Ba Inds 111 Study Guide

INDS 111:
Molecules to Global Health
STUDY GUIDE
LEARNING OBJECTIVES, SUGGESTED
AND REQUIRED READINGS*
Prepared by Dr. Anne Andermann

September 2016
* Required readings = Approximately 200 pages of “whole course” readings and all small group
preparation readings (i.e. for afternoon sessions). All other readings (i.e. for morning lectures)
are suggested, but not required. Please note, certain longitudinal themes (e.g. clinical method)
may have cumulative exams later in the year, and may assign required readings for evaluations
that extend beyond this course.
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Table of contents
Whole course required readings ....................................................................................................... 4

Week 1 - Lectures.............................................................................................................................. 8
Dr. Andermann – Public health theme (improving health) .......................................................... 8
Dr. Boillat – Clinical method theme (history-taking) .................................................................... 8
Dr. Ragsdale – Basic science theme (molecular biology) .............................................................. 9
Dr. McKee – Basic science theme (histology) ............................................................................... 9
Dr. McKee – Basic science theme (histology) ............................................................................... 9
Dr. Michel – Basic science theme (pathology) ............................................................................ 10
Dr. Hebert – Basic science theme (pharmacology) ..................................................................... 10
Dr. Chaudhury & McGill librarian – Evidence-based medicine theme ....................................... 10
Dr. Klein – Public health theme (epidemiology) ......................................................................... 11
Dr. Saylor – Public health theme (Indigenous health) ................................................................ 11
Week 1 - Afternoons ....................................................................................................................... 12
Clinical exposure ......................................................................................................................... 12
Public health SG1 ........................................................................................................................ 12
Histology Lab 1 ............................................................................................................................ 13
Student wellness, diversity and careers SG ................................................................................ 13
Week 2 - Lectures............................................................................................................................ 14
Dr. Andermann – Public health theme (improving health) ........................................................ 14
Dr. Dawson – Clinical method theme (history taking) ................................................................ 15
Dr. Ragsdale – Basic science theme (molecular biology) ............................................................ 15
Dr. Blumenkrantz – Basic science theme (pathology) ................................................................ 16
Dr. Hebert – Basic sciences theme (pharmacology) ................................................................... 16
Dr. Greenaway – Public health theme (immigrant and refugee health) .................................... 16
Dr. Chaudhury & McGill librarian N. Torabi – Evidence-based medicine theme ........................ 17
Dr. Moore – Basic sciences theme (anatomy) ............................................................................ 18
Prof. Rees – Medicine and society theme................................................................................... 18
Dr. Kirmayer – Public health theme (immigrant and refugee health) ........................................ 18
Dr. Masse – Public health theme (public health) ........................................................................ 19
Dr. Weinstock – Public health theme (public health ethics) ....................................................... 19
Week 2 - Afternoons ....................................................................................................................... 20
Histology Lab 2 ............................................................................................................................ 20
Pathology SG1 ............................................................................................................................. 20
Clinical method SG1 .................................................................................................................... 21
Epidemiology SG1 ....................................................................................................................... 21
EBM SG1 ...................................................................................................................................... 21
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Week 3 - Lectures............................................................................................................................ 22
Dr. Boudreau – Clinical method theme ...................................................................................... 22
Dr. Ragsdale – Basic science theme (molecular biology) ............................................................ 23
Dr. Pelmus – Basic sciences theme (pathology).......................................................................... 23
Dr. Ernst – Public health theme (epidemiology) ......................................................................... 24
Dr. Scharf – Public health theme (health care quality) ............................................................... 24
Prof. Maioni – Public health theme (health in all policies) ......................................................... 24
Dr. Stock – Public health theme (occupational health) .............................................................. 25
Dr. Farmer – Public health theme (health in all policies)............................................................ 25
Dr. Laporta – Public health theme (global health) ...................................................................... 26
Dr. Andermann – Public health theme (clinical prevention) ...................................................... 26
Week 3 - Afternoons ....................................................................................................................... 27
Public health SG2 ........................................................................................................................ 27
EBM SG2 ...................................................................................................................................... 28
Pathology SG2 ............................................................................................................................. 28
Epidemiology SG2 ....................................................................................................................... 29
Week 4 - Lectures............................................................................................................................ 29
Dr. Greenfield – Clinical method theme (alliance building) ........................................................ 29
Dr. Michel – Basic science theme (pathology) ............................................................................ 30
Dr Hebert – Basic sciences theme (pharmacology) .................................................................... 31
Dr. Lapointe – Public health theme (elder health) ..................................................................... 31
Ms Fitzpatrick – Basic sciences theme (genetics) ....................................................................... 32
Dr. Braverman – Basic sciences theme (genetics) ...................................................................... 32
Dr. Weinstock – Public health theme (public health ethics) ....................................................... 33
Dr. Drager – Public health theme (global health) ....................................................................... 33
Week 4 - Afternoons ....................................................................................................................... 34
Inter-professionalism (IP) SG ...................................................................................................... 34
Advocacy SG ................................................................................................................................ 34
Clinical method SG2 .................................................................................................................... 34
Genetics SG1 ............................................................................................................................... 35
Research longitudinal experience SG.......................................................................................... 35
Public health SG3: Small group project presentations ............................................................... 35
Dr. Slapcoff – Physician apprenticeship ...................................................................................... 36
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Whole course required readings
Andermann A. Chapter 2: Strategies for Improving Health. In: Andermann A. Evidence for Health:
From Patient Choice to Global Policy. Cambridge: Cambridge University Press, 2013, pp. 5-23.
http://mcgill.eblib.com/patron/FullRecord.aspx?p=1099965
“Health is a complex concept that can be examined and defined in many different ways. A widely used
definition is inscribed in the 1948 constitution of the World Health Organization (WHO), which considers
health to be “a state of complete physical, mental and social well-being and not merely the absence of
disease or infirmity.” This definition moves away from a strictly biomedical model of health that focuses
only on the disease or disability. Instead, the WHO definition adopts a wider bio-psycho-social model to
better integrate the importance of the psychological and social dimensions of health. One might go even
further and include a spiritual dimension of health. According to the Canadian Royal Commission on
Aboriginal Peoples, many indigenous communities consider health to be “a state of balance and
harmony involving body, mind, emotions and spirit. It links each person to family, community and the
earth in a circle of dependence and interdependence, described by some in the language of the
Medicine Wheel.” Health is therefore a holistic and multidimensional concept that must be explored
from different angles and perspectives to be fully understood.”
Rose G. Sick individuals and sick populations. Int J Epidemiol 1985; 14: 32-38.
http://ije.oxfordjournals.org/cgi/reprint/14/1/32.pdf
“In teaching epidemiology to medical students, I have often encouraged them to consider a question
which I first heard enunciated by Roy Acheson: 'Why did this patient get this disease at this time?'. It is
an excellent starting-point, because students and doctors feel a natural concern for the problems of the
individual. Indeed, the central ethos of medicine is seen as an acceptance of responsibility for sick
individuals. It is an integral part of good doctoring to ask not only, 'What is the diagnosis, and what is the
treatment?' but also, 'Why did this happen, and could it have been prevented?'. Such thinking shapes
the approach to nearly all clinical and laboratory research into the causes and mechanisms of illness.
Hypertension research, for example, is almost wholly preoccupied with the characteristics which
distinguish individuals at the hypertensive and normotensive ends of the blood pressure distribution.
Research into diabetes looks for genetic, nutritional and metabolic reasons to explain why some people
get diabetes and others do not. The constant aim in such work is to answer Acheson's question, 'Why
did this patient get this disease at this time?'.”
Chapter 8: Illness Prevention and Health Promotion in: AFMC Primer on Population Health. Ottawa:
Association of Faculties of Medicine of Canada, 2012, pages 1-10. http://phprimer.afmc.ca/Part3-
PracticeImprovingHealth/Chapter8IllnessPreventionAndHealthPromotion
PDF of primer in English

https://www.afmc.ca/sites/default/files/documents/en/Medical-Education/Public-Health/AFMC-
Primer-on-Population-Health-2013-08-14.pdf
PDF of primer in French
https://www.afmc.ca/pdf/AFMC-Primer-on-Population-Health-2013-07-24_Fr.pdf
“There are two main overlapping approaches to maintaining and improving health: the first is to identify
individuals at high risk and intervene to reduce their risk, and the second is to reduce the average risk
level for the whole population. Intervening with individuals at high risk is generally the domain of clinical
medicine, although public health authorities coordinate certain clinically implemented programmes in
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order to achieve population health objectives. For example, in Canada, the breast cancer screening
programme and the childhood vaccination programme are undertaken in individual encounters, but
have population level objectives. Other individual interventions, such as hypertension and diabetes
screening and treatment, or counselling on tobacco and alcohol, are generally not organized to the
extent that they have population level objectives. The second way of improving health is to intervene at
the population level; sometimes this is without the consent or even knowledge of people in the
population. An example of a population level intervention is the addition of certain nutrients to foods to
reduce disease. For instance, iodine can be added to salt to reduce goitre, vitamin D can be added to
milk to replace what is lost in the skimming process, B vitamins are added to flour and bread to replace
the vitamins removed with the bran. These population-wide interventions work by shifting the entire
distribution of exposure to reduce the overall level of risk in the population. Although some individuals
retain a risk higher than the population mean, the overall burden of disease is reduced. Population-wide
interventions also target health determinants in an attempt to improve overall health, rather than to
prevent specific diseases. For instance, if income redistribution policies succeed in reducing poverty,
they will improve health and reduce the burden of all diseases associated with poverty. Improving built
environments can address a number of health determinants and risk factors at once. For instance,
neighbourhoods that offer pedestrians safe walkways and services within walking distance encourage
active transport and, as a result, address risk factors for the metabolic syndrome and arthritis.
Adequately lit buildings reduce the risk of accidents. These broad kinds of interventions are difficult to
bring about because they require collaboration across a number of sectors in society, each one of which
has different roles and objectives.”
Ottawa Charter for Health Promotion. Geneva: World Health Organization, 1986, pages 1-5.
http://www.phac-aspc.gc.ca/ph-sp/docs/charter-chartre/pdf/charter.pdf
“Health promotion goes beyond health care. It puts health on the agenda of policy makers in all sectors
and at all levels, directing them to be aware of the health consequences of their decisions and to accept
their responsibilities for health. Health promotion policy combines diverse but complementary
approaches including legislation, fiscal measures, taxation and organizational change. It is coordinated
action that leads to health, income and social policies that foster greater equity. Joint action contributes
to ensuring safer and healthier goods and services, healthier public services, and cleaner, more
enjoyable environments. Health promotion policy requires the identification of obstacles to the
adoption of healthy public policies in non-health sectors, and ways of removing them. The aim must be
to make the healthier choice the easier choice for policy makers as well.”
AFMC Primer, Chapter 12: The organization of health services in Canada http://phprimer.afmc.ca/Part3-
PracticeImprovingHealth/Chapter12TheOrganizationOfHealthServicesInCanada
“Health care systems are complex organisations comprising regulatory, funding, and service provision
bodies that provide access to health care in accordance with societal goals and values. The metaphor of
a house (see Figure 12.1) can be useful in describing health care systems. The roof corresponds to the
societal goals and values that shelter service provision, which is founded on legislation and regulations
that control the relationships among providers (the rooms of the house), funding agencies (the power
source) and citizens. Regulations also control who can provide care (back door) and who can access it
(main door). Note that the model can be applied to the country as a whole or to smaller regions. It can
also be applied to specific programmes, such as cancer or HIV/AIDS care.”
Maioni A. Chapter 2: Portrait of Health Care in Canada. In: Maioni A. Health Care in Canada. Oxford:
Oxford University Press, 2014. pp. 31-46. [PDF available in MyCourses]
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“Health care organization and delivery in Canada is far from a single “system.” Instead, it is best
envisioned as a mosaic, mixture, or medley of a number of health care systems across the country, with
each province and territory responsible for the organization and financing of health care services for its
residents. Indeed, in many ways, health care represents the extensive decentralization that exists in the
mix of Canadian social policies. Unlike in other federal polities—such as Germany or Australia—health
care in Canada is not a constitutionally shared jurisdiction since it remains in the purview of the
provinces. Moreover, the central government does not retain a hands-on role in administration or
funding decisions. In fact, even the US federal government has a more active role in health care than its
Canadian counterpart, through a direct responsibility for the Medicare program.”
The World Health Report 2008: Primary Health Care – Now More than Ever. Geneva: World Health
Organization, 2008, pages 1-14. http://www.who.int/whr/2008/08_overview_en.pdf
“On the whole, people are healthier, wealthier and live longer today than 30 years ago. If children were
still dying at 1978 rates, there would have been 16.2 million deaths globally in 2006. In fact, there were
only 9.5 million such deaths . This difference of 6.7 million is equivalent to 18 329 children’s lives being
saved every day. The once revolutionary notion of essential drugs has become commonplace. There
have been significant improvements in access to water, sanitation and antenatal care. This shows that
progress is possible. It can also be accelerated. There have never been more resources available for
health than now. The global health economy is growing faster than gross domestic product (GDP),
having increased its share from 8% to 8.6% of the world’s GDP between 2000 and 2005. In absolute
terms, adjusted for inflation, this represents a 35% growth in the world’s expenditure on health over a
five-year period. Knowledge and understanding of health are growing rapidly. The accelerated
technological revolution is multiplying the potential for improving health and transforming health
literacy in a better-educated and modernizing global society. A global stewardship is emerging: from
intensified exchanges between countries, often in recognition of shared threats, challenges or
opportunities; from growing solidarity; and from the global commitment to eliminate poverty
exemplified in the Millennium Development Goals (MDGs). However, there are other trends that must
not be ignored. First, the substantial progress in health over recent decades has been deeply unequal,
with convergence towards improved health in a large part of the world, but at the same time, with a
considerable number of countries increasingly lagging behind or losing ground. Furthermore, there is
now ample documentation – not available 30 years ago – of considerable and often growing health
inequalities within countries.”
Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health.
Geneva: World Health Organization, 2008, pages 1-7.
http://whqlibdoc.who.int/publications/2008/9789241563703_eng_annex.pdf
“In order to address health inequities, and inequitable conditions of daily living, it is necessary to
address inequities – such as those between men and women – in the way society is organized. This
requires a strong public sector that is committed, capable, and adequately financed. To achieve that
requires more than strengthened government – it requires strengthened governance: legitimacy, space
and support for civil society, for an accountable private sector, and for people across society to agree
public interests and reinvest in the value of collective action. In a globalized world, the need for
governance dedicated to equity applies equally from the community level to global institutions.”
Hertzman C, Siddiqui A. Can communities succeed when states fail them? A case study of early human
development and social resilience in a neoliberal era. In: Hall P, Lamont M (Eds.), Social resilience in the
neoliberal era. Cambridge: Cambridge University Press, 2013, pp. 293-
318. http://proxy3.library.mcgill.ca/login?url=http://dx.doi.org/10.1017/CBO9781139542425.017
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"Canada's having the weakest public funding and provision for ECD in the wealthy world generally trumped
local community efforts to reduce developmental vulnerability in the earliest years of life. In most places
in British Columbia, the state of early human development measurably declined despite a wide range of
community initiatives to support it. Even though some exceptional communities managed to buck the
trends, it has proven especially hard to do so in the absence of adequate ongoing support from senior
governments. On the plane of economic and social policy, the case study provides an illustration of how
shifts in public policy in line with the market ideologies of the neoliberal era led to families bearing a
greater burden for coping with the life risks that pose serious challenges to their children's development
and wellbeing. It turns out that it is much harder to secure ECD when basic levels of material inequality are
higher."
Mullan F, Epstein L. Community-oriented primary care: new relevance in a changing world. Am J Public
Health 2002;92(11):1748-55. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221479/
“In 1940, two young South African physicians, Sidney and Emily Kark, went to live and work in an
impoverished, rural, Zulu tribal reserve called Pholela in the province of Natal. Their task was to set up a
system of health service delivery for a population that previously had received little benefit from
Western medicine. They were, perforce, the public health authority and the emergency room, the
sanitarian and the primary care doctor. Their responsibilities, as they embraced them, entailed not only
treating illness presented to them, but also taking a census of the local population and performing basic
epidemiologic surveys to establish a baseline of illness in the community as a starting point for planned
interventions. They carried out their surveillance work as well as their day-to-day clinical functions in
collaboration with the leadership of the tribal reserve. They trained local people as health workers who
carried out surveys, staffed the clinic, and gradually took on increasing responsibilities training others in
health work. In subsequent years, the Karks immigrated to Israel, establishing a teaching and research
program associated with the Hebrew University. They trained scores of clinicians, public health workers,
and epidemiologists from all over the world in the blended practice of public health and primary care
that they came to call community-oriented primary care (COPC). In the half century since the Kark’s
seminal work, COPC has played an important role in health care systems in many parts of the world.
Although COPC is not the predominant mode of practice in any country, its concepts have influenced
programs as varied and as important as the community health center movement in the United States,
the general practice movement in the United Kingdom, and recent reforms in the public health system
of the Republic of South Africa. COPC has provided a steady, provocative, and positive influence on
global health services delivery. The strength of the COPC idea over the years has been that it appeals to
both practicality and principle. Practicality argues for coordination between public health strategies and
primary care delivery despite the fact that most health care systems around the world have developed
without collaboration between these 2 vital and complementary forces.”
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Week 1 - Lectures
Dr. Andermann – Public health theme (improving health)

Health and its determinants
At the end of this lecture, students will be able to:
 Understand health as a multidimensional concept

 Discuss the growing problem of health inequities within and between populations
 Distinguish between risk factors and upstream determinants that influence health status
 Recognize that the health care system is only one of many determinants of health
 List the 2 main goals of the population health approach
 Appreciate how the health of individuals and populations are interconnected
Suggested readings:
 Chapter 1: Concepts of Health and Illness in: AFMC Primer on Population Health. Ottawa:
Association of Faculties of Medicine of Canada, 2012, pages 1-5. http://phprimer.afmc.ca/Part1-
TheoryThinkingAboutHealth/Chapter1ConceptsOfHealthAndIllness
 Chapter 2: Determinants of Health and Health Inequities in: AFMC Primer on Population Health.
Ottawa: Association of Faculties of Medicine of Canada, 2012, pages 1-5.
http://phprimer.afmc.ca/Part1-
TheoryThinkingAboutHealth/Chapter2DeterminantsOfHealthAndHealthInequities
 Chapter 2: Strategies for Improving Health in: Andermann A. Evidence for Health: From Patient
Choice to Global Policy. Cambridge: Cambridge University Press, 2013, pages 5-23.
 Constitution of the World Health Organization. Geneva: World Health Organization, 2002
(amendment to the original 1946 document), pages 1-4.
http://www.who.int/governance/eb/who_constitution_en.pdf
Dr. Boillat – Clinical method theme (history-taking)

Introduction to Clinical Method and Fundamentals of history taking I
 List the fundamental questions that patients have when they perceive a health problem
 List the fundamental tasks of the clinician (physician or dentist) in the face of the patients’
fundamental questions
 Define the term: ‘clinical method’
 Discuss the association between a clinical method and the perceived mandate of medicine (i.e.
goals of clinical medicine)
 Describe the evolution in clinical method based on developments in the French school occurring
in the late 18th and early 19th century; developments occurring in the early 20th century in
Canada and the U.S. and; more recent developments related to ‘patient-centeredness’
 List the specific elements of McGill’s clinical method (i.e. clinical observation, attentive listening,
history taking & communication skills, narrative competence, physical examination, description
& documentation, alliance building, clinical thinking, reflection)
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 Describe the process of a medical interview
 Describe the components of the Calgary-Cambridge Communication Skills Framework
 Identify effective communication strategies while observing a patient interview
 Discuss the patient’s perspective in the medical interview
 Review the evidence that links effective communication and positive health outcomes
Suggested readings:
 Chapter 1 in: Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients. 2nd Edition,
Radcliffe Publishing, 2005, pages 7-34.
Dr. Ragsdale – Basic science theme (molecular biology)

The molecular basis of life
 Understand the historical basis and modern rationale for instruction in basic scientific concepts
in the medical school curriculum.
 Identify the molecular building blocks of life.
 Describe the structure and function of the major biological macromolecules.
Suggested readings:
 Key concepts for review, in particular: 1) Basics of the cell, 2) DNA and the central tenets of
molecular biology, 3) Proteins, 4) Genetics in: http://www.mcgill.ca/ugme/links/summer-prep-
medical-school/key-concepts
 Zien A. A Primer on Molecular Biology pages 1-19 at:
http://mitpress.mit.edu/sites/default/files/titles/content/9780262195096_sch_0001.pdf
Dr. McKee – Basic science theme (histology)

Cell structure and function
 Understand basic cell structure and organelle membrane systems.
Suggested readings:
 Gartner L, Hiatt J. Colour Textbook of Histology. 6th edition. Lippincott Williams and Wilkins,
2014. Main Section of Chapter 1: The Cell. Pages 2-15.
Dr. McKee – Basic science theme (histology)

Hierarchical organization of cells into tissues
 Understand how cells organized hierarchically to form tissue layers.
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 Understand relationships at the interface between epithelia and connective tissue.
Suggested readings:
 Gartner L, Hiatt J. Colour Textbook of Histology. 6th edition. Lippincott Williams and Wilkins,
2014. Main Section of Chapter 2: Epithelium. Pages 34-43 and Main Section of Chapter 3:
Connective tissue. Pages 58-67.
Dr. Michel – Basic science theme (pathology)

Health lost: disease
 Define “disease”, and related terms (condition, disorder, illness…).

 List and explain the broad overall characteristics of diseases (etiology, pathogenesis…, to signs
and symptoms and therapy…).
 Define “pathology” and explain the role of the pathologist in diagnosis and treatment of disease.
Suggested readings:
 No required readings
Dr. Hebert – Basic science theme (pharmacology)

The use of medications for treatment and prevention, and issues of non-compliance
 Examine the use of drugs by physicians to treat disease from scientific, clinical and patient
perspectives. Here we will focus on the interaction between caregiver and patient with respect
to prescribed medicine
Suggested readings:
 Asche, C. et al. Clin. Therapeutics 2011; 33:74-109

http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1016/j.clinthera.2011.01.019
Dr. Chaudhury & McGill librarian – Evidence-based medicine theme

The EBM process step 1: Asking a focused question
 Describe the five stages of the EBM process

 Differentiate background from foreground questions
 Describe the components of a PICO question
 Categorize PICO questions and identify the best studies to answer each question type
Suggested readings:
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 Guyatt G, Meade M, Agoritsas T, Richardson W, Jaeschke R (2014). Chapter 4. What Is the
Question?. In Guyatt G, Rennie D, Meade M.O., Cook D.J. (Eds), Users' Guides to the Medical
Literature. http://proxy.library.mcgill.ca/login?url=http://jamaevidence.mhmedical.com/ (Tip:
Click on Users' Guides to the Medical Literature and then click on Show Chapters)
If you have no prior knowledge about research methodology and design, make sure to read the
following articles:
 Levin, KA. "Study design I." Evidence-based dentistry 2005; 6.3: 78-79.
http://proxy.library.mcgill.ca/login?url=http://www.nature.com/ebd/journal/v6/n3/full/640035
5a.html
 Levin, KA. "Study design III: Cross-sectional studies." Evidence-based dentistry 2006; 7.1: 24-25.
5a.html
 Levin, KA. "Study design IV: Cohort studies." Evidence-based dentistry 2006; 7.2: 51-52.
http://proxy.library.mcgill.ca/login?url=http://www.nature.com/ebd/journal/v7/n2/abs/640040
7a.html
 Levin, KA. "Study design V. Case–control studies." Evidence-based dentistry 2006; 7.3: 83-84.
6a.html
 Levin, KA. "Study design VI-Ecological studies." Evidence-based dentistry 2006; 7.4: 108.
4a.html
Dr. Klein – Public health theme (epidemiology)

Measuring health and disease
 Understand how disease is measured and tracked

 Recognize the basic types of Epidemiologic studies
 Recognize primary health outcomes (“the five D’s”)
 Calculate the basic measures of the frequency of disease in populations (e.g. prevalence,
incidence, attack rates etc.)
 Appreciate the epidemiology of global health problems and how causes of disease are
frequently complex and intertwined with social, economic and physical environments.
Suggested readings:
 Chapters 1 & 2 in: Fletcher RH and Fletcher SW. Clinical Epidemiology: The Essentials. 5th
ed. Lippincott, Williams & Wilkins, 2014.
Dr. Saylor – Public health theme (Indigenous health)

Addressing the underlying social determinants of Indigenous health

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 Explain who is considered an Indigenous person
 Outline the history that plays a role in the health of Indigenous peoples'
 Identify common health issues affecting Indigenous peoples
 Understand the social determinants that affect Indigenous peoples' health
Suggested readings:
 Improving the Health of Canadians. Canadian Institute of Health Information, 2004. Excerpt
from Chapter 4: Aboriginal Peoples' Health. Pages 73-89.
https://secure.cihi.ca/free_products/IHC2004rev_e.pdf
 Inuit Stistical Profile 2008. Inuit Tapiriit Kanatami. Pages 1-11
https://www.itk.ca/sites/default/files/InuitStatisticalProfile2008_0.pdf
 2011 National Household Survey: Aboriginal Peoples in Canada: First Nations People, Metis and
Inuit. Pages 1-3. http://www.statcan.gc.ca/daily-quotidien/130508/dq130508a-eng.pdf
Week 1 - Afternoons
Clinical exposure
Longitudinal Family Medicine Experience
At the end of this small group / afternoon activity, students will be able to:
 Recognize that the family physician plays a pivotal role in the medical system; the family
physician's office often represents the patient's point of entry into the medical system.
 Realize that illness often presents in an undifferentiated fashion.
 Appreciate the challenges and rewards of continuous comprehensive care.
Required readings:
 See LFME manual
Public health SG1

Aboriginal health and chronic disease prevention
 Identify the multiple determinants which influence health in Aboriginal populations living in
Canada, including poverty, housing, as well as the impact of colonial policies on health inequities
observed in these populations today;
 Understand the concept of cultural safety and how it applies to interventions aimed at
improving and promoting health in Aboriginal populations today.
Required readings:
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 Allan B, Smylie J. First Peoples, second class treatment: The role of racism in the health and well-
being of Indigenous peoples in Canada. Toronto, ON: The Wellesley Institute, 2015
http://www.wellesleyinstitute.com/publications/first-peoples-second-class-treatment/ (Just the
executive summary - about 20 pages)
Histology Lab 1
Digital Histology and the study of cells
 Learn how to handle and observe glass histology slides with a light microscope interfaced to a
computer workstation.
 Learn how to access and search online histology resources.
Required readings:
 Mescher A. Junqueira's Basic Histology: Text and Atlas. 13th edition, 2013. Pages 1-17.
http://mcgill.worldcat.org/oclc/854567882
Student wellness, diversity and careers SG
Dr. Gupta – Student wellness and career advising theme

How to excel in medical school
 Mitigate the anxiety associated with entering a professional medical degree with large amounts
of material, little time and high stakes evaluation
 Increase visibility of resources available throughout medical school
Dr. Razack – Equity and diversity theme

The rewards of caring for a diverse population
 Consider him/herself as a person with diverse identities that he/she may bring to clinical
encounter.
 Identify links between care that attends to patients’ diversities and their health status and
experience of illness.
 Define culture, diversity, oppression, marginalization, discrimination, micro-aggression, and
privilege.
Dr. Tellier – Student wellness and career advising theme

Looking after your own health and managing stress during medical school
 Be aware of the common issues that can affect student wellness

 List methods to manage health issues that may arise during their studies and professional lives.
Ms. Lefebvre – Student wellness and career advising theme
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Understanding yourself: the first step to choosing your future career
 By the end of this session, students should be familiar with the career planning resources
available at McGill, and should appreciate that “understanding yourself” is the most important
first step in making informed career decisions.
Dr. Dalton – Student wellness and career advising theme

Family Medicine careers
 The session will provide an overview about what makes Family Medicine a distinct discipline.
We will review career opportunities within Family Medicine, including special interests, focused
practices, and the "medical home". We will also address concerns about obstacles to starting
out as a Family Physician in Quebec.
Dr. Richer – Student wellness and career advising theme

Public health careers
 The session will introduce students to the field of Public Health and Preventive Medicine. By
definition, it aims to meet the needs of the community and foster the health of populations. We
will review some of the key functions provided by physicians in this medical specialty and
“typical” careers in the field will be presented highlighting the importance of leadership and
advocacy in having a population-based approach to health often leading to important roles in
industry, academia and government.
Dr. Doucet – Student wellness and career advising theme

Global health careers
 This session will introduce students to opportunities for getting involved in global health during
medical school and beyond in their future careers, whether as global health researchers,
volunteers for non-governmental organizations (e.g. Medecins sans Frontieres, Medecins du
Monde, etc.) or through other channels.
Required readings:
 Ludwig D, Kabat-Zinn J. Mindfulness in medicine. JAMA 2008; 300(11):1350-2.

http://jama.jamanetwork.com/article.aspx?articleid=182551
 Hölzel B, Carmody J, Vangel M, Congleton C, Yerramsetti S, Gard T, Lazar S. Mindfulness practice
leads to increases in regional brain gray matter density. Psychiatry Res 2011; 191(1):36-43.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004979/
 No required readings for Dr Tellier, Dr Dalton
Week 2 - Lectures

A continuum of strategies for improving health

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 Describe the continuum of strategies for improving the health of individuals and populations
 Distinguish between primary, secondary and tertiary prevention
 List the 5 action areas of the Ottawa Charter for Health Promotion
 Explain the concepts of intersectoral action, health in all policies and coalition building
 Describe the core functions of public health including population health assessment,
surveillance, protection, prevention and promotion
 Understand the steps involved in health planning
 Discuss the role of research evidence for improving health
Suggested readings:
 Chapter 8: Illness Prevention and Health Promotion in: AFMC Primer on Population Health.
Ottawa: Association of Faculties of Medicine of Canada, 2012, pages 1-10.
PracticeImprovingHealth/Chapter8IllnessPreventionAndHealthPromotion
 The Population Health Template Working Tool. Ottawa: Public Health Agency of Canada, 2001,
pages 1-6. http://action.web.ca/home/narcc/attach/Population%20Health%20Approach%20-
%20template%20working%20tool.pdf
 Ottawa Charter for Health Promotion. Geneva: World Health Organization, 1986, pages 1-5.
http://www.phac-aspc.gc.ca/ph-sp/docs/charter-chartre/pdf/charter.pdf
 Rose G. Sick individuals and sick populations. Int J Epidemiol 1985; 14: 32-38.
http://ije.oxfordjournals.org/cgi/reprint/14/1/32.pdf
Dr. Dawson – Clinical method theme (history taking)

Fundamentals of history-taking II
 Describe the content of the medical interview

 Acquire the vocabulary to describe symptoms and their chronology
 Identify the reason(s) for visit and past medical history
 Describe the components of the History of Present Illness
 Conduct a functional enquiry of the affected system
Suggested readings:
 Chapter 2 in: Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients. 2nd Edition,
Radcliffe Publishing, 2005, pages 35-55.

From molecules to systems
 Explain the differences between cells, tissues, organs and organ systems.
 Describe how the organ systems of the body work together to maintain homeostasis.
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Suggested readings:
 Key concepts for review, in particular: 5) Cell division, 6) Cellular signalling, 7) Energy
metabolism, 8) Developmental biology in: http://www.mcgill.ca/ugme/links/summer-prep-
medical-school/key-concepts
 Molecular biology primer pages 57-78 at:
http://web.stanford.edu/class/cs173/papers/JPch3.pdf
 Kitano H. Systems biology: a brief overview. Science 2002; 295(5560):1662-4.
http://theory.bio.uu.nl/BPA/pdf/Obligatory_reading/Kitano_s02.pdf
Dr. Blumenkrantz – Basic science theme (pathology)

Cell injury, death and adaptation
 List the main causes of cell injury and the exogenous factors (e.g. lifestyle, environment) that
lead to increased risk of cell injury and disease.
 Explain the molecular mechanisms of cell injury and death.
 Define and explain the differences between cell death due to apoptosis and due to necrosis;
briefly outline the molecular mechanisms of each.
 Describe the morphologic features associated with cell injury, apoptosis, and death.
 Explain adaptive mechanisms of cells including atrophy, hyperplasia, hypertrophy, and
metaplasia.
 Explain the causes, mechanisms and morphological features of accumulation of various
intracellular substances (e.g., lipids, iron…).
Suggested readings:
 Kumar V, Abbas A, Aster J. Robbins Basic Pathology. 9th edition. Philadelphia, PA: Elsevier
Saunders, 2013. Pages 1-26. http://mcgill.worldcat.org/oclc/796815759
Dr. Hebert – Basic sciences theme (pharmacology)

The science of how drugs work: pharmacodynamics and receptors
 To introduce the field of pharmacology more formally, reinforce the concept of a drug and
discuss what your body does to drugs and what they do to you.
 To discuss the relationship between dosage and biological response
Suggested readings:
 Katzung, B.G. Basic and Clinical Pharmacology, 12th edition, Chapter 2.

 Goodman and Gilman's The Pharmacological Basis of Therapeutics, 12th edition, Chapter 3.
Both available at: www.accessmedicine.com
Dr. Greenaway – Public health theme (immigrant and refugee health)

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Immigrant and refugee health
 Describe migration trends and the demographics of immigration to Canada

 Explain the "healthy immigrant effect"
 Describe the major health challenges that migrants face
 List the multiple factors influencing the health of new migrants
 Discuss approaches for improving immigrant and refugee health
Suggested readings:
 Pottie K, Greenaway C, Feightner J, et al. Evidence based clinical guidelines for immigrants and refugees.
CMAJ 2011; 183(12): E824-925, specifically, pages E824 to E830, E883 to E886, and E901 to E912.
http://www.cmaj.ca/content/183/12/E824

Sensitivity and specificity of diagnostic tests
 Understand how to evaluate new diagnostic test

 To be able to calculate and interpret the characteristics of diagnostic tests including the
sensitivity, specificity, PPV, NPV, likelihood ratios
 Understand the impact of prevalence on predictive values
 Apply likelihood ratios in clinical decision making
Suggested readings:
 Chapter 8 in: Fletcher RH and Fletcher SW. Clinical Epidemiology: The Essentials. 5th ed.
Lippincott, Williams & Wilkins, 2014.
Dr. Chaudhury & McGill librarian N. Torabi – Evidence-based medicine theme

The EBM process step 2: Acquiring and appraising the evidence
 Identify resources to find best evidence to answer clinical questions

 Identify the three guiding questions for critically appraising any study type: Are the results valid?
What are the results? How can I apply the results to patient care?
Suggested readings:
 Guyatt G, Jaeschke R, Meade M (2014). Chapter 6. Why Study Results Mislead: Bias and Random
Error. In Guyatt G, Rennie D, Meade M.O., Cook D.J. (Eds), Users' Guides to the Medical
Literature. http://proxy.library.mcgill.ca/login?url=http://jamaevidence.mhmedical.com/ (Tip:
Click on Users' Guides to the Medical Literature and then click on Show Chapters)
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 Levin, KA. "Study design II. Issues of chance, bias, confounding and contamination." Evidence-
based dentistry 6.4 (2005): 102-103.
6a.html
 Parfrey P, Ravani P. Chapter 1. Section 9. Hierarchy of Evidence. On Framing the Research
Question and Choosing the Appropriate Research Design. In Clinical Epidemiology: Practice and
Methods, 2015, pp 13-14. http://mcgill.worldcat.org/oclc/57251369
Dr. Moore – Basic sciences theme (anatomy)

The biology of stress: understanding the autonomic nervous system
 TBA
Suggested readings:
 TBA
Prof. Rees – Medicine and society theme

What is a body?
 Explain that our comprehension of the human body is time and space specific and by no means
universal.
 Give an example for how medical research (or changing medical conceptions of organs)
can alter what it means to have a body and be human.
 Explain the societal predicaments the clash of different cultural conceptions of bodies can
generate.
Suggested readings:
 Scheper-Hughes N, Lock M. The Mindful Body: A Prolegomenon to Future Work in Medical

Anthropology. Medical Anthropology Quarterly 1987; 1(1): 6-41.
http://links.jstor.org/sici?sici=0745-
5194%28198703%292%3A1%3A1%3C6%3ATMBAPT%3E2.0.CO%3B2-A
Dr. Kirmayer – Public health theme (immigrant and refugee health)

Cultural competency
 Understand the importance of addressing cultural diversity in health care

 Define current concepts of cultural competence and cultural safety
 List some of the benefits and limitations of different approaches to cultural competence
 Identify strategies and resources for promoting practitioner and organizational cultural
competence
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Suggested readings:
 Kirmayer L. Rethinking cultural competence. Transcultural Psychiatry 2012; 49(2):149-164.

http://tps.sagepub.com/content/49/2/149.long
Dr. Masse – Public health theme (public health)

The Director of Public Health, MADOs & the Quebec Public Health Law
 Understand core aspects of the Québec Public Health Legislation (including: surveillance, ethics
committee, health promotion and health impact assessment, health protection and outbreak
investigation and emergency measures).
 Discuss the roles and responsibilities of Directors of Public Health through different examples
 Understand Mandatory Reportable Diseases and related surveillance and investigations
Suggested readings:
 Public Health Act. Quebec: Government of Quebec, 2014.

http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=2&file=/S
_2_2/S2_2_A.html
 Regulation under the Public Health Act. Quebec: Government of Quebec, 2014.
http://www2.publicationsduquebec.gouv.qc.ca/dynamicSearch/telecharge.php?type=3&file=/S
_2_2/S2_2R1_A.HTM
Dr. Weinstock – Public health theme (public health ethics)

Individual rights and collective responsibilities
 Identify the primary ethical dilemmas raised by the practice of population health.
 Identify the primary areas of conflict between clinicians’ duty towards individual patients, and
their duties towards the population and/or wider community.
Suggested readings:
 Roberts M, Reich M. Ethical analysis in public health. The Lancet 2002; 359(9311): 1055-1059
http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1016/S0140-6736(02)08097-2
 Fairchild A, Merritt Johns D. Beyond Bioethics: Reckoning With the Public Health Paradigm.
American Journal of Public Health 2012; 102(8): 1447-1450.
http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.2105/AJPH.2012.300661 .
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Week 2 - Afternoons
Clinical exposure
 Describe the common clinical presentations in a family medicine setting

 Describe the essential components of clinical preventive practices and health promotion
 Describe the importance of social context for individual patients and the impact of social
determinants on the health of individuals and the community
Required readings:
 See LFME manual
Histology Lab 2
Epithelial and connective tissue
 View how cells are organized hierarchically to form tissue layers.

 View examples of epithelia and connective tissues, and understand their relationships.
Required readings:
 Clermont Y, Lalli M, Bencsath-Makkai Z. Light Microscopic Histology Atlas Online. Epithelia

Chapter, Pages 1-24 http://audilab.bmed.mcgill.ca/HA/html/epi_introduction_E.html
 Clermont Y, Lalli M, Bencsath-Makkai Z. Light Microscopic Histology Atlas Online. Connective
Tissue Chapter, Pages 1-19 http://audilab.bmed.mcgill.ca/HA/html/ct_introduction_E.html
Pathology SG1
Cell injury, death and adaptation
 Understand the risk factors contributing to ischemic heart disease, mechanisms of myocardial
injury.
 Recognize the histological features of myocardial infarction at different time points post-
infarction and relate them to complications of myocardial infarcts.
 Understand mechanisms of alcohol-induced liver disease.
 Recognize pathologic features of alcoholic liver disease (evolution of disease, reversible and
irreversible cell injury).
Required readings:
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Saunders, 2013. Pages 374-381 (ischemic heart disease), 621-625 (steatosis and liver disease).
Clinical method SG1

History-taking through role-plays
 Describe the content of the medical interview

 Acquire the vocabulary to describe symptoms and their chronology
 Identify the reason(s) for visit and past medical history
 Describe the components of the History of Present Illness
 Conduct a functional enquiry of the affected system
Required readings:
 Excerpt from Chapter 3 in: Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients.
2nd Edition, Radcliffe Publishing, 2005, pages 57-85.
Epidemiology SG1
Interpreting diagnostic tests
 Understand how to evaluate new diagnostic test

 To be able to calculate and interpret the characteristics of diagnostic tests including the
sensitivity, specificity, PPV, NPV, likelihood ratios
 Understand the impact of prevalence on predictive values
 Apply likelihood ratios in clinical decision making
Required readings:
 Boehme et al. Rapid Molecular Detection of Tuberculosis and Rifampin Resistance. N Engl J Med
2010; 363:1000-15 (PLEASE READ IN ADVANCE AND WORK THROUGH PROBLEMS)
 Cocharane Review: Steingart KR, Sohn H, Schiller I, Kloda LA, Boehme CC, Pai M, Dendukuri N.
Xpert® MTB/RIF assay for pulmonary tuberculosis and rifampicin resistance in adults
(OPTIONAL)
EBM SG1
PICO question formulation
 Develop a well-formed PICO question from a clinical scenario
Required readings:
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 PICO Concept Map (posted on D2L)
 Greenhalgh T. Chapter 3: Getting your bearings (what is this paper about?) In: How to read a
paper: The basics of evidence-based medicine. John Wiley & Sons, 2014.
Week 3 - Lectures

What can health workers do to address the social causes of poor health?
 Describe the different kinds of actions that frontline health workers can use in the clinic and in
the community to address the social causes underlying poor health
 Discuss the facilitators and barriers to frontline health workers becoming more engaged in
addressing health inequities
 Appreciate that there is a long history of community-oriented primary care (COPC) that is just as
relevant today as it was when it was conceived decades ago
 Recognize that addressing health inequities will require new ways of working and a “systems
change” in the way that we interact with patients and think about health
Suggested readings:
 Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of
Health. Geneva: World Health Organization, 2008, pages 1-7.
http://whqlibdoc.who.int/publications/2008/9789241563703_eng_annex.pdf
 The World Health Report 2008: Primary Health Care – Now More than Ever. Geneva: World
Health Organization, 2008, pages 1-14. http://www.who.int/whr/2008/08_overview_en.pdf
 Mullan F, Epstein L. Community-oriented primary care: new relevance in a changing world. Am J
Public Health 2002;92(11):1748-55. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3221479/
Dr. Boudreau – Clinical method theme

Observation skills: Gateway to the physical exam
 Describe the evolution in clinical method based on developments in the French school occurring
in the late 18th and early 19th century; developments occurring in the early 20th century in
Canada and the U.S. and; more recent developments related to ‘patient-centredness’
 List the specific elements of McGill’s clinical method (i.e. clinical observation, attentive listening,
history taking & communication skills, narrative competence, physical examination, description
& documentation, alliance building, clinical thinking, reflection)
 Define the term: ‘observation’
 List the main features of the physical examination
 Describe how observation overlaps with ‘inspection’ in the physical examination
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 Describe a set of principles in clinical observation
 Describe and demonstrate the application of a hierarchy in clinical observation (based on
Berger’s hierarchy) with an emphasis on apparent state of health
 Discuss two ‘never never do’s’ in clinical observation
 Describe the standard protocol for performing a physical examination
 List the common ‘sensory assists’ used in the current physical examination (i.e. stethoscope,
sphygmomanometer, oxymeter, reflex hammer, bedside ultrasound, otoscope and
ophthalmoscope)
 Define the traditional ‘vital signs’
Suggested readings:
 Excerpts from Chapter 1 and Chapter 4 in: Bickley L, Szilagyi P, Bates B. Bates Guide to Physical
Examination and History Taking. 10th Edition. Philadelphia: Lippincott Williams & Wilkins, 2009,
pages 13-23 and pages 114-121.
 Bates’ Visual Guide to Physical Examination
http://mediasite.campus.mcgill.ca/bates/disc1/index.htm
http://mediasite.campus.mcgill.ca/bates/disc2/index.htm

Medicine and the scientific world view
 Discuss the scientific method and how it relates to medicine.
Suggested readings:
 Engel GL. The need for a new medical model: a challenge for biomedicine. Science 1977;
196(4286):129-36. http://public-
health.medunigraz.at/archiv/artikel/Artikel%201977/1977_Engel_Biopsychosocial%20model.pd
f
 Ayala FJ. On the Scientific Method, Its Practice and Pitfalls History and Philosophy of the Life
Sciences 1994; 16(2): 205-240
http://www.jstor.org/discover/10.2307/23331738?uid=2&uid=4&sid=21104415776807
Dr. Pelmus – Basic sciences theme (pathology)

Responses to cell injury: inflammation and repair I & II
 Categorize and define the different types of inflammation

 Explain the main molecular pathways involved in inflammation and wound healing
 Give some clinical examples of inflammatory diseases, and explain their pathogenesis using
information acquired in objectives 1 and 2.
Suggested readings:
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Saunders, 2013. Pages 29-73.
Dr. Ernst – Public health theme (epidemiology)

Principles of screening (a form of secondary prevention)
 Identify characteristics of a disease which makes it amenable to screening.

 Identify the qualities of a test which are needed to make it useful as a screening tool.
 Understand the major biases which complicate the interpretation of studies of screening results.
Suggested readings:
Dr. Scharf – Public health theme (health care quality)

Patient safety and health care quality
 Know what quality in healthcare means, and what quality is

 Appreciate how we can objectively define and measure quality metrics in healthcare
 Understand a constructive way to address errors in healthcare
 See an example of a quality improvement project
 Recognize the importance of safe systems in healthcare
 Understand the role of leadership, organizational culture, and teamwork in quality improvement
Suggested readings:
 Baker G, Norton P, Flintoft V, et al. The Canadian Adverse Events Study: the incidence of adverse
events among hospital patients in Canada. CMAJ 2004; 170(11):1678-86.
http://www.cmaj.ca/content/170/11/1678.full.pdf+html
 Nolan T. System changes to improve patient safety. BMJ 2000;320(7237):771-3.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1117771/pdf/771.pdf
Prof. Maioni – Public health theme (health in all policies)

Organization, financing and access to health care in Canada
 Understand the major challenges facing health care systems, with an emphasis on cost, quality,
and access.
 Review methods of health care financing, delivery and organization
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 Discuss recent health policy initiatives and impact on health reform
Suggested readings:
 AFMC Primer, Chapter 12: The organization of health services in Canada

PracticeImprovingHealth/Chapter12TheOrganizationOfHealthServicesInCanada
Dr. Stock – Public health theme (occupational health)

Work as a determinant of health
 Describe what occupational health is and why it is important

 Appreciate that work exposures are important determinants of health
 Describe some aspects of the burden of illness associated with work
 Describe broad strategies for prevention of occupational disease and injury
 Understand how occupational health is integrated into public health in Quebec
Suggested readings:
 Sokas RK & Sprince NL. Occupational Health: Overview. International Encyclopedia Of Public
Health, 2008, Elsevier Inc. P.639-649
 Levy BS, Wegman DH, Baron SL, Sokas RK. (Ed.) Occupational and Environmental Health:
Recognizing and Preventing Disease and Injury. 6th Edition, Oxford University Press (Chapter 1),
2011
 Wegman DH. The potential impact of epidemiology on the prevention of occupational disease.
Am J Public Health 1992; 82:944-954
 Kraut A. Estimates of the Extent of Morbidity and Mortality due to Occupational Diseases in
Canada. Am J Indust Med 1994; 25: 267-278
 Vézina, M., E. Cloutier, S. Stock, K. Lippel, E. Fortin et al. (2011). Québec Survey on Working and
Employment Conditions and Occupational Health and Safety (EQCOTESST): Summary Report.
Dr. Farmer – Public health theme (health in all policies)

Improving the health of homeless people
 Understand who are the homeless in Canada

 Discuss improving health from a community perspective: Housing First presented as a cost-
effective community-based program that mitigates these inequities and emphasizes the roles of
doctors as community leaders and advocates.
 Describe strategies for working effectively with the homeless
Suggested readings:
 Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, Ciliska D, Kouyoumdjian F, & Hwang SW. (2011).

Effectiveness of interventions to improve the health and housing status of homeless people: a
25
rapid systematic review. BMC Public Health, 11, 638, pages 1-14.
http://www.biomedcentral.com/content/pdf/1471-2458-11-638.pdf
 Zlotnick C, Zerger S, Wolfe P. Health Care for the Homeless: What We Have Learned in the Past
30 Years and What's Next. Am J Public Health 2013; 103(Suppl 2):S199-205.
http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2013.301586
Dr. Laporta – Public health theme (global health)

Mental health from a global perspective
 Understand some terminology used in the global mental health literature (DALY; GBD; YLD;
treatment gap)
 Identify the impact of mental health problems worldwide
 Understand how human rights, social determinants of health, and non-psychiatric medical
disease outcomes interact with mental health
 Understand some solutions proposed by the WHO to improve mental health care.
 Understand the importance of access to mental health care and factors influencing this.
Suggested readings:
 WHO Comprehensive Mental Health Action Plan 2013-20

http://apps.who.int/iris/bitstream/10665/89966/1/9789241506021_eng.pdf?ua=1
 WHO-WONCA: Integrating Mental Health into Primary Care: A Global Perspective, 2008
http://www.who.int/mental_health/resources/mentalhealth_PHC_2008.pdf
 mhGAP Intervention Guide for mental, neurological and substance use disorders, 2010
http://whqlibdoc.who.int/publications/2010/9789241548069_eng.pdf?ua=1
 Iasc Guidelines on Mental Health and Psychosocial Support in Emergency Settings
http://www.google.ca/url?url=http://www.humanitarianinfo.org/iasc/downloadDoc.as
px%3FdocID%3D4445&rct=j&frm=1&q=&esrc=s&sa=U&ei=sfIbVZOnK8risASQlQI&ved=0
CBgQFjAA&usg=AFQjCNF9GN3YcG7qagEMrZJ2e5TE2CQUBQ
Dr. Andermann – Public health theme (clinical prevention)

Clinical guidelines for the prevention of cancer
 Understand the role of frontline health workers in the clinical prevention of cancer
 Explain the importance of developing pharmacological (e.g. metformin) and non-
pharmacological (e.g. smoking cessation) approaches for the primary prevention of cancer (i.e.
preventing cancer before it starts)
 Describe existing cancer screening initiatives in the province of Quebec, for instance, for the
prevention of breast cancer, cervical cancer and colorectal cancer (secondary prevention)
 Discuss the use chemoprophylaxis (e.g. tamoxifen, raloxifene) for the prevention of cancer
recurrence among those who have already been treated for cancer (tertiary prevention)
Suggested readings:
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 Vineis P, Wild CP. Global cancer patterns: causes and prevention. Lancet 2014; 383(9916):549-57.
 Hanahan D. Rethinking the war on cancer. Lancet 2014; 383(9916):558-63.
 Coleman MP. Cancer survival: global surveillance will stimulate health policy and improve
equity. Lancet 2014; 383(9916):564-73.
http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1038/clpt.2012.237
Week 3 - Afternoons
Clinical exposure
 Demonstrate history-taking and physical examination skills in a clinical setting

 Demonstrate basic clinical reasoning skills through exposure to undifferentiated problems
 Understand the principles of patient-centered care
 Appreciate the importance of continuity of care and the family physician’s commitment to the
patient throughout the life cycle
 Appreciate the family physician’s understanding of the community and ability to link with
available resources
Required readings:
 See LFME manual
Public health SG2

Determinants of health and addressing the social causes underlying poor health
 Understand what influences health and illness at both the individual and community levels
 Appreciate issues relating to diversity, social status and inequity through games / role play
 Discuss the many ways in which frontline health workers can become more engaged in
addressing the social factors that underlie poor health, to improve health and reduce inequities
Required readings:
 Andermann A. Addressing the social causes of poor health is integral to practising good
medicine. CMAJ 2011; 183(18): 2196. http://www.cmaj.ca/content/183/18/2196.full.pdf+html
 Bloch G. Poverty: A clinical tool for primary care in Ontario. Toronto: Ontario College of Family
Physicians and University of Toronto, 2012, pages 1-4. http://ocfp.on.ca/docs/default-source/poverty-
tool/poverty-a-clinical-tool-2013-(with-references).pdf?sfvrsn=0
27
 Bonin E, Brehove T, Carlson C, et al. Adapting Your Practice: General Recommendations for the Care of
Homeless Patients. Nashville: National Health Care for the Homeless Council, 2010, pages vii-x.
http://www.nhchc.org/wp-content/uploads/2011/09/GenRecsHomeless2010.pdf
 Chemiak D, Grant L, Mason R, et al. Intimate Partner Violence Consensus Statement. JOGC 2005; 157:
365-88, pages 365-367. http://www.sogc.org/guidelines/public/157E-CPG-April2005.pdf
 How doctors can close the gap: Tackling the social determinants of health through culture change,
advocacy and education. London: Royal College of Physicians, 2010, pages 1-14.
http://www.sduhealth.org.uk/documents/publications/1279291348_jQjW_how_doctors_can_close_t
he_gap.pdf
EBM SG2
Library searching workshop
 Select an appropriate source to search for evidence to best answer their PICO questions
 Utilize information sources effectively to find best available evidence for a given PICO question
Required readings:
 Review EBM lecture 1 and 2 notes

 Glover, Jan, and Lei Wang. Find it Fast: The Clinical Question [video] : http://cwml-
tutorials.blogspot.ca/2009/01/find-it-fast-evidence-based-practice_14.html
Pathology SG2
Responses to cell injury: inflammation and repair
 Case 1. Using a patient with acute appendicitis, e.g., the niece of patient 2, the 43 year old male
with chronic cough, outline in detail the events occurring in acute inflammation, the
pathophysiology, pathological findings, the ensuing clinical and laboratory effects and
complications of this disease.
 Case 2. Considering patient 2, the 43 year old male with chronic cough with tuberculosis, detail
the events occurring in chronic inflammation, particularly granulomatous, including the
pathophysiology, pathological findings, the ensuing clinical and laboratory effects and
complications of this disease.
 Case 3. Using patient 1 from week 1, the 51 year old woman with chest pain, explain the events
occurring in the healing process, pathophysiology, pathological findings and relate these to the
clinical picture and complications.
Required readings:
Saunders, 2013. Pages 600-601 (acute appendicitis), 493-499 (pulmonary tuberculosis - also
applicable to INDS 112).
28
Epidemiology SG2
Principles of screening
 Identify characteristics of a disease which makes it amenable to screening.

 Identify the qualities of a test which are needed to make it useful as a screening tool.
 Understand major issues which complicate the interpretation of studies of screening.
Required readings:
 Esserman L et al. Rethinking screening for breast cancer and prostate cancer. JAMA 2009; 302:
1685-1692.
Week 4 - Lectures

Measuring progress and making a difference
 Discuss how decisions at the individual, population and global levels can influence health
 Explain the concept of results-based management
 Understand the need for developing a “culture of evaluation”
 Describe different types of health indicators that can be used to measure progress
 Discuss various facilitators and barriers to making progress on improving health
Suggested readings:
 Introduction in: The Guide to Community Preventive Services: What Works to Promote Health?
Oxford: Oxford University Press, 2005, pages xxv-xxxv.
http://www.thecommunityguide.org/library/book/Front-Matter.pdf
 Altman D, Bland J. Absence of evidence is not evidence of absence. BMJ 1995; 311: 485
http://www.bmj.com/cgi/reprint/311/7003/485.pdf
 Newman T. The power of stories over statistics. BMJ 2003; 327:1424-7.
http://www.bmj.com/cgi/pdf_extract/327/7429/1424.pdf
 Andermann A. Evidence for Health: From Patient Choice to Global Policy. Cambridge: Cambridge
University Press, 2013, pages 146-147.
 Peters D, Adam T, Alonge O, Agyepong I, Tran N. Implementation research: what it is and how to
do it. BMJ 2013; 347:f6753, pages 1-7.
http://www.bmj.com/cgi/pmidlookup?view=long&pmid=24259324
Dr. Greenfield – Clinical method theme (alliance building)

Alliance building in clinical care
29
 Appreciate the dynamics of alliance building with an adolescent in crisis

 Appreciate the significance of parental participation in such a setting
 Consider the importance of non-verbal communication in such a setting.
Suggested readings:
 American Psychiatric Association: Practice Guideline for the Psychiatric Evaluation of Adults.
2nd ed. Am J Psychiatry. 2006; 163 (June Suppl).
http://www.guideline.gov/content.aspx?id=9317
 Bennett MJ. The Empathic Healer: An Endangered Species? San Diego: Academic Press; 2001.
 Cruz M, Pincus HA: Research on the influence that communication in psychiatric encounters has
on treatment. Psychiatr Serv. 2002; 53: 1253-65.
 Kashner TM, Rush AJ, Suris A, Biggs MM, Gajewski VL: Impact of structured clinical interview on
physicians’ practices in community mental health settings. Psychiatr Serv. 2003; 54:712-718.
 Sadock BJ, Sadock VA, Ruiz, P, Kaplan HI: Kaplan& Sadock’s Comprehensive Textbook of
Psychiatry. 9th ed. Philadelphia. Wolters Kluwer Health/Lippincott, Williams and Wilkins. 2009:
886-892.
Dr. Michel – Basic science theme (pathology)

Neoplasia: cell proliferation gone wild I
 Define and compare and contrast, and state the significance of the non-neoplastic growth such
as hamartoma and comparing them to hypertrophy, hyperplasia and metaplasia.
 Define and explain the terms: neoplasm/neoplasia, tumor, carcinoma, sarcoma, cancer,
differentiation, anaplasia, dysplasia, dedifferentiated, undifferentiated.
 Explain the basis for classification of neoplasms.
 Draw an algorithm for the generic approach to a patient presenting with a mass in any site.
 Generate the current general nomenclature of the classification scheme for neoplasms.
 List and discuss the general, macroscopic, light microscopic features of neoplasms, as well as
some of the functional, including endocrine, manifestations.
 Define, list, and compare and contrast features of benign and malignant neoplasms.
 List, define and describe the steps in the sequence of events in a carcinoma, e.g., carcinoma of
the uterine cervix from the etiology (generally HPV) to invasive carcinoma.
 Define angiogenesis, list its sequence of events and explain its importance in the growth of
neoplasms. Describe the pathogenesis and growth factors involved in angiogenesis.
 Describe the mechanisms and steps involved in invasion and metastasis of a neoplasm.
 Define, describe, and compare and contrast grading and staging of a malignant neoplasm and
their clinical significance.
 List and explain the steps in the diagnosis of a neoplasm, including the role of the pathologist.
 Define, describe and compare and contrast “prognostic” and “predictive” factors in malignant
neoplasms.
 Give a brief description of general therapeutic approaches to malignant neoplasms.
 List and briefly explain the clinical effects of neoplasms, particularly malignant ones.
30
Suggested readings:
Saunders, 2013. Pages 161-189 (remainder of chapter to page 214 will be assigned for INDS
112).
Dr Hebert – Basic sciences theme (pharmacology)

Targeting therapy and the risk-benefit window
 Understand that different levels of risk are associated with drug treatment depending on the
severity of the underlying disease. Here, we will look at the therapeutic window - the difference
between medicine and poison in the context of cancer treatment. We’ll start by exploring some
introductory notions of the relationship between drug dose and biological response - something
we’ll explore in more detail in INDS 112. We’ll also introduce you to the concept of
“personalized” medicine.
Suggested readings:
 Gonzales de Castro D, et al. Clin Pharmacol Ther 2013; 93:252-259

http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1038/clpt.2012.237
 Gasparini G, Longo R. Expert Opin Ther Targets 2012; Suppl 1:S7-S16
http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1517/14728222.2011.637921
 Ginsburg G, Willard H. Trans Res 2009; 154:277-287
http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1016/j.trsl.2009.09.005
Dr. Lapointe – Public health theme (elder health)

Aging and palliative care as a global health issue
 Explain the impact of demographic changes (aging) on the prevalence of life-threatening illness
and access to quality end-of-life care
 Identify key elements of the public health challenge of unrelieved pain in terminally ill patients
in both the developing and developed world.
 Describe fundamental measures (elaborated by WHO) for a successful public health approach to
the development of palliative care.
 Identify some of the benefits seen in various initiatives for the implementation of such a public
health approach.
 Identify some of the key barriers to the provision of quality end-of-life care in developing and
developed countries
 Explain some of the reasons for and implications of the international movement to establish
palliative care as a ‘human right’
Suggested readings:
31
 No required reading
Ms Fitzpatrick – Basic sciences theme (genetics)

Mendelian inheritance and genetic diseases
 Recognize the pedigree patterns associated with autosomal dominant, autosomal recessive, X-
linked, Y-linked and mitochondrial modes of inheritance.
 Use a pedigree and a known inheritance pattern to calculate probabilities of transmission of
particular single gene traits to members of the kindred.
 Explain how factors such as reduced penetrance, variable expressivity, genetic heterogeneity
(locus and allelic) and pleiotropy affect the phenotypic expression of a disease and the
observed pattern of inheritance.
Suggested readings:
 Turnpenny P and Ellard S, Eds. Emery’s Elements of Medical Genetics, 14th Ed. Elsevier, 2012.
Chapter 7 – Patterns of Inheritance, pages 109 – 127.
http://proxy.library.mcgill.ca/login?url=http://www.clinicalkey.com/dura/browse/bookChapter/
3-s2.0-C20090491281
Dr. Braverman – Basic sciences theme (genetics)

Non-Mendelian inheritance and the era of personalized medicine
 Explain the principle of multifactorial inheritance and how this differs from single gene
inheritance.
 Explain how the environment, gene-gene interactions and protective polymorphisms can
influence the expression of disease.
 Understand how genetic variation can predict response to medications.
 Explain the potential for genetics to be used in providing personalized health care with a focus
on assessment of disease risk and prevention.
 Describe the underlying genetic mechanisms of uniparental disomy, epigenetics and genomic
imprinting, and unstable repeat expansion and contraction. Explain how these phenomena
affect the phenotype and recurrence risk of genetic disorders.
Suggested readings:
 Turnpenny P and Ellard S, Eds. Emery’s Elements of Medical Genetics, 14th Ed. Elsevier, 2012.
Chapter 9 – Polygenic and Multifactorial Inheritance, pages 143 – 146 only.
Chapter 15 – Genetic Factors in Common Diseases, pages 233 – 235 only.
http://proxy.library.mcgill.ca/login?url=http://www.clinicalkey.com/dura/browse/bookChapter/
3-s2.0-C20090491281

32
Abnormality – or what happens if you order 20 tests
 Understand how criteria for abnormality are constructed and how this can impact clinical
decision making
 Describe and summarize different types of data
 Understand validity, reliability and range in relationship to the evaluation of measurements
 Understand variation and recognize different data distributions
 Describe the phenomenon of regression to the mean
Suggested readings:
Dr. Weinstock – Public health theme (public health ethics)

Resource allocation and distributive justice
 Review the main theories of distributive justice guiding different resource allocation paradigms.
 Apply different distributive frameworks to a case study involving distribution of influence
vaccine before and during a pandemic.
Suggested readings:
 Kotalik J. Preparing for an influenza pandemic: ethical issues. Bioethics 2005; 19: 422–431.
http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1111/j.1467-8519.2005.00453.x
 Emanuel E, Wertheimer A. Public health: Who Should Get Influenza Vaccine When Not All Can?
Science 2006; 312(5775): 854-855.
http://proxy.library.mcgill.ca/login?url=http://dx.doi.org/10.1126/science.1125347
Dr. Drager – Public health theme (global health)

Global health diplomacy
 Describe the global health policy environment within which global health diplomacy (GHD)
takes place
 Identify the main instruments and mechanisms of GHD
 Engage with colleagues and others in a dialogue on some of the key current and emerging issues
of GHD, the actors that engage in GHD and the fora where GHD takes place
Suggested readings:
33
 Labonté R. Health in All (Foreign) Policy: challenges in achieving coherence. Health Promot Int
2014; 29 Suppl 1: i48-58. http://heapro.oxfordjournals.org/content/29/suppl_1/i48.long
 Kickbusch I, Szabo M. A new governance space for health. Glob Health Action 2014; 7: 23507.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925805/
 Kickbusch I. Global health diplomacy: how foreign policy can influence health. BMJ 2011; 342:
d3154. http://www.bmj.com/content/342/bmj.d3154.long
Week 4 - Afternoons
Inter-professionalism (IP) SG
Working collaboratively for health
 Appreciate the importance of interprofessional practice during medical school, residency and
future practice.
 Define interprofessional education (IPE) and interprofessional practice (IPP).
 Appreciate and respect the roles of one’s own profession and of other healthcare professions.
 Integrate and value the patient as a partner in his medical care (patient-centered care).
 Know the components of highly effective teams and behaviors that facilitate teamwork.
Required readings:
 No required readings.
Advocacy SG
Leadership for improving health local to global
 Define and describe advocacy according to the CanMeds 2015 Health Advocate Role
 Identify several frameworks on how to effectively accomplish health advocacy
 Make contact with representatives of established health advocacy initiatives at McGill and beyond
Required readings:
 No required readings.
Clinical method SG2

History taking through role plays
 Practice interviewing skills through role plays

 Apply their knowledge of the components of the History of Present Illness and of the Calgary-
Cambridge Communication Skills Framework
34
 Review the symptoms of common clinical presentations (e.g. respiratory, cardiovascular,
gastrointestinal, genitourinary systems, musculoskeletal, neurological)
Required readings:
 Excerpt from Chapter 3 in: Silverman J, Kurtz S, Draper J. Skills for Communicating with Patients.
2nd Edition, Radcliffe Publishing, 2005, pages 86-105.
Genetics SG1
Family history-taking and risk assessment
 Use a three-generation family history to construct a pedigree.

 Practice analyzing pedigrees to identify different inheritance patterns (autosomal dominant,
autosomal recessive, X-linked, and Y-linked).
 Practice calculating risk of disease based on information contained in a sample pedigree.
Required readings:
 Same readings as for genetics lectures.
Research longitudinal experience SG
 List the requirements for success in the research component of the new curriculum, including: a.
The rationale for adding a research program to the new curriculum, b. The three streams for
completion of the research program of the new curriculum, c. The aim, dates and deadlines
associated with the Bursary Program.
 Define “research” and its relationship to scholarly activity: a. Describe and differentiate
between hypothesis driven research and observation based research questions, b. Define a
primary versus a secondary source, c. Articulate at least three values that are commonly
assigned to research.
 Understand that a research question starts with careful observation and reflection.
 List three methods commonly used for dissemination of research findings and the concept of
peer review: a. Posters, b. Papers, c. Platform presentations
 Appreciate the interdisciplinary nature of medical research
Required readings:
 No readings required
Public health SG3: Small group project presentations

Improving the health of individuals and populations
35
 Describe the health needs of a disadvantaged population:
o Recognize that each community is composed of diverse groups of individuals and sub-
populations and that due to variations in factors such as physical location, culture,
behaviours, age and gender structure, populations have different health risks and needs that
must be addressed in order to achieve health equity
 Develop a logic model to identify potential areas for taking action and review the evidence for
effective interventions that can improve health:
o Describe the research cycle and how the evidence produced contributes to better
understanding and improving the health of individuals and populations, including measuring
health problems, understanding the causes, developing and testing interventions, and
evaluating success
 Make recommendations for changing policy and practice and describe success stories and discuss
challenges to improving individual and population health:
o Describe the overall approach as well as the continuum of strategies that can be used to
improve the health of individuals and populations ranging from addressing the upstream
determinants of health and health promotion, to primary, secondary and tertiary prevention,
diagnosis, treatment, and rehabilitation
Required readings:
 Small group project instructions in course outline
Dr. Slapcoff – Physician apprenticeship

Osler fellows meeting (to be scheduled at some time in September)
Triggers for discussion:

 What does being healthy mean to everyone in the group?
 What are the goals of medicine?
 How should the students prepare for the first meeting with the “First-Year Patient”?
Required readings:
 No required readings
36

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INDS 111:

Molecules to Global Health

Prepared by Dr. Anne Andermann

Whole course required readings ....................................................................................................... 4

PDF of primer in English

Dr. Andermann – Public health theme (improving health)

At the end of this lecture, students will be able to:

 Understand health as a multidimensional concept

Dr. Boillat – Clinical method theme (history-taking)

At the end of this lecture, students will be able to:

Dr. Ragsdale – Basic science theme (molecular biology)

At the end of this lecture, students will be able to:

Dr. McKee – Basic science theme (histology)

At the end of this lecture, students will be able to:

 Understand basic cell structure and organelle membrane systems.

Dr. McKee – Basic science theme (histology)

At the end of this lecture, students will be able to:

 Understand how cells organized hierarchically to form tissue layers.

Dr. Michel – Basic science theme (pathology)

At the end of this lecture, students will be able to:

 Define “disease”, and related terms (condition, disorder, illness…).

Dr. Hebert – Basic science theme (pharmacology)

At the end of this lecture, students will be able to:

 Asche, C. et al. Clin. Therapeutics 2011; 33:74-109

Dr. Chaudhury & McGill librarian – Evidence-based medicine theme

At the end of this lecture, students will be able to:

 Describe the five stages of the EBM process

Dr. Klein – Public health theme (epidemiology)

At the end of this lecture, students will be able to:

 Understand how disease is measured and tracked

Dr. Saylor – Public health theme (Indigenous health)

At the end of this lecture, students will be able to:

 See LFME manual

Public health SG1

Student wellness, diversity and careers SG

Dr. Gupta – Student wellness and career advising theme

Dr. Razack – Equity and diversity theme

Dr. Tellier – Student wellness and career advising theme

 Be aware of the common issues that can affect student wellness

Ms. Lefebvre – Student wellness and career advising theme

Dr. Dalton – Student wellness and career advising theme

Dr. Richer – Student wellness and career advising theme

Dr. Doucet – Student wellness and career advising theme

 Ludwig D, Kabat-Zinn J. Mindfulness in medicine. JAMA 2008; 300(11):1350-2.

Dr. Andermann – Public health theme (improving health)

At the end of this lecture, students will be able to:

Dr. Dawson – Clinical method theme (history taking)

At the end of this lecture, students will be able to:

 Describe the content of the medical interview

Dr. Ragsdale – Basic science theme (molecular biology)

At the end of this lecture, students will be able to:

Dr. Blumenkrantz – Basic science theme (pathology)

At the end of this lecture, students will be able to:

Dr. Hebert – Basic sciences theme (pharmacology)

At the end of this lecture, students will be able to:

 Katzung, B.G. Basic and Clinical Pharmacology, 12th edition, Chapter 2.

Dr. Greenaway – Public health theme (immigrant and refugee health)

At the end of this lecture, students will be able to:

 Describe migration trends and the demographics of immigration to Canada

Dr. Klein – Public health theme (epidemiology)

At the end of this lecture, students will be able to:

 Understand how to evaluate new diagnostic test

Dr. Chaudhury & McGill librarian N. Torabi – Evidence-based medicine theme

At the end of this lecture, students will be able to: