Medical Council of Canada (MCC) Clinical Presentations: How are they used in our curriculum?

Our UG curriculum has been built to accept the MCC clinical presentations as the core or spine for our Medical Expert role and competencies.

What are they?

MCC clinical presentations are part of the learning objectives for the MCC Exams, under the “Expert” section. They contain approximately 190 ways in which a patient with clinical issues may present to a clinician. The MCC clinical presentations are located at http://apps.mcc.ca/Objectives_Online/objectives.pl?loc=home&lang=english

The Medical Council of Canada changes and updates the presentations and keeps a record of this on its website. The website has a great search feature, under which you can search for disease entities, foundational science concepts, etc. http://apps.mcc.ca/Objectives_Online/objectives.pl?lang=english&loc=search

The website is newly updated with population health, and the intrinsic roles of a physician as well as a “Normal Values” section.

Queen’s Meds and the MCC’s

Previously we at Queen’s Undergraduate Medical Education (UGME) had modified the MCC presentations. However, the UGME Curriculum Committee has decided to use the full MCC presentations as they are represented on their website, and change annually to accord with the updates.

Important Note:  Soon, the UGME Educational Team will send out to Course Directors, on behalf of the UGME Curriculum Committee, a list of all the MCC presentations that have been assigned to each course. Course Directors are encouraged to review these as there may be some changes from previous assignments, due to MCC changes, and due to our conversion to the MCC presentations. With a new tracking report, Course Directors will also have access to data that shows where the MCC presentations have been tagged in their courses at the learning event level.

What if a Course contains other MCC’s than were assigned?

There may be MCC presentations that are taught in courses that have not been formally assigned by the UGME Curriculum Committee. A Course Director should bring this either to the Year Director for the Curriculum Committee or bring it directly to the Curriculum Committee.

The role of the committee is to ensure that all the MCC presentations are taught in the four years of medical school, and to ensure that there is a logical, spiral progression to the teaching. Thus, if two or more courses teach about the same presentations, there is usually no difficulty, but all concerned parties must be aware of who is teaching the presentation, how, and when. The Curriculum Committee will ensure that course directors are brought together to discuss this, usually through the Educational Team or the Teaching, Learning and Innovation Committee’s special projects.

What if a Course Director judges the teaching of a specific MCC to be a problem in a course?

If a Course Director feels that a specific MCC assigned to the course presents a problem, the process outlined above holds good here too…either bring the matter to the Year Director for Curriculum Committee or to the Curriculum Committee with an explanation. Again, the concern of the Committee is to ensure that the MCC presentation is taught in the appropriate place and manner within the four years of medical school.

How are the MCC presentations taught in our courses?

It’s important for us in UGME to consider how these MCC presentations may be taught in our classes. Our UGME curriculum is varied and integrated. In early pre-clinical years, MCC presentations may be a part of teaching such as:
1. Foundational science teaching and learning leading to clinical application
2. Links of a clinical presentation to systems and disease/conditions
3. Approaches to patient presentation
4. Collection and interpretation of information
5. Diagnosis
6. Intervention/Management
7. Complexities, multi-system integration, co-morbidities
8. A component of learning about “intrinsic” (non-medical expert) objectives

In clerkship, the MCC presentations are often integrated within all or many of the above.

But MCC clinical presentations often apply to more than one system or course…What then?

This is one of the reasons that the Curriculum Committee has adopted the MCC clinical presentations: because often a patient doesn’t come in knowing his/her disease or knowing which body system has been affected. In fact, it is important that our students learn undifferentiated diagnostic skills for “chest pain,” “cough,” “headache,” or “dyspnea.”It is one thing to know that dyspnea will be an indicator of a heart condition if the teaching is part of the Cardiovascular unit in the CV/Respiratory Course. It is a very different thing to encounter dyspnea in the Emergency Department, in Internal Medicine, or in Family Practice and trace it to a specific cause.

This is why we are building more undifferentiated diagnosis sessions into our preclinical years. As well, it’s why anatomists and physiologists in our first term of teaching in medical schools partner with clinicians to teach about the different aspects of a clinical presentation—considering anatomical/physiological changes and pathological insults that are of concern to the treatment and management of an illness or condition.

We are working on the spiral nature of our curriculum, building to an integrated approach to clinical presentations in the clerkship. That is, we’re revisiting topics from years 1-4, in greater complexity.  That’s why it’s important the different people teaching about the same presentation need to be in contact with each other and consider the best way to approach this shared teaching to create the spiral.

Do you have questions about this process of assignment of MCC Clinical Presentations in Queen’s UGME? If so, write here, or to sheila.pinchin@queensu.ca

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