Clerkship courses

This is a general overview of the Clerkship courses for third year and fourth year. For a description of the Clerkship Curriculum, refer to the Academic Calendar. Course details, including learning objectives and assessment breakdowns, can be found on the course's website on Elentra (UTORid required). For information about course contacts, see clerkship Course Directors and Administrators.

Third Year

Transition to Clerkship (TTC 310Y)

The one-week Transition to Clerkship (TTC) course assists students in developing the knowledge, skills and attitudes necessary to transition from being a student in the Foundations curriculum, to being a member of the healthcare team as a clinical clerk. The course builds on the very substantial learning from the first two years of the MD program and provides students with the opportunity to immerse themselves in the skills required to begin clerkship rotations through a variety of immersion and onboarding learning activities (including simulations, online modules, academy and campus-based seminars and shadowing experiences). An emphasis is placed on intrinsic CanMeds skills and specific medical expert competencies. TTC core curriculum activities consist of both large and small group interactive seminars/workshops, and several required online learning modules. Academy Orientation and Academy Clinical Skills Days incorporate some registration tasks (e.g. mask-fit testing, computer systems training) along with practical skills (order writing, managing violent patients).

Anaesthesia (ANS 310Y)

The two-week Anaesthesia course is based on a 'flipped classroom' model. Students are required to complete seven e-modules where faculty is available via a discussion board. The rotation includes two days of simulation training at Sunnybrook Health Sciences Centre. The first day includes a comprehensive training on IV skills, airway management and fluid responsiveness using ultrasound. Case scenarios are used to teach ACLS protocols and communication skills during critical events in a simulated operating room. During the exit simulation day, the students rotate through preoperative, intraoperative and postoperative scenarios that reinforce the content in the e-modules and work through integrated cases that highlight module content. For clinical shifts, you are assigned to a faculty staff member in the operating room, labour floor, pre-admission clinic, or pain service where one on one teaching is provided. You assist in all aspects of anesthetic care. There is no overnight call.

Emergency Medicine (EMR 310Y)

The four-week Emergency Medicine course commences with three days of hands-on workshops and seminars utilizing simulation, skills-based teaching, and case-based interactive sessions. These sessions provide opportunities to acquire essential knowledge and skills in preparation for clinical experience, and cover topics that include medical imaging, airway management, cardiac dysrhythmias, trauma, ultrasound, toxicology, chest pain, wound management, and splinting. Students are then placed at one of the ten Emergency Departments in the Greater Toronto Area to complete 15 shifts, including up to two weekends and three overnight shifts. During the clinical experience you function as members of an interprofessional team and are assigned one or two preceptors with whom at least half their shifts occur. Each clerk spends half a shift with members of the interprofessional team. You learn to manage many types of patient problems that present to the Emergency Department, including exposure to core emergency medicine cases. There are additional opportunities to perform basic procedures (intravenous insertion, venipuncture, foley catheter insertion, NG insertion, ECG) and observe the triage process.

Family and Community Medicine (FCM 310Y)

The six-week Family and Community Medicine course begins with centrally delivered core seminars for the first two days. Core seminars include: orientation, family violence, motivational interviewing, global health, palliative care and geriatrics. After core seminars, the students go to their respective sites to start the clinical portion of the rotation. You experience family medicine at a family medicine teaching unit or a community family physician’s office or a combination of both teaching environments. A small number of rural placements are also available through the Rural Ontario Medical Program (ROMP) . The course exposes students to various comprehensive care models and strives to have students learn in an interprofessional environment. You also participate in site-based seminars and complete e-modules.

Internal Medicine (MED 310Y)

The eight-week Internal Medicine course begins with an interactive, case-based seminar series for two and a half days. Additional seminars occur approximately once per week for the remaining weeks. Each clerk is assigned to a single Internal Medicine Team for the entire rotation. A sub-group of students may choose a two-week ambulatory care experience in the current academic year. Over the entire length of the course, there is a graduated experience with increasing responsibility. You have the opportunity to perform the admitting history and physical examinations on patients who present to the Emergency Room, and are asked to provide a provisional diagnosis and differential diagnosis, and to construct an investigation and management plan. You also provide direct patient care for your assigned patients under supervision. Later in the rotation, you carry up to six patients and have enhanced responsibilities for patients while on call. Support is provided by other members of the team, including the attending physician and supervising residents. You are also assigned to six half-days in ambulatory clinics so that you have an opportunity to learn about how care is delivered to medical patients in this setting.

Obstetrics and Gynaecology (OBS 310Y)

The six-week Obstetrics and Gynaecology rotation offers a variety of clinical activities related to all aspects women’s health care, including rotations in labour and delivery, inpatient antenatal and postpartum units, antenatal clinics, gynaecologic ambulatory care, inpatient gynaecology units, the operating room and the emergency department. In addition to clinical activities, you attend daily small-group teaching seminars on a range of obstetrical and gynaecological topics. Further to the seminar series, each hospital site also conducts its own set of teaching and/or grand rounds which you are expected to attend. Students are assigned to one of eight teaching hospital sites.

Ophthalmology (OPT 310Y)

The one-week ophthalmology course begins with a clinical skills review and orientation session. Throughout the week, you see a variety of ambulatory ophthalmology patients in eye clinics or in the offices of attending ophthalmologists. In clinic, you examine patients, which may involve taking an ophthalmic history and performing relevant ocular examinations, as well as formulating a differential diagnosis and management plan. Students may attend the operating room for a half day. You are expected to research each assigned patient’s disease using appropriate texts and journals and review course topics including: cornea and anterior segment (the red eye), lens and optics, glaucoma, retina, uveitis and inflammatory diseases, neuroophthalmology, oculoplastics and orbital diseases, paediatric ophthalmology and strabismus, and ocular emergencies and trauma. In addition, all students attend seminars on paediatric ophthalmology at the Hospital for Sick Children.

Otolaryngology-Head & Neck Surgery (OTL 310Y)

The one-week Otolaryngology course includes site-specific teaching sessions and clinical experience in outpatient clinics. The remainder of the time is spent on the wards, in the operating room, on seminars and self-directed learning with otoscopy and nasal packing simulators and online cases. The rotation includes a series of online seminars, covering common and important topics in otolaryngology including hearing loss, vertigo, epistaxis, rhinosinusitis, emergencies, and head and neck malignancies. You are also given a paediatrics otolaryngology seminar, an Otosim seminar, and an audiology lecture at the Hospital for Sick Children. Attendance in the operating room is available to students and may be arranged at their Academy with the site director at the beginning of their rotation.

Paediatrics (PAE 310Y)

In the six-week Paediatrics course, students are exposed to a combination of ambulatory and inpatient paediatric patients. Students are either placed in a paediatric setting at a Community Hospital, or in the Emergency Dept or Paediatric Wards at The Hospital for Sick Children combined with outpatient paediatric clinics. Students will have the opportunity to conduct complete clinical assessments, develop diagnostic impressions and management plans. Learning modalities include direct hands-on clinical experiences, two central days of seminars and workshops, local hospital teaching rounds, a comprehensive paediatric handbook, e-learning modules, and practice MCQs. Depending on the placement, there are opportunities to learn from residents and fellows and from interdisciplinary team members.

Portfolio (PFL 310Y)

In third year, the Portfolio component continues to facilitate professional and personal development through guided reflection. Portfolio encourages students to develop their knowledge of the six non-Medical Expert CanMEDS roles of Collaborator, Communicator, Leader, Health Advocate, Scholar and Professional. Through self and critical reflection of their clinical experiences in third year, students will learn to navigate and integrate these core competencies into their professional identities. The various CanMEDS roles are incorporated throughout the six themed sessions which take place over the academic year. Examples of the themed topics include Patient Safety, Resilience and Wellness, Power Dynamic and the Hidden Curriculum, My First Patient Death and Humility and Uncertainty. There are two summative assessment components to the evaluation of Portfolio: the Process Component and the Written Component. The Process component consists of mandatory attendance at six small-group meetings, where the themed reflections are shared in student groups of approximately eight, with one resident (Junior Academy Scholar) and one faculty member (Academy Scholar). During the meeting, Scholars provide support in developing reflections on clinical experiences and their meaning and impact on personal and professional development. There are also two mandatory one-on-one Progress Review meetings with the Academy Scholar throughout the academic year where students have the opportunity to develop personal learning plans and reflect on the assessment data in their MD Program Learner Chart. The Written Component of the evaluation includes two progress review reports and the six thematic session reflections. Three of the assigned reflections are marked anonymously with a pass/fail grade and formative feedback based on the Portfolio Assessment Rubric (page 23, PFL310Y Handbook). There are also two MD Program Professionalism forms completed per year.

Psychiatry (PSS 310Y)

The six-week Psychiatry course begins with centralized teaching sessions that occur during the first three days. The clinical experience takes place in a variety of settings including inpatient units, psychotherapy clinics, ambulatory clinics, consultation liaison teams, and emergency settings. An integral component of the course is interviewing patients and/or standardized patients with anxiety, mood, psychosis, cognitive, and substance disorders with focus on symptomatology, diagnosis, and basic treatment principles. All clerks will have exposure to psychiatric emergencies mostly by taking night and weekend on-call not exceeding one in five, until 11 p.m. Clinical experience with children and families take place during two half-days in a child psychiatry setting under the direct supervision of a child psychiatrist. Seminars are held weekly at each hospital site and include topics such as interviewing skills and dealing with challenging personality styles.

Surgery (SRG 310Y)

This eight-week course commences with a one-week centralized program, “Prelude to Surgery,” which provides an orientation and introduction to important surgical topics. The students then rotate through two three-week sub-rotations: one sub-rotation in General Surgery and the other sub-rotation in one of the other surgery specialties. The last week will comprise of attending the Central Seminars, debriefing and exam preparation sessions, and other administrative tasks. Students have input into their choice of sub-rotation specialties and are assigned to a surgeon preceptor for each of their sub-rotations. Students contribute to the admissions and daily patient care and attend the operating room and the clinic /office of their preceptor or team. The on-call schedule is one night in four. Call must be taken in General Surgery, Orthopaedics, or Neurosurgery. This provides them the opportunity to see patients in the ER as well as taking call to the ward and OR, where appropriate.

Clerkship Objective Structured Clinical Examination (OSCE) (OSC 310Y / OSC 410Y)

The Clerkship Objective Structured Clinical Examination (OSCE) is a transcripted assessment that occurs after the first half of clerkship is complete. The exact timing of the Clerkship OSCE will vary slightly each academic year, and will be dependent on the Year 3 Clerkship schedule.

Students will be assessed on clinical content areas that they were exposed to the in the first half of clerkship. The assessment blueprint will cover key areas as outlined in the Medical Council of Canada (MCC) blueprint including the dimensions of care provided by physicians (i.e. health promotion and illness prevention, acute, chronic, psychosocial) and key physician activities (assessment/diagnosis, management, communication and professional behaviours). The OSCE stations will focus on content from both the Clerkship Course Objectives and the MCC’s Clinical Presentations and Diagnoses.

Standard for the Clerkship OSCE will be determined by the Borderline Regression Method. Students who do not meet standard on the Clerkship OSCE will be required to work with the SCORE program to support clinical skills development and will be required to challenge a supplementary OSCE at the end of Year 3 Clerkship.

Fourth year

Electives (ELV 410Y)

Electives provide students with the opportunity to explore career possibilities, gain experience in aspects of medicine beyond the core Clerkship rotations, and study disciplines in greater depth. In May or June of Year 3, students have the option to complete a two-week home school (U of T) elective that counts toward the MD Program elective requirements. At the beginning of Year 4, 14 weeks between September to December are allocated to completion of elective experiences. Students must register for electives in accordance with the program’s registration procedures and requirements.

An orientation to selecting electives is provided in Transition to Clerkship (TTC310) at the beginning of Year 3. Two additional electives presentations will be provided over the course of the Year 4 during Transition Education Days.

Clerkship Objective Structured Clinical Examination (OSCE) (OSC 310Y / OSC 410Y)

Portfolio (PFL 410Y)

In the fourth year of Portfolio, students solidify their foundation in critical and self-reflection through discussion and written assignments designed to consolidate their knowledge of the intrinsic CanMeds roles and their personal and professional journey into newly graduating physicians. Portfolio guides students in assessing their progress as professionals as well as provide opportunity for reflection, in preparation for the CaRMS process and transition to postgraduate training. Students and Scholars will continue with the same groups from the previous year to maintain continuity and integrity of the group and relationships. The Process component of the course consists of two mandatory small group meetings centered on themed topics including “Carms Preparation” “The physician I aspire to be” and one Progress Review Meeting with the Academy Scholar. The Written component contains each student’s final Portfolio with two thematic reflections and the Progress Review Report. The written reflection and Progress Review Report are evaluated using the same format used in year 3 Portfolio. In addition, an MD Program Professionalism form will completed at least once over the year.

Transition to Residency (TTR 410Y)

The 14-week Transition to Residency (TTR) course occurs during the final 14 weeks of the MD Program, and is designed to bring together and build upon many of the concepts students have learned about functioning as doctors. The course has two main themes: understanding the health care needs individual members of diverse groups within the Canadian population, and learning to use the health care system to meet those needs. The course is comprised of two 'campus weeks' which contain both independent and classroom based learning activities, three selectives clinical placements over nine weeks, and the fusion period which brings the students back together for review of previously learned clinical material in preparation for the Medical Council of Canada Qualifying Examination (MCCQE) Part 1.