Abstract
ABSTRACT Many challenges could occur that result in the need to handle an increase in the number of medical student clinical placements, such as curricular transformations or viral pandemics, such as COVID 19. Here, we describe four different institutions’ approaches to addressing the impact of curricular transformation on clerkships using an implementation science lens. Specifically, we explore four different approaches to managing the ‘bulge’ as classes overlap in clerkships Curriculum leaders at four medical schools report on managing the bulge of core clinical placements resulting from reducing the duration of the foundational sciences curriculum and calendar shifts for the respective clerkship curriculum. These changes, which occurred between 2014 and 2018, led to more students being enrolled in core clinical rotations at the same time than occurred previously. Schools provided respective metrics used to evaluate the effectiveness of their bulge management technique. These data typically included number of students affected in each phase of their curricular transformation, performance on standardized examinations, and student and faculty feedback. Not all data were available from all schools, as some schools are still working through their ‘bulge’ or are affected by COVID-19. There is much to be learned about managing curricular transformations. Working on such endeavors in a learning collaborative such as the AMA Accelerating Change in Medical Education Initiative provided support and insights about how to survive, thrive and identifying lessons learned during curricular transformation.
Highlights
Innovative educational transformations are occurring across physician training, including undergraduate medical education (UME) [1,2,3] and graduate medical education (GME) [4,5,6,7]
Some curricular revisions occurring in UME involve decreasing basic science education delivered before core clerkships, which can result in an influx of medical students entering clinical rotations earlier than occurred in the prior curriculum, creating a ‘bulge’ in student clinical placements
Implementation science frameworks have largely been addressed in theory rather than application [11,13,14]
Summary
Innovative educational transformations are occurring across physician training, including undergraduate medical education (UME) [1,2,3] and graduate medical education (GME) [4,5,6,7]. Some curricular revisions occurring in UME involve decreasing basic science education delivered before core clerkships, which can result in an influx of medical students entering clinical rotations earlier than occurred in the prior curriculum, creating a ‘bulge’ in student clinical placements. Such transformations can stress faculty, staff, residents, and medical students, especially when two different curri cula are running simultaneously. The American Medical Association’s (AMA) Accelerating Change in Medical Education Consortium [8] is a learning collaborative formed in September 2013, initially including 11 medical schools and expanding to 32 schools in January 2016 This ongoing collaborative was designed to share ideas across North American medical schools implementing innovations. The four schools repre sented in this paper united around the fact that we were assessing the impact curricular changes had in some detail
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