an Exceeds Requirements (H), Meets Requirements (P), Borderline (P-), or Does Not Meet Requirements (F) basis; overall, Electives are graded on a Pass/Fail basis. The Year 4 OSCE assesses competency in the following domains: history-taking, physical examination, communication skills, diagnosis, patient management, patient education (counseling), professionalism/ethics, and inter-professional team work. The Medical Council of Canadas Clinical Presentations list and the Year 3 Must See/Must Do list will be used to guide the selection of suitable cases for the Year 4 OSCE: (http://www.mcc.ca/objectives_online/objectives.pl?lang=english&loc=contents) The Pass/Fail cut-off will be determined through a criterion-referenced standard-setting method (similar to the modified Ebel and Angoff methods), and may vary from year to year depending on the specific examination blueprint. An aggregate score for the competency domains targeted by the examination will be generated, based on the performance of students across all OSCE stations, using the examiners ratings. In addition, the application

http://www.mcc.ca/objectives_online/objectives.pl?lang=english&loc=contents

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of clinical knowledge will be assessed in individual stations through case scenarios within the context of safe clinical practice. In order to pass the Year 4 OSCE, students must demonstrate satisfactory performance in each competency domain and pass a pre-determined number of stations. The Year 4 OSCE is an exit examination and must be passed in order to successfully complete Year 4 of the UBC MD Programme. Students who fail the Year 4 OSCE will be required to undertake remedial clinical work ranging from 4 to 8 weeks duration during their Elective time which may result in a change of Electives and/or cancellation of Out-of-Province/Out-of-Country Electives. Students will take a supplemental OSCE at the end of the remediation period. The supplemental Year 4 OSCE must be passed in order to graduate from the UBC MD Programme. The same pass standards and scoring criteria as described above for the initial Year 4 OSCE will apply to supplemental OSCE. Failure of the supplemental OSCE will result in an overall failure of Year 4. Students who fail Year 4 may be offered the opportunity to repeat the Year, either fully or in part, at the discretion of the Promotions Committee. Upon completion of the prescribed clinical work to qualify for graduation, students will be required to pass an exit Year 4 OSCE as outlined above. Failure in the PMP Course, an Elective, or the Year 4 OSCE will result in the requirement to successfully complete an appropriately designed remedial program during the Electives in February and March as well as achieve a passing grade in a supplemental examination, assignment or supplemental OSCE. Elective plans which include travel may need to be cancelled, therefore students should be prepared to accept that plans for remediation take precedent over Out-of-Province (OOP) or international Electives. The score (standard) required on remedial or supplemental assessments will be the same as that set for the curriculum component or Course. Students will receive individual score reports with information about their own performance in the individual stations and the OSCE as a whole. For security reasons, individual station checklists are not shared with students. The Year 4 OSCE Director will review the individual checklists of all students with sub-standard performance and will identify the specific areas for improvement but students will not be permitted to view their individual score sheets personally. Failure of the supplemental PMP Course assessments, supplemental Elective , supplemental OSCE or any of the Elective components including those after the CaRMS match will result in a student being required to undertake further remediation before being awarded the MD degree from the UBC Distributed Program and taking up a residency training position. Students with borderline clinical marks or issues of professionalism which may occur post CaRMS match may expect letters noting such concerns to be sent to Residency Program Directors. This may also involve a delay in graduation. All components of the Year 4 curriculum must be satisfactorily completed in order for students to be approved by the Promotions Committee to receive the MD degree.

D. Release of Grades and Promotions Committee Decisions

All grades are provisional until reviewed by the Promotions Committee. Due to the discipline-specific Electives in Year 4, Clinical Departments are responsible for the release of provisional marks (pending formal approval by the Promotions Committee). Students who are required to do supplemental work will be informed by e-mail and/or telephone as soon as possible following the Promotions meeting to enable them to plan for any required additional work with faculty. Every effort will be made to notify students of their performance within seven days of the Promotions meeting. Those students who are concerned about their performance may contact the Deans Office following Promotions meetings.

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Students who are required to complete Remedial and/or Supplemental Exams following their last Year 3 rotation must accommodate the requirements in their schedule either during the August break or at the beginning of Year 4.

Students who use the August break to complete Year 3 requirements are advised that results may not be known for the year-end Student Promotions Committee meeting for promotion into Year 4. These students are advised not to arrange Out-of-Province Electives during the first four weeks of Year 4 because further remedial or supplemental work may require cancellation. Students should therefore discuss their plans with the Year 4 Director.

If a student has Year 3 requirements to complete in Year 4 (August or September) such as:

Remedial exam(s)

Supplemental exam(s)

Supplemental rotation(s)

Make up time from LOA

Examination(s) deferred

Incomplete required MUST-See/Do items

the Promotions Committee will formally refer the student directly to the Year 4 Director (Chair) or designate and information about the students performance will be shared. Students will be also asked to attend an individual Student Support and Development Committee (SSDC) meeting to discuss plans for remediation and supplemental work. A student will be notified of the Year 4 referral and SSDC referral by a letter from the Promotions Committee Chair. If the Promotions Committee has two or more concerns about a student such as:

Remedial exam(s) written and passed

Weakness in clinical performance

Professionalism issues

or a single concern that is of sufficient magnitude that it may have an impact on the students learning, the Promotions Committee will formally refer students to an individual SSDC to develop learning expectations (a Best Plan) with the student. Information Sharing with the Year 4 Director (Chair) or designate may be part of this contract. Students will be notified of the SSDC referral by a letter from the Promotions Committee Chair.

The purpose of the above referrals is to provide educational support for the student: to facilitate his/her success within the undergraduate program and set the framework for success in a residency program and independent clinical practice. The Year 4 Director (Chair) or designate will help the student choose appropriate Year 4 Electives given the Best Plan and the identified difficulties, and may provide review and feedback on the issues throughout Year 4. Guidance and/or overseeing progress will support the students planning and preparation for CaRMS applications and interviews during the first three Electives of Year 4.

Referrals will begin with the February Years 3 and 4 Student Promotions Committee meeting.

E. Special Recognition and Awarding of Scholarships and Prizes

Student grades in Year 3 as well as all clinical assessments, assignments, and other related objectives relevant to Year 4, will be used by the Promotions Committee to recommend scholarships and prizes.

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F. Academic Probation

A student about whom the Promotions Committee has serious concerns about academic performance and/or professional behaviour may be asked to meet with the Year 4 Director/and the Home Site Director to review certain conditions that are specified in a remediation plan. The plan will be discussed with, and signed by the student as a condition of continuing in the Program. A student may not be allowed to undertake Electives at other institutions while on Academic Probation.

G. Problems related to Unprofessional Behaviour

Problems may arise in Electives relating to unprofessional behaviour or interpersonal difficulties which may in turn interfere with the learning process, especially in the context of clinical care. The following steps should be considered in addressing such problems, and these should be pursued as quickly as possible. The specific steps to be followed will depend on the severity and nature of the problem.

1. Individual Discussion between Student and Preceptor. The preceptor who identifies a problem should initiate a discussion about the situation as part of the feedback process, with the goal of resolving the problem.

2. Outside Assistance. If step #1 does not resolve the problem, the preceptor should bring the problem to the attention of the Elective Owner and the Site Director as well as the Year 4 Director. All activities relating to steps one and two should occur as quickly as possible (in a time-frame of less than one week).

3. Referral of Problem to Regional Associate Dean. If the problem persists, the Year 4 Director and the Home Site Director should notify the Regional Associate Dean about the problem in writing, to request that a meeting be held with the student to resolve the problem. Depending on the nature and severity of the problem, the matter may be brought to the Promotions Committee.

4. Record-Keeping. Letters, meeting summaries and other documentation pertaining to the problem and the process of attempting its resolution should be forwarded to the Regional Associate Dean.

5. The Office of Student Affairs should be considered an option for student support and advocacy.

H. Information Sharing

For the purposes of ensuring that academic and/or professionalism issues are successfully remediated, the Promotions Committee may mandate Information Sharing as part of the Best Plan developed with a student (i.e. with the students knowledge).

The goals of Information Sharing are to help the student, and to alert preceptors to the difficulties being experienced by the student, so that they may make an effective contribution to the resolution of any problem.

If the problem is in the process of being resolved through the above interventions and if this process carries over to a new Elective opportunity, the student is encouraged to update the new preceptor about the problem and what is being done to resolve it. The Best Plan may specify that new preceptors, Site Directors and Elective owners must be advised of the concerns to best support the student during that Elective.

If problems persist, Information Sharing may be a requirement set by the Promotions Committee. Referral to the Student Support and Development Committee (SSDC) for VFMP, NMP, SMP and IMP for

further details may also occur. Appendix 14

I. Withdrawal from the Program

Although satisfactory academic performance is a prerequisite for advancement, it is not the sole criterion used in the consideration of the suitability of a student for promotion or graduation. The Faculty reserves the right to require a student to withdraw from the program if there is evidence that the required competencies including professionalism cannot be effectively addressed through remediation.

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J. Appeals Policy and Process

If a student does not agree with the assessment provided by the Clinical Preceptor, the following applies. Step 1: Student and Preceptor meet to discuss the discrepancy. If a satisfactory agreement is not reached: Step 2: Student brings appeal with written rationale to the Year 4 Director/Home Site Director who will attempt to facilitate a resolution. In some cases the appeal may need to be brought to the Promotions Committee.

K. Appeal of Promotions Decisions

Decisions about academic standing made by the Promotions Committee (e.g. withdrawal from the Program, requirement to repeat the year) may be appealed to the Dean. The student should address their appeal in writing (not email) to the Dean of the Faculty of Medicine, detailing the reason for the appeal, the specific reasons why the appeal should be considered and submit any relevant objective documentation supporting the appeal. Appeals should be submitted as soon as possible after the student has been informed of the Promotions Committee decision. Please refer to APPENDIX 17: Appeals Policy

IV. ADMINISTRATIVE POLICIES

A. Year 4 Scheduling Policies

Holidays A student is allocated two weeks of holiday during the academic year over the Christmas/New Year period.

Holidays cannot be taken during any Clinical Elective time or PMP academic blocks. Statutory holidays, except for scheduled holidays as noted above should not be assumed to be holidays for

the student. Students should check with Clinical Preceptors, Year 4 Director/Home Site Director/ and or Supervisors about whether clinical placements are available on the statutory holiday. The UBC mid-term break does not apply to students.

Work Hours

Each clinical specialty and clinical settings have varying hours of work and work responsibilities. Therefore specific hours a student is expected to work cannot be clearly defined in a general way.

Students are expected to make use of all clinical opportunities to learn as much as possible. This may mean staying beyond a scheduled OR time, ER shift or clinic time to complete the learning experience.

If students feel that the above policies are not being followed or that the hours they are working are extraordinary, they should first address this concern with their Clinical Preceptor/Supervisor, Year 4 Director/Site Director if possible. The students may address this with the Office of Student Affairs if they are uncomfortable or dissatisfied in addressing it directly.

In the event a disruption occurs before or during a teaching and learning activity due to inclement weather, labor disputes or facility closures: students may be requested not to attend or concessions may be made about attendance. Please see Appendix for Disruption of Teaching and Learning for guidelines.

B. Policies Relating to Insurance during Year 4 Electives

1. Malpractice Insurance through the Universitys General Liability and Medical Malpractice Insurance Policy will cover the UBC student undertaking an Elective in UBC-affiliated sites as well as in other locations approved by the UBC Faculty of Medicine.

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2. Health Insurance for students undertaking Electives outside British Columbia, particularly in the United States, should be arranged before the student leaves British Columbia. It is the students responsibility to ensure that he/she has adequate health insurance coverage. 3. Hospital Insurance will be covered by the hospitals insurance policy while the student is on site. This applies to all aspects of the coverage except long-term disability. This policy applies to the major UBC-affiliated teaching hospitals. 4. All students are strongly encouraged to obtain Disability Insurance, if they do not already have this protection. This can be purchased through the BCMA, or the OSA will have information about other provider .

C. Pagers

Students in Year 4 are responsible for pager requirements for Electives. In some cases, pagers may be provided, however, if not; students should assume a professional manner towards fulfilling clinical obligations in the Elective by arranging to have a pager. Students should also provide the pager number/changes to the Deans Office, Undergraduate Education. Students should ask about areas where their outside pagers may not work as well as any required procedures. These might include serving notice to a main ward or an office prior to entering a problem area.

D. Dress code

A proper dress code demonstrates a professional attitude, and respect. When medical students are working in any clinical setting with patients, they are required to maintain a clean, neat and tidy appearance. 1. Clean, white, short clinical jackets should be worn on the wards, ambulatory clinics and doctors offices. (Students will not wear their white jackets in Psychiatry unless asked to do so). 2. ID badges must be worn and clearly visible at all times. 3. Students must not wear jeans, shorts or T-shirts. Clothes should not be torn or ragged. Inappropriate exposure of the mid torso or low necklines is unacceptable. 4. Students should wear closed shoes as this is a safety issue. 5. Obvious body piercing and tattoos could affect your patients perception of you and your professionalism. Please make every effort to carefully consider and suitably address this matter. 6. Hair should be well groomed; long hair pulled back. 7. Hands should always be clean. Nails must be trimmed neatly and kept to a length that does not interfere with physical examination techniques and procedural skills. 8. In the interest of patient and colleague comfort, heavy perfume/cologne should not be worn. Some hospitals and clinics are designated scent-free. Please respect any restrictions noted for ones attention.

E. Absence Policy & Procedures

In extraordinary circumstances, students may have an Unavoidable Absence or request an Anticipated or Negotiated Absence from their clinical education. All students are expected to approach potential absences in a professional manner, and seriously consider implications on their education, their patients, and fellow members of the medical team. Therefore, a request for leave will be reviewed, and either approved or not approved. For the SMP, IMP and NMP, this will be done by the Year 4 Electives Director in consultation with the Site /PMP Director. For the VFMP, this will be done by the VFMP Site Director in consultation with the relevant Department preceptor and/or the Director of Year 4.

The following procedures outline the steps that must be taken in the event a student is considering an Absence, (either Unavoidable, Anticipated, or Negotiated), from their studies. All Absences will be recorded on a spreadsheet in a secure student folder.

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A. Unavoidable Absences: Illness, injury, family emergency or bereavement

The student will notify the preceptor responsible for the time period being missed (phone or in-person) at his/her earliest opportunity.

1. The student will contact the appropriate administrator(s) via email or phone. For the NMP and IMP: Year 3-4 Clinical Program Assistant and/or the Year 3-4 Program Manager; for the VFMP: the Departmental Program Administrator and/or the Year 4 Program Assistants.

2. Upon his/her return, the student must provide the above administrator(s) with a Record of Student Absence Form reporting an Unavoidable Absence.

3. The student should connect with the preceptor to explore opportunities to make-up the missed work (if more than three days) and note this on the Record of Student Absence Form.

4. Copies of the Record of Student Absence Form will be distributed as follows: NMP/IMP:

Year 3-4 Clinical Program Assistant NMP/IMP Files

Assistant Dean, Student Affairs NMP/IMP Files

Student mailbox VFMP:

VFMP Department Program Administrator/Assistant Departmental files

Year 4 Program Assistants VFMP files

Associate/Assistant Dean, Student Affairs VFMP Files B. Anticipated Absences: For medical or dental appointments or religious holidays (for a complete list, please refer to http://students.ubc.ca/current/holidays.cfm?page=all). Students will attempt to book medical or dental appointments for times outside of scheduled clinical duties.

Prior to the Anticipated Absence:

1. The student will contact the IMP/NMP Site Electives/PMP Director or the VFMP Site Director in a

timely fashion to discuss the potential for an Anticipated Absence. The site directors will consult with the relevant DSSL or Preceptor, Elective owner for Year 4 and the Assistant/Associate Dean of Student Affairs, if necessary, before approving the absence. The DSSL or Year 4 Departmental Representative does have power to refuse the absence. If the Anticipated Absence is approved, the student will complete a Record of Student Absence Form and have the Home Site Director sign it. Students should outline what action they propose to take in order to catch up on missed work (if more than two days) and how they will fulfill their clinical responsibilities on the Record of Student Absence Form.

2. The student will submit the signed/approved Record of Student Absence Form to the appropriate administrators. For the NMP and IMP: Year 3-4 Clinical Program Assistant; for the VFMP: the Departmental Program Administrator/Assistant and the Year 4 Program Assistant.

3. The student will notify the appropriate preceptor responsible for the time period being missed. 4. Copies of the Record of Student Absence Form will be distributed as follows:

NMP/IMP:

Year 3-4 Clinical Program Assistant NMP/IMP Files

Assistant Dean, Student Affairs NMP/IMP Files

Student mailbox VFMP:

http://students.ubc.ca/current/holidays.cfm?page=all

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VFMP Department Program Administrator/Assistant Departmental files

Year 4 Program Assistants VFMP files

Associate/Assistant Dean, Student Affairs VFMP Files

B. Negotiated Absences: Negotiated Absences are for academic pursuits of a one-time nature (e.g. commencement exercises, attendance at a scientific meeting to present a paper or accept an award), participation in major varsity team events, participation in major faculty activities , or rare occurrences (e.g., compassionate leave, marriage). Holidays cannot be taken during any Year 4 clinical rotation outside of the Christmas Holiday break. Please note that Negotiated Absences may or may not be granted and are at the discretion of the IMP/NMP/SMP/VFMP Site/ PMP Director or the Year 4 Director.

Prior to the Negotiated Absence:

1. The student will contact the IMP/NMP/SMP/VFMP Site /PMP Course Director or Year 4 Director

to discuss the potential for a Negotiated Absence. This should be preferably 6 weeks, at least one month prior to the absence. They will consult with the relevant DSSL and the Associate/Assistant Dean of Student Affairs, if necessary, before approving the absence. The Preceptor or DSSL does have power to refuse the absence. If the Absence is approved, the student will complete a Record of Student Absence Form for the appropriate site designate to sign. The student should outline what action he/she propose to take in order to catch up on missed work and how they will fulfill their clinical responsibilities on the Record of Student Absence Form.

2. The student will submit the signed/approved Record of Student Absence Form to the relevant administrator. For the NMP and IMP: Year 3-4 Clinical Program Assistant; for the VFMP: the Departmental Program Administrator/Assistant and the Year 4 Program Manager.

3. The student will notify the preceptor responsible for the session being missed. 4. Copies of the Record of Student Absence Form will be distributed as follows:

NMP/IMP: a. Year 3-4 Clinical Program Assistant NMP/IMP Files b. Assistant Dean, Student Affairs NMP Files c. Student mailbox VFMP: d. VFMP Department Program Administrator/Assistant Departmental files e. Year 4 Program Manager VFMP files f. Associate/Assistant Dean, Student Affairs VFMP Files

Grievances Students with grievances pertaining to any absence are encouraged to meet with the Associate/Assistant Dean, Student Affairs.

Absence Request forms are available on One45 & MEDICOL Extended Leave of Absence In the event a student is considering a request for a leave of absence from their studies, an appointment must be arranged with the Associate/Assistant Dean Student Affairs, to discuss the request. All requests must be approved by the Associate/Assistant Dean, Student Affairs in consultation with the Year 4 Site Director(s).

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F. Parental Leave of Absence Policy

The Faculty of Medicine supports MD undergraduate student requests for Parental Leaves of Absence. This policy applies to all medical students who are becoming parents and does not discriminate on the basis of gender or sexual orientation. It is a goal of the Faculty of Medicine to support students in creating a Leave Plan that both optimizes the time they need with family and ensures that they have the best opportunity for success within the MD degree program. Students have a professional obligation to ensure that their training will be complete and a leave of absence will not risk their future ability to serve their patients needs.

G. Parental Leave in Year 4

Students are responsible for completion of all of the objectives and assignments of Year 4, and are expected to meet the same level of academic/clinical competence as their peers. Students may be required to complete missed clinical or course time. To that end, it is vital that students seeking Parental Leave recognize that many important elements of the MD degree program are delivered once during the year. Each Parental Leave will be negotiated on an individual basis, depending on Elective, length of leave, academic concerns and remediation requirements. Students with absences in excess of four weeks from one or more Elective will require an extension of the usual Year 4 or may require an extension of the four year time frame for completion of their MD degree. This option would be limited by the students academic record (for example, need for remediation), by the time needed to be made up, and the programs capacity to accommodate additional learners. This may have an impact on the students CaRMS process and graduation. Process for requesting Parental Leave in Year 4

1. VFMP students requesting Parental Leave are required to meet with their Assistant/Associate Dean for Student Affairs and the Year 4 Chair, in consultation with Year 4 Program Directors. NMP and IMP students requesting Parental Leave will meet with the Assistant Dean for Student Affairs and the Year 4 Site Director (in consultation with the Year 4 Chair, Program Directors and DSSLS if applicable). The meeting will be held to discuss the Program and the personal and financial implications of a Leave. At that time, the elements of this Policy will be discussed.

2. Following this discussion, students are required to present a written Leave Plan, including the time they expect to be away from the Program. If everything is in order, the Assistant/Associate Dean of Student Affairs and the Associate Dean of Curriculum or Associate Dean of the IMP or NMP (or designates) will respond to the student in writing supporting the plan and granting permission for a Leave of Absence.

3. Appropriate Course Directors and administrative staff will be notified in writing by the Office of Student Affairs (VFMP/IMP/NMP) when a Leave has been granted. The Administrative Director, Faculty of Medicine, in the Deans Office must also be notified.

4. It will be the students responsibility to determine how he/she will make up the work missed during the Leave, retaining the balance prescribed by the curriculum requirements. This planning process will be in conjunction with the Year 4 Chair, Site Directors and DSSLs if applicable.

5. Students will contact their Associate/Assistant Dean of Student Affairs and the Year 4 Chair or Home Site Director if it appears that their leave will be longer than expected. Initial expectations regarding time lines for Course completion may have to be adjusted accordingly. If a major change in the Curriculum

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occurs during an extended Leave of Absence, it may necessitate re-entry at an earlier level in the Program.

6. Students are expected to meet with their Associate/Assistant Dean of Student Affairs and Year 4 Directors, one to three months prior to returning from a Parental Leave (depending on length of absence) to discuss their options and requirements for reintegration into the Program. The timing of this meeting should be documented in the written Leave Plan. (see 2 above)

7. If the Leave becomes longer than originally anticipated, it will be important for students to maintain contact with their Associate/Assistant Dean of Student Affairs and Year 4 Director or NMP/IMP Year 4 Director. Students will re-negotiate the timing for the reintegration meeting to ensure that plans are in place for return to the program.

H. Academic Concessions

Students may request academic concession in circumstances that may adversely affect their attendance or performance in a Course or Program. Such circumstances include:

A medical condition (student must provide documented evidence of condition) Emotional or other problems Religious observance

Please note that students who intend to request or as the result of circumstance must request academic concessions must notify their respective Associate/Assistant Dean, Student Affairs, (not an individual faculty or Course Director), as specified in the procedures below. In the case of a request for alternative written examination accommodation, a student must provide the documented request two weeks prior to the scheduled exam. Please notethe Year 4 OSCE will occur over a weekend (Saturday and Sunday). In the case of a request for alternative OSCE accommodation, based on religious observance only, a student must provide the document request to their respective Associate/Assistant Dean, Student Affairs: three months prior to the scheduled examination. Students may not request a date or time of their scheduled OSCE based on personal motivation. Religious observance may preclude attending classes or examinations at certain times. Students who wish to be accommodated for religious reasons must notify their respective Associate/Assistant Dean, Student Affairs, in writing, as soon as they have been given their schedule in which they see a conflict. Students absent from final examinations held in the official examination periods must request academic concession from the Undergraduate Deans/Student Affairs Office. Students who are absent at the other times, or are unable to complete assignments/tests or other graded work because of short term illness, religious obligation or for other reasons, should normally discuss with their Associate/Assistant Dean, Student Affairs how they can make up missed work, according to written guidelines given to them at the start of the course. The Associate/Assistant Dean, Student Affairs is not required to make allowances for any missed test or incomplete work that is not satisfactorily accounted for. Students who wish to request academic concession from the Undergraduate Deans/Student Affairs office must apply as soon as possible after their attendance is adversely affected. The University, in considering these requests or any appeals of decisions on academic concession, will not normally take into account untimely notifications. When a student requests academic, he or she will be asked to provide such evidence as is deemed appropriate. It there is a medical problem, the student should submit a Statement of Illness obtained from the Student Health Service or attending physician. The student may be asked to provide additional information.

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I. Accommodation for Examinations

A student who requires accommodation for examinations due to a disability should contact Access & Diversity (A & D) at UBC. Documentation will be required in order for any assessments (written, lab or OSCE exams) to be taken under different circumstances (e.g. extra time, larger font, and use of special equipment). Requests for accommodation must be made to A & D several weeks in advance of an examination, because documentation will be required. A student with a known disability who does not make a request for accommodation and subsequently fails an examination cannot appeal the failure on the basis of the disability. Students must take responsibility to self-identify and seek support through the A & D to obtain the arrangements they require to optimize ability to succeed in the Program. Students who are granted accommodation for examinations are required to meet the same academic standards as all other students.

J. Policy and Procedure for Missed Examinations

Responsibility of the Deans Office relating to Deferred Examinations and Follow-up for Leave of Absence The Deans Office, Faculty of Medicine is responsible for:

1. Informing the Registrars Office of all leaves of absences where a students academic record is affected; 2. Informing, in writing, the Program Directors, of all students who have been granted a leave of absence or

have missed an examination and been granted a deferral; 3. Providing arrangements (location and date) for the student to write the deferred examinations; 4. Forwarding remedial marks to the Registrars Office; 5. Completing the Record of Student Absence form (Faculty of Medicine) for the student file; and 6. Forwarding the application for re-admission form to the student returning from a leave of absence and

preparing the appropriate paperwork (licenses, etc.).

K. Student Movement between Sites of the UBC MD Undergraduate Program

Opportunities for student movement: Year 4 Electives: Students from all program sites will be able to take an Elective anywhere within the UBC Program or elsewhere in Canada, dependent on availability of places. PMP Course January/April blocks: Students may apply to transfer for PMP January/April Blocks (2015). However, in keeping with the current transfer process, requests may only be accommodated (a) if space at an alternate site is available, or (b) the reasons for a students requests are of a compelling or medical nature and not based solely on a students personal preference. Requests for transfer between sites for component of Year 4 should be directed to Dr. Linlea Armstrong attention: (jessica.hartley@ubc.ca). Requests are expected to include site preference for the January 2015 and April 2015 PMP blocks as well as the reasons underlying the transfer.

L. Transfer requests

A student may formally request a transfer from one Program to another according to the Transfer Policy below. Offers of admission to the MD Undergraduate Program are specific to a site. Applicants are informed that acceptance of this site-specific offer is binding to the site for the length of the program, and that transfers will only occur in exceptional circumstances. Exceptional circumstances are expected to be infrequent. The Faculty may require a student to transfer between sites on academic grounds. Students may request a transfer between sites for compassionate/extraordinary reasons or for the PMP Course blocks due to current Elective location in Year 4 but transfers will only be considered if an opening exists in the site that is being requested. i) Student primary site assignments at the time of admission are expected to be valid for the entire MD

Undergraduate Program. ii) Program switches by students between sites are generally discouraged.

mailto:jessica.hartley@ubc.ca

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iii) The Faculty reserves the right to require a student to transfer between sites for extraordinary reasons. iv) Although a students education may occur in a variety of locations, each student will continue to be

considered a member of his/her original primary program site for administrative and other purposes, unless a formal transfer is requested and approved.

v) Transfers may be requested by students with extraordinary circumstances or on compassionate grounds. vi) Requests for transfer must be made in writing and will require approval of the PMP Course Director prior

to authorization. vii) Supporting documentation will be required when any medical or personal issues referred to in the

transfer request are considered compelling. viii) Resources to accommodate the requirements of any transferring students must not significantly diminish

the resources available to existing enrolled students. ix) Any additional costs incurred by a students request for transfer will be the responsibility of student.

Travel stipends apply only twice and are intended for the use of the student moving to the Island or Northern Medical Programs.

x) If a transfer is refused or cannot be accommodated and the student is unable to continue at his/her current primary program site, the student must withdraw from the MD Undergraduate Program and re-apply, stating his/her preference for a desired site.

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APPENDIX 1: Defined Competencies: Learning Goals and Objectives Extracted from UBC MD Undergraduate Program Mission, Goals & Objectives

(Approved Faculty Executive, January 2005) Now in Revision

LG1. Exit competencies: to ensure that every graduating student meets or exceeds the competency requirements necessary for postgraduate training and as a foundation for lifelong learning and proficient medical care

Learning objectives: Defined competencies for the UBC MD Undergraduate Program include:

LO1. Knowledge integration and analytical skills: Knowledge skills relate to the acquisition, maintenance, integration and use of knowledge. Students should be able to demonstrate that they can: LO1.1 acquire new knowledge and retrieve essential knowledge from memory to effectively

provide clinical care in health, disease and illness LO1.2 think critically and apply the scientific method LO1.3 commit themselves to life long reflection and learning for the purpose of maintaining

and enhancing professional competence LO1.4 integrate new research knowledge into clinical practice LO1.5 Students should be able to demonstrate an in-depth knowledge of: LO1.6 normal molecular, biochemical and cellular mechanisms of the body and its organ

systems LO1.7 the various aetiologies of disorders and the mechanisms by which they cause disease

(pathogenesis) LO1.8 altered structure (pathology) and function (patho-physiology) of the body and its

major organ systems LO1.9 clinical and pathologic manifestations of the most common and serious acute and

chronic disorders LO1.10 standard clinical and laboratory investigations and radiological imaging appropriate to

common and serious disorders LO1.11 management options for the most common and serious disorders, diseases, and

illnesses requiring immediate and long-term treatment LO1.12 relieving pain and ameliorating the suffering of patients LO1.13 the incidence and impact of economic, psychological, societal, and cultural

determinants of health, illness and disease for individuals and within populations LO1.14 the power of the scientific method in establishing the causation of disease and

efficacy of traditional and non-traditional therapies

LO2. Communication skills: These skills relate to communication between doctor and patient, doctor and the patients family, doctor and doctor, doctor and health care team, and doctor as manager/ leader. Students should be able to demonstrate that they can: LO2.1. conduct an interview with a patient in an empathic manner, which is both therapeutic

and effective in eliciting information. During an interview, the student will: LO2.2. establish good rapport LO2.3. proceed logically

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LO2.4. obtain the essential history, including issues related to age, gender, and socio-economic status

LO2.5. listen carefully LO2.6. observe non-verbal cues LO2.7. demonstrate an understanding of the person, and their life LO2.8. determine the patients feelings, understanding of illness and expectations. Students should also be able to demonstrate that they can: LO2.9. communicate truthfully and compassionately with patients, their families, colleagues,

and other professionals both verbally and in writing LO2.10 develop and maintain effective relationships with patients with complex problems L02.11 provide information, emotional support and recommendation to ensure understanding

and informed consent for a mutually agreeable therapeutic plan LO2.12 recognize and handle appropriately the reactions to bad news, loss, grief and other

common but difficult clinical situations LO2.13 apply negotiation and conflict resolution skills in interpersonal relationships.

LO3. Professional behaviours: These behaviours relate to professional conduct. Students should be able

to demonstrate that they can:

LO3.1 meet or exceed accepted ethical standards, including the Professional Standards for Faculty Members and Learners in the Faculties of Medicine and Dentistry at the University of British Columbia, with the highest sense of honesty and integrity.

LO3.2 interact with patients, patients families, colleagues, and others with honesty, integrity, compassion, and respect

LO3.3 demonstrate respect and protection of the patients confidentiality, dignity and autonomy when discussing personal issues, illness, and disease, prognosis and treatment options with patients, their families, or other members of the health care team

LO3.4 advocate at all times the primacy of patient well-being in the clinical setting LO3.5 not discriminate in interactions with others, on protected grounds such as age, race, colour,

ancestry, place of origin, political belief, religion, marital status, family status, physical or mental disability, sex, sexual orientation or unrelated criminal convictions

LO3.6 respect social and cultural differences in attitudes and beliefs LO3.7 understand and exhibit appropriate strategies to deal with boundary issues LO3.8 exhibit professional conduct regarding demeanour, use of language, and appearance in

health care settings LO3.9 understand the contributions of other health care disciplines, show respect for the skills of

others, and be prepared to practice effectively within a multidisciplinary, inter-professional team

LO3.10 understand and value the concept of patient-centred care and the non-disease-oriented determinants of wellness

LO3.11 understand the threats to medical professionalism posed by the conflicts of interest inherent in various financial and organizational arrangements for the practice of medicine

LO3.12 demonstrate an ethos of service to better meet the health needs of all British Columbians LO4. Clinical skills including clinical reasoning: These competencies relate to providing highly skilled clinical care to patients. Students should be able to demonstrate that they can:

LO4.1 obtain a complete and accurate history of the patients presenting complaints

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LO4.2 perform a complete general and organ-specific examination including mental status examination of patients, where appropriate

LO4.3 summarize and prioritize a patients clinical problems and present the results in a standard written and oral form

LO4.4 request and interpret the results of appropriate investigations and diagnostic procedures LO4.5 accurately record history and physical findings, test results, and other information pertinent

to the care of the patient LO4.6 distinguish normal structure and function from abnormal and understand the significance

of these abnormalities in each of the major organ systems LO4.7 analyze the information obtained from the medical history, physical examination, and

appropriate investigations in order to reach a working or provisional diagnosis (diagnostic reasoning)

LO4.8 consider natural history, evaluate options and formulate a management plan (therapeutic reasoning)

LO4.9 recognize urgent situations requiring immediate response and provide the appropriate response

LO4.10 identify persons at risk for common health problems and provide health promotion/ risk prevention education and counselling.

LO5. Practical and technical skills: Students should be competent in performing a set of core practical

and technical skills meeting the specific objectives of all clerkships as outlined in the attached appendices.

LO6. Information management skills: These skills relate to the acquisition and use of information.

Students should be able to demonstrate that they can:

LO6.1 use general-purpose computer software packages LO6.2 use electronic networks for communication with others LO6.3 search, retrieve, and organize information from a variety of information sources LO6.4 select and use materials as resources in self-directed learning, including computer-aided

and web-based learning resources LO6.5 be adept at using hospital information systems LO6.6 critically evaluate the validity and applicability of commonly encountered information

sources, including published literature and the Internet, and critically evaluate material from pharmaceutical and other health-related industries.

LO7. Personal management skills: These skills relate to development of the Person. Students should be

able to demonstrate that they can:

LO7.1 manage time effectively between work, study, recreation, and other activities. LO7.2 prioritize tasks, plan and schedule work to meet deadlines and communicate effectively

with others around planning and scheduling work LO7.3 select appropriate learning methods for the subject/ competency to be mastered LO7.4 assess their own strengths and weaknesses and be willing to seek help or accept feedback

about personal limitations in knowledge and skills; acknowledge error and institute corrective action

LO7.5 recognize and respond appropriately to emotional distress in themselves and others, including colleagues, or seek help where appropriate

LO7.6 develop and practice active coping skills and when distressed, seek appropriate help.

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LO8. Health policy skills: These skills relate to working within the health care delivery system. Students

should be able to demonstrate that they can:

LO8.1 identify major issues of health care policy, economics and services in BC, Canada, and the world

LO8.2 discuss the Canada Health Act and the Canadian health care system in relation to health care delivery, including delivery to underserved citizens of Canada, and understand that health care systems in other developed and less developed nations may be different

LO8.3 explain and integrate quality assurance and practice audit principles into clinical practice LO8.4 understand the cost and societal implications of approaches to providing health care

services for patients and explain the principles of cost-effective patient care LO8.5 recognize and appropriately address gender and cultural biases in the process of health

care delivery LO8.6 advocate for access to health care for members of traditionally underserved populations.

APPENDIX 2: Students Engaging in Clinical Activities All medical students at the University of British Columbia that are undertaking scheduled, supervised clinical experiences, either during an academic semester or between such semesters, are eligible for coverage by the Universitys General Liability and Medical Malpractice Insurance policy and hold valid educational licenses at the College of Physicians & Surgeons of British Columbia.

Year 3 & 4: Clerkship & Elective Supervision, and Assessment Policies Roles and Responsibilities of Medical Students Medical students require clinical training in hospital and ambulatory settings. The usual model for this is called a clerkship wherein medical students take part in health care delivery of patients with physicians. Historically these clerkships took place in teaching hospitals where the students could be continuously supervised. More recently with the changing nature of our health care systems the training of medical students has shifted to include community-based sites. In the UBC MD Undergraduate Program, the third and fourth years of our four-year program are the clerkship years: Year 3 is considered core or junior; Year 4 is considered senior or Elective. Any of the below have to be considered within the specific program objectives of each Program/Discipline or Department. Medical students may become involved in any aspect of patient care. The following are examples: 1. Carry out a history and physical assessment in physicians offices, hospital wards or the Emergency Room. 2. The normal delivery of an infant. 3. A surgical procedure in an Operating Room.

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4. The admission of a patient to an acute care ward and the follow-up of such a patient. 5. Be a member of a multi-disciplinary team in an ambulatory setting. Students therefore carry out and provide the normal spectrum of medical services as physicians do, with limitations, as follows: 1. They must be supervised at all times: this can be done by a post-graduate resident or an attending physician. 2. Histories and physicals must be completed, reviewed, and signed by the attending physician (or resident)

within 24 hours of admission. 3. Orders written by clerks under appropriate supervision are recognized (by the hospital) as equivalent to

orders written by other members of the resident and medical staff. Appropriate supervision is defined as previous discussion of such orders with a resident or attending staff physician. For all orders, clerks must indicate CLERK or MSI after their names.

4. In case of invasive diagnostic procedures or investigations, or therapeutic drug orders, including orders for intravenous fluids (this includes blood and blood products), the clerk shall, except in an emergency, write the name of the resident or attending physician with whom the orders have been discussed after his/her own signature. The above orders must be countersigned by the responsible resident or attending physician. The responsible resident or attending staff physician should preferably countersign orders before they are carried out. If this is not practical the order may be carried out and then countersigned at the earliest opportunity. Note: "In an emergency, narcotics and controlled drugs are to be treated in exactly the same way as any other therapeutic agent ordered by clerks."

5. All orders written and signed in the Emergency Department require prior discussion with an on site resident or attending staff physician before the orders are carried out. Clinical clerks in other Departments may write and sign the following without requiring prior discussion:

Investigations: a. Simple imaging procedures, non- contrast X-rays (but excluding CT scans, portable examinations, ultrasound

examinations and radionuclide scans.) b. Electrocardiograms, echocardiograms. c. Blood and urine tests, excluding bone marrow aspiration. d. Microbiology cultures. Medications: e. Non-controlled analgesics and anti-pyretics. f. Shampoos, dermatological preparations other than those containing steroids. g. Vitamins. 6. Clerks may perform procedures under appropriate supervision. The words under appropriate supervision

mean that the supervising medical and resident staff shall ensure that the clerk has been sufficiently trained to carry out the elements of patient care and that he/she is capable of performing the procedure he/she is permitted to undertake. In addition, it is the responsibility of the clerk to ensure that he/she is competent to undertake the elements of patient care. Patient and student safety must be ensured by supervisors in clinical settings. Students must not be required to attempt procedures that they are inadequately trained to perform or procedures with any significant foreseeable risk e.g. attempting to suture the agitated HIV/Hep C patient.

7. Clerks may not discharge a patient from a ward in the hospital, from the Emergency Department, or the Outpatient Department.

8. Clerks cannot sign birth and death certificates, although they may carry out the clinical task of certifying death. Prescriptions to be filled outside the hospital cannot be signed by clerks.

9. Physicians and clerks are advised to exercise care and caution during introductions to hospital staff and patients, so that the role of the clerk cannot be misinterpreted. Each Department, Service or Hospital to which a clerk is attached must be able to identify by name, the person responsible for the educational experience of

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the clerk while he/she is attached to the Department, Service, or Hospital. Temporary registration is provided to the clerk under Section 38 [2](d) of the Medical Practitioners Act.

10. Clerks are not permitted to dictate final versions of discharge summaries or consultation letters. Learning how to prepare discharge summaries or consultation letters under supervision has potential educational value and should be encouraged.

Examples of:

What Year 3 and 4 Students CAN Do What Year 3 and 4 Students CANT Do

Carry out a history and physical assessment in physicians offices, hospital wards or the emergency

room.

Discharge a patient from a ward in the hospital, from the emergency department, or the outpatient department.

Be involved in the normal delivery of an infant. Sign birth and death certificates.

Be involved in a surgical procedure in an operating room.

Sign prescriptions to be filled outside the hospital

Be involved in any aspect of patient care during the admission of a patient to an acute care ward and the

follow-up of such a patient.

Write orders in the Emergency Department without prior discussion with an on site resident or attending staff

physician.

Be a member of a multi-disciplinary team in an ambulatory setting.

Write orders that are countersigned by resident or staff.

Order non contrast x-rays (but excluding CT scans, tomograms, portable examinations, ultrasound

examinations and radionuclide scans).

Order electrocardiograms and echocardiograms.

Order blood and urine tests, excluding bone marrow aspiration.

Order microbiology cultures.

Carry out the clinical task of certifying death.

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Appendix 3: Mid & End of Elective Assessment Forms

Class of 20__

End of Elective Preceptor Assessment of Student in Year 4

Name of Elective: _________________________________________________________ Student: _________________________________________________________________ For dates: ____________________________ to _________________________________ Completed by Preceptor: ___________________________________________________ Dear Colleague, This form runs to several pages, but will take only a few minutes to complete. There are definitions for each of the items to guide your rating of how your student has performed this is why the form is so long, but should make your task quicker and easier. End of rotation assessments are important for student learning and allow us to assign credit for the time spent with you. Thank you for completing this assessment. Please remember the vast majority of student will do well and should receive Meets Requirements.

Definitions of Standards: Does Not Meet Requirements = Failure

critical errors or omissions

disorganized

jeopardizes patient care

passive

lacking insight

Requires Improvement = Borderline Pass

gaps in functioning at an appropriat