In 1988, a conference on medical education was held in Edinburgh, Scotland. The resulting Edinburgh Declaration on Medical Education opened with the statement:
"Thousands suffer and die every day from diseases which are preventable, curable or self-inflicted and millions have no ready access to health care of any kind. Such facts have produced a mounting concern in medical education about equity in health care, the humane delivery of health services, and the cost to society.
The aim of medical education is to produce doctors who will promote the health of all people - not merely deliver curative service to those who can afford it or those for whom it is readily available.
That aim is not being realized in many places despite the enormous progress that has been made during this century in the biomedical sciences. This problem is not new, but prior efforts to introduce greater social awareness into academic medical schools have not been notably successful... "
(World Conference on Medical Education, Edinburgh, August 1988)
The SIM curriculum forms our response to this challenge. It discusses the context of medical practice in the 21st century:
- It reviews patterns of disease you will encounter in your future practice;
- It introduces public and population health, and outlines the social determinants of illness;
- It discusses Aboriginal and international health issues;
- It outlines the Canadian health care system, and introduces alternative therapies;
- It includes a foundation course in epidemiology and statistical methods; this introduces the theme of critical appraisal of the medical literature and evidence-based medicine;
- It reviews medical ethics and the law.
In brief, it covers all the topics relevant to a physician's career that lie outside the human body.
These topics are covered under the Medical Council of Canada's learning objectives. Note: these topics ARE on the Medical Council's Qualifying Exam (the MCCQE). Furthermore, these topics form part of the requirements for a medical curriculum as specified by the Committee on Accreditation of Canadian Medical Schools. Finally, the Association of Faculties of Medicine of Canada has specified its version of learning objectives for this component of your overall curriculum. We have included these within the SIM curriculum.
SIM runs through the first three (pre-clerkship) years of the curriculum. In years 1 and 2, there is one session each week; often a panel discussion, sometimes a lecture, and sometimes small group workshops or a community visit.
In year 3, SIM occupies six two-hour blocks within the mandatory selective, given four times per year.
While the scope is extremely broad, the topics can be grouped under three main themes. The content for each theme is spread across years 1, 2 and 3.
Theme 1. Methodological Building Blocks: Statistics and Epidemiology
What? This component introduces basic concepts used in medical research (study designs, basic statistics, etc.), and skills such as how to interpret diagnostic tests.
Why? Medical science changes fast and most of the therapies you learn about during your training will be replaced during the time you are in practice. Clinicians must therefore keep up with evolving medical knowledge and know how to interpret research studies to guide them in modifying their practice approach.
How? Introductory lectures + tutorials form the basis for a series of small group sessions on Evidence-Based Medicine (EBM). You will learn basic statistical concepts and their application, study design and methodology, and the tools used to critically appraise medical literature.
Theme 2. Health Issues
What? The overall curriculum is built around the CBL problem of the week. For many CBLs, SIM provides contextual information on the problem and issues related to managing it (prevention, health promotion, immunization, etc).
Why? As well as providing basic facts and figures, we wish to introduce the broader origins and implications of health issues: social determinants of health, ethnicity and health, international health, and so forth. Unless the underlying determinants of health are recognized and tackled, medical care will be limited to treating symptoms of society’s underlying problems. The Health Issues component encourages you to think of how we may move upstream to tackle the determinants of health.
How? Sometimes lectures, sometimes patients with the condition will discuss how they cope with their disorder. Sessions cover prevention, alternative therapies, public health policies, etc. Please recognize, however, that as SIM covers many topics, the sessions do not always tie into the CBL problem of the week.
Theme 3. Professional Development
What? The Physician Skills Development curriculum teaches specific clinical skills; SIM covers the awareness you develop and the attitudes you form concerning your role as a health professional.
Why? There is more to being a physician than clinical competence. The implication of being a health professional includes being informed about the health care system in which you practice, the legal and ethical principles that guide practice, and the various roles of the physician - as healer, as advocate for the sick, and as scholar.
How? Sessions cover the health care system, ethical issues in care, patient counselling and behaviour change; these are applied in a tutorial series on professionalism.