MED 8740 Advanced Practice Integration 2023

MED 8740 Advanced Practice integration (Selectives/P2P)
Phase 4, Class of 2023
Academic Year 2022-2023

Assessment Plan


Enables learners to be assigned to a physician, physician group or discipline for experiences that focus on following patients as they interact with the health care system.

Entrustable Professional Activities (EPAs)
EPA 1: Obtain a history and perform a physical examination adapted to the patient’s clinical situation.
EPA 2: Formulate and justify a prioritized differential diagnosis.
EPA 3: Formulate an initial plan of investigation based on the diagnostic hypotheses.
EPA 4: Interpret and communicate results of common diagnostic and screening tests.
EPA 5: Formulate, communicate and implement management plans.
EPA 6: Present oral and written reports that document a clinical encounter.
EPA 7: Provide and receive the handover in transitions of care.
EPA 8: Recognize a patient requiring urgent or emergent care, provide initial management and seek help.
EPA 9: Communicate in difficult situations.
EPA 10: Participate in health quality improvement initiatives.
EPA 11: Perform general procedures of a physician.
EPA 12: Educate patients on disease management, health promotion and preventative medicine.
EPA 13: Collaborate as a member of an interprofessional team.
EPA 14*: Identify and account for the relevant social determinants of health (SDoH) and cultural safety in relation to patient’s illness and
               management planning.

* EPA 14 is included as a pilot and can be assessed as deemed appropriate by the learner or preceptor.

Course Structure
A summary of requirements for MED 8740 is available here.
Option 1
12 weeks as follows:

  • 4 consecutive weeks in a rural site* in one of the core disciplines for the Rural Core Selective (Family Medicine, Pediatrics, Internal Medicine, Obstetrics and Gynecology, Psychiatry, General or Orthopedic Surgery, Emergency Medicine, Anesthesia, Anesthesia/Emergency Medicine)
  • 4 weeks Surgery (two 2 week selectives or one 4 week selective)
  • 4 weeks Non-core (two different 2 week selectives) in lab medicine, radiology, or a discipline of the learner’s choice.

*Definition of a rural site 
For the province of Newfoundland and Labrador, a rural site is defined as having a population of less than 50,000 people and not within a one hour commute of a population centre exceeding 100,000. For the province of New Brunswick, rural includes any location outside the main centers of New Brunswick (Moncton, Saint John, Fredericton).
Option 2:
Progression to Postgraduate (P2P)
12 weeks integrated selectives based with a rural preceptor or other preceptor appropriate to the learner’s needs.
       Objectives for P2P

                Medical Expert
  • Take a witnessed complete and accurate patient-centred history appropriate to the patient's experience (EPA 1, 8)
  • Perform a witnessed complete and accurate physical examination based on the patient's problem (EPA 1, 8)
  • Provide opportunities for longitudinal experiences in management of multiple co-morbidities across all age groups, especially for elderly care (EPA 2 - 5, 9, 13)
  • Provide opportunities to increase learner experiences in areas of need/ interest (EPA 1-13)
  • Communicate effectively with third parties other than health professionals (EPA 9, 13)
  • Effectively convey oral and written information associated with a medical encounter in an office setting (EPA 5, 6, 9, 13)
  • Participate effectively with physicians (intra-professional) and other health care professionals (inter-professional) to provide ongoing care for individuals, communities, and populations (EPA 5, 9, 13)
  • Allocate health care resources effectively  (EPA 3 - 5, 9, 13)
  • Employ information technology as appropriate for patient care and practice management (EPA 6, 7)
  • Review and improve an appropriate clinical deficiency within the office practice (EPA 10)
    Health Advocate
  • Assess and respond to the specific determinants of health relevant to the individual, the community, and/or the population (EPA 3 - 6, 9, 13)
  • Apply principles of research and information to learning and practice (EPA 5, 10)
  • Facilitate the learning of others as part of professional responsibility (EPA 5, 9, 10, 13)
  • Accept responsibility for ensuring continuity of care (EPA 7, 10)
  • Maintain patient confidentiality (EPA 5, 9, 13)
  • Show respect for others in complex situations (EPA 1 – 7, 9 – 11, 13)

 Objectives/Learning Plan
Each learner required to submit personal objectives/learning plan linked to EPAs and in response to their progress to date.
Learners identified as requiring remediation will require objectives/learning plan to be developed in conjunction with UGME (Phase 4 Lead) and approved by the Phase 4 Management Team. These learners will be required to complete these electives in NL/NB/PEI with a Memorial Faculty member as a preceptor.
Teaching and Learning Methods
Clinical teaching
Assessment plan
In Training Assessment Report (ITAR) – Clinical
Option 1:
Summative ITAR at the end of the rotation for all selectives.
Option 2:
Formative: Mid rotation ITAR at 6 weeks and electronic field notes. 
Electronic field notes must be regularly completed throughout the P2P rotation, minimum two field notes per week. This ensures frequent narrative feedback and enables learners to identify learning needs. Learners or preceptors can complete the electronic field note using the T-res app.

Summative: ITAR at the end of the rotation.
EPAs to be assessed to be linked to customized objectives above.
Customized to the EPAs deemed pre-entrustable after completion of the 12 weeks and designed by Phase 4 Management Team. 
Course Success Criteria
To pass the course, a learner must:

  • Achieve entrustability as documented in the ITAR for all EPAs identified for each selective/P2P rotation
  • Obtain an overall rating of performance as appropriate for this level of training in the ITAR for all selective/P2P rotations
  • Have no outstanding concerns with professionalism

As outlined in the MD program objectives, the Faculty of Medicine at Memorial University values professionalism as a core competency and a requirement of the MD program. Recognizing that medical learners are developing their professional identity, professionalism lapses will be remediated where possible and appropriate. Unsuccessful remediation will result in failure of the Phase.  Professionalism lapses may render a learner incompatible with continuation in the MD program (as outlined in the Memorial University Calendar Regulation 10.5 Promotion).

As outlined in Section 10.5.2 and 10.5.3 of the Regulations for the Degree of Doctor of Medicine in the University calendar, learners with a Fail grade in any course cannot be promoted to graduation. Even in the absence of any Fail grades, a learner for whom substantial concerns about performance have been expressed may either be required to repeat the Phase or required to withdraw conditionally or unconditionally. 

Version date: June 14, 2021
Approved by SAS: April 28, 2021
Approved by UGMS: May 19, 2021