Rush Medical College

Abstract

Curriculum Management and Governance Structure ♦ See Figure 1 for a diagram of the curriculum management and governance structure.FIGURE 1:: Curriculum Management and Governance Structure♦ The Dean, the Associate Dean for Medical Student Programs (MSPs), and the Associate Dean for Curriculum and Innovation provide leadership in the management of the educational programs and in developing policies and procedures of the college. ♦ The Associate Dean for Medical Student Programs manages the day-to-day activities of RMC and ensures educational standards are met for internal and external reviews. ♦ The Associate Dean for Medical Student Programs oversees the RMC recruitment and admission programs, career exploration, the match process, and specialized programs. ♦ Specialized programs include those focused on academic skills development, the Dean's Office Summer Research Fellowship, the peer tutoring program, the program designed to facilitate the transition to medical school, and the career advisor program. ♦ The Office of Medical Student Programs (OMSP) manages a centralized database that includes the demographic and academic data for RMC students. This provides quick and accurate retrieval of student academic records needed for internal review committees and other needs associated with the oversight of the educational programs. ♦ With the advice of the OMSP “Curriculum Team,” the Associate Dean for Curriculum and Innovation manages the curriculum for the entire four-year program, curriculum renewal, and all clinical education programs. ♦ The OMSP Curriculum Team includes the Associate Dean for Medical Student Programs, the Associate Dean for Curriculum and Innovation, the Assistant Dean for Basic Science Education, the Director of RMC Academic Support Services, and an education specialist. ♦ Assistant Deans and Directors manage specific elements of the educational programs. The Assistant Deans include Assistant Dean, Basic Sciences Education; Assistant Dean, Student Development; and Assistant Dean, Academic Development. Directors include Director, Recruitment and Special Programs; Director, Academic Support Services; and Director, Medical Student Systems. ♦ Additional support for educational programs comes from the Center for Medical Education and Research. ♦ The Center is funded for four shared, faculty-level educational specialists and one administrator. ♦ Other specific tasks and programs are managed by faculty physicians, funded through the OMSP, including (1) the first- and second-year program, which places students in the offices of practicing physicians, (2) the third-year summative Objective Structured Clinical Exam (OSCE), called the Clinical Skills Assessment, and (3) the system for tracking student experiences with patients. ♦ The Committee on Curriculum and Evaluation (CCE) is the standing committee of RMC responsible for the management and evaluation of the curriculum. ♦ The CCE, dean, associate deans, and assistant deans work closely with basic science and clinical department chairs, course directors, and faculty to implement innovations in the curriculum and evaluate the impact of these changes. ♦ This OMSP works directly with students and their elected leadership from Student Council to gather suggestions from the student community for innovation in the curriculum. ♦ The dean, associate deans, and assistant deans provide guidance and administrative support to the CCE and the Committee on Student Evaluation and Promotion (COSEP). ♦ The Committee on Student Evaluation and Promotion (COSEP is responsible for setting policies regarding student performance, evaluation, promotion, remediation, and graduation. ♦ All standing committees of RMC, including the CCE and the COSEP, comprise elected faculty and student members. ♦ Five “Work Groups” of the CCE actively manage and evaluate a subset of the RMC curriculum and provide recommendations to the CCE: (1) M1 Work Group, (2) M2 Work Group, (3) Physicianship Work Group (spans the M1 and M2 years), (4) Core Clerkship Work Group, and (5) M4 Work Group (including the required subinternship and electives). ♦ Work Group members are drawn from the CCE membership, the student body, course directors, and other interested faculty. ♦ The CCE evaluates all RMC courses annually through a robust process carried out by the Work Groups. ♦ The CCE, independently and through the recommendations of the Work Groups, monitors all modifications of the curriculum. ♦ Changes in the curriculum are made as the results of course evaluations, proposals from faculty or the student body, student opinion, surveys, and outcome data (such as exam performance, clinical performance, and the graduate questionnaire). ♦ All curricular changes are reviewed and approved by CCE prior to implementation. ♦ Implementation of curricular change at the recommendation of the CCE is managed by the OMSP. Office of Education ♦ The RMC Office of Medical Student Programs (OMSP) supports all Rush medical student educational programs. ♦ The Center for Medical Education and Research, within the OMSP, currently employs one doctoral-level educator with plans to add four additional positions in the coming years. ♦ Each medical educator works half-time with one or two departments enhancing medical education programs within those departments and half-time for the OMSP. Financial Management of Educational Programs ♦ Teaching contributions, reviewed annually by the Dean's Office, are funded centrally. ♦ In spite of the recent fiscal crisis, RMC educational programs continue to be fully supported, and significant curriculum renewal has continued. ♦ RMC faculty are under increased pressure to generate salary support through funded research or clinical care. ♦ In order to continue to recruit the best teachers for education programs, and to appropriately compensate faculty and departments for teaching efforts, RMC is developing a new compensation model. The new system is designed to support all faculty and department teaching efforts and to reward innovative programs. ♦ This new compensation system assigns relative values to the entire range of teaching activities, programs, and administrative roles for RMC faculty. Valuing Teaching ♦ Faculty promotion is determined primarily by three most important factors: teaching, patient care, and research; these three contributions are equally weighted. ♦ Faculty are recognized for teaching excellence through a variety of awards. ♦ Graduating seniors honor outstanding teachers with a number of awards. Among these are awards for preclinical teachers, clinical teachers, resident teachers, and a special award for the “doctoral hooder” at the graduation ceremony. ♦ The Mark Lepper Society of RMC elects faculty members annually to this society for teaching excellence from a list of nominees submitted by department chairs, faculty, and students. ♦ The Rush Chapter of the AOA recognizes the best Resident Teacher of the Quarter and the best volunteer faculty. ♦ Most departments recognize outstanding teachers with annual awards. Curriculum Renewal Process ♦ The RMC preclerkship curriculum is in the midst of a complete revision occurring in two phases. ♦ Phase I, the development of the new two-year, competency-based “Physicianship Program,” began in September 2009 with the incoming M1 class. ♦ The Physicianship Program replaced multiple courses previously taught in the first two years with an integrated program designed to prepare students better for clinical work in physicians' offices and the M3 clerkships. ♦ The development of the Physicianship Program drew upon national guidelines for preclerkship education and was designed by a team of physicians and basic scientists and approved by the CCE. ♦ The Physicianship Program begins with a two-week Clinical Skills Intensive (CSI), which develops a foundation in basic clinical skills and cross-cultural medicine prior to the students' first patient contact. ♦ The Physicianship Program includes the new Student Continuity Experience (SCE), which places the student in the office of a practicing physician for one year at a time, seeing patients for a half-day every other week. The first year, the student is assigned to a primary care physician. ♦ New assessment activities include the use of recorded interactions with simulated patients and OSCEs (objective structured clinical exams). ♦ The Physicianship Program is supported by a full-time, master's-level educator. ♦ Phase II of curricular innovation, to be implemented in September 2010, moves the basic science curriculum from a discipline-based system to a case-based, organ-system block curriculum integrated across disciplines and departments. Seven blocks, each approximately four weeks in duration, present the major organ systems. Each block begins with the introduction of an authentic clinical case. A second case for the block is introduced in week three of the block. The cases are the platform through which basic science concepts are applied. Each case is finalized at the end of the two-week period by a physician drawing on the basic science material taught in the preceding two weeks. ♦ The new block curriculum has been developed through a collaboration of the current course directors, other basic scientists, a physician, and the OMSP curriculum team. Through weekly meetings, a working model of the new block curriculum was developed by consolidating learning objectives into what was referred to as the “objectives matrix.” The objectives were sorted and sequenced by block. Blocks were then separated into topic areas. Gaps and redundancies in content were identified and corrected. Content that was moved or deleted was archived. Objectives shared by disciplines became the foundation for integration. Based on the content of the new blocks, clinical cases were selected through a collaboration of the basic scientists and the physician who was part of the curriculum development team. Basic science faculty then aligned content with the cases and developed new presentations of the basic science content that was directly related to the cases. ♦ New assessments of performance have been developed for the block curriculum. Students complete a midblock self-assessment similar to the block final exam. An integrated exam is given at the end of each block. ♦ The new basic science curriculum (Phase II) and the Physicianship Program (Phase I) are horizontally integrated. ♦ Beginning in September of 2011, the block curriculum will be implemented in the M2 year. ♦ The Physicianship Program continues in the second year beginning in September 2010. The second-year student will be assigned to a physician practicing in a subspecialty in which continuity with patients is the norm. Student contacts with patients are logged into an electronic database to identify gaps in patient experiences to ensure students acquire equivalent experiences. ♦ Curriculum renewal will continue after September 2010 with the horizontal integration across all four years of a number of key content areas including ethics, cross-cultural medicine, patient safety, quality management, data analysis, evidence-based medicine, medical informatics, and professionalism. ♦ Although significant strides have been made toward resolution of a number of challenges the new curriculum presents, further progress must be made: continued support of the new administrative infrastructure required by the new curriculum. measuring the outcomes of the changes. limited faculty time to develop the new curriculum while teaching current courses. resources needed for small-group learning sessions. support for the teaching faculty as they balance research and clinical-practice priorities. ♦ With the experience gathered over the past several years with a new review process, the CCE will continue to reform this process for the new curriculum. Learning Outcomes/Competencies ♦ The RMC goals for medical education guide curriculum development and the current educational programs (see Table 1).Table 1: Objectives for Medical Education New Topics in the Curriculum since 2000 ♦ A proposal currently in development identifies a number of content areas to be taught over all four years of the curriculum. These areas include ethics, cross-cultural medicine, patient safety, quality management, data analysis, evidence-based medicine, medical informatics, and professionalism. ♦ Patient safety and quality improvement are both currently introduced to M1 students as a part of the “Clinical Skills Intensive,” a two-week program that begins on the first day of medical school. The concepts are then revisited in the first- and second-year curricula. ♦ The Physicianship Program includes multiple opportunities for the M1 and M2 students to interact with simulated patients in recorded encounters that are reviewed one-on-one with a behavioral scientist. ♦ The Student Continuity Experience (SCE), developed in 2009, places students with a single primary care physician beginning in week three of the M1 year for four hours per week, every other week for the entire year. ♦ Although the SCE is based in a primary care physician's office the first year, the objectives of the program do not fall solely within the area of primary care practice but rather revolve around the opportunities to practice skills such as establishing and nurturing patient relationships, patient education, practice operations, and common physician–patient interactions. ♦ Second-year students are placed with several specialty physicians who experience continuity with patients as a part of their practices. ♦ Team-based learning has been used successfully in the M1 biochemistry course, which will be integrated into the new curriculum. Other faculty have been encouraged to adopt this teaching methodology. ♦ Simulations and training in new surgical techniques are part of the RMC transition course, a three-day workshop-based course taught between the M2 and M3 years. ♦ Self-reflection, as a critical function for the practicing physician, is introduced to students in the CSI. ♦ Cross-cultural medicine is taught in the CSI using a popular book. ♦ Cross-cultural awareness is visited recurrently in the M1 curriculum, M2 curriculum, and the transition course before the start of the M3 year. ♦ Two multidisciplinary courses taught at the University level are required for M1 students: Health Care in America and Health Care Ethics. ♦ University interdisciplinary courses pose new challenges. Large class size. Varied educational levels of students across colleges. Shared responsibility for course management across colleges. Development of a new infrastructure for curricular issues at the university level. ♦ The Rush Community Services Initiatives Program (RCSIP) provides a complementary clinical experience for student volunteers. RCSIP is a grant-funded program. Students and volunteer faculty staff interdisciplinary clinical settings including community health clinics, mobile medical vans, and homeless shelters. Changes in Pedagogy ♦ Team-based learning (TBL) is employed as a teaching method regularly in biochemistry. Material that was previously presented in a lecture format is now taught through team-based workshops. Success of TBL is measured through student evaluations, faculty satisfaction, and exam performance. ♦ The foundation of the new M1 block curriculum is the presentation of material through authentic clinical cases. ♦ Several clinical cases for the new curriculum have already been used in the biochemistry and physiology courses. ♦ The new Physicianship Program primarily utilizes the small-group learning format. ♦ Rush University recently employed a new electronic learning management system, which allows a variety of new teaching formats including online discussion groups. ♦ The M1 histology lab now uses “virtual histology” rather than microscopes. ♦ In the gross anatomy lab, half the class works on dissection in small groups and then presents to their colleagues in the other half of the class. ♦ Tasks in biochemistry now include a research paper based on an original review of the literature. Changes in Assessment ♦ The Physicianship Program has expanded the use of simulated patients in interviews evaluated by the behavioral science faculty. ♦ New final exams are currently being written for the block curriculum. ♦ The core clerkships have adopted more diversified methods of assessment and a standardized minimum pass level for the NBME miniboard exams. ♦ The Clinical Skills Assessment (CSA), the M3 OSCE, has been expanded for May 2010. Clinical Experiences ♦ The majority of clinical rotations for RMC students occur at Rush University Medical Center. ♦ Most rotations not based at Rush are based at the John H. Stroger Jr. Hospital of Cook County. ♦ Both employed physicians and private practitioners host M1 and M2 students for the Student Continuity Experience (SCE). ♦ Clinical experiences begin in the third week of medical school for the M1 students after the completion of the Clinical Skills Intensive (CSI). ♦ The Dean's Summer Fellowships fund clinical opportunities for students over the summer between the M1 and M2 years. Students work under the supervision of faculty and staff in research, community service, primary care, and international health projects. ♦ The M3 core clerkships provide a combination of inpatient and ambulatory rotations. ♦ Seven M3 core clerkships (internal medicine, surgery, pediatrics, obstetrics and gynecology, psychiatry, family medicine, surgery, and neurology) and an M4 subinternship are required clinical rotations. ♦ The greatest current challenge to the clinical curriculum is the increased external pressure being placed on clinicians to focus more time on patient care. ♦ Other challenges to the clinical curriculum include the following: maintaining an adequate number of clinical sites for training, ensuring the equivalency of assessment of students across sites and experiences, diversifying the students' clinical experiences, developing new measures of student performance. Highlights of the Program/School ♦ Highlights and unique features of the educational program at RMC include the new Physicianship Program, the new M1 block curriculum, the teacher–practitioner model, close personalized attention from faculty, and the opportunities for interdisciplinary learning.