New York University School of Medicine

Abstract

Curriculum Management and Governance Structure ♦ The Dean has overall authority for the educational program of the School of Medicine. He has invested the Vice Dean for Education, Faculty and Academic Affairs with responsibility for the undergraduate curriculum. ♦ In the spring of 2008, an Associate Dean for Curriculum was appointed to direct the Office of Medical Education and oversee the administration of the medical degree program. ♦ The Office of Medical Education centrally manages and coordinates the interdisciplinary curriculum and collects and shares all evaluative data with the course and clerkship directors, Curriculum Committee, and relevant department chairs. ♦ The Curriculum Committee directly assumes responsibility for the curriculum and provides both component-specific and global oversight of the educational program. This integrated body, with rotating membership, includes members of the faculty, administration, and student body in proportions appropriate to assure wide understanding of the issues at hand, flexibility, a lack of bias, and full representation across the institution, in order to achieve the school's overall educational objectives. ♦ The Committee reviews and advises the Dean regarding proposals for additions or deletions to the core curriculum, annually reviews each component of the educational program, tracks student workload and preparation time, and cyclically reviews the cohesiveness and congruence of the entire educational program with the objectives of the School of Medicine and the dynamic environment of medical education. ♦ Oversight of the content and quality for each unit of the Basic Science Modules and the Clinical Clerkships resides with Department Chairs. In consultation with the Office of Medical Education, the Chairs appoint directors and faculty for each thematic unit and clerkship. These individuals design, develop, and implement all components of the curriculum. ♦ Under the direction of the Vice Dean, regularly scheduled meetings of the Medical Education and Student Affairs Deans and staff center on practical measures to strengthen the curriculum and facilitate the curricular reform. ♦ Open lines of communication and dialogue among the Deans' Office, Department Chairs, and faculty and regular meetings of Clerkship and Module Directors foster development of an integrated curriculum (Figure 1).FIGURE 1:: Curriculum Management and Governance Structure Office of Education ♦ In the spring of 2008, the Office of Medical Education was restructured to better manage the curriculum; this included the appointment of the Associate Dean for Curriculum, a Director of Education for the Clinical Sciences, a Director of Education for the Basic Sciences, and the hiring of a full-time Manager and additional full-time support staff. ♦ The Office of Medical Education leaders provide curricular oversight, support for curriculum development, and are instrumental in the curriculum reform process. The office staff is responsible for the administrative support of curriculum evaluation, student assessment, and coordination of educational programs. ♦ The office maintains a centralized comprehensive plan for evaluation of all courses and the overall educational program. Financial Management of Educational Programs ♦ In the face of the recent downturn in the U.S. economy and the challenges it presented, the NYU School of Medicine has strategically positioned itself to continue to provide and grow the level of financial support for the educational mission. ♦ The growth in our mission is being accomplished via continued development of our Curriculum for the 21st Century and educational informatics program through joint collaborative efforts, pursuit of advanced technologies, increased academic affiliations with New York City's Health and Hospitals Corporation, and faculty growth and recruitment. ♦ The School of Medicine has maintained its funding levels for scholarships, accomplished via implementing cost containment measures through targeted reduction in deficit spending coupled with increased philanthropic contributions. Valuing Teaching ♦ NYULMC does not currently have an academy or institute for educators. ♦ Development of a teaching academy is a major goal of the Curriculum for the 21st Century initiative over the next academic year. ♦ The School of Medicine leadership is presently working with New York University, which is in the process of planning its teaching academy. ♦ Faculty members on the tenure track who have achieved extraordinary distinction as educators and scholars in pedagogical topics may be promoted and awarded tenure on the basis of their superior teaching accomplishments. ♦ In 2009, the School of Medicine approved Revisions to the Policies and Procedures for Appointment, Promotion and Tenure at the School of Medicine. The revisions are directed to the full-time, nontenure eligible Clinician Investigator/Educator and Research/Educator tracks. The revisions are designed to recognize individuals who make significant contributions to the academic mission, which are worthy of promotion but which are not captured by the current criteria for promotion. ♦ The committee recommended that promotion on these tracks should be reserved for individuals who distinguish themselves as teachers, mentors, program leaders, and scientific collaborators. Curriculum Renewal Process ♦ In the Fall of 2008, the Dean of the School of Medicine asked the Vice Dean for Education, Faculty and Academic Affairs to form a task force to examine the four-year medical school curriculum and to make recommendations for curricular change. ♦ Ten working groups were created to examine every aspect of our curriculum and to make recommendations for major curriculum change. This effort, which included over 125 faculty, students, administrators, and support staff, formed the nexus for the Curriculum for the 21st Century (C21). ♦ The goals of the curriculum renewal process included Full integration of the Preclinical and Clinical Curricula New Educational Opportunities and Learner-Centered Curricular Pathways Flexibility allowing students to “customize” their education Earlier Exposure to Clinical Medicine and Education Leadership in Innovation and Educational Technology Leadership in Assessment and New Approaches to Evaluation Faculty and Student Engagement; Increased Enthusiasm among Faculty and Students Increased Emphasis on Cultural Competency, Diversity and Global Health Content; Local and Global Community Engagement ♦ Components of the C21 include the following: A restructured medical school curriculum from the current “two plus two” model to a model with 1.5 preclinical years +2.5 clinical years. A reorganization of the third-year clerkships into four 12-week blocks with 1-week intersessions between each block. Appropriate combinations of clerkships will allow horizontal integration of the clerkships within each 12-week period. Intersessions will integrate basic science curriculum into clinical years. A Spiral Curriculum based on Multidisciplinary Thematic Pillars: Beginning day one of medical school, disease-based patient cases representative of each thematic pillar will spiral up through the four-year curriculum. Students will learn principles of basic and clinical science, as well as epidemiology, public health, pharmacology, and nutrition, through these exemplary cases. We have piloted three pillar cases for the class of 2013: Diabetes, Colon Cancer, and Atherosclerosis. Longitudinal patient-centered experiences Classroom: Patient Presentations within the Pillars Clinical venues: Patient-based Longitudinal Ambulatory Clinical Experience (PLACE), in which students will follow a panel of patients during dedicated biweekly timeslots Selective clerkships: May include topics such as palliative care, geriatrics, emergency medicine, radiology, epidemiology and population sciences, computational biology, medical informatics, genomics, community-based medicine, international health, and clinical and molecular pharmacology Choice of Subinternship Individualized Curriculum allowing for “Concentrations” including expanded Dual Degree programs Scholarly Project to be completed in fourth year Capstone/Medical Frontiers Course Asynchronous Modules and Simulation Collaborative teaching: Scientists, Clinicians, Nurses, and Social Workers ♦ The C21 Task Force recommendations have been approved by the Dean, the C21 Executive and Steering Committees, and the Curriculum Committee. The intention is to fully implement the Curriculum for the 21st Century for the incoming class of 2014. ♦ A preliminary reorganization of the curriculum began for the class of 2013. This included piloting the Spiral Pillar curriculum and increasing early clinical exposure through patient presentations beginning day one of medical school and the new PLACE program. Learning Outcomes/Competencies NYU School of Medicine Educational Objectives are presented in List 1.LIST 1: Educational ObjectivesLIST 1: (Continued) New Topics in the Curriculum Since 2000 ♦ Following our previous curriculum revision in 2001, the longitudinal Skills and Science of Doctoring Module was created. Throughout the first year, students have their first patient encounters, begin to develop clinical skills, learn to listen to the patient's narrative, and begin the study of the contracts among physician, patients, and society through units on health prevention, disabilities, cultural diversity, professionalism, and an introduction to systems-based practice. Within the second year, students learn to (1) apply their growing capacity to understand complex medical issues to integrative topics such as pain management, care of the disabled and chronically ill patient, medical ethics, team-based medical care, and domestic violence; (2) apply principles of biostatistics and epidemiology to gain an understanding of population- and evidence-based medical diagnosis and decision making, and (3) develop their history-taking and physical diagnostic skills as they are learning the relevant pathophysiology. In the fall of 2009, the PLACE component was piloted within this longitudinal module as well. ♦ Simulations/training in new surgical techniques In June 2005, the Department of Surgery opened a new Surgical Skills Laboratory, a 3,000-square-foot facility located at Bellevue Hospital. Within this center, students in the Surgery Clerkship, and during Clerkship Orientation, have the opportunity to practice techniques such as suturing and Foley catheter placement using partial task trainers. Patient simulation exercises utilizing the Laerdal SimMan have been developed and implemented for both preclinical and clinical courses. ♦ Clerkship orientation: A two-week, multidisciplinary, transitional program is designed to bridge the gap between the preclinical and clinical experiences. In this phase of clinical skills development, emphasis is placed upon the cross-discipline and cross-clerkship commonalities in acquisition, organization, and interpretation of patient information. ♦ The clerkship orientation stresses evidence-based reasoning as a guide to differential diagnosis and professional behavior as a member of an interdisciplinary health care team. ♦ Advanced science selectives: Rising fourth-year students, seasoned with a full year of clinical experience, engage in an in-depth, seminar-, and original-literature-based selective in advanced science. ♦ Students select from a palette of topics drawn from the frontiers of translational medicine and biomedical technology, making choices based upon their own individualized interests and emerging differentiated focus. Previous topics have included Stem Cell Therapy, Models of Multigenic Disease, Vaccine Development, Neurobiology of Pain, Ion Channels and Disease, DNA Technology in Medicine, Anatomy for Surgeons, and the Microbiology of Bioterrorism. Changes in Pedagogy ♦ Since 2000, the entire curriculum has been posted to a web-based learning management system. Students can access online learning modules, syllabi, lecture notes, and slides, as well as an audio-visual recording, through iTunesU, of the lecturer's voice synchronized with his/her PowerPoint presentation. ♦ The utilization of standardized patients has been increased throughout the clinical and preclinical curriculum for both formative and summative OSCEs. ♦ The School has expanded the use of audience response technology throughout the preclinical curriculum. Effectiveness of these presentations is assessed via the course evaluations, and appropriate adjustments have been made following student feedback and examination performance. ♦ Web Initiative for Surgical Education Modules (WISE-MD): This application was designed as an integral part of the third-year medical student surgical clerkship at the NYU School of Medicine. ♦ Because a significant portion of surgical patient care now occurs in an outpatient setting that is not accessible for a medical student, we've attempted to provide a computerized linear narrative of the patient's illness and the patient–physician interaction from the patient's first visit with his or her physician, through the diagnostic process, into the operating room, through the laboratory studies and pathology, and finally to the postoperative visits. ♦ The School has developed a number of online learning modules utilizing the LAMS Foundation Learning Activity Management System (LAMS) software. Module topics include: Pharmacokinetics, Hemodynamics, Thrombosis, Hemostasis, Psychosocial Aspects of Disaster and Bioterrorism, Gastrointestinal Stromal Tumor, and Introduction to the Mental Status Examination. Many others are in development. Changes in Assessment ♦ The Office of Medical Education has implemented a standardized, web-based student assessment instrument administered through the E*value platform. All clerkships utilize this instrument for assessing students' knowledge; physical examination, history and interviewing skills; write-ups; oral presentations, clinical problem solving, procedural, and manual skills; and professional development. ♦ A Comprehensive Clinical Skills Examination (CCSE) was piloted in 2004. It has since been fully implemented as a graded exercise required of all medical students progressing from the third to the fourth year. The CCSE, modeled on the USMLE Step II clinical skills examination, is a cross-disciplinary, integrative examination, which uses standardized patients in a number of clinical encounters. Specific remediation is offered to all students who do not meet or exceed expectations in this clinical skill set. ♦ Since 2000, the School has implemented a new grade scheme: preclinical coursework is reported as Pass/Fail, and clinical clerkships are reported as Honors/High Pass/Pass/Fail. Clinical Experiences ♦ Bellevue Hospital Center ♦ Concorde Medical Group ♦ Gouverneur Diagnostic and Treatment Center ♦ Lenox Hill Hospital ♦ Murray Hill Medical Group ♦ NY Downtown Hospital ♦ NY Downtown Family Care Center (FCC) ♦ NYU Cancer Institute ♦ NYU Hospital for Joint Diseases ♦ NYU Langone Tisch Hospital ♦ NYU Langone Trinity Center ♦ NYU Student Health Service ♦ Woodhull Medical and Mental Health Center ♦ Veterans Affairs New York Harbor Health Care System Manhattan Campus ♦ Challenges: Insufficient clinical teaching sites, and the limited number of patients at each site, have produced a strain on those sites available for training our students. The planned C21 curricular reform includes a reorganization of the clerkship blocks that will allow us to reduce the number of students in each clerkship and thus reduce the current strain. Highlights of the Program/School ♦ Affiliation with New York City's Bellevue Hospital Center: NYU medical students participate in preceptorships, clerkships, subinternships, ambulatory rotations, inpatient rotations, and clinical research electives at Bellevue Hospital, an 800-bed hospital with just under 30,000 discharges a year and over 500,000 outpatient visits. The patient mix is extraordinarily diverse from demographic and pathophysiological perspectives. Bellevue has recently opened a state-of-the-art intensive care unit and a 208,000 square-foot ambulatory care facility to which medical students are assigned. There are close to 500 NYU faculty on site at Bellevue providing patient care and trainee supervision. ♦ Exceptional IT support for the SOM Curriculum: Through the reorganization of the NYU Langone Medical Center Information Technology Department and the continuous expansion of the Division of Educational Informatics (DEI), the school has had the opportunity to vastly increase the use of asynchronous learning within our curriculum. DEI has developed a robust web-based learning management system that provides online access to the full complement of course materials, including screen-captured lectures. In addition, DEI supports the development and maintenance of various online learning modules, web-based simulation [Web Initiative for Surgical Education (WISE-MD)], virtual microscopy, and student learning portfolios (in development for the new C21 curriculum). ♦ New Spiral Curriculum based on Multidisciplinary Thematic Pillars: Beginning day one, disease-based patient cases, representative of each thematic pillar, will spiral through the four-year curriculum. Through these exemplary cases, students will learn principles of basic and clinical science, as well as epidemiology, public health, pharmacology, and nutrition. Furthermore, the interdisciplinary aspect of the pillar curriculum also helps students understand the social impact of the diseases they study. The teaching of key basic science concepts, in the context of a patient-centered pillar curriculum, creates a seamless educational experience across the four years upon which the clinical and scientific basis of medicine is built. Along with classroom presentation of patients within the Pillars, we have introduced a new clinical course, the Patient-based Longitudinal Ambulatory Care Experience (PLACE), which allows students very early clinical contact in conjunction with their basic science curriculum. Working with a preceptor, each student follows a panel of three to four patients during the preclerkship years. A unique aspect of PLACE is that students have the opportunity to see the same patients in different venues outside the preceptor session. The introduction of live patients in the preclinical curriculum further enhances students' early clinical exposure and helps to bring clinical context to the basic sciences. ♦ International Health Program (IHP): The NYU School of Medicine values the importance of providing students with the unique opportunity to travel abroad and participate in clinical or basic science research, public health initiatives, or clinical education programs. Since its inception in 2003, the IHP was established to provide meaningful academic and scholarly experiences that mirror the School of Medicine's education curriculum abroad, heighten the awareness of issues related to urban and global health, and make positive contributions to the community being served. The IHP currently sends approximately 60 students abroad per year to a range of countries on almost every continent.