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Introduction

When the University of Calgary Medical School was founded in 1970, the ‘Systems-Based’ curricular model was adopted, and produced highly qualified physicians over its 30 years of existence. Building on the strengths of this curricular model, the University of Calgary Medical School modified its curriculum in the mid 1990s to what is called a ‘Clinical Presentation’ curriculum.

This innovative model, which has now been adopted by over 15 other medical schools worldwide, aims to organize teaching around the 120+/- 5 ways a patient can present to a physician. These clinical presentations can take the form of historical points (e.g. chest pain), physical examination signs (e.g. hypertension), or laboratory abnormalities (e.g. elevated serum lipids). This structure thus takes the over 3200 diagnostic entities known in medicine, and organizes them within the framework of the finite (120+/-5) ways patients present to their physicians.

Overview of the Curriculum

Faculty members help develop the curriculum

When the UME Clinical Presentation curriculum was adopted, University of Calgary faculty members were asked to develop their course objectives in a logical and structured fashion. What spontaneously emanated from the minds of these skilled teachers were classification systems, unique to each clinical presentation, that have subsequently been called ‘schemes’. These schemes provide scaffolding onto which basic and clinical sciences knowledge can be both structured and integrated, while also aiding in clinical problem solving.

This use of schemes, or clinical problem-solving pathways, has been widely supported in medical education and cognitive psychology literature, including studies originating at the University of Calgary. The Clinical Presentation curriculum teaches the basic science and clinical knowledge pertinent to each clinical presentation and provides an approach to the solution of the clinical problems.

The schemes for all 120 clinical presentations have now been compiled into one book, the University of Calgary “Black Book”, which will be given to you upon entering medical school. Each class will be expected to continue the process of modifying and improving the new editions of this compilation.

Students take part in curriculum development

After 10 years of experience with the Clinical Presentation curriculum, faculty and students recommended changes beginning in August 2006 to further strengthened our curriculum, and as a result, the pre-clerkship curriculum was reorganized. Traditional “systems” with overlapping clinical presentations were linked into one longer course (e.g. Cardio-Respiratory, which share the “chest pain” and “dyspnea” clinical presentations). This reorganization was built on the strengths identified of the Clinical Presentation curriculum, while satisfying a number of practical and pedagogical concerns raised over the first 10 years of the Clinical Presentation curriculum.

From a teaching perspective, the longer, linked courses aim to better integrate clinical presentations across systems (horizontal integration), decrease redundancies, and emphasize schemes as a powerful knowledge organization teaching tool. The longer courses are an attempt to “disperse” the teaching over an extended period of time, as opposed to the more traditional model of highly condensed, shorter courses.

On a more practical point, the modified curriculum allows for better timing of courses before Christmas and during the summer, a formative examination system, time off during clerkship for residency interviews, and the introduction of a formal review period before each certifying examination.

The Year 1 & 2 menu page is a schematic representation of the pre-clerkship years at our school.