Keck School of Medicine of the University of Southern California

Abstract

Curriculum Management and Governance Structure ♦ Education Policy Committee (EPC): The EPC advises the Dean and evaluates all matters related to medical education including general oversight of the curriculum and focuses on policies related to administering medical education. ♦ The EPC membership includes representatives from every clinical and basic science department, chairpersons of the Year I-II and Year III-IV Curriculum Committees, as well as student representatives. Educational deans and medical education faculty participate in an ex officio capacity. ♦ Curriculum Committees: The curriculum committees that report to the EPC are comprised of System Chairs and Discipline Coordinators (Year I-II Curriculum Committee) and Clerkship Directors, Medical Student Educators (MSE), and Basic Science representatives (Year III-IV Curriculum Committee). Students, educational deans, and medical education faculty participate in all meetings. Office of Education ♦ There are multiple offices that support the medical student education program: The Curriculum Office, the Student Affairs Office, the Office of Diversity, and the Division of Medical Education. ♦ The Division of Medical Education was organized in 1963. The Division is staffed by ten doctorate-level professionals with degrees in education and six full-time staff members. ♦ The Division of Medical Education was established to support and encourage the improvement of medical education by providing faculty development; consulting on the design, implementation, and revision of educational programs; and conducting research into effective means of delivering medical education. The division has an active standardized patient program that provides patients for teaching and evaluation at USC. The program conducts clinical performance examinations for all USC students matriculating into the fourth year of medical school as well as Objective Structured Clinical Examinations (OSCE) for students in Introduction to Clinical Medicine (ICM) and the clerkships. The program participates as a member of the California Consortium for the Assessment of Clinical Competence, which was created by a grant from the Josiah Macy Jr. Foundation. Medical Education maintains a unit with expertise in psychometrics, research design, and statistical analysis. The unit is active in institutional research (i.e., admission history and graduation rates) and other educational research projects. The division offers a masters degree program for faculty in health professions, two faculty development fellowships in Teaching/Learning and Educational Leadership, and an Educational Scholars program for USC faculty. The division also supports a Learning Resource Specialist who counsels students experiencing academic difficulties. Financial Management of Educational Program ♦ The KSOM has a mix of revenues to support its varied activities. This mix negates any volatility of its revenues and allows for a consistent revenue stream. ♦ Additionally, USC is a large private university and as such remains unaffected by the decreased support from the State of California that has negatively impacted other California medical schools. ♦ In 2008, the Dean appointed a new position, Vice Dean for Education, providing centralized financial management. ♦ In FY 2009, a new budget methodology was enacted that allocated budgets to departments based on medical student teaching effort. The budget allocation to the respective department was provided based on a formula that evaluated teaching effort provided by faculty that were based within their department. Valuing Teaching ♦ The Medical Educators' Collegium is constituted as an honor society of faculty, fellows, residents, and students committed to promoting and supporting educational excellence at the Keck School of Medicine. Its faculty members are individuals with established records of excellence as educators. ♦ The promotion and tenure process includes a Clinical Educator designation for clinician faculty whose primary activities include teaching and educational scholarship. Promotion of tenure track faculty requires demonstrable excellence in teaching of medical students and trainees. Curriculum Renewal Process ♦ Full curriculum integration was advanced through redesign of the Keck curriculum, initiated in 2001, in which each section and system of the curriculum builds upon previously acquired knowledge and skills. Disciplines that had been taught and graded separately in the old curriculum were integrated within the new curriculum. ♦ Ongoing integration and coordination is managed through systematic curriculum review by the Curriculum Committees and periodic meetings of the EPC with the Curriculum Committees. ♦ A phased-in revision of the year III-IV curriculum has occurred over the past nine years. The years I-II and III-IV Curriculum Committees perform regular review of their respective curricula. If results of curricular review suggest that educational delivery of a particular unit may not be optimal, this information is brought to the attention of the appropriate Curriculum Committee and/or EPC for further discussion. ♦ If necessary, a subcommittee may be appointed to conduct a needs assessment and report back to the EPC. In this way, curricular planning operates as an extension of curricular evaluation. Learning Outcomes/Competencies Competencies for KSOM graduates have been established and linked to the School's Educational Objectives, as indicated in Table 1.TABLE 1: Competencies for GraduatesTABLE 1: (Continued)New Topics in the Curriculum Since 2000 ♦ Patient Safety and Quality Improvement are taught in an integrated manner across all four years of the curriculum. Students are introduced to core concepts in year I and II ICM, receive instructions during year III Orientation, which is reinforced during each of the core clerkships, and they participate in a day-long seminar on Patient Safety (including performing a root cause analysis) during year IV. ♦ Simulations have been a part of the curriculum at USC since standardized patients were introduced in the 1970s. KSOM currently uses the SimMan/Ventriloscope/eye model in the ICM program and in the Medicine core clerkships. Students visit the Procedural Skills Center during all four years, and prior to beginning year III, they take a required one-day course in IV catheter insertion, ABGs, Foley catheter and nasogastric tube placement, suturing, incision, and drainage procedures, and so on. These skills are reinforced during all core clerkships, both in the Center and on the wards. Changes in Pedagogy ♦ Professionalism and the Practice of Medicine (PPM): This Year I-II course was implemented with the curricular revision in 2001 and was designed to address KSOM's core program goals in the domains of professionalism, ethics, cultural competence, and health care policy/finance. Students meet once per week in cohorts of 24 students with two faculty mentors. PPM stresses group process and reflective work, and students are evaluated on participation and presentation skills (Elliott DD, May W, Schaff PB, Nyquist JG, Tria J, Reilly JM, Lattore P. Shaping professionalism in preclinical medical students: Professionalism and the practice of medicine. Med Teacher. 2009; 31:7, e295–e302). ♦ Integrated Cases Section (ICS): This seven-week course takes place at the end of Year II. ICS includes studies of cases that integrate basic science knowledge with the diagnosis and management of complex clinical cases where multiple organ systems are involved. ICS emphasizes problem solving in the diagnosis and management of cases. Under the guidance of faculty facilitators, students learn clinical reasoning related to managing undifferentiated clinical problems such as fever, fatigue, and headache. The cases on the end-of-Year II OSCE are designed to evaluate students' mastery of the educational objectives of ICS. ♦ Student Practice Profile (SPP): The SPP integrates 200 case studies within all portions of the curriculum, providing a structure for curriculum organization and clinical relevance across the four-year curriculum. In Years I and II, SPP cases are integrated into the systems, providing a framework for establishing clinical relevance and correlations with the basic sciences. Clinical and didactic experience with SPP cases is completed in Years III and IV; required clerkships identify SPP cases and patient encounters needed to meet clerkship objectives, and adjustments have been made across clerkships to assure that all SPP cases are experienced, and the clerkship required cases are balanced and coordinated (Abbott A, Sullivan M, Nyquist J, Taylor C. The development of a ‘Medical Student Practice Profile’ core curriculum at the University of Southern California. Teaching Learning Med. In Press. 2010). Changes in Assessment ♦ Peer assessment of professionalism was implemented in the PPM course in 2001. ♦ Professionalism of students, residents, and faculty is also being assessed as part of the NBME Assessment of Professional Behaviors (APB) pilot project during 2009–11. ♦ Computerized testing was implemented in years I and II beginning in 2009. ♦ NBME subject examinations are now used in all core clerkships. ♦ All clerkships (with the exception of Pediatrics) now use OSCEs as part of the evaluation of students. ♦ Each clerkship also incorporates assessment of students' mastery of the SPP that represents the overarching structure (as well as the must-see cases) of the KSOM curriculum. Clinical Experiences ♦ KSOM's primary clinical teaching site, the new LAC + USC Medical Center, opened in November 2008 and provides students with a state-of-the-art learning environment and a wealth of patients and opportunities for clinical experiences. In anticipation of the new hospital having fewer beds than the old, KSOM recently added additional affiliated clinical sites. This includes two sites (Kaiser and California Hospital) for the Obstetrics-Gynecology clerkship to ensure that students have adequate labor and delivery experiences, as well as Santa Barbara Cottage Hospital where students can rotate through OB-GYN, Pediatrics, Internal Medicine, and Psychiatry. In April 2009, the University acquired ownership of USC University Hospital and Norris Cancer Hospital, thereby assuring a more seamless clinical education at these two hospitals. ♦ All clinical sites are reviewed by the Year III-IV Curriculum Committee for the appropriateness of clinical exposure, equivalence of opportunities across sites and excellence of faculty at sites other than KSOM's core teaching sites (LAC + USC, CHLA, USCUH, and Norris). For example, the Psychiatry clerkship sites (many of which were added as the clerkship sought to identify sufficient opportunities for clinical education) were reviewed, and of the multiple sites utilized in 2007–08, five were deemed to offer an inadequate educational experience during a review in 2008–09. Modifications were made, and for academic year 2009–10, students rotated through seven Psychiatry sites. ♦ Sites for clinical education are listed in Table 2.TABLE 2: Clinical Sites* Highlights of the Program/School ♦ Medical Student Educators (MSEs): Because medical school faculty members face increased clinical and academic demands, leaving less time for teaching, curriculum development, and assessment of learners, KSOM has hired a dedicated medical student educator (MSE) for each required clerkship. ♦ The medical student educator (usually an advanced practice nurse or physician assistant) assists the clerkship director with clinical teaching, curriculum development, student and program evaluation, and administrative functions. The program has been well received by both students and faculty. ♦ Students believe that the medical student educators add value to their clinical experiences and support both their clinical education and personal and professional development. ♦ Preliminary data suggest that student performance has improved, and additional measures of quantitative impact are under way (Elliott D, Ingersoll S, Sullivan M, Bruning M, Logan M, Taylor C. The nonphysician ‘medical student educator’: A formal addition to the clerkships and key programs at an academic medical center. Teaching Learning Med. 2007; 19(2): 154–161). ♦ Introduction to Clinical Medicine (ICM): The ICM program celebrates its 40th birthday this year and is considered by many students and faculty to be the “jewel in the crown” of the KSOM curriculum. ♦ Students spend one to two half days per week during Years I and II with a clinical faculty member as they learn interviewing and physical examination skills and the art and science of medicine. ♦ The majority of the ICM experience takes place in the clinical setting, with students beginning their clinical encounters in the first few weeks of medical school. ♦ Professionalism and the Practice of Medicine (PPM): With increasing emphasis placed on the teaching and assessment of professionalism in the continuum of medical education, KSOM aimed to develop a novel longitudinal course in professionalism spanning the first two years of the curriculum. Using the conceptual framework of constructivism, principles of adult learning, experiential learning, and reflective practice to integrate learning with experience, we include student input in session development. ♦ Faculty mentors serve as role models to guide, assist, and counsel students. Assessment of learners is accomplished using self, peer, and mentor evaluation and a student portfolio. Program evaluation is by course and faculty evaluation. ♦ The Student Practice Profile (SPP), as described above, integrates case studies within all portions of the curriculum, providing a structure for clinical relevance and curriculum organization across the four-year curriculum. ♦ Program in Medical Humanities, Arts, and Ethics: In 2006–07, KSOM rejuvenated its Humanities, Ethics, Art, and Law (HEAL) curriculum and implemented an integrated four-year longitudinal program. Students experience these curricular components in ICM, PPM, the core clerkships, the Senior Seminar Series, and in year IV electives. ♦ Additionally, the extracurricular components include a faculty-student reading group, a faculty-staff-student art gallery (home to two shows per year), life-drawing classes, museum visits, and the opportunity to experience cultural and artistic events in Los Angeles through the University's Arts and Humanities Initiative.