An Interview with Letchmi Devi Ponnusamy

McGill University Faculty of Medicine.

Contributor biographies

Rush Medical College

Medical Education Program Highlights The University of Michigan Medical School (UMMS) was founded in 1850. For much of its existence, the curriculum followed a traditional Flexnerian model. Over time, the preclinical curriculum shortened, and the clinical curriculum lengthened. In 2016, the curricular structure inverted. A 17 + 12 + 12-month model transitioned to a 12 + 12 + 17-month model to provide a robust integrated foundation with early clinical immersion, followed by an expanded postclerkship phase for impact-focused work and deliberate professional and leadership development. The new curriculum consists of a “trunk” and “branches,” in honor of the oak trees for which Ann Arbor is named. See List 1—Program Highlights. Curriculum Curriculum description The preclinical phase, the scientific trunk, consists of 12 months of foundational learning focused on basic and health system sciences. The core clinical phase, the clinical trunk, consists of the 1-month Transition to Clerkships course and 12 months of departmentally based clinical clerkships. The advanced phase, the professional development branches, is 17 months of required and elective activities. Longitudinal courses are integrated across all 3 phases. See Supplemental Digital Appendix 1—Curriculum Overview—at https://links.lww.com/ACADMED/A890. Scientific trunk The scientific trunk comprises 6 integrated blocks. Normal functioning is taught concurrently with pathophysiology in a single-pass curriculum. Disciplines (e.g., anatomy, pathology, pharmacology) are threaded throughout all or portions of the year. Basic science content is longitudinally integrated with other courses (e.g., as students learn about the cardiovascular system, they simultaneously learn to perform a cardiac history and physical exam in the Doctoring program). In the scientific trunk, instruction occurs through a combination of lectures (~50%), small groups (~30%), labs, standardized patient (SP) interactions, patient presentations, tutorials, and online modules (~20% combined). Clinical trunk Transition to Clerkships prepares learners to think deeply about basic science connected to clinical care through case-based learning and multiple SP assessments. The clerkships include internal medicine, pediatrics, obstetrics–gynecology, family medicine, psychiatry, neurology, and surgery and applied sciences. Learning on clerkships primarily occurs through immersion on inpatient and outpatient care teams. Clerkship didactics supplement clinical learning using a variety of pedagogies (e.g., flipped classroom, simulation, lecture, case-based learning). Three specific initiatives emphasize foundational science in the clinical phase: applied sciences—a 4-week rotation during surgery comprising anatomy, radiology, pathology, and pathophysiology; Science and Practice of Medicine—a longitudinal, case-based learning course on core and cutting-edge science topics; and Health Systems Science—a 1-week course on health disparities, ethics, quality improvement (QI), patient safety (PS), and value-based care. Professional development branches The branches constitute the third and final phase of the UMMS curriculum. Students select 1 of 4 branches: Patients and populations (primary care, population health, patient-centered medical homes, longitudinal clinic experience) Systems- and hospital-based care (hospitalized patients, health systems, QI, PS, value-based care) Procedure-based care (patients requiring diagnostic and therapeutic procedures, technical and nontechnical skills) Diagnostics and therapeutics (technologies to diagnose and treat disease; disease-based electives) The branches aim to ensure clinical excellence, so learners are “ready day one” for residency, while providing flexible, individualized professional development pathways to launch students on impact-focused careers. Students can pursue any elective or residency from any branch. A branch advisor helps learners align their schedule with professional goals. Students use abundant elective time to engage in research or other scholarly pursuits. Branches culminate in specialty-specific residency preparatory courses containing high-yield topics for incoming interns, using a number of pedagogies. Longitudinal elements Doctoring is a 4-year longitudinal clinical skills and coaching program. Small groups are cotaught by 2 physician faculty. One serves as the primary instructor/assessor and the other serves as a coach, helping learners reflect on competency development, work–life integration, professional identity formation, and well-being. Chief Concern is a 1-year longitudinal clinical reasoning course teaching students how to think through clinical problems. Health Systems Science, leadership, and interprofessional education (IPE) are also 4-year longitudinal threads. The Health Systems Science course involves the study of health policy, disparities, ethics, value-based care, and QI/PS. The Leadership Development Program strives to produce physicians who will become leaders and change agents. Students develop a personal mission, vision, and values statement and attend skill-building sessions, then apply their skills in the classroom, clinic, and extracurricular settings. The IPE thread includes a unique early clinical experience where students observe practicing health professionals caring for patients, as well as classroom and clinic-based experiences with other learners. The Paths of Excellence are optional scholarly concentrations in which ~80% of the student body participates. Students choose from ethics, global health and disparities, health policy, innovation and entrepreneurship, medical humanities, PS/QI/complex systems, scholarship of learning and teaching, or scientific discovery. Learners engage in small-group didactic sessions to deepen knowledge and build community and receive 1:1 mentorship on a capstone. The Capstone for Impact is a longitudinal experiential project aimed at creating new knowledge and/or delivering a solution, improvement, or innovation to a real-world issue, requiring sustained self-directed learning with guidance from advisors and mentors. Examples of capstones include research on postcholecystectomy opiate prescribing practices, a podcast on the Detroit water shortage, and invention and marketing of a “neovent” (an affordable neonatal bubble continuous positive airway pressure device for resource-poor settings). Curriculum changes since 2010 Triggered by a charge from the dean to better prepare learners as leaders and change agents of the future, in 2015, the faculty voted for a sweeping curricular transformation made up of 8 elements: scientific trunk, clinical trunk, branches, Paths of Excellence Program, Leadership Development Program, IPE, M-Home learning community, and competency-based assessment. The first 6 elements have been described above. The M-Home emphasizes connections, community, personal authenticity, and meaning and purpose to enhance well-being and work–life integration. The M-Home is organized into 4 houses, serving as the anchor for Doctoring small groups, where personal and professional support is provided by a network of peers, counselors, faculty, and directors. The approach to assessment transitioned from a higher-stakes, course/clerkship-based model, with a heavy emphasis on medical knowledge, toward a competency-based model, with frequent lower-stakes assessments across multiple competency domains. While students still have graded courses on their academic transcript (exclusively pass/fail in the preclinical phase, mostly honors/high pass/pass/fail in the clinical phase), overall progression through the curriculum is assessed through the lens of competency development. Assessment The medical school identified and reviewed competencies from multiple sources (e.g., ACGME objectives, the Physician Competency Reference Set) and constructed 8 UMMS competency domains, 6 aligned with ACGME objectives. Leadership, teamwork and interprofessionalism, and critical thinking and discovery were added to complete the vision of the new UMMS graduate. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A890. Organizational and structural changes were implemented to support the shift toward competency-based medical education (CBME). A robust electronic learning outcomes dashboard was developed to capture multisource competency assessment data and present them visually, facilitating review and decision making. Data include quantitative measures, Likert-scale assessments of competency development, and narrative descriptions. Competency development is monitored by Competency Committees, with broad representation from faculty, allied health professionals, patient advocates, and student services. These committees follow matriculating cohorts longitudinally and holistically review all students multiple times to ensure appropriate development in all competency domains, and identify support for students. Students have full access to their data, and periodically perform self-assessments, guided by coaches. Identified competency assessment gaps are progressively being filled with novel assessments. For example, assessment of the capstone projects focus on harder-to-assess domains such as practice-based learning and improvement, leadership, teamwork and interprofessionalism, and critical thinking and discovery. Traditional assessments have been reorganized to support learning. Students now take the USMLE Step 1 examination after the clerkships, to foster deep learning of the scientific underpinnings of clinical medicine. Multiple SP-based assessments have been dispersed across the first 2 years to provide frequent, low-stakes assessment and feedback. A postclerkship multistation clinical assessment guides students’ branches work and preparation for USMLE Step 2 Clinical Skills. We are exploring competency-based, time-independent progression through the postclerkship phase, which may facilitate time-variable completion of the MD degree in the future. Pedagogy Overall, we decreased lectures and labs and increased active learning, case-based learning, online modules, simulation, and SP encounters. Several courses are made up almost entirely of active learning (e.g., Doctoring, Chief Concern, the Leadership Development Program, IPE, Transition to Clerkships, Science and Practice of Medicine). Clinical experiences Students are first exposed to patients in fall of year 1 as part of IPE. Learners are fully immersed in clinical care by September year 2. The majority (~85%) of core clinical experiences occur at Michigan Medicine hospitals. Students also rotate at 2 large urban health care centers, 2 neighboring community hospitals, and the Veterans Administration. The balance of inpatient and ambulatory experiences is roughly 65:35. A 12-month longitudinal clinic is required in the patients and populations branch where students work with the same preceptor, often encountering the same patients. Curricular Governance Curricular governance is overseen centrally by the Curriculum Policy Committee (CPC) and its 5 curricular subcommittees. Competency Committees (CCs) assess competency development and monitor academic progress. CPC and CCs report directly to the Executive Committee (EC). Elected student representatives serve on all committees, except for the EC, reflecting a core value of partnering with learners. See Figure 1—Curricular governance structure.Figure 1: Curricular governance structure.Education Staff Medical education leadership The Office of Medical Student Education (OMSE) plans, implements, evaluates, and oversees all aspects of the medical student program. The associate dean and senior director for medical student education oversee 4 central units and the M-Home, each collaboratively led by faculty (assistant dean or director) and a staff director. The OMSE sits within Medical School Administration, led by the executive vice president for medical affairs/dean. See Figure 2—Academic affairs organizational chart.Figure 2: Academic affairs organizational chart.Curricular leadership and faculty with significant teaching roles are supported by direct salary offsets from the OMSE. Smaller teaching roles are compensated via educational value unit-mediated funds flow to departments. In addition to the OMSE, UMMS has the Department of Learning Health Sciences (DLHS), a first-in-the-nation basic science department focused on the sciences related to learning. DLHS is organized around 4 collaboratives (education, simulation, infrastructure, and implementation) to support academic and research efforts. Key offerings include the Medical Education Scholars Program (that introduces faculty to educational design and scholarship) and a competency-based Master of Health Professions Education. Faculty Development and Support in Education The Office of Faculty Development offers more than 100 unique courses annually to meet the continuing education needs of faculty. Leadership programming and coaching are notable strengths. Two communities of practice support health sciences education. The first is the Academy for Educational Excellence and Scholarship. With over 400 members, the Academy helps augment the educational rigor and innovation of its faculty by bringing the community together to discuss important topics and engage in peer development and mentoring. The second is RISE (Research. Innovation. Scholarship. Education.), which aims to develop and implement innovative and potentially transformative education ideas. Members receive personal innovation coaching, including instruction on change management. Faculty educational efforts are recognized in promotion and tenure decisions. The promotion criteria for the clinical track were recently revised, and a clinician–educator pathway was delineated. The definition of scholarship was expanded beyond peer-reviewed manuscripts to include book chapters, innovative teaching practices, educational modules, curriculum development, and patient and community education, among others. Initiatives in Progress As a public institution, UMMS is committed to both innovation and continuous QI to improve the health of patients and society. Three initiatives in progress will continue to guide our work: Fully actualizing the CBME vision, by expanding assessments of all 8 competencies and leveraging big data to make judgments. Time variability and effective educational handovers to residency programs are future goals. Enhancing well-being and improving the learning environment by adopting system-wide cultural transformation strategies toward kinder, civil, and health-supporting values. Growing communities of practice in health sciences education (e.g., RISE) that emphasize both bold innovation and responsible change management, to tackle the big issues facing medical education, and the needs of society. List 1 Program Highlights 12-month foundational science curriculum (scientific trunk) Normal and abnormal systems taught side by side in single-pass curriculum 12-month core clinical clerkships (clinical trunk) Early clinical immersion (September of year 2) Basic science emphasis (Science and Practice of Medicine course; surgery and applied science clerkship) Postclerkship USMLE Step 1 examination 17-month postclerkship phase (professional development branches) Tailored professional development (branch advisor helps design schedule) Pursue impact-focused work, Capstone for Impact deliverable Residency prep courses (specialty specific) Longitudinal elements 4-year clinical skills and coaching program (Doctoring) Health Systems Science course, Leadership Development Program, and interprofessional education Clinical reasoning course (Chief Concern in year 1) Paths of Excellence (scholarly concentrations), most enter in spring of year 1 M-Home learning communities Competency-based medical education Learning outcomes dashboard (multisource assessment data) Competency committees, holistic review Expanding programs of assessment for all competencies

Emerald Studies in Higher Education, Innovation and Technology seeks to provide a multifaceted and interdisciplinary approach to these interconnected topics and invites proposals from all scholars working in these fields. The underlying purpose of this series is to demonstrate how innovations in education, educational technology and teaching can advance research and practice and help us respond to socio-economic changes and challenges. The series has a broad scope, covering many topics, including but not limited to learning analytics, open and distributed learning, technology enhanced learning, digital pedagogies, data mining, virtual and augmented realities, cloud computing, social media, educational robotics, flipped classrooms, active learning, innovation networks and many more.

University of Michigan Medical School

International Review of MissionVolume 74, Issue 294 p. 158-168 “BEING ONE, LET ME BE MANY” FACETS OF THE RELATIONSHIP BETWEEN THE GOSPEL AND CULTURE Julius Lipner, Julius Lipner Julius Lipner is senior lecturer in comparative religion and Sanskrit at The Divinity School, the University of Cambridge, U.K. This article was presented as the keynote address at a colloquium on gospel and culture at Riano, Italy, organized by the Commission on World Mission and Evangelism, World Council of Churches, 27 May to 2 June 1984.Search for more papers by this author Julius Lipner, Julius Lipner Julius Lipner is senior lecturer in comparative religion and Sanskrit at The Divinity School, the University of Cambridge, U.K. This article was presented as the keynote address at a colloquium on gospel and culture at Riano, Italy, organized by the Commission on World Mission and Evangelism, World Council of Churches, 27 May to 2 June 1984.Search for more papers by this author First published: April 1985 https://doi.org/10.1111/j.1758-6631.1985.tb02572.x AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Volume74, Issue294April 1985Pages 158-168 RelatedInformation

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Editors and Readers,Having finished the last weeks of the spring 2020 semester, never in my imagination did I envision having led a department and an athletic training program through a pandemic, a sudden shift to remote teaching and learning, and planning and strategizing for a Fall semester that may continue remotely. Like many readers of the Athletic Training Education Journal, I have been amazed at my students' resilience, have been concerned for the patients, preceptors, and partners in clinical practice that are essential to athletic training education, and have been relying on the innovative offers of support to continue teaching. Regrettably, during this most difficult time, I was also responsible for the difficult task of announcing the closure of a graduate professional education athletic training program, before it had even had the chance to enroll students. We were in the “teach-out phase” of our undergraduate program—one remaining class of seniors preparing to graduate in May 2020. We had spent the 2018 to 2019 and 2019 to 2020 academic years recruiting for an inaugural class in 2020. In February, before the pandemic, I was asked to reconsider starting the graduate program. Ultimately, it was decided: we would never finish the final step in the Substantive Change Process. We announced Voluntary Withdrawal of Accreditation and program closure in April 2020.Given the uncertainty that the COVID-19 pandemic has foisted upon institutions of higher education, I suspect that other program directors and administrators are considering what may come. Unfortunately, I anticipate that others will be making similar announcements in the near future. As institutions of higher education are examining their financial status, anticipating a decline in enrollment and tuition revenue and increased costs for operational processes, administrators will be hard-pressed not to examine educational programming with a view toward return on investment (ROI). Though the mission of higher education is to teach, to discover, and to serve, in order to do so, it must also be able to function as a business, meeting its expenses and planning for the future. I offer this editorial (and eulogy of sorts) to (1) assist those who may be watching their athletic training program for signs of distress and (2) prepare those who remain for the continued turbulent times ahead. Readers are encouraged to consider the questions presented in the Table within their own institutional contexts.Athletic training education has responded to previous periods of growth and change. Readers are encouraged to read the extensive review by Delforge and Behnke1 of the history and evolution of athletic training education published in 1999 to commemorate the 50th anniversary of the National Athletic Trainers' Association (NATA). These first 50 years were marked by growth, refinement, and recognition of the unique skill set that the athletic trainer brings to the sports medicine team. As athletic training neared its golden anniversary, the profession was poised for another moment of significant change. In 1997, the Education Reform Task Force's recommendations were formally endorsed by the NATA Board of Directors to establish the Education Council and set-in motion the elimination of the internship route to certification and the mandate that all programs be accredited by 2000. Institutions that had previously sponsored exam candidates for the Board of Certification (BOC) through the internship route to certification had to decide if they were going to pursue accreditation by the (then) Joint Review Committee on Educational Programs in Athletic Training and the Commission on Accreditation of Allied Health Education Programs to meet the 2004 deadline for BOC eligibility. Some colleges and universities chose not to pursue accreditation, while others committed the resources needed to meet the standards for initial accreditation. Between 2000 and 2004, the number of accredited programs doubled from 120 to over 250. Throughout the 2000s, improvements and adjustments were made to athletic training curriculum content, qualifications for preceptors and affiliated clinical sites, workloads and financial support, and establishment of program outcomes.Moving ahead to 2009, during the Great Recession and soon thereafter, institutions of higher education experienced a wave of furloughs, budget cuts, and enrollment declines, but relatively few athletic training programs were eliminated. Programs successfully navigated the first round of re-accreditations and prepared for revisions to the Commission on Accreditation of Athletic Training Education (CAATE) Standards, the NATA Educational Competencies, and the BOC Practice Analysis. With the establishment of Standard 11 with the 2012 CAATE Standards, that programs must meet a 3-year aggregate first-time pass rate of 70% or greater, it was speculated by many that the number of professional athletic training programs would diminish as programs that were on probation or unsuccessful in meeting the standard would be eliminated. While some programs did voluntarily withdraw, the vast majority of programs responded by bolstering their curricula and improving student performance. But disparities existed in program outcomes; questions remained about the future of the profession and how to best prepare students for clinical practice.In 2014, when the NATA Board of Directors published the Executive Committee for Education's White Paper, examining the professional degree level for athletic training, program directors and faculty were once more forced to consider the future and their place in it. With the Strategic Alliance's announcement in 2015 that athletic training education was moving to the master's degree level, another round of discussions had to take place at the program, department, school, and institutional levels. Over the last 5 years, institutions have announced voluntary withdrawal; others have begun the process of growing graduate programs, recognizing their potential impact on bottom lines. Others, with a history of postprofessional master's degree programs, began offering professional education programs as well as or in lieu of accredited postprofessional degrees.So, in 2020, with the manner and structure of the coming academic year in question, program administrators and faculty are looking again at a monumental shift in athletic training education—not solely due to the implementation of the 2020 Standards for Accreditation for Professional Programs, the decision to discontinue accreditation of Post-Professional Degree Programs, and the revision to CAATE-accredited residency program and fellowship program standards. The impact of the novel corona virus, COVID-19, on higher education as a whole now places additional pressures on athletic training education and its processes.Readers would do well to use the months ahead for introspection and planning. Two additional recruiting cycles remain in which entering students may choose between enrolling at an institution offering a 4-year undergraduate professional degree program, enrolling at an institution offering a 5- or 6-year combined preprofessional and professional degree program, or enrolling at an institution not affiliated with an athletic training program and decide to adjust their academic career plans. Higher education institutions, researchers, market analysts, and consulting firms spend considerable time, energy, and resources trying to understand the decision-making processes of traditional-aged high school graduates and their families. Similar efforts are made to understand undergraduate students who are balancing the options of applying to professional or graduate schools or entering the workforce. Alternatively, individuals in the labor market are also weighing the ROI of returning to school on a full-time or part-time basis to augment their earning potential, or change careers for improved personal fulfillment or family circumstances or as a result of job loss. Recruiting for an athletic training program regardless of degree level requires an understanding of the current landscape and the market for potential students.When transitioning from an undergraduate program to a graduate program, program personnel spend considerable time preparing—conducting an environmental scan, negotiating with administration, developing a financial projection model, completing the substantive change applications or “mini self-study,” organizing curricula and marketing to future students. The launch of a new graduate program brings excitement and energy—a good story to tell and to showcase: an institution poised for growth.Over the past 5 years, my faculty and I pursued a dual strategy, expanding our offerings in health, wellness, and exercise science while being creative and innovative in our athletic training curriculum. Our goals were to showcase all that undergraduate education should offer in preparing students for professional graduate study in the health sciences (critical thinking, quantitative and informed reasoning, ethical decision making, an understanding of the biopsychosocial determinants of health and health disparities, and the essential elements of humanity in the liberal arts), while simultaneously encouraging students to consider a career in athletic training to promote physical activity, to prevent and address the prevalence of chronic disease, to manage acute illness and injury, and to promote exercise as a therapeutic intervention. While navigating the self-study process and gaining a 10-year reaccreditation in 2019 and completing the degree transition process, I am confident in saying we tried our best.Regrettably, this fall as applicants did not materialize, as program head count for the summer was tenuous, I had to make one of the most difficult decision of my career as an athletic training educator: to recommend closing my own program. How did we get there? As a program based in Cincinnati, Ohio, we are blessed to be located in a metropolitan region with a high population density. We have significant numbers of graduates from the surrounding region and robust clinical placement opportunities. We have over a 30-year history of graduating athletic trainers (ATs) for professional practice. The hospital systems in the region hire recent athletic training graduates in a variety of employment settings, and our students were able to find work easily. We have a robust network of affiliated clinical sites and an active advisory board. We had had such high aspirations and projections that making the transition would be fruitful and the right thing to do. We had completed the self-study as well as a business plan to demonstrate how we would fill our class and meet our benchmarks.Unfortunately, as the months progressed in our recruitment cycle, the data has demonstrated expanding options for students, regionally and statewide, and declining interest in athletic training education at the graduate level. Cincinnati has more than 10 institutions of higher education in a 60-mile radius. Of those institutions, remarkably, 8 offered professional athletic training programs (4 public institutions: University of Cincinnati, Miami University [Ohio], Northern Kentucky University, and Wright State University; 4 private institutions: Xavier University, Thomas More University, Wilmington College, and Mount St. Joseph University). Three of the private institutions (1 National Collegiate Athletic Association Division I, 1 National Collegiate Athletic Association Division III, and 1 National Association of Intercollegiate Athletics) had already transitioned to the graduate level, having led the region with a year's head start, before my institution received final approval from the CAATE and the Higher Learning Commission. The 2 largest public universities (1 Football Bowl Subdivision Division I/Very High Research University and the other a Division I/Comprehensive Master's University) have transitioned or planned to transition but have delayed the start of their graduate programs. When we had originally proposed the Master of Athletic Training degree, there was 1 graduate professional program in Ohio (more than 5 hours away). By the time we were approved 2 years later and began recruiting, there were 11 graduate programs in the state (2 within our own county). Our program's historic niche had been to recruit traditional-aged students to the institution, with about half of those students also having plans to pursue graduate study in physical therapy. As we expanded our exercise science offerings, fewer students decided on athletic training as a career goal. This trend was also evident as the entering classes of athletic training students at the graduate professional programs in the state hovered at 10 students or less per cohort. Despite considerable efforts to market the athletic training program to undergraduate students at other like-sized institutions in surrounding states and connecting with pre-health students and advisors at larger universities, the numbers had not materialized.In February, as my dean and I prepared the summer and fall schedules for 2020, answered questions from Admissions and the Provost's Office, and began preparing the annual department budget, there were few remaining justifications for continuing to offer an accredited professional athletic training education program. Faced with market saturation, declining interest both internally and externally, and the obvious costs of weathering an unknown time period of low enrollment, we determined that it was in the best interests of the institution to announce program closure.It was the right thing to do for the well-being and future of my institution, but it was no less painful for myself, my students, and my colleagues. We made the decision based on data and the common good. Announcing program closure is much more reserved and measured than announcing a new program or expanded program offerings. It requires a delicate balance of showing compassion while also defending calculated decision making. Instead of celebrating an opening, announcing a program closure requires informing undergraduate students that their hoped-for destination will not be accepting students, perhaps announcing the elimination of faculty positions, and saying good-bye to trusted and respected colleagues. When advising students, faculty should be able to provide contingency plans and consider working with nearby programs to establish articulation agreements whereby students can pursue accelerated acceptance into another graduate athletic training program.To be clear, the decision to close our athletic training program was made in the opening days of the Spring 2020 semester, before the stay-at-home orders were issued, before Fall 2020 semester formats were in question, before our fiscal year budget was devastated by having to return income from residence hall room and board, and before our enrollment projections for the Fall semester had become so much more critical. Despite recruitment efforts over the past 18 months, it was determined that the anticipated enrollment we needed in order to sustain the athletic training graduate program was not going to materialize without significant investment of time, talent, and money. Providing a high-quality, accredited health care professional program is costly and resource-intensive. As more programs have transitioned from the bachelor's degree level to the graduate level, the recruiting landscape has become more predictably difficult. Despite a strong reputation in the health sciences generally, and a history of preparing ATs, programs may not be able to draw undergraduate students from other institutions to meet expectations and financial plans to keep the education reasonably priced for students. Smaller, regionally focused, comprehensive liberal arts universities without broad brand recognition will struggle to recruit students for graduate education in athletic training. The ability to recruit students to newly accredited programs in physician assistant studies, for entry-level nursing, and for physical therapy requires investment, but for athletic training, more so. The varied stakeholders in athletic training education (the NATA, the CAATE, the newly formed Association of Athletic Training Educators [AATE], the faculty, the future employers, and the alumni of these programs) will need to focus considerable effort and resources toward marketing athletic training as a destination career to potential students whether they be traditional-aged undergraduate students or career changers resulting in an older student population.So, as others are likely facing similar circumstances, now compounded by the ramifications of the COVID-19 pandemic, I encourage athletic training educators to take a hard look at their institutions' long-term well-being and the well-being of the remaining athletic training programs in their region to determine a path forward. I am certain that athletic training programs will continue to thrive and will take on the best elements of the programs that have closed and ensure their legacy.With deepest regards and hope for future ATs, BC Charles-Liscombe.

The aim of this article is to investigate the argument that choice and competition will unleash entrepreneurial innovation in free schools. Free schools were introduced as a subset of the Academies by the Conservative–Liberal Democrat Coalition government, following the general election in 2010. The government made it possible for non-state providers to set up their own independent, state-funded schools in order to create more choice, competition and innovation. We conclude that a higher level of substantive innovation is taking place in regards to management practices than in respect of curriculum and pedagogical practices. Innovation in curriculum and pedagogical practices is very limited. Creating a free school offer that seems to differ from other schools appears to be done through marketing and branding rather than innovation. We argue that parents, OFSTED, and the relative isolation of free schools constrain innovation from taking place.

No part of this book may be reproduced, stored in a retrieval system, transmitted in any form or by any means electronic, mechanical, photocopying, recording or otherwise without either the prior written permission of the publisher or a licence permitting restricted copying issued in the UK by The Copyright Licensing Agency and in the USA by The Copyright Clearance Center. Any opinions expressed in the chapters are those of the authors. Whilst Emerald makes every effort to ensure the quality and accuracy of its content, Emerald makes no representation implied or otherwise, as to the chapters' suitability and application and disclaims any warranties, express or implied, to their use.

Georgetown University School of Medicine

University of Florida College of Medicine

Curriculum Management and Governance Structure ♦ The Medical Curriculum Committee (MCC) is a standing committee of the Academic Council and is charged with reviewing, evaluating, recommending policy, and managing the medical student curriculum for all four years of the program (Figure 1).FIGURE 1:: Curriculum Management and Governance Structure♦ The MCC reports on a yearly basis to the Academic Council all matters related to educational policy and performance. ♦ Implementation of curricular policy is the responsibility of the Dean, who may delegate some or all of it to the Associate Dean for Medical Education. ♦ Standing subcommittees of MCC include Assessment of Student Learning Educational Program Evaluation Faculty Development Educational Resources (Library and Information Technology) ♦ Two other main committees are involved in the implementation of the curriculum and provide input to the MCC via the subcommittees listed above. ♦ Critical to the operation of these committees is the support provided by the Associate Dean for Medical Education, with the advice and consult of the Department Chairs and the Associate Dean for Clinic and Regional Integration. ♦ Phase-1 Committee is composed of the Block Directors (I-VIII) for Years 01 and 02, the Associate Dean for Research, the Directors for Interprofessionalism, and the Clinical Sciences Directors for Blocks I-VIII and is chaired by the Associate Dean for Medical Education. A student from each class in Year 01-02 is elected to this committee. ♦ This committee is responsible for the planning and implementation of the MCC recommendations regarding the educational program in Phase-1 (Years 01 and 02).The Phase-1 Committee meets two times per year to discuss the educational program and may meet more often if the need arises. ♦ Phase-2 Committee is composed of the Clerkship Directors, the Director of the Electives Program, the Associate Dean for Research, and the Directors for Interprofessionalism and is chaired by the Associate Dean for Medical Education. A student from each class in Year 03-04 is elected to this committee. ♦ This committee is responsible for the planning and implementation of the MCC recommendations regarding the educational program in Phase-2 (Years 03 and 04). The Phase-2 Committee meets two times per year to discuss the educational program and may meet more often if the need arises. Office of Education ♦ The Associate Dean for Medical Education provides primary support to the Dean for oversight and implementation of the curriculum. ♦ Several faculty and staff positions are supportive to the Associate Dean for Medical Education and include an Assistant Dean for Medical Education, the Director of Student Assessment, the Director of Program Evaluation/Senior Statistician, and faculty within the Office of Faculty Development. Financial Management of Educational Programs ♦ On an annual basis, the VTCSOM faculty reviews the curriculum and identifies the educational program requirements. ♦ The Associate Dean for Medical Education is charged with determining the resources required to deliver the curriculum and will submit those to the Dean as part of the annual budget development process. ♦ The cost accounting system for the VTCSOM is organized by department. ♦ The allocation of funds to support the requirements of the curriculum (in terms of faculty and program development) is reflected in the accounting code for which the Associate Dean for Medical Education is responsible. ♦ The Director of Finances, under the Senior Associate Dean for Operations, will transfer the VTC funds to these accounts and provide financial management support to the Associate and Assistant Deans. This process ensures that the Associate Dean for Medical Education has control of the resources necessary to deliver the curriculum. ♦ Carilion Clinic and Virginia Tech provided ramp-up funds to support a minimum of five years of operations for the VTCSOM to ensure that the short-term volatility of the markets and the uncertainty of health care reform would not affect the quality of the medical education program. ♦ The funds have been appropriated to the Associate Dean for Medical Education, and that position is authorized to allocate those resources as needed. Valuing Teaching ♦ Promotion represents recognition by VTC that the faculty member has made, and is continuing to make, contributions to the education of medical students and is engaging in the honored activities of inquiry, research, and discovery. ♦ Specific guidelines are included in the VTC Faculty Handbook that describe the promotion and tenure process that emphasize the importance of teaching to promotion and tenure at VTC. ♦ Principles of promotion and tenure are also included that emphasize the importance of quality teaching at VTC and include “The education of medical students is the primary reason for the existence of the Virginia Tech Carilion School of Medicine. Therefore, teaching is the activity that unites all faculty members of VTC.” “Given the primacy of teaching, it is expected that faculty members striving for promotion will be judged on the quality, and to some degree on the quantity, of their teaching. Similarly, faculty members should recognize that skills can always be improved and evidence of a desire to improve ones teaching is also expected. Scholarship is one of the criteria by which faculty members should be judged in consideration for promotion.” “At VTC, scholarship can be seen to emanate from any or all of the fundamental missions of the School including the Scholarship of Teaching. Innovation in the pedagogy of medical education presents opportunities for scholarly activity. Documentation of innovation can be in many forms including publication of papers, textbooks, chapters, technical journals, videos/audios; presentation at meetings or conferences (oral, printed); achievement of grants or funding; development of curriculum with evidence of dissemination; development of new modes of education such as electronic teaching aides; development of new programs in skills achievement and new methods of assessment or evaluation; and collaboration in task forces or committees charged with educational innovation and other forms of scholarship.” Curriculum Development Process ♦ 2005–06: Early medical school planning between Carilion Clinic and Virginia Tech including consultant discussions and site visits to various medical schools with innovative curricula and an emphasis on student research programs. ♦ January 2007: Public announcement by the Governor of Virginia for the development of a new medical school to be located in Roanoke. ♦ January–July 2007: Curriculum planning continued with establishment of an advisory committee with representation from Carilion Clinic and Virginia Tech. Further site visits were conducted. Curricular experts in PBL were consulted. A PBL-Hybrid curriculum model was developed. This pedagogy involves integrating a limited number of Basic Science lectures and labs into a body-systems format that supports PBL focused on patient cases. The recruitment for a Founding Dean was initiated. ♦ January 2008: The Founding Dean of the Virginia Tech Carilion School of Medicine was hired. ♦ January–May 2008: Senior administrative Dean's staff recruited including Senior Associate Dean for Operations, Associate Dean for Medical Education, Associate Dean for Research, Associate Dean for Student Affairs and Admissions, Associate Dean for Clinical and Regional Integration, Assistant Dean for Faculty Affairs, Assistant Dean for Medical Education, and an Assistant Dean for Diversity. ♦ LCME accreditation teams were formed including a Curriculum Planning Committee to develop the Education database and formalize the curriculum. ♦ April–June 2008: Accomplishments and major decisions leading to adoption of curriculum by the LCME ED database committee: Created an overall VTC Goals and Objectives document that outlined what our graduate profile should be, linked to the ACGME competencies, and tied to specific assessment measures. Decided that the curriculum will be a PBL-Hybrid model with normal structure and function of the human body as the focus of Year 01 and Pathobiology as the focus in Year 02. Created four major educational Value Domains that will exist throughout the four years of the curriculum (Basic Sciences, Clinical Sciences, Research, and Interprofessionalism). Created a comprehensive student assessment plan for Years 01/02. Incorporated dedicated time for Research and Interprofessionalism into the sequencing of clinical rotations and electives in Phase-2. ♦ August 2008: Block Directors, Block Design Teams in Year 01, Directors for Value Domains of Clinical Sciences and Interprofessionalism were selected. ♦ September 2008: Collaboration with Jefferson College of Health Sciences administrators and faculty on Interprofessional Healthcare Education was begun. ♦ January 2009: Submission of LCME database ♦ February 2009: LCME Site visit ♦ June 3, 2009: LCME Preliminary Accreditation Granted to VTC. Learning Outcomes/Competencies ♦ The Goals and Objectives document for the Virginia Tech Carilion School of Medicine (VTC) incorporate the ACGME core competencies and the core areas identified by the Institute of Medicine in their report on Health Professional Education (2003). They can be found at www.vtc.vt.edu. Innovative Topics in the Curriculum ♦ Research fundamentals and application to an individual student hypothesis-driven project ♦ Interprofessionalism education and experiences including teamwork, conflict resolution, health care roles and responsibilities, and leadership training ♦ Interprofessional Service Learning Project ♦ Portable Ultrasound (anatomy, physiology, clinical skills) ♦ Geriatrics and palliative care ♦ “Healer's art,” humanities, and humanism in medicine ♦ Oral health ♦ Patient safety and quality improvement in the Interprofessionalism Domain and more in-depth in the MS in Biomedical Sciences options ♦ Simulations in clinical skills using task trainers, standardized patients, and high-fidelity patient manikins Innovations in Pedagogy ♦ PBL-Hybrid Model for basic science instruction using patient cases ♦ Virtual histology and pathology laboratory experiences ♦ Clinical sciences and skills integrated from the beginning ♦ Longitudinal Ambulatory Care Experience (LACE) providing students with early patient and clinical practice experience from the beginning of medical school ♦ Fourteen-week period at end of Year 2 for research and other projects ♦ Research and Interprofessionalism dedicated time throughout the four years ♦ Four Educational Value Domains throughout the four years (Basic Sciences, Clinical Sciences, Research, Interprofessionalism) ♦ Hypothesis-driven Research Project ♦ Interprofessionalism Healthcare Education and Experience from the beginning of medical school including a Service Learning Project ♦ Opportunities for MS in Biomedical Sciences in four years and an MPH in five years Innovations in Assessment ♦ Integrated assessments at the end of each block directed at competency targets in each of the four Value Domains ♦ Peer feedback for small-group performance ♦ Pass/Fail grading with opportunities to demonstrate academic excellence ♦ Team examinations for Interprofessional experiences ♦ Remediation program at the end of each block Clinical Experiences ♦ Clinical education will primarily occur in the first two years in the medical education building, which is equipped with 10 clinic-style examination rooms that are fully electronically equipped for teaching and assessing clinical skills. ♦ Standardized patients are utilized for the early part of this program. ♦ Each student is assigned to an ambulatory setting in or near Roanoke within the Carilion Clinic system as part of LACE. ♦ Students will be required to attend this clinic two afternoons per block where they will gain longitudinal experiences in clinical practice and continuity of patient care and will be assessed on their developing clinical skills. ♦ Students in Phase-2 will rotate through various inpatient and ambulatory clinical experiences in the Carilion Roanoke Memorial Hospital, an 825-bed facility located on the VTC campus. ♦ In addition, seven other hospitals and numerous outpatient settings will also be utilized for the clinical education of students. ♦ Students will also be afforded ample elective opportunities to enhance their interests and career ambitions both at Carilion Clinic and other approved sites. Challenges ♦ Creating a medical school Highlights of the Program/School ♦ Small class size (42 students per class) with integrated learning of basic and clinical sciences ♦ Focus on in-depth research experience ♦ Institutionalized Interprofessional Healthcare Education and Practice ♦ Early patient and clinical practice experiences

Higher education institutions (HEIs) are the powerhouse of a knowledge-based society. The core of their activities takes place at the academic departments. Considerable studies show that departmental leaders play an instrumental role in enhancing students' learning performance through effective resource management and construction of an organizational environment conducive to the betterment of teaching and research (Chin, 2007; Kok & McDonald, 2015, p. 2; Pounder, 2011; Waters, Marzano, & McNulty, 2003). While the significance of departmental leadership has become prominent (Bush, 2008), leadership of HEIs in Hong Kong was rated below satisfactory level by academic staff (Coates, Dobson, Goedegebuure, & Meek, 2010). Development of departmental leaders is thus a pertinent issue. Unfortunately, departmental leaders in many countries and regions, including Hong Kong, generally received little training to cope with a myriad of challenges (Avolio, Walumbwa, & Weber, 2009; Burgoyne, Mackness, & Williams, 2009; Sirkis, 2011; Vilkinas & Ladyshewsky, 2012). Thus, leader development is put at the top of agenda for policy making in countries like the UK for example (Burgoyne et al., 2009). To develop a deeper and richer understanding of the leader development experiences of departmental leaders, a qualitative study of eight departmental leaders from eight Hong Kong HEIs was conducted through one-to-one, in-depth, semi-structured interviews. Deploying Kegan's (1982) constructive-developmental theory as the theoretical lens, five major themes were identified through an interpretative phenomenological analysis (IPA) approach: (1) top-down approach in leader selection and promotion, (2) advancing leadership expertise through reflective practice, (3) rich developmental experience as catalyst for growth, (4) personal drive as impetus for growth, and (5) leader maturation through cumulative learning. The findings supported that leader development is a multi-level, longitudinal, adaptive learning process grounded in the social environment, in which individual leaders construct and advance their leadership expertise and develop broadened leader identities over time through accumulative lived experiences. The findings call for both personal commitment and organizational commitment to a systemic approach to leader development. Their profound implications on leader development research and practice are discussed.