Jefferson Medical College of Thomas Jefferson University

Abstract

Curriculum Management and Governance Structure The Curriculum Committee is a standing committee chaired by a faculty member with rank of professor and demonstrated leadership and expertise in medical education. ♦ As per the Jefferson Medical College (JMC) bylaws, this Committee is responsible for the undergraduate curriculum including approval and evaluation of all programs, schedules, and examinations. ♦ The Senior Associate Dean for Academic Affairs/UME serves as the Dean's representative to the Curriculum Committee and works very closely with the Chair. ♦ Voting members include course and clerkship directors; faculty-at-large; a member from Academic and Instructional Support and Resources; and eight students from the second-, third- and fourth-year classes. ♦ The Curriculum Committee has instituted a “sunshine policy”—any member of the faculty or student body is welcome to attend meetings. ♦ The Year One and the Year Two Steering Committees and the Clinical Liaison Committee are convened by the Office of Academic Affairs/UME; each meets every four to six weeks as a forum for informal discussion of curriculum “current events” and for addressing student and faculty questions and concerns. ♦ The Steering Committees have been specifically designed to have equivalent representation from faculty (all course directors and the Chair of the Curriculum Committee) and students (all student liaisons). ♦ The Clinical Liaison Committee, composed of student liaisons from each of the core clerkships, meets at the end of each clerkship block for general discussions, curriculum planning, and problem solving. ♦ Issues in need of attention are communicated from these three groups to the appropriate committee, faculty, and/or staff. ♦ The Years One/Two and Years Three/Four Subcommittees meet monthly for discussion of curriculum management and planning issues. These groups include course or clerkship directors, key faculty, and students. Action items are sent as proposals for Curriculum Committee review. ♦ Ad hoc working groups are convened to review a specific curricular issue in detail and to develop proposals for implementation or change. These groups always include faculty members with expertise in a content area who are not current members of the Curriculum Committee and are designed to expand the scope of input into curriculum decisions. ♦ The working groups also include students and, depending on the issue, may have members appointed from other standing committees, most often, the Committee on Student Promotion. A diagram of the curriculum management structure is included as Figure 1.FIGURE 1:: Curriculum Organization The Office of Academic Affairs has responsibility for support of undergraduate medical education, graduate medical education, and affiliations at Jefferson. ♦ The Office coordinates medical student curriculum planning and evaluation, the student promotion and remediation processes, accreditation activities, and affiliate collaborations. ♦ The Office staff includes two senior associate deans, one full-time and three part-time associate deans, one assistant dean, and three administrative assistants. ♦ An associate dean, with doctoral training in educational psychology, oversees medical student accommodations, study skills, and remediation services and provides longitudinal professional development services to multiple student and resident groups. ♦ The Office of Academic Affairs works closely with the JMC Center for Research in Medical Education and Health Care. ♦ There are currently five faculty members and three part-time computer specialists staffing the Center. ♦ Core services include test scoring, psychometric support for clinical simulation-based assessments, course evaluation, program evaluation, and graduate medical education evaluation. The activities of the Center reach far beyond these essential services. For more than 40 years, the Center has conducted research involving the Jefferson community, national and international organizations, and governmental agencies concerned with medical education and health care. ♦ Center faculty and staff publish in U.S. and international journals, present at scientific meetings, and contribute to faculty development through joint publications with JMC faculty. ♦ The Jefferson Longitudinal Study of Medical Education, developed and maintained by the Center, is the most comprehensive database in medical education, encompassing academic and career outcome data on more than 10,000 Jefferson medical students and graduates. Financial Management of Educational Programs Although the financial crisis of the past two years has had an impact on JMC, we have been fortunate compared to many other educational institutions due to a consistent, long-term, conservative investment strategy. ♦ The University implemented cost-saving measures including tight position control, cost of living raises only for individuals in the lower salary range, limitations on discretionary spending, and small across-the-board budget cuts. Mission-based budgeting, including line-item support from the Dean to course and clerkship directors and their key staff members, was implemented in 2006-07. This mechanism functions well in assuring support for the educational programs. Tuition increases have been specifically directed to the education programs. ♦ Targets for scholarship funds are on track. ♦ Increases in sponsored research as a result of a high success rate in securing funds linked to the American Recovery and Reinvestment Act has had a “counterbalancing” impact. Valuing Teaching JMC has a longstanding tradition of honoring excellence in teaching. This includes not only annual awards, but also, since 1861, the selection of one faculty member each year by the graduating class for the painting of a faculty portrait for presentation by the Class to the University during Match Week. ♦ In recognition of the fact that many faculty, beyond those few who are selected for major recognition, dedicate time and effort to student, resident, and fellow teaching and mentoring, the Dean created two new awards: the Dean's Citation for Faculty Mentoring and the Dean's Citation for Significant Contributions to the Advancement of Education. ♦ Criteria include superior effectiveness as a teacher; significant time and effort devoted to teaching over a minimum of three years; and major achievements or innovations in a course, clerkship, or program. ♦ Since its inception in 2004, more than 180 faculty members have been awarded this honor at a yearly gala dinner. ♦ To harness this teaching talent, the Jefferson Academy of Master Educators will be launched in 2010. ♦ The goals of the Academy are to promote, sustain, and recognize excellence in medical education. Society members will serve as mentors; lead faculty development programs, journal clubs, and peer review activities; and create lectureships and symposia showcasing leadership and research in medical education. ♦ To fairly and appropriately recognize the contributions of faculty members to the core missions of the medical college, a major review and subsequent revision of promotion and tenure policies was conducted. ♦ A key outcome of this process was the adoption of a clear definition of educational scholarship and the subsequent creation of a Clinical and Educational Scholarship Track in July 2006. ♦ The criteria for tenure were reviewed and expanded, creating Universitywide standards. The four criteria for tenure, briefly stated are (1) scholarship that has achieved national or international impact, (2) leadership and service to one's profession, (3) service to the university—including teaching commitment, and (4) adherence to professional ethical standards Curriculum Renewal Process In 1999, the Curriculum Committee embarked on a wide-sweeping evaluation of the educational program. The Committee began this process by developing the first version of the JMC Learning Objectives, modeled on the AAMC guidelines and officially adopted in September 2000. What has followed is a decade of curricular reform, guided by these objectives with some modification, in part based on the ACGME competencies. Important curricular changes include ♦ Integration of discipline-specific content into a systems-based curriculum in the first two years ♦ Linkage of the basic sciences and clinical medicine from “day 1” ♦ Creation of a more interactive, student-centered learning environment ♦ Development of longitudinal curricula in clinical skills, evidence-based medicine, chronic disease management, teamwork skills, and professionalism ♦ For the past two years, attention has been directed to increasing the emphasis on basic science applications and use of diagnostics in the third and fourth years Key elements that have enabled the JMC curriculum renewal process include (1) a Dean with vision and dedication to excellence in medical education, (2) the support of a thoughtful, knowledgeable, dedicated cadre of educators, (3) collaboration among departments and with our students, (4) communication via multiple channels, (5) creation of a financial model that reaches across departmental silos, (6) creation of a promotion system that rewards educational efforts, and (7) an energetic and high-functioning dean's staff. Learning Outcomes/Competencies ♦ The JMC Learning Objectives were officially adopted in September 2000. They have undergone periodic review, most recently in the spring of 2009 with revision and expansion into a competency-based format. The domains of the JMC Competencies are Professionalism and Altruism, Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Lifelong Learning, and Systems-Based Care. New Topics in the Curriculum Since 2000 ♦ The topic of quality improvement has been in the JMC curriculum since the early 1990s. Since 2002, this topic has been expanded and includes case-based discussions about quality and safety in the first- and second-year Introduction to Medicine courses and a third-year full-day “Patient Safety Inter-Clerkship.” JMC was one of 10 medical schools awarded an Enhancing Education for Chronic Illness Care grant, sponsored by AAMC and the Josiah Macy Jr. Foundation (2006-08). This provided partial support not only for improvement in chronic illness care education, but also for design and implementation of a team-based learning project, which has now grown to include five other health professional student programs. Modules include (1) a longitudinal interprofessional student-patient mentor program, Jefferson Health Mentors (described in more detail in the Highlights section below), (2) follow-up of a discharged hospitalized patient with chronic disease regarding transitions of care during the third-year internal medicine clerkship, and (3) participation in a practice-based improvement module during the fourth-year outpatient subinternship. ♦ A major initiative to expand and improve clinical skills teaching and evaluation via use of simulation began in 2001-02 with the hiring of two new faculty and the opening of a small, temporary clinical skills center. ♦ Over the ensuing years, a four-year curriculum has been planned and implemented using standardized patients, models, mannequins, simulators, and AV digital recordings as educational resources (see Changes in Assessment). ♦ In 2008, the six-story, 136,000-square-foot Dorrance H. Hamilton Building, with two floors dedicated to clinical skills teaching and simulation, was opened. It is equipped with the most up-to-date simulation equipment and supports educational programs in undergraduate medical education, graduate medical education, continuing medical education, nursing education, health professions education, and remedial programs. ♦ Other topics introduced and enhanced over the past decade include cell biology, cancer biology, genetics, geriatrics, palliative care, community health, and public health topics including health care disparities and health literacy. Changes in Pedagogy There is not one element of the JMC curriculum that has not been affected by changes in pedagogy. Changes implemented to foster interactive learning in the context of a class size of about 255 students per year include ♦ Increased faculty-facilitated small-group, case-based learning: Introduction to Clinical Medicine courses, core clerkship didactic sessions. ♦ Team learning: creates a small-group problem-solving experience within a large-group setting, guided by faculty experts. ♦ Peer teaching: anatomy laboratory sessions that split the class in half, alternating dissection sessions with students teaching the other half of their small group the key findings. ♦ Audience response system: used for interactive full-class case discussions and review sessions. It provides each student immediate, confidential self-assessment and the faculty with immediate assessment of the level of class performance. Faculty can then tailor the ensuing discussion of the case to the level of understanding of the class. Other applications of new technology over the past decade include ♦ virtual microscopy for microscopic anatomy and pathology ♦ expanded use of the intranet: all course information, collection of assignments, testing, posting of grades, online resources (such as Up-to-Date, WISE-MD) ♦ digital AV recording of Jefferson lectures, posted on the intranet ♦ team assignments across multiple clinical campuses using blogs and wikis ♦ high-fidelity simulation: SimMan, SimBaby, Noelle Increased student satisfaction with teaching has been one consistent measure of the success. Changes in Assessment As was anticipated in our report a decade ago, the most significant change in student assessment has been the incorporation of simulation in assessment of clinical skills. ♦ Encounters with standardized patients (SPs) are incorporated into the Introduction to Clinical Medicine curriculum in both the first and second years. Formative feedback is provided by physician-trained SPs and by small-group peers and faculty during group reviews of digital AV recordings. ♦ End-of-clerkship and end-of-year OSCEs have been incorporated into the student summative assessments. ♦ In addition to testing communication/interpersonal skills and basic physical diagnosis skills, by using “hybrid” stations with a model and an SP, core procedural skills are also evaluated. Other changes in assessment include ♦ Increased use of NBME-style examination questions for course examinations, use of the NBME clinical subject examinations in core clerkships, and reflection papers. ♦ Computer-based testing as the only testing platform in several courses and in combination with traditional methods in others. Over the past few years, much more attention has been focused on providing opportunities for “benchmarked” student self-assessment. Examples include: ♦ online test question banks ♦ classroom use of the audience response system ♦ self-assessment of performance in clinical coursework Clinical Experiences Jefferson has an extraordinary regional clinical network. Our 19 hospital affiliations include the university hospital; several academic health centers; a veteran's administration hospital; and pediatric, neurological, psychiatric, rehabilitation, and eye specialty hospitals. ♦ Community-based training is a rich component of the curriculum. Sites include primary care and specialty offices and clinics, patients' homes, geriatric centers, nursing homes, and community health sites. ♦ We work hard to assure that each of our students continues to have a rich clinical experience with active involvement in the care of a diverse patient population under the supervision of outstanding faculty and resident role models. Regional Campus ♦ Planning is under way for the development of a regional health sciences campus in Delaware. This campus is one component of a new initiative, the Delaware Health Sciences Alliance (DHSA). ♦ The DHSA is built on many long-standing educational collaborations between JMC and Delaware health and science programs and projects. ♦ The member institutions of the DHSA are the University of Delaware, the Nemours Foundation, the Christiana Care Health System, and Thomas Jefferson University. Highlights of the Program/School Professionalism Heightened concern about and attention to professionalism at JMC led to the creation by the Curriculum Committee student-faculty Task Force in 2000; this initiative has steadily grown in scope. Most recently, in July 2009, a new position of Associate Dean for Education, with specific responsibilities for enhancing teaching of medical professionalism, was created. ♦ The Associate Dean now coordinates professionalism education with the Offices of Graduate Medical Education and Faculty Affairs and in all four years of the medical school curriculum. This curriculum includes discussions on professionalism in the First Year Orientation, small-group and team-based learning sessions in Introduction to Clinical Medicine I and II, a day-long interactive third-year “interclerkship” session, and newly developed professionalism workshops during five of the core clerkships. ♦ These five workshops are led by faculty facilitators with no role in grading the students, and they focus on a different area of professionalism. These areas include managing conflicts of interests (during the internal medicine clerkship), patient autonomy (surgery), honesty with patients (pediatrics), patient confidentiality (obstetrics-gynecology), and conflict resolution (emergency medicine). ♦ The third- and fourth-year workshops begin with a discussion of cases and commentaries from the text Professionalism in Medicine: A Case-Based Guide for Medical Students (Cambridge University Press, 2009). The text is edited by JMC faculty and contains 72 medical professionalism vignettes and commentaries and literature reviews of eight professionalism areas. ♦ Most of the workshop time is dedicated to professionalism concerns raised by students about encounters they have experienced during their clinical rotations. For information on the book and videos, go to http://professionalism.jefferson.edu/. Interprofessional Education ♦ The Jefferson Health Mentors Program, developed by a team of faculty from across the university under the auspices of the Enhancing Education for Chronic Illness Care award described earlier, has served as the cornerstone of a robust initiative to ensure that all Jefferson students graduate with core skills in patient-centered, team-based care. ♦ The Jefferson InterProfessional Education Center (JCIPE), established in 2007, is now home for interprofessional curriculum and co-curricular activities, faculty development, and scholarship. Codirected by faculty from the medical college and nursing school, the Center works with 50 faculty and will train approximately 1,500 students in 2009-10. ♦ Evaluation has included quantitative assessment of readiness for interprofessional learning and attitudes to team-based care and qualitative evaluation of program impact. ♦ Scholarly work since 2007 includes 31 peer-reviewed presentations, 3 peer-reviewed papers, and 3 peer-reviewed abstracts. ♦ The Jefferson Attitudes to Chronic Illness Care tool, developed with the Center for Research in Medical Education and Health Care, has documented the attitudes of medical and other health professions students toward caring for patients with chronic conditions and appears to be sensitive to students' exposure to patients as teachers. ♦ Baseline assessment of Jefferson medical and nursing students' attitudes (Arenson CA, Rattner S, Borden C, Collins LG, Fields SK, Gavin E, Veloski JJ. Cross-sectional assessment of medical and nursing students' attitudes toward chronic illness at matriculation and graduation. Academic Medicine, 2008:83[10 Suppl]:S93–96) was awarded the Outstanding Paper Award at the 48th Annual RIME Conference. Interprofessional Care for the 21st Century: Redefining Education and Care, sponsored by JCIPE, has grown from a university faculty development program in 2008 to an international meeting of educators and clinicians striving to improve health care education and practice. Development of Web-Based Educational Management Resources Although there was individual use of the Blackboard Academic Suite started in 1996, faculty development and collegewide adoption began in 2000 with the official launch of the Jefferson intranet, PULSE, as our communications hub. All courses and core clerkships now post communications and resources for use by students and faculty. This includes digital audiovisual recordings of many lectures. ♦ The Jefferson Patient Encounter Log System (PELS) software has been used to record and track patient encounters on the core clerkships since 2002. This PDA-based program was implemented at that time to replace scanned cards. ♦ In 2009, a parallel option was developed and implemented, allowing students to enter encounters and procedures on either a PDA or web-enabled computer. This process allows the students to enter patient data securely via the Internet whenever possible, using the more convenient user interface of a desktop computer. ♦ In 2007, the Office of Academic Affairs, with Thomas Jefferson University Hospital, began a project to develop a unified electronic, online evaluation system for our undergraduate and graduate medical education programs. ♦ A commercial vendor was engaged to develop a system that would permit faculty, residents, and students to use a single site for all clinical evaluations. An extensive process to select this vendor included interviews with current customers and hands-on testing of multiple products. ♦ An important decision point included the willingness of the vendor to make necessary modifications to accommodate fundamental differences between resident evaluations and student evaluations. Information technology specialists, from the vendor and Jefferson, worked to develop a novel site that enables all users to login with a “single sign-on” using credentials already on file at Jefferson. ♦ Future directions include development of electronic portfolios for student and residents.