Ponce School of Medicine

Abstract

Curriculum Management and Governance Structure ♦ Curriculum Committees The MD curriculum is managed by a central Medicine Program Curriculum Committee (MPCC) that involves faculty representing the preclinical and clinical sciences in addition to students and administration representatives. The MPCC is divided into two subcommittees: (1) the Preclinical Sciences Curriculum Committee (PCSCC) representing the faculty in preclinical courses in the first and second years, and (2) the Clinical Sciences Curriculum Committee (CSCC), which includes representative faculty from the clinical clerkships in the third and fourth years. ♦ Responsibilities The MPCC has the primary responsibility to assess how well the MD program is achieving its goals and objectives and determining the effects of curricular changes. The purpose is to improve the MD curriculum. The committee focuses on how well individual courses are organized and taught; how well the curriculum fits together into an integrated and logical whole, how adequate the resources are for teaching, and how satisfied all parties are with the quality of the educational program. The committee assesses the effectiveness of the curriculum using learning outcomes measures to determine how well medicine students are achieving the knowledge, skills, and attitudes/values expected in the program's goals. The committee also defines core competencies for promotion and graduation, develops objective student clinical performance evaluation instruments, develops a uniform course and program evaluation systems, and identifies needs and priorities for faculty development. The two subcommittees will report to the chair of the MPCC, and their main role will be revision of the components of the curriculum. ♦ Institutional Oversight The MPCC is responsible for the central oversight and the management of the entire MD curriculum. The MPCC ensures that the MD curriculum is coherent and coordinated and that the revisions and recommendations submitted by the subcommittees are congruent with the program's educational objectives and reflect the mission and goals of the Institution. The MPCC brings a broader perspective to the four years of the MD curriculum. The departments implement the decisions of the MD curriculum committees. The Associate Dean for Academic Affairs (ADAA) provides support to the curriculum committees and monitors the implementation of curricular changes. (Figure 1 illustrates the structure of the curriculum committees.)FIGURE 1:: Curriculum Management and Governance Structure Office of Education ♦ The Ponce School of Medicine (PSM) has an office of education under the ADAA and is directed by the Assistant Dean for Education (ADE). It is staffed by full-time staff: the ADE and an executive secretary. The ADE has a doctoral degree in education (EdD) and specialization in curriculum and instruction. The role of the office of education is to monitor the compliance of medical education program with the standards of the Liaison Committee on Medical Education (LCME). advise curriculum committee members about curricular management and curricular changes of the MD Program. assist the faculty to improve their teaching methods and skills and designing innovative teaching strategies. instruct the faculty in educational measurement, research, and evaluation. design instruments to evaluate faculty performance in teaching, scholarly activity, and service. assist in the evaluation of educational effectiveness of the MD program. assist the Clinical Practice Examination Committee in the technical development of student performance assessment. conduct validity and reliability assessment of new evaluation methodologies. Financial Management of Educational Programs ♦ A budget to support the educational program is developed by the School's administration with the insight of department chairs and associate and assistant deans. The annual budget is approved by the board of trustees. The education budget is allocated to support administration, research, instructional activities, student services, and health services. ♦ The sources of revenue include student tuition and fees, federal and private grants, service activities revenues, fundraising and development, tuition from summer courses, and others. ♦ The PSM has taken the following steps to address the current financial downturn in order to be able to support the educational programs: Temporary 10% reduction of personnel working hours representing significant annual savings. This plan was designed not to affect academic and educational activities. Reevaluation of mortgage loan. After negotiations with the bank officers, a moratorium of the payment of the principle on the outstanding mortgage loans was obtained. The approval of the continuation of federal research grants and the approval of new ones have led to an increase in indirect cost revenues. The efforts to obtain external funding from research, service, and educational grants have been intensified. Valuing Teaching ♦ Faculty Development Program PSM has implemented an active Faculty Development Program (FDP) to identify and improve skills in teaching and evaluation of student achievements, with innovative and effective student-centered learning strategies. The needs assessment for this program is obtained from the faculty, program directors, departmental chairs, and current educational trends. Other implemented strategies include the following: Newly appointed course/clerkship directors are required to attend their corresponding academic society's new course/clerkship director's workshop. Faculty is encouraged to keep current in their specialty area, providing evidence of CME and/or participation certificates of professional development activities. Faculty members are sponsored by PSM to attend national and regional academic society meetings. PSM sponsors workshops presenting innovations in medical education, education technology, and other topics based on faculty development needs. Mentoring is available to new faculty members. Evidence of professional growth and development is highly valued in annual evaluations and in faculty promotion. ♦ Criteria for Faculty Promotion Three tracks have been identified to characterize the academic endeavors and professional developments of the PSM faculty. These are the Clinician-Teacher, the Investigator-Teacher, and the Investigator tracks, each containing specific criteria set forth to guide the general expectations of the faculty and to frame their appointment and promotion procedures. ♦ Clinician-Teacher Track: designed for faculty members with local and/or national recognition by peers and patients as an excellent clinician with active and ongoing achievements in clinical research, documented community service involvement, and evidence of excellence in teaching, as described in the Faculty Regulations Manual. ♦ Investigator-Teacher Track: for faculty members with evidence of excellence in investigation with sustained external funding of competitive peer-reviewed research projects; continued publications in peer-reviewed journals; authorship or editorship of textbooks, chapters, monographs, or journals; membership in editorial boards, study sections, and/or advisory groups; leadership and membership in major scientific societies; and evidence of excellence in teaching, as described in the Faculty Regulations Manual. Investigator Track: these faculty members must show evidence of excellence in investigation (as described above) with national and/or international recognition. Curriculum Renewal Process ♦ The curriculum renewal process was initiated during the first semester of academic year 2003–04 and was included as a strategic goal in the 2004–09 PSM Strategic Plan. ♦ Goal The goal of the curricular renewal process is to develop a coherent, integrated, and high-quality MD curriculum, to educate a new generation of physicians for the 21st century who are able to effectively, ethically, and responsibly respond to the needs of their patients and of society as a whole. Educational principles that guide the curricular renewal process of the PSM are as follows: The major purpose is to improve the quality of the MD curriculum and of the teaching and learning processes. The revision of the MD curriculum must be viewed as a continuous process. The MD curriculum is dynamic and constantly changing. Medical education must be viewed as a continuum. Medical students are actors in the learning process. Learning is active and must be student centered. Faculty is responsible for curriculum management through the established curriculum committees. The incorporation of new content must be based on the information needs of the students. Students and faculty participation in the curriculum revision process is key for the successful implementation of the MD curriculum. The process of medical education must evolve to satisfy the changing needs of society and the health care environment. ♦ Specific objectives of curricular renewal are to: improve the quality of the teaching and learning processes and the student learning outcomes. foster independent and self-directed learning and the development of the skills of problem solving, clinical reasoning, and critical thinking. continue the preparation of students for taking and approving the medical licensing examinations. train students for advancing to the next level of training: graduate medical education. develop the skills of life-long learning. update basic and clinical sciences content to include new knowledge and current technological advances. include the competencies, skills, attitudes, and knowledge responsive to the changes that are transforming the practice of medicine in Puerto Rico and in the world. provide a relevant, integrated, and challenging curriculum to MD students. adapt learning to new trends of health care and patients needs. provide feedback to the curricular renewal process through the use of interrelated methods such as planning, implementation, and assessment in order to ensure follow-up and continuity of the process. Learning Outcomes/Competencies ♦ MD Program Educational Objectives During the 2008 LCME Self-Study, the Educational Program Committee recommended to revisit the educational objectives of the MD program in light of the six ACGME competencies: Medical Knowledge, Patient Care, Interpersonal and Communication Skills, Practice-Based Learning and Improvement, Systems-Based Practice, and Professionalism. The medical curriculum committees have already generated the statement of the competencies with the accompanied specific educational objectives. The competencies and revised educational objectives will be presented to the Curriculum Policy Committee and the Academic Senate. Once approved, they will be available for publication. New Topics in the Curriculum Since 2000 ♦ Patient safety Basic Psychiatry (second-year course) discusses patient safety during the sessions of ethics in psychiatry, psychiatric emergencies, and forensic psychiatry. Formal and informal discussions concerning patient safety are held for third-year pediatrics students. Prevention of patient errors is continuously addressed during the surgery and Ob-Gyn clerkships. Pediatric residents involve medical students in record revision for evaluating record's legibility, dose calculations, and the use of abbreviations as contributors of medical errors in Pediatrics. The family medicine residency offers formal conferences to residents and medical students in patient safety using the guidelines of the Joint Commission, the measures of QUIPRO, and hospital protocols. The Introduction to Clinical Practice (ICP) summer course teaches universal precautions and risk management to second-year students. ♦ Team-based learning The team-based learning approach is used for case discussions during the Introduction to Clinical Skills course and in the Pediatric Clerkship. Groups of students prepare and deliver seminars on the latest advances of surgical topics in surgery after review of the medical literature. PBL cases, small-group activities, and clinical correlations are used as the context to help students to learn in cooperative teams and develop communication skills. ♦ Surgical techniques Students are trained in operating room techniques and suturing and wound healing during the ICP course. Students participate in major and minor gynecology surgeries, cesarean sections, and pap smears in the Ob-Gyn clerkship. Students observe hand and reconstructive surgery, neurosurgery, and pediatrics surgery techniques during the third-year Surgery clerkship. ♦ Evidence-based medicine (EBM) Students conduct literature searches and collect external evidence during the ICP course. They review assigned web-based EBM cases in Pediatrics to find answers to problems posed on case study information. The concept of EBM is discussed during required clinical clerkships to help medical students base clinical practice on valid evidence. ♦ End-of-life care The topic is discussed in the clinical clerkships of Family Medicine, Internal Medicine, Pediatrics, and Surgery and in the medical ethics, behavioral science, and family and community medicine courses. A family medicine preceptor introduces the topic of death and dying in the ICP course. ♦ Geriatrics The Family Medicine and Internal Medicine Departments integrate the topic of geriatrics across the four years of medical school. Students are exposed to geriatric patients and have the opportunity to conduct geriatric assessments in the Community Medicine course. Psychiatry and Family Medicine clerkships introduce sessions of elder neglect during the clinical clerkships. ♦ Domestic violence and abuse The diagnosis, prevention, reporting, and treatment of domestic violence and abuse are discussed in the Internal Medicine, Family Medicine, Psychiatry, Pediatrics, and Ob-Gyn clerkships and in the Behavioral Science and Basic Psychiatry courses. ♦ Health Service Management Senior medical students participate in a one-week required course in which they discuss issues related to health care service models, medical licensing, rules and regulations that affect the medical practice, prevention of fraud and abuse, quality service at the ambulatory setting, the billing cycle, electronic medical records, office personnel issues, and cost-effective medical care. Course Revision ♦ The following changes have occurred in the MD curriculum since 2000 as a result of curricular revision: incorporation of the Skills Development course for second-year students. This course protects time at the end of the second year for independent study to prepare to take and pass the USMLE 1. integration of first-year general pathology with the second-year systemic pathology into the Pathology course for second-year students. redistribution of the number of weeks for the clinical clerkships: from 10 to eight weeks in Internal Medicine, Pediatrics, and Surgery; from five to eight weeks in Ob-Gyn; and from five to four weeks in Family Medicine and Psychiatry. introduction of the Community Medicine course for first-year students. substitution of the subinternship course in the fourth year for a primary-care selective course. introduction of a neurophysiology block in the neuroscience course during the first year. renaming the Introduction to Clinical Medicine (ICM) course as Introduction to Clinical Skills (ICS) and the Pathophysiology course as Fundamental Pathophysiology for Clinical Medicine. integration of standardized patient activities into the ICS course. integration of Geriatrics into the medicine curriculum. use of clinical correlations in the neuroanatomy block. increase time for laboratory activities and clinical correlations in the Anatomy course. approval of a model of 10 clinical rotations/20 days each for the third-year clinical clerkships. comprehensive revision of the Physiology and Microbiology courses based on the national learning objectives. redistribution of basic science courses to assign the last block of the first year to Medical Ethics I and the first block of the second year to Medical Ethics II. integration of Biochemistry and Genetics into Medical Biochemistry for first-year students. decrease of lecture contact hours to increase the time for small-group activities and independent study. adjusting lecture time from 1 hour and 20 minutes to 1 hour in the mornings. The afternoons are used for small-group discussions and laboratory activities, ending formal instructional activities by 3:00 pm. substitution of the two-week surgical specialties course in the fourth-year curriculum for an additional (third) week in Clinical Radiology and incorporation of a one-week required course in Introduction to Health Services Management effective in 2008–09. Changes in Pedagogy ♦ The following pedagogy changes and innovations have been implemented in the MD curriculum since 2000: an FDP was established to coordinate faculty development activities for improving teaching skills. emphasis on Problem-Based Learning (PBL) appointment of a new director. conduct of workshops to train faculty on PBL. incorporation of biomedical senior students as teacher/tutor in PBL. use of computer-assisted instruction modules in Anatomy. increase of interactive, student-centered activities. development of NBME-style examinations to help students prepare for taking the USMLEs. use of interactive cases online (CLIPP Cases). incorporation of diagnostic tools such as Kaplan and the NBME Comprehensive Basic Science Examination. adoption of the Moodle distance learning platform with the corresponding training for users. Changes in Assessment ♦ The following changes in student assessment have been implemented since 2000: incorporated NBME Shelf Examinations in the Neuroscience and the Fundamental Pathophysiology for Clinical Medicine courses. administered the Comprehensive Basic Sciences Examination at the end of the second year as a diagnostic tool for measuring student readiness to take the USMLE Step 1. initiated annual curriculum evaluations of courses and clerkships by medical students. implemented a revised policy for decreasing the weight of the subject examination from 30% to 20% when computing the final grade of the clinical clerkships. assigned to the OSCE a weight of 10% when computing the final grade of the third-year clerkships. assigned a grade of Pass/Fail to the Ethics course. designed the clinical performance evaluation form for clinical clerkships based on the ACGME competencies. incorporated the use of patient diagnosis and procedures logs in all clerkships. introduced changes on the Clinical Performance Examination (CPX) to better prepare students for taking the USMLE 2 CS: taught communication skills in English using standardized patients (formerly done in Spanish). included an activity to evaluate the quality of documentation on the medical record. recruited an assessment specialist to provide support to the academic programs. developed a policy for the reposition of the clinical shelves. Carried out continuous evaluation of the effectiveness of medicine courses using the following criteria: student satisfaction with individual courses. student satisfaction with the quality of teaching. results with the shelf and comparative analysis with national norms of achievement. results of the USMLEs. analysis of student recommendations submitted during annual curriculum evaluations. incorporation of the electronic platform E-value available through the Internet for the evaluation of students, faculty, and courses for clinical years. development of a pilot project for those students who fail the USMLE 1 on the first attempt but who have a high probability to pass on the second attempt to let them register in the third clinical year and complete the required clerkship during the summer. use of the Moodle platform for grade reporting and test administration. Clinical Experiences ♦ Inpatient and ambulatory teaching sites Hospital Episcopal San Lucas Damas Hospital La Concepcion Hospital Tito Mattei Hospital San Cristobal Hospital Ponce School of Medicine Health Services Clinics at Ponce and Mayaguez La Playa Diagnostic and Treatment Center ♦ Challenges for Clinical Education The Health Reform in Puerto Rico and its effect in the availability of clinical sites The need for new residency programs and additional resident slots Availability of resources for clinical research Medical liability coverage for clinical teachers and high costs of liability insurance Highlights of the Program/School Strong interpersonal collaboration across all educational programs of the schools: Medicine, Biomedical Sciences, Public Health, and Clinical Psychology. The standardized patients unit performs comprehensive integration of standardized patient-based formative and summative assessments across all years of the curriculum. Wide variety of service learning opportunities that foster student involvement in the community and the profession. Offers a decelerated five-year medical curriculum Development of a successful Clinical Research Center for clinical trials. Continuity of the RCMI and MBRS research grants Has affiliation with the Moffitt Cancer Center in Tampa, Florida for collaborative activities in cancer research. PSM has been granted a $19.2 million award from the Department of Health and Human Services to establish a Regional Extension Center (REC) for the adoption and implementation of Health Information Technology (HIT) in Puerto Rico and the Virgin Islands beginning in 2010.