e-Learning Module: Intro to Dermatology

Part 1, Medical Foundation 1

Approximately 7% of all adult outpatients have a primary skin complaint, and 60% of outpatient visits for skin disease are made to non-dermatologists. With dermatological conditions being so prevalent, it is important that medical students have a minimum core of dermatological knowledge at the time of graduation.

Active Large Group Session: Introduction to Oncology

Part 2, Medical Foundation 2, Hematology, Week 4

Active Large Group Session: Abnormal Uterine Bleeding (AUB)

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 1

Prevalence of Abnormal Uterine Bleeding. Impact of Abnormal Uterine Bleeding (AUB) on Women. Clinical, Economic, and Lifestyle. Pathogenesis of AUB. A brief look at causality. Investigation and treatment of women with AUB. What to do, when to do it.

Active Large Group Session: CisWoman's Sexual Health and Cervical Cancer Screening

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 1

Active Large Group Session: Skin Cancer and Common Dermatology Procedures

Part 3, Medical Foundation 3, Reproduction and Pregnancy, Week 2

Tutorial: Nick DeMarco MF3 Gastroenterology and Nutrition

Part 3, Medical Foundation 3, Gastroenterology and Nutrition, Week 1

Nick DeMarco is a 51 year old physical education teacher at a local elementary school. He has noticed increasing fatigue with exertion and complains about feeling exhausted at the end of the school day. He explains that he has been experiencing epigastric discomfort after eating and he has tried taking Advil for pain relief. He states the pain and regurgitation wakes him up at night. He reports that he is usually able to get back to sleep after taking antacids and a glass of milk.

Tutorial: Pit Parapan MF3 Endocrinology

Part 3, Medical Foundation 3, Endocrinology, Week 4

A 32-year-old female was seen in emergency department for abdominal pain, nausea and diarrhea. Her serum calcium was found to be elevated at 2.94 mmol/L (normal 2.15-2.55 mmol/L). She was treated with intravenous fluids. Her calcium improved to 2.65 mmol/L and she was discharged home to care for her 6-year-old son. She was referred urgently to an outpatient clinic to investigate her elevated calcium. She was also prescribed pantoprazole for worsening heartburn. In the clinic, Ms. Parapan reported a 2-year history of abdominal pain that was getting worse over time. The pantoprazole she was prescribed was modestly helpful in easing her heartburn and abdominal pain. She denied symptoms of polyuria, polydipsia, confusion or mood changes. There is no history of kidney stones. She had a fracture of her humerus at age 15 due to a ski accident. She was taking pantoprazole and a multivitamin daily. Ms. Parapan’s family history is significant for a father who had a pancreatic tumour, though she does not know any more details about his condition. Both her sister and her paternal aunt had a parathyroidectomy. The same aunt had a pituitary tumour requiring surgery.

Active Large Group Session: MSK Radiology

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Compare and contrast how various imaging modalities can be best utilized to image the different components of the musculoskeletal system. Develop an approach to the interpretation of MSK radiographs. Develop an approach to the interpretation of the cervical spine radiograph. Compare and contrast the appropriate use of various imaging modalities in the work up of the following cases: Scaphoid fracture; Acute knee pain; Ankle trauma; C-spine trauma.

Tutorial: Giuseppe Carnivale MF4 MSK

Part 4, Medical Foundation 4, Musculoskeletal Medicine, Week 4

Giuseppe Carnivale is a 42 year old construction worker who presents with the complaint of gradually increasing weakness in his legs. He has noted difficulty climbing stairs. He feels the strength in his arms is normal, except when working over his head. He admits to mild aching in his muscles, but has no muscle pain or tenderness. The weakness has been insidious. A rash has been present on his face and upper chest for several months.

Tutorial: Neil Wartson (Part 2) MF4 Neuro

Part 4, Medical Foundation 4, Neuroscience, Week 1

Neil Wartson is brought back to his family doctor 6 months later. The MRI has still not been performed, but the audiology testing confirmed severe sensorineural hearing loss on the right. Upon entering the office, Neil’s mother is very upset and agitated. Over the last month, she has noticed that Neil has become clumsier and is falling frequently. He also has started to rub his eye a lot and complains that things are “fuzzy”. She also reports that, since the last visit, Neil’s father has been investigated for his hearing loss. He is currently being worked up for Neurofibromatosis Type II. Neil’s mother has looked this up on the internet and is convinced that Neil has this as well.

Tutorial: Arielle D

Part 5, Integration Foundation

Arielle is a 41 yr old female presenting to her family doctors office with concerns of irregular menstrual cycles and painful intercourse. Arielle states she has noticed increased episodes of spotting in between her menstrual cycles over the past 8 months. Arielle has also noticed increased vaginal discharge and abdominal cramping at times with associated swelling of her legs. Arielle thought her lower leg symptoms were a result of her long work hours and standing for long periods of time. Arielle immigrated to Canada from the United States 15 years ago. She works as a daycare attendant and a waitress on the weekends to support her parents who reside with her and her partner. Arielle did not have regular access to healthcare as a teenager while living in Florida with her parents who immigrated to the US from Mexico shortly after Arielle was born. Arielle did not receive any vaccinations as a child or as a teenager. Arielle was sexually active at the age of 14 with multiple partners before her husband. She has been in a monogamous relationship for the past 6 years. Arielle reports she has given birth to 3 children which she gave up for adoption and underwent 2 pregnancy terminations prior to meeting her husband. Her husband does not know about any of the previous pregnancies or procedures she underwent prior to meeting him.

Tutorial: Ethel MacConkey IF Host Defence and Neoplasia

Integration Foundation, Host Defense and Neoplasia, Week 1

Ethel is a 76 year old widow. She has a history of hypertension (treated with a thiazide diuretic and a calcium channel blocker), hyperlipidemia (treated with an HMGCoA reductase inhibitor), and obesity. Apart from this, she has been relatively healthy, and plays an active role with her 3 grandchildren as well as her church. Unfortunately, over the past few years, she has had increasing difficulty walking because of pain from osteoarthritis in her hips (especially her right hip) and, to a lesser extent, her knees. She therefore undergoes a right total hip arthroplasty. After 6 days in hospital, she is transferred to the rehab ward for further physiotherapy to improve her mobility. Five weeks into her rehab stay she develops a fever of 38.7 C. Additionally her physiotherapist has noticed that over the past 7-8 days Ethel has been less willing to participate in her exercises due to complaints of pain in her right hip. Concerned about Ethel's fever, the nurses give her acetaminophen and call the attending physiatrist to assess the patient for a potential infectious source.

Tutorial: Yaser Kallas IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Yaser is a 36-year-old man who is brought to the emergency room by his wife after feeling quite unwell for the past 2 days with shaking chills and fever, along with some upset stomach. He is extremely weak and unable to provide significant details and his wife does not speak English. In reviewing his chart from a previous visit for a sprained ankle you are able to elicit that he’s a refugee from Syria who came to Canada 18 months ago and has two children. He was not previously taking any regular medications and he does not seem to have a significant past medical history other than a splenectomy secondary to a trauma 8 years ago. On assessment at triage he is found to have a temperature of 39.2 Celsius, a blood pressure of 86/60 and a heart rate of 125 bpm. His oxygen saturation is 85% on room air and he is tachypneic with a respiratory rate of 34. He is very drowsy, but rousable, however unable to engage in significant conversation. He appears diaphoretic and his extremities are warm to touch.

Tutorial: Melissa Wang IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Melissa is a 35-year-old mother of three who works in marketing. She is being seen in consultation by the Internal Medicine service while admitted to Thoracic Surgery for an empyema. Three months prior she began to have cough with intermittent fevers and chills. She has been treated as an outpatient by her family doctor with Amoxicillin, Azithromycin and Levofloxacin over this time. Her symptoms would initially improve but would return within days of completing her antibiotic course. Her condition continued to worsen until this admission. On review of her past history, she has chronic facial pain and pressure with frequent purulent discharge, and typically has 2-3 sinus infections per year requiring antibiotics. She has never had pneumonia before this year. She has never received pneumococcal vaccination. She received her childhood immunization series and had her last tetanus and diphtheria booster 4 years ago. She has been re-vaccinated for measles, mumps, rubella twice, after prenatal evaluation deemed her non-immune. Prior to onset of these symptoms, her only medication was the oral contraceptive pill. In addition to leaving recommendations to manage her empyema, you wonder about her history of recurrent sinusitis and recent pneumonias. As such, you order some screening bloodwork.

Watching a Video: Communicable Diseases Part 1: Identification and Reporting

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Understand surveillance systems and the role of physicians in reporting and responding to disease. Appreciate the role that physicians can play in promoting health and preventing diseases at the individual and community level.

Watching a Video: Communicable Diseases Part 2: Outbreak Management

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Define an outbreak in terms of an excessive number of cases beyond that usually expected. Know the characteristics of an outbreak and how to recognize one when it occurs. Describe and understand the main steps in outbreak management and prevention. Demonstrate an understanding of effective outbreak management including infection control when the outbreak is due to an infectious agent. Describe skills involved in controlling an outbreak and its impact on the public, in collaboration with public health authorities as appropriate. Case example of influenza.

Watching a Video: Measures of Health

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Describe the health status of a defined population. Key concepts covered are incidence, prevalence, attack rate, relative risk, case-fatality rate and principles of standardization.

Active Large Group Session: Antibiotic Prescribing

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Watching a Video: Surveillance: Data for Action

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Historical context of surveillance of public health. Definition and key principles of surveillance. Surveillance systems. Surveillance is the collection and analysis of data for action. There are many complementary surveillance systems in place in Canada to inform action.

Clinical Skills Sessions: Knee Pain in the ER

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

To practice a history and physical exam for acute mono-arthritis, with focus on knee joint examination. To review can’t miss diagnoses for acute inflammatory monoarthritis. To review NEJM Clinical Video on Knee Arthrocentesis: https://www.nejm.org/doi/full/10.1056/NEJMvcm051914. To practice using likelihood ratios from the JAMA Rational Clinical Exam Article Does This Adult Patient Have Septic Arthritis to formulate a post-test probability of septic arthritis in this case. To discuss initial next steps in management including investigations in workup for acute inflammatory monoarthritis, and empiric antibiotics for septic arthritis

Anatomy Lectures: Breast Anatomy and Lymphatic System

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Breast blood supply. Pathology of the breast. Benign and malignant tumours.

Active Large Group Session: Outbreak Management

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 1

Tutorial: P.J. Peters (Part 1) IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 2

As you head off to lunch after wrapping up your morning clinic, you peruse your afternoon schedule and note that the first patient is someone you have not seen in three years. You therefore grab his chart to review his history. P.J. Peters is a 34-year-old male who immigrated from Uganda 10 years ago. Four years ago, he presented with a dry cough and mild shortness of breath. Given that you had noted a few crackles in his lower lungs bilaterally, you had prescribed him antibiotics for pneumonia. In spite, of therapy his symptoms progressed over a 2-3 week period and he landed in the emergency. A chest x-ray at the time revealed a bilateral interstitial infiltrate. Due to progressive hypoxia he underwent a bronchoalveolar lavage which revealed he had pneumocystis jiroveci pneumonia (PJP or PCP). This raised the suspicion of underlying HIV and his serology was sent off and came back positive. On further questioning, he admitted to a 2 year period in his life in his early 20s where he had unprotected sex with multiple partners.

Tutorial: P.J. Peters (Part 2) IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 2

When you see Mr. Peters next, you learn that he had continued to take his HAART faithfully an additional 6 months after he last saw you. He had been feeling physically well and figured his virus was under control (as he recalled it had last been "non-detectable") and so began questioning the need to continue his medications. He was concerned about long-term side effects of therapy and figured he could diminish his risk by reducing his exposure to HAART. Moreover he had started a new job around that time and did not want anyone to inadvertently find out about his diagnosis of HIV. He therefore elected to stop taking his anti-retrovirals. Mr. Peters was reluctant to tell his physicians about his decision and so he had not come back for his follow ups. He returns today complaining of a new painful rash on his chest that appeared 2 days prior. Additionally he notes a 3-month history of increasing fatigue as well as intermittent fevers, night sweats and a 20 lb weight loss. On examination his temperature is 37.2º C, blood pressure 135/80, pulse 79. There are 2 cm nodes palpable in the cervical and axillary areas bilaterally. His throat is clear. When you examine his chest you notice a vesicular rash over the right side of his chest extending from the midline towards his right axilla at the level of his nipple. Examination of his respiratory and cardiovascular system are unremarkable. His abdomen is soft with no palpable masses or organomegaly. Examination of his extremities is unremarkable.

Clinical Skills Sessions: Headache

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 2

Review and to practice an approach to history and exam of headache including red flags. A 21yo F presents to family medicine clinic with headache.

Tutorial: Philippe LaCologne IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 3

Mr. Lacologne is a 41 year old man who had a stage II colon cancer resected 3 years prior. He had his annual CT scan, and there was a 3 cm hypoechoic lesion in segment 6. His surgeon referred him to a liver Surgeon and Medical Oncologist. The surgeon explained that this is likely recurrent disease from his colon cancer, and recommended chemotherapy neo-adjuvantly and after surgery. He was started on FOLFOX chemotherapy for 6 cycles, subsequent CT and MRI of his liver showed a partial response to chemotherapy. He underwent a left hepatic lobectomy, and following recovery completed an additional 6 cycles of FOLFOX. Two years later subsequent lung lesions are identified in multiple lobes bilaterally. He returns to the Medical Oncologist, and is recommended to start chemotherapy (FOLFIRI/bevacizumab). He asks why surgery is not an option now, and said he heard on the internet that that this bevacizumab drug can cure cancer.

Tutorial: Godlewski Family IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 3

Paula Godlewski is a 50 year old Jewish woman of east European descent. She comes to the appointment with her daughter Anna. She has come to be assessed by a medical oncologist for consideration of systemic therapy following the diagnosis of a node positive breast cancer. Anna, who is 25 years old, asks if this cancer is inherited and whether she will get breast or ovarian cancer. she asks whether she should have prophylactic mastectomies and oophorectomies if her tests were to be positive.

Tutorial: Grace Tran IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 3

Grace is a 50-year-old woman working full-time and busy with her family. She has been feeling exhausted lately and feels like she may have had fevers on and off. She is having difficulty finding the energy to coach her daughter's early-morning hockey games. At the urging of her partner, she sees her family physician who notes that she is afebrile with mild dyspnea and a cough, having faint crackles on the right side of her chest. Suspecting pneumonia, her physician sends Grace for a chest x-ray and she is given an antibiotic prescription to treat community-acquired pneumonia. The x-ray report described a density in the right lower lung zone, and Grace starts her medication with follow up in 3 weeks. When she returns, she mentions that she finished the course of antibiotics but that they “did nothing” and that she feels a bit worse actually. Her exam is unchanged, but given that she has a 30 pack-year smoking history, her physician orders a repeat chest x-ray. This shows mild interval growth of the original opacity. This time, the radiologist states that the area is suspicious for possible malignancy. On further history, Grace was treated for Hodgkin's lymphoma at the age of 18, for which she received 3 cycles of ABVD chemotherapy followed by radiation to the mediastinal lymph nodes. She has been “cancer free” and completely well since, so much so that she stopped going to her AfterCare follow-up appointments. Grace grew up in a middle-class suburban neighbourhood and completed a geosciences degree at a local university. She has spent the last 20 years working for a mining company evaluating many different ore samples. She frequently deals with silica ores and metal-based ores, including iron, nickel, chromium, zinc and aluminum. She wears an N95 dust mask when handling the samples. Grace comes from a family of heavy smokers. Grace's father died 5 years ago from bladder cancer. Her paternal uncle, also a smoker and a heavy consumer of alcohol, had previously died of a throat cancer. Her older sister, yet another smoker, had cancer of the cervix treated successfully with radiotherapy. Due to the x-ray findings, Grace is sent for a CT scan of her chest. This confirms a 2.5 cm lesion in the central right lower lobe well away from the chest wall and the hilum.

Clinical Skills Sessions: Melena Stool

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 3

Review and practice an approach to history and exam in GI Bleeding. A 65yo M presents with melena stool to urgent care.

Clinical Skills Sessions: Palliative Care

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Describe and Identify patients who would benefit from a palliative care approach early in their illness trajectory. Systematically assess symptoms in patients with palliative care needs and participate in the evidence-based holistic and interprofessional management of these symptoms. Identify the components of a holistic, interprofessional management plan for a patient with palliative care needs. Describe the hierarchy for Substitute Decision Making for a patient who lacks Capacity. Describe the role of POAs or SDMs in palliative and end-of-life care planning.

Clinical Skills Sessions: New Lymphadenopathy and STBBI assessment

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Review and to practice an approach to history and exam for lymphadenopathy and STBBI (sexually transmitted and blood-borne infection) assessment. A 27yo F presents with new lymphadenopathy and concern for STBBI to Emergency room.

Active Large Group Session: Occupational Medicine

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Active Large Group Session: End-of-Life Care

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Tutorial: Albert Johnson IF Host Defence and Neoplasia

Part 5, Integration Foundation, Host Defense and Neoplasia, Week 4

Mr. Johnson is a previously fit, retired 70-year old Afro-Canadian gentleman. His son and daughter-in-law live several hundred miles away in another city and maintain contact with him by telephone. They return home on a Friday evening to surprise him for his birthday and find his apartment in disarray and Mr. Johnson in bed, in too much pain to move. He seems unable to stand independently, though it is hard to tell if this is a result of his overall weakness, or the pain. They call an ambulance and he is taken to the Emergency Department of the local community hospital.

e-Learning Module: Integration Foundation Rapid Fire Cases: Medical decision making in the acute care setting

Part 5, Integration Foundation, Maternal Health Risks/Aging-Related Care, Week 4

12-15 cases of rapid action required or immediate clinical decision making. Content of these modules: Internal Medicine, Surgery, Obstetrics, Paediatrics, Geriatrics and Radiology.

e-Learning Module: Integration Foundation Pathology Cases

Part 5, Integration Foundation, Complexity and Chronicity, Week 1

Normal Histology and Disease. Integrating Pathology Into the Clinical Picture. The frozen section (intraoperative consultation).

Clinical Exposure: Women's Health

Clerkship, Family Medicine Rotation

Tutorial: Women's Health

Clerkship, Family Medicine Rotation

Clinical Exposure: Lung nodule

Clerkship, Internal Medicine Rotation

Large Group Session: Gynecological Cancers and HPV

Clerkship, Obstetrics and Gynecology Rotation

Endometrial tumours. Uterine malignancies. Ovarian neoplasms. Cancer of the cervix. Cancer of the Vulva. Human Papillomavirus pap smears and the vaccine.

Clinical Exposure: Inguinal/Scrotal complaints

Clerkship, Surgery Rotation

Clinical Exposure: Breast mass/inflammation/discharge

Clerkship, Surgery Rotation

e-Learning Module: Skin cancer

Clerkship, Surgery Rotation

This module reviews the presentation, diagnosis, and management of skin cancer, specifically melanoma.

Round Table Discussion: Colorectal

Clerkship, Surgery Rotation

Review of anatomy. Review of physiology. Diverticular disease. Large Bowel Obstruction (Cancer, Volvulus). Colitis (Infectious and Ischemic).

Round Table Discussion: Breast Diseases

Clerkship, Surgery Rotation

Large Group Session: Oncology

Clerkship, Surgery Rotation

Assessment of a patient with pulmonary nodule. Lung Cancer Screening. Lung Cancer Staging. Operative Treatment of Lung Cancer. Take home messages for the multiple disciplines of medicine.

Large Group Session: Head and Neck

Clerkship, Surgery Rotation

Introduction to Head and Neck Surgery: basic clinical exam; relevant anatomy. Review common clinical scenarios in head and neck surgery. Neck Mass. Thyroid Nodules.

Essential Clinical Experience: Breast mass/inflammation/discharge

Surgery Rotation

e-Learning Module: Thyroid nodule

Clerkship, Surgery Rotation

In this module, you will learn about the presentation, diagnosis, and management of thyroid nodules and specifically of thyroid cancer.

e-Learning Module: Lung cancer

Clerkship, Surgery Rotation

In this module, you will learn about presentation, diagnosis, and staging of lung cancer along with patient evaluation to assess suitability for pulmonary resection.

e-Learning Module: Colon cancer

Clerkship, Surgery Rotation

At the end of this module, you will be able to determine the epidemiology of colorectal cancer in the United States, understand the pathophysiology of colorectal cancer, determine a framework for the treatment and management of colon cancer and recognize ways to detect colon cancer polyps at an early stage.

e-Learning Module: Breast cancer surgery

Clerkship, Surgery Rotation

In this module, you will learn about the presentation, diagnosis, and management of breast cancer.

Concept Integration and Review: Dermatology

Post-clerkship, Concept Integration and Review

Acne, Rosacea, Seborrheic Dermatitis; Acne, Perioral Dermatitis ; Psoriasis, Atopic Dermatitis; Warts, Molluscum ; Vitiligo, Tinea Versicolour, Progressive Macular Hypomelanosis; Urticaria, Urticarial

Concept Integration and Review: Gastroenterology

Post-clerkship, Concept Integration and Review, Week 2

Upper GI: Dyspepsia, GERD & peptic ulcer disease. Small and large bowel: Celiac disease, Irritable bowel syndrome (IBS) and Inflammatory bowel disease (IBD). Pancreatic diseases. Acute pancreatitis, chronic pancreatitis, adenocarcinoma of the pancreas, cystic fibrosis. GI bleeding.