Transition to Residency

About the Course

About the Course in General... 

1) Making productive use of the end of the MD training period, TTR is characterized by:

  • less structured learning, in preparation for PGY1 where workplace learning is predominant;
  • increasing responsibility for students' own work in clinical settings, commensurate with near-graduate status;
  • self directed learning with respect to needs and to resources obtained to accomplish learning goals;
  • learning goals which are integrative and holistic across multiple settings and experiences; and
  • consolidation of learning that has occurred in different settings in previous years.

2) Students will learn content relating to the “real world” and “real work” of doctors - with direction to be provided through centralized learning in the two Central Weeks, and consolidation provided through clinical experiences. (“Clinical” here is defined as any experiences in the real world of physician work, and not necessarily restricted to experiences with patients.) 

Centrally produced content will be delivered in the two Central Weeks and students will be directed to look for opportunities to apply it in each selective.  Students will be directed to focus on understanding the community they are in, the associated resources, and how they can work there in a socially responsible way.

3) Selectives have been developed with guidance from the central committee, but rely substantially on local resources and innovation in their actual delivery.  Selectives provide an environment for students to begin to work at a pre-PGY1 level, regardless of the content area of the Selective. 

Interdisciplinary content is to be encouraged, both in terms of physician specialties, and in terms of interactions with other health care providers.  The rationale for this is to encourage the students to acquire/develop knowledge, skills and attitudes relevant to broad areas of future practice. Diversity of contexts means going beyond the usual sites for students’ clinical experience.  Community sites (here defined as non-TAHSN associated sites) must comprise at least one of the Selectives. The Selectives catalogue was produced through departmental contacts, the former ACE course participants, and the Rural Ontario Medicine Program. Well-defined global health opportunities are also eligible.

4) Students are expected to produce evidence of learning as assessed through diverse formats, in order to successfully complete this course.  Assessment of students in Selectives will be based upon their supervisors' observations of their work in the Selective environment; the other components of the students' assessments are centrally administered.

General Comments about the Selectives in Particular...

(go to the Selectives tab above for more detailed information)

A Selective is a student-selected component of the MD degree. It is a placement, in a clinical environment, which supports the curriculum of the Transition to Residency course. It differs from an Elective in that the student's choice is directed toward a catalogue of opportunities that have been designed specifically to ensure students can achieve the objectives of the TTR course. 
Selectives are 2 or 4 weeks in length.
Selectives will allow students to work more independently than they did during their 3rd year core rotations, often in a student-mentor relationship, but with supervision commensurate with their pre-MD status.  Students will be engaged in the workplace environment of the selective and are expected to gain tangible knowledge, skills and attitudes from it; they will also have responsibilities to study, independently, the population and systems they encounter in the selectives, in a self directed manner.
The workplace based learning of the Selectives will allow students increased (graded) responsibility under supervision, and will allow the students to bring many different areas of knowledge and skill together in the care of patients or populations, as they get ready for the increased responsibility of PGY1 programs. They will also serve as a resource for students to complete specific self-directed learning activities for course credit, in addition to an evaluation performed by their supervisor(s). More information can be found under the Evaluation link. 

The emphasis for Selective providers is on ensuring the students have access to rich experiences, and wide ranges of activities, which they can make the most of, both for personal development and for satisfying course requirements. 

Here are some guiding principles for Selective providers:

  • Students should be able to participate in patient care and other workplace activity relatively independently, actively contributing to the work in a meaningful way, and learning to develop their competence to the PGY1 level;
  • Students should experience how concepts like Communication, Collaboration, Advocacy, Management, etc all work together in “real” clinical activity;
  • Students ideally should be able to interact with multiple disciplines (physician specialties, other health care professions) over patient care issues to develop a more holistic understanding of those issues. The extent to which this can occur will vary from site to site.

“Clinical departments” here are defined as departments which can provide an experience relevant to the “real world” work of physicians.  This would include lab medicine areas, as well as Dalla Lana School of Public Health, and the Joint Centre for Bioethics, amongst others. 

Departments have been encouraged to partner with each other in producing selectives with high value to a wide variety of students, in terms of bringing together previously acquired knowledge, gaining insight into different modes of physician practice, and developing generalizable skills.  When students work within more than one discipline, emphasis should be placed on following the care of patients from one environment to another within the Selective, as much as possible.

Departments sponsoring electives have guidance as to what the students are expected to learn, and what they are responsible for. However, the clinical faculty supervising students are NOT responsible for re-teaching the material learned in the central weeks.  In any rich clinical environment, there will be ample opportunities for students to see the principles learned in the Central Weeks put into practice, and to reflect on how they see themselves doing this.