Medical University of South Carolina College of Medicine.

Abstract

Medical Education Program Highlights A longitudinal interprofessional education curriculum includes required interprofessional courses and activities in the preclerkship phase, required interprofessional experiences in each clerkship, a robust offering of electives (e.g., culinary health elective), and increased opportunities to work with underserved populations in various community settings through the CARES student-run free medical clinic. The new Flex Curriculum offers students options for pathways: global health with scholarship support for global field experiences, health humanities, physician as teacher, clinical and basic science research, a primary care parallel curriculum, and an accelerated 3-year MD degree program that tracks into a residency position in 1-on-1 residency programs. A newly developed wellness program, Student Wellness Council, and learning community model emphasize the importance of personal wellness, resilience, and supportive relationships. Curriculum Curriculum description See Supplemental Digital Appendix 1—Curriculum Map—at https://links.lww.com/ACADMED/A912. See Figure 1—Flex pathways.Figure 1: Flex pathways.Curriculum changes since 2010 In 2009, a new preclinical integrated curriculum was implemented that replaced traditional courses with a comprehensive, organ system–based curriculum of basic science and clinical science content administered through a coordinated, central governance model. Building on successes and lessons learned, the new Flex Curriculum preclerkship phase (66 weeks) was implemented in AY 2018–2019 as organ system blocks that cohesively blend learning of normal and abnormal to teach the spectrum of human health and disease in engaged learning formats. Learners engage in early clinical experiences in the hospital, the community, and simulation settings that enhance application of basic science concepts. In the Flex pathways phase (13 weeks), each learner selects a scholarly concentration pathway (basic science or clinical science research, health humanities, global health, or physician as teacher) that best meets their educational needs, professional interests, and career aspirations. Alternatively, students who are eligible may apply to the accelerated medical pathway (AMP), which leads to graduation after 3 years with entry into a conditional residency position at the Medical University of South Carolina (MUSC). The clinical immersion phase (49 weeks) comprises 7 core clinical clerkships: family medicine, internal medicine, neurology and rehabilitation medicine, obstetrics–gynecology, pediatrics, psychiatry, and surgery. Students choose 2 selectives for additional immersion in specialties of their choice. The clinical enrichment phase (34 weeks) is made up of a new, required critical care elective, advanced clinical electives, and the Internship 101 Capstone course, all of which are designed to prepare learners for the transition to increased levels of responsibility for patient care. The class size was increased from 174 to 180 when the regional campus was established. The regional campus offers a primary care parallel track that integrates the traditional curriculum with unique opportunities for learners to attain greater breadth and depth of experience in the areas of primary care, community medicine, population health, and service learning. 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. Medical education program objectives The medical education program objectives were informed by the following competency frameworks: ACGME domains of competence, AAMC Core Entrustable Professional Activities, and the Physician Competency Reference Set competencies. See Supplemental Digital Appendix 2—Program Objectives and Assessment Methods—at https://links.lww.com/ACADMED/A912. MUSC College of Medicine offers 2 parallel curricula: Primary care parallel curriculum at the AnMed Health regional campus (https://medicine.musc.edu/education/medical-students/curriculum/anmed-clinical) AMP 3-year parallel curriculum (https://medicine.musc.edu/education/medical-students/curriculum/clinical-curriculum/accelerated-medical-pathways) Pedagogy The medical education program uses a variety of pedagogical approaches in the preclerkship phase and the clinical immersion and enrichment phases. Pedagogical approaches that are new to the curriculum since 2010 are indicated with (*). Case-based and team-based learning* are used throughout the organ system–based preclerkship blocks. Lecture-based didactics are used to prepare learners for applied learning experiences. Multiple-patient panels are used to enhance the learner’s understanding of the patient experience of disease, the health care system, and disparate treatment.* The new multisystem integration block* emphasizes the use of self-directed learning and clinical problem solving. Anatomy laboratory teaching is enhanced by a peer teaching model.* The longitudinal clinical skills curriculum that spans the preclerkship phase uses a combination of small-group discussion, simulated and standardized patient encounters, inpatient teaching rounds, and clinical reasoning case-based learning strategies. The AnMed Health clinical campus uses a longitudinal continuity clinic model.* The core clerkship curricula use inpatient care, ambulatory care, skills workshops, small-group discussion, and simulation-based teaching in each clerkship. Clinical experiences Clinical sites for required educational experiences: Charleston campus: MUSC hospitals and ambulatory clinics, which include Storm Eye Institute, Shawn Jenkins Children’s Hospital, Pearl Tourville Women’s Pavilion, Main Hospital, Ashley River Tower, Institute of Psychiatry, Hollings Cancer Center; Ralph H. Johnson VA Medical Center; Roper Rehabilitation Hospital AnMed Health Clinical Campus: AnMed Health hospitals and ambulatory clinics, which include the AnMed Health Medical Center and AnMed Health Rehabilitation Hospital; Patrick B. Harris Psychiatric Hospital Required longitudinal experiences The Longitudinal Clinical Skills course spans the preclerkship curriculum. The senior mentor program pairs each student with a community-dwelling senior for the duration of the MD degree program. Students meet with their mentors each semester; the curriculum reflects core geriatric competencies that address topics pertinent to healthy aging (e.g., nutrition assessment, fall risk prevention, advance directives). Medical ethics small-group discussion sessions occur throughout the third- and fourth-year curriculum (3 per semester); students discuss issues that arise during their clinical rotations and apply foundational principles first introduced in the preclerkship curriculum. The Careers in Medicine program and the financial literacy curriculum are required beginning at prematriculation through the spring semester of the senior year. Clinical experience first encounter Students work with standardized and simulated patients beginning the first week of medical school and continuing in each curriculum block from year 1 through year 3. Real patient care experiences begin in the first academic year: Fall I: Each student is assigned to PARTNERS experiences with 2 different interprofessional clinical teams and submits structured reflections on team member roles, effectiveness, and impact on the quality of the patient care. Students are also introduced to the senior mentor they will work with for all 4 years. Spring I: Each student is assigned to a master clinical skills teacher and participates in teaching rounds 5 times over 3 semesters with a focus on history-taking, physical examination, clinical reasoning, and medical documentation. Summer I: In the clinical immersion phase, each student prerounds/rounds with a clinical team in their preferred specialty for 4 consecutive days and participates in clinical care experiences. Required and elective community-based rotations The medical education program uses community-based, ambulatory clinical sites across the state for the 6-week family medicine rural clerkship. Surgery, medicine, psychiatry, and neurology clerkships use the Ralph H. Johnson VA Medical Center. The rehabilitation medicine portion of the neurology clerkship occurs at the Roper Rehabilitation Hospital. Curricular Governance The Undergraduate Curriculum Committee is responsible for curricular governance and has 4 working committees that carry out planning, implementation, assessment, and evaluation functions: Preclerkship Planning and Evaluation Committee Clinical Sciences Planning and Evaluation Committee Selectives and Electives Committee Teaching Effectiveness Assessment Committee The College of Medicine education funds flow process allocates funding to basic science and clinical science departments based on faculty teaching effort and course direction responsibilities. Education Staff Medical student education is organized centrally through the Office of Curriculum, Office of Student Affairs, Office of Admissions, and an Office of Assessment, Evaluation, and Quality Improvement (OAE-QI). The Office of Curriculum organizes the planning, implementation, and evaluation of the curriculum with the support of the OAE-QI; these offices collaborate to develop and maintain the tools to support curriculum delivery, monitoring, and management. The Office of Medical Education works collaboratively with basic science and clinical science departments to secure faculty appointments and protect faculty effort for teaching, course direction, and education leadership for the medical education program. See Figure 2—Medical education administration.Figure 2: Medical education administration.Faculty Development and Support in Education The College of Medicine develops faculty for their role in teaching, assessment, mentoring, and advising students through the collaborative efforts of the Dean’s Office, associate deans for faculty affairs and faculty development, Office of Education, and clinical science and basic science departments. Education grand rounds, round tables, workshops, and special programs offered through the college’s Academy of Medical Educators and the university Apple Tree Society provide a wide variety of development opportunities. Professional development for faculty as educators The Academy of Medical Educators (AME) promotes teaching effectiveness and innovation in medical education and recognizes teaching excellence and scholarship, through a variety of faculty development opportunities: Provides peer observation of teaching in which AME members mentor faculty to improve teaching skills, educational materials, objectives, and assessments Offers workshops for members and nonmembers on topics of teaching and learning Recognizes teaching excellence and scholarship; hosts the annual Pearls for Medical Educators event in which distinguished faculty are invited to share their insights and experiences AME welcomes applications from faculty, fellows, residents, administrators, and staff affiliated with medical education program. Based on defined criteria, individual applicants join AME in 1 of 4 membership categories: distinguished teacher, master teacher, developing teacher, and education specialist. As part of the application process, members are asked to develop an education portfolio in domains that include teaching activity; curriculum; and/or assessment development, advising and mentoring, educational leadership, and educational research. A detailed description can be viewed on the AME website (https://medicine.musc.edu/faculty-affairs/academy-of-medical-educators). The Apple Tree Society is a university-wide academy that promotes excellence in teaching and learning for the faculty of all 6 colleges of the medical university. Role of teaching in promotion and tenure Excellence in teaching and mentoring of students, curriculum development, innovation in education, scholarship in education, and education leadership and course direction activities are viewed as critical components of the criteria for promotion and tenure consideration in the clinician–educator track. The College of Medicine Appointment, Promotion, and Tenure Committee sets criteria that value teaching and education-related efforts. Scholarly activity, curriculum development, and sustained efforts in teaching and education leadership are documented in a faculty intramural teaching effort report. Regional Medical Campus See Table 1—Regional Medical Campus.Table 1: Regional Medical CampusEducational experience across sites The clerkship curriculum at the regional campus uses the same objectives, core didactics, required patient care experiences and procedures, assessments, and expectations for feedback and observation of clinical skills as the main campus. Regional campus site directors for each clerkship participate along with clerkship directors in the CSPEC monthly meetings and biannual retreats; one of the biannual retreats for clinical education is held at the regional campus. At-large faculty and associate deans from the regional campus are active members of the Curriculum Committee and subcommittees. Clinical clerkship directors and associate deans/directors for education, student affairs, and assessment and evaluation have regularly scheduled conference calls with regional campus site directors and faculty and make site visits to meet with campus faculty. Regular meetings are conducted to collect feedback from regional campus students.