Hackensack Meridian School of Medicine at Seton Hall University.

Abstract

Medical Education Program Highlights To create the new Hackensack Meridian School of Medicine (SOM) at Seton Hall University, we began with the vision: Each person in New Jersey, and in the United States, regardless of race or socioeconomic status, will enjoy the highest levels of wellness in an economically and behaviorally sustainable fashion. This informed not only our curricular content but also our pedagogies and how we structured the school: Community and the determinants of health (DoH): At the center of the vision is the role that community and context have on health and well-being. The framework for the entire SOM curriculum is the DoH: the different types of factors that drive health outcomes, categorized into the biologic/genetic, behavioral, social, environmental, and health care itself. At the heart of the SOM curriculum is the longitudinal Human Dimension course in which medical student pairs are matched with families in the community whom they follow over time. Experiences in the families’ homes, communities, and health care settings bring the DoH to life for the students. Students are trained to help and provide benefit to their family and community partners. Students also complete a community assessment project that leads to a community health project in their matched community. All content learned in the Human Dimension course is linked to what they are learning in the rest of the curriculum. Individualized educational program: Another central feature of the SOM curriculum is its ability to be individualized to each student’s professional goals and developmental needs. Our 3 + 1 model includes a 3-year core curriculum (Phases 1 and 2) for all students, plus an individualized fourth year (Phase 3). Students work with their advisors to plan a Phase 3 that meets their individual needs and goals. They can obtain a second degree or graduate certificate or complete a research year, community-based project, or clinical immersion. They also have the option of graduating after 3 years and entering residency within the Hackensack Meridian Health (HMH) network. Integrated and patient-centered curriculum: Courses in the Phase 1 (preclerkship) curriculum integrate content from the biomedical, behavioral, social, and health system sciences. Each week is framed by a weekly patient presentation in which students generate hypotheses that connect the underlying basic science mechanisms explaining aspects of the case, integrate all content learned within the week, and link the case and the science content to different DoH. Curriculum The 3 + 1 curriculum includes the core curriculum: Phase 1 (16-month preclerkship) and Phase 2 (clerkships and advanced clinical rotations), followed by the individualized Phase 3. See Supplemental Digital Appendix 1—Curriculum Schematic—at https://links.lww.com/ACADMED/A950. Parallel curriculum or tracks One option for Phase 3 is graduation after 3 years with entry into residency within the HMH network. The HMH network has over 190 first-year residency positions in 15 specialties. Students begin the application for this option during the second year and do not make a final commitment until they have completed all clerkships. This is an option for students who have clarity on their career goals and have demonstrated strong academic success. Assessment The SOM educational program objectives (EPOs) were derived from the AAMC’s Physician Competency Reference Set. Additional EPOs were created and existing EPOs were modified to more fully reflect the SOM vision and goals for our graduates. In addition, the SOM’s developmental and integrated 3-year core curriculum uses 18 Entrustable Professional Activities (EPAs). These include the 13 AAMC Core EPAs as well as 5 EPAs we developed so that we could fully represent the SOM graduation goals. Our 18 EPAs form the framework, milestones, and developmental competencies for Phase 1 and Phase 2. All feedback, formative assessment, and summative assessment are structured and delivered using these EPAs. The 18 EPAs are assessed longitudinally over Phase 2, with increasing expectations over the course of the year. Various methods, both clerkship-specific and longitudinal, are used, including: Observation and assessment in the clinical setting, both workplace-based assessment and summative overall assessment; final clinical evaluations are synthesized and created by competency and grading committees Assessments in the simulation center, including high-fidelity simulation, standardized patient encounters, and part-task simulation Clerkship-based assignments See List 1—EPAs Taught and Assessed. See Chart 1—Content of Additional EPAs.Chart 1: Content of Additional EPAsSee Supplemental Digital Appendix 2—Competencies, Objectives, and Assessment Methods—available at https://links.lww.com/ACADMED/A950. Pedagogy Each teaching method used in Phase 1 was chosen to build specific skills needed for clinical practice. During Phase 1, each week is framed by our patient presentation problem-based learning (PBL) curriculum (PPPC). Each week begins and ends with a weekly patient presentation, based on a hybrid of case-based learning and modified PBL. Case-based learning is introduced Monday morning with the patient presentation. Students review the clinical information and develop a differential diagnosis. The case evolves in basic science and clinical skills teaching sessions throughout the week, pushing students to learn underlying mechanisms of disease or treatment. Students also identify questions related to the case and select self-directed learning research topics they present during Friday morning small group, using peer teaching to facilitate a discussion applying information learned to the case. Throughout the week each student creates an individual concept map using the week’s patient presentation as a scaffold, connecting and integrating content from all sciences learned throughout the week, and identifying specific DoH at play. During Friday morning small group, the team creates a team concept map integrating the week’s content and information from self-directed research presentations. Large-group active learning sessions occur 3 to 5 times per week within Phase 1. Flipped classroom methodology is used, with prework assigned and in-class activities focused on knowledge application. Videos and podcasts are used for prework and supplemental learning. Team-based learning is used regularly in Phase 1, approximately weekly. Small-group discussions occur in Friday morning PPPC sessions as well as Wednesday morning Human Dimension and Clinical Skills sessions. Students participate in laboratory sessions approximately once per week during Phase 1, including anatomy (dissection and prosection), pathology, radiology, simulation, and others. Role play, dramatization, and simulation are used throughout the curriculum to promote active, engaged learning and align with our goal for explicit clinical relevance, maintaining focus on the patient. These experiential sessions include video review, reflection, and development of growth goals. Simulation and standardized/simulated patient sessions are core components of the 3-year clinical skills curriculum and are also used in basic science teaching sessions. The Human Dimension course uses robust experiential learning in families’ homes and community settings, as well as workshops on the skills needed for community-based work. See Figure 1—Sample week: Phase 1.Figure 1: Sample week: Phase 1.Clinical experiences Throughout the curriculum, students are part of the health care team at a variety of sites across the HMH network, which includes 17 hospitals and over 500 outpatient, community-based, and other care settings. Students complete clinical experiences across a range of settings. Longitudinal clinical experience Beginning in the first year, students are assigned to an ambulatory-based longitudinal clinical preceptorship. The mentoring and role modeling relationships from this longitudinal format build students’ professional identity, transition them to the culture and expectations of the clinical workplace, and provide professional development that fosters self-assessment, reflection, and growth. Before beginning, students are trained in patient-centered communication, clinical reasoning, and full history and physical examination so that they can practice and develop these skills in the clinical setting. Community-based experiences Aligned with the SOM vision, many required experiences occur in community and ambulatory sites. All clerkships have an emphasis on the outpatient setting, with each clerkship’s outpatient clinical time ranging between 30% and 80%. The experiential and service-learning curriculum within the Human Dimension course takes place in community-based settings and families’ homes. Students develop communication and patient-centered skills through these experiences. Challenges in designing and implementing clinical experiences for medical students The robust and progressive HMH network is a significant strength of our school. It provides a breadth of learning opportunities, opportunities for integration, and intentional growth of skills across the developmental arc of UME to GME to clinical practice. The cohesive structure of our health network from training to practice provides great opportunities for medical education research. Challenges encountered in implementation have included: Recruitment of clinical faculty Onboarding students across multiple sites and settings Faculty development Logistics and leveraging the strengths of the vast health care network Curricular Governance Our Medical Education Committee has 3 standing subcommittees, one for each phase of the curriculum. Each of the 3 phase subcommittees are responsible for the educational outcomes; the development, review, and enhancement of objectives, content, student workload, student performance, evaluations, and integration of the courses/clerkships; and other curricular components within their phase, as well as of the phase as a whole. The Phase 3 curriculum subcommittee is also responsible for reviewing and monitoring the outcomes of Phase 3 programs, including student completion of degrees and programs, residency match, and internship preparation. Centralized governance and administration (processes and support) include instructional design, faculty development, administrative support of teaching activities, and compensation for teaching faculty in the preclerkship curriculum. Each curriculum subcommittee, and ultimately the Medical Education Committee, is responsible for the design, implementation, and continuous enhancement of each curricular component and the curriculum as a whole. Departments are responsible for the quality and outcomes of their courses/clerkships and faculty and are provided data and support for this from central SOM offices. Budgeting of teaching time for clinical faculty is decentralized and varies based on clinical site, faculty employment structure, and responsibilities within the SOM. Education Staff The Office of Medical Education (OME) supports the design, implementation, and continuous enhancement of the educational program. The OME has 5 divisions: Educational and curriculum design and delivery Curricular administration Institutional effectiveness and assessment Medical education research and innovation Community programs Administrators and staff support faculty in all phases of the curriculum and collaborate closely with other units of the SOM. The OME administers and supports curriculum committees, the curriculum management plan, and assessment. This includes development, maintenance, and utilization of the learning management system; the curriculum database; and our longitudinal medical education research database (LongMED). Academic support and advising is a unit within the Office of Student Affairs and Wellbeing, providing academic and learning support to students. Faculty, advisors, and staff within the Office of Student Affairs and Wellbeing and the OME work together closely to support student success. The following units within the SOM have responsibilities and deans related to UME, faculty development, and learner support: Office of the Dean OME Office of Student Affairs and Wellbeing Office of Faculty/faculty development division Office of Diversity and Equity Office of the Medical Education Continuum Faculty Development and Support in Education Faculty development is a collaboration between the Office of Faculty and the OME, covering a wide range of topics from curriculum development, to classroom and clinical teaching skills, to scholarship and academic development. Faculty development trainers within the Office of Faculty provide training and development for clinical faculty in on-campus, virtual, and clinical settings. Faculty participate in development before beginning a teaching responsibility as well as in development sessions throughout the course/clerkship. The vice dean for the medical education continuum and the associate dean of diversity and equity serve as co-chief academic officers of the health network, with GME and CME falling under their scope. Faculty development efforts are coordinated and aligned across the UME–GME–CME continuum. As the next phase of faculty and professional development emerges, a teaching academy may be developed. It is a priority of the SOM to create a culture of learning and growth for students as well as faculty and staff. Role of teaching and education activities in promotion Teaching and education are important factors that are considered for promotion decisions. The Office of Faculty, Appointment and Promotions Committee, department chairs, and the SOM dean all play a role in the promotions process. The SOM does not offer tenure. Faculty submit a promotion application to their chair and the Office of Faculty, including an educational portfolio, curriculum vitae, and letters of reference. Criteria for appointment, renewal, and promotion are based on performance in teaching, scholarship (including research), and service (including clinical service).