McGovern Medical School at The University of Texas Health Science Center at Houston.

Abstract

Medical Education Program Highlights The curriculum of McGovern Medical School (MMS) integrates basic science and clinical experiences with an emphasis on active learning in small groups and new pedagogical methods. Weekly opportunities for student self-assessment and frequent feedback from faculty engage students in shaping their learning experiences. During the second semester, students begin a yearlong longitudinal patient care experience supervised by community preceptors. Required core clerkships begin in the spring of the second year. The accelerated schedule provides more elective opportunities for students to focus on career interests and residency preparation. MMS offers a variety of programs that enhance and extend the core curriculum: There are 14 interdisciplinary scholarly concentrations available to students to enrich their educational experiences through learning and scholarly activities. Students enrolled in a concentration are required to complete a scholarly project before graduation. Career focus tracks (CFTs) provide a baseline structure to the fourth year based on career aspirations, as well as more formal career mentoring, while maintaining the flexibility to pursue additional areas of interest. The 4 CFTs—applied anatomy, primary care, acute care, and academic career—provide guidance and mentorship to students in the specialty to which they plan to apply. A poverty simulation occurs at the end of the second year before the students begin the clerkships. The simulation assigns all students to play the role of a family member experiencing varying degrees of poverty. The goal of the simulation is to enhance students’ awareness of the realities of their impoverished patients in hopes that they will deliver culturally appropriate and economically sensitive care as well as to identify community resources to address their patients’ medical and nonmedical needs. During the Transition to Clerkships course, all the second-year students participate in an interprofessional mass casualty simulation. MMS students work with UTHealth students from the Cizik School of Nursing, the School of Public Health, the School of Dentistry, and the School of Biomedical Informatics in a mass casualty simulation. Students are directly observed by faculty from each school and are provided formative assessment focused on their interactions with the students from the other health care disciplines. Curriculum Curriculum description The medical education program consists of 3 major phases: integrated medical science, required clerkships, and career focus tracks. The integrated medical science phase consists of a Foundations of Medical Science course including team-based learning, organ system modules, and Doctoring courses, which include problem-based learning sessions during Doctoring 2 and 3. The second phase of the medical education program consists of required clerkships. The third phase consists of the career focus tracks. During the tracks, the students complete 3 required advanced clinical selectives (ambulatory care, advanced patient care, and critical care) and 7 four-week electives. See Supplemental Digital Appendix 1—Curriculum Map—at https://links.lww.com/ACADMED/A928. Curriculum changes since 2010 Over the last 10 years, the curriculum has evolved to be more fully integrated by transitioning from a curriculum based on basic science disciplines to one based on organ system modules. There has been a significant effort to include clinical faculty teaching within the preclerkship curriculum. The revised curriculum also features 5 longitudinal themes. The themes are clinical skills, population health, ethics and professionalism, evidence-based medicine, and systems of care/health systems science. The revised curriculum was implemented in 2016. Since 2010, the class size increased from 230 to 240 students per class per year. This increase did not affect the medical school’s structure or functions. Assessment Medical education program objectives are described in outcome-based terms that allow the assessment of medical students’ progress in developing the competencies that the profession and the public expect of a physician (2020–2021 LCME Standard 6.1). The Curriculum Committee reviews and approves the educational program objectives yearly. There are educational program objectives related to patient care, clinical procedures (routine and specialized), medical knowledge, interpretation of medical data/practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The educational program objectives are based on the ACGME domains of competence as well as selected Core Entrustable Professional Activities. Since 2010, we have adopted NBME customized examinations for organ system modules in years 1 and 2. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A928. Parallel curriculum or tracks MMS introduced a longitudinal integrated clerkship (LIC) pilot in academic year 2019–2020 for 10 third-year medical students. In the pilot year, the LIC was 24 weeks long and included the internal medicine, pediatrics, obstetrics–gynecology, and geriatrics disciplines. Students complete their clinical learning in an integrated fashion, rotating between the various specialty areas every half day with continuity of preceptors, patients, and locations. For the 2020–2021 academic year, family medicine will be added to the LIC, and the duration of the LIC will increase to 28 weeks. Pedagogy In the preclerkship curriculum, a variety of pedagogical approaches are used including problem-based learning, team-based learning, lectures, laboratories, preceptorships, simulations, standardized patients, and case-based learning to deliver the majority of content. Active and self-directed learning modalities are emphasized. In the clinical curriculum, we use ambulatory and inpatient clinical experiences, lectures, team-based learning, case-based learning, small-group discussions, simulations, and standardized patients. The majority of content is delivered through direct patient experiences. The simulation program has grown significantly since 2010. Two preclerkship modules (cardiovascular and gastrointestinal) and 2 clerkships (internal medicine and neurology) incorporate simulation activities. As indicated above, active and self-directed learning modalities are emphasized, and the overall number of lecture hours has decreased with the addition of flipped classroom activities in the preclerkship curriculum. Clinical experiences Clinical education occurs in several sites including outpatient clinics, hospitals, and community preceptor offices. Students first encounter standardized patients during the Doctoring 1 course in the first semester of the first year. Beginning in the second semester of the first year, students participate in a longitudinal clinical experience where a half day per week is spent working with a preceptor in an outpatient setting. Students participate in a required ambulatory medicine selective during the fourth year. This is an outpatient clinic–based selective, allowing students to choose a particular area of focus consistent with their career trajectory. Students also revisit the principles of evidence-based medicine and complete a critical review of the literature for a clinical question based on a patient experience. We are fortunate to be affiliated with 2 large teaching hospitals providing complementary clinical experiences and a large number and diversity of patients. Challenges associated with the clinical education of our students are related to the large class size (240 students per year) and faculty attendings with multiple responsibilities. Curricular Governance The Curriculum Committee is charged by the dean to provide oversight of the medical education program, including the design, management, integration, evaluation, and enhancement of a coherent and coordinated medical curriculum. There are 6 subcommittees of the Curriculum Committee: The Policy Review Subcommittee reviews and discusses proposed policies and procedures before presentation to the Curriculum Committee for formal approval and implementation (if approved). The Preclerkship Education Subcommittee provides oversight of all preclerkship courses and modules including adherence to the preclerkship contact hours policy; the academic workload policy; review of pedagogical methods used; and the coordination of educational content with other modules, the problem-based learning curriculum, and the longitudinal themes. The Clinical Education Subcommittee provides oversight of the medical student required clinical experiences, including adherence to the duty hours policy, review and approval of required clinical and procedural/skills experiences, completion by students of required clinical and procedural experiences, completion of midrotation feedback, submission of grades, and appropriate supervision by full-time faculty. The Preclerkship Evaluation Subcommittee reviews the preclerkship courses and modules annually and presents findings to the Curriculum Committee. The Clerkship and Advanced Clinical Education Evaluation Subcommittee reviews the clerkships and required advanced clinical selectives annually and presents findings to the Curriculum Committee. The Continuous Accreditation Review and Quality Improvement Subcommittee provides ongoing monitoring to assure medical school compliance with LCME accreditation standards and elements and engages in continuous quality improvement activities to enhance medical education programmatic quality. The dean of the medical school allocates state funds to departments specifically for education. These funds are used to support faculty with major teaching responsibilities. (e.g., clerkship directors) as well as clerkship coordinators. The dean also allocates funds to the Office of Educational Programs for general support of the educational program (e.g., core faculty, course/module directors, simulation activities, etc.). Education Staff The Office of Educational Programs (OEP) is responsible for the planning, implementation, evaluation, and oversight of the curriculum. The OEP provides administrative support for all of the curriculum review activities. The OEP also develops and maintains tools to support curriculum delivery, monitoring, and management. The OEP includes a vice dean, 4 associate deans, 3 assistant deans, 1 director of educational development, 1 director of educational technology, 2 educational specialists, 1 medical educator, 2 senior program managers, 3 program managers, 1 instructional designer, and 4 educational coordinators. See Figure 1—Education staff.Figure 1: Education staff.The OEP faculty and staff provide general administrative oversight and management for all aspects of the undergraduate medical education curriculum. This includes chairing the Curriculum Committee and its associated subcommittees; administering interdepartmental courses and fourth-year clinical selectives; managing the standardized patient program; administration of the comprehensive clinical competency examination at the end of the third year; as well as several student programs, including the preentry program, the summer research program, the scholarly concentrations program, and the career focus tracks. The OEP monitors student performance outcomes to measure the efficacy of the curriculum, including student performance on national examinations and performance in residency training programs. The office is also responsible for managing the Surgical and Clinical Skills Center. The OEP is not responsible for medical school admissions or student affairs. Faculty Development and Support in Education Faculty development activities include educator development sessions, educational retreats, online faculty development through Magna Commons “20-Minute Mentor” videos, the Health Educators Fellowship Program, and the Academy of Master Educators. The OEP provides workshops as requested by the medical school departments, as well as individual consultations with faculty to enhance their teaching skills and understanding of learner evaluation. The monthly educator development sessions are recorded so that faculty who are not able to attend sessions can access the material. It is intended that these sessions will be live streamed to faculty at other sites in the future. Faculty must demonstrate ability in 4 domains of achievement to be considered for promotion and tenure: clinical/patient care, research/scholarship, education, and service/administration. Teaching activities, such as didactic teaching, problem-based learning facilitation, and student mentoring, may count toward the education domain. Educational scholarship can also be applied to the research/scholarship domain provided it demonstrates impact on the candidate’s field. Scholarly activity can be in many forms (e.g., peer-reviewed publications, invited articles, awards and honors, speaking invitations). MMS Academy of Master Educators (AME) is a formal organization of distinguished scholars recognized for their teaching and educational excellence, and committed to the enhancement of medical education. A goal of the AME is to have diverse membership representing the many disciplines in health science education. AME members encourage faculty who are dedicated to scholarly teaching and to educational scholarship and serve as professional role models and mentors for faculty, residents, fellows, and students. AME membership is open to any medical school faculty member.