Fishing for a Longitudinal Integrated Clerkship at McMaster Jonel Miklea, MD CCFP Asst Prof, Undergraduate Program Director Dept of Family Medicine McMaster University Hamilton, ON, Canada

Ice Fishing Locations Shelters Fishing equipment Modern ice fishing Dangers Contests Current Fishing Conditions References Ice fishing is the activity of catching fish with lines and fish hooks or spears through an opening in the ice on a frozen body of water. Ice anglers may sit on the stool in the open on a frozen lake, or in a heated cabin on the ice, some with bunks and amenities.

My god son and I fishing at lake Simcoe, Ontario in February 2009

Location Canada Finland Estonia Latvia Norway Russia Sweden Ukraine Germany USA Flinders Minnesota USF Harvard UBC Calgary Edmonton NOSM …and soon McMaster Of note is that Minnesota has both Ice fishing and LIC

Shelters Shelter = ice shanty, ice shack, fish house, bobhouse, or ice hut. LIC will be sheltered in our 2 distant campuses; Niagara campus and Kitchener/Waterloo These are dragged or trailered onto the lake using a vehicle such as a snowmobile, ATV or truck

Fishing Equipment Ice saw Skimmer Heater Fishing rod Lures Buy in from faculty, deans and community Interest among students Budget Skimmer - remove new ice as it forms

Modern Ice Fishing Power drills Flashers (sonar) Snowmobiles Evidence: students perform as well or better than colleagues in traditional clerkship programs graduates overwhelmingly choose primary care specialties in rurally based programs, at least 50% of grads choose rural practice locations Power drills Flashers (sonar) Snowmobiles The name of the game is mobility, for today’s modern ice fishermen Sonar = provides depth information, indicates presence of fish, displays movement of fish There is plenty of evidence for modern day LIC:

Dangers Walking - 10cm (6cm) Sleds, Snowmobiles - 12cm Light cars - 25cm Frostbites, CO poisoning from fish-house heaters Student’s anxiety re exam performance, Exam structure Administration - central Equitable experiences Program evaluation Some people take the risk and walk on only Accreditation

Contests Catching a big fish, no matter what the species, is always a thrill, and it usually requires exceptional fishing skill. Improved resiliency Comfort with uncertainty Patient-centred care As you may know…There are numerous Ice Fishing Contests throughout the world. There seem to be almost a contest going in between traditional and LIC students but the students going through LIC show

Current fishing conditions At McMaster

COMPASS Concept-oriented Multidisciplinary Problem-based Practice for transfer Simulations in clerkship Streaming With the beginning of the new millenium, McMaster MD program has developed further its MD school curriculum, with COMPASS, which stands for concept-oriented, multidisciplinary, problem based, practice for transfer, simulations in clerkship, streaming… That’s a mouth full!

Pre-Clerkship FM Experience STUDENTS: Mandatory 6 week at the beginning of Med School or optional 12 weeks FACULTY: teaching Clinical Skills, Precepting 6 week Mandatory FM, strong presence in Professional Competencies Family Medicine faculty have a very strong presence within the medical school at every level from teaching clinical skills to teaching ProComp.

Professional Competencies Domains Effective Communication Professionalism and Role Recognition Self Awareness and Self Care Lifelong Learning Social and Community Context of Health Care Moral Reasoning and Ethical Judgment Clinical Examination More than 50% faculty teaching ProComp are GPs. This is a 16month, half a day per week,mandatory longitudinal experience for McMaster medical students.

Family Medicine Clerkship FM Clerkship = 6 week rotation 6-7 half days/week with FM clinical preceptor integrated with other teaching activities Total # students 182: Local 108 & Rural 76 1 tutorial per week Daily evaluations & Key Feature Exam 2011 class = 182 students, 20 based in KW and 15 based in Niagara Campus

Integration 4 half days of Palliative Care 3 half days of Early years 2 half days of Global Health 1 half day of Care of the Elderly 2 half days FM Selective 2 half days of Complementary/Alternative Medicine

Our Success 50% of our students choose FM as a career choice National average 32.5%

LIC Pilot at Mac November 2011 distant campuses Niagara and Kitchener Waterloo 8 mo in FM, 1.5 month ward based Peds, 1.5 month ward based IM and 2 month elective More to share at the 2010 Global Community Engaged Medical Education Conference, Barossa Valley 4-5 half days/wk of FM, half day Obs/Gyne, half day Surg, half day Allied health, 2 half day Academic, 1 day perweek & 1 w/e permonth ER

References Fishing: LIC literature: Gruenwald, Tom and Genz, Dave (1999) Modern Methods of Ice Fishing LIC literature: Paul Worley Gwen Halaas Lucie Walters Molly Cook

Conclusions If students have their clinical training mainly in hospitals, especially tertiary care hospitals, they will get the message: ‘this is what disease is and this method for investigating it, is the method of medicine.’ If they never care for a patient at home, the message will be ‘the home is no place for a physician.’ If they are taught mainly by specialists, they will get the message: ‘this is where authority, prestige, and power lie.’ Ian McWhinney Many men go fishing all of their lives without knowing that it is not fish they are after. Henry David Thoreau

Thank You!