Clinical Year Medical Student Rotation Model Overview

Clinical Year Medical Student Rotation Model C Version 1.0 14 Feb 2018

4th Year Medical Student

Clinical Year Medical Student Rotation Model 4th Year Medical Students Core clinical clerkship 40 weeks; Elective rotation 4 weeks; Vacation 8 weeks Clinical Foundation 1 10 weeks Clinical Foundation 3 10 weeks Clinical Foundation 2 10 weeks Clinical Foundation 4 10 weeks Vacation 2 weeks (3 days of PD) EPA 1,2,3,4 EPA 1-6 EPA 1,2 EPA 1,2,3,4,5,6 Vacation 4 weeks Group 5 Group 1 Group 5 Group 5 Group 1 Group 5 Group 1 Group 1 Elective 4 weeks Mentors Group Group 2 Group 6 Group 2 Group 2 Group 6 Group 6 Group 2 Group 6 Group 3 Group 7 Group 3 Group 3 Group 7 Group 7 Group 3 Group 7 Vacation 1 week Vacation 1 week Group 4 Group 4 Group 4 Group 4 Group 8 Group 8 Group 8 Group 8 Longitudinal OPD / IPD 21 CPs 33 CPs 23 CPs 20 CPs Core lectures Core lectures Core lectures Core lectures Activities to Learning achieve CPs Bedside teaching Bedside teaching Bedside teaching Bedside teaching Small group topics Small group topics Small group topics Small group topics Med//Sx/Gyne/ Ped/FM/Rad/ER Sx/Med/Gyne/Ped/ ENT/Rad Ortho/Sx/PMR/Anes/Eye/ ENT/Ped/Med/ER/Rad Psy/ER/Med/ENT/ Eye/Sx/Ped/Rad

4th Year Medical Students Foundation 1 Week 1 Clinical Year Medical Student Rotation Model Monday Tuesday Wednesday Thursday Friday Clinical Foundation 1 10 weeks IPD Adult 1 / IPD Adult 2 / IPD Woman & Ped Core lectures by staff from RA-PYT EPA 1,2 Adult IPD bedside teaching 1 Woman & Ped IPD bedside teaching Longitudinal OPD OR surgery / OR orthopedics / PMR Primary care unit (PCU) / Health system Group 1 Mentors Group AM Group 1 S 1-6 S 7-12 S 1-6 S 7-12 S 1-6 S 7-12 S 1-8 S 9-16 S 19-25 S 19-25 S 13-18 S 13-18 S 19-25 S 13-18 S 17-25 Longitudinal OPD and IPD (4 RA-PYT staff) (4 RA-PYT staff) (by 6-8 mentors) (3 CNMI staff) (4 PCU sites) Meet the mentors Team-based learning topic discussion Self-directed learning (SDL) / Simulation Lab Research / EBM / Personal development (PD) Cross-sectional OPD 33 CPs Core lectures PM Activities to S 1-6 S 7-12 Learning achieve CPs Group 1 Group 1 Bedside teaching S 19-25 S 13-18 (Friday afternoon) (1 RA-PYT staff 1 CNMI staff) (4 subgroups by 4 CNMI staff) (Wednesday afternoon) Small group topics Med//Sx/Gyne/Ped FM/Rad/ER IPD Adult 1 / Adult 2 / Woman & Ped IPD Adult 1 / Adult 2 / Woman & Ped

Clinical Year Medical Student Rotation Model 4th Year Medical Students Foundation 1 Week 1 2 3 4 5 6 7 8 9 10 Clinical Foundation 1 10 weeks EPA 1,2 IPD Adult 2 IPD Adult 1 IPD Woman & Ped S 1-8 Group 1 Mentors Group IPD Adult 1 IPD Woman & Ped IPD Adult 2 S 9-16 Vacation 1 week S 17-25 IPD Woman & Ped IPD Adult 2 IPD Adult 1 Core lectures by staff from RA-PYT Longitudinal OPD and IPD Adult IPD bedside teaching 1 (4 subgroups by 4 staff from RA-PYT) Woman & Ped IPD bedside teaching (4 subgroups by 4 staff from RA-PYT) Primary care unit (PCU) / Health system (4 PCU sites) 33 CPs Cross-sectional OPD (4 subgroups by 4 CNMI staff) Core lectures Activities to Longitudinal OPD (by 6-8 mentors) Learning achieve CPs Bedside teaching OR Sx / OR Ortho / PMR (3 subgroups by CNMI staff) Small group topics Team-based learning topic discussion (staff from RA-PYT and CNMI staff) Med//Sx/Gyne/Ped FM/Rad/ER SDL / Simulation Lab Research PD EBM EBM Research PD Research PD EBM EBM Meet the mentors (Friday afternoon)

5th Year Medical Student

Clinical Year Medical Student Rotation Model 5th Year Medical Students Selective Modules (4 weeks for each module) Choose 3 from 6 modules o Advanced radiology o Bone and joint o Cancer o Communicable diseases o Comprehensive rehabilitation o Research methodology o Scent and sound o Vision Clinical clerkship 24 weeks; Selective rotation 12 weeks; Elective rotation 8 weeks; Vacation 8 weeks Surgery and Perioperative Module Selective Module (Surgery/Anesthesia) 8 weeks 4 weeks Woman and Neonatal Care Module Selective Module Vacation 4 weeks (OB/Gyn/Ped) 8 weeks 4 weeks Elective Modules (2 weeks for each module) Choose 4 from 8 modules o Dermatology and cosmetics o Health informatics o Infection control o Intensive care o Toxicology o HIV Medicine o Sport medicine o Well child care Mind and Brain Module (Psy/Med/Ped) 4 weeks Community Medicine Module (Com Med) 4 weeks Vacation 4 weeks Elective Module Elective Module Elective Module Elective Module Selective Module 4 weeks 2 weeks 2 weeks 2 weeks 2 weeks EPA 1-6,8,11 Longitudinal OPD and meet the mentors (at CNMI/FM for a day once a month)

6th Year Medical Student

Clinical Year Medical Student Rotation Model 6th Year Medical Students Selective Modules Choose total 8 weeks 4 weeks for each module o Adolescent medicine o Geriatrics o Palliative care 2 weeks for each module o Applying research to practice o Infection control and outbreak investigation o Omics and diseases o Transfusion medicine Core clinical clerkship 24 weeks; Selective rotation 8 weeks; Elective rotation 16 weeks; Vacation 4 weeks Emergency Module (+Stroke/MI Fast Tract) Trauma Module Selective Module (Ortho/Sx/ER) 4 weeks (ER/Med/Sx) 4 weeks 4 weeks Research presentation (2 weeks) Ambulatory Practicum Module Intensive Care Module Selective Module Vacation 2 weeks (Med/Ped/Anes) 4 weeks (Med/Ped/FM) 4 weeks 4 weeks Elective Modules (2-4 weeks for each module) Choose total 16 weeks Research Project Module Elective Module Elective Module Forensics Module (Patho) 2 weeks Vacation o o o o o o Alternative Medicine o HIV Medicine o NICU o Sport medicine o Well child care .. .. .. .. .. 2 weeks 2 weeks 2 weeks 4 weeks Elective Module Elective Module Elective Module Elective Module 4 weeks 4 weeks 2 weeks 2 weeks EPA 1-6,8,11,7,9,10,12 Meet the mentors (at CNMI for half day once a month)

How could learning activities be matched with the core concepts? Standardize learning outcomes and individualize learning processes Continue professional identity formation and clinical experience with close supervision Integrate interdisciplinary approach without boundary of departments Build habits of inquiry and innovation committed to social accountability Provide an ideal setting to lay the foundation for teamwork and leadership Core concepts Clinical years Core lectures Bedside teaching SDL / Sim lab Elective Longitudinal OPD Cross-sectional OPD OR / PMR PD Meet the mentors Longitudinal OPD TBL PCU Research / EBM PD PCU PD TBL PCU Longitudinal OPD 4th year Meet the mentors Meet the mentors Meet the mentors Meet the mentors New integrated block rotation Selective Elective Meet the mentors New integrated block rotation Longitudinal OPD New integrated block rotation Research in selective module Community medicine module 5th year Meet the mentors Meet the mentors Meet the mentors Meet the mentors New integrated block rotation Selective Elective Meet the mentors New integrated block rotation Ambulatory practicum Meet the mentors New integrated block rotation Research project and presentation Research project and presentation 6th year Meet the mentors Meet the mentors Meet the mentors Horizontal integration

Back up slides

Topics CP Cardiovascular disorder/abdomen/normal growth/development and aging CF1 33 CF2 Neurological disorder/psychiatry 21 23 CF3 Musculoskeletal problem/mass/hematology 20 CF4 Infection/rash/nephrology 97 Total

Entrustable Entrustable Professional Activities (EPA) Professional Activities (EPA) EPA 1: EPA 2: EPA 3: EPA 4: EPA 5: EPA 6: EPA 7: EPA 8: EPA 9: EPA 10: EPA 11: EPA 12:

CF CF1 Week 1 2 3 4 5 6 7 8 9 Clinical Problem (CP) Shock Dyspnea, orthopnea, cough, hemoptysis Alteration of consciousness Fainting, syncope, fatigue, palpitation, murmur, cyanosis Chest pain Hypertension Abdominal pain, distension, constipation, diarrhea Jaundice, GI bleeding, vomiting Acute fever 10 11 12 Growth, development, menstruation, aging, menopause, failure to thrive Formative examination

CF CF2 Week 13 14 15 16 17 18 Clinical problem Headache, seizure Weakness, numbness Movement disorder, abnormal gait, vertigo/dizziness Hearing loss, tinnitus Reaction to stress, mood disturbance, anxiety, psychosis Substance abuse, suicide, homicide, sexual/physical abuse Dementia, multiple somatic complaint, behavioral change due to medical problem Dying, grief, bereavement Weight loss/gain, obesity, metabolic syndrome 19 20 21 22 23 24 Formative examination

CF CF3 Week 25 26 27 28 29 30 31 Clinical problem Trauma, accident (1) Trauma, accident (2) Burn, eye trauma Neck pain, low back pain, fall in elderly Pain control, bites and stings Neck mass, breast mass, skin/subcutaneous mass Abdominal mass, musculoskeletal mass, anorectal problem, scrotal mass Anemia, abnormal WBC, lymphadenopathy Bleeding tendency, epistaxis 32 33 34 35 36 Formative examination

CF CF4 Week 37 Clinical problem Subacute-chronic fever Upper respiratory tract symptoms, ear pain/discharge, red eye, oral health Skin rash, soft tissue infection Parasite, infection control Genital ulcer, vaginal discharge Edema, oliguria/anuria Abnormal urinary symptom, hematuria, urinary incontinence Disorder of acid-base and metabolic disturbance Joint pain/arthritis 38 39 40 41 42 43 44 45 46 47 48 Formative examination

Standardize learning outcomes & individualize learning processes Continue professional identity formation & clinical experience with close supervision Integrate interdisciplinary approach without boundary of departments Build Provide habits of inquiry and innovation committed to social accountability an ideal setting to lay the foundation for teamwork and leadership

Med Med Sx Ped OB/Gyne Ortho

( ) 5 44 0 2 ( NL2) 6 ( 6) 52 4 40 0 4 8 52 6 48 2 2 0 52 Clinical clerkship Selective rotation Elective rotation Vacation Total

( ) 5 24 12 8 8 52 4 36 4 4 8 52 6 24 8 16 4 52 Clinical clerkship Selective rotation Elective rotation Vacation Total